| 1. |
- Johannesdottir, Fjola, et al.
(författare)
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Distribution of cortical bone in the femoral neck and hip fracture: A prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK Study
- 2011
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Ingår i: Bone. - : Elsevier BV. - 1873-2763 .- 8756-3282. ; 48:6, s. 1268-1276
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Tidskriftsartikel (refereegranskat)abstract
- In this prospective nested case-control study we analyzed the circumferential differences in estimated cortical thickness (Est CTh) of the mid femoral neck as a risk factor for osteoporotic hip fractures in elderly women and men. Segmental QCT analysis of the mid femoral neck was applied to assess cortical thickness in anatomical quadrants. The superior region of the femoral neck was a stronger predictor for hip fracture than the inferior region, particularly in men. There were significant gender differences in Est CTh measurements in the control group but not in the case group. In multivariable analysis for risk of femoral neck (FN) fracture, Est CTh in the supero-anterior (SA) quadrant was significant in both women and men, and remained a significant predictor after adjustment for FN areal BMD (aBMD, dimensions g/cm(2), DXA-like), (p = 0.05 and p<0.0001, respectively). In conclusion, Est CTh in the SA quadrant best discriminated cases (n = 143) from controls (n = 298), especially in men. Cortical thinning superiorly in the hip might be of importance in determining resistance to fracture. (C) 2011 Elsevier Inc. All rights reserved.
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| 2. |
- Johannesdottir, Fjola, et al.
(författare)
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Mid-Thigh Cortical Bone Structural Parameters, Muscle Mass and Strength, and Association with Lower Limb Fractures in Older Men and Women (AGES-Reykjavik Study)
- 2012
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Ingår i: Calcified Tissue International. - : Springer Science and Business Media LLC. - 1432-0827 .- 0171-967X. ; 90:5, s. 354-364
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Tidskriftsartikel (refereegranskat)abstract
- In a cross-sectional study we investigated the relationship between muscle and bone parameters in the mid-thigh in older people using data from a single axial computed tomographic section through the mid-thigh. Additionally, we studied the association of these variables with incident low-trauma lower limb fractures. A total of 3,762 older individuals (1,838 men and 1,924 women), aged 66-96 years, participants in the AGES-Reykjavik study, were studied. The total cross-sectional muscular area and knee extensor strength declined with age similarly in both sexes. Muscle parameters correlated most strongly with cortical area and total shaft area (adjusted for age, height, and weight) but explained < 10 % of variability in those bone parameters. The increment in medullary area (MA) and buckling ratio (BR) with age was almost fourfold greater in women than men. The association between MA and muscle parameters was nonsignificant. During a median follow-up of 5.3 years, 113 women and 66 men sustained incident lower limb fractures. Small muscular area, low knee extensor strength, large MA, low cortical thickness, and high BR were significantly associated with fractures in both sexes. Our results show that bone and muscle loss proceed at different rates and with different gender patterns.
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| 3. |
- Siggeirsdottir, Kristin, et al.
(författare)
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Effect of vertebral fractures on function, quality of life and hospitalisation the AGES-Reykjavik study
- 2012
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Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 1468-2834 .- 0002-0729. ; 41:3, s. 351-357
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Tidskriftsartikel (refereegranskat)abstract
- Objective: assess the effect of clinical vertebral and other osteoporotic fractures on function and the subsequent risk of hospitalisation. Design: individuals from the prospective population-based cohort study Age, Gene/Environment Susceptibility (AGES)-Reykjavik study were examined between 2002 and 2006 and followed up for 5.4 years. Subjects: a total of 5,764 individuals, 57.7% women, born 1907-35, mean age 77. Method: four groups with a verified fracture status were used; vertebral fractures, other osteoporotic fractures excluding vertebral, non-osteoporotic fractures and not-fractured were compared and analysed for the effect on mobility, strength, QoL, ADL, co-morbidity and hospitalisation. Results: worst performance on functional tests was in the vertebral fracture group for women (P < 0.0001) and the other osteoporotic fractures group for men (P < 0.05). Both vertebral and other osteoporotic fractures, showed an increased risk of hospitalisation, HR = 1.4 (95% CI: 1.3-1.7) and 1.2 (95% CI: 1.1-1.2) respectively (P < 0.0001). Individuals with vertebral fractures had 50% (P < 0.0001) longer hospitalisation than not-fractured and 33% (P < 0.002) longer than the other osteoporotic fractures group. Conclusion: individuals with a history of clinical vertebral fracture seem to carry the greatest health burden compared with other fracture groups, emphasising the attention which should be given to those individuals.
