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Elam RE, Bůžková P, Delaney JAC, Fink HA, Barzilay JI, Carbone LD, Saha R, Robbins JA, Mukamal KJ, Valderrábano RJ, Psaty BM, Tracy RP, Olson NC, Huber SA, Doyle MF, Landay AL, Cauley JA. Association of Immune Cell Subsets with Incident Hip Fracture: The Cardiovascular Health Study. Calcif Tissue Int 2023; 113:581-590. [PMID: 37650930 DOI: 10.1007/s00223-023-01126-8] [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: 06/23/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
In this study, we aimed to evaluate the association of innate and adaptive immune cell subsets in peripheral blood mononuclear cells (PBMCs) with hip fracture. To conduct this study, we used data from the Cardiovascular Health Study (CHS), a U.S. multicenter observational cohort of community-dwelling men and women aged ≥ 65 years. Twenty-five immune cell phenotypes were measured by flow cytometry from cryopreserved PBMCs of CHS participants collected in 1998-1999. The natural killer (NK), γδ T, T helper 17 (Th17), and differentiated/senescent CD4+CD28- T cell subsets were pre-specified as primary subsets of interest. Hip fracture incidence was assessed prospectively by review of hospitalization records. Multivariable Cox hazard models evaluated associations of immune cell phenotypes with incident hip fracture in sex-stratified and combined analyses. Among 1928 persons, 259 hip fractures occurred over a median 9.7 years of follow-up. In women, NK cells were inversely associated with hip fracture [hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.60-0.99 per one standard deviation higher value] and Th17 cells were positively associated with hip fracture [HR 1.18, 95% CI 1.01-1.39]. In men, γδ T cells were inversely associated with hip fracture [HR 0.60, 95% CI 0.37-0.98]. None of the measured immune cell phenotypes were significantly associated with hip fracture incidence in combined analyses. In this large prospective cohort of older adults, potentially important sex differences in the associations of immune cell phenotypes and hip fracture were identified. However, immune cell phenotypes had no association with hip fracture in analyses combining men and women.
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Affiliation(s)
- Rachel E Elam
- Division of Rheumatology, Department of Medicine, Augusta University, Augusta, GA, USA.
- Charlie Norwood Veterans Affairs Medical Center, Veterans Affairs Health Care System, Augusta, GA, USA.
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Joseph A C Delaney
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura D Carbone
- Division of Rheumatology, Department of Medicine, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Veterans Affairs Health Care System, Augusta, GA, USA
| | - Rick Saha
- Department of Internal Medicine, New York University Langone, New York, NY, USA
| | - John A Robbins
- Department of Medicine, University of California Davis, Davis, CA, USA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Rodrigo J Valderrábano
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Department of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Biochemistry, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Nels C Olson
- Department of Pathology and Laboratory Medicine, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Sally A Huber
- Department of Pathology and Laboratory Medicine, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Margaret F Doyle
- Department of Pathology and Laboratory Medicine, Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Rice C, Ayyala DN, Shi H, Madera-Acosta A, Bell S, Qureshi A, Carbone LD, Coughlin SS, Elam RE. Sex and Racial Differences in Systemic Lupus Erythematosus Among US Adults in the All of Us Research Program. Arthritis Care Res (Hoboken) 2023; 75:2096-2106. [PMID: 36705447 PMCID: PMC10372192 DOI: 10.1002/acr.25093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/28/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Men with systemic lupus erythematosus (SLE) are an understudied population. The present study characterized differences between men and women with SLE. METHODS We examined cross-sectionally participants with SLE in the All of Us Research Program, a US cohort with a participant survey at enrollment (May 2018 to June 2022) and linked electronic health record (EHR) data. We described and compared characteristics of men and women with SLE encompassing disease manifestations and prescribed medications from EHR data and socioeconomic factors, including health literacy and health care access and utilization, from surveys. We reported racial variations stratified by sex. RESULTS Of 1,462 participants with SLE, 126 (9%) were male. Men reported lower educational attainment and less fatigue than women. Myocardial infarction was significantly more common in men. Men had significantly less confidence in completing medical forms than women and exhibited a trend toward requiring more help in reading health-related materials. Barriers to health care access and utilization were common in both men and women (40% versus 47%, respectively, reporting some reason for delay in care; P = 0.35). Women of race other than Black or African American or White more often reported delaying care due to cultural differences between patient and provider. CONCLUSION Our study demonstrated major clinical and health literacy differences in men and women with SLE. Socioeconomic factors were significant barriers to health care in both sexes. Our study suggests men have disproportionately poorer health literacy, which may exacerbate preexisting disparities. Further large prospective studies, focusing on recruiting men, are needed to better characterize racial differences in men with SLE.
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Affiliation(s)
| | - Deepak Nag Ayyala
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Augusta University, Augusta, GA, USA
| | - Hong Shi
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Adria Madera-Acosta
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Stephen Bell
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Anam Qureshi
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Laura D. Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Steven S. Coughlin
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA
| | - Rachel E. Elam
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
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Robbins JA, Buzkova P, Barzilay JI, Cauley JA, Fink HA, Carbone LD, Chen Z, Stein PK, Elam R, Sheets K, Mukamal KJ. Mortality Following Hip Fracture in Older Adults With and Without Coronary Heart Disease. Am J Med 2023; 136:789-795.e2. [PMID: 37100188 PMCID: PMC10524655 DOI: 10.1016/j.amjmed.2023.03.036] [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: 12/12/2022] [Revised: 02/26/2023] [Accepted: 03/30/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Comorbidities like coronary heart disease are common among older people who sustain an osteoporotic hip fracture. However, their impact on short- and long-term mortality post-hip fracture is not well quantified. METHODS We examined 4092 and 1173 older adults without and with prevalent coronary heart disease, respectively. Post-hip fracture mortality rates were computed with Poisson models and hazard ratios with Cox regression. For perspective, we compared mortality rates among participants with prevalent coronary heart disease who had either a hip fracture or incident heart failure (but no hip fracture). RESULTS Among participants without prevalent coronary heart disease, the mortality rate post-hip fracture was 21.83 per 100 participant years, including 49.27 per 100 participant years in the first 6 months following hip fracture. Among participants with prevalent coronary heart disease, the corresponding mortality rates were 32.52 and 79.44 per 100 participant years, respectively. Participants with prevalent coronary heart disease and incident heart failure (but no hip fracture) had corresponding post-incident heart failure mortality rates per 100 participant years of 25.62 overall and 46.4 in the first 6 months. In all 3 groups, the hazard ratio for mortality was similarly elevated: 5- to 7-fold at 6 months and 1.7- to 2.5-fold beyond 5 years. CONCLUSION As a case study in the absolute effects of a comorbidity on post-hip fracture mortality, hip fracture in a person with coronary heart disease carries an exceedingly high mortality rate, even higher than that following incident heart failure in individuals with coronary heart disease.
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Affiliation(s)
- John A Robbins
- Department of Medicine, University of California, Davis, Sacramento
| | - Petra Buzkova
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Duluth; Department of Endocrinology, Emory University School of Medicine, Atlanta, Ga.
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pa
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, Minn; Department of Medicine, University of Minnesota, Minneapolis
| | - Laura D Carbone
- Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta
| | - Zhao Chen
- Epidemiology and Biostatistics Department, College of Public Health, University of Arizona, Tucson
| | - Phyllis K Stein
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine in Saint Louis, Mo
| | - Rachel Elam
- Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta
| | - Kerry Sheets
- Geriatric Medicine, Hennepin Healthcare, Minneapolis, Minn
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Brookline, Mass
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Craven BC, Cirnigliaro CM, Carbone LD, Tsang P, Morse LR. The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury. J Pers Med 2023; 13:966. [PMID: 37373955 DOI: 10.3390/jpm13060966] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The prevention of lower extremity fractures and fracture-related morbidity and mortality is a critical component of health services for adults living with chronic spinal cord injury (SCI). METHODS Established best practices and guideline recommendations are articulated in recent international consensus documents from the International Society of Clinical Densitometry, the Paralyzed Veterans of America Consortium for Spinal Cord Medicine and the Orthopedic Trauma Association. RESULTS This review is a synthesis of the aforementioned consensus documents, which highlight the pathophysiology of lower extremity bone mineral density (BMD) decline after acute SCI. The role and actions treating clinicians should take to screen, diagnose and initiate the appropriate treatment of established low bone mass/osteoporosis of the hip, distal femur or proximal tibia regions associated with moderate or high fracture risk or diagnose and manage a lower extremity fracture among adults with chronic SCI are articulated. Guidance regarding the prescription of dietary calcium, vitamin D supplements, rehabilitation interventions (passive standing, functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES)) to modify bone mass and/or anti-resorptive drug therapy (Alendronate, Denosumab, or Zoledronic Acid) is provided. In the event of lower extremity fracture, the need for timely orthopedic consultation for fracture diagnosis and interprofessional care following definitive fracture management to prevent health complications (venous thromboembolism, pressure injury, and autonomic dysreflexia) and rehabilitation interventions to return the individual to his/her pre-fracture functional abilities is emphasized. CONCLUSIONS Interprofessional care teams should use recent consensus publications to drive sustained practice change to mitigate fracture incidence and fracture-related morbidity and mortality among adults with chronic SCI.
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Affiliation(s)
- Beverley Catharine Craven
- KITE Research Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation, Research, and Development Service, Spinal Cord Damage Research Center, Bronx, NY 10468, USA
| | - Laura D Carbone
- Department of Medicine: Rheumatology, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA
| | - Philemon Tsang
- KITE Research Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota, 500 Harvard St SE, Minneapolis, MN 55455, USA
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Sheets KM, Buzkova P, Chen Z, Carbone LD, Cauley JA, Barzilay JI, Starks JL, Miller LM, Fink HA. Association of covert brain infarcts and white matter hyperintensities with risk of hip fracture in older adults: the Cardiovascular Health Study. Osteoporos Int 2023; 34:91-99. [PMID: 36355067 PMCID: PMC9812913 DOI: 10.1007/s00198-022-06565-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/02/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
Covert brain infarcts and white matter hyperintensities (WMHs), incidental markers of brain microvascular disease commonly seen on brain MRIs in older adults, have been associated with falls and lower bone mineral density. We found covert infarcts and WMHs may also be associated with an increased risk of future hip fracture. INTRODUCTION To determine whether covert infarcts and white matter hyperintensities (WMHs) are associated with increased risk of incident hip fracture. METHODS A prospective cohort of 3373 community-dwelling adults aged ≥ 65 years enrolled in the Cardiovascular Health Study with a brain MRI (1992-1993) was analyzed. Covert infarcts were categorized by number of infarcts and largest infarct size. WMH burden was assessed by radiologists and graded qualitatively from 0 (no WMHs) to 9 (extensive). RESULTS Participants had 465 incident hip fractures during a mean follow-up of 12.8 years. The demographic-adjusted hazard of incident hip fracture was 32% higher among participants with ≥ 1 covert infarct compared to those without infarcts (hazard ratio (HR) 1.32; 95% CI, 1.08-1.62). The hazard of incident hip fracture was similar after further adjustment for medications and medical history (HR = 1.34; 95% CI, 1.08-1.65), but attenuated following additional adjustment for functional status, frailty, and falls (HR = 1.25; 95% CI, 0.99-1.57). Fully adjusted hazard of incident hip fracture per increase in infarct number was 1.10 (95% CI, 0.98-1.23); risk in individuals whose largest infarct was ≥ 20 mm versus 3 to < 20 mm was similar. Compared with WMH grades 0-1, the demographic-adjusted hazard of hip fracture was 1.34 (95% CI, 1.09-1.66) and 1.83 (95% CI, 1.37-2.46), respectively, for WMH grades 2-3 and 4-9. The hazard was similar following adjustment for medications and medical history (grades 2-3: HR = 1.32; 95% CI, 1.05-1.64; grades 4-9: HR = 1.69; 95% CI, 1.23-2.30), but attenuated following additional adjustment for functional status, frailty, and falls (grades 2-3: HR = 1.24; 95% CI, 0.98-1.56; grades 4-9: HR = 1.34; 95% CI, 0.95-1.90). CONCLUSION Older, community-dwelling adults with covert infarcts or WMHs may be at increased risk of hip fracture.
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Affiliation(s)
- Kerry M Sheets
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN, 55415, USA.
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Zhao Chen
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Center, Augusta, GA, USA
- Department of Medicine, J. Harold Harrison M.D. Distinguished Chair in Rheumatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburg, Pittsburg, PA, USA
| | - Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Duluth, GA, USA
- Division of Endocrinology, Emory University School of Medicine, Druid Hills, USA
| | - Jamie L Starks
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
- Department of Neurology, VA Health Care System, Minneapolis, MN, USA
| | - Lindsay M Miller
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA
| | - Howard A Fink
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN, USA
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Etingen B, Carbone LD, Guihan M, Ray C, Aslam H, Elam R, Weaver FM. Lower extremity fracture prevention and management in persons with spinal cord injuries and disorders: The patient perspective. J Spinal Cord Med 2022; 45:946-956. [PMID: 33830880 PMCID: PMC9662005 DOI: 10.1080/10790268.2021.1907675] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT/OBJECTIVE To describe patient experiences with fracture prevention and management among persons with spinal cord injuries/disorders (SCI/D). DESIGN Qualitative data collected via semi-structured telephone interviews. SETTING Veterans Health Administration (VA) SCI/D System of Care. PARTICIPANTS Veterans with SCI/D (n = 32) who had experienced at least one lower-extremity fracture in the prior 18 months. INTERVENTIONS N/A. OUTCOME MEASURES Interview questions addressed patients': pre-fracture knowledge of osteoporosis and bone health, diagnosis and management of osteoporosis, history and experiences with fracture treatment, and post-fracture care and experiences. RESULTS Participants expressed concerns about bone health and fractures in particular, which for some, limited activities and participation. Participants recalled receiving little information from providers about bone health or osteoporosis and described little knowledge about osteoporosis prevention prior to their fracture. Few participants reported medication management for osteoporosis, however many reported receiving radiographs/scans to confirm a fracture and most reported being managed non-operatively. Some reported preference for surgical treatment and believed their outcomes would have been better had their fracture been managed differently. Many reported not feeling fully included in treatment decision-making. Some described decreased function, independence and/or participation post-fracture. CONCLUSION(S) Our results indicate that persons with SCI/D report lacking substantive knowledge about bone health and/or fracture prevention, and following fracture, feel unable and/or hesitant to resume pre-fracture participation. In addition, our findings indicate that individuals with SCI/D may not feel as engaged as they would like to be in establishing fracture treatment plans. As such, persons with SCI/D may benefit from ongoing discussions with providers about risks and benefits of fracture treatment options and consideration of subsequent function and participation, to ensure patients preferences are considered.
