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Praveen AD, Aspelund T, Ferguson SJ, Sigurðsson S, Guðnason V, Pálsson H, Matchar D, Helgason B. Refracture and mortality risk in the elderly with osteoporotic fractures: the AGES-Reykjavik study. Osteoporos Int 2024:10.1007/s00198-024-07096-3. [PMID: 38658459 DOI: 10.1007/s00198-024-07096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
There is imminent refracture risk in elderly individuals for up to six years, with a decline thereafter except in women below 75 who face a constant elevated risk. Elderly men with fractures face the highest mortality risk, particularly those with hip and vertebral fractures. Targeted monitoring and treatment strategies are recommended. PURPOSE Current management and interventions for osteoporotic fractures typically focus on bone mineral density loss, resulting in suboptimal evaluation of fracture risk. The aim of the study is to understand the progression of fractures to refractures and mortality in the elderly using multi-state models to better target those at risk. METHODS This prospective, observational study analysed data from the AGES-Reykjavik cohort of Icelandic elderly, using multi-state models to analyse the evolution of fractures into refractures and mortality, and to estimate the probability of future events in subjects based on prognostic factors. RESULTS At baseline, 4778 older individuals aged 65 years and older were included. Elderly men, and elderly women above 80 years of age, had a distinct imminent refracture risk that lasted between 2-6 years, followed by a sharp decline. However, elderly women below 75 continued to maintain a nearly constant refracture risk profile for ten years. Hip (30-63%) and vertebral (24-55%) fractures carried the highest 5-year mortality burden for elderly men and women, regardless of age, and for elderly men over 80, lower leg fractures also posed a significant mortality risk. CONCLUSION The risk of refracture significantly increases in the first six years following the initial fracture. Elderly women, who experience fractures at a younger age, should be closely monitored to address their long-term elevated refracture risk. Elderly men, especially those with hip and vertebral fractures, face substantial mortality risk and require prioritized monitoring and treatment.
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Affiliation(s)
- Anitha D Praveen
- Campus for Research Excellence and Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore.
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association Research Institute, Kopavogur, Iceland
| | - Stephen J Ferguson
- Campus for Research Excellence and Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore
- Institute for Biomechanics, ETH-Zürich, Zurich, Switzerland
| | | | - Vilmundur Guðnason
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association Research Institute, Kopavogur, Iceland
| | - Halldór Pálsson
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - David Matchar
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
| | - Benedikt Helgason
- Campus for Research Excellence and Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore
- Institute for Biomechanics, ETH-Zürich, Zurich, Switzerland
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Lima DP, Chagas-Neto FAD, Gomes de Luna JR, Martins YDO, de Almeida SB, Feitosa CX, Gradvohl LB, Rosa ID, Lopes FKDM, Aragão LFF, Viana-Júnior AB, Augusto KL, Roriz-Filho JDS, d’Alva CB, Montenegro-Júnior RM, Braga-Neto P. Osteoporosis in Parkinson's disease and the role of lean body mass: a cross-sectional study in a Brazilian tertiary center. Front Endocrinol (Lausanne) 2024; 15:1326212. [PMID: 38711983 PMCID: PMC11070524 DOI: 10.3389/fendo.2024.1326212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
Background Parkinson's disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures. Objective This study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD. Methods We performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person's 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations. Results We evaluated 107 patients in total, of whom 45 (42%) were women. The group's mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria. Conclusion Our findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD.
