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Manis DR, Katz P, Lane NE, Rochon PA, Sinha SK, Andel R, Heckman GA, Kirkwood D, Costa AP. Rates of Hospital-Based Care among Older Adults in the Community and Residential Care Facilities: A Repeated Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1341-1348. [PMID: 37549887 DOI: 10.1016/j.jamda.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE We examine annual rates of emergency department (ED) visits, hospital admissions, and alternate levels of care (ALC) days (ie, the number of days that an older adult remained in hospital when they could not be safely discharged to an appropriate setting in their community) among older adults. DESIGN Repeated cross-sectional study. SETTING AND PARTICIPANTS Linked, individual-level health system administrative data on community-dwelling persons, home care recipients, residents of assisted living facilities, and residents of nursing homes aged 65 years and older in Ontario, Canada, from January 1, 2013, to December 31, 2019. METHODS We calculated rates of ED visits, hospital admissions, and ALC days per 1000 individuals per older adult population per year. We used a generalized linear model with a gaussian distribution, log link, and year fixed effects to obtain rate ratios. RESULTS There were 1,655,656 older adults in the community, 237,574 home care recipients, 42,600 older adults in assisted living facilities, and 94,055 older adults in nursing homes in 2013; there were 2,129,690 older adults in the community, 281,028 home care recipients, 56,975 older adults in assisted living facilities, and 95,925 older adults in nursing homes in 2019. Residents of assisted living facilities had the highest rates of ED visits (1260.692019 vs 1174.912013), hospital admissions (482.632019 vs 480.192013), and ALC days (1905.572019 vs 1443.032013) per 1000 individuals. Residents of assisted living facilities also had significantly higher rates of ED visits [rate ratio (RR) 3.30, 95% CI 3.20, 3.41), hospital admissions (RR 6.24, 95% CI 6.01, 6.47), and ALC days (RR 25.68, 95% CI 23.27, 28.35) relative to community-dwelling older adults. CONCLUSIONS AND IMPLICATIONS The disproportionate use of ED visits, hospital admissions, and ALC days among residents of assisted living facilities may be attributed to the characteristics of the population and fragmented licensing and regulation of the sector, including variable models of care. The implementation of interdisciplinary, after-hours, team-based approaches to home and primary care in assisted living facilities may reduce the potentially avoidable use of ED visits, hospital admissions, and ALC days among this population and optimize resource allocation in health care systems.
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Affiliation(s)
- Derek R Manis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada.
| | - Paul Katz
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Natasha E Lane
- ICES, Toronto, ON, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paula A Rochon
- ICES, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada; Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; National Institute on Ageing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; ICES, Toronto, ON, Canada; Schlegel Research Institute for Aging, Waterloo, ON, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Manis DR, Katz P, Lane NE, Rochon PA, Sinha SK, Andel R, Heckman GA, Kirkwood D, Costa AP. Clinical Comorbidities and Transitions Between Care Settings Among Residents of Assisted Living Facilities: A Repeated Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1356-1360. [PMID: 37507099 DOI: 10.1016/j.jamda.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We investigate the changes in the sociodemographic characteristics, clinical comorbidities, and transitions between care settings among residents of assisted living facilities. DESIGN Repeated cross-sectional study. SETTING AND PARTICIPANTS Linked, individual-level health system administrative data on residents of assisted living facilities in Ontario, Canada, from January 1, 2013, to December 31, 2019. METHODS Counts and proportions were calculated to describe the sociodemographic characteristics and clinical comorbidities. Relative changes and trend tests were calculated to quantify the longitudinal changes in the characteristics of residents of assisted living facilities between 2013 and 2019. A Sankey plot was graphed to display transitions between different care settings (ie, hospital admission, nursing home admission, died, or remained in the assisted living facility) each year from 2013 to 2019. RESULTS There was a 34% relative increase in the resident population size of assisted living facilities (56,9752019 vs 42,6002013). These older adults had a mean age of 87 years, and women accounted for nearly two-thirds of the population across all years. The 5 clinical comorbidities that had the highest relative increases were renal disease (24.3%), other mental health conditions (16.8%), cardiac arrhythmias (9.6%), diabetes (8.5%), and cancer (6.9%). Nearly 20% of the original cohort from 2013 remained in an assisted living facility at the end of 2019, and approximately 10% of that cohort transitioned to a nursing home in any year from 2013 to 2019. CONCLUSIONS AND IMPLICATIONS Residents of assisted living facilities are an important older adult population that has progressively increased in clinical complexity within less than a decade. Clinicians and policy makers should advocate for the implementation of on-site medical care that is aligned with the needs of these older adults.
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Affiliation(s)
- Derek R Manis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Paul Katz
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Natasha E Lane
- ICES, Toronto, Ontario, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paula A Rochon
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada; Division of Geriatric Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine and Geriatrics, Sinai Health and University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; National Institute on Ageing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, Toronto, Ontario, Canada; Schlegel Research Institute for Aging, Waterloo, Ontario, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Hoben M, Li W, Dampf H, Hogan DB, Corbett K, Chamberlain SA, McGrail K, Griffith LE, Gruneir A, Lane NE, Baumbusch J, Maxwell C. Caregiver Involvement and Concerns with Care of Residents of Assisted Living before and during the COVID-19 Pandemic. Gerontology 2023; 69:839-851. [PMID: 37068467 DOI: 10.1159/000530622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/03/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care - especially during the COVID-19 pandemic and especially in assisted living (AL) homes, where resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, little research is available on caregiver involvement and concerns with care of AL residents prior to and during waves 1 and 2 of the COVID-19 pandemic. This study addressed this important knowledge gap. METHODS This prospective cohort study used baseline and follow-up online surveys with primary caregivers to AL residents in Western Canada who were 65 years or older and had lived in the AL home for at least 3 months before Mar 1, 2020. Surveys assessed the following outcomes in the 3 months prior to and during waves 1 and 2 of the pandemic: sociodemographics, 5 ways of visiting or communicating with residents, involvement in 16 care tasks, concerns with 9 resident physical/mental health conditions, perceived lack of resident access to 7 care services, and whether caregivers felt well informed and involved with resident care. RESULTS Based on 386 caregiver responses, in-person visits dropped significantly in wave 1 of the pandemic and so did caregiver involvement in nearly all care tasks. While these rates increased in wave 2, most did not return to pre-pandemic levels. Correspondingly, caregiver concerns (already high before the pandemic) substantially increased in wave 1 and stayed high in wave 2. These were particularly elevated among caregivers who did not feel well informed/involved with resident care. CONCLUSIONS Restricted in-person visiting disrupted resident care and was associated with worse perceptions of resident health and well-being. Continued caregiver involvement in resident care and communication with caregivers even during lockdowns is key to mitigating these issues.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wenshan Li
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Hana Dampf
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kim McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- ICES, Toronto, Ontario, Canada
| | - Natasha E Lane
- ICES, Toronto, Ontario, Canada
- Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Maxwell
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Hoben M, Baumbusch J, B. Hogan D, Gruneir A, A. Chamberlain S, Corbett K, E. Griffith L, McGrail KM, E. Amuah J, E. Lane N, J. Maxwell C. Caregivers' Concerns About Assisted Living Residents' Mental Health During the COVID-19 Pandemic: A Cross-Sectional Survey Study. J Fam Nurs 2023; 29:28-42. [PMID: 36124925 PMCID: PMC9490393 DOI: 10.1177/10748407221124159] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Family or friend caregivers' concerns about assisted living (AL) residents' mental health are reflective of poor resident and caregiver mental health. COVID-19-related visiting restrictions increased caregiver concerns, but research on these issues in AL is limited. Using web-based surveys with 673 caregivers of AL residents in Western Canada, we assessed the prevalence and correlates of moderate to severe caregiver concerns about residents' depressed mood, loneliness, and anxiety in the 3 months before and after the start of the COVID-19 pandemic. Caregiver concerns doubled after the start of the pandemic (resident depressed mood: 23%-50%, loneliness: 29%-62%, anxiety: 24%-47%). Generalized linear mixed models identified various modifiable risk factors for caregiver concerns (e.g., caregivers' perception that residents lacked access to counseling services or not feeling well informed about and involved in resident care). These modifiable factors can be targeted in efforts to prevent or mitigate caregiver concerns and resident mental health issues.
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Affiliation(s)
- Matthias Hoben
- York University, Toronto, Ontario, Canada
- University of Alberta, Edmonton, Canada
| | | | | | - Andrea Gruneir
- University of Alberta, Edmonton, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | | | | | | | - Natasha E. Lane
- The University of British Columbia, Vancouver, Canada
- ICES, Toronto, Ontario, Canada
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Maxwell CJ, Dayes L, Amuah JE, Hogan DB, Lane NE, McGrail KM, Gruneir A, Griffith LE, Chamberlain SA, Rutter EC, Corbett K, Hoben M. Coping Behaviors and Health Status during the COVID-19 Pandemic among Caregivers of Assisted Living Residents in Western Canada. J Am Med Dir Assoc 2022; 24:410-418.e9. [PMID: 36669529 PMCID: PMC9771753 DOI: 10.1016/j.jamda.2022.12.017] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To examine the prevalence of coping behaviors during the first 2 waves of the COVID-19 pandemic among caregivers of assisted living residents and variation in these behaviors by caregiver gender and mental health. DESIGN Cross-sectional and longitudinal survey. SETTING AND PARTICIPANTS Family/friend caregivers of assisted living residents in Alberta and British Columbia. METHODS A web-based survey, conducted twice (October 28, 2020 to March 31, 2021 and July 12, 2021 to September 7, 2021) on the same cohort obtained data on caregiver sociodemographic characteristics, anxiety and depressive symptoms, and coping behaviors [seeking counselling, starting a psychotropic drug (sedative, anxiolytic, antidepressant), starting or increasing alcohol, tobacco and/or cannabis consumption] during pandemic waves 1 and 2. Descriptive analyses and multivariable (modified) Poisson regression models identified caregiver correlates of each coping behavior. RESULTS Among the 673 caregivers surveyed at baseline, most were women (77%), White (90%) and age ≥55 years (81%). Alcohol (16.5%) and psychotropic drug (13.3%) use were the most prevalent coping behaviors reported during the initial wave, followed by smoking and/or cannabis use (8.0%), and counseling (7.4%). Among the longitudinal sample (n = 386), only alcohol use showed a significantly lower prevalence during the second wave (11.7% vs 15.1%, P = .02). During both waves, coping behaviors did not vary significantly by gender, however, psychotropic drug and substance use were significantly more prevalent among caregivers with baseline anxiety and depressive symptoms, including in models adjusted for confounders [eg, anxiety: adjusted risk ratio = 3.87 (95% CI 2.50-6.00] for psychotropic use, 1.87 (1.28-2.73) for alcohol use, 2.21 (1.26-3.88) for smoking/cannabis use). CONCLUSIONS AND IMPLICATIONS Assisted living caregivers experiencing anxiety or depressive symptoms during the pandemic were more likely to engage in drug and substance use, potentially maladaptive responses. Public health and assisted living home initiatives that identify caregiver mental health needs and provide targeted support during crises are required to mitigate declines in their health.
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Affiliation(s)
- Colleen J. Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada,ICES, Toronto, Ontario, Canada,Address correspondence to Colleen J. Maxwell PhD, School of Pharmacy, University of Waterloo, 200 University Ave West, Waterloo, Ontario, Canada, N2L 3G1
| | - Lauren Dayes
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Joseph E. Amuah
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David B. Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natasha E. Lane
- ICES, Toronto, Ontario, Canada,Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn M. McGrail
- Center for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada,Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie A. Chamberlain
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Emily C. Rutter
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada,School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
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Lane NE, Hoben M, Amuah JE, Hogan DB, Baumbusch J, Gruneir A, Chamberlain SA, Griffith LE, McGrail KM, Corbett K, Maxwell CJ. Prevalence and correlates of anxiety and depression in caregivers to assisted living residents during COVID-19: a cross-sectional study. BMC Geriatr 2022; 22:662. [PMID: 35962356 PMCID: PMC9372518 DOI: 10.1186/s12877-022-03294-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/12/2022] [Indexed: 12/30/2022] Open
Abstract
Background Family and friend caregivers play significant roles in advocating for and ensuring quality health and social care of residents in Assisted Living (AL) homes. However, little is known about how the COVID-19 pandemic and related visitor restrictions affected their health and mental well-being. We examined the prevalence and correlates of anxiety and depressive symptoms among caregivers of AL residents during the initial wave of COVID-19 in two Canadian provinces. Methods A cross-sectional web-based survey was conducted among family/friend caregivers of AL residents in Alberta and British Columbia (Oct 28, 2020—Mar 31, 2021) to collect data on their sociodemographic, health and caregiving characteristics, as well as concerns about residents’ health and social care before and during the first wave of the pandemic. A clinically significant anxiety disorder and depressive symptoms were assessed with the GAD-7 and CES-D10 instruments, respectively. Separate multivariable (modified) Poisson regression models identified caregiver correlates of each mental health condition. Results Among the 673 caregivers completing the survey (81% for Alberta residents), most were women (77%), white (90%) and aged ≥ 55 years (81%). Clinically significant anxiety and depression were present in 28.6% and 38.8% of caregivers respectively. Both personal stressors (comorbidity level, income reduction, low social support) and caregiving stressors exacerbated by the pandemic were independently associated with caregiver anxiety and depression. The latter included increased concern about the care recipients’ depression (adjusted risk ratio [adjRR] = 1.84, 95% confidence interval [CI] 1.19–2.85 for caregiver anxiety and adjRR = 1.75, 95% CI 1.26–2.44 for caregiver depressive symptoms) and reported intention to withdraw the resident from AL because of COVID-19 (adjRR = 1.24, 95%CI 0.95–1.63 for caregiver anxiety and adjRR = 1.37, 95%CI 1.13–1.67 for caregiver depressive symptoms). Conclusions Caregivers of residents in AL homes reported significant personal and caregiving-related stressors during the initial wave of COVID-19 that were independently associated with an increased likelihood of experiencing clinically significant anxiety and depressive symptoms. Healthcare providers and AL staff should be aware of the prevalence and varied correlates of caregivers’ mental health during public health crises so that appropriate screening and support may identified and implemented. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03294-y.
