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Mahmud M, Muscatello DJ, Rahman MB, Osborne NJ. Association between socioeconomic deprivation and bone health status in the UK biobank cohort participants. Osteoporos Int 2024:10.1007/s00198-024-07115-3. [PMID: 38806788 DOI: 10.1007/s00198-024-07115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/27/2024] [Indexed: 05/30/2024]
Abstract
The effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health. PURPOSE Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40-69 years at recruitment during 2006-2010. METHOD We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode. RESULTS At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42-1.49), 1.26 times (95% CI 1.22-1.30), 1.31 times (95% CI 1.26-1.36) and 1.16 times (95% CI 1.13-1.19) higher for the most deprived compared with the least deprived quantile. CONCLUSION Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health.
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Affiliation(s)
- Mafruha Mahmud
- School of Population Health, University of New South Wales, Sydney, Australia.
| | | | - Md Bayzidur Rahman
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Kirby Institute, UNSW, Kensington, Australia
- The School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Nicholas John Osborne
- School of Population Health, University of New South Wales, Sydney, Australia
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
- European Centre for Environment and Human Health, University of Exeter, Truro, TR1 3HD, UK
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Chandran M, Brind'Amour K, Fujiwara S, Ha YC, Tang H, Hwang JS, Tinker J, Eisman JA. Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: a systematic review. Osteoporos Int 2023; 34:1037-1053. [PMID: 36735053 DOI: 10.1007/s00198-022-06657-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023]
Abstract
UNLABELLED Robust data on osteoporosis in the Asia Pacific region could improve healthcare decision-making. Osteoporosis affects 10-30% of women aged 40 + , and up to 10% of men in 7 developed economies in Asia Pacific. Fractures affect 500-1000 adults aged 50 + per 100,000 person-years. Policymakers and clinicians must address this problem. PURPOSE Osteoporosis and associated fractures result in considerable morbidity, loss of productivity, early mortality, and increased healthcare expenses. Many countries in the Asia Pacific (AP) region, especially middle- and higher-income economies, are faced with aging and increasingly sedentary populations. It is critical to consolidate and analyze the available information on the prevalence and incidence of the disease in these countries. METHODS We systematically reviewed articles and gray literature for Australia, China, Hong Kong, Japan, Singapore, South Korea, and Taiwan. We searched PubMed, ScienceDirect, JSTOR, Cochrane, Google Scholar, and other databases for data published 2009-2018. We included articles with prevalence or incidence estimates for adults with osteoporosis or related fractures. RESULTS All locations had data available, but of widely varying quantity and quality. Most estimates for osteoporosis prevalence ranged from 10 to 30% for women ages 40 and older, and up to 10% for men. Osteoporotic fracture incidence typically ranged between 500 and 1000 per 100,000 person-years among adults aged 50 and older. Both outcomes typically increased with age and were more common among women. CONCLUSION Osteoporosis and associated fractures affect significant portions of the adult population in developed economies in the AP region. Governments and healthcare systems must consider how best to prevent and diagnose osteoporosis, and manage affected individuals, to reduce healthcare costs and mortality associated with fractures.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
| | | | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, Republic of China
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | - John A Eisman
- UNSW Sydney and School of Medicine Sydney, Garvan Institute of Medical Research, St Vincent's Hospital, University of Notre Dame Australia, Sydney, NSW, Australia
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Izquierdo-Avino R, Cebollada-Gadea L, Jordan-Jarque M, Bordonaba-Bosque D, López-Cabanas JA. Risk of osteoporotic fracture and refracture: the importance of index fracture site. Arch Osteoporos 2023; 18:27. [PMID: 36705860 DOI: 10.1007/s11657-023-01213-1] [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: 03/30/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023]
Abstract
The current study shows that patients aged 50 or more who have sustained an osteoporotic fracture have a significant risk of suffering a new fracture. Refracture risk is also increased when anatomic site of both index and subsequent fracture are the same. PURPOSE The purpose of this study is to describe the profile of a patient sustaining a fragility fracture, the influence of the initial or index fracture on subsequent fracture risk and the role that anatomic site of index and subsequent fracture play on fracture risk. METHODS In this retrospective observational cohort study, individuals aged ≥ 50 years who sustained at least one clinical fragility fracture were identified from the public health service register between January 1, 2014, and December 31, 2015. Two separate analysis cohorts were identified. Group 1 (index FF) included patients that sustained at least one clinical fragility fracture during the study period. Group 2 (subsequent FF) included those patients from group 1 who sustained at least one clinical subsequent fracture during the following 2 years after index fracture. RESULTS A total of 11,986 fractures constituted group 1 (index FF), and 792 constituted group 2 (subsequent FF). The incidence of subsequent fractures was 6.61%, with a major percentage of them (36.99%) identified within the first 6 months following index FF. Hip was the most frequent site for index (30.09%) and subsequent fracture (34.85%). We found an increased risk mainly when anatomic site of index and subsequent FF are the same. CONCLUSIONS Sustaining a subsequent fracture after an index fracture is a common event in the population over age 50, more commonly occurring within 6 months of index fracture. Analysis of fracture site correlation shows that refracture risk is increased mainly when index and subsequent fracture site are the same.
