Predictors of fractures among the aged: a population-based study with 12-year follow-up in a Finnish municipality
|
|
- Millicent Bishop
- 6 years ago
- Views:
Transcription
1 Aging Clinical and Experimental Research among the aged: a population-based study with 12-year follow-up in a Finnish municipality Maarit Piirtola 1,2,3, Tero Vahlberg 4, Raimo Isoaho 1,5,6, Pertti Aarnio 7, and Sirkka-Liisa Kivelä 1,2,8 1Department of Family Medicine, University of Turku, Turku, Finland, 2 Satakunta Central Hospital, Pori, Finland, 3 Härkätie Health Centre, Lieto, Finland, 4 Department of Biostatistics, University of Turku, Turku, Finland, 5 Pori Health Centre, Pori, Finland, 6 Nordic School of Public Health, Gothenburg, Sweden, 7Department of Surgery, Satakunta Central Hospital, Pori, Finland, 8 Unit of Family Medicine, Turku University Hospital, Turku, Finland ABSTRACT. Background and aims: The incidence of fractures is high in older populations. More information is needed about long-term predictors of fractures, for preventive measures. The aim of this study was to analyze gender-specific predictors of fractures among persons aged 65 years or older during a 12- year follow-up. Methods: A true cohort study in the municipality of Lieto, southwestern Finland, started in October Baseline data and information about fractures in 1177 subjects (482 men, 695 women), mean age 73 years (range 65-97), were obtained individually from health care registers during The mean follow-up period was 8.5 years. Subjects having sustained at least one fracture (n=295) were compared with subjects with no fractures during the follow-up. were analyzed using a Poisson regression model, separately by gender. Results: In multivariate Poisson regression analyses, the following predictors of fractures during the 12-year follow-up were identified: reduced handgrip strength (RR 1.6, 95% CI in middle quartiles, RR 2.2, 95% CI in lowest quartile) and body mass index (BMI) (RR 1.9, 95% CI ) or BMI <25 (RR 2.0, 95% CI ) compared with BMI 30 or over among women, and a large number of depressive symptoms (RR 2.1, 95% CI ) among men. A compression fracture in one or more thoracic or upper lumbar vertebrae on chest radiography at baseline was associated with fractures in both women (RR 2.0, 95% CI ) and men (RR 3.5, 95% CI ). Conclusions: The predictors of fractures among aged persons varied by gender, and were associated with both risk factors of falling and bone fragility. (Aging Clin Exp Res 2008; 20: ) INTRODUCTION The incidence of fractures is high in older populations (1-3). Most types of fractures are more common in older women than men (1-5), and the predictors of fractures in women have been the subject of greater interest (6-8). However, the number and incidence of fractures in men have increased during the last few decades (1, 2, 4). A history of falling accidents (8-10), fall-related factors such as neuromuscular and visual impairment (6, 9), advanced age (3, 5, 8, 11), low body mass index (BMI) (12), a previous fracture (8, 11, 13-15), cigarette smoking and excessive alcohol consumption (11), use of systemic corticosteroids, rheumatoid arthritis (11) and low bone mineral density (BMD) (8, 11, 16, 17) have been reported to be associated with new fractures. There is evidence that some clinical risk factors contribute to the fracture risk, independently of BMD (11). Although there are many studies on the risk factors of fractures and several population-based studies with rather long follow-up periods (8, 14, 15, 18-25), there is still inconsistency regarding the interaction of fall-related factors and bone fragility as causative factors in sustaining fractures. Reduced BMD and osteoporosis (BMD T- score lower than 2.5 standard deviations (SD) below the mean for young healthy women) have been used as indicators of bone fragility, and found to be associated with fractures in both women and men (26). Reduced Key words: Aged, epidemiology, follow-up studies, fractures, predictors, risk factors. Correspondence: Maarit Piirtola, University of Turku, Dept. of Family Medicine, Lemminkäisenkatu 1, University of Turku, Finland. maarit.piirtola@utu.fi Received January 22, 2007; accepted in revised form April 17, Aging Clin Exp Res, Vol. 20, No
2 M. Piirtola, T. Vahlberg, R. Isoaho, et al. Aging Clin Exp Res 19: , 2007 BMD alone predicts only 60-70% of all fractures (17) and less than half of non-vertebral fractures (18). Not all persons with low BMD sustain a fracture after a fall (26). The use of BMD as a predictor of fractures among the oldest old people may be limited (17). Falling accidents and fall-related factors are independent predictors of fractures regardless of BMD (7, 19), although high BMD seems to protect from fractures regardless of falling (17). More information is needed about the predictors of fractures for the development of easy-to-use, sensitive long-term risk assessment and screening tools (26), especially for older men. The aim of this study was to analyze long-term genderspecific predictors of fractures among persons aged 65 years old or older, sustaining at least one fracture during the follow-up of 12 years. METHODS Participants This study is part of a larger, longitudinal, epidemiological population-based study of subjects aged 65 years or older living in the municipality of Lieto, southwestern Finland (27). Baseline data were collected during the first wave of the Lieto Study, between 1 October 1990 and 31 December The original population consisted of all residents in Lieto born in 1926 or earlier and alive at the baseline (n=1283), of whom 1196 (93%), 488 men and 708 women, participated. Fractures and accidents during follow-up Information about radiologically diagnosed fractures was collected individually from the medical records of the Lieto and Turku Health Centers, the Finnish Hospital Discharge Register and the Finnish Cause of Death Statistics from 1 October 1990 to 31 December Data on fractures from these sources were obtained for 482 men and 695 women (n=1177). All subjects with fractures were followed from the beginning of the follow-up to the occurrence of a fracture, and persons with no fractures to the end of the follow-up period (31 December 2002) or to death. Fractures were classified according to ICD-9 codes during and to ICD-10 codes from 1996 onward. All codes were converted into ICD- 10 codes. Fractures were grouped as hip (S72.0, S72.1, S72.2), wrist (S52), tibial and ankle (S82), rib(s) (S22.3, S22.4), proximal humerus (S42.2), and other fractures. Accidents were grouped as moderate (falling from standing height or less), more serious (due to falling from stairs or higher than standing height, but not higher than two meters, or due to traffic accidents) and most serious (due to falling from higher than two meters, impact of a falling object or traffic accident). Fractures with pathological backgrounds (n<5) and those caused by the most serious accidents (n=14) were excluded. For persons who sustained more than one fracture in an accident, the main fracture contributing to the need for treatment was taken into account. The double calculation error due to hospital transfers was eliminated by following the treatment of all fractures individually during the whole 12-year follow-up period (28). Validation of follow-up fracture data Altogether, 616 of the 1177 subjects participating in the first wave (baseline of the present study) of the Lieto Study in also participated in the second wave during We compared the data on fractures collected from the three sources: baseline examination ( ), second wave of the Lieto Study ( ), and follow-up data from the present study until According to the comparison, no diagnosed fractures that had occurred in these 616 participants were missed (28). Fractures before baseline examination Reviews of medical records also covered information on fractures that had occurred before the baseline examination in The quality of background information varied. Only fractures sustained after the age of 45 years, before the baseline examination, were included as a predicting variable of a new fracture during follow-up. The age limit was chosen to coincide with the beginning of the menopause in women and to exclude wartime injuries ( ) in men. Informed consent and ethical approval Informed consent was obtained from all participants or their caregivers. The Joint Ethics Committee of the University of Turku and the Hospital District of Southwest Finland approved the baseline study plan. The Finnish Ministry of Social Affairs and Health, Finnish National Research and Development Centre for Welfare and Health, and Lieto District Health Authority approved the collection of follow-up data (28). Baseline interviews, tests and measurements During the collection of baseline data, participants made two visits to the Lieto Health Centre. The interviews, tests and measurements were carried out by two trained nurses and the clinical examinations by an experienced general practitioner, GP (RI). If a person was not able to come to the Health Centre, the GP and one of the nurses made a visit to the participant s home or to the institution where the person lived. Proxy interviews were made for 76 (6%) subjects with cognitive decline or dementia. The clinical tests conducted at baseline according to the study protocol are described in the original research reports of the Lieto Study (27, 29). Socio-economic factors included information about gender, age, marital status, education, occupation, and ac- 243 Aging Clin Exp Res, Vol. 20, No. 3
