| 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. |
- Egund, Lisa, et al.
(författare)
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Disability and Pain are the Best Predictors of Sick Leave After a Distal Radius Fracture in Men
- 2020
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Ingår i: Journal of Occupational Rehabilitation. - : Springer Science and Business Media LLC. - 1053-0487 .- 1573-3688. ; 30:4, s. 656-664
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Distal radius fracture often compromises working ability, but clinical implications are less studied in men due to its lower incidence. This study therefore describes sick leave in men with distal radius fracture, specifically exploring the impact of patient- and fracture-related factors. Methods Professionally active men aged 20–65 with distal radius fracture were followed prospectively for 1-year (n = 88). Data included treatment method, radiographic parameters pre/post treatment, complications, health, lifestyle and occupational demand. Patient outcomes were self-reported sick leave; Disability of the Arm, Shoulder and Hand (DASH) score; pain (5 likert scale); SF-36: Physical Component Scale (PCS) and Mental Component Scale (MCS). Results Median sick leave was 4 weeks (IQR 0; 8); almost a third reported taking no sick leave. Categorizing sick leave into 3 groups (0–6, 7–12 and > 12 weeks), men with the longest sick leave had 22 points higher DASH score (p = 0.001) and 5 points lower PCS (p = 0.02) at 1 week and the difference remained over time; they were also older and more often treated surgically. The strongest predictors of length of sick leave were one-week post-fracture DASH score (rs = 0.4, p < 0.001), pain intensity (rs = 0.4, p < 0.001) and PCS (rs = − 0.4, p = 0.002). The correlation between sick leave and pain was even stronger analyzing treatment groups separately (closed reduction and cast rs = 0.56, p = 0.007, surgery rs = 0.42, p = 0.04). Conclusions Self-reported disability, pain and global health measurements as early as 1 week post-fracture are the strongest predictors of length of sick leave regardless of treatment; an important finding easily transferrable to clinical management of distal radius fractures.
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| 3. |
- Egund, Lisa, et al.
(författare)
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High Luteinizing Hormone and Lower Levels of Sex Hormones in Younger Men With Distal Radius Fracture
- 2020
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Ingår i: JBMR Plus. - : Wiley. - 2473-4039. ; 4:11
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates the sex steroid hormone profile in younger men with distal radius fracture (DRF) to elucidate if this could explain the low bone density and osteoporosis previously observed. In a case–control study, 73 men with DRF (mean age 38 ± 9 years; range, 20–51) was compared with 194 age-matched, population controls. Performed assays: total testosterone (TT), calculated free testosterone (cFT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (SHBG), and total estradiol (E2). BMD hip and spine were measured. Fracture cases had lower cFT (298 versus 329 pmol/L; p = 0.008), but not TT, compared with controls. FSH and SHBG were not statistically different. LH was almost 30% higher (5.7 versus 4.5 IU/L; p < 0.001) and a lower E2 was observed (80.0 versus 87.1; p = 0.098). Men with DRF had a lower E2/SHBG ratio compared with controls (2.3 versus 2.9; p = 0.013). A higher proportion of the fracture group had low TT (<10.5 nmol/L; 21% versus 11%; p = 0.052), low cFT (<220 pmol/L; 18% versus 8%; p = 0.017), and low E2 (<73 pmol/L; 48% versus 35%; p = 0.044). Odds ratio (OR) for fracture when having low cFT was 2.3 (95% CI, 1.02–5.49; p = 0.044); with low E2, the OR was 1.7 (95% CI, 0.96–2.96). In this study in young men with DRF exploring sex hormone levels, we find that sex hormone profiles may be disturbed with a lower E2/SHBG ratio, lower cFT, and higher LH. Estrogen is also a strong determinant of bone mass in men; hence, low levels of E2 may be contributing to the observed lower BMD and these differences may be relevant to fracture risk.
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| 4. |
- Egund, Lisa, et al.
