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Zechmann S, Scherz N, Reich O, Brüngger B, Senn O, Rosemann T, Neuner-Jehle S. Appropriateness of bone density measurement in Switzerland: a cross-sectional study. BMC Public Health 2018; 18:423. [PMID: 29606111 PMCID: PMC5879564 DOI: 10.1186/s12889-018-5305-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/13/2018] [Indexed: 11/27/2022] Open
Abstract
Background According to the WHO, osteoporosis is one of the most important non- communicable diseases worldwide. Different screening procedures are controversially discussed, especially concerning the concomitant issues of overdiagnosis and harm caused by inappropriate Dual X-ray Absorptiometry (DXA). The aim of this study was to evaluate the frequency and appropriateness of DXA as screening measure in Switzerland considering individual risk factors and to evaluate covariates independently associated with potentially inappropriate DXA screening. Methods Retrospective cross-sectional study using insurance claim data of 2013. Among all patients with DXA screening, women < 65 and men < 70 years without osteoporosis or risk factors for osteoporosis were defined as receiving potentially inappropriate DXA. Statistics included descriptive measures and multivariable regressions to estimate associations of relevant covariates with potentially inappropriate DXA screening. Results Of 1,131,092 patients, 552,973 were eligible. Among those 2637 of 10,000 (26.4%) underwent potentially inappropriate DXA screening. Female sex (Odds ratio 6.47, CI 6.41–6.54) and higher age showed the strongest association with any DXA screening. Female gender (Odds ratio 1.84, CI 1.49–2.26) and an income among the highest 5% (Odds ratio 1.40, CI 1.01–1.98) were significantly positively associated with potentially inappropriate DXA screening, number of chronic conditions (Odds ratio 0.67, CI 0.65–0.70) and living in the central region of Switzerland (Odds ratio 0.67, CI 0.48–0.95) negatively. Conclusion One out of four DXAs for screening purpose is potentially inappropriate. Stakeholders of osteoporosis screening campaigns should focus on providing more detailed information on appropriateness of DXA screening indications (e.g. age thresholds) in order to avoid DXA overuse. Electronic supplementary material The online version of this article (10.1186/s12889-018-5305-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Zechmann
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | - Nathalie Scherz
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
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Screening for osteoporosis following non-vertebral fractures in patients aged 50 and older independently of gender or level of trauma energy-a Swiss trauma center approach. Arch Osteoporos 2017; 12:38. [PMID: 28391563 DOI: 10.1007/s11657-017-0334-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/03/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Screening in a standardized manner for osteoporosis in non-vertebral fracture patients aged 50 and older independently of both gender and level of trauma energy yielded the indication for osteoporotic therapy for every fourth male high-energy fracture patient. PURPOSE This study aimed to identify the rate of osteoporosis in patients of both genders after fracture independently of the underlying level of trauma energy. METHODS A random cohort of patients aged 50 or older with non-vertebral fractures participated in a standardized diagnostic protocol to evaluate the indication for treatment of osteoporosis (number needed to screen (NNS)). Univariate and multivariate analysis as well as correlation testing were performed to determine statistical relationships. Significance was set at p < 0.05. RESULTS Of 478 fracture patients with a mean age of 69.3 ± 11.8 years, 317 (66.3%) were female and 161 (33.7%) male. One hundred nineteen patients (24.9%) sustained high-energy fractures (HEFs) and 359 (75.1%) low-energy fractures (LEFs). Twenty-eight percent of males and 47% of females qualified as osteoporotic in densitometry (dual-energy X-ray absorptiometry (DXA)), resulting in a NNS of 2.1 for women and 3.6 for men. The indication for treatment of osteoporosis increased to an NNS of 1.5 for females and 2.4 for males if the fracture risk assessment tool (FRAX) was included in the diagnostics (DXA and FRAX). With regard to the energy of trauma, the NNS for treatment following DXA and FRAX was 1.5 for LEF and 2.9 for HEF. Subgroup analysis revealed that HEF males within the decennia 50+ and 80+ had an NNS of around 3, i.e., comparable to females and about twice as high as LEF patients. CONCLUSIONS These preliminary findings appear to confirm the pragmatic approach to screening in a standardized manner for osteoporosis in all non-vertebral fracture patients aged 50 and older-independently of both gender and level of trauma energy.
