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- Carlsson, Martin, et al.
(författare)
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Older Swedish Adults with High Self-Perceived Health Show Optimal 25-Hydroxyvitamin D Levels Whereas Vitamin D Status Is Low in Patients with High Disease Burden
- 2016
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 8:11
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Tidskriftsartikel (refereegranskat)abstract
- Controversy pervades the definition of adequate and optimal vitamin D status. The Institutes of Medicine have recommended serum 25(OH) D levels above 50 nmol/L based upon evidence related to bone health, but some experts, including the Endocrine Society and International Osteoporosis Foundation, suggest a minimum serum 25(OH) D level of 75 nmol/L to reduce the risk of falls and fractures in older adults. In a cross-sectional study, we compared vitamin D status in people >= 75 years selected from four groups with a frailty phenotype, combined with a control group free from serious illness, and who considered themselves completely healthy. Only 13% of the 169 controls were vitamin D deficient (S-25(OH) D) < 50 nmol/L), in contrast with 49% of orthopedic patients with hip fractures (n = 133), 31% of stroke patients (n = 122), 39% of patients visiting the hospital's emergency department >= 4 times a year (n = 81), and 75% of homebound adult residents in long-term care nursing homes (n = 51). The mean vitamin D concentration of the healthy control group (74 nmol/L) was similar to a suggested optimal level based on physiological data and mortality studies, and much higher than that of many officially recommended cut-off levels for vitamin D deficiency (< 50 nmol/L). The present study provides a basis for planning and implementing public guidelines for the screening of vitamin D deficiency and vitamin D treatment for frail elderly patients.
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| 3. |
- Nordqvist, Ola, 1979-, et al.
(författare)
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A novel index to assess low energy fracture risks in patients prescribed antiepileptic drugs
- 2021
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Ingår i: PLOS ONE. - San Francisco : Public Library of Science. - 1932-6203. ; 16:8
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To develop an index assessing the risks of low energy fractures (LEF) in patients prescribed antiepileptic drugs (AED) by exploring five previously suggested risk factors; age, gender, AED-type, epilepsy diagnosis and BMI.Methods: In a population-based retrospective open cohort study we used real world data from the Electronic Health Register (EHR) in Region Kalmar County, Sweden. 23 209 patients prescribed AEDs at any time from January 2008 to November 2018 and 23 281 matching controls were followed from first registration in the EHR until the first documented LEF, disenrollment (or death) or until the end of the study period, whichever came first. Risks of LEF measured as hazard rate ratios in relation to the suggested risk factors and in comparison to matched controls were analyzed using Cox regression. The index was developed using a linear combination of the statistically significant variables multiplied by the corresponding regression coefficients.Results: Data from 23 209 patients prescribed AEDs and 2084 documented LEFs during a follow-up time of more than 10 years resulted in the Kalmar Epilepsy Fracture Risk Index (KEFRI). KEFRI = Age-category x (1.18) + Gender x (-0.51) + AED-type x (0.29) + Epilepsy diagnosis-category x (0.31) + BMI-category x (-0.35). All five previously suggested risk factors were confirmed. Women aged 75 years and older treated with an inducing AED against epilepsy and BMIs of 25 kg/m2 or below had 48 times higher LEF rates compared to men aged 50 years or younger, treated with a non-inducing AED for a condition other than epilepsy and BMIs above 25 kg/m2.Conclusion: The KEFRI is the first weighted multifactorial assessment tool estimating risks of LEF in patients prescribed AEDs and could serve as a feasible guide within clinical practice.
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| 4. |
- Nordqvist, Ola, et al.
(författare)
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Low-energy fracture prediction in patients prescribed antiepileptic drugs : A Swedish case-control study assessing the value of BMD and TBS
- 2021
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Ingår i: <em>Presented at the IOF WCO ESCEO (virtual congress), London, UK, 2021</em>.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Antiepileptic drugs (AED) are known to increase the risk of low energy fractures by causing secondary osteoporosis. In this study, we determined the value of bone mineral density (BMD) and trabecular bone score (TBS) as predictors for low energy fractures in patients prescribed AED.Material and Methods: This case-control study included 517 low energy fractures, i.e. a combination of ICD-10 codes according to the Swedish National Board of Health and Welfare's definition of osteoporosis- related fractures and ICD-10 codes for low energy trauma, in 1 385 subjects who had all participated in a TBS convertible DXA examination between July 2011 and November 2018 in Kalmar county, southeast Sweden. The AED-users were stratified according to Cytochrome P-450 enzyme inducing ability and compared to controls. The dataset was a combination of previously collected data from the electronic health register (EHR) and new BMD and TBS data from a DXA database. Univariate and multivariate logistic regressions were applied. Results: In this study BMD-spine did not predict low energy fractures; however, both BMD-hip (aOR: 0.35, 95% CI: 0.24-0.50) and TBS (aOR: 0.65, 95% CI: 0.46-0.92) were inversely related to fractures. Patients prescribed enzyme inducing AED had an increased fracture odds (aOR: 2.15, 95% CI: 1.24-3.72). There was no difference for fracture outcome between subjects with non-inducing drugs and controls (p-value 0.476). In this study 67.5% of the TBS convertible DXAs were performed within a year of the low energy fracture. Of the included patients, 82% were women.Conclusions: While BMD-spine was not associated with low energy fractures, both BMD-hip and TBS predicted low energy fractures independently in patients prescribed AED. This is the first study demonstrating the value of TBS in patients prescribed AED. In clinical practice, BMD-hip and TBS could be combined to improve the assessment of bone health in this growing patient group. The value of the combination of the two measures should be assessed in a future prospective randomized study.
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