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Schene MR, Willems HC, Driessen JHM, Vranken L, Heersprink FOL, Janzing HMJ, van der Velde RY, van den Bergh JP, Wyers CE. Physical performance and sarcopenia assessment in patients with a recent fracture visiting the Fracture Liaison Service. Osteoporos Int 2024; 35:851-862. [PMID: 38349472 PMCID: PMC11031480 DOI: 10.1007/s00198-023-07009-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 12/20/2023] [Indexed: 04/20/2024]
Abstract
Impaired physical performance is associated with increased fracture risk. Performance on four physical functioning tests and prevalence of sarcopenia were assessed for 1789 fracture patients and compared to reference data. Performance was low on all tests, especially for patients with a hip, major or ≥ 1 prevalent vertebral fracture. PURPOSE INTRODUCTION Impaired physical performance and sarcopenia are associated with increased fracture risk. This study aims to assess physical performance and the prevalence of sarcopenia in patients with a recent clinical fracture attending the Fracture Liaison Service (FLS) compared to population means. METHODS In this cross-sectional study, chair stand test (CST), handgrip strength (HGS), timed-up-and-go (TUG), 6-min walking-test (6MWT), and sarcopenia (following EWGSOP2) were assessed. The proportion of patients with impaired/poor performance compared to reference data was calculated (Z-score: ≥ - 2SD to < - 1 (impaired) and < - 2 SD (poor)). Associations of fracture type, sex, age, and time since fracture with Z-scores were assessed using linear regression analyses. RESULTS A total of 1789 consecutive FLS patients were included (median age (IQR): 66 (59-74), 70.7% females, 3.9 (± 1.6) months after fracture). The prevalence of impaired/poor performance for CST, HGS, TUG, and 6MWT was 39.2%, 30.4%, 21.9%, and 71.5%, respectively (expected proportion of 16%) and 2.8% had sarcopenia. Lower Z-scores (P < 0.001) were found for hip, major, and ≥ 1 prevalent vertebral fracture (VF) in CST (major: regression coefficient (B) (95%CI) = - 0.25 [- 0.34, - 0.16]; hip: B = - 0.32 [- 0.47, - 0.17], VF: B = - 0.22 [- 0.34, - 0.11]), TUG; (major: B = - 0.54 [- 0.75, - 0.33]; hip: B = - 1.72 [- 2.08, -1.35], VF: B = - 0.61 [- 0.88, - 0.57]), 6MWT (major: B = - 0.34 [- 0.47, - 0.21]; hip: B = - 0.99 [- 1,22, - 0.77], VF: B = - 0.36 [- 0.53, - 0.19]). CONCLUSIONS Physical performance is significantly lower in FLS patients compared to healthy peers, especially in patients with hip, major or prevalent VF. These findings underline the need to assess and improve the physical performance of FLS patients, despite a low prevalence of sarcopenia.
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Affiliation(s)
- M R Schene
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine and Geriatrics, Meibergdreef 9, Amsterdam, Netherlands
| | - H C Willems
- Amsterdam UMC Location University of Amsterdam, Internal Medicine and Geriatrics, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Bone Center, Movement Sciences Amsterdam, Maastricht, The Netherlands
| | - J H M Driessen
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School of Cardiovascular Disease, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - L Vranken
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | | | - H M J Janzing
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - R Y van der Velde
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Schene MR, Bevers MSAM, van der Vijgh WJF, Driessen JHM, Vranken L, van der Velde RY, Willems HC, Wyers CE, van den Bergh JP. PPI use is not associated with bone microarchitecture and strength assessed with HR-pQCT after three-years follow-up in patients visiting the Fracture Liaison Service. Bone 2024; 182:117066. [PMID: 38438097 DOI: 10.1016/j.bone.2024.117066] [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: 10/30/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND The use of proton pump inhibitors (PPIs) has been associated with an increased fracture risk in observational studies. However, the reported association between PPI use and bone mineral density (BMD), bone microarchitecture, and bone strength is inconsistent. This study aims to assess the association between PPI use and bone microarchitecture and strength using high-resolution peripheral quantitative CT (HR-pQCT) in a three-year follow-up study in patients with a recent fracture visiting the Fracture Liaison Service (FLS). METHODS This three-year prospective cohort study included FLS patients aged ≥ 50 years with a recent fracture (median age 62 [IQR 56-69] years, 68.7 % females) and without anti-osteoporosis treatment indication. HR-pQCT scans (distal radius and tibia) were obtained at baseline (T0) and three-year follow-up (T3). Volumetric bone mineral density and bone area, microarchitecture, and strength (micro-finite element analysis) were determined. The association between three-year continuous PPI use and the percentage change in HR-pQCT parameters between T0 and T3 was assessed using sex-stratified multivariate linear regression analyses. Covariates included age, BMI, vitamin-D deficiency (< 50 nmol/l), glucocorticoid use, and cardiovascular co-morbidity (males and females) fracture type (major/hip vs. all others, only males) and probable sarcopenia (only females). RESULTS In total, 282 participants had available medication data throughout follow-up, of whom 20.6 % were continuous PPI users. In both males and females with complete HR-pQCT follow-up data (males: N = 69 radius, N = 84 tibia; females: N = 147 radius, N = 168 tibia), PPI use was not associated with the percentage change of any of the bone microarchitecture or strength parameters between T0 and T3 at the radius and tibia as compared to non-use. CONCLUSION Compared to non-use, PPI use was not associated with the change of bone microarchitecture and strength in FLS patients at three years of follow-up. These results do not support that an altered bone microarchitecture or strength may contribute to the increased fracture risk associated with PPI use, as reported in observational studies.
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Affiliation(s)
- M R Schene
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Amsterdam UMC location University of Amsterdam, Internal Medicine and Geriatrics, Meibergdreef 9, Amsterdam, Netherlands
| | - M S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - W J F van der Vijgh
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands
| | - J H M Driessen
- Department of clinical pharmacy, CARIM School of Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - L Vranken
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - R Y van der Velde
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands
| | - H C Willems
- Amsterdam UMC location University of Amsterdam, Internal Medicine and Geriatrics, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Bone Center, Movement Sciences Amsterdam, the Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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Bevers MSAM, Harsevoort AGJ, Gooijer K, Wyers CE, Feenstra J, van Rietbergen B, Boomsma MF, van den Bergh JP, Janus GJM. Bone microarchitecture and strength assessment in adults with osteogenesis imperfecta using HR-pQCT: normative comparison and challenges. J Bone Miner Res 2024; 39:271-286. [PMID: 38477754 DOI: 10.1093/jbmr/zjae013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/12/2023] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Abstract
Data on bone microarchitecture in osteogenesis imperfecta (OI) are scarce. The aim of this cross-sectional study was to assess bone microarchitecture and strength in a large cohort of adults with OI using high-resolution peripheral quantitative computed tomography (HR-pQCT) and to evaluate challenges of using HR-pQCT in this cohort. Second-generation HR-pQCT scans were obtained at the distal radius and tibia in 118 men and women with Sillence OI type I, III, or IV using an extremity-length-dependent scan protocol. In total, 102 radius and 105 tibia scans of sufficient quality could be obtained, of which 11 radius scans (11%) and 14 tibia scans (13%) had a deviated axial scan angle as compared with axial angle data of 13 young women. In the scans without a deviated axial angle and compared with normative HR-pQCT data, Z-scores at the radius for trabecular bone mineral density (BMD), number, and separation were -1.6 ± 1.3, -2.5 ± 1.4, and -2.7 (IQR: 2.7), respectively. They were -1.4 ± 1.5 and -1.1 ± 1.2 for stiffness and failure load and between ±1 for trabecular thickness and cortical bone parameters. Z-scores were significantly lower for total and trabecular BMD, stiffness, failure load, and cortical area and thickness at the tibia. Additionally, local microarchitectural inhomogeneities were observed, most pronounced being trabecular void volumes. In the scans with a deviated axial angle, the proportion of Z-scores <-4 or >4 was significantly higher for trabecular BMD and separation (radius) or most total and trabecular bone parameters (tibia). To conclude, especially trabecular bone microarchitecture and bone strength were impaired in adults with OI. HR-pQCT may be used without challenges in most adults with OI, but approximately 12% of the scans may have a deviated axial angle in OI due to bone deformities or scan positioning limitations. Furthermore, standard HR-pQCT parameters may not always be reliable due to microarchitectural inhomogeneities nor fully reflect all inhomogeneities.
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Affiliation(s)
- M S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE, Eindhoven, The Netherlands
| | - A G J Harsevoort
- Expert Center for adults with Osteogenesis Imperfecta, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - K Gooijer
- Expert Center for adults with Osteogenesis Imperfecta, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - J Feenstra
- Expert Center for adults with Osteogenesis Imperfecta, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - B van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE, Eindhoven, The Netherlands
- Department of Orthopedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - M F Boomsma
- Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - G J M Janus
- Expert Center for adults with Osteogenesis Imperfecta, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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Azari F, Uniyal P, Soete J, Coudyzer W, Wyers CE, Quintiens J, van den Bergh JP, van Lenthe GH. Accuracy of photon-counting computed tomography for the measurement of bone quality in the knee. Bone 2024; 181:117027. [PMID: 38309413 DOI: 10.1016/j.bone.2024.117027] [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: 11/23/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
Visualization and quantification of bone microarchitecture in the human knee allows gaining insight into normal bone structure, and into the structural changes occurring in the onset and progression of bone diseases such as osteoporosis and osteoarthritis. However, current imaging modalities have limitations in capturing the intricacies of bone microarchitecture. Photon counting computed tomography (PCCT) is a promising imaging modality that presents high-resolution three-dimensional visualization of bone with a large field of view. However, the potential of PCCT in assessing trabecular microstructure has not been investigated yet. Therefore, this study aimed to evaluate the accuracy of PCCT in quantifying bone microstructure and bone mechanics in the knee. Five human cadaveric knees were scanned ex vivo using a PCCT scanner (Naetom alpha, Siemens, Germany) with an in-plane resolution of 146.5 μm and slice thickness of 100 μm. To assess accuracy, the specimens were also scanned with a high-resolution peripheral quantitative computed tomography (HR-pQCT; XtremeCT II, Scanco Medical, Switzerland) with a nominal isotropic voxel size of 60.7 μm as well as with micro-computed tomography (micro-CT; TESCAN UniTOM XL, Czech Republic) with a nominal isotropic voxel size of 25 μm which can be considered gold standards for in vivo and ex vivo scanning, respectively. The thickness and porosity of the subchondral bone and the microstructure of the underlying trabecular bone were assessed in the load bearing regions of the proximal tibia and distal femur. The apparent Young's modulus was determined by micro-finite element (μFE) analysis of subchondral trabecular bone (STB) in the load bearing regions of the proximal tibia using PCCT, HR-pQCT and micro-CT images. The correlation between PCCT measurements and micro-CT and HR-pQCT, respectively, was calculated. The coefficients of determination (R2) between PCCT and micro-CT based parameters, ranged from 0.69 to 0.87. The coefficients of determination between PCCT and HR-pQCT were slightly higher and ranged from 0.71 to 0.91. Apparent Young's modulus, assessed by μFE analysis of PCCT images, correlated well with that of micro-CT (R2 = 0.80, mean relative difference = 19 %). However, PCCT overestimated the apparent Young's modulus by 47 %, but the correlation (R2 = 0.84) remained strong when compared to HR-pQCT. The results of this study suggest that PCCT can be used to quantify bone microstructure in the knee.
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Affiliation(s)
- Fahimeh Azari
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - Piyush Uniyal
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - Jeroen Soete
- Department of Materials Engineering, KU Leuven, Leuven, Belgium
| | - Walter Coudyzer
- Radiology Section, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Jilmen Quintiens
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G Harry van Lenthe
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium.
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Schene MR, Wyers CE, Driessen JHM, Vranken L, Meijer K, van den Bergh JP, Willems HC. The "Can Do, Do Do" Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service. J Pers Med 2024; 14:337. [PMID: 38672964 PMCID: PMC11050804 DOI: 10.3390/jpm14040337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/28/2024] Open
Abstract
The "can do, do do" framework combines measures of poor and normal physical capacity (PC, measured by a 6 min walking test, can do/can't do) and physical activity (PA, measured by accelerometer, do do/don't do) into four domains and is able to categorize patient subgroups with distinct clinical characteristics, including fall and fracture risk factors. This study aims to explore the association between domain categorization and prospective fall, fracture, and mortality outcomes. This 6-year prospective study included patients visiting a Fracture Liaison Service with a recent fracture. Outcomes were first fall (at 3 years of follow-up, measured by fall diaries), first subsequent fracture, and mortality (at 6 years). Cumulative incidences of all three outcomes were calculated. The association between domain categorization and time to the three outcomes was assessed by uni- and multivariate Cox proportional hazard analysis with the "can do, do do" group as reference. The physical performance of 400 patients with a recent fracture was assessed (mean age: 64 years; 70.8% female), of whom 61.5%, 20.3%, and 4.9% sustained a first fall, sustained a subsequent fracture, or had died. Domain categorization using the "can do, do do" framework was not associated with time to first fall, subsequent fracture, or mortality in the multivariate Cox regression analysis for all groups. "Can't do, don't do" group: hazard ratio [HR] for first fall: 0.75 (95% confidence interval [CI]: 0.45-1.23), first fracture HR: 0.58 (95% CI: 0.24-1.41), and mortality HR: 1.19 (95% CI: 0.54-6.95). Categorizing patients into a two-dimensional framework seems inadequate to study complex, multifactorial outcomes. A personalized approach based on known fall and fracture risk factors might be preferable.
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Affiliation(s)
- Merle R. Schene
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Caroline E. Wyers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Johanna H. M. Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Department of Clinical Pharmacy, CARIM School for Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Joop P. van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Hanna C. Willems
- Internal Medicine and Geriatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Li N, van den Bergh JP, Boonen A, Wyers CE, Bours SPG, Hiligsmann M. Cost-effectiveness analysis of fracture liaison services: a Markov model using Dutch real-world data. Osteoporos Int 2024; 35:293-307. [PMID: 37783759 PMCID: PMC10837229 DOI: 10.1007/s00198-023-06924-2] [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: 04/19/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
This study assessed the lifetime cost-effectiveness of a fracture liaison service (FLS) compared to no-FLS in the Netherlands from a societal perspective and suggested that FLS was cost-effective in patients with a recent fracture aged 50 years and older. The implementation of FLS could lead to lifetime health-economic benefits. INTRODUCTION The objective of this study was to investigate the lifetime cost-effectiveness of a fracture liaison service (FLS) compared to no-FLS in the Netherlands from a societal perspective and using real-world data. METHODS Annual fracture incidence, treatment scenarios as well as treatment initiation in the years 2017-2019 were collected from a large secondary care hospital in the Netherlands. An individual-level, state transition model was designed to simulate lifetime costs and quality-adjusted life years (QALYs). Treatment pathways were differentiated by gender, presence of osteoporosis and/or prevalent vertebral fracture, and treatment status. Results were presented as incremental cost-effectiveness ratios (ICER). Both one-way and probabilistic sensitivity analyses were conducted. RESULTS For patients with a recent fracture aged 50 years and older, the presence of an FLS was associated with a lifetime €45 higher cost and 0.11 additional QALY gained leading to an ICER of €409 per QALY gained, indicating FLS was cost-effective compared to no-FLS at the Dutch threshold of €20,000/QALY. The FLS remained cost-effectiveness across different age categories. Our findings were robust in all one-way sensitivity analyses, the higher the treatment initiation rate in FLS, the greater the cost-effective of FLS. Probabilistic sensitivity analyses revealed that FLS was cost-effective in 90% of the simulations at the threshold of €20,000/QALY, with women 92% versus men 84% by gender. CONCLUSION This study provides the first health-economic analysis of FLS in the Netherlands, suggesting the implementation of FLS could lead to lifetime health-economic benefits.