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He WT, Liang BC, Shi ZY, Li XY, Li CW, Shi XL. Weak cation exchange magnetic beads coupled with matrix-assisted laser desorption ionization-time of flight-mass spectrometry in screening serum protein markers in osteopenia. SPRINGERPLUS 2016; 5:679. [PMID: 27347465 PMCID: PMC4899343 DOI: 10.1186/s40064-016-2276-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/04/2016] [Indexed: 02/04/2023]
Abstract
The present study aimed at investigating the weak cation magnetic separation technology and matrix-assisted laser desorption ionization-time of flight-mass spectrometry (MALDI-TOF-MS) in screening serum protein markers of osteopenia from ten postmenopausal women and ten postmenopausal women without osteopenia as control group, to find a new method for screening biomarkers and establishing a diagnostic model for primary type I osteoporosis. Serum samples were collected from postmenopausal women with osteopenia and postmenopausal women with normal bone mass. Proteins were extracted from serum samples by weak cation exchange magnetic beads technology, and mass spectra acquisition was done by MALDI-TOF-MS. The visualization and comparison of data sets, statistical peak evaluation, model recognition, and discovery of biomarker candidates were handled by the proteinchip data analysis system software(ZJU-PDAS). The diagnostic models were established using genetic arithmetic based support vector machine (SVM). The SVM result with the highest Youden Index was selected as the model. Combinatorial Peaks having the highest accuracy in distinguishing different samples were selected as potential biomarker. From the two group serum samples, a total of 133 differential features were selected. Ten features with significant intensity differences were screened. In the pair-wise comparisons, processing of MALDI-TOF spectra resulted in the identification of ten differential features between postmenopausal women with osteopenia and postmenopausal women with normal bone mass. The difference of features by Youden index showed that the highest features had a mass to charge ratio of 1699 and 3038 Da. A diagnosis model was established with these two peaks as the candidate marker, and the specificity of the model is 100 %, the sensitivity was 90 % by leave-one-out cross validation test. The two groups of specimens in SVM results on the scatter plot could be clearly distinguished. The peak with m/z 3038 in the SVM model was suggested as Secretin by TagIdent tool. To provide further validation, the secretin levels in serum were analyzed using enzyme-linked immunosorbent assays that is a competitive inhibition enzyme immunoassay technique for the in vitro quantitative measurement of secretin in human serum.
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Affiliation(s)
- Wei-Tao He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310005 China
| | - Bo-Cheng Liang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310005 China
| | - Zhen-Yu Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310005 China
| | - Xu-Yun Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310005 China
| | - Chun-Wen Li
- Department of Diagnostics of Traditional Chinese Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310005 China
| | - Xiao-Lin Shi
- Department of Osteology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Holmberg T, Bech M, Gram J, Hermann AP, Rubin KH, Brixen K. Point-of-Care Phalangeal Bone Mineral Density Measurement Can Reduce the Need of Dual-Energy X-Ray Absorptiometry Scanning in Danish Women at Risk of Fracture. Calcif Tissue Int 2016; 98:244-52. [PMID: 26590810 DOI: 10.1007/s00223-015-0084-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/08/2015] [Indexed: 01/20/2023]
Abstract
Identifying persons with a high risk of osteoporotic fractures remains a challenge. DXA uptake in women with elevated risk of osteoporosis seems to be depending on distance to scanning facilities. This study aimed to investigate the ability of a small portable scanner in identifying women with reduced bone mineral density (BMD), and to define triage thresholds for pre-selection. Total hip and lumbar spine BMD was measured by dual-energy X-ray absorptiometry and phalangeal BMD by radiographic absorptiometry in 121 Danish women with intermediate or high 10-year fracture probability (aged 61-81 years). Correlation between the two methods was estimated using correlation coefficient (r) and Bland-Altman plots. A moderate correlation between phalangeal BMD versus total hip (r = 0.47) and lumbar spine (r = 0.51), and an AUC on 0.80 was found. The mean difference between phalangeal T score and total hip T score/lumbar spine T score was low, and ranged from -0.26 SD to -0.31 SD depending on site and reference database used for calculation of T scores, but, large variation was seen at an individual level. When applying a triage approach approx. one-third of all DXA scan could be avoided and only 6 % of women in the low-risk group would be false negatives.
