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- Hasserius, Ralph, et al.
(författare)
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Vertebral deformation in urban Swedish men and women: prevalence based on 797 subjects
- 2001
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 72:3, s. 273-278
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Tidskriftsartikel (refereegranskat)abstract
- Vertebral fracture-deformation, a common feature of osteoporosis, shows considerable age, sex and geographical variation. We present the prevalence in an urban population of south-west Sweden. Lateral spine radiographs of 797 men and women, age 50-86 years, were evaluated by morphomety. The age-standardized prevalence of subjects with vertebral deformation using the deformation criterion -3 SD was 39 (95%CI 34-43)% in women and 33 (95%CI 28-38)% in men. The prevalence increased with age in both sexes. After adjustment for age, women had a higher prevalence than men, odds ratio 1.4. The proportion of vertebrae with deformation ranged from 2%-11%, increasing with age. The vertebrae most commonly deformed were Th 11, Th 12 and L1.
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- Hasserius, Ralph
(författare)
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Vertebral Deformity and Vertebral Fracture in the Elderly
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Osteoporosis is a systemic, skeletal disease with the consequence of an increased risk of sustaining a fracture, one of the most common fractures being a vertebral fracture. The lifetime risk of sustaining a clinically diagnosed vertebral fracture from age 50 years onward is 8% in men and 15% in women. These fractures are followed by increased morbidity and mortality as well as an increased risk of sustaining future fragility fractures, a fact that emphasizes the need of preventing the disease. Individuals with a clinically diagnosed vertebral fracture are, however, only a subset of all individuals with vertebral fractures, revealed if a generalized radiological screening is performed. Furthermore, the changes in the shape of the vertebral body, visible on lateral spine radiographs, do not always represent fractures. As a consequence, changes in the shape of the vertebral body are, in epidemiological studies, referred to as vertebral deformities instead of vertebral fractures. This thesis evaluates the occurrence as well as the consequences of prevalent vertebral deformities and clinically diagnosed vertebral fractures in Swedish men and women, aged 50 years or more. In a cross-sectional study the prevalence of vertebral deformity in 343 men and 454 women, age 50-86 years, from two different, population-based cohorts from southwest Sweden, was evaluated using a morphometric method. Thirty-three percent of the men and 39% of the women had vertebral deformities. More women than men had vertebral deformities, and in both genders the prevalence increased with age. The vertebrae most commonly deformed were L1, Th12 and Th11. The European Vertebral Osteoporosis Study (EVOS) was a multi-centre study evaluating the prevalence of vertebral deformity in 19 European countries. The individuals who were invited but declined to participate in the Malmö part of the EVOS study were analyzed regarding risk factors for vertebral deformities and were compared with age- and gender-matched participants. The “true” prevalence of subjects with vertebral deformity in the whole male Malmö population at risk was probably underestimated in the EVOS study. Whether this is also the case for women was not so clearly indicated. In the population-based cohort of 298 men and 300 women, age 50-80 years, in the Malmö part of the EVOS study, men and women with a prevalent vertebral deformity had a 2.4- and 2.3-fold, respectively, increased risk of dying during a 10-year follow-up period, compared with individuals without a prevalent vertebral deformity. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. The presence of a vertebral deformity predicted also future fractures of any type in both genders and future fragility fractures in women. The prevalence of vertebral deformities among 196 hip fracture patients was higher than among reference subjects from two population-based cohorts. This difference was most pronounced among individuals less than 80 years old. The result suggests that a prevalent vertebral deformity possibly indicates an increased risk of sustaining a hip fracture. There was no difference in the prevalence of vertebral deformity between patients with a per- or subtrochanteric hip fracture and patients with a cervical hip fracture. Among individuals over 50 years of age, in the Swedish city of Malmö, 1.8 out of 1000 men and 3.6 out of 1000 women sustained a clinically diagnosed vertebral fracture during 1979. Among the women, there were more individuals who, at a follow-up examination 12 years later, had back pain and an impaired health status compared with women from a population-based cohort. Both men and women with a clinically diagnosed vertebral fracture had an increased mortality during the 22 years following the diagnosis compared with the population at risk.
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- Herbertsson, Pär, et al.
(författare)
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Uncomplicated Mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study.
