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Hassanabadi N, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D, Morin SN. Geographic variation in bone mineral density and prevalent fractures in the Canadian longitudinal study on aging. Osteoporos Int 2024; 35:599-611. [PMID: 38040857 DOI: 10.1007/s00198-023-06975-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates. PURPOSE We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces. METHODS We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50-85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012-2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates. RESULTS The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity. CONCLUSION Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors.
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Affiliation(s)
- N Hassanabadi
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - C Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, Canada
| | - A M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - E Rahme
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
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Seckinger A, Majocchi S, Moine V, Nouveau L, Ngoc H, Daubeuf B, Ravn U, Pleche N, Calloud S, Broyer L, Cons L, Lesnier A, Chatel L, Papaioannou A, Salgado-Pires S, Krämer S, Gockel I, Lordick F, Masternak K, Poitevin Y, Magistrelli G, Malinge P, Shang L, Kallendrusch S, Strein K, Hose D. Development and characterization of NILK-2301, a novel CEACAM5xCD3 κλ bispecific antibody for immunotherapy of CEACAM5-expressing cancers. J Hematol Oncol 2023; 16:117. [PMID: 38087365 PMCID: PMC10717981 DOI: 10.1186/s13045-023-01516-3] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND T-cell retargeting to eliminate CEACAM5-expressing cancer cells via CEACAM5xCD3 bispecific antibodies (BsAbs) showed limited clinical activity so far, mostly due to insufficient T-cell activation, dose-limiting toxicities, and formation of anti-drug antibodies (ADA). METHODS We present here the generation and preclinical development of NILK-2301, a BsAb composed of a common heavy chain and two different light chains, one kappa and one lambda, determining specificity (so-called κλ body format). RESULTS NILK-2301 binds CD3ɛ on T-cells with its lambda light chain arm with an affinity of ≈100 nM, and the CEACAM5 A2 domain on tumor cells by its kappa light chain arm with an affinity of ≈5 nM. FcγR-binding is abrogated by the "LALAPA" mutation (Leu234Ala, Leu235Ala, Pro329Ala). NILK-2301 induced T-cell activation, proliferation, cytokine release, and T-cell dependent cellular cytotoxicity of CEACAM5-positive tumor cell lines (5/5 colorectal, 2/2 gastric, 2/2 lung), e.g., SK-CO-1 (Emax = 89%), MKN-45 (Emax = 84%), and H2122 (Emax = 97%), with EC50 ranging from 0.02 to 0.14 nM. NILK-2301 binds neither to CEACAM5-negative or primary colon epithelial cells nor to other CEACAM family members. NILK-2301 alone or in combination with checkpoint inhibition showed activity in organotypic tumor tissue slices and colorectal cancer organoid models. In vivo, NILK-2301 at 10 mg/kg significantly delayed tumor progression in colon- and a pancreatic adenocarcinoma model. Single-dose pharmacokinetics (PK) and tolerability in cynomolgus monkeys at 0.5 or 10 mg/kg intravenously or 20 mg subcutaneously showed dose-proportional PK, bioavailability ≈100%, and a projected half-life in humans of 13.1 days. NILK-2301 was well-tolerated. Data were confirmed in human FcRn TG32 mice. CONCLUSIONS In summary, NILK-2301 combines promising preclinical activity and safety with lower probability of ADA-generation due to its format compared to other molecules and is scheduled to enter clinical testing at the end of 2023.
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Affiliation(s)
- Anja Seckinger
- LamKap Bio Alpha AG, Bahnhofstrasse 1, 8808, Pfäffikon, SZ, Switzerland
| | - Sara Majocchi
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Valéry Moine
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Lise Nouveau
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Hoang Ngoc
- Institute of Anatomy, Leipzig University, Liebigstrasse 13, 04103, Leipzig, Germany
| | - Bruno Daubeuf
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Ulla Ravn
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Nicolas Pleche
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Sebastien Calloud
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Lucile Broyer
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Laura Cons
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Adeline Lesnier
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Laurence Chatel
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Anne Papaioannou
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Susana Salgado-Pires
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Sebastian Krämer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Florian Lordick
- Department of Medicine II, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Liebigstrasse 22, 04103, Leipzig, Germany
| | - Krzysztof Masternak
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Yves Poitevin
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Giovanni Magistrelli
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Pauline Malinge
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Limin Shang
- Light Chain Bioscience - Novimmune SA, Chemin du Pré-Fleuri 15, 1228, Plan-les-Ouates, Switzerland
| | - Sonja Kallendrusch
- Institute of Anatomy, Leipzig University, Liebigstrasse 13, 04103, Leipzig, Germany
- Institute of Clinical Research and System Medicine, Health and Medical University Potsdam, Schiffbauergasse 14, 14467, Potsdam, Germany
| | - Klaus Strein
- LamKap Bio Alpha AG, Bahnhofstrasse 1, 8808, Pfäffikon, SZ, Switzerland
| | - Dirk Hose
- LamKap Bio Alpha AG, Bahnhofstrasse 1, 8808, Pfäffikon, SZ, Switzerland.
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. Publisher Correction: International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1139. [PMID: 37036475 DOI: 10.1007/s00198-023-06717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1065-1074. [PMID: 36799981 DOI: 10.1007/s00198-023-06688-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/28/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
UNLABELLED We identified a knowledge gap in the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. MAIN RESULTS This international consensus process established multidisciplinary biopsychosocial recommendations on pain, nutrition, safe movement, and exercise for individuals with acute and chronic vertebral fractures. SIGNIFICANCE These recommendations will guide clinical practice and inform interventions for future research. PURPOSE To establish international consensus on recommendations for the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. METHODS We adopted a five-step modified Delphi consensus process: (1) literature search and content analysis, (2) creation of the survey, (3) selection of the expert panel, (4) first round of the rating process, and (5) second round of the rating process. The first round included 49 statements and eight open-ended questions; the second round included 30 statements. Panelists were asked to rate their agreement with each of the statements using a 9-point scale, with the option to provide further comments. Consensus for each statement was determined by counting the number of panelists whose rating was outside the 3-point region containing the median. RESULTS We invited 76 people with degree in medicine, physiotherapy, kinesiology, and experience in the management of osteoporotic vertebral; 31 (41%) and 27 (36%) experts agreed to participate to the first and the second round, respectively. The mean percentage agreement after the first and second rounds was 76.6% ± 16.0% and 90.7% ± 6.5%, respectively. We established consensus on recommendations on pain, early satiety, weight loss, bracing, safe movement, and exercise for individuals with acute and chronic vertebral fractures. CONCLUSION Our international consensus provides multidisciplinary biopsychosocial recommendations to guide the management of osteoporotic vertebral fractures and inform interventions for future research.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Peppa V, Zoros E, Alexiou A, Bourmpos P, Papaioannou A, Pissakas G, Papagiannis P, Karaiskos P. DOSE VERIFICATION FOR CRANIOSPINAL IRRADIATION WITH VOLUMETRIC MODULATED ARC THERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Chotiyarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D, Abrahamsen B, Adachi JD, Borgström F, Bruyere O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison E, Diaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lewiecki EM, Lips P, Lorenc RS, Ortolani S, Papaioannou A, Silverman S, Sosa M, Szulc P, Ward KA, Yoshimura N, Kanis JA. Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group. Arch Osteoporos 2022; 17:87. [PMID: 35763133 PMCID: PMC9239944 DOI: 10.1007/s11657-022-01117-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. INTRODUCTION The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. METHODS The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. RESULTS AND CONCLUSION The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.
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Affiliation(s)
- P Chotiyarnwong
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - E V McCloskey
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Lorentzon
- University of Gothenburg, Gothenburg, Sweden
- Australian Catholic University, Melbourne, Australia
| | - D Prieto-Alhambra
- Oxford NIHR Biomedical Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- GREMPAL (Grup de Recerca en Malalties Prevalents de L'Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007, Barcelona, Spain
| | - B Abrahamsen
- Department of Clinical Research, Odense Patient Data Exploratory Network, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - J D Adachi
- Department of Medicine, Michael G DeGroote School of Medicine, St Joseph's Healthcare-McMaster University, Hamilton, ON, Canada
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - O Bruyere
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - P Clark
- Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Diaz-Curiel
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - D Grigorie
- Carol Davila University of Medicine, Bucharest, Romania
- Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - P Khashayar
- Center for Microsystems Technology, Imec and Ghent University, 9050, Ghent, Belgium
| | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - P Lips
- Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R S Lorenc
- Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland
| | - S Ortolani
- IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- GERAS Centre for Aging Research, Hamilton, ON, Canada
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Sosa
- Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria, Spain
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - K A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - J A Kanis
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
- Australian Catholic University, Melbourne, Australia
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Pinto D, Alshahrani M, Chapurlat R, Chevalley T, Dennison E, Camargos BM, Papaioannou A, Silverman S, Kaux JF, Lane NE, Morales Torres J, Paccou J, Rizzoli R, Bruyere O. The global approach to rehabilitation following an osteoporotic fragility fracture: A review of the rehabilitation working group of the International Osteoporosis Foundation (IOF) committee of scientific advisors. Osteoporos Int 2022; 33:527-540. [PMID: 35048200 DOI: 10.1007/s00198-021-06240-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To conduct a review of the current state of the evidence for rehabilitation strategies post-fragility fracture. METHODS Narrative review conducted by the Rehabilitation Working Group of the International Osteoporosis Foundation Committee of Scientific Advisors characterizing the range of rehabilitation modalities instrumental for the management of fragility fractures. RESULTS Multi-modal exercise post-fragility fracture to the spine and hip is strongly recommended to reduce pain, improve physical function, and improve quality of life. Outpatient physiotherapy post-hip fracture has a stronger evidence base than outpatient physiotherapy post-vertebral fracture. Appropriate nutritional care after fragility fracture provides a large range of improvement in morbidity and mortality. Education increases understanding of osteoporosis which in turn increases utilization of other rehabilitation services. Education may improve other health outcomes such as pain and increase a patient's ability for self-advocacy. CONCLUSION Rehabilitation interventions are inter-reliant, and research investigating the interaction of exercise, nutrition, and other multi-modal therapies may increase the relevance of rehabilitation research to clinical care.
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Affiliation(s)
- D Pinto
- Department of Physical Therapy, Marquette University, P.O. Box 1881, Wisconsin, 53201, Milwaukee, USA.
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, 4000, Liège, Belgium.
| | - M Alshahrani
- Department of Physical Therapy, Marquette University, P.O. Box 1881, Wisconsin, 53201, Milwaukee, USA
- Department of Medical Rehabilitation Science, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - T Chevalley
- Division of Bone Diseases, Department of Medicine, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - B M Camargos
- Densitometry Diagnostic Unit - Rede Materdei de Saúde, Belo Horizonte, Mina Gerais, Brazil
| | - A Papaioannou
- Department of Medicine, Division of Geriatrics, McMaster University, Hamilton, Canada
| | - S Silverman
- Cedars-Sinai Medical Center and University of California, Los Angeles, CA, USA
| | - J-F Kaux
- Department of Physical and Rehabilitation Medicine, University Hospital of Liège, University of Liège, Liège, Belgium
| | - N E Lane
- Department of Medicine and Rheumatology, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - J Morales Torres
- University of Guanajuato at León, Osteoporosis Unit, Hospital Aranda de La Parra, León, Mexico
| | - J Paccou
- Département Universitaire de Rhumatologie, Centre Hospitalier Et Universitaire, Hôpital Roger Salengro, Lille, France
| | - R Rizzoli
- Division of Bone Diseases, Department of Medicine, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - O Bruyere
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, 4000, Liège, Belgium
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El-Kotob R, Craven BC, Thabane L, Papaioannou A, Adachi JD, Giangregorio LM. Exploring changes in bone mass in individuals with a chronic spinal cord injury. Osteoporos Int 2021; 32:759-767. [PMID: 33089353 DOI: 10.1007/s00198-020-05705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022]
Abstract
UNLABELLED People experience rapid bone loss shortly after a spinal cord injury (SCI), but the long-term bone changes are yet to be confirmed. This study showed that trabecular bone may have reached a steady state, whereas cortical bone continued to decline in people with a chronic SCI (mean time post injury: 15.5 ± 10 years). INTRODUCTION (1) To explore changes in bone [primary measure: trabecular volumetric bone mineral density (vBMD); secondary measures: cortical vBMD, cortical thickness, cortical cross-sectional area (CSA), and polar moment of inertia] over 2 years in individuals with a chronic spinal cord injury (SCI). (2) To explore whether muscle density changes were potential correlates of the observed bone changes. METHODS This study is a secondary data analysis of a prospective, observational study involving 70 people with a chronic SCI (≥ 2 years post injury). The study included 4 strata of participants with diverse impairments: (1) Paraplegia (T1-T12) motor complete American Spinal Injury Association Impairment Scale (AIS) A/B (n = 23), (2) Paraplegia motor incomplete AIS C/D (n = 11), (3) Tetraplegia (C2-C8) AIS A/B (n = 22), and (4) Tetraplegia AIS C/D (n = 14). Peripheral quantitative computed tomography scans were taken at the 4% (distal tibia), 38% (diaphyseal tibia), and 66% (muscle cross-sectional area) tibia sites by measuring from the distal to proximal tibia starting at the inferior border of the medial malleolus. The tibia sites were assessed annually over a span of 2 years. Comparisons were made using a paired-samples t test and simple linear regression was used to adjust for sex, time post injury, and bisphosphonate use. RESULTS We observed no changes in trabecular vBMD at the 4% tibia site, but there was a statistically significant decline in cortical vBMD, cortical thickness, and CSA at the 38% tibia site. Changes in muscle density were not associated with the decreases observed in cortical bone. CONCLUSION Our findings suggest that individuals with chronic SCI (mean duration of injury: 15.5 ± 10 years) may have reached a plateau in bone loss with respect to trabecular bone, but cortical bone loss can continue well into the chronic stages.