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Affiliation(s)
- R Izquierdo-Avino
- Fracture Liaison Service Unit, Department of Trauma and Orthopaedic Surgery, Hospital Provincial Nuestra Señora de Gracia, Zaragoza, Spain.
| | - L Cebollada-Gadea
- Fracture Liaison Service Unit, Department of Trauma and Orthopaedic Surgery, Hospital Provincial Nuestra Señora de Gracia, Zaragoza, Spain
| | - M Jordan-Jarque
- Fracture Liaison Service Unit, Department of Trauma and Orthopaedic Surgery, Hospital Provincial Nuestra Señora de Gracia, Zaragoza, Spain
| | - D Bordonaba-Bosque
- Statistical and Methodological Support (SAME), Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - J A López-Cabanas
- Statistical and Methodological Support (SAME), Aragon Health Sciences Institute (IACS), Zaragoza, Spain
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Sayyari Y, Kardar MH, Sadeghian F, Mirrezaie SM. The impact of socioeconomic status on hand injury severity. HAND SURGERY & REHABILITATION 2022; 41:695-700. [PMID: 36089214 DOI: 10.1016/j.hansur.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/28/2022] [Accepted: 08/31/2022] [Indexed: 01/04/2023]
Abstract
Socioeconomic status (SES) is an important factor affecting different aspects of human health, including self-care and healthcare service use. The relation between SES and hand injury severity is not well defined; therefore, the present study aimed to investigate the relation between SES and hand injury severity. This cross-sectional descriptive and analytical study included 215 patients with hand injury. Demographic, clinical, and SES-related factors were collected by questionnaire. Injury severity was assessed on Hand Injury Severity Score (HISS). Statistical analysis used the Student t-test, chi-square test and a multinomial regression model to calculate the odds ratio (OR) of each predictive factor. Mean age was 38.02 ± 13.49 years (range, 12-80 years). 73.5% of the participants were men. Patients with low SES were significantly more likely to develop severe hand injury (OR = 5.25 and 9.25 at HISS levels 3 and 4, respectively). In addition, there was a significant association between being born in rural areas and severe (HISS level 3, OR = 2.63) or major (HISS level 4, OR = 2.63) hand injury. Also, major (HISS level 4) hand injuries were significantly more prevalent in patients living in rural areas (OR = 4.23) and those injured in road accidents (OR = 1.98) or practicing sports (OR = 3.51). The study concluded that patients with low SES were 5-10-fold more likely to suffer from severe and major hand injuries, and thus provided valuable information for Iranian policymakers to take preventive measures for hand injuries. It is recommended to improve postoperative care in patients with low SES who underwent hand surgery, take the necessary measures to decrease the incidence of road accident injuries, facilitate early referral of patients with hand injury to trauma centers, and improve postoperative follow-up until full recovery. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Y Sayyari
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, 7 Tir SQ, 36147-73943 Shahroud, Iran
| | - M H Kardar
- School of Medicine, Shahroud University of Medical Sciences, Plastic Reconstructive & Hand Surgery, 7 Tir SQ, 36147-73943 Shahroud, Iran
| | - F Sadeghian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, 7 Tir SQ, 36147-73943 Shahroud, Iran
| | - S M Mirrezaie
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, 7 Tir SQ, 36147-73943 Shahroud, Iran; Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Ayatollah Tawhidi Street, 36169-51835 Shahroud, Iran.
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Héquette-Ruz R, Beuscart JB, Ficheur G, Chazard E, Guillaume E, Paccou J, Puisieux F, Genin M. Hip fractures and characteristics of living area: a fine-scale spatial analysis in France. Osteoporos Int 2020; 31:1353-1360. [PMID: 32140738 DOI: 10.1007/s00198-020-05363-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022]
Abstract
UNLABELLED We investigated the association between hip fracture incidence and living area characteristics in France. The spatial distribution of hip fracture incidence was heterogeneous and there was a significant relationship between social deprivation, urbanization, health access, and hip fracture risk. INTRODUCTION Several studies have shown great disparities in spatial repartition of hip fractures (HF). The aim of the study was to analyze the association between HF incidence and characteristics of the living area. METHODS All patients aged 50 or older, living in France, who were hospitalized for HF between 2012 and 2014 were included, using the French national hospital discharge database. Standardized incidence ratio (SIR) was calculated for each spatial unit and adjusted on age and sex. An ecological regression was performed to analyze the association between HF standardized incidence and ecological variables. We adjusted the model for neighborhood spatial structure. We used three variables to characterize the living areas: a deprivation index (French-EDI); healthcare access (French standardized index); land use (percentage of artificialized surfaces). RESULTS A total of 236,328 HF were recorded in the French hospital national database, leading to an annual HF incidence of 333/100,000. The spatial analysis revealed geographical variations of HF incidence with SIR varying from 0.67 (0.52; 0.85) to 1.45 (1.23; 1.70). There was a significant association between HF incidence rates and (1) French-EDI (trend p = 0.0023); (2) general practitioner and nurse accessibility (trend p = 0.0232 and p = 0.0129, respectively); (3) percentage of artificialized surfaces (p < 0.0001). CONCLUSION The characteristics of the living area are associated with significant differences in the risk of hip fracture of older people.
