| 1. |
- Björkman, Ann-Sofi, 1983-, et al.
(author)
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Mobile learning device increased study efficiency for radiology residents but with risk of temporary novelty effect
- 2019
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In: Acta Radiologica Open. - : Sage Publications. - 2058-4601. ; 8:11, s. 1-8
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Journal article (peer-reviewed)abstract
- Background: Digital resources in learning are increasingly available and offer new possibilities in education. Mobile learning devices (MLD) such as tablets provide easy and flexible access for users.Purpose: To investigate whether the introduction of MLDs in radiology education affected time spent on studies over a longer time frame and whether learning behavior and attitudes changed.Material and Methods: The radiology residents employed during 2015–2016 were invited to participate in this 12-month MLD intervention study. Results were evaluated using online questionnaires at six months (6 m) and 12 months (12 m).Results: Thirty-one residents were included, of whom half were in the early stages of residency (<2 years). After the MLD introduction, most participants (91% [6 m] and 83% [12 m]) estimated increased time spent on studies. Of these, 32% stated “a lot more” at 6 m but only 8% at 12 m (P ¼ 0.12). The MLDs showed positive effects on the experience of radiology studies, as a majority of participants stated better quality and effectiveness in their studies (100% [6 m]–92% [12 m]), that MLD facilitated access to educational materials to a high degree (83% [6 m]–75% [12 m]), and that studies had become better and more fun (96% [6 m]–100% [12 m]).Conclusion: The use of MLDs seems to facilitate learning effectively for radiologic residents. However, a larger scale study is required as a trend of decreasing figures in the longer term was seen, but our results did not show a significant reduction of time spent on radiology studies.
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| 2. |
- Gutefeldt, Kerstin, 1972-, et al.
(author)
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Clinical Examination and Self-Reported Upper Extremity Impairments in Patients with Long-Standing Type 1 Diabetes Mellitus
- 2020
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In: Journal of Diabetes Research. - : Hindawi Publishing Corporation. - 2314-6745 .- 2314-6753. ; 2020
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Journal article (peer-reviewed)abstract
- Aim. The aims of the current study were (1) to determine the prevalence of upper extremity impairments (UEIs) in patients with type 1 diabetes by clinical investigation; (2) to investigate if self-reported impairments were concordant with clinical findings and if key questions could be identified; and (3) to investigate if answers to our self-reported questionnaire regarding UEIs are reliable. Methods. Patients with type 1 diabetes were invited to participate in a cross-sectional study of clinical and self-reported (12 items) UEIs in adjunction to ordinary scheduled clinical visit. Before the visit, a questionnaire on UEIs was filled in twice (test-retest) followed by clinical testing at the planned visit. Results. In total, 69 patients aged and with diabetes duration were included in the study. In the clinical examination, two-thirds (65%) of the patients showed one or more UEI, with failure to perform hand against back as the most common clinical finding (40%) followed by positive Phalen’s test (27%), Tinel’s test (26%), and Prayer’s sign (24%). UEIs observed by clinical examination were often bilateral, and multiple impairments often coexisted. Self-reported shoulder stiffness was associated with impaired shoulder mobility and with Prayer’s sign. Self-reported reduced hand strength was associated to lower grip force, Prayer’s sign, trigger finger, fibrosis string structures, and reduced thenar strength as well as reduced shoulder mobility. In addition, self-reporting previous surgery of carpal tunnel and trigger finger was associated with several clinical UEIs including shoulder, hand, and finger. The test-retest of the questionnaire showed a high agreement of 80-98% for reported shoulder, hand, and finger impairments. Conclusion. UEIs are common in type 1 diabetes. Self-reported shoulder stiffness and reduced hand strength might be used to capture patients with UEIs in need of clinical investigation and enhanced preventive and therapeutic strategies, as well as rehabilitative interventions.
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| 3. |
- Gutefeldt, Kerstin, 1972-, et al.
