| 1. |
- Albertsson, Daniel M, 1957-, et al.
(författare)
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Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study
- 2010
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Ingår i: BMC Musculosceletal disorders. - 1471-2474. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD) technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL) and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA) technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis) among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality) Index combined the clinical risk factors age ≥80 years, weight <60 kg, prior fragility fracture, and impaired rise-up ability. Women having 2-4 risk factors showed odds ratio (OR) for hip fracture of 5.9 and fragility fracture of 4.4. High risk group hip fracture risk was 2.8% annually compared to 0.5% for the low risk majority (69%). Heel BMD showed hip fracture OR of 3.1 and fragility fracture OR of 2.6 per SD decrease. For 30 DXA assessed participants mean hip BMD at -2.5 SD level corresponded to a lower BMD at the heel. Five of seven hip fractures occurred within a small risk group of 32 women, identified by high FRAMO Index + prior fragility fracture + heel T-score ≤-3.5 SD. Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%). These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.
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| 2. |
- Albertsson, Daniel M, 1957-, et al.
(författare)
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Risk group for hip fracture in elderly women identified by primary care questionnaire--clinical implications.
- 2006
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Ingår i: Upsala journal of medical sciences. - 0300-9734. ; 111:2, s. 179-87
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Every fourth Swedish woman suffers hip fracture during life-time. Several methods for fall and fracture prevention are known. In this study we identify women at high hip fracture risk in a primary care population, describing their needs for possible fracture prevention as well. METHODS: Cross-sectional questionnaire study for self-assessment by randomly chosen elderly women (n=100) over 70 years of age in a Primary health Care district at 1998. Questionnaire was designed from previous validated study. Follow-up study after three years performed at 2001. RESULTS: Response rate was 92% (n=92, mean age 78) and 90% (n=83) answered the main 40 questions. 30% had at least two of four major risk factors for hip fracture; age over 80 years, body weight below 60 kg, recent fall and previous fragility fracture. The recall ability for at least two of these four risk factors was 93% in follow-up study after three years (relative risk = 8.0 with 95% confidence interval 3.5 to 18). 34% of the women had experienced any fracture since the age of 50. Only 22% of the women with previous fragility fracture had any pharmacological treatment for osteoporosis. 26% had falls in the preceding 12 months, mainly at home. Needs for fracture prevention were found in 34% (27 women). CONCLUSIONS: Age, weight, recent falls or previous fragility fracture were common and important clinical risk factors for hip fracture with good recall ability after three years. By using this questionnaire in a Primary health Care district we identified women at high fracture risk. Needs for fracture prevention were observed for one third.
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| 3. |
- Albertsson, Daniel M, 1957-, et al.
(författare)
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Validation of a 4-item score predicting hip fracture and mortality risk among elderly women.
- 2007
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Ingår i: Annals of family medicine. - 1544-1717. ; 5:1, s. 48-56
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: One in 4 Swedish women experiences a hip fracture, an event that has high concomitant morbidity and mortality. We developed and validated a clinical predictor of fracture and mortality risk, the Fracture and Mortality (FRAMO) Index. METHODS: This was a population-based prospective cohort study with a baseline questionnaire and 2-year outcomes of hip fracture, fragility fracture, and death. The questionnaire was sent to 1,498 women aged 70 years or older in 3 rural populations, asking them about their age, weight, height, mobility, previous fractures, smoking, medication use, and housing. Some women were also asked about previous vertebral radiographs. We defined 2 risk models before outcome data collection and subsequently renamed 1 model (age =80 years, weight <60 kg, previous fragility fracture, and the need to use arms to rise from the sitting position) the FRAMO Index. We used logistic regression analysis to study the association between the FRAMO Index and outcomes in all participants. RESULTS: The participation rate was 83% in this elderly female population (N = 1,248). The 63% of women with 0 to 1 risk factor had a 2-year hip fracture risk of 0.8% and mortality risk of 3.2%. In contrast, women with 2 to 4 risk factors had a 2-year hip fracture risk of 5.4% (odds ratio = 7.5; 95% confidence interval, 3.0-18.4) and mortality risk of 23.7% (odds ratio = 9.5; 95% confidence interval, 6.0-14.9). These differences remained significant after adjustment for age as a continuous variable. Mortality increased with the number of risk factors. The proportion of women reporting previous vertebral fractures was higher among the group specifically questioned about vertebral radiographs (P <.001). CONCLUSIONS: The FRAMO Index identified the majority of women who experienced hip fractures during a 2-year follow-up, who might have been candidates for intensified preventive measures. The FRAMO Index, based on 4 binary risk factors, would be practical for routine use in primary care.
