| 1. |
- Armbrecht, Gabriele, et al.
(författare)
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Degenerative inter-vertebral disc disease osteochondrosis intervertebralis in Europe : Prevalence, geographic variation and radiological correlates in men and women aged 50 and over
- 2017
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Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 56:7, s. 1189-1199
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To assess the prevalences across Europe of radiological indices of degenerative inter-vertebral disc disease (DDD); and to quantify their associations with, age, sex, physical anthropometry, areal BMD (aBMD) and change in aBMD with time. Methods. In the population-based European Prospective Osteoporosis Study, 27 age-stratified samples of men and women from across the continent aged 50+ years had standardized lateral radiographs of the lumbar and thoracic spine to evaluate the severity of DDD, using the Kellgren-Lawrence (KL) scale. Measurements of anterior, mid-body and posterior vertebral heights on all assessed vertebrae from T4 to L4 were used to generate indices of end-plate curvature. Results. Images from 10 132 participants (56% female, mean age 63.9 years) passed quality checks. Overall, 47% of men and women had DDD grade 3 or more in the lumbar spine and 36% in both thoracic and lumbar spine. Risk ratios for DDD grades 3 and 4, adjusted for age and anthropometric determinants, varied across a three-fold range between centres, yet prevalences were highly correlated in men and women. DDD was associated with flattened, non-ovoid inter-vertebral disc spaces. KL grade 4 and loss of inter-vertebral disc space were associated with higher spine aBMD. Conclusion. KL grades 3 and 4 are often used clinically to categorize radiological DDD. Highly variable European prevalences of radiologically defined DDD grades 3+ along with the large effects of age may have growing and geographically unequal health and economic impacts as the population ages. These data encourage further studies of potential genetic and environmental causes.
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| 11. |
- Elmståhl, S., et al.
(författare)
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Increased incidence of fractures in middle-aged and elderly men with low intakes of phosphorus and zinc
- 1998
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 8:4, s. 333-340
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to determine dietary risk factors for fracture in men aged 46-68 years. Six thousand five hundred and seventy-six men were randomly invited using the Municipal Registry to a diet and health study. The diet was assessed using a combined 7-day menu book for hot meals, beverages and dietary supplements and a quantitative food frequency questionnaire for other foods. The fracture incidence was 103/10,000 person-years during a mean follow-up of 2.4 years. Zinc and phosphorus intake were associated with fracture risk and showed a threshold effect. The zinc intake in the lowest decentile, 10 mg daily, was associated with almost a doubled risk of fracture compared with the fourth and fifth quintiles (RR = 0.47; 95% confidence interval, 27-82) of zinc intake adjusted for energy, previous fractures, lifestyle factors and co-morbidity. Energy-adjusted phosporus intake in the lowest quintile, mean level 1357 mg, was associated with an increased fracture risk compared with subjects in the second quintile. Smoking, martial status and physical activity were independently associated with fracture risk. Calcium, retinol and vitamin D showed no associations with fracture risk. We conclude that inadequate intakes of zinc and phosporus are important risk factors for fracture.
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| 12. |
- Hallengren, Bengt, et al.
(författare)
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No increase in fracture incidence in patients treated for thyrotoxicosis in Malmo during 1970-74. A 20-year population-based follow-up
- 1999
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 246:2, s. 139-144
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To study whether there is an increased fracture incidence following thyrotoxicosis. Design. A case-control study. Setting. Malmo University Hospital, Malmo, Sweden. Subjects: All patients (n = 333) from the population of Malmo who were treated for thyrotoxicosis for the first time during the 5-year period 1970-74. A total of 618 controls were selected from the local municipality registry in Malmo. For each case the aim was to randomly select two age- and gender-specific controls, alive in 1993 and born the same year and month as the case. Main outcome measures. Fracture incidence. Results. Comparing survivors, there were no differences in the percentage of individuals with fractures (all, fragility, non-fragility) between the patients and the controls. Comparing all individuals and including all fractures, the percentage of individuals with fractures in the entire female patient group (24.6%) was lower (P < 0.05) than in female controls (33.1%). There was a similar but non-significant pattern between male patients and controls. The mean number of all fractures was lower in male patients than in controls (P < 0.05), but no significant difference was noted between female patients and controls. For fragility fractures, there were no significant differences in the percentage of individuals with fractures or in the mean number of fractures between female or male patients and controls. Conclusion. In conclusion we found no increased incidence of fragility fractures in patients with previous thyrotoxicosis as compared with controls. Our results do not support the suggestion that screening for osteoporosis should be performed in patients with previous thyrotoxicosis.
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| 14. |
- Josefsson, Per O, et al.
