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Solbakken SM, Meyer HE, Dahl C, Finnes TE, Hjellvik V, Nielsen CS, Omsland TK, Stigum H, Holvik K. The medication-based Rx-Risk Comorbidity Index and risk of hip fracture - a nationwide NOREPOS cohort study. BMC Med 2024; 22:118. [PMID: 38481235 PMCID: PMC10938738 DOI: 10.1186/s12916-024-03335-w] [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: 09/08/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Few previous studies have assessed overall morbidity at the individual level with respect to future risk of hip fracture. The aim of this register-based cohort study was to examine the association between morbidity measured by the medication-based Rx-Risk Comorbidity Index (Rx-Risk) and the risk of first hip fracture. METHODS Individual-level data on medications dispensed from pharmacies (2005-2016) was retrieved from the Norwegian Prescription Database and used to calculate Rx-Risk for each calendar year. Information on first hip fractures (2006-2017) was obtained from a nationwide hip fracture database. Individuals ≥ 51 years who filled at least one prescription during the study period comprised the population at risk. Using Rx-Risk as a time-varying exposure variable, relative risk estimates were obtained by a negative binomial model. RESULTS During 2006-2017, 94,104 individuals sustained a first hip fracture. A higher Rx-Risk was associated with increased risk of hip fracture within all categories of age and sex. Women with the highest Rx-Risk (> 25) had a relative risk of 6.1 (95% confidence interval (CI): 5.4, 6.8) compared to women with Rx-Risk ≤ 0, whereas the corresponding relative risk in women with Rx-Risk 1-5 was 1.4 (95% CI: 1.3, 1.4). Similar results were found in men. Women > 80 years with Rx-Risk 21-25 had the highest incidence rate (514 (95% CI: 462, 566) per 10, 000 person years). The relative increase in hip fracture risk with higher Rx-Risk was most pronounced in the youngest patients aged 51-65 years. CONCLUSIONS Rx-Risk is a strong predictor of hip fracture in the general outpatient population and may be useful to identify individuals at risk in a clinical setting and in future studies.
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Affiliation(s)
- Siri Marie Solbakken
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
| | - Haakon Eduard Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Vidar Hjellvik
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher Sivert Nielsen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Tone Kristin Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Saizen Y, Ikuta K, Katsuhisa M, Takeshita Y, Moriki Y, Kasamatsu M, Onishi M, Wada K, Honda C, Nishimoto K, Nabetani Y, Iwasaki T, Koujiya E, Yamakawa M, Takeya Y. Impact of nurse-led interprofessional work in older patients with heart failure and multimorbidity: A retrospective cohort study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 38:100361. [PMID: 38510745 PMCID: PMC10946049 DOI: 10.1016/j.ahjo.2024.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/04/2024] [Indexed: 03/22/2024]
Abstract
Background The number of patients with multimorbidity has increased due to the aging of the global population. Although the World Health Organization has indicated that multimorbidity will be a major medical problem in the future, the appropriate interventions for patients with multimorbidity are currently unknown. This study aimed to investigate whether nurse-led interprofessional work is associated with improved prognosis in heart failure patients with multimorbidity aged ≥65 years who were admitted in an acute care hospital. Methods Patients who were admitted to the cardiovascular medicine ward of an acute care hospital in Osaka, Japan, and underwent nurse-led interprofessional work from April 1, 2017 to March 31, 2020, and from April 1, 2014 to March 31, 2016, were included in this retrospective cohort study. The patients were matched by age, sex, and New York Heart Association classification. The nurse-led interprofessional work was based on a three-step model that incorporates recommendations from international guidelines for multimorbidity. The primary outcome was all-cause mortality. Results The mean age of the participants was 80 years, and 62 % were men. The nurse-led interprofessional work group showed a significant difference in all-cause mortality compared with the usual care group (hazard ratio, 0.45; 95 % confidence interval [CI], 0.29-0.69; P < 0.001). Compared with the usual care group, the nurse-led interprofessional work group exhibited a 7 % difference in mortality rate at 1-year post-discharge (P < 0.001). Conclusions Nurse-led interprofessional work may reduce the all-cause mortality in older patients with heart failure and multimorbidity.
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Affiliation(s)
- Yuichiro Saizen
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
| | - Kasumi Ikuta
- Tokyo Medical and Dental University Graduate School of Health Sciences, Department of Home Care Nursing, Tokyo, Japan
| | - Mizuki Katsuhisa
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
| | - Yuko Takeshita
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
| | - Yuki Moriki
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
| | - Misaki Kasamatsu
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
| | - Mai Onishi
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
| | - Kiyoko Wada
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Chiharu Honda
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kyoko Nishimoto
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | | | - Eriko Koujiya
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
| | - Miyae Yamakawa
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
| | - Yasushi Takeya
- Osaka University Graduate School of Medicine Gerontological Nursing Laboratory, Osaka, Japan
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Vizcarra P, Moreno A, Vivancos MJ, Muriel García A, Ramirez Schacke M, González-Garcia J, Curran A, Palacios R, Sánchez Guirao AJ, Reus Bañuls S, Moreno Guillén S, Casado JL. A Risk Assessment Tool for Predicting Fragility Fractures in People with HIV: Derivation and Internal Validation of the FRESIA Model. J Bone Miner Res 2023; 38:1443-1452. [PMID: 37545089 DOI: 10.1002/jbmr.4894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
People with HIV have a higher risk of fracture than the general population. Because of the low performance of the existing prediction tools, there is controversy surrounding fracture risk estimation in this population. The aim of the study was to develop a model for predicting the long-term risk of fragility fractures in people with HIV. We included 11,899 individuals aged ≥30 years from the Spanish HIV/AIDS research network cohort. We identified incident fragility fractures from medical records, defined as nontraumatic or those occurring after a casual fall, at major osteoporotic sites (hip, clinical spine, forearm, proximal humerus). Our model accounted for the competing risk of death and included 12 candidate predictors to estimate the time to first fragility fracture. We assessed the discrimination and calibration of the model and compared it with the FRAX tool. The incidence rate of fragility fractures was 4.34 (95% CI 3.61 to 5.22) per 1000 person-years. The final prediction model included age, chronic kidney disease, and chronic obstructive pulmonary disease as significant predictors. The model accurately predicted the 5- and 10-year risk of fragility fractures, with an area under the receiving operator characteristic curve of 0.768 (95% CI 0.722 to 0.814) and agreement between the observed and expected probabilities. Furthermore, it demonstrated better discrimination and calibration than the FRAX tool, improving the classification of over 35% of individuals with fragility fractures compared to FRAX. Our prediction model demonstrated accuracy in predicting the long-term risk of fragility fractures. It can assist in making personalized intervention decisions for individuals with HIV and could potentially replace the current tools recommended for fracture risk assessment in this population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Pilar Vizcarra
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María J Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel García
- Unit of Biostatistics, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica en Red, Epidemiología y Salud Pública (CIBERESP), Universidad de Alcalá, Madrid, Spain
| | - Margarita Ramirez Schacke
- Unit of Infectious Diseases - HIV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan González-Garcia
- Unit of VIH, Department of Internal Medicine II, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Adrián Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rosario Palacios
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | - Sergio Reus Bañuls
- Unit of Infectious Diseases, ISABIAL, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Santiago Moreno Guillén
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José L Casado
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Bokrantz T, Manhem K, Lorentzon M, Karlsson M, Ljunggren Ö, Ohlsson C, Mellström D. The association between peripheral arterial disease and risk for hip fractures in elderly men is not explained by low hip bone mineral density. Results from the MrOS Sweden study. Osteoporos Int 2022; 33:2607-2617. [PMID: 35986119 PMCID: PMC9652164 DOI: 10.1007/s00198-022-06535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022]
Abstract
UNLABELLED In this prospective study in Swedish elderly men, PAD based on an ABI < 0.9 was associated with an increased risk of hip fracture, independent of age and hip BMD. However, after further adjustments for comorbidity, medications, physical function, and socioeconomic factors, the association diminished and was no longer statistically significant. INTRODUCTION To examine if peripheral arterial disease (PAD) is associated with an increased risk for hip fracture in men independent of hip BMD. METHODS Ankle-brachial index (ABI) was assessed in the Swedish MrOS (Osteoporotic Fractures in Men) study, a prospective observational study including 3014 men aged 69-81 years at baseline. PAD was defined as ABI < 0.90. Incident fractures were assessed in computerized X-ray archives. The risk for hip fractures was calculated using Cox proportional hazard models. At baseline, BMD was assessed using DXA (Lunar Prodigy and Hologic QDR 4500) and functional measurements and blood samples were collected. Standardized questionnaires were used to collect information about medical history, falls, and medication. RESULTS During 10 years of follow-up, 186 men had an incident hip fracture. The hazard ratio (HR) for hip fracture in men with PAD was 1.70 (95% CI 1.14-2.54), adjusted for age and study site. Additional adjustment for total hip BMD marginally affected this association (HR 1.64; 95% CI 1.10-2.45). In a final multivariate model, the HR attenuated to a non-significant HR 1.38 (95% CI 0.91-2.11) adjusted for age, site, hip BMD, BMI, falls, smoking, eGFR, handgrip strength, walking speed, former hip fracture, antihypertensive treatment, diabetes, education, and history of cardiovascular disease. CONCLUSION This study suggests that PAD is associated with an increased risk for hip fracture independently of hip BMD in elderly Swedish men. However, the high frequency of comorbidity and lower physical performance among men with PAD might partly explain this association.
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Affiliation(s)
- Tove Bokrantz
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
| | - Karin Manhem
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Mattias Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences Malmö (IKVM), Lund University, Skåne University Hospital, Malmö, Sweden
| | - Östen Ljunggren
- Department of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Surís X, Vela E, Clèries M, Pueyo-Sánchez MJ, Llargués E, Larrosa M. Epidemiology of major osteoporotic fractures: a population-based analysis in Catalonia, Spain. Arch Osteoporos 2022; 17:47. [PMID: 35267128 DOI: 10.1007/s11657-022-01081-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to estimate the incidence of major osteoporotic fractures in Catalonia, Spain, in 2018 and 2019 and their association with age, sex, income, climate and a set of comorbidities. METHODS Data on age, sex, smoking, alcohol abuse, comorbidities (obesity, Parkinson's disease, arthritis, chronic kidney disease, hepatic cirrhosis, diabetes, chronic obstructive pulmonary disease, dementia, cerebrovascular disease, hyperthyroidism, multiple myeloma and epilepsy) and income levels in people aged ≥ 50 years with a new diagnosis of major osteoporotic fractures in 2018 and 2019 were collected from the Catalan Health Surveillance System (CHSS). Climatological variables were obtained from the Catalan Meteorological Service. Incidence rates were estimated for five major osteoporotic fractures (MOF). Associations between osteoporotic fractures and age, sex, income, comorbidities and climate variables were ascertained through multilevel generalized linear model analysis (Poisson's regression). RESULTS There were 60,671 MOF. The annual incidence rate per 1000 persons/years at risk (PYAR) was 10.6 (3.1 for hip, 2.3 for distal forearm, 2.2 for vertebrae, 1.7 for pelvis and 1.5 for proximal humerus). Female sex, older age, lower income, smoking, alcohol abuse and some common comorbidities were associated with a higher incidence of MOF while obesity was a protective factor. CONCLUSIONS MOF are frequent in the adult Catalan population, especially in older women and people on low incomes. Hip fracture is the most frequent, followed by forearm and vertebral fractures. Smoking, alcohol abuse and some comorbidities were associated with an increased incidence of fracture.