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| 4. |
- Almqvist, Erik G., et al.
(författare)
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Factors influencing insulin sensitivity in patients with mild primary hyperparathyroidism before and after parathyroidectomy
- 2012
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Ingår i: Scandinavian Journal of Clinical & Laboratory Investigation. - informa healthcare. - 0036-5513. ; 72:2, s. 92-99
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Primary hyperparathyroidism (PHPT) is associated with cardiovascular disease. The aims of this study were to investigate lipid and glucose metabolism in mild PHPT, and to identify whether insulin sensitivity correlates with circulating levels of adiponectin, SHBG, and osteocalcin before and after parathyroidectomy (PTX). Materials and methods. Forty-five patients with PHPT were examined before and 1 year after PTX. Circulating levels of triglycerides, total cholesterol, HDL-cholesterol, insulin, glucose, adiponectin, SHBG, osteocalcin, and erythropoietin were measured. Results. At baseline, the mean serum levels of total cholesterol, LDL-cholesterol and triglycerides were above the upper reference limit or in the upper normal range, and insulin sensitivity was reduced as assessed using the HOMA index. One year after parathyroidectomy, serum lipids as well as HOMA index and erythropoietin were unchanged while adiponectin had increased (p < 0.05), and SHBG and osteocalcin had decreased (p < 0.05 and p < 0.0001, respectively). HOMA index correlated negatively with circulating levels of adiponectin, SHBG and osteocalcin. In multiple regression analysis SHBG was the most important predictor of insulin sensitivity, both pre- and postoperatively. Conclusion. Untreated mild PHPT is associated with a moderate derangement of lipid and glucose metabolism. As previously shown in population-based cohorts, insulin sensitivity is positively associated with circulating concentrations of adiponectin, SHBG and osteocalcin. One year after PTX, the mean level of adiponectin was increased, but the levels of SHBG and osteocalcin had decreased and the levels of serum lipids and the insulin sensitivity remained unchanged as compared with baseline.
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| 5. |
- Andersson, N., et al.
(författare)
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A variant near the interleukin-6 gene is associated with fat mass in Caucasian men.
- 2010
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Ingår i: International journal of obesity. - 1476-5497. ; 34:6, s. 1011-1019
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Tidskriftsartikel (refereegranskat)abstract
- Context: Regulation of fat mass appears to be associated with immune functions. Studies of knockout mice show that endogenous interleukin (IL)-6 can suppress mature-onset obesity. Objective: To systematically investigate associations of single nucleotide polymorphisms (SNPs) near the IL-6 (IL6) and IL-6 receptor (IL6R) genes with body fat mass, in support for our hypothesis that variants of these genes can be associated with obesity. Design and Study Subjects: The Gothenburg Osteoporosis and Obesity Determinants (GOOD) study is a population-based cross-sectional study of 18- to 20-year-old men (n = 1049), from the Gothenburg area (Sweden). Major findings were confirmed in two additional cohorts consisting of elderly men from the Osteoporotic Fractures in Men (MrOS) Sweden (n = 2851) and MrOS US (n = 5611) multicenter population-based studies. Main Outcome: The genotype distributions and their association with fat mass in different compartments, measured with dual-energy X-ray absorptiometry. Results: Out of 18 evaluated tag SNPs near the IL6 and IL6R genes, a recently identified SNP rs10242595 G/A (minor allele frequency = 29%) 3' of the IL6 gene was negatively associated with the primary outcome total body fat mass (effect size -0.11 standard deviation (s.d.) units per A allele, P-0.02). This negative association with fat mass was also confirmed in the combined MrOS Sweden and MrOS US cohorts (effect size -0.05 s.d. units per A allele, P = 0.002). When all three cohorts were combined (n = 8927, Caucasian subjects), rs10242595*A showed a negative association with total body fat mass (effect size -0.05 s.d. units per A allele, P<0.0002). Furthermore, the rs10242595*A was associated with low body mass index (effect size -0.03, P<0.001) and smaller regional fat masses. None of the other SNPs investigated in the GOOD study were reproducibly associated with body fat. Conclusions: The IL6 gene polymorphism rs10242595*A is associated with decreased fat mass in three combined cohorts of 8927 Caucasian men. International Journal of Obesity (2010) 34, 1011-1019; doi:10.1038/ijo.2010.27; published online 16 February 2010
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| 6. |
- Boonen, Steven, et al.