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Affiliation(s)
- Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2, 1399, Copenhagen K, Denmark.
| | - Mickael Bech
- KORA, the Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Jeppe Gram
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | | | - Katrine Hass Rubin
- Odense Patient Data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Kim Brixen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Mirandola L, Wade R, Verma R, Pena C, Hosiriluck N, Figueroa JA, Cobos E, Jenkins MR, Chiriva-Internati M. Sex-driven differences in immunological responses: challenges and opportunities for the immunotherapies of the third millennium. Int Rev Immunol 2016; 34:134-42. [PMID: 25901858 DOI: 10.3109/08830185.2015.1018417] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF THE STUDY Male-based studies, both at the biochemical and at the pre-clinical/clinical trial levels, still predominate in the scientific community. Many studies are based on the wrong assumption that both sexes are fundamentally identical in their response to treatments. As a result, findings obtained mainly in males are applied to females, resulting in negative consequences female patients. In cancer immunotherapy, there is still a scarce focus on this topic. Here we review the main differences in immune modulation and immune system biology between males and females with a particular focus on how these differences affect cancer immunotherapy and cancer vaccines. METHODS We reviewed articles published on PubMed from 1999 to 2014, using the keywords: sex hormones, immune response, estrogen, immunotherapy, testosterone, cancer vaccines, sex-based medicine. We also present new data wherein the expression of the cancer testis antigen, Ropporin-1, was determined in patients with multiple myeloma, showing that the expression of Ropporin-1 was influenced by sex. RESULTS Male and female immune systems display radical differences mainly due to the immune regulatory effects of sex hormones. These differences might have a dramatic impact on the immunological treatment of cancer. Moreover, the expression of tumor antigens that can be targeted by anti-cancer vaccines is associated with sex. CONCLUSION Future clinical trials focusing on cancer immunotherapy will need to take into account the differences in the immune response and in the frequency of target antigen expression between male and females, in order to optimize these anti-cancer immunotherapies of the third millennium.
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Affiliation(s)
- Leonardo Mirandola
- Division of Hematology/Oncology, Department of Internal Medicine, Texas Tech University Health Sciences Center , Lubbock, TX , USA
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Risk factors for osteoporosis and factors related to the use of DXA in Norway. Arch Osteoporos 2015; 10:16. [PMID: 26067929 DOI: 10.1007/s11657-015-0220-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/05/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED To evaluate the case-finding strategy for osteoporosis in Norway, a questionnaire concerning risk factors for osteoporosis and history of osteodensitometry was mailed to a population-based cohort of 6000 men and 6000 women. Suboptimal examination rates among high risk and reallocation of scanning capacity to seemingly low-risk individuals was found. PURPOSE In Norway, a case-finding strategy for osteoporosis has been used. No data exist regarding the efficacy of this approach. The aim was to examine the prevalence of risk factors for osteoporosis and factors related to the use of dual X-ray absorptiometry (DXA) in Norway. METHODS Questionnaires regarding previous history of DXA, risk factors for osteoporosis and fracture were sent to an age-stratified, nationwide cross-sectional sample of 6000 men and 6000 women aged 40-90 years, drawn from the Norwegian Civil Registration System. RESULTS Valid responses (6029) were included. Twenty-two point three percent of women and 3.8 % of men had been examined by DXA. Suboptimal examination rates among high risk (e.g., current/previous glucocorticoid treatment or previous low-energy fracture) and reallocation of scanning capacity to seemingly low-risk individuals was found. Of all DXA, 19.5 % were reported by women without any risk factor for osteoporosis, similarly by 16.2 % of men. Distance to DXA facilities and current smoking were inversely related to probability of reporting a DXA. CONCLUSIONS Suboptimal examination rates among high risk and reallocation of scanning capacity to seemingly low-risk individuals were found. Distance to DXA, current smoking, and male sex constituted possible barriers to the case-finding strategy employed. Cheap and more available diagnostic tools for osteoporosis are needed, and risk stratification tools should be employed more extensively.