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Affiliation(s)
- Xavier Surís
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain. .,Rheumatology Department, Hospital General de Granollers, C/ Francesc Ribas SN, 08400, Granollers, Barcelona, Spain. .,School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain. .,Catalan Health Service, Catalonia, Spain.
| | - Emili Vela
- Knowledge and Information Unit, Catalan Health Service, Catalonia, Spain.,Digitalization for the Sustainability of the Healthcare System, Catalonia, Spain
| | - Montserrat Clèries
- Knowledge and Information Unit, Catalan Health Service, Catalonia, Spain.,Digitalization for the Sustainability of the Healthcare System, Catalonia, Spain
| | - Maria-Jesús Pueyo-Sánchez
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain.,Catalan Health Service, Catalonia, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.,Internal Medicine Department, Hospital General de Granollers, Granollers, Spain
| | - Marta Larrosa
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain
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Clausen A, Möller S, Skjødt MK, Bech BH, Rubin KH. Evaluating the performance of the Charlson Comorbidity Index (CCI) in fracture risk prediction and developing a new Charlson Fracture Index (CFI): a register-based cohort study. Osteoporos Int 2022; 33:549-561. [PMID: 34993562 DOI: 10.1007/s00198-021-06293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED The Charlson Comorbidity Index (CCI) may be applicable for predicting fracture risk since several diagnoses from the index are predictors of fracture. Main results were that the CCI was updated to predict risk of hip fracture with fair precision and that the index could be useful in detecting high-risk individuals. PURPOSE Several of the Charlson Comorbidity Index (CCI) diagnoses are validated predictors of fracture. The purpose of this study was to evaluate the performance of the CCI 1987 by Charlson et al. and of the CCI 2011 by Quan et al. in predicting major osteoporotic fracture (MOF) and hip fracture (HF). Furthermore, it was examined whether the index could be modified to improve fracture risk prediction. METHODS The study population included the entire Danish population aged 45 + years as per January 1, 2018. The cohort was split randomly 50/50 into a development and a validation cohort. CCI diagnoses and fracture outcomes were identified from hospital diagnoses. The weighting of diagnoses was updated in a new Charlson Fracture Index (CFI) using multivariable logistic regression. Predictive capabilities of the CCI 1987, the updated CCI 2011 and the new Charlson Fracture index were evaluated in the validation cohort by receiver operating characteristics (ROC) curves and area under the curve (AUC). RESULTS In the validation cohort, the 1987 and 2011 CCIs resulted in AUCs below or around 0.7 in prediction of MOF and HF in both sexes. The CFI resulted in AUCs < 0.7 in prediction of MOF in both sexes. In prediction of HF, the CFI resulted in AUC of 0.755 (95% CI 0.749; 0.761) in women and 0.782 (95% CI 0.772; 0.793) in men. CONCLUSION The 1987 and 2011 CCIs showed overall poor accuracy in fracture risk prediction. The CFI showed fair accuracy in prediction of HF in women and in men.
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Affiliation(s)
- A Clausen
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - S Möller
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M K Skjødt
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - B H Bech
- Department of Public Health - Department of Epidemiology, Aarhus University, Aarhus, Denmark
| | - K H Rubin
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Andrich S, Haastert B, Neuhaus E, Frommholz K, Arend W, Ohmann C, Grebe J, Vogt A, Brunoni C, Jungbluth P, Thelen S, Dintsios CM, Windolf J, Icks A. Health care utilization and excess costs after pelvic fractures among older people in Germany. Osteoporos Int 2021; 32:2061-2072. [PMID: 33839895 PMCID: PMC8510957 DOI: 10.1007/s00198-021-05935-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Our study demonstrates a strong increase in utilization of inpatient health care and clear excess costs in older people in the first year after pelvic fracture, the latter even after adjustment for several confounders. Excess costs were particularly high in the first few months and mainly attributable to inpatient treatment. INTRODUCTION We aimed to estimate health care utilization and excess costs in patients aged minimum 60 years up to 1 year after pelvic fracture compared to a population without pelvic fracture. METHODS In this retrospective population-based observational study, we used routine data from a large statutory health insurance (SHI) in Germany. Patients with a first pelvic fracture between 2008 and 2010 (n=5685, 82% female, mean age 80±9 years) were frequency matched with controls (n=193,159) by sex, age at index date, and index month. We estimated health care utilization and mean total direct costs (SHI perspective) with 95% confidence intervals (CIs) using BCA bootstrap procedures for 52 weeks before and after the index date. We calculated cost ratios (CRs) in 4-week intervals after the index date by fitting mixed two-part models including adjustment for possible confounders and repeated measurement. All analyses were further stratified for men/women, in-/outpatient-treated, and major/minor pelvic fractures. RESULTS Health care utilization and mean costs in the year after the index date were higher for cases than for controls, with inpatient treatment being particularly pronounced. CRs (95% CIs) decreased from 10.7 (10.2-11.1) within the first 4 weeks to 1.3 (1.2-1.4) within week 49-52. Excess costs were higher for inpatient than for outpatient-treated persons (CRs of 13.4 (12.9-13.9) and 2.3 (2.0-2.6) in week 1-4). In the first few months, high excess costs were detected for both persons with major and minor pelvic fracture. CONCLUSION Pelvic fractures come along with high excess costs and should be considered when planning and allocating health care resources.
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Affiliation(s)
- S Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz-Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - B Haastert
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- mediStatistica, Neuenrade, Germany
| | | | | | - W Arend
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - C Ohmann
- Clinical Research Infrastructure Network (ECRIN), Düsseldorf, Germany
| | - J Grebe
- Coordination Centre for Clinical Trials, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - A Vogt
- Coordination Centre for Clinical Trials, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - C Brunoni
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - P Jungbluth
- Department of Orthopaedics and Trauma Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - S Thelen
- Department of Orthopaedics and Trauma Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - C-M Dintsios
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Windolf
- Department of Orthopaedics and Trauma Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz-Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Salaffi F, Carotti M, Di Carlo M, Ceccarelli L, Galli M, Sarzi-Puttini P, Giovagnoni A. Predicting Severe/Critical Outcomes in Patients With SARS-CoV2 Pneumonia: Development of the prediCtion seveRe/crItical ouTcome in COVID-19 (CRITIC) Model. Front Med (Lausanne) 2021; 8:695195. [PMID: 34568363 PMCID: PMC8456023 DOI: 10.3389/fmed.2021.695195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/12/2021] [Indexed: 01/02/2023] Open
Abstract
Objective: To create a prediction model of the risk of severe/critical disease in patients with Coronavirus disease (COVID-19). Methods: Clinical, laboratory, and lung computed tomography (CT) severity score were collected from patients admitted for COVID-19 pneumonia and considered as independent variables for the risk of severe/critical disease in a logistic regression analysis. The discriminative properties of the variables were analyzed through the area under the receiver operating characteristic curve analysis and included in a prediction model based on Fagan's nomogram to calculate the post-test probability of severe/critical disease. All analyses were conducted using Medcalc (version 19.0, MedCalc Software, Ostend, Belgium). Results: One hundred seventy-one patients with COVID-19 pneumonia, including 37 severe/critical cases (21.6%) and 134 mild/moderate cases were evaluated. Among all the analyzed variables, Charlson Comorbidity Index (CCI) was that with the highest relative importance (p = 0.0001), followed by CT severity score (p = 0.0002), and age (p = 0.0009). The optimal cut-off points for the predictive variables resulted: 3 for CCI [sensitivity 83.8%, specificity 69.6%, positive likelihood ratio (+LR) 2.76], 69.9 for age (sensitivity 94.6%, specificity 68.1, +LR 2.97), and 53 for CT severity score (sensitivity 64.9%, specificity 84.4%, +LR 4.17). Conclusion: The nomogram including CCI, age, and CT severity score, may be used to stratify patients with COVID-19 pneumonia.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi, Italy
| | - Marina Carotti
- Dipartimento di Scienze Radiologiche Struttura Organizzativa Dipartimentale Radiologia Pediatrica e Specialistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi, Italy
| | - Luca Ceccarelli
- Unità Operativa di Radiologia - Ospedale degli Infermi, Azienda Unità Sanitaria Locale della Romagna, Faenza, Italy
| | - Massimo Galli
- Divisione di Malattie Infettive, Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco, " Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
| | - Piercarlo Sarzi-Puttini
- Divisione di Reumatologia, Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco, " Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
| | - Andrea Giovagnoni
- Dipartimento di Scienze Radiologiche Struttura Organizzativa Dipartimentale Radiologia Pediatrica e Specialistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
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Development and implementation of a perioperative management guide for patients with hip fracture: Health management and clinical impact. ACTA ACUST UNITED AC 2021. [PMID: 34112450 DOI: 10.1016/j.recote.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Hip fracture (HF) in the elderly has a high prevalence and risk of morbidity and mortality in the short and long term. It can reduce life expectancy by almost 2 years, and require permanent socio-sanitary assistance in one in 5 patients. Its management as a process where the patient takes priority over the activities of the organisation can bring new perspectives, optimisation tools and redesign of the workflow to make it more efficient. OBJECTIVE to develop an in-hospital clinical guide for the management of patients with HR adapted to the environment, clear and concise, to be able to intervene in the best possible conditions and favour their adequate recovery. MATERIAL AND METHODS 407 patients divided into 3 groups: pre-implementation (knowing the scope of the problem and areas for improvement); implementation (after the development of the management guide) and post-implementation (valued its implementation). RESULTS The clinical results obtained with this guide allowed improving surgical programming and reducing delay times (increasing the proportion of patients operated in the first 48h and reducing the average hospital stay in 3 days), raising awareness of the problem at all Services involved, improve the management of drugs that altered hemostasia, optimise transfusion therapy and reduce hospital stay and perioperative complications. CONCLUSION The implementation of this guide, with integrated global criteria, has improved the results of this process, and achieved a more efficient management, reducing the consumption of resources and as a consequence, health expenditure.
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10
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Risk factors for second hip fracture in elderly patients: an age, sex, and fracture type matched case-control study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:437-442. [PMID: 34003374 DOI: 10.1007/s00590-021-02996-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/04/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Prevention of second hip fracture is mandatory for orthopedic surgeons. We aimed to clarify the incidence and duration of second hip fracture, to compare survival rate and walking ability of patients with a second hip fracture to that of patients with a unilateral fracture, and to identify risk factors for second hip fracture using matched case-control methods. METHODS This retrospective study conducted in a single tertiary emergency center comprised 119 patients with second hip fractures who underwent bilateral operations at our institution from 2007 to 2017 (second hip fracture group [Group A]). The control group (Group B) comprised 357 patients matched to Group A for age, sex, and fracture type. RESULTS The incidence of second hip fracture was 7.6%, and the average interval from initial fracture to second hip fracture was 22.8 months. Significantly more patients in Group A had decreased postoperative walking ability. Five-year survival rates from initial fracture were 65.0% in Group A and 50.6% in Group B (P = 0.346). Dementia and heart disease were identified as independent risk factors (dementia: HR 2.08, 95% CI 1.27-3.41, P = 0.004; heart disease: HR 1.27, 95% CI1.11-3.22, P = 0.019). Valvular disease was also revealed to be a risk factor for heart disease (P = 0.0272). CONCLUSIONS The incidence of second hip fracture was not low. Although survival rates did not differ between the patients with or without second hip fracture, walking ability of patients with second hip fracture worsened. Dementia and cardiac disease could be risk factors for second hip fracture in elderly patients, and valvular disease might be associated with second hip fracture in patients with heart disease.
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11
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Lee ES, Koh HL, Ho EQY, Teo SH, Wong FY, Ryan BL, Fortin M, Stewart M. Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes. BMJ Open 2021; 11:e041219. [PMID: 33952533 PMCID: PMC8103380 DOI: 10.1136/bmjopen-2020-041219] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES There are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling individuals. The secondary objective was to provide details of the requirements, strengths and limitations of these instruments, and the chosen outcomes. METHODS We conducted the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018105297). We searched MEDLINE, Embase and CINAHL electronic databases published in English and manually searched the Journal of Comorbidity between 1 January 2010 and 23 October 2020 inclusive. Studies also had to select adult patients from primary care or general population and had at least one specified outcome variable. Two authors screened the titles, abstracts and full texts independently. Disagreements were resolved with a third author. The modified Newcastle-Ottawa Scale was used for quality assessment. RESULTS Ninety-six studies were identified, with 69 of them rated to have a low risk of bias. In total, 33 unique instruments were described. Disease Count and weighted indices like Charlson Comorbidity Index were commonly used. Other approaches included pharmaceutical-based instruments. Disease Count was the common instrument used for measuring all three essential core outcomes of multimorbidity research: mortality, mental health and quality of life. There was a rise in the development of novel weighted indices by using prognostic models. The data obtained for measuring multimorbidity were from sources including medical records, patient self-reports and large administrative databases. CONCLUSIONS We listed the details of 33 instruments for measuring the level of multimorbidity as a resource for investigators interested in the measurement of multimorbidity for its association with or prediction of a specific outcome.