(författare)
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Safety and efficacy of teriparatide in elderly women with established osteoporosis: bone anabolic therapy from a geriatric perspective.
- 2006
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Ingår i: Journal of the American Geriatrics Society. - 0002-8614. ; 54:5, s. 782-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess the safety and efficacy of teriparatide in patients aged 75 and older and compare these findings with those of women younger than 75 using data from the Fracture Prevention Trial (FPT). DESIGN: The FPT was a randomized, multicenter, double-blind, placebo-controlled study. SETTING: The FPT multicenter international study. PARTICIPANTS: Postmenopausal women aged 42 to 86 were randomized to placebo (N=544) or teriparatide 20 mug (N=541) by daily self-injection for a median of 19 months. Patients received daily oral supplements of 1,000 mg calcium and 400 to 1,200 IU vitamin D. For this analysis, subgroups were defined according to patient age younger than 75 (N=841) and 75 and older (N=244). MEASUREMENTS: The effects of teriparatide on bone mineral density (BMD) of the lumbar spine and femoral neck; the incidence of new vertebral and new nonvertebral fragility fractures; bone turnover markers, including bone-specific alkaline phosphatase; and urinary deoxypyridinoline corrected for creatinine clearance, as well as the safety of teriparatide, were investigated. RESULTS: There were no significant treatment-by-age interactions for the bone turnover markers, femoral neck BMD, vertebral fractures, nonvertebral fragility fractures, height loss, hyperuricemia, or hypercalcemia. A significant treatment-by-age interaction for lumbar spine BMD (P=.08) was due to an increase in BMD observed in the placebo group aged 75 and older. There were no treatment-by-age interactions for important treatment-emergent adverse events (TEAEs), including back pain, nausea, leg cramps, and dizziness. The most important TEAEs in women aged 80 and older (23 patients from the placebo group and 25 patients from the teriparatide group) were also reviewed; no unexpected TEAEs were found in the patients treated with teriparatide. These results indicate that the clinical effects of teriparatide were consistent in the older and younger women. CONCLUSION: Age does not affect the safety and efficacy of teriparatide in postmenopausal women with osteoporosis.
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| 7. |
- Chan, Ruth, et al.
(författare)
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Association between serum 25-hydroxyvitamin D and psychological health in older Chinese men in a cohort study.
- 2011
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Ingår i: Journal of affective disorders. - 1573-2517. ; 130:1-2, s. 251-259
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few studies evaluated the association between vitamin D and psychological health in Chinese. This study examined these associations in Chinese older men in Hong Kong. METHODS: Baseline serum 25-hydroxyvitamin D (25OHD), depression and cognitive function were assessed in 939 community-dwelling Chinese men aged >65. Data on depression status at 4-year follow up was available in 629 men. Data were collected for confounding factors: demographics, number of diseases, smoking, alcohol use, body mass index, physical activity, mobility limitations, dietary intake, season of blood measurement, and serum parathyroid hormone level. Multivariate logistic regression analyses were performed with adjustments for confounding factors. RESULTS: An inverse association between serum 25OHD and baseline depression was observed. Men in the highest (>=92nmol/L) compared with lowest (<=63nmol/L) quartile of serum 25OHD had an adjusted odds ratio for depression of 0.46 (95% CI: 0.22-0.98, P(trend)=0.004). The association was more pronounced in low vitamin D season than in high vitamin D season. No association was observed between serum 25OHD and incident depression at 4years. Baseline cognitive impairment was not associated with serum 25OHD in all models. LIMITATIONS: Self-reported measure of depression and cognitive performance, the small number of incident depression at 4-year follow up and selection bias may affect the study validity. CONCLUSIONS: Serum 25OHD was inversely associated with depression at baseline and was not linked to baseline cognitive impairment and 4-year incident depression in Chinese older men. Future studies are warranted to evaluate these associations in populations with higher prevalence of vitamin D deficiency.