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Affiliation(s)
- Natasha E Lane
- ICES, Toronto, ON, Canada.,Department of Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Joseph E Amuah
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Gruneir
- ICES, Toronto, ON, Canada.,Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie A Chamberlain
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Colleen J Maxwell
- ICES, Toronto, ON, Canada. .,School of Pharmacy, University of Waterloo, ON, N2L 3G1, Waterloo, Canada. .,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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7
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Pinto D, Alshahrani M, Chapurlat R, Chevalley T, Dennison E, Camargos BM, Papaioannou A, Silverman S, Kaux JF, Lane NE, Morales Torres J, Paccou J, Rizzoli R, Bruyere O. The global approach to rehabilitation following an osteoporotic fragility fracture: A review of the rehabilitation working group of the International Osteoporosis Foundation (IOF) committee of scientific advisors. Osteoporos Int 2022; 33:527-540. [PMID: 35048200 DOI: 10.1007/s00198-021-06240-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 06/16/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To conduct a review of the current state of the evidence for rehabilitation strategies post-fragility fracture. METHODS Narrative review conducted by the Rehabilitation Working Group of the International Osteoporosis Foundation Committee of Scientific Advisors characterizing the range of rehabilitation modalities instrumental for the management of fragility fractures. RESULTS Multi-modal exercise post-fragility fracture to the spine and hip is strongly recommended to reduce pain, improve physical function, and improve quality of life. Outpatient physiotherapy post-hip fracture has a stronger evidence base than outpatient physiotherapy post-vertebral fracture. Appropriate nutritional care after fragility fracture provides a large range of improvement in morbidity and mortality. Education increases understanding of osteoporosis which in turn increases utilization of other rehabilitation services. Education may improve other health outcomes such as pain and increase a patient's ability for self-advocacy. CONCLUSION Rehabilitation interventions are inter-reliant, and research investigating the interaction of exercise, nutrition, and other multi-modal therapies may increase the relevance of rehabilitation research to clinical care.
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Affiliation(s)
- D Pinto
- Department of Physical Therapy, Marquette University, P.O. Box 1881, Wisconsin, 53201, Milwaukee, USA.
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, 4000, Liège, Belgium.
| | - M Alshahrani
- Department of Physical Therapy, Marquette University, P.O. Box 1881, Wisconsin, 53201, Milwaukee, USA
- Department of Medical Rehabilitation Science, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - T Chevalley
- Division of Bone Diseases, Department of Medicine, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - B M Camargos
- Densitometry Diagnostic Unit - Rede Materdei de Saúde, Belo Horizonte, Mina Gerais, Brazil
| | - A Papaioannou
- Department of Medicine, Division of Geriatrics, McMaster University, Hamilton, Canada
| | - S Silverman
- Cedars-Sinai Medical Center and University of California, Los Angeles, CA, USA
| | - J-F Kaux
- Department of Physical and Rehabilitation Medicine, University Hospital of Liège, University of Liège, Liège, Belgium
| | - N E Lane
- Department of Medicine and Rheumatology, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - J Morales Torres
- University of Guanajuato at León, Osteoporosis Unit, Hospital Aranda de La Parra, León, Mexico
| | - J Paccou
- Département Universitaire de Rhumatologie, Centre Hospitalier Et Universitaire, Hôpital Roger Salengro, Lille, France
| | - R Rizzoli
- Division of Bone Diseases, Department of Medicine, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - O Bruyere
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, 4000, Liège, Belgium
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Zeng C, Lane NE, Li X, Wei J, Lyu H, Shao M, Lei G, Zhang Y. Association between bariatric surgery with long-term analgesic prescription and all-cause mortality among patients with osteoarthritis: a general population-based cohort study. Osteoarthritis Cartilage 2021; 29:1412-1417. [PMID: 34293442 DOI: 10.1016/j.joca.2021.05.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES There is still a large unmet need for novel osteoarthritis (OA) treatments that could provide clinically important effects on long-term pain relief (≥12 months). We examined the relation of bariatric surgery along with weight loss to analgesic prescription and all-cause mortality among individuals with OA. METHODS We conducted a cohort study among individuals with OA using The Health Improvement Network. We compared the rate of no analgesic prescription ≥12 consecutive months and the risk of all-cause mortality using inverse probability weighting Cox-proportional hazard models and the difference in number of analgesic prescriptions (non-steroidal anti-inflammatory drugs, opioids, and paracetamol) in the 50th, 75th and 90th percentiles using quantile regression model between bariatric and non-bariatric cohorts. RESULTS Included were 588,494 individuals (694 had bariatric surgery). Compared with non-bariatric group, the rate of no analgesic prescription ≥12 consecutive months was higher (HR = 1.23, 95% CI: 1.08-1.38) in bariatric surgery group, and the number of analgesic prescriptions was lower in the 75th (44 vs 58) and 90th (74 vs 106) percentiles during a mean follow-up of 4.3 years. All-cause mortality in bariatric surgery group was lower than comparison group (HR = 0.46, 95% CI: 0.41-0.51). CONCLUSION This study presents the first evidence that bariatric surgery was associated with decreased long-term analgesic prescription and decreased all-cause mortality among individuals with OA. However, our findings may be overestimated owing to intractable confounding by indication for bariatric surgery; thus, future studies (e.g., clinical trials) are warranted.
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Affiliation(s)
- C Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
| | - N E Lane
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of California, Davis, CA, USA.
| | - X Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.
| | - J Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China.
| | - H Lyu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
| | - M Shao
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
| | - G Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Y Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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9
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Watt JA, Lane NE, Veroniki AA, Vyas MV, Williams C, Ramkissoon N, Thompson Y, Tricco AC, Straus SE, Goodarzi Z. Diagnostic accuracy of virtual cognitive assessment and testing: Systematic review and meta-analysis. J Am Geriatr Soc 2021; 69:1429-1440. [PMID: 33948937 DOI: 10.1111/jgs.17190] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND/OBJECTIVES Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID-19 pandemic. Our objectives were to compare the diagnostic accuracy of virtual to in-person cognitive assessments and tests and barriers to virtual cognitive assessment implementation. DESIGN Systematic review and meta-analysis. SETTING MEDLINE, EMBASE, CDSR, CENTRAL, PsycINFO, and gray literature (inception to April 1, 2020). PARTICIPANTS AND INTERVENTIONS Studies describing the accuracy or reliability of virtual compared with in-person cognitive assessments (i.e., reference standard) for diagnosing dementia or mild cognitive impairment (MCI), identifying virtual cognitive test cutoffs suggestive of dementia or MCI, or describing correlations between virtual and in-person cognitive test scores in adults. MEASUREMENTS Reviewer pairs independently conducted study screening, data abstraction, and risk of bias appraisal. RESULTS Our systematic review included 121 studies (15,832 patients). Two studies demonstrated that virtual cognitive assessments could diagnose dementia with good reliability compared with in-person cognitive assessments: weighted kappa 0.51 (95% confidence interval [CI] 0.41-0.62) and 0.63 (95% CI 0.4-0.9), respectively. Videoconference-based cognitive assessments were 100% sensitive and specific for diagnosing dementia compared with in-person cognitive assessments in a third study. No studies compared telephone with in-person cognitive assessment accuracy. The Telephone Interview for Cognitive Status (TICS; maximum score 41) and modified TICS (maximum score 50) were the only virtual cognitive tests compared with in-person cognitive assessments in >2 studies with extractable data for meta-analysis. The optimal TICS cutoff suggestive of dementia ranged from 22 to 33, but it was 28 or 30 when testing was conducted in English (10 studies; 1673 patients). Optimal modified TICS cutoffs suggestive of MCI ranged from 28 to 31 (3 studies; 525 patients). Sensory impairment was the most often voiced condition affecting assessment. CONCLUSION Although there is substantial evidence supporting virtual cognitive assessment and testing, we identified critical gaps in diagnostic certainty.
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Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, G1 06, Toronto, Ontario, Canada
| | - Natasha E Lane
- ICES, G1 06, Toronto, Ontario, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.,Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Manav V Vyas
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chantal Williams
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Naveeta Ramkissoon
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Yuan Thompson
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
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10
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van Buuren MMA, Arden NK, Bierma-Zeinstra SMA, Bramer WM, Casartelli NC, Felson DT, Jones G, Lane NE, Lindner C, Maffiuletti NA, van Meurs JBJ, Nelson AE, Nevitt MC, Valenzuela PL, Verhaar JAN, Weinans H, Agricola R. Statistical shape modeling of the hip and the association with hip osteoarthritis: a systematic review. Osteoarthritis Cartilage 2021; 29:607-618. [PMID: 33338641 DOI: 10.1016/j.joca.2020.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 07/15/2020] [Revised: 10/30/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. DESIGN We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. RESULTS Nine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion). CONCLUSIONS Various radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.
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Affiliation(s)
- M M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - N K Arden
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; NIHR Musculoskeletal Biomedical Research Unit, Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, University of Oxford, Oxford, UK
| | - S M A Bierma-Zeinstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice and Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland; Laboratory of Exercise and Health, ETH Zürich, Schwerzenbach, Switzerland
| | - D T Felson
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - N E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - C Lindner
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - N A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A E Nelson
- Thurston Arthritis Research Center and Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - P L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - J A N Verhaar
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - R Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Yazici Y, McAlindon TE, Gibofsky A, Lane NE, Lattermann C, Skrepnik N, Swearingen CJ, Simsek I, Ghandehari H, DiFrancesco A, Gibbs J, Tambiah JRS, Hochberg MC. A Phase 2b randomized trial of lorecivivint, a novel intra-articular CLK2/DYRK1A inhibitor and Wnt pathway modulator for knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:654-666. [PMID: 33588087 DOI: 10.1016/j.joca.2021.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 07/20/2020] [Revised: 01/13/2021] [Accepted: 02/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lorecivivint (LOR; SM04690), an investigational Wnt pathway modulator, previously demonstrated patient-reported and radiographic outcome improvements vs placebo in clinically relevant subjects with moderate to severe knee osteoarthritis (OA). This study's objective was to identify effective LOR doses. DESIGN Subjects in this 24-week, Phase 2b, multicenter, randomized, double-blind, placebo (PBO)-controlled trial received an intra-articular injection of 2 mL LOR (0.03, 0.07, 0.15, or 0.23 mg), PBO, or dry-needle sham. The primary efficacy endpoints were changes in Pain NRS [0-10], WOMAC Pain [0-100], WOMAC Function [0-100], and radiographic mJSW outcomes, which were measured using baseline-adjusted analysis of covariance at Week 24. Multiple Comparison Procedure-Modeling (MCP-Mod) was performed for dose modeling. RESULTS In total, 695/700 subjects were treated. Pain NRS showed significant improvements vs PBO after treatment with 0.07 mg and 0.23 mg LOR at Weeks 12 (-0.96, 95% CI [-1.54, -0.37], P = 0.001; -0.78 [-1.39, -0.17], P = 0.012) and 24 (-0.70 [-1.34, -0.06], P = 0.031; -0.82 [-1.51, -0.12], P = 0.022). Additionally, 0.07 mg LOR significantly improved WOMAC Pain and Function subscores vs PBO at Week 12 (P = 0.04, P = 0.021), and 0.23 mg LOR significantly improved both WOMAC subscores at Week 24 (P = 0.031, P = 0.017). No significant differences from PBO were observed for other doses. No radiographic progression was observed in any group at Week 24. MCP-Mod identified 0.07 mg LOR as the lowest effective dose. CONCLUSION This 24-week Phase 2b trial demonstrated the efficacy of LOR on PROs in knee OA subjects. The optimal dose for future studies was identified as 0.07 mg LOR.
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Affiliation(s)
- Y Yazici
- Samumed, LLC, San Diego, CA, USA; New York University School of Medicine, New York, NY, USA.
| | | | - A Gibofsky
- Weill Cornell Medical College, New York, NY, USA
| | - N E Lane
- University of California Davis Medical School, Burlingame, CA, USA
| | | | - N Skrepnik
- Tucson Orthopaedic Institute, Tucson, AZ, USA
| | | | - I Simsek
- Samumed, LLC, San Diego, CA, USA
| | | | | | - J Gibbs
- Samumed, LLC, San Diego, CA, USA
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12
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Lane NE, Saag K, O'Neill TJ, Manion M, Shah R, Klause U, Eastell R. Real-world bone turnover marker use: impact on treatment decisions and fracture. Osteoporos Int 2021; 32:831-840. [PMID: 33236195 PMCID: PMC8043891 DOI: 10.1007/s00198-020-05734-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022]
Abstract
UNLABELLED The use of bone turnover marker (BTM) testing for patients with osteoporosis in the USA has not been well characterized. This retrospective US-based real-world data study found BTM testing has some association with treatment decision-making and lower fracture risk in patients with presumed osteoporosis, supporting its use in clinical practice. INTRODUCTION The purpose of this study was to characterize bone turnover marker (BTM) testing patterns and estimate their clinical utility in treatment decision-making and fragility fracture risk in patients with osteoporosis using a retrospective claims database. METHODS Data from patients aged ≥ 50 years with newly diagnosed osteoporosis enrolled in the Truven MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Co-ordination of Benefits databases from January 2008 to June 2018 were included. Osteoporosis was ascertained by explicit claims, fragility fracture events associated with osteoporosis, or prescribed anti-resorptive or anabolic therapy. BTM-tested patients were 1:1 propensity score matched to those untested following diagnosis. Generalized estimating equation models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for testing versus no testing on both treatment decision-making and fragility fracture. RESULTS Of the 457,829 patients with osteoporosis, 6075 were identified with ≥ 1 BTM test following diagnosis; of these patients, 1345 had a unique treatment decision made ≤ 30 days from BTM testing. The percentage of patients receiving BTM tests increased significantly each year (average annual % change: + 8.1%; 95% CI: 5.6-9.0; p = 0.01). Patients tested were significantly more likely to have a treatment decision (OR: 1.14; 95% CI: 1.13-1.15), and testing was associated with lower odds of fracture versus those untested (OR: 0.87; 95% CI: 0.85-0.88). CONCLUSION In this large, heterogeneous population of patients with presumed osteoporosis, BTM testing was associated with treatment decision-making, likely leading to fragility fracture reduction following use.
