Hearing impairment increases the risk of distal radius, hip, and spine fractures: A longitudinal follow-up study using a national sample cohort

Hearing loss and risk of major osteoporotic fracture: a population-based cohort study in the United Kingdom

Using the UK Clinical Practice Research Datalink, our cohort study matched 237,297 individuals with hearing loss (HL) to 829,431 without HL. The study found an 8-10% higher risk of major osteoporotic fracture in individuals with HL compared to those without. Additionally, within the HL cohort, we identified risk factors for potential inclusion in fracture risk models.

PURPOSE

Assess association between hearing loss (HL) and major osteoporotic fracture (MOF; spine, wrist/forearm, shoulder/proximal humerus, hip) in individuals aged ≥ 60 years, and risk factors for MOF in individuals with HL.

METHODS

From the UK Clinical Practice Research Datalink, our cohort study matched individuals aged ≥ 60 years diagnosed with HL (READ/ICD-10 codes; 01January2001-31December2021; index event), without secondary osteoporosis causes, with up to five individuals without HL (birth, index year, sex, general practice). Incidence rates and Cox proportional hazard ratios (HL vs. no HL; stratified by low/high fracture risk) were calculated for MOF and hip fracture; multivariate logistic regression assessed risk factors for MOF and hip fracture (HL cohort).

RESULTS

A total of 237,297 individuals with HL matched to 829,431 without HL, with a median age of 74 and 72 years, respectively. Compared with those without HL, individuals with HL had greater frailty (severe electronic frailty index, 5.9% vs. 2.7%), higher incidence of prior falls (14.1% vs. 10.6%), longer mean follow-up with higher incidence of MOF and hip fractures (5.1 vs. 4.4 years, 20.1 and 5.32 vs. 16.58 and 4.54 per 1000 person-years, respectively) and higher risk of MOF and hip fracture (adjusted HR, 1.10 and 1.08, respectively). Significant risk factors for MOF and hip fracture included age ≥ 70 years, fracture history, falls, osteoporosis diagnosis, chronic obstructive pulmonary disorder and cardiovascular disease (HL cohort).

CONCLUSION

In individuals with HL, we observed an 8-10% higher risk of MOF and hip fracture versus individuals without HL and identified risk factors for potential inclusion in fracture risk models.

Prevalence and risk factors of osteoporotic fracture among the elderly population in China: a multicenter cross-sectional study

PURPOSE

Prevalence of osteoporotic fracture (OPF) is increasing with ageing, resulting in a significant financial burden for healthcare. However, research on the nationwide epidemiological data of OPF in Chinese elderly is still scarce. The aim of this study was to investigate the prevalence and risk factors of OPF in Chinese population aged 60 years or order.

METHODS

A cross-sectional survey was conducted in an elderly Chinese population in five centres. Questionnaire investigation and imaging examination were taken in all participants to identify OPF prevalence and risk factors. Diagnosis of OPF was determined based on imaging of vertebral fractures or history of fall-related fractures. We then used multivariate logistic regression model to analyze the associations between the potential risk factors and OPF.

RESULTS

The overall prevalence of OPF in population aged 60 years or older was 24.7% (1,071/4,331), showing an increasing trend with age (P < 0.001). The prevalence of OPF was geographically distinct (P < 0.001), but similar between men and women (P > 0.05). Up to 96.8% of OPFs consisted of vertebral fractures, especially involving T11, T12, and L1 segments. Advanced age (≥ 80), vision loss, severe hearing loss, multiple exercise forms, chronic kidney disease, osteoarthritis, and trauma-related vertebral fractures were significantly associated with risk factors, while education level and vitamin D supplementation were associated with protective factors of OPF.

CONCLUSION

High prevalence of OPF is a serious threat to bone health among elderly people in China. There is an urgent need for effective strategies to diagnose, prevent, and treat OPF in elderly adults.

Defining pre-existing disability among adults captured by the National Trauma Data Bank: A descriptive assessment of patient characteristics and details of injury

BACKGROUND

There is limited research on trauma in people with disability (PWD), despite potentially increased risk for trauma and negative outcomes following injury.

OBJECTIVE

This study describes characteristics of trauma among both narrow and broad subsamples of PWD.

METHODS

Data from the 2016 National Trauma Data Bank was used to identify two Disability Comparison Groups (DCGs). DCG-1 included adult patients with a functionally dependent health status, and DCG-2 included DCG-1 plus other adult patients with disability-associated diagnoses. Trauma characteristics (e.g., signs of life, intent of injury, mechanism of injury, and injury severity score [ISS]) were compared via logistic regression.