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| 4. |
- Siggeirsdottir, Kristin, et al.
(författare)
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Inaccuracy in self-report of fractures may underestimate association with health outcomes when compared with medical record based fracture registry
- 2007
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 22:9, s. 631-639
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and objective Misreporting fractures in questionnaires is known. However, the effect of misreporting on the association of fractures with subsequent health outcomes has not been examined. Methods Data from a fracture registry (FR) developed from an extensive review of radiographic and medical records were related to self-report of fracture for 2,255 participants from the AGES Reykjavik Study. This data was used to determine false negative and false positive rates of self-reported fractures, correlates of misreporting, and the potential effect of the misreporting on estimates of health outcomes following fractures. Results In women, the false positive rate decreased with age as the false negative rate increased with no clear trend with age in men. Kappa values for agreement between FR and self-report were generally higher in women than men with the best agreement for forearm fracture (men 0.64 and women 0.82) and the least for rib (men 0.28 and women 0.25). Impaired cognition was a major factor associated with discordant answers between FR and self-report, OR 1.7 (95% CI: 1.3-2.1) (P < 0.0001). We estimated the effect of misreporting on health after fracture by comparison of the association of the self-report of fracture and fracture from the FR, adjusting for those factors associated with discordance. The weighted attenuation factor measured by mobility and muscle strength was 11% (95% CI: 0-24%) when adjusted for age and sex but reduced to 6% (95% CI: -10-22%) when adjusted for cognitive impairment. Conclusion Studies of hip fractures should include an independent ascertainment of fracture but for other fractures this study supports the use of self-report.
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| 5. |
- Siggeirsdottir, K, et al.
(författare)
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Short hospital stay augmented with education and home-based rehabilitation improves function and quality of life after hip replacement - Randomized study of 50 patients with 6 months of follow-up
- 2005
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 76:4, s. 555-562
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Tidskriftsartikel (refereegranskat)abstract
- Background Because of current cost restrictions, we studied the effect of a shorter hospital stay on function, pain and quality of life (QOL) after total hip replacement (THR). Patients and methods 50 patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team, and a control group (CG) of 23 patients receiving "conventional" rehabilitation often augmented by a stay at a rehabilitation center. Results Mean hospital stay was shorter for the SG than for the CG (6.4 days and 10 days, respectively; p < 0.001). During the 6-month study period, there were 9 non-fatal complications in the SG and 12 in the CG (p = 0.3). The difference in Oxford Hip Score between the groups was not statistically significant before the operation, but was better for the SG at 2 months (p = 0.03) and this difference remained more or less constant throughout the study. The overall score from the Nottingham Health Profile indicated a better QOL in the SG. Interpretation Our preoperative education program, followed by postoperative home-based rehabilitation, appears to be safer and more effective in improving function and QOL after THR than conventional treatment.
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| 6. |
- Sigurdsson, Eyjolfur, et al.
(författare)
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Early discharge and home intervention reduces unit costs after total hip replacement: results of a cost analysis in a randomized study
- 2008
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Ingår i: International Journal of Health Care Finance and Economics. - : Springer Science and Business Media LLC. - 1573-6962 .- 1389-6563. ; 8:3, s. 181-192
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Tidskriftsartikel (refereegranskat)abstract
- Total hip replacement (THR) is a common and costly procedure. The number of THR is expected to increase over the coming years. Two pathways of postoperative treatment were compared in a randomized study. Fifty patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team. A control group (CG) of 23 patients received "conventional" rehabilitation augmented by a stay at a rehabilitation center if needed. All costs for the two groups both in hospitals and after discharge were collected and analyzed. On average total costs for the SG were $8,550 and $11,952 for the CG, a 28% cost reduction. Total inpatient costs were $5,225 for the SG and $6,515 for the CG. In a regression analysis the group difference is statistically significant. Adjusting for changes in the Oxford Hip Score gives effective costs (C/E). The ratio of the SGs C/E to the CGs is 0.60. That is a cost-effectiveness gain of 40%. A shorter hospital stay augmented with better preoperative education and home treatment appears to be more effective and costs less than the traditional in hospital pathway of treatment.
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| 7. |
- Styrkarsdottir, Unnur, et al.