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Affiliation(s)
- N E Lane
- Department of Internal Medicine, UC Davis Health, Sacramento, CA, USA.
| | - K Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - T J O'Neill
- Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
| | - M Manion
- Roche Diagnostics, Indianapolis, IN, USA
| | - R Shah
- Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
| | - U Klause
- Roche Diabetes Care, Roche Diagnostics, Indianapolis, IN, USA
| | - R Eastell
- Metabolic Bone Centre, Northern General Hospital, Sheffield, UK
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13
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Lane NE, Ling V, Glazier RH, Stukel TA. Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study. BMC Fam Pract 2021; 22:51. [PMID: 33750310 PMCID: PMC7945328 DOI: 10.1186/s12875-021-01398-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022]
Abstract
Background Some jurisdictions restrict primary care physicians’ daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. Methods Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians’ daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. Results People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. Conclusions People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01398-9.
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Affiliation(s)
- Natasha E Lane
- Department of Medicine, University of British Columbia, British Columbia, 2775 Laurel Street, 10th Floor , Vancouver, V5Z 1M9, Canada. .,ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
| | - Vicki Ling
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Richard H Glazier
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Thérèse A Stukel
- ICES, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine At Dartmouth, 74 College Street, Hanover, NH, 03755, USA
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14
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Swanson CM, Blatchford PJ, Stone KL, Cauley JA, Lane NE, Rogers-Soeder TS, Redline S, Bauer DC, Wright KP, Wierman ME, Kohrt WM, Orwoll ES. Sleep duration and bone health measures in older men. Osteoporos Int 2021; 32:515-527. [PMID: 32930851 PMCID: PMC7933119 DOI: 10.1007/s00198-020-05619-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023]
Abstract
UNLABELLED The associations between objective measures of sleep duration and bone outcomes in older men are unknown. No consistent, significant association was identified between sleep duration and bone mineral density (BMD) in the current analysis. However, future research should determine if vitamin D status modifies this relationship. INTRODUCTION Prior studies, predominantly in women, reported that long and short self-reported sleep duration are associated with lower BMD. Associations between actigraphy-determined sleep duration and BMD or bone turnover markers (BTMs) in older men are unknown. METHODS Men in The Osteoporotic Fractures in Men (MrOS) Study with wrist actigraphy and concurrent BMD assessment but without comorbidities affecting bone health were included. Sleep duration was considered as a continuous (N = 1926) and dichotomized variable where men were classified as getting the recommended (7-8 h/night; N = 478) or short (< 6 h/night; N = 577) sleep. The cross-sectional association between BMD, BTMs, and sleep duration was examined using a t test or linear regression, where appropriate, in unadjusted and adjusted models. RESULTS There were no clinically or statistically significant differences in BMD at the L-spine, total hip, or femoral neck between men getting the recommended vs. short sleep duration, using actigraphy or self-reported sleep duration (all p ≥ 0.07). When sleep duration was considered as a continuous variable, femoral neck BMD was higher in men with longer self-reported sleep duration (β = 0.006 ±0.003, p = 0.02), but this was not significant after further adjustment. In men with low 25OHD (< 20 ng/mL), longer actigraphy-determined sleep duration was associated with higher total hip BMD (β = 0.016 ± 0.008; p = 0.04). Sleep duration and BTMs were not associated. CONCLUSION Sleep duration was not associated with hip or L-spine BMD or BTMs in older men. Future research should determine if vitamin D status or other factors modify this relationship.
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Affiliation(s)
- C M Swanson
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA.
| | - P J Blatchford
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - K L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- San Francisco Coordinating Center, University of California San Francisco, San Francisco, CA, USA
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - N E Lane
- Center for Musculoskeletal Health, University of California, Davis Health, Davis, CA, USA
| | | | - S Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - D C Bauer
- San Francisco Coordinating Center, University of California San Francisco, San Francisco, CA, USA
- University of California San Francisco Medical Center, San Francisco, CO, USA
| | - K P Wright
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - M E Wierman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - W M Kohrt
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado VA Geriatric, Research, Education, and Clinical Center (GRECC), Aurora, CO, USA
| | - E S Orwoll
- Division of Endocrinology and Bone & Mineral Unit, Oregon Health & Science University, Portland, OR, USA
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15
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Lane NE, Saag K, O'Neill TJ, Manion M, Shah R, Klause U, Eastell R. Correction to: Real-world bone turnover marker use: impact on treatment decisions and fracture. Osteoporos Int 2021; 32:609. [PMID: 33464393 PMCID: PMC7929952 DOI: 10.1007/s00198-021-05828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N E Lane
- Department of Internal Medicine, UC Davis Health, Sacramento, CA, USA.
| | - K Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - T J O'Neill
- Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
| | - M Manion
- Roche Diagnostics, Indianapolis, IN, USA
| | - R Shah
- Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
| | - U Klause
- Roche Diabetes Care, Roche Diagnostics, Indianapolis, IN, USA
| | - R Eastell
- Metabolic Bone Centre, Northern General Hospital, Sheffield, UK
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16
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Faber BG, Bredbenner TL, Baird D, Gregory J, Saunders F, Giuraniuc CV, Aspden RM, Lane NE, Orwoll E, Tobias JH. Subregional statistical shape modelling identifies lesser trochanter size as a possible risk factor for radiographic hip osteoarthritis, a cross-sectional analysis from the Osteoporotic Fractures in Men Study. Osteoarthritis Cartilage 2020; 28:1071-1078. [PMID: 32387760 PMCID: PMC7387228 DOI: 10.1016/j.joca.2020.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/17/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Statistical shape modelling (SSM) of hip dual-energy X-ray absorptiometry (DXA) scans has identified relationships between hip shape and radiographic hip OA (rHOA). We aimed to further elucidate shape characteristics related to rHOA by focusing on subregions identified from whole-hip shape models. METHOD SSM was applied to hip DXAs obtained in the Osteoporotic Fractures in Men Study. Whole-hip shape modes (HSMs) associated with rHOA were combined to form a composite at-risk-shape. Subsequently, subregional HSMs (cam-type and lesser trochanter modes) were built, and associations with rHOA were examined by logistic regression. Subregional HSMs were further characterised, by examining associations with 3D-HSMs derived from concurrent hip CT scans. RESULTS 4,098 participants were identified with hip DXAs and radiographs. Composite shapes from whole-hip HSMs revealed that lesser trochanter size and cam-type femoral head are related to rHOA. From sub-regional models, lesser trochanter mode (LTM)1 [OR 0.74; 95%CI 0.63.0.87] and cam-type mode (CTM)3 [OR 1.27; 1.13.1.42] were associated with rHOA, associations being similar to those for whole hip HSMs. 515 MrOS participants had hip DXAs and 3D-HSMs derived from hip CT scans. LTM1 was associated with 3D-HSMs that also represented a larger lesser trochanter [3D-HSM7 (beta (β)-0.23;-0.33,-0.14) and 3D-HSM9 (β0.36; 0.27.0.45)], and CTM3 with 3D-HSMs describing cam morphology [3D-HSM3 (β-0.16;-0.25,-0.07) and 3D-HSM6 (β 0.19; 0.10.0.28)]. CONCLUSION Subregional SSM of hip DXA scans suggested larger lesser trochanter and cam morphology underlie associations between overall hip shape and rHOA. 3D hip modelling suggests our subregional SSMs represent true anatomical variations in hip shape, warranting further investigation.
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Affiliation(s)
- B G Faber
- Medical Research Council Clinical Research Fellow, Musculoskeletal Research Unit, University of Bristol, Bristol, UK.
| | - T L Bredbenner
- Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado, USA
| | - D Baird
- Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - J Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - F Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - C V Giuraniuc
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - N E Lane
- Center for Musculoskeletal Health, U.C. Davis School of Medicine, Sacramento, CA 95817, USA
| | - E Orwoll
- Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR, USA
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
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Lane NE, Stukel TA, Boyd CM, Wodchis WP. Long-Term Care Residents' Geriatric Syndromes at Admission and Disablement Over Time: An Observational Cohort Study. J Gerontol A Biol Sci Med Sci 2020; 74:917-923. [PMID: 29955879 PMCID: PMC6521919 DOI: 10.1093/gerona/gly151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Indexed: 01/29/2023] Open
Abstract
Background Disablement occurs when people lose their ability to perform activities of daily living (ADLs) like bathing and dressing, and is measured as the rate of increasing disability over time. We examined whether balance impairment, cognitive impairment, or pain among residents at admission to long-term care homes were predictive of their rate of disablement over the subsequent 2 years. Methods Linked administrative databases were used to conduct a longitudinal cohort study of 12,334 residents admitted to 633 long-term care (LTC) homes between April 1, 2011 and March 31, 2012, in Ontario, Canada. Residents received an admission assessment of disability upon admission to LTC using the RAI-MDS 2.0 ADL long-form score (ADL LFS, range 0–28) and at least two subsequent disability assessments. Multivariable regression models estimated the adjusted association between balance impairment, cognitive impairment, and pain present at admission and residents’ subsequent disablement over 2 years. Results This population sample of newly admitted Ontario long-term care residents had a median disability score of 13 (interquartile range [IQR] = 7, 19) at admission. Greater balance impairment and cognitive impairment at admission were significantly associated with faster resident disablement over 2 years in adjusted models, while daily pain was not. Conclusions Balance impairment and cognitive impairment among newly admitted long-term care home residents are associated with increased rate of disablement over the following 2 years. Further research should examine the mechanisms driving this association and identify whether they are amenable to intervention.
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Affiliation(s)
- Natasha E Lane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Thérèse A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Cynthia M Boyd
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario
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Langsetmo L, Harrison S, Jonnalagadda S, Pereira SL, Shikany JM, Farsijani S, Lane NE, Cauley JA, Stone K, Cawthon PM. Low Protein Intake Irrespective of Source is Associated with Higher Mortality Among Older Community-dwelling Men. J Nutr Health Aging 2020; 24:900-905. [PMID: 33009543 PMCID: PMC7734969 DOI: 10.1007/s12603-020-1422-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Our aim was to determine the association between protein intake (overall and by source) and all-cause and cause-specific mortality among older men. DESIGN Prospective cohort study. SETTING 5790 ambulatory community-dwelling older men from multicenter Osteoporotic Fractures in Men (MrOS) study. MEASUREMENTS Total energy and protein intake, and protein intake by source (dairy, non-dairy animal, plant) were assessed using a 69-item food frequency questionnaire. We included up to 10-year follow-up with adjudicated cardiovascular, cancer and other mortality outcomes. We used time-to-event analysis with protein exposures, mortality outcome, and adjusted for possible confounders including age, center, education, race, smoking, alcohol use, physical activity, weight, total energy intake (TEI), and comorbidities. Hazard ratios were expressed per each unit=2.9% TEI decrement for all protein intake variables. RESULTS The mean (SD) baseline age of 5790 men was 73.6 (5.8) y. There were 1611 deaths and 211 drop-outs prior to 10 years, and 3868 men who were alive at the 10-year follow-up. The mean (SD) total protein intake was 64.7 (25.8) g/d, while the mean (SD) intake expressed as percent of total energy intake (%TEI) was 16.1 (2.9) %TEI. Lower protein intake was associated with an increased risk of death, with unadjusted HR=1.11 (95% CI: 1.06, 1.17) and adjusted HR=1.09 (95% CI: 1.04, 1.14) and the associations for protein intake by source were similar. The adjusted HR for cancer mortality was HR=1.13 (95% CI: 1.03, 1.25) while the association for CVD mortality was HR=1.08 (95% CI: 0.99, 1.18). CONCLUSIONS Low protein intake, irrespective of source, was associated with a modest increase in risk of all-cause and cause-specific mortality among older men. Special consideration should be given to level of protein intake among older adults.
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Affiliation(s)
- L Langsetmo
- Lisa Langsetmo, Ph.D., Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, USA, 55454. E-mail:
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Watt FE, Blauwet MB, Fakhoury A, Jacobs H, Smulders R, Lane NE. Tropomyosin-related kinase A (TrkA) inhibition for the treatment of painful knee osteoarthritis: results from a randomized controlled phase 2a trial. Osteoarthritis Cartilage 2019; 27:1590-1598. [PMID: 31356878 DOI: 10.1016/j.joca.2019.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/23/2019] [Revised: 05/05/2019] [Accepted: 05/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the TrkA inhibitor, ASP7962, for treatment of painful knee osteoarthritis. DESIGN Phase 2a, double-blind, placebo- and naproxen-controlled, double-dummy, parallel-group study. Adults with knee osteoarthritis were randomized (2:2:1) to ASP7962 (100 mg), placebo, or naproxen (500 mg) twice daily (BID) for 4 weeks. Primary endpoint: change from baseline to Week 4 in Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale score. Secondary endpoints: change from baseline to Weeks 1, 2, and End of Treatment (EoT) in WOMAC pain subscale score; change from baseline to Weeks 1, 2, 4, and EoT in WOMAC physical function and stiffness subscales, walking pain and WOMAC total scores; and change from baseline in daily average pain score. RESULTS 215 participants were randomized (ASP7962 100 mg BID, n = 85; placebo, n = 87; naproxen 500 mg BID, n = 43). No significant difference was observed between ASP7962 and placebo in change from baseline to Week 4 in WOMAC pain subscale score (-0.14; 90% 2-sided CI: -0.62, 0.34; P = 0.316); a significant difference was observed between naproxen and placebo (-0.67; 80% 2-sided CI: -1.12, -0.23; P = 0.027). No differences were observed between ASP7962 and placebo in change from baseline in any WOMAC subscale score; statistically significant changes were observed between naproxen and placebo (P ≤ 0.01, all time points for all WOMAC endpoints). ASP7962 was safe and well-tolerated. CONCLUSIONS Four-week treatment with ASP7962 (100 mg BID) did not improve pain or physical function in individuals with painful knee osteoarthritis. ClinicalTrials.gov, NCT02611466; EudraCT Number, 2014-004996-22.