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Affiliation(s)
- Danielle Pessoa Lima
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
- Department of Health Sciences, Medical School of Universidade de Fortaleza, Fortaleza, Ceará, Brazil
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
| | - Francisco Abaeté das Chagas-Neto
- Diagnostic Imaging Department, Division of Radioloy and Sports Medicine of Hospital Geral do Fortaleza, Fortaleza, Ceará, Brazil
- Diagnostic Imaging Department, TS Health Center, Fortaleza, Ceará, Brazil
| | - João Rafael Gomes de Luna
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Yasmin de Oliveira Martins
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Samuel Brito de Almeida
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
| | - Camila Ximenes Feitosa
- Department of Health Sciences, Medical School of Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Leticia Brasil Gradvohl
- Department of Health Sciences, Medical School of Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Isabele Dantas Rosa
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Fábia Karine de Moura Lopes
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
| | - Luciana Felipe Férrer Aragão
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
- Division of Endocrinology and Metabolism, Department of Clinical Medicine, Fortaleza, Ceará, Brazil
| | - Antonio Brazil Viana-Júnior
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
| | - Kristopherson Lustosa Augusto
- Department of Health Sciences, Medical School of Universidade de Fortaleza, Fortaleza, Ceará, Brazil
- Medical School of Faculty of Universidade Federal do Ceará, Department of Clinical Medicine, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Jarbas de Sá Roriz-Filho
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Catarina Brasil d’Alva
- Division of Endocrinology and Metabolism, Department of Clinical Medicine, Fortaleza, Ceará, Brazil
| | - Renan Magalhães Montenegro-Júnior
- Clinical Research Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará/EBSERH, Fortaleza, Ceará, Brazil
- Division of Endocrinology and Metabolism, Department of Clinical Medicine, Fortaleza, Ceará, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Clinical Medicine Department, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil
- Health Sciences Center, Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil
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Fu SH, Yu PY, Li CY, Hung CC, Lee CC, Chen HY, Tai TW, Hwang JS, Yang RS, Chiang H, Lin SY, Wu CH, Liao LC, Chuang CJ, Wu CY, Chang CY, Lee MT, Chen CH, Wang CY. Diagnostic accuracy of algorithms to define incident and second hip fractures: A Taiwan validation study. J Formos Med Assoc 2023; 122 Suppl 1:S82-S91. [PMID: 37353444 DOI: 10.1016/j.jfma.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/31/2023] [Accepted: 05/29/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Previous epidemiological researchers have used various algorithms to identify a second hip fracture; however, there has been no validation of these algorithms to date. This study aimed to verify existing algorithms for identifying second hip fracture under the International Classification of Diseases diagnostic coding systems. Furthermore, we examined the validity of two newly proposed algorithms that integrated the concept of periprosthetic fractures and laterality of the ICD-10 coding system. METHODS Claims data of patients hospitalized for hip fracture from National Taiwan University Hospitals between 2007 and 2020 were retrieved. Hip fracture was confirmed by 2 orthopaedic surgeons with medical records and imaging data as gold standards. The validity of 9 existing and 2 newly proposed algorithms for identifying second hip fracture was evaluated. RESULTS The positive predictive value (PPV) range between 84% and 90% in existing algorithms for identifying second hip fractures. Noteworthy, the longer time interval for discrimination resulted in slightly increased PPV (from 87% to 90%), while decreased sensitivity noticeably (from 87% to 72%). When considering the information about periprosthetic fracture, the PPV increased to 91% without diminished sensitivity. The PPV of the newly proposed ICD-10-specific algorithm was 100%. CONCLUSION Algorithms integrated clinical insights of periprosthetic fractures and laterality concept of ICD-10 coding system provided satisfactory validity and help precisely define second hip fracture in future database research.
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Affiliation(s)
- Shau-Huai Fu
- Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ying Yu
- Department of General Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chih-Chien Hung
- Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Chia-Che Lee
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Hsuan-Yu Chen
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hongsen Chiang
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Yen Lin
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ling-Chiao Liao
- Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Chin-Ju Chuang
- Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Chiu-Yi Wu
- Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Cheng-Ying Chang
- Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Ming-Tsung Lee
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan; Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Orthopaedic Research Center and Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital and Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Chen-Yu Wang
- Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Duprey MS, Zullo AR, Gouskova NA, Lee Y, Capuano A, Kiel DP, Daiello LA, Kim DH, Berry SD. Development and validation of the fall-related injury risk in nursing homes (INJURE-NH) prediction tool. J Am Geriatr Soc 2023; 71:1851-1860. [PMID: 36883262 PMCID: PMC10258142 DOI: 10.1111/jgs.18277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Existing models to predict fall-related injuries (FRI) in nursing homes (NH) focus on hip fractures, yet hip fractures comprise less than half of all FRIs. We developed and validated a series of models to predict the absolute risk of FRIs in NH residents. METHODS Retrospective cohort study of long-stay US NH residents (≥100 days in the same facility) between January 1, 2016 and December 31, 2017 (n = 733,427) using Medicare claims and Minimum Data Set v3.0 clinical assessments. Predictors of FRIs were selected through LASSO logistic regression in a 2/3 random derivation sample and tested in a 1/3 validation sample. Sub-distribution hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated for 6-month and 2-year follow-up. Discrimination was evaluated via C-statistic, and calibration compared the predicted rate of FRI to the observed rate. To develop a parsimonious clinical tool, we calculated a score using the five strongest predictors in the Fine-Gray model. Model performance was repeated in the validation sample. RESULTS Mean (Q1, Q3) age was 85.0 (77.5, 90.6) years and 69.6% were women. Within 2 years of follow-up, 43,976 (6.0%) residents experienced ≥1 FRI. Seventy predictors were included in the model. The discrimination of the 2-year prediction model was good (C-index = 0.70), and the calibration was excellent. Calibration and discrimination of the 6-month model were similar (C-index = 0.71). In the clinical tool to predict 2-year risk, the five characteristics included independence in activities of daily living (ADLs) (HR 2.27; 95% CI 2.14-2.41) and a history of non-hip fracture (HR 2.02; 95% CI 1.94-2.12). Performance results were similar in the validation sample. CONCLUSIONS We developed and validated a series of risk prediction models that can identify NH residents at greatest risk for FRI. In NH, these models should help target preventive strategies.