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Affiliation(s)
- N Li
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - J P van den Bergh
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- School of Nutrition and Translational Research and Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- School of Nutrition and Translational Research and Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S P G Bours
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Hiligsmann
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Maas L, Raskin N, van Onna M, Cornelissen D, Bours S, van der Weijden T, van den Bergh JP, van Oostwaard M, Wyers CE, Hiligsmann M, Boonen A. Development and usability of a decision aid to initiate anti-osteoporosis medication treatment in patients visiting the fracture liaison service with a recent fracture. Osteoporos Int 2024; 35:69-79. [PMID: 37733067 PMCID: PMC10786983 DOI: 10.1007/s00198-023-06906-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
This study describes the development of a decision aid (DA), aimed at supporting patients in their decision whether to start anti-osteoporosis medication. People with recent fractures or osteoporosis and health professionals were supportive of the DA initiative. An experimental study been started to assess (cost-)effectiveness of the DA. PURPOSE At fracture liaison services (FLS), patients with a recent fracture ánd osteoporosis or a prevalent vertebral fracture are advised to start anti-osteoporosis medication (AOM). This study describes the development of a decision aid (DA) to support patients and healthcare providers (HCPs) in their decision about whether to start AOM. METHODS The DA was developed according to International Patient Decision Aid Standards (IPDAS). A systematic procedure was chosen including scope, design, prototype development, and alpha testing. A previously developed DA for women with osteoporosis was used as a basis. Furthermore, input from literature searches, the Dutch guideline on management of osteoporosis, and from people with a fracture or osteoporosis was used. The updated DA was evaluated during alpha testing. RESULTS The DA facilitates the decision of patients whether to initiate AOM treatment and provides information on fractures and osteoporosis, general risk factors that increase the likelihood of a subsequent fracture, the role of lifestyle, personalized risk considerations of a subsequent fracture with and without AOM treatment, and AOM options and their characteristics in an option grid. Alpha testing with 15 patients revealed that patient preferences and needs were adequately presented, and several suggestions for improvement (e.g. adding more specific information, simplifying terminology, improving icon use) were accounted for. Participants from the alpha testing recommended use of the DA during outpatient visits. CONCLUSION Professionals and persons with osteoporosis were supportive of the proposed DA and its usability. The DA could help in a shared decision-making process between patients and HCPs.
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Affiliation(s)
- Lieke Maas
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Nele Raskin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O Box 616, 6200 MD, Maastricht, The Netherlands
| | - Marloes van Onna
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dennis Cornelissen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sandrine Bours
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Marsha van Oostwaard
- Department of Internal Medicine, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- Department of Internal Medicine, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O Box 616, 6200 MD, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
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de Haan L, Ten Wolde M, Beudel M, Olde Engberink RHG, Appelman B, Haspels-Hogervorst EK, Rusch D, Gritters van den Oever NC, Simsek S, Paternotte N, van den Bergh JP, Wyers CE, de Kruif MD, Dormans T, Moeniralam H, Bokhizzou N, Brinkman K, Douma R. What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals. BMJ Open 2023; 13:e075232. [PMID: 37963704 PMCID: PMC10649520 DOI: 10.1136/bmjopen-2023-075232] [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: 05/08/2023] [Accepted: 09/15/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES To evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes. DESIGN Observational study. SETTING Secondary care; 11 Dutch hospitals (2 university and 9 general hospitals). PARTICIPANTS An analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital. OUTCOME MEASURES We studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion. RESULTS Hyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11-1.46; p<0.001)), not associated with mortality or the risk for intubation. Patients with hypernatraemia had higher mortality rates (OR 2.25 (1.49-3.41; p<0.001)) and were at risk for ICU admission (OR 2.89 (1.83-4.58)) and intubation (OR 2.95 (1.83-4.74)). CONCLUSIONS Hypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.
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Affiliation(s)
- Lianne de Haan
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
- Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Marije Ten Wolde
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rik H G Olde Engberink
- Center of Experimental and Molecular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Brent Appelman
- Center of Experimental and Molecular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Daisy Rusch
- Department of Intensive Care, Martini Hospital, Groningen, The Netherlands
| | | | - Suat Simsek
- Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Nienke Paternotte
- Department of Pulmonology, Northwest Hospital Group, Alkmaar, The Netherlands
| | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Tom Dormans
- Department of Intensive Care, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Hazra Moeniralam
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Neyma Bokhizzou
- Department of Internal Medicine, Bovenij Hospital, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - Renee Douma
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
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9
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Schene MR, Wyers CE, Driessen AMH, Souverein PC, Gemmeke M, van den Bergh JP, Willems HC. Imminent fall risk after fracture. Age Ageing 2023; 52:afad201. [PMID: 37930741 DOI: 10.1093/ageing/afad201] [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] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 11/07/2023] Open
Abstract
RATIONALE Adults with a recent fracture have a high imminent risk of a subsequent fracture. We hypothesise that, like subsequent fracture risk, fall risk is also highest immediately after a fracture. This study aims to assess if fall risk is time-dependent in subjects with a recent fracture compared to subjects without a fracture. METHODS This retrospective matched cohort study used data from the UK Clinical Practice Research Datalink GOLD. All subjects ≥50 years with a fracture between 1993 and 2015 were identified and matched one-to-one to fracture-free controls based on year of birth, sex and practice. The cumulative incidence and relative risk (RR) of a first fall was calculated at various time intervals, with mortality as competing risk. Subsequently, analyses were stratified according to age, sex and type of index fracture. RESULTS A total of 624,460 subjects were included; 312,230 subjects with an index fracture, matched to 312,230 fracture-free controls (71% females, mean age 70 ± 12, mean follow-up 6.5 ± 5 years). The RR of falls was highest in the first year after fracture compared to fracture-free controls; males had a 3-fold and females a 2-fold higher risk. This imminent fall risk was present in all age and fracture types and declined over time. A concurrent imminent fracture and mortality risk were confirmed. CONCLUSION/DISCUSSION This study demonstrates an imminent fall risk in the first years after a fracture in all age and fracture types. This underlines the need for early fall risk assessment and prevention strategies in 50+ adults with a recent fracture.
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Affiliation(s)
- Merle R Schene
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Annemariek M H Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
- CARIM School of Cardiovascular Disease, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Marle Gemmeke
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Hanna C Willems
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam, The Netherlands
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Bevers MSAM, Heyer FL, Wyers CE, van Rietbergen B, Geusens PPMM, Janzing HMJ, Lambers Heerspink O, Poeze M, van den Bergh JP. The contribution of lower-mineralized tissue to the healing of distal radius fractures assessed using HR-pQCT. Bone 2023; 175:116859. [PMID: 37507063 DOI: 10.1016/j.bone.2023.116859] [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: 05/17/2023] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
High-resolution peripheral quantitative CT (HR-pQCT) enables quantitative assessment of distal radius fracture healing. In previous studies, lower-mineralized tissue formation was observed on HR-pQCT scans, starting early during healing, but the contribution of this tissue to the stiffness of distal radius fractures is unknown. Therefore, the aim of this study was to investigate the contribution of lower-mineralized tissue to the stiffness of fractured distal radii during the first twelve weeks of healing. We did so by combining the results from two series of micro-finite element (μFE-) models obtained using different density thresholds for bone segmentation. Forty-five postmenopausal women with a conservatively-treated distal radius fracture had HR-pQCT scans of their fractured radius at baseline (BL; 1-2 weeks post-fracture), 3-4 weeks, 6-8 weeks, and 12 weeks post-fracture. Compression stiffness (S) was computed using two series of μFE-models from the scans: one series (Msingle) included only higher-mineralized tissue (>320 mg HA/cm3), and one series (Mdual) differentiated between lower-mineralized tissue (200-320 mg HA/cm3) and higher-mineralized tissue. μFE-elements were assigned a Young's Modulus of 10 GPa (higher-mineralized tissue) or 5 GPa (lower-mineralized tissue), and an axial compression test to 1 % strain was simulated. The contribution of the lower-mineralized tissue to S was quantified as the ratio Sdual/Ssingle. Changes during healing were quantified using linear mixed effects models and expressed as estimated marginal means (EMMs) with 95 %-confidence intervals (95 %-CI). Median time to cast removal was 5.0 (IQR: 1.1) weeks. Sdual and Ssingle gradually increased during healing to a significantly higher value than BL at 12 weeks post-fracture (both p < 0.0001). In contrast, Sdual/Ssingle was significantly higher than BL at 3-4 weeks post-fracture (p = 0.0010), remained significantly higher at 6-8 weeks post-fracture (p < 0.0001), and then decreased to BL-values at the 12-week visit. EMMs ranged between 1.05 (95 %-CI: 1.04-1.06) and 1.08 (95 %-CI: 1.07-1.10). To conclude, combining stiffness results from two series of μFE-models obtained using single- and dual-threshold segmentation enables quantification of the contribution of lower-mineralized tissue to the stiffness of distal radius fractures during healing. This contribution is minor but changes significantly around the time of cast removal. Its course and timing during healing may be clinically relevant. Quantification of the contribution of lower-mineralized tissue to stiffness gives a more complete impression of strength recovery post-fracture than the evaluation of stiffness using a single series of μFE-models.
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Affiliation(s)
- Melissa S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Frans L Heyer
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Piet P M M Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medicine and Life Sciences, Hasselt University, Belgium
| | | | | | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery and Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands.
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11
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Schene MR, Meijer K, Cheung D, Willems HC, Driessen JHM, Vranken L, van den Bergh JP, Wyers CE. Physical Functioning in Patients with a Recent Fracture: The "Can Do, Do Do" Framework Applied to Explore Physical Capacity, Physical Activity and Fall Risk Factors. Calcif Tissue Int 2023:10.1007/s00223-023-01090-3. [PMID: 37367955 PMCID: PMC10371931 DOI: 10.1007/s00223-023-01090-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
Physical capacity (PC) and physical activity (PA) are associated physical performance measures, and combined, PC and PA are used to categorize physical performance in the "can do, do do" framework. We aimed to explore physical performance of patients attending the fracture liaison service (FLS). In this cross-sectional study, PC was measured by 6-min-walking-test (can't do/can do) and PA by accelerometer (don't do/do do). Following quadrants were defined based on predefined cut-off scores for poor performance: (1) "can't do, don't do"; (2) "can do, don't do"; (3) "can't do, do do"; (4) "can do, do do". Odds ratios (OR) were calculated and fall and fracture risk factors were assessed between quadrants. Physical performance of 400 fracture patients was assessed (mean age 64; female 70.8%). Patients performed as follows: 8.3% "can't do, don't do"; 3.0% "can do, don't do"; 19.3% "can't do, do do"; 69.5% "can do, do do". For the "can't do" group the OR for low PA was 9.76 (95% CI: 4.82-19.80). Both the "can't do, don't do" and "can't do, do do" group differed significantly compared to the "can do, do do" group on several fall and fracture risk factors and had lower physical performance. The "can do, do do" framework is able to identify fracture patients with an impaired physical performance. Of all FLS patients 20% "can't do, but "do do" while having a high prevalence of fall risk factors compared to persons that "can do, do do", which may indicate this group is prone to fall.
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Affiliation(s)
- M R Schene
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - K Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - D Cheung
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - H C Willems
- Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Bone Center, Movement Sciences Amsterdam, Amsterdam, The Netherlands
| | - J H M Driessen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School of Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - L Vranken
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - J P van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - C E Wyers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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12
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Treurniet S, Bevers MSAM, Wyers CE, Micha D, Teunissen BP, Elting MW, van den Bergh JP, Eekhoff EMW. Bone Microarchitecture and Strength Changes During Teriparatide and Zoledronic Acid Treatment in a Patient with Pregnancy and Lactation-Associated Osteoporosis with Multiple Vertebral Fractures. Calcif Tissue Int 2023; 112:621-627. [PMID: 36764958 PMCID: PMC10106348 DOI: 10.1007/s00223-023-01066-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis, of which the pathogenesis and best treatment options are unclear. In this report, we describe the case of a 34-year old woman diagnosed with severe osteoporosis and multiple vertebral fractures after her first pregnancy, who was subsequently treated with teriparatide (TPTD) and zoledronic acid (ZA). We describe the clinical features, imaging examination, and genetic analysis. Substantial improvements were observed in areal and volumetric bone mineral density (BMD), microarchitecture, and strength between 7 and 40 months postpartum as assessed by dual-energy X-ray absorptiometry at the total hip and spine and by high-resolution peripheral quantitative CT at the distal radius and tibiae. At the hip, spine, and distal radius, these improvements were mainly enabled by treatment with TPTD and ZA, while at the distal tibiae, physiological recovery and postpartum physiotherapy due to leg pain after stumbling may have played a major role. Additionally, the findings show that, despite the improvements, BMD, microarchitecture, and strength remained severely impaired in comparison with healthy age- and gender-matched controls at 40 months postpartum. Genetic analysis showed no monogenic cause for osteoporosis, and it is suggested that PLO in this woman could have a polygenic origin with possible susceptibility based on familiar occurrence of osteoporosis.