(author)
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Low health-related quality of life is strongly linked to upper extremity impairments in type 1 diabetes with a long duration
- 2021
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In: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 43:18, s. 2578-2584
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Journal article (peer-reviewed)abstract
- Purpose: To compare health-related quality of life (HRQOL) in type 1 diabetes and non-diabetic controls and possible links to upper extremity impairments (UEIs). Prevalence of sick-leave and causes were investigated.Materials and methods: This Swedish population-based case-control study included type 1 diabetes patients <67 years old and with a diabetes duration ≥20 years. Participants completed a postal questionnaire including Short Form 36, and questions regarding UEIs, and sick-leave.Results: In total, 773 patients, aged 50 ± 10 years (diabetes duration 35 ± 10 years), and 708 non-diabetic controls, aged 54 ± 9 years, completed the study. Patients reported significantly lower HRQOL compared with controls. The difference was greatest for general health, vitality, and bodily pain. Patients with shoulder or hand but not finger impairments scored significantly lower than asymptomatic patients. The prevalence of sick leave was higher in patients vs. controls (23% vs. 9%, p < 0.001), and nearly half cited impairments from back, muscles, or joints as the main reason.Conclusions: Health-related quality of life is lower in type 1 diabetes than controls and in patients with shoulder and hand impairments than in asymptomatic. Musculoskeletal impairments (back/muscle/joints) have impact on work ability. Identification of UEIs is important for initiating preventative-, therapeutic-, and rehabilitative interventions.Implications for rehabilitationUpper extremity impairments (UEIs) that are common in type 1 diabetes, and associated with reduced health-related quality of life, should preferably be screened for on a regular basis along with other known diabetes complications.Early identification of UEIs is important to improve health by initiating preventive as well as therapeutic multi-professional rehabilitative interventions.Sick leave is higher in type 1 diabetes than in controls. Musculoskeletal impairments, including the back, muscles, and joints, are a common cause for sick leave warranting further studies.
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| 4. |
- Gutefeldt, Kerstin, 1972-
(author)
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Upper extremity impairments in type 1 diabetes in comparison to matched controls without diabetes : associations to the IGF-system, metabolic factors, disability and quality of life
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Compared with the general population, people with type 1 diabetes (T1D) more often exhibit pathological alterations in musculoskeletal tissue (impairments). Some of these impairments involve the upper extremities, i.e., the shoulders, hands, and fingers. Although present in diabetes, these complications are underdiagnosed and not actively searched for during routine clinical examinations. Furthermore, much is still unclear about these impairments, specifically regarding their etiology, risk factors, and consequences on daily life activities and quality of life. The growth hormone (GH)/insulinlike growth factor (IGF)-system is known to be affected in diabetes, but whether this is involved in upper extremity impairments (UEIs) is unclear. The aim of this thesis was to describe the prevalence of UEIs in patients with diabetes compared with controls. Furthermore, we aimed to search for risk factors of UEIs, and elucidate the impact of UEIs on daily life activities and health-related quality of life (HRQOL). We used two cohorts; the LedIG cohort (papers I–III), a large population-based study in which all patients with a long duration of T1D (>20 years), aged <67 years, living in the south-east region of Sweden were invited to participate, as well as matched controls without diabetes. This study was based on questionnaires as well as blood samples from the participants. The last paper (IV) included a smaller cohort (n=69) of patients with T1D, who both completed a questionnaire and were the subjects of a clinical examination.Paper I: The UEIs were common in diabetes, with a prevalence of up to 48%. Hand paresthesia was the most common impairment, followed by shoulder pain and stiffness. The prevalence of UEIs was 2–4 times higher in patients than in controls and was associated with more activity limitations. Risk factors were heterogeneous for the different UEIs and included female sex, increasing age, longer duration of diabetes, and poor glycemic control.Paper II: The GH-IGF-axis is important for the growth and function of musculoskeletal tissues. We examined differences in the IGF system between patients with T1D on subcutaneous insulin treatment and controls. We found lower levels of IGF-I and insulinlike growth factor-binding protein (IGFBP)-3 and higher levels of GH and IGFBP-1 in patients with T1D than in controls. The largest difference was found in IGFBP-1, and this probably reflected insulin deficiency. The IGF-I levels were increased with increasing insulin doses. However, even at very high insulin doses (>1 U/kg) the IGF-I Z-score was subnormal, indicating that IGF-I cannot be normalized by subcutaneous insulin treatment. Residual endogenous insulin secretion counteracted these alterations. Furthermore, we investigated possible relationships between UEIs and IGF-I, and found no association.Paper III: The HRQOL was lower in patients with T1D than in controls. Patients with shoulder impairments, hand paresthesia, and hand stiffness, but not finger impairments, had lower HRQOL scores than patients without these impairments. The patients with T1D showed a higher frequency of sick leave than controls, and a common reason for this was musculoskeletal impairments.Paper IV: In addition to the self-reported UEIs, the prevalence of UEIs was also investigated by clinical examination. Clinical UEIs were found in 65% of the participants, with shoulder test (hands against back), prayer sign test, and the Phalen’s and Tinel’s tests being most prevalent. We compared self-reported UEIs to clinical UEIs and found that self-reported impairments were associated with clinical examination. We also found that self-reported shoulder impairments, reduced hand strength, and previous surgery for carpal tunnel syndrome and trigger finger were associated with several other UEIs.In current diabetic care, there is no established routine to capture UEIs, as opposed to other known diabetes complications. We show that UEIs are more common in patients with T1D than in controls, and that they are related to impaired HRQOL and daily life activity limitations. Clinical routines including self-reported UEIs, e.g. shoulder stiffness and reduced hand strength, might be used to identify patients with UEIs in need of clinical investigation, enhanced preventive and therapeutic strategies, as well as rehabilitative interventions.