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Affiliation(s)
- Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hui Li Koh
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Elaine Qiao-Ying Ho
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sok Huang Teo
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Fang Yan Wong
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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12
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Papaioannou I, Pantazidou G, Kokkalis Z, Georgopoulos N, Jelastopulu E. Systematic Review: Are the Elderly With Diabetes Mellitus Type 2 Prone to Fragility Fractures? Cureus 2021; 13:e14514. [PMID: 34007765 PMCID: PMC8124092 DOI: 10.7759/cureus.14514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diabetes mellitus type 2 (T2DM) is an emerging public health issue with high prevalence rates among older adults while fragility fractures constitute a significant public health burden with a great impact. Osteoporosis is the most important metabolic bone disease in patients with diabetes mellitus. Based on current evidence, individuals with T2DM are more vulnerable to fragility fractures than their non-diabetic counterparts, although until now, there aren’t any systematic reviews or meta-analyses concerning the impact of T2DM on the risk of fragility fractures in elderly patients. The aim of this study is to fill this gap in the current literature concerning this specific patient group. Literature in PubMed and Google Scholar was searched for relevant articles published up to January 2021. The keywords used were: elderly, diabetes mellitus type 2, and fragility fractures. Among the 180 articles retrieved, only four full-text articles were eligible and, finally, two studies (one population-based cohort study and one cross-sectional study) met the inclusion criteria for the review. Although we identified 15 records through the manual research, finally 17 records were included in the current review. The records retrieved from the manual research were 11 prospective cohort studies, two population-based studies, one prospective observational study, and one retrospective cohort study. The author's name, year of publication, country, type of study, and number of patients were reported. According to this systematic review, there is almost consensus about the increased prevalence of all kinds of fragility fractures and especially low-energy hip fractures among elderly patients with T2DM compared with their counterparts without T2DM while there is relative controversy concerning non-vertebral fractures. Vertebral fractures in the elderly with T2DM require further evaluation because the results from cohort studies are more conflicting. Finally, insulin usage can increase the possibility of fragility fractures and can even double this risk. Bone fragility should be recognized as a new complication of T2DM, especially in elderly patients, due to several additional aggravating factors such as senile osteoporosis, severe vitamin D deficiency, presence of many comorbidities, increased possibility of insulin usage, and the presence of diabetes-related complications (mainly neuropathy and retinopathy). Clinicians who treat these patients should be aware of the special diagnostic and therapeutic approaches concerning these patients.
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Affiliation(s)
| | - Georgia Pantazidou
- Otolaryngology - Head and Neck Surgery, General Hospital of Patras, Patras, GRC
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13
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Desarrollo e implementación de una guía de manejo perioperatorio de pacientes con fractura de cadera: gestión sanitaria e impacto clínico. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recot.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Díez-Manglano J, Berges Vidal M, Martínez Barredo L, Poblador-Plou B, Gimeno-Miguel A, Martínez Heras P, Prados-Torres A. Chronic Obstructive Pulmonary Disease and Incidence of Hip Fracture: A Nested Case-Control Study in the EpiChron Cohort. Int J Chron Obstruct Pulmon Dis 2020; 15:2799-2806. [PMID: 33177817 PMCID: PMC7652231 DOI: 10.2147/copd.s270713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine whether chronic obstructive pulmonary disease (COPD) is a risk factor for hip fracture and identify other factors associated with hip fracture. Patients and Methods Observational nested case-control study was conducted in Aragon, Spain in 2010. We included COPD patients aged >40 years, in the EpiChron cohort. Each COPD patient was matched for age, sex, and number of comorbidities with a control subject without COPD. Patients with an existing diagnosis of osteoporosis and those with hip fracture before 2011 were excluded. We collected baseline demographic, comorbidity, and pharmacological treatment data. During a 5-year follow-up period, we recorded the incidence of hip fracture. A logistic regression model was constructed to identify factors associated with hip fracture. Results The study population consisted of 26,517 COPD patients and the same number of controls (median [interquartile range] age, 74 [17] years; women, 24.7%). Smoking and heart failure were more frequent in COPD patients, and obesity, hypertension, diabetes, dyslipidemia, stroke, arthritis, and visual or hearing impairment were less frequent (all p<0.001). Consumption of benzodiazepines (p=0.037), bronchodilators (p<0.001), and corticosteroids (p<0.001) was higher in the COPD group, while that of beta-blockers and thiazides was lower (both p<0.001). During follow-up, 898 (1.7%) patients experienced hip fracture, with no differences observed between COPD and control patients. Multivariate analysis revealed that independent of COPD status, age, female sex, chronic liver disease, heart failure, and benzodiazepine use were independently associated with a higher risk of hip fracture, and obesity with a lower risk. In COPD patients, use of inhaled anticholinergics was independently associated with hip fracture (OR, 1.390; 95% CI 1.134-1.702; p=0.001). Conclusion COPD is not a risk factor for a hip fracture within 5 years. The association between the use of inhaled anticholinergics and risk of hip fracture warrants further study.
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Affiliation(s)
- Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain.,EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
| | - María Berges Vidal
- EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
| | | | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
| | - Pilar Martínez Heras
- Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
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15
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Chen HY, Su PY, Lin TK, Jong GP. Association between statin use and osteoporotic fracture in patients with chronic obstructive pulmonary disease: a population-based, matched case-control study. Lipids Health Dis 2020; 19:232. [PMID: 33143674 PMCID: PMC7641811 DOI: 10.1186/s12944-020-01412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In the recent years, chronic obstructive pulmonary disease (COPD) has been found to be associated with a higher risk of new-onset osteoporotic fracture (NOF). However, the existence of such an association in the COPD patients receiving statin treatment remains unknown. The present study aimed to investigate the association between COPD and NOF in statin-treated patients. METHODS The present study was conducted over a period of 10 years (January 2004 to December 2013) in Taiwan. COPD patients receiving statin treatment were included in the statin user group, whereas the randomly selected statin non-users, with 1:1 matching for sex, age, index date, and Charlson Comorbidity Index, were included in the statin non-user group. The hazard ratio (HR) of NOFs in COPD patients was estimated between statin user and non-user groups. RESULTS A total of 86,188 cases were identified as the statin-treated patients, and 86,188 subjects were included in the control group of statin non-users. Initially, the risk of NOF was found to be higher among the statin users as compared to non-users [HR, 1.12; 95% confidence interval (CI), 1.01-1.25]. However, the calculation of risk for NOFs after the adjustment for age, sex, comorbidities, and concurrent medications indicated no association of NOF (HR, 0.81; 95% CI, 0.55-1.21) with COPD in patients receiving statin treatment as compared to statin non-users. CONCLUSION The results of the study provided first evidence for the absence of any association between COPD and NOFs in statin-treated patients during a follow-up period of 10 years. Thus, the findings of this study might support the hypothesis stating the potent pleiotropic effects of statins. In clinical practice, these drugs might prove beneficial for the patients with COPD.
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Affiliation(s)
- Hung-Yi Chen
- Department of Pharmacy, China Medical University, Taichung, Taiwan, Republic of China.,Department of Pharmacy, China Medical University Beigang Hospital, Yunlin County, Taiwan, Republic of China
| | - Pei-Yu Su
- Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Tsung-Kun Lin
- Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, Republic of China.
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Vilaca T, Schini M, Harnan S, Sutton A, Poku E, Allen IE, Cummings SR, Eastell R. The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update. Bone 2020; 137:115457. [PMID: 32480023 DOI: 10.1016/j.bone.2020.115457] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diabetes is associated with increased fracture risk but we do not know what affects this risk. We investigated the risk of hip and non-vertebral fractures in diabetes and whether this risk was affected by age, gender, body mass index, diabetes type and duration, insulin use and diabetic complications. METHODS We selected a previously published review to be updated. MEDLINE, Embase and Cochrane databases were searched up to March 2020. We included observational studies with age and gender-adjusted risk of fractures in adults with diabetes compared to adults without diabetes. We extracted data from published reports that we summarised using random effects model. FINDINGS From the 3140 records identified, 49 were included, 42 in the hip fracture analysis, reporting data from 17,571,738 participants with 319,652 fractures and 17 in the non-vertebral fracture review, reporting data from 2,978,487 participants with 181,228 fractures. We found an increase in the risk of fracture in diabetes both for hip (RR 4.93, 3.06-7.95, in type 1 diabetes and RR1.33, 1.19-1.49, in type 2 diabetes) and for non-vertebral fractures (RR 1.92, 0.92-3.99, in type 1 and RR 1.19, 1,11-1.28 in type 2). At the hip, the risk was higher in the younger population in both type 1 and type 2 diabetes. In those with type 2 diabetes, longer diabetes duration and insulin use was associated with an increased risk. We did not investigate the effect of bone density, falls, anti-diabetic drugs and hypoglycemia. CONCLUSION Diabetes is associated with an increase in both hip and non-vertebral fracture risk.
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Affiliation(s)
- Tatiane Vilaca
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK.
| | - Marian Schini
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK.
| | - Susan Harnan
- School of Health and Related Research (ScHARR), University of Sheffield, UK.
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, UK.
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, UK.
| | | | - Steven R Cummings
- San Francisco Coordinating Center, Sutter Health, University of California, San Francisco, USA.
| | - Richard Eastell
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK.
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17
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Vilaca T, Salam S, Schini M, Harnan S, Sutton A, Poku E, Allen IE, Cummings SR, Eastell R. Risks of Hip and Nonvertebral Fractures in Patients With CKD G3a-G5D: A Systematic Review and Meta-analysis. Am J Kidney Dis 2020; 76:521-532. [PMID: 32654892 DOI: 10.1053/j.ajkd.2020.02.450] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Disordered mineral metabolism complicates chronic kidney disease (CKD), but the effect of reduced kidney function on fracture risk has not been fully established. We conducted a systematic review and meta-analysis of the risks for hip and nonvertebral fractures in people with CKD. We also investigated the effects of age, sex, and CKD stage. STUDY DESIGN Systematic review and meta-analysis. STUDY POPULATION Adults with CKD glomerular filtration rate (GFR) categories 3a-5D (G3a-G5D) compared with adults without CKD G3a-G5D. SELECTION CRITERIA FOR STUDIES Observational studies. DATA EXTRACTION Data extraction was conducted by 1 reviewer and checked by a second reviewer. ANALYTICAL APPROACH MEDLINE, EMBASE, and Cochrane databases were searched in March 2018 and an update was conducted in November 2019. We used random-effects models to calculate pooled risk estimates and 95% CIs. RESULTS 17 studies met the inclusion criteria. We included 13 studies in the hip fracture systematic review and 10 studies in the meta-analysis. Studies reported data from 250,440,035 participants; 5,798,566 with CKD G3a-G5D and 363,410 with hip fractures. 4 studies were included in the nonvertebral fracture analysis, reporting data from 1,396,976 participants; 464,978 with CKD G3a-G5D and 115,284 fractures. Studies reported data from participants aged 18 to older than 90 years. We found a significant increase in fracture risk both for hip (relative risk [RR], 2.36; 95% CI, 1.64-3.39) and nonvertebral fractures (RR, 1.47; 95% CI, 1.15-1.88). For hip fractures, younger patients (<65 years) had higher relative risk (RR, 7.66; 95% CI, 2.76-21.26) than older patients (>65 years; RR, 2.11; 95% CI, 1.41-3.16). Greater GFR loss was associated with higher relative risk for fractures. LIMITATIONS We could not assess the effects of bone mineral density, biochemical abnormalities, renal osteodystrophy, frailty, falls, or medications on risk for fractures. CONCLUSIONS Risks for hip and nonvertebral fractures are increased in CKD G3a-G5D. The relative risk of hip fracture is greater in the younger than the older population and increases progressively with loss of GFR. We suggest that fracture prevention should be a consideration in CKD at any age.
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Affiliation(s)
- Tatiane Vilaca
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.
| | - Syazrah Salam
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Marian Schini
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Susan Harnan
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Edith Poku
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Richard Eastell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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18
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Pisa FE, Reinold J, Kollhorst B, Haug U, Schink T. Individual Antidepressants and the Risk of Fractures in Older Adults: A New User Active Comparator Study. Clin Epidemiol 2020; 12:667-678. [PMID: 32606992 PMCID: PMC7319507 DOI: 10.2147/clep.s222888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 04/01/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the risk of hip–pelvis and other non-vertebral fractures in older adults using antidepressants (ADs). Methods We conducted a case–control study nested in a cohort of new users of ADs aged ≥65 years without prior hip–pelvis or other non-vertebral fractures, identified in the German Pharmacoepidemiological Research Database (GePaRD) during 2005–2014. Cases were patients first hospitalized for hip–pelvis or other non-vertebral fractures. Up to 100 controls per case were selected using incidence density sampling. AD use was ascertained at index date (ID) based on the supply of last dispensing. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression with current users of mirtazapine as reference (active comparator). Results A total of 39,853 cases of hip–pelvis fracture (80% women, median age 81 years) and 31,577 cases of other fractures (84% women, median age 79 years) were matched to >3 million controls. For hip–pelvis fracture, aORs in current users were about 1.3 with little variation between individual ADs, ranging from 1.33 for citalopram (95% CI 1.27–1.39) to 1.28 for amitriptyline (1.21–1.35). For other fractures, the aORs were highest in current users of citalopram (1.50; 1.42–1.58) and duloxetine (1.54; 1.39–1.71) and lowest for amitriptyline (1.18; 1.11–1.26) and trimipramine (1.16; 1.03–1.29). For all examined ADs, the aORs were higher for other fractures than for hip–pelvis fracture. Conclusion The risk of fractures varies between ADs, but for most agents is higher than the risk for mirtazapine. When treating older adults with ADs, prescribers should carefully consider the risk profile of individual ADs regarding fractures, which are a major health problem in this population.