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Affiliation(s)
- R Héquette-Ruz
- CHU Lille, Geriatrics department, F-59000, Lille, France
| | - J-B Beuscart
- CHU Lille, Geriatrics department, F-59000, Lille, France.
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France.
| | - G Ficheur
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
- CHU Lille, Department of Methodology and Biostatistics, F-59000, Lille, France
| | - E Chazard
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
- CHU Lille, Department of Methodology and Biostatistics, F-59000, Lille, France
| | - E Guillaume
- U1086 INSERM, Université Caen Normandie-UFR Santé, Caen, France
| | - J Paccou
- MABLab UR 4490, Department of Rheumatology, Univ. Lille, CHU Lille, 59000, Lille, France
| | - F Puisieux
- CHU Lille, Geriatrics department, F-59000, Lille, France
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | - M Genin
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
- CHU Lille, Department of Methodology and Biostatistics, F-59000, Lille, France
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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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8
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Brennan-Olsen SL, Friel S. Australia's health divide: time to address the underlying causes. Med J Aust 2019; 208:461. [PMID: 29848250 DOI: 10.5694/mja17.01215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/09/2018] [Indexed: 11/17/2022]
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Unhealthy lifestyles are associated with the increased risk of low-energy fracture in Chinese men ≥ 50 years, a population-based survey. Arch Osteoporos 2019; 14:57. [PMID: 31144116 DOI: 10.1007/s11657-019-0600-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/14/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to investigate the incidence of low-energy fractures in men aged 50 years and older in China and to explore associated risk factors. METHODS All the relevant data were available from the China National Fracture Survey (CNFS), which was a cross-sectional survey carried out in eight Chinese provinces (municipalities) between January and May 2015. RESULTS Through 2014, 76,687 men above 50 years participated in this study and 223 participants had low-energy fractures, indicating the incidence rate 290.8 (95%CI, 252.7-328.9)/100,000 men. Over 80% of the fractures occurred at home and on the common road. The fracture incidence rate presented a significant rising trend with advanced age (p = 0.039). Current smoking, alcohol overconsumption, insufficient sleep duration, and history of past fracture were identified as significant risk factors associated with low-energy fracture (p < 0.05). CONCLUSIONS These results will assist the decisions regarding allocation of healthcare provision to populations of greatest need and aid the design and implementation of strategies to reduce fracture incidence. Accordingly, individuals should be encouraged to reduce alcohol consumption, immediately quit smoking, and get sufficient sleep, especially in those with a history of past fracture. In addition, primary preventives especially home prevention should be emphasized.
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Johnson NA, Jeffery J, Stirling E, Thompson J, Dias JJ. Effects of deprivation, ethnicity, gender and age on distal radius fracture incidence and surgical intervention rate. Bone 2019; 121:1-8. [PMID: 30599298 DOI: 10.1016/j.bone.2018.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/28/2018] [Accepted: 12/24/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Social deprivation has been shown to be associated with increased incidence of many types of fracture but the causes for this have not been established. The aim of this study was to establish if distal radius fracture was associated with deprivation and investigate reasons for this. METHOD Data was reviewed of 4463 adult patients who attended our Emergency Department over a four year period. The Index of Multiple Deprivation was used to measure deprivation for each patient. Modelling techniques were used to investigate the relationship between fracture rate and deprivation, gender, ethnicity and age. RESULTS Distal radius fracture rate was higher for patients in more deprived quintiles. Mean age in the most deprived two quintiles was 54.4 years compared to 60.1 years in the least deprived three quintiles. Modelling showed important differences between ethnic groups. Deprivation was an independent risk factor for distal radius fracture only in white patients. Deprived white women had a lower second metacarpal cortical index than women of other ethnicities suggesting increased bone fragility. Being male is a risk factor for fracture when deprivation, ethnicity and age are taken into account. Incidence rate ratio of the least deprived quintile compared to the most deprived was 0.33 (95% CI: 0.30-0.37) for white men and 0.47 (95% CI: 0.44-0.49) for white women. CONCLUSION Effective interventions exist to prevent further fragility fracture and this work allows geographical areas at risk to be identified. Presentation with a distal radius fracture provides an opportunity to implement interventions. In the current economic climate resources are scarce and must be used prudently. Resources should be targeted to those at risk patients from deprived areas and preventative strategies put in place.