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| 5. |
- Jonsson, E., et al.
(author)
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A health economic simulation model for the clinical management of osteoporosis
- 2018
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In: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 29:3, s. 545-555
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Journal article (peer-reviewed)abstract
- The objective was to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. Results showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings.IntroductionThe purpose of this study is to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice.MethodsThe analysis was carried out using a model that simulates the individual patients considered for pharmacological treatment during 1 year and their projected osteoporosis treatment pathway, quality-adjusted life years (QALYs) and costs over their remaining lifetime. All patients regardless of treatment or no treatment were simulated. Information on current management of osteoporosis in terms of patient characteristics and treatment patterns were derived from a Swedish osteoporosis research database based on national registers and patient records. Current (standard) clinical management was compared with alternative scenarios mirroring Swedish treatment guidelines.ResultsThe national burden in terms of lost QALYs was estimated at 14,993 QALYs and the total economic cost at €776M. Scenario analyses showed that 382–3864 QALYs could be gained at a cost/QALY ranging from cost-saving to €31368, depending on the scenario. The margin of investment, i.e. the maximum amount that could be invested in the healthcare system to achieve these improvements up to the limit of the willingness to pay/QALY, was estimated at €199M on a population level (€3,634/patient).ConclusionsThe analysis showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings. From a cost-effectiveness perspective, there is also considerable room for investment to achieve these improvements in the management of osteoporosis.
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| 6. |
- Mc Gowan, BM, et al.
(author)
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Hypothalamic mapping of orexigenic action and Fos-like immunoreactivity following relaxin-3 administration in male Wistar rats.
- 2007
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In: American Journal of Physiology. Endocrinology and Metabolism. - : American Physiological Society. - 0193-1849 .- 1522-1555. ; 292, s. 913-919
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Journal article (peer-reviewed)abstract
- The insulin superfamily, characterized by common disulphide bonds, includes not only insulin but also insulin-like peptides such as relaxin-1 and relaxin-3. The actions of relaxin-3 are largely unknown, but recent work suggests a role in regulation of food intake. Relaxin-3 mRNA is highly expressed in the nucleus incertus, which has extensive projections to the hypothalamus, and relaxin immunoreactivity is present in several hypothalamic nuclei. In the rat, relaxin-3 binds and activates both relaxin family peptide receptor 1, which also binds relaxin-1, and a previously orphaned G protein-coupled receptor, RXFP3. These receptors are extensively expressed in the hypothalamus. The aims of these studies were twofold: 1) map the hypothalamic site(s) of the orexigenic action of relaxin-3 and 2) examine the site(s) of neuronal activation following central relaxin-3 administration. After microinjection into hypothalamic sites, human relaxin-3 (H3; 180 pmol) significantly stimulated 0- to 1-h food intake in the supraoptic nucleus (SON), arcuate nucleus (ARC), and the anterior preoptic area (APOA) [SON 0.4 ± 0.2 (vehicle) vs. 2.9 ± 0.5 g (H3), P < 0.001; ARC 0.7 ± 0.3 (vehicle) vs. 2.7 ± 0.2 g (H3), P < 0.05; and APOA 0.8 ± 0.1 (vehicle) vs. 2.2 ± 0.2 g (H3), P < 0.05]. Cumulative food intake was significantly increased 8 h following administration into the SON and 4 h into the APOA. A significant increase in Fos-like immunoreactivity was seen in the SON following central relaxin-3 administration. Relaxin-3 stimulates feeding in several hypothalamic nuclei, and these studies provide additional support for relaxin-3 as an important peptide in appetite regulation.
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| 7. |
- Rejler, Martin, et al.
