| 31. |
- Redlund-Johnell, Inga, et al.
(författare)
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Backward tilting of the posterior atlantal arch in rheumatoid arthritis
- 1989
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 1502-7732 .- 0300-9742. ; 18:5, s. 261-263
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Tidskriftsartikel (refereegranskat)abstract
- In a retrospective survey of 450 patients with rheumatoid arthritis on whom cervical spine radiography was performed, one patient was found with a backward tilting of the posterior arch of the atlas. With preserved relations anteriorly, the posterior arch was rotated downward in front of the spinous process of the axis, encroaching on the space of the spinal canal.
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| 32. |
- Ringsberg, Karin A.M., et al.
(författare)
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The impact of long-term moderate physical activity on functional performance, bone mineral density and fracture incidence in elderly women
- 2001
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Ingår i: Gerontology. - : S. Karger AG. - 1423-0003 .- 0304-324X. ; 47:1, s. 15-20
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Earlier studies have shown that physical exercise and a higher workload increase muscle strength and improve gait and balance at all ages for both sexes. Published studies have, so far, failed to investigate the functional performance of elderly individuals concerning their long-term physical activity and variables of daily living. OBJECTIVE: To compare elderly women who participate in long-term, moderate exercise programmes with two age-matched groups of women from an urban and a rural community. METHODS: All participants answered a questionnaire about health, social circumstances and fractures. We measured the vibration threshold of the lower extremities, bone mineral density of the distal radius and functional performance such as muscle strength, balance and gait. RESULTS: The elderly, active groups performed significantly better in all functional tests and had sustained fewer fractures than the urban control group. When the comparison was made with the rural control group the differences were less obvious. The active group rated their health as better than both the control groups. CONCLUSION: Elderly women, who continue with moderate exercise programmes over many years, sustain fewer fractures and have better muscle strength, balance, gait and health ratings than women in general. Whether this is the result of the exercise or inherited characters, remains to be proved.
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| 33. |
- Sahlstrom, Arne, et al.
(författare)
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The natural course of arthrosis of the knee
- 1997
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Ingår i: Clinical Orthopaedics and Related Research. - 0009-921X. ; 340, s. 152-157
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the course of untreated or conservatively treated arthrosis of the knee joint. Of 265 patients presenting with knee pain who had weightbearing radiographs taken between 1970 and 1973, 132 (33 men and 99 women) responded to and participated in a clinical followup 20 years later using the Hospital for Special Surgery score and new weightbearing radiographs. Arthrosis was defined as an equal to or greater than 50% joint space narrowing. In 75 of 132 knees of Ahlback Class 0 (57%) and 20 of 52 knees of Ahlback Class I (39%), the classification remained unchanged. The Hospital for Special Surgery score at followup was compared with the Ahlback classes in the 1970s for the 110 cases for which surgery was not done. A higher Ahlback class at the time of presentation was associated with lower functional score (Hospital for Special Surgery) 20 years later. In addition, in the contralateral knee a reduction of joint space may occur. In the arthrosis group with total joint space reduction or attrition there was a clinical and radiographic deterioration that would merit surgical intervention to avoid unnecessary loss of function. However, in knees with equal to or greater than 50% joint space reduction (Ahlback I) and pain, a considerable number (39%) did not deteriorate radiographically during a 20-year period, and 25% remain free of pain. It appears that the long-term prognosis of mild knee arthrosis is not necessarily poor. A substantial number of these patients will not have progression of the arthrosis.
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| 34. |
- Sernbo, Ingmar, et al.
(författare)
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Radiographic prediction of failure after fixation of cervical hip fracture
- 1994
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 65:3, s. 295-298
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Tidskriftsartikel (refereegranskat)abstract
- During 1984-1985, 410 patients with cervical hip fracture were randomized between 2 methods of internal fixation--a single nail (Rydell) or 2 LIH hook pins (LIH). The patients were followed-up prospectively for at least 2 years. Radiographs were taken after 1 week, 1, 3, 6, 12, and 24 months. The radiographs of the 295 patients alive 2 years postoperatively were examined by one of the authors. The sliding and the diversion of the pins and the nail in the anteroposterior projection and the diversion in the lateral projection were measured. In the failure group (non-union, late segmental collapse), the greatest sliding was noted within 1 month postoperatively and the diversion increased up to 3 months. Significant differences between the failure and the non-failure groups could be seen even after 1 week. We also found that the degree of sliding of the LIH pins and the Rydell nail 1 month postoperatively is comparable to the scintigraphic pattern 2 weeks postoperatively in predicting failure after internal fixation of cervical hip fractures.
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| 35. |
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| 36. |
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| 37. |
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| 38. |
- Boonen, S, et al.