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Affiliation(s)
- Matthew S. Duprey
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI 02912
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40536
| | - Andrew R. Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI 02912
- Department of Pharmacy, Lifespan Rhode Island Hospital, Providence, RI 02903
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Natalia A. Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Roslindale, MA 02131
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI 02912
| | - Alyssa Capuano
- Department of Pharmacy, Lifespan Rhode Island Hospital, Providence, RI 02903
| | - Douglas P. Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Roslindale, MA 02131
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215
| | - Lori A. Daiello
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI 02912
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Roslindale, MA 02131
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215
| | - Sarah D. Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Roslindale, MA 02131
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215
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Li H, Sun T, Han D, Gong W, Mao W, Gan X, Shu D, Zhou Q, Xu L, Hou L, Zhou M, Cai M, Lai X. Risk factors of osteoporosis in elderly inpatients: A cross-sectional single-centre study. FRONTIERS IN AGING 2023; 4:1126172. [PMID: 37229241 PMCID: PMC10204113 DOI: 10.3389/fragi.2023.1126172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023]
Abstract
Objective: This study aimed to identify factors significantly associated with the occurrence of osteoporosis in elderly and very elderly patients. Methods: Elderly hospitalized patients who were older than 60 years old, from the Rehabilitation Hospital from December 2019 to December 2020 were selected. Barthel index (BI), nutritional assessment, the causes of bone mineral density (BMD) reductions in elderly and elderly patients were analysed. Results: A total of 94 patients (83.56 ± 8.37 years old) were enrolled. With increasing age, the BMD of the lumbar spine, femoral neck, and femoral shaft of elderly patients significantly decreased, and the incidence of osteoporosis (OP) significantly increased. The BMD of the lumbar spine was negatively correlated with female and positively correlated with serum 25-hydroxyvitamin D levels, the difference between actual body weight and ideal body weight, and blood uric acid levels; The BMD of the femoral neck was negatively correlated with age and female, and positively correlated with height and geriatric nutrition risk index score. The BMD of the femoral shaft was negatively correlated with female and positively correlated with BI. Conclusion: With increasing age, the BMD of the lumbar spine and the femoral shaft significantly decreased, and the incidence of OP significantly increased in elderly and very elderly patients. Aric acid may protect bone health in elderly patients. Early attention to the nutritional status, exercise capacity, 25-hydroxyvitamin D level, and blood uric acid level in the elderly population can help identify high-risk elderly patients with OP.
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Affiliation(s)
- Han Li
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Tianbao Sun
- The Rehabilitation Department, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Dongmei Han
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Weiwei Gong
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Weiwei Mao
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xianze Gan
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Dan Shu
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Qian Zhou
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Lei Xu
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Liufang Hou
- The Rehabilitation Department of Nephrology, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | | | - Mingwei Cai
- The Rehabilitation Department of Orthopedics, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xueli Lai
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, China
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Corrao G, Biffi A, Porcu G, Ronco R, Adami G, Alvaro R, Bogini R, Caputi AP, Cianferotti L, Frediani B, Gatti D, Gonnelli S, Iolascon G, Lenzi A, Leone S, Michieli R, Migliaccio S, Nicoletti T, Paoletta M, Pennini A, Piccirilli E, Rossini M, Tarantino U, Brandi ML. Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021. Front Endocrinol (Lausanne) 2023; 14:1137671. [PMID: 37143730 PMCID: PMC10151776 DOI: 10.3389/fendo.2023.1137671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field. Purpose This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline. Methods The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations. Results Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively. Conclusions The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
| | - Annalisa Biffi
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Luisella Cianferotti
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Salvatore Leone
- AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy
| | - Raffaella Michieli
- Italian Society of General Medicine and Primary Care Società Italiana di Medicina Generale e delle cure primarie (SIMG), Florence, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy
| | - Tiziana Nicoletti
- CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa Pennini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | | | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Department of Orthopedics and Traumatology, “Policlinico Tor Vergata” Foundation, Rome, Italy
| | - Maria Luisa Brandi
- Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell’Osso (FIRMO), Florence, Italy
- *Correspondence: Giovanni Corrao, ; Maria Luisa Brandi,
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Silva BC, Madeira M, d'Alva CB, Maeda SS, de Holanda NCP, Ohe MN, Szejnfeld V, Zerbini CAF, de Paula FJA, Bandeira F. Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:591-603. [PMID: 36191263 PMCID: PMC10118822 DOI: 10.20945/2359-3997000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Several drugs are available for the treatment of osteoporosis in postmenopausal women. Over the last decades, most patients requiring pharmacological intervention were offered antiresorptive drugs as first-line therapy, while anabolic agents were considered a last resource for those with therapeutic failure. However, recent randomized trials in patients with severe osteoporosis have shown that anabolic agents reduce fractures to a greater extent than antiresorptive medications. Additionally, evidence indicates that increases in bone mineral density (BMD) are maximized when patients are treated with anabolic agents first, followed by antiresorptive therapy. This evidence is key, considering that greater increases in BMD during osteoporosis treatment are associated with a more pronounced reduction in fracture risk. Thus, international guidelines have recently proposed an individualized approach to osteoporosis treatment based on fracture risk stratification, in which the stratification risk has been refined to include a category of patients at very high risk of fracture who should be managed with anabolic agents as first-line therapy. In this document, the Brazilian Society of Endocrinology and Metabolism and the Brazilian Association of Bone Assessment and Metabolism propose the definition of very high risk of osteoporotic fracture in postmenopausal women, for whom anabolic agents should be considered as first-line therapy. This document also reviews the factors associated with increased fracture risk, trials comparing anabolic versus antiresorptive agents, efficacy of anabolic agents in patients who are treatment naïve versus those previously treated with antiresorptive agents, and safety of anabolic agents.