(author)
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Improved population-based care: : Implementing patient- and demand-directed care for inflammatory bowel disease and evaluating the redesign with a population-based registry
- 2007
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In: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 16:1, s. 38-50
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Journal article (peer-reviewed)abstract
- The gastroenterology unit at the Höglands Hospital in Eksjö is responsible for the care of all 466 patients with inflammatory bowel disease (IBD) in a geographic area including approximately 115,000 inhabitants. In 2000, the frustration over an inadequate traditional outpatient clinic inspired us to redesign our outpatient unit to become more patient and demand directed. The redesign included the following: A direct telephone line for patients to a specialized nurse, available during working hours; appointments were scheduled in accordance with expected needs, and emergency appointments were available daily; traditional follow-ups of IBD patients were replaced by an annual telephone contact with a specialized nurse; the team agreed on a patient-centered value base for its work, and the redesign was monitored using clinical outcome measures reflecting 4 dimensions (see parentheses below) of the care in a Value compass; quality of life (functional) and routine blood samples (clinical) were followed yearly and collected in a computerized IBD registry together with basic information about the patients; access and waiting lists together with patient satisfaction (satisfaction) are followed regularly; and ward utilization (financial) was registered. Our study shows that the new design offers a more efficient outpatient clinic in which waiting lists are markedly reduced although production rates remains the same. Utilization data show a significant decrease in comparison with national data, showing that the new care is economically favorable. The clinical results regarding anemia frequency in the IBD population are highly comparable with or even better than those found in the literature. We also show good results regarding quality of life where more than 88% of patients achieve set goals. In conclusion, our new patient- and demand-directed care seems to be more efficient and with clinical and quality-of-life results remaining on a high standard.
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| 8. |
- Shibre, Teshome, et al.
(author)
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Traditional treatment of mental disorders in rural Ethiopia
- 2008
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In: Ethiopian Medical Journal. - 0014-1755. ; 46:1, s. 87-91
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Journal article (peer-reviewed)abstract
- BACKGROUND: Mental disorders are known to be as prevalent in Ethiopia as in other countries. Only 26 psychiatrists are working in the country with close to 80 million inhabitants. To this should be added clinics run by psychiatric nurses in most of the general hospitals. This means that still most of the mentally ill in the country are trected and cared for in a traditional way.OBJECTIVES: This paper presents the situation regarding traditional treatment of mental illness in a rural area in central Ethiopia, Butajira, with a population of about 350,000 persons, predominantly Muslim.METHODS: All traditional healers in Butajira area were mapped by asking key informants. Twenty-four healers were so identified and interviewed about their perception of mental illness and the treatment they offer. Clients from the healers and patients from the local health centre were interviewed about their opinions on the service given.FINDINGS: A majority of both clients and patients were satisfied with the consultation, but the clients of the healers were more satisfied than the patients in health centres.CONCLUSION: As most persons with mental disorders are treated by traditional healers in rural Ethiopia and in most other developing countries it is important to do more comprehensive studies on the traditional treatment and to find ways of collaboration between traditional practice and modern medicine.
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| 9. |
- Spångeus, Anna, 1975-, et al.
(author)
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Adherence to and persistence with zoledronic acid treatment for osteoporosis-reasons for early discontinuation
- 2020
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In: ARCHIVES OF OSTEOPOROSIS. - : SPRINGER LONDON LTD. - 1862-3522 .- 1862-3514. ; 15:1
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Journal article (peer-reviewed)abstract
- This retrospective study reports 81% long-term (> 3 years) adherence to and 77% persistence with zoledronic acid (ZA) treatment in osteoporosis patients, with ZA being costfree for patients. Eight percent of patients discontinued treatment because of adverse events (AEs), with a tendency of higher discontinuation rate in older patients. Purpose This study investigated (1) long-term adherence to and persistence with ZA treatment in a real-world setting, (2) extent to which an adverse reaction to ZA impacted on adherence and persistence, and (3) whether there were sex or age differences in patients that had early treatment termination (ETT) due to AEs and those who adhered to the regimen. Methods All patients treated with ZA at the Endocrinology Department at Linkoping University Hospital, Linkoping, Sweden between 2012 and 2017 were included. ETT was defined as < 3 ZA infusions, which was confirmed from patients medical records. Results A total of 414 patients were treated with ZA, with 81% receiving > 3 ZA infusions. Three-year persistence was 77% for a treatment window of 365 days +/- 90 days (75% with 365 days +/- 60 days window). The most common reason for ETT was AEs (8%), followed by medical conditions (5%), biological aging (3%), and other (e.g., lost to follow-up [3%]). Most patients who discontinued treatment because of AEs reported symptoms of acute-phase reaction, and tended to be older than those who adhered to treatment (74 +/- 9 vs 70 +/- 13 years, p = 0.064). There was no difference in sex ratio between the 2 groups (85% vs 90% females, p = 0.367). Conclusion Rates of long-term adherence to and persistence with ZA treatment were high with a pre-scheduled 3-year treatment regimen in the tax-financed Swedish healthcare system. AEs-mainly acute-phase reaction-were the most common reason for ETT, occurring in nearly 1 out of 10 patients.
