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- Manouchehrinia, A, et al.
(författare)
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Clinical course of multiple sclerosis: A nationwide cohort study
- 2017
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Ingår i: Multiple sclerosis (Houndmills, Basingstoke, England). - : SAGE Publications. - 1477-0970 .- 1352-4585. ; 23:11, s. 1488-1495
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Tidskriftsartikel (refereegranskat)abstract
- The course of multiple sclerosis (MS) has been studied in several cohorts; however, results have varied significantly. Objective: To describe the clinical course of MS in a nationwide cohort of patients. Method: Data from the Swedish MS register (SMSreg) were used to estimate the median time to the sustained Expanded Disability Status Scale (EDSS) scores 3.0, 4.0 and 6.0, onset of secondary progressive multiple sclerosis (SPMS) and death using Kaplan–Meier method. A possible effect of first-line treatments on age at EDSS 6.0 and SPMS was estimated. Results: In all, 12,703 patients were included. Median ages at EDSS scores 3.0, 4.0 and 6.0 were 55.4 (95% confidence interval (CI): 54.8−55.8), 60.7 (95% CI: 60.1−61.2) and 64.3 (95% CI: 63.6−64.7), respectively. Median age at SPMS was 57.4 (95% CI: 56.9−57.9). The median age at the time of death was 80.5 (95% CI: 79.9−81.1). Males and progressive-onset patients showed higher risks of disability worsening. On average, treated patients gained 1.6 years (95% CI: 0.2−3) to EDSS 6.0 as a result of treatment. Conclusion: Ages at disability milestones in this population-based cohort were higher than previously described in clinic- and regional-based samples. Nevertheless, MS patients die at younger age and live at an average almost 20 years with moderate and 30 years with severe disability.
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- Wilczek, M L, et al.
(författare)
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Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk-a study in 5,420 women and 2,837 men
- 2013
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Ingår i: European Radiology. - : Springer Verlag (Germany). - 0938-7994 .- 1432-1084. ; 23:5, s. 1383-1391
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Tidskriftsartikel (refereegranskat)abstract
- To assess whether digital X-ray radiogrammetry (DXR) analysis of standard clinical hand or wrist radiographs obtained at emergency hospitals can predict hip fracture risk. less thanbrgreater than less thanbrgreater thanA total of 45,538 radiographs depicting the left hand were gathered from three emergency hospitals in Stockholm, Sweden. Radiographs with insufficiently included metacarpal bone, fractures in measurement regions, foreign material or unacceptable positioning were manually excluded. A total of 18,824 radiographs from 15,072 patients were analysed with DXR, yielding a calculated BMD equivalent (DXR-BMD). Patients were matched with the national death and inpatient registers. Inclusion criteria were age a parts per thousand yen 40 years, no prior hip fracture and observation time andgt; 7 days. Hip fractures were identified via ICD-10 codes. Age-adjusted hazard ratio per standard deviation (HR/SD) was calculated using Cox regression. less thanbrgreater than less thanbrgreater than8,257 patients (65.6 % female, 34.4 % male) met the inclusion criteria. One hundred twenty-two patients suffered a hip fracture after their radiograph. The fracture group had a significantly lower DXR-BMD than the non-fracture group when adjusted for age. The HR/SD for hip fracture was 2.52 and 2.08 in women and men respectively. The area under the curve was 0.89 in women and 0.84 in men. less thanbrgreater than less thanbrgreater thanDXR analysis of wrist and hand radiographs obtained at emergency hospitals predicts hip fracture risk in women and men. less thanbrgreater than less thanbrgreater thanKey Points less thanbrgreater than less thanbrgreater thanDigital X-ray radiogrammetry of emergency hand/wrist radiographs predicts hip fracture risk. less thanbrgreater than less thanbrgreater thanDigital X-ray radiogrammetry (DXR) predicts hip fracture risk in both women and men. less thanbrgreater than less thanbrgreater thanOsteoporosis can potentially be identified in patients with suspected wrist fractures. less thanbrgreater than less thanbrgreater thanDXR can potentially be used for selective osteoporosis screening.
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- Wilczek, M, et al.
(författare)
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Predicting hip fracture risk with hand or wrist radiographs using digital X-ray Radiogrammetry
- 2012
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Ingår i: Bone. - : Elsevier. - 8756-3282 .- 1873-2763. ; 50:Supplement 1, s. S65-S65
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Background: More than 50% of patients diagnosed with osteoporosis after a fracture have had at least one previous fracture. Despite an established relationship between bone mineral density (BMD) and fracture risk, as well as proven effective pharmacological treatment, there is still no routine for screening for osteoporosis. Digital X-ray Radiogrammetry (DXR) analysis provides a simple way to obtain a BMD measurement. However, there is a need for larger studies evaluating the relationship between BMD obtained through DXR and future fracture risk. If such a relationship is strong enough, it should be possible to find osteoporotic patients already at the time of the first fracture by analyzing hand X-ray images with DXR. Aim: To evaluate if conventional radiographs can be used to estimate future hip fracture risk with DXR analysis. Method and materials: After receiving approval from the local ethical committee, all radiographs depicting the left hand were collected from three emergency hospitals in Stockholm, Sweden (n = 45,538). Radiographs with insufficiently depicted metacarpal bone, foreign material such as fixation pins, unacceptable positioning of the metacarpals or fractures in the measurement regions, were manually excluded. 18,824 radiographs from 15,072 unique patients were considered suitable for DXR analysis. These patients were matched with the death and inpatient registers found at the Swedish National Board of Health and Welfare. Exclusion criteria were age < 40 years (n = 6,611) and prior hip fracture (n = 199). ICD-10 codes were used to identify hip fractures, including only patients coded for both diagnosis and adequate intervention. Results: 5420 women and 2842 men met the inclusion criteria. Average observation time was 3 years and 3 months, resulting in a total observation time of 27,072 person years. In total 122 patients had a hip fracture after their radiograph of the hand or wrist. Patients who suffered from a hip fracture had a significantly lower BMD than that of non-fractured patients when adjusted for age (0.53 g/cm2, SD 0.08 versus 0.42 g/cm2, SD 0.05 in females and 0.63 g/cm2, SD 0.07 versus 0.54 g/cm2, SD 0.09 in males; p < 0.0001, both). The age-adjusted RR/SD for hip fracture was 2.52 in females and 2.08 in males. The AUC was 0.89 in female and 0.84 in male. Conclusion: DXR analysis of wrist and hand radiographs obtained at emergency hospitals in Sweden predicts hip fracture risk in women and men.
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