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Affiliation(s)
- F E Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive Headington, Oxford, UK.
| | - M B Blauwet
- Astellas Pharma Global Development, Northbrook, IL, USA.
| | - A Fakhoury
- Astellas Pharma Global Development, Northbrook, IL, USA.
| | - H Jacobs
- Formerly with Astellas Pharma Global Development, Leiden, the Netherlands.
| | - R Smulders
- Astellas Pharma Global Development, Northbrook, IL, USA.
| | - N E Lane
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA, USA.
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Zeng C, Lane NE, Hunter DJ, Wei J, Choi HK, McAlindon TE, Li H, Lu N, Lei G, Zhang Y. Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2019; 27:855-862. [PMID: 30703543 DOI: 10.1016/j.joca.2019.01.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [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] [Received: 10/04/2018] [Revised: 01/06/2019] [Accepted: 01/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A recent randomized clinical trial reported that repeated intra-articular corticosteroids (IACs) were associated with a greater cartilage loss. This study aimed to examine the relation of IACs to knee radiographic osteoarthritis (ROA) progression in a real-world setting. DESIGN A cohort that initiated IACs and a comparison cohort without IACs from participants with mild to moderate knee ROA in the Osteoarthritis Initiative (OAI) were assembled (from 0-month to 48-month). Two measures of knee ROA progression were assessed during the follow-up period: (1) an increase in Kellgren and Lawrence (KL) grade by ≥1 grade or having a knee replacement (i.e., KL grade worsening); and (2) a decrease in joint space width (JSW) by ≥0.7 mm or having a knee replacement (i.e., JSW worsening). The associations of IACs initiation using a propensity-score matched cohort study and continuous IACs using marginal structural models with the risk of knee ROA progression were examined. RESULTS Among 684 propensity-score matched participants at baseline (148 IACs initiators, 536 comparators), 65 knees (21.7/100 person-years) in the IACs initiation cohort and 90 knees (7.1/100 person-years) in the comparison cohort experienced KL worsening. The hazard ratios (HRs) of KL worsening from IACs initiation and continuous IACs were 3.02 (95% confidence interval [CI], 2.19-4.16) and 4.67 (95% CI, 2.92-7.47), respectively. The corresponding HRs of JSW worsening were 2.93 (95% CI, 2.13-4.02) and 3.26 (95% CI, 1.78-5.96), respectively. All HRs for continuous use of IACs were further away from the null. CONCLUSIONS IACs, especially continuous IACs, may be associated with an increased risk of knee ROA progression.
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Affiliation(s)
- C Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - N E Lane
- Center for Musculoskeletal Health and Department of Medicine, University of California School of Medicine, Sacramento, CA, USA.
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia.
| | - J Wei
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - H K Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - T E McAlindon
- Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
| | - H Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - N Lu
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - G Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Y Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Lane NE, Nyman JS, Uppuganti S, Chaudhari AJ, Aguirre JI, Shidara K, Liu XP, Yao W, Kimmel DB. Inhibition of vascular endothelial growth factor in young adult mice causes low bone blood flow and bone strength with no effect on bone mass in trabecular regions. Bone Rep 2019; 10:100210. [PMID: 31193542 PMCID: PMC6535464 DOI: 10.1016/j.bonr.2019.100210] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To determine the effect of an antibody to vascular endothelial growth factor (VEGF) on bone blood flow, bone strength, and bone mass in the young adult mouse. Methods Ten-week-old male BALB/cJ mice were body weight-randomized into either a rodent anti-VEGF monoclonal antibody (anti-VEGF, B20-4.1.1; 5 mg/kg 2×/wk.; n = 12) group or a vehicle (VEH; n = 12) group. After 42 days, mice were evaluated for bone blood flow at the distal femur by 18F-NaF-PET/CT and then necropsied. Samples from trabecular and cortical bone regions were evaluated for bone strength by mechanical testing, bone mass by peripheral quantitative computed tomography (pQCT), and micoarchitecture (MicroCT). Hydration of the whole femur was studied by proton nuclear magnetic resonance relaxometry (1H NMR). Results Distal femur blood flow was 43% lower in anti-VEGF mice than in VEH mice (p = 0.009). Ultimate load in the lumbar vertebral body was 25% lower in anti-VEGF than in VEH mice (p = 0.013). Bone mineral density (BMD) in the trabecular region of the proximal humeral metaphysis by pQCT, and bone volume fraction and volumetric BMD by MicroCT were the same in the two groups. Volume fraction of bound water (BW) of the whole femur was 14% lower in anti-VEGF than in VEH mice (p = 0.003). Finally, BW, but not cortical tissue mineral density, helped section modulus explain the variance in the ultimate moment experienced by the femur in three-point bending. Conclusion Anti-VEGF caused low bone blood flow and bone strength in trabecular bone regions without influencing BMD and microarchitecture. Low bone strength was also associated with low bone hydration. These data suggest that bone blood flow is a novel bone property that affects bone quality. An antibody to vascular endothelial growth factor (anti-VEGF) caused low bone blood flow in a trabecular bone rich region. Anti-VEGF did not affect trabecular bone region and bone hydration of the whole femur were also low, trabecular bone mass was not affected by anti-VEGF. Bone blood flow may be a bone property that affects bone quality through bone hydration. Anti-VEGF caused low trabecular bone strength in the vertebral body and low bone hydration of the whole femur.
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Affiliation(s)
- N E Lane
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA 95817, USA
| | - J S Nyman
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - S Uppuganti
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - A J Chaudhari
- Center for Molecular and Genomic Imaging, Department of Radiology, University of California at Davis, Davis, CA 95616, USA
| | - J I Aguirre
- Department of Physiological Sciences, University of Florida, Gainesville, FL 32610, USA
| | - K Shidara
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA 95817, USA
| | - X P Liu
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA 95817, USA
| | - W Yao
- Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA 95817, USA
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida, Gainesville, FL 32610, USA
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Wei J, Gross D, Lane NE, Lu N, Wang M, Zeng C, Yang T, Lei G, Choi HK, Zhang Y. Risk factor heterogeneity for medial and lateral compartment knee osteoarthritis: analysis of two prospective cohorts. Osteoarthritis Cartilage 2019; 27:603-610. [PMID: 30597274 DOI: 10.1016/j.joca.2018.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/13/2018] [Revised: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the etiologic heterogeneity between medial and lateral tibiofemoral radiographic osteoarthritis (ROA). METHODS Knees without medial or lateral tibiofemoral ROA at baseline were followed for 60-month in Multicenter Osteoarthritis Study (MOST) and for 48-month in Osteoarthritis Initiative (OAI). We examined the relation of previously reported risk factors to incident medial and lateral tibiofemoral ROA separately and determined the etiology heterogeneity with a ratio of rate ratios (RRs) (i.e., the RR for medial tibiofemoral ROA divided by the RR for lateral tibiofemoral ROA) using a duplication method for Cox proportional hazard regression. RESULTS Of 2,016 participants in MOST, 436 and 162 knees developed medial or lateral tibiofemoral ROA, respectively. Obesity and varus malalignment were 95% and 466% more strongly associated with incident medial tibiofemoral ROA than with lateral tibiofemoral ROA, respectively (ratios of RRs, 1.95 [95% confidence interval (CI):1.05-3.62] and 5.66 [95% CI:3.20-10.0]). In contrast, the associations of female sex and valgus malalignment with incident medial tibiofemoral ROA were weaker or in an opposite direction compared with lateral tibiofemoral Osteoarthritis (OA) (ratios of RRs, 0.40 [95% CI:0.26-0.63] and 0.20 [95% CI:0.12-0.34], respectively). Older age tended to show a weaker association with incident medial tibiofemoral ROA than with incident lateral tibiofemoral ROA. No heterogeneity was observed for the relation of race, knee injury, or contralateral knee ROA. These findings were closely replicated in OAI. CONCLUSION Risk factor profiles for medial and lateral tibiofemoral ROA are different. These results can provide a framework for the development of targeted prevention and potential treatment strategies for specific knee OA subtypes.
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Affiliation(s)
- J Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.
| | - D Gross
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - N E Lane
- Center for Musculoskeletal Health University of California, Davis, CA, USA
| | - N Lu
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - C Zeng
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - T Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - G Lei
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - H K Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Y Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Christiansen BA, Harrison SL, Fink HA, Lane NE. Incident fracture is associated with a period of accelerated loss of hip BMD: the Study of Osteoporotic Fractures. Osteoporos Int 2018; 29:2201-2209. [PMID: 29992510 PMCID: PMC6553454 DOI: 10.1007/s00198-018-4606-6] [Citation(s) in RCA: 15] [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: 11/27/2017] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
Abstract
UNLABELLED Bone loss following a fracture could increase the risk of future fractures. In this study, we found that elderly women who had an upper body fracture or multiple fractures lost more bone at the hip than those who did not fracture. This suggests a possible systemic bone loss response initiated by fracture. INTRODUCTION A prior fracture is one of the strongest predictors of subsequent fracture risk, but the etiology of this phenomenon remains unclear. Systemic bone loss post-fracture could contribute to increased risk of subsequent fractures. Therefore, in this study, we investigated whether incident fractures, including those distant to the hip, are associated with accelerated loss of hip bone mineral density (BMD) in elderly women. METHODS We analyzed data from 3956 Caucasian women aged ≥ 65 years who were enrolled in the Study of Osteoporotic Fractures and completed hip BMD measurements at study visit 4 (year 6) and visit 6 (year 10). Clinical fractures between visits 4 and 6 were ascertained from triannual questionnaires and centrally adjudicated by review of community radiographic reports. Subjects provided questionnaire information and clinical variables at examinations for known and potential covariates. Generalized linear models were used to calculate average annual percent change in total hip BMD between visits 4 and 6 for each incident fracture type and for upper body and lower body fractures combined. A subset of women (n = 3783) was analyzed for annual total hip BMD change between study visits 4 and 5 and between study visits 5 and 6 to evaluate change in total hip BMD during these 2-year intervals. RESULTS Women with incident upper body fracture or incident lower body fracture exhibited reductions in total hip BMD of 0.89 and 0.77% per year, respectively, while women who did not fracture exhibited reductions in total hip BMD of 0.66% per year during the 4-year period. Accelerated loss of hip BMD was isolated to the 2-year time interval that included the fracture. Loss of total hip BMD was not affected by the number of days from fracture to follow up DXA. CONCLUSIONS Systemic bone loss following fracture may increase the risk of future fractures at all skeletal sites. There is a need for improved understanding of mechanisms leading to apparent accelerated bone loss following a fracture in order to reduce subsequent fracture risk.
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Affiliation(s)
- B A Christiansen
- Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, University of California Davis Health, 4635 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA.
| | - S L Harrison
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - H A Fink
- Geriatric Research, Education & Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA
| | - N E Lane
- Department of Internal Medicine - Rheumatology, Allergy, and Clinical Immunology, University of California Davis Health, Sacramento, CA, USA
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Ensrud KE, Vo TN, Burghardt AJ, Schousboe JT, Cauley JA, Taylor BC, Hoffman AR, Orwoll ES, Lane NE, Langsetmo L. Weight loss in men in late life and bone strength and microarchitecture: a prospective study. Osteoporos Int 2018; 29:1549-1558. [PMID: 29572622 PMCID: PMC6035779 DOI: 10.1007/s00198-018-4489-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/12/2018] [Indexed: 01/22/2023]
Abstract
UNLABELLED Weight loss in men in late life was associated with lower bone strength. In contrast, weight gain was not associated with a commensurate increase in bone strength. Future studies should measure concurrent changes in weight and parameters of bone strength and microarchitecture and evaluate potential causal pathways underlying these associations. INTRODUCTION Our aim was to determine associations of weight loss with bone strength and microarchitecture. METHODS We used data from 1723 community-dwelling men (mean age 84.5 years) who attended the MrOS study Year (Y) 14 exam and had high-resolution peripheral quantitative computed tomography (HR-pQCT) scans at ≥ 1 skeletal sites (distal tibia, distal radius, or diaphyseal tibia). Weight change from Y7 to Y14 exams (mean 7.3 years between exams) was classified as moderate weight loss (loss ≥ 10%), mild weight loss (loss 5 to < 10%), stable weight (< 5% change), or weight gain (gain ≥ 5%). Mean HR-pQCT parameters (95%CI) were calculated by weight change category using linear regression models adjusted for age, race, site, health status, body mass index, limb length, and physical activity. The primary outcome measure was estimated failure load. RESULTS There was a nonlinear association of weight change with failure load at each skeletal site with different associations for weight loss vs. weight gain (p < 0.03). Failure load and total bone mineral density (BMD) at distal sites were lower with greater weight loss with 7.0-7.6% lower failure loads and 4.3-5.8% lower BMDs among men with moderate weight loss compared to those with stable weight (p < 0.01, both comparisons). Cortical, but not trabecular, BMDs at distal sites were lower with greater weight loss. Greater weight loss was associated with lower cortical thickness at all three skeletal sites. CONCLUSION Weight loss in men in late life is associated with lower peripheral bone strength and total BMD with global measures reflecting cortical but not trabecular parameters.