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| 10. |
- Spångeus, Anna, 1975-, et al.
(author)
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DENUSOMAB PERSISTENCE DURING THE COVID PANDEMIC (Poster 883)
- 2021
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Conference paper (other academic/artistic)abstract
- Objective: To investigate the effect of the COVID-19 pandemic on denosumab persistence. Methods: All patients who initiated denosumab treatment at our outpatient care (osteoporosis/endocrinology unit) between 2016-2019 were included and date of injections were recorded from case records. Persistence was analyzed regarding 2-y persistence and 1-y persistence. Persistence was defined as a maximum interval of either 1) 8 months (m) [6+2m], or 2) 9m [6+3m]. Results: In total 171 patients were included. Mean age was 74.3+10.2 y (range 35-93 y) and 87% were women. Age and gender distribution did not differ significantly between the year of denosumab initiation. The 2-y persistence rate (8-m interval permitted) was lower in patients starting denosumab 2019 than those starting 2016-1018, i.e., 69% vs. 83%, p=0.044. No significant difference was seen analyzing 1-y persistence in the same groups (87 vs. 91%, p=0.410). When using a more liberal persistence definition, i.e., 9+m interval permitted, no difference was seen between 2 y persistence, 77 vs. 83%, p=0.341. Conclusion: The present study indicates that a higher number of patients got their injection later than recommended during the pandemic, but despite high pressure on our healthcare system and health concerns in the general population, no significant influence on denosumab persistence using a more liberal interval allowance was seen in this outpatient osteoporosis group.
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| 11. |
- Spångeus, Anna, Bitr Professor, 1975-, et al.
(author)
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Patient Education Improves Pain and Health-Related Quality of Life in Patients with Established Spinal Osteoporosis in Primary Care—A Pilot Study of Short- and Long-Term Effects
- 2023
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:6
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Journal article (peer-reviewed)abstract
- Fragility fractures, in particular vertebral fractures, are associated with high morbidity, including chronic pain and reduced health-related quality of life. We aimed to investigate the short- and long-term effects of patient education, including interdisciplinary themes, with or without physical training or mindfulness/medical yoga for patients with established spinal osteoporosis in primary care. Osteoporotic persons aged sixty years or older with one or more vertebral fractures were randomized to theory only, theory and physical exercise, or theory and mindfulness/medical yoga and were scheduled to once a week for ten weeks. Participants were followed up by clinical tests and questionnaires. Twenty-one participants completed the interventions and the one-year follow-up. Adherence to interventions was 90%. Pooled data from all participants showed significant improvements after intervention on pain during the last week and worst pain, and reduced painkiller use (any painkillers at baseline 70% [opioids 25%] vs. post-intervention 52% [opioids 14%]). Significant improvements were seen regarding RAND-36 social function, Qualeffo-41 social function, balance, tandem walking backwards, and theoretical knowledge. These changes were maintained at the 1-year follow-up. Patient group education combined with supervised training seems to have positive effects on pain, and physical function in persons with established spinal osteoporosis. The improved quality of life was maintained at the 1-year follow-up.
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| 12. |
- Spångeus, Anna, Bitr Professor, 1975-, et al.
(author)
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Prevalence of denosumab-induced hypocalcemia: a retrospective observational study of patients routinely monitored with ionized calcium post-injection
- 2024
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In: Osteoporosis International. - : SPRINGER LONDON LTD. - 0937-941X .- 1433-2965. ; 35:1, s. 173-180
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Journal article (peer-reviewed)abstract
- Summary: We assessed the prevalence of hypocalcemia after denosumab injections in a real-world cohort routinely monitored for calcium during up to 7.5 years of treatment. Among 1096 injections in 242 patients, 6.3% resulted in hypocalcemia, and was independent of the injection number. Severe hypocalcemia was rare (1%).Purpose: To assess the prevalence of and risk factors for hypocalcemia after administration of denosumab in a patient cohort routinely monitored for ionized calcium after each dose.Methods: In this retrospective observational study, we analyzed denosumab-induced hypocalcemia in a real-world cohort who were routinely followed up with ionized calcium pre- and post-injection (within 31 days after injection) during the period 2011 to 2020.Results: In total, we included data from 1096 denosumab injections in 242 individuals (1–15 injections per patient). The mean age for the first injection was 74 ± 10 years, and 88% were female. Post-injection hypocalcemia occurred after 6.3% of all injections (4.6% mild, 0.6% moderate, and 1.1% severe) and was independent of the number of injections (rate of hypocalcemia varied from 3–8%). Risk factors for hypocalcemia were male sex, severe renal failure, pre-injection hypocalcemia, hypomagnesemia, hypophosphatemia, and vitamin D insufficiency. Furthermore, older age was not associated with an increased hypocalcemia risk.Conclusions: Denosumab-induced hypocalcemia is a prevalent adverse event, which occurs independently of the number of injections. However, severe hypocalcemia is a rare occurrence, and severe renal failure and nutritional status appear to be important predictive factors. Magnesium and phosphate might add value in the pre-injection risk assessment; however, this observation needs to be confirmed in larger cohorts.