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Affiliation(s)
- Sanne Treurniet
- Department of Internal Medicine Section Endocrinology, Rare Bone Disease Center, Amsterdam, Movement Sciences, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Melissa S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dimitra Micha
- Department of Human Genetics, Amsterdam Movement Sciences, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Bernd P Teunissen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mariet W Elting
- Department of Human Genetics, Amsterdam Movement Sciences, Amsterdam Rare Bone Disease/Amsterdam Bone Center, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisabeth M W Eekhoff
- Department of Internal Medicine Section Endocrinology, Rare Bone Disease Center, Amsterdam, Movement Sciences, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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13
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Daniels AM, Kranendonk J, Wyers CE, Janzing HMJ, Sassen S, van Rietbergen B, Geusens PPMM, Kaarsemaker S, Hannemann PFW, Poeze M, van den Bergh JP. What Is the Diagnostic Performance of Conventional Radiographs and Clinical Reassessment Compared With HR-pQCT Scaphoid Fracture Diagnosis? Clin Orthop Relat Res 2023; 481:97-104. [PMID: 35833810 PMCID: PMC9750568 DOI: 10.1097/corr.0000000000002310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Conventional radiographs and clinical reassessment are considered guides in managing clinically suspected scaphoid fractures. This is a unique study as it assessed the value of conventional radiographs and clinical reassessment in a cohort of patients, all of whom underwent additional imaging, regardless of the outcome of conventional radiographs and clinical reassessment. QUESTIONS/PURPOSES (1) What is the diagnostic performance of conventional radiographs in patients with a clinically suspected scaphoid fracture compared with high-resolution peripheral quantitative CT (HR-pQCT)? (2) What is the diagnostic performance of clinical reassessment in patients with a clinically suspected scaphoid fracture compared with HR-pQCT? (3) What is the diagnostic performance of conventional radiographs and clinical reassessment combined compared with HR-pQCT? METHODS Between December 2017 and October 2018, 162 patients with a clinically suspected scaphoid fracture presented to the emergency department (ED). Forty-six patients were excluded and another 25 were not willing or able to participate, which resulted in 91 included patients. All patients underwent conventional radiography in the ED and clinical reassessment 7 to 14 days later, together with CT and HR-pQCT. The diagnostic performance characteristics and accuracy of conventional radiographs and clinical reassessment were compared with those of HR-pQCT for the diagnosis of fractures since this was proven to be superior to CT scaphoid fracture detection. The cohort included 45 men and 46 women with a median (IQR) age of 52 years (29 to 67). Twenty-four patients with a median age of 44 years (35 to 65) were diagnosed with a scaphoid fracture on HR-pQCT. RESULTS When compared with HR-pQCT, conventional radiographs alone had a sensitivity of 67% (95% CI 45% to 84%), specificity of 85% (95% CI 74% to 93%), positive predictive value (PPV) of 62% (95% CI 46% to 75%), negative predictive value (NPV) of 88% (95% CI 80% to 93%), and a positive and negative likelihood ratio (LR) of 4.5 (95% CI 2.4 to 8.5) and 0.4 (95% CI 0.2 to 0.7), respectively. Compared with HR-pQCT, clinical reassessment alone resulted in a sensitivity of 58% (95% CI 37% to 78%), specificity of 42% (95% CI 30% to 54%), PPV of 26% (95% CI 19% to 35%), NPV of 74% (95% CI 62% to 83%), as well as a positive and negative LR of 1.0 (95% CI 0.7 to 1.5) and 1.0 (95% CI 0.6 to 1.7), respectively. Combining clinical examination with conventional radiography produced a sensitivity of 50% (95% CI 29% to 71%), specificity of 91% (95% CI 82% to 97%), PPV of 67% (95% CI 46% to 83%), NPV of 84% (95% CI 77% to 88%), as well as a positive and negative LR of 5.6 (95% CI 2.4 to 13.2) and 0.6 (95% CI 0.4 to 0.8), respectively. CONCLUSION The accuracy of conventional radiographs (80% compared with HR-pQCT) and clinical reassessment (46% compared with HR-pQCT) indicate that the value of clinical reassessment is limited in diagnosing scaphoid fractures and cannot be considered directive in managing scaphoid fractures. The combination of conventional radiographs and clinical reassessment does not increase the accuracy of these diagnostic tests compared with the accuracy of conventional radiographs alone and is therefore also limited in diagnosing scaphoid fractures. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Anne M. Daniels
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | | | - Caroline E. Wyers
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Sander Sassen
- Department of Radiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Piet P. M. M. Geusens
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands
- Faculty of Medicine, Hasselt University, Belgium
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Pascal F. W. Hannemann
- Department of Surgery, Subdivision of Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Subdivision of Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Joop P. van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
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van Oostwaard MM, van den Bergh JP, van de Wouw Y, Janssen-Heijnen M, de Jong M, Wyers CE. High prevalence of vertebral fractures at initiation of androgen deprivation therapy for prostate cancer. J Bone Oncol 2022; 38:100465. [PMID: 36591574 PMCID: PMC9798166 DOI: 10.1016/j.jbo.2022.100465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Treatment of Prostate Cancer (PCa) with Androgen Deprivation Therapy (ADT) involves long-term consequences including bone loss and fractures. Our aim was to evaluate the calculated fracture risk and the prevalence of osteoporosis, vertebral fractures (VF) and sarcopenia in men with PCa at initiation of ADT, as ADT will increase fracture risk from that moment onward. Methods In this cross-sectional real-world study in men at ADT initiation, fracture risk factors including comorbidities, medication, and 10-year fracture risk (FRAX®) were assessed. Laboratory tests, dual-energy X-ray absorptiometry, and spinal X-rays were performed. Sarcopenia was defined according to EWGSOP2. Results In 115 men at ADT initiation, aged 73.3 (±7.6) years, osteoporosis was diagnosed in 4.3 % and osteopenia in 35.7 %. The mean 10-year fracture risk of major osteoporotic fracture was 4.4 % and of hip fracture 1.7 %, respectively. At least one VF was present in 32.2 % and 33.9 % of men had osteoporosis and/or a VF assessed on spinal X-rays. In 10.4 % at least one new fracture-risk-associated metabolic bone disorder was diagnosed with laboratory testing. Sarcopenia was diagnosed in only one patient. Conclusions Although the prevalence of osteoporosis, sarcopenia and 10-years fracture risk is low, there is a high prevalence of vertebral fractures in a third of the men with PCa at the time of ADT initiation. Besides a BMD measurement and fracture risk calculation using FRAX, a systematic vertebral fracture assessment should be considered in all men with PCa at initiation of ADT to provide a reliable baseline classification of VFs to improve identification of true incident VFs during ADT.
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Affiliation(s)
- Marsha M. van Oostwaard
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD Maastricht, the Netherlands,Corresponding author at: Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands.
| | - Joop P. van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Yes van de Wouw
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands,Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Marc de Jong
- Department of Urology, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands
| | - Caroline E. Wyers
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands
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15
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Vranken L, de Bruin IJA, Driessen AHM, Geusens PPM, Eisman JA, Center JR, van der Velde RY, Janzing HMJ, Kaarsemaker S, van den Bergh JP, Wyers CE. Decreased Mortality and Subsequent Fracture Risk in Patients With a Major and Hip Fracture After the Introduction of a Fracture Liaison Service: A 3-Year Follow-Up Survey. J Bone Miner Res 2022; 37:2025-2032. [PMID: 36087016 PMCID: PMC9826296 DOI: 10.1002/jbmr.4674] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 04/05/2022] [Revised: 07/22/2022] [Accepted: 08/07/2022] [Indexed: 01/11/2023]
Abstract
Fracture liaison services (FLS) are considered to be the most effective organizational approach for secondary fracture prevention. In this study, we evaluated whether FLS care was associated with reduced subsequent fracture and mortality risk over 3 years of follow-up. In total, 8682 consecutive patients aged 50-90 years with a recent fracture were included. Before FLS introduction, regular fracture treatment procedures were followed (pre-FLS). After FLS introduction, patients were invited to the FLS and FLS attenders were assessed for osteoporosis, prevalent vertebral fractures, metabolic bone disorders, medication use, and fall risk, and treatment for fracture prevention was initiated according to Dutch guidelines. All fractures were radiographically confirmed and categorized into major/hip (pelvis, proximal humerus or tibia, vertebral, multiple rib, distal femur) and non-major/non-hip (all other fractures). Mortality risk was examined using age and sex adjusted Cox proportional hazard models. For subsequent fracture risk, Cox proportional hazard models were adjusted for age, sex, and competing mortality risk (subdistribution hazard [SHR] approach). The pre-FLS group consisted of 2530 patients (72% women), of whom 1188 (46.9%) had major/hip index fractures, the post-FLS group consisted of 6152 patients (69% women), of whom 2973 (48.3%) had major/hip index fractures. In patients with a non-major/non-hip fracture there was no difference in subsequent non-major/non-hip fracture risk or mortality between pre-FLS and post-FLS. In patients with a major/hip index fracture, mortality risk was lower post-FLS (hazard ratio [HR] 0.84; 95% confidence interval [CI], 0.73-0.96) and subsequent major/hip fracture risk was lower in the first 360 days after index fracture post-FLS compared to pre-FLS (SHR 0.67; 95% CI, 0.52-0.87). In conclusion, FLS care was associated with a lower mortality risk in the first 3 years and a lower subsequent major/hip fracture risk in the first year in patients with a major/hip index fracture but not in patients with a non-major/non-hip fracture. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, The Netherlands
| | - Irma J A de Bruin
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, The Netherlands
| | - Annemariek H M Driessen
- Department of Clinical Pharmacy and Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, CARIM School for Cardiovascular Disease, Maastricht UMC+, Maastricht, The Netherlands
| | - Piet P M Geusens
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht UMC+, Maastricht, The Netherlands.,Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - John A Eisman
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,Clinical School, St Vincent's, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,School of Medicine Sydney, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Jacqueline R Center
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,Clinical School, St Vincent's, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Robert Y van der Velde
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, The Netherlands
| | | | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, The Netherlands
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16
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Vranken L, Wyers CE, Van der Velde RY, Janzing HMJ, Kaarsemakers S, Driessen J, Eisman J, Center JR, Nguyen TV, Tran T, Bliuc D, Geusens P, van den Bergh JP. Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study. BMJ Open 2022; 12:e058983. [PMID: 35896286 PMCID: PMC9335024 DOI: 10.1136/bmjopen-2021-058983] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the risk of subsequent fractures in patients who attended the Fracture Liaison Service (FLS), with and without incident falls after the index fracture. DESIGN A 3-year prospective observational cohort study. SETTING An outpatient FLS in the Netherlands. PARTICIPANTS Patients aged 50+ years with a recent clinical fracture. OUTCOME MEASURES Incident falls and subsequent fractures. RESULTS The study included 488 patients (71.9% women, mean age: 64.6±8.6 years). During the 3-year follow-up, 959 falls had been ascertained in 296 patients (60.7%) (ie, fallers), and 60 subsequent fractures were ascertained in 53 patients (10.9%). Of the fractures, 47 (78.3%) were fall related, of which 25 (53.2%) were sustained at the first fall incident at a median of 34 weeks. An incident fall was associated with an approximately 9-fold (HR: 8.6, 95% CI 3.1 to 23.8) increase in the risk of subsequent fractures. CONCLUSION These data suggest that subsequent fractures among patients on treatment prescribed in an FLS setting are common, and that an incident fall is a strong predictor of subsequent fracture risk. Immediate attention for fall risk could be beneficial in an FLS model of care. TRIAL REGISTRATION NUMBER NL45707.072.13.
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Affiliation(s)
- Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Robert Y Van der Velde
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Sjoerd Kaarsemakers
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - Johanna Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University, Maastricht, The Netherlands
| | - John Eisman
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Jacqueline R Center
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Tuan V Nguyen
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Thach Tran
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Dana Bliuc
- Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Piet Geusens
- Department of Internal Medicine, Subdivision Rheumatology, Research School CAPHRI, Maastricht Univeristy Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Research School NUTRIM, Maastricht University Medical Centre+, Maastricht, The Netherlands
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17
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Li N, van Oostwaard M, van den Bergh JP, Hiligsmann M, Boonen A, van Kuijk SMJ, Vranken L, Bours SPG, Wyers CE. Health-related quality of life of patients with a recent fracture attending a fracture liaison service: a 3-year follow-up study. Osteoporos Int 2022; 33:577-588. [PMID: 34671823 PMCID: PMC8843901 DOI: 10.1007/s00198-021-06204-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/28/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study explored the course of health state utility value over 3 years in patients with a recent fracture attending a Fracture Liaison Service and suggested that the overall change in health-related quality of life was not significant, although significant improvements were observed at 6 and 12 months compared to baseline. INTRODUCTION To estimate the 3-year health-related quality of life (HRQoL) of patients with a recent fracture presenting at a Fracture Liaison Service (FLS) and to explore factors associated with health state utility value (HSUV). METHODS Patients' HSUVs were derived from the EQ-5D-5L and SF-6D and calculated at six time points. Multiple imputation was applied for missing data. Linear mixed-effects regression analysis with random intercept and slope was applied to explore the course of HSUV over 3 years. The impact of subsequent fracture and the length of time between FLS visit and patients' index fracture on HSUV were also investigated. A backward stepwise elimination was applied to identify factors associated with HSUV. RESULTS A total of 499 patients were included. The change of EQ-5D HSUV was not significant over 3-year follow-up (P = 0.52), although slightly but significantly higher HSUV was captured at 6 months (mean difference (MD): 0.015, P = 0.02) and 12 months (MD: 0.018, P = 0.01). There was no significant difference in the course of EQ-5D HSUV between fracture locations (P = 0.86). A significant increase in HSUV was only captured for patients had shorter time period (< 107 days) between FLS visit and their index fracture. Suffering a subsequent fracture was associated with significant QoL loss (MD: - 0.078, P < 0.001). Subsequent fracture, previous treatment with anti-osteoporosis medication, a prevalent vertebral fracture (grade 2 or 3), use of a walking aid, previous falls, and higher BMI were negatively associated with mean EQ-5D HSUV over 3 years. Comparable results were found using SF-6D HSUV. The lack of HRQoL data immediately after fracture and selection bias were two main limitations. CONCLUSION The 3-year change in HSUV was not statistically significant, although significant improvements were observed at 6 and 12 months in comparison with baseline. Six factors were negatively associated with EQ-5D HSUV.
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Affiliation(s)
- N Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - M van Oostwaard
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine, Hasselt University, Hasselt, Belgium
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Vranken
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S P G Bours
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
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18
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Mys K, Stockmans F, Gueorguiev B, Wyers CE, van den Bergh JPW, van Lenthe GH, Varga P. Adaptive local thresholding can enhance the accuracy of HR-pQCT-based trabecular bone morphology assessment. Bone 2022; 154:116225. [PMID: 34634527 DOI: 10.1016/j.bone.2021.116225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) devices can scan extremities at bone microstructural level in vivo and are used mainly in research of bone diseases. Two HR-pQCT scanners are commercially available to date: XtremeCT (first generation) and XtremeCT-II (second generation) from Scanco Medical AG (Switzerland). Recently, we have proposed an adaptive local thresholding (AT) technique and showed that it can improve quantification accuracy of bone microstructural parameters, with visually less sharp cone-beam CT (CBCT) images providing a similar accuracy than XtremeCT. The aim of this study was to evaluate whether the AT segmentation technique could enhance the accuracy of HR-pQCT in quantifying bone microstructural images and to assess whether the agreement between XtremeCT and XtremeCT-II could be improved. Nineteen radii were scanned with three scanners from Scanco Medical AG: (1) XtremeCT at 82 μm, (2) XtremeCT-II at 60.7 μm and (3) the small animal microCT scanner VivaCT40 at 19 μm voxel size. The scans were segmented applying two different methods, once following the manufacturer standard technique (ST), and once by means of AT. Three-dimensional (3D) morphological analysis was performed on the trabecular volume of the segmented images using the manufacturer's standard software to calculate bone volume fraction (BV/TV), trabecular thickness (Tb.Th), separation (Tb.Sp) and number (Tb.N). The average accuracy of XtremeCT improved from R2 = 0.76 (ST) to 0.85 (AT) and reached the same level of accuracy as XtremeCT-II with ST (R2 = 0.86). The largest improvements were obtained for BV/TV and Tb.Th. For XtremeCT-II, mean accuracy improved slightly from R2 = 0.86 (ST) to 0.89 (AT). For both segmentations and both scanners, the standard section was quantified slightly more accurate than the subchondral section. The agreement between the scanners was enhanced from R2 = 0.89 (ST) to 0.98 (AT). In conclusion, AT can enhance the accuracy of XtremeCT to quantify distal radius bone microstructural parameters close to XtremeCT-II level and increases the agreement between the two HR-pQCT scanners. High-resolution peripheral quantitative computed tomography, segmentation, bone microstructural parameters.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium; AO Research Institute Davos, Davos, Switzerland.
| | - Filip Stockmans
- Muscles & Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Joop P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - G Harry van Lenthe
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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19
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Li N, Boonen A, van den Bergh JP, van Kuijk SMJ, Wyers CE, van Oostwaard M, Vranken L, Bours SPG, Hiligsmann M. A head-to-head comparison of EQ-5D-5L and SF-6D in Dutch patients with fractures visiting a Fracture Liaison Service. J Med Econ 2022; 25:829-839. [PMID: 35674412 DOI: 10.1080/13696998.2022.2087409] [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] [Indexed: 10/18/2022]
Abstract
AIMS This study compared the psychometric properties of EQ-5D-5L and SF-6D to assess the interchangeability of both instruments in patients with a recent fracture presenting at a Fracture Liaison Service (FLS). MATERIALS AND METHODS Data from a prospective observational study in a Dutch FLS clinic were used. Over 3 years, subjects were interviewed at several time points using EQ-5D-5L and SF-36. Floor and ceiling effects were evaluated. Agreement was evaluated by intra-class correlation coefficients and visualized in Bland-Altman plots. Spearman's rank correlation coefficients were applied to assess convergent validity. Mann-Whitney U test or Kruskal-Wallis H test as well as effect size (ES) were used to explore known-groups validity. Responsiveness was explored using standardized response mean (SRM) and ES. For each measurement property, hypotheses on direction and magnitude of effects were formulated. RESULTS A total of 499 patients were included. EQ-5D-5L had a considerable ceiling effect in comparison to SF-6D (21 vs. 1.2%). Moderate agreement between the (UK and Dutch) EQ-5D-5L and SF-6D was identified with intra-class correlation coefficients of 0.625 and 0.654, respectively. Bland-Altman plots revealed proportional bias as the differences in utilities between two instruments were highly dependent on the health states. High correlation between instruments was found (UK: rho = 0.758; Dutch: rho = 0.763). EQ-5D-5L and SF-6D utilities showed high correlation with physical component score but low correlation with mental component score of SF-36. Both instruments showed moderate discrimination (ES > 0.5) for subgroup by baseline fracture type, and moderate responsiveness (SRM > 0.5) in patients that sustained a subsequent fracture. CONCLUSION Both EQ-5D-5L and SF-6D appeared to be valid utility instruments in patients with fractures attending the FLS. However, they cannot be used interchangeably given only moderate agreement was identified, and differences in utilities and ceiling effect were revealed. Comparable construct validity and responsiveness were indicated, and neither instrument was found to be clearly superior.