(författare)
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GWAS of bone size yields twelve loci that also affect height, BMD, osteoarthritis or fractures
- 2019
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Bone area is one measure of bone size that is easily derived from dual-energy X-ray absorptiometry (DXA) scans. In a GWA study of DXA bone area of the hip and lumbar spine (N ≥ 28,954), we find thirteen independent association signals at twelve loci that replicate in samples of European and East Asian descent (N = 13,608 – 21,277). Eight DXA area loci associate with osteoarthritis, including rs143384 in GDF5 and a missense variant in COL11A1 (rs3753841). The strongest DXA area association is with rs11614913[T] in the microRNA MIR196A2 gene that associates with lumbar spine area (P = 2.3 × 10 −42 , β = −0.090) and confers risk of hip fracture (P = 1.0 × 10 −8 , OR = 1.11). We demonstrate that the risk allele is less efficient in repressing miR-196a-5p target genes. We also show that the DXA area measure contributes to the risk of hip fracture independent of bone density.
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| 8. |
- Jonsson, Brynjolfur
(författare)
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Destructive reumatoid arthritis : Epidemiological, economic, and rheumasurgical aspects
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study comprising 8 separate papers is concerned with the prevalence of rheumatic disease and different aspects of destructive rheumatoid arthritis in the population. In an epidemiologically representative population subjective joint disease was found in 30% in ages 45 years and over. All those people were clinically examined and diagnosis established. Joint disease becomes commoner with increasing age and causes considerable disability. Destructive rheumatoid arthritis, ARA criteria 5-8, i.e. classical and definite RA, was found in 0.65% of the population. This patient group with joint destructions is the most interesting from rheumasurgical view. A clinical evaluating system, total locomotion score, comprising of a subjective and an objective part, was developed for numerical multifactorial assessment of patients with destructive RA. It is based on WHO's recommandations for disease integration (1980). This system was tested and was found to have good interobserver reliability and showed good correlation between patient's subjective and objective status. All 82 RA patients found in the epidemiological population were evaluated by total locomotion score and for hand function with Sollerman's hand function test and current status emerged. The destructive RA manifestations of the locomotor system, including the hand, were increasing with age, longer disease duration, and were more pronounced in women than men. In this patient group further reconstructive operations were needed in 55% of cases and this care was closely correlated with low total locomotion score. Reconstructive joint and hand surgery was found to prevent deterioration of the disease. The costs of RA were correlated to effects of the disease destructions; patients in working-age had highest indirect costs and elderly patient medical and social costs. Total costs of the disease were better correlated to the status of lower extremities than upper. Elbow replacement in RA reliefs pain well and improves function of arm and hand. Total hip and knee replacement in RA improves status regardless age, sex, and low preoperative total locomotion score. Besides better quality of life, reduced indirect costs and reduced costs of home help are achieved.
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| 9. |
- Jonsson, Brynjolfur, et al.
(författare)
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Fracture rate in a population-based sample of men in Reykjavik
- 2004
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 75:2, s. 195-200
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Tidskriftsartikel (refereegranskat)abstract
- The population-based Reykjavik Heart Study, started in 1967, aims at finding and evaluating risk factors for cardiovascular diseases. It included 4,137 men born between 1907 and 1934 and we examined all fractures recorded in these subjects from January 1977 until the end of December 2000, or death. Their mean age at the start of this study was 54 (42-69) years and the mean follow-up time 19 years. We examined the patients' records, including those from the Radiological Departments in all Reykjavik hospitals and the only out-patient accident clinic in Reykjavik. Old fractures and those caused by a malignancy were excluded. The intensity of the trauma was estimated from E-numbers. Altogether 1,531 fractures were recorded in 939 (23%) persons. A low-energy trauma caused 53% of all fractures. 612 had a single fracture during this period. 323 had two or more fractures-a 53% risk of sustaining additional fractures. The fracture incidence increased by 40% in each 10-year period.. Fractures of the ribs were commonest (246), followed by those of the hand (241). 135 were hip fractures, 75% caused by low-energy trauma. The fracture rate was 20 per 1000 persons year-i.e., similar to that in other studies.
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| 10. |
- Jonsson, Brynjolfur, et al.
(författare)
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Function 10 years after hip fracture. 74 patients after internal fixation
- 1993
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 64:6, s. 645-646
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Tidskriftsartikel (refereegranskat)abstract
- We examined the physical and social function of patients surviving 10 years after internal fixation of a hip fracture. 74 out of 362 patients were alive 10 years after their fracture. In 47 survivors after cervical fracture, secondary hip arthroplasties had been performed in 25, and nails had been extracted in 13. The implants had been removed in 8 of 27 with trochanteric fracture. 58 survivors were interviewed; three fourths were still living in their own homes, with more than half needing no home assistance. However, limitation of activities, caused by the fracture, was experienced by more than one third of the survivors.
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