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Affiliation(s)
- Federica Edith Pisa
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Jonas Reinold
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Researchand Epidemiology - BIPS, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Fernández-Cortiñas AB, Vidal Campos J, Marco Martínez F. Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice. Musculoskelet Surg 2020; 105:167-172. [PMID: 32008184 DOI: 10.1007/s12306-020-00642-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the relevance of a commonly used morbidity prognostic tool, the Charlson comorbidity index (CCI), in determining the survival rate of patients with isolated proximal humeral fractures (PHFs) and to determine the impact of surgical treatment according to previous comorbidities (measured with CCI). MATERIALS AND METHODS All patients who were treated for a single PHF in our institution for 29 consecutive months were included in this retrospective study, with a minimum follow-up of 24 months (mean 52.8 months). Two groups were established according to the type of treatment received (surgical versus non-surgical). Preinjury comorbidities were identified, and the age-adapted CCI was calculated. All complications and mortality rates were prospectively recorded over the complete follow-up period. RESULTS Patients with elevated preinjury comorbidities (CCI > 5) demonstrated a significant increase in mortality (HR = 4.64) compared to those with CCI ≤ 5. In addition, patients with high comorbidities (CCI > 5) who underwent surgical treatment demonstrated a statistically significant increase in mortality (HR = 6.92) compared to patients with similarly high comorbidities (CCI > 5) who underwent non-surgical treatment. CONCLUSIONS Patients with high preinjury comorbidities (CCI > 5) experienced an increased mortality risk if they underwent surgical treatment for isolated PHFs. The use of a morbidity prognostic tool, such as the CCI, can help predict the outcome (particularly mortality) in these patients and may aid in making decisions in terms of operative versus non-operative treatment to minimize patient mortality. LEVEL OF EVIDENCE Level III; Retrospective Comparative Study; Treatment Study.
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Affiliation(s)
- Ana Belén Fernández-Cortiñas
- Complutense University of Madrid, Madrid, Spain. .,Department of Orthopaedic Surgery, Cosaga Hospital, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | - Jesús Vidal Campos
- Department of Orthopaedic Surgery, El Carmen Hospital, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Fernando Marco Martínez
- Complutense University of Madrid, Madrid, Spain.,Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University, Madrid, Spain
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Probert N, Lööw A, Akner G, Wretenberg P, Andersson ÅG. A Comparison of Patients with Hip Fracture, Ten Years Apart: Morbidity, Malnutrition and Sarcopenia. J Nutr Health Aging 2020; 24:870-877. [PMID: 33009538 DOI: 10.1007/s12603-020-1408-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To investigate possible differences in morbidity, malnutrition, sarcopenia and specific drug use in patients with hip fracture, ten years apart. To analyse 1-year mortality and possible associations with variables. DESIGN A prospective, observational study. SETTING Örebro University Hospital, Sweden. PARTICIPANTS Two cohorts of patients with hip fracture, included in 2008 (n=78) and 2018 (n=76). MEASUREMENTS Presence of comorbidity according to the Elixhauser comorbidity measure, multimorbidity defined as ≥3 comorbidities, preoperative American Society of Anaesthesiologists Classification (ASA-class), malnutrition according to the definition by the Global Leadership Initiative on Malnutrition (GLIM), sarcopenia according to the most recently revised definition by the European Working Group on Sarcopenia in Older People (EWGSOP), polypharmacy defined as ≥5 prescribed medications, use of Potentially Inappropriate Medications (PIM) and Fall-Risk-Increasing-Drugs (FRID) and postoperative 1-year mortality. RESULTS When comparing the cohorts, significant increases over time was seen for mean comorbidity-count (Difference -1; p=0.002), multimorbidity (Difference -15%; 95%CI -27;-2), ASA-class 3-4 (Difference -25%; 95%CI -39;-9) and polypharmacy (Difference -17%; 95%CI -32;-2). Prevalence of malnutrition and sarcopenia coherently decreased with 22% (95%CI 5;37) and 14% (95%CI 1;29) respectively. One-year mortality remained unchanged and a significant association was found for a higher ASA-class in 2008 (OR 3.5, 95%CI 1.1;11.6) when adjusted for age. Results on PIM exposure suggest a decrease while exposure to FRID remained high. CONCLUSION Our findings support an increasing morbidity within the population over time. However, also presented is a coherent decrease in malnutrition and sarcopenia, suggesting a decrease in frailty as a possible explanation for the observed unaltered mortality, in turn suggesting advances in treatment of comorbidities.
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Affiliation(s)
- N Probert
- Noelle Probert, MD, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,
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21
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Zacharopoulou G, Zacharopoulou V, Voudouri E, Leondiou L, Dermatis Z. Socioeconomic and clinical risk factors of hip fracture among the elderly: a case-control study. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/bjhc.2019.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background/Aims The aim of the study was to investigate the socioeconomic and clinical risk factors for hip fracture among a community-dwelling elderly population in Greece. It also aimed to identify characteristics associated with reducing mobility. Methods A case-control study was conducted on 202 patients who had a hip fracture and on 202 other members of the elderly population who did not have a hip fracture as the control group. Results In the multivariate analysis, the variables related to an increased risk of hip fracture were: gender (odds ration [OR]=10.88; 95%confidence Interval [CI]=2.28–51.98), income (OR=32.50; 95%CI=2.96–356.43), income adequacy (OR=129,34; 95%CI=7,09–2360,88), inability to pay expenses/medication (OR=0.02; 95%CI=0.003–0.09), depression (OR=0.03; 95%CI=0.002–0.35), multimorbidity (OR=0.01; 95%CI=0.001–0.97), number of medication (OR=0.02; 95%CI=0.001–0.28) and history of falls (OR=0.08; 95%CI=0.01–0.40). Factors related to deterioration of mobility were: age (OR=28.43; 95%CI:5.45–148.32), dementia (OR=15.60; 95%CI:1.80–135.27), walking ability (OR=0.20; 95%CI:0.07–0.56), balance (OR=9.10; 95%CI:1.89–43.75), use of walking aid (OR=7.42; 95%CI:2.70–20.39), and length of hospitalisation (OR=3.01; 95%CI:1.27–7.14). Conclusions Socioeconomic and clinical factors that lead to an increased risk of hip fracture were identified, as well as factors affecting post-operative functional ability that could guide prevention programmes.
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Affiliation(s)
- Georgia Zacharopoulou
- Faculty of Economy, Management and Informatics, Department of Economics, University of Peloponnese, Tripoli, Greece
| | - Vasiliki Zacharopoulou
- Faculty of Economy, Management and Informatics, Department of Economics, University of Peloponnese, Tripoli, Greece
| | | | | | - Zacharias Dermatis
- Laboratory Teaching Staff, Faculty of Economy, Management and Informatics, Department of Economics, University of Peloponnese, Tripoli, Greece
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22
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Liou YS, Lin TK, Chen HY, Jong GP. Medications associated with fracture risk in patients with rheumatoid arthritis. Ann Rheum Dis 2019; 80:e140. [PMID: 31530558 DOI: 10.1136/annrheumdis-2019-216262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Yi-Sheng Liou
- Department of Family Medicine and Geriatrics, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Tsung-Kun Lin
- Department of Pharmacy, Taoyuan Armed Forces General Hospital, Lungtan, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Yi Chen
- Department of Pharmacy, China Medical University, Taichung, Taiwan.,Department of Pharmacy, China Medical University Beigang Hospital, Beigang, Taiwan
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan .,Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
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23
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Andrich S, Ritschel M, Meyer G, Hoffmann F, Stephan A, Baltes M, Blessin J, Jobski K, Fassmer AM, Haastert B, Gontscharuk V, Arend W, Theunissen L, Colley D, Hinze R, Thelen S, Fuhrmann P, Sorg CGG, Windolf J, Rupprecht CJ, Icks A. Healthcare provision, functional ability and quality of life after proximal femoral fracture - 'ProFem': Study protocol of a population-based, prospective study based on individually linked survey and statutory health insurance data. BMJ Open 2019; 9:e028144. [PMID: 31243034 PMCID: PMC6597653 DOI: 10.1136/bmjopen-2018-028144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Proximal femoral fractures (PFF) are among the most frequent fractures in older people. However, the situation of people with a PFF after hospital discharge is poorly understood. Our aim is to (1) analyse healthcare provision, (2) examine clinical and patient-reported outcomes (PROs), (3) describe clinical and sociodemographic predictors of these and (4) develop an algorithm to identify subgroups with poor outcomes and a potential need for more intensive healthcare. METHODS AND ANALYSIS This is a population-based prospective study based on individually linked survey and statutory health insurance (SHI) data. All people aged minimum 60 years who have been continuously insured with the AOK Rheinland/Hamburg and experience a PFF within 1 year will be consecutively included (SHI data analysis). Additionally, 700 people selected randomly from the study population will be consecutively invited to participate in the survey. Questionnaire data will be collected in the participants' private surroundings at 3, 6 and 12 months after hospital discharge. If the insured person considers themselves to be only partially or not at all able to take part in the survey, a proxy person will be interviewed where possible. SHI variables include healthcare provision, healthcare costs and clinical outcomes. Questionnaire variables include information on PROs, lifestyle characteristics and socioeconomic status. We will use multiple regression models to estimate healthcare processes and outcomes including mortality and cost, investigate predictors, perform non-responder analysis and develop an algorithm to identify vulnerable subgroups. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (approval reference 6128R). All participants including proxies providing written and informed consent can withdraw from the study at any time. The study findings will be disseminated through scientific journals and public information. TRIAL REGISTRATION NUMBER DRKS00012554.