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Affiliation(s)
- Barbara C Silva
- Unidade de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
- Unidade de Endocrinologia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Departamento de Medicina, Centro Universitário de Belo Horizonte (UNI-BH), Belo Horizonte, MG, Brasil,
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Miguel Madeira
- Divisão de Endocrinologia e Metabolismo, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Catarina Brasil d'Alva
- Departamento de Medicina Clínica, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Sergio Setsuo Maeda
- Unidade de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Narriane Chaves Pereira de Holanda
- Divisão de Endocrinologia e Metabolismo, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Monique Nakayama Ohe
- Unidade de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
| | - Vera Szejnfeld
- Divisão de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Cristiano A F Zerbini
- Centro Paulista de Investigação Clínica, São Paulo, SP, Brasil
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Francisco José Albuquerque de Paula
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
- Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO)
| | - Francisco Bandeira
- Divisão de Endocrinologia e Metabolismo, Faculdade de Medicina, Universidade de Pernambuco, Recife, PE, Brasil
- Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM)
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Vandenput L, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schei B, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan. Osteoporos Int 2022; 33:2103-2136. [PMID: 35639106 DOI: 10.1007/s00198-022-06435-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022]
Abstract
UNLABELLED We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
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Affiliation(s)
- L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Center Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Bone Biology, Healthy Ageing Theme, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research Oxford Biomedical Research Unit, , University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, University Hospital and University of Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - P J M Elders
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- School of Sport Sciences, Arctic University of Norway, Tromsø, Norway
| | - P Nordström
- Unit of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- Institute for Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Barwon Health, Geelong, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Gynecology, St Olavs Hospital, Trondheim, Norway
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP (Research Group), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
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Risk factors for a second nonsimultaneous hip fracture in a prospective cohort study. Arch Orthop Trauma Surg 2022; 142:2611-2617. [PMID: 34125250 DOI: 10.1007/s00402-021-03991-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/09/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The risk factors for a second nonsimultaneous hip fracture are unclear, and in general, it is empirically assumed that they are similar to those associated with the first hip fracture. We aimed to determine the incidence of a second hip fracture and define the characteristics of the patients sustaining the event in a prospective cohort study in a Spanish population. MATERIALS AND METHODS We conducted a multicentric, prospective cohort study in a representative sample of 45 hospitals from 15 autonomic regions in Spain. In total, the study included 994 patients. One hundred and one patients presented a nonsimultaneous contralateral hip fracture, constituting the intervention group. The remaining 893 patients presenting with a hip fracture formed the control group. The main outcome measures of this study were sociodemographic characteristics of the patient, comorbid conditions, and baseline and postfracture clinical outcomes (inpatient complications and acute mortality). RESULTS The key fracture risk factors were a history of fragility fractures, the need for assistance when walking outdoors and a history of falls. There were no associations between the groups in any of the common fragility risk factors, including rheumatoid arthritis, secondary osteoporosis, or steroid consumption. The results showed that patients suffering a nonsimultaneous hip fracture had an increased risk of mortality after discharge compared with the control group. CONCLUSION A nonsimultaneous second hip fracture leads to a near-significant increase in four-month mortality. In our study, this fracture was associated with a history of falls, prior fragility fractures, and the need for a walking aid.