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Affiliation(s)
- K E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
- Center for Chronic Disease Outcomes Research, VA Health Care System, One Veterans Drive (111-0), Minneapolis, MN, 55417, USA.
| | - T N Vo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - A J Burghardt
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | - J T Schousboe
- HealthPartners Institute, Bloomington, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - B C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, One Veterans Drive (111-0), Minneapolis, MN, 55417, USA
| | - A R Hoffman
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - E S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - N E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - L Langsetmo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
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Rogers TS, Harrison S, Judd S, Orwoll ES, Marshall LM, Shannon J, Langsetmo L, Lane NE, Shikany JM. Dietary patterns and longitudinal change in hip bone mineral density among older men. Osteoporos Int 2018; 29:1135-1145. [PMID: 29450584 PMCID: PMC6842326 DOI: 10.1007/s00198-018-4388-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/05/2018] [Indexed: 01/15/2023]
Abstract
UNLABELLED Studying dietary patterns is often more informative than individual nutrients or foods. We found that a Prudent dietary pattern (rich in vegetables and fish) was associated with reduced loss of total hip BMD in older men. A Prudent dietary pattern may be a potential lifestyle strategy for minimizing bone loss. INTRODUCTION This study aimed to identify baseline dietary patterns using factor analysis in a cohort of older men and to evaluate whether the dietary patterns were associated with bone mineral density change (%ΔBMD) at the total hip and femoral neck over time. METHODS Participants (n = 4379; mean age 72.9 ± 5.5 years) were from the Osteoporotic Fractures in Men (MrOS) prospective cohort study and had dietary data collected at baseline (March 2000-April 2002) and BMD measured at baseline and Visit 2 (March 2005-May 2006). Dietary intake was assessed with a brief Block food frequency questionnaire (FFQ); factor analysis was used to derive dietary patterns. BMD was measured by dual-energy x-ray absorptiometry (DXA); %ΔBMD was calculated from baseline to Visit 2. We used generalized linear regression to estimate least square (LS) means of %ΔBMD in quartiles of the dietary pattern scores adjusted for potential confounding factors. RESULTS Two major dietary patterns were derived: Prudent (abundant in vegetables, salad, and non-fried fish) and Western (rich in hamburger, fries, processed meats, cheese, and sweets/desserts). There was an inverse association between adherence to the Prudent pattern and total hip %ΔBMD (p-trend = 0.028 after adjusting for age and clinical site; p-trend = 0.033 after further adjustment for smoking, calcium supplement use, diabetes, hypertension, and total energy intake). No other consistent associations between dietary patterns and %ΔBMD were observed. CONCLUSIONS Greater adherence to a Prudent dietary pattern may attenuate total hip BMD loss (%ΔBMD) in older men.
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Affiliation(s)
- T S Rogers
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California - Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA.
| | - S Harrison
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - S Judd
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - E S Orwoll
- Oregon Health and Science University, Portland, OR, USA
| | - L M Marshall
- Oregon Health and Science University, Portland, OR, USA
| | - J Shannon
- Oregon Health and Science University, Portland, OR, USA
| | - L Langsetmo
- University of Minnesota Epidemiology and Community Health, Minneapolis, MN, USA
| | - N E Lane
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California - Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA
| | - J M Shikany
- University of Alabama at Birmingham, Birmingham, AL, USA
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Deshmukh V, Hu H, Barroga C, Bossard C, Kc S, Dellamary L, Stewart J, Chiu K, Ibanez M, Pedraza M, Seo T, Do L, Cho S, Cahiwat J, Tam B, Tambiah JRS, Hood J, Lane NE, Yazici Y. A small-molecule inhibitor of the Wnt pathway (SM04690) as a potential disease modifying agent for the treatment of osteoarthritis of the knee. Osteoarthritis Cartilage 2018; 26:18-27. [PMID: 28888902 DOI: 10.1016/j.joca.2017.08.015] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [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: 01/02/2017] [Revised: 07/18/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Osteoarthritis (OA) is a degenerative disease characterized by loss of cartilage and increased subchondral bone within synovial joints. Wnt signaling affects the pathogenesis of OA as this pathway modulates both the differentiation of osteoblasts and chondrocytes, and production of catabolic proteases. A novel small-molecule Wnt pathway inhibitor, SM04690, was evaluated in a series of in vitro and in vivo animal studies to determine its effects on chondrogenesis, cartilage protection and synovial-lined joint pathology. DESIGN A high-throughput screen was performed using a cell-based reporter assay for Wnt pathway activity to develop a small molecule designated SM04690. Its properties were evaluated in bone-marrow-derived human mesenchymal stem cells (hMSCs) to assess chondrocyte differentiation and effects on cartilage catabolism by immunocytochemistry and gene expression, and glycosaminoglycan breakdown. In vivo effects of SM04690 on Wnt signaling, cartilage regeneration and protection were measured using biochemical and histopathological techniques in a rodent acute cruciate ligament tear and partial medial meniscectomy (ACLT + pMMx) OA model. RESULTS SM04690 induced hMSC differentiation into mature, functional chondrocytes and decreased cartilage catabolic marker levels compared to vehicle. A single SM04690 intra-articular (IA) injection was efficacious in a rodent OA model, with increased cartilage thickness, evidence for cartilage regeneration, and protection from cartilage catabolism observed, resulting in significantly improved Osteoarthritis Research Society International (OARSI) histology scores and biomarkers, compared to vehicle. CONCLUSIONS SM04690 induced chondrogenesis and appeared to inhibit joint destruction in a rat OA model, and is a candidate for a potential disease modifying therapy for OA.
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Affiliation(s)
| | - H Hu
- Samumed, LLC, San Diego, CA, USA.
| | | | | | - S Kc
- Samumed, LLC, San Diego, CA, USA.
| | | | | | - K Chiu
- Samumed, LLC, San Diego, CA, USA.
| | - M Ibanez
- Samumed, LLC, San Diego, CA, USA.
| | | | - T Seo
- Samumed, LLC, San Diego, CA, USA.
| | - L Do
- Samumed, LLC, San Diego, CA, USA.
| | - S Cho
- Samumed, LLC, San Diego, CA, USA.
| | | | - B Tam
- Samumed, LLC, San Diego, CA, USA.
| | | | - J Hood
- Samumed, LLC, San Diego, CA, USA.
| | - N E Lane
- University of California, Davis, CA, USA.
| | - Y Yazici
- Samumed, LLC, San Diego, CA, USA.
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Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, Gladin A, Fan B, Allaire B, Kado DM, Lane NE. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int 2017; 28:2831-2841. [PMID: 28689306 PMCID: PMC5873977 DOI: 10.1007/s00198-017-4109-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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: 04/10/2017] [Accepted: 05/31/2017] [Indexed: 01/01/2023]
Abstract
A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis. Participants receiving the intervention improved self-image and satisfaction with their appearance. Results suggest that spine-strengthening exercise and postural training may be an effective treatment option for older adults with hyperkyphosis. INTRODUCTION The purpose of the present study is to determine in a randomized controlled trial whether spine-strengthening exercises improve Cobb angle of kyphosis in community-dwelling older adults. METHODS We recruited adults ≥60 years with kyphosis ≥40° and enrolled 99 participants (71 women, 28 men), mean age 70.6 ± 0.6 years, range 60-88, with baseline Cobb angle 57.4 ± 12.5°. The intervention included group spine-strengthening exercise and postural training, delivered by a physical therapist, 1-h, three times weekly for 6 months. Controls received four group health education meetings. The primary outcome was change in the gold standard Cobb angle of kyphosis measured from standing lateral spine radiographs. Secondary outcomes included change in kyphometer-measured kyphosis, physical function (modified Physical Performance Test, gait speed, Timed Up and Go, Timed Loaded Standing, 6-Min Walk), and health-related quality of life (HRQoL) (PROMIS global health and physical function indexes, SRS-30 self-image domain). ANCOVA was used to assess treatment effects on change from baseline to 6 months in all outcomes. RESULTS There was a -3.0° (95% CI -5.2, -0.8) between-group difference in change in Cobb angle, p = 0.009, favoring the intervention and approximating the magnitude of change from an incident vertebral fracture. Kyphometer-measured kyphosis (p = 0.03) and SRS-30 self-esteem (p < 0.001) showed favorable between-group differences in change, with no group differences in physical function or additional HRQoL outcomes, p > 0.05. CONCLUSIONS Spine-strengthening exercise and posture training over 6 months reduced kyphosis compared to control. Our randomized controlled trial results suggest that a targeted kyphosis-specific exercise program may be an effective treatment option for older adults with hyperkyphosis. TRIAL REGISTRATION NUMBER AND NAME OF TRIAL REGISTER ClinicalTrials.gov; identifier NCT01751685.
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Affiliation(s)
- W B Katzman
- University of California, 1500 Owens Street, San Francisco, CA, 94158, USA.
| | - E Vittinghoff
- University of California, 550 16th. Street, San Francisco, CA, 94158, USA
| | - F Lin
- University of California, 550 16th. Street, San Francisco, CA, 94158, USA
| | - A Schafer
- University of California, 4150 Clement St, San Francisco, CA, 94121, USA
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA
| | - R K Long
- University of California, 550 16th. Street, San Francisco, CA, 94143, USA
| | - S Wong
- University of California, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - A Gladin
- Kaiser Permanente Northern CA, San Francisco Medical Center, 1635 Divisadero Street, Suite 300, San Francisco, CA, 94115, USA
| | - B Fan
- University of California, 400 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - B Allaire
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - D M Kado
- University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - N E Lane
- University of California, 4625 Second Avenue, Suite 2000, Sacramento, CA, 95616, USA
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Yazici Y, McAlindon TE, Fleischmann R, Gibofsky A, Lane NE, Kivitz AJ, Skrepnik N, Armas E, Swearingen CJ, DiFrancesco A, Tambiah JRS, Hood J, Hochberg MC. A novel Wnt pathway inhibitor, SM04690, for the treatment of moderate to severe osteoarthritis of the knee: results of a 24-week, randomized, controlled, phase 1 study. Osteoarthritis Cartilage 2017; 25:1598-1606. [PMID: 28711582 DOI: 10.1016/j.joca.2017.07.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [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: 02/24/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the safety, pharmacokinetics, and exploratory efficacy of SM04690, a novel Wnt pathway inhibitor, as a potential disease modifying treatment for knee osteoarthritis (OA). DESIGN Subjects with Kellgren-Lawrence grade 2-3 knee OA were randomized in successive dose-escalation cohorts to receive a knee intra-articular (IA) injection with 0.03, 0.07, or 0.23 mg SM04690, or placebo (PBO) (4:1 ratio). Safety, pharmacokinetics, efficacy (WOMAC Total/Function/Pain, Pain VAS, Physician Global Assessment [MDGA], and OMERACT-OARSI Response), OA-related biomarker (P1NP, ß-CTX, and cartilage oligomeric matrix protein [COMP]), and radiographic/imaging data were collected at baseline and during 24-week follow-up. RESULTS 61 subjects (SM04690 n = 50; PBO n = 11) enrolled. Two dose limiting toxicities (DLTs), increased pain following injection and paroxysmal tachycardia (also the single serious AE), were reported in the 0.07 mg cohort. A total of 72 AEs were reported; Sixteen (occurring in eight subjects) were considered related to study medication. There were three discontinuations; one due to an AE (0.03 mg cohort). Bone marrow edema (BME) remained constant for most subjects. No doses were excluded from further study due to DLT criteria. Plasma levels of SM04690 were below the limit of detection at all time points. At Week 24, improvements from baseline were seen in all cohorts for the exploratory measures WOMAC Total, WOMAC Function, WOMAC Pain, MDGA, Pain VAS, and OMERACT-OARSI response. Joint space width (JSW) improvement was observed in the 0.07 mg cohort (P = 0.02 vs PBO). CONCLUSION SM04690 appeared safe and well tolerated, with no evidence of systemic exposure. Exploratory efficacy analyses suggested positive trends for measurements of OA pain, function and disease-modifying osteoarthritis drug (DMOAD) properties. CLINICALTRIALS. GOV REGISTRATION NCT02095548.
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Affiliation(s)
| | | | - R Fleischmann
- University of Texas Southwestern Medical Center, TX, USA
| | - A Gibofsky
- Hospital for Special Surgery-Weill Cornell Medicine, NY, USA
| | - N E Lane
- UC Davis Medical Center, CA, USA
| | - A J Kivitz
- Altoona Center for Clinical Research, PA, USA
| | | | - E Armas
- Well Pharma Medical Research, USA
| | | | | | | | | | - M C Hochberg
- University of Maryland School of Medicine, MD, USA
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Radnovich R, Scott D, Patel AT, Olson R, Dasa V, Segal N, Lane NE, Shrock K, Naranjo J, Darr K, Surowitz R, Choo J, Valadie A, Harrell R, Wei N, Metyas S. Cryoneurolysis to treat the pain and symptoms of knee osteoarthritis: a multicenter, randomized, double-blind, sham-controlled trial. Osteoarthritis Cartilage 2017; 25:1247-1256. [PMID: 28336454 DOI: 10.1016/j.joca.2017.03.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 09/30/2016] [Revised: 02/22/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate the efficacy and safety/tolerability of cryoneurolysis for reduction of pain and symptoms associated with knee osteoarthritis (OA). DESIGN Randomized, double-blind, sham-controlled, multicenter trial with a 6-month follow-up in patients with mild-to-moderate knee OA. Patients were randomized 2:1 to cryoneurolysis targeting the infrapatellar branch of the saphenous nerve (IPBSN) or sham treatment. The primary endpoint was the change from baseline to Day 30 in the Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain score adjusted by the baseline score and site. Secondary endpoints, including visual analogue scale (VAS) pain score and total WOMAC score, were tested in a pre-defined order. RESULTS The intent-to-treat (ITT) population consisted of 180 patients (n = 121 active treatment, n = 59 sham treatment). Compared to the sham group, patients who received active treatment had a statistically significant greater change from baseline in the WOMAC pain subscale score at Day 30 (P = 0.0004), Day 60 (P = 0.0176), and Day 90 (P = 0.0061). Patients deemed WOMAC pain responders at Day 120 continued to experience a statistically significant treatment effect at Day 150. Most expected side effects were mild in severity and resolved within 30 days. The incidence of device- or procedure-related adverse events was similar in the two treatment groups with no occurrence of serious or unanticipated adverse device effects (ADE). CONCLUSIONS Cryoneurolysis of the IPBSN resulted in statistically significant decreased knee pain and improved symptoms compared to sham treatment for up to 150 days, and appeared safe and well tolerated.