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Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development Service, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA,Correspondence to: Bella Etingen, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, 5000 South 5th Avenue (151H), Hines, Illinois60141, USA. Ph: (708) 202-4922.
| | - Laura D. Carbone
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA,Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Marylou Guihan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development Service, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development Service, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Hamad Aslam
- Shepherd Center for Spinal Cord Injury Rehabilitation, Atlanta, Georgia, USA
| | - Rachel Elam
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development Service, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA,Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, Illinois, USA
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Barzilay JI, Buzkova P, Kuller LH, Cauley JA, Fink HA, Sheets K, Robbins JA, Carbone LD, Elam RE, Mukamal KJ. The Association of Lipids and Lipoproteins with Hip Fracture Risk: The Cardiovascular Health Study. Am J Med 2022; 135:1101-1108.e1. [PMID: 35679877 PMCID: PMC9536862 DOI: 10.1016/j.amjmed.2022.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/15/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND It is uncertain if lipids or lipoproteins are associated with osteoporotic fractures. In this study, incident hip fracture risk according to conventional lipid levels and lipoprotein levels and sizes was examined. METHODS We followed 5832 participants aged ≥65 years from the Cardiovascular Health Study for hip fracture for a mean of 13.5 (SD 5.7) years. Standard enzymatic methods were used to determine lipid levels (ie, high-density lipoprotein-cholesterol [HDL-c], low-density lipoprotein-cholesterol [LDL-c], and triglycerides). Nuclear magnetic resonance spectroscopy was used to measure lipoprotein fractions (ie, very-low-density lipoprotein-particle [VLDL-P], low-density lipoprotein-particle [LDL-P], high-density lipoprotein-particle [HDL-P]) in a subset of 1849 participants. RESULTS We documented 755 incident hip fractures among women (1.19 fractures per 100 participant years [95% confidence interval, 1.04, 1.35]) and 197 among men (0.67 fractures per 100 participant years [95% CI, 0.41, 1.10]) over an average follow-up. HDL-c and LDL-c levels had statistically significant nonlinear U-shaped relationships with hip fracture risk (HDL-c, P = .009; LDL-c, P = .02). Triglyceride levels were not significantly associated with hip fracture risk. In fully adjusted conjoint models, higher VLDL-P concentration (hazard ratio [HR] per 1 standard deviation [SD] increment 1.47 [1.13, 1.91] and size [HR per 1 SD increment 1.24 [1.05, 1.46]) and higher high-density lipoprotein particle size (HR per 1 SD increment 1.81 [1.25, 2.62]) were all associated with higher hip fracture risk. CONCLUSIONS Lipids and lipoproteins are associated with hip fracture risk in older adults. The associations are complex. Mechanistic studies are needed to understand these findings.
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Affiliation(s)
- Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, and Department of Endocrinology, Emory University School of Medicine, Atlanta, Ga.
| | - Petra Buzkova
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Penn
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Penn
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, Minn; Department of Medicine, University of Minnesota, Minneapolis
| | - Kerry Sheets
- Division of Geriatrics and Palliative Care, Hennepin Healthcare, Department of Medicine, University of Minnesota, Minneapolis
| | - John A Robbins
- Department of Medicine, University of California, Davis, Sacramento
| | - Laura D Carbone
- Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta Ga
| | - Rachel E Elam
- Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta Ga
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, Mass
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Elam RE, Bůžková P, Barzilay JI, Wang Z, Nemet I, Budoff MJ, Cauley JA, Fink HA, Lee Y, Robbins JA, Wang M, Hazen SL, Mozaffarian D, Carbone LD. Trimethylamine N-oxide and hip fracture and bone mineral density in older adults: The cardiovascular health study. Bone 2022; 161:116431. [PMID: 35577327 PMCID: PMC10712255 DOI: 10.1016/j.bone.2022.116431] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) may adversely affect bone by inducing oxidative stress. Whether this translates into increased fracture risk in older adults is uncertain. OBJECTIVE Determine the associations of plasma TMAO with hip fracture and bone mineral density (BMD) in older adults. DESIGN AND SETTING Cox hazard models and linear regression stratified by sex examined the associations of TMAO with hip fracture and BMD in the longitudinal cohort of the Cardiovascular Health Study. PARTICIPANTS 5019 U.S. adults aged ≥65 years. EXPOSURE Plasma TMAO. MAIN OUTCOME MEASURES Incident hip fractures; total hip BMD dual x-ray absorptiometry in a subset (n = 1400). RESULTS Six hundred sixty-six incident hip fractures occurred during up to 26 years of follow-up (67,574 person-years). After multivariable adjustment, TMAO was not significantly associated with hip fracture (women: hazard ratio (HR) [95% confidence interval (CI)] of 1.00[0.92,1.09] per TMAO doubling; men: 1.12[0.95,1.33]). TMAO was also not associated with total hip BMD (women: BMD difference [95% CI] of 0.42 g/cm2*100 [-0.34,1.17] per TMAO doubling; men: 0.19[-1.04,1.42]). In exploratory analyses, we found an interaction between body mass index (BMI) and the association of TMAO with hip fracture (P < 0.01). Higher TMAO was significantly associated with risk of hip fracture in adults with overweight or obesity (BMI ≥ 25) (HR [95% CI]:1.17[1.05,1.31]), but not normal or underweight. CONCLUSIONS Among older US men and women, TMAO was not significantly associated with risk of hip fracture or BMD overall. Exploratory analyses suggested a significant association between higher TMAO and hip fracture when BMI was elevated, which merits further study.
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Affiliation(s)
- Rachel E Elam
- Division of Rheumatology, Department of Medicine, Augusta University, Augusta, GA, USA; Charlie Norwood Veterans Affairs Medical Center, Veterans Affairs Health Care System, Augusta, GA, USA.
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Emory University School of Medicine, Atlanta, GA, USA
| | - Zeneng Wang
- Department of Cardiovascular & Metabolic Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Ina Nemet
- Department of Cardiovascular & Metabolic Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew J Budoff
- Department of Cardiology and Medicine, University of California - Los Angeles, Los Angeles, CA, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Yujin Lee
- Department of Food and Nutrition, Myongji University, Yongin, Republic of Korea
| | - John A Robbins
- Department of Medicine, University of California, Davis, Modesto, CA, USA
| | - Meng Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Stanley L Hazen
- Department of Cardiovascular & Metabolic Sciences, Cleveland Clinic, Cleveland, OH, USA; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Laura D Carbone
- Division of Rheumatology, Department of Medicine, Augusta University, Augusta, GA, USA; Charlie Norwood Veterans Affairs Medical Center, Veterans Affairs Health Care System, Augusta, GA, USA
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Tinker LF, Huang Y, Johnson KC, Carbone LD, Snetselaar L, Van Horn L, Manson JE, Liu S, Mossavar-Rahmani Y, Prentice RL, Lampe JW, Neuhouser ML. Estimating 24-Hour Urinary Excretion of Sodium and Potassium Is More Reliable from 24-Hour Urine Than Spot Urine Sample in a Feeding Study of US Older Postmenopausal Women. Curr Dev Nutr 2021; 5:nzab125. [PMID: 34761160 PMCID: PMC8575727 DOI: 10.1093/cdn/nzab125] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Assessing estimated sodium (Na) and potassium (K) intakes derived from 24-h urinary excretions compared with a spot urine sample, if comparable, could reduce participant burden in epidemiologic and clinical studies. OBJECTIVES In a 2-week controlled-feeding study, Na and K excretions from a 24-h urine collection were compared with a first-void spot urine sample, applying established algorithms and enhanced models to estimate 24-h excretion. Actual and estimated 24-h excretions were evaluated relative to mean daily Na and K intakes in the feeding study. METHODS A total of 153 older postmenopausal women ages 75.4 ± 3.5 y participated in a 2-wk controlled-feeding study with a 4-d repeating menu cycle based on their usual intake (ClinicalTrials.gov Identifier: NCT00000611). Of the 150 participants who provided both a first-void spot urine sample and a 24-h urine collection on the penultimate study day, statistical methods included Pearson correlations for Na and K between intake, 24-h collections, and the 24-h estimated excretions using 4 established algorithms: enhanced biomarker models by regressing ln-transformed intakes on ln-transformed 24-h excretions or ln-transformed 24-h estimated excretions plus participant characteristics and sensitivity analyses for factors potentially influencing Na or K excretion (e.g., possible kidney disease estimated glomerular filtration rate <60 mL/min/1.73 m2 ). RESULTS Pearson correlation coefficients between Na and K intakes and actual 24-h excretions were 0.57 and 0.38-0.44 for estimated 24-h excretions, depending on electrolyte and algorithm used. Enhanced biomarker model cross-validated R 2 (CVR2) for 24-h excretions were 38.5% (Na), 40.2% (K), and 42.0% (Na/K). After excluding participants with possible kidney disease, the CVR2 values were 43.2% (Na), 40.2% (K), and 38.1% (Na/K). CONCLUSIONS Twenty-four-hour urine excretion measurement performs better than estimated 24-h excretion from a spot urine as a biomarker for Na and K intake among a sample of primarily White postmenopausal women.
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Affiliation(s)
- Lesley F Tinker
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ying Huang
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Laura D Carbone
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Linda Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simin Liu
- Departments of Epidemiology, Medicine, and Surgery and Center for Global Cardiometabolic Health, Brown University, Providence, RI, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ross L Prentice
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Johanna W Lampe
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Madera-Acosta A, Johnson-Wall H, Carbone LD, Meszaros A, Berman AE, White J. Cannabidiol (CBD) oil toxicity mimicking extraglandular complications of Sjögren's syndrome. Rheumatol Adv Pract 2021; 5:rkab010. [PMID: 33748661 PMCID: PMC7962723 DOI: 10.1093/rap/rkab010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Adria Madera-Acosta
- Division of Rheumatology, Medical College of Georgia, Augusta University.,Charlie Norwood Veterans Affairs Medical Center
| | | | - Laura D Carbone
- Division of Rheumatology, Medical College of Georgia, Augusta University.,Charlie Norwood Veterans Affairs Medical Center
| | - Adam Meszaros
- Division of Rheumatology, Medical College of Georgia, Augusta University.,Charlie Norwood Veterans Affairs Medical Center
| | - Adam E Berman
- Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Carbone LD, Johnson K, Larson JC, Thomas F, Wactawski-Wende J, Bollinger K, Chen Z, Watsky M. Association of vitamin D with incident glaucoma: findings from the Women's Health Initiative. J Investig Med 2021; 69:jim-2020-001645. [PMID: 33431603 DOI: 10.1136/jim-2020-001645] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 11/03/2022]
Abstract
The relationship between vitamin D and glaucoma is controversial. The objective of this study was to examine women from the Women's Health Initiative (WHI) to determine if there is an association between vitamin D and incident glaucoma in postmenopausal women. We examined the association between dietary vitamin D intake, vitamin D supplements and serum 25 hydroxyvitamin D (25(OH)D) levels and the risk of developing glaucoma. 143,389 postmenopausal women from the WHI including a subset with serum 25(OH) D measurements were examined to determine the association of dietary, supplemental and serum levels of vitamin D to the development of glaucoma. Dietary intakes of vitamin D, use of vitamin D supplements and serum levels of 25(OH) D were predictors examined for the main outcome of incident glaucoma. In multivariable models adjusted for demographic, clinical variables and medication use, dietary vitamin D, vitamin D supplements, total vitamin D intake (diet plus supplements) and serum 25 (OH) D measurements were not significantly associated with incident glaucoma. In the CaD placebo-controlled intervention clinical trial, there was also no association in the active intervention arm with glaucoma. We conclude that dietary vitamin D intake, supplements and serum levels are not significantly related to the risk of developing glaucoma in postmenopausal women.
