| 1. |
- Egund, Lisa, et al.
(författare)
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Patient-related outcome, fracture displacement and bone mineral density following distal radius fracture in young and older men
- 2020
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Distal radius fractures can adversely affect wrist function; for men with this fracture, the role played by fracture severity, age and osteoporosis on fracture outcome has not been sufficiently studied. Objective: To describe patient-reported outcome and the association with bone integrity, fracture severity and future fracture risk among young and older men with distal radius fracture. Methods: This prospective study includes 133 men with acute distal radius fracture, mean age 54 (range 21–88), who were followed for 12 months. They were categorized as younger (< 65) and older (65+). Main outcome was DASH (Disability of the Arm, Shoulder and Hand) at 12 months; DASH > 15 was defined as poor outcome. Fractures were classified and radiographic displacement identified at initial presentation and follow-up. BMD was measured and FRAX 10-year probability of fracture calculated. Results: Disability was higher in older men (DASHmedian 10 vs 2; p = 0.002); a clinically meaningful difference (ΔDASH = 10, p = 0.017) remained after adjustment for displacement, fracture classification and treatment method. Almost 50% of older men vs 14% in younger had poor outcome, p < 0.001. Bone mineral density did not independently predict outcome. Older men with a displaced fracture at initial presentation had greater disability (DASHmedian, IQR 45, 14;73) and risk of fracture (FRAXmajor osteoporotic 14, 8;21). Conclusion: Men over the age of 65 with a distal radius fracture are more likely to have post-fracture disability regardless of radiographic appearance. Fracture displacement, indicating impaired bone strength, is also more common and associated with an increased risk of fracture within 10-years. Secondary fracture prevention should therefore be considered in men presenting with distal radius fracture.
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| 2. |
- Tenne, Max, et al.
(författare)
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Degenerative changes at the lumbar spine-implications for bone mineral density measurement in elderly women.
- 2013
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 24:4, s. 1419-1428
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Tidskriftsartikel (refereegranskat)abstract
- Degenerative changes of the lumbar spine may lead to misinterpretation of bone mineral density (BMD) measurements and cause underdiagnosis of osteoporosis. This longitudinal study of 1,044 women, 75 years at inclusion and followed for 10 years, shows that identification of apparent degenerative changes on the dual energy X-ray absorptiometry (DXA) scan can increase the proportion diagnosed. INTRODUCTION: In the elderly, degenerative manifestations in the lumbar spine may result in falsely elevated BMD values, consequently missing a large proportion of those with osteoporosis. Our aim was to determine the distribution and impact of degenerative changes on lumbar spine DXA over time and its clinical implications. METHODS: Participants were 1,044 women from the population-based Osteoporosis Risk Assessment cohort. All women were 75 years old at invitation and followed up after 5 years (n = 715) and 10 years (n = 382). Degenerative changes were evaluated visually on the DXA image for each vertebra L1 to L4 (intraobserver precision kappa values of 0.66-0.70). RESULTS: At baseline, apparent degenerative changes were more frequent in the inferior segments of the lumbar spine [5 % (L1), 15 % (L2), 26 % (L3), and 36 % (L4)] and increased over time. At 10 years, the prevalences were 20 % (L1), 39 % (L2), 59 % (L3), 72 % (L4), resulting in a significant increase in overall BMD. In women without apparent degenerative changes, BMD remained stable between 75 and 85 rather than an expected bone loss. At baseline, 37 % had osteoporosis (BMD < -2.5) at L1-L4; exclusion of women with apparent degenerative changes increased this proportion to 47 %. Using L1-L2, which was less prone to degenerative changes, 46 % of women were classified as osteoporotic regardless of degenerative changes. CONCLUSION: Degenerative changes were very common in elderly women, accelerated disproportionately over time, were increasingly frequent from vertebrae L1 to L4, and had significant impact on diagnosing osteoporosis. This suggests that routine reporting of spine BMD at L1-L2 would add valuable information for reassessment and monitoring.
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| 3. |
- von Friesendorff, My, et al.
(författare)
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Hip fracture in men-survival and subsequent fractures: a cohort study with 22-year follow-up.