3 Aging Clin Exp Res 19: , 2007 commodation. Questions about health and medical status included information about diagnosed diseases, symptoms, and use of drugs. Medical diagnoses and the use of prescription drugs were confirmed from health center records when available. Health behavior was assessed by questions about smoking and physical activity. Engagement in physical exercise was elicited by one dichotomized question: In addition to your ordinary household work, do you do physical exercise as a hobby? The interview also included 14 questions about mobility (e.g., moving outdoors, walking between rooms, negotiating stairs, walking at least 400 metres) and the ability to manage the activities of daily living (ADL: toileting, washing and bathing, dressing and undressing, getting in and out of bed, eating) and instrumental activities of daily living (IADL: doing one s own cooking, doing light housework, doing heavy housework, carrying a 5-kg load at least 100 meters, cutting one s toe nails) (30, 31). The use of mobility aids was recorded. Weight and height were measured. Diastolic and systolic blood pressures were measured in a sitting position. Handgrip strength was measured with an Elmed Vigorimeter (hand dynamometer) consisting of three different-sized rubber balls, and the measurement was used as an index of muscle strength. The research nurse selected a suitable rubber ball for each person. One technically successful attempt was accepted. If a subject could not use one or the other hand, only one hand was tested. Binocular visual acuity was tested with the Snellen E- Chart. Subjects using glasses were asked to wear them for the test. The ability to read normal print (font 12) was tested in a sitting position from a distance of 40 cm. The ability to hear normal speech with or without a hearing aid at a distance of one to five meters was tested. Cognitive ability was measured with the Mini-Mental State Examination test (MMSE) (32) and depressive symptoms with the Zung Self-rating Depression Scale (ZSDS) (33). Chest roentgenograms were taken from two different angles and checked by the same experienced GP (RI). A compressed fracture was diagnosed if a vertebra was obviously compressed to a wedge shape. In addition to roentgenograms, possible information about kyphotic spine and history of back pain were obtained. Only definite compression fractures were recorded. One or more compression fractures in the thoracic and upper lumbar vertebrae diagnosed in these examinations were used as an indicator of bone fragility. squared (kg/m 2 ) and categorized according to WHO recommendations as <25, and 30. Subjects were coded as having a large number of depressive symptoms if they scored 45 or more points on the ZSDS (34, 35). The ability to manage ADL and IADL functions was categorized into three classes: 1) independent, 2) independent with difficulties, and 3) dependent. Handgrip strength was calculated as the mean of both hands best values. Systolic and diastolic blood pressures and handgrip strength recordings were categorized, based on the lowest quartile, the second and the third quartiles combined, and highest quartile, separately by gender. Methods of analysis A 12-year follow-up period ( ) was used in analyzing the predictors of fractures. Those who had sustained at least one fracture during the followup made up the group of fractured persons and those who had sustained no fractures served as a reference group. The first fracture of each individual was included into the analyses. Univariate and age-adjusted Poisson regression analyses (36) were applied first. The variables showing significant associations with fractures in age-adjusted analyses were further included in multivariate analyses. Age was used as a continuous variable in age-adjusted and multivariate analyses. All analyses were made separately for men and women. Follow-up periods in each analysis were calculated as person-years (PY). Person-years were calculated from the beginning of the follow-up to the occurrence of a fracture or, for persons with no fractures, to the end of the follow-up period (2002) or to death. The results are presented using relative risks (RR) with their 95% confidence intervals (95% CI). In all analyses, p-values of less than 0.05 were considered statistically significant. Statistical analyses were performed with the SAS System for Windows, version 8.2 (SAS Institute Inc, Cary, NC). RESULTS Background At baseline, subjects mean age was 73 years [72.4 (SD 6.6) in men and 73.8 (SD 7.0) in women], range 65 to 97 (Table 1). The mean number of diagnosed diseases was 4.6 (SD 2.7) in men and 5.2 (SD 2.8) in women. At the end of the 12-year follow-up period ( ), 569 persons (205 men, 364 women) were still alive. Statistical methods Categorization The selected baseline variables and their categorization are listed in Table 1. Diagnosed diseases and health behavior variables, with reasonable evidence to serve as predictors of fractures, were included in the analyses. Body mass index (BMI) was calculated as kilograms per height Fractures before baseline Altogether 279 (23%) persons (87 men and 192 women) had sustained at least one fracture after the age of 45 years but before the baseline ( ) (Table 1). The median time-point of having sustained the last fracture was 6 years (0 to 31 years), and the median age of sustaining this fracture was 67 years (48 to 94 years). Aging Clin Exp Res, Vol. 20, No
4 M. Piirtola, T. Vahlberg, R. Isoaho, et al. Aging Clin Exp Res 19: , 2007 Table 1 - Baseline characteristics among men and women who sustained no fractures or sustained at least one fracture during 12-year follow-up. Values are numbers, percentages are shown in brackets. Characteristics Men n=482 Women n=695 No fractures At least one fracture No fractures At least one fracture n=408 (85) n=74 (15) n=474 (68) n=221 (32) Socio-demographic Age group at baseline (69) 38 (51) 285 (60) 121 (55) (27) 33 (45) 140 (30) 86 (39) (4) 3 (4) 49 (10) 14 (6) Marital status - married or co-habiting 305 (75) 56 (76) 195 (41) 92 (42) - single, widowed, divorced or judicial separation 103 (25) 18 (24) 278 (59) 129 (58) Home residence and living partner* - own home or sheltered housing 392 (96) 71 (96) 439 (93) 211 (95) - with another person alone long-term institutional care 16 (4) 3 (4) 35 (7) 10 (5) Physical functional abilities Mobility, managing ADL and IADL * - independent with no difficulties in any task 219 (54) 36 (49) 180 (38) 85 (38) - with difficulties or dependence in at least one task 189 (46) 38 (51) 291 (62) 136 (62) Walking between rooms - independent 316 (78) 59 (80) 323 (68) 164 (74) - independent with difficulties 83 (20) 15 (20) 120 (25) 51 (23) - dependent 9 (2) 0 (0) 31 (7) 6 (3) Negotiating stairs - independent 269 (68) 60 (69) 244 (51) 128 (58) - independent with difficulties 93 (23) 15 (20) 151 (32) 66 (30) - dependent 37 (9) 8 (11) 79 (17) 27 (12) Washing and bathing - independent 335 (82) 61 (83) 353 (74) 171 (77) - independent with difficulties 33 (8) 4 (5) 51 (11) 26 (12) - dependent 40 (10) 9 (12) 70 (15) 24 (11) Carrying a 5-kg load at least 100 m - independent 279 (68) 54 (73) 241 (51) 118 (53) - independent with difficulties 52 (13) 9 (12) 66 (14) 33 (15) - dependent 77 (19) 11 (15) 167 (35) 70 (32) Mobility aids* - no aids 347 (85) 63 (85) 371 (79) 175 (79) - walking aids 51 (13) 10 (14) 66 (14) 40 (18) - wheelchair or other 9 (2) 1 (1) 34 (7) 6 (3) Cognitive abilities Cognitive ability (MMSE score)* (82) 58 (80) 377 (80) 176 (80) (12) 14 (19) 53 (11) 31 (14) (6) 1 (1) 40 (9) 14 (6) Health behavior Smoking* - non-smoker 125 (31) 23 (31) 426 (90) 203 (92) - ex-smoker 219 (53) 44 (59) 28 (6) 12 (5) - current smoker 64 (16) 7 (10) 18 (4) 5 (2) Physical exercise (self-reported)* - yes 201 (49) 42 (57) 179 (38) 94 (43) - no 206 (51) 32 (43) 295 (62) 127 (57) Clinical background data Systolic blood pressure (mmhg) M 168+ W (24) 27 (36) 120 (25) 65 (30) M W (51) 30 (41) 252 (53) 98 (44) M <136 W < (25) 17 (23) 102 (22) 58 (26) Diastolic blood pressure (mmhg) (34) 28 (38) 162 (34) 72 (32) (45) 31 (42) 214 (45) 90 (41) (21) 15 (20) 98 (21) 59 (27) (Continued) 245 Aging Clin Exp Res, Vol. 20, No. 3
5 Aging Clin Exp Res 19: , 2007 Table 1 - (Continued) Characteristics Men n=482 Women n=695 No fractures At least one fracture No fractures At least one fracture n=408 (85) n=74 (15) n=474 (68) n=221 (32) Handgrip strength (kpa)* M 86+ W (26) 17 (24) 131 (29) 38 (18) M W (50) 33 (46) 222 (49) 108 (52) M 54 W (24) 22 (30) 97 (22) 61 (30) Body mass index (BMI)* (20) 14 (19) 179 (38) 49 (22) (48) 39 (53) 173 (37) 98 (44) < (32) 21 (28) 121 (26) 74 (34) Binocular sight* (95) 70 (96) 416 (93) 197 (92) < (5) 3 (4) 33 (7) 17 (8) Ability to read print* - yes 382 (96) 71 (96) 432 (95) 204 (94) - no 17 (4) 3 (4) 24 (5) 12 (6) Ability to hear whisper or talk within 1-5 meters (bilateral)* - yes 386 (95) 69 (93) 450 (96) 212 (96) - no 21 (5) 5 (7) 21 (4) 8 (4) Number of prescription drugs (84) 60 (81) 355 (75) 170 (77) 6 65 (16) 14 (19) 119 (25) 51 (23) Parkinson s disease - no 405 (99) 73 (99) 470 (99) 220 (99) - yes 3 (1) 1 (1) 4 (1) 1 (1) Diabetes - no 358 (88) 68 (92) 422 (89) 196 (89) - yes 50 (12) 6 (8) 52 (11) 25 (11) Rheumatoid arthritis - no 398 (98) 73 (99) 464 (98) 216 (98) - yes 10 (2) 1 (1) 10 (2) 5 (2) Cardiovascular disease* - no 285 (72) 50 (69) 349 (78) 167 (79) - yes 111 (28) 22 (31) 98 (22) 44 (21) Depressive symptoms (ZSDS score)* (83) 51 (76) 348 (82) 164 (80) (17) 16 (24) 78 (18) 40 (20) At least one previous fracture after age of 45 years but before baseline - no 339 (83) 56 (76) 355 (75) 148 (67) - yes 69 (17) 18 (24) 119 (25) 73 (33) Compression fracture/s in thoracic or upper lumbar vertebrae visible on chest radiogram at baseline* - no 384 (94) 61 (82) 426 (91) 186 (84) - yes 23 (6) 13 (18) 43 (9) 35 (16) (M=men; W=women). *Number of missing observations of variable by gender (Living partner: Men 19/ Women 45; Mobility, managing ADL and IADL : W 3; Mobility aids: M 1/ W 3; MMSE: M 3/ W 4; Smoking: W 3; Physical exercise: M 1; Handgrip strength: M 14/ W 36; BMI: M 1/ W 1; Binocular sight: M 10/ W 36; Ability to read print: M 9/ W 32; Bilateral hearing: M 1/ W 4; Cardiovascular disease: M 14/ W 37; ZSDS: M 46/ W 65; Compression fractures: M 1/ W 5). Includes 14 questions about mobility (moving outdoors, walking between rooms, negotiating stairs, walking at least 400 meters), ADL (toileting, washing and bathing, dressing and undressing, getting in and out of bed, eating) and IADL (doing one s own cooking, doing light housework, doing heavy housework, carrying a 5-kg load, cutting one s toe nails). Fractures during follow-up During the 12-year follow-up, 295 persons [74 men (15%); 221 (32%) women] sustained at least one fracture. During the follow-up, 19 (26%) of the men s and 42 (19%) of the women s first fractures were of the hip, 7 (9%) and 73 (33%) wrist, 11 (15%) and 22 (10%) tibial and ankle, 16 (22%) and 11 (5%) rib(s), 4 (5%) and 20 (9%) upper part of humerus, and 17 (23%) and 53 (24%) other fractures. Aging Clin Exp Res, Vol. 20, No