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Dai Z, Hirani V, Sahni S, Felson DT, Naganathan V, Blyth F, Couteur DL, Handelsman D, Seibel MJ, Waite L, Kiel DP, Cumming R. Association of dietary fiber and risk of hip fracture in men from the Framingham Osteoporosis Study and the Concord Health and Ageing in Men Project. Nutr Health 2022; 28:229-238. [PMID: 33940973 PMCID: PMC10622166 DOI: 10.1177/02601060211011798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Data in the Offspring Framingham Osteoporosis Study (FOS) suggested that higher intake of dietary fiber was modestly protective against loss of bone mineral density at the femoral neck in men but not in women. AIM To examine the relationship of fiber intake with risk of hip fractures in men. METHODS We included 367 men from the FOS Original cohort, 1730 men from the FOS Offspring cohort, and 782 men from the Concord Health and Ageing in Men Project (CHAMP) in the analysis. Incident fractures were defined as medically confirmed first occurrence of osteoporotic fractures at the proximal femur. Fiber intake was estimated via a validated food frequency questionnaire (FFQ) or diet history. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A random-effects model was used to estimate the pooled relative risk in meta-analysis. RESULTS Seventy-two incident hip fractures were identified, of which 24 occurred in the FOS Original cohort [mean (SD): age 75.3 (5.1) years; follow-up time: 8.5 (6.2) years; dietary fiber: 19 (8) (g/d)], 19 in the FOS Offspring cohort [58.8 (9.8) years; 11.0 (5.9) years; 19 (8) (g/d)], and 29 in CHAMP [81.4 (4.5) years; 5.2 (1.5) years; 28 (10) (g/d)]. We did not find significant associations within each cohort between fiber intake and risk of hip fractures. The pooled HR (95% CI) was 0.80 (0.39, 1.66) comparing energy-adjusted dietary fiber at tertile 3 vs. tertile 1 (I2 = 0, p = 0.56). CONCLUSION These data suggested that dietary fiber was not associated with risk of incident hip fractures in men.
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Affiliation(s)
- Zhaoli Dai
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, D17, The Hub, Camperdown, NSW, 2006, Australia
- Boston University School of Medicine, Department of Medicine, Rheumatology and Clinical Epidemiology, USA
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
| | - Vasant Hirani
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research, University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Shivani Sahni
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David T. Felson
- Boston University School of Medicine, Department of Medicine, Rheumatology and Clinical Epidemiology, USA
- Central Manchester Foundation Trust and University of Manchester, Manchester UK
| | - Vasi Naganathan
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Aging and Alzheimer’s Institute, Concord Hospital, Sydney, New South Wales, Australia
| | - David Le Couteur
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Handelsman
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Aging and Alzheimer’s Institute, Concord Hospital, Sydney, New South Wales, Australia
| | - Markus J Seibel
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Waite
- Bone Research Program, ANZAC Research Institute, and Department of Endocrinology and Metabolism, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Robert Cumming
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Khalid S, Reyes C, Ernst M, Delmestri A, Toth E, Libanati C, Abrahamsen B, Prieto-Alhambra D. One- and 2-year incidence of osteoporotic fracture: a multi-cohort observational study using routinely collected real-world data. Osteoporos Int 2022; 33:123-137. [PMID: 34392386 PMCID: PMC8758600 DOI: 10.1007/s00198-021-06077-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022]
Abstract
We estimated and characterized the imminent fracture risk (1-2 years) of high-risk fracture patients through a multinational (UK, Spain, Denmark) cohort study. Older individuals with newly diagnosed osteoporosis and individuals who had a fracture while on treatment with a bisphosphonate were at a high risk of imminent fracture. PURPOSE To characterize and estimate 1- to 2-year fracture risk in high-risk fracture patients. METHODS Multi-cohort study in (database/study period) UK (CPRD/1995-2017), Spain (SIDIAP/2006-2016) and Denmark (DHR/1995-2016) including individuals ≥ 50 years old in NDO (newly diagnosed osteoporosis), OFx (incident osteoporotic fracture), BP (incident oral bisphosphonates use) or FWOT (fracture while on treatment with bisphosphonates). Outcomes (ICD-10/READ): hip, clinical spine, non-hip, non-spine and hip/humerus/distal forearm fracture. FOLLOW-UP from cohort entry until death, migration/transfer or end of the study. STATISTICS baseline characteristics and incidence rate (IR per 1000 persons). RESULTS (1-YEAR IR): NDO included 69,899 (UK), 37,901 (Spain) and 158,191 (Denmark) individuals. Spanish-IR was lowest for hip (4.7), clinical spine (2.5) and major osteoporotic fracture (MOF) (17.3) and highest in Denmark (74.2, 26.0 and 120.1, respectively). OFx included 83,514 (UK), 51,044 (Spain) and 509,551 (Denmark) individuals. IR in Denmark was highest for hip (24.1) and MOF (47.2), in Spain was highest for the clinical spine (9.4) and lowest for hip (9.5) and in the UK was lowest for the clinical spine (2.8) and MOF (20.7). BP included 148,507 (UK), 52,037 (Spain) and 204,010 (Denmark) individuals. Spanish-IR was lowest for hip (5.0) and MOF (21.1) and highest in Denmark (20.3 and 48.6, respectively). FWOT included 28,930 (UK), 1,865 (Spain) and 31,882 (Denmark) individuals. Clinical spine-IR was highest for Spain (12.0). Hip-IR was lowest for Spain (7.6) and highest for Denmark (33.6). Comparing young subjects, those who have FWOT started with an increased fracture rate. CONCLUSION OFx and FWOT individuals experience higher re-fracture incidence rates than those with osteoporosis with or without treatment.