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| 13. |
- Söreskog, Emma, et al.
(author)
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Risk of major osteoporotic fracture after first, second and third fracture in Swedish women aged 50 years and older
- 2020
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In: Bone. - : Elsevier BV. - 8756-3282 .- 1873-2763. ; 134
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Journal article (peer-reviewed)abstract
- Background: Osteoporosis affects approximately one in five European women and leads to fragility fractures, which result in poor health, social and economic consequences. Fragility fractures are a strong risk factor for subsequent major osteoporotic fracture (MOF), with risk of MOF being elevated in the 1–2 years following an earlier fracture, a concept described as “imminent risk”. This study examines risk of subsequent MOF in patients with one, two or three prior fractures by age and type of fracture. Methods: In this retrospective, observational cohort study, Swedish women aged ≥50 years with ≥1 any clinical fragility fracture between July 1, 2006 and December 31, 2012 were identified from Sweden's National Patient Register. Each patient was age- and sex-matched to three controls without history of fracture. Group 1 women included those with one fragility fracture during the study period; Group 2 included those with two fragility fractures; and Group 3 included those with three fragility fractures. “Index fracture” was defined as the first fracture during the study period for Group 1; the second for Group 2; and the third for Group 3. Patients in each cohort and matched controls were followed for up to 60 months or until subsequent MOF (hip, vertebra, forearm, humerus), death or end of data availability. Results: 231,769 women with at least one fracture were included in the study and therefore constituted Group 1; of these, 39,524 constituted Group 2 and of those, 7656 constituted Group 3. At five years, cumulative incidence of subsequent MOF was higher in patients with a history of fracture as compared to controls (Group 1: 20.7% vs 12.3%; Group 2: 32.0% vs 15.3%). Three-year cumulative incidence for Group 3 was 12.1% (vs 10.7% for controls). After adjusting for baseline covariates, risk of subsequent MOF was highest within 0–24 months following an index fracture, then decreased but remained elevated as compared to controls. Having two prior fractures, vertebral fractures and younger age at time of index fracture were associated with greater relative risk. Conclusions: Women with a history of osteoporotic fracture are at increased risk of subsequent fracture, which is highest during the first 24 months following a fracture. Younger women and those with vertebral fractures are at greatest relative risk, suggesting that treatment should target these patients and be timely enough to impact the period of imminent risk.
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| 14. |
- Toth, Emese, et al.
(author)
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History of Previous Fracture and Imminent Fracture Risk in Swedish Women Aged 55 to 90 Years Presenting With a Fragility Fracture
- 2020
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In: Journal of Bone and Mineral Research. - : Wiley. - 0884-0431 .- 1523-4681. ; 35:5, s. 861-868
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Journal article (peer-reviewed)abstract
- The term “fracture cascade” refers to the sequence of fragility fractures resulting from the increased fracture risk that occurs with aging and following fractures. Here, we evaluate the sequence of previous fractures in women aged 55 to 90 years presenting with a fragility fracture and subsequent (12 to 24 months) fracture incidence. In this retrospective, observational study, women aged 55 to 90 years with an “index” fragility fracture in 2013 were identified from Swedish national registries. A history of previous fractures (2001 to 2012) and osteoporosis treatment was used to characterize fracture cascade patterns. Cumulative incidence of new fractures within 12 to 24 months following the index fracture, based on index fracture type and age, were used to describe the risk of subsequent fractures. A total of 35,146 women with a mean age of 73.8 years were included (7180 hip, 2786 clinical vertebral, and 25,180 nonhip/nonvertebral [NHNV] index fractures); 38% of women with hip, 38% with clinical vertebral, and 25% with NHNV index fractures had one or more previous fractures. Across all index fracture types, the proportion of women with any previous fracture increased with age; 34% to 46% of index hip or clinical vertebral fractures in women ≥70 years were not their first fracture. Following any index fracture, cumulative incidence of a new fracture over 24 months was over 11% (index clinical vertebral 18%; index hip 14%). Osteoporosis treatment rates were low both in patients with (27%) and without (18%) a previous fracture. These descriptive data demonstrate that almost one-third of women aged 55 to 90 years suffering a new fracture have had a previous fragility fracture. Fracture location influences incidence and type of subsequent fracture during the 24 months following a fragility fracture, with clinical vertebral fractures carrying the greatest imminent fracture risk. These data highlight the clinical impact and need for early, effective treatment soon after any fragility fracture.