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Affiliation(s)
- Nick A Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
| | - John Jeffery
- Nuffield Orthopaedic Centre, Windmill road, Oxford OX3 7HE, UK
| | - Euan Stirling
- Nuffield Orthopaedic Centre, Windmill road, Oxford OX3 7HE, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Joseph J Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK
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Holmberg T, Möller S, Rothmann MJ, Gram J, Herman AP, Brixen K, Tolstrup JS, Høiberg M, Bech M, Rubin KH. Socioeconomic status and risk of osteoporotic fractures and the use of DXA scans: data from the Danish population-based ROSE study. Osteoporos Int 2019; 30:343-353. [PMID: 30465216 DOI: 10.1007/s00198-018-4768-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED There is a need of studies exploring the link between socioeconomic status and DXA scans and osteoporotic fracture, which was the aim of the present study. No differences in socioeconomic status and risk of osteoporotic fractures were found. However, women with further/higher education and higher income are more often DXA-scanned. INTRODUCTION Lower socioeconomic status is known to be associated with a range of chronic conditions and with access to health care services. The link between socioeconomic status and the use of DXA scans and osteoporotic fracture, however, needs to be explored more closely. Therefore, the aim of this study was to examine the relationship between socioeconomic status and both DXA scan utilization and major osteoporotic fractures (MOF) using a population-based cohort of Danish women and national registers. METHODS The study included 17,155 women (65-81 years) sampled from the Risk-stratified Osteoporosis Strategy Evaluation study (ROSE). Information on socioeconomic background, DXA scans, and MOFs was retrieved from national registers. Competing-risk regression analyses were performed. Mean follow-up was 4.8 years. RESULTS A total of 4245 women had a DXA scan (24.7%) and 1719 (10.0%) had an incident MOF during follow-up. Analyses showed that women with basic education had a lower probability of undergoing DXA scans than women with further or higher education (greater than upper secondary education and vocational training education) (subhazard ratio (SHR) = 0.82; 95% CI 0.75-0.89, adjusted for age and comorbidity). Moreover, women with disposable income in the low and medium tertiles had a lower probability of undergoing DXA scans than women in the high-income tertile (SHR = 0.90; 95% CI 0.84-0.97 and SHR = 0.88, 95% CI 0.82-0.95, respectively, adjusted for age and comorbidity). No association between socioeconomic background and probability of DXA was found in adjusted analyses. CONCLUSION The study found no differences in risk of osteoporotic fractures depending on socioeconomic status. However, women with further or higher education as well as higher income are more often DXA-scanned.
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Affiliation(s)
- T Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1355, Copenhagen K, Denmark.
| | - S Möller
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M J Rothmann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - A P Herman
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K Brixen
- Odense University Hospital, Odense, Denmark
| | - J S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1355, Copenhagen K, Denmark
| | - M Høiberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Hospital of Southern Norway, Kristiansand, Norway
| | - M Bech
- Department of Political Science, Aarhus University, Aarhus, Denmark
| | - K H Rubin
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Holloway-Kew KL, Moloney DJ, Bucki-Smith G, Hyde NK, Brennan-Olsen SL, Timney EN, Dobbins AG, Pasco JA. Sports participation and fracture in older Australian men. Arch Osteoporos 2018; 13:43. [PMID: 29675770 DOI: 10.1007/s11657-018-0459-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/29/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Older men who participated in a sporting activity were less likely to sustain any fracture or major osteoporotic fracture over a 6-year follow-up period. PURPOSE Regular weight-bearing physical activity can reduce fracture risk through an increase in bone strength, as well as reducing falls risk by improving muscle strength and balance. In this study, we aimed to determine whether a specific type of physical activity, sports participation, reduces fracture risk in older Australian men. METHODS Participation in sporting activities was documented for men aged 60 years and over enrolled in the Geelong Osteoporosis Study situated in south-eastern Australia. Fractures at any skeletal site (excluding skull, face, fingers and toes) and major osteoporotic fracture sites (MOF; wrist, proximal humerus, spine and hip) were ascertained through examination of radiological reports (median follow-up 6.63 years, IQR 5.58-7.29). Multivariable logistic regression was used to investigate the association between sports participation (either binary or continuous) and any fracture or MOF. Other clinical measures and lifestyle variables (such as comorbidity, falls and mobility) were included as potential confounders. RESULTS During follow-up, 82 of 656 men (12.5%) sustained at least one fracture at any site and 58 sustained at least one MOF (8.8%). Of those who did and did not fracture (any site), 17 (20.7%) and 204 (35.5%) participated in at least one sporting activity. For MOF, the values were 11 (19.0%) and 210 (35.1%), respectively. Participation in any sporting activity was associated with a reduction in the likelihood of any fracture during follow-up (unadjusted: OR 0.47, 95%CI 0.27-0.83), which persisted after adjusting for other factors (adjusted: OR 0.52, 95%CI 0.29-0.91). The results for MOF were similar (unadjusted: OR 0.43, 0.22-0.85; adjusted 0.48, 0.24-0.95). When considering sports participation as a continuous variable, a trend was observed (adjusted: p = 0.051 and p = 0.059 for any and MOF, respectively). A sensitivity analysis showed similar results when excluding men who reported using a walking aid. CONCLUSIONS In this group of older men, participation in sporting activity was associated with a reduced risk of fracture during the subsequent follow-up period.
