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Vizcarra P, Moreno A, Vivancos MJ, Muriel García A, Ramirez Schacke M, González-Garcia J, Curran A, Palacios R, Sánchez Guirao AJ, Reus Bañuls S, Moreno Guillén S, Casado JL. A Risk Assessment Tool for Predicting Fragility Fractures in People with HIV: Derivation and Internal Validation of the FRESIA Model. J Bone Miner Res 2023; 38:1443-1452. [PMID: 37545089 DOI: 10.1002/jbmr.4894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
People with HIV have a higher risk of fracture than the general population. Because of the low performance of the existing prediction tools, there is controversy surrounding fracture risk estimation in this population. The aim of the study was to develop a model for predicting the long-term risk of fragility fractures in people with HIV. We included 11,899 individuals aged ≥30 years from the Spanish HIV/AIDS research network cohort. We identified incident fragility fractures from medical records, defined as nontraumatic or those occurring after a casual fall, at major osteoporotic sites (hip, clinical spine, forearm, proximal humerus). Our model accounted for the competing risk of death and included 12 candidate predictors to estimate the time to first fragility fracture. We assessed the discrimination and calibration of the model and compared it with the FRAX tool. The incidence rate of fragility fractures was 4.34 (95% CI 3.61 to 5.22) per 1000 person-years. The final prediction model included age, chronic kidney disease, and chronic obstructive pulmonary disease as significant predictors. The model accurately predicted the 5- and 10-year risk of fragility fractures, with an area under the receiving operator characteristic curve of 0.768 (95% CI 0.722 to 0.814) and agreement between the observed and expected probabilities. Furthermore, it demonstrated better discrimination and calibration than the FRAX tool, improving the classification of over 35% of individuals with fragility fractures compared to FRAX. Our prediction model demonstrated accuracy in predicting the long-term risk of fragility fractures. It can assist in making personalized intervention decisions for individuals with HIV and could potentially replace the current tools recommended for fracture risk assessment in this population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Pilar Vizcarra
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María J Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel García
- Unit of Biostatistics, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica en Red, Epidemiología y Salud Pública (CIBERESP), Universidad de Alcalá, Madrid, Spain
| | - Margarita Ramirez Schacke
- Unit of Infectious Diseases - HIV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan González-Garcia
- Unit of VIH, Department of Internal Medicine II, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Adrián Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rosario Palacios
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | - Sergio Reus Bañuls
- Unit of Infectious Diseases, ISABIAL, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Santiago Moreno Guillén
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José L Casado
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Abstract
INTRODUCTION This study estimated the direct medical costs of osteoporotic fractures from a large claims database in Korea. MATERIALS AND METHODS We compared the medical costs of hip, vertebral, and wrist fractures between two age groups (50-64 years vs 65 years and older). We used a generalized linear model to investigate the drivers of osteoporotic fracture medical costs. RESULTS Hip fractures had the highest costs, regardless of age, followed by vertebral and wrist. The cost of hip fracture was USD 7285 for those aged 65 years and over and USD 6589 for those aged 50-64 years. The length of hospital days was higher in hip fracture patients, regardless of age, followed by vertebral and wrist. As the number of hospitalizations increased, the medical cost increased by 33.0% (p < 0.0001). Patients older than 65 years who were hospitalized for a fracture had a longer total length of hospital stay, compared to patients aged 50-64, regardlessness of the site of the fracture. The cost of treating fractures among those 65 years and older increased by 31.8% compared to those 50-64 years old (p < 0.0001). The direct medical costs increased by 8.6% as the number of fractures increased (p = 0.041). CONCLUSIONS We identified that osteoporotic fracture-related medical costs and hospitalization days increased with age. Interventions are effective in reducing fracture risk the potential to yield substantial cost savings.