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Affiliation(s)
- Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michaela Ritschel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Sciences, Medical Faculty, Halle (Saale), Germany
| | - Falk Hoffmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Astrid Stephan
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Sciences, Medical Faculty, Halle (Saale), Germany
| | - Marion Baltes
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Sciences, Medical Faculty, Halle (Saale), Germany
| | - Juliane Blessin
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Sciences, Medical Faculty, Halle (Saale), Germany
| | - Kathrin Jobski
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Alexander M Fassmer
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Burkhard Haastert
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- mediStatistica, Neuenrade, Germany
| | - Veronika Gontscharuk
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Werner Arend
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lena Theunissen
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Denise Colley
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Raoul Hinze
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Simon Thelen
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Germany
| | - Petra Fuhrmann
- Department Health Policy – Health Economics – Press Relations, AOK Rheinland/Hamburg, Düsseldorf, Germany
| | - Christian G G Sorg
- Department Health Policy – Health Economics – Press Relations, AOK Rheinland/Hamburg, Düsseldorf, Germany
| | - Joachim Windolf
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Germany
| | - Christoph J Rupprecht
- Department Health Policy – Health Economics – Press Relations, AOK Rheinland/Hamburg, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Brozek W, Reichardt B, Zwerina J, Dimai HP, Klaushofer K, Zwettler E. Higher dose but not low dose proton pump inhibitors are associated with increased risk of subsequent hip fractures after first hip fracture: A nationwide observational cohort study. Bone Rep 2019; 10:100204. [PMID: 30993153 PMCID: PMC6451165 DOI: 10.1016/j.bonr.2019.100204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 02/26/2019] [Accepted: 03/30/2019] [Indexed: 12/12/2022] Open
Abstract
Aim To examine the association of proton pump inhibitor (PPI) use with subsequent hip fracture incidence in hip fracture patients, accounting for gender, age, PPI doses, PPI initiation before or after first fracture, and year from first fracture in which the first subsequent fracture occurred. Methods Data from 31,668 Austrian patients ≥50 years with the first hip fracture between July 2008 and December 2010 were analyzed retrospectively. After exclusion of patients on anti-osteoporotic medication, incidence of subsequent hip fractures was compared between users and non-users of PPIs using regression models. Results In general, use of PPIs among hip fracture patients was associated with increased risk for subsequent hip fracture (OR 1.58, 95%-CI 1.25–2.00), in particular in men, in the age group of 70–84 years, and when PPIs were initiated before the first fracture. Low PPI doses of ≤90 cumulative DDDs and ≤0.25 DDDs/day, however, were not linked to elevated subsequent fracture risk, especially among female patients. Subsequent hip fracture incidence was elevated within the first year after first fracture in female and male PPI users (OR 1.75, 95%-CI 1.28–2.38) and dropped in women but not in men in the second year. Conclusions Low-dose PPI use is not associated with increased risk of subsequent hip fractures, especially in women. Patients thus get most benefit of short-term PPI use after a hip fracture that has previously been linked to lowered mortality if low doses are not exceeded. Varying risk profiles for the time of subsequent hip fracture could have implications for risk group-specific follow-up care. PPI users were at particularly high risk of subsequent hip fracture within the first year after first fracture Use of proton pump inhibitors (PPIs) was generally associated with increased risk of subsequent hip fractures Low PPI doses ≤90 DDDs and ≤0.25 DDDs/day were not associated with increased subsequent hip fractures, particularly in women Short-term PPI use at low doses has positive effects on survival after hip fracture as demonstrated recently
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Affiliation(s)
- Wolfgang Brozek
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria
| | - Berthold Reichardt
- Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Siegfried Marcus Str. 5, 7000 Eisenstadt, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria
| | - Hans Peter Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria
| | - Elisabeth Zwettler
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria
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Is the Charlson comorbidity index a good predictor of mortality and adverse effects in proximal humerus fractures? Orthop Traumatol Surg Res 2019; 105:301-305. [PMID: 30765307 DOI: 10.1016/j.otsr.2018.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Proximal humerus fractures (PHF) are frequent in elderly patients. This population also suffers from a series of associated comorbidities, and PHF increases morbidity and mortality. The Charlson Comorbidity Index (CCI) is a tool used for calculating comorbidity and therefore the mortality risk. HYPOTHESIS Our hypothesis is that CCI is a good predictor of mortality in patients suffering from PHF, and that there is a relationship between CCI and the development of adverse events. PATIENTS AND METHODS A retrospective study with prospective data collection of 354 patients who had been diagnosed and treated for a single PHF between August 1st, 2013 and July 31st, 2015 was carried out at our hospital. The minimum follow-up was 24 months (mean 51.1 months). This study included all patients regardless the severity of the fracture, the treatment performed (surgical or conservative treatment) or whether the patient had been admitted to the hospital or was treated as an outpatient. Adverse effects and mortality data were collected and the CCI was calculated. RESULTS Patients with high CCI (>5) had a higher mortality risk 4.6 (95% CI [2.4-9.0]) compared to those with CCI<5. During follow-up, 40 (11%) patients died, being the mean follow-up of the patients overall 4.3 years 95% CI [4.1-4.4]. Patients suffering from systemic complications had a higher CCI average (p=0.001) compared to those who did not present adverse effects (HR=6.6; 95% CI [3.5-12.4]). No statistically significant relationship between the type of fracture (p=0.473) and mortality was found. CONCLUSION In our study CCI has proven to be a good predictor of mortality and there is a relationship between CCI and the development of adverse effects in patients suffering from PHF, which maybe should be taken into consideration in our therapeutic decision making. LEVEL OF EVIDENCE IV, retrospective observational study.
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Buss L, McKeever T, Nightingale J, Akyea R, Ollivere B, Moppett I, Bolton C. Hip fracture outcomes in patients with chronic obstructive pulmonary disease. Br J Anaesth 2018; 121:1377-1379. [DOI: 10.1016/j.bja.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022] Open
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Ungprasert P, Wijarnpreecha K, Thongprayoon C, Cheungpasitporn W. Peripheral arterial disease and risk of hip fracture: A systematic review and meta-analysis of cohort studies. J Postgrad Med 2018; 64:220-225. [PMID: 30004038 PMCID: PMC6198699 DOI: 10.4103/jpgm.jpgm_685_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/02/2018] [Accepted: 06/07/2018] [Indexed: 02/06/2023] Open
Abstract
Background Previous studies have suggested an increased risk of hip fracture among patients with peripheral arterial disease (PAD), however, the results have been inconsistent. This meta-analysis was conducted with the aim to summarize all available evidence to better characterize the risk of incident hip fracture among these patients. Materials and Methods A comprehensive literature review was conducted using the MEDLINE and EMBASE databases through October 2017 to identify all cohort and case-control studies that compared the risk of subsequent hip fracture between patients with PAD and individuals without PAD. Effect estimates of the included studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results The systematic review process yielded six eligible cohort studies comprising 15,895 patients with PAD. There was a significant association between incident hip fracture and PAD with the pooled relative risk (RR) of 1.64 (95% CI, 1.17-2.29; I2, 80%), comparing patients with PAD and individuals without PAD. Subgroup analysis by study design revealed significant results for both prospective studies (pooled RR 1.60; 95% CI, 1.12-2.28; I2, 0%) and retrospective studies (pooled RR 1.72; 95% CI, 1.07-2.77; I2, 92%). The funnel plot is relatively asymmetric suggesting publication bias. Conclusion This study found a significant association between PAD and hip fracture with the pooled RR of 1.64 (95% CI, 1.17-2.29) on comparing patients with PAD and individuals without PAD. Major limitations include high between-study heterogeneity, possibility of publication bias, and lack of data on the characteristics and type of hip fracture which may limit the clinical significance of the observations.
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Affiliation(s)
- P Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - K Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA
| | - C Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA
| | - W Cheungpasitporn
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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González Silva Y, Abad Manteca L, de la Red Gallego H, Álvarez Muñoz M, Rodríguez Carbajo M, Murcia Casado T, Ausín Pérez L, Abadía Otero J, Pérez-Castrillón JL. Relationship between the FRAX index and physical and cognitive functioning in older people. Ann Med 2018; 50:538-543. [PMID: 30041550 DOI: 10.1080/07853890.2018.1505052] [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] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To assess the relationship between the FRAX index and the Barthel index/MiniMental State Examination in older people. PATIENTS AND METHODS Observational descriptive study. Demographic data, comorbidity, dependency and cognitive state, and risk of osteoporotic fracture were collected. RESULTS A total of 375 patients were included (60% female) Patients with a low-risk FRAX for hip fractures had a higher Mini-mental (25, 95% CI = 24-27 vs. 22, 95% = 21 to 23, p = .0001), a higher Barthel index (88, 95% CI = 84-93 vs 72, 69 to 76, p = .0001) without differences in the Charlson index. Bivariate analysis showed an inverse association between FRAX and scales but logistic regression showed only female sex (OR 4.4, 95% CI = 2.6-7.6) and the non-dependent Barthel index (OR = 0.104, 95% CI = 0.014-0.792) remained significant and. Barthel index/Mini-mental constructed a significant model capable of predicting a risk of hip fracture of >3% measured by the FRAX index, with an area under the curve of 0.76 (95% CI = 0.7-0.81). CONCLUSIONS The FRAX index is related to other markers of geriatric assessment and the association between these variables can predict a risk of hip fracture of >3% measured by the FRAX index. Key messages Geriatric assessment indexes may be as important as the FRAX index, which is based on clinical risk factors, in predicting the fracture risk in older patient.
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Affiliation(s)
| | - Laura Abad Manteca
- b Internal Medicine Department , Hospital Universitario Río Hortega , Valladolid , Spain
| | | | - Mónica Álvarez Muñoz
- d Servicio de Urgencias de Atención Primaria Arturo Eyries , Valladolid Oeste , Spain
| | | | | | - Lourdes Ausín Pérez
- g Residencia Mixta Personas Mayores "Parquesol" , Gerencia Territorial de Servicios Sociales de Valladolid , Valladolid , Spain
| | - Jésica Abadía Otero
- b Internal Medicine Department , Hospital Universitario Río Hortega , Valladolid , Spain
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L Riska BS, Forsén L, Omsland TK, Søgaard AJ, Meyer HE, Holvik K. Does the Association of Comorbidity with 1-Year Mortality After Hip Fracture Differ According to Gender? The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). J Am Geriatr Soc 2018; 66:553-558. [PMID: 29427505 DOI: 10.1111/jgs.15207] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Excess mortality after hip fracture is higher in men than in women. The objective was to study whether comorbidity differs in men and women with hip fracture and to what degree differences in comorbidity according to gender may explain the higher excess mortality in men. DESIGN Population-based matched cohort covering the population aged 50 and older in Norway. SETTING Specialist healthcare (individuals with hip fracture) and general population (controls). PARTICIPANTS All individuals with hip fracture aged 50 and older from 2005 to 2008 (n = 32,175) and individuals without hip fracture matched 3:1 to those with hip fracture on gender, age, and county of residence (n = 96,410). MEASUREMENTS Comorbid diagnoses were recorded during the hospital stay. Relative and absolute excess 1-year mortality in individuals with hip fracture according to gender and Charlson Comorbidity Index (CCI) were investigated using Cox regression and linear regression, respectively. RESULTS Despite lower age (mean 78.7 vs 81.7), men had higher comorbidity than women. Compared with controls, women (hazard ratio (HR) = 6.5, 95% confidence interval (CI) = 6.2-6.9) and men (HR = 7.8, 95% CI = 7.3-8.3) with a CCI of 2 or greater were more likely to die. Women with a CCI of 2 or greater had an estimated 1-year risk of dying of 44%, and controls had an 11% risk; men with a CCI of 2 or greater had an estimated risk of dying of 53%, and controls had a 12% risk. Men were twice as likely as women to die within 1 year (HR = 2.0, 95% CI = 1.9-2.1). When adjusting for comorbidity, the difference was only slightly smaller (HR = 1.8, 95% CI = 1.7-1.8). CONCLUSION Men had greater comorbidity than women, but this did not explain the difference according to gender in excess mortality after hip fracture. Men who fracture a hip are an especially vulnerable subpopulation, even when there is no apparent comorbidity, and warrant special attention in follow-up and care.
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Affiliation(s)
- Brit Solvor L Riska
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.,Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Lisa Forsén
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.,Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Tone K Omsland
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Johanne Søgaard
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Holvik
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
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Marin C, Luyten FP, Van der Schueren B, Kerckhofs G, Vandamme K. The Impact of Type 2 Diabetes on Bone Fracture Healing. Front Endocrinol (Lausanne) 2018; 9:6. [PMID: 29416527 PMCID: PMC5787540 DOI: 10.3389/fendo.2018.00006] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/05/2018] [Indexed: 12/14/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease known by the presence of elevated blood glucose levels. Nowadays, it is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Many are the complications caused by this chronic disorder, including a negative impact on the cardiovascular system, kidneys, eyes, muscle, blood vessels, and nervous system. Recently, there has been increasing evidence suggesting that T2DM also adversely affects the skeletal system, causing detrimental bone effects such as bone quality deterioration, loss of bone strength, increased fracture risk, and impaired bone healing. Nevertheless, the precise mechanisms by which T2DM causes detrimental effects on bone tissue are still elusive and remain poorly studied. The aim of this review was to synthesize current knowledge on the different factors influencing the impairment of bone fracture healing under T2DM conditions. Here, we discuss new approaches used in recent studies to unveil the mechanisms and fill the existing gaps in the scientific understanding of the relationship between T2DM, bone tissue, and bone fracture healing.
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Affiliation(s)
- Carlos Marin
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Prometheus—Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium
- Biomaterials—BIOMAT, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Frank P. Luyten
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Prometheus—Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Greet Kerckhofs
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Prometheus—Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium
| | - Katleen Vandamme
- Prometheus—Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium
- Biomaterials—BIOMAT, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
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Hall RK, Sloane R, Pieper C, Van Houtven C, LaFleur J, Adler R, Colón-Emeric C. Competing Risks of Fracture and Death in Older Adults with Chronic Kidney Disease. J Am Geriatr Soc 2018; 66:532-538. [PMID: 29319880 DOI: 10.1111/jgs.15256] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine whether chronic kidney disease (CKD) at any stage is associated with fracture risk after adjusting for competing mortality and to determine whether age or race modify the relationship between CKD and fracture risk. DESIGN Prospective cohort study. SETTING Department of Veterans Affairs (VA) national healthcare system. PARTICIPANTS Men receiving VA primary care aged 65 and older with no history of fracture or osteoporosis therapy (N = 712, 918). MEASUREMENTS We determined CKD stage from baseline estimated glomerular filtration rate (eGFR). Participants were followed for up to 10 years for occurrence of any fracture or death. We ascertained fractures and covariates from VA medical records and Medicare claims. RESULTS Of the 356,459 older veterans with CKD (defined as eGFR <60 mL/min per 1.73 m2 ), 15.7% (n = 56,032) experienced a fracture, and 43.0% (n = 153,438) died over a median time at risk of 5.2 years. Veterans with CKD Stages 3 to 5 had a greater risk of death than those without CKD, which biased estimates from traditional survival models. Competing risk models showed that Stage 3 CKD was associated with greater hazard (adjusted subdistribution hazard ratio (sdHR) = 1.07, 95% confidence interval (CI) = 1.02-1.11) of fracture (than those without CKD) and a trend toward greater hazard for Stage 4 (sdHR = 1.07, 95% CI = 0.94-1.22) and Stage 5 (sdHR = 1.31, 95% CI = 0.97-1.77) CKD. Age, race, and bone mineral density did not modify the relationship between CKD and fracture risk. CONCLUSIONS In older male veterans, CKD, including Stage 3, is associated with a moderately greater fracture risk irrespective of age, race, or bone mineral density.
