| 41. |
- Jaiswal, Raju, et al.
(författare)
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Hemoglobin Levels Improve Fracture Risk Prediction in Addition to FRAX Clinical Risk Factors and Bone Mineral Density
- 2023
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Ingår i: The Journal of clinical endocrinology and metabolism. - : Endocrine Society. - 1945-7197 .- 0021-972X. ; 108:12
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX, the most utilized fracture prediction tool worldwide, is unknown. OBJECTIVE: To investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate whether Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs). METHODS: A total of 2778 community-dwelling women, aged 75-80 years, and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs, and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive. RESULTS: The median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), and lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included and not included ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively. CONCLUSION: Anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk.
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| 42. |
- Johnson, Matthew F., et al.
(författare)
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Accounting for the power of nature: Using flume and field studies to compare the capacities of bio-energy and fluvial energy to move surficial gravels
- 2024
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Ingår i: Earth Surface Processes and Landforms. - : John Wiley & Sons. - 0197-9337 .- 1096-9837. ; 49:9, s. 2612-2627
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Tidskriftsartikel (refereegranskat)abstract
- River channels, riparian and floodplain forms and dynamics are all influenced strongly by biological processes. However, the influence of macroinvertebrates on entrainment and transport of river sediments remains poorly understood. We use an energy-based approach to explore the capacity of benthic animals to move surficial, gravel-bed particles in field and laboratory settings and use the results to assess the relative significance of biological and physical benthic processes. Our results showed that in 11 British gravel-bed rivers, the maximum energy content (i.e., calorific content) of macroinvertebrate communities generally matched the flow energy associated with median discharges and, at multiple sites, exceeded that of the 10-year return interval flood. A series of laboratory experiments used to estimate the minimum energy expended by signal crayfish (Pacifastacus leniusculus) when performing geomorphic work established that crayfish move gravel particles at energy levels below that expected of the flow, complicating direct comparisons of the capacity for macroinvertebrates and fluvial flows to influence bed mobility. Our findings suggest that the influence of macroinvertebrate communities in either promoting or suppressing, the mobilisation of the bed may be large compared to equivalent values of fluvial energy. Based on these findings, we conclude that in the gravel-bed rivers studied, the macroinvertebrate community's potential to perform geomorphic work matches or exceeds the stream power during most of the year. Although our study examined biological and fluvial energy systems separately, it is important to recognise that in nature, these systems are highly interactive. It follows that utilising the energy framework presented in this paper could lead to rapid advances in both fluvial biogeomorphology and river management and restoration.
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| 43. |
- Kanis, J. A., et al.
(författare)
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Overview of Fracture Prediction Tools
- 2017
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Ingår i: Journal of Clinical Densitometry. - : Elsevier BV. - 1094-6950. ; 20:3, s. 444-450
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Tidskriftsartikel (refereegranskat)abstract
- The characterization of risk factors for fracture that contribute significantly to fracture risk, over and above that provided by the bone mineral density, has stimulated the development of risk assessment tools. The more adequately evaluated tools, all available online, include the FRAX (R) tool, the Garvan fracture risk calculator and, in the United Kingdom only, QFracture (R). Differences in the input variables, output, and model construct give rise to marked differences in the computed risks from each calculator. Reasons for the differences include the derivation of fracture probability (FRAX) rather than incidence (Garvan and QFracture), limited calibration (Garvan), and inappropriate source information (QFracture). These differences need to be taken into account in the evaluation of assessment guidelines.
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| 44. |
- Kanis, John A., et al.
(författare)
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Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk
- 2024
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Ingår i: OSTEOPOROSIS INTERNATIONAL. - 0937-941X .- 1433-2965.
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Tidskriftsartikel (refereegranskat)abstract
- Task Force on 'Clinical Algorithms for Fracture Risk' commissioned by the American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee has recommended that FRAX (R) models in the US do not include adjustment for race and ethnicity. This position paper finds that an agnostic model would unfairly discriminate against the Black, Asian and Hispanic communities and recommends the retention of ethnic and race-specific FRAX models for the US, preferably with updated data on fracture and death hazards. In contrast, the use of intervention thresholds based on a fixed bone mineral density unfairly discriminates against the Black, Asian and Hispanic communities in the US. This position of the Working Group on Epidemiology and Quality of Life of the International Osteoporosis Foundation (IOF) is endorsed both by the IOF and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).
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| 45. |
- Tobias, Jonathan H., et al.