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Affiliation(s)
- Laura D Carbone
- Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
- Medicine, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Karen Johnson
- Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joseph C Larson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Fridtjof Thomas
- Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jean Wactawski-Wende
- Epidemiology and Environmental Health, University at Buffalo-The State University of New York, Buffalo, New York, USA
| | - Kathryn Bollinger
- Ophthalmology, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Zhao Chen
- Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Mitchell Watsky
- Cellular Biology and Anatomy, Augusta University Medical College of Georgia, Augusta, Georgia, USA
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Le B, Ray C, Gonzalez B, Miskevics S, Weaver FM, Priebe M, Carbone LD. Reasons for Initiation and Discontinuation of Pharmacological Therapies for Osteoporosis in Veterans with Spinal Cord Injury and Disorders. J Clin Densitom 2021; 24:67-77. [PMID: 31262561 DOI: 10.1016/j.jocd.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/01/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Medications for osteoporosis have not been reported to reduce fracture rates in patients with spinal cord injury and disorders (SCI/D), yet these medications are still prescribed. Clinical decision-making underscoring the initiation and discontinuation of osteoporosis medications in SCI/D remains poorly understood. METHODOLOGY Veterans with a SCI/D with at least one prescription for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, and teriparatide) who received healthcare within Veterans Affairs (VA) from 2005 to 2015 were identified using VA administrative databases. A 10% subsample of Veterans was selected for electronic health record review. RESULTS Two hundred and sixty-seven Veterans with 330 prescriptions underwent electronic health record review. Bisphosphonates were the most frequently prescribed medication for osteoporosis (n = 223, 67.6%). Of the 187 Veterans with prescriptions for prevention or treatment of osteoporosis, the primary reason for initiation was Dual Energy X-ray Absorptiometry (DXA) scan with osteopenia or osteoporosis (n = 119, 63.6% of Veterans), primarily at the hip (81.0% of DXAs). The majority (79.0%) of DXAs were "screening tests," with SCI/D being the sole reason for the scan. Fractures (n = 51, 27.3%) and fall risk concerns (n = 29, 15.5%) were other major reasons for initiation. On average, oral bisphosphonates were filled for <3 yr, with medication-related side effects (n = 23, 15.8% of bisphosphonates discontinued), predominately gastrointestinal (n = 17, 73.9% of reported side effects), the most common reason for discontinuation. Drug holidays occurred in 14.3% of 35 oral bisphosphonates used for ≥5 yr. No cases of osteonecrosis of the jaw were found. There was one case of an atypical femoral fracture which could not be confirmed. CONCLUSIONS The decision to initiate pharmacological therapies in SCI/D is primarily based on osteopenia or osteoporosis at the hip by screening DXAs. Gastrointestinal side effects are the major reason for discontinuation of oral bisphosphonates. New therapies for osteoporosis in SCI/D are needed.
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Affiliation(s)
- Brian Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biostatistics, University of Illinois, Chicago, IL, USA; Department of Mathematics, Northeastern Illinois University, Chicago, IL, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA; Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Michael Priebe
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Division of Rheumatology, J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
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Weaver FM, Gonzalez B, Ray C, Etingen B, Schwartz A, Burns S, Le B, Aslam H, Priebe M, Carbone LD. Factors influencing providers' decisions on management of bone health in people with spinal cord injury. Spinal Cord 2020; 59:787-795. [PMID: 33239741 DOI: 10.1038/s41393-020-00589-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Survey. OBJECTIVES Managing osteoporosis in persons with chronic spinal cord injury (SCI) is difficult as little evidence exists regarding effective strategies. We examined the effect of key factors on providers' bone health management decisions in persons with SCI. SETTING USA. METHODS Providers reviewed blocks of 9 hypothetical cases that varied on four factors: osteoporosis, osteopenia, or normal bone mineral density using dual-energy X-ray absorptiometry (DXA); DXA region of interest (lumbar spine, hip, knee), prior lower extremity fracture; and no or limited ambulation. They indicated how likely they would recommend pharmacological management, what treatment(s) they would recommend, and whether they would request another DXA before treatment. RESULTS Eighty-two healthcare providers completed the survey. Treatment recommendations for bisphosphonates and Vitamin D/calcium supplements, respectively, were more likely if there was a prior fracture (OR: 2.65, 95%CI: 1.76-3.99, p < 0.0001; OR: 2.96, 95%CI: 1.40-6.26, p = 0.004) and if a DXA scan found osteopenia (OR: 2.23, 95%CI: 1.41-3.54, p = 0.001; OR: 6.56, 95%CI: 2.71-15.85, p < 0.0001) or osteoporosis (OR: 12.08, 95%CI: 7.09-20.57, p < 0.0001; OR: 4.54, 95%CI: 2.08-9.90, p < 0.0001). Another DXA scan was more likely to be requested if there was a prior fracture (OR: 1.75, 95%CI: 1.10-2.78, p = 0.02) but less likely if the person was nonambulatory (OR: 0.41, 95%: 0.19-0.90, p = 0.03). CONCLUSIONS Prior fracture and DXA findings influenced treatment recommendations for bone health management in SCI. Reliance on lumbar spine scans to determine bone loss and treatment identifies a knowledge gap for which future education is required.
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Affiliation(s)
- Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA. .,Parkinson School of Health Sciences and Public Health, Loyola University, Chicago, IL, USA.
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - Alan Schwartz
- Department of Medical Education, and Department of Pediatrics at the University of Illinois at Chicago, Chicago, IL, USA
| | - Stephen Burns
- Spinal Cord Injury Service, VA Puget Sound health Care System, Seattle, WA, USA.,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian Le
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Hammad Aslam
- Altanta Rehabilitation Consultants, Duluth, GA, USA
| | - Michael Priebe
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Laura D Carbone
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA.,Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
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Crandall CJ, Larson J, Wright NC, Laddu D, Stefanick ML, Kaunitz AM, Watts NB, Wactawski-Wende J, Womack CR, Johnson KC, Carbone LD, Jackson RD, Ensrud KE. Serial Bone Density Measurement and Incident Fracture Risk Discrimination in Postmenopausal Women. JAMA Intern Med 2020; 180:1232-1240. [PMID: 32730575 PMCID: PMC7385675 DOI: 10.1001/jamainternmed.2020.2986] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 11/14/2022]
Abstract
IMPORTANCE Repeated bone mineral density (BMD) testing to screen for osteoporosis requires resources. For patient counseling and optimal resource use, it is important for clinicians to know whether repeated BMD measurement (compared with baseline BMD measurement alone) improves the ability to discriminate between postmenopausal women who will and will not experience a fracture. OBJECTIVE To assess whether a second BMD measurement approximately 3 years after the initial assessment is associated with improved ability to estimate fracture risk beyond the baseline BMD measurement alone. DESIGN, SETTING, AND PARTICIPANTS The Women's Health Initiative is a prospective observational study. Participants in the present cohort study included 7419 women with a mean (SD) follow-up of 12.1 (3.4) years between 1993 and 2010 at 3 US clinical centers. Data analysis was conducted between May 2019 and December 2019. MAIN OUTCOMES AND MEASURES Incident major osteoporotic fracture (ie, hip, clinical spine, forearm, or shoulder fracture), hip fracture, baseline BMD, and absolute change in BMD were assessed. The area under the receiver operating characteristic curve (AU-ROC) for baseline BMD, absolute change in BMD, and the combination of baseline BMD and change in BMD were calculated to assess incident fracture risk discrimination during follow-up. RESULTS Of 7419 participants, the mean (SD) age at baseline was 66.1 (7.2) years, the mean (SD) body mass index was 28.7 (6.0), and 1720 (23%) were nonwhite individuals. During the study follow-up (mean [SD] 9.0 [3.5] years after the second BMD measurement), 139 women (1.9%) experienced hip fractures, and 732 women (9.9%) experienced major osteoporotic fracture. In discriminating between women who experience hip fractures and those who do not, AU-ROC values were 0.71 (95% CI, 0.67-0.75) for baseline total hip BMD, 0.61 (95% CI, 0.56-0.65) for change in total hip BMD, and 0.73 (95% CI, 0.69-0.77) for the combination of baseline total hip BMD and change in total hip BMD. Femoral neck and lumbar spine BMD values had similar discrimination for hip fracture. For discrimination of major osteoporotic fracture, AU-ROC values were 0.61 (95% CI, 0.59-0.63) for baseline total hip BMD, 0.53 (95% CI, 0.51-0.55) for change in total hip BMD, and 0.61 (95% CI, 0.59-0.63) for the combination of baseline total hip BMD and change in total hip BMD. Femoral neck and lumbar spine BMD values had similar ability to discriminate between women who experienced major osteoporotic fracture and those who did not. Associations between change in bone density and fracture risk did not differ by subgroup, including diabetes, age, race/ethnicity, body mass index, or baseline BMD T score. CONCLUSIONS AND RELEVANCE The findings of this study suggest that a second BMD assessment approximately 3 years after the initial measurement was not associated with improved discrimination between women who did and did not experience subsequent hip fracture or major osteoporotic fracture beyond the baseline BMD value alone and should not routinely be performed.
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Affiliation(s)
- Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | - Joseph Larson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Deepika Laddu
- Department of Physical Therapy, University of Illinois, Chicago
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville
| | - Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - Catherine R Womack
- Division of General Internal Medicine, Department of Medicine, The University of Tennessee Health Science Center College of Medicine, Memphis
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Laura D Carbone
- Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta
| | - Rebecca D Jackson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University, Columbus
| | - Kristine E Ensrud
- Division of Epidemiology & Community Health, Department of Medicine, University of Minnesota and Veterans Affairs Health Care System, Minneapolis
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Huang D, Weaver F, Obremskey WT, Ahn J, Peterson K, Anderson J, Veazie S, Carbone LD. Treatment of Lower Extremity Fractures in Chronic Spinal Cord Injury: A Systematic Review of the Literature. PM R 2020; 13:510-527. [PMID: 32500657 DOI: 10.1002/pmrj.12428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To review the literature regarding outcomes of surgical and nonsurgical management of lower extremity (LE) fractures in chronic spinal cord injury (SCI). TYPE: Systematic review. LITERATURE SURVEY Medline (PubMed), Embase, Cochrane Database of Systemic Reviews, Cochrane Central, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trials were searched from January 1, 1966, to March 1, 2019. METHODOLOGY Search was restricted to English language and adults (age ≥ 18 yr). Titles and abstracts were reviewed for relevance to study topics for inclusion. Case reports, reviews, non-SCI population studies, and studies examining fractures at the time of acute SCI were excluded. References of included articles from the original search and task force and external submissions yielded two additional articles that were included in the review after voting by task force members. Data extraction was performed by four task force members using a data extraction form, glossary, and instructions created in Microsoft Excel. Quality assessment was performed by three methodologists using prespecified criteria. SYNTHESIS Twenty-three articles were included. Use of surgery to treat LE fractures in chronic SCI has increased, though nonoperative management was still more frequently reported. Regardless of type of management, amputations, nonunion/malunion, and pressure injuries were among the most commonly reported complications. Functional and quality of life outcomes were less frequently reported. CONCLUSIONS There is insufficient evidence to support operative versus nonoperative management as best practice for management of LE fracture of SCI. Existing literature was limited by small sample sizes, lack of randomization or matched study designs, significant heterogeneity in populations and treatment strategies studied, and variability in defining and reporting outcomes of interest. The field would benefit from future research to address study design issues and standardization of outcome reporting to facilitate comparison of outcomes of operative versus nonoperative management.
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Affiliation(s)
- Donna Huang
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Frances Weaver
- Health Services Research and Development, Department of Veterans' Affairs, Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, IL, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - William T Obremskey
- Division of Orthopedic Trauma Research, Center for Musculoskeletal Research, Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jaimo Ahn
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly Peterson
- Veterans' Affairs Evidence-Based Synthesis Program, Portland VA Healthcare System, Portland, OR, USA
| | - Johanna Anderson
- Veterans' Affairs Evidence-Based Synthesis Program, Portland VA Healthcare System, Portland, OR, USA
| | - Stephanie Veazie
- Veterans' Affairs Evidence-Based Synthesis Program, Portland VA Healthcare System, Portland, OR, USA
| | - Laura D Carbone
- Charlie Norwood VA Medical Center, Augusta, GA, USA.,Division of Rheumatology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Le B, Ray C, Gonzalez B, Miskevics S, Weaver FM, Priebe M, Carbone LD. Laboratory evaluation of secondary causes of bone loss in Veterans with spinal cord injury and disorders. Osteoporos Int 2019; 30:2241-2248. [PMID: 31410501 DOI: 10.1007/s00198-019-05089-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/29/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED An electronic health record (eHR) review of Veterans with a spinal cord injury and disorder (SCI/D) was conducted to understand the extent to which Veterans Affairs (VA) providers pursue workups for secondary causes of osteoporosis in this population. Laboratory tests for secondary causes were ordered in only one-third of Veterans, with secondary causes identified in two-thirds of those tested, most frequently, hypogonadism and hypovitaminosis D. PURPOSE To identify workups for secondary causes of osteoporosis in SCI/D and the extent to which subspecialty consultations are sought. METHODS A total of 3018 prescriptions for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, teriparatide) among 2675 Veterans were identified in fiscal years 2005-2015 from VA administrative databases. Approximately 10% of these prescriptions were selected for eHR review. RESULTS eHR records of 187 Veterans with a SCI/D who had received pharmacological treatment for osteoporosis were reviewed. Workups for secondary causes of osteoporosis were performed in 31.5% of Veterans (n = 59) with approximately 64.4% of those tested (n = 38) having at least one abnormality. Hypogonadism (52.0% of those tested) and hypovitaminosis D (50.0% of those tested) were the most common secondary causes of osteoporosis identified in this population. Approximately 10% of primary care and SCI providers consulted subspecialists for further evaluation and treatment of osteoporosis. Endocrinologists more frequently performed a workup for secondary causes of osteoporosis compared to other provider specialties. CONCLUSIONS Screening for secondary causes of osteoporosis, particularly for hypogonadism and hypovitaminosis D, should be considered in patients with a SCI/D.
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Affiliation(s)
- B Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - C Ray
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - B Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biostatistics, University of Illinois, Chicago, IL, USA
| | - S Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Mathematics, Northeastern Illinois University, Chicago, IL, USA
| | - M Priebe
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Department of Medicine, Division of Rheumatology, J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 309012, USA.