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Affiliation(s)
- Rasheeda K Hall
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs, Durham, North Carolina.,Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Richard Sloane
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Carl Pieper
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Courtney Van Houtven
- Health Services Research and Development, Durham Veterans Affairs, Durham, North Carolina
| | - Joanne LaFleur
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah.,Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Robert Adler
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Cathleen Colón-Emeric
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs, Durham, North Carolina.,Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Health Services Research and Development, Durham Veterans Affairs, Durham, North Carolina
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32
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Silva DMW, Borba VZC, Kanis JA. Evaluation of clinical risk factors for osteoporosis and applicability of the FRAX tool in Joinville City, Southern Brazil. Arch Osteoporos 2017; 12:111. [PMID: 29224172 DOI: 10.1007/s11657-017-0405-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/24/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Clinical risk factors for fracture in Southern Brazil are similar to those used in Fracture Risk Assessment Tool (FRAX®). Age-dependent intervention thresholds had higher accuracy than a fixed cut-off point. INTRODUCTION Access to bone mineral density testing is wanted for a large part of the Brazilian population. The FRAX® has an option to calculate the risk of fracture without this costly evaluation but relies on the clinical risk factors (CRFs) identified in the source cohorts used to generate FRAX. OBJECTIVE The aims of this study were to determine whether the CRFs used in FRAX are also risk indicators for individuals in Southern Brazil and to evaluate possible intervention thresholds for treatment in Brazil. METHODS We determined the CRFs for hip fractures in women and men aged 50 years and more with a hip fracture and controls in Joinville, Southern Brazil (April 1, 2010, and March 31, 2012). For intervention thresholds, we determined the accuracy of using the fixed thresholds of National Osteoporosis Foundation (NOF), USA, compared with the age-dependent thresholds of the National Osteoporosis Guideline Group (NOGG), UK. RESULTS CRFs that were significant for hip fracture were very similar to FRAX, apart from chronic obstructive pulmonary disease and malabsorptive intestinal disease. FRAX based on the NOGG and NOF models had an accuracy of 64.2 and 58.7%, respectively. CONCLUSION CRFs used in FRAX® were similar to those in the Southern Brazil. The NOGG model seems to be more accurate to discriminate patients with increased fracture risk in this population compared to the NOF model, but not significantly.
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Affiliation(s)
- Dalisbor Marcelo Weber Silva
- Medical School of Univille, Universidade da Região de Joinville, Rua Plácido Gomes, 520, Anita Garibaldi, Joinville, SC, Brazil.
| | | | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia
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Andrich S, Haastert B, Neuhaus E, Neidert K, Arend W, Ohmann C, Grebe J, Vogt A, Jungbluth P, Thelen S, Windolf J, Icks A. Excess Mortality After Pelvic Fractures Among Older People. J Bone Miner Res 2017; 32:1789-1801. [PMID: 28272751 DOI: 10.1002/jbmr.3116] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 12/21/2022]
Abstract
The study aimed to estimate excess mortality in patients aged 60 years or older up to 1 year after pelvic fracture compared with a population without pelvic fracture. In this retrospective population-based observational study, we use routine data from a large health insurance in Germany. For each patient with a first pelvic fracture between 2008 and 2010 (n = 5685 cases, 82% female, mean age 80 ± 9 years), about 34 individuals without pelvic fracture (n = 193,159 controls) were frequency matched by sex, age at index date, and index month. We estimated survival probabilities in the first year after the index date separated for cases (further stratified into inpatient/outpatient treated or minor/major pelvic fractures) and controls using Kaplan-Meier curves. Additionally, time-dependent hazard ratios (HRs) measuring excess mortality in 4-week intervals up to 52 weeks were estimated by fitting Cox regression models including adjustment for relevant confounders. Twenty-one percent of cases and 11% of controls died within 1 year. HRs (95% confidence intervals) decreased from 3.9 (3.5-4.5) within the first 4 weeks to 1.4 (1.1-1.9) within weeks 49 to 52 after the index date. After full adjustment, HRs lowered substantially (3.0 [2.6-3.4] and 1.0 [0.8-1.4]) but were still significantly increased up to week 32. Adjusted HRs in women were lower than in men: 2.8 (2.4-3.2) and 1.0 (0.7-1.4) versus 3.8 (2.9-5.0) and 1.2 (0.6-2.3). We found a clear excess mortality among older people in the first 8 months after pelvic fracture even after full adjustment. Excess mortality was higher among men in the beginning as well as for inpatient-treated persons. Absence of excess mortality was noticed for outpatient-treated persons within the first 3 months. When broken down into site-specific data, excess mortality was no longer significant for most pelvic fractures classified as minor. The only exception was fracture of pubis within the first 4 weeks. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Burkhard Haastert
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.,mediStatistica, Neuenrade, Germany
| | | | | | - Werner Arend
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Ohmann
- Coordination Centre for Clinical Trials, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Jürgen Grebe
- Coordination Centre for Clinical Trials, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Andreas Vogt
- Coordination Centre for Clinical Trials, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Pascal Jungbluth
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Simon Thelen
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Joachim Windolf
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Le B, Waller JL, Radhakrishnan R, Oh SJ, Kheda MF, Nahman NS, Carbone L. Osteoporotic fractures in patients with systemic lupus erythematosus and end stage renal disease. Lupus 2017; 27:17-24. [PMID: 28530467 DOI: 10.1177/0961203317709953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The incidence of end stage renal disease (ESRD) in patients with systemic lupus erythematosus (SLE) is rising. However, the relationship between osteoporotic fractures and SLE in the setting of ESRD remains uninvestigated. The purpose of this study was to compare the frequency of incident osteoporotic fractures in patients with ESRD with and without SLE, to identify risk factors for fractures in patients with SLE and ESRD, and to examine the contribution of these fractures to mortality. Methods Retrospective cohort study of patients with SLE ( n = 716) and a 5% random sample of controls without SLE ( n = 4176) in the United States Renal Data System (USRDS) from years 2006-2008 enrolled in Medicare Part D. Results Fractures occurred in 10.6% ( n = 76) of patients with SLE and ESRD and 12.1% ( n = 507) of patients with ESRD without SLE ( p = 0.24). Older age (adjusted relative risk 1.02, 95% confidence interval 1.01-1.04) was associated with an increased risk for fracture in patients with SLE and ESRD. In multivariable analyses, vertebral and hip fractures more than doubled the risk for mortality. Conclusions The frequency of osteoporotic fractures in patients with SLE and ESRD is similar to the general population of patients with ESRD. Vertebral and hip fractures are significant contributors to mortality in patients with SLE and ESRD. Fracture prevention, in particular, for elderly patients with SLE and ESRD, should be considered. Summary SLE is not an independent risk factor for fractures in patients with ESRD. However, among patients with SLE and ESRD, vertebral and hip fractures are significant contributors to mortality.
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Affiliation(s)
- B Le
- 1 Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,2 Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - J L Waller
- 3 Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia, USA
| | - R Radhakrishnan
- 4 School of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - S J Oh
- 5 Division of Rheumatology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - M F Kheda
- 6 Southwest Georgia Nephrology Clinic, PC, Albany, Georgia, USA
| | - N S Nahman
- 1 Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,2 Charlie Norwood VA Medical Center, Augusta, Georgia, USA.,7 Division of Nephrology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - L Carbone
- 1 Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,2 Charlie Norwood VA Medical Center, Augusta, Georgia, USA.,5 Division of Rheumatology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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35
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Brozek W, Reichardt B, Zwerina J, Dimai HP, Klaushofer K, Zwettler E. Use of proton pump inhibitors and mortality after hip fracture in a nationwide study. Osteoporos Int 2017; 28:1587-1595. [PMID: 28083667 DOI: 10.1007/s00198-017-3910-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED We analyzed the association of proton pump inhibitors (PPIs) with mortality after osteoporosis-related hip fracture in Austria. PPIs were associated with reduced 90-day mortality but elevated mortality after half a year when initiated pre-fracture. Inpatients and discharged patients on PPIs showed lowered in-hospital and 90-day mortality, respectively. INTRODUCTION We herein investigated use of proton pump inhibitors (PPIs) and mortality among hip fracture patients in a nationwide study in Austria. METHODS In this retrospective cohort study, data on use of PPIs were obtained from 31,668 Austrian patients ≥50 years with a hip fracture between July 2008 and December 2010. All-cause mortality in patients without anti-osteoporotic drug treatment who had received their first recorded PPI prescription in the study period either before or after fracture was compared with hip fracture patients on neither PPIs nor anti-osteoporotic medication using logistic and Cox regression analysis. RESULTS With PPI use, 90-day mortality was significantly reduced, both at initiation before (OR 0.66; p < 0.0001) and after hip fracture (OR 0.23; p < 0.0001). 90-day mortality was also reduced when PPIs were prescribed not until after discharge from the last recorded hip fracture-related hospital stay (OR 0.49; p < 0.0001) except for patients aged <70 years. In a sub-cohort of patients beginning PPIs during hospital stay, in-hospital mortality (0.2%) was substantially reduced relative to matched control patients (3.5%) (p < 0.0001). Longer-term mortality significantly increased after half a year post-fracture only among those who started PPI prescription before fracture. CONCLUSIONS PPI use during and after hospital stay due to hip fracture is associated with a considerable decrease in mortality. These findings could have implications for hip fracture treatment.
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Affiliation(s)
- W Brozek
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria.
| | - B Reichardt
- Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Esterhazyplatz 3, 7000, Eisenstadt, Austria
| | - J Zwerina
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - K Klaushofer
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
| | - E Zwettler
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
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36
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Moayeri A, Mohamadpour M, Mousavi SF, Shirzadpour E, Mohamadpour S, Amraei M. Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: a systematic review and meta-analysis. Ther Clin Risk Manag 2017; 13:455-468. [PMID: 28442913 PMCID: PMC5395277 DOI: 10.2147/tcrm.s131945] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim Patients with type 2 diabetes mellitus (T2DM) have an increased risk of bone fractures. A variable increase in fracture risk has been reported depending on skeletal site, diabetes duration, study design, insulin use, and so on. The present meta-analysis aimed to investigate the association between T2DM with fracture risk and possible risk factors. Methods Different databases including PubMed, Institute for Scientific Information, and Scopus were searched up to May 2016. All epidemiologic studies on the association between T2DM and fracture risk were included. The relevant data obtained from these papers were analyzed by a random effects model and publication bias was assessed by funnel plot. All analyses were done by R software (version 3.2.1) and STATA (version 11.1). Results Thirty eligible studies were selected for the meta-analysis. We found a statistically significant positive association between T2DM and hip, vertebral, or foot fractures and no association between T2DM and wrist, proximal humerus, or ankle fractures. Overall, T2DM was associated with an increased risk of any fracture (summary relative risk =1.05, 95% confidence interval: 1.04, 1.06) and increased with age, duration of diabetes, and insulin therapy. Conclusion Our findings strongly support an association between T2DM and increased risk of overall fracture. These findings emphasize the need for fracture prevention strategies in patients with diabetes.
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Affiliation(s)
| | | | | | | | - Safoura Mohamadpour
- Department of Epidemiology, Prevention of Psychosocial Injuries Research Center
| | - Mansour Amraei
- Department of Physiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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Leavy B, Michaëlsson K, Åberg AC, Melhus H, Byberg L. The Impact of Disease and Drugs on Hip Fracture Risk. Calcif Tissue Int 2017; 100:1-12. [PMID: 27671989 PMCID: PMC5214955 DOI: 10.1007/s00223-016-0194-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/13/2016] [Indexed: 11/13/2022]
Abstract
We report the risks of a comprehensive range of disease and drug categories on hip fracture occurrence using a strict population-based cohort design. Participants included the source population of a Swedish county, aged ≥50 years (n = 117,494) including all incident hip fractures during 1 year (n = 477). The outcome was hospitalization for hip fracture (ICD-10 codes S72.0-S72.2) during 1 year (2009-2010). Exposures included: prevalence of (1) inpatient diseases [International Classification of Diseases (ICD) codes A00-T98 in the National Patient Register 1987-2010] and (2) prescribed drugs dispensed in 2010 or the year prior to fracture. We present age- and sex-standardized risk ratios (RRs), risk differences (RDs) and population attributable risks (PARs) of disease and drug categories in relation to hip fracture risk. All disease categories were associated with increased risk of hip fracture. Largest risk ratios and differences were for mental and behavioral disorders, diseases of the blood and previous fracture (RRs between 2.44 and 3.00; RDs (per 1000 person-years) between 5.0 and 6.9). For specific drugs, strongest associations were seen for antiparkinson (RR 2.32 [95 % CI 1.48-1.65]; RD 5.2 [1.1-9.4]) and antidepressive drugs (RR 1.90 [1.55-2.32]; RD 3.1 [2.0-4.3]). Being prescribed ≥10 drugs during 1 year incurred an increased risk of hip fracture, whereas prescription of cardiovascular drugs or ≤5 drugs did not appear to increase risk. Diseases inferring the greatest PARs included: cardiovascular diseases PAR 22 % (95 % CI 14-29) and previous injuries (PAR 21 % [95 % CI 16-25]; for specific drugs, antidepressants posed the greatest risk (PAR 16 % [95 % CI 12.0-19.3]).