- 2004
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 86-A:3, s. 569-574
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of this study was to evaluate the incidence and the long-term results of closed uncomplicated Mason type-II and III fractures in a defined population of adults. Methods: Seventy women and thirty men who were a mean of forty-seven years old when they sustained a fracture of the radial head or neck (a Mason type-II fracture in seventy-six patients and a Mason type-III fracture in twenty-four) were reexamined after a mean of nineteen years. Radiographic signs of degenerative changes of the elbow were recorded. The fracture had been treated with an elastic bandage or a collar and cuff sling with mobilization for forty-four individuals, with cast immobilization for thirty-four, with resection of the radial head in nineteen, with open reduction of the radial head in two, and with a collateral ligament repair in one. Secondary excision of the radial head was performed because of residual pain in nine patients, and a neurolysis of the ulnar nerve was performed in one patient. Results: Seventy-seven individuals had no symptoms in the injured elbow at the time of follow-up, twenty-one had occasional pain, and two had daily pain. The injured elbows had a slight flexion deficit compared with the uninjured elbows (mean and standard deviation, 138° ± 8° compared with 140° ± 7°) as well as a small extension deficit (mean and standard deviation, –4° ± 8° compared with –1° ± 6°) (p < 0.001 for both). The prevalence of degenerative changes was higher in the injured elbows than in the uninjured ones (76% compared with 16%, p < 0.001). Conclusions: The results following uncomplicated Mason type-II and III fractures are predominantly favorable. A secondary radial head resection is usually effective for patients with an unfavorable outcome (predominantly long-standing pain). Levels of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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- Johnell, Olof, et al.
(författare)
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Targeting of hormone replacement therapy immediately after menopause
- 2001
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Ingår i: Bone. - 1873-2763. ; 28:4, s. 440-445
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to model the effect of short (3-year) treatments with hormone replacement therapy (HRT) at the time of menopause on the risk of osteoporotic fracture, and to assess the impact of strategies to target high-risk individuals. From the relationship between bone mineral density (BMD) and fracture risk, treatment that increased bone mineral density at the hip by 6% over untreated women would save 35 vertebral, 62 hip, 13 proximal humeral, and 16 forearm fractures per 1000 women. The number needed to treat (NNT) to prevent one of these fractures was 8. The NNT fell modestly by targeting HRT to women with low bone mass or osteoporosis (NNT 6 and 5, respectively). The gains in fractures saved from targeting women with low bone mass or osteoporosis were offset by the requirement for assessment by BMD. Changes in the assumptions about the efficacy of HRT had a modest impact on fractures saved compared with the effect of changing assumptions concerning the offset of effect when treatment was stopped. We conclude that comparatively short courses of HRT might be effectively offered to all suitable women at menopause provided that the effects on bone persist when treatment is stopped.
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- Karlsson, Magnus, et al.
(författare)
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A modeling capacity of vertebral fractures exists during growth - an up to 47-year follow-up
- 2003
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Ingår i: Spine. - 0362-2436. ; 28:18, s. 2087-2092
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. The study is an observational cohort study. Objectives. To determine the incidence and the long-term outcome of thoracic or lumbar vertebral fractures in children. Summary of Background Data. The incidence of vertebral fractures in children is described as rare and the outcome as favorable. However, no studies evaluate the clinical and radiographic long-term outcome and if a fractured vertebra could be rebuilt during growth. Method. The incidence of vertebral fractures in children was evaluated through the radiographic archives. Twelve boys and 12 girls, aged 7-16 when sustaining the fracture, 21 one-column compression fractures and 3 burst fractures Denis type B, all without neurologic deficits, attended the follow-up. Primary treatment consisted of immediate mobilization without brace. Clinical and radiographic examination were performed 27-47 years after the injury. Results. The annual incidence of thoracic and lumbar vertebral body fractures in individuals below age 16 was 0.07%. Twenty-one individuals had, at follow-up. no subjective complaints, 3 had occasional back pain (Oswestry Scores, 8, 22, and 26), 23 were classified as Frankel E, and 1 as Frankel D. The radiographic ratio anterior height/posterior height of the fractured vertebral body increased from 0.75 after injury to 0.87 at follow-up (P<0.001). The posttraumatic kyphosis in the fracture region decreased in 8 individuals (33%), all aged 13 or less at fracture. No increased disc degeneration was observed. Conclusion. Thoracolumbar vertebral fractures without neurologic deficits, sustained during growth, have a favorable long-term outcome. A modeling capacity, reducing the fracture deformity exists at least in the youngest patients.
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