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Affiliation(s)
- R El-Kotob
- Deparment of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M4G 3V9, Canada.
| | - B C Craven
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M4G 3V9, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - L Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - A Papaioannou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - L M Giangregorio
- Deparment of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada
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Papaioannou A, McCloskey E, Bell A, Ngui D, Mehan U, Tan M, Goldin L, Langer A. Use of an electronic medical record dashboard to identify gaps in osteoporosis care. Arch Osteoporos 2021; 16:76. [PMID: 33893868 PMCID: PMC8068625 DOI: 10.1007/s11657-021-00919-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/17/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Using an electronic medical record (EMR)-based dashboard, this study explored osteoporosis care gaps in primary care. Eighty-four physicians shared their practice activities related to bone mineral density testing, 10-year fracture risk calculation and treatment for those at high risk. Significant gaps in fracture risk calculation and osteoporosis management were identified. PURPOSE To identify care gaps in osteoporosis management focusing on Canadian clinical practice guidelines (CPG) related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk. METHODS The ADVANTAGE OP EMR tool consists of an interactive algorithm to facilitate assessment and management of fracture risk using CPG. The FRAX® and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools were embedded to facilitate 10-year fracture risk calculation. Physicians managed patients as clinically indicated but with EMR reminders of guideline recommendations; participants shared practice level data on management activities after 18-month use of the tool. RESULTS Eighty-four physicians (54%) of 154 who agreed to participate in this study shared their aggregate practice activities. Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture. Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed; most common reasons for this were intention to order BMD later (48%), physician belief that BMD was not required (15%) and patient refusal (20%). For patients with BMD completed, fracture risk was calculated in 29%; 19% were at high risk, of whom 37% were not treated with osteoporosis medications as recommended by CPG. CONCLUSION Despite access to CPG and fracture risk calculators through the ADVANTAGE OP EMR tool, significant gaps remain in fracture risk calculation and osteoporosis management. Additional strategies are needed to address this clinical inertia among family physicians.
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Affiliation(s)
- A. Papaioannou
- McMaster University, Hamilton, Ontario Canada ,GERAS Centre for Aging Research, St. Peter’s Hospital, Hamilton Health Sciences, 88 Maplewood Ave, Hamilton, Ontario L8M 1W9 Canada
| | - E. McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - A. Bell
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - D. Ngui
- University of British Columbia, Vancouver, British Columbia Canada
| | - U. Mehan
- McMaster University, Hamilton, Ontario Canada ,Centre for Family Medicine Family Health Team, Kitchener, Ontario Canada
| | - M. Tan
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| | - L. Goldin
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| | - A. Langer
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
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10
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Hassan S, Seung SJ, Clark RE, Gibbs JC, McArthur C, Mittmann N, Thabane L, Kendler D, Papaioannou A, Wark JD, Ashe MC, Adachi JD, Templeton JA, Giangregorio LM. Describing the resource utilisation and costs associated withvertebral fractures: the Build Better Bones with Exercise (B3E) Pilot Trial. Osteoporos Int 2020; 31:1115-1123. [PMID: 32219499 DOI: 10.1007/s00198-020-05387-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/10/2020] [Indexed: 11/26/2022]
Abstract
UNLABELLED This analysis examined costs/resources of 141 women with vertebral fractures, randomised to a home exercise programme or control group. Total, mean costs and the incremental cost-effectiveness ratio (ICER) were calculated. Quality of life was collected. Cost drivers were caregiver time, medications and adverse events (AEs). Results show adding an exercise programme may reduce the risk of AEs. INTRODUCTION This exploratory economic analysis examined the health resource utilisation and costs experienced by women with vertebral fractures, and explored the effects of home exercise on those costs. METHODS Women ≥ 65 years with one or more X-ray-confirmed vertebral fractures were randomised 1:1 to a 12-month home exercise programme or equal attention control group. Clinical and health system resources were collected during monthly phone calls and daily diaries completed by participants. Intervention costs were included. Unit costs were applied to health system resources. Quality of life (QoL) information was collected via EQ-5D-5L at baseline, 6 and 12 months. RESULTS One hundred and forty-one women were randomised. Overall total costs (CAD 2018) were $664,923 (intervention) and $614,033 (control), respectively. The top three cost drivers were caregiver time ($250,269 and $240,811), medications ($151,000 and $122,145) and AEs ($58,807 and $71,981). The mean cost per intervention participant of $9365 ± $9988 was higher compared with the mean cost per control participant of $8772 ± $9718. The mean EQ-5D index score was higher for the intervention participants (0.81 ± 0.11) compared with that of controls (0.79 ± 0.13). The differences in quality-adjusted life year (QALY) (0.02) and mean cost ($593) were used to calculate the ICER of $29,650. CONCLUSIONS Women with osteoporosis with a previous fracture experience a number of resources and associated costs that impact their care and quality of life. Caregiver time, medications and AEs are the biggest cost drivers for this population. The next steps would be to expand this feasibility study with more participants, longer-term follow-up and more regional variability.
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Affiliation(s)
- S Hassan
- HOPE Research Centre, Sunnybrook Research Institute, Toronto, Ontario, M4N 3M5, Canada.
| | - S J Seung
- HOPE Research Centre, Sunnybrook Research Institute, Toronto, Ontario, M4N 3M5, Canada
| | - R E Clark
- University of Waterloo, Waterloo, Canada
| | - J C Gibbs
- McGill University, Montreal, Quebec, Canada
| | | | | | - L Thabane
- McMaster University, Hamilton, Canada
| | - D Kendler
- University of British Columbia, Vancouver, Canada
| | | | - J D Wark
- University of Melbourne, Melbourne, Australia
| | - M C Ashe
- University of British Columbia, Vancouver, Canada
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Papaioannou A, Adachi JD, Berger C, Jiang Y, Barron R, McGinley JS, Wirth RJ, Anastassiades TP, Davison KS, Hanley DA, Ioannidis G, Kaiser SM, Kovacs CS, Leslie WD, Morin SN, Prior JC, Towheed T, Goltzman D. Testing a theoretical model of imminent fracture risk in elderly women: an observational cohort analysis of the Canadian Multicentre Osteoporosis Study. Osteoporos Int 2020; 31:1145-1153. [PMID: 32034452 DOI: 10.1007/s00198-020-05330-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
UNLABELLED We examined the underlying relationship between fracture risk factors and their imminent risk. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher imminent fracture risk. Past year falls indirectly predicted imminent risk through physical functioning and general health. INTRODUCTION This study aimed to examine direct and indirect effects of several factors on imminent (1 year) fracture risk. METHODS Data from women age 65 and older from population-based Canadian Multicentre Osteoporosis Study were used. Predictors were identified from study years 5 and 10, and imminent fracture data (1-year fracture) came from years 6 and 11 (year 5 predicts year 6, year 10 predicts year 11). A structural equation model (SEM) was used to test the theoretical construct. General health and physical functioning were measured as latent variables using items from the 36-Item Short Form Health Survey (SF-36) and bone mineral density (BMD) T-score was a latent variable based on observed site-specific BMD data (spine L1-L4, femoral neck, total hip). Observed variables were fractures and falls. Model fit was evaluated using root mean square error of approximation (RMSEA), Tucker Lewis index (TLI), and comparative fit index (CFI). RESULTS The analysis included 3298 women. Model fit tests showed that the SEM fit the data well; χ2(172) = 1122.10 < .001, RMSEA = .03, TLI = .99, CFI = .99. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher risk of fracture in the subsequent year (p < .001). Past year falls had a statistically significant but indirect effect on imminent fracture risk through physical functioning and general health (p < .001). CONCLUSIONS We found several direct and indirect pathways that predicted imminent fracture risk in elderly women. Future studies should extend this work by developing risk scoring methods and defining imminent risk thresholds.
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Affiliation(s)
| | - J D Adachi
- McMaster University, Hamilton, ON, Canada
| | - C Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Y Jiang
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
| | - R Barron
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - J S McGinley
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | - R J Wirth
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | | | - K S Davison
- University of Victoria, Victoria, BC, Canada
| | - D A Hanley
- Cumming School of Medicine, University of Calgary, Calgary, AL, Canada
| | | | - S M Kaiser
- Dalhousie University, Halifax, NS, Canada
| | - C S Kovacs
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - W D Leslie
- University of Manitoba, Winnipeg, MB, Canada
| | - S N Morin
- McGill University, Montreal, QC, Canada
| | - J C Prior
- University of British Columbia, Vancouver, BC, Canada
| | - T Towheed
- Queen's University, Kingston, ON, Canada
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Papiris S, Georgakopoulos A, Papaioannou A, Pianou N, Kallergi M, Kolilekas L, Kelekis N, Gialafos H, Manali E, Chatziioannou S. 18F-FDG PET/CT IN SARCOIDOSIS EMERGING PATTERNS AND PHENOTYPES FROM A GREEK STUDY. Chest 2020. [DOI: 10.1016/j.chest.2020.05.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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McKee H, Ioannidis G, Lau A, Treleaven D, Gangji A, Ribic C, Wong-Pack M, Papaioannou A, Adachi JD. Correction to: Comparison of the clinical effectiveness and safety between the use of denosumab vs bisphosphonates in renal transplant patients. Osteoporos Int 2020; 31:981. [PMID: 32189031 DOI: 10.1007/s00198-020-05381-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The original version of this article, published on 03 January 2020 contained a mistake. An author's name was misspelled.