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| 8. |
- Chan, Ruth, et al.
(författare)
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Not All Elderly People Benefit From Vitamin D Supplementation with Respect to Physical Function: Results From the Osteoporotic Fractures in Men Study, Hong Kong.
- 2012
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Ingår i: Journal of the American Geriatrics Society. - 1532-5415. ; 60:2, s. 290-295
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine vitamin D status and its association with physical performance and muscle mass in older Chinese men. DESIGN: Cross-sectional and prospective cohort study design. SETTING: Hong Kong, People's of Republic of China. PARTICIPANTS: Nine hundred thirty-nine community-dwelling men aged 65 and older for cross-sectional analysis and 714 for longitudinal analysis. MEASUREMENTS: Baseline serum 25-hydroxyvitamin D (25OHD) was measured using a competitive radioimmunoassay kit. Baseline and 4-year physical performance measures (grip strength, 6-m walking speed, step length in a 6-m walk, time to complete five chair stands) were measured, and appendicular skeletal muscle mass (ASM) was assessed using dual-energy X-ray absorptiometry. Data were collected for confounding factors: demographic, number of diseases, smoking, alcohol use, body mass index, physical activity, diet, season of blood sampling, and serum parathyroid hormone (PTH) level. Multivariate regression analyses were performed with adjustments for confounding factors. RESULTS: Mean ± standard deviation serum 25OHD level of this sample of Chinese community-dwelling older men who had a high level of baseline physical function was 77.9 ± 20.5 nmol/L; 94.1% of participants had serum 25OHD levels of 50 nmol/L or greater. Median (interquartile range) serum PTH level was 4.1 pmol/L (3.1-5.5 pmol/L). After adjustment for potential confounding factors, serum 25OHD levels were not associated with baseline or 4-year change in physical performance measures and ASM. CONCLUSION: In Chinese older men who are vitamin D replete and have a high level of baseline physical function, vitamin D may not have an important role in physical function and muscle mass.
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| 9. |
- Chan, R, et al.
(författare)
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Serum 25-hydroxyvitamin D and parathyroid hormone levels in relation to blood pressure in a cross-sectional study in older Chinese men.
- 2012
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Ingår i: Journal of human hypertension. - 1476-5527. ; 26:1, s. 20-27
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Tidskriftsartikel (refereegranskat)abstract
- Vitamin D status, parathyroid hormone (PTH) level and their associations with blood pressure in Chinese population are unknown. This study examined these associations in older Chinese men. Blood pressure, serum 25-hydroxyvitamin D (25OHD) and PTH was measured in 939 community-dwelling Chinese men aged 65 years and older. Linear regression analyses were performed with adjustments for age, body mass index, education, season of measurement, medication use, self-reported history of stroke and Parkinson's disease, and other lifestyle factors. In either crude or adjusted models, serum 25OHD was not associated with blood pressure, whereas increasing PTH levels was associated with higher blood pressure. Men in the highest quartile of serum PTH level had a mean difference of 3.4 mm Hg and 2.8 mm Hg higher in as systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively, than men in the lowest quartile of serum PTH level (P(trend)=0.019 for SBP and <0.001 for DBP). In conclusion, the findings support an association between serum PTH and blood pressure, but not for serum 25OHD in older Chinese men whose vitamin D status is optimal. The lack of association between serum 25OHD and blood pressure may possibly because of the relatively high serum 25OHD levels of the study sample.
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| 10. |
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