RESULTS

Among the 782,241 reported trauma events, 39,011 belonged to DCG-1 and 193,513 to DCG-2. Falls caused most instances of trauma across both groups (DCG-1: 88.7 %; DCG-2: 67.3 %). Both DCGs were less likely than patients without disability to arrive at the facility without signs of life (DCG-1:aOR = 0.22, 95%CI 0.15-0.31; DCG-2:aOR = 0.40, 95%CI 0.36-0.45) or to have an ISS greater than 15 (DCG-1:aOR = 0.81, 95%CI 0.79-0.84; DCG-2:aOR = 0.92, 95%CI:0.91-0.94). They were, however, more likely to have an ISS greater than or equal to 8 (DCG-1:aOR = 1.14, 95%CI 1.11-1.16; DCG-2:aOR = 1.06, 95%CI 1.05-1.07).

CONCLUSION

PWD have greater odds for moderately scored injuries and presenting with signs of life at U.S. trauma centers compared to patients without disability. However, they can be more likely to have certain intents and mechanisms of trauma depending on their functional status and the nature of their impairment. Differences warrant further and continued assessment of trauma experiences among patients with pre-existing disability.

Tenofovir disoproxil fumarate versus tenofovir alafenamide on risk of osteoporotic fracture in patients with chronic hepatitis B: A nationwide claims study in South Korea

BACKGROUND

As tenofovir disoproxil fumarate (TDF) requires long-term use, a reduction in bone density should be considered a possibility when treating patients with chronic hepatitis B (CHB) with aging and systemic diseases. Patients treated with tenofovir alafenamide (TAF) have improved bone mineral density loss compared to patients treated with TDF. Although improvements in bone density caused by TAF have been reported, studies on the actual reduction of fractures are insufficient.

AIM

To evaluate the impact of TAF on the risk of osteoporotic fractures in comparison with that of TDF.

METHODS

Using the national claims data of the Health Insurance Review and Assessment Service, we conducted a retrospective cohort study of 32,582 patients with CHB who had been initially treated with TDF or TAF between November 2017 and December 2020. The numbers of patients treated with TDF and TAF were 20,877 and 11,705, respectively. The annual fracture rate per 100 patients in each group was calculated, and the Cox proportional hazard ratio (HR) was analysed after applying inverse probability treatment weights (IPTW) for both groups.

RESULTS

Among 32,582 patients, the average age was 47.8 ± 11.2 years, 64.5% were men, and the follow-up period was 24.4 ± 11.6 months. The incidence of osteoporotic fractures was 0.78 and 0.49 per 100 person-years in the TDF and TAF groups, respectively. After application of IPTW, the HR was 0.68 (95% confidence interval 0.55-0.85, p = 0.001).

CONCLUSION

TAF-treated patients with CHB had a significantly lower risk of osteoporotic fracture than TDF-treated patients.

Prevalence of aortic aneurysms and dissections in patients with systemic vessel aneurysms and dissections; matched case-control study using a national sample cohort

Objective

Aneurysms in systemic arteries are rare, and little is known about their relationship with aortic aneurysms. In this study, we aimed to evaluate the prevalence of aortic aneurysms and dissections (AAD) in patients with other systemic vessel aneurysms and dissections (OVAD) and identify their potential risk factors.

Methods

This cross-sectional study used a nationwide representative cohort sample from the Korea National Health Insurance Service-National Sample Cohort database. We defined OVAD as systemic vessel aneurysms and dissections excluding intracranial and aortic dissections and aneurysms. With a total of 690 OVAD patients and 2,760 non-OVAD matched controls, we investigated the prevalence of AAD in patients with OVAD and potential risk factors for their concurrence using the χ2 test and logistic regression.

Results

The prevalence of AAD in patients with OVAD was 10.6% (73/690) and 0.3% (9/2,760) in patients with non-OVAD. The adjusted odds ratio (OR) for having concurrent AAD with OVAD was 37.56 (95% CI: 18.29-77.12, p < 0.001) after stratification by sex, age, income, region of residence and after adjustment for hypertension, diabetes mellitus, dyslipidemia, and extent of disability. The adjusted ORs of AAD were significantly higher in females [adjusted OR = 47.63 (95% CI: 10.72-211.55)], and individuals aged ≥60 years [adjusted OR = 28.18 (95% CI: 13.42-59.17)], as well as those without hypertension [adjusted OR = 95.44 (95% CI: 18.21-500.23)], diabetes mellitus [adjusted OR = 46.39 (95% CI: 18.85-114.17)], without dyslipidemia [adjusted OR = 60.99 (95% CI: 20.83-178.56), p < 0.001 for all]. The prevalence of AAD significantly differed by according to specific sites of OVAD in carotid artery, upper extremity artery, iliac artery, lower extremity artery, and splanchnic artery (p < 0.001 for all).

