| 1. |
- Berry, S D, et al.
(författare)
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Application of the National Osteoporosis Foundation Guidelines to postmenopausal women and men: the Framingham Osteoporosis Study.
- 2010
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Ingår i: Osteoporosis international. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 21:1, s. 53-60
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Tidskriftsartikel (refereegranskat)abstract
- We applied the 2008 National Osteoporosis Foundation (NOF) Guidelines to Framingham Osteoporosis Study participants and found nearly one half of Caucasian postmenopausal women and one sixth of men aged 50 years and older would be recommended for osteoporosis treatment. Given the high proportion of persons recommended for treatment, NOF Guidelines may need to be re-evaluated with respect to budget impact. INTRODUCTION: Little is known about the public health impact of the NOF Guidelines. Therefore, we determined the proportion of US Caucasians recommended for treatment of osteoporosis according to NOF Guidelines (2003 and 2008). METHODS: One thousand nine hundred and forty-six postmenopausal women and 1,681 men aged > or =50 years from the Framingham Study with information on bone mineral density (1987-2001) were included. Information on clinical predictors was used to estimate the 10-year probability of hip and major osteoporotic fracture by FRAX (version 3.0). RESULTS: Overall proportion of women meeting treatment criterion was less when the 2008 NOF Guidelines were applied (41.1%) compared with 2003 Guidelines (47.8%). The proportion of women aged <65 years meeting treatment criterion was much less when applying 2008 Guidelines (23.1% in 2003, 8.3% in 2008), whereas the proportion of women aged >75 years increased slightly (78.3% in 2003, 86.0% in 2008). Seventeen percent of men aged > or =50 years met treatment criterion (2.5% aged 50-64 years, 49.8% aged >75 years). CONCLUSIONS: Nearly one half of Caucasian postmenopausal women and one sixth of men aged 50 years and older would be recommended for osteoporosis treatment according to 2008 NOF Guidelines. Given the high proportion of persons recommended for treatment, NOF Guidelines may need to be re-evaluated with respect to budget impact.
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| 2. |
- Borgström, F, et al.
(författare)
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The cost-effectiveness of strontium ranelate in the UK for the management of osteoporosis.
- 2010
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 21:2, s. 339-49
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Tidskriftsartikel (refereegranskat)abstract
- The cost-effectiveness of strontium ranelate was compared to no treatment in UK women using the FRAX algorithm for fracture risk assessment. At a willingness-to-pay of pound 30,000 per quality-adjusted life-year (QALY), strontium ranelate was generally cost-effective in women with prior fracture at the threshold of osteoporosis from an age of 65 years. INTRODUCTION: The objectives of the study were to estimate the cost-effectiveness of strontium ranelate in the UK for the treatment of osteoporosis and to establish intervention thresholds for treatment using the FRAX tool. METHODS: The cost-effectiveness of strontium ranelate was compared to no treatment in postmenopausal women with clinical risk factors for fracture using a lifetime simulation model based on Markov cohort methodology that incorporated the features of FRAX. RESULTS: At a threshold of pound 30,000 per QALY, strontium ranelate was generally cost-effective in women from an age of 65 years with prior fracture at the threshold of osteoporosis (i.e., a T-score of -2.5 SD) and in women with a prior fracture (and no information on bone mineral density) from the age of 65 years. At a threshold of pound 20,000, strontium ranelate became cost-effective at a 10-year fracture probability of 25.7% and at 16.9% with a threshold of pound 30,000 for a QALY. CONCLUSIONS: Strontium ranelate is a cost-effective agent for the treatment of established osteoporosis in women over the age of 65 years. Cost-effective scenarios were also found for the prevention and treatment of fractures associated with osteoporosis, in younger women with additional clinical risk factors.
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| 3. |
- Brennan, S L, et al.
(författare)
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FRAX provides robust fracture prediction regardless of socioeconomic status.