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Friis-Holmberg T, Rubin KH, Brixen K, Tolstrup JS, Bech M. Fracture risk prediction using phalangeal bone mineral density or FRAX(®)?-A Danish cohort study on men and women. J Clin Densitom 2014; 17:7-15. [PMID: 23623379 DOI: 10.1016/j.jocd.2013.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/15/2013] [Accepted: 03/15/2013] [Indexed: 10/26/2022]
Abstract
In this prospective study, we investigated the ability of Fracture Risk Assessment Tool (FRAX), phalangeal bone mineral density (BMD), and age alone to predict fractures using data from a Danish cohort study, Danish Health Examination Survey 2007-2008, including men (n = 5206) and women (n = 7552) aged 40-90 yr. Data were collected using a self-administered questionnaire and by phalangeal BMD measurement. Information on incident and prevalent fractures, rheumatoid arthritis, and secondary osteoporosis was retrieved from the Danish National Patient Registry. Survival analyses were used to examine the association between low, intermediate, and high risk by phalangeal T-score or FRAX and incident fractures, and receiver operating characteristic curves were obtained. Mean follow-up time was 4.3 yr, and a total of 395 persons (3.1%) experienced a fracture during follow-up. The highest rate of major osteoporotic fractures was observed in persons with a high combined risk (FRAX ≥20% and T-score ≤-2.5; women: 32.7 and men: 27.6 per 1000 person-yr). This group also had the highest risk of hip fractures (women: 8.1 and men: 7.2 per 1000 person-yr). FRAX and T-score in combination analyzed as continuous variables performed overall best in the prediction of major osteoporotic fractures. In predicting hip fractures, there was a tendency of T-score performing worse than the other methods.
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Affiliation(s)
- Teresa Friis-Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Katrine Hass Rubin
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kim Brixen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Mickael Bech
- COHERE, Department of Business and Economics, University of Southern Denmark, Odense, Denmark
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Abstract
Osteoporotic fractures in older men (>50 years of age) are common and associated with considerable mortality and morbidity, but osteoporosis in men is under-recognized and undertreated. Secondary osteoporosis is also common in men, and causes include androgen deprivation therapy for prostate cancer, glucocorticoid treatment and alcohol excess. Clinical trials have demonstrated the efficacy of pharmacological osteoporosis treatments in men in terms of increasing BMD and decreasing levels of bone turnover markers; however, few trials have included fracture reduction end points. This Review will consider the pathophysiology of osteoporosis in men and the evidence for testing and treatment. The aims of the Review are to inform clinical practice, to discuss the current evidence base and to highlight the 2012 Endocrine Society clinical practice guidelines on osteoporosis in men.
