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Dimai HP, Muschitz C, Amrein K, Bauer R, Cejka D, Gasser RW, Gruber R, Haschka J, Hasenöhrl T, Kainberger F, Kerschan-Schindl K, Kocijan R, König J, Kroißenbrunner N, Kuchler U, Oberforcher C, Ott J, Pfeiler G, Pietschmann P, Puchwein P, Schmidt-Ilsinger A, Zwick RH, Fahrleitner-Pammer A. [Osteoporosis-Definition, risk assessment, diagnosis, prevention and treatment (update 2024) : Guidelines of the Austrian Society for Bone and Mineral Research]. Wien Klin Wochenschr 2024; 136:599-668. [PMID: 39356323 PMCID: PMC11447007 DOI: 10.1007/s00508-024-02441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Austria is among the countries with the highest incidence and prevalence of osteoporotic fractures worldwide. Guidelines for the prevention and management of osteoporosis were first published in 2010 under the auspices of the then Federation of Austrian Social Security Institutions and updated in 2017. The present comprehensively updated guidelines of the Austrian Society for Bone and Mineral Research are aimed at physicians of all specialties as well as decision makers and institutions in the Austrian healthcare system. The aim of these guidelines is to strengthen and improve the quality of medical care of patients with osteoporosis and osteoporotic fractures in Austria. METHODS These evidence-based recommendations were compiled taking randomized controlled trials, systematic reviews and meta-analyses as well as European and international reference guidelines published before 1 June 2023 into consideration. The grading of recommendations used ("conditional" and "strong") are based on the strength of the evidence. The evidence levels used mutual conversions of SIGN (1++ to 3) to NOGG criteria (Ia to IV). RESULTS The guidelines include all aspects associated with osteoporosis and osteoporotic fractures, such as secondary causes, prevention, diagnosis, estimation of the 10-year fracture risk using FRAX®, determination of Austria-specific FRAX®-based intervention thresholds, drug-based and non-drug-based treatment options and treatment monitoring. Recommendations for the office-based setting and decision makers and institutions in the Austrian healthcare system consider structured care models and options for osteoporosis-specific screening. CONCLUSION The guidelines present comprehensive, evidence-based information and instructions for the treatment of osteoporosis. It is expected that the quality of medical care for patients with this clinical picture will be substantially improved at all levels of the Austrian healthcare system.
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Affiliation(s)
- Hans Peter Dimai
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Christian Muschitz
- healthPi Medical Center, Medizinische Universität Wien, Wollzeile 1-3, 1010, Wien, Österreich.
- Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Karin Amrein
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | | | - Daniel Cejka
- Interne 3 - Nieren- und Hochdruckerkrankungen, Transplantationsmedizin, Rheumatologie, Ordensklinikum Linz Elisabethinen, Linz, Österreich
| | - Rudolf Wolfgang Gasser
- Universitätsklinik für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Reinhard Gruber
- Universitätszahnklinik, Medizinische Universität Wien, Wien, Österreich
| | - Judith Haschka
- Hanusch Krankenhaus Wien, 1. Medizinische Abteilung, Ludwig Boltzmann Institut für Osteologie, Wien, Österreich
- Rheuma-Zentrum Wien-Oberlaa, Wien, Österreich
| | - Timothy Hasenöhrl
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Franz Kainberger
- Klinische Abteilung für Biomedizinische Bildgebung und Bildgeführte Therapie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Katharina Kerschan-Schindl
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Roland Kocijan
- Hanusch Krankenhaus Wien, 1. Medizinische Abteilung, Ludwig Boltzmann Institut für Osteologie, Wien, Österreich
| | - Jürgen König
- Department für Ernährungswissenschaften, Universität Wien, Wien, Österreich
| | | | - Ulrike Kuchler
- Universitätszahnklinik, Medizinische Universität Wien, Wien, Österreich
| | | | - Johannes Ott
- Klinische Abteilung für gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Georg Pfeiler
- Klinische Abteilung für Gynäkologie und Gynäkologische Onkologie, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Peter Pietschmann
- Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie (CEPII), Medizinische Universität Wien, Wien, Österreich
| | - Paul Puchwein
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
| | | | - Ralf Harun Zwick
- Ludwig Boltzmann Institut für Rehabilitation Research, Therme Wien Med, Wien, Österreich
| | - Astrid Fahrleitner-Pammer
- Privatordination Prof. Dr. Astrid Fahrleitner-Pammer
- Klinische Abteilung für Endokrinologie und Diabetes, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
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6
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Kanis JA, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O’Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Vandenput L, Harvey NC, Lorentzon M, Leslie WD. Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX. Osteoporos Int 2023; 34:2027-2045. [PMID: 37566158 PMCID: PMC7615305 DOI: 10.1007/s00198-023-06870-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. RESULTS A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.
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Affiliation(s)
- John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Helena Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Sweden
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK; MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Enwu Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Kristina E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Fred A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rafael Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain; GROIMAP (research group), Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’investigació en Atenció Primària Jordi Gol, Cerdanyola del Vallès, Barcelona, Spain; PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
| | | | - Charlotte Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands
| | - Heike A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland; Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - Emmanuel Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, United States
| | - Jacqueline R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent’s Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia; School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Roland Chapurlat
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK; NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - José AP da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Adolfo Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - Alyssa B Dufour
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John A Eisman
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia; St Vincent’s Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia; School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Petra JM Elders
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Serge Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yuki Fujita
- Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
| | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women’s University, Hiroshima, Japan
| | - Claus-Christian Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - Inbal Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland; University of Iceland, Reykjavik, Iceland
| | - Jill Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Didier Hans
- Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Masayuki Iki
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | | | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Sundeep Khosla
- Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Douglas P Kiel
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Fjorda Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark A Kotowicz
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - Heikki Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland; Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Olivier Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland; Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian; University of Science and Technology, Trondheim, Norway
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurt Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dan Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - Thomas Merlijn
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anna Nordström
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden; Department of Medical Sciences, Uppsala University, Sweden
| | - Peter Nordström
- Department of public health and caring sciences, Uppsala University, Uppsala, Sweden
| | - Terence W O’Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria; Center for Biomarker Research in Medicine, Graz, Austria
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Eric S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Julie A Pasco
- Deakin University, Institute for Physical and Mental Health and Clinical Translation (IMPACT), Geelong, Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; Barwon Health, Geelong, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anne Marie Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland, USA
| | - Kristin Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland; Janus Rehabilitation, Reykjavik, Iceland
| | - Eleanor M Simonsick
- Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, Maryland
| | | | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Karin MA Swart
- Department of General Practice, Amsterdam UMC, location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Junko Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Tjeerd P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Joan Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marta Zwart
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain; Department of Medical Sciences, University of Girona, Girona, Spain; GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca Girona, Institut Universitari d’investigació en Atenció Primària Jordi Gol, Girona, Spain
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
| | - Liesbeth Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mattias Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Sweden; Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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