- 2013
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 25:1, s. 61-69
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the fracture risk assessment tool (FRAX) Canada calibration and discrimination according to income quintile in 51,327 Canadian women, with and without a competing mortality framework. Our data show that, under a competing mortality framework, FRAX provides robust fracture prediction and calibration regardless of socioeconomic status (SES).
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| 4. |
- Dawson-Hughes, B, et al.
(författare)
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The potential impact of new National Osteoporosis Foundation guidance on treatment patterns.
- 2010
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Ingår i: Osteoporosis international. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 21:1, s. 41-52
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Tidskriftsartikel (refereegranskat)abstract
- This analysis of National Health and Nutrition Examination Survey III data describes the prevalence of risk factors for osteoporosis and the proportions of men and postmenopausal women age 50 years and older who are candidates for treatment to lower fracture risk, according to the new FRAX-based National Osteoporosis Foundation Clinician's Guide. INTRODUCTION: Little information is available on prevalence of osteoporosis risk factors or proportions of US men and women who are potential candidates for treatment. METHODS: The prevalence of risk factors used in the new National Osteoporosis Foundation (NOF) FRAX-based Guide to the Prevention and Treatment of Osteoporosis was estimated using data from the third National Health and Nutrition Examination Survey (NHANES III). Risk factors not measured in NHANES III were simulated using World Health Organization cohorts. The proportion of US men and postmenopausal women age 50+ years who are treatment candidates by the new NOF Guide were calculated; for non-Hispanic white (NHW) women, the proportion eligible by the new NOF Guide was compared with that based on an earlier NOF Guide. RESULTS: Twenty percent of men and 37% of women were potential candidates for treatment to prevent fractures by the new NOF Guide. Among NHW women, 53% were potential candidates by the previous NOF Guide compared with 41% by the new guide. CONCLUSIONS: One fifth of men and 37% of postmenopausal women are eligible for osteoporosis treatment consideration by the new NOF Guide. However, fewer NHW women are eligible by the new guide than by the previous NOF Guide.
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| 5. |
- de Peppo, Giuseppe Maria, 1981, et al.
(författare)
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Osteogenic response of human mesenchymal stem cells to well-defined nanoscale topography in vitro
- 2014
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Ingår i: International journal of nanomedicine. - : Informa UK Limited. - 1176-9114 .- 1178-2013. ; 9:1, s. 2499-2515
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patterning medical devices at the nanoscale level enables the manipulation of cell behavior and tissue regeneration, with topographic features recognized as playing a significant role in the osseointegration of implantable devices. Methods: In this study, we assessed the ability of titanium-coated hemisphere-like topographic nanostructures of different sizes (approximately 50, 100, and 200 nm) to influence the morphology, proliferation, and osteogenic differentiation of human mesenchymal stem cells (hMSCs). Results: We found that the proliferation and osteogenic differentiation of hMSCs was influenced by the size of the underlying structures, suggesting that size variations in topographic features at the nanoscale level, independently of chemistry, can be exploited to control hMSC behavior in a size-dependent fashion. Conclusion: Our studies demonstrate that colloidal lithography, in combination with coating technologies, can be exploited to investigate the cell response to well defined nanoscale topography and to develop next-generation surfaces that guide tissue regeneration and promote implant integration.
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| 6. |
- Giangregorio, Lora M, et al.