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Affiliation(s)
- Eu Gene Kim
- Graduate school of Public Health, Seoul National University, Seoul, Korea
| | - Green Bae
- Collge of Pharmacy, Ewha Woman's University, Seoul, South Korea
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Chen HY, Su PY, Lin TK, Jong GP. Association between statin use and osteoporotic fracture in patients with chronic obstructive pulmonary disease: a population-based, matched case-control study. Lipids Health Dis 2020; 19:232. [PMID: 33143674 PMCID: PMC7641811 DOI: 10.1186/s12944-020-01412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In the recent years, chronic obstructive pulmonary disease (COPD) has been found to be associated with a higher risk of new-onset osteoporotic fracture (NOF). However, the existence of such an association in the COPD patients receiving statin treatment remains unknown. The present study aimed to investigate the association between COPD and NOF in statin-treated patients. METHODS The present study was conducted over a period of 10 years (January 2004 to December 2013) in Taiwan. COPD patients receiving statin treatment were included in the statin user group, whereas the randomly selected statin non-users, with 1:1 matching for sex, age, index date, and Charlson Comorbidity Index, were included in the statin non-user group. The hazard ratio (HR) of NOFs in COPD patients was estimated between statin user and non-user groups. RESULTS A total of 86,188 cases were identified as the statin-treated patients, and 86,188 subjects were included in the control group of statin non-users. Initially, the risk of NOF was found to be higher among the statin users as compared to non-users [HR, 1.12; 95% confidence interval (CI), 1.01-1.25]. However, the calculation of risk for NOFs after the adjustment for age, sex, comorbidities, and concurrent medications indicated no association of NOF (HR, 0.81; 95% CI, 0.55-1.21) with COPD in patients receiving statin treatment as compared to statin non-users. CONCLUSION The results of the study provided first evidence for the absence of any association between COPD and NOFs in statin-treated patients during a follow-up period of 10 years. Thus, the findings of this study might support the hypothesis stating the potent pleiotropic effects of statins. In clinical practice, these drugs might prove beneficial for the patients with COPD.
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Affiliation(s)
- Hung-Yi Chen
- Department of Pharmacy, China Medical University, Taichung, Taiwan, Republic of China.,Department of Pharmacy, China Medical University Beigang Hospital, Yunlin County, Taiwan, Republic of China
| | - Pei-Yu Su
- Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Tsung-Kun Lin
- Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, Republic of China.
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van Dort MJ, Geusens P, Driessen JH, Romme EA, Smeenk FW, Wouters EF, van den Bergh JP. High Imminent Vertebral Fracture Risk in Subjects With COPD With a Prevalent or Incident Vertebral Fracture. J Bone Miner Res 2018; 33:1233-1241. [PMID: 29572955 DOI: 10.1002/jbmr.3429] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 01/08/2023]
Abstract
Subjects with chronic obstructive pulmonary disease (COPD) have an increased risk of vertebral fractures (VFs); however, VF incidence is largely unknown. Therefore, the aim of our study was to determine the incidence of new and/or worsening VF in subjects with COPD. Smokers and subjects with COPD (GOLD II-IV) from the ECLIPSE study with complete set of chest CT scans (baseline and 1- and 3-year follow-up) to evaluate vertebrae T1 down to L1 were included. If a VF was diagnosed on the last scan, detailed VF assessment of the previous scans was performed. VFs were scored according to the method of Genant as mild, moderate, or severe. Main outcome measure was the cumulative incidence of new and/or worsening VF at subject level, within 1 and 3 years. Of 1239 subjects (mean age 61 years, 757 males [61%], 999 subjects with COPD), 253 (20.5%) had ≥1 prevalent VF. The cumulative incidence of VFs was 10.1% within 1 year and 24.0% within 3 years. After adjustment for age, sex, body mass index (BMI), pack-years, and smoking status, prevalence and incidence were similar between smokers and COPD GOLD stages. Within 1 year, 29.2% of the subjects with a prevalent VF had an incident VF, compared with 5.1% in absence of prevalent VF (hazard ratio [HR] = 5.1; 95% confidence interval [CI] 3.6-7.4) and 58.5% versus 15.0% within 3 years (HR = 3.6; 95% CI 2.9-4.6). The incidence of VF was higher with increasing number and severity of prevalent VFs. Among subjects having an incident VF within the first year, 57.3% had a subsequent VF within the next 2 years. In this study, more than half of the smokers and subjects with COPD with a prevalent VF or an incident VF within the first year sustained a subsequent VF within 3 years. The 3-year risk was even higher in the presence of multiple or severe prevalent VFs. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Affiliation(s)
- Mayke J van Dort
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Piet Geusens
- Department of Internal Medicine/Rheumatology, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Johanna Hm Driessen
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Elisabeth Apm Romme
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Frank Wjm Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Emiel Fm Wouters