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Affiliation(s)
- Jennifer S Walsh
- Academic Unit of Bone Metabolism, Sorby Wing, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
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Baggio G, Corsini A, Floreani A, Giannini S, Zagonel V. Gender medicine: a task for the third millennium. Clin Chem Lab Med 2013; 51:713-27. [PMID: 23515103 DOI: 10.1515/cclm-2012-0849] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/18/2013] [Indexed: 01/07/2023]
Abstract
Gender-specific medicine is the study of how diseases differ between men and women in terms of prevention, clinical signs, therapeutic approach, prognosis, psychological and social impact. It is a neglected dimension of medicine. In this review we like to point out some major issues in five enormous fields of medicine: cardiovascular diseases (CVDs), pharmacology, oncology, liver diseases and osteoporosis. CVDs have been studied in the last decades mainly in men, but they are the first cause of mortality and disability in women. Risk factors for CVD have different impacts in men and women; clinical manifestations of CVD and the influence of drugs on CVD have lot of gender differences. Sex-related differences in pharmacokinetics and pharmacodynamics are also emerging. These differences have obvious relevance to the efficacy and side effect profiles of various medications in the two sexes. This evidence should be considered for drug development as well as before starting any therapy. Gender disparity in cancer incidence, aggressiveness and prognosis has been observed for a variety of cancers and, even if partially known, is underestimated in clinical practice for the treatment of the major types of cancer. It is necessary to systematize and encode all the known data for each type of tumor on gender differences, to identify where this variable has to be considered for the purposes of the prognosis, the choice of treatment and possible toxicity. Clinical data suggest that men and women exhibit differences regarding the epidemiology and the progression of certain liver diseases, i.e., autoimmune conditions, genetic hemochromatosis, non-alcoholic steatohepatitis and chronic hepatitis C. Numerous hypotheses have been formulated to justify this sex imbalance including sex hormones, reproductive and genetic factors. Nevertheless, none of these hypothesis has thus far gathered enough convincing evidence and in most cases the evidence is conflicting. Osteoporosis is an important public health problem both in women and men. On the whole, far more epidemiologic, diagnostic and therapeutic studies have been carried out in women than in men. In clinical practice, if this disease remains underestimated in women, patients' and physicians' awareness is even lower for male osteoporosis, for which diagnostic and therapeutic strategies are at present less defined. In conclusion this review emphasizes the urgency of basic science and clinical research to increase our understanding of the gender differences of diseases.
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Affiliation(s)
- Giovannella Baggio
- Internal Medicine Unit, Azienda Ospedaliera di Padova, Via Giustiniani 2, Padua 35125, Italy.
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Phalangeal bone mineral density predicts incident fractures: a prospective cohort study on men and women--results from the Danish Health Examination Survey 2007–2008 (DANHES 2007–2008). Arch Osteoporos 2012; 7:291-9. [PMID: 23152065 DOI: 10.1007/s11657-012-0111-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/28/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures. PURPOSE The aim of this study was to evaluate the ability of a compact and portable scanner using radiographic absorptiometry (RA) to predict major osteoporotic fractures. METHODS This prospective study included a cohort of 15,542 men and women aged 18–95 years, who underwent a BMD scan in Danish Health Examination Survey 2007–2008. BMD at the middle phalanges of the second, third and fourth digits of the non-dominant hand was measured using RA (Alara MetriScan®). These data were merged with information on incident fractures retrieved from the Danish National Patient Registry comprising the International Classification of Diseases (ICD-10). Follow-up was 27–45 months. Major osteoporotic fractures (vertebral fractures, humerus fractures, forearm fractures and hip fractures) were used in the analyses. Fracture events were calculated as "persons with fracture" and evaluated using survival analysis. RESULTS A total of 307 (1.98 %) of the participants had experienced a new fracture during follow-up. BMD was significantly lower in subjects with fracture (0.32 vs. 0.34 g/cm(2); p < 0.001 adjusted for age, gender, prevalent fractures, height, weight and smoking). In both women and men, a 1 SD decrease in BMD (T score units) was associated with an increased risk of fracture when adjusted for age and prevalent fractures (women: HR = 1.39, CI 1.24–1.54, p < 0.001; men: HR = 1.47, CI 1.20–1.79, p < 0.001). CONCLUSION Phalangeal BMD as measured using RA predicts the incidence of major osteoporotic fractures.
