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ABSTRACT: We identified hospitalizations throughout Canada during 2000-2005 in which the most responsible diagnosis was a proximal femoral fracture. Use of the US fracture risk assessment tool (FRAX) would be inappropriate for Canada as it would overestimate fracture risk in Canadian women and older men.
It is recommended that the WHO fracture risk assessment tool should be calibrated to the target population.
We identified hospitalizations for women and men throughout Canada during the study period 2000-2005 in which the most responsible diagnosis was a proximal femoral fracture (147,982 hip fractures). Age-standardized hip fracture rates were compared between Canadian provinces, and national rates were compared with those reported for the USA and Germany.
There were relatively small differences in hip fracture rates between provinces, and most did not differ appreciably from the Canadian average. Hip fracture rates for women in Canada in 2001 were substantially lower than in the USA (population-weighted rate ratio 0.70) and were also lower than in Germany for 2004 (population-weighted rate ratio 0.74).
Overall hip fracture rates for Canadian women were found to be substantially lower than those for the USA and Germany. This study underscores the importance of assessing country-specific fracture patterns prior to adopting an existing FRAX tool.
Osteoporosis International 10/2009; 21(8):1317-22. · 4.58 Impact Factor
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ABSTRACT: SAUMMARY: Using a Markov state-transition model, we estimated fractures averted with risedronate using two different types of clinical efficacy data. Summary data, as opposed to individual patient data (IPD), underestimated the number of fractures averted when applied in a specified high risk population. The choice of clinical efficacy data is an important consideration in health economic models evaluating osteoporosis therapies.
This paper contrasts fracture reduction estimates for risedronate utilizing efficacy data from two approaches to meta-analysis: summary data versus individual patient data. We also examined differences in fracture reduction explained by varied cohort selection, especially the inclusion of low- versus high-risk populations.
Using a Markov state-transition model, we compared fractures averted over 3 years in a hypothetical cohort by inputting fracture risk reduction estimates (risedronate versus placebo) from two data sources (summary data versus IPD). The cohort consisted of 100,000 Canadian women, age > or =65 years with osteoporosis (WHO criteria T-score < or = -2.5) and prevalent morphometric vertebral fracture.
Non-vertebral fractures averted with risedronate were: 3,571 and 6,584 per 100,000 women for summary data and IPD, respectively. For vertebral fractures, the numbers were 8,552 and 10,127. When IPD versus summary data was used, an additional 3,013 more non-vertebral fractures and 1,575 vertebral fractures were averted.
Relative risk estimates from IPD analyses were the best choice for modelling fracture outcomes when applied in a specified high-risk population. In addition to superior statistical methodology, they utilized RCT cohorts that are more representative of higher risk patients requiring treatment (osteoporotic women > or =65 years with a prevalent vertebral fracture).
Osteoporosis International 03/2009; 20(10):1785-93. · 4.58 Impact Factor
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ABSTRACT: Incident hip fractures and non-hip osteoporotic fractures were studied in 30,953 women during mean 3.7 years of observation. Hip axis length (HAL) and strength index (SI) made a small but statistically significant contribution to hip fracture prediction that was independent of age and hip bone density.
It is uncertain whether bone geometric measures improve fracture prediction independent of conventional areal bone mineral density (BMD).
Women aged > or =50 years with hip dual-energy x-ray absorptiometry were identified from the regionally based database in the Province of Manitoba, Canada. Scans were reprocessed to derive parameters of hip bone geometry. Incident hip fractures (N = 270) and non-hip osteoporotic fractures (N = 1,347) were identified during mean 3.7 years of observation.
HAL was greater in both hip and non-hip fracture cases than in non-fracture cases, whereas cross-sectional moment of inertia, cross-sectional area, and femoral SI were all significantly less. After adjustment for total hip BMD, HAL [hazard ratio (HR) 1.22 per SD increase, 95% CI 1.07-1.38] and SI (HR 1.21 per SD decrease, 95% CI 1.07-1.37) were independent predictors of hip fractures but not of non-hip fractures. When both HAL and SI were added to