Conclusions

The prevalence of AAD in patients with OVAD was 37.56 times higher than that in the matched population. We may approach aneurysms as systemic diseases and further investigations of pathophysiology would help to clarify the relationships between AAD and OVAD.

Association between hearing loss and trauma based on population data of Korea

BACKGROUND

Although several studies have been conducted to assess the association between hearing loss (HL) and trauma, no studies have analyzed trauma comprehensively based on population-based data.

OBJECTIVES

To investigate the association between HL and trauma in daily life using National Health Insurance Service National Sample Cohort data of Korea.

MATERIALS AND METHODS

People who were registered with severe or mild hearing disability by the Korean government from 2002 to 2015, were included in this study. Trauma was defined as an outpatient visit or admission under diagnostic codes associated with trauma. The risk for trauma was analyzed using multiple logistic regression model.

RESULTS

There were 5,114 subjects in the mild hearing disability group and 1,452 in the severe hearing disability group. The risk for trauma was significantly higher in the mild and severe hearing disability groups than in the control group. The risk was higher in the mild hearing disability group than in the severe hearing disability group.

CONCLUSIONS AND SIGNIFICANCE

Individuals with hearing disability are at a higher risk for trauma based on population-based data in Korea, which indicates that HL increases the risk for trauma.

Association of Dual Sensory Impairment with Declining Physical Function in Community-Dwelling Older Adults

Few studies have investigated whether dual sensory impairment (DSI) adversely affects the deterioration of physical function in older adults compared to single sensory impairment (SSI, visual or auditory). We studied the association between DSI and declining physical function by analyzing the data of 2780 Korean community-dwelling adults aged 70-84 years. Sensory impairment was assessed through pure tone audiometry and visual acuity testing. Muscle strength (handgrip strength) and physical performance (timed up and go test and short physical performance battery (SPPB)) were evaluated. In the cross-sectional analysis, DSI was associated with higher odds of having low muscle strength (odds ratio (OR), 1.78; 95% confidence interval (CI), 1.27-2.48) and poor physical performance (SPPB: OR, 2.04; 95% CI, 1.38-3.00) than SSI. Among all sensory impairment groups in the longitudinal analysis, DSI at baseline increased the risk of deteriorating physical performance during the follow-up period (OR, 1.94; 95% CI, 1.31-2.88; p < 0.01) the most. DSI showed a more severe adverse effect on the decline in physical function among community-dwelling older adults than SSI. More comprehensive care is needed to prevent the deterioration of physical function in older adults due to DSI.

Direct cost of cochlear implants in Germany - a strategic simulation

BACKGROUND

Despite the current undersupply of cochlear implants (CIs) with simultaneously increasing indication, CI implantation numbers in Germany still are at a relatively low level.

METHODS

As there are hardly any solid forecasts available in the literature, we develop a System Dynamics model that forecasts the number and costs of CI implantations in adults for 40 years from a social health insurance (SHI) perspective.

RESULTS

CI demand will grow marginally by demographic changes causing average annual costs of about 538 million €. Medical-technical progress with following relaxed indication criteria and patients' increasing willingness for implantation will increase implantation numbers significantly with average annual costs of 765 million €.

CONCLUSION

CI demand by adults will increase in the future, thus will the costs for CI supply. Continuous research and development in CI technology and supply is crucial to ensure long-term financing of the growing CI demand through cost-reducing innovations.

The Impact of High Dose Glucocorticoids on Bone Health and Fracture Risk in Systemic Vasculitides

Systemic vasculitides are a range of conditions characterized by inflammation of blood vessels which may manifest as single organ or life-threatening multisystem disease. The treatment of systemic vasculitis varies depending on the specific disease but historically has involved initial treatment with high dose glucocorticoids alone or in conjunction with other immunosuppressive agents. Prolonged glucocorticoid treatment is frequently required as maintenance treatment. Patients with small and large vessel vasculitis are at increased risk of fracture. Osteoporosis may occur due to intrinsic factors such as chronic inflammation, impaired renal function and to a large extent due to pharmacological therapy with high dose glucocorticoid or combination treatments. This review will outline the known mechanism of bone loss in vasculitis and will summarize factors attributing to fracture risk in different types of vasculitis. Osteoporosis treatment with specific consideration for patients with vasculitis will be discussed. The use of glucocorticoid sparing immunosuppressive agents in the treatment of systemic vasculitis is a significant area of ongoing research. Adjunctive treatments are used to reduce cumulative doses of glucocorticoids and therefore may significantly decrease the associated fracture risk in patients with vasculitis. Lastly, we will highlight the many unknowns in the relation between systemic vasculitis, its treatment and bone health and will outline key research priorities for this field.