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Affiliation(s)
- Kara L Holloway-Kew
- Deakin University, Geelong, Victoria, 3216, Australia. .,Epi-Centre for Healthy Ageing, IMPACT SRC, School of Medicine, Deakin University, C/- HERB L3, Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia.
| | | | | | | | - Sharon L Brennan-Olsen
- Deakin University, Geelong, Victoria, 3216, Australia.,Australian Institute for Musculoskeletal Sciences (AIMSS), The University of Melbourne, and Western Health, St Albans, Victoria, 3021, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Victoria, 3021, Australia.,Australian Health Policy Collaboration, Melbourne, Victoria, 3000, Australia
| | | | | | - Julie A Pasco
- Deakin University, Geelong, Victoria, 3216, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Victoria, 3021, Australia.,Barwon Health, Ryrie Street, Geelong, Victoria, 3220, Australia
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Holloway KL, Sajjad MA, Mohebbi M, Kotowicz MA, Livingston PM, Khasraw M, Hakkennes S, Dunning TL, Brumby S, Page RS, Pedler D, Sutherland A, Venkatesh S, Brennan-Olsen SL, Williams LJ, Pasco JA. The epidemiology of hip fractures across western Victoria, Australia. Bone 2018; 108:1-9. [PMID: 29229437 DOI: 10.1016/j.bone.2017.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hip fractures are associated with considerable morbidity and mortality. Hip fracture incidence varies across different levels of accessibility/remoteness and socioeconomic status (SES). As part of the Ageing, Chronic Disease and Injury Study, we aimed to map the pattern of hip fractures across the western region of the Australian state of Victoria, which contains a range of remoteness levels and SES. METHODS Data on hip fractures resulting in hospital admission were extracted from the Victorian Admitted Episodes Dataset (VAED) for men and women aged 40+years during 2010-2013 inclusive. An age-adjusted incidence rate (per 10,000population/year) was calculated for the entire region. Crude incidence rates and length of acute care hospital stay (excluding rehabilitation) were calculated for each Local Government Area (LGA). The impact of aggregated age, accessibility/remoteness index of Australia (ARIA) and SES on hip fracture rates aggregated across LGAs was determined using Poisson regression. RESULTS For men, the age-standardised rate of hospitalisations for hip fracture across the whole region was 19.2 per 10,000population/year (95%CI 18.0-20.4) and for women, 40.0 (95%CI 38.3-41.7). The highest incidence rates for both sexes occurred in the less accessible LGAs of Yarriambiack and Hindmarsh, as well as the LGA with the lowest SES, Central Goldfields. In both sexes, approximately two thirds of individuals were discharged from acute hospital care within 14days. Increasing age, higher remoteness and lower SES were all associated with higher hip fracture rates. CONCLUSION Crude incidence rates varied by location. Given that a high proportion of patients had acute hospital care of ≤14days, and accessibility and SES were associated with hip fracture rates, these results can inform policy and provide a model for other groups to conduct similar research in their local environment.
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Affiliation(s)
| | | | | | - Mark A Kotowicz
- Deakin University, School of Medicine, Geelong, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia
| | | | | | | | | | - Susan Brumby
- Deakin University, School of Medicine, Geelong, Australia; National Centre for Farmer Health, Western District Health Service, Hamilton, Australia
| | - Richard S Page
- Deakin University, School of Medicine, Geelong, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia; Barwon Centre of Orthopaedic Research and Education (B-CORE), St John of God Hospital and Barwon Health, Geelong, Australia
| | - Daryl Pedler
- Deakin University, School of Medicine, Geelong, Australia
| | - Alasdair Sutherland
- Deakin University, School of Medicine, Geelong, Australia; South West Healthcare, Warrnambool, Australia
| | | | - Sharon L Brennan-Olsen
- Deakin University, School of Medicine, Geelong, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Australia; The Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
| | | | - Julie A Pasco
- Deakin University, School of Medicine, Geelong, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia
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Fredman NJ, Duque G, Duckham RL, Green D, Brennan-Olsen SL. Associations between socioeconomic factors and proinflammatory cytokines in children, adolescents and young adults: a systematic review protocol. BMJ Open 2018; 8:e019381. [PMID: 29490962 PMCID: PMC5855348 DOI: 10.1136/bmjopen-2017-019381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION There is now substantial evidence of a social gradient in bone health. Social stressors, related to socioeconomic status, are suggested to produce an inflammatory response marked by increased levels of proinflammatory cytokines. Here we focus on the particular role in the years before the achievement of peak bone mass, encompassing childhood, adolescence and young adulthood. An examination of such associations will help explain how social factors such as occupation, level of education and income may affect later-life bone disorders. This paper presents the protocol for a systematic review of existing literature regarding associations between socioeconomic factors and proinflammatory cytokines in those aged 6-30 years. METHODS AND ANALYSIS We will conduct a systematic search of PubMed, OVID and CINAHL databases to identify articles that examine associations between socioeconomic factors and levels of proinflammatory cytokines, known to influence bone health, during childhood, adolescence or young adulthood. The findings of this review have implications for the equitable development of peak bone mass regardless of socioeconomic factors. Two independent reviewers will determine the eligibility of studies according to predetermined criteria, and studies will be assessed for methodological quality using a published scoring system. Should statistical heterogeneity be non-significant, we will conduct a meta-analysis; however, if heterogeneity prevent numerical syntheses, we will undertake a best-evidence analysis to determine whether socioeconomic differences exist in the levels of proinflammatory cytokines from childhood through to young adulthood. ETHICS AND DISSEMINATION This study will be a systematic review of published data, and thus ethics approval is not required. In addition to peer-reviewed publication, these findings will be presented at professional conferences in national and international arenas.
