| 1. |
- Buttazzoni, Christian, et al.
(författare)
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A Pediatric Bone Mass Scan Has Poor Ability to Predict Adult Bone Mass: A 28-Year Prospective Study in 214 Children.
- 2014
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Ingår i: Calcified Tissue International. - : Springer Science and Business Media LLC. - 1432-0827 .- 0171-967X. ; 94:2, s. 232-239
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Tidskriftsartikel (refereegranskat)abstract
- As the correlation of bone mass from childhood to adulthood is unclear, we conducted a long-term prospective observational study to determine if a pediatric bone mass scan could predict adult bone mass. We measured cortical bone mineral content (BMC [g]), bone mineral density (BMD [g/cm(2)]), and bone width (cm) in the distal forearm by single photon absorptiometry in 120 boys and 94 girls with a mean age of 10 years (range 3-17) and mean 28 years (range 25-29) later. We calculated individual and age-specific bone mass Z scores, using the control cohort included at baseline as reference, and evaluated correlations between the two measurements with Pearson's correlation coefficient. Individual Z scores were also stratified in quartiles to register movements between quartiles from growth to adulthood. BMD Z scores in childhood and adulthood correlated in both boys (r = 0.35, p < 0.0001) and girls (r = 0.50, p < 0.0001) and in both children ≥10 years at baseline (boys r = 0.43 and girls r = 0.58, both p < 0.0001) and children <10 years at baseline (boys r = 0.26 and girls r = 0.40, both p < 0.05). Of the children in the lowest quartile of BMD, 58 % had left the lowest quartile in adulthood. A pediatric bone scan with a value in the lowest quartile had a sensitivity of 48 % (95 % confidence interval [CI] 27-69 %) and a specificity of 76 % (95 % CI 66-84 %) to identify individuals who would remain in the lowest quartile also in adulthood. Childhood forearm BMD explained 12 % of the variance in adult BMD in men and 25 % in women. A pediatric distal forearm BMD scan has poor ability to predict adult bone mass.
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| 2. |
- Buttazzoni, Christian, et al.
(författare)
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A Pediatric Bone Mass Scan has Poor Ability to Predict Peak Bone Mass: An 11-Year Prospective Study in 121 Children.
- 2015
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Ingår i: Calcified Tissue International. - : Springer Science and Business Media LLC. - 1432-0827 .- 0171-967X. ; 96:5, s. 379-388
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Tidskriftsartikel (refereegranskat)abstract
- This 11-year prospective longitudinal study examined how a pre-pubertal pediatric bone mass scan predicts peak bone mass. We measured bone mineral content (BMC; g), bone mineral density (BMD; g/cm(2)), and bone area (cm(2)) in femoral neck, total body and lumbar spine by dual-energy X-ray absorptiometry in a population-based cohort including 65 boys and 56 girls. At baseline all participants were pre-pubertal with a mean age of 8 years (range 6-9), they were re-measured at a mean 11 years (range 10-12) later. The participants were then mean 19 years (range 18-19), an age range that corresponds to peak bone mass in femoral neck in our population. We calculated individual BMC, BMD, and bone size Z scores, using all participants at each measurement as reference and evaluated correlations between the two measurements. Individual Z scores were also stratified in quartiles to register movements between quartiles from pre-pubertal age to peak bone mass. The correlation coefficients (r) between pre-pubertal and young adulthood measurements for femoral neck BMC, BMD, and bone area varied between 0.37 and 0.65. The reached BMC value at age 8 years explained 42 % of the variance in the BMC peak value; the corresponding values for BMD were 31 % and bone area 14 %. Among the participants with femoral neck BMD in the lowest childhood quartile, 52 % had left this quartile at peak bone mass. A pediatric bone scan with a femoral neck BMD value in the lowest quartile had a sensitivity of 47 % [95 % confidence interval (CI) 28, 66] and a specificity of 82 % (95 % CI 72, 89) to identify individuals who would remain in the lowest quartile at peak bone mass. The pre-pubertal femoral neck BMD explained only 31 % of the variance in femoral neck peak bone mass. A pre-pubertal BMD scan in a population-based sample has poor ability to predict individuals who are at risk of low peak bone mass.