6 M. Piirtola, T. Vahlberg, R. Isoaho, et al. Aging Clin Exp Res 19: , 2007 Table 2 - Predicting factors* and relative risks (RR) with 95% confidence intervals (95% CI) for fractures in univariate, age-adjusted and multivariate Poisson regression analyses among women who sustained at least one fracture during 12-year follow-up. Predicting factor* Univariate analysis Age-adjusted analysis Multivariate analysis# RR (95% CI) p-value RR (95% CI) p-value RR (95% CI) p-value Age group ( ) < ( ) Home residence - own home or sheltered housing long-term institutional care 2.0 ( ) ( ) Mobility, ADL and IADL tasks** - independent with no difficulties in any task with difficulties or dependence in at least one task 1.4 ( ) ( ) Washing and bathing - independent independent with difficulties 1.4 ( ) ( ) dependent 1.8 ( ) ( ) Carrying a 5-kg load at least 100 m - independent independent with difficulties 1.2 ( ) ( ) dependent 1.4 ( ) ( ) Mobility aids - no aids walking aids 1.7 ( ) ( ) wheelchair or other 1.5 ( ) ( ) Cognitive ability (MMSE score) ( ) ( ) ( ) ( ) Diastolic blood pressure (mmhg) ( ) ( ) ( ) ( ) Number of drugs ( ) ( ) Handgrip strength (kpa) ( ) ( ) ( ) ( ) < ( ) < ( ) Body mass index (BMI) ( ) ( ) ( ) < ( ) < ( ) < ( ) Binocular sight (Snellen E-Chart) < ( ) ( ) Ability to read print - yes no 1.9 ( ) ( ) Previous fracture after age of 45 years## - no yes 1.4 ( ) ( ) ( ) Compression fracture/s in thoracic or upper lumbar vertebrae - no yes 2.5 ( ) < ( ) < ( ) *Includes variables showing significant results in univariate Poisson regression analysis. #Age, handgrip strength, BMI, occurrence of a previous fracture after 45 years of age and compression of thoracic or upper lumbar vertebrae were included in multivariate Poisson regression model. Age was used as a continuous variable in age-adjusted and multivariate analyses. **Includes 14 questions about mobility (moving outdoors, walking between rooms, negotiating stairs, walking at least 400 meters), ADL (toileting, washing and bathing, dressing and undressing, getting in and out of bed, eating) and IADL (doing one s own cooking, doing light housework, doing heavy housework, carrying a 5-kg load, cutting one s toe nails). ## At least one registered fracture after age of 45 years but before baseline. 247 Aging Clin Exp Res, Vol. 20, No. 3
7 Aging Clin Exp Res 19: , 2007 Characteristics of accidents causing fractures During the follow-up in , 243 (82%) of fractures included were caused by moderately serious accidents and 16 (6%) by more serious accidents. Information about the type of accident was missing in 36 (12%) of cases. Nineteen percent of the fractures occurred outdoors and 40% indoors; detailed information about the place of accident was missing in 41% of cases. There were no significant differences in the severity (p=0.924) or circumstances (p=0.426) of accidents between genders. According to univariate Poisson regression analysis, being in long-term institutional care, dependence in carrying a 5-kg load at least 100 meters, use of walking aids, low (lowest quartile) diastolic blood pressure (<78 mmhg), BMI scores <30, poor sight (binocular sight <0.3 or inability to read print) and a previous fracture sustained after the age of 45 years but before the baseline were all significantly associated with fractures during the follow-up among women (Table 2). Among men, dependence in negotiating stairs, systolic blood pressure between 136 to 167 mmhg, and a large number of depressive symptoms (ZSDS score 45 or over) were predictors of fractures (Table 3). Advanced age (men 75 to 84 years, women 75+ years), difficulties or dependence in at least one mobility, ADL or IADL task, difficulties or dependence in washing and bathing, impaired cognitive abilities (men MMSE 18 to 23, women MMSE <24), use of 6 or more prescription drugs, reduced handgrip strength (men <55 kpa, women <76 kpa), and a compression fracture in one or more thoracic or upper lumbar vertebrae were all significant predictors for fractures in both women and men. In age-adjusted Poisson regression analysis among women, handgrip strength <76 kpa, BMI scores <30, a previous fracture sustained after the age of 45 years but before the baseline, and a compression fracture in one or more thoracic or upper lumbar vertebrae were significantly related to the risk of fractures (Table 2). Among men, significant predictors were a large number of depressive symptoms (ZSDS score 45 or over) and a compression fracture in one or more thoracic or upper lumbar vertebrae at baseline (Table 3). In multivariate Poisson regression analysis, handgrip strength <76 kpa, BMI scores <30, and a compression fracture in one or more thoracic or upper lumbar vertebrae were independent predictors for fracture among women (Table 2). Among men, only a large number of depressive symptoms (ZSDS score 45 or over) and a compression fracture in one or more thoracic or upper lumbar vertebrae were related to fractures (Table 3). DISCUSSION This 12-year cohort study showed that the predictors of fractures in older Finns differ by gender. In multivariate analyses, low handgrip strength (the lowest quartiles), BMI score lower than 30, and a compression fracture in one or more thoracic or upper lumbar vertebrae were significantly associated with the risk of fractures in women, whereas a large number of depressive symptoms and a compression fracture in one or more thoracic or upper lumbar vertebrae were similarly associated in men. We assume that both risk factors of falling and risk factors of bone fragility are important predictors of fractures. The participation rate during the first wave of the Lieto Study in was 93% (27), one of the highest reported in population studies worldwide. Information about fractures was achieved for nearly all participants (n=1196), but the medical records of all participants were not found in the local health centers, mainly because some subjects had moved from the district during the follow-up. These 19 persons (2%) were excluded from the baseline data of this study. Due to the use of several data collection sources and the organization of the health care system in Finland (37), coverage of fracture data during the follow-up in this study is high. We may have missed only a few vertebral fractures (some minor ones during baseline examination and/or some during follow-up) and fractures sustained by participants who were abroad for several months, but such cases were rare or non-existent. We compared the age distribution of the study subjects (n=1177) with that of the total Finnish population aged 65 years or over in 1991, by gender and by dividing the population into 5-year age groups. No significant differences were found in either men (p=0.081) or women (p=0.092) (28). According to a study by Sund (38), the incidence rates of hip fractures among aged Finns did not differ in the various hospital districts during Our results on the incidence rates of hip fractures in the aged population in Lieto (28) are similar to those obtained in the above register-based study in the whole of Finland (38). There is no published evidence to suggest that the BMD values or incidence rates of other age-related fractures (vertebral, wrist, upper part of humerus, etc.) than hip fractures might vary by hospital district among the aged population in Finland. We assume that our results may be generalized to represent the Finnish aged population. The first wave of the Lieto study in was not originally designed to analyze the risk factors of fractures. Information about previously proven risk factors of fractures, such as bone mineral density, calcium intake, vitamin D intake, family history of fractures, height loss, alcohol consumption, leanness, body balance, and the strength of the lower extremities was not elicited in the baseline study. The number of subjects with BMI <18.5 was small (10 men, 11 women), and the two lowest categories were therefore combined as BMI <25. However, baseline data includes accumulated wide-ranging data Aging Clin Exp Res, Vol. 20, No