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Affiliation(s)
- H McKee
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
| | - G Ioannidis
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Lau
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - D Treleaven
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Gangji
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - C Ribic
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - M Wong-Pack
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Papaioannou
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - J D Adachi
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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McKee H, Ioannidis G, Lau A, Treleaven D, Gangji A, Ribic C, Wong-Pack M, Papaioannou A, Adachi JD. Comparison of the clinical effectiveness and safety between the use of denosumab vs bisphosphonates in renal transplant patients. Osteoporos Int 2020; 31:973-980. [PMID: 31900542 DOI: 10.1007/s00198-019-05267-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/30/2019] [Accepted: 12/15/2019] [Indexed: 12/29/2022]
Abstract
UNLABELLED A retrospective chart review was conducted on 85 renal transplant patients aged 19-88 years, treated with denosumab or bisphosphonate therapy. Bone densitometry measures were compared between treatment groups at baseline; at years 1, 2, and 3; and at final follow-up (average of 3.4 years). Both bisphosphonate and denosumab treatments increased lumbar spine bone density; however, the effect of denosumab was greater compared with that of bisphosphonate treatment. Denosumab treatment increased femoral neck BMD, whereas bisphosphonate treatment had a mean decrease in femoral neck BMD at final follow-up. Thus, our study provides evidence for the efficacy of denosumab treatment in renal transplant patients. Caution around hypocalcemia is warranted. We recommend more prospective studies to analyze the effects of long-term antiresorptive therapy in patients with a renal transplant. INTRODUCTION To compare the clinical effectiveness and safety between the use of denosumab and bisphosphonates on bone density and incidence of adverse events in renal transplant patients. METHODS A retrospective chart review was conducted on 85 renal transplant patients aged 19-88 years, treated with denosumab or bisphosphonate therapy. Bone densitometry measures were compared between treatment groups at baseline; years 1, 2, and 3; and at final follow-up (average of 3.4 years). RESULTS Absolute change in lumbar spine and femoral neck BMD over the treatment period was 0.029 ± 0.075 g/cm2 and - 0.003 ± 0.064 g/cm2, respectively, in the bisphosphonate group. Absolute change in lumbar spine and femoral neck BMD at final follow-up was 0.072 ± 0.094 g/cm2 and 0.025 ± 0.063 g/cm2, respectively, in the denosumab group. Denosumab resulted in significantly greater increases in lumbar spine BMD (0.045 g/cm2 greater in the denosumab group). Similarly, the absolute change in BMD at the femoral neck was 0.022 g/cm2 greater in the denosumab group as compared with the bisphosphonate group. The denosumab group had one event of severe hypocalcemia following first injection and one report of hospitalized pneumonia. No serious adverse events were reported in the bisphosphonate group. CONCLUSIONS Both treatments increased lumbar spine BMD; however, the effect of denosumab was greater compared with that of bisphosphonate treatment. Our study provides evidence for the efficacy of denosumab treatment in renal transplant patients. Caution around hypocalcemia is warranted. We recommend more prospective studies to analyze the effects of long-term antiresorptive therapy in patients with a renal transplant.
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Affiliation(s)
- H McKee
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
| | - G Ioannidis
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Lau
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - D Treleaven
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Gangji
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - C Ribic
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - M Wong-Pack
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - A Papaioannou
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - J D Adachi
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Grenier A, Griffin M, Andrews G, Wilton R, Burke E, Ojembe B, Feldman B, Papaioannou A. Meanings and feelings of (Im)mobility in later life: Case study insights from a ‘New Mobilities’ perspective. J Aging Stud 2019; 51:100819. [DOI: 10.1016/j.jaging.2019.100819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 01/20/2023]
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16
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Van de Lande L, Papaioannou A, Breakey R, Schievano S, Dunaway D. A new 3D statistical model for treacher collins syndrome using machine learning techniques to quantify facial shape differences from the normal. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Majocchi S, Moine V, Chauchet X, Broyer L, Cons L, Chatel L, Hatterer E, Buatois V, Haddouk H, Didelot G, Magistrelli G, Poitevin Y, Ravn U, Papaioannou A, Richard F, Shang L, Kosco-Vilbois MH, Fischer N, Ferlin WG, Masternak K. Abstract A088: Selective blockage of the innate immune checkpoint receptor CD47 on mesothelin (MSLN) positive solid tumor cells via dual targeting bispecific antibodies alters the tumor microenvironment to control tumor growth. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-a088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Up-regulation of CD47 is an immune evasion mechanism used by different cancers to evade immune surveillance. Through its interaction with signal-regulatory protein alpha (SIRPα) on myeloid cells, CD47 delivers a universal “don’t eat me” signal to phagocytes, which prevents immune cells from efficiently eliminating tumor cells. Blockade of the SIRPα–CD47 innate immune checkpoint has therefore emerged as a new way to treat cancer. Several CD47-targeting molecules are in development with encouraging results obtained with monoclonal antibodies (mAb). However, the pharmacologic properties and the safety profile of molecules indiscriminately blocking CD47 can be improved by selectively inhibiting CD47 only on tumor cells. For this purpose, we generated bispecific antibodies (bsAbs) capable of targeting blockade of CD47 specifically to malignanT-cells through the co-engagement of a tumor-associated antigen (TAA). The bsAb NI-1801 specifically targets mesothelin (MSLN)-positive tumors. NI-1801 was shown to bind to MSLN-positive tumor cells, but not to MSLN-negative cells expressing physiologic levels of CD47 (e.g., leukocytes, erythrocytes, platelets). NI-1801 blocks the CD47-SIRPα interaction in a MSLN-dependent manner and thus minimizes the side effects related to a nonspecific blockade of CD47 on healthy cells. Studying antibody-dependent cellular phagocytosis (ADCP) and antibody-dependent cellular cytotoxicity (ADCC) of various MSLN-positive human tumor cell lines revealed that NI-1801 markedly enhanced killing as compared to amatuximab (an anti-MSLN mAb in clinical trials) and to the corresponding anti-MSLN mAb, exemplifying the role of blocking the “don’t eat me” signal to target cancer. NI-1801 also showed efficacy in various xenograft tumor models and analysis of the tumor microenvironment (TME) revealed a significant increase in leukocyte subpopulations (macrophages/monocytes and NK cells) of NI-1801 treated mice, suggesting that NI-1801 mediates the recruitment of monocytes from blood. Additionally, NI-1801 treatment affected the ratio between MHC-II-low and MHC-II-high macrophages in the TME. Finally, nonhuman primate studies with NI-1801 demonstrated a linear elimination profile, minimal target-mediated drug disposition and no hematologic toxicity. Taken together, these results illustrate that this strategy possesses potent anticancer activities both in vitro and in vivo in conjunction with favorable pharmacologic and toxicologic profiles.
Citation Format: Stefano Majocchi, Valéry Moine, Xavier Chauchet, Lucile Broyer, Laura Cons, Laurence Chatel, Eric Hatterer, Vanessa Buatois, Hasnaà Haddouk, Gérard Didelot, Giovanni Magistrelli, Yves Poitevin, Ulla Ravn, Anne Papaioannou, Françoise Richard, Limin Shang, Marie H. Kosco-Vilbois, Nicolas Fischer, Walter G. Ferlin, Krzysztof Masternak. Selective blockage of the innate immune checkpoint receptor CD47 on mesothelin (MSLN) positive solid tumor cells via dual targeting bispecific antibodies alters the tumor microenvironment to control tumor growth [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr A088.
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Affiliation(s)
| | | | | | | | - Laura Cons
- Novimmune SA, Plan-les-Ouates, Switzerland
| | | | | | | | | | | | | | | | - Ulla Ravn
- Novimmune SA, Plan-les-Ouates, Switzerland
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Giangregorio LM, Gibbs JC, Templeton JA, Adachi JD, Ashe MC, Bleakney RR, Cheung AM, Hill KD, Kendler DL, Khan AA, Kim S, McArthur C, Mittmann N, Papaioannou A, Prasad S, Scherer SC, Thabane L, Wark JD. Build better bones with exercise (B3E pilot trial): results of a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in older women with vertebral fracture. Osteoporos Int 2018; 29:2545-2556. [PMID: 30091064 DOI: 10.1007/s00198-018-4652-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED We pilot-tested a trial of home exercise on individuals with osteoporosis and spine fracture. Our target enrollment was met, though it took longer than expected. Participants stayed in the study and completed the exercise program with no safety concerns. Future trials should expand the inclusion criteria and consider other changes. PURPOSE Osteoporotic fragility fractures create a substantial human and economic burden. There have been calls for a large randomized controlled trial examining the effect of exercise on fracture incidence. The B3E pilot trial was designed to evaluate the feasibility of a large trial examining the effects of home exercise on individuals at high risk of fracture. METHODS Community-dwelling women ≥ 65 years with radiographically confirmed vertebral compression fractures were recruited at seven sites in Canada and Australia. We randomized participants in a 1:1 ratio to a 12-month home exercise program or equal attention control group, both delivered by a physiotherapist (PT). Participants received six PT home visits in addition to monthly phone calls from the PT and a blinded research assistant. The primary feasibility outcomes of the study were recruitment rate (20 per site in 1 year), retention rate (75% completion), and intervention adherence rate (60% of weeks meeting exercise goals). Secondary outcomes included falls, fractures and adverse events. RESULTS One hundred forty-one participants were recruited; an average of 20 per site, though most sites took longer than anticipated. Retention and adherence met the criteria for success: 92% of participants completed the study; average adherence was 66%. The intervention group did not differ significantly in the number of falls (IRR 0.97, 95% CI 0.58 to 1.63) or fragility fractures (OR 1.11, 95% CI 0.60 to 2.05) compared to the control group. There were 18 serious adverse events in the intervention group and 12 in the control group. CONCLUSION An RCT of home exercise in women with vertebral fractures is feasible but recruitment was a challenge. Suggestions are made for the conduct of future trials.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
| | - J C Gibbs
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - J A Templeton
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - J D Adachi
- McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada
| | - M C Ashe
- University of British Columbia, Vancouver, Canada
- Centre for Hip Health and Mobility, Vancouver, Canada
| | | | - A M Cheung
- University of Toronto, Toronto, Ontario, Canada
| | - K D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - D L Kendler
- University of British Columbia, Vancouver, Canada
| | - A A Khan
- McMaster University, Hamilton, Ontario, Canada
| | - S Kim
- University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - C McArthur
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Ontario, Canada
| | - N Mittmann
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A Papaioannou
- McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Ontario, Canada
| | - S Prasad
- McMaster University, Hamilton, Ontario, Canada
| | - S C Scherer
- Broadmeadows Health Service, Broadmeadows, Australia
- University of Melbourne, Melbourne, Australia
| | - L Thabane
- McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada
| | - J D Wark
- University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Parkville, Australia
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19
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Buatois V, Johnson Z, Salgado-Pires S, Papaioannou A, Hatterer E, Chauchet X, Richard F, Barba L, Daubeuf B, Cons L, Broyer L, D'Asaro M, Matthes T, LeGallou S, Fest T, Tarte K, Clarke Hinojosa RK, Genescà Ferrer E, Ribera JM, Dey A, Bailey K, Fielding AK, Eissenberg L, Ritchey J, Rettig M, DiPersio JF, Kosco-Vilbois MH, Masternak K, Fischer N, Shang L, Ferlin WG. Preclinical Development of a Bispecific Antibody that Safely and Effectively Targets CD19 and CD47 for the Treatment of B-Cell Lymphoma and Leukemia. Mol Cancer Ther 2018; 17:1739-1751. [PMID: 29743205 DOI: 10.1158/1535-7163.mct-17-1095] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/15/2018] [Accepted: 05/04/2018] [Indexed: 12/14/2022]
Abstract
CD47, an ubiquitously expressed innate immune checkpoint receptor that serves as a universal "don't eat me" signal of phagocytosis, is often upregulated by hematologic and solid cancers to evade immune surveillance. Development of CD47-targeted modalities is hindered by the ubiquitous expression of the target, often leading to rapid drug elimination and hemotoxicity including anemia. To overcome such liabilities, we have developed a fully human bispecific antibody, NI-1701, designed to coengage CD47 and CD19 selectively on B cells. NI-1701 demonstrates favorable elimination kinetics with no deleterious effects seen on hematologic parameters following single or multiple administrations to nonhuman primates. Potent in vitro and in vivo activity is induced by NI-1701 to kill cancer cells across a plethora of B-cell malignancies and control tumor growth in xenograft mouse models. The mechanism affording maximal tumor growth inhibition by NI-1701 is dependent on the coengagement of CD47/CD19 on B cells inducing potent antibody-dependent cellular phagocytosis of the targeted cells. NI-1701-induced control of tumor growth in immunodeficient NOD/SCID mice was more effective than that achieved with the anti-CD20 targeted antibody, rituximab. Interestingly, a synergistic effect was seen when tumor-implanted mice were coadministered NI-1701 and rituximab leading to significantly improved tumor growth inhibition and regression in some animals. We describe herein, a novel bispecific antibody approach aimed at sensitizing B cells to become more readily phagocytosed and eliminated thus offering an alternative or adjunct therapeutic option to patients with B-cell malignancies refractory/resistant to anti-CD20-targeted therapy. Mol Cancer Ther; 17(8); 1739-51. ©2018 AACR.