High Risk of Hip and Spinal Fractures after Distal Radius Fracture: A Longitudinal Follow-Up Study Using a National Sample Cohort

The purpose of the present study was to estimate the risk of hip and spinal fracture after distal radius fracture. Data from the Korean National Health Insurance Service—National Sample Cohort were collected between 2002 and 2013. A total of 8013 distal radius fracture participants who were 50 years of age or older were selected. The distal radius fracture participants were matched for age, sex, income, region of residence, and past medical history in a 1:4 ratio with control participants. In the subgroup analysis, participants were stratified according to age group (50–59, 60–69, or ≥70 years) and sex (male or female). Distal radius fracture patients had a 1.51-fold and 1.40-fold higher incidence of hip fracture and spinal fracture in the adjusted models, respectively. Among males, patients of all ages had a significantly higher incidence of hip fracture, and those who were 50 to 69 years of age had a significantly higher incidence of spinal fracture. Among females, those older than 70 years had a significantly higher incidence of hip fracture, and patients of all ages had a significantly higher incidence of spinal fracture. Previous distal radius fracture has a significant impact on the risk of subsequent hip and spinal fractures.

Blindness increases the risk for hip fracture and vertebral fracture but not the risk for distal radius fracture: a longitudinal follow-up study using a national sample cohort

The risks for hip fracture and vertebral fracture, but not the risk for distal radius fracture, were significantly higher in the blindness group than in the control group with a maximum 12-year follow-up.

PURPOSE

To evaluate the influence of visual impairment on the risk for osteoporotic fractures at common sites: hip, thoracic/lumbar vertebra, and distal radius.

METHODS

This longitudinal follow-up study used a database of a national sample cohort from 2002 to 2013 provided by the Korean National Health Insurance Service. Of a total of 1,125,691 subjects, 3918 patients with visual impairment and age ≥ 50 years were enrolled in a 1:4 ratio; 15,672 control participants were matched for age, sex, income, and region of residence. Stratified Cox proportional-hazards models were used to evaluate the crude and adjusted (for steroid medication, rheumatoid arthritis, depression, osteoporosis, diabetes mellitus, and stroke history) hazard ratios (HRs) for each fracture site. Fracture diagnoses were based on the ICD-10 codes: hip fracture (S720, S721, S722), vertebral fracture (S220, S320), and distal radius fracture (S525).

RESULTS

The HRs for hip and vertebral fracture were significantly higher in the blindness group (adjusted HR = 2.46, p < 0.001 for hip fracture; adjusted HR = 1.42, p = 0.020 for thoracic/lumbar vertebral fracture) than in the matched control group. However, the HR for distal radius fracture was not higher in the blindness group. The HRs for all three fracture sites were not significantly higher in the non-blindness visual impairment group after adjustment.

CONCLUSION

The risks for hip fracture and vertebral fracture were significantly higher in the blindness group. However, the risk for distal radius fracture was not related to visual impairment including blindness.

Hearing loss but not bone-regulating hormones predicts fractures in older women-a 17-year follow-up of the Gothenburg BEDA study

High-frequency hearing loss and S-Ca, but not hormones related to bone structure and strength, or lifestyle factors, predicted incident fractures during 17 years of follow-up in women up to 97 years of age.

INTRODUCTION

The fracture risk increases and inner ear function deteriorates with increasing age. The aim of this study was to investigate whether hearing loss was of greater importance than bone-regulating hormones for the risk of fracture in elderly women.

METHODS

In 1997, a random population sample of 63-82-year-old women, n = 552, underwent a physical examination, audiometry and blood sampling for analyses of serum albumin-adjusted calcium (S-Ca), parathyroid hormone (PTH), 25(OH) vitamin D and insulin-like growth factor-1 (IGF-1). Data on medication, lifestyle, previous fractures, hearing, vision and dizziness were obtained using questionnaires. Data on subsequent fractures were retrieved, and censored at death, through December 2013.