(författare)
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FRAX underestimates fracture risk in patients with diabetes
- 2012
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Ingår i: Journal of bone and mineral research. - : Wiley. - 1523-4681 .- 0884-0431. ; 27:2, s. 301-308
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Tidskriftsartikel (refereegranskat)abstract
- The study objective was to determine whether diabetes is a risk factor for incident hip or major osteoporotic fractures independent of FRAX. Men and women with diabetes (N=3,518) and non-diabetics (N=36,085) age ≥50 years at the time of BMD testing (1990-2007) were identified in a large clinical database from Manitoba, Canada. FRAX probabilities were calculated and fracture outcomes to 2008 were established via linkage with a population-based data repository. Multivariable Cox proportional hazards models were used to determine if diabetes was associated with incident hip fractures or major osteoporotic fractures after controlling for FRAX risk factors. Mean 10-year probabilities of fracture were similar between groups for major fractures (diabetic 11.1±7.2 vs. non-diabetic 10.9±7.3, p-value=0.116) and hip fractures (diabetic 2.9±4.4 vs. non-diabetic 2.8±4.4, p-value=0.400). Diabetes was a significant predictor of subsequent major osteoporotic fracture (HR 1.61 [95% CI; 1.42-1.83]) after controlling for age, sex, medication use, and FRAX risk factors including BMD. Similar results were seen after adjusting for FRAX probability directly (HR 1.59 [95% CI; 1.40-1.79]). Diabetes was also associated with significantly higher risk for hip fractures (p-value<0.001). Higher mortality from diabetes attenuated but did not eliminate the excess fracture risk. FRAX underestimated observed major osteoporotic and hip fracture risk in diabetics (adjusted for competing mortality), but demonstrated good concordance with observed fractures for non-diabetics. We conclude that diabetes confers an increased risk of fracture that is independent of FRAX derived with BMD. This suggests that diabetes might be considered for inclusion in future iterations of FRAX. © 2011 American Society for Bone and Mineral Research.
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| 7. |
- Haghsheno, Mohammad-Ali, et al.
(författare)
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Low 25-OH Vitamin D Level is Associated with Benign Prostatic Enlargement (BPE).
- 2013
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 190:2, s. 608-614
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To test the hypothesis that low levels of vitamin D were associated with Benign Prostatic Enlargement (BPE). We also studied whether body composition, sex hormones, serum SHBG, albumin corrected serum calcium, adiponectin and lipid statuses were associated with BPE. MATERIALS AND METHODS: 184 representative randomly selected men aged 72 - 76 years, enrolled in the Gothenburg arm of the MrOs study, were investigated. Men with a medical history of prostate cancer, prostate operation or medication for BPE were excluded leaving 155 men to be analyzed. A cross-sectional study was conducted in which BPE, as measured by the total prostate gland volume, was related to clinical, anthropometric, endocrine and metabolic factors, using univariate and multivariate analyses with regression models. RESULTS: The median prostate volume was 40 ml. In multivariate models only 25-OH vitamin D, albumin corrected serum calcium, serum SHBG and HDL-cholesterol were significantly and inversely associated with large prostate glands. CONCLUSION: The present report adds four independent factors associated with BPE: Low levels of 25-OH vitamin D, serum calcium, SHBG and HDL-cholesterol.
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| 8. |
- Johansson, Helena, 1981, et al.
(författare)
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A comparison of case-finding strategies in the UK for the management of hip fractures.
- 2012
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 23:3, s. 907-15
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Tidskriftsartikel (refereegranskat)abstract
- Treatment criteria published by the National Osteoporosis Guideline Group (NOGG) in the UK make more efficient use of bone mineral density (BMD) resources than the previous Royal College of Physicians (RCP) guideline.
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| 9. |
- Johansson, Helena, 1981, et al.
(författare)
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A meta-analysis of the association of fracture risk and body mass index in women.
- 2014
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Ingår i: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. - : Wiley. - 1523-4681. ; 29:1, s. 223-33
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Tidskriftsartikel (refereegranskat)abstract
- Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20-105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30kg/m(2) ) was present in 22%. A majority of osteoporotic fractures (81%) and hip fractures (87%) arose in non-obese women. Compared to a BMI of 25kg/m(2) , the hazard ratio (HR) for osteoporotic fracture at a BMI of 35kg/m(2) was 0.87 (95% confidence interval [CI], 0.85-0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic fracture was increased (HR, 1.16; 95% CI, 1.09-1.23). Low BMI is a risk factor for hip and all osteoporotic fracture, but is a protective factor for lower leg fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) fracture. When adjusted for BMD, low BMI remained a risk factor for hip fracture but was protective for osteoporotic fracture, tibia and fibula fracture, distal forearm fracture, and upper arm fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm fracture but was also a risk factor for all osteoporotic fractures. The association between BMI and fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility fracture. The contribution of increasing population rates of obesity to apparent decreases in fracture rates should be explored. © 2014 American Society for Bone and Mineral Research.