8 M. Piirtola, T. Vahlberg, R. Isoaho, et al. Aging Clin Exp Res 19: , 2007 Table 3 - Predicting factors* and relative risks (RR) with 95% confidence intervals (95% CI) for fractures in univariate, age-adjusted and multivariate Poisson regression analyses among men who sustained at least one fracture during 12-year follow-up. Predicting factor* Univariate analysis Age-adjusted analysis Multivariate analysis# RR p-value RR p-value RR p-value Age group ( ) < ( ) Mobility, ADL and IADL tasks** - independent with no difficulties in any task difficulties or dependence in at least one task 1.8 ( ) ( ) Washing and bathing - independent independent with difficulties 1.0 ( ) ( ) dependent 3.3 ( ) ( ) Negotiating stairs - independent independent with difficulties 1.2 ( ) ( ) dependent 2.7 ( ) ( ) Handgrip strength (kpa) ( ) ( ) < ( ) ( ) Cognitive ability (MMSE score) ( ) ( ) < ( ) ( ) Systolic blood pressure (mmhg) ( ) ( ) ( ) ( ) Number of prescription drugs ( ) ( ) ZSDS score ( ) ( ) ( ) Compression fracture/s in thoracic or upper lumbar vertebrae - no yes 3.6 ( ) < ( ) ( ) < *Includes variables showing significant results in univariate Poisson regression analysis. #Age, ZSDS and compression of a thoracic or upper lumbar vertebrae were included in multivariate Poisson regression model. Age was used as a continuous variable in age-adjusted and multivariate analyses. **Includes 14 questions about mobility (moving outdoors, walking between rooms, negotiating stairs, walking at least 400 meters), ADL (toileting, washing and bathing, dressing and undressing, getting in and out of bed, eating) and IADL (doing one s own cooking, doing light housework, doing heavy housework, carrying a 5-kg load, cutting one s toe nails). about participants health and functional status. The thorough collection of data concerning fractures during the 12-year follow-up and the detailed information about the fractures before the actual follow-up, combined with baseline data, yielded unique possibilities of analyzing other clinical risk factors of fractures over a long period. The data were also capable of yielding risk factors of fractures in aged men. The range of yearly fluctuation in the number of fractures was quite wide and the yearly number and incidence of fractures low, which may have had an impact, especially on the results of risk factors in men (28). The small number of fractures did not allow us to analyze risk factors between age groups, severity of accidents, or types of fractures. It has been reported that the incidence rates of all fracture types combined (39, 40) and many subtypes of fractures, such as hip, spine, upper arm and pelvic fractures, increase with age (8, 20, 40), whereas the incidence of wrist and foot or ankle fractures does not (39, 41). Our present results and our previous report on the incidence of fractures support these findings (28). In addition to functional limitations and poor physical performance in older persons, low handgrip strength predicts fractures (8, 42). Low handgrip strength is as- 249 Aging Clin Exp Res, Vol. 20, No. 3
9 Aging Clin Exp Res 19: , 2007 sociated with women s menopausal bone loss (43) and future fractures (8, 43). In our data, men s overall handgrip strength was about 10% higher in every quartile compared with women s corresponding values, and reduced handgrip strength was associated with an increased risk of fractures in women, but not in men. We assume that poor handgrip strength reflects poor overall muscle strength, and is one of the risk factors of falling without a direct connection with bone fragility and bone strength. Handgrip strength can easily be measured in outpatient clinics or during home visits, and may be a good tool in screening persons with a high risk of falling and fractures. Low BMI is a well-documented risk factor for future fracture, but the significance of BMI as a risk factor seems to depend on BMD and to vary according to how BMI is categorized (12). In our study, a BMI value <30 at baseline predicted a new fracture in women. There is some evidence, however, that overweight may be a risk factor for sustaining ankle fractures in women (44). Women may benefit from slight overweight at older age, and the lower BMI scores (especially BMI <18.5) in women reflect not only a loss of muscle mass but also of undiagnosed diseases causing bone fragility and osteoporosis, or both. The BMI value, and especially a decrease in BMI, may be an alarm signal of overall poor health and a predictor of fractures, at least in women. Depression is associated with falling accidents in both men and women (45, 46) and with fractures in women (46-48). Depressive symptoms have been reported to decrease BMD, independently of body weight and behavioral factors, such as calcium compliance and exercise, in women (49). A low quality of life as measured by the SF- 36 physical component summary score has been reported as a risk for fractures in menopausal women (21). We found that a large number of depressive symptoms measured with ZSDS independently predicted fractures in men but not in women. This result is opposite that obtained in a Norwegian study (48). A large number of depressive symptoms in addition to cognitive impairment has been shown to be a risk factor for functional decline (50). Depressed persons may be passive in physical exercise and lack appetite, which may lead to a decrease in BMD, muscle strength and body balance. A high risk of fractures may be explained by these factors. We propose that depressive symptoms should be screened in older persons. Smoking is a risk factor of fractures, according to a large meta-analysis including several prospective population-based studies (51). We did not find smoking to be a risk for fractures either in women or men. The proportion of smoking women was very small, and the number of fractures that occurred in men was too small to prove an actual risk. The number of current smokers was quite small even among men, because many Finnish males stop smoking with advancing age. The occurrence of three or more chronic diseases has been reported to be associated with fractures in women (25). In our study, individual diseases showed no association with fractures. We also used the number of prescription drugs to reflect a person s medical condition. There was some evidence of polypharmacy as a predictor of fractures in both genders, but the association was not significant in age-adjusted analyses. We analyzed the interactions between number of depressive symptoms and BMI and between number of prescription drugs and BMI. According to our results, there was some evidence of interaction between BMI and the ZSDS sum score, or number of drugs, in men but not in women. Men who use 6 or more drugs, and men with a high number of depressive symptoms (ZSDS over 45) and a BMI score lower than 25 seem to sustain fewer fractures. These results are based on a small number of events in men, and should be confirmed in studies with larger sample sizes. A previous fracture is a predictor of sustaining a new fracture (8, 20, 23, 25, 44). Our study confirms these findings, even though a fracture before baseline but after the age of 45 years was a significant predictor only in women, and did not predict fractures independently in multivariate analyses. A compression fracture in one or more thoracic or upper lumbar vertebrae seen in chest X- rays at baseline was used as an indicator of bone fragility and osteoporosis, and proved to be the strongest independent predictor for a new fracture in both women and men. Previous vertebral fractures have also been established as risk factors for future fractures in other studies (14, 15, 20, 52). Although bone fragility and low BMD cannot be used as the only predictors of fractures (18, 19), spine X-rays can potentially identify vertebral fractures and find persons at high risk of fracture (20). Previous reports have shown many risk factors of fractures to be common to older men and women (15, 24, 51, 53), but gender differences also seem to exist (48). Many studies analyzing the predictors of fractures have been conducted in women, and information about men is scarce. We found the predictors of fractures to vary between genders. Only a compression fracture in one or more thoracic or upper lumbar vertebrae at baseline was an independent predictor of fractures in both genders. Bone health seems to be an important and independent predictor for future fractures, but some factors related to the risk of falling also proved here to be predictive of fractures. It has been reported that some risk factors of fractures differ by type of fracture (21, 25, 54, 55) or by falling mechanism (56). Risk factors may also vary by age group (11). We suggest that accident types, falling mechanisms, and risk factors of fractures differ not only between type of fracture and gender but also between age group, influencing even the age-specific incidences of fractures. In Aging Clin Exp Res, Vol. 20, No
10 M. Piirtola, T. Vahlberg, R. Isoaho, et al. Aging Clin Exp Res 19: , 2007 future studies, the predictors of fractures should be analyzed by type of fracture, severity of accident, and gender and age. These subgroup analyses require meta-analyses or large data sets gathered in multicenter studies. CONCLUSIONS This study showed that the predictors of fractures during the 12-year follow-up differ between genders. Reduced handgrip muscle strength, a BMI score <30, and a compression fracture in one or more thoracic or upper lumbar vertebrae on chest radiography at baseline in women and a large number of depressive symptoms (ZS- DS score 45 or over) and a compression fracture in one or more thoracic or upper lumbar vertebrae in men, were independent predictors of fractures. The results show that both risk factors of falling and of bone fragility are important predictors of fractures. As the number of aged people is increasing, it is important to screen them for predictors of fractures and to implement preventive action. Our results on long-term risk factors provide information for screening older persons at high risk of fractures. ACKNOWLEDGEMENTS The baseline study was supported by the Academy of Finland, Yrjö Jahnsson Foundation, and Finnish Anti-Tuberculosis Association. Data collection of fractures and analysis of predictors of fractures were supported by the La Carita Foundation, Finnish Cultural Foundation, Juho Vainio Foundation, grants from Satakunta Hospital District, and Lieto Health Centre, and the scholarship fund of the Ageing, Wellbeing and Technology graduate school. We are indebted to all those persons who attended baseline data collection , and especially to Jukka Saukkoriipi for technical assistance in biostatistics. We also thank the Lieto Health Centre and Turku Health Centre personnel for their positive attitude, as well as the assistance of Teemu Kemppainen and Eila Räisänen during collection of fracture data. We are also grateful to Prof. Harri Suominen, Department of Health Sciences, University of Jyväskylä for his comments during data analysis and in writing the manuscript. 8. Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD. Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone 2003; 32: Kannus P, Uusi-Rasi K, Palvanen M, Parkkari J. Non-pharmacological means to prevent fractures among older adults. Ann Med 2005; 37: Lee SH, Dargent-Molina P, Breart G. Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res 2002; 17: Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int 2005; 16: De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 2005; 16: Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004; 35: van der Klift M, de Laet CE, McCloskey EV, et al. Risk factors for incident vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res 2004; 19: Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G, Fukunaga M. Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 2003; 18: Cummings SR, Cawthon PM, Ensrud KE, Cauley JA, Fink HA, Orwoll ES. BMD and risk of hip and nonvertebral fractures in older men: A prospective study and comparison with older women. J Bone Miner Res 2006; 21: Cheng S, Suominen H, Sakari-Rantala R, Laukkanen P, Avikainen V, Heikkinen E. Calcaneal bone mineral density predicts fracture occurrence: a five-year follow-up study in elderly people. J Bone Miner Res 1997; 12: Schuit SC, van der Klift M, Weel AE, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 2004; 34: Kaptoge S, Benevolenskaya LI, Bhalla AK, et al. Low BMD is less predictive than reported falls for future limb fractures in women across Europe: results from the European Prospective Osteoporosis Study. Bone 2005; 36: Kaptoge S, Armbrecht G, Felsenberg D, et al. Whom to treat? The contribution of vertebral X-rays to risk-based algorithms for fracture prediction. Results from the European Prospective Osteoporosis Study. Osteoporos Int 2006; 17: Papaioannou A, Joseph L, Ioannidis G, et al. Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 2005; 16: Melton LJ 3rd, Atkinson EJ, O Connor MK, O Fallon WM, Riggs BL. Bone density and fracture risk in men. J Bone Miner Res 1998; 13: Johansson H, Oden A, Johnell O, et al. Optimization of BMD measurements to identify high risk groups for treatment - a test analysis. J Bone Miner Res 2004; 19: Nguyen TV, Center JR, Sambrook PN, Eisman JA. Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: the Dubbo Osteoporosis Epidemiology Study. Am J Epidemiol 2001; 153: Huopio J, Kroger H, Honkanen R, Saarikoski S, Alhava E. Risk factors for perimenopausal fractures: a prospective study. Osteoporos Int 2000; 11: Sambrook P, Cooper C. Osteoporosis. Lancet 2006; 367: REFERENCES 1. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int 1997; 7: Kannus P, Niemi S, Parkkari J, Palvanen M, Vuori I, Jarvinen M. Nationwide decline in incidence of hip fracture. J Bone Miner Res 2006; 21: Jones G, Nguyen T, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA. Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos Int 1994; 4: Melton LJ 3rd, Amadio PC, Crowson CS, O Fallon WM. Longterm trends in the incidence of distal forearm fractures. Osteoporos Int 1998; 8: Kanis JA, Johnell O, Oden A, et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 2000; 11: Dargent-Molina P, Favier F, Grandjean H, et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996; 348: Schwartz AV, Nevitt MC, Brown BW Jr, Kelsey JL. Increased falling as a risk factor for fracture among older women: the study of osteoporotic fractures. Am J Epidemiol 2005; 161: Aging Clin Exp Res, Vol. 20, No. 3
11 Aging Clin Exp Res 19: , Isoaho R, Puolijoki H, Huhti E, Kivela SL, Tala E. Prevalence of asthma in elderly Finns. J Clin Epidemiol 1994; 47: Piirtola M, Vahlberg T, Isoaho R, Aarnio P, Kivelä S-L. Incidence of fractures among the aged in Finland - a population-based 12-year follow-up. Aging Clin Exp Res 2007; 19: Isoaho R, Puolijoki H, Huhti E, Kivela SL, Laippala P, Tala E. Prevalence of chronic obstructive pulmonary disease in elderly Finns. Respir Med 1994; 88: Heikkinen E, Waters WE, Brzezinsky ZJ. The Elderly in Eleven Countries, a Sociomedical Survey. Copenhagen: World Health Organization, Waters WE, Heikkinen E, Dontas AS. Health, Lifestyles and Services for the Elderly. Copenhagen: World Health Organization; Folstein MF, Folstein SE, McHugh PR. Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: Zung WW. A Self-rating Depression Scale. Arch Gen Psychiatry 1965; 12: Rainio A. Zungin lomakkeiston sensitiivisyys ja spesifisyys epidemiologisessa tutkimuksessa [Sensitivity and specificity of Zung Self-rating Depression Scale (ZSDS) in epidemiological studies]. Oulu, Finland: University of Oulu, Department of Public Health Science and General Practise; Salminen M, Isoaho R, Vahlberg T, Ojanlatva A, Kivela SL. Effects of a health advocacy, counselling, and activation programme on depressive symptoms in older coronary heart disease patients. Int J Geriatr Psychiatry 2005; 20: Breslow NE, Day NE. Statistical methods in cancer research. Volume II - The design and analysis of cohort studies. IARC Scientific Publications 1987(82): Health care in Finland Available at: accessed ( ) 38. Sund R. Lonkkamurtumien ilmaantuvuus Suomessa (The incidence of hip fractures in Finland during ). Duodecim 2006; 122: Johansen A, Evans RJ, Stone MD, Richmond PW, Lo SV, Woodhouse KW. Fracture incidence in England and Wales: a study based on the population of Cardiff. Injury 1997; 28: van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone 2001; 29: Seeley DG, Kelsey J, Jergas M, Nevitt MC. Predictors of ankle and foot fractures in older women. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1996; 11: Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P. Functional limitations and poor physical performance as independent risk factors for self-reported fractures in older persons. Osteoporos Int 2004; 15: Sirola J, Rikkonen T, Tuppurainen M, Jurvelin JS, Kroger H. Association of grip strength change with menopausal bone loss and related fractures: a population-based follow-up study. Calcif Tissue Int 2006; 78: Valtola A, Honkanen R, Kroger H, Tuppurainen M, Saarikoski S, Alhava E. Lifestyle and other factors predict ankle fractures in perimenopausal women: a population-based prospective cohort study. Bone 2002; 30: Biderman A, Cwikel J, Fried AV, Galinsky D. Depression and falls among community dwelling elderly people: a search for common risk factors. J Epidemiol Community Health 2002; 56: Whooley MA, Kip KE, Cauley JA, Ensrud KE, Nevitt MC, Browner WS. Depression, falls, and risk of fracture in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999; 159: Mussolino ME. Depression and hip fracture risk: the NHANES I epidemiologic follow-up study. Public Health Rep 2005; 120: Sogaard AJ, Joakimsen RM, Tverdal A, Fonnebo V, Magnus JH, Berntsen GK. Long-term mental distress, bone mineral density and non-vertebral fractures. The Tromso Study. Osteoporos Int 2005; 16: Milliken LA, Wilhelmy J, Martin CJ, et al. Depressive symptoms and changes in body weight exert independent and site-specific effects on bone in postmenopausal women exercising for 1 year. J Gerontol A Biol Sci Med Sci 2006; 61: Mehta KM, Yaffe K, Covinsky KE. Cognitive impairment, depressive symptoms, and functional decline in older people. J Am Geriatr Soc 2002; 50: Kanis JA, Johnell O, Oden A, et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int 2005; 16: Pongchaiyakul C, Nguyen ND, Jones G, Center JR, Eisman JA, Nguyen TV. Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res 2005; 20: Kanis JA, Johansson H, Johnell O, et al. Alcohol intake as a risk factor for fracture. Osteoporos Int 2005; 16: Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR. Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group. Am J Epidemiol 1992; 135: Honkanen R, Tuppurainen M, Kroger H, Alhava E, Saarikoski S. Relationships between risk factors and fractures differ by type of fracture: a population-based study of 12,192 perimenopausal women. Osteoporos Int 1998; 8: Palvanen M, Kannus P, Parkkari J, et al. The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls. Osteoporos Int 2000; 11: Aging Clin Exp Res, Vol. 20, No
Dr Tuan V NGUYEN. Mapping Translational Research into Individualised Prognosis of Fracture Risk
Dr Tuan V NGUYEN Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney NSW Mapping Translational Research into Individualised Prognosis of Fracture Risk From the age of 60, one
More informationBody Mass Index as Predictor of Bone Mineral Density in Postmenopausal Women in India
International Journal of Public Health Science (IJPHS) Vol.3, No.4, December 2014, pp. 276 ~ 280 ISSN: 2252-8806 276 Body Mass Index as Predictor of Bone Mineral Density in Postmenopausal Women in India
More informationRisk Factors for Postmenopausal Fractures What We Have Learned from The OSTPRE - study
Risk Factors for Postmenopausal Fractures What We Have Learned from The OSTPRE - study Heikki Kröger Kuopio Musculoskeletal Research Unit, University of Eastern Finland (UEF) Dept. of Orthopaedics, Traumatology
More informationBone loss and the risk of non-vertebral fractures in women and men: the Tromsø study
Osteoporos Int (2010) 21:1503 1511 DOI 10.1007/s00198-009-1102-z ORIGINAL ARTICLE Bone loss and the risk of non-vertebral fractures in women and men: the Tromsø study L. A. Ahmed & N. Emaus & G. K. Berntsen
More informationIncreased mortality after fracture of the surgical neck of the humerus: a case-control study of 253 patients with a 12-year follow-up.
Increased mortality after fracture of the surgical neck of the humerus: a case-control study of 253 patients with a 12-year follow-up. Olsson, Christian; Petersson, Claes; Nordquist, Anders Published in:
More informationCAROLYN M. KLOTZBUECHER, PHILIP D. ROSS, PAMELA B. LANDSMAN, THOMAS A. ABBOTT III, and MARC BERGER ABSTRACT
JOURNAL OF BONE AND MINERAL RESEARCH Volume 15, Number 4, 2000 2000 American Society for Bone and Mineral Research Patients with Prior Fractures Have an Increased Risk of Future Fractures: A Summary of
More informationAn audit of bone densitometry practice with reference to ISCD, IOF and NOF guidelines
Osteoporos Int (2006) 17: 1111 1115 DOI 10.1007/s00198-006-0101-6 SHORT COMMUNICATION An audit of bone densitometry practice with reference to ISCD, IOF and NOF guidelines R. Baddoura. H. Awada. J. Okais.