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Affiliation(s)
- Breiffni Leavy
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
- Stockholms Sjukhem Foundation, Stockholm, Sweden.
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Osteoporosis and Clinical Pharmacogenetics, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
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Wu ZJ, Zhao P, Liu B, Yuan ZC. Effect of Cigarette Smoking on Risk of Hip Fracture in Men: A Meta-Analysis of 14 Prospective Cohort Studies. PLoS One 2016; 11:e0168990. [PMID: 28036356 PMCID: PMC5201259 DOI: 10.1371/journal.pone.0168990] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/11/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Several observational studies have suggested an association between cigarette smoking and risk of hip fracture. However, no formal systematic review or meta-analysis was performed to summarize this risk in men. MATERIALS AND METHODS A search was applied to MEDLINE, EMBASE, and web of science (up to November 1 2016). All prospective cohort studies assessing risk of hip fracture with the factor of cigarette smoking in men without language restriction were reviewed, and qualities of all included studies were assessed using the Newcastle-Ottawa Scale. Two authors independently assessed literatures and extracted information eligibility, and any disagreement was resolved by consensus. Newcastle-Ottawa quality assessment scale was used to evaluate studies' quality in meta-analyses. We calculated the RR with 95% CIs in a random-effects model as well as the fixed-effects model using the metan command in the STATA version 12.0 (StataCorp, USA). RESULTS Fourteen prospective cohort studies were eligible for the present analysis. A meta-analysis of 12 prospective studies showed that the relative risk (RR) for current male smoking was 1.47 [95% confidence interval (CI) (1.28-1.66), p = 0.54; I2 = 0%]. Subgroup analyses show study characteristics (including geography region, length of follow-up, size of cohorts and study quality) did not substantially influence these positive associations. Eight studies reported the RRs for former smokers compared with never smokers and the pooled RR was 1.15 [95% CI, (0.97-1.34), (I2 = 0%, p = 0.975)]. CONCLUSIONS The present meta-analysis of 14 prospective studies suggests that, compared with never smokers, cigarette smoking increases risk of hip fracture in man, specifically in current smokers. However, further larger prospective cohorts with more power or meta-analysis of individual patient data are needed to confirm this association.
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Affiliation(s)
- Zhen-Jie Wu
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Peng Zhao
- Department of Head and Neck Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Bin Liu
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Zhen-Chao Yuan
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
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Smith TO, Penny F, Fleetcroft R. Medical morbidities in people following hip and knee arthroplasty: data from the Osteoarthritis Initiative. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:99-106. [PMID: 26474996 DOI: 10.1007/s00590-015-1713-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Total hip (THA) and knee (TKA) arthroplasty are common orthopaedic procedures most frequently for older people. Whilst it is known that this older population frequently present with medical morbidities, no studies have previously documented the prevalence of such morbidities in people who have undergone THA or TKA.The purpose of this study was to determine the prevalence and what factors are in association with the presentation of medical morbidities in these populations. METHODS Data from the Osteoarthritis Initiative, a population-based observational study, was assessed. In total 419 people who had undergone a THA or TKA were assessed to determine the prevalence of recorded morbidities within 12 months post-arthroplasty. All medical morbidities were then assessed using univariate and then multivariate logistic regression analysis to identify factors influencing the presentation of specific morbidities at 12 months following THA or TKA. RESULTS The most common medical morbidities included: osteoporosis (16 %), mild-to-moderate depression (8 %), cancer (8 %), diabetes (6 %), history of stroke or TIA (6 %) and asthma (5 %). The medical morbidities demonstrated are similar between those who undergo THA and TKA. Only gender and ethnic origin were identified as statistically significant predictors of medical morbidities in these populations. Gender was a predictor of history of heart failure, whilst ethnic origin significantly predicted depression. CONCLUSIONS People who undergo THA or TKA may present with a variety of medical morbidities. Accordingly consideration should be made on how to encourage the adoption and maintenance of physical activity and healthy lifestyle choices for this population.
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40
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Bethel M, Weaver FM, Bailey L, Miskevics S, Svircev JN, Burns SP, Hoenig H, Lyles K, Carbone LD. Risk factors for osteoporotic fractures in persons with spinal cord injuries and disorders. Osteoporos Int 2016; 27:3011-21. [PMID: 27230522 DOI: 10.1007/s00198-016-3627-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/02/2016] [Indexed: 01/15/2023]
Abstract
UNLABELLED Clinical risk factors for fracture were explored among Veterans with a spinal cord injury. At the end of 11 years of follow-up, the absolute risk of fracture was approximately 20 %. Among the clinical and SCI-related factors explored, a prior history of fracture was strongly associated with incident fracture. INTRODUCTION Few studies to date have comprehensively addressed clinical risk factors for fracture in persons with spinal cord injury (SCI). The purpose of this study was to identify risk factors for incident osteoporotic fractures in persons with a SCI that can be easily determined at the point of care. METHODS The Veteran's Affairs Spinal Cord Dysfunction Registry, a national database of persons with a SCI, was used to examine clinical and SCI-related risk factors for fracture. Incident fractures were identified in a cohort of persons with chronic SCI, defined as SCI present for at least 2 years. Cox regression models were used to estimate the risk of incident fractures. RESULTS There were 22,516 persons with chronic SCI included in the cohort with 3365 incident fractures. The mean observational follow-up time for the overall sample was 6.2 years (median 6.0, IQR 2.9-11.0). The mean observational follow-up time for the fracture group was 3.9 years (median 3.3, IQR 1.4-6.1) and 6.7 years (median 6.7, IQR 3.1-11.0) for the nonfracture group. By the end of the study, which included predominantly older Veterans with a SCI observed for a relatively short period of time, the absolute (i.e., cumulative hazard) for incident fractures was 0.17 (95%CI 0.14-0.21). In multivariable analysis, factors associated with an increased risk of fracture included White race, traumatic etiology of SCI, paraplegia, complete extent of SCI, longer duration of SCI, use of anticonvulsants and opioids, prevalent fractures, and higher Charlson Comorbidity Indices. Women aged 50 and older were also at higher risk of sustaining an incident fracture at any time during the 11-year follow-up period. CONCLUSIONS There are multiple clinical and SCI-related risk factors which can be used to predict fracture in persons with a SCI. Clinicians should be particularly concerned about incident fracture risk in persons with a SCI who have had a previous fracture.
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Affiliation(s)
- M Bethel
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA.
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L Bailey
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Miskevics
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA
| | - J N Svircev
- VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - S P Burns
- VA Puget Sound Health Care System-Seattle Division, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, Durham, NC, USA
| | - K Lyles
- Department of Medicine, Duke University, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, VAMC, Durham, NC, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA
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Fraccaro P, Kontopantelis E, Sperrin M, Peek N, Mallen C, Urban P, Buchan IE, Mamas MA. Predicting mortality from change-over-time in the Charlson Comorbidity Index: A retrospective cohort study in a data-intensive UK health system. Medicine (Baltimore) 2016; 95:e4973. [PMID: 27787358 PMCID: PMC5089087 DOI: 10.1097/md.0000000000004973] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/29/2016] [Accepted: 09/06/2016] [Indexed: 01/02/2023] Open
Abstract
Multimorbidity is common among older people and presents a major challenge to health systems worldwide. Metrics of multimorbidity are, however, crude: focusing on measuring comorbid conditions at single time-points rather than reflecting the longitudinal and additive nature of chronic conditions. In this paper, we explore longitudinal comorbidity metrics and their value in predicting mortality.Using linked primary and secondary care data, we conducted a retrospective cohort study on adults in Salford, UK from 2005 to 2014 (n = 287,459). We measured multimorbidity with the Charlson Comorbidity Index (CCI) and quantified its changes in various time windows. We used survival models to assess the relationship between CCI changes and mortality, controlling for gender, age, baseline CCI, and time-dependent CCI. Goodness-of-fit was assessed with the Akaike Information Criterion and discrimination with the c-statistic.Overall, 15.9% patients experienced a change in CCI after 10 years, with a mortality rate of 19.8%. The model that included gender and time-dependent age, CCI, and CCI change across consecutive time windows had the best fit to the data but equivalent discrimination to the other time-dependent models. The absolute CCI score gave a constant hazard ratio (HR) of around 1.3 per unit increase, while CCI change afforded greater prognostic impact, particularly when it occurred in shorter time windows (maximum HR value for the 3-month time window, with 1.63 and 95% confidence interval 1.59-1.66).Change over time in comorbidity is an important but overlooked predictor of mortality, which should be considered in research and care quality management.
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Affiliation(s)
- Paolo Fraccaro
- Health eResearch Centre, Farr Institute for Health Informatics Research
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health
| | - Evangelos Kontopantelis
- Health eResearch Centre, Farr Institute for Health Informatics Research
- NIHR School for Primary Care Research, University of Manchester, Manchester
| | - Matthew Sperrin
- Health eResearch Centre, Farr Institute for Health Informatics Research
| | - Niels Peek
- Health eResearch Centre, Farr Institute for Health Informatics Research
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health
| | - Christian Mallen
- Research Institute for Primary Care & Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom
| | - Philip Urban
- Cardiovascular Department, Hôpital de La Tour, Geneva, Switzerland
| | - Iain E. Buchan
- Health eResearch Centre, Farr Institute for Health Informatics Research
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health
| | - Mamas A. Mamas
- Health eResearch Centre, Farr Institute for Health Informatics Research
- Keele Cardiovascular Research Group, Keele University Stoke-on-Trent and Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
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42
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de Miguel-Diez J, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, Puente-Maestu L, Ramírez García L, Lopez de Andres A. Is COPD a Risk Factor for Hip Fracture? COPD 2016; 13:779-789. [PMID: 27379970 DOI: 10.1080/15412555.2016.1195348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Javier de Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Valentin Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Pilar Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Luis Puente-Maestu
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Laura Ramírez García
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Lopez de Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Bliemel C, Lechler P, Oberkircher L, Colcuc C, Balzer-Geldsetzer M, Dodel R, Ruchholtz S, Buecking B. Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures. Dement Geriatr Cogn Disord 2016; 40:33-43. [PMID: 25896170 DOI: 10.1159/000381334] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the influence of cognitive impairment on the functional outcomes and complication rates of patients with hip fracture during in-patient treatment. METHODS A total of 402 patients who were surgically treated for hip fractures were consecutively enrolled at a single trauma center. The patients were grouped according to their results on the Mini-Mental State Examination (MMSE), i.e., ≥20 points (group I) and ≤19 points (group II). Complication and in-hospital mortality rates as well as postoperative functional outcomes according to the Barthel Index (BI) were compared between the groups. A multivariate regression analysis was performed to control for additional factors. RESULTS 33% of the patients had MMSE scores ≤19 points. The complication rates were similar between the groups (p > 0.05). Likewise, the overall in-hospital mortality rates were similar between the patients in group I (4.5%) and those in group II (9.8%; β = 0.218, p < 0.740). Functional outcomes, as assessed by the BI, were lower in group II (β = -0.266, p < 0.001). The patients in group II were transferred to a rehabilitation clinic less frequently (52.3 vs. 76.0%, p < 0.001). CONCLUSIONS Patients with lower MMSE scores are at a higher risk for poorer functional outcomes. Perioperative care should focus on the preservation of functional abilities to protect these patients from an additional loss of independence and disadvantageous clinical course.