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Affiliation(s)
- Sara Khalid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, Nuffield Orthopaedic Centre, Oxford, UK
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a ÍAtenció Primària de Salut Jordi Gol i Gorina (IDIAPJ Gol), CIBERFES, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Martin Ernst
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, Nuffield Orthopaedic Centre, Oxford, UK
| | | | | | - Bo Abrahamsen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, Nuffield Orthopaedic Centre, Oxford, UK
- Open Patient Data Explorative Network, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, Nuffield Orthopaedic Centre, Oxford, UK.
- Fundació Institut Universitari per a la recerca a ÍAtenció Primària de Salut Jordi Gol i Gorina (IDIAPJ Gol), CIBERFES, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.
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12
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Smolle MA, Leitner L, Böhler N, Seibert FJ, Glehr M, Leithner A. Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:1006-1019. [PMID: 34909221 PMCID: PMC8631245 DOI: 10.1302/2058-5241.6.210058] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This systematic review and meta-analysis aimed to analyse negative effects of smoking in orthopaedic and trauma patients. A PubMed search was carried out for studies published until July 2020 regarding effects of smoking on fracture risk, nonunion, infection after orthopaedic surgery, and persisting nonunion after scaphoid nonunion surgery. Random effects models calculated for outcome parameters, and relative risks (RR) with 95% confidence intervals are provided. No adjustments for covariates were made. Heterogeneity was assessed with Higgins’ I2, publication bias with Harbord’s p (Hp), sensitivity analysis performed on funnel plots and quality of studies was analysed using the Newcastle-Ottawa Scale. Of 3362 retrieved entries, 69 were included in the final analysis. Unadjusted RR for smokers to develop vertebral (six studies, seven entries; RR: 1.61; p = 0.008; I2 = 89.4%), hip (11 studies, 15 entries; RR: 1.28; p = 0.007; I2 = 84.1%), and other fractures (eight studies, 10 entries; RR: 1.75; p = 0.019; I2 = 89.3%) was significantly higher. Postoperative infection risk was generally higher for smokers (21 studies; RR: 2.20; p < 0.001; I2 = 58.9%), and remained upon subgroup analysis for elective spinal (two studies; RR: 4.38; p < 0.001; I2 = 0.0%) and fracture surgery (19 studies; RR: 2.10; p < 0.001; I2 = 58.5%). Nonunion risk after orthopaedic (eight studies; RR: 2.15; p < 0.001; I2 = 35.9%) and fracture surgery (11 studies; RR: 1.85; p < 0.001; I2 = 39.9%) was significantly higher for smokers, as was persisting nonunion risk after surgery for scaphoid nonunion (five studies; RR: 3.52; p < 0.001; I2 = 0.0%). Sensitivity analysis for each model reduced heterogeneity whilst maintaining significance (all I2 < 20.0%). Smoking has a deleterious impact on fracture incidence, and (subsequent) development of nonunions and postoperative infections.
Cite this article: EFORT Open Rev 2021;6:1006-1019. DOI: 10.1302/2058-5241.6.210058
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Nikolaus Böhler
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria
| | - Franz-Josef Seibert
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Mathias Glehr
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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13
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Skjødt MK, Möller S, Hyldig N, Clausen A, Bliddal M, Søndergaard J, Abrahamsen B, Rubin KH. Validation of the Fracture Risk Evaluation Model (FREM) in predicting major osteoporotic fractures and hip fractures using administrative health data. Bone 2021; 147:115934. [PMID: 33757901 DOI: 10.1016/j.bone.2021.115934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/12/2021] [Accepted: 03/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prevention of osteoporotic fractures remains largely insufficient, and effective means to identify patients at high, short-term fracture risk are needed. The FREM tool is available for automated case finding of men and women aged 45 years or older at high imminent (1-year) risk of osteoporotic fractures, based on administrative health data with a 15-year look-back. The aim of this study was to validate the performance of FREM, and the effect of applying a shorter look-back period. We also evaluated FREM for 5-year fracture risk prediction. METHODS Using Danish national health registers we generated consecutive general population cohorts for the years 2014 through 2018. Within each year and across the full time period we estimated the individual fracture risk scores and determined the actual occurrence of major osteoporotic fractures (MOF) and hip fractures. Risk scores were calculated with 15- and 5-year look-back periods. The discriminative ability was evaluated by area under the receiver operating curve (AUC), and negative predictive value (NPV) and positive predictive value (PPV) were estimated applying a calculated risk cut-off of 2% for MOF and 0.3% for hip fractures. RESULTS Applying a 15-year look-back, AUC was around 0.75-0.76 for MOF and 0.84-0.87 for hip fractures in 2014, with minor decreases in the subsequent fracture cohorts (2015 to 2018). Applying a 5-year look-back generated similar results, with only marginally lower AUC. In the 5-year risk prediction setting, AUC-values were 0.70-0.72 for MOF and 0.81-0.84 for hip fractures. Generally, PPVs were low, while NPVs were very high. CONCLUSION FREM predicts the 1- and 5-year risk of MOF and hip fractures with acceptable vs excellent discriminative power, respectively, when applying both a 15- and a 5-year look-back. Hence, the FREM tool may be applied to improve identification of individuals at high imminent risk of fractures using administrative health data.