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Brennan SL, Wluka AE, Gould H, Nicholson GC, Leslie WD, Ebeling PR, Oldenburg B, Kotowicz MA, Pasco JA. Social determinants of bone densitometry uptake for osteoporosis risk in patients aged 50yr and older: a systematic review. J Clin Densitom 2012; 15:165-75. [PMID: 22321656 DOI: 10.1016/j.jocd.2011.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/06/2011] [Accepted: 12/08/2011] [Indexed: 11/17/2022]
Abstract
The World Health Organization identifies that osteoporosis is one of the leading health problems in the Western world. An increased risk of fragility fracture is observed in more socially disadvantaged individuals in most Western countries. Dual-energy X-ray absorptiometry (DXA) is currently the procedure of choice to diagnose osteoporosis and assess fracture risk. We systematically reviewed the literature regarding social determinants of DXA utilization for osteoporosis detection in patients aged 50yr and older using a computer-aided search of MEDLINE, EMBASE, CINAHL, and PsychINFO from January 1994 to December 2010. Five cross-sectional studies, incorporating 16 separate analyses, were identified for inclusion in this review. The best evidence analysis identified limited evidence for a positive association between either income or education with DXA utilization; furthermore, the best evidence analysis found no evidence for an association between either marital status or working status and DXA utilization. Further research is required to identify whether a relationship exists and elucidate reasons for disparities in DXA utilization between different social groups, such as choice and referral processes, as a necessary precursor in identifying modifiable determinants and appropriate strategies to promote preventive screening to identify fracture risk.
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Affiliation(s)
- Sharon L Brennan
- Department of Medicine, NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, St Albans, Victoria, Australia.
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Leslie WD, Brennan SL, Prior HJ, Lix LM, Metge C, Elias B. The post-fracture care gap among Canadian First Nations peoples: a retrospective cohort study. Osteoporos Int 2012; 23:929-36. [PMID: 22212736 DOI: 10.1007/s00198-011-1880-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 10/27/2011] [Indexed: 12/21/2022]
Abstract
UNLABELLED Despite targeted attempts to reduce post-fracture care gaps, we hypothesized that a larger care gap would be experienced by First Nations compared to non-First Nations people. First Nations peoples were eight times less likely to receive post-fracture care compared to non-First Nations peoples, representing a clinically significant ethnic difference in post-fracture care. INTRODUCTION First Nations peoples are the largest group of aboriginal (indigenous or native) peoples in Canada. Canadian First Nations peoples have a greater risk of fracture compared to non-First Nations peoples. We hypothesized that ethnicity might be associated with a larger gap in post-fracture care. METHODS Non-traumatic major osteoporotic fractures for First Nations and non-First Nations peoples aged ≥ 50 years were identified from a population-based data repository for Manitoba, Canada between April 1996 and March 2002. Logistic regression analysis was used to examine the probability of receiving a BMD test, a diagnosis of osteoporosis, or beginning an osteoporosis-related drug in the 6 months post-fracture. RESULTS A total of 11,234 major osteoporotic fractures were identified; 502 occurred in First Nations peoples. After adjustment for confounding covariates, First Nations peoples were less likely to receive a BMD test [odds ratio (OR) 0.1, 95% confidence interval (CI), 0.0-0.5], osteoporosis-related drug treatment (OR, 0.5; 95% CI, 0.3-0.7), or a diagnosis of osteoporosis (OR, 0.5; 95% CI, 0.3-0.7) following a fracture compared to non-First Nations peoples. Females were more likely to have a BMD test (OR, 5.0; 95% CI, 2.6-9.3), to be diagnosed with osteoporosis (OR, 1.7; 95% CI, 1.5-2.0), and to begin drug treatment (OR, 4.1; 95% CI, 2.7-6.4) compared to males. CONCLUSIONS An ethnicity difference in post-fracture care was observed. Further work is needed to elucidate underlying mechanisms for this difference and to determine whether failure to initiate treatment originates with the medical practitioner, the patient, or a combination of both. It is imperative that all residents of Manitoba receive efficacious and equal care post-fracture, regardless of ethnicity.
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Affiliation(s)
- W D Leslie
- Department of Medicine, C5121, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, Canada R2H 2A6.
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