1. 
 De Laet, C, et al.
(författare)

The impact of the use of multiple risk indicators for fracture on casefinding strategies: a mathematical approach.
 2005

Ingår i: Osteoporosis international.  0937941X. ; 16:3, s. 3138

Tidskriftsartikel (refereegranskat)abstract
 The value of bone mineral density (BMD) measurements to stratify fracture probability can be enhanced in a casefinding strategy that combines BMD measurement with independent clinical risk indicators. Putative risk indicators include age and gender, BMI or weight, prior fracture, the use of corticosteroids, and possibly others. The aim of the present study was to develop a mathematical framework to quantify the impact of using combinations of risk indicators with BMD in case finding. Fracture probability can be expressed as a risk gradient, i.e. a relative risk (RR) of fracture per standard deviation (SD) change in BMD. With the addition of other continuous or categorical risk indicators a continuous distribution of risk indicators is obtained that approaches a normal distribution. It is then possible to calculate the risk of individuals compared with the average risk in the population, stratified by age and gender. A risk indicator with a gradient of fracture risk of 2 per SD identified 36% of the population as having a higher than average fracture risk. In individuals so selected, the risk was on average 1.7 times that of the general population. Where, through the combination of several risk indicators, the gradient of risk of the test increased to 4 per SD, a smaller proportion (24%) was identified as having a higher than average risk, but the average risk in this group was 3.1 times that of the population, which is a much better performance. At higher thresholds of risk, similar phenomena were found. We conclude that, whereas the change of the proportion of the population detected to be at high risk is small, the performance of a test is improved when the RR per SD is higher, indicated by the higher average risk in those identified to be at risk. Casefinding strategies that combine clinical risk indicators with BMD have increased efficiency, while having a modest impact on the number of individuals requiring treatment. Therefore, the costeffectiveness is enhanced.


2. 
 Johnell, Olof, et al.
(författare)

The burden of hospitalised fractures in Sweden.
 2005

Ingår i: Osteoporosis international.  0937941X. ; 16:2, s. 2228

Tidskriftsartikel (refereegranskat)abstract
 The aim of this study was to characterise the hospital burden of fractures in the Swedish population by age and gender. The number of patients and number of fractures were documented according to site of fracture, age, sex and duration of hospital stay for the whole population of Sweden in 1996. Fractures were additionally classified as osteoporotic according to fracture site. In 1996 there were 54,000 admissions for fracture in men and women aged 50 years or more, accounting for 600,000 hospitalbed days. Hip fractures accounted for 63% of admissions for fracture in men and 72% in women, for 69% and 73% of hospitalbed days, respectively. Fractures considered to be osteoporotic accounted for 84% of all hospitalbed days due to fracture in men, and 93% in women. More hospitalbed days were due to osteoporotic fracture than to breast cancer and prostate cancer combined. The number of hospitalbed days due to osteoporotic fracture was between the amount due to ischaemic heart disease and the amount due to stroke.