(författare)
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Jones fracture. Surgical versus nonsurgical treatment
- 1994
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Ingår i: Clinical Orthopaedics and Related Research. - 0009-921X. ; 299, s. 252-255
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-three patients with 66 transverse and short oblique fractures of the proximal shaft of the fifth metatarsal bone (Jones fracture) were evaluated an average of five years (range, one to ten years) after the injury. There were 27 acute fractures and 39 chronic, or stress, fractures. The primary treatment was surgical for one third of the injuries and nonsurgical for the others. Surgical treatment consisted of the insertion of medullary screws. Nonsurgical treatment consisted of the application of either a plaster cast or an elastic bandage. Almost one fourth of the fractures treated nonsurgically later had to be treated surgically because of delayed unions or refractures. Late surgery was required in 12% of acute fractures and in 50% of chronic fractures with sclerosis narrowing the medullary canal. Irrespective of the primary treatment, all the patients had full function at the time of the follow-up evaluation, and no nonunions were diagnosed.
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| 15. |
- Jönsson, B, et al.
(författare)
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Cost-effectiveness of Fracture Prevention in Established Osteoporosis
- 1996
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Ingår i: Scandinavian Journal of Rheumatology. Supplement. - : Taylor & Francis. - 0301-3847 .- 1502-7740 .- 0300-9742 .- 1502-7732. ; 25:Suppl. 103, s. 30-38
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Tidskriftsartikel (refereegranskat)abstract
- This study presents the results of a computer simulation model for calculating the cost-effectiveness and cost-utility of treating patients with established osteoporosis in order to reduce the risk of fractures. The results are based on Swedish data for risk of fracture and costs. The treatment intervention modelled is based on treatment of a 62-year-old woman with established osteoporosis. The cost per hip fracture avoided is 350,000 SEK, assuming a 50% reduction in the risk of fracture due to 5 years of treatment. A sensitivity analysis for changes in the cost and effectiveness of treatment, the risk of fracture and the discount rate is performed. The cost per life-year gained and the cost per quality-adjusted life-year (QALY) gained is presented to enable comparison of the cost-effectiveness of treating osteoporosis with that of other health care interventions. A comparison between treating the same woman for osteoporosis and mild hypertension shows a cost per life-year gained of 220,000 SEK and 128,000 SEK respectively. Cost per QALY gained is very similar for the two interventions: 105,000 SEK and 103,000 SEK respectively. This model provides a tool to enable clinicians, administrators and health policy makers to analyze and understand the economic aspects of a major health policy issue.
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| 16. |
- Jönsson, B, et al.
(författare)
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Cost-effectiveness of fracture prevention in established osteoporosis.
- 1995
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Ingår i: Osteoporosis International. - : Springer. - 0937-941X .- 1433-2965. ; 5:2, s. 136-142
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Tidskriftsartikel (refereegranskat)abstract
- This study presents the results of a computer simulation model for calculating the cost-effectiveness and cost-utility of treating patients with established osteoporosis in order to reduce the risk of fractures. The results are based on Swedish data for risk of fracture and costs. The treatment intervention modelled is based on treatment of a 62-year-old woman with established osteoporosis. The cost per hip fracture avoided is 350,000 SEK, assuming a 50% reduction in the risk of fracture due to 5 years of treatment. A sensitivity analysis for changes in the cost and effectiveness of treatment, the risk of fracture and the discount rate is performed. The cost per life-year gained and the cost per quality-adjusted life-year (QALY) gained is presented to enable comparison of the cost-effectiveness of treating osteoporosis with that of other health care interventions. A comparison between treating the same woman for osteoporosis and mild hypertension shows a cost per life-year gained of 220,000 SEK and 128,000 SEK respectively. Cost per QALY gained is very similar for the two interventions: 105,000 SEK and 103,000 SEK respectively. This model provides a tool to enable clinicians, administrators and health policy makers to analyze and understand the economic aspects of a major health policy issue.
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| 17. |
- Jönsson, Bengt, et al.
(författare)
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Cost-effectiveness of preventing hip fracture in the general female population
- 2001
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Ingår i: Osteoporosis international. - : Springer. - 1433-2965 .- 0937-941X. ; 12:5, s. 356-361
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to determine whether treatments that reduce the incidence of hip fracture might be used in the general female population rather than screening or case-finding strategies. Cost-effectiveness, measured as cost per quality-adjusted life-year (QALY) gained using threshold values for cost-effectiveness of $20.000 or $30.000/QALY gained, was assessed during and after treatment using a computer simulation model applied to the female population of Sweden. The base case assumed a 5-year intervention that reduced the risk of hip fracture by 35% during the treatment period, and an effect that reversed to the pretreatment risk during the next 5 years. Sensitivity analyses included the effects of age, different treatment costs and effectiveness. Cost-effectiveness was critically dependent upon the age and costs of intervention. Reasonable cost-effectiveness was shown even with relatively high intervention costs for women at average risk at the age of 84 years or more. For the cheapest interventions ($63/year) cost-effectiveness could be found from the age of 53 years. Variations in effectiveness (15–50% risk reduction) had marked effects on the age that treatment was worthwhile. We conclude that segments of the apparently healthy population could be advantaged by treatment if efficacy were supported by randomized controlled studies.