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Weaver FM, Le B, Ray C, Miskevics S, Gonzalez B, Carbone LD. Predicting osteoporosis medication receipt in Veterans with a spinal cord injury: A retrospective cohort study. J Spinal Cord Med 2019; 42:760-767. [PMID: 30888309 PMCID: PMC6830189 DOI: 10.1080/10790268.2019.1584259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: To describe frequency and predictors of use of pharmacological therapies for osteoporosis in persons with a spinal cord injury (SCI).Design: Retrospective cohort study.Setting: United States Veterans Health Administration (VA) national databases.Participants: 11,048 persons with a traumatic SCI who received VA health care between Fiscal Years (FY) 2005-2015. Pharmacy data from VA's Corporate Data Warehouse were used to identify prescriptions for Food and Drug Administration-approved pharmacological treatments for osteoporosis including bisphosphonates, calcitonin, denosumab, raloxifene and teriparatide.Outcome Measures: Demographics, clinical and SCI-related characteristics, receipt of a dual energy x-ray absorptiometry (DXA), and prevalent lower extremity fractures were examined to determine factors related to receiving a pharmacological agent for osteoporosis.Results: 1,041 persons (9.4%) had a prescription for a pharmacological agent for osteoporosis; the majority (n = 964, 93.0%) were bisphosphonates. There was a significant decline in the number of these prescriptions from FY 2005 (13.0%) to FY 2015 (2.2%). In multivariable analysis, age (>50 years) (OR = 1.60, 95% CI 1.31-1.94); female sex (OR = 4.09, 95% CI 2.74-6.09); opioid (OR = 1.24, 95% CI 1.01-1.51) or corticosteroid (OR = 1.92, 95% CI 1.01-1.51) prescriptions; complete injury (OR = 1.26, 95% CI 1.04-1.53); receipt of a DXA scan (OR = 84.03, 95% CI 59.80-118.07) and prevalent fracture (OR = 5.43, 95% CI 4.13-7.15) were positive predictors. Black race (OR = 0.43, 95% CI 0.33-0.57) and obese BMI (OR = 0.59, 95% CI 0.45-0.76) were negative predictors.Conclusions: Prescriptions for osteoporosis medications for persons with a SCI declined in recent years. The strongest predictors for having filled these prescriptions were having had a DXA or a prevalent fracture.
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Affiliation(s)
- Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA,Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA,Correspondence to: Frances M. Weaver, PhD, CINCCH (151H), Hines VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA.
| | - Brian Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA,Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA,Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Department of Biostatistics, University of Illinois, Chicago, Illinois, USA,Department of Mathematics, Northeastern Illinois University, Chicago, Illinois, USA
| | - Laura D. Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA,Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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Morse LR, Biering-Soerensen F, Carbone LD, Cervinka T, Cirnigliaro CM, Johnston TE, Liu N, Troy KL, Weaver FM, Shuhart C, Craven BC. Bone Mineral Density Testing in Spinal Cord Injury: 2019 ISCD Official Position. J Clin Densitom 2019; 22:554-566. [PMID: 31501005 DOI: 10.1016/j.jocd.2019.07.012] [Citation(s) in RCA: 44] [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: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
Spinal cord injury (SCI) causes rapid osteoporosis that is most severe below the level of injury. More than half of those with motor complete SCI will experience an osteoporotic fracture at some point following their injury, with most fractures occurring at the distal femur and proximal tibia. These fractures have devastating consequences, including delayed union or nonunion, cellulitis, skin breakdown, lower extremity amputation, and premature death. Maintaining skeletal integrity and preventing fractures is imperative following SCI to fully benefit from future advances in paralysis cure research and robotic-exoskeletons, brain computer interfaces and other evolving technologies. Clinical care has been previously limited by the lack of consensus derived guidelines or standards regarding dual-energy X-ray absorptiometry-based diagnosis of osteoporosis, fracture risk prediction, or monitoring response to therapies. The International Society of Clinical Densitometry convened a task force to establish Official Positions for bone density assessment by dual-energy X-ray absorptiometry in individuals with SCI of traumatic or nontraumatic etiology. This task force conducted a series of systematic reviews to guide the development of evidence-based position statements that were reviewed by an expert panel at the 2019 Position Development Conference in Kuala Lumpur, Malaysia. The resulting the International Society of Clinical Densitometry Official Positions are intended to inform clinical care and guide the diagnosis of osteoporosis as well as fracture risk management of osteoporosis following SCI.
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Affiliation(s)
- Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Fin Biering-Soerensen
- Clinic for Spinal Cord Injuries, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tomas Cervinka
- Department of Physiotherapy and Rehabilitation, Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Therese E Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Nan Liu
- Department of Rehabilitation Medicine and Osteoporosis and Metabolic Bone Disease Center, Peking University Third Hospital, Beijing, China
| | - Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Christopher Shuhart
- Swedish Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle WA, USA
| | - Beverley C Craven
- Neural Engineering and Therapeutics Team, KITE Research Institute - University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario Canada
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Carbone LD, Vasan S, Prentice RL, Harshfield G, Haring B, Cauley JA, Johnson KC. The renin-angiotensin aldosterone system and osteoporosis: findings from the Women's Health Initiative. Osteoporos Int 2019; 30:2039-2056. [PMID: 31209511 DOI: 10.1007/s00198-019-05041-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/13/2018] [Accepted: 05/30/2019] [Indexed: 01/30/2023]
Abstract
UNLABELLED New users of RAAS inhibitors, including ACE inhibitors and ARBs, have a small increased risk for fracture in the first 3 years of use, with a reduced risk of fracture with longer duration of use. INTRODUCTION Pharmacological inhibitors of the renin-angiotensin aldosterone system (RAAS) are used to treat hypertension. However, the relationship of these medications to osteoporosis is inconsistent, and no study has included simultaneous measurements of both incident fractures and bone mineral density (BMD). METHODS The association of RAAS inhibitor use (n = 131,793) with incident fractures in new users of these medications in women in the Women's Health Initiative over a minimum median follow-up of 6.5 years was assessed by Cox proportional hazard models. The association of incident fractures by a cumulative duration of use of these medications (< 3 years.) and (> 3 years.) was also estimated. Subgroup analysis of fracture risk by RAAS inhibitor use confined to women with hypertension was also performed (n = 33,820). The association of RAAS inhibitor use with changes in BMD of the hip was estimated by linear regression in 8940 women with dual energy X-ray absorptiometry measurements. RESULTS There was no significant association between RAAS inhibitor use and all fractures in the final adjusted multivariable models including hip BMD (HR 0.86 (0.59, 1.24)). However, among users of RAAS inhibitors, including ACE inhibitors and angiotensin receptor blockers (ARBs), hazard ratios for all incident fracture sites in final multivariable models including hip BMD showed dramatic differences by duration of use, with short duration of use (3 years or less) associated with a marked increased risk for fracture (HR 3.28 (1.66, 6.48)) to (HR 6.23 (3.11, 12.46)) and use for more than 3 years associated with a reduced fracture risk (HR 0.40 (0.24, 0.68) to (HR 0.44 (0.20, 0.97)) . Findings were similar in the subgroup of women with a history of hypertension. There was no significant change in BMD of the hip by RAAS inhibitor use. CONCLUSIONS In postmenopausal women, use of RAAS inhibitors, including ACE inhibitors and ARBs, is associated with an increased risk for fracture among new users of these medications in the first 3 years of use. However, long-term use (> 3 years) is associated with a reduced risk. Consideration for fracture risk may be part of the decision-making process for initiation of these medications for other disease states.
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Affiliation(s)
- L D Carbone
- Department of Medicine, Division of Rheumatology, J. Harold Harrison MD, Distinguished University Chair in Rheumatology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
| | - S Vasan
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - R L Prentice
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - G Harshfield
- Georgia Prevention Institute, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - B Haring
- Department of Medicine, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Bavaria, Germany
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - K C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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21
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Le B, Bůžková P, Robbins JA, Fink HA, Raiford M, Isales CM, Shikany JM, Coughlin SS, Carbone LD. The Association of Aromatic Amino Acids with Incident Hip Fracture, aBMD, and Body Composition from the Cardiovascular Health Study. Calcif Tissue Int 2019; 105:161-172. [PMID: 31115639 PMCID: PMC6663558 DOI: 10.1007/s00223-019-00562-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
In 5187 persons from the Cardiovascular Health Study, there was no significant association of dietary intakes of aromatic amino acids (AAA) with areal BMD of the hip or body composition. However, those who had the lowest dietary intakes of AAA were at increased risk for incident hip fractures. Prior studies of the association of protein intake with osteoporosis are conflicting and have not directly examined the relationship of aromatic amino acids (AAA) with fractures, areal bone mineral density (aBMD), and body composition. We sought to determine the relationship of dietary intakes of AAA with osteoporosis parameters in elderly men and women. 5187 men and women aged ≥ 65 years from the Cardiovascular Health Study (CHS) with dietary intakes of AAA (tryptophan, phenylalanine, tyrosine) estimated by food frequency questionnaire (FFQ) were included. We examined the relationship between a one-time estimate of daily dietary AAA intake with risk of incident hip fractures over a median of 13.2 years of fracture follow-up. A subset (n = 1336) who had dual energy X-ray absorptiometry (DXA) performed were included in a cross-sectional analysis of the association of dietary AAA intake with aBMD of the total hip and measurements of body composition. In multivariable models adjusted for demographic and clinical variables, medication use, and diet, higher dietary AAA intake was not significantly associated with incident hip fractures. All hazard ratios (HR) were less than one (tryptophan, HR 0.14, 95% CI 0.01 to 1.89; phenylalanine, HR 0.60, 95% CI 0.23 to 1.55; tyrosine, HR 0.59, 95% CI 0.27 to 1.32), but confidence intervals were wide and included no difference. However, in post hoc analyses, the lowest quartile of intake for each AAA was associated with an increased risk for hip fracture compared to higher quartiles (p ≤ 0.047 for all). Dietary AAA intakes were not significantly associated with total hip aBMD or any measurements of body composition. Overall, there was no significant association of dietary AAA intake with hip fractures, aBMD of the hip, or body composition. However, there may be a subset of elderly individuals with low dietary intakes of AAA who are at increased for hip fractures.
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Affiliation(s)
- Brian Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - John A Robbins
- Department of Medicine, University of California - Davis, Sacramento, CA, USA
| | - Howard A Fink
- Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Mattie Raiford
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - Carlos M Isales
- Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven S Coughlin
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Department of Medicine, J. Harold Harrison MD Distinguished University Chair in Rheumatology, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA.
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Carbone LD, Bůžková P, Fink HA, Raiford M, Le B, Isales CM, Shikany JM, Coughlin SS, Robbins JA. Association of Dietary Niacin Intake With Incident Hip Fracture, BMD, and Body Composition: The Cardiovascular Health Study. J Bone Miner Res 2019; 34:643-652. [PMID: 30659655 PMCID: PMC6663556 DOI: 10.1002/jbmr.3639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/20/2018] [Revised: 10/18/2018] [Accepted: 11/09/2018] [Indexed: 11/12/2022]
Abstract
Interest in niacin has increased in the setting of reports suggesting that niacin plays a role in diseases of aging. No study to date has examined the association of dietary niacin intake with multiple skeletal health parameters including bone mineral density (BMD), hip fractures, and body composition, and none have included both African American and white men and women. Participants included 5187 men and women ≥65 years from the Cardiovascular Health Study (CHS). Mean daily dietary niacin intake was 32.6 mg, with quartiles 1 through 4 defined as 3.6 to 21.8 mg/day, 21.9 to 30.2 mg/day, 30.3 to 40.9 mg/day, and 41.0 to 102.4 mg/day, respectively. Risk of incident hip fracture per 10 mg increment of daily dietary niacin intake was estimated using proportional hazards models. During a median follow-up of 13 years, 725 participants had an incident hip fracture. In models adjusted for demographic and clinical characteristics and diet, dietary niacin intake was significantly associated with an increased risk of hip fractures (hazard ratio [HR] 1.12; 95% CI, 1.01 to 1.24) with spline models suggesting a U-shaped association. In post hoc analyses, both the lowest (HR 1.31; 95% CI, 1.04 to 1.66) and highest (HR 1.53; 95% CI, 1.20 to 1.95) quartiles of niacin intake were associated with an increased risk of incident hip fracture versus quartiles 2 and 3. There was a trend for a significant inverse association of dietary niacin intake with hip BMD (p = 0.06), but no significant association with total body BMD or any body composition measures. In this cohort of elderly, community-dwelling African American and white men and women, both high and low dietary niacin intakes were associated with a significantly increased risk of subsequent hip fracture, suggesting a possible U-shaped association. By comparison, dietary niacin may have an inverse linear association with hip BMD. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, J. Harold Harrison M.D. Distinguished University Chair in Rheumatology, Medical College of Georgia, Augusta University, Augusta, GA, USA,
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Howard A Fink
- Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Mattie Raiford
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA,
| | - Brian Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA,
| | - Carlos M Isales
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA,
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven S Coughlin
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - John A Robbins
- Department of Medicine, University of California-Davis, Sacramento, CA, USA
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Prentice RL, Huang Y, Neuhouser ML, Manson JE, Mossavar-Rahmani Y, Thomas F, Tinker LF, Allison M, Johnson KC, Wassertheil-Smoller S, Seth A, Rossouw JE, Shikany J, Carbone LD, Martin LW, Stefanick ML, Haring B, Van Horn L. Associations of Biomarker-Calibrated Sodium and Potassium Intakes With Cardiovascular Disease Risk Among Postmenopausal Women. Am J Epidemiol 2017. [PMID: 28633342 DOI: 10.1093/aje/kwx238] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studies of the associations of sodium and potassium intakes with cardiovascular disease incidence often rely on self-reported dietary data. In the present study, self-reported intakes from postmenopausal women at 40 participating US clinical centers are calibrated using 24-hour urinary excretion measures in cohorts from the Women's Health Initiative, with follow-up from 1993 to 2010. The incidence of hypertension was positively related to (calibrated) sodium intake and to the ratio of sodium to potassium. The sodium-to-potassium ratio was associated with cardiovascular disease incidence during an average follow-up period of 12 years. The estimated hazard ratio for a 20% increase in the sodium-to-potassium ratio was 1.13 (95% confidence interval (CI): 1.04, 1.22) for coronary heart disease, 1.20 (95% CI: 1.01, 1.42) for heart failure, and 1.11 (95% CI: 1.04, 1.19) for a composite cardiovascular disease outcome. The association with total stroke was not significant, but it was positive for ischemic stroke and inverse for hemorrhagic stroke. Aside from hemorrhagic stroke, corresponding associations of cardiovascular disease with sodium and potassium jointly were positive for sodium and inverse for potassium, although some were not statistically significant. Specifically, for coronary heart disease, the hazard ratios for 20% increases were 1.11 (95% CI: 0.95, 1.30) for sodium and 0.85 (95% CI: 0.73, 0.99) for potassium; and corresponding values for heart failure were 1.36 (95% CI: 1.02, 1.82) for sodium and 0.90 (95% CI: 0.69, 1.18) for potassium.