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Affiliation(s)
| | - Zoë Johnson
- Novimmune S.A., Plan-les-Ouates, Switzerland
| | | | | | | | | | | | | | | | - Laura Cons
- Novimmune S.A., Plan-les-Ouates, Switzerland
| | | | | | - Thomas Matthes
- Medical Faculty, University of Geneva, Genève, Switzerland
| | | | - Thierry Fest
- Rennes 1 University, Inserm U1236, Rennes, France
| | - Karin Tarte
- Rennes 1 University, Inserm U1236, Rennes, France
| | - Robert K Clarke Hinojosa
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias Pujol, Badalona, Barcelona, Spain
| | - Eulàlia Genescà Ferrer
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias Pujol, Badalona, Barcelona, Spain
| | - José María Ribera
- Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias Pujol, Badalona, Barcelona, Spain
| | - Aditi Dey
- Paul O'Gorman Building, University College London (UCL) Cancer Institute, London, United Kingdom
| | - Katharine Bailey
- Paul O'Gorman Building, University College London (UCL) Cancer Institute, London, United Kingdom
| | - Adele K Fielding
- Paul O'Gorman Building, University College London (UCL) Cancer Institute, London, United Kingdom
| | - Linda Eissenberg
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Julie Ritchey
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Rettig
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - John F DiPersio
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | - Limin Shang
- Novimmune S.A., Plan-les-Ouates, Switzerland
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20
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Ziebart C, McArthur C, Lee L, Papaioannou A, Laprade J, Cheung AM, Jain R, Giangregorio L. "Left to my own devices, I don't know": using theory and patient-reported barriers to move from physical activity recommendations to practice. Osteoporos Int 2018; 29:1081-1091. [PMID: 29441402 DOI: 10.1007/s00198-018-4390-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022]
Abstract
UNLABELLED Knowledge exchange with community-dwelling individuals across Ontario revealed barriers to implementation of physical activity recommendations that reflected capability, opportunity, and motivation; barriers unique to individuals with osteoporosis include fear of fracturing, trust in providers, and knowledge of exercise terminology. Using the Behaviour Change Wheel, we identified interventions (training, education, modeling) and policy categories (communication/marketing, guidelines, service provision). INTRODUCTION Physical activity recommendations exist for individuals with osteoporosis; however, to change behavior, we must address barriers and facilitators to their implementation. The purposes of this project are (1) to identify barriers to and facilitators of uptake of disease-specific physical activity recommendations (2) to use the findings to identify behavior change strategies using the Behaviour Change Wheel (BCW). METHODS Focus groups and semi-structured interviews were conducted with community-dwelling individuals attending osteoporosis-related programs or education sessions in Ontario. They were stratified by geographic area, urban/rural, and gender, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and interventions were identified. RESULTS Two hundred forty community-dwelling individuals across Ontario participated (mean ± SD age = 72 ± 8.28). Barriers were as follows: capability: disease-related symptoms hinder exercise and physical activity participation, lack of exercise-related knowledge, low exercise self-efficacy; opportunity: access to exercise programs that meet needs and preferences, limited resources and time, physical activity norms and preferences; motivation: incentives to exercise, fear of fracturing, trust in exercise providers. Interventions selected were training, education, and modeling. Policy categories selected were communication/marketing, guidelines, and service provision. CONCLUSIONS Barriers unique to individuals with osteoporosis included the following: lack of knowledge on key exercise concepts, fear of fracturing, and trust in providers. Behavior change techniques may need tailoring to gender, age, or presence of comorbid conditions.
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Affiliation(s)
- C Ziebart
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - C McArthur
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - L Lee
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - A Papaioannou
- Department of Health and Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - J Laprade
- Division of Anatomy, University of Toronto, Toronto, ON, Canada
- Ontario Osteoporosis Strategy, Toronto, ON, Canada
- Osteoporosis Canada, Toronto, ON, Canada
| | - A M Cheung
- University Health Network, Toronto, ON, Canada
| | - R Jain
- Ontario Osteoporosis Strategy, Toronto, ON, Canada
- Osteoporosis Canada, Toronto, ON, Canada
| | - L Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
- University Health Network, Toronto, ON, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada.
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21
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Kontopodis N, Papaioannou A, Tavlas E, Papadopoulos G, Lioudaki S, Tzirakis K, Ioannou CV. The use of local anesthesia to perform lower limb revascularization in the fragile patient with critical limb ischemia. G Chir 2018; 39:77-81. [PMID: 29694305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients with critical limb ischemia are usually compromised, frequently making administration of general or regional anesthesia problematic. We treated 3 fragile patients presenting contraindications to undertake traditional anesthetic techniques for lower limb revascularization, in whom local anesthesia with conscious sedation was used to complete the operation. An axillo-bifemoral, a unilateral axillo-femoral and a femoro-femoral bypass were performed. Procedure was uneventful in all three cases despite the coexistence of specific surgical challenges (distal anastomosis at the profunda in two cases, redo surgery and scarred groin in the third). Surgical revascularization under local anesthesia may be considered in selected high risk patients.
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22
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Silverman SL, Siris E, Belazi D, Recknor C, Papaioannou A, Brown JP, Gold DT, Lewiecki EM, Quinn G, Balasubramanian A, Yue S, Stolshek B, Kendler DL. Persistence at 24 months with denosumab among postmenopausal women with osteoporosis: results of a prospective cohort study. Arch Osteoporos 2018; 13:85. [PMID: 30088189 PMCID: PMC6096691 DOI: 10.1007/s11657-018-0491-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/18/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Persistence with prescribed medications for chronic diseases is important; however, persistence with osteoporosis treatments is historically poor. In this prospective cohort study of postmenopausal women treated for osteoporosis in real-world clinical practice settings in the USA and Canada, 24-month persistence with denosumab was 58%. PURPOSE Patients who persist with their prescribed osteoporosis treatment have increased bone mineral density (BMD) and reduced risk of fracture. Twelve-month persistence with denosumab in routine clinical practice is as high as 95%, but there are limited data on longer-term persistence with denosumab in this setting. METHODS This single-arm, prospective, cohort study evaluated 24-month persistence with denosumab administered every 6 months in postmenopausal women receiving treatment for osteoporosis in real-world clinical practice in the USA and Canada. Endpoints and analyses included the percentage of patients who persist with denosumab at 24 months (greater than or equal to four injections with a gap between injections of no more than 6 months plus 8 weeks), the total number of injections received by each patient, changes in BMD in persistent patients, and the incidence of serious adverse events (SAEs) and fractures. RESULTS Among 935 enrolled patients, 24-month persistence was 58% (50% in US patients and 75% in Canadian patients). A majority of patients received at least four injections over the observation period (62% of US patients and 81% of Canadian patients). Among patients who were persistent at 24 months and who had a baseline, 12-month, and 24-month DXA scan, mean BMD increased from baseline to 24 months by 7.8% at the lumbar spine and 2.1% at the femoral neck. SAEs and fractures were reported for 122 (13.0%) patients and 54 (5.8%) patients, respectively. CONCLUSIONS Persistence with denosumab for 24 months yields improvement in BMD among postmenopausal women with osteoporosis treated in routine clinical practice in the USA and Canada.
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Affiliation(s)
- Stuart L. Silverman
- OMC Clinical Research Center, Cedars-Sinai Medical Center and David Geffen School of Medicine UCLA, 8641 Wilshire Blvd, Suite 301, Beverly Hills, CA 90211 USA
| | - E. Siris
- Columbia University Medical Center, 180 Fort Washington Avenue, HP9-964, New York, NY USA
| | - D. Belazi
- AlchemiPharma, 1582 High Grove LN, Malvern, PA USA
| | - C. Recknor
- United Osteoporosis Centers, 2350 Limestone Parkway, Gainesville, GA USA
| | - A. Papaioannou
- Juravinski Research Center, McMaster University, Room 151, 88 Maplewood Avenue, Hamilton, Canada
| | - J. P. Brown
- CHU de Québec (CHUL) Research Center, Laval University, Room TR-83, 2705 Laurier Boulevard, Quebec City, QC Canada
| | - D. T. Gold
- Duke University Medical Center, Box 3003, Durham, NC USA
| | - E. M. Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, University of New Mexico School of Medicine, 300 Oak St. NE, Albuquerque, NM USA
| | - G. Quinn
- Outlier Statistics Ltd, 25 Blacksmith Close, St Michaels Mead, Bishop’s Stortford, UK
| | | | - S. Yue
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA USA
| | - B. Stolshek
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA USA
| | - D. L. Kendler
- Department of Medicine, University of British Columbia, Prohealth, 150-943 W Broadway, Vancouver, BC Canada
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23
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Chatzistathis T, Papaioannou A, Gasparatos D, Molassiotis A. From which soil metal fractions Fe, Mn, Zn and Cu are taken up by olive trees (Olea europaea L., cv. 'Chondrolia Chalkidikis') in organic groves? J Environ Manage 2017; 203:489-499. [PMID: 28841516 DOI: 10.1016/j.jenvman.2017.07.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/14/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
Organic farming has been proposed as an alternative agricultural system to help solve environmental problems, like the sustainable management of soil micronutrients, without inputs of chemical fertilizers. The purposes of this study were: i) to assess Fe, Mn, Zn and Cu bioavailability through the determination of sequentially extracted chemical forms (fractions) and their correlation with foliar micronutrient concentrations in mature organic olive (cv. 'Chondrolia Chalkidikis') groves; ii) to determine the soil depth and the available forms (fractions) by which the 4 metals are taken up by olive trees. DTPA extractable (from the soil layers 0-20, 20-40 and 40-60 cm) and foliar micronutrient concentrations were determined in two organic olive groves. Using the Tessier fractionation, five fractions, for all the metals, were found: exchangeable, bound to carbonates (acid-soluble), bound to Fe-Mn oxides (reducible), organic (oxidizable), as well as residual form. Our results indicated that Fe was taken up by the olive trees as organic complex, mainly from the soil layer 40-60 cm. Manganese was taken up from the exchangeable fraction (0-20 cm); Zinc was taken up as organic complex from the layers 0-20 and 40-60 cm, as well as in the exchangeable form from the upper 20 cm. Copper was taken up from the soil layers 0-20 and 40-60 cm as soluble organic complex, and as exchangeable ion from the upper 20 cm. Our data reveal the crucial role of organic matter to sustain metal (Fe, Zn and Cu) uptake -as soluble complexes-by olive trees, in mature organic groves grown on calcareous soils; it is also expected that these data will constitute a thorough insight and useful tool towards a successful nutrient and organic C management for organic olive groves, since no serious nutritional deficiencies were found.
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Affiliation(s)
- T Chatzistathis
- Department of Agriculture, School of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, Greece.
| | - A Papaioannou
- Department of Forestry and Natural Environment, School of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, Greece
| | - D Gasparatos
- Department of Agriculture, School of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, Greece.
| | - A Molassiotis
- Department of Agriculture, School of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, Greece
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24
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Pritchard JM, Kennedy CC, Karampatos S, Ioannidis G, Misiaszek B, Marr S, Patterson C, Woo T, Papaioannou A. Measuring frailty in clinical practice: a comparison of physical frailty assessment methods in a geriatric out-patient clinic. BMC Geriatr 2017; 17:264. [PMID: 29132301 PMCID: PMC5683585 DOI: 10.1186/s12877-017-0623-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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: 01/06/2017] [Accepted: 10/08/2017] [Indexed: 01/13/2023] Open
Abstract
Background The objectives of this study were to determine: 1) the prevalence of frailty using Fried’s phenotype method and the Short Performance Physical Battery (SPPB), 2) agreement between frailty assessment methods, 3) the feasibility of assessing frailty using Fried’s phenotype method and the SPPB. Methods This cross-sectional study was conducted at a geriatric out-patient clinic in Hamilton, Canada. A research assistant conducted all frailty assessments. Patients were classified as non-frail, pre-frail or frail according to Fried’s phenotype method and the SPPB. Agreement among methods is reported using the Cohen kappa statistic (standard error). Feasibility data included the percent of eligible participants agreeing to attempt the frailty assessments (criterion for feasibility: ≥90% of patients agreeing to the frailty assessment), equipment required, and safety considerations. A p-value of <0.05 is considered significant. Results A total of 110 participants (92%) and 109 participants (91%) agreed to attempt Fried’s phenotype method and SPPB, respectively. No adverse events occurred during any assessments. According to Fried’s phenotype method, the prevalence of frailty and pre-frailty was 35% and 56%, respectively, and according to the SPPB, the prevalence of frailty and pre-frailty was 50% and 35%, respectively. There was fair to moderate agreement between methods for determining which participants were frail (0.488 [0.082], p < 0.001) and pre-frail (0.272 [0.084], p = 0.002). Conclusions Frailty and pre-frailty are common in this geriatric outpatient population, and there is fair to moderate agreement between Fried’s phenotype method and the SPPB. Over 90% of the patients who were eligible for the study agreed to attempt the frailty assessments, demonstrating that according to our feasibility criteria, frailty can be assessed in this patient population. Assessing frailty may help clinicians identify high-risk patients and tailor interventions based on baseline frailty characteristics.