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| 18. |
- Kanis, J.A., et al.
(författare)
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Prediction of fracture from low bone mineral density measurements overestimates risk
- 2000
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Ingår i: Bone (New York, N.Y.). - : Elsevier Inc. - 1873-2763 .- 8756-3282. ; 26:4, s. 387-391
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Tidskriftsartikel (refereegranskat)abstract
- There is a well-established relationship between bone mineral density (BMD) and fracture risk. Estimates of the relative risk of fracture from BMD have been derived mainly from short-term studies in which the correlation between BMD at assessment and BMD in later life ranged from 0.8 to 0.9. Because individuals lose bone mineral at different rates throughout later life, the long-term predictive value of low BMD is likely to decrease progressively with time. This article examines and formalizes the relationship between current BMD, correlation coefficients, and long-term risk. The loss of predictive value has important implications for early assessment and supports the view that measurements should be optimally targeted at the time interventions are contemplated and, when necessary, repeated in later life.
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| 19. |
- Kanis, J.A, et al.
(författare)
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Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis
- 2000
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Ingår i: Bone. - : Elsevier Inc. - 1873-2763 .- 8756-3282. ; 27:5, s. 585-590
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Tidskriftsartikel (refereegranskat)abstract
- The risk of hip fracture is commonly expressed as a relative risk. The aim of this study was to examine the utility of relative risks of hip fracture in men and women using World Health Organization (WHO) diagnostic criteria for low bone mass and osteoporosis. Reference data for bone mineral density (BMD) at the femoral neck, from the third National Health and Nutrition Examination Survey (NHANES III), were applied to the population of Sweden. Relative risks (RRs) were calculated from the known relationship between BMD at the femoral neck and hip fracture risk. The apparent prevalence of low bone mass and osteoporosis depended on the segment of the young population chosen for reference ranges. Using a reference derived from women aged 20–29 years, the prevalence of osteoporosis was 21.2% in women between the ages of 50 and 84 years and 6.3% in men. The RRs associated with osteoporosis depended markedly on the risk comparison. For example, in men or women aged 50 years, the RR of hip fracture in those with osteoporosis compared to those without osteoporosis was 7.4 and 6.1, respectively. The RR of those at the threshold value for osteoporosis compared to those with an average value for BMD at that age was 6.6 and 4.6 in men and women, respectively. RRs were lower comparing those at the threshold value compared to the risk of the general population at that age (4.2 and 2.9, respectively). When RR was expressed in relation to the population risk rather than to the risk at the average value for BMD, RR decreased at all ages by 37%. Such adjustments are required for risk assessment in individuals and for the combined use of different risk factors. Because the average T score at each age decreased with age, the RR of hip fracture at any age decreased with advancing age in the presence of osteoporosis. The decrease in relative risk with age is, however, associated with an increase in absolute risk. Thus, for clinical use, the expression of absolute risks may be preferred to relative risks.
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| 20. |
- Kanis, J A, et al.
(författare)
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Risk of hip fracture derived from relative risks: an analysis applied to the population of Sweden
- 2000
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Ingår i: Osteoporosis international. - 1433-2965 .- 0937-941X. ; 11:2, s. 120-127
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Tidskriftsartikel (refereegranskat)abstract
- Bone mineral density measurements are widely used to estimate the relative risk of hip fracture. In addition, many other risk factors have been identified, some of which are known to add to the risk independently of other risk factors, including bone mineral density measurements. In this paper we develop an algorithm that converts relative risks for hip fracture to absolute (15 years and lifetime) risks, modeled on the population of Sweden. Lifetime risks increased as expected with increments in relative risk. Average lifetime risk in women at the age of 50 years was 22.7%, which increased to 64.9% when the relative risk was 6.0. In men the risk increased from 11.1% to 41.3%. The identification of high-risk groups had little effect on the specificity of assessments but increased the sensitivity over a wide range of assumptions. The increment in lifetime risk was relatively stable across all ages, reducing the complexity of computing lifetime risks from relative risk. The derivation of absolute risk from relative risk permits the optimization of selection of individuals or populations either for further risk assessment or for treatment.