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| 10. |
- Johansson, Helena, 1981
(författare)
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Estimation of risk in the field of osteoporosis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Osteoporosis has been recognised as an established and well-defined disease that affects more than 75 million people in the United States, Europe and Japan. Osteoporosis has been operationally defined by the WHO on the basis of bone mineral density (BMD) assessment. Although risk factors for fracture are well-known and thoroughly investigated, osteoporosis is an under-diagnosed and under-treated disease in women, and even more so in men. Objective: The general objective of this work is in the context of the development an assessment tool (FRAX) for the prediction of fracture in men and women with the use of clinical risk factors for fracture with and without the use of femoral neck BMD. The rationale arises from the observation that factors other than BMD contribute towards fracture risk and that estimates of probability permit the integration of multiple clinical risk factors (CRFs) including the competing risk of death. The material presented in this thesis aims to illustrate several components of this work. The first is the identification of a clinical risk factor (exposure to glucocorticoids) as a potential candidate for its inclusion into the FRAX algorithm. A second aim was to determine the increase in operating characteristics of combining clinical risk factors with and without the inclusion of BMD. A novel feature of the FRAX models is that they integrate the fracture and death hazards in the determination of fracture probabilities. Several clinical risk factors affect the death hazard as well as the fracture hazard, so that a third aim was to explore the effect of a well established CRF (BMD) and a potential CRF (serum 25-hydroxyvitamin D) on the risk of death. A final aim was to determine the potential of a new candidate risk variable (serum adiponectin) for fracture. Methods: To create the risk assessment tool baseline and follow-up data is used from eleven international prospective population-based cohorts comprising 15 259 men and 44 902 women with 5 563 fractures of any kind and 978 hip fractures. Cohorts were followed for a total of over 250 000 person years. Primary data from the cohorts is used so that important interactions could be determined. In addition a Swedish cohort of 3 014 elderly men (MrOS) is used, drawn from the general population. Results: The risk factors incorporated in the assessment tool comprised body mass index (as a continuous variable), a prior history of fracture, a parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis, current smoking and alcohol intake >2 units daily. Their inclusion was based on their international validity and independent contribution to fracture risk. Four models were then constructed to compute fracture probabilities in nine of the cohorts. These comprised the probability of hip fracture, with and without femoral neck BMD, and the probability of other osteoporotic fractures, with and without BMD. For each model fracture and death hazards functions were computed and used to compute 10-year fracture probabilities (FRAX). The model could be calibrated to any country where the epidemiology of fracture and death is known. In the publications included in this thesis, exposure to glucocorticoids is shown to be a significant risk factor for fracture, providing the rational for the inclusion of this CRF in the FRAX algorithms. We also show that the incorporation of CRFs improves the operating characteristics of fracture risk assessment over and above that provided by BMD alone. In elderly men in the Swedish MrOS cohort, it is shown that low BMD is associated with increased mortality in a non-linear pattern (overall gradient of risk (GR) 1.27; 95% CI 1.14-1.42, multivariable adjusted), that low vitamin D is associated with increased mortality (overall GR; 1.15; 95% CI 1.03-1.29, multivariable adjusted) and that the association wanes with time. It is also shown that high adiponectin is associated with higher fracture risk in elderly men (overall GR; 1.32; 95% CI 1.15-1.52, multivariable adjusted). Conclusion: Components of the work in this thesis have contributed to the creation of FRAX, a fracture risk assessment tool, that has been recommended by WHO and is widely used in clinical practice to identify patients suitable for pharmacological intervention. In elderly men it is showed that low BMD and low vitamin D are risk factors for death and high adiponectin is a risk factor for fracture. The biostatistical contribution to these associations is the identification of non-linearity of the associations and their dependence on time since baseline assessment.
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