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Abderhalden L, Weaver FM, Bethel M, Demirtas H, Burns S, Svircev J, Hoenig H, Lyles K, Miskevics S, Carbone LD. Response to Sabour: Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders: methodological issues. Osteoporos Int 2017; 28:2261-2262. [PMID: 28508089 DOI: 10.1007/s00198-017-4056-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- L Abderhalden
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - M Bethel
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St., 6D-155, Augusta, GA, 30912, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - H Demirtas
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Burns
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - J Svircev
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, 508 Fulton St, Durham, NC, USA
| | - K Lyles
- VA Medical Centers, Duke University, Durham, NC, USA
- The Carolinas Center for Medical Excellence, Cary, NC, USA
| | - S Miskevics
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St., 6D-155, Augusta, GA, 30912, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Carbone LD, Bůžková P, Fink HA, Robbins JA, Bethel M, Hamrick MW, Hill WD. Association of Plasma SDF-1 with Bone Mineral Density, Body Composition, and Hip Fractures in Older Adults: The Cardiovascular Health Study. Calcif Tissue Int 2017; 100:599-608. [PMID: 28246930 PMCID: PMC5649737 DOI: 10.1007/s00223-017-0245-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/30/2017] [Indexed: 12/21/2022]
Abstract
Aging is associated with an increase in circulating inflammatory factors. One, the cytokine stromal cell-derived factor 1 (SDF-1 or CXCL12), is critical to stem cell mobilization, migration, and homing as well as to bone marrow stem cell (BMSC), osteoblast, and osteoclast function. SDF-1 has pleiotropic roles in bone formation and BMSC differentiation into osteoblasts/osteocytes, and in osteoprogenitor cell survival. The objective of this study was to examine the association of plasma SDF-1 in participants in the cardiovascular health study (CHS) with bone mineral density (BMD), body composition, and incident hip fractures. In 1536 CHS participants, SDF-1 plasma levels were significantly associated with increasing age (p < 0.01) and male gender (p = 0.04), but not with race (p = 0.63). In multivariable-adjusted models, higher SDF-1 levels were associated with lower total hip BMD (p = 0.02). However, there was no significant association of SDF-1 with hip fractures (p = 0.53). In summary, circulating plasma levels of SDF-1 are associated with increasing age and independently associated with lower total hip BMD in both men and women. These findings suggest that SDF-1 levels are linked to bone homeostasis.
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Affiliation(s)
- Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Howard A Fink
- Veterans Affairs Health Care System, Geriatric Research Education & Clinical Center, Minneapolis, MN, USA
- Veterans Affairs Health Care System, Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - John A Robbins
- Department of Medicine, University of California - Davis, Sacramento, CA, USA
| | - Monique Bethel
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - Mark W Hamrick
- Institute for Regenerative and Reparative Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
- Department of Orthopaedic Surgery, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Sanders Research Building, CB1119 1459 Laney-Walker Blvd., Augusta, Georgia, 30912-2000, USA
| | - William D Hill
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Institute for Regenerative and Reparative Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA.
- Department of Orthopaedic Surgery, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA.
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Sanders Research Building, CB1119 1459 Laney-Walker Blvd., Augusta, Georgia, 30912-2000, USA.
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Carbone LD, Bůžková P, Fink HA, Robbins JA, Bethel M, Isales CM, Hill WD. Association of DPP-4 activity with BMD, body composition, and incident hip fracture: the Cardiovascular Health Study. Osteoporos Int 2017; 28:1631-1640. [PMID: 28150034 PMCID: PMC5653373 DOI: 10.1007/s00198-017-3916-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/06/2017] [Indexed: 12/25/2022]
Abstract
UNLABELLED There was no association of plasma DPP-4 activity levels with bone mineral density (BMD), body composition, or incident hip fractures in a cohort of elderly community-dwelling adults. INTRODUCTION Dipeptidyl peptidase IV (DPP-4) inactivates several key hormones including those that stimulate postprandial insulin secretion, and DPP-4 inhibitors (gliptins) are approved to treat diabetes. While DPP-4 is known to modulate osteogenesis, the relationship between DPP-4 activity and skeletal health is uncertain. The purpose of the present study was to examine possible associations between DPP-4 activity in elderly subjects enrolled in the Cardiovascular Health Study (CHS) and BMD, body composition measurements, and incident hip fractures. METHODS All 1536 male and female CHS participants who had evaluable DXA scans and plasma for DPP-4 activity were included in the analyses. The association between (1) BMD of the total hip, femoral neck, lumbar spine, and total body; (2) body composition measurements (% lean, % fat, and total body mass); and (3) incident hip fractures and plasma levels of DPP-4 activity were determined. RESULTS Mean plasma levels of DPP-4 activity were significantly higher in blacks (227 ± 78) compared with whites (216 ± 89) (p = 0.04). However, there was no significant association of DPP-4 activity with age or gender (p ≥ 0.14 for both). In multivariable adjusted models, there was no association of plasma DPP-4 activity with BMD overall (p ≥ 0.55 for all) or in gender stratified analyses (p ≥ 0.23). There was also no association of DPP-4 levels and incident hip fractures overall (p ≥ 0.24) or in gender stratified analyses (p ≥ 0.39). CONCLUSION Plasma DPP-4 activity, within the endogenous physiological range, was significantly associated with race, but not with BMD, body composition, or incident hip fractures in elderly community-dwelling subjects.
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Affiliation(s)
- L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - P Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - H A Fink
- Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - J A Robbins
- Department of Medicine, University of California-Davis, Sacramento, CA, USA
| | - M Bethel
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - C M Isales
- Department of Medicine, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
- Institute for Regenerative and Reparative Medicine, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - W D Hill
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Institute for Regenerative and Reparative Medicine, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA.
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA.
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University (Formerly Georgia Regents University and Georgia Health Sciences University), Sanders Research Building, CB1119, b1459 Laney-Walker Blvd., Augusta, GA, 30912-2000, USA.
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Fohtung RB, Brown DL, Koh WJH, Bartz TM, Carbone LD, Civitelli R, Stein PK, Chaves PHM, Kestenbaum BR, Kizer JR. Bone Mineral Density and Risk of Heart Failure in Older Adults: The Cardiovascular Health Study. J Am Heart Assoc 2017; 6:e004344. [PMID: 28288973 PMCID: PMC5523996 DOI: 10.1161/jaha.116.004344] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 07/25/2016] [Accepted: 01/17/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite increasing evidence of a common link between bone and heart health, the relationship between bone mineral density (BMD) and heart failure (HF) risk remains insufficiently studied. METHODS AND RESULTS We investigated whether BMD measured by dual-energy x-ray absorptiometry was associated with incident HF in an older cohort. Cox models were stratified by sex and interactions of BMD with race assessed. BMD was examined at the total hip and femoral neck separately, both continuously and by World Health Organization categories. Of 1250 participants, 442 (55% women) developed HF during the median follow-up of 10.5 years. In both black and nonblack women, neither total hip nor femoral neck BMD was significantly associated with HF; there was no significant interaction by race. In black and nonblack men, total hip, but not femoral neck, BMD was significantly associated with HF, with evidence of an interaction by race. In nonblack men, lower total hip BMD was associated with higher HF risk (hazard ratio, 1.13 [95% CI, 1.01-1.26] per 0.1 g/cm2 decrement), whereas in black men, lower total hip BMD was associated with lower HF risk (hazard ratio, 0.74 [95% CI, 0.59-0.94]). There were no black men with total hip osteoporosis. Among nonblack men, total hip osteoporosis was associated with higher HF risk (hazard ratio, 2.83 [95% CI, 1.39-5.74]) compared with normal BMD. CONCLUSIONS Among older adults, lower total hip BMD was associated with higher HF risk in nonblack men but lower risk in black men, with no evidence of an association in women. Further research is needed to replicate these findings and to study potential underlying pathways.
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Affiliation(s)
- Raymond B Fohtung
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - David L Brown
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - William J H Koh
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA
| | - Laura D Carbone
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA
- Charlie Norwood Veterans Affairs, Augusta, GA
| | - Roberto Civitelli
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Phyllis K Stein
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Department of Medicine, Family Medicine, and Community Health, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Bryan R Kestenbaum
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jorge R Kizer
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Abderhalden L, Weaver FM, Bethel M, Demirtas H, Burns S, Svircev J, Hoenig H, Lyles K, Miskevics S, Carbone LD. Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders. Osteoporos Int 2017; 28:925-934. [PMID: 27924381 DOI: 10.1007/s00198-016-3841-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/11/2016] [Indexed: 01/09/2023]
Abstract
UNLABELLED Low T-scores at the hip predict incident fractures in persons with a SCI. INTRODUCTION Persons with a spinal cord injury (SCI) have substantial morbidity and mortality following osteoporotic fractures. The objective of this study was to determine whether dual-energy X-ray absorptiometry (DXA) measurements predict osteoporotic fractures in this population. METHODS A retrospective historical analysis that includes patients (n = 552) with a SCI of at least 2 years duration who had a DXA performed and were in the VA Spinal Cord Disorders Registry from fiscal year (FY) 2002-2012 was performed. RESULTS The majority of persons (n = 455, 82%) had a diagnosis of osteoporosis or osteopenia, with almost half having osteoporosis. BMD and T-scores at the lumbar spine were not significantly associated with osteoporotic fractures (p > 0.48) for both. In multivariable analyses, osteopenia (OR = 4.75 95% CI 1.23-17.64) or osteoporosis (OR = 4.31, 95% CI 1.15-16.23) compared with normal BMD was significantly associated with fractures and higher T-scores at the hip were inversely associated with fractures (OR 0.73 (95% CI 0.57-0.92)). There was no significant association of T-scores or World Health Organization (WHO) classification with incident fractures in those with complete SCI (p > 0.15 for both). CONCLUSION The majority (over 80%) of individuals with a SCI have osteopenia or osteoporosis. DXA-derived measurements at the hip, but not the lumbar spine, predict fracture risk in persons with a SCI. WHO-derived bone density categories may be useful in classifying fracture risk in persons with a SCI.
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Affiliation(s)
- L Abderhalden
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - M Bethel
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - H Demirtas
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Burns
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - J Svircev
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, 508 Fulton St, Durham, NC, USA
| | - K Lyles
- Duke University and VA Medical Centers, Durham, NC, USA
- The Carolinas Center for Medical Excellence, Cary, NC, USA
| | - S Miskevics
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Coughlin SS, Carbone LD, Heboyan V, Williams LB, Hatzigeorgiou C, Rangachari P, De Leo G. Use of My Health eVet patient web portal among veterans seen for diabetes mellitus at a medical center in the southeastern United States. Mhealth 2017; 3:50. [PMID: 29354642 PMCID: PMC5762985 DOI: 10.21037/mhealth.2017.10.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/01/2017] [Accepted: 10/12/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND An increasing number of studies have examined the use of information technology to improve diabetes care and patient self-management. The goal of the current study was to determine the number of veterans seen for diabetes at a large medical center in the southeastern region of the U.S. and to examine whether they had registered for VA's My HealtheVet patient web portal according to selected characteristics. METHODS Existing patient records were reviewed including My HealtheVet web portal registration by veterans treated for diabetes (ICD-10 code for type 2 diabetes) at the Charlie Norwood VAMC. Number of outpatient clinic patients seen for diabetes who had or had not registered for My HealtheVet were examined by age categories, sex, race, Hispanic ethnicity, and era of military service. RESULTS A total of 49,341 veterans receive care at the Charlie Norwood VAMC. Of those patients, 10,950 have been seen for diabetes. Of the 49,341 patients, 21,372 patients (43.3%) are using My HealtheVet and 10,465 patients (21.2%) have used secure messages. Of 10,950 diabetic patients, only 1,256 (11.5%) have registered for My HealtheVet. Women with diabetes were more likely to be registered for My HealtheVet than their male counterparts [13.92% vs. 11.24%; odds ratio (OR)=1.28; 95% confidence interval (CI): 1.05-1.55). Veterans with diabetes who served during WW II or the Korean War were less likely to use My HealtheVet than those who served during more recent eras (OR=0.33; 95% CI: 0.24-0.44). Use of the patient portal was highest among diabetic patients ages 51-55 years (15.6%). CONCLUSIONS A low percentage of Veterans with diabetes are active users of My HealtheVet. Studies are needed to identify My HealtheVet portal design features and veteran characteristics that will increase use of this patient portal which may improve diabetes care.