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Affiliation(s)
- J M Pritchard
- Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada. .,Department of Kinesiology and Interdisciplinary Science, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada.
| | - C C Kennedy
- Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada.,Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - S Karampatos
- Population Health Research Institute (PHRI), St. Joseph's Healthcare, Hamilton, ON, L8N 4A6, Canada
| | - G Ioannidis
- Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada.,Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - B Misiaszek
- Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada.,Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - S Marr
- Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada.,Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - C Patterson
- Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada.,Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - T Woo
- Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada.,Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - A Papaioannou
- Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada.,Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
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25
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Giangregorio L, Clark R, McArthur C, Papaioannou A, Cheung AM, Laprade J, Lee L, Jain R. Osteoporosis exercise knowledge and education in medicine and nursing: response to comments by Nguyen. Osteoporos Int 2017; 28:3071-3073. [PMID: 28685280 DOI: 10.1007/s00198-017-4121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Affiliation(s)
- L Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada.
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - R Clark
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - C McArthur
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - A Papaioannou
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada
- McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - A M Cheung
- University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - J Laprade
- University of Toronto, Toronto, ON, M5S 1A1, Canada
- Ontario Osteoporosis Strategy & Osteoporosis Canada, Toronto, ON, M3C 1H9, Canada
| | - L Lee
- Schlegel-UW Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada
- McMaster University, Hamilton, ON, L8S 4L8, Canada
- Centre for Family Medicine, Kitchener, Canada
| | - R Jain
- Ontario Osteoporosis Strategy & Osteoporosis Canada, Toronto, ON, M3C 1H9, Canada
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26
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Giangregorio L, Ziebart C, McArthur C, Cheung A, Laprade J, Jain R, Lee L, Papaioannou A. TRANSLATING RESEARCH INTO PRACTICE USING PATIENT-CENTRED VIDEOS: DEVELOPMENT AND ANALYSIS OF UPTAKE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L. Giangregorio
- Kinesiology, University of Waterloo, Waterloo, Ontario, Canada,
- University Health Network, Toronto, Ontario, Canada,
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Ontario, Canada,
| | - C. Ziebart
- Kinesiology, University of Waterloo, Waterloo, Ontario, Canada,
| | - C. McArthur
- Kinesiology, University of Waterloo, Waterloo, Ontario, Canada,
| | - A. Cheung
- University Health Network, Toronto, Ontario, Canada,
- University of Toronto, Toronto, Ontario, Canada,
| | - J. Laprade
- University of Toronto, Toronto, Ontario, Canada,
| | - R. Jain
- Osteoporosis Canada, Toronto, Ontario, Canada,
| | - L. Lee
- McMaster University, Hamilton, Ontario, Canada
| | - A. Papaioannou
- McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Ontario, Canada,
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Durepos P, Kaasalainen S, Tamara S, Ploeg J, Parker D, Brazil K, Papaioannou A. ASSESSING FAMILY CARE CONFERENCES IN LONG-TERM CARE: LESSONS LEARNED FROM CONTENT ANALYSIS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P.M. Durepos
- McMaster Universtiy, Hamilton, Ontario, Canada,
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada,
| | | | - S. Tamara
- McGill University, Montreal, Quebec, Canada,
| | - J. Ploeg
- McMaster Universtiy, Hamilton, Ontario, Canada,
| | - D. Parker
- University of Technology Sydney, Sydney, Ontario, Canada
| | - K. Brazil
- Queen’s University, Belfast, Ireland,
| | - A. Papaioannou
- McMaster Universtiy, Hamilton, Ontario, Canada,
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada,
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Cervinka T, Lynch CL, Giangregorio L, Adachi JD, Papaioannou A, Thabane L, Craven BC. Agreement between fragility fracture risk assessment algorithms as applied to adults with chronic spinal cord injury. Spinal Cord 2017; 55:985-993. [PMID: 28607522 DOI: 10.1038/sc.2017.65] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES The objective of the study was to determine and report agreement in fracture risk stratification of adults with spinal cord injury (SCI) using (1) Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and Canadian Fracture Risk Assessment (FRAX) tools with and without areal bone mineral density (aBMD) and (2) SCI-specific fracture thresholds. SETTING Tertiary rehabilitation center, Ontario, Canada. METHODS Community-dwelling adults with chronic SCI (n=90, C2-T12, AIS A-D) consented to participation. Femoral neck aBMD values determined 10-year fracture risk (CAROC and FRAX). Knee-region aBMD and distal tibia volumetric BMD values were compared to SCI-specific fracture thresholds. Agreements between CAROC and FRAX risk stratifications, and between fracture threshold risk stratification, were assessed using prevalence- and bias-adjusted Kappa statistics (PABAK). RESULTS CAROC and FRAX assessment tools showed moderate agreement for post-menopausal women (PABAK=0.56, 95% confidence interval (CI): 0.27, 0.84) and men aged ⩾50 years (PABAK=0.51, 95% CI: 0.34, 0.67), with poor agreement for young men and pre-menopausal women (PABAK⩽0). Excellent agreement was evident between FRAX with and without aBMD in young adults and in those with motor incomplete injury (PABAK=0.86-0.92). In other subgroups, agreement ranged from moderate to substantial (PABAK=0.41-0.73). SCI-specific fracture thresholds (Eser versus Garland) showed poor agreement (PABAK⩽0). CONCLUSION Fracture risk estimates among individuals with SCI vary substantially with the risk assessment tool. Use of SCI-specific risk factors to identify patients with high fracture risk is recommended until a validated SCI-specific tool for predicting fracture risk is developed.
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Affiliation(s)
- T Cervinka
- Department of Research, Neural Engineering and Therapeutics Team, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - C L Lynch
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - L Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - L Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - B C Craven
- Department of Research, Neural Engineering and Therapeutics Team, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Dheilly E, Moine V, Broyer L, Salgado-Pires S, Johnson Z, Papaioannou A, Cons L, Calloud S, Majocchi S, Nelson R, Rousseau F, Ferlin W, Kosco-Vilbois M, Fischer N, Masternak K. Selective Blockade of the Ubiquitous Checkpoint Receptor CD47 Is Enabled by Dual-Targeting Bispecific Antibodies. Mol Ther 2017; 25:523-533. [PMID: 28153099 PMCID: PMC5368402 DOI: 10.1016/j.ymthe.2016.11.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [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: 07/05/2016] [Revised: 11/04/2016] [Accepted: 11/04/2016] [Indexed: 01/05/2023] Open
Abstract
CD47 is a ubiquitously expressed immune checkpoint receptor that is often upregulated in cancer. CD47 interacts with its counter-receptor SIRPα on macrophages and other myeloid cells to inhibit cancer cell phagocytosis and drive immune evasion. To overcome tolerability and “antigen sink” issues arising from widespread CD47 expression, we generated dual-targeting bispecific antibodies that selectively block the CD47-SIRPα interaction on malignant cells expressing a specific tumor-associated antigen; e.g., CD19 or mesothelin. These bispecific κλ bodies are fully human, native IgG1 molecules, combining tumor targeting and selective CD47 blockade with immune activating mechanisms mediated by the Fc portion of the antibody. CD47-neutralizing κλ bodies efficiently kill cancer cells in vitro and in vivo but interact only weakly with healthy cells expressing physiological levels of CD47. Accordingly, a κλ body administered to non-human primates showed a typical IgG pharmacokinetic profile and was well tolerated. Importantly, κλ bodies preserve their tumoricidal capabilities in the presence of a CD47 antigen sink. Thus, dual-targeting κλ bodies allow for efficacious yet safe targeting of CD47 in cancer. Such a bispecific design could be applied to limit the extent of neutralization of other ubiquitously expressed therapeutic targets.
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Affiliation(s)
- Elie Dheilly
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | - Valéry Moine
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | - Lucile Broyer
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | | | - Zoë Johnson
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | - Anne Papaioannou
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | - Laura Cons
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | | | - Stefano Majocchi
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | - Robert Nelson
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | | | - Walter Ferlin
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
| | | | - Nicolas Fischer
- Novimmune SA, 14 chemin des Aulx, 1228 Plan-les-Ouates, Switzerland
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Clark RE, McArthur C, Papaioannou A, Cheung AM, Laprade J, Lee L, Jain R, Giangregorio LM. "I do not have time. Is there a handout I can use?": combining physicians' needs and behavior change theory to put physical activity evidence into practice. Osteoporos Int 2017; 28:1953-1963. [PMID: 28413842 DOI: 10.1007/s00198-017-3975-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/15/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Guidelines for physical activity exist and following them would improve health. Physicians can advise patients on physical activity. We found barriers related to physicians' knowledge, a lack of tools and of physician incentives, and competing demands for limited time with a patient. We discuss interventions that could reduce these barriers. INTRODUCTION Uptake of physical activity (PA) guidelines would improve health and reduce mortality in older adults. However, physicians face barriers in guideline implementation, particularly when faced with needing to tailor recommendations in the presence of chronic disease. We performed a behavioral analysis of physician barriers to PA guideline implementation and to identify interventions. The Too Fit To Fracture physical activity recommendations were used as an example of disease-specific PA guidelines. METHODS Focus groups and semi-structured interviews were conducted with physicians and nurse practitioners in Ontario, stratified by type of physician, geographic area, and urban/rural, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the behavior change wheel framework, themes were categorized into capability, opportunity and motivation, and interventions were identified. RESULTS Fifty-nine family physicians, specialists, and nurse practitioners participated. Barriers were as follows: Capability-lack of exercise knowledge or where to refer; Opportunity-pragmatic tools, fit within existing workflow, available programs that meet patients' needs, physical activity literacy and cultural practices; Motivation-lack of incentives, not in their scope of practice or professional identity, competing priorities, outcome expectancies. Interventions selected: education, environmental restructuring, enablement, persuasion. Policy categories: communications/marketing, service provision, guidelines. CONCLUSIONS Key barriers to PA guideline implementation among physicians include knowledge on where to refer or what to say, access to pragmatic programs or resources, and things that influence motivation, such as competing priorities or lack of incentives. Future work will report on the development and evaluation of knowledge translation interventions informed by the barriers.
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Affiliation(s)
- R E Clark
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - C McArthur
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - A Papaioannou
- McMaster University, Hamilton, ON, L8S 4L8, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada
| | - A M Cheung
- University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - J Laprade
- University of Toronto, Toronto, ON, M5S 1A1, Canada
- Ontario Osteoporosis Strategy & Osteoporosis Canada, Toronto, ON, M3C 1H9, Canada
| | - L Lee
- McMaster University, Hamilton, ON, L8S 4L8, Canada
- Centre for Family Medicine, Kitchener, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada
| | - R Jain
- Ontario Osteoporosis Strategy & Osteoporosis Canada, Toronto, ON, M3C 1H9, Canada
| | - L M Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada.
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
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Kaasalainen S, Sussman T, Bui M, Akhtar-Danesh N, Laporte RD, McCleary L, Wickson Griffiths A, Brazil K, Parker D, Dal Bello-Haas V, Papaioannou A, O'Leary J. What are the differences among occupational groups related to their palliative care-specific educational needs and intensity of interprofessional collaboration in long-term care homes? BMC Palliat Care 2017; 16:33. [PMID: 28521799 PMCID: PMC5437548 DOI: 10.1186/s12904-017-0207-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 05/03/2017] [Indexed: 11/27/2022] Open
Abstract
Background The purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes. Methods A cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman’s approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians). Results A total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers. Conclusions These study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff related to working with dying residents and their families are needed. Optimal palliative care may require resources to increase the availability of support for all staff involved in the care of patients.