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| 15. |
- Woisetschläger, Mischa, 1974-, et al.
(author)
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Dual energy 4D-CT of parathyroid adenomas not clearly localized by sestamibi scintigraphy and ultrasonography - a retrospective study
- 2020
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In: European Journal of Radiology. - : Elsevier. - 0720-048X .- 1872-7727. ; 124
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Journal article (peer-reviewed)abstract
- Purpose: At present, the gold standard for diagnosing PAs includes ultrasonography of the neck and sestamibi scans of the parathyroid. The objective of this study was to evaluate scans performed in 4D-DECT (4D-dualenergy mode) at three different time points, in order to analyze spectral information from PAs, lymph nodes (LNs), and thyroid gland (Thy).Method: Fifteen patients (mean age: 57 +/- 18.9 years) with primary hyperparathyroidism, in which previous ultrasound and sestamibi scanning proved to be negative or equivocal, underwent 4D-DECT in three different phases. Hounsfield units (HU), dual-energy information (electron density [Rho], atomic number [Z], dual-energy index [DEW, and spectral information (keV) were determined.Results: For all energies, PAs exhibited significantly lower HU-values than the Thy in non-contrast images, and higher HU-values than LNs in the arterial phase (p < 0.05). All three tissues differed significantly in HU in the venous phase at 90 kV, 150 kV, and mixed 0.8 images; the Thy showed significantly higher HU-values than PAs or LNs in non-contrast images at 90 kV, 150 kV, mixed 0.8 images, and [Rho] (p < 0.05). LNs exhibited significantly lower HU-values than PAs and Thy in the arterial phase at 90 kV, 150 kV, mixed 0.8, Rho, Z, and DEI (p < 0.05). With regards to spectral information, lower energies showed greater HU differences between the three tissues. During the venous phase, there were significant differences between all three tissues up to 100 keV (p < 0.05).Conclusions: We identified significant differences in HU-values and spectral information between PAs, LNs, and Thy at different energies and contrast phases.
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| 16. |
- Woisetschläger, Mischa, 1974-, et al.
(author)
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Model for improved correlation of BMD values between abdominal routine dual-energy CT data and DXA scans
- 2018
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In: European Journal of Radiology. - : Elsevier BV. - 0720-048X .- 1872-7727. ; 99, s. 76-81
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Conference paper (other academic/artistic)abstract
- Background:Osteoporosis is a common but underdiagnosed and undertreated disease causing severe morbidity and economic burden. The gold standard for detection of osteoporosis is DXA (dual energy x-ray absorptiometry), which is a dedicated examination for osteoporosis. Dual energy CT (DECT) examinations are increasingly used in daily routine for a wide variety of diagnoses. In the present study, we wanted to examine whether vBMD (volume bone mass density) could be evaluated as a side product in non-contrast as well as contrast phases as well as to evaluate a correction model taking known shortcomings for DXA into account. Methods:A total of 20 patients, i.e. 79 vertebrae (one excluded due to vertebral fracture), mean age 71 years (range 43 – 85) with a mean BMI (body mass index) of 26 (range 17 – 33) were examined with both abdominal/pelvic DECT as well as DXA. Furthermore, aortic calcium was measured as well as the presence of osteoarthritis of the spine (OAS) and osteoarthritis in facet joints (OAF) with a 5-grade scaling system. Results:A significant correlation was found between DXA BMD and vBMD from DECT without with no contrast (WNC) (r=0.424, p=0.001), and with venous contrast (WVC) (r=0.402, p<0.001), but no significant correlation was found with arterial contrast (WAC). Using multivariate linear regression with DXA BMD as dependent, two models were created combining DECT WNC, aortic calciumscore (ACS), OAS and BMI yielding an R2 = 0.616 (model 1) and replacement of WNC to WVC a R2 = 0.612 (model 2). The Pearson correlation between DXA and predictive DXA BMD value of model 1 was r = 0.785 (p<0.001) and model 2 r = 0.782 (p<0.001).Conclusion:There is a correlation between DXA BMD and DECT in non-contrast and venous contrast scans but not in arterial scans. The correlation is further improved by quantifying the degree of different confounding factors (osteoarthritis of the spine, body mass index and aortic calcium score) and taking these into account in an explanatory model. Future software solutions with DECT data as input data might be able to automatically measure the BMD in the trabecular bone as well as measuring the confounding factors automatically in order to obtain spinal DXA comparable BMD values.