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Affiliation(s)
- Nick John Fredman
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Louise Duckham
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Darci Green
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Lee Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Health Policy Collaboration, Victoria University, Melbourne, Victoria, Australia
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Green D, Duque G, Fredman N, Rizvi A, Brennan-Olsen SL. Is there a social gradient of sarcopenia? A meta-analysis and systematic review protocol. BMJ Open 2018; 8:e019088. [PMID: 29331970 PMCID: PMC5905744 DOI: 10.1136/bmjopen-2017-019088] [Citation(s) in RCA: 4] [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] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Sarcopenia (or loss of muscle mass and function) is a relatively new area within the field of musculoskeletal research and medicine. Investigating whether there is a social gradient, including occupation type and income level, of sarcopenia, as observed for other diseases, will contribute significantly to the limited evidence base for this disease. This new information may inform the prevention and management of sarcopenia and widen the evidence base to support existing and future health campaigns. METHODS AND ANALYSIS We will conduct a systematic search of the databases PubMed, Ovid, CINAHL, Scopus and EMBASE to identify articles that investigate associations between social determinants of health and sarcopenia in adults aged 50 years and older. Eligibility of the selected studies will be determined by two independent reviewers. The methodological quality of eligible studies will be assessed according to predetermined criteria. Established statistical methods to identify and control for heterogeneity will be used, and where appropriate, we will conduct a meta-analysis. In the event that heterogeneity prevents numerical synthesis, a best evidence analysis will be employed. This systematic review protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols reporting guidelines and will be registered with the International Prospective Register of Systematic Reviews (PROSPERO). ETHICS AND DISSEMINATION This systematic review will use published data, thus ethical permissions will not be required. In addition to peer-reviewed publication, our results will be presented at (inter)national conferences relevant to the field of sarcopenia, ageing and/or musculoskeletal health and disseminated both electronically and in print. PROSPERO REGISTRATION NUMBER CRD42017072253.
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Affiliation(s)
- Darci Green
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Nick Fredman
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Melbourne, Victoria, Australia
| | - Aoun Rizvi
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Lee Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Institute of Health and Aging, Australian Catholic University, Melbourne, Victoria, Australia
- Department of Medicine, Deakin University, Geelong, Victoria, Australia
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17
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Brennan-Olsen SL, Vogrin S, Leslie WD, Kinsella R, Toombs M, Duque G, Hosking SM, Holloway KL, Doolan BJ, Williams LJ, Page RS, Pasco JA, Quirk SE. Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology. Bone Rep 2017; 6:145-158. [PMID: 28560269 PMCID: PMC5437735 DOI: 10.1016/j.bonr.2017.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences. METHODS On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries. RESULTS Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture. CONCLUSIONS The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.
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Affiliation(s)
- Sharon L Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Department of Medicine, University of Melbourne-Western Precinct, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia.,Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, 3000, VIC, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia
| | - William D Leslie
- Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg R2H 2A6, Canada
| | - Rita Kinsella
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia
| | - Maree Toombs
- Rural Clinical School, School of Medicine, University of Queensland, Toowoomba, 4350, QLD, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Western Health, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Department of Medicine, University of Melbourne-Western Precinct, 176 Furlong Road, St Albans, 3021, VIC, Australia
| | - Sarah M Hosking
- Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia
| | - Kara L Holloway
- Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia
| | | | - Lana J Williams
- Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia
| | - Richard S Page
- Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia.,Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health, St John of God Hospital, Ryrie Street, PO Box 281, Geelong, 3220, VIC, Australia
| | - Julie A Pasco
- Department of Medicine, University of Melbourne-Western Precinct, 176 Furlong Road, St Albans, 3021, VIC, Australia.,Deakin University, Pigdon Road, Geelong, 3220, VIC, Australia.,Department of Preventive Medicine and Epidemiology, Monash University, Alfred Centre, Commercial Road, Prahran, VIC, Australia
| | - Shae E Quirk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Wellington Road, Clayton, 3168, VIC, Australia
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18
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Peters TL, Weibull CE, Fang F, Sandler DP, Lambert PC, Ye W, Kamel F. Association of fractures with the incidence of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:419-425. [PMID: 28316249 DOI: 10.1080/21678421.2017.1300287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Elevated bone turnover observed in ALS patients suggests poor bone health and increased fracture risk. We therefore evaluated the relationship of fracture to subsequent ALS risk. METHODS We followed 4,529,460 Swedes from 1987 to 2010 and identified ALS and fractures from the Swedish National Patient Register. We examined associations of ALS risk with all fractures, osteoporotic and non-osteoporotic fractures, and traumatic and non-traumatic fractures among individuals aged 30-80 years. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We analysed the association of ALS with time since fracture using a Poisson regression model. RESULTS All fractures (HR: 1.51, 95% CI 1.39-1.65) as well as osteoporotic (HR: 1.59, 95% CI 1.41-1.79), non-osteoporotic (HR: 1.46, 95% CI 1.31-1.63), traumatic (HR: 1.50, 95% CI 1.37-1.63), and non-traumatic (HR: 1.80, 95% CI 1.35-2.40) fractures were associated with a higher incidence of ALS. Increased ALS incidence was associated with fractures occurring from one (HR: 2.33, 95% CI 2.04-2.66) to 18 (HR: 1.19, 95% CI 1.01-1.43) years before ALS diagnosis. CONCLUSIONS Poor bone health may be related to ALS. These findings may offer insight into ALS pathophysiology.