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Affiliation(s)
- Michael K Skjødt
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Heden 16, DK-5000 Odense C, Denmark; Department of Medicine, Holbæk Hospital, Smedelundsgade 60, DK-4300 Holbæk, Denmark
| | - Sören Möller
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Heden 16, DK-5000 Odense C, Denmark
| | - Nana Hyldig
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Heden 16, DK-5000 Odense C, Denmark
| | - Anne Clausen
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Heden 16, DK-5000 Odense C, Denmark
| | - Mette Bliddal
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Heden 16, DK-5000 Odense C, Denmark
| | - Jens Søndergaard
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense, Denmark
| | - Bo Abrahamsen
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Heden 16, DK-5000 Odense C, Denmark; Department of Medicine, Holbæk Hospital, Smedelundsgade 60, DK-4300 Holbæk, Denmark
| | - Katrine Hass Rubin
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Heden 16, DK-5000 Odense C, Denmark.
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14
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Tran O, Silverman S, Xu X, Bonafede M, Fox K, McDermott M, Gandra S. Long-term direct and indirect economic burden associated with osteoporotic fracture in US postmenopausal women. Osteoporos Int 2021; 32:1195-1205. [PMID: 33411007 PMCID: PMC8128807 DOI: 10.1007/s00198-020-05769-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/30/2020] [Indexed: 11/05/2022]
Abstract
UNLABELLED The study examined long-term direct and indirect economic burden of osteoporotic fractures among postmenopausal women. Healthcare costs among fracture patients were substantial in first year after fracture and remained higher than fracture-free controls for 5 years which highlight needs for early detection of high-risk patients and continued management for osteoporosis. INTRODUCTION This study compared direct and indirect healthcare costs between postmenopausal women and demographically matched controls in the 5 years after incident non-traumatic fracture, and by fracture type in commercially insured and Medicare populations. METHODS Two hundred twenty-six thousand one hundred ninety women (91,925 aged 50-64 years; 134,265 aged ≥ 65 years) with incident non-traumatic fracture (hip, vertebral, and non-hip non-vertebral (NHNV)) from 2008 to 2017 were identified. Patients with fracture were directly matched (1:1) to non-fracture controls based on demographic characteristics. Direct healthcare costs were assessed using general linear models, adjusting for baseline costs, comorbidities, osteoporosis diagnosis, and treatment. Indirect costs associated with work loss due to absenteeism and short-term disability (STD) were assessed among commercially insured patients. Costs were standardized to 2019 US dollars. RESULTS Osteoporosis diagnosis and treatment rates prior to fracture were low. Patients with fracture incurred higher direct costs across 5-year post-index compared with non-fracture controls, regardless of fracture type or insurance. For commercially insured hip fracture patients, the mean adjusted incremental direct healthcare costs in years 1, 3, and 5 were $59,327, $6885, and $3241, respectively. Incremental costs were lower, but trends were similar for vertebral and NHNV fracture types and Medicare-insured patients. Commercially insured patients with fracture had higher unadjusted indirect costs due to absenteeism and STD in year 1 and higher adjusted indirect costs due to STD at year 1 (incremental cost $5848, $2748, and $2596 for hip, vertebral, and NHNV fracture). CONCLUSIONS A considerable and sustained economic burden after a non-traumatic fracture underscores the need for early patient identification and continued management.
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Affiliation(s)
- Oth Tran
- IBM Watson Health, 75 Binney St, Cambridge, MA, 02142, USA.