More informationORIGINAL INVESTIGATION. Limb Fractures in Elderly Men as Indicators of Subsequent Fracture Risk
ORIGINAL INVESTIGATION Limb Fractures in Elderly Men as Indicators of Subsequent Fracture Risk Bruce Ettinger, MD; G. Thomas Ray, MBA; Alice R. Pressman, MS; Oscar Gluck, MD Background: Whether limb fracture
More informationModule 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC
Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with
More informationInterpreting DEXA Scan and. the New Fracture Risk. Assessment. Algorithm
Interpreting DEXA Scan and the New Fracture Risk Assessment Algorithm Prof. Samir Elbadawy *Osteoporosis affect 30%-40% of women in western countries and almost 15% of men after the age of 50 years. Osteoporosis
More informationFractures: Epidemiology and Risk Factors. July 2012 CME (35 minutes) 7/24/ July12 1. Osteoporotic fractures: Comparison with other diseases
Financial Disclosures Fractures: Epidemiology and Risk Factors Research grants, speaking or consulting: Amgen, Lilly, Merck, Novartis, Radius Dennis M. Black, PhD Department of Epidemiology and Biostatistics
More informationORIGINAL ARTICLE. E. Barrett-Connor & S. G. Sajjan & E. S. Siris & P. D. Miller & Y.-T. Chen & L. E. Markson
Osteoporos Int (2008) 19:607 613 DOI 10.1007/s00198-007-0508-8 ORIGINAL ARTICLE Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National
More informationDisclosures Fractures:
Disclosures Fractures: A. Schwartz Epidemiology and Risk Factors Research Funding: GlaxoSmithKline, Merck Ann V. Schwartz, PhD Department of Epidemiology and Biostatistics UCSF Outline Fracture incidence
More informationO. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster
DOI 10.1007/s00296-012-2460-y ORIGINAL ARTICLE Comparison of the proportion of patients potentially treated with an anti-osteoporotic drug using the current criteria of the Belgian national social security
More informationScreening for absolute fracture risk using FRAX tool in men and women within years in urban population of Puducherry, India
International Journal of Research in Orthopaedics Firoz A et al. Int J Res Orthop. 217 Sep;3(5):151-156 http://www.ijoro.org Original Research Article DOI: http://dx.doi.org/1.1823/issn.2455-451.intjresorthop21739
More informationAn audit of osteoporotic patients in an Australian general practice
professional Darren Parker An audit of osteoporotic patients in an Australian general practice Background Osteoporosis is a major contributor to morbidity and mortality in Australia, and is predicted to
More informationDisclosures Fractures: A. Schwartz Epidemiology and Risk Factors Consulting: Merck
Disclosures Fractures: A. Schwartz Epidemiology and Risk Factors Consulting: Merck Ann V. Schwartz, PhD Department of Epidemiology and Biostatistics UCSF Outline Fracture incidence and impact of fractures
More informationASJ. How Many High Risk Korean Patients with Osteopenia Could Overlook Treatment Eligibility? Asian Spine Journal. Introduction
Asian Spine Journal Asian Spine Clinical Journal Study Asian Spine J 2014;8(6):729-734 High http://dx.doi.org/10.4184/asj.2014.8.6.729 risk patients with osteopenia How Many High Risk Korean Patients with
More informationFall-related risk factors and osteoporosis in older women referred to an open access bone densitometry service
Age and Ageing 05; 34: 67 71 Age and Ageing Vol. 34 No. 1 British Geriatrics Society 04; all rights reserved doi:10.1093/ageing/afh238 Published electronically 15 November 04 Fall-related risk factors
More informationFracture Prediction From Bone Mineral Density in Japanese Men and Women ABSTRACT
JOURNAL OF BONE AND MINERAL RESEARCH Volume 18, Number 8, 2003 2003 American Society for Bone and Mineral Research Fracture Prediction From Bone Mineral Density in Japanese Men and Women SAEKO FUJIWARA,
More informationOsteoporosis Screening and Treatment in Type 2 Diabetes
Osteoporosis Screening and Treatment in Type 2 Diabetes Ann Schwartz, PhD! Dept. of Epidemiology and Biostatistics! University of California San Francisco! October 2011! Presenter Disclosure Information
More informationnogg Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK
nogg NATIONAL OSTEOPOROSIS GUIDELINE GROUP Guideline for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK Produced by J Compston, A Cooper,
More informationORIGINAL INVESTIGATION. Continuously Increasing Number and Incidence of Fall-Induced, Fracture-Associated, spinal cord injuries in older persons
ORIGINAL INVESTIGATION Continuously Increasing Number and of Fall-Induced, Fracture-Associated, Spinal Cord Injuries in Elderly Persons Pekka Kannus, MD, PhD; Seppo Niemi; Mika Palvanen, MD; Jari Parkkari,
More informationFractures: Epidemiology and Risk Factors. Osteoporosis in Men (more this afternoon) 1/5 men over age 50 will suffer osteoporotic fracture 7/16/2009
Fractures: Epidemiology and Risk Factors Mary L. Bouxsein, PhD Department of Orthopaedic Surgery Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA Outline Fracture incidence and impact
More informationAssessment of the risk of osteoporotic fractures in Prof. J.J. Body, MD, PhD CHU Brugmann Univ. Libre de Bruxelles
Assessment of the risk of osteoporotic fractures in 2008 Prof. J.J. Body, MD, PhD CHU Brugmann Univ. Libre de Bruxelles Estimated lifetime fracture risk in 50-year-old white women and men Melton et al.;
More informationResearch Article Mikkeli Osteoporosis Index Identifies Fracture Risk Factors and Osteoporosis and Intervention Thresholds Parallel with FRAX
SAGE-Hindawi Access to Research Osteoporosis Volume 2011, Article ID 732560, 7 pages doi:10.4061/2011/732560 Research Article Mikkeli Osteoporosis Index Identifies Fracture Risk Factors and Osteoporosis
More informationOsteoporosis International. Original Article. Bone Mineral Density and Vertebral Fractures in Men
Osteoporos Int (1999) 10:265 270 ß 1999 International Osteoporosis Foundation and National Osteoporosis Foundation Osteoporosis International Original Article Bone Mineral Density and Vertebral Fractures
More informationDEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN
October 2-4, Liverpool, UK EURO SPINE 2013 DEVELOPMENT OF A RISK SCORING SYSTEM TO PREDICT A RISK OF OSTEOPOROTIC VERTEBRAL FRACTURES IN POSTMENOPAUSAL WOMEN D. Colangelo, L. A. Nasto, M. Mormando, E.
More informationMen and Osteoporosis So you think that it can t happen to you
Men and Osteoporosis So you think that it can t happen to you Jonathan D. Adachi MD, FRCPC Alliance for Better Bone Health Chair in Rheumatology Professor, Department of Medicine Michael G. DeGroote School
More informationTHE INCIDENCE OF OSTEOPOrotic
ORIGINAL CONTRIBUTION Low Bone Mineral Density and Risk of Fracture in White Female Nursing Home Residents Julie M. Chandler, PhD Sheryl I. Zimmerman, PhD Cynthia J. Girman, DrPH Allison R. Martin, MHA
More informationAssessment of Individual Fracture Risk: FRAX and Beyond
Curr Osteoporos Rep (2010) 8:131 137 DOI 10.1007/s11914-010-0022-3 Assessment of Individual Fracture Risk: FRAX and Beyond Joop P. W. van den Bergh & Tineke A. C. M. van Geel & Willem F. Lems & Piet P.
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Osteoporosis- Do We Need to Think Beyond Bone Mineral Density? Dr Preeti Soni 1, Dr Shipra
More informationHow can we tell who will fracture? Beyond bone mineral density to the new world of fracture risk assessment
Copyright 2008 by How can we tell who will fracture? Beyond bone mineral density to the new world of fracture risk assessment Dr. Bone density testing: falling short of expectations More than 25 years
More informationUsing the FRAX Tool. Osteoporosis Definition
How long will your bones remain standing? Using the FRAX Tool Gary Salzman M.D. Director Banner Good Samaritan/ Hayden VAMC Internal Medicine Geriatric Fellowship Program Phoenix, Arizona Using the FRAX
More informationThe Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks
Volume ** Number ** ** VALUE IN HEALTH The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks Tjeerd-Peter van Staa, MD, MA, PhD, 1,2 John A. Kanis,
More informationTitle. Bow, CH; Tsang, SWY; Loong, CHN; Soong, CSS; Yeung, SC; Kung, AWC. Author(s)
Title Author(s) Bone mineral density enhances use of clinical risk factors in predicting ten-year risk of osteoporotic fractures in Chinese men: The Hong Kong Osteoporosis Study Bow, CH; Tsang, SWY; Loong,
More informationAMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT. Committee on Rheumatologic Care
AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT SUBJECT: PRESENTED BY: FOR DISTRIBUTION TO: Bone Mineral Density Measurement and the Role of Rheumatologists in the Management of Osteoporosis Committee
More informationJuly 2012 CME (35 minutes) 7/12/2016
Financial Disclosures Epidemiology and Consequences of Fractures Advisory Board: Amgen Janssen Pharmaceuticals Inc. Ann V. Schwartz, PhD Department of Epidemiology and Biostatistics UCSF Outline Osteoporotic
More informationOsteoporosis in Men. Until recently, the diagnosis of osteoporosis. A New Type of Patient. Al s case. How is the diagnosis made?