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Affiliation(s)
- Steven S. Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Laura D. Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Division of Rheumatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Vahé Heboyan
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Lovoria B. Williams
- Department of Biobehavioral Nursing, College of Nursing, Augusta University, Augusta, GA, USA
| | - Christos Hatzigeorgiou
- Division of General Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Pavani Rangachari
- Office of the Associate Dean for Practice and Community Health, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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Bethel M, Bailey L, Weaver F, Harmon RL, Priebe MM, Le B, Aslam H, Fausel Z, Hoenig H, Carbone LD. A historical study of appendicular fractures in veterans with traumatic chronic spinal cord injury: 2002-2007. J Spinal Cord Med 2016; 39:686-692. [PMID: 26899918 PMCID: PMC5137562 DOI: 10.1080/10790268.2016.1149930] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Describe the incidence and distribution of appendicular fractures in a cohort of veterans with spinal cord injury (SCI). DESIGN Retrospective, observational study of fractures in veterans with a chronic traumatic SCI. SETTING The Veterans Health Administration (VA) healthcare system. PARTICIPANTS Veterans included in the VA Spinal Cord Dysfunction Registry from Fiscal Years (FY) FY2002-FY2007. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Description of fractures by site and number. Mortality at one year following incident fracture among men with single vs. multiple fractures. RESULTS Male and female veterans sustained incident fractures with similar observed frequency (10.5% vs 11.5%). The majority of fractures occurred in the lower extremities for both men and women. In men, a complete extent of injury (compared to incomplete) was associated with 41% greater relative risk (RR) of incident fracture (RR 1.41, 95% confidence interval [1.17, 1.70]) among those with tetraplegia, but not paraplegia. Furthermore, many men (33.9%, n = 434) sustained multiple fractures over the course of the study. There were no differences in mortality between men who sustained a single fracture and those who had multiple fractures. CONCLUSIONS The extent of injury may be an important predictor of fracture risk for male veterans with tetraplegia. Once a fracture occurs, male veterans with SCI appear to be at high risk for additional fractures.
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Affiliation(s)
- Monique Bethel
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA,Department of Medicine, Georgia Regents University, Augusta, GA, USA,Correspondence to: Monique Bethel, Charlie Norwood Veterans Affairs Medical Center, 950 15th Street, Augusta, GA 30912, USA.
| | - Lauren Bailey
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA,Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA,Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Robert L. Harmon
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA
| | - Michael M. Priebe
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA
| | - Brian Le
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA,Department of Medicine, Georgia Regents University, Augusta, GA, USA
| | - Hammad Aslam
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA,Department of Medicine, Georgia Regents University, Augusta, GA, USA
| | - Zachary Fausel
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA,Department of Medicine, Georgia Regents University, Augusta, GA, USA
| | | | - Laura D. Carbone
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA,Department of Medicine, Georgia Regents University, Augusta, GA, USA
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Bethel M, Weaver FM, Bailey L, Miskevics S, Svircev JN, Burns SP, Hoenig H, Lyles K, Carbone LD. Risk factors for osteoporotic fractures in persons with spinal cord injuries and disorders. Osteoporos Int 2016; 27:3011-21. [PMID: 27230522 DOI: 10.1007/s00198-016-3627-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/24/2016] [Accepted: 05/02/2016] [Indexed: 01/15/2023]
Abstract
UNLABELLED Clinical risk factors for fracture were explored among Veterans with a spinal cord injury. At the end of 11 years of follow-up, the absolute risk of fracture was approximately 20 %. Among the clinical and SCI-related factors explored, a prior history of fracture was strongly associated with incident fracture. INTRODUCTION Few studies to date have comprehensively addressed clinical risk factors for fracture in persons with spinal cord injury (SCI). The purpose of this study was to identify risk factors for incident osteoporotic fractures in persons with a SCI that can be easily determined at the point of care. METHODS The Veteran's Affairs Spinal Cord Dysfunction Registry, a national database of persons with a SCI, was used to examine clinical and SCI-related risk factors for fracture. Incident fractures were identified in a cohort of persons with chronic SCI, defined as SCI present for at least 2 years. Cox regression models were used to estimate the risk of incident fractures. RESULTS There were 22,516 persons with chronic SCI included in the cohort with 3365 incident fractures. The mean observational follow-up time for the overall sample was 6.2 years (median 6.0, IQR 2.9-11.0). The mean observational follow-up time for the fracture group was 3.9 years (median 3.3, IQR 1.4-6.1) and 6.7 years (median 6.7, IQR 3.1-11.0) for the nonfracture group. By the end of the study, which included predominantly older Veterans with a SCI observed for a relatively short period of time, the absolute (i.e., cumulative hazard) for incident fractures was 0.17 (95%CI 0.14-0.21). In multivariable analysis, factors associated with an increased risk of fracture included White race, traumatic etiology of SCI, paraplegia, complete extent of SCI, longer duration of SCI, use of anticonvulsants and opioids, prevalent fractures, and higher Charlson Comorbidity Indices. Women aged 50 and older were also at higher risk of sustaining an incident fracture at any time during the 11-year follow-up period. CONCLUSIONS There are multiple clinical and SCI-related risk factors which can be used to predict fracture in persons with a SCI. Clinicians should be particularly concerned about incident fracture risk in persons with a SCI who have had a previous fracture.
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Affiliation(s)
- M Bethel
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA.
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L Bailey
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - J N Svircev
- VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - S P Burns
- VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, Durham, NC, USA
| | - K Lyles
- Department of Medicine, Duke University, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, VAMC, Durham, NC, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA
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Bethel M, Bůžková P, Fink HA, Robbins JA, Cauley JA, Lee J, Barzilay JI, Jalal DI, Carbone LD. Soluble CD14 and fracture risk. Osteoporos Int 2016; 27:1755-63. [PMID: 26659065 DOI: 10.1007/s00198-015-3439-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/19/2015] [Indexed: 12/26/2022]
Abstract
UNLABELLED Soluble CD14 (sCD14) is an inflammatory marker associated with osteoclasts. Using Cox proportional hazards models, we found a positive association between plasma levels of sCD14 and risk of incident fracture among participants in the Cardiovascular Health Study. sCD14 may be useful in identifying those at risk for fracture. INTRODUCTION Soluble CD14, a proinflammatory cytokine, is primarily derived from macrophages/monocytes that can differentiate into osteoclasts. The purpose of this study was to examine the relationship between sCD14 levels and osteoporotic fractures. METHODS In the Cardiovascular Health Study, 5462 men and women had sCD14 levels measured at baseline. Incident hip fractures (median follow-up time 12.5 years) and incident composite fractures (defined as the first hip, pelvis, humerus, or distal radius fracture, median follow-up 8.6 years) were identified from hospital discharge summaries and/or Medicare claims data. Cox proportional hazards models were used to model the association between sCD14 levels and time to incident hip or composite fracture, overall and as a function of race and gender. RESULTS In unadjusted models, there was a positive association between sCD14 levels (per 1 standard deviation increase, i.e., 361.6 ng/mL) and incident hip (HR, 1.26; 95 % CI, 1.17, 1.36) and composite (HR, 1.20; 95 % CI, 1.12, 1.28) fractures. When models were fully adjusted for demographics, lifestyle factors, and medication use, these associations were no longer significant. However, in whites, the association of sCD14 levels with hip fractures remained significant in fully adjusted models (HR, 1.11; 95 % CI, 1.01-1.23). Associations of sCD14 levels with hip and composite fracture did not differ between men and women. CONCLUSIONS In this large cohort of community-dwelling older adults, higher sCD14 levels were associated with an increased risk of incident hip fractures in whites.
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Affiliation(s)
- M Bethel
- Department of Medicine, Medical College of Georgia, 1120 15th Street, BI 5070, Augusta, GA, 30912, USA.
- Subspecialty Service, Charlie Norwood VA Medical Center, Augusta, GA, USA.
| | - P Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - H A Fink
- Geriatric Research Education and Clinical Center, and Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - J A Robbins
- Division of General Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Lee
- Divisions of Endocrinology, Clinical Nutrition and Vascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - J I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - D I Jalal
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - L D Carbone
- Department of Medicine, Medical College of Georgia, 1120 15th Street, BI 5070, Augusta, GA, 30912, USA
- Subspecialty Service, Charlie Norwood VA Medical Center, Augusta, GA, USA
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Bethel M, Yang FM, Li S, Nahman NS, Oliver AM, Machua W, Carbone LD. Hydroxychloroquine in patients with systemic lupus erythematosus with end-stage renal disease. J Investig Med 2016; 64:908-10. [PMID: 26911274 DOI: 10.1136/jim-2016-000065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine dosing patterns and examine predictors of filled hydroxychloroquine (HCQ) prescriptions in patients with systemic lupus erythematosus (SLE) with end-stage renal disease (ESRD). METHODS This was a retrospective cohort study of patients with SLE in the US Renal Data System (USRDS) database in fiscal year 2011. All patients were Medicare Part D beneficiaries. Patients with a diagnosis of SLE were identified by the International Classification of Diseases, 9th revision code 710. The prevalence, dosing, and predictors of filled HCQ prescriptions (demographic factors, dialysis type, and provider subspecialty) were determined. RESULTS There were 10,276 patients with SLE identified; 2048 (19.9%) had a prescription for HCQ filled. The mean daily dose of HCQ was 321 mg (range 58-2000 mg). The most common daily doses were 200 (n=768, 37.5%) and 400 mg (n=1161, 56.7%). In multivariable logistic regression analysis, significant predictors of filled HCQ prescriptions included black/African-American race (OR 1.34, 95% CI (1.17 to 1.46)), hemodialysis (1.50, 95% CI (1.29 to 1.74)), and care from a rheumatologist (5.06, 95% CI (4.56 to 5.62)). Negative predictors of filled HCQ prescriptions included male gender (OR 0.72, 95% CI (0.63 to 0.83)) and those aged 45 years or older (compared to 20 years old and younger, aged 45-64 years, OR 0.66, 95% CI (0.54 to 0.79); aged 65-74 years, OR 0.58, 95% CI (0.44 to 0.76); aged 75 years and older, OR 0.56, 95% CI (0.39 to 0.82)). CONCLUSIONS In patients with SLE with ESRD, the dosing strategies for HCQ with regard to potential toxicity and disparities in prescribing patterns need further study.
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Affiliation(s)
- Monique Bethel
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, Georgia, USA Department of Medicine, Augusta University, Augusta, Georgia, USA
| | - Frances M Yang
- Department of Epidemiology and Biostatistics, Augusta University, Augusta, Georgia, USA
| | - Shuang Li
- Department of Epidemiology and Biostatistics, Augusta University, Augusta, Georgia, USA
| | - N Stanley Nahman
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, Georgia, USA Department of Medicine, Augusta University, Augusta, Georgia, USA
| | - Alyce M Oliver
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, Georgia, USA Department of Medicine, Augusta University, Augusta, Georgia, USA
| | - Wambui Machua
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, Georgia, USA Department of Medicine, Augusta University, Augusta, Georgia, USA
| | - Laura D Carbone
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, Georgia, USA Department of Medicine, Augusta University, Augusta, Georgia, USA
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Carbone LD, Hovey KM, Andrews CA, Thomas F, Sorensen MD, Crandall CJ, Watts NB, Bethel M, Johnson KC. Urinary Tract Stones and Osteoporosis: Findings From the Women's Health Initiative. J Bone Miner Res 2015; 30:2096-102. [PMID: 25990099 PMCID: PMC5618440 DOI: 10.1002/jbmr.2553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 01/22/2015] [Revised: 05/07/2015] [Accepted: 05/10/2015] [Indexed: 12/13/2022]
Abstract
Kidney and bladder stones (urinary tract stones) and osteoporosis are prevalent, serious conditions for postmenopausal women. Men with kidney stones are at increased risk of osteoporosis; however, the relationship of urinary tract stones to osteoporosis in postmenopausal women has not been established. The purpose of this study was to determine whether urinary tract stones are an independent risk factor for changes in bone mineral density (BMD) and incident fractures in women in the Women's Health Initiative (WHI). Data were obtained from 150,689 women in the Observational Study and Clinical Trials of the WHI with information on urinary tract stones status: 9856 of these women reported urinary tract stones at baseline and/or incident urinary tract stones during follow-up. Cox regression models were used to determine the association of urinary tract stones with incident fractures and linear mixed models were used to investigate the relationship of urinary tract stones with changes in BMD that occurred during WHI. Follow-up was over an average of 8 years. Models were adjusted for demographic and clinical factors, medication use, and dietary histories. In unadjusted models there was a significant association of urinary tract stones with incident total fractures (HR 1.10; 95% CI, 1.04 to 1.17). However, in covariate adjusted analyses, urinary tract stones were not significantly related to changes in BMD at any skeletal site or to incident fractures. In conclusion, urinary tract stones in postmenopausal women are not an independent risk factor for osteoporosis.
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Affiliation(s)
- Laura D Carbone
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA.,Department of Medicine, Section of Rheumatology, Georgia Regents University, Augusta, GA, USA
| | - Kathleen M Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Christopher A Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mathew D Sorensen
- Division of Urology, VA Puget Sound Health Care System, Department of Veterans Affairs Medical Center, Seattle, WA, USA.,Department of Urology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Carolyn J Crandall
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA
| | - Monique Bethel
- Subspecialty Service, Department of Veterans Affairs Medical Center, Augusta, GA, USA.,Department of Medicine, Section of Rheumatology, Georgia Regents University, Augusta, GA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Bailey L, Weaver FM, Chin AS, Carbone LD. Estimation of a recurrent event gap time distribution: an application to morbidity outcomes following lower extremity fracture in Veterans with spinal cord injury. Health Serv Outcomes Res Method 2015. [DOI: 10.1007/s10742-014-0128-7] [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: 10/24/2022]
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Watsky MA, Carbone LD, An Q, Cheng C, Lovorn EA, Hudson MM, Pui CH, Kaste SC. Bone turnover in long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2014; 61:1451-6. [PMID: 24648266 PMCID: PMC4625912 DOI: 10.1002/pbc.25025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/16/2014] [Accepted: 02/12/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND We investigated the effects of demographic, lifestyle (self-reported smoking status and physical activity levels), cancer-related treatment factors (radiation and chemotherapy), and diet (calcium and vitamin D intake) on bone turnover and the relationship of bone turnover to lumbar spine bone mineral density (BMD) Z-scores (LS-BMD Z-scores) determined by quantitative computed tomography (QCT) in 418 ≥5-year survivors of childhood acute lymphoblastic leukemia (ALL). PROCEDURE Bone turnover was assessed by biomarkers including serum bone-specific alkaline phosphatase (BALP), osteocalcin (OC), and urinary N-telopeptide of type I collagen indexed to creatinine (NTX/Cr). The 215 males ranged in age from 9 to 36 years (median age 17 years). RESULTS Age and tanner score were inversely associated with all biomarkers (BALP, OC, NTX/Cr) (P < 0.001). Males had higher BALP and OC than females (P < 0.001). Body mass index (BMI) was inversely associated with OC and NTX/Cr (P < 0.001). There was no significant association of biomarkers with lifestyle related factors, ALL treatment-related factors, dietary calcium, vitamin D, or LS-BMD Z-score. CONCLUSIONS In this population of long-term survivors of ALL, bone turnover was significantly associated with age, gender, tanner stage, and BMI. ALL-related treatments did not influence bone turnover and bone turnover was not predictive of volumetric LS-BMD Z-score.