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Affiliation(s)
- R Radnovich
- Injury Care Medical Center, 4850 N. Rosepoint Way, Ste 100, Boise, ID 83713, USA
| | - D Scott
- Spokane Joint Replacement Center, 785 E Holland Avenue, Spokane, WA 99218, USA
| | - A T Patel
- Kansas City Bone & Joint Clinic, 10701 Nall Avenue, #200, Overland Park, KS 66211, USA
| | - R Olson
- OrthoIllinois, 5875 Riverside Blvd., Rockford, IL 61114, USA
| | - V Dasa
- Department of Orthopaedics, LSU School of Medicine, 1542 Tulane Avenue, Box T6-7, New Orleans, LA 70112, USA
| | - N Segal
- Kansas University Medical Center, Rehabilitation Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - N E Lane
- Center for Musculoskeletal Health, UC Davis Health System, 4625 2nd Avenue, Suite 2006, Sacramento, CA 95817, USA
| | - K Shrock
- Shrock Orthopedic Research, 1414 SE 3rd Avenue, Fort Lauderdale, FL 33316, USA
| | - J Naranjo
- South Florida Clinical Research, LLC, 7000 SW 62nd Avenue, Suite 590, South Miami, FL 33143, USA
| | - K Darr
- Covington Orthopedic and Sport Medicine Institute, 19343 Sunshine Avenue, Covington, LA 70433, USA
| | - R Surowitz
- Health Awareness, Inc., 411 West Indiantown Road, Jupiter, FL 33458, USA
| | - J Choo
- Pain Consultants of East Tennessee, 1128 E. Weisgarber Road., Suite 100A, Knoxville, TN 37909, USA
| | - A Valadie
- Coastal Orthopedics, 6015 Pointe West Blvd, Bradenton, FL 34209, USA
| | - R Harrell
- Triangle Orthopaedic Associates, 120 William Penn Plaza, Durham, NC 27704, USA
| | - N Wei
- Arthritis Treatment Center, 71 Thomas Johnson Drive, Frederick, MD 21702, USA
| | - S Metyas
- Covina Arthritis Clinic, 500 W. San Bernardino Road, Suite A, Covina, CA 91722, USA
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30
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Mondor L, Maxwell CJ, Hogan DB, Bronskill SE, Gruneir A, Lane NE, Wodchis WP. Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort. PLoS Med 2017; 14:e1002249. [PMID: 28267802 PMCID: PMC5340355 DOI: 10.1371/journal.pmed.1002249] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/02/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND For community-dwelling older persons with dementia, the presence of multimorbidity can create complex clinical challenges for both individuals and their physicians, and can contribute to poor outcomes. We quantified the associations between level of multimorbidity (chronic disease burden) and risk of hospitalization and risk of emergency department (ED) visit in a home care cohort with dementia and explored the role of continuity of physician care (COC) in modifying these relationships. METHODS AND FINDINGS A retrospective cohort study using linked administrative and clinical data from Ontario, Canada, was conducted among 30,112 long-stay home care clients (mean age 83.0 ± 7.7 y) with dementia in 2012. Multivariable Fine-Gray regression models were used to determine associations between level of multimorbidity and 1-y risk of hospitalization and 1-y risk of ED visit, accounting for multiple competing risks (death and long-term care placement). Interaction terms were used to assess potential effect modification by COC. Multimorbidity was highly prevalent, with 35% (n = 10,568) of the cohort having five or more chronic conditions. In multivariable analyses, risk of hospitalization and risk of ED visit increased monotonically with level of multimorbidity: sub-hazards were 88% greater (sub-hazard ratio [sHR] = 1.88, 95% CI: 1.72-2.05, p < 0.001) and 63% greater (sHR = 1.63; 95% CI: 1.51-1.77, p < 0.001), respectively, among those with five or more conditions, relative to those with dementia alone or with dementia and one other condition. Low (versus high) COC was associated with an increased risk of both hospitalization and ED visit in age- and sex-adjusted analyses only (sHR = 1.11, 95% CI: 1.07-1.16, p < 0.001, for hospitalization; sHR = 1.07, 95% CI: 1.03-1.11, p = 0.001, for ED visit) but did not modify associations between multimorbidity and outcomes (Wald test for interaction, p = 0.566 for hospitalization and p = 0.637 for ED visit). The main limitations of this study include use of fixed (versus time-varying) covariates and focus on all-cause rather than cause-specific hospitalizations and ED visits, which could potentially inform interventions. CONCLUSIONS Older adults with dementia and multimorbidity pose a particular challenge for health systems. Findings from this study highlight the need to reshape models of care for this complex population, and to further investigate health system and other factors that may modify patients' risk of health outcomes.
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Affiliation(s)
- Luke Mondor
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Health System Performance Research Network, Toronto, Ontario, Canada
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Health System Performance Research Network, Toronto, Ontario, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - David B Hogan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Division of Geriatric Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Health System Performance Research Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gruneir
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Natasha E Lane
- Health System Performance Research Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Health System Performance Research Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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Lane NE, Wodchis WP, Boyd CM, Stukel TA. Disability in long-term care residents explained by prevalent geriatric syndromes, not long-term care home characteristics: a cross-sectional study. BMC Geriatr 2017; 17:49. [PMID: 28183274 PMCID: PMC5301427 DOI: 10.1186/s12877-017-0444-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Self-care disability is dependence on others to conduct activities of daily living, such as bathing, eating and dressing. Among long-term care residents, self-care disability lowers quality of life and increases health care costs. Understanding the correlates of self-care disability in this population is critical to guide clinical care and ongoing research in Geriatrics. This study examines which resident geriatric syndromes and chronic conditions are associated with residents’ self-care disability and whether these relationships vary across strata of age, sex and cognitive status. It also describes the proportion of variance in residents’ self-care disability that is explained by residents’ geriatric syndromes versus long-term care home characteristics. Methods We conducted a cross-sectional study using a health administrative cohort of 77,165 long-term care home residents residing in 614 Ontario long-term care homes. Eligible residents had their self-care disability assessed using the RAI-MDS 2.0 activities of daily living long-form score (range: 0–28) within 90 days of April 1st, 2011. Hierarchical multivariable regression models with random effects for long-term care homes were used to estimate the association between self-care disability and resident geriatric syndromes, chronic conditions and long-term care home characteristics. Differences in findings across strata of sex, age and cognitive status (cognitively intact versus cognitively impaired) were examined. Results Geriatric syndromes were much more strongly associated with self-care disability than chronic conditions in multivariable models. The direction and size of some of these effects were different for cognitively impaired versus cognitively intact residents. Residents’ geriatric syndromes explained 50% of the variation in their self-care disability scores, while characteristics of long-term care homes explained an additional 2% of variation. Conclusion Differences in long-term care residents’ self-care disability are largely explained by prevalent geriatric syndromes. After adjusting for resident characteristics, there is little variation in self-care disability associated with long-term care home characteristics. This suggests that residents’ geriatric syndromes—not the homes in which they live—may be the appropriate target of interventions to reduce self-care disability, and that such interventions may need to differ for cognitively impaired versus unimpaired residents. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0444-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natasha E Lane
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada.
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada.,Institute for Clinical Evaluative Sciences, G1 06 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Toronto Rehabilitation Institute, 550 University Avenue, 3rd Floor, Toronto, ON, M5G 2A2, Canada
| | - Cynthia M Boyd
- Johns Hopkins School of Medicine, 1830 E. Monument St, Baltimore, MD, 21287, USA.,Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.,Johns Hopkins Center on Aging and Health, 2024 E. Monument St, Suite 2-700, Baltimore, MD, 21205, USA
| | - Thérèse A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON, M5T 3M6, Canada.,Institute for Clinical Evaluative Sciences, G1 06 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
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Abstract
Both epidemiologic and clinical research continues to be performed in osteoarthritis (OA). While epidemiologic studies identify risk factors for incident and progressive disease, clinical studies explore the role of both non-pharmacologic and pharmacologic treatments, including oral and intra-articular therapies. We performed a systematic review of the literature using PubMed for the time period between April 1, 2015 to February 22, 2016. Selected publications in the areas of both epidemiology and treatment are reviewed in this article.
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Affiliation(s)
- N E Lane
- Center for Musculoskeletal Health, University of California at Davis School of Medicine, Sacramento, CA 95817, USA; Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA 95817, USA; Affiliated Faculty, Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA 94143, USA.
| | - K Shidara
- Center for Musculoskeletal Health, University of California at Davis School of Medicine, Sacramento, CA 95817, USA; Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA 95817, USA
| | - B L Wise
- Center for Musculoskeletal Health, University of California at Davis School of Medicine, Sacramento, CA 95817, USA; Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA 95817, USA; Department of Orthopaedic Surgery, University of California at Davis School of Medicine, Sacramento, CA 95817, USA
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33
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Zerbini CAF, Clark P, Mendez-Sanchez L, Pereira RMR, Messina OD, Uña CR, Adachi JD, Lems WF, Cooper C, Lane NE. Biologic therapies and bone loss in rheumatoid arthritis. Osteoporos Int 2017; 28:429-446. [PMID: 27796445 DOI: 10.1007/s00198-016-3769-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [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: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a common systemic autoimmune disease of unknown cause, characterized by a chronic, symmetric, and progressive inflammatory polyarthritis. One of the most deleterious effects induced by the chronic inflammation of RA is bone loss. During the last 15 years, the better knowledge of the cytokine network involved in RA allowed the development of potent inhibitors of the inflammatory process classified as biological DMARDs. These new drugs are very effective in the inhibition of inflammation, but there are only few studies regarding their role in bone protection. The principal aim of this review was to show the evidence of the principal biologic therapies and bone loss in RA, focusing on their effects on bone mineral density, bone turnover markers, and fragility fractures. METHODS Using the PICOST methodology, two coauthors (PC, LM-S) conducted the search using the following MESH terms: rheumatoid arthritis, osteoporosis, clinical trials, TNF- antagonists, infliximab, adalimumab, etanercept, certolizumab, golimumab, IL-6 antagonists, IL-1 antagonists, abatacept, tocilizumab, rituximab, bone mineral density, bone markers, and fractures. The search was conducted electronically and manually from the following databases: Medline and Science Direct. The search period included articles from 2003 to 2015. The selection included only original adult human research written in English. Titles were retrieved and the same two authors independently selected the relevant studies for a full text. The retrieved selected studies were also reviewed completing the search for relevant articles. The first search included 904 titles from which 253 titles were selected. The agreement on the selection among researchers resulted in a Kappa statistic of 0.95 (p < 0.000). Only 248 abstracts evaluated were included in the acronym PICOST. The final selection included only 28 studies, derived from the systematic search. Additionally, a manual search in the bibliography of the selected articles was made and included into the text and into the section of "small molecules of new agents." CONCLUSION Treatment with biologic drugs is associated with the decrease in bone loss. Studies with anti-TNF blocking agents show preservation or increase in spine and hip BMD and also a better profile of bone markers. Most of these studies were performed with infliximab. Only three epidemiological studies analyzed the effect on fractures after anti-TNF blocking agent's treatment. IL-6 blocking agents also showed improvement in localized bone loss not seen with anti-TNF agents. There are a few studies with rituximab and abatacept. Although several studies reported favorable actions of biologic therapies on bone protection, there are still unmet needs for studies regarding their actions on the risk of bone fractures.
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Affiliation(s)
- C A F Zerbini
- Centro Paulista de Investigação Clínica, Rua Moreira e Costa, 342-Ipiranga, São Paulo, SP, 04266-010, Brazil.
| | - P Clark
- Hospital Infantil Federico Gómez-Faculty of Medicine UNAM, Ciudad de México D.F, Mexico
| | - L Mendez-Sanchez
- Hospital Infantil Federico Gómez-Faculty of Medicine UNAM, Ciudad de México D.F, Mexico
| | - R M R Pereira
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - O D Messina
- IRO Clinical Research Center Buenos Aires, Buenos Aires, Argentina
| | - C R Uña
- IRO Clinical Research Center Buenos Aires, Buenos Aires, Argentina
| | - J D Adachi
- Actavis Chair for Better Bone Health in Rheumatology, Hamilton, ON, Canada
| | - W F Lems
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- University of Oxford, Oxford, UK
| | - N E Lane
- Center for Musculoskeletal Health, Sacramento, CA, USA
- UC Davis Health System, University of California, Sacramento, CA, USA
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An H, Marron JS, Schwartz TA, Renner JB, Liu F, Lynch JA, Lane NE, Jordan JM, Nelson AE. Novel statistical methodology reveals that hip shape is associated with incident radiographic hip osteoarthritis among African American women. Osteoarthritis Cartilage 2016; 24:640-6. [PMID: 26620089 PMCID: PMC4799754 DOI: 10.1016/j.joca.2015.11.013] [Citation(s) in RCA: 20] [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: 06/21/2015] [Revised: 10/17/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip shape is a risk factor for the development of hip osteoarthritis (OA), and current methods to assess hip shape from radiographs are limited; therefore this study explored current and novel methods to assess hip shape. METHODS Data from a prior case-control study nested in the Johnston County OA Project were used, including 382 hips (from 342 individuals). Hips were classified by radiographic hip OA (RHOA) status as RHOA cases (baseline Kellgren Lawrence grade [KLG] 0 or 1, follow-up [mean 6 years] KLG ≥ 2) or controls (KLG = 0 or 1 at both baseline and follow-up). Proximal femur shape was assessed using a 60-point model as previously described. The current analysis explored commonly used principal component analysis (PCA), as well as novel statistical methodologies suited to high dimension low sample size settings (Distance Weighted Discrimination [DWD] and Distance Projection Permutation [DiProPerm] hypothesis testing) to assess differences between cases and controls. RESULTS Using these novel methodologies, we were able to better characterize morphologic differences by sex and race. In particular, the proximal femurs of African American women demonstrated significantly different shapes between cases and controls, implying an important role for sex and race in the development of RHOA. Notably, discrimination was improved with the use of DWD and DiProPerm compared to PCA. CONCLUSIONS DWD with DiProPerm significance testing provides improved discrimination of variation in hip morphology between groups, and enables subgroup analyses even under small sample sizes.
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Affiliation(s)
- H An
- Department of Statistics and Operations Research, University of North Carolina, Hanes Hall CB 3260, Chapel Hill, NC 27599, USA.
| | - J S Marron
- Department of Statistics and Operations Research, University of North Carolina, Hanes Hall CB 3260, Chapel Hill, NC 27599, USA.
| | - T A Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, 3106E McGavran-Greenberg Hall CB 7420, Chapel Hill, NC 27599, USA.
| | - J B Renner
- Department of Radiology, University of North Carolina, 509 Old Infirmary Bldg CB 7510, Chapel Hill, NC 27599, USA; Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599, USA.
| | - F Liu
- University of California at San Francisco, Mission Hall: Global Health & Clinical Sciences Bldg, 550 16th St, 2nd Floor, San Francisco, CA 94158-2549, USA.
| | - J A Lynch
- University of California at San Francisco, Mission Hall: Global Health & Clinical Sciences Bldg, 550 16th St, 2nd Floor, San Francisco, CA 94158-2549, USA.
| | - N E Lane
- University of California Davis School of Medicine, 451 Health Sciences Dr, Davis, CA 95616, USA.
| | - J M Jordan
- Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599, USA.
| | - A E Nelson
- Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599, USA.