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Affiliation(s)
- Nannan Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine, University Hasselt, Hasselt, Belgium
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marsha van Oostwaard
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sandrine P G Bours
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Bevers MSAM, Daniels AM, van Rietbergen B, Geusens PPMM, van Kuijk SMJ, Sassen S, Kaarsemaker S, Hannemann PFW, Poeze M, Janzing HMJ, van den Bergh JP, Wyers CE. Assessment of the healing of conservatively-treated scaphoid fractures using HR-pQCT. Bone 2021; 153:116161. [PMID: 34455117 DOI: 10.1016/j.bone.2021.116161] [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: 02/04/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
Improving the clinical outcome of scaphoid fractures may benefit from adequate monitoring of their healing in order to for example identify complications such as scaphoid nonunion at an early stage and to adjust the treatment strategy accordingly. However, quantitative assessment of the healing process is limited with current imaging modalities. In this study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used for the first time to assess the changes in bone density, microarchitecture, and strength during the healing of conservatively-treated scaphoid fractures. Thirteen patients with a scaphoid fracture (all confirmed on HR-pQCT and eleven on CT) received an HR-pQCT scan at baseline and three, six, twelve, and 26 weeks after first presentation at the emergency department. Bone mineral density (BMD) and trabecular microarchitecture of the scaphoid bone were quantified, and failure load (FL) was estimated using micro-finite element analysis. Longitudinal changes were evaluated with linear mixed-effects models. Data of two patients were excluded due to surgical intervention after the twelve-week follow-up visit. In the eleven fully evaluable patients, the fracture line became more apparent at 3 weeks. At 6 weeks, individual trabeculae at the fracture region became more difficult to identify and distinguish from neighboring trabeculae, and this phenomenon concerned a larger region around the fracture line at 12 weeks. Quantitative assessment showed that BMD and FL were significantly lower than baseline at all follow-up visits with the largest change from baseline at 6 weeks (-13.6% and - 23.7%, respectively). BMD remained unchanged thereafter, while FL increased. Trabecular thickness decreased significantly from baseline at three (-3.9%), six (-6.7%), and twelve (-4.4%) weeks and trabecular number at six (-4.5%), twelve (-7.3%), and 26 (-7.9%) weeks. Trabecular separation was significantly higher than baseline at six (+13.3%), twelve (+19.7%), and 26 (+16.3%) weeks. To conclude, this explorative HR-pQCT study showed a substantial decrease in scaphoid BMD, Tb.Th, and FL during the first 6 weeks of healing of conservatively-treated scaphoid fractures, followed by stabilization or increase in these parameters. At 26 weeks, BMD, trabecular microarchitecture, and FL were not returned to baseline values.
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Affiliation(s)
- M S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - A M Daniels
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Surgery, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, the Netherlands
| | - B van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - P P M M Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Medicine and Life Sciences, Hasselt University, Agoralaan 1, 3590 Hasselt, Belgium
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - S Sassen
- Department of Radiology, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, the Netherlands
| | - S Kaarsemaker
- Department of Orthopedic Surgery, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, the Netherlands
| | - P F W Hannemann
- Department of Surgery and Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - M Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Surgery and Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - H M J Janzing
- Department of Surgery, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, the Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Medicine and Life Sciences, Hasselt University, Agoralaan 1, 3590 Hasselt, Belgium
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
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21
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Bevers MSAM, Wyers CE, Daniels AM, Audenaert EA, van Kuijk SMJ, van Rietbergen B, Geusens PPMM, Kaarsemaker S, Janzing HMJ, Hannemann PFW, Poeze M, van den Bergh JP. Association between bone shape and the presence of a fracture in patients with a clinically suspected scaphoid fracture. J Biomech 2021; 128:110726. [PMID: 34534791 DOI: 10.1016/j.jbiomech.2021.110726] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Scaphoid fractures are difficult to diagnose with current imaging modalities. It is unknown whether the shape of the scaphoid bone, assessed by statistical shape modeling, can be used to differentiate between fractured and non-fractured bones. Therefore, the aim of this study was to investigate whether the presence of a scaphoid fracture is associated with shape modes of a statistical shape model (SSM). Forty-one high-resolution peripheral quantitative computed tomography (HR-pQCT) scans were available from patients with a clinically suspected scaphoid fracture of whom 15 patients had a scaphoid fracture. The scans showed no motion artefacts affecting bone shape. The scaphoid bones were semi-automatically contoured, and the contours were converted to triangular meshes. The meshes were registered, followed by principal component analysis to determine mean shape and shape modes describing shape variance. The first five out of the forty shape modes cumulatively explained 87.8% of the shape variance. Logistic regression analysis was used to study the association between shape modes and fracture presence. The regression models were used to classify the 41 scaphoid bones as fractured or non-fractured using a cut-off value that maximized the sum of sensitivity and specificity. The classification of the models was compared with fracture diagnosis on HR-pQCT. A regression model with four shape modes had an area under the ROC-curve of 72.3% and correctly classified 75.6% of the scaphoid bones (fractured: 60.0%, non-fractured: 84.6%). To conclude, fracture presence in patients with a clinically suspected scaphoid fracture appears to be associated with the shape of the scaphoid bone.
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Affiliation(s)
- Melissa S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anne M Daniels
- NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Emmanuel A Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Electromechanics, Op3Mech research group, University of Antwerp, Antwerp, Belgium
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bert van Rietbergen
- Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Piet P M M Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Sjoerd Kaarsemaker
- Department of Orthopedic Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | | | - Pascal F W Hannemann
- Department of Surgery and Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery and Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium.
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22
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Cornelissen D, Boonen A, Evers S, van den Bergh JP, Bours S, Wyers CE, van Kuijk S, van Oostwaard M, van der Weijden T, Hiligsmann M. Improvement of osteoporosis Care Organized by Nurses: ICON study - Protocol of a quasi-experimental study to assess the (cost)-effectiveness of combining a decision aid with motivational interviewing for improving medication persistence in patients with a recent fracture being treated at the fracture liaison service. BMC Musculoskelet Disord 2021; 22:913. [PMID: 34715838 PMCID: PMC8555732 DOI: 10.1186/s12891-021-04743-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Given the health and economic burden of fractures related to osteoporosis, suboptimal adherence to medication and the increasing importance of shared-decision making, the Improvement of osteoporosis Care Organized by Nurses (ICON) study was designed to evaluate the effectiveness, cost-effectiveness and feasibility of a multi-component adherence intervention (MCAI) for patients with an indication for treatment with anti–osteoporosis medication, following assessment at the Fracture Liaison Service after a recent fracture. The MCAI involves two consultations at the FLS. During the first consultation, a decision aid is will be used to involve patients in the decision of whether to start anti-osteoporosis medication. During the follow-up visit, the nurse inquires about, and stimulates, medication adherence using motivational interviewing techniques. Methods A quasi-experimental trial to evaluate the (cost-) effectiveness and feasibility of an MCAI, consisting of a decision aid (DA) at the first visit, combined with nurse-led adherence support using motivational interviewing during the follow-up visit, in comparison with care as usual, in improving adherence to oral anti-osteoporosis medication for patients with a recent fracture two Dutch FLS. Medication persistence, defined as the proportion of patients who are persistent at one year assuming a refill gap < 30 days, is the primary outcome. Medication adherence, decision quality, subsequent fractures and mortality are the secondary outcomes. A lifetime cost-effectiveness analysis using a model-based economic evaluation and a process evaluation will also be conducted. A sample size of 248 patients is required to show an improvement in the primary outcome with 20%. Study follow-up is at 12 months, with measurements at baseline, after four months, and at 12 months. Discussion We expect that the ICON-study will show that the MCAI is a (cost-)effective intervention for improving persistence with anti-osteoporosis medication and that it is feasible for implementation at the FLS. Trial registration This trial has been registered in the Netherlands Trial Registry, part of the Dutch Cochrane Centre (Trial NL7236 (NTR7435)). Version 1.0; 26-11-2020.
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Affiliation(s)
- Dennis Cornelissen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; and Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Silvia Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.,Department of Internal Medicine, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Sandrine Bours
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center; and Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.,Department of Internal Medicine, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marsha van Oostwaard
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.,Department of Internal Medicine, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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23
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Hensgens KR, van Rensen IH, Lekx AW, van Osch FH, Knarren LH, Wyers CE, van den Bergh JP, Barten DG. Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department. Int J Environ Res Public Health 2021; 18:9271. [PMID: 34501861 PMCID: PMC8431352 DOI: 10.3390/ijerph18179271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To reduce the risk of nosocomial transmission, suspected COVID-19 patients entering the Emergency Department (ED) were assigned to a high-risk (ED) or low-risk (acute medical unit, AMU) area based on symptoms, travel and contact history. The objective of this study was to evaluate the performance of our pre-triage screening method and to analyse the characteristics of initially undetected COVID-19 patients. METHODS This was a retrospective, observational, single centre study. Patients ≥ 18 years visiting the AMU-ED between 17 March and 17 April 2020 were included. Primary outcome was the (correct) number of COVID-19 patients assigned to the AMU or ED. RESULTS In total, 1287 patients visited the AMU-ED: 525 (40.8%) AMU, 762 (59.2%) ED. Within the ED group, 304 (64.3%) of 473 tested patients were COVID-19 positive, compared to 13 (46.4%) of 28 tested patients in the AMU group. Our pre-triage screening accuracy was 63.7%. Of the 13 COVID-19 patients who were initially assigned to the AMU, all patients were ≥65 years of age and the majority presented with gastro-intestinal or non-specific symptoms. CONCLUSION Older COVID-19 patients presenting with non-specific symptoms were more likely to remain undetected. ED screening protocols should therefore also include non-specific symptoms, particularly in older patients.
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Affiliation(s)
- Kirsten R.C. Hensgens
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
- VieCuri Medical Centre, Department of Intensive Care, 5912 BL Venlo, The Netherlands
| | - Inge H.T. van Rensen
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
| | - Anita W. Lekx
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
| | - Frits H.M. van Osch
- VieCuri Medical Centre, Department of Clinical Epidemiology, 5912 BL Venlo, The Netherlands;
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
| | - Lieve H.H. Knarren
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Caroline E. Wyers
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Joop P. van den Bergh
- School of Nutrition and Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.E.W.); (J.P.v.d.B.)
- VieCuri Medical Centre, Department of Internal Medicine, T5912 BL Venlo, The Netherlands;
| | - Dennis G. Barten
- VieCuri Medical Centre, Department of Emergency Medicine, 5912 BL Venlo, The Netherlands; (I.H.T.v.R.); (A.W.L.); (D.G.B.)
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Berkvens JJL, Wyers CE, Mergler S, Beerhorst K, Verschuure P, Tan IY, Majoie HJM, van den Bergh JPW. Incidence of clinical fractures: A 7-year follow-up study in institutionalized adults with epilepsy and intellectual disability. Seizure 2021; 92:56-61. [PMID: 34438165 DOI: 10.1016/j.seizure.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the incidence of clinical fractures over seven years of follow-up, in adults with epilepsy and intellectual disability, residing in a long-stay care facility. METHODS In 2009, all institutionalized adult patients (n = 261) were invited to undergo a Dual-energy X-ray Absorptiometry (DXA) measurement and a Vertebral Fracture Assessment (VFA). Participants were followed over seven years or until date of discharge (in case of moving from the care facility) or date of death. The patients' medical files were screened for radiology reports and staff notes, to identify clinical fractures. Fracture incidence rates (IR) were determined and compared for subgroups, by calculating incidence rate ratios. Hazard ratios were calculated to identify factors associated with fracture risk, using Cox Proportional Hazards analyses. RESULTS A total of 205 patients (124 male, 60.5%) aged between 18 and 88 years (median 48, IQR 34-60) were enrolled. At baseline, 92 patients (44.9%) were diagnosed with osteopenia and 65 (31.7%) with osteoporosis. Between 2009 and 2016, 30 patients (14.6%) deceased and 3 patients (1.5%) left the care facility. During follow-up, 156 clinical fractures were reported in 82 patients (40.0%). Thirty-eight patients (18.5%) had at least one major osteoporotic fracture. Overall, the IR was 11.6 fractures per 100 person-years. Fracture risk was significantly lower in patients who were wheelchair dependent than in patients who were able to walk (p<.001). CONCLUSION This study demonstrated that 40% of institutionalized adults with epilepsy and intellectual disability had at least one clinical fracture during seven years of follow-up, despite adequate anti-osteoporosis treatment.
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Affiliation(s)
- J J L Berkvens
- Department of Residential Care, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Mergler
- Medical Department ASVZ, Care and Service Center for People with Intellectual Disabilities, Sliedrecht, The Netherlands; Department of General Practice and Intellectual Disability Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K Beerhorst
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - P Verschuure
- Laboratory for Clinical Chemistry & Pharmacology, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - I Y Tan
- Department of Residential Care, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - H J M Majoie
- Department of Neurology, Academic Center for Epileptology Kempenhaeghe and Maastricht University Medical Center, Heeze and Maastricht, The Netherlands; MHeNs School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Li N, Hiligsmann M, Boonen A, van Oostwaard MM, de Bot RTAL, Wyers CE, Bours SPG, van den Bergh JP. The impact of fracture liaison services on subsequent fractures and mortality: a systematic literature review and meta-analysis. Osteoporos Int 2021; 32:1517-1530. [PMID: 33829285 PMCID: PMC8376729 DOI: 10.1007/s00198-021-05911-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/03/2021] [Indexed: 12/29/2022]
Abstract
UNLABELLED This systematic review and meta-analysis suggests that fracture liaison service (FLS) is associated with a significantly lower probability of subsequent fractures and mortality although the latter was only found in studies comparing outcomes before and after the introduction of an FLS. INTRODUCTION To systematically review and evaluate the impact of fracture liaison services (FLSs) on subsequent fractures and mortality using meta-analysis. METHODS A literature search was performed within PubMed and Embase to identify original articles published between January 1, 2010, and April 30, 2020, reporting the effect of FLSs on subsequent fractures and/or mortality. Only studies comparing FLS to no-FLS were included. A meta-analysis using random-effects models was conducted. The quality of studies was appraised after combining and modifying criteria of existing quality assessment tools. RESULTS The search retrieved 955 published studies, of which 16 studies fulfilled the inclusion criteria. Twelve studies compared outcomes before (pre-FLS) and after (post-FLS) FLS implementation, two studies compared outcomes between hospitals with and without FLS, and two other studies performed both comparisons. In total, 18 comparisons of FLS and no-FLS care were reported. Follow-up time varied from 6 months to 4 years. Sixteen comparisons reported on subsequent fractures and 12 on mortality. The quality assessment revealed methodological issues in several criteria. Excluding studies with very high selection bias, the meta-analysis of nine comparisons (in eight papers) revealed that the FLS care was associated with a significantly lower probability of subsequent fractures (odds ratio: 0.70, 95% CI: 0.52-0.93, P=0.01). In studies with a follow-up > 2 years, a significantly lower probability of subsequent fractures was captured for FLS care (odds ratio: 0.57, 95% CI: 0.34-0.94, P=0.03), while in studies ≤ 2 years, there was no difference in the odds of subsequent fractures. No significant difference in the odds of mortality was observed (odds ratio: 0.73, 95% CI: 0.49-1.09, P=0.12) in the meta-analysis of eight comparisons (in seven papers). However, a significantly lower probability of mortality was identified in the six pre-post FLS comparisons (odds ratio: 0.65, 95% CI: 0.44-0.95, P=0.03), but not in studies comparing hospitals with and without FLS. No difference was observed in mortality stratified by follow-up time. CONCLUSION This systematic review and meta-analysis suggests that FLS care is associated with a significantly lower probability of subsequent fractures and mortality although the latter was only found in studies comparing outcomes before and after the introduction of an FLS. The quality assessment revealed that some important methodological issues were unmet in the currently available studies. Recommendations to guide researchers to design high-quality studies for evaluation of FLS outcomes in the future were provided.