- Department of Respiratory Diseases, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Joop Pw van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
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Kok VC, Zhang HW, Lin CT, Huang SC, Wu MF. Positive association between hypertension and urinary bladder cancer: epidemiologic evidence involving 79,236 propensity score-matched individuals. Ups J Med Sci 2018; 123:109-115. [PMID: 29911922 PMCID: PMC6055751 DOI: 10.1080/03009734.2018.1473534] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION We hypothesized that hypertensive patients harbor a higher risk of urinary bladder (UB) cancer. MATERIAL AND METHODS We performed a population-based cohort study on adults using a National Health Insurance Research Database (NHIRD) dataset. Hypertension and comparison non-hypertensive (COMP) groups comprising 39,618 patients each were propensity score-matched by age, sex, index date, and medical comorbidities. The outcome was incident UB cancer validated using procedure codes. We constructed multivariable Cox models to derive adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Cumulative incidence was compared using a log-rank test. RESULTS During a total follow-up duration of 380,525 and 372,020 person-years in the hypertension and COMP groups, 248 and 186 patients developed UB cancer, respectively, representing a 32% increase in the risk (aHR, 1.32; 95% CI, 1.09-1.60). Hypertensive women harbored a significantly increased risk of UB cancer (aHR, 1.55; 95% CI, 1.12-2.13) compared with non-hypertensive women, whereas men with hypertension had a statistically non-significant increased risk (aHR, 1.22; 95% CI, 0.96-1.55). The sensitivity analysis demonstrated that the increased risk was sustained throughout different follow-up durations for the entire cohort; a statistical increase in the risk was also noted among hypertensive men. CONCLUSION This nationwide population-based propensity score-matched cohort study supports a positive association between hypertension and subsequent UB cancer development.
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Affiliation(s)
- Victor C. Kok
- Department of Internal Medicine, Division of Medical Oncology, Kuang Tien General Hospital, Taichung, Taiwan (ROC)
- Disease Informatics Research Unit, Asia University Taiwan, Taichung, Taiwan (ROC)
- CONTACT Victor C. Kok, MMedSc, MD, PhD, FACP, Department of Internal Medicine, Kuang Tien General Hospital, 117 Sha-Tien Rd, Taichung 43303, Taiwan (ROC)
| | - Han-Wei Zhang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan (ROC)
- PhD Program for Aging, China Medical University, Taichung, Taiwan (ROC)
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan (ROC)
| | - Chin-Teng Lin
- Brain Research Center, National Chiao Tung University, Hsinchu, Taiwan (ROC)
- Centre for Artificial Intelligence, School of Software, Faculty of Engineering & IT, University of Technology, Sydney, Australia (ROC)
| | - Shih-Chung Huang
- Division of Cardiology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan (ROC)
| | - Ming-Feng Wu
- Department of Medical Intensive Care Unit, Kuang Tien General Hospital, Taichung, Taiwan (ROC)
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Kok VC, Horng JT, Wang MN, Chen ZY, Kuo JT, Hung GD. Gout as a risk factor for osteoporosis: epidemiologic evidence from a population-based longitudinal study involving 108,060 individuals. Osteoporos Int 2018; 29:973-985. [PMID: 29383389 DOI: 10.1007/s00198-018-4375-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/02/2018] [Indexed: 02/07/2023]
Abstract
UNLABELLED Is gout a risk factor for future osteoporosis? This large population-based study comprising two matched groups of individuals with and without gout demonstrates that patients with gout have a 20% increase in the risk of developing osteoporosis in future through an 8-year follow-up. INTRODUCTION To examine if gout is associated with an increased risk of osteoporosis. METHODS We conducted a nationwide population-based retrospective matched-cohort study. Two matched cohorts (n = 36,458 with gout and 71,602 without gout) assembled and recruited from the Longitudinal Health Insurance Dataset containing 1 million subjects. Exclusion criteria were missing data, age < 20 years, short follow-up period, and pre-existing osteoporosis. Both cohorts were followed up until incident osteoporosis, death, or the end of the study. Person-year data and incidence rates were evaluated. A multivariable Cox model was used to derive an adjusted hazard ratio (aHR) after controlling for socioeconomic proxy, geographical difference, glucocorticoid and allopurinol exposure, various prespecified medical conditions, and comorbidities. RESULTS Men comprised 72.8% of the cohorts. With a follow-up of 183,729 and 359,900 person-years for the gout and non-gout cohorts, 517 and 811 incidents of osteoporosis occurred, respectively, after excluding osteoporosis incidents in the first 3 years of follow-up. The cumulative incidence of osteoporosis was statistically higher in the gout cohort than in the non-gout cohort, at 3.3 versus 2.1% (P = 0.0036, log-rank). Our Cox model showed a 1.2-fold increase in the incidence of osteoporosis in the gout cohort, with an aHR of 1.2 (95% confidence interval, 1.06-1.35). CONCLUSIONS This first population-based epidemiologic study supports the hypothesis that compared with individuals without gout; those with gout have a modest increase in the risk of developing osteoporosis in future.