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Affiliation(s)
| | - Laura D. Carbone
- Department of Medicine, Georgia Regents University, Augusta, Ga, USA
| | - Qi An
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Elizabeth A. Lovorn
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M. Hudson
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sue C. Kaste
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Carbone LD, Chin AS, Burns SP, Svircev JN, Hoenig H, Heggeness M, Bailey L, Weaver F. Mortality after lower extremity fractures in men with spinal cord injury. J Bone Miner Res 2014; 29:432-9. [PMID: 23873733 DOI: 10.1002/jbmr.2050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 06/28/2013] [Accepted: 07/11/2013] [Indexed: 01/22/2023]
Abstract
In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. The risk of mortality after fractures in SCI is unknown. This was a population-based, cohort study of all male veterans (mean age 54.1; range, 20.3-100.5 years) with a traumatic SCI of at least 2 years' duration enrolled in the Veterans Affairs (VA) Spinal Cord Dysfunction Registry from FY2002 to FY2010 to determine the association between lower extremity fractures and mortality. Mortality for up to 5 years was determined. The lower extremity fracture rate was 2.14 per 100 patient-years at risk for at least one fracture. In unadjusted models and in models adjusted for demographic, SCI-related factors, healthcare use, and comorbidities, there was a significant association between incident lower extremity fracture and increased mortality (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17-1.63; HR, 1.36; 95% CI, 1.15-1.61, respectively). In complete SCI, the hazard of death after lower extremity fracture was also increased (unadjusted model: HR, 1.46; 95% CI, 1.13-1.89; adjusted model: HR, 1.32; 95% CI, 1.02-1.71). In fully-adjusted models, the association of incident lower extremity fracture with increased mortality was substantially greater in older men (age ≥50 years) for the entire cohort (HR, 3.42; 95% CI, 2.75-4.25) and for those with complete SCI (HR, 3.13; 95% CI, 2.19-4.45), compared to younger men (age <50 years) (entire cohort: HR, 1.42; 95% CI, 0.94-2.14; complete SCI: HR, 1.71; 95% CI, 0.98-3.01). Every additional point in the Charlson comorbidity index was associated with a 10% increase in the hazard of death in models involving the entire cohort (HR, 1.11; 95% CI, 1.09-1.13) and also in models limited to men with complete SCI (HR, 1.10; 95% CI, 1.06-1.15). These data support the concept that both the fracture itself and underlying comorbidities are drivers of death in men with SCI.
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Affiliation(s)
- Laura D Carbone
- Veterans Affairs Medical Center, Memphis, TN, USA; Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Carbone LD, Chin AS, Burns SP, Svircev JN, Hoenig H, Heggeness M, Weaver F. Morbidity following lower extremity fractures in men with spinal cord injury. Osteoporos Int 2013; 24:2261-7. [PMID: 23392311 DOI: 10.1007/s00198-013-2295-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 10/08/2012] [Accepted: 01/03/2013] [Indexed: 11/29/2022]
Abstract
UNLABELLED The Veterans Affairs Spinal Cord Dysfunction Registry from 2002 to 2007 was reviewed to determine whether men with spinal cord injury (SCI) and lower extremity fractures had an increased risk of complications compared to those without fractures. We determined that fractures are associated with significant consequences, particularly during the first month postfracture. INTRODUCTION Despite increasing longevity, patients with SCI have a substantial number of illnesses and comorbid conditions. Lower extremity fractures are frequent events in these patients. However, whether these fractures are associated with any increased risk of complications in SCI is not certain. The purpose of this report was to determine the impact of lower extremity fractures on morbidities in men with SCI. METHODS A population-based, nested, case-control (1,027 cases and 1,027 propensity-matched controls) of men enrolled in the Veterans Affairs Spinal Cord Dysfunction Registry from fiscal years 2002 to 2007 was reviewed to determine whether lower extremity fractures were associated with an increased risk for complications. RESULTS In propensity score models matched for demographic (age, race) and SCI-related injury factors (level/completeness of SCI), Veterans Affairs-service connection status, and comorbidities, at 1 month following the fracture, there was an increased risk for respiratory infections, pressure ulcers, urinary tract infections, thromboembolic events, depression, and delirium (p ≤ 0.03 for all). Over 12 months, the only complication more common in fracture cases was pressure ulcers (p < 0.01), with an absolute difference of less than 2 % when compared to controls. There was no significant increased risk of cardiac arrhythmias at any time examined following fracture (≥0.12). CONCLUSIONS Lower extremity fractures are associated with significant consequences in men with SCI during the first month postfracture, but they do not persist for a long term, except for pressure ulcers. Targeted interventions to prevent complications should be considered following lower extremity fractures in SCI, particularly in the first month following fracture.
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Affiliation(s)
- L D Carbone
- Veterans Affairs Medical Center, Memphis, TN 38163, USA.
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Chlebowski RT, Cirillo DJ, Eaton CB, Stefanick ML, Pettinger M, Carbone LD, Johnson KC, Simon MS, Woods NF, Wactawski-Wende J. Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial. Menopause 2013; 20:600-8. [PMID: 23511705 PMCID: PMC3855295 DOI: 10.1097/gme.0b013e31828392c4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although joint symptoms are commonly reported after menopause, observational studies examining exogenous estrogen's influence on joint symptoms provide mixed results. Against this background, estrogen-alone effects on joint symptoms were examined in post hoc analyses in the Women's Health Initiative randomized, placebo-controlled, clinical trial. METHODS A total of 10,739 postmenopausal women who have had a hysterectomy were randomized to receive daily oral conjugated equine estrogens (0.625 mg/d) or a matching placebo. The frequency and severity of joint pain and joint swelling were assessed by questionnaire in all participants at entry and on year 1, and in a 9.9% random subsample (n = 1,062) after years 3 and 6. Logistic regression models were used to compare the frequency and severity of symptoms by randomization group. Sensitivity analyses evaluated adherence influence on symptoms. RESULTS At baseline, joint pain and joint swelling were closely comparable in the randomization groups (about 77% with joint pain and 40% with joint swelling). After 1 year, joint pain frequency was significantly lower in the estrogen-alone group compared with the placebo group (76.3% vs 79.2%, P = 0.001), as was joint pain severity, and the difference in pain between randomization groups persisted through year 3. However, joint swelling frequency was higher in the estrogen-alone group (42.1% vs 39.7%, P = 0.02). Adherence-adjusted analyses strengthen estrogen's association with reduced joint pain but attenuate estrogen's association with increased joint swelling. CONCLUSIONS The current findings suggest that estrogen-alone use in postmenopausal women results in a modest but sustained reduction in the frequency of joint pain.
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Affiliation(s)
- Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
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Carbone LD, Chin AS, Lee TA, Burns SP, Svircev JN, Hoenig HM, Akhigbe T, Weaver FM. The association of opioid use with incident lower extremity fractures in spinal cord injury. J Spinal Cord Med 2013; 36:91-6. [PMID: 23809522 PMCID: PMC3595973 DOI: 10.1179/2045772312y.0000000060] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To determine the association between opioid use and lower extremity fracture risk in men with spinal cord injury (SCI). DESIGN Retrospective cohort study. SETTING Veterans Affairs Healthcare System. PARTICIPANTS In total, 7447 male Veterans with a history of a traumatic SCI identified from the Veterans Affairs (VA) Spinal Cord Dysfunction Registry (SCD) from September 2002 through October 2007 and followed through October 2010. OUTCOME MEASURES Incident lower extremity fractures by use of opioids. RESULTS In individuals identified from the VA SCD Registry 2002-2007, opioid use was quite common, with approximately 70% of the cohort having received a prescription for an opioid. Overall, there were 892 incident lower extremity fractures over the time period of this study (597 fractures in the opioid users and 295 fractures in the non-opioid users). After adjusting for covariates, there was a statistically significant relationship between opioid use and increased risk for lower extremity fractures (hazard ratio 1.82 (95% confidence interval 1.59-2.09)). Shorter duration of use (<6 months) and higher doses were positively related to fracture risk (P < 0.0001). CONCLUSIONS Opioid use is quite common in SCI and is associated with an increased risk for lower extremity fractures. Careful attention to fracture prevention is warranted in patients with SCI, particularly upon initiation of an opioid prescription and when higher doses are used.
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Affiliation(s)
- Laura D. Carbone
- Department of Research, Veterans Affairs Medical Center, Memphis, TN, USA; and Department of Medicine, Division of Connective Tissues Disorders, University of Tennessee Health Science Center, Memphis, TN, USA,Correspondence to: Laura Carbone, University of Tennessee Health Science Center, 956 Court Avenue, Rm G326, Memphis, TN 38163-0001, USA.
| | - Amy S. Chin
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA
| | - Todd A. Lee
- University of Illinois at Chicago, Chicago, IL, USA
| | - Stephen P. Burns
- VA Puget Sound Health Care System & Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jelena N. Svircev
- VA Puget Sound Health Care System & Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Titilola Akhigbe
- Department of Research, Veterans Affairs Medical Center, Memphis, TN, USA; and Department of Medicine, Division of Connective Tissues Disorders, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Frances M. Weaver
- Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr VA Hospital, Hines, IL, USA
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Carbone LD, Satterfield S, Liu C, Kwoh KC, Neogi T, Tolley E, Nevitt M. Assistive walking device use and knee osteoarthritis: results from the Health, Aging and Body Composition Study (Health ABC Study). Arch Phys Med Rehabil 2012; 94:332-9. [PMID: 23041146 DOI: 10.1016/j.apmr.2012.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 09/14/2012] [Accepted: 09/24/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify factors that predicted incident use of assistive walking devices (AWDs) and to explore whether AWD use was associated with changes in osteoarthritis of the knee. DESIGN Prospective cohort study. SETTING Community. PARTICIPANTS Older adults (N=2639) in the Health, Aging and Body Composition (Health ABC) Study including a subset of 874 patients with prevalent knee pain. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Incident use of AWDs, mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores, and the frequency of joint space narrowing on knee radiographs over a 3-year time period. RESULTS AWD use was initiated by 9% of the entire Health ABC cohort and 12% of the knee pain subset. Factors that predicted use in both groups were age ≥73 (entire cohort: odds ratio [OR]=2.07; 95% confidence interval [CI], 1.43-3.01; knee pain subset: OR=1.87; 95% CI, 1.16-3.03), black race (entire cohort: OR=2.95; 95% CI, 2.09-4.16; knee pain subset: OR=3.21; 95% CI, 2.01-5.11), and lower balance ratios (entire cohort: OR=3.18; 95% CI, 2.21-4.59; knee pain subset: OR=3.77; 95% CI, 2.34-6.07). Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users. Twenty percent of non-AWD users and 28% of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least 1 knee. Fourteen percent of non-AWD users and 12% of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least 1 knee. CONCLUSIONS AWDs are frequently used by older adults. Knee pain and balance problems are significant reasons why older adults initiate use of an AWD. In an exploratory analysis, there was no consistent relation between the use or nonuse of an AWD and WOMAC pain scores or knee joint space narrowing progression. Further studies of the relation of use of AWDs to changes in knee osteoarthritis are needed.
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Affiliation(s)
- Laura D Carbone
- Department of Veterans Affairs Medical Center, Memphis, TN, USA.
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Conroy MB, Kwoh CK, Krishnan E, Nevitt MC, Boudreau R, Carbone LD, Chen H, Harris TB, Newman AB, Goodpaster BH. Muscle strength, mass, and quality in older men and women with knee osteoarthritis. Arthritis Care Res (Hoboken) 2012; 64:15-21. [PMID: 22213722 DOI: 10.1002/acr.20588] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine the relationship between knee osteoarthritis (OA) and muscle parameters in a biracial cohort of older adults. METHODS Participants in the Health, Aging and Body Composition Study (n = 858) were included in this cross-sectional analysis. Computed tomography was used to measure muscle area, and quadriceps strength was measured isokinetically. Muscle quality (specific torque) was defined as strength per unit of muscle area for both the entire thigh and quadriceps. Knee OA was assessed based on radiographic features and knee pain. We compared muscle parameters between those with and without radiographic knee OA (+RKOA group and -RKOA group, respectively) and among 4 groups defined by +RKOA and -RKOA with and without pain. RESULTS The mean ± SD age was 73.5 ± 2.9 years and the mean ± SD body mass index (BMI) was 27.9 ± 4.8 kg/m(2) . Fifty-eight percent of participants were women and 44% were African American. Compared to the -RKOA participants, +RKOA participants had a higher BMI (30.2 versus 26.8 kg/m(2)), larger thigh muscles (117.9 versus 108.9 cm(2)), and a greater amount of intermuscular fat (12.5 versus 9.9 cm(2) ; all P < 0.0001). In adjusted models, the +RKOA participants had significantly lower specific torque (P < 0.001), indicating poorer muscle quality, than -RKOA participants, but there was no difference between groups in quadriceps specific torque. The +RKOA without pain (P < 0.05) and the +RKOA with pain (P < 0.001) participants had lower specific torque compared to the -RKOA without pain group. There were no significant differences in quadriceps specific torque among groups. CONCLUSION Muscle quality was significantly poorer in participants with RKOA regardless of pain status. Future studies should address how lifestyle interventions might affect muscle quality and progression of knee OA.