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Affiliation(s)
- Tracy L Peters
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.,b Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park , NC , USA , and
| | - Caroline E Weibull
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Fang Fang
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Dale P Sandler
- b Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park , NC , USA , and
| | - Paul C Lambert
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.,c Department of Health Sciences , University of Leicester , Leicester , UK
| | - Weimin Ye
- a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Freya Kamel
- b Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park , NC , USA , and
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21
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Curtis EM, van der Velde R, Moon RJ, van den Bergh JPW, Geusens P, de Vries F, van Staa TP, Cooper C, Harvey NC. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone 2016; 87:19-26. [PMID: 26968752 PMCID: PMC4890652 DOI: 10.1016/j.bone.2016.03.006] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/09/2016] [Accepted: 03/07/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED Rates of fracture worldwide are changing. Using the Clinical Practice Research Datalink (CPRD), age, and gender, geographical, ethnic and socioeconomic trends in fracture rates across the United Kingdom were studied over a 24-year period 1988-2012. Previously observed patterns in fracture incidence by age and fracture site were evident. New data on the influence of geographic location, ethnic group and socioeconomic status were obtained. INTRODUCTION With secular changes in age- and sex-specific fracture incidence observed in many populations, and global shifts towards an elderly demography, it is vital for health care planners to have an accurate understanding of fracture incidence nationally. We aimed to present up to date fracture incidence data in the UK, stratified by age, sex, geographic location, ethnicity and socioeconomic status. METHODS The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 6.9% of the UK population. Information comes from General Practitioners, and covers 11.3 million people from 674 practices across the UK, demonstrated to be representative of the national population. The study population consisted of all permanently registered individuals aged ≥18years. Validated data on fracture incidence were obtained from their medical records, as was information on socioeconomic deprivation, ethnicity and geographic location. Age- and sex-specific fracture incidence rates were calculated. RESULTS Fracture incidence rates by age and sex were comparable to those documented in previous studies and demonstrated a bimodal distribution. Substantial geographic heterogeneity in age- and sex adjusted fracture incidence was observed, with rates in Scotland almost 50% greater than those in London and South East England. Lowest rates of fracture were observed in black individuals of both sexes; rates of fragility fracture in white women were 4.7 times greater than in black women. Strong associations between deprivation and fracture risk were observed in hip fracture in men, with a relative risk of 1.3 (95% CI 1.21-1.41) in Index of Multiple Deprivation category 5 (representing the most deprived) compared to category 1. CONCLUSIONS This study presents robust estimates of fracture incidence across the UK, which will aid decisions regarding allocation of healthcare provision to populations of greatest need. It will also assist the implementation and design of strategies to reduce fracture incidence and its personal and financial impact on individuals and health services.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- Correspondence and reprint requests to: Professor Cyrus Cooper, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK. Tel: +44 (0) 23 8077 7624 Fax: +44 (0) 23 8070 4021,
| | - Robert van der Velde
- Dept of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, the Netherlands
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Joop P W van den Bergh
- Dept of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, the Netherlands
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Piet Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- University Hasselt, Hasselt, Belgium
| | - Frank de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tjeerd P van Staa
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, 1.003 Vaughan House, Portsmouth Road, M13 9PL, UK
- Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands, 3508 TB
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopedic Centre, Headington, Oxford, OX3 7HE, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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Abstract
Fractures in the elderly are increasing in incidence and becoming a major health issue in many countries. With an increasing number of the elderly living to an older age, the problems associated with fractures will continue to increase. We describe the epidemiology of fractures in the elderly and identify six fracture patterns in the population of patients who are sixty-five years of age or older. We also analyzed multiple fractures and open fractures in the elderly and we show that both increase in incidence with older age. The incidence of open fractures in elderly women is equivalent to that in young men. Many factors, including patient socioeconomic deprivation, increase the incidence of fractures in the elderly. More than 90% of fractures follow low-energy falls and the mortality is considerable. Mortality increases with older age and medical comorbidities, but there is also evidence that it relates to premature discharge from the hospital.