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Affiliation(s)
- V C Kok
- Department of Internal Medicine, Kuang Tien General Hospital, 117 Sha-Tien Road, Taichung, 43303, Taiwan.
- Disease Informatics Research Group, Asia University Taiwan, Taichung, 41354, Taiwan.
| | - J-T Horng
- Disease Informatics Research Group, Asia University Taiwan, Taichung, 41354, Taiwan
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, 32001, Taiwan
| | - M N Wang
- Department of Orthopedic Surgery, Kuang Tien General Hospital, Tachia, Taichung, 43761, Taiwan
- College of Medicine & Nursing, Hungkuang University, Taichung, 43302, Taiwan
| | - Z-Y Chen
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, 32001, Taiwan
| | - J-T Kuo
- Division of Biostatistics, Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - G-D Hung
- Division of Rheumatology, Immunology, and Allery, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, 43303, Taiwan
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Lin CH, Chen KH, Chen CM, Chang CH, Huang TJ, Lin CH. Risk factors for osteoporosis in male patients with chronic obstructive pulmonary disease in Taiwan. PeerJ 2018; 6:e4232. [PMID: 29340241 PMCID: PMC5768161 DOI: 10.7717/peerj.4232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/14/2017] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the risk factors for osteoporosis in male Taiwanese patients with chronic obstructive pulmonary disease (COPD). Methods This cross-sectional study evaluated male COPD outpatients and age-matched male subjects at a regional teaching hospital. The following data were obtained and analyzed: bone mineral density of the lumbar spine and hip on dual-energy X-ray absorptiometry, demographic characteristics, questionnaire interview results, pulmonary function test results, chest posterior–anterior radiographic findings, and biochemical and high-sensitivity C-reactive protein (hs-CRP) levels. Results Fifty-nine male COPD patients and 36 age-matched male subjects were enrolled. COPD patients had lower body mass index (BMI) (23.6 ± 4.1 vs. 25.2 ± 3.0 kg/m2) and higher total prevalence for osteoporosis and osteopenia than controls. Among COPD patients, patients with osteoporosis had lower BMI, body weight, waist circumference, and triglyceride level but higher hs-CRP level, and tended to have lower creatinine level. Binary logistic regression analysis for factors including age, BMI, creatinine, hs-CRP, smoking, steroid use, and forced expiratory volume in one second (FEV1) revealed that an hs-CRP level ≥5 and decreased creatinine level were independent risk factors for osteoporosis in COPD patients. Lower BMI tended to be associated with osteoporosis development, although it did not reach statistical significance, and hs-CRP was associated with COPD severity and steroid use history. Conclusion The total prevalence of osteoporosis and osteopenia in male Taiwanese COPD patients is higher than that in age-matched male subjects and systemic inflammation is an independent risk factors for osteoporosis. Low creatinine level in COPD patients should raise the suspicion of sarcopenia and associated increased risk of osteoporosis.
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Affiliation(s)
- Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Puzi City, Chiayi County, Taiwan
| | - Kai-Hua Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Puzi City, Chiayi County, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Puzi City, Chiayi County, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chia-Hao Chang
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Puzi City, Chiayi County, Taiwan
| | - Tung-Jung Huang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Mailiao Township, Yunlin County, Taiwan.,Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Puzi City, Chiayi County, Taiwan
| | - Chia-Hung Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Puzi City, Chiayi County, Taiwan
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