- 2011
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Ingår i: Journal of the American Geriatrics Society. - : Wiley. - 0002-8614. ; 59:5, s. 806-813
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Tidskriftsartikel (refereegranskat)abstract
- Abstract OBJECTIVES: To evaluate the influence of age on survival and risk of subsequent fracture in men with hip fracture, applying a residual lifetime perspective. DESIGN: Retrospective cohort study with 22-year follow-up. SETTING: Skåne University Hospital, Malmö, Sweden. PARTICIPANTS: Men aged 60 and older (N=226) with an index hip fracture during 1984/85. MEASUREMENTS: Twenty-two-year survival (mortality) and risk of new fractures evaluated in 5-year age bands and age groups (<75, 75-84, ≥85). RESULTS: Mean age was 78±9. Mortality at 22 years was 98%. Survivors were all younger than 75 at inclusion. Mortality was dependent on age at all time points (18%, 38%, 69% at 1 year, increasing to 71%, 93%, 100% by 10 years in <75, 75-84, ≥85, respectively). Median survival was 5.4 years, 2.0 years, and 3 months, respectively, in these age groups, and 33%, 27%, and 13% of each age-group sustained subsequent fractures, generally within 5 years. Overall 10-year fracture risk was 29% (95% confidence interval (CI)=19-38%), increasing to 44% (95% CI=30-58%) when adjusted for mortality. Residual lifetime risk of new fracture was 33% (95% CI=23-43%), and mortality-adjusted risk was 63% (95% CI=45-81%). Participants younger than 75 at index hip fracture were at greatest risk of new fracture (hazard ratio=2.7, 95% CI=1.1-6.4, P=.03). CONCLUSION: Almost one-third of men with hip fracture have subsequent fractures during their remaining lifetime. Time at risk is highly dependent on age. Most new fractures occur in relatively younger men and within 5 years, whereas most aged 75 and older die before experiencing a new fracture.
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| 4. |
- von Friesendorff, My, et al.
(författare)
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Long-Term Survival and Fracture Risk After Hip Fracture: A 22-Year Follow-Up in Women
- 2008
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Ingår i: Journal of Bone and Mineral Research. - 1523-4681. ; 23:11, s. 1832-1841
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Tidskriftsartikel (refereegranskat)abstract
- Hip fracture is associated with high early mortality. Little is known about long-term survival and subsequent fracture risk. The aim of this study was to evaluate survival and fracture risk after hip fracture in women at different ages. All women suffering a hip fracture during 1984-1985 in Malmo, Sweden, were identified (n = 766) and followd up to 22 yr or death. All new radiographic examinations related to musculoskeletal trauma with or without fracture were registered. Survival (mortality) and fracture was evaluated in 5-yr age bands and in age groups(<75, 75-84, and >= 85 yr). Mean age was 79.6 +/- 9.9 yr (range, 31.6-99.4 yr), with 42% between 75 and 85 yr of age. Overall 22-yr survival was 6%; 79% at 1 yr, 48% at 5 yr, and 33% at 10 yr (i.e., population at risk). One-year mortality was 7%, 21%, and 33% for <75, 75-84, and >= 85 yr of age, respectively, and 95% of those >= 85 yr were dead at 10 yr. Prior hip fracture did not affect age-adjusted mortality (OR1.05; 95% CI, 0.756-1.20; p = 0.15). A total of 768 fractures were registered at 715 occasions in 342 women (45%; mean, 2.3 fractures/woman; range, 1-11 fractures/woman). Of the fracture occasions, 1.5% occurred within the first year. 27% within 2 yr, and 73% within 5 yr. The residual lifetime fracture risk was 45%, with a mortality-adjusted increase to 86%. The 10-yr fracture risk was 40% with a mortality-adjusted increased to 65%. In conclusion, almost one half of all women with a hip fracture suffer a new fracture during their remaining lifetime. Fracture risk is highly dependent on age and survival, emphasizing that preventive strategies need to he tailored to each age group specifically.
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| 5. |
- Önsten, Ingemar, et al.
(författare)
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Migration of the Charnley stem in rheumatoid arthritis and osteoarthritis. A roentgen stereophotogrammetric study
- 1995
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Ingår i: Journal of Bone and Joint Surgery: British Volume. - 2044-5377. ; 77-B:1, s. 18-22
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Tidskriftsartikel (refereegranskat)abstract
- Migration of 65 Charnley stems implanted with modern cementing techniques was studied by roentgen stereophotogrammetry. There were 25 patients with rheumatoid arthritis (RA) and 40 with osteoarthritis (OA) followed up for two years. In 43 cases a bone sample for histomorphometric analysis was obtained from the femur during the operation. In 22 cases the mean subsidence of the prosthetic head was 0.40 mm and in 20 the mean posterior migration was 1.25 mm. There was no difference in migration between the two diagnostic groups (p = 0.8) after adjusting for variations in gender, age and weight. Male gender was associated with increased subsidence (p = 0.006). Histological examination showed that the RA series had more osteoid surface (p = 0.04), but neither this, nor any of the other histomorphometric variables, influenced migration. These results suggest that, unlike the acetabular socket, the cemented Charnley femoral component is equally secure in osteoarthritis and in rheumatoid arthritis, and that its initial fixation is not influenced by the quality of the local cancellous bone. Our results provide data with which the early performance of new prosthetic designs and fixation methods can be compared.
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