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Katzman WB, Vittinghoff E, Kado DM, Lane NE, Ensrud KE, Shipp K. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial. Osteoporos Int 2016; 27:899-903. [PMID: 26782685 PMCID: PMC4939887 DOI: 10.1007/s00198-015-3478-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/29/2015] [Indexed: 01/08/2023]
Abstract
SUMMARY Biomechanical analyses support the theory that thoracic spine hyperkyphosis may increase risk of new vertebral fractures. While greater kyphosis was associated with an increased rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture. INTRODUCTION Biomechanical analyses suggest hyperkyphosis may increase risk of incident vertebral fracture by increasing the load on vertebral bodies during daily activities. We propose to assess the association of kyphosis with incident radiographic vertebral fracture. METHODS We used data from the Fracture Intervention Trial among 3038 women 55-81 years of age with low bone mineral density (BMD). Baseline kyphosis angle was measured using a Debrunner kyphometer. Vertebral fractures were assessed at baseline and follow-up from lateral radiographs of the thoracic and lumbar spine. We used Poisson models to estimate the independent association of kyphosis with incident fracture, controlling for age and femoral neck BMD. RESULTS Mean baseline kyphosis was 48° (SD = 12) (range 7-83). At baseline, 962 (32%) participants had a prevalent fracture. There were 221 incident fractures over a median of 4 years. At baseline, prevalent fracture was associated with 3.7° greater average kyphosis (95% CI 2.8-4.6, p < 0.0005), adjusting for age and femoral neck BMD. Before adjusting for prevalent fracture, each 10° greater kyphosis was associated with 22% increase (95% CI 8-38%, p = 0.001) in annualized rate of new radiographic vertebral fracture, adjusting for age and femoral neck BMD. After additional adjustment for prevalent fracture, estimated increased annualized rate was attenuated and no longer significant, 8% per 10° kyphosis (95% CI -4 to 22%, p = 0.18). CONCLUSIONS While greater kyphosis increased the rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture.
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Affiliation(s)
- W B Katzman
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of California, 1500 Owens Suite 400, San Francisco, CA, 94158, USA.
| | - E Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - D M Kado
- Departments of Family and Preventive Medicine and Internal Medicine, University of California, San Diego, USA
- Department of Internal Medicine, University of California, Davis, USA
| | - N E Lane
- Department of Internal Medicine, University of California, Davis, USA
| | - K E Ensrud
- Minneapolis VA Health Care System, University of Minnesota, Minneapolis, USA
| | - K Shipp
- Division of Physical Therapy, Department of Community and Family Medicine, Duke University, Durham, USA
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Pitzul KB, Lane NE, Voruganti T, Khan AI, Innis J, Wodchis WP, Baker GR. Role of context in care transition interventions for medically complex older adults: a realist synthesis protocol. BMJ Open 2015; 5:e008686. [PMID: 26586323 PMCID: PMC4654392 DOI: 10.1136/bmjopen-2015-008686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/21/2015] [Accepted: 09/21/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Approximately 30-50% of older adults have two or more conditions and are referred to as multimorbid or complex patients. These patients often require visits to various healthcare providers in a number of settings and are therefore susceptible to fragmented healthcare delivery while transitioning to receive care. Care transition interventions have been implemented to improve continuity of care, however, current evidence suggests that some interventions or components of interventions are only effective within certain contexts. There is therefore a need to unpack the mechanisms of how and within which contexts care transition interventions and their components are effective. Realist review is a synthesis method that explains how complex programmes work within various contexts. The purpose of this study is to explain the effect of context on the activities and mechanisms of care transition interventions in medically complex older adults using a realist review approach. METHODS AND ANALYSIS This synthesis will be guided by Pawson and colleagues' 2004 and 2005 protocols for conducting realist reviews. The underlying theories of care transition interventions were determined based on an initial literature search using relevant databases. English language peer-reviewed studies published after 1993 will be included. Several relevant databases will be searched using medical subject headings and text terms. A screening form will be piloted and titles, abstracts and full text of potentially relevant articles will be screened in duplicate. Abstracted data will include study characteristics, intervention type, contextual factors, intervention activities and underlying mechanisms. Patterns in Context-Activity-Mechanism-Outcome (CAMO) configurations will be reported. ETHICS AND DISSEMINATION Internal knowledge translation activities will occur throughout the review and existing partnerships will be leveraged to disseminate findings to frontline staff, hospital administrators and policymakers. Finalised results will be presented at local, national and international conferences, and disseminated via peer-reviewed publications in relevant journals.
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Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Natasha E Lane
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Teja Voruganti
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Anum I Khan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jennifer Innis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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Lane NE, Maxwell CJ, Gruneir A, Bronskill SE, Wodchis WP. Absence of a Socioeconomic Gradient in Older Adults' Survival with Multiple Chronic Conditions. EBioMedicine 2015; 2:2094-100. [PMID: 26844290 PMCID: PMC4703730 DOI: 10.1016/j.ebiom.2015.11.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Individuals of low socioeconomic status experience a disproportionate burden of chronic conditions; however it is unclear whether chronic condition burden affects survival differently across socioeconomic strata. METHODS This retrospective cohort study used health administrative data from all residents of Ontario, Canada aged 65 to 105 with at least one of 16 chronic conditions on April 1, 2009 (n = 1,518,939). Chronic condition burden and unadjusted mortality were compared across neighborhood income quintiles. Multivariable Cox proportional hazards models were used to examine the effect of number of chronic conditions on two-year survival across income quintiles. FINDINGS Prevalence of five or more chronic conditions was significantly higher among older adults in the poorest neighborhoods (18.2%) than the wealthiest (14.3%) (Standardized difference > 0·1). There was also a socioeconomic gradient in unadjusted mortality over two years: 10.1% of people in the poorest neighborhoods died compared with 7.6% of people in the wealthiest neighborhoods. In adjusted analyses, having more chronic conditions was associated with a statistically significant increase in hazard of death over two years, however the magnitude of this effect was comparable across income quintiles. Individuals in the poorest neighborhoods with four chronic conditions had 2.07 times higher hazard of death (95% CI: 1.97-2.19) than those with one chronic condition, but this was comparable to the hazard associated with four chronic conditions in the wealthiest neighborhoods (HR: 2.29, 95% CI: 2.16-2.43). INTERPRETATION Among older adults with universal access to health care, the deleterious effect of increasing chronic condition burden on two-year hazard of death was consistent across neighborhood income quintiles once baseline differences in condition burden were accounted for. This may be partly attributable to equal access to, and utilization of, health care. Alternate explanations for these findings, including study limitations, are also discussed.
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Affiliation(s)
- Natasha E Lane
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Andrea Gruneir
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Women's College Hospital, 790 Bay Street, Toronto, Ontario M5G 1N8, Canada; Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta T6G 2T4, Canada
| | - Susan E Bronskill
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Toronto Rehabilitation Institute, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
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Lane NE, Hochberg MC, Nevitt MC, Simon LS, Nelson AE, Doherty M, Henrotin Y, Flechsenhar K, Flechsenhar K. OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for hip osteoarthritis. Osteoarthritis Cartilage 2015; 23:761-71. [PMID: 25952347 DOI: 10.1016/j.joca.2015.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 01/09/2015] [Revised: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
The ability to assess the efficacy and effectiveness of an intervention for the treatment of hip osteoarthritis (OA) requires strong clinical trial methodology. This consensus paper provides recommendations based on a narrative literature review and best judgment of the members of the committee for clinical trials of hip OA. We provide recommendations on clinical trial design, outcome measures, including structural (radiography), and patient and physician global assessments, performance based measures, molecular markers and experimental endpoints including MRI imaging. This information can be utilized by sponsors of trials for new therapeutic agents for hip OA.
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Affiliation(s)
- N E Lane
- University of California at Davis School of Medicine, Sacramento, CA 95817, USA.
| | - M C Hochberg
- University of Maryland, School of Medicine, Baltimore, MD 21201, USA
| | - M C Nevitt
- University of California at San Francisco, San Francisco, CA 94143, USA
| | | | - A E Nelson
- University of North Carolina, Chapel Hill, NC 27599, USA
| | - M Doherty
- University of Nottingham, School of Medicine, Nottingham, UK
| | | | - K Flechsenhar
- Sanofi, Research and Development, Bio Innovation, Frankfurt, Germany
| | - K Flechsenhar
- Sanofi, Research and Development, Bio Innovation, Frankfurt, Germany
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Chaganti RK, Lane NE, Nevitt MC. Response to Letter to the Editor: "Food frequency questionnaire is an effective method for measuring micronutrient intake.". Osteoarthritis Cartilage 2014; 22:1949-50. [PMID: 25168364 DOI: 10.1016/j.joca.2014.08.007] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Affiliation(s)
- R K Chaganti
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - N E Lane
- Department of Medicine, University of California at Davis Medical School, Sacramento, CA, USA
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
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Amugongo SK, Yao W, Jia J, Lay YAE, Dai W, Jiang L, Walsh D, Li CS, Dave NKN, Olivera D, Panganiban B, Ritchie RO, Lane NE. Effects of sequential osteoporosis treatments on trabecular bone in adult rats with low bone mass. Osteoporos Int 2014; 25:1735-50. [PMID: 24722767 PMCID: PMC4394748 DOI: 10.1007/s00198-014-2678-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 05/14/2013] [Accepted: 09/03/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED We used an osteopenic adult ovariectomized (OVX) rat model to evaluate various sequential treatments for osteoporosis, using FDA-approved agents with complementary tissue-level mechanisms of action. Sequential treatment for 3 months each with alendronate (Aln), followed by PTH, followed by resumption of Aln, created the highest trabecular bone mass, best microarchitecture, and highest bone strength. INTRODUCTION Individual agents used to treat human osteoporosis reduce fracture risk by ∼ 50-60%. As agents that act with complementary mechanisms are available, sequential therapies that mix antiresorptive and anabolic agents could improve fracture risk reduction, when compared with monotherapies. METHODS We evaluated bone mass, bone microarchitecture, and bone strength in adult OVX, osteopenic rats, during different sequences of vehicle (Veh), parathyroid hormone (PTH), Aln, or raloxifene (Ral) in three 90-day treatment periods, over 9 months. Differences among groups were evaluated. The interrelationships of bone mass and microarchitecture endpoints and their relationship to bone strength were studied. RESULTS Estrogen deficiency caused bone loss. OVX rats treated with Aln monotherapy had significantly better bone mass, microarchitecture, and bone strength than untreated OVX rats. Rats treated with an Aln drug holiday had bone mass and microarchitecture similar to the Aln monotherapy group but with significantly lower bone strength. PTH-treated rats had markedly higher bone endpoints, but all were lost after PTH withdrawal without follow-up treatment. Rats treated with PTH followed by Aln had better bone endpoints than those treated with Aln monotherapy, PTH monotherapy, or an Aln holiday. Rats treated initially with Aln or Ral, then switched to PTH, also had better bone endpoints, than monotherapy treatment. Rats treated with Aln, then PTH, and returned to Aln had the highest values for all endpoints. CONCLUSION Our data indicate that antiresorptive therapy can be coupled with an anabolic agent, to produce and maintain better bone mass, microarchitecture, and strength than can be achieved with any monotherapy.
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Affiliation(s)
- S K Amugongo
- Center for Musculoskeletal Health and Department of Medicine, University of California Davis Medical Center, 4625 2nd Avenue, Suite 1002, Sacramento, CA, 95817, USA
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Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ, Harris ST, Jan de Beur SM, Khosla S, Lane NE, Lindsay R, Nana AD, Orwoll ES, Saag K, Silverman S, Watts NB. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 2014; 25:1439-43. [PMID: 24577348 PMCID: PMC3988515 DOI: 10.1007/s00198-014-2655-z] [Citation(s) in RCA: 368] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/11/2014] [Indexed: 12/13/2022]
Abstract
UNLABELLED Osteoporosis causes an elevated fracture risk. We propose the continued use of T-scores as one means for diagnosis but recommend that, alternatively, hip fracture; osteopenia-associated vertebral, proximal humerus, pelvis, or some wrist fractures; or FRAX scores with ≥3% (hip) or 20% (major) 10-year fracture risk also confer an osteoporosis diagnosis. INTRODUCTION Osteoporosis is a common disorder of reduced bone strength that predisposes to an increased risk for fractures in older individuals. In the USA, the standard criterion for the diagnosis of osteoporosis in postmenopausal women and older men is a T-score of ≤ -2.5 at the lumbar spine, femur neck, or total hip by bone mineral density testing. METHODS Under the direction of the National Bone Health Alliance, 17 clinicians and clinical scientists were appointed to a working group charged to determine the appropriate expansion of the criteria by which osteoporosis can be diagnosed. RESULTS The group recommends that postmenopausal women and men aged 50 years should be diagnosed with osteoporosis if they have a demonstrable elevated risk for future fractures. This includes having a T-score of less than or equal to -2.5 at the spine or hip as one method for diagnosis but also permits a diagnosis for individuals in this population who have experienced a hip fracture with or without bone mineral density (BMD) testing and for those who have osteopenia by BMD who sustain a vertebral, proximal humeral, pelvic, or, in some cases, distal forearm fracture. Finally, the term osteoporosis should be used to diagnose individuals with an elevated fracture risk based on the World Health Organization Fracture Risk Algorithm, FRAX. CONCLUSIONS As new ICD-10 codes become available, it is our hope that this new understanding of what osteoporosis represents will allow for an appropriate diagnosis when older individuals are recognized as being at an elevated risk for fracture.