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| 21. |
- Kanis, J A, et al.
(författare)
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Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds
- 2001
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Ingår i: Osteoporosis international. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 12:12, s. 989-995
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of the present study were to estimate 10 year probabilities of osteoporotic fractures in men and women according to age and bone mineral density (BMD) at the femoral neck. Risks were computed from the incidence of a first hip, distal forearm, proximal humerus and symptomatic vertebral fracture from patient records in Malmö, Sweden and future mortality rates for each year of age from Poisson models using the Swedish patient register and statistical year book. Fracture probability was computed using the Swedish population and cut-off values for T-scores based on the NHANES III female population. We assumed that the risk of fracture increased with decreasing BMD as assessed by meta-analysis in independent studies. The 10-year probability of any fracture was determined from the proportion of individuals fracture-free from the age of 45 years. With the exception of forearm fractures in men, 10 year probabilities increased with age and T-score. In the case of hip and spine fractures, fracture probabilities for any age with low BMD were similar between men and women. The effect of age on risk independently of BMD suggests that intervention thresholds should not be at a fixed T-score but vary according to absolute probabilities. Intervention thresholds based on hip BMD T-scores are similar between sexes.
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| 22. |
- Karlsson, M. K., et al.
(författare)
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Bone mineral mass in hip fracture patients
- 1993
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Ingår i: Bone. - : Elsevier BV. - 8756-3282. ; 14:2, s. 161-165
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to measure the bone mineral density (BMD) and some anthropometric variables in patients with hip fracture, to compare these data with those from controls, and to compare the fractured and unfractured hip. Bone mineral measurements with dual energy X-ray absorptiometry (DEXA) were undertaken in 93 consecutive hip fracture patients, 26 men and 67 women, with a mean age of 75 and 78 years, respectively, within 10 days after injury. We found lower BMD in most measurements in both men and women compared with age- and sex-matched controls. The body weight and lean body mass were also significantly lower in the male hip fracture patients; in women only weight was lower. In women there was lower BMD in spine and hip in those who had sustained trochanteric hip fractures compared with those with cervical fracture. No such difference was found in men. There was no difference in BMD in the hip when patients with stable and unstable fractures were compared. In the fractured and nonfractured hips we measured BMD in regions of interest. In women with trochanteric hip fractures the BMD was decreased in the fractured hip compared with the uninjured. No such difference was found for cervical fractures or in men.
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| 26. |
- Mellstrom, D, et al.
(författare)
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Osteoporosis, metabolic aberrations, and increased risk for vertebral fractures after partial gastrectomy
- 1993
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Ingår i: Calcified Tissue International. - 1432-0827. ; 53:6, s. 370-377
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Tidskriftsartikel (refereegranskat)abstract
- A case-control study compared 129 men with earlier partial gastrectomy (operation during the period 1952-1961) with 216 men from a community-based population study. All were born 1910-1915 and the mean age was 72 years. Men with a previous partial gastrectomy had vertebral fractures in 19% compared with 4% (P < 0.01) in the control population. Bone mineral density (BMD) in the right calcaneus measured with dual energy photon absorptiometry was 20% lower in men with a Billroth II operation (P < 0.001) and 8% lower with a Billroth I operation (ns). In comparison with the controls, the men subjected to partial gastrectomy had higher serum concentrations of osteocalcin and alkaline phosphatase activity, a lower serum concentration of 25-hydroxyvitamin D (25OHD) and a lower body mass index (BMI). There were no difference in serum concentrations of free calcium, intact parathyroid hormone (PTH), or free thyroxine. The smoking prevalence was significantly higher in men with partial gastrectomy than in controls. Smokers had significantly lower serum concentrations of intact PTH and 25OHD than nonsmokers and also lower BMD and BMI. The relationships between intact PTH on one hand, and ionized calcium (inverse relationship) and osteocalcin (direct relationship) on the other were preserved in smokers, however. Gastroscopy was performed in 78 men with multiple biopsies in the gastric remnant and also in the small intestine. All but two subjects had chronic gastritis. Examination of sternal bone marrow smears showed that 40% of the Billroth-operated men lacked bone marrow reticular iron.(ABSTRACT TRUNCATED AT 250 WORDS)
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| 28. |
- Michaëlsson, Karl, 1959-, et al.