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| 3. |
- Buttazzoni, Christian
(författare)
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Bone Mass from Childhood to Adulthood
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Attaining high peak bone mass (PBM), the highest bone mass value in life which is reached in young adulthood, is important as it reduces the risk of having low bone mass in old age69, 80. Low bone mass is associated with high fracture risk3, 60. Osteoporosis is the result of bone loss, a physiological process related to aging and/or low PBM. It would therefore be of great value to identify children at risk of reaching low PBM for possible interventions. But the level of correlation, in the thesis referred to as “tracking”, in bone mass from childhood to adulthood is unclear. Making predictions about adult bone mineral density (BMD) from childhood measurements is difficult as bone properties change rapidly during growth59. Most studies that have evaluated the question are either cross-sectional, have a short follow-up time or end close to the final growth spurt, making reliable predictions difficult. There are some reports suggesting that a childhood excess62, 76 or deficit77, 116 in BMD remains in adulthood, and the few prospective studies that have addressed the question infer that there is a partial “tracking” in BMD during growth. Longitudinal studies with serial measurements that cover both the pre- and post-pubertal phases and that follow the participants until peak bone mass (PBM) would provide data with a higher level of evidence and thereby increase our knowledge. In this thesis, with a long-term prospective study design, we have evaluated the “tracking” of bone mass from childhood to adulthood, and specifically evaluated two risk factors linked to low BMD. The first is a fracture in childhood which has been an event identified as associated with low BMD both in childhood31 and in adulthood54. The second is premature birth in relation to low birth weight, since both traits have been associated with low PBM67, 84. We invited subjects from three previous studies63, 86-87 published during 1981–1985 to be re-measured almost three decades after the initial measurement. The study subjects with a mean age of 10 years (range 3–17) at the first measurement were re-measured a mean 27 (range 25–29) years later. Bone traits were prospectively evaluated with singlephoton absorptiometry (SPA) in 214 individuals consisting of three cohorts: healthy control subjects, children with fracture during childhood and children born preterm, either small for gestational age (SGA) or appropriate for gestational (AGA). In the second cohort we evaluated bone traits prospectively by dual-energy X-ray absorptiometry (DXA) in 121 children from the Pediatric Osteoporosis Prevention (POP) study, an exercise intervention study that is primarily designed to assess 10 musculoskeletal development and fracture risk in response to increased physical education in school children. The study subjects with a mean age of 8 years (range 7– 9) at the first measurement were re-measured a mean 11 (range 10–12) years later. Our aim was to evaluate (i) whether a bone mass scan in childhood can be used to predict bone mass in adulthood, (ii) whether children who sustain a fracture are at increased risk of reaching low adult BMD and (iii) whether prematurely born children, either AGA or SGA, are at increased risk of reaching low adult BMD. The correlation coefficients (r) between pre-pubertal and young adulthood measurements for distal radius BMC and BMD varied between 0.35 and 0.64 and for femoral neck BMC, BMD and bone area it varied between 0.37 and 0.65. A childhood fracture in men was associated with a low BMC Z-score (–0.4 (95% CI –0.6, –0.1)) and low BMD Z-score (–0.4 (95% CI –0.7, –0.1)) at baseline and with a low BMC Zscore (–0.5 (95% CI –0.8, –0.2)) and low BMD Z-score (–0.4 (95% CI –0.7, –0.1)) at follow-up. Preterm-born children were still shorter in adulthood (p=0.03), they also had lower femoral neck (FN) BMC, FN BMD, tibial cortical BMD, tibial crosssectional area and SSI than controls (all p-values 0.001 to <0.05). The deficits were driven by lower bone traits in preterm SGA individuals, while no differences were seen in preterm AGA individuals compared to controls. This thesis shows that an individual pediatric bone mass scan, regardless of whether it is evaluated with SPA or DXA and independent of the measured skeletal region, has poor ability to predict an adult bone mass value. We also show that a childhood fracture in men was associated with low BMD and smaller bone size in young adulthood and that prematurity and being born SGA is another risk factor for low bone mass in young adulthood.
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| 4. |
- Buttazzoni, Christian, et al.
(författare)
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Does a childhood fracture predict low bone mass in young adulthood? - A 27-year prospective controlled study.
- 2013
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Ingår i: Journal of Bone and Mineral Research. - : Wiley. - 1523-4681 .- 0884-0431. ; 28:2, s. 351-359
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A fracture in childhood is associated with low bone mineral density (BMD), but it is debated whether a fracture at growth also predicts low BMD in young adulthood. PURPOSE: To gender-specifically evaluate whether children with a fracture are at increased risk of low BMD in young adulthood. METHODS: Distal forearm BMD (g/cm(2) ) was measured with single photon absorptiometry (SPA) in 47 boys and 26 girls (mean age 10 years, range 3-16) with an index fracture and in 41 boys and 43 girls (mean age 10 years, range 4-16) with no fracture. BMD was re-measured mean 27 years later with the same SPA apparatus and with dual energy absorptiometry (DXA), quantitative ultrasound (QUS) and peripheral computed tomography (pQCT). Individual Z-scores were calculated using the control cohort as reference population. Data are presented as means with 95% confidence intervals (95% CI) within brackets and correlation with Pearson's correlation coefficient RESULTS: Boys with an index fracture had at fracture event a distal forearm BMD Z-score of -0.4 (-0.7, -0.1) and at follow-up -0.4 (-0.7, -0.1). Corresponding values in girls were -0.2 (-0.5, 0.1) and -0.3 (-0.7, 0.1). The deficit in absolute bone mass was driven by men with index fractures in childhood due to low rather than moderate or high energy. There were no changes in BMD Z-score during the follow-up period. The BMD deficit at follow-up was in boys with an index fracture verified with all advocated techniques CONCLUSIONS: A childhood fracture in men was associated with low BMD and smaller bone size in young adulthood while the deficit in women did not reach statistical significance. © 2012 American Society for Bone and Mineral Research.