A New Type of Patient Rafat Faraawi, MD, FRCP(C), FACP Until recently, the diagnosis of osteoporosis in men was uncommon and, when present, it was typically described as a consequence of secondary causes.
More informationThe Impact of Nonhip Nonvertebral Fractures in Elderly Women and Men
ORIGINAL ARTICLE Endocrine Care The Impact of Nonhip Nonvertebral Fractures in Elderly Women and Men Dana Bliuc, Tuan V. Nguyen, John A. Eisman, and Jacqueline R. Center Osteoporosis and Bone Biology (D.B.,
More informationCoordinator of Post Professional Programs Texas Woman's University 1
OSTEOPOROSIS Update 2007-2008 April 26, 2008 How much of our BMD is under our control (vs. genetics)? 1 2 Genetic effects on bone loss: longitudinal twin study (Makovey, 2007) Peak BMD is under genetic
More informationThe Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (9), Page
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (9), Page 5278-5283 Epidemiology outcomes of proximal humerus fractures in Saudi Arabia Nibras Khaled Aljabri 1, Ashaq Mubarak Al-Qahtani 2,
More informationResearch Article What Accounts for Rib Fractures in Older Adults?
SAGE-Hindawi Access to Research Osteoporosis Volume 2011, Article ID 457591, 6 pages doi:10.4061/2011/457591 Research Article What Accounts for Rib Fractures in Older Adults? Lisa-Ann Wuermser, 1 Sara
More informationBiological theory for the construct of intrinsic capacity to be used in clinical settings Matteo Cesari, MD, PhD
Biological theory for the construct of intrinsic capacity to be used in clinical settings Matteo Cesari, MD, PhD World Health Organization Geneva (Switzerland) December 1, 2016 World Health Organization.
More informationOsteoporosis International. Original Article. The Tromsø Study: Body Height, Body Mass Index and Fractures
Osteoporos Int (1998) 8:436 442 ß 1998 European Foundation for Osteoporosis and the National Osteoporosis Foundation Osteoporosis International Original Article The Tromsø Study: Body Height, Body Mass
More informationRisk of subsequent fracture and mortality within 5 years after a non-vertebral fracture
Osteoporos Int (21) 21:27 282 DOI 1.17/s198-1-1178- ORIGINAL ARTICLE Risk of subsequent fracture and mortality within years after a non-vertebral fracture K. M. B. Huntjens & S. Kosar & T. A. C. M. van
More informationPrevalence of vertebral fractures on chest radiographs of elderly African American and Caucasian women
Osteoporos Int (2011) 22:2365 2371 DOI 10.1007/s00198-010-1452-6 ORIGINAL ARTICLE Prevalence of vertebral fractures on chest radiographs of elderly African American and Caucasian women D. Lansdown & B.
More informationCASE 1 WHY IS IT IMPORTANT TO TREAT? FACTS CONCERNS
4:30-5:15pm Ask the Expert: Osteoporosis SPEAKERS Silvina Levis, MD OSTEOPOROSIS - FACTS 1:3 older women and 1:5 older men will have a fragility fracture after age 50 After 3 years of treatment, depending
More information1.2 Health states/risk factors affected by the intervention
1.1 Definition of intervention The intervention is opportunistic screening for low bone mineral density (BMD) for women aged 70 to 90 years who present to their GP for an unrelated purpose, and subsequent
More informationAvailable online at ScienceDirect. Osteoporosis and Sarcopenia 1 (2015) 109e114. Original article
HOSTED BY Available online at www.sciencedirect.com ScienceDirect Osteoporosis and Sarcopenia 1 (2015) 109e114 Original article Localized femoral BMD T-scores according to the fracture site of hip and
More informationWhat Is FRAX & How Can I Use It?
What Is FRAX & How Can I Use It? Jacqueline Osborne PT, DPT Board Certified Geriatric Clinical Specialist Certified Exercise Expert for the Aging Adult Brooks Rehabilitation; Jacksonville, FL Florida Physical
More informationThe NOF & NBHA Quality Improvement Registry
In collaboration with CECity The NOF & NBHA Quality Improvement Registry This registry is approved by CMS as a Qualified Clinical Data Registry (QCDR) for Eligible Professionals and GPRO Practices for
More informationA FRAX Experience in Korea: Fracture Risk Probabilities with a Country-specific Versus a Surrogate Model
J Bone Metab 15;:113-11 http://dx.doi.org/.15/jbm.15..3.113 pissn 7-375 eissn 7-79 Original Article A FRAX Experience in Korea: Fracture Risk Probabilities with a Country-specific Versus a Surrogate Model
More informationMild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures
DOI 10.1007/s00198-013-2460-0 ORIGINAL ARTICLE Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures H. Johansson & A. Odén & E. V. McCloskey & J. A. Kanis Received:
More informationClinical risk factor assessment had better discriminative ability than bone mineral density in identifying subjects with vertebral fracture
Osteoporos Int (2011) 22:667 674 DOI 10.1007/s00198-010-1260-z ORIGINAL ARTICLE Clinical risk factor assessment had better discriminative ability than bone mineral density in identifying subjects with
More informationThe Result of the treatment in osteoporotic ankle fractures with small fragment using claw plate in elderly
The Result of the treatment in osteoporotic ankle fractures with small fragment using claw plate in elderly Jun-Beom Kim M.D, Byeong-Seop Park M.D, Chi-Hun, Ahn M.D Foot and Ankle Clinics, Department of
More informationVERTEBRAL FRACTURES ARE THE
ORIGINAL CONTRIBUTION Long-term Risk of Incident Vertebral Fractures Jane A. Cauley, DrPH Marc C. Hochberg, MD, MPH Li-Yung Lui, MA, MS Lisa Palermo, MS Kristine E. Ensrud, MD, MPH Teresa A. Hillier, MD,
More informationComparison of Bone Density of Distal Radius With Hip and Spine Using DXA
ORIGINAL ARTICLE Comparison of Bone Density of Distal Radius With Hip and Spine Using DXA Leila Amiri 1, Azita Kheiltash 2, Shafieh Movassaghi 1, Maryam Moghaddassi 1, and Leila Seddigh 2 1 Rheumatology
More informationIdentification of patient with high risk of fracture
12 Rev Osteoporos Metab Miner 2010;2 (Supl 3): S12-S21 Jódar Gimeno E Servicio de Endocrinología y Nutrición Clínica - Hospital Quirón Madrid Identification of patient with high risk of fracture Correspondence:
More informationChallenging the Current Osteoporosis Guidelines. Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA
Challenging the Current Osteoporosis Guidelines Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at UCLA Whom to screen Which test How to diagnose Whom to treat Benefits
More informationRadhika Patil¹, Kirsti Uusi-Rasi 1,2, Kari Tokola¹, Pekka Kannus 1,3,4, Saija Karinkanta 1, Harri Sievänen 1 IFA
Effects of a multi-component exercise program on physical function and falls among older women: a two-year community-based, randomized controlled trial Radhika Patil¹, Kirsti Uusi-Rasi 1,2, Kari Tokola¹,
More informationSkeletal Manifestations
Skeletal Manifestations of Metabolic Bone Disease Mishaela R. Rubin, MD February 21, 2008 The Three Ages of Women Gustav Klimt 1905 1 Lecture Outline Osteoporosis epidemiology diagnosis secondary causes
More informationACUTE PARALYTIC POLIOMYELITIS is primarily a
1030 ORIGINAL ARTICLE Osteoporosis in a Postpolio Clinic Population Muriel Haziza, MD, Richard Kremer, MD, Andrea Benedetti, PhD, Daria A. Trojan, MD ABSTRACT. Haziza M, Kremer R, Benedetti A, Trojan DA.
More informationBEST PRACTICE FRAMEWORK QUESTIONNAIRE
CAPTURE the FRACTURE BEST PRACTICE FRAMEWORK QUESTIONNAIRE INTRODUCTION Capture the Fracture invites Fracture Liaison Services (FLS) to apply for Capture the Fracture Best Practice Recognition programme.