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| 17. |
- Woisetschläger, Mischa, 1974-, et al.
(author)
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Patient Education in Osteoporosis : What the Patients Prefer
- 2022
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Conference paper (peer-reviewed)abstract
- Objective: Patient education is part of fracture liaison services in many organizations and has been shown to have positive effects on several important patient outcomes. The present study aimed to assess the patients’ preferences when seeking disease specific information on osteoporosis. Methods: Patients with denosumab (Den) or zoledronic acid (ZA) treatment administrated at our endocrinology clinic July 2017 – December 2017 were sent a postal questionnaire with questions on preferences on how to obtain information about osteoporosis. One reminder was sent to nonresponders. Participants were mainly patients followed by primary healthcare, but with help from specialized hospital care to administrate injections/infusions. No osteoporosis school was arranged by the health organization in the catchment area. Results: A total number of 155 patients (84% females, mean age±SD 75±9 y) participated in the study. Dropout rate was 26%. A total of 67% of patients actively searched for disease specific information on osteoporosis. No difference in search behavior was seen regarding type of treatment (Den or ZA) or age. More women than men searched for information as did patients experiencing any adverse event (both p<0.01). The most used source of information was brochure (46%), internet sites from healthcare providers (27%), internet in general (15%) and weekly magazines (8%). In total, 57% of participants stated they would like to attend a school for osteoporosis. Of these 44% preferred general lectures, 39% group education with physical meet-ups, 23% internet (general information) and 13% internet osteoporosis schools. Conclusion: Disease specific information is prompted by a majority of osteoporosis patients. Type of education and sources varies. Internet sources, preferentially from the healthcare organization, was used by a third of patients. The study was done pre-pandemic and it is possible that the use of internet resources might have changed.
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| 18. |
- Woisetschläger, Mischa, 1974-, et al.
(author)
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Selection of risk assessment methods for osteoporosis screening in postmenopausal women with low-energy fractures : A comparison of fracture risk assessment tool, digital X-ray radiogrammetry, and dual-energy X-ray absorptiometry
- 2022
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In: SAGE Open Medicine. - : SAGE PUBLICATIONS INC. - 2050-3121. ; 10
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Journal article (peer-reviewed)abstract
- Objectives:Fracture liaison services are designed to identify patients needing osteoporosis treatment after a fracture. Some fracture liaison service designs involve a prescreening step, for example, fracture risk assessment tool (FRAX®). Another possible prescreening tools are bone mass density assessment in the acute setting. The aim of this study was to assess the effectiveness of prescreening tools.Methods:In the present prospective cohort study, women aged >55 years with a radius fracture were included. Patients were recruited at the emergency department after experiencing their fracture. All patients performed fracture risk assessment by fracture risk assessment tool, and bone mass density assessment by digital X-ray radiogrammetry and dual-energy X-ray absorptiometry (prescreening steps) as well as full routine evaluation at the osteoporosis unit (endpoint). The main outcome measures were sensitivity, specificity, predictive values, and area under the curve.Results:Forty-one women were recruited (mean age: 70 ± 8 years). Of these, 54% fulfilled the treatment indication criteria of osteoporosis after a full examination. Fracture risk assessment tool without bone mass density (cutoff ⩾ 15%) for prescreening patients had a high sensitivity (90%) but a low area under the curve (0.50) and specificity (16%). The highest area under the curve (0.73) was found prescreening with bone mass density assessment (dual-energy X-ray absorptiometry or digital X-ray radiogrammetry) having a sensitivity of 59%–86% and specificity of 61%–90%.Conclusion:This study, though small, raises questions regarding the effectiveness of using a prescreening step in fracture liaison services for high-risk individuals. In this cohort, FRAX® without bone mass density had a low precision, with a risk of both underestimating and overestimating patients requiring treatment. Bone mass density assessment in the acute setting could improve the precision of prescreening. Further investigations on the effectiveness and health economics of prescreening steps in fracture liaison services are needed.
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