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Affiliation(s)
- Christopher Bliemel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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Lee PH, Kok VC, Chou PL, Ku MC, Chen YC, Horng JT. Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study. PeerJ 2016; 4:e2634. [PMID: 27812429 PMCID: PMC5088616 DOI: 10.7717/peerj.2634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/30/2016] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Osteoporosis is becoming an impending epidemic in the Asia-Pacific region. The association between risk of osteoporotic fracture (OTPF) and chronic obstructive pulmonary disease (COPD) in East Asian patients is yet to be fully examined. We conducted a nationwide population-based retrospective cohort study of 98,700 patients aged ≥50 years with or without COPD using a national administrative claims dataset. MATERIALS AND METHODS The patients were divided into COPD and comparison groups comprising 19,740 and 78,960 patients, respectively. The groups were 1 to 4 matched for age, gender, index date, diabetes mellitus, pre-existing osteoporosis and chronic kidney disease. Information such as the geographic area where southern part represented more sunshine exposure, smoking-related diagnoses, alcohol use disorder, whether there was regular use of inhaled corticosteroids and oral corticosteroids, vitamin D prescriptions, Charlson-Deyo comorbidity index score, and other relevant medical comorbidities were extracted for analysis. They were followed up until OTPF or the end of the year 2013. The outcome measure was an osteoporotic vertebral fracture and other long-bone fractures. A multivariate Cox model was constructed to derive adjusted hazard ratios (aHR) for OTPF with corresponding 95% confidence intervals (CI) after controlling for age, sex, insurance premium category, vitamin D prescription, osteoporosis, and coronary heart disease (CHD). Kaplan-Meier curves of the probability of OTPF-free survival for each cohort were compared using the log-rank test. Patients with OTPF during the first follow-up year were excluded from the overall risk calculation. Contributing factors to the increased risk of OTPF in COPD patients were examined in a sensitivity analysis. RESULTS After a total follow-up of 68,743 patient-years for the COPD group and 278,051 patient-years for the matched comparison group, the HR for OTPF was 1.24 (95% CI [1.02-1.51]; P = 0.0322) in COPD patients. The aHR was increased by 30% for vertebral OTPF (aHR = 1.297, 95% CI [1.020-1.649]; P = 0.0339). Differential lag time sensitivity analysis revealed a progressively elevated risk up to 8-fold increase in women (aHR = 8.0 (95% CI [1.81-35.4]; P < 0.01)) during the fifth follow-up year. COPD patients with pre-existing osteoporosis or given vitamin D prescription harbor a sustained increased risk up to the 5th (aHR, 4.1; 95% CI [1.61-10.35]) and third (aHR, 2.97; 95% CI [1.48-5.97]) follow-up year, respectively. CONCLUSIONS Our nationwide population-based cohort study demonstrates that East Asian COPD patients aged 50 and beyond do harbor a modestly increased risk for osteoporotic vertebral fractures particularly for those who are female, have pre-existing osteoporosis or require vitamin D prescription.
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Affiliation(s)
- Ping-Hsueh Lee
- Department of Geriatric Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - Victor C. Kok
- KTGH Cancer Center, Kuang Tien General Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Po-Liang Chou
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
| | - Ming-Chang Ku
- Jen-Te Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
- Department of Diagnostic Radiology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yu-Ching Chen
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
| | - Jorng-Tzong Horng
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
- Disease Informatics Research Group, Asia University Taiwan, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Jhongli, Taoyuan, Taiwan
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Abstract
Diabetes is associated with a number of lower extremity orthopedic conditions and complications including fractures, Charcot neuroarthropathy, plantar ulcers, and infection. These complications are of significant clinical concern in terms of morbidity, mortality, and socioeconomic costs. A review of each condition is discussed, with particular emphasis on the clinical importance, diagnostic considerations, and orthopedic treatment recommendations. The goal of the article is to provide a clinical picture of the challenges that orthopedic surgeons confront, and highlight the need for specific clinical guidelines in diabetic patients.
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Affiliation(s)
- Daniel J Gehling
- Department of Orthopaedic Surgery, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States.
| | - Beata Lecka-Czernik
- Department of Orthopaedic Surgery, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States; Department of Physiology and Pharmacology, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States; Center for Diabetes and Endocrine Research, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States
| | - Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, OH 43614, United States
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Bohlken J, Jacob L, Schaum P, Rapp MA, Kostev K. Hip fracture risk in patients with dementia in German primary care practices. DEMENTIA 2015; 16:853-864. [PMID: 26701959 DOI: 10.1177/1471301215621854] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim was to analyze the risk of hip fracture in German primary care patients with dementia. This study included patients aged 65-90 from 1072 primary care practices who were first diagnosed with dementia between 2010 and 2013. Controls were matched (1:1) to cases for age, sex, and type of health insurance. The primary outcome was the diagnosis of hip fracture during the three-year follow-up period. A total of 53,156 dementia patients and 53,156 controls were included. A total of 5.3% of patients and 0.7% of controls displayed hip fracture after three years. Hip fracture occurred more frequently in dementia subjects living in nursing homes than in those living at home (9.2% versus 4.3%). Dementia, residence in nursing homes, and osteoporosis were risk factors for fracture development. Antidementia, antipsychotic, and antidepressant drugs generally had no significant impact on hip fracture risk when prescribed for less than six months. Dementia increased hip fracture risk in German primary care practices.
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Affiliation(s)
- Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin, Germany
| | - Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - Peter Schaum
- Praxis für Chirurgie und Unfallchirurgie Kübke/Schaum, Berlin, Germany
| | - Michael A Rapp
- Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
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Carbonell-Abella C, Pages-Castella A, Javaid MK, Nogues X, Farmer AJ, Cooper C, Diez-Perez A, Prieto-Alhambra D. Early (1-year) Discontinuation of Different Anti-osteoporosis Medications Compared: A Population-Based Cohort Study. Calcif Tissue Int 2015. [PMID: 26202819 DOI: 10.1007/s00223-015-0040-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although a number of reports suggest very low persistence with oral bisphosphonates, there is limited data on persistence with other anti-osteoporosis medications. We compare rates of early discontinuation (in the first year) with all available outpatient anti-osteoporosis drugs in Catalonia, Spain. We conducted a population-based retrospective cohort study using data from the SIDIAP database. SIDIAP contains computerized primary care records and pharmacy dispensing data for >80 % of the population of Catalonia (>5 million people). All SIDIAP participants starting an anti-osteoporosis drug between 1/1/2007 and 30/06/2011 (with 2 years wash-out) were included. We modelled persistence as the time between first prescription and therapy discontinuation (refill gap of at least 6 months) using Fine and Gray survival models with competing risk for death. We identified 127,722 patients who started any anti-osteoporosis drug in the study period. The most commonly prescribed drug was weekly alendronate (N = 55,399). 1-Year persistence ranges from 40 % with monthly risedronate to 7.7 % with daily risedronate, and discontinuation was very common [from 49.5 % (monthly risedronate) to 84.4 % (daily risedronate)] as was also switching in the first year of therapy [from 2.8 % (weekly alendronate) to 10 % (daily alendronate)]. Multivariable-adjusted models showed that only monthly risedronate had better one-year persistence than weekly alendronate and teriparatide equivalent, whilst all other therapies had worse persistence. Early discontinuation with available anti-osteoporosis oral drugs is very common. Monthly risedronate, weekly alendronate, and daily teriparatide are the drugs with the best persistence, whilst daily oral drugs have 40-60 % higher first-year discontinuation rates compared to weekly alendronate.
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Affiliation(s)
- C Carbonell-Abella
- GREMPAL Research Group, IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Català de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - A Pages-Castella
- GREMPAL Research Group, IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M K Javaid
- Oxford NIHR BRU, NDORMS, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - X Nogues
- Musculoskeletal Research Unit, FIMIM, Parc Salut Mar, and RETICEF, Barcelona, Spain
| | - A J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - C Cooper
- Oxford NIHR BRU, NDORMS, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - A Diez-Perez
- Musculoskeletal Research Unit, FIMIM, Parc Salut Mar, and RETICEF, Barcelona, Spain
| | - D Prieto-Alhambra
- GREMPAL Research Group, IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Oxford NIHR BRU, NDORMS, University of Oxford, Oxford, UK.
- MRC Lifecourse Epidemiology Unit, Southampton, UK.
- Musculoskeletal Research Unit, FIMIM, Parc Salut Mar, and RETICEF, Barcelona, Spain.
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Carcas AJ, Abad Santos F, Sánchez Perruca L, Dal-Ré R. [Electronic medical record in clinical trials of effectiveness of drugs integrated in clinical practice]. Med Clin (Barc) 2015; 145:452-7. [PMID: 25913907 DOI: 10.1016/j.medcli.2015.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/29/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Antonio J Carcas
- Servicio de Farmacología Clínica, Hospital Universitario La Paz, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Francisco Abad Santos
- Servicio de Farmacología Clínica, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IP), Madrid, España
| | - Luis Sánchez Perruca
- Dirección Técnica de Sistemas de Información Sanitaria, Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Consejería de Salud de la Comunidad Autónoma de Madrid, Madrid, España
| | - Rafael Dal-Ré
- Investigación Clínica, Programa BUC (Biociencias UAM+CSIC), Centro de Excelencia Internacional, Universidad Autónoma de Madrid, Madrid, España.
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Roh HW, Hong CH, Lee S, Lee Y, Lee KS, Chang KJ, Oh BH, Choi SH, Kim SY, Back JH, Chung YK, Lim KY, Noh JS, Son SJ. Frontal Lobe Function and Risk of Hip Fracture in Patient With Alzheimer Disease: An Analysis of Linked Data. Medicine (Baltimore) 2015; 94:e1918. [PMID: 26559259 PMCID: PMC4912253 DOI: 10.1097/md.0000000000001918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the association between frontal lobe function and risk of hip fracture in patients with Alzheimer disease (AD).Retrospective cohort study using multicenter hospital-based dementia registry and national health insurance claim data was done. Participants who had available data of neuropsychological test, national health insurance claim, and other covariates were included. A total of 1660 patients with AD were included based on Stroop Test results. A total of 1563 patients with AD were included based on the Controlled Oral Word Association Test (COWAT) results. Hip fracture was measured by validated identification criteria using national health insurance claim data. Frontal lobe function was measured by Stroop Test and COWAT at baseline.After adjusting for potential covariates, including cognitive function in other domains (language, verbal and nonverbal memory, and attention), the Cox proportional hazard regression analysis revealed that risk of a hip fracture was decreased with a hazard ratio (HR) of 0.98 per one point of increase in the Stroop Test (adjusted HR = 0.98, 95% confidence interval [CI]: 0.97-1.00) and 0.93 per one point increase in COWAT (adjusted HR = 0.93, 95% CI: 0.88-0.99).The risk of hip fracture in AD patients was associated with baseline frontal lobe function. The result of this research presents evidence of association between frontal lobe function and risk of hip fracture in patients with AD.
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Affiliation(s)
- Hyun Woong Roh
- From the Department of Psychiatry, Ajou University School of Medicine, Suwon (HWR, CHH, KJC, YKC, KYL, JSN, SJS); Health Administration, Department of Management & Administration, Backseok Arts University, Seoul (SJL); Department of Preventive Medicine and Public Health, Ajou University School of Medicine (YL); Institute on Aging, Ajou University Medical Center, Suwon (HWR, CHH, YL, KJC, SJS); Department of Psychiatry, CHA University College of Medicine, Gangnam Medical Center and CHAUM Life Center (KSL); Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul (BHO); Department of Neurology, Inha University School of Medicine, Incheon (SHC); Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul (SYK); and Health Insurance Police Research Institute, National Health Insurance Service, Seoul, Republic of Korea (JHB)
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Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients. PLoS One 2015; 10:e0127240. [PMID: 25984790 PMCID: PMC4436150 DOI: 10.1371/journal.pone.0127240] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/12/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in incident hemodialysis patients (mCCI-IHD), thereby improving risk stratification for mortality. METHODS Data on 24,738 Koreans who received their first hemodialysis treatment between 2005 and 2008 were obtained from the Korean Health Insurance dataset. The mCCI-IHD score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazards model. The modified index was validated in an independent nationwide prospective cohort (n=1,100). RESULTS The Cox proportional hazards model revealed that all comorbidities in the CCI except ulcers significantly predicted mortality. Thus, the mCCI-IHD included 14 comorbidities with re-assigned severity weights. In the validation cohort, both the CCI and the mCCI-IHD were correlated with mortality. However, the mCCI-IHD showed modest but significant increases in c statistics compared with the CCI at 6 months and 1 year. The analyses using continuous net reclassification improvement revealed that the mCCI-IHD improved net mortality risk reclassification by 24.6% (95% CI, 2.5-46.7; P=0.03), 26.2% (95% CI, 1.0-51.4; P=0.04) and 42.8% (95% CI, 4.9-80.8; P=0.03) with respect to the CCI at 6 months and 1 and 2 years, respectively. CONCLUSIONS The mCCI-IHD facilitates better risk stratification for mortality in incident hemodialysis patients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies.
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