More informationSCHEDULE 2 THE SERVICES. A. Service Specifications
SCHEDULE 2 THE SERVICES A. Service Specifications Service Specification No. 04/MSKT/0013 Service PAN DORSET FRACTURE LIAISON SERVICE Commissioner Lead CCP for Musculoskeletal & Trauma Provider Lead Deputy
More informationAnalysis of Clinical Features of Hip Fracture Patients with or without Prior Osteoporotic Spinal Compression Fractures
J Bone Metab 2013;20:11-15 http://dx.doi.org/10.11005/jbm.2013.20.1.11 pissn 2287-6375 eissn 2287-7029 Original Article Analysis of Clinical Features of Hip Fracture Patients with or without Prior Osteoporotic
More informationNGUYEN THI NGOC LAN- TAO THI MINH THUY
ASSESSING THE RISK FACTORS FOR OSTEOPOROSIS AND PREDICTING FRACTURE RISK FOLLOWING FRAX MODEL IN WOMEN AGED FROM 50 YEARS AND ABOVE IN THE NORTHERN PART OF VIETNAM NGUYEN THI NGOC LAN- TAO THI MINH THUY
More informationAppendix G How to start and expand Fracture Liaison Services
1 Appendix G How to start and expand Fracture Liaison Services The International Osteoporosis Foundation (IOF) Capture the Fracture Campaign has recognized that development of Fracture Liaison Services
More informationHow to start and expand Fracture Liaison Services
How to start and expand Fracture Liaison Services The International Osteoporosis Foundation (IOF) Capture the Fracture Campaign has recognized that development of Fracture Liaison Services (FLS) may occur
More informationPostmenopausal osteoporosis is a systemic
OSTEOPOROSIS: HARD FACTS ABOUT BONES Steven T. Harris, MD, FACP* ABSTRACT As a consequence of the aging process, osteoporosis affects all men and women. Agerelated loss of bone mass leads to skeletal fragility
More informationThe health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden Willis M S
The health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden Willis M S Record Status This is a critical abstract of an economic evaluation that meets the criteria
More informationLongitudinal Changes in Forearm Bone Mineral Density in Women and Men Aged Years: The Tromsø Study, a Population-based Study
American Journal of Epidemiology Copyright ª 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A. Vol. 163, No. 5 DOI: 10.1093/aje/kwj055 Advance Access publication
More informationHealthy Ageing. 12 years of results from the Australian Longitudinal Study on Women s Health (ALSWH) Professor Julie Byles
Healthy Ageing 12 years of results from the Australian Longitudinal Study on Women s Health (ALSWH) Professor Julie Byles SCHOOL OF POPULATION HEALTH THE UNIVERSITY OF QUEENSLAND Life in your years, not
More informationThe Significance of Vertebral Fractures
Special Report The Significance of Vertebral Fractures Both the prevalence and the clinical significance of vertebral fractures has been greatly underestimated by physicians. Vertebral fractures are much
More informationThis is a repository copy of Microarchitecture of bone predicts fractures in older women.
This is a repository copy of Microarchitecture of bone predicts fractures in older women. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/130351/ Version: Accepted Version
More informationKYPHON Balloon Kyphoplasty
KYPHON Results from a randomized controlled study comparing KYPHON to nonsurgical care for treatment of vertebral compression fractures Relief. Mobility. Quality of Life. What is? KYPHON is a minimally
More informationFRAX and the assessment of fracture probability in men and women from the UK
Osteoporos Int (28) 19:385 397 DOI 1.17/s198-7-543-5 SPECIAL POSITION PAPER FRAX and the assessment of fracture probability in men and women from the UK J. A. Kanis & O. Johnell & A. Oden & H. Johansson
More informationCommunity Collaboration Towards Bone Health
Community Collaboration Towards Bone Health Wong Hsiao Wah (Christina) Registered Nurse (O&T), Prince of Wales Hospital,Hong Kong Literature Review Osteoporosis: attract less attention (lower mortality
More informationDiscovering prior fractures in your postmenopausal patient may be the LINK to reducing her fragility fracture* risk in the future.
Discovering prior fractures in your postmenopausal patient may be the LINK to reducing her fragility fracture* risk in the future. *A fragility fracture is defined as a fracture caused by minimal trauma,
More informationFall risk among urban community older persons
Fall risk among urban community older persons Mary Joan Therese Valera University of the Philippines Manila College of Nursing. Corresponding author: maryjoantheresevalera@yahoo.com Abstract. The elderly
More informationDual-energy Vertebral Assessment
Dual-energy Vertebral Assessment gehealthcare.com Dual-energy Vertebral Assessment More than 40% of women with normal or osteopenic BMD had a moderate or severe vertebral deformation seen with DVA. Patrick
More informationFactors associated with diagnosis and treatment of osteoporosis in older adults
Osteoporos Int (2009) 20:1963 1967 DOI 10.1007/s00198-008-0831-8 SHORT COMMUNICATION Factors associated with diagnosis and treatment of osteoporosis in older adults S. Nayak & M. S. Roberts & S. L. Greenspan
More informationEfficacy of risedronate in men with primary and secondary osteoporosis: results of a 1-year study
Rheumatol Int (2006) 26: 427 431 DOI 10.1007/s00296-005-0004-4 ORIGINAL ARTICLE J. D. Ringe Æ H. Faber Æ P. Farahmand Æ A. Dorst Efficacy of risedronate in men with primary and secondary osteoporosis:
More informationOsteoporosis is estimated to develop in 1 out of 4 women over the age of 50. Influence of bone densitometry results on the treatment of osteoporosis
Influence of bone densitometry results on the treatment of osteoporosis Nicole S. Fitt, * Susan L. Mitchell, * Ann Cranney, Karen Gulenchyn, Max Huang, * Peter Tugwell Abstract Background: Measurement
More informationESTIMATION OF RISK IN THE FIELD OF OSTEOPOROSIS
ESTIMATION OF RISK IN THE FIELD OF OSTEOPOROSIS Helena Johansson UNIVERSITY OF GOTHENBURG Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2011 1 2 ESTIMATION
More informationManaging falls in the elderly: real world approach DR PRISCILLA NG
Managing falls in the elderly: real world approach DR PRISCILLA NG A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. FALL:
More informationAPPROXIMATELY 1.5 MILLION
ORIGINAL CONTRIBUTION High-Trauma s and Low Bone Mineral Density in Older Women and Men Dawn C. Mackey, MSc Li-Yung Lui, MA, MS Peggy M. Cawthon, PhD Douglas C. Bauer, MD Michael C. Nevitt, PhD Jane A.
More informationFracture Risk Prediction Using BMD and Clinical Risk Factors in Early Postmenopausal Women: Sensitivity of the WHO FRAX Tool
ORIGINAL ARTICLE JBMR Fracture Risk Prediction Using BMD and Clinical Risk Factors in Early Postmenopausal Women: Sensitivity of the WHO FRAX Tool Florence A Trémollieres, 1,2,3 Jean-Michel Pouillès, 1
More informationBone Density Measurement in Women
Bone Density Measurement in Women Revised 2005 Scope This guideline defines the medical necessity of bone mineral density (BMD) measurement using dualenergy x-ray absorptiometry (DXA or DEXA), and applies
More informationRisk factors associated with low bone mineral density in Ajman, UAE
Risk factors associated with low bone mineral density in Ajman, UAE Tarek Fawsy 1, Jayadevan Sreedharan 2*, Jayakumary Muttappallymyalil 2, Salma Obaid Saeed Alshamsi 2, Mariyam Saif Salim Humaid Bin Bader
More informationScreening for Osteoporosis in Men Aged 70 Years and Older in a Primary Care Setting in the United States
478826JMHXXX10.1177/1557988313478826 American Journal of Men s HealthLim et al. Article Screening for Osteoporosis in Men Aged 70 Years and Older in a Primary Care Setting in the United States American
More informationRisedronate prevents hip fractures, but who should get therapy?
INTERPRETING KEY TRIALS CHAD L. DEAL, MD Head, Center for Osteoporosis and Metabolic Bone Disease, Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic THE HIP TRIAL Risedronate prevents
More informationATTENTION-DEFICIT/HYPERACTIVITY DISORDER, PHYSICAL HEALTH, AND LIFESTYLE IN OLDER ADULTS
CHAPTER 5 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, PHYSICAL HEALTH, AND LIFESTYLE IN OLDER ADULTS J. AM. GERIATR. SOC. 2013;61(6):882 887 DOI: 10.1111/JGS.12261 61 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER,
More informationIncidence and Mortality after Proximal Humerus Fractures Over 50 Years of Age in South Korea: National Claim Data from 2008 to 2012
J Bone Metab 2015;22:17-21 http://dx.doi.org/10.11005/jbm.2015.22.1.17 pissn 2287-6375 eissn 2287-7029 Original Article Incidence and Mortality after Proximal Humerus Fractures Over 50 s of Age in South
More informationImportant risk factors and attributable risk of vertebral fractures in the population-based Tromsø study
Waterloo et al. BMC Musculoskeletal Disorders 2012, 13:163 RESEARCH ARTICLE Important risk factors and attributable risk of vertebral fractures in the population-based Tromsø study Open Access Svanhild
More informationMale osteoporosis: clinical approach and management in family practice
Singapore Med J 2014; 55(7): 353-357 doi: 10.11622/smedj.2014085 CMEArticle Male osteoporosis: clinical approach and management in family practice Lay Hoon Goh 1,2, MMed, FCFP, Choon How How 1, MMed, FCFP,
More informationThe Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page
The Egyptian Journal of Hospital Medicine (January 2018) Vol. 70 (5), Page 850-854 Awareness of Osteoporosis among Saudi Population in Saudi Arabia Especially Taif governorate Abdulaziz Saleh Alharthi
More informationChapter 39: Exercise prescription in those with osteoporosis
Chapter 39: Exercise prescription in those with osteoporosis American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York:
More informationGeriatr Gerontol Int 2016; 16: ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
bs_bs_banner Geriatr Gerontol Int 2016; 16: 1324 1331 ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH Lower body function as a predictor of mortality over 13 years of follow up: Findings from
More informationA Study of Risk Factors: Comparison between Osteoporosis and Osteopenia in the District of Patiala
Journal of Exercise Science and Physiotherapy, Vol. 6, No. 1: 5-56, 21 A Study of Risk Factors: Comparison between and in the District of Patiala Multani 1, N.K. and Chahal 2, A. 1 Prof. Department of
More information