| | - Stuart Silverman
- Cedars-Sinai Medical Center and David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | - Kathleen Fox
- Strategic Healthcare Solutions, LLC, Aiken, SC, USA
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15
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McCloskey EV, Borgstrom F, Cooper C, Harvey NC, Javaid MK, Lorentzon M, Kanis JA. Short time horizons for fracture prediction tools: time for a rethink. Osteoporos Int 2021; 32:1019-1025. [PMID: 33914103 PMCID: PMC7611752 DOI: 10.1007/s00198-021-05962-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Fredrik Borgstrom
- Quantify Research, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mohamed K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mattias Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
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16
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Barnsley J, Buckland G, Chan PE, Ong A, Ramos AS, Baxter M, Laskou F, Dennison EM, Cooper C, Patel HP. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res 2021; 33:759-773. [PMID: 33742387 PMCID: PMC8084810 DOI: 10.1007/s40520-021-01817-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/13/2021] [Indexed: 12/12/2022]
Abstract
Osteoporosis, a common chronic metabolic bone disease is associated with considerable morbidity and mortality. As the prevalence of osteoporosis increases with age, a paralleled elevation in the rate of incident fragility fractures will be observed. This narrative review explores the origins of bone and considers physiological mechanisms involved in bone homeostasis relevant to management and treatment. Secondary causes of osteoporosis, as well as osteosarcopenia are discussed followed by an overview of the commonly used pharmacological treatments for osteoporosis in older people.
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Affiliation(s)
- J Barnsley
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Buckland
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P E Chan
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Ong
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A S Ramos
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Baxter
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - F Laskou
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Oxford, Oxford, UK
| | - Harnish P Patel
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Academic Geriatric Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and The University of Southampton, Southampton, UK.
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17
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Legrand MA, Chapurlat R. Imminent fracture risk. Joint Bone Spine 2020; 88:105105. [PMID: 33171311 DOI: 10.1016/j.jbspin.2020.105105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/26/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Mélanie A Legrand
- Department of Rheumatology, Edouard Herriot University Hospital, 5, Place d'Arsonval, 69003 Lyon, France; INSERM UMR 1033, Université de Lyon, Lyon, France.
| | - Roland Chapurlat
- Department of Rheumatology, Edouard Herriot University Hospital, 5, Place d'Arsonval, 69003 Lyon, France; INSERM UMR 1033, Université de Lyon, Lyon, France
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18
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Compston JE, Drake MT. Defining Very High Fracture Risk: Is FRAX Fit for Purpose? J Bone Miner Res 2020; 35:1399-1403. [PMID: 32696997 DOI: 10.1002/jbmr.4134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, and Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
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19
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Søgaard AJ, Magnus JH, Bjørnerem Å, Holvik K, Ranhoff AH, Emaus N, Meyer HE, Strand BH. Grip strength in men and women aged 50-79 years is associated with non-vertebral osteoporotic fracture during 15 years follow-up: The Tromsø Study 1994-1995. Osteoporos Int 2020; 31:131-140. [PMID: 31650188 DOI: 10.1007/s00198-019-05191-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/07/2019] [Indexed: 01/16/2023]
Abstract
UNLABELLED In 50-79-year-olds who participated in the Tromsø Study (1994-1995), the risk of non-vertebral osteoporotic fractures during 15 years follow-up increased by 22% in men and 9% in women per 1 SD lower grip strength. The strongest association was observed in men aged 50-64 years. INTRODUCTION We aimed to explore whether low grip strength was associated with increased risk of non-vertebral osteoporotic fracture in the population-based Tromsø Study 1994-1995. METHODS Grip strength (bar) was measured by a Martin Vigorimeter and fractures were retrieved from the X-ray archives at the University Hospital of North Norway between 1994 and 2010. At baseline, weight and height were measured, whereas information on the other covariates were obtained through self-reported questionnaires. Cox regression was used to estimate the hazard ratio (HR) of fracture in age- and gender-specific quintiles of grip-strength, and per 1 SD lower grip strength. Similar analyses were done solely for hip fractures. Adjustments were made for age, height, body mass index (BMI), marital status, education, smoking, physical activity, use of alcohol, self-perceived health, and self-reported diseases. RESULTS In 2891 men and 4002 women aged 50-79 years, 1099 non-vertebral osteoporotic fractures-including 393 hip fractures-were sustained during the median 15 years follow-up. Risk of non-vertebral osteoporotic fracture increased with declining grip strength: hazard ratios per SD decline was 1.22 (95% CI 1.05-1.43) in men and 1.09 (95% CI 1.01-1.18) in women. HR for fracture in lower vs. upper quintile was 1.58 (95% CI 1.02-2.45) in men and 1.28 (95% CI 1.03-1.59) in women. The association was most pronounced in men aged 50-64 years with HR = 3.39 (95% CI 1.76-6.53) in the lower compared to the upper quintile. CONCLUSIONS The risk of non-vertebral osteoporotic fracture increased with declining grip-strength in both genders, particularly in men aged 50-64 years.
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Affiliation(s)
- A J Søgaard
- Division of Mental and Physical Health, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway.
| | - J H Magnus
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Å Bjørnerem
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway
| | - K Holvik
- Division of Mental and Physical Health, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway
| | - A H Ranhoff
- Division of Mental and Physical Health, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - N Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - H E Meyer
- Division of Mental and Physical Health, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - B H Strand
- Division of Mental and Physical Health, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
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