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Affiliation(s)
- Molly B Conroy
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Hayes BL, Curtis JR, Laster A, Saag K, Tanner SB, Liu C, Womack C, Johnson KC, Khaliq F, Carbone LD. Osteoporosis care in the United States after declines in reimbursements for DXA. J Clin Densitom 2010; 13:352-60. [PMID: 21029972 PMCID: PMC4420198 DOI: 10.1016/j.jocd.2010.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/28/2010] [Accepted: 08/04/2010] [Indexed: 11/29/2022]
Abstract
In January 2007, in the United States (US), Medicare initiated a series of cuts to reimbursement for dual-energy X-ray absorptiometry (DXA) services performed in the nonfacility setting that by January 2010 reduced payments for these services by more than 60% compared with 2006 levels. The objectives of this study were to determine if a temporal association exists between Medicare Physician Fee Schedule changes in office-based DXA reimbursement and attendance at educational conferences for osteoporosis, physicians' perceptions of changes in their medical practices, or national trends in retail prescription medications for osteoporosis in those aged 65 and older. Compared with the 2 yr before the decline in Medicare reimbursement for DXA (2005-2006), attendance at educational meetings for osteoporosis in the US declined in the 2 yr after these cuts (2007-2008) by 6%; declines in attendance were only present in meetings selective for bone densitometry. Survey participants reported changes in DXA services with approximately one-third indicating that they had either decreased the number of DXAs they performed or declined service contracts or hardware/software updates compared with 2005-2006. The number of retail prescriptions for Food and Drug Administration-approved osteoporosis drugs (excluding estrogen compounds and raloxifene) in the age 65 and older population increased by 5.5% in the time period 2007-2008 compared with 2005-2006. However, in the last year of the study (2008), total retail prescriptions for these drugs experienced for the first time over the interval of the study, a decline (1.4%) compared with the previous year. This occurred despite a 2.6% increase in the US population age 65 and older. In conclusion, there were temporal associations noted between Medicare cuts in DXA payments in attendance at educational conferences for bone densitometry, self-report of office-based provision of DXA services in the US, and retail prescriptions for osteoporosis therapies.
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Affiliation(s)
- Burton L. Hayes
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeffrey R. Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, AL, USA
| | - Andrew Laster
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, NC, USA
| | - Kenneth Saag
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, NC, USA
| | - S. Bobo Tanner
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Caiqin Liu
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Catherine Womack
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fazila Khaliq
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Laura D. Carbone
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Veterans Affairs Medical Center, Memphis, TN, USA
- Address correspondence to: Laura D. Carbone, MD, University of Tennessee Health Science Center, 956 Court Ave., Memphis, TN 38163.
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Yin Z, Carbone LD, Gotoh M, Postlethwaite A, Bolen AL, Tigyi GJ, Murakami-Murofushi K, Watsky MA. Lysophosphatidic acid-activated Cl- current activity in human systemic sclerosis skin fibroblasts. Rheumatology (Oxford) 2010; 49:2290-7. [PMID: 20823096 DOI: 10.1093/rheumatology/keq260] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES SSc (scleroderma) is an often fatal disease characterized by widespread tissue fibrosis. Fibroblasts play a key role in SSc-associated fibrosis. This study was designed to determine: (i) whether fibroblasts isolated from skin of patients with SSc have increased lysophosphatidic acid-activated Cl- current (IClLPA) activity vs healthy controls; (ii) whether myofibroblast differentiation is involved in SSc skin fibrosis; and (iii) whether SSc fibroblasts have different proliferation rates vs controls. METHODS Skin biopsies were taken from involved and uninvolved skin of SSc patients and controls. Whole-cell perforated patch-clamping was used to measure IClLPA activity in fibroblasts isolated and cultured from these biopsies. Western blotting was used to measure α-smooth muscle actin (α-SMA). Proliferation was measured using a colorimetric assay. RESULTS Fibroblasts cultured from SSc skin show significantly increased IClLPA activity following LPA exposure compared with control skin fibroblasts. α-SMA protein was significantly increased in cultured SSc skin fibroblasts vs controls. No significant differences in proliferation rates were found. CONCLUSIONS Elevated IClLPA activity is a hallmark of SSc skin fibroblasts. Blocking IClLPA activation may be a new therapeutic approach for treating SSc-associated fibrosis.
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Affiliation(s)
- Zhaohong Yin
- Department of Physiology, University of Tennessee Health Science Center, 894 Union Ave., Memphis, TN 38163, USA
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Tokumura A, Carbone LD, Yoshioka Y, Morishige J, Kikuchi M, Postlethwaite A, Watsky MA. Elevated serum levels of arachidonoyl-lysophosphatidic acid and sphingosine 1-phosphate in systemic sclerosis. Int J Med Sci 2009; 6:168-76. [PMID: 19521548 PMCID: PMC2695151 DOI: 10.7150/ijms.6.168] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 06/02/2009] [Indexed: 12/12/2022] Open
Abstract
Systemic sclerosis (SSc) is an often fatal disease characterized by autoimmunity and inflammation, leading to widespread vasculopathy and fibrosis. Lysophosphatidic acid (LPA), a bioactive phospholipid in serum, is generated from lysophospholipids secreted from activated platelets in part by the action of lysophospholipase D (lysoPLD). Sphingosine 1-phosphate (S1P), a member of the bioactive lysophospholipid family, is also released from activated platelets. Because activated platelets are a hallmark of SSc, we wanted to determine whether subjects with SSc have altered serum lysophospholipid levels or lysoPLD activity. Lysophospholipid levels were measured using mass spectrometric analysis. LysoPLD activity was determined by quantifying choline released from exogenous lysophosphatidylcholine (LPC). The major results were that serum levels of arachidonoyl (20:4)-LPA and S1P were significantly higher in SSc subjects versus controls. Furthermore, serum LPA:LPC ratios of two different polyunsaturated phospholipid molecular species, and also the ratio of all species combined, were significantly higher in SSc subjects versus controls. No significant differences were found between other lysophospholipid levels or lysoPLD activities. Elevated 20:4 LPA, S1P levels and polyunsaturated LPA:LPC ratios may be markers for and/or play a significant role in the etiology of SSc and may be future pharmacological targets for SSc treatment.
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Affiliation(s)
- Akira Tokumura
- Department of Health Chemistry, Institute of Health Bioscience, The University of Tokushima Graduate School, 1-78-1 Shomachi, Tokushima 770-8505, Japan
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Carbone LD, Johnson KC, Bush AJ, Robbins J, Larson JC, Thomas A, LaCroix AZ. Loop diuretic use and fracture in postmenopausal women: findings from the Women's Health Initiative. ACTA ACUST UNITED AC 2009; 169:132-40. [PMID: 19171809 DOI: 10.1001/archinternmed.2008.526] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The relationship of loop diuretics to bone mineral density (BMD), falls, and fractures in postmenopausal women has not been established. METHODS We examined whether loop diuretics are associated with changes in BMD, falls, and fractures in women enrolled in the Women's Health Initiative. We included the 133,855 women (3411 users and 130,444 nonusers of loop diuretics) who were enrolled in the WHI from October 29, 1993 to December 31, 1998 and determined incident falls and fractures for a mean of 7.7 years. Women who had BMD measurements at baseline and at year 3 (300 users and 9124 nonusers of loop diuretics) were also examined. RESULTS After adjustment for covariates, no significant association was found between ever use of loop diuretics and total (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.00-1.19), hip (HR, 1.21; 95% CI, 0.91-1.60), and clinical vertebral fractures (HR, 1.17; 95% CI, 0.92-1.48) and falls (1.02; 0.96-1.08). An increased risk was found for other clinical fractures (1.16; 1.01-133) and total fractures (1.16; 1.03-1.31) with more than 3 years' use of loop diuretics. The BMD changes were not associated with loop diuretic use. CONCLUSIONS After adjustment for confounding variables, no significant association was found between ever use of loop diuretics and changes in BMD, falls, and fractures. Loop diuretics were used by women in poor health who were already at risk for fractures. However, prolonged use of loop diuretics was associated with higher fracture risk in postmenopausal women.
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Affiliation(s)
- Laura D Carbone
- Department of Veterans Affairs Medical Center, Memphis, TN, USA.
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Carbone LD, Cross JD, Raza SH, Bush AJ, Sepanski RJ, Dhawan S, Khan BQ, Gupta M, Ahmad K, Khouzam RN, Dishmon DA, Nesheiwat JP, Hajjar MA, Chishti WA, Nasser W, Khan M, Womack CR, Cho T, Haskin AR, Weber KT. Fracture risk in men with congestive heart failure risk reduction with spironolactone. J Am Coll Cardiol 2008; 52:135-8. [PMID: 18598893 DOI: 10.1016/j.jacc.2008.03.039] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [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] [Received: 12/05/2007] [Revised: 02/15/2008] [Accepted: 03/04/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether spironolactone use is associated with fractures in men with congestive heart failure (CHF). BACKGROUND In rats with aldosteronism, spironolactone preserves skeletal strength. However, in humans, the relationship of spironolactone to fractures is not known. METHODS The medical records of all male patients with CHF from 1999 to 2005 treated at the Veterans Affairs Medical Center, Memphis, Tennessee, were reviewed (n = 4,735). Odds ratios with 95% confidence intervals of having a fracture associated with spironolactone use were estimated using conditional logistic regression. RESULTS We identified 167 cases with a single-incident fracture and matched these by age and race to 668 control subjects without fractures. After adjustment for covariates, spironolactone use was inversely associated with total fracture (odds ratio: 0.575; 95% confidence interval: 0.346 to 0.955, p = 0.0324). CONCLUSIONS The use of spironolactone is inversely associated with fractures in men with CHF.
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Affiliation(s)
- Laura D Carbone
- Department of Veterans Affairs Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
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Carbone LD, Rosenberg EW, Tolley EA, Holick MF, Hughes TA, Watsky MA, Barrow KD, Chen TC, Wilkin NK, Bhattacharya SK, Dowdy JC, Sayre RM, Weber KT. 25-Hydroxyvitamin D, cholesterol, and ultraviolet irradiation. Metabolism 2008; 57:741-8. [PMID: 18502255 DOI: 10.1016/j.metabol.2008.01.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 01/10/2008] [Indexed: 11/21/2022]
Abstract
Vitamin D deficiency may have implications for cardiovascular health. The purpose of this study was to determine the relationship of 25-hydroxyvitamin D (25[OH]D) to cholesterol and lipoprotein particles and to determine whether increasing 25(OH)D through ultraviolet (UV) irradiation impacted on these parameters in healthy young men and women. This was a randomized trial of 51 adults exposed to suberythemal doses of whole-body irradiation using UV lamps that emitted UV-A and UV-B radiation, compared with a control group, twice weekly for 12 weeks. 25-Hydroxyvitamin D, cholesterol, and lipoprotein subfractions were measured at baseline and after 12 weeks. There was a significant (P < .03) positive association between 25(OH)D and apolipoprotein A-I (Apo A-I) and lipoprotein A-I (Lp A-I). The ratio of low-density lipoprotein to high-density lipoprotein was significantly (P < or = .044) negatively correlated with 25(OH)D levels. The levels of 25(OH)D increased significantly in the treated compared with control group (P < .05). Overall, there were no significant differences between the treated and control groups in any lipoproteins or apolipoproteins after administration of UV irradiation. Subgroup analysis for Apo A-II confined to those with 25(OH)D insufficiency (25[OH]D <75 nmol/L [30 ng/mL]) revealed decreases in Apo A-II in the treated group and increases in the control group that were statistically significantly different between the groups (P = .026). We found a significant positive correlation between 25(OH)D and Apo A-I and Lp A-I and a significant negative correlation between 25(OH)D and the ratio of low-density lipoprotein to high-density lipoprotein. In those with vitamin D insufficiency, we found small decreases in Apo A-II in the treated relative to the control group. Overall, though, twice weekly exposure to UV radiation resulting in an increase in serum 25(OH)D had no significant impact on lipoprotein composition.
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Affiliation(s)
- Laura D Carbone
- Department of Veterans Affairs Medical Center, Memphis, TN 38104, USA.
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Tylavsky FA, Ryder KM, Li R, Park V, Womack C, Norwood J, Carbone LD, Cheng S. Preliminary findings: 25(OH)D levels and PTH are indicators of rapid bone accrual in pubertal children. J Am Coll Nutr 2007; 26:462-70. [PMID: 17914135 DOI: 10.1080/07315724.2007.10719637] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the role of serum levels of 25(OH)D and PTH on the accumulation of whole body bone mass in a cohort of children. METHODS This was a longitudinal study (1.98 +/- 0.07 y) of sixty-nine children (89% Caucasian, 44% male) enrolled in a calcium supplementation trial. Bone area, bone mineral content (BMC) and density (BMD) of the whole body and radius were assessed using a QDR 2000 (Hologic, Inc) dual energy x-ray absorptiometer. Serum PTH and 25(OH)D were measured using radioimmunoassays. RESULTS Vitamin D stores were inversely related gain in bone area (p < 0.002), BMC (p < 0.002) BMD (p < 0.027), as well as to PTH levels (p < 0.0001). Compared to those with adequate vitamin D stores (>34 ng/ml), those who had consistently low vitamin D stores (18 ng/ml) had a 8% larger gain in bone area (p < 0.05); 11% in BMC (p < 0.05) and no differences in gain in BMD; after adjusting for baseline bone measurements, race, gender, season measured, Tanner stage, and calcium intake. CONCLUSIONS High normal PTH with low-normal 25(OH)D stores and moderate to high calcium intake may be beneficial to accruing larger bone size and BMC during puberty.
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