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Affiliation(s)
- E S Siris
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, NY, USA,
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Javaid MK, Kiran A, Guermazi A, Kwoh CK, Zaim S, Carbone L, Harris T, McCulloch CE, Arden NK, Lane NE, Felson D, Nevitt M. Individual magnetic resonance imaging and radiographic features of knee osteoarthritis in subjects with unilateral knee pain: the health, aging, and body composition study. ACTA ACUST UNITED AC 2013; 64:3246-55. [PMID: 22736267 DOI: 10.1002/art.34594] [Citation(s) in RCA: 43] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Strong associations between radiographic features of knee osteoarthritis (OA) and pain have been demonstrated in persons with unilateral knee symptoms. This study was undertaken to compare radiographic and magnetic resonance imaging (MRI) features of knee OA and assess their ability to discriminate between painful and nonpainful knees in persons with unilateral symptoms. METHODS The study population included 283 individuals ages 70-79 years with unilateral knee pain who were enrolled in the Health, Aging, and Body Composition Study, a study of weight-related diseases and mobility. Radiographs of both knees were read for Kellgren/Lawrence (K/L) grade and individual radiographic features, and 1.5T MRIs were assessed using the Whole-Organ Magnetic Resonance Imaging Score. The association between structural features and pain was assessed using a within-person case-control design and conditional logistic regression. Receiver operating characteristic (ROC) analysis was then used to test the discriminatory performance of structural features. RESULTS In conditional logistic analyses, knee pain was significantly associated with both radiographic features (any joint space narrowing grade ≥ 1) (odds ratio 3.20 [95% confidence interval 1.79-5.71]) and MRI features (any cartilage defect scored ≥ 2) (odds ratio 3.67 [95% confidence interval 1.49-9.04]). However, in most subjects, MRI revealed osteophytes and cartilage and bone marrow lesions in both knees, and using ROC analysis, no individual structural feature discriminated well between painful and nonpainful knees. The best-performing MRI feature (synovitis/effusion) was not significantly more informative than K/L grade ≥ 2 (P = 0.42). CONCLUSION In persons with unilateral knee pain, MRI and radiographic features were associated with knee pain, confirming that structural abnormalities in the knee have an important role in the etiology of pain. However, no single MRI or radiographic finding performed well in discriminating between painful and nonpainful knees. Further work is needed to examine how structural and nonstructural factors influence knee pain.
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Lane NE, Leatherdale ST, Dubin JA, Hammond D. Student and school characteristics associated with use of nicotine replacement therapy: a multilevel analysis among Canadian youth. Addict Behav 2012; 37:811-6. [PMID: 22475584 DOI: 10.1016/j.addbeh.2012.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 02/10/2012] [Accepted: 03/06/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Research indicates that it is common for youths to use nicotine replacement therapy (NRT) despite limited empirical evidence for its effectiveness within this population. Since very little is known about the characteristics associated with NRT use by youth, the current study examined the association between ever and current use of NRT as a function of student characteristics and the characteristics of the schools they attend. METHODS This study used nationally representative student-level data from 29,296 grade 9 to 12 students who participated in the 2008-2009 Canadian Youth Smoking Survey (YSS). School-level data on the built environment surrounding schools were provided by DMTI-Spatial, and data on school location were provided by the Canadian Census. Two multilevel logistic regression models were used to predict ever use of NRT and current use of NRT as a function of student and school characteristics among current smokers. RESULTS Overall, 21.1% of youth smokers in Canada had ever used NRT and 5.1% were currently using NRT. Odds of ever and current NRT use were highest among daily smokers and boys, while youths who had made multiple quit attempts or participated in a quit and win contest were more likely to be ever NRT users. Attending a school located within an urban area increased youths' odds of ever and current NRT use, whereas higher density of pharmacies surrounding a school was inversely associated with current NRT use. CONCLUSIONS Characteristics of students and the schools they attend were associated with the likelihood of youth smokers using NRT. Significant between-school differences in NRT use exist, however further research is needed to identify which school characteristics account for these differences and understand how youth are accessing NRT.
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Affiliation(s)
- Natasha E Lane
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, ON, Canada
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Schnitzer TJ, Lane NE, Birbara C, Smith MD, Simpson SL, Brown MT. Long-term open-label study of tanezumab for moderate to severe osteoarthritic knee pain. Osteoarthritis Cartilage 2011; 19:639-46. [PMID: 21251985 DOI: 10.1016/j.joca.2011.01.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [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: 10/04/2010] [Revised: 12/14/2010] [Accepted: 01/09/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study was designed to evaluate the long-term safety and effectiveness of repeated doses of the humanized anti-nerve growth factor antibody, tanezumab, during open-label treatment of patients with OA knee pain. DESIGN The current study (clinicaltrials.gov identifier: NCT00399490) was a multicenter, phase II, open-label, multiple-dose extension of an earlier randomized clinical trial. All patients (N=281) received infusions of tanezumab 50μg/kg on Days 1 and 56 with subsequent doses administered at 8-week intervals (up to a total of eight infusions). The primary endpoint of this study was safety. Effectiveness evaluations included overall knee pain, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index subscales, and subject global assessment (SGA) of response to therapy on 0-100 point visual analog scales. RESULTS Repeated administration of tanezumab resulted in a low incidence of treatment-related adverse events (AEs; 7.5%). The rate of serious AEs was also low (2.8%) with none considered treatment-related. Few AEs of abnormal peripheral sensation were reported; hypoesthesia was reported by nine patients (3.2%), paresthesia by seven patients (2.5%), and hyperesthesia, peripheral neuropathy, and sensory disturbance were each reported by one patient (0.4% for each). Most AEs of abnormal peripheral sensation were rated as mild (95%) and the majority (65%) resolved before study completion. At Week 8, overall knee pain and SGA improved from baseline by a mean (± standard error) of -12.8 (±1.78) and 8.0 (±1.66), respectively. Similar improvements occurred for WOMAC subscales. CONCLUSIONS Repeated injections of tanezumab in patients with moderate to severe knee OA provide continued pain relief and improved function with a low incidence of side effects. Additional studies to define the efficacy and duration of pain reduction and to provide a more complete assessment of long-term safety are warranted.
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Affiliation(s)
- T J Schnitzer
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Lane NE, Leatherdale ST, Ahmed R. Use of Nicotine Replacement Therapy Among Canadian Youth: Data From the 2006–2007 National Youth Smoking Survey. Nicotine Tob Res 2011; 13:1009-14. [DOI: 10.1093/ntr/ntr091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Panoutsopoulou K, Southam L, Elliott KS, Wrayner N, Zhai G, Beazley C, Thorleifsson G, Arden NK, Carr A, Chapman K, Deloukas P, Doherty M, McCaskie A, Ollier WER, Ralston SH, Spector TD, Valdes AM, Wallis GA, Wilkinson JM, Arden E, Battley K, Blackburn H, Blanco FJ, Bumpstead S, Cupples LA, Day-Williams AG, Dixon K, Doherty SA, Esko T, Evangelou E, Felson D, Gomez-Reino JJ, Gonzalez A, Gordon A, Gwilliam R, Halldorsson BV, Hauksson VB, Hofman A, Hunt SE, Ioannidis JPA, Ingvarsson T, Jonsdottir I, Jonsson H, Keen R, Kerkhof HJM, Kloppenburg MG, Koller N, Lakenberg N, Lane NE, Lee AT, Metspalu A, Meulenbelt I, Nevitt MC, O'Neill F, Parimi N, Potter SC, Rego-Perez I, Riancho JA, Sherburn K, Slagboom PE, Stefansson K, Styrkarsdottir U, Sumillera M, Swift D, Thorsteinsdottir U, Tsezou A, Uitterlinden AG, van Meurs JBJ, Watkins B, Wheeler M, Mitchell S, Zhu Y, Zmuda JM, Zeggini E, Loughlin J. Insights into the genetic architecture of osteoarthritis from stage 1 of the arcOGEN study. Ann Rheum Dis 2010; 70:864-7. [PMID: 21177295 PMCID: PMC3070286 DOI: 10.1136/ard.2010.141473] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives The genetic aetiology of osteoarthritis has not yet been elucidated. To enable a well-powered genome-wide association study (GWAS) for osteoarthritis, the authors have formed the arcOGEN Consortium, a UK-wide collaborative effort aiming to scan genome-wide over 7500 osteoarthritis cases in a two-stage genome-wide association scan. Here the authors report the findings of the stage 1 interim analysis. Methods The authors have performed a genome-wide association scan for knee and hip osteoarthritis in 3177 cases and 4894 population-based controls from the UK. Replication of promising signals was carried out in silico in five further scans (44 449 individuals), and de novo in 14 534 independent samples, all of European descent. Results None of the association signals the authors identified reach genome-wide levels of statistical significance, therefore stressing the need for corroboration in sample sets of a larger size. Application of analytical approaches to examine the allelic architecture of disease to the stage 1 genome-wide association scan data suggests that osteoarthritis is a highly polygenic disease with multiple risk variants conferring small effects. Conclusions Identifying loci conferring susceptibility to osteoarthritis will require large-scale sample sizes and well-defined phenotypes to minimise heterogeneity.
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Chaganti RK, Parimi N, Lang T, Orwoll E, Stefanick ML, Nevitt M, Lane NE. Bone mineral density and prevalent osteoarthritis of the hip in older men for the Osteoporotic Fractures in Men (MrOS) Study Group. Osteoporos Int 2010; 21:1307-16. [PMID: 20101493 PMCID: PMC3354730 DOI: 10.1007/s00198-009-1105-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 09/09/2009] [Indexed: 01/14/2023]
Abstract
SUMMARY We evaluated the association of bone mineral density (BMD) and osteoarthritis (OA) of the hip in elderly men. We found that elderly men with moderate to severe radiographic hip OA (RHOA) had significantly higher areal BMD (aBMD) and volumetric BMD (vBMD) at both the lumbar spine and hip compared to age similar controls without OA. INTRODUCTION We evaluated the association of BMD measured by dual energy X-ray absorptiometry (DXA) and quantitative computerized tomography (integral, cortical, and trabecular vBMD) and RHOA in a cohort of elderly men. METHODS A cross-sectional analysis was conducted within the Study of Osteoporotic Fractures in Men, a prospective cohort study of 5,995 US men age > or = 65 years. Standing pelvic x-rays were done in 4,024 subjects and scored for prevalent RHOA severity. DXA was done in 3,886 subjects, and aBMD and vBMD associations were compared with RHOA score using linear regression, adjusting for covariates. RESULTS Both moderate and severe RHOA groups had significantly higher aBMD at all BMD sites (range, 3.7-10.0% difference; p value 0.0012 and p value < 0.005) compared to the control group with no RHOA. The difference remained strong after adjusting for covariates. While the total hip and lumbar spine cortical vBMD measurements of subjects with moderate or severe RHOA was increased compared to controls, trabecular vBMD was not. CONCLUSION Older men, with both moderate and severe RHOA, had significantly higher aBMD and integral vBMD at the hip and lumbar spine compared to controls without RHOA.
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Affiliation(s)
- R K Chaganti
- University of California at San Francisco, San Francisco, CA, USA
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Chaganti RK, Parimi N, Cawthon P, Dam TL, Nevitt MC, Lane NE. Association of 25-hydroxyvitamin D with prevalent osteoarthritis of the hip in elderly men: the osteoporotic fractures in men study. ACTA ACUST UNITED AC 2010; 62:511-4. [PMID: 20112402 DOI: 10.1002/art.27241] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the cross-sectional association of serum levels of 25-hydroxyvitamin D, or 25(OH)D, with prevalent radiographic hip osteoarthritis (OA) in elderly men. METHODS In a cohort of 1,104 elderly men from the Osteoporotic Fractures in Men Study, 25(OH)D serum levels were determined by mass spectrometry, followed by pelvic radiographs approximately 4.6 years later. Categories of vitamin D levels were defined as follows: deficiency as < or =15 ng/ml, insufficiency as 15.1-30 ng/ml, and sufficiency as >30 ng/ml. Radiographs were assessed for severity of hip OA using a summary grade of 0-4 for individual features of hip OA. Logistic regression was used to assess associations of serum 25(OH)D levels with prevalent radiographic hip OA; covariates included age, clinic site, season at the time of blood withdrawal, self-reported hip pain for >30 days, timed 6-meter walk, presence of at least 1 coexisting condition, and self-rated health status. RESULTS Men with radiographic hip OA had a slower 6-meter walking time (P < 0.0001), reported more hip pain (P = 0.0001), had a lower vitamin D level (P = 0.0002), and had a higher prevalence of vitamin D insufficiency (P = 0.002) and vitamin D deficiency (P = 0.012) compared with controls. Higher 25(OH)D levels were associated with a lower prevalence of radiographic hip OA (odds ratio [OR] 1.39 per 1 SD decrease in 25[OH]D, 95% confidence interval [95% CI] 1.11-1.74) after adjusting for age, season, and clinic site. Men with vitamin D insufficiency had an increased likelihood of prevalent radiographic hip OA (OR 2.19, 95% CI 1.21-3.97) compared with men with sufficient levels of 25(OH)D, and in men with vitamin D deficiency, there was a tendency toward an increased likelihood of radiographic hip OA (OR 1.99, 95% CI 0.83-4.74). CONCLUSION Men with vitamin D deficiencies are twice as likely to have prevalent radiographic hip OA, and therefore vitamin D therapy to augment skeletal health in the elderly is warranted.
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Affiliation(s)
- R K Chaganti
- University of California, San Francisco, CA, USA
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Stehling C, Schwaiger BJ, Müller-Höcker C, Krug R, Kuo D, Lane NE, Nevitt MC, Lynch J, McCulloch CE, Link TM. Veränderungen der Knorpel T2 Relaxationzeit einzelner Kniekompartimente bei körperlicher Aktivität: 24 Monate Verlaufskontrolle bei 182 asymptomatischen Personen der Osteoarthritis Initiative. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252535] [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: 10/19/2022]
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Stehling C, Müller-Höcker C, Schwaiger BJ, Lane NE, Nevitt MC, McCulloch CE, Link TM. Knorpel T2 Relaxationzeiten und Knieveränderungen bei 3 Tesla sagen Veränderungen von klinischen Parametern über 2 Jahre voraus: Analyse von 217 asymptomatischen Personen der Osteoarthritis Initiative. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252528] [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: 10/19/2022]
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