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Affiliation(s)
- S Kaasalainen
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada. .,Queen's University Belfast, Belfast, UK.
| | - T Sussman
- McGill University, Montreal, QC, Canada
| | - M Bui
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - N Akhtar-Danesh
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | | | - L McCleary
- Brock University, St. Catharines, ON, Canada
| | | | - K Brazil
- Queen's University Belfast, Belfast, UK
| | - D Parker
- Deborah Parker, University of Western Sydney, Sydney, Australia
| | - V Dal Bello-Haas
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - A Papaioannou
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - J O'Leary
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
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Jamal SA, Goltzman D, Hanley DA, Papaioannou A, Prior JC, Josse RG. Retraction to: Nitrate use and changes in bone mineral density: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 2017; 28:421. [PMID: 27909783 DOI: 10.1007/s00198-016-3843-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S A Jamal
- Medicine, University of Toronto, Toronto, ON, Canada.
- , 76 Grenville Street, Suite 805, Toronto, ON, M5S 1B2, Canada.
| | - D Goltzman
- Medicine, McGill University, Montreal, PQ, Canada
| | - D A Hanley
- Medicine, University of Calgary, Calgary, AB, Canada
| | | | - J C Prior
- Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R G Josse
- Medicine, University of Toronto, Toronto, ON, Canada
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Blain H, Masud T, Dargent-Molina P, Martin F, Rosendahl E, van der Velde N, Bousquet J, Benetos A, Cooper C, Kanis J, Reginster J, Rizzoli R, Cortet B, Barbagallo M, Dreinhöfer K, Vellas B, Maggi S, Strandberg T, Alvarez M, Annweiler C, Bernard PL, Beswetherick N, Bischoff-Ferrari H, Bloch F, Boddaert J, Bonnefoy M, Bousson V, Bourdel-Marchasson I, Capisizu A, Che H, Clara J, Combe B, Delignieres D, Eklund P, Emmelot-Vonk M, Freiberger E, Gauvain JB, Goswami N, Guldemond N, Herrero Á, Joël ME, Jónsdóttir A, Kemoun G, Kiss I, Kolk H, Kowalski M, Krajcík Š, Kutsal Y, Lauretani F, Macijauskienė J, Mellingsæter M, Morel J, Mourey F, Nourashemi F, Nyakas C, Puisieux F, Rambourg P, Ramírez A, Rapp K, Rolland Y, Ryg J, Sahota O, Snoeijs S, Stephan Y, Thomas E, Todd C, Treml J, Adachi R, Agnusdei D, Body JJ, Breuil V, Bruyère O, Burckardt P, Cannata-Andia J, Carey J, Chan DC, Chapuis L, Chevalley T, Cohen-Solal M, Dawson-Hughes B, Dennison E, Devogelaer JP, Fardellone P, Féron JM, Perez A, Felsenberg D, Glueer C, Harvey N, Hiligsman M, Javaid M, Jörgensen N, Kendler D, Kraenzlin M, Laroche M, Legrand E, Leslie W, Lespessailles E, Lewiecki E, Nakamura T, Papaioannou A, Roux C, Silverman S, Henriquez M, Thomas T, Vasikaran S, Watts N, Weryha G. A comprehensive fracture prevention strategy in older adults: The European union geriatric medicine society (EUGMS) statement. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Hopkins RB, Burke N, Von Keyserlingk C, Leslie WD, Morin SN, Adachi JD, Papaioannou A, Bessette L, Brown JP, Pericleous L, Tarride J. The current economic burden of illness of osteoporosis in Canada. Osteoporos Int 2016; 27:3023-32. [PMID: 27166680 PMCID: PMC5104559 DOI: 10.1007/s00198-016-3631-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED We estimate the current burden of illness of osteoporosis in Canada is double ($4.6 billion) our previous estimates ($2.3 billion) due to improved data capture of the multiple encounters and services that accompany a fracture: emergency room, admissions to acute and step-down non-acute institutions, rehabilitation, home-assisted or long-term residency support. INTRODUCTION We previously estimated the economic burden of illness of osteoporosis-attributable fractures in Canada for the year 2008 to be $2.3 billion in the base case and as much as $3.9 billion. The aim of this study is to update the estimate of the economic burden of illness for osteoporosis-attributable fractures for Canada based on newly available home care and long-term care (LTC) data. METHODS Multiple national databases were used for the fiscal-year ending March 31, 2011 (FY 2010/2011) for acute institutional care, emergency visits, day surgery, secondary admissions for rehabilitation, and complex continuing care, as well as national dispensing data for osteoporosis medications. Gaps in national data were supplemented by provincial and community survey data. Osteoporosis-attributable fractures for Canadians age 50+ were identified by ICD-10-CA codes. Costs were expressed in 2014 dollars. RESULTS In FY 2010/2011, the number of osteoporosis-attributable fractures was 131,443 resulting in 64,884 acute care admissions and 983,074 acute hospital days. Acute care costs were $1.5 billion, an 18 % increase since 2008. The cost of LTC was 33.4 times the previous estimate ($31 million versus $1.03 billion) because of improved data capture. The cost for rehabilitation and secondary admissions increased 3.4 fold, while drug costs decreased 19 %. The overall cost of osteoporosis was over $4.6 billion, an increase of 83 % from the 2008 estimate. CONCLUSION Since the 2008 estimate, new Canadian data on home care and LTC are available which provided a better estimate of the burden of osteoporosis in Canada. This suggests that our previous estimates were seriously underestimated.
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Affiliation(s)
- R B Hopkins
- Programs for Assessment of Technology in Health (PATH), St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
- PATH Research Institute, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada.
| | - N Burke
- Programs for Assessment of Technology in Health (PATH), St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - C Von Keyserlingk
- Programs for Assessment of Technology in Health (PATH), St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Papaioannou
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - L Bessette
- Department of Medicine, Laval University, Quebec City, Canada
| | - J P Brown
- Department of Medicine, Laval University, Quebec City, Canada
| | | | - J Tarride
- Programs for Assessment of Technology in Health (PATH), St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Giangregorio LM, Papaioannou A, Heinonen A, Cheung AM, Laprade J, Ashe MC, MacIntyre NJ, Shipp K, McGill S, Ravi J, Keller H, Wark JD. Intensity is a subjective construct. Osteoporos Int 2016; 27:2391-2392. [PMID: 26860501 PMCID: PMC5094884 DOI: 10.1007/s00198-016-3507-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/26/2016] [Indexed: 11/25/2022]
Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2K 2N1, Canada.
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- Schlegel-UW Research Institute for Aging, Wareloo, ON, Canada.
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - A M Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Laprade
- Division of Anatomy, University of Toronto, Toronto, ON, Canada
| | - M C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - N J MacIntyre
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - K Shipp
- Department of Community and Family Medicine, Duke University, Durham, NC, USA
| | - S McGill
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2K 2N1, Canada
| | - J Ravi
- Ontario Osteoporosis Strategy & Osteoporosis Canada, Toronto, ON, Canada
| | - H Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2K 2N1, Canada
- Schlegel-UW Research Institute for Aging, Wareloo, ON, Canada
| | - J D Wark
- University of Melbourne Department of Medicine, and Bone and Mineral Medicine, Royal Melbourne Hospital, Victoria, Australia
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Papaioannou A, Kennedy CC, Ioannidis G, Cameron C, Croxford R, Adachi JD, Mursleen S, Jaglal S. Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012. Osteoporos Int 2016; 27:887-897. [PMID: 26801930 PMCID: PMC5096943 DOI: 10.1007/s00198-015-3477-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/29/2015] [Indexed: 01/25/2023]
Abstract
SUMMARY In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. INTRODUCTION This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. METHODS This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). RESULTS Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. CONCLUSION Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.
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Affiliation(s)
- A Papaioannou
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
- Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
| | - C C Kennedy
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - G Ioannidis
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
- Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
- Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - C Cameron
- International Centre for Disability and Rehabilitation, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - R Croxford
- Institute for Clinical Evaluative Sciences, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
| | - J D Adachi
- Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - S Mursleen
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - S Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Langsetmo L, Barr SI, Berger C, Kreiger N, Rahme E, Adachi JD, Papaioannou A, Kaiser SM, Prior JC, Hanley DA, Kovacs CS, Josse RG, Goltzman D. Associations of Protein Intake and Protein Source with Bone Mineral Density and Fracture Risk: A Population-Based Cohort Study. J Nutr Health Aging 2015; 19:861-8. [PMID: 26412291 PMCID: PMC5092173 DOI: 10.1007/s12603-015-0544-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
UNLABELLED High dietary protein has been hypothesized to cause lower bone mineral density (BMD) and greater fracture risk. Previous results are conflicting and few studies have assessed potential differences related to differing protein sources. OBJECTIVE To determine associations between total protein intake, and protein intake by source (dairy, non-dairy animal, plant) with BMD, BMD change, and incident osteoporotic fracture. DESIGN/SETTING Prospective cohort study (Canadian Multicentre Osteoporosis Study). Participants/Measures: Protein intake was assessed as percent of total energy intake (TEI) at Year 2 (1997-99) using a food frequency questionnaire (N=6510). Participants were contacted annually to ascertain incident fracture. Total hip and lumbar spine BMD was measured at baseline and Year 5. Analyses were stratified by group (men 25-49 y, men 50+ y, premenopausal women 25-49 y, and postmenopausal women 50+ y) and adjusted for major confounders. Fracture analyses were limited to those 50+ y. RESULTS Intakes of dairy protein (with adjustment for BMI) were positively associated with total hip BMD among men and women aged 50+ y, and in men aged 25-49. Among adults aged 50+ y, those with protein intakes of <12% TEI (women) and <11% TEI (men) had increased fracture risk compared to those with intakes of 15% TEI. Fracture risk did not significantly change as intake increased above 15% TEI, and was not significantly associated with protein source. CONCLUSIONS In contrast to hypothesized risk of high protein, we found that for adults 50+ y, low protein intake (below 15% TEI) may lead to increased fracture risk. Source of protein was a determinant of BMD, but not fracture risk.
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Affiliation(s)
- L Langsetmo
- David Goltzman, Royal Victoria Hospital, CaMos, 687 Pine Ave W, Room E1.64, Montreal, QC H3A 1A1, , Telephone: 514-843-1632, FAX: 514-843-1651
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Masternak K, Broyer L, Dheilly E, Majocchi S, Moine V, Magistrelli G, Rousseau F, Ravn U, Gueneau F, Malinge P, Calloud S, Charreton-Galby M, Guerrier M, Costes N, Bosson N, Didelot G, Bernard L, Buatois V, Cons L, Chatel L, Papaioannou A, Johnson Z, Ferlin W, Kosco-Vilbois M, Fischer N. Abstract 2482: Neutralizing CD47 in cancer cells with dual targeting kappa/lambda bodies. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Neutralizing CD47, the ‘don't eat me signal’ hijacked by different tumor types, is a novel generally applicable therapeutic strategy. Because of a distinct mechanism of action and the ability to stimulate the innate anti-tumor immunity, CD47-neutralizing agents are poised as attractive candidates for combination therapies in association with other immunotherapies. However, the development of general CD47 antagonists could be hindered by the ubiquitous and abundant expression of CD47 on virtually all healthy cells. To overcome potential pharmacological and clinical liabilities of a general CD47 antagonist, we have developed bispecific kappa/lambda bodies, which selectively target CD47 in cancer cells. These kappa/lambda bodies:
(i) are full-length bispecific IgGs, (ii) bind with high affinity and neutralize the CD47-SIRP alpha interaction in cancer cells expressing a tumor-associated antigen (TAA), and (iii) mediate efficient cell killing of TAA-positive cancer cells in vitro through Fc-dependent mechanisms such as ADCP (antibody mediated cellular phagocytosis) and ADCC (antibody mediated cellular cytotoxicity).