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Affiliation(s)
- N Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - M M van Oostwaard
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R T A L de Bot
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Orthopaedics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S P G Bours
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine, University Hasselt, Hasselt, Belgium
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Ottenhoff MC, Ramos LA, Potters W, Janssen MLF, Hubers D, Hu S, Fridgeirsson EA, Piña-Fuentes D, Thomas R, van der Horst ICC, Herff C, Kubben P, Elbers PWG, Marquering HA, Welling M, Simsek S, de Kruif MD, Dormans T, Fleuren LM, Schinkel M, Noordzij PG, van den Bergh JP, Wyers CE, Buis DTB, Wiersinga WJ, van den Hout EHC, Reidinga AC, Rusch D, Sigaloff KCE, Douma RA, de Haan L, Gritters van den Oever NC, Rennenberg RJMW, van Wingen GA, Aries MJH, Beudel M. Predicting mortality of individual patients with COVID-19: a multicentre Dutch cohort. BMJ Open 2021; 11:e047347. [PMID: 34281922 PMCID: PMC8290951 DOI: 10.1136/bmjopen-2020-047347] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Develop and validate models that predict mortality of patients diagnosed with COVID-19 admitted to the hospital. DESIGN Retrospective cohort study. SETTING A multicentre cohort across 10 Dutch hospitals including patients from 27 February to 8 June 2020. PARTICIPANTS SARS-CoV-2 positive patients (age ≥18) admitted to the hospital. MAIN OUTCOME MEASURES 21-day all-cause mortality evaluated by the area under the receiver operator curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value. The predictive value of age was explored by comparison with age-based rules used in practice and by excluding age from the analysis. RESULTS 2273 patients were included, of whom 516 had died or discharged to palliative care within 21 days after admission. Five feature sets, including premorbid, clinical presentation and laboratory and radiology values, were derived from 80 features. Additionally, an Analysis of Variance (ANOVA)-based data-driven feature selection selected the 10 features with the highest F values: age, number of home medications, urea nitrogen, lactate dehydrogenase, albumin, oxygen saturation (%), oxygen saturation is measured on room air, oxygen saturation is measured on oxygen therapy, blood gas pH and history of chronic cardiac disease. A linear logistic regression and non-linear tree-based gradient boosting algorithm fitted the data with an AUC of 0.81 (95% CI 0.77 to 0.85) and 0.82 (0.79 to 0.85), respectively, using the 10 selected features. Both models outperformed age-based decision rules used in practice (AUC of 0.69, 0.65 to 0.74 for age >70). Furthermore, performance remained stable when excluding age as predictor (AUC of 0.78, 0.75 to 0.81). CONCLUSION Both models showed good performance and had better test characteristics than age-based decision rules, using 10 admission features readily available in Dutch hospitals. The models hold promise to aid decision-making during a hospital bed shortage.
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Affiliation(s)
- Maarten C Ottenhoff
- Department of Neurosurgery, Maastricht University, Maastricht, The Netherlands
| | - Lucas A Ramos
- Department of Biomedical Engineering and Physics/Department of Epidemiology & Data Science, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Wouter Potters
- Department of Neurology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Marcus L F Janssen
- Department of Clinical Neurophysiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Deborah Hubers
- Department of Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Shi Hu
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Egill A Fridgeirsson
- Department of Psychiatry, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Dan Piña-Fuentes
- Department of Neurology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Rajat Thomas
- Department of Psychiatry, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Christian Herff
- Department of Neurosurgery, Maastricht University, Maastricht, The Netherlands
| | - Pieter Kubben
- Department of Neurosurgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics/Department of Epidemiology & Data Science, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Max Welling
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Tom Dormans
- Vascular Medicine, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Lucas M Fleuren
- Department of Intensive Care, Amsterdam University Medical Centres, Duivendrecht, Noord-Holland, The Netherlands
| | - Michiel Schinkel
- Center for Experimental and Molecular Medicine (C.E.M.M.), Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology and Intensive Care, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - David T B Buis
- Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Department of Internal Medicine, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
- Center for Experimental and Molecular Medicine (C.E.M.M.), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ella H C van den Hout
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Auke C Reidinga
- Department of Intensive Care, Martini Ziekenhuis, Groningen, The Netherlands
| | - Daisy Rusch
- Research, Martini Ziekenhuis, Groningen, The Netherlands
| | - Kim C E Sigaloff
- Department of Internal Medicine, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Renee A Douma
- Department of Internal Medicine, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | - Lianne de Haan
- Department of Internal Medicine, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | | | - Roger J M W Rennenberg
- Department of Internal Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Guido A van Wingen
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel J H Aries
- Department of Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
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van Rensen IHT, Hensgens KRC, Lekx AW, van Osch FHM, Knarren LHH, van Kampen-van den Boogaart VEM, Mehagnoul-Schipper JDJ, Wyers CE, van den Bergh JP, Barten DG. Early detection of hospitalized patients with COVID-19 at high risk of clinical deterioration: Utility of emergency department shock index. Am J Emerg Med 2021; 49:76-79. [PMID: 34087575 PMCID: PMC8137356 DOI: 10.1016/j.ajem.2021.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 12/31/2022] Open
Abstract
Background The COVID-19 outbreak has put an unprecedented strain on Emergency Departments (EDs) and other critical care resources. Early detection of patients that are at high risk of clinical deterioration and require intensive monitoring, is key in ED evaluation and disposition. A rapid and easy risk-stratification tool could aid clinicians in early decision making. The Shock Index (SI: heart rate/systolic blood pressure) proved useful in detecting hemodynamic instability in sepsis and myocardial infarction patients. In this study we aim to determine whether SI is discriminative for ICU admission and in-hospital mortality in COVID-19 patients. Methods Retrospective, observational, single-center study. All patients ≥18 years old who were hospitalized with COVID-19 (defined as: positive result on reverse transcription polymerase chain reaction (PCR) test) between March 1, 2020 and December 31, 2020 were included for analysis. Data were collected from electronic medical patient records and stored in a protected database. ED shock index was calculated and analyzed for its discriminative value on in-hospital mortality and ICU admission by a ROC curve analysis. Results In total, 411 patients were included. Of all patients 249 (61%) were male. ICU admission was observed in 92 patients (22%). Of these, 37 patients (40%) died in the ICU. Total in-hospital mortality was 28% (114 patients). For in-hospital mortality the optimal cut-off SI ≥ 0.86 was not discriminative (AUC 0.49 (95% CI: 0.43–0.56)), with a sensitivity of 12.3% and specificity of 93.6%. For ICU admission the optimal cut-off SI ≥ 0.57 was also not discriminative (AUC 0.56 (95% CI: 0.49–0.62)), with a sensitivity of 78.3% and a specificity of 34.2%. Conclusion In this cohort of patients hospitalized with COVID-19, SI measured at ED presentation was not discriminative for ICU admission and was not useful for early identification of patients at risk of clinical deterioration.
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Affiliation(s)
- Inge H T van Rensen
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
| | - Kirsten R C Hensgens
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands; VieCuri Medical Center, Intensive Care Unit, Venlo, the Netherlands.
| | - Anita W Lekx
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
| | - Frits H M van Osch
- VieCuri Medical Center, Department of Epidemiology, Venlo, the Netherlands; Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands.
| | - Lieve H H Knarren
- VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands.
| | | | | | - Caroline E Wyers
- Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands; VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands; Maastricht University Medical Center, Department of Internal Medicine, Maastricht, the Netherlands.
| | - Joop P van den Bergh
- Maastricht University Medical Center, School of Nutrition and Metabolism (NUTRIM), Maastricht, the Netherlands; VieCuri Medical Center, Department of Internal Medicine, Venlo, the Netherlands; Maastricht University Medical Center, Department of Internal Medicine, Maastricht, the Netherlands.
| | - Dennis G Barten
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, the Netherlands.
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28
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Blomaard LC, van der Linden CMJ, van der Bol JM, Jansen SWM, Polinder-Bos HA, Willems HC, Festen J, Barten DG, Borgers AJ, Bos JC, van den Bos F, de Brouwer EJM, van Deudekom FJA, van Dijk SC, Emmelot-Vonk MH, Geels RES, van de Glind EMM, de Groot B, Hempenius L, Kamper AM, Kampschreur LM, de Koning MMM, Labots G, Looman R, Lucke JA, Maas HAAM, Mattace-Raso FUS, el Moussaoui R, van Munster BC, van Nieuwkoop C, Oosterwijk L(BLE, Regtuijt M(EM, Robben SHM, Ruiter R, Salarbaks AM, Schouten HJ, Smit OM, Smits RAL, Spies PE, Vreeswijk R, de Vries OJ, Wijngaarden MA, Wyers CE, Mooijaart SP. Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study. Age Ageing 2021; 50:631-640. [PMID: 33951156 PMCID: PMC7929372 DOI: 10.1093/ageing/afab018] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. Objective The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. Methods This was a multicentre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. Results A total of 1,376 patients were included (median age 78 years (interquartile range 74–84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6–9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 versus 7 days), lower oxygen demand and lower levels of C-reactive protein. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared with patients with CFS 1–3, patients with CFS 4–5 had a two times higher risk (odds ratio (OR) 2.0 (95% confidence interval (CI) 1.3–3.0)) and patients with CFS 6–9 had a three times higher risk of in-hospital mortality (OR 2.8 (95% CI 1.8–4.3)). Conclusions The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.
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Affiliation(s)
- Laura C Blomaard
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Steffy W M Jansen
- Department of Geriatrics, Catharina Hospital, Eindhoven, the Netherlands
| | - Harmke A Polinder-Bos
- Section Geriatrics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hanna C Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | | | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Anke J Borgers
- Department of Geriatrics, Deventer Hospital, Deventer, the Netherlands
| | - Jeannet C Bos
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Floor J A van Deudekom
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | | | - Raya E S Geels
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Geriatrics, Alrijne Hospital, Leiderdorp, the Netherlands
| | | | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Liesbeth Hempenius
- Department of Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Ad M Kamper
- Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands
| | - Linda M Kampschreur
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Marre M M de Koning
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Geert Labots
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Roy Looman
- Section Geriatrics, Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Huub A A M Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | | | - Barbara C van Munster
- Department of Internal Medicine and Geriatrics, University Medical Center Groningen, Groningen, the Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Leanne (B L E) Oosterwijk
- Section Geriatrics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Sarah H M Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aisha M Salarbaks
- Department of Geriatrics, Hospital Group Twente, Almelo, the Netherlands
| | - Henrike J Schouten
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Orla M Smit
- Section Geriatrics, Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Rosalinde A L Smits
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Petra E Spies
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Ralph Vreeswijk
- Department of Geriatrics, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Oscar J de Vries
- Department of Internal Medicine and Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Marjolein A Wijngaarden
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Simon P Mooijaart
- Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Chatterjee A, Wu G, Primakov S, Oberije C, Woodruff H, Kubben P, Henry R, Aries MJH, Beudel M, Noordzij PG, Dormans T, Gritters van den Oever NC, van den Bergh JP, Wyers CE, Simsek S, Douma R, Reidinga AC, de Kruif MD, Guiot J, Frix AN, Louis R, Moutschen M, Lovinfosse P, Lambin P. Can predicting COVID-19 mortality in a European cohort using only demographic and comorbidity data surpass age-based prediction: An externally validated study. PLoS One 2021; 16:e0249920. [PMID: 33857224 PMCID: PMC8049248 DOI: 10.1371/journal.pone.0249920] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To establish whether one can build a mortality prediction model for COVID-19 patients based solely on demographics and comorbidity data that outperforms age alone. Such a model could be a precursor to implementing smart lockdowns and vaccine distribution strategies. METHODS The training cohort comprised 2337 COVID-19 inpatients from nine hospitals in The Netherlands. The clinical outcome was death within 21 days of being discharged. The features were derived from electronic health records collected during admission. Three feature selection methods were used: LASSO, univariate using a novel metric, and pairwise (age being half of each pair). 478 patients from Belgium were used to test the model. All modeling attempts were compared against an age-only model. RESULTS In the training cohort, the mortality group's median age was 77 years (interquartile range = 70-83), higher than the non-mortality group (median = 65, IQR = 55-75). The incidence of former/active smokers, male gender, hypertension, diabetes, dementia, cancer, chronic obstructive pulmonary disease, chronic cardiac disease, chronic neurological disease, and chronic kidney disease was higher in the mortality group. All stated differences were statistically significant after Bonferroni correction. LASSO selected eight features, novel univariate chose five, and pairwise chose none. No model was able to surpass an age-only model in the external validation set, where age had an AUC of 0.85 and a balanced accuracy of 0.77. CONCLUSION When applied to an external validation set, we found that an age-only mortality model outperformed all modeling attempts (curated on www.covid19risk.ai) using three feature selection methods on 22 demographic and comorbid features.
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Affiliation(s)
- Avishek Chatterjee
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Guangyao Wu
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Sergey Primakov
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Cary Oberije
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Henry Woodruff
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Pieter Kubben
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ronald Henry
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcel J. H. Aries
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Peter G. Noordzij
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Tom Dormans
- Department of Intensive Care, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | - Caroline E. Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Renée Douma
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
| | - Auke C. Reidinga
- Department of Intensive Care, Martiniziekenhuis, Groningen, The Netherlands
| | - Martijn D. de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Julien Guiot
- Department of Respiratory Medicine, CHU of Liège, Liège, Belgium
| | - Anne-Noelle Frix
- Department of Respiratory Medicine, CHU of Liège, Liège, Belgium
| | - Renaud Louis
- Department of Respiratory Medicine, CHU of Liège, Liège, Belgium
| | | | - Pierre Lovinfosse
- Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liège, Liège, Belgium
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
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30
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Botman E, Bevers MSAM, Wyers CE, van Rietbergen B, Teunissen BP, Raijmakers PG, Netelenbos JC, van den Bergh JP, Eekhoff EMW. Microarchitecture of Heterotopic Ossification in Fibrodysplasia Ossificans Progressiva: An HR-pQCT Case Series. Front Cell Dev Biol 2021; 9:627784. [PMID: 33777936 PMCID: PMC7991097 DOI: 10.3389/fcell.2021.627784] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/02/2021] [Indexed: 11/13/2022] Open
Abstract
It is challenging to study heterotopic ossification (HO) in patients with fibrodysplasia ossificans progressiva (FOP) due to the contraindication of invasive techniques (i.e., bone biopsies), which can trigger flare-ups. The aim of this case study was to assess mature HO at the microarchitectural level non-invasively with high-resolution peripheral quantitative computed tomography (HR-pQCT). Depending on the patient’s mobility, HR-pQCT scans were acquired of peripherally located HO and standard distal radius and tibia regions in two FOP patients, a 33-year-old woman and a 23-year-old man, with the classical mutation (p.R206H). HO was located around the halluces, the ankles, and in the Achilles tendon. Standard HR-pQCT analyses were performed of the distal radius, tibia, and HO to quantify bone mineral density (BMD) and bone microarchitecture. Micro-finite element analysis was used to estimate failure load (FL). The outcomes were compared between HO and neighboring skeletal bone and with an age- and gender-matched normative dataset from literature. The bone parameters of the radius were within the interquartile range (IQR) of normative data. In contrast, in the tibiae of both patients, total and trabecular BMD were below the IQR, as were trabecular bone volume fraction, number, and thickness, cortical thickness, and FL. Trabecular separation and heterogeneity were above the IQR. Isolated HO in the Achilles tendon had a lower total, trabecular, and cortical BMD, trabecular bone volume fraction, and cortical thickness than the normative tibia data. Trabecular microarchitecture was within the IQR, and FL was approximately 10% higher than that of the neighboring tibia after accounting for areal differences. Other scanned HO could only be qualitatively assessed, which revealed coalescence with the neighboring skeletal bone, development of a neo-cortex, and partial replacement of the original skeletal cortex with trabeculae. To conclude, isolated HO seemed microarchitecturally more comparable to reference tibia data than the peripheral skeleton of the FOP patients. HO and skeleton also appear to be able to become one entity when contiguous.