RESULTS

In 1997, 228 women (41%) reported a previous fracture, most commonly of the wrist (18%). During the following 17 years, 323 fractures occurred in 207 women (38%). Hip fractures were the most frequent, in 96 women (17%). In a Cox regression analysis adjusted for age and previous fractures, hearing loss, reflected by a high pure tone average ≥ 59 dB, almost doubled the risk of a subsequent fracture (hazard ratio (HR) 1.81, 95% CI 1.25; 2.61, p = 0.002). S-Ca (HR 1.21 (1.02; 1.44) p = 0.028) also predicted future fractures, whereas PTH, IGF-1, 25(OH) vitamin D, hormone replacement therapy, smoking, degree of physical activity, impaired vision and dizziness did not.

CONCLUSION

Hearing loss and higher S-Ca, but not bone-regulating hormones, medication or lifestyle factors predicted incident fractures, mainly caused by falling, during 17 years of follow-up in women up to 97 years of age.

Increased risk of herpes zoster in patients with peptic ulcers: A longitudinal follow-up study using a national sample cohort

The purpose of this study was to investigate the association of herpes zoster infection with peptic ulcer disease in a Korean population.The Korean National Health Insurance Service selects samples directly from the entire Korean population database, and 1,125,691 participants with 114,369,638 medical claim codes were selected from the entire Korean population (50 million). A total of 127,802 peptic ulcer disease participants were matched with 127,802 control participants at a ratio of 1:1, considering age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed stratified Cox proportional hazard models to calculate the hazard ratios of peptic ulcer with respect to herpes zoster. For subgroup analyses, we divided the participants by age, sex, and time periods after the index date.The rate of herpes zoster was higher in the peptic ulcer group (9.1% [11,669/127,802]) than in the control group (7.4% [9,397/127,802], P < .001). The adjusted hazard ratio of herpes zoster was 1.24 (95% CI = 1.21-1.28, P < .001). In subgroup analyses performed according to age and sex, all crude and adjusted hazard ratios of herpes zoster were higher in the peptic ulcer disease group than in the control group (each P < .05). In another subgroup analysis according to follow-up periods, the crude and adjusted hazard ratios of herpes zoster were higher in the peptic ulcer disease group than in the control group except for < 1 year periods after the index dates (each P < .001).The hazard ratios of herpes zoster were significantly increased in the peptic ulcer group compared with those in the control group in all age and sex groups.

Fracture rate in women with oestrogen deficiency - Comparison of Turner syndrome and premature ovarian insufficiency

OBJECTIVE

Women with early-onset oestrogen deficiency are at risk of reduced bone mineral density (BMD). We sought to assess fracture history and BMD in women with Turner syndrome (TS) and premature ovarian insufficiency (POI).

DESIGN

A cross-sectional observational study.

PATIENTS

Two hundred and sixty seven women with TS (median age 34.3 years) and 67 women with POI (median age 28.1 years).

MEASUREMENTS

A questionnaire was used to collect data on fracture history, co-morbidities and drug history including age at first oestrogen exposure. Clinical data included height, weight, serum vitamin D and hip and spine T-scores, which were adjusted for height and age. Fractures were subdivided into major osteoporotic fractures (MOF) and 'other' fracture types.

RESULTS

Overall fracture rate was similar in women with TS and POI (82 [30.5%] vs 22 [32.8%] respectively, P = .74). Compared to women with POI, those with TS had more fractures at MOF sites (30.2% vs 52.7%, P = .012) and fewer phalangeal fractures (27.9% vs 9.8%, P = .005). There was no difference in BMD between women who sustained a fracture compared to those who did not. Women with TS who fractured were more likely to suffer from hearing impairment compared to those with no fracture (62.2% vs 48.1%, P = .045).

CONCLUSIONS

TS is not associated with an overall excess risk of bone fracture. The higher rate of fractures at MOF sites in women with TS may be secondary to hearing impairment, thin cortical bone and abnormal bone remodelling.

Appendectomy and rheumatoid arthritis: A longitudinal follow-up study using a national sample cohort

The present study evaluated the association between appendectomy and rheumatoid arthritis (RA) using a national sample cohort of the Korean population. In this cohort study, the Korean National Health Insurance Service-National Sample Cohort of individuals ≥20 years old was collected from 2002 to 2013. A total of 14,995 appendectomy participants were 1:4 matched with 59,980 control subjects for age, group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed the occurrence of RA in both the appendectomy and control groups. Appendectomies were identified using operation codes for appendicitis only. RA was defined by International Classification of Disease-10 codes (M05 or M06) and medication histories. Crude and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. Subgroup analyses were performed on groups stratified by age and sex. The adjusted HR for RA was 1.02 (95% confidence interval = 0.76-1.38) in the appendectomy group (P = .883). In all of the subgroup analyses according to age and sex, the adjusted HRs for RA were not higher in the appendectomy group than those in the control group. We could not identify any significant relationship between appendectomy and RA.