We are currently developing two molecules of this type, one targeting CD47 and CD19 (for B cell malignancies), the other targeting CD47 and mesothelin (for various mesothelin-positive solid tumors). The efficacy of the CD47/CD19 kappa/lambda body was demonstrated in vivo, using two B-cell lymphoma xenograft models in NOD/SCID mice. We also performed a pharmacokinetics study in non-human primates with the CD47/CD19 lead candidate, with the objective of assessing the potential “antigen sink” effect related to ubiquitous CD47 expression on erythrocytes, platelets and other cells. Encouragingly, the CD47/CD19 kappa/lambda body administered in a single dose to cynomolgus monkeys, at 0.5 and 10 mg/kg, showed an acceptable pharmacokinetic profile and the absence of hematological toxicities. The example of the CD47/CD19 kappa/lambda body illustrates the power of the dual-targeting approach for addressing a ubiquitous cell surface receptor such as CD47.
Citation Format: Krzysztof Masternak, Lucile Broyer, Elie Dheilly, Stefano Majocchi, Valéry Moine, Giovanni Magistrelli, François Rousseau, Ulla Ravn, Franck Gueneau, Pauline Malinge, Sébastien Calloud, Maud Charreton-Galby, Mireille Guerrier, Nessie Costes, Nicolas Bosson, Gérard Didelot, Lucie Bernard, Vanessa Buatois, Laura Cons, Laurence Chatel, Anne Papaioannou, Zoë Johnson, Walter Ferlin, Marie Kosco-Vilbois, Nicolas Fischer. Neutralizing CD47 in cancer cells with dual targeting kappa/lambda bodies. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2482. doi:10.1158/1538-7445.AM2015-2482
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Johnson Z, Papaioannou A, Bernard L, Cosimo E, Daubeuf B, Richard F, Chauchet X, Moine V, Broyer L, Shang L, Deehan M, Fischer N, Masternak K, Kosco-Vilbois M, Michie A, Ferlin W. Bispecific antibody targeting of CD47/CD19 to promote enhanced phagocytosis of patient B lymphoma cells. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Emilio Cosimo
- Paul OGorman Leukaemia Research Centre, University of Glasgow, Glasgow, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Alison Michie
- Paul OGorman Leukaemia Research Centre, University of Glasgow, Glasgow, United Kingdom
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Ioannou CV, Kontopodis N, Kehagias E, Papaioannou A, Kafetzakis A, Papadopoulos G, Pantidis D, Tsetis D. Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia. Br J Radiol 2015; 88:20140735. [PMID: 25966288 DOI: 10.1259/bjr.20140735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To present our experience with the Ovation Abdominal Stent Graft System (TriVascular Inc., Santa Rosa, CA) during endovascular aneurysm repair (EVAR) and compare results according to the type of anaesthesia. METHODS We conducted a single-centre retrospective study including patients who underwent EVAR using the Ovation endograft between May 2011 and July 2014. Outcome was evaluated regarding pre-, peri- and immediate postoperative and follow-up measures. Overall results are reported, while additional analysis was performed to compare the outcome between groups of patients undertaking either local or regional/general anaesthesia (LA vs RGA). RESULTS 66 patients were included. Median follow-up was 13 months (range, 1-39 months). Median age was 72 years and median abdominal aortic aneurysm diameter was 58 mm (range, 54-100 mm). Technical success was 63 (95%), while there were 2 (3%) conversions to open surgery. A total percutaneous approach was used in 50/66 (76%) cases. Overall, 9/66 (14%) subjects suffered from any kind of morbidity. Median hospitalization was 3 days (range, 1-16 days). Immediate and midterm mortality rate was 0%. No endoleak Type I, III, IV or stent migration was observed. There were 8 (13%) Type II endoleaks. Overall, additional endovascular procedures were required in 6 (9%), while surgery was performed in 4 (6%) patients. 44 (67%) patients underwent LA and 22 (23%) RGA. Differences between groups were significant for procedural time (85 vs 107 min; p < 0.001), percutaneous access (91% vs 45%; p < 0.001) and systematic complications (2.3% vs 14%; p = 0.05). CONCLUSION EVAR with the use of the Ovation endograft shows promising short-term and midterm results regarding safety and effectiveness. Completion of the procedures under LA using a total percutaneous approach seems advantageous and may be used in routine practice. ADVANCES IN KNOWLEDGE The Ovation Abdominal Stent Graft System is an ultra-low profile stent graft system that allows percutaneous deployment for EVAR and offers excellent overall efficacy and safety. Totally percutaneous EVAR under LA seems advantageous and may be used as a routine with this specific endograft.
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Affiliation(s)
- C V Ioannou
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - N Kontopodis
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - E Kehagias
- 2 Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece
| | - A Papaioannou
- 3 Anesthesiology Department, University of Crete Medical School, Heraklion, Crete, Greece
| | - A Kafetzakis
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - G Papadopoulos
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - D Pantidis
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - D Tsetis
- 2 Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece
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Papaioannou A, Louis M, Dhital B, Ho HP, Chang EJ, Boutis GS. Quantitative comparison of structure and dynamics of elastin following three isolation schemes by 13C solid state NMR and MALDI mass spectrometry. Biochim Biophys Acta 2015; 1854:391-401. [PMID: 25592991 PMCID: PMC4380551 DOI: 10.1016/j.bbapap.2014.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
Methods for isolating elastin from fat, collagen, and muscle, commonly used in the design of artificial elastin based biomaterials, rely on exposing tissue to harsh pH levels and temperatures that usually denature many proteins. At present, a quantitative measurement of the modifications to elastin following isolation from other extracellular matrix constituents has not been reported. Using magic angle spinning (13)C NMR spectroscopy and relaxation methodologies, we have measured the modification in structure and dynamics following three known purification protocols. Our experimental data reveal that the (13)C spectra of the hydrated samples appear remarkably similar across the various purification methods. Subtle differences in the half maximum widths were observed in the backbone carbonyl suggesting possible structural heterogeneity across the different methods of purification. Additionally, small differences in the relative signal intensities were observed between purified samples. Lyophilizing the samples results in a reduction of backbone motion and reveals additional differences across the purification methods studied. These differences were most notable in the alanine motifs indicating possible changes in cross-linking or structural rigidity. The measured correlation times of glycine and proline moieties are observed to also vary considerably across the different purification methods, which may be related to peptide bond cleavage. Lastly, the relative concentration of desmosine cross-links in the samples quantified by MALDI mass spectrometry is reported.
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Affiliation(s)
- A Papaioannou
- The Graduate Center of the City University of New York, Department of Physics, New York, NY, USA
| | - M Louis
- York College of The City University of New York, Department of Chemistry, Jamaica, New York, USA
| | - B Dhital
- The Graduate Center of the City University of New York, Department of Physics, New York, NY, USA
| | - H P Ho
- York College of The City University of New York, Department of Chemistry, Jamaica, New York, USA; The Graduate Center of the City University of New York, Department of Chemistry, New York, NY, USA
| | - E J Chang
- York College of The City University of New York, Department of Chemistry, Jamaica, New York, USA; The Graduate Center of the City University of New York, Department of Chemistry, New York, NY, USA
| | - G S Boutis
- The Graduate Center of the City University of New York, Department of Physics, New York, NY, USA; The Graduate Center of the City University of New York, Department of Chemistry, New York, NY, USA; Brooklyn College, Physics Department, Brooklyn, New York, USA.
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Moore C, Craven B, Thabane L, Laing A, Frank-Wilson A, Kontulainen S, Papaioannou A, Adachi J, Giangregorio L. Lower-extremity muscle atrophy and fat infiltration after chronic spinal cord injury. J Musculoskelet Neuronal Interact 2015; 15:32-41. [PMID: 25730650 PMCID: PMC5092153] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atrophy and fatty-infiltration of lower-extremity muscle after spinal cord injury (SCI) predisposes individuals to metabolic disease and related mortality. OBJECTIVES To determine the magnitude of atrophy and fatty-infiltration of lower-extremity muscles and related factors in a group of individuals with chronic SCI and diverse impairment. METHODS Muscle cross-sectional area and density were calculated from peripheral quantitative computed tomography scans of the 66% site of the calf of 70 participants with chronic SCI [50 male, mean age 49 (standard deviation 12) years, C2-T12, AIS A-D] and matched controls. Regression models for muscle area and density were formed using 16 potential correlates selected a priori. RESULTS Participants with motor-complete SCI had ≈ 32% lower muscle area, and ≈ 43% lower muscle density values relative to controls. Participants with motor-incomplete SCI had muscle area and density values that were both ≈ 14% lower than controls. Body mass (+), tetraplegia (+), motor function (+), spasticity (+), vigorous physical activity (+), wheelchair use (-), age (-), and waist circumference (-) were associated with muscle size and/or density in best-fit regression models. CONCLUSIONS There are modifiable factors related to muscle size, body composition, and activity level that may offer therapeutic targets for preserving metabolic health after chronic SCI.
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Affiliation(s)
- C.D. Moore
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network,Department of Kinesiology, University of Waterloo,Corresponding author: Cameron Moore, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, Ontario, M4G 3V9, Canada E-mail:
| | - B.C. Craven
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network,Department of Kinesiology, University of Waterloo
| | - L. Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University
| | - A.C. Laing
- Department of Kinesiology, University of Waterloo
| | | | | | - A. Papaioannou
- Department of Clinical Epidemiology and Biostatistics, McMaster University,Department of Medicine, McMaster University
| | | | - L.M. Giangregorio
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network,Department of Kinesiology, University of Waterloo
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Chatzistathis T, Alifragis D, Papaioannou A. The influence of liming on soil chemical properties and on the alleviation of manganese and copper toxicity in Juglans regia, Robinia pseudoacacia, Eucalyptus sp. and Populus sp. plantations. J Environ Manage 2015; 150:149-156. [PMID: 25485934 DOI: 10.1016/j.jenvman.2014.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/24/2014] [Accepted: 11/18/2014] [Indexed: 06/04/2023]
Abstract
Juglans regia, Robinia pseudoacacia, Eucalyptus sp. and Populus sp. plantations, suffering from Mn and Cu toxicity, were limed in order to reduce Cu and Mn solubility in soil. The purposes of the present work were: i) to study the changes in soil chemical properties after the addition of CaCO3, ii) to investigate the influence of liming on the reduction of Mn and Cu toxicity. After the addition of CaCO3 (three applications, during three successive years), pH and CaCO3 content were significantly increased, while organic C and N were significantly reduced. Exchangeable Ca concentrations have been slightly, or significantly, increased, while those of Mg have been decreased; in addition, ratios Ca/Mg and C/N have been significantly increased after liming. Impressive reductions of DTPA extractable Cu and Mn concentrations (more than 10 times in most cases) were recorded. It was also found that trees without Mn and Cu toxicity symptoms (healthy tress) before liming did not have, in many cases, significantly greater leaf Mn, Cu and Fe concentrations, than trees after soil liming (all the trees were healthy). This probably happened because excess Mn and Cu quantities had been accumulated into their root system. Finally, leaf Mn, Cu and Zn concentrations of trees suffering from toxicity were significantly decreased after soil liming, while leaf Fe concentrations, in all the plant species studied, were increased.