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| 5. |
- Buttazzoni, Christian, et al.
(författare)
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Preterm Children Born Small for Gestational Age are at Risk for Low Adult Bone Mass.
- 2016
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Ingår i: Calcified Tissue International. - : Springer Science and Business Media LLC. - 1432-0827 .- 0171-967X. ; 98:2, s. 105-113
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Tidskriftsartikel (refereegranskat)abstract
- Cross-sectional studies suggest that premature birth and low birth weight may both be associated with low peak bone mass. We followed bone traits in preterm individuals and controls for 27 years and examined the effects of birth weight relative to gestational age [stratified as small for gestational age (SGA) or appropriate for gestational (AGA)] on adult bone mineral density (BMD). We measured distal forearm BMC (g/cm) and BMD (g/cm(2)) with single-photon absorptiometry (SPA) in 46 preterm children (31 AGA and 15 SGA) at mean age 10.1 years (range 4-16) and in 84 healthy age-matched children. The measurements were repeated 27 years later with the same SPA apparatus but then also with dual energy absorptiometry and peripheral computed tomography (pQCT). Preterm individuals were shorter (p = 0.03) in adulthood than controls. Preterm AGA individuals had similar BMC and BMD height-adjusted Z-scores in adulthood compared to controls. Preterm SGA individuals had lower distal forearm BMC and BMD height-adjusted Z-scores in adulthood than both controls and preterm AGA individuals. Preterm SGA individuals had lower gain from childhood to adulthood in distal forearm BMC height-adjusted Z-scores than controls (p = 0.03). The deficits in preterm SGA individuals in adulthood were also captured by DEXA in height-adjusted femoral neck (FN) BMC Z-score and height-adjusted FN BMD Z-score and by pQCT in tibial cross-sectional area (CSA) Z-score and stress strain index (SSI) Z-score, where all measurements were lower than controls (all p values <0.05). Preterm SGA individuals are at increased risk of reaching low adult bone mass, at least partly due to a deficit in the accrual of bone mineral during growth. In our cohort, we were unable to find a similar risk in preterm AGA individuals.
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| 6. |
- Korsnes, Lars, et al.
(författare)
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Undersizing the Exeter stem in hip hemiarthroplasty increases the risk of periprosthetic fracture
- 2020
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Ingår i: HIP International. - : Sage Publications. - 1120-7000 .- 1724-6067. ; 30:4, s. 469-473
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Tidskriftsartikel (refereegranskat)abstract
- Introduction:: Whether under- or oversizing of the femoral component of cemented hip hemiarthroplasties impacts the risk of periprosthetic fractures (PPF) has only been examined experimentally. This study was carried out to add more knowledge about the risks of PPF in cemented polished tapered hemiarthroplasties.Methods: 20 patients with PPF following hip hemiarthroplasty with cemented Exeter V40 stems were compared to 50 controls who never suffered PPF having received the same type of Exeter hemiprosthesis for the same indication. The difference between stem size and post-hoc radiographic ideal templated size was investigated as a predictor of PPF.Results: Cases had a median size difference to post-hoc templating of –2, while controls had a median size difference of –1 (p = 0.09). An ROC curve constructed to find an optimal cutoff point in size difference between cases and controls arrived at an area under curve of 63%, with –1.5 as the cutoff. Patients with size differences exceeding –1.5 had a statistically significant increased PPF risk (odds ratio = 3.8, 95% confidence interval, 1.1–13.3, p < 0.05). This group covered 55% of all cases.Conclusion: An implanted femoral component that is 2 or more sizes smaller than the template that is shown to be appropriate will increase the risk of PPF in Exeter hip hemiarthroplasties.
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| 7. |
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| 8. |
- Schmidt, Viktor, et al.
(författare)
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Functional outcomes are restored a decade after a distal radius fracture : a prospective long-term follow-up study
- 2024
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 49:3, s. 322-328
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Tidskriftsartikel (refereegranskat)abstract
- We performed an 11-13-year prospective follow-up of patients after a distal radial fracture (DRF) to investigate the association between fracture malunion, radiocarpal osteoarthritis and clinical outcome. In total, 292 patients responded to patient-reported outcome measures; of them, 242 underwent clinical examination. Clinical outcomes improved with time. A decade after fracture, median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 5, EuroQol Five-dimensions score was 1.0, and range of motion and grip strength were 96% of the contralateral side. Neither osteoarthritis (6%) nor pseudoarthrosis of the ulnar styloid (30%) affected the outcomes. Dorsal tilt, radial inclination, ulnar variance and intra-articular extension did not affect long-term clinical outcomes or the risk of osteoarthritis. Recovery after a DRF is an ongoing process that lasts years. A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes.Level of evidence: II.
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