(författare)
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The need for clinical guidance in the use of calcium and vitamin D in the management of osteoporosis: a consensus report
- 2004
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 15:7, s. 511-519
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Forskningsöversikt (refereegranskat)abstract
- A European Union (EU) directive on vitamins and minerals used as ingredients of food supplements with a nutritional or physiological effect (2002/46/EC) was introduced in 2003. Its implications for the use of oral supplements of calcium and vitamin D in the prevention and treatment of osteoporosis were discussed at a meeting organized with the help of the World Health Organization ( WHO) Collaborating Center for Public Health Aspects of Rheumatic Diseases (Liege, Belgium) and the support of the WHO Collaborating Center for Osteoporosis Prevention (Geneva, Switzerland). The following issues were addressed: Is osteoporosis a physiological or a medical condition? What is the evidence for the efficacy of calcium and vitamin D in the management of postmenopausal osteoporosis? What are the risks of self-management by patients in osteoporosis? From their discussions, the panel concluded that: (1) osteoporosis is a disease that requires continuing medical attention to ensure optimal therapeutic benefits; (2) when given in appropriate doses, calcium and vitamin D have been shown to be pharmacologically active (particularly in patients with dietary deficiencies), safe, and effective for the prevention and treatment of osteoporotic fractures; (3) calcium and vitamin D are an essential, but not sufficient, component of an integrated management strategy for the prevention and treatment of osteoporosis in patients with dietary insufficiencies, although maximal benefit in terms of fracture prevention requires the addition of antiresorptive therapy; (4) calcium and vitamin D are a cost-effective medication in the prevention and treatment of osteoporosis; (5) it is apparent that awareness of the efficacy of calcium and vitamin D in osteoporosis is still low and further work needs to be done to increase awareness among physicians, patients, and women at risk; and (6) in order that calcium and vitamin D continues to be manufactured to Good Manufacturing Practice standards and physicians and other health care professionals continue to provide guidance for the optimal use of these agents, they should continue to be classified as medicinal products.
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| 39. |
- Borgstrom, F, et al.
(författare)
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Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden - An economic evaluation based on the MORE study
- 2004
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Ingår i: PharmacoEconomics. - : Adis Data Information BV.. - 1179-2027 .- 1170-7690. ; 22:17, s. 1153-1165
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Multiple Outcomes of Raloxifene Evaluation (MORE) study showed that treatment with raloxifene reduces the risk of vertebral fracture and breast cancer in postmenopausal women with osteoporosis. Objective: Based on the MORE study the aim of the present study was to assess the cost effectiveness of raloxifene (compared with no treatment) for the treatment of osteoporosis in postmenopausal women in Sweden. Design: A revised version of a previously developed computer simulation model was used. The impact of the risk-reducing effect of raloxifene on vertebral fractures and breast cancer on cost effectiveness was analysed using a clinical and a morphometric definition of vertebral fracture. Benefits of raloxifene treatment were measured in quality-adjusted life-years (QALYs) and life-years gained. The study estimated the cost effectiveness mainly from a healthcare perspective but the cost effectiveness taking a societal perspective was also analysed. Results: Intervention costs (in Swedish kronor [SEK] and euros [E], year 2001 values) in postmenopausal women with a relative risk of vertebral fracture of 2 were SEK372 000 (E40 000) SEK303 000 (E33 000) and SEK263 000 (E28 000) per QALY for women aged 60, 70 and 80 years, at start of treatment, respectively, when the clinical vertebral definition was used. The cost effectiveness using a clinical morphometric vertebral fracture definition was similar to the cost effectiveness using a clinical vertebral fracture definition. Conclusions: In relation to accepted threshold values for cost per QALY in Sweden, this model indicates, with its underlying assumptions and data that raloxifene (compared with no treatment) is cost effective for the treatment of postmenopausal women at an increased risk of vertebral fracture. from the Swedish healthcare and societal perspectives.
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| 40. |
- Borgstrom, F, et al.
(författare)
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The cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective
- 2006
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 17:7, s. 996-1007
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Risedronate, a bisphosphonate for treatment and prevention of osteoporosis, has been shown in several clinical trials to reduce the risk of fractures in postmenopausal women with osteoporosis. The cost-effectiveness of risedronate treatment has previously been evaluated within different country settings using different model and analysis approaches. The objective of this study was to assess the cost-effectiveness of risedronate in postmenopausal women in four European countries-Sweden, Finland, Spain, and Belgium-by making use of the same modelling framework and analysis setup. Methods: A previously developed Markov cohort model for the evaluation of osteoporosis treatments was used to estimate the cost-effectiveness of risedronate treatment. For each country, the model was populated with local mortality, fracture incidence, and cost data. Hip fractures, clinical vertebral fractures, and wrist fractures were included in the model. Results: The incremental cost per quality-adjusted life years (QALY) gained from a 5-year intervention with risedronate compared to "no intervention" in 70-year-old women at the threshold of osteoporosis [T-score = -2.5 based on National Health and Nutrition Examination Survey (NHANES) III data] and previous vertebral fracture was estimated to be E860, E19,532, E11,782, and E32,515 in Sweden, Finland, Belgium, and Spain, respectively. Among 70-year-old women at the threshold of osteoporosis without previous fracture the estimated cost per QALY gained ranged from E21,148 (Sweden) to E80,100 (Spain). The differences in cost-effectiveness between countries are mainly explained by different costs (fracture and treatment costs), fracture risks, and discount rates. Based on cost per QALY gained threshold values found in the literature, the study results indicated risedronate to be cost effective in the treatment of elderly women with established osteoporosis in all the included countries. Conclusions: At a hypothetical threshold value of E40,000 per QALY gained, the results in this study indicate that risedronate is a cost-effective treatment in elderly women at the threshold of osteoporosis (i.e., a T-score of -2.5) with prevalent vertebral fractures in Sweden, Finland, Belgium, and Spain.
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