(författare)
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High Prevalence of Osteoporosis in Men with Distal Radius Fracture : A Cross-Sectional Study of 233 Men
- 2016
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Ingår i: Calcified Tissue International. - : Springer Science and Business Media LLC. - 0171-967X .- 1432-0827. ; 99:3, s. 250-258
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Tidskriftsartikel (refereegranskat)abstract
- Distal radius fracture is an early indicator of osteoporosis, yet little is known about men with this fracture and osteoporosis prevalence. The purpose of this cross-sectional, controlled study was to evaluate bone mineral density (BMD) in men, from working age to the elderly, with distal radius fracture. Recruitment was as follows: men who fractured during 1999–2000 were evaluated retrospectively in 2003 and men who fractured during 2003–2007 were followed prospectively for one year post-fracture. A total of 233 patients, response rate 40 %, were enrolled and compared with 643 controls. Fractures from all degrees of trauma were included. BMD was measured at femoral neck, total hip, and lumbar spine. Mean age at fracture was 52 years (21–88 years). Men aged 40–64 years had 5.4–6.7 % lower BMD at all sites compared to controls (p = 0.001) and in >65 years BMD was lower by 10.7–13.8 % (p <0.001), while not significant at 65 years: 23.3 vs 8.3 %) BMD did not differ with trauma level. Already from age 40, men with a distal radius fracture had lower BMD, the difference becoming more pronounced with increasing age. Also, the prevalence of osteoporosis was higher, surprisingly even in the youngest age group.
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| 5. |
- Egund, Tove Lisa Ulrika
(författare)
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Distal radius fracture in men from working age to the oldest. Bone mass and patient-related outcome.
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The distal radius fracture is the most common fracture of them all and it affects both men and women of all ages. However, no study had investigated men specifically. The overall aim of this thesis was to comprehensively study adult men with distal radius fracture addressing the bone mass of adult men from working age to the old and in addition, exploring determinants for self-reported outcome and sick leave. Recruitment was as follows: men who fractured during 1999-2000 were evaluated retrospectively in 2003 and men who fractured during 2003-2007 were followed prospectively for one-year post-fracture. A total of 233 patients, response rate 40%, were enrolled and compared with 643 controls. Fractures from all degrees of trauma were included. In paper I, we asked if bone mineral density (BMD) differed between men with distal radius fracture and a control group representative of the background population. Already from the age of 40, men with a distal radius fracture had lower BMD, the difference becoming more pronounced with increasing age. BMD did not differ with trauma level. Osteoporosis was more prevalent at all ages (20-39y: 8.5% vs 1.5%; 40-64y: 16.8% vs 5.1%; >65y: 23.3% vs 8.3%). Sex hormones are crucial to skeletal health in adolescence and older age. In paper II, we investigated the sex hormone profile in younger men with distal radius fracture in order to elucidate, if this contributes to explaining the low bone density and osteoporosis previously observed. The main finding was that younger men, aged 20 to 50, have an altered hormone profile with reduced levels of both free estradiol and testosterone and elevated luteinizing hormone when compared to age-matched controls. A distal radius fracture and probably other appendicular fractures in younger men might therefor be early signs of silent hypogonadism for clinicians to be aware of. Self-reported outcome after distal radius fracture differ between young and elderly. In paper III, we asked how self-reported outcome relate to fracture appearance, BMD and fracture risk in young and elderly men. We found that men over the age of 65 are more likely to have displaced fractures at both initial presentation and at follow up and higher degree of disability independent of radiographic appearance at follow up. BMD per se was not related to displacement or disability; however, most older men initially presenting with a displaced fracture also had unacceptable reduction at follow-up and higher future fracture risk, indicative of poorer bone quality. Sick leave following a fracture is a common negative consequence. But what factors are of importance after distal radius fracture and what is the impact of patient- and fracture related factors, respectively, on length of sick leave? In paper IV we found that higher self-perceived disability and pain as early as one week after fracture are the strongest predictors of length of sick leave, regardless of treatment type. In conclusion, our results show that in men, as in women, a distal radius fracture is a red flag for impaired bone strength. Men should be evaluated for osteoporosis as routine and sex hormones should also be considered. The treatment of older men with radius fracture needs further improvement, since many have disability 1 year after fracture. High degree of pain early after fracture is the greatest risk factor of longer sick leave.
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| 6. |
- Pedersen, Bolette, et al.
(författare)
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Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review
- 2011
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Ingår i: BMC Surgery. - : Springer Science and Business Media LLC. - 1471-2482. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs. Methods: A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics. Results: The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months. Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients. The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up. Conclusions: Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.
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