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Affiliation(s)
- Esmée Botman
- Department of Internal Medicine Section Endocrinology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Melissa S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands.,Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bert van Rietbergen
- Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bernd P Teunissen
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Jan Coen Netelenbos
- Department of Internal Medicine Section Endocrinology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Elisabeth M W Eekhoff
- Department of Internal Medicine Section Endocrinology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Mys K, Varga P, Stockmans F, Gueorguiev B, Neumann V, Vanovermeire O, Wyers CE, van den Bergh JPW, van Lenthe GH. High-Resolution Cone-Beam Computed Tomography is a Fast and Promising Technique to Quantify Bone Microstructure and Mechanics of the Distal Radius. Calcif Tissue Int 2021; 108:314-323. [PMID: 33452889 DOI: 10.1007/s00223-020-00773-5] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/27/2020] [Indexed: 10/22/2022]
Abstract
Obtaining high-resolution scans of bones and joints for clinical applications is challenging. HR-pQCT is considered the best technology to acquire high-resolution images of the peripheral skeleton in vivo, but a breakthrough for widespread clinical applications is still lacking. Recently, we showed on trapezia that CBCT is a promising alternative providing a larger FOV at a shorter scanning time. The goals of this study were to evaluate the accuracy of CBCT in quantifying trabecular bone microstructural and predicted mechanical parameters of the distal radius, the most often investigated skeletal site with HR-pQCT, and to compare it with HR-pQCT. Nineteen radii were scanned with four scanners: (1) HR-pQCT (XtremeCT, Scanco Medical AG, @ (voxel size) 82 μm), (2) HR-pQCT (XtremeCT-II, Scanco, @60.7 μm), (3) CBCT (NewTom 5G, Cefla, @75 μm) reconstructed and segmented using in-house developed software and (4) microCT (VivaCT40, Scanco, @19 μm-gold standard). The following parameters were evaluated: predicted stiffness, strength, bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp) and number (Tb.N). The overall accuracy of CBCT with in-house optimized algorithms in quantifying bone microstructural parameters was comparable (R2 = 0.79) to XtremeCT (R2 = 0.76) and slightly worse than XtremeCT-II (R2 = 0.86) which were both processed with the standard manufacturer's technique. CBCT had higher accuracy for BV/TV and Tb.Th but lower for Tb.Sp and Tb.N compared to XtremeCT. Regarding the mechanical parameters, all scanners had high accuracy (R2 [Formula: see text] 0.96). While HR-pQCT is optimized for research, the fast scanning time and good accuracy renders CBCT a promising technique for high-resolution clinical scanning.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium.
- AO Research Institute Davos, Davos, Switzerland.
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | - Filip Stockmans
- Muscles & Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | | | | | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Joop P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Harry van Lenthe
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
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32
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Ariës MJH, van den Bergh JP, Beudel M, Boersma W, Dormans T, Douma RA, Eerens A, Elbers PWG, Fleuren LM, Gritters van den Oever NC, de Haan L, van der Horst IJCC, Hu S, Hubers D, Janssen MLF, de Kruif M, Kubben PL, van Kuijk SMJ, Noordzij PG, Ottenhoff M, Piña-Fuentes DAI, Potters WV, Reidinga AC, Renckens RSC, Rigter S, Rusch D, Schinkel M, Sigaloff KCE, Simsek S, Stassen P, Stassen R, Thomas RM, van Wingen GA, Vonk Noordegraaf A, Welling M, Wiersinga WJ, Wolvers MDJ, Wyers CE. [Clinical course of COVID-19 in the Netherlands: an overview of 2607 patients in hospital during the first wave]. Ned Tijdschr Geneeskd 2021; 165:D5085. [PMID: 33651497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To systematically collect clinical data from patients with a proven COVID-19 infection in the Netherlands. DESIGN Data from 2579 patients with COVID-19 admitted to 10 Dutch centers in the period February to July 2020 are described. The clinical data are based on the WHO COVID case record form (CRF) and supplemented with patient characteristics of which recently an association disease severity has been reported. METHODS Survival analyses were performed as primary statistical analysis. These Kaplan-Meier curves for time to (early) death (3 weeks) have been determined for pre-morbid patient characteristics and clinical, radiological and laboratory data at hospital admission. RESULTS Total in-hospital mortality after 3 weeks was 22.2% (95% CI: 20.7% - 23.9%), hospital mortality within 21 days was significantly higher for elderly patients (> 70 years; 35, 0% (95% CI: 32.4% - 37.8%) and patients who died during the 21 days and were admitted to the intensive care (36.5% (95% CI: 32.1% - 41.3%)). Apart from that, in this Dutch population we also see a risk of early death in patients with co-morbidities (such as chronic neurological, nephrological and cardiac disorders and hypertension), and in patients with more home medication and / or with increased urea and creatinine levels. CONCLUSION Early death due to a COVID-19 infection in the Netherlands appears to be associated with demographic variables (e.g. age), comorbidity (e.g. cardiovascular disease) but also disease char-acteristics at admission.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Shi Hu
- Universiteit van Amsterdam
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van Son J, Oussaada SM, Şekercan A, Beudel M, Dongelmans DA, van Assen S, Eland IA, Moeniralam HS, Dormans TPJ, van Kalkeren CAJ, Douma RA, Rusch D, Simsek S, Liu L, Kootte RS, Wyers CE, IJzerman RG, van den Bergh JP, Stehouwer CDA, Nieuwdorp M, Ter Horst KW, Serlie MJ. Overweight and Obesity Are Associated With Acute Kidney Injury and Acute Respiratory Distress Syndrome, but Not With Increased Mortality in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:747732. [PMID: 34970220 PMCID: PMC8713548 DOI: 10.3389/fendo.2021.747732] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/26/2021] [Accepted: 11/17/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the association between overweight and obesity on the clinical course and outcomes in patients hospitalized with COVID-19. DESIGN Retrospective, observational cohort study. METHODS We performed a multicenter, retrospective, observational cohort study of hospitalized COVID-19 patients to evaluate the associations between overweight and obesity on the clinical course and outcomes. RESULTS Out of 1634 hospitalized COVID-19 patients, 473 (28.9%) had normal weight, 669 (40.9%) were overweight, and 492 (30.1%) were obese. Patients who were overweight or had obesity were younger, and there were more women in the obese group. Normal-weight patients more often had pre-existing conditions such as malignancy, or were organ recipients. During admission, patients who were overweight or had obesity had an increased probability of acute respiratory distress syndrome [OR 1.70 (1.26-2.30) and 1.40 (1.01-1.96)], respectively and acute kidney failure [OR 2.29 (1.28-3.76) and 1.92 (1.06-3.48)], respectively. Length of hospital stay was similar between groups. The overall in-hospital mortality rate was 27.7%, and multivariate logistic regression analyses showed that overweight and obesity were not associated with increased mortality compared to normal-weight patients. CONCLUSION In this study, overweight and obesity were associated with acute respiratory distress syndrome and acute kidney injury, but not with in-hospital mortality nor length of hospital stay.
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Affiliation(s)
- Jamie van Son
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sabrina M Oussaada
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Aydin Şekercan
- Department of Surgery, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centre (UMC), Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sander van Assen
- Department of Internal Medicine/Infectious Diseases, Treant Zorggroep, Emmen, Netherlands
| | - Ingo A Eland
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Hazra S Moeniralam
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Tom P J Dormans
- Department of Intensive Care, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Renée A Douma
- Department of Internal Medicine, Flevo Hospital, Almere, Netherlands
| | - Daisy Rusch
- Department of Intensive Care Medicine, Martini Hospital, Groningen, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- Department of Internal Medicine/Endocrinology, Amsterdam University Medical Centre (UMC), VU (Vrije Universiteit) University Medical Centre, Amsterdam, Netherlands
| | - Limmie Liu
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ruud S Kootte
- Department of Acute Internal Medicine, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, Viecuri Medical Center, Noord-Limburg, Venlo, Netherlands
| | - Richard G IJzerman
- Department of Internal Medicine, Amsterdam University Medical Centre (UMC), Diabetes Centre, Vrije Universiteit (VU) University Medical Centre, Amsterdam, Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, Viecuri Medical Center, Noord-Limburg, Venlo, Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Kasper W Ter Horst
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
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Mys K, Varga P, Stockmans F, Gueorguiev B, Wyers CE, van den Bergh JPW, van Lenthe GH. Quantification of 3D microstructural parameters of trabecular bone is affected by the analysis software. Bone 2021; 142:115653. [PMID: 33059103 DOI: 10.1016/j.bone.2020.115653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/02/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 02/08/2023]
Abstract
Over the last decades, the use of high-resolution imaging systems to assess bone microstructural parameters has grown immensely. Yet, no standard defining the quantification of these parameters exists. It has been reported that different voxel size and/or segmentation techniques lead to different results. However, the effect of the evaluation software has not been investigated so far. Therefore, the aim of this study was to compare the bone microstructural parameters obtained with two commonly used commercial software packages, namely IPL (Scanco, Switzerland) and CTan (Bruker, Belgium). We hypothesized that even when starting from the same segmented scans, different software packages will report different results. Nineteen trapezia and nineteen distal radii were scanned at two resolutions (20 μm voxel size with microCT and HR-pQCT 60 μm). The scans were segmented using the scanners' default protocol. The segmented images were analyzed twice, once with IPL and once with CTan, to quantify bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N) and specific bone surface (BS/BV). Only small differences between IPL and CTan were found for BV/TV. For Tb.Th, Tb.Sp and BS/BV high correlations (R2 ≥ 0.99) were observed between the two software packages, but important relative offsets were observed. For microCT scans, the offsets were relative constant, e.g., around 15% for Tb.Th. However, for the HR-pQCT scans the mean relative offsets ranged over the different bone samples (e.g., for Tb.Th from 14.5% to 19.8%). For Tb.N, poor correlations (0.43 ≤ R2 ≤ 0.81) for all tested cases were observed. We conclude that trabecular bone microstructural parameters obtained with IPL and CTan cannot be directly compared except for BV/TV. For Tb.Th, Tb.Sp and BS/BV, correction factors can be determined, but these depend on both the image voxel size and specific anatomic location. The two software packages did not produce consistent data on Tb.N. The development of a universal standard seems desirable.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium; AO Research Institute Davos, Davos, Switzerland.
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | - Filip Stockmans
- Muscles & Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Joop P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - G Harry van Lenthe
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
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Daniels AM, Bevers MSAM, Sassen S, Wyers CE, van Rietbergen B, Geusens PPMM, Kaarsemaker S, Hannemann PFW, Poeze M, van den Bergh JP, Janzing HMJ. Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT. J Bone Joint Surg Am 2020; 102:2138-2145. [PMID: 33079896 DOI: 10.2106/jbjs.20.00124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/01/2023]
Abstract
BACKGROUND Computed tomography (CT), magnetic resonance imaging, and bone scintigraphy are second-line imaging techniques that are frequently used for the evaluation of patients with a clinically suspected scaphoid fracture. However, as a result of varying diagnostic performance results, no true reference standard exists for scaphoid fracture diagnosis. We hypothesized that the use of high-resolution peripheral quantitative CT (HR-pQCT) in patients with a clinically suspected scaphoid fracture could improve scaphoid fracture detection compared with conventional CT in the clinical setting. METHODS The present study included 91 consecutive patients (≥18 years of age) who presented to the emergency department with a clinically suspected scaphoid fracture between December 2017 and October 2018. All patients were clinically reassessed within 14 days after first presentation, followed by CT and HR-pQCT. If a scaphoid fracture was present, the fracture type was determined according to the Herbert classification system and correlation between CT and HR-pQCT was estimated with use of the Kendall W statistic or coefficient of concordance (W) (the closer to 1, the higher the correlation). RESULTS The cohort included 45 men and 46 women with a median age of 52 years (interquartile range, 29 to 67 years). HR-pQCT revealed a scaphoid fracture in 24 patients (26%), whereas CT revealed a scaphoid fracture in 15 patients (16%). Patients with a scaphoid fracture were younger and more often male. The correlation between CT and HR-pQCT was high for scaphoid fracture type according to the Herbert classification system (W = 0.793; 95% confidence interval [CI], 0.57 to 0.91; p < 0.001) and very high for scaphoid fracture location (W = 0.955; 95%, CI 0.90 to 0.98; p < 0.001). CONCLUSIONS In the present study, the number of patients diagnosed with a scaphoid fracture was 60% higher when using HR-pQCT as compared with CT. These findings imply that a substantial proportion of fractures-in this study, more than one-third-will be missed by the current application of CT scanning in patients with a clinically suspected scaphoid fracture. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- A M Daniels
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - M S A M Bevers
- Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S Sassen
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands
| | - C E Wyers
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B van Rietbergen
- Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - P P M M Geusens
- Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - S Kaarsemaker
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands
| | - P F W Hannemann
- Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J P van den Bergh
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Departments of Internal Medicine (C.E.W., P.P.M.M.G., and J.P.v.d.B.) and Surgery and Trauma Surgery (P.F.W.H. and M.P.), Maastricht University Medical Centre, Maastricht, the Netherlands.,Faculty of Medicine, Hasselt University, Belgium
| | - H M J Janzing
- Departments of Surgery (A.M.D. and H.M.J.J.), Radiology (S.S.), Internal Medicine (C.E.W. and J.P.v.d.B.), and Orthopedic Surgery (S.K.), VieCuri Medical Centre, Venlo, the Netherlands
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de Bruin IJA, Vranken L, Wyers CE, van der Velde RY, Trienekens TAM, Kaarsemaker S, Janzing HMJ, Wolters FL, Wouda S, Geusens PPMM, van den Bergh JPW. The Prevalence of Celiac Disease in a Fracture Liaison Service Population. Calcif Tissue Int 2020; 107:327-334. [PMID: 32725291 PMCID: PMC7497300 DOI: 10.1007/s00223-020-00725-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center's FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33-1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.
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Affiliation(s)
- Irma J A de Bruin
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Robert Y van der Velde
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Thera A M Trienekens
- Department of Medical Microbiology, VieCuri Medical Center, Venlo, The Netherlands
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Frank L Wolters
- Department of Gastro-Enterology, VieCuri Medical Center, Venlo, The Netherlands
| | - Siep Wouda
- Department of Pathology, VieCuri Medical Center, Venlo, The Netherlands
| | - Piet P M M Geusens
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands
- Biomedical Research Centre, Hasselt University, Agoralaan-gebouw D, 3590, Diepenbeek, Belgium
| | - Joop P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, PO Box 1926, 5900 BX, Venlo, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands.
- Biomedical Research Centre, Hasselt University, Agoralaan-gebouw D, 3590, Diepenbeek, Belgium.