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Brennan-Olsen SL, Page RS, Berk M, Riancho JA, Leslie WD, Wilson SG, Saban KL, Janusek L, Pasco JA, Hodge JM, Quirk SE, Hyde NK, Hosking SM, Williams LJ. DNA methylation and the social gradient of osteoporotic fracture: A conceptual model. Bone 2016; 84:204-212. [PMID: 26723576 DOI: 10.1016/j.bone.2015.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/19/2015] [Accepted: 12/21/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although there is a documented social gradient for osteoporosis, the underlying mechanism(s) for that gradient remain unknown. We propose a conceptual model based upon the allostatic load theory, to suggest how DNA methylation (DNAm) might underpin the social gradient in osteoporosis and fracture. We hypothesise that social disadvantage is associated with priming of inflammatory pathways mediated by epigenetic modification that leads to an enhanced state of inflammatory reactivity and oxidative stress, and thus places socially disadvantaged individuals at greater risk of osteoporotic fracture. METHODS/RESULTS Based on a review of the literature, we present a conceptual model in which social disadvantage increases stress throughout the lifespan, and engenders a proinflammatory epigenetic signature, leading to a heightened inflammatory state that increases risk for osteoporotic fracture in disadvantaged groups that are chronically stressed. CONCLUSIONS Our model proposes that, in addition to the direct biological effects exerted on bone by factors such as physical activity and nutrition, the recognised socially patterned risk factors for osteoporosis also act via epigenetic-mediated dysregulation of inflammation. DNAm is a dynamic modulator of gene expression with considerable relevance to the field of osteoporosis. Elucidating the extent to which this epigenetic mechanism transduces the psycho-social environment to increase the risk of osteoporotic fracture may yield novel entry points for intervention that can be used to reduce individual and population-wide risks for osteoporotic fracture. Specifically, an epigenetic evidence-base may strengthen the importance of lifestyle modification and stress reduction programs, and help to reduce health inequities across social groups. MINI ABSTRACT Our conceptual model proposes how DNA methylation might underpin the social gradient in osteoporotic fracture. We suggest that social disadvantage is associated with priming of inflammatory signalling pathways, which is mediated by epigenetic modifications, leading to a chronically heightened inflammatory state that places disadvantaged individuals at greater risk of osteoporosis.
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Affiliation(s)
- Sharon L Brennan-Olsen
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia; Australian Institute for Musculoskeletal Sciences, The University of Melbourne, C/- Sunshine Hospital, Furlong Road, Melbourne, 3021, VIC, Australia; Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, VIC, Australia.
| | - Richard S Page
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia; Barwon Orthopaedic Research Unit, Barwon Health, Geelong, 3220, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - José A Riancho
- Department of Internal Medicine, Valdecilla Research Institute (IDIVAL), University of Cantabria, Santander, Spain
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott G Wilson
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia; School of Medicine and Pharmacology, The University of Western Australia, Nedlands, 6009, WA, Australia; Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Karen L Saban
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA; Centre of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Linda Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Julie A Pasco
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Jason M Hodge
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Shae E Quirk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Natalie K Hyde
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Sarah M Hosking
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Lana J Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
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Ito K, Aida J, Yamamoto T, Ohtsuka R, Nakade M, Suzuki K, Kondo K, Osaka K. Individual- and community-level social gradients of edentulousness. BMC Oral Health 2015; 15:34. [PMID: 25884467 PMCID: PMC4460930 DOI: 10.1186/s12903-015-0020-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background Community-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual- and community-level social inequalities in edentulousness and to determine any explanatory factors in this association. Methods We analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual- and community-level incomes after adjusted for covariates. Results Of 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual- and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community- and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction < 0.001). Conclusions Individual- and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.
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Affiliation(s)
- Kanade Ito
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai City, Miyagi, Japan. .,Division of Oral Health Sciences, Department of Health Sciences, School of Health and Social Services, Saitama Prefectural University, Koshigaya City, Saitama, Japan.
| | - Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai City, Miyagi, Japan.
| | - Tatsuo Yamamoto
- Department of Dental Sociology, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka City, Kanagawa, Japan.
| | - Rika Ohtsuka
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Itabashi Ward, Tokyo, Japan.
| | - Miyo Nakade
- Department of Nutrition, Faculty of Health and Nutrition, Tokaigakuen University, Nagoya City, Aichi, Japan.
| | - Kayo Suzuki
- Center for Well-being and Society, Nihon Fukushi University, Nagoya City, Aichi, Japan. .,Department of Policy Studies, Aichi Gakuin University, Nisshin City, Aichi, Japan.
| | - Katsunori Kondo
- Center for Well-being and Society, Nihon Fukushi University, Nagoya City, Aichi, Japan. .,Center for Preventive Medical Sciences, Chiba University, Chiba City, Chiba, Japan.
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai City, Miyagi, Japan.
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