(författare)
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Variation in the Efficacy of Hormone Replacement Therapy in the Prevention of Hip Fracture
- 1998
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 8:6, s. 540-546
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Tidskriftsartikel (refereegranskat)abstract
- Use of postmenopausal hormone replacement therapy (HRT) has been associated with a reduced risk of osteoporotic fractures. However, it is uncertain whether this risk reduction is modified by other risk factors for hip fracture. In a population-based case-control study in Sweden, we investigated the association between HRT and hip fracture risk within categories of age, body measures and lifestyle factors in postmenopausal women, 50-81 years of age. Mailed questionnaires and telephone interviews were used to collect data. Of those eligible, 1328 incident cases with hip fracture (82.5%) and 3312 randomly selected controls (81.6%) answered the questionnaire. Ever use of HRT in women less than 75 years old was associated with an odds ratio (OR) of 0.66 (95% confidence interval: 95% CI 0.50-0.87) for hip fracture compared with OR 0.40 (95% CI 0.21-0.77) in women 75 years or older. We found a significant interaction between HRT and both weight and physical activity (p < 0.05). The protective effect of HRT was particularly pronounced in lean women: compared with never HRT users, ever users weighing under 60 kg had an OR of 0.44 (95% CI 0.30-0.66) whereas women weighing more than 70 kg had an OR of 0.91 (95% CI 0.53-1.56). Women with low recent leisure physical activity (less than 1 h/week) similarly benefited more from HRT for hip fracture prevention than women with a higher degree of recreational physical activity. The observed interactions with weight and physical activity suggest that HRT has the best protective effect against hip fracture among high-risk women.
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| 29. |
- Oden, A, et al.
(författare)
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The burden of osteoporotic fractures : A method for setting intervention thresholds
- 2001
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Ingår i: Osteoporosis international. - : Springer. - 1433-2965 .- 0937-941X. ; 12:5, s. 417-427
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess the relationship between morbidity from hip fracture and that from other osteoporotic fractures by age and sex based on the population of Sweden. Osteoporotic fractures were designated as those associated with low bone mineral density (BMD) and those that increased in incidence with age after the age of 50 years. Severity of fractures was weighted according to their morbidity using utility values based on those derived by the National Osteoporosis Foundation. Morbidity from fractures other than hip fracture was converted to hip fracture equivalents according to their disutility weights. Excess morbidity was 3.34 and 4.75 in men and women at the age of 50 years, i.e. the morbidity associated with osteoporotic fractures was 3-5 times that accounted for by hip fracture. Excess morbidity decreased with age to approximately 1.25 between the ages of 85 and 89 years. On the assumption that the age- and sex-specific pattern of fractures due to osteoporosis is similar in different communities, the computation of excess morbidity can be utilized to determine the total morbidity from osteoporotic fractures from knowledge of hip fracture rates alone. Such data can be used to weight probabilities of hip fracture in different countries in order to take into account the morbidity from fractures other than hip fracture, and to modify intervention thresholds based on hip fracture risk alone. If, for example, a 10-year probability of hip fracture of 10% was considered an intervention threshold, this would be exceeded in women with osteoporosis aged 65 years and more, but when weighted for other osteoporotic fractures would be exceeded in all women (and men) with osteoporosis.
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| 31. |
- Strom, O., et al.
(författare)
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Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries - an economic evaluation based on the fracture intervention trial
- 2007
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 18:8, s. 1047-1061
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Tidskriftsartikel (refereegranskat)abstract
- Treatment with alendronate ( Fosamax (R)) has been shown to significantly reduce the risk of fragility fractures. Cost-effectiveness of treatment was assessed in nine European countries in a Markov model and was generally found to be cost effective in women with a previous spine fracture. Introduction Treatment with alendronate (Fosamax (R)) reduces the risk of osteoporotic fractures at the spine, hip and wrist in women with and without prevalent vertebral fracture. Cost-effectiveness estimates in one country may not be applicable elsewhere due to differences in fracture risks, costs and drug prices. The aim of this study was to assess the cost-effectiveness of treating postmenopausal women with alendronate in nine European countries, comprising Belgium, Denmark, France, Germany, Italy, Norway, Spain, Sweden, and the UK. Methods A Markov model was populated with data for the nine European populations. Effect of treatment was taken from the Fracture Intervention Trial, which recruited women with low BMD alone or with a prior vertebral fracture. Results The cost per QALY gained of treating postmenopausal women with prior vertebral fractures ranged in the base case from "cost saving" in the Scandinavian countries to Euro 15,000 in Italy. Corresponding estimates for women without prior vertebral fractures ranged from "cost saving" to Euro 40,000. Conclusions In relation to thresholds generally used, the analysis suggests that alendronate is very cost effective in the treatment of women with previous vertebral fracture, and in women without previous vertebral fracture, cost-effectiveness depends on the country setting, discount rates, and chosen monetary thresholds.
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