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de Bruin IJA, Wyers CE, Souverein PC, van Staa TP, Geusens PPMM, van den Bergh JPW, de Vries F, Driessen JHM. The risk of new fragility fractures in patients with chronic kidney disease and hip fracture-a population-based cohort study in the UK. Osteoporos Int 2020; 31:1487-1497. [PMID: 32266436 PMCID: PMC7360657 DOI: 10.1007/s00198-020-05351-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/14/2020] [Indexed: 01/04/2023]
Abstract
Chronic kidney disease (CKD) is a risk factor for fractures. However, in hip fracture patients, CKD G3-G5 was associated with a higher mortality risk and not associated with a higher risk of subsequent non-hip fractures compared to eGFR > 60 ml/min. The higher mortality risk may, as competing risk, explain our findings. INTRODUCTION Chronic kidney disease (CKD) is a known risk factor for fragility fractures. Patients aged 50+ with a recent fragility fracture have an increased risk of subsequent fractures. Our aim was to evaluate the association between CKD stages G3-G5 versus estimated glomerular filtration rate (eGFR) > 60 ml/min and the risk of a new non-hip fracture or fragility fracture in patients with a first hip fracture. METHODS Population-based cohort study using the UK general practices in the Clinical Practice Research Datalink. Associations between CKD stage and first subsequent fracture were determined using Cox proportional hazard analyses to estimate hazard ratios (HRs). To explore the potential competing risk of mortality, cause-specific (cs) HRs for mortality were estimated. RESULTS CKD G3-G5 was associated with a lower risk of any subsequent non-hip fracture (HR: 0.90, 95%CI: 0.83-0.97), but not with the risk of subsequent major non-hip fragility fracture. CKD G3-G5 was associated with a higher mortality risk (cs-HR: 1.05, 95%CI: 1.01-1.09). Mortality risk was 1.5- to 3-fold higher in patients with CKD G4 (cs-HR: 1.50, 95%CI: 1.38-1.62) and G5 (cs-HR: 2.93, 95%CI: 2.48-3.46) compared to eGFR > 60 ml/min. CONCLUSIONS The risk of a subsequent major non-hip fragility fractures following hip fracture was not increased in patients with CKD G3-G5 compared to eGFR > 60 ml/min. Mortality risk was higher in both hip fracture and non-hip fracture patients with CKD G4 and G5. The higher mortality risk may, as competing risk, explain our main finding of no increased or even decreased subsequent fracture risk after a hip fracture in patients with CKD G3-G5.
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Affiliation(s)
- I J A de Bruin
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - P C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
| | - T P van Staa
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, England
| | - P P M M Geusens
- Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
- CAPHRI Care and Public Health Research Institute, Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
| | - F de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - J H M Driessen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Bevers MSAM, Daniels AM, Wyers CE, van Rietbergen B, Geusens PPMM, Kaarsemaker S, Janzing HMJ, Hannemann PFW, Poeze M, van den Bergh JPW. The Feasibility of High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) in Patients with Suspected Scaphoid Fractures. J Clin Densitom 2020; 23:432-442. [PMID: 31495579 DOI: 10.1016/j.jocd.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/26/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Diagnosing scaphoid fractures remains challenging. High-resolution peripheral quantitative computed tomography (HR-pQCT) might be a potential imaging technique, but no data are available on its feasibility to scan the scaphoid bone in vivo. METHODOLOGY Patients (≥18 years) with a clinically suspected scaphoid fracture received an HR-pQCT scan of the scaphoid bone (three 10.2-mm stacks, 61-μm voxel size) with their wrist immobilized with a cast. Scan quality assessment and bone contouring were performed using methods originally developed for HR-pQCT scans of radius and tibia. The contouring algorithm was applied on coarse hand-drawn pre-contours of the scaphoid bone, and the resulting contours (AUTO) were manually corrected (sAUTO) when visually deviating from bone margins. Standard morphologic analyses were performed on the AUTO- and sAUTO-contoured bones. RESULTS Ninety-one patients were scanned. Two out of the first five scans were repeated due to poor scan quality (40%) based on standard quality assessment during scanning, which decreased to three out of the next 86 scans (3.5%) when using an additional thumb cast. Nevertheless, after excluding one scan with an incompletely scanned scaphoid bone, post hoc grading revealed a poor quality in 14.9% of the stacks and 32.9% of the scans in the remaining 85 patients. After excluding two scans with contouring problems due to scan quality, bone indices obtained by AUTO- and sAUTO-contouring were compared in 83 scans. All AUTO-contours were manually corrected, resulting in significant but small differences in densitometric and trabecular indices (<1.0%). CONCLUSIONS In vivo HR-pQCT scanning of the scaphoid bone is feasible in patients with a clinically suspected scaphoid fracture when using a cast with thumb part. The proportion of poor-quality stacks is similar to radius scans, and AUTO-contouring appears appropriate in good- and poor-quality scans . Thus, HR-pQCT may be promising for diagnosis of and microarchitectural evaluations in suspected scaphoid fractures.
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Affiliation(s)
- M S A M Bevers
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - A M Daniels
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - C E Wyers
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - P P M M Geusens
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Faculty of Medicine, Hasselt University, Belgium
| | - S Kaarsemaker
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - H M J Janzing
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - P F W Hannemann
- Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J P W van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Faculty of Medicine, Hasselt University, Belgium.
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Daniels AM, Wyers CE, Janzing HMJ, Sassen S, Loeffen D, Kaarsemaker S, van Rietbergen B, Hannemann PFW, Poeze M, van den Bergh JP. The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT. Bone Joint J 2020; 102-B:478-484. [DOI: 10.1302/0301-620x.102b4.bjj-2019-0632.r3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/05/2022]
Abstract
Aims Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a scaphoid fracture. A secondary aim was to investigate the interobserver agreement for the presence of other fractures and for the classification of scaphoid fracture. Methods Two radiologists and two orthopaedic trauma surgeons evaluated HR-pQCT scans of 31 patients with a clinically-suspected scaphoid fracture. The observers were asked to determine the presence of a scaphoid or other fracture and to classify the scaphoid fracture based on the Herbert classification system. Fleiss kappa statistics were used to calculate the interobserver agreement for the diagnosis of a fracture. Intraclass correlation coefficients (ICCs) were used to assess the agreement for the classification of scaphoid fracture. Results A total of nine (29%) scaphoid fractures and 12 (39%) other fractures were diagnosed in 20 patients (65%) using HR-pQCT across the four observers. The interobserver agreement was 91% for the identification of a scaphoid fracture (95% confidence interval (CI) 0.76 to 1.00) and 80% for other fractures (95% CI 0.72 to 0.87). The mean ICC for the classification of a scaphoid fracture in the seven patients diagnosed with scaphoid fracture by all four observers was 73% (95% CI 0.42 to 0.94). Conclusion We conclude that the diagnosis of scaphoid and other fractures is reliable when using HR-pQCT in patients with a clinically-suspected fracture. Cite this article: Bone Joint J 2020;102-B(4):478–484.
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Affiliation(s)
- Anne M. Daniels
- Department of Surgery, ViCuri Medical Centre, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Caroline E. Wyers
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, ViCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sander Sassen
- Department of Radiology, ViCuri Medical Centre, Venlo, The Netherlands
| | - Daan Loeffen
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, ViCuri Medical Centre, Venlo, The Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pascal F. W. Hannemann
- Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joop P. van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, ViCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Rapagna S, Berahmani S, Wyers CE, van den Bergh JP, Reynolds KJ, Tozzi G, Janssen D, Perilli E. Quantification of human bone microarchitecture damage in press-fit femoral knee implantation using HR-pQCT and digital volume correlation. J Mech Behav Biomed Mater 2019; 97:278-287. [DOI: 10.1016/j.jmbbm.2019.04.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/04/2019] [Accepted: 04/28/2019] [Indexed: 11/27/2022]
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van Maren MA, Wyers CE, Driessen JHM, Visser JV, de Vries F, van de Wijdeven K, Gevers S, Lems WF, Emmelot-Vonk MH, van den Bergh JPW. Two-year persistence with teriparatide improved significantly after introduction of an educational and motivational support program. Osteoporos Int 2019; 30:1837-1844. [PMID: 31321446 PMCID: PMC6717185 DOI: 10.1007/s00198-019-05052-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/27/2018] [Accepted: 06/06/2019] [Indexed: 11/01/2022]
Abstract
UNLABELLED This study evaluated the 2-year persistence with teriparatide in the Netherlands. Analyses showed that the risk of non-persistence was 28% lower in patients who were followed according to an additional educational and motivational support program. INTRODUCTION Until recently, teriparatide (TPTD) was a third-line treatment option for severe osteoporosis in the Netherlands, which could only be prescribed by medical specialists based on a specific medical statement. We aimed to determine whether an educational and motivational support program (EMSP) increased 2-year treatment persistence with TPTD in patients with severe osteoporosis. METHODS We evaluated persistence in 1573 Dutch patients treated with TPTD from January 2013 until January 2018. From January 2013 onwards, all patients received a basic support program (BSP) consisting of an educational home visit to initiate TPTD treatment and phone calls (at 1, 2.5 and 8 weeks). Since May 2015, all patients received the EMSP consisting of the BSP extended with evaluation of medication adherence during phone calls, an additional phone call (at 12 months), and motivational letters at 9 and 14 months. RESULTS The EMSP showed a statistically significantly higher 2-year persistence (78%) with TPTD as compared with the BSP (72%). Reasons for treatment discontinuation were comparable between groups, except for the proportion of patients who had stopped TPTD administration due to side effects, which was significantly lower in the EMSP group (8% vs. 15% in BSP, p < 0.001). Overall, the risk of non-persistence was 28% lower in the EMSP compared with the BSP group (HR: 0.72; 95% CI: 0.55-0.93). CONCLUSION The introduction of the EMSP has demonstrated to improve the persistence with TPTD, resulting in 78% of the patients being persistent with TPTD during the 2-year treatment period.
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Affiliation(s)
- M A van Maren
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, the Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, the Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - J H M Driessen
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Epidemiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center (Maastricht UMC+), Maastricht, the Netherlands
| | | | - F de Vries
- Division of Pharmacoepidemiology and Clinical Epidemiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center (Maastricht UMC+), Maastricht, the Netherlands
| | | | - S Gevers
- ApotheekZorg, Bladel, the Netherlands
| | - W F Lems
- Location VU Medical Center, Department of Rheumatology and Immunology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - M H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, the Netherlands.
- Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands.
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
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Vranken L, Wyers CE, van Rietbergen B, Driessen JHM, Geusens PPMM, Janzing HMJ, van der Velde RY, van den Bergh JPW. The association between prevalent vertebral fractures and bone quality of the distal radius and distal tibia as measured with HR-pQCT in postmenopausal women with a recent non-vertebral fracture at the Fracture Liaison Service. Osteoporos Int 2019; 30:1789-1797. [PMID: 31312863 PMCID: PMC6719323 DOI: 10.1007/s00198-019-05081-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/17/2018] [Accepted: 07/03/2019] [Indexed: 11/21/2022]
Abstract
We evaluated the association between prevalent vertebral fractures and bone micro-architecture and strength measured using HR-pQCT in postmenopausal women with a recent non-vertebral fracture visiting the Fracture Liaison Service. The presence and severity of prevalent vertebral fracture reflect generalized bone deterioration. INTRODUCTION We evaluated the association between prevalent vertebral fractures (VFs) and bone micro-architecture and strength measured using HR-pQCT in postmenopausal women visiting the Fracture Liaison Service. METHODS In this cross-sectional study in women aged 50-90 with a recent non-vertebral fracture (NVF), VFs were identified on lateral spine images by dual-energy X-ray absorptiometry. Bone micro-architecture and strength were measured at the non-dominant distal radius and distal tibia using HR-pQCT. Linear regression analyses were used to estimate the association between prevalent VFs and HR-pQCT parameters. RESULTS We included 338 women of whom 74 (21.9%) women had at least one prevalent VF. After adjustment for femoral neck aBMD (FN aBMD) and other parameters, women with at least one prevalent vertebral fracture had significantly lower total and trabecular vBMD and trabecular number (β - 16.7, - 11.8, and - 7.8 in the radius and - 21.4, - 16.6, and - 7.2 in the tibia, respectively), higher trabecular separation at the radius and tibia (β 9.0 and 9.3, respectively), and lower cortical thickness and calculated ultimate failure load and compressive bone strength at the tibia (β - 5.9, - 0.6, and - 10.9, respectively) as compared with those without prevalent VFs. Furthermore, more severe prevalent VFs were associated with even lower total and trabecular vBMD and lower ultimate failure load and compressive stiffness at the radius and tibia, and lower trabecular number and higher trabecular separation at the radius. CONCLUSION This study indicates that the presence and severity of prevalent VFs reflect generalized bone deterioration in women with a recent NVF, independently of FN aBMD.
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Affiliation(s)
- L Vranken
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - B van Rietbergen
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - J H M Driessen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - P P M M Geusens
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Biomedical Research Center, Hasselt University, Agoralaan, Gebouw D, 3590, Diepenbeek, Belgium
| | - H M J Janzing
- Department of Surgery, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - R Y van der Velde
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center +, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Biomedical Research Center, Hasselt University, Agoralaan, Gebouw D, 3590, Diepenbeek, Belgium.
- Department of Surgery, VieCuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
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Wyers CE, Reijven PLM, Breedveld-Peters JJL, Denissen KFM, Schotanus MGM, van Dongen MCJM, Eussen SJPM, Heyligers IC, van den Brandt PA, Willems PC, van Helden S, Dagnelie PC. Efficacy of Nutritional Intervention in Elderly After Hip Fracture: A Multicenter Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2019; 73:1429-1437. [PMID: 30204859 PMCID: PMC6132112 DOI: 10.1093/gerona/gly030] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Malnutrition after hip fracture is associated with increased rehabilitation time, complications, and mortality. We assessed the effect of intensive 3 month nutritional intervention in elderly after hip fracture on length of stay (LOS). Methods Open-label, randomized controlled trial. Exclusion criteria: age < 55 years, bone disease, life expectancy < 1 year, bedridden, using oral nutritional supplements (ONS) before hospitalization, and cognitive impairment. Intervention: weekly dietetic consultation, energy-protein–enriched diet, and ONS (400 mL per day) for 3 months. Control: usual nutritional care. Primary outcome: total LOS in hospital and rehabilitation clinic, including readmissions over 6 months (Cox regression adjusted for confounders); hazard ratio (HR) < 1.0 reflects longer LOS in the intervention group. Secondary outcomes: nutritional and functional status, cognition, quality of life, postoperative complications (6 months); subsequent fractures and all-cause mortality (1 and 5 years). Effect modification by baseline nutritional status was also tested. Results One hundred fifty-two patients were randomized (73 intervention, 79 control). Median total LOS was 34.0 days (range 4–185 days) in the intervention group versus control 35.5 days (3–183 days; plogrank = .80; adjusted hazard ratio (adjHR): 0.98; 95% CI: 0.68–1.41). Hospital LOS: 12.0 days (4–56 days) versus 11.0 days (3–115 days; p = .19; adjHR: 0.75; 95% CI: 0.53–1.06) and LOS in rehabilitation clinics: 19.5 days (0–174 days) versus 18.5 days (0–168 days; p = .82; adjHR: 1.04; 95% CI: 0.73–1.48). The intervention improved nutritional intake/status at 3, but not at 6 months, and did not affect any other outcome. No difference in intervention effect between malnourished and well-nourished patients was found. Conclusions Intensive nutritional intervention after hip fracture improved nutritional intake and status, but not LOS or clinical outcomes. Paradigms underlying nutritional intervention in elderly after hip fracture may have to be reconsidered.
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Affiliation(s)
- Caroline E Wyers
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Petronella L M Reijven
- Department of Dietetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - José J L Breedveld-Peters
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Karlijn F M Denissen
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Center Sittard-Geleen, The Netherlands
| | - Martien C J M van Dongen
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Simone J P M Eussen
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Ide C Heyligers
- Department of Orthopaedic Surgery, Zuyderland Medical Center Heerlen, Heerlen, The Netherlands
| | - Piet A van den Brandt
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Paul C Willems
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Svenhjalmar van Helden
- Department of Trauma surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Trauma surgery, Isala Klinieken, Zwolle, The Netherlands
| | - Pieter C Dagnelie
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Daniels AM, Theelen LMA, Wyers CE, Janzing HMJ, van Rietbergen B, Vranken L, van der Velde RY, Geusens PPMM, Kaarsemaker S, Poeze M, van den Bergh JP. Bone Microarchitecture and Distal Radius Fracture Pattern Complexity. J Orthop Res 2019; 37:1690-1697. [PMID: 30977554 PMCID: PMC6767516 DOI: 10.1002/jor.24306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/27/2018] [Revised: 03/02/2019] [Accepted: 03/27/2019] [Indexed: 02/04/2023]
Abstract
Distal radius fractures (DRFs) occur in various complexity patterns among patients differing in age, gender, and bone mineral density (BMD). Our aim was to investigate the association of patient characteristics, BMD, bone microarchitecture, and bone strength with the pattern complexity of DRFs. In this study, 251 patients aged 50-90 years with a radiologically confirmed DRF who attended the Fracture Liaison Service of VieCuri Medical Centre, the Netherlands, between November 2013 and June 2016 were included. In all patients fracture risk factors and underling metabolic disorders were evaluated and BMD measurement with vertebral fractures assessment by dual-energy X-ray absorptiometry was performed. Radiographs of all DRFs were reviewed by two independent investigators to assess fracture pattern complexity according to the AO/OTA classification in extra-articular (A), partially articular (B), and complete articular (C) fractures. For this study, patients with A and C fractures were compared. Seventy-one patients were additionally assessed by high-resolution peripheral quantitative computed tomography. Compared to group A, mean age, the proportion of males, and current smokers were higher in group C, but BMD and prevalent vertebral fractures were not different. In univariate analyses, age, male gender, trabecular area, volumetric BMD (vBMD), and stiffness were associated with type C fractures. In multivariate analyses, only male gender (odds ratio (OR) 8.48 95% confidence interval (CI) 1.75-41.18, p = 0.008]) and age (OR 1.11 [95% CI 1.03-1.19, p = 0.007]) were significantly associated with DRF pattern complexity. In conclusion, our data demonstrate that age and gender, but not body mass index, BMD, bone microarchitecture, or strength were associated with pattern complexity of DRFs.© 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. J Orthop Res 37:1690-1697, 2019.
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Affiliation(s)
- Anne M. Daniels
- Department of SurgeryVieCuri Medical CentreVenloThe Netherlands,NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Luuk M. A. Theelen
- Department of Orthopaedic SurgeryVieCuri Medical CentreVenloThe Netherlands
| | - Caroline E. Wyers
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | | | - Bert van Rietbergen
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyEind hovenThe Netherlands,Department of Orthopaedic Surgery, Research School CAPHRIMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Lisanne Vranken
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands
| | - Robert Y. van der Velde
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands
| | - Piet P. M. M. Geusens
- Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands,Faculty of Medicine, Division of Internal MedicineHasselt UniversityHasseltBelgium
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic SurgeryVieCuri Medical CentreVenloThe Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Surgery, Division of TraumasurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Joop P. van den Bergh
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands,Faculty of Medicine, Division of Internal MedicineHasselt UniversityHasseltBelgium
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Abstract
In view of the high imminent risk of having subsequent fractures after a fracture, early evaluation and treatment decisions to prevent subsequent fractures are advocated. After a hip fracture, the fracture liaison service (FLS) and orthogeriatric care are considered the most appropriate organisational approaches for secondary fracture prevention following a recent fracture. Their introduction and implementation have been shown to increase evaluation and treatment of patients at high risk for subsequent fracture. Of real-world cohort studies, most, but not all studies, indicate a lower incidence of fracture and longer survival after treatment with nitrogen-containing bisphosphonates.
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Affiliation(s)
- Piet Geusens
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre +, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Biomedical Research Centre, Hasselt University, Agoralaan, Gebouw D, 3590 Diepenbeek, Belgium.
| | - Sandrine P G Bours
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre +, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - Caroline E Wyers
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, the Netherlands.
| | - Joop P van den Bergh
- Biomedical Research Centre, Hasselt University, Agoralaan, Gebouw D, 3590 Diepenbeek, Belgium; Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, the Netherlands.
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de Bruin IJA, Klop C, Wyers CE, Overbeek JA, Geusens PPMM, van den Bergh JPW, Driessen JHM, de Vries F. All-cause mortality with current and past use of antidepressants or benzodiazepines after major osteoporotic and hip fracture. Osteoporos Int 2019; 30:573-581. [PMID: 30737577 PMCID: PMC6422967 DOI: 10.1007/s00198-019-04851-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/10/2019] [Indexed: 01/22/2023]
Abstract
UNLABELLED In the first year, after an osteoporotic fracture of a hip, forearm, upper arm, or spine, the dispensing rates of antidepressants and benzodiazepines increased significantly. After those fractures, recent and past use of antidepressants and benzodiazepines was associated with increased all-cause mortality; current use was not associated with mortality risk. INTRODUCTION It remains unclear to what extent use of antidepressants and benzodiazepines is associated with mortality risk after a major osteoporotic fracture (MOF). We aimed to study the cumulative use of antidepressants and benzodiazepines during the year after MOF or hip fracture (HF) and whether the use was associated with mortality. METHODS A cohort study was performed within the Dutch PHARMO Database Network including all patients aged 65+ with a first record of MOF (hip, humerus, forearm, and clinical vertebral fracture) between 2002 and 2011. Data were analyzed using Cox regression models, adjusted for comorbidities, and concomitant medication use and broken down to index fracture type. RESULTS A total of 4854 patients sustained a first MOF, of whom 1766 patients sustained a HF. Mean follow-up was 4.6 years, divided in 30-day periods. The cumulative antidepressant and benzodiazepine use during the first year after MOF increased from 10.6 to 14.7% and from 24.0 to 31.4%, respectively. Recent (31-92 days before each follow-up period) and past use (> 92 days before) of antidepressants and benzodiazepines after MOF or HF was associated with an increased all-cause mortality risk but current use (< 30 days before) was not. CONCLUSION There is a considerable increase in dispensing rate of antidepressants and benzodiazepines in the first year after a MOF. Recent and past use of these medications was associated with all-cause mortality. The finding that current use was not associated with mortality should be further explored and may probably be explained by the healthy survivor's bias.
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Affiliation(s)
- I J A de Bruin
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
| | - C Klop
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcome Research, Utrecht, Netherlands
| | - P P M M Geusens
- Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
- CAPHRI, Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center +, Maastricht, Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
- Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
| | - J H M Driessen
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- NUTRIM/CAPHRI, Maastricht University Medical Center +, Maastricht, Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P Debyelaan 25, Maastricht, Netherlands
| | - F de Vries
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P Debyelaan 25, Maastricht, Netherlands.
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
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van der Velde RY, Wyers CE, Geusens PPMM, van den Bergh JPW, de Vries F, Cooper C, van de Staa TP, Harvey NC. Incidence of subsequent fractures in the UK between 1990 and 2012 among individuals 50 years or older. Osteoporos Int 2018; 29:2469-2475. [PMID: 30030587 PMCID: PMC6205600 DOI: 10.1007/s00198-018-4636-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/12/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
We studied the incidence of subsequent fractures in persons of 50+ years from 1990 to 2012 and the relative risk (RR) of subsequent fractures after an index femur/hip fracture, stratified per 5-year age band. Patients suffering a fracture have a high incidence of a subsequent fracture; the RR of subsequent fracture after a femur/hip fracture ranged from 2 to 7. INTRODUCTION Recent information on the risk of subsequent fractures after a broad range of index fractures in the UK population is scarce. We therefore studied the rates of subsequent fractures of the femur/hip, humerus, radius/ulna, vertebrae, rib, or pelvis after fractures at one of these sites from 1990 to 2012 in 3,156,347 UK men and women aged 50 years or over. METHODS We undertook a retrospective observational study using the UK Clinical Practice Research Datalink (CPRD). The incidence of subsequent fractures at a specific site was calculated by dividing the observed number of fractures by the number of person-years (py) at risk. The relative risk (RR) of subsequent fractures after a femur/hip fracture, by 5-year age band, was calculated by dividing the incidence of a specific subsequent fracture type by the incidence of first fractures at the same site in the same age group. RESULTS The highest subsequent fracture incidence after a femur/hip fracture was for humerus fracture in men (59.5/10.000 py) and radius/ulna fracture in women (117.2/10.000 py). After an index fracture of the radius/ulna, humerus fracture in men (59.3/10.000 py) and femur/hip fracture in women (82.4 per 10.000 py) were most frequent. The RR of fractures after a femur/hip fracture ranged from 2 to 7 and were highest in men and younger age groups. CONCLUSION Patients suffering a fracture have a high incidence of a subsequent fracture. Our findings demonstrate the importance of fracture prevention in patients with a history of a fracture by adequate medical diagnosis and treatment.
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Affiliation(s)
- R Y van der Velde
- Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - P P M M Geusens
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD, Maastricht, The Netherlands
- Biomedical Research Centre, Hasselt University, Agoralaan - gebouw D, 3590, Diepenbeek, Belgium
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, PO Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre (MUMC), PO Box 616, 6200 MD, Maastricht, The Netherlands
- Biomedical Research Centre, Hasselt University, Agoralaan - gebouw D, 3590, Diepenbeek, Belgium
| | - F de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - T P van de Staa
- Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Health eResearch Centre, University of Manchester, Manchester, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
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Hiligsmann M, Wyers CE, Mayer S, Evers SM, Ruwaard D. A systematic review of economic evaluations of screening programmes for cardiometabolic diseases. Eur J Public Health 2018; 27:621-631. [PMID: 28040737 DOI: 10.1093/eurpub/ckw237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background The early detection and adequate management of cardiometabolic diseases (CMD) is becoming a priority to prevent future health problems and related healthcare costs. Aim This study systematically reviewed the economic evaluations of screening programmes for the early detection of persons at risk for CMD. Methods A systematic review was conducted using MEDLINE, Web of Science, NHSEED and the CEA registry to identify relevant articles published between 1 January 2005 and 1 May 2015. Two reviewers independently selected articles, systematically extracted data and critically appraised the study quality using the Extended Consensus on Health Economic Criteria (CHEC) List. Results From the initial 2820 studies identified, 17 were included. Six studies assessed whether screening would be cost-effective, seven aimed to determine the most efficient screening programme and four assessed the cost-effectiveness of existing programmes. There were 11 cost-utility analyses using quality-adjusted life years (QALYs) or disability-adjusted life years. Decision-analytic modelling (e.g. Markov model) was most frequently used (n = 10), followed by simulation models (n = 4), observational (n = 2) and trial-based (n = 1) studies. All studies assessing the cost per QALY gained of screening for cardiovascular diseases and diabetes mellitus (n = 8) were below a threshold of £30 000, while those assessing chronic kidney diseases (n = 2) were above the threshold. Conclusions: In view of the heterogeneity in study objectives, country setting, screening programmes, comparators, methodology and outcomes, it is not possible to make clear recommendations about the economic value of screening programmes for CMD. Developing further screening programmes and conducting thorough economic analysis, including usual care, is needed.
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Affiliation(s)
- Mickael Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands.,Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Susanne Mayer
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Silvia M Evers
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Vranken L, Wyers CE, Van der Velde RY, Janzing HM, Kaarsemaker S, Geusens PP, Van den Bergh JP. Comorbidities and medication use in patients with a recent clinical fracture at the Fracture Liaison Service. Osteoporos Int 2018; 29:397-407. [PMID: 29170857 PMCID: PMC5818578 DOI: 10.1007/s00198-017-4290-y] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/25/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED In this cross-sectional study, two-thirds of Fracture Liaison Service (FLS) patients had comorbidities and medications associated with increased bone- or fall-related fracture risk. Bone-related and fall-related fracture risk (BRR and FRR) were associated with age and fracture type, but not with gender or BMD. Systematic evaluation of these factors leads to a more profound assessment in FLS care. INTRODUCTION This study is a systematic evaluation of comorbidities and medications associated with increased fracture risk in patients aged 50-90 years with a recent fracture visiting the FLS. METHODS In this cross-sectional cohort study, comorbidities were classified according to ICD-10 and medications according to the Anatomic Therapeutic Chemical (ATC) classification and further categorized into those associated BRR and FRR. RESULTS Of 1282 patients (72% women; 65 ± 9 years), 53% had at least one BRR, 46% had at least one FRR, and 66% at least one BRR and/or FRR. At least one BRR, as well as at least one FRR were associated with age, BMI, and fracture type, but not with gender or BMD. The proportion of patients with only BRR (± 20%) or only FRR (± 10%) was similar among ages, gender, BMI, fracture type, and BMD. The combination of at least one BRR and at least one FRR was significantly associated with age, BMI, and major fractures, but not with gender or BMD. CONCLUSION Comorbidities and medications associated with increased fracture risk are present in two-thirds of patients visiting the FLS. In addition, the proportion of patients having a combination of BRR and FRR increased significantly with age, BMI, and fracture severity. This indicates that systematic evaluation of these factors is important for a more profound assessment of subsequent fracture risk in FLS care.
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Affiliation(s)
- L Vranken
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - R Y Van der Velde
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - H M Janzing
- Department of Surgery, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - S Kaarsemaker
- Department of Orthopaedic Surgery, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
| | - P P Geusens
- Department of Internal Medicine, Subdivision Rheumatology, CAPHRI, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Biomedical Research Centre, Hasselt University, Agoralaan, Gebouw D, 3590, Diepenbeek, Belgium
| | - J P Van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Biomedical Research Centre, Hasselt University, Agoralaan, Gebouw D, 3590, Diepenbeek, Belgium
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50
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den Teuling JWAM, Pauwels BS, Janssen L, Wyers CE, Janzing HMJ, van den Bergh JPW, Morrenhof JW. The influence of bone mineral density and cortical index on the complexity of fractures of the proximal humerus. Bone Joint Res 2017; 6:584-589. [PMID: 29054991 PMCID: PMC5670366 DOI: 10.1302/2046-3758.610.bjr-2017-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The goal of this study is to investigate the relation between indicators of osteoporosis (i.e., bone mineral density (BMD), and Cortical Index (CI)) and the complexity of a fracture of the proximal humerus as a result of a low-energy trauma. METHODS A retrospective chart review of 168 patients (mean age 67.2 years, range 51 to 88.7) with a fracture of the proximal humerus between 2007 and 2011, whose BMD was assessed at the Fracture Liaison Service with Dual Energy X-ray Absorptiometry (DXA) measurements of the hip, femoral neck (FN) and/or lumbar spine (LS), and whose CI and complexity of fracture were assessed on plain anteroposterior radiographs of the proximal humerus. RESULTS No significant differences were found between simple and complex fractures of the proximal humerus in the BMD of the hip, FN or LS (all p > 0.3) or in the CI (p = 0.14). Only the body mass index was significantly higher in patients with a complex fracture compared with those with a simple fracture (26.9 vs 25.2; p = 0.05). CONCLUSION There was no difference in BMD of the hip, FN, LS or CI of the proximal humerus in simple compared with complex fractures of the proximal humerus after a low-energy trauma. Factors other than the BMD and CI, for example body mass index, may play a more important role in the complexity of this fracture.Cite this article: J.W.A.M. den Teuling, B.S. Pauwels, L. Janssen, C.E. Wyers, H. M. J. Janzing, J.P.W. van den Bergh, J. W. Morrenhof. The Influence of bone mineral density and cortical index on the complexity of fractures of the proximal humerus. Bone Joint Res 2017;6:584-589. DOI: 10.1302/2046-3758.610.BJR-2017-0080.
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Affiliation(s)
- J W A M den Teuling
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - B S Pauwels
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - L Janssen
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Venlo and Maastricht, The Netherlands
| | - H M J Janzing
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Venlo and Maastricht, The Netherlands
| | - J W Morrenhof
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
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