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Affiliation(s)
- T Chatzistathis
- School of Agriculture, Forestry and Natural Environment, Aristotle University, 54124 Thessaloniki, Greece.
| | - D Alifragis
- School of Agriculture, Forestry and Natural Environment, Aristotle University, 54124 Thessaloniki, Greece
| | - A Papaioannou
- School of Agriculture, Forestry and Natural Environment, Aristotle University, 54124 Thessaloniki, Greece
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Giangregorio LM, McGill S, Wark JD, Laprade J, Heinonen A, Ashe MC, MacIntyre NJ, Cheung AM, Shipp K, Keller H, Jain R, Papaioannou A. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporos Int 2015; 26:891-910. [PMID: 25510579 PMCID: PMC5101068 DOI: 10.1007/s00198-014-2881-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/27/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED An international consensus process resulted in exercise and physical activity recommendations for individuals with osteoporosis. Emphasis was placed on strength, balance, and postural alignment. Rather than providing generic restrictions, activity should be encouraged while considering impairments, fracture risk, activity history, and preference, and guidance on spine sparing techniques should be provided. INTRODUCTION The objectives of this study were to establish expert consensus on key questions posed by patients or health care providers regarding recommended assessment domains to inform exercise prescription, therapeutic goals of exercise, and physical activity and exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. METHODS The Too Fit To Fracture expert panel identified researchers and clinicians with expertise in exercise and osteoporosis and stakeholder groups. We delivered a modified online Delphi survey (two rounds) to establish consensus on assessment, exercise, and physical activities for three cases with varying risk (osteoporosis based on bone mineral density; 1 spine fracture and osteoporosis; multiple spine fractures, osteoporosis, hyperkyphosis, and pain). Duplicate content analyses of free text responses were performed. RESULTS Response rates were 52% (39/75) and 69% (48/70) for each round. Key consensus points are the following: (a) Current physical activity guidelines are appropriate for individuals with osteoporosis without spine fracture, but not for those with spine fracture; (b) after spine fracture, physical activity of moderate intensity is preferred to vigorous; (c) daily balance training and endurance training for spinal extensor muscles are recommended for all; (d) providing guidance on spine-sparing techniques (e.g., hip hinge) during activities of daily living or leisure, considering impairments, fracture risk, activity history, and preference, is recommended rather than providing generic restrictions (e.g., lifting <10 lbs, no twisting), but for those with vertebral fracture, especially in the presence of pain, multiple fractures, or hyperkyphosis, the risks of many activities may outweigh the benefits-physical therapist consultation is recommended. Examples of spine-sparing techniques and exercise prescription elements are provided. CONCLUSIONS Our recommendations guide health care providers on assessment, exercise prescription, and safe movement for individuals with osteoporosis.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada,
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Silverman SL, Siris E, Kendler DL, Belazi D, Brown JP, Gold DT, Lewiecki EM, Papaioannou A, Simonelli C, Ferreira I, Balasubramanian A, Dakin P, Ho P, Siddhanti S, Stolshek B, Recknor C. Persistence at 12 months with denosumab in postmenopausal women with osteoporosis: interim results from a prospective observational study. Osteoporos Int 2015; 26:361-72. [PMID: 25236877 PMCID: PMC4286624 DOI: 10.1007/s00198-014-2871-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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] [Received: 12/31/2013] [Accepted: 08/21/2014] [Indexed: 11/15/2022]
Abstract
UNLABELLED To determine persistence with subcutaneous denosumab every 6 months in women being treated for osteoporosis, we conducted a single-arm prospective, observational study in the United States and Canada. Among 935 patients enrolled, 12-month persistence was 82%, with 66 patients (7%) reporting serious adverse events and 19 patients (2%) reporting fractures. INTRODUCTION Increased persistence with osteoporosis therapy is associated with reduced fracture risk. Denosumab reduced fracture risk in clinical trials; persistence in community settings is undetermined. This study evaluates persistence with denosumab in community practice in the United States (US) and Canada. METHODS In a 24-month multicenter, prospective, single-arm, observational study, women being treated for osteoporosis were enrolled ≤4 weeks after the first subcutaneous injection of denosumab. For this 12-month prespecified interim analysis, endpoints include persistence (one injection at study entry and another within 6 months + 8 weeks), attributes associated with persistence (univariate analysis), and serious adverse events (SAEs). RESULTS Among 935 patients (mean age 71 years), mean baseline T-scores were -2.18 (femoral neck) and -2.00 (lumbar spine); 50% of patients had experienced osteoporotic fracture(s). At 12 months, 82 % of patients were persistent with denosumab. Baseline factors significantly (p < 0.05) associated with higher persistence included use of osteoporosis medications >5 years previously, lumbar spine T-score > -2.5, and treatment by female physicians (US). Lower persistence was associated (p < 0.05) with psychiatric diagnoses including depression, southern US residence, being divorced, separated, or widowed (US), and prior hip fracture (Canada). SAEs were reported in 66 patients (7%); no SAEs of osteonecrosis of the jaw, atypical femoral fracture, fracture healing complications, hypocalcemia, eczema, or hypersensitivity were reported. Nineteen patients (2%) reported osteoporotic fractures. CONCLUSIONS The 12-month persistence observed in this single-arm open-label study of US and Canadian community practice extends the evidence regarding denosumab's potential role in reducing fracture risk in postmenopausal women with osteoporosis.
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Affiliation(s)
- S L Silverman
- Cedars-Sinai Medical Center and OMC Clinical Research Center, 8641 Wilshire Blvd, Suite 301, Los Angeles, CA, 90211, USA,
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Wong AKO, Beattie KA, Min KKH, Gordon C, Pickard L, Papaioannou A, Adachi JD. Peripheral quantitative computed tomography-derived muscle density and peripheral magnetic resonance imaging-derived muscle adiposity: precision and associations with fragility fractures in women. J Musculoskelet Neuronal Interact 2014; 14:401-410. [PMID: 25524965 PMCID: PMC5092150] [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] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To determine the degree to which muscle density and fractures are explained by inter and intramuscular fat (IMF). METHODS Women ⋝50 years of age (Hamilton, ON, Canada) had peripheral magnetic resonance imaging and peripheral quantitative computed tomography scans at 66% of the tibial length. Muscle on computed tomography images was segmented from subcutaneous fat and bone using fixed thresholds, computing muscle density. IMF was segmented from muscle within magnetic resonance images using a region-growing algorithm, computing IMF volume. Fracture history over the last 14 years was obtained. Odds ratios for fractures were determined for muscle density, adjusting for IMF volume, total hip BMD, age and body mass index. RESULTS Women with a history of fractures were older (N=32, age:75.6±8.3 years) than those without (N=39, age: 67.0±5.2 years) (<0.01). IMF volume explained 49.3% of variance in muscle density (p<0.001). Odds for fractures were associated with lower muscle density even after adjusting for IMF volume but were attenuated after adjusting for age. CONCLUSIONS Muscle adiposity represents only 50% of the muscle density measurement. Properties of muscle beyond its adiposity may be related to fractures, but larger and prospective studies are needed to confirm these associations.
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Affiliation(s)
- A K O Wong
- Osteoporosis Program, University Health Network, Toronto, ON, Canada
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Kennedy CC, Ioannidis G, Rockwood K, Thabane L, Adachi JD, Kirkland S, Pickard LE, Papaioannou A. A Frailty Index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 2014; 25:2825-32. [PMID: 25103215 PMCID: PMC5094886 DOI: 10.1007/s00198-014-2828-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/25/2014] [Indexed: 11/26/2022]
Abstract
UNLABELLED We created a 30-item Frailty Index in the Canadian Multicentre Osteoporosis Study. A Frailty Index is a sensitive measure that can quantify fracture risk according to degree of frailty. Our results indicated that at any age, frailty was an important independent risk factor for fracture over 10 years. INTRODUCTION In later life, frailty has been linked to fractures. It is likely that the antecedents of fracture are seen across the life course, in ways not entirely captured by traditional osteoporosis risk factors. Using data collected from the prospective, population-based Canadian Multicentre Osteoporosis Study (CaMos), we created the 30-item CaMos Frailty Index and examined whether it was associated with incident fractures over 10 years. METHODS All CaMos participants aged 25 years and older (n = 9,423) were included in the analysis. To examine the relationship between baseline Frailty Index scores and incident fractures, a competing risk proportional sub-distribution hazards model was used with death considered a competing risk. Analyses were adjusted for age, sex, body mass index, education level, femoral neck T-score, and antiresorptive therapy. RESULTS At baseline, the mean age was 62.1 years [standard deviation (SD) 13.4], and 69.4 % were women. The mean Frailty Index score was 0.13 (SD 0.11), ranging from 0 to 0.66. For every 0.10 increase in Frailty Index scores (approximately one SD), the hazard ratio was 1.25 (p < 0.001) for all fractures, 1.18 (p = 0.043) for hip fractures, and 1.30 (p ≤ 0.001) for clinical vertebral fractures. CONCLUSION The CaMos Frailty Index quantified fracture risk according to degree of frailty. Irrespective of age and bone mineral density, the Frailty Index was associated with hip, vertebral, and all-type clinical fractures. Predicting late onset illnesses may have to consider overall health status and not just traditional risk factors.
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Affiliation(s)
- C C Kennedy
- Department of Medicine, Division of Geriatrics, McMaster University, St. Peter's Hospital, GERAS Centre, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada,
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Manali E, Pianou N, Georgakopoulos A, Papaioannou A, Roussou A, Papadaki G, Kolilekas L, Gialafos E, Tomos J, Kagouridis K, Chatziioannou S, Papiris S. AB0961 Clinical Utility of 18F-Fdg-Pet/Ct for Evaluation of Patients with Musculoskeletal Sarcoidosis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Moura C, Bernatsky S, Abrahamowicz M, Papaioannou A, Bessette L, Adachi J, Goltzman D, Prior J, Kreiger N, Towheed T, Leslie WD, Kaiser S, Ioannidis G, Pickard L, Fraser LA, Rahme E. Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS). Osteoporos Int 2014; 25:1473-81. [PMID: 24566587 PMCID: PMC5094888 DOI: 10.1007/s00198-014-2649-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/05/2014] [Indexed: 01/22/2023]
Abstract
UNLABELLED We used data from a large, prospective Canadian cohort to assess the association between selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) and fracture. We found an increased risk of fractures in individuals who used SSRI or SNRI, even after controlling for multiple risk factors. INTRODUCTION Previous studies have suggested an association between SSRIs and increasing risk of fragility fractures. However, the majority of these studies were not long-term analyses or were performed using administrative data and, thus, could not fully control for potential confounders. We sought to determine whether the use of SSRIs and SNRIs is associated with increased risk of fragility fracture, in adults aged 50 + . METHODS We used data from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective randomly selected population-based community cohort; our analyses focused on subjects aged 50+. Time to event methodology was used to assess the association between SSRI/SNRI use, modeled time-dependently, and fragility fracture. RESULTS Among 6,645 subjects, 192 (2.9%) were using SSRIs or/and SNRIs at baseline. During the 10-year study period, 978 (14.7%) participants experienced at least one fragility fracture. In our main analysis, SSRI/SNRI use was associated with increased risk of fragility fracture (hazard ratio (HR), 1.88; 95% confidence intervals (CI), 1.48-2.39). After controlling for multiple risk factors, including Charlson score, previous falls, and bone mineral density hip and lumbar bone density, the adjusted HR for current SSRI/SNRI use remained elevated (HR, 1.68; 95% CI, 1.32-2.14). CONCLUSIONS Our results lend additional support to an association between SSRI/SNRI use and fragility fractures. Given the high prevalence of antidepressants use, and the impact of fractures on health, our findings may have a significant clinical impact.
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Affiliation(s)
- C Moura
- McGill University, Montreal, Canada,
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Giangregorio LM, MacIntyre NJ, Heinonen A, Cheung AM, Wark JD, Shipp K, McGill S, Ashe MC, Laprade J, Jain R, Keller H, Papaioannou A. Too Fit To Fracture: a consensus on future research priorities in osteoporosis and exercise. Osteoporos Int 2014; 25:1465-72. [PMID: 24610579 PMCID: PMC5094885 DOI: 10.1007/s00198-014-2652-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED An international consensus process identified the following research priorities in osteoporosis and exercise: study of exercise in high-risk cohorts, evaluation of multimodal interventions, research examining translation into practice and a goal to examine fracture outcomes. INTRODUCTION To identify future research priorities related to exercise for people with osteoporosis with and without osteoporotic spine fracture via international consensus. METHODS An international expert panel and representatives from Osteoporosis Canada led the process and identified opinion leaders or stakeholders to contribute. A focus group of four patient advocates identified quality of life, mobility, activities of daily living, falls, bone mineral density, and harms as outcomes important for decision-making. Seventy-five individuals were invited to participate in an online survey asking respondents to define future research priorities in the area of osteoporosis and exercise; the response rate was 57%. Fifty-five individuals from seven countries were invited to a half-day consensus meeting; 60% of invitees attended. The results of the online survey, knowledge synthesis activities, and results of the focus group were presented. Nominal group technique was used to come to consensus on research priorities. RESULTS Research priorities included the study of exercise in high-risk cohorts (e.g., ≥ 65 years, low BMD, moderate/high risk of fracture, history of osteoporotic vertebral fractures, hyperkyphotic posture, functional impairments, or sedentary), the evaluation of multimodal interventions, research examining translation into practice, and a goal to examine fracture outcomes. The standardization of outcomes or protocols that could be evolved into large multicentre trials was discussed. CONCLUSIONS The research priorities identified as part of the Too Fit To Fracture initiative can be used to inform the development of multicentre collaborations to evaluate and implement strategies for engaging individuals with osteoporosis in a safe and effective exercise.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada,
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