(författare)
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Femoral neck width genetic risk score is a novel independent risk factor for hip fractures
- 2024
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Ingår i: JOURNAL OF BONE AND MINERAL RESEARCH. - 0884-0431 .- 1523-4681. ; 39:3, s. 241-251
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Tidskriftsartikel (refereegranskat)abstract
- Femoral neck width (FNW) derived from DXA scans may provide a useful adjunct to hip fracture prediction. Therefore, we investigated whether FNW is related to hip fracture risk independently of femoral neck bone mineral density (FN-BMD), using a genetic approach. FNW was derived from points automatically placed on the proximal femur using hip DXA scans from 38 150 individuals (mean age 63.8 yr, 48.0% males) in UK Biobank (UKB). Genome-wide association study (GWAS) identified 71 independent genome-wide significant FNW SNPs, comprising genes involved in cartilage differentiation, hedgehog, skeletal development, in contrast to SNPs identified by FN-BMD GWAS which primarily comprised runx1/Wnt signaling genes (MAGMA gene set analyses). FNW and FN-BMD SNPs were used to generate genetic instruments for multivariable Mendelian randomization. Greater genetically determined FNW increased risk of all hip fractures (odds ratio [OR] 1.53; 95% CI, 1.29-1.82 per SD increase) and femoral neck fractures (OR 1.58;1.30-1.92), but not trochanteric or forearm fractures. In contrast, greater genetically determined FN-BMD decreased fracture risk at all 4 sites. FNW and FN-BMD SNPs were also used to generate genetic risk scores (GRSs), which were examined in relation to incident hip fracture in UKB (excluding the FNW GWAS population; n = 338 742, 3222 cases) using a Cox proportional hazards model. FNW GRS was associated with increased risk of all incident hip fractures (HR 1.08;1.05-1.12) and femoral neck fractures (hazard ratio [HR] 1.10;1.06-1.15), but not trochanteric fractures, whereas FN-BMD GRS was associated with reduced risk of all hip fracture types. We conclude that the underlying biology regulating FNW and FN-BMD differs, and that DXA-derived FNW is causally related to hip fractures independently of FN-BMD, adding information beyond FN-BMD for hip fracture prediction. Hence, FNW derived from DXA analyses or a FNW GRS may contribute clinically useful information beyond FN-BMD for hip fracture prediction. Femoral neck width (FNW) derived from DXA scans may provide useful information about hip fracture prediction, over and above that provided by BMD measurements. Therefore, we investigated whether FNW is related to hip fracture risk independently of BMD, using a genetic approach. FNW was derived from points automatically placed on the hip in DXA scans obtained from 38 150 individuals (mean age 63.8 yr, 48.0% males) in UK Biobank. Seventy-one distinct genetic factors were found to be associated with FNW. Individuals who were predicted by their genes to have greater FNW had a higher risk of hip but not forearm fractures. In contrast, those with greater genetically determined BMD of the femoral neck had a lower risk of both hip and forearm fractures. We conclude that the underlying biology regulating FNW and BMD of the femoral neck differs, and that FNW derived from DXA analyses may contribute clinically useful information beyond BMD for hip fracture prediction.
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| 46. |
- Westbury, Leo D., et al.
(författare)
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Predictive value of sarcopenia components for all-cause mortality: findings from population-based cohorts
- 2024
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Ingår i: AGING CLINICAL AND EXPERIMENTAL RESEARCH. - : Springer. - 1594-0667 .- 1720-8319. ; 36:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Low grip strength and gait speed are associated with mortality. However, investigation of the additional mortality risk explained by these measures, over and above other factors, is limited.Aim We examined whether grip strength and gait speed improve discriminative capacity for mortality over and above more readily obtainable clinical risk factors.Methods Participants from the Health, Aging and Body Composition Study, Osteoporotic Fractures in Men Study, and the Hertfordshire Cohort Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over 2.4-6 m. Verified deaths were recorded. Associations between sarcopenia components and mortality were examined using Cox regression with cohort as a random effect; discriminative capacity was assessed using Harrell's Concordance Index (C-index).Results Mean (SD) age of participants (n = 8362) was 73.8(5.1) years; 5231(62.6%) died during a median follow-up time of 13.3 years. Grip strength (hazard ratio (95% CI) per SD decrease: 1.14 (1.10,1.19)) and gait speed (1.21 (1.17,1.26)), but not ALM index (1.01 (0.95,1.06)), were associated with mortality in mutually-adjusted models after accounting for age, sex, BMI, smoking status, alcohol consumption, physical activity, ethnicity, education, history of fractures and falls, femoral neck bone mineral density (BMD), self-rated health, cognitive function and number of comorbidities. However, a model containing only age and sex as exposures gave a C-index (95% CI) of 0.65(0.64,0.66), which only increased to 0.67(0.67,0.68) after inclusion of grip strength and gait speed.Conclusions Grip strength and gait speed may generate only modest adjunctive risk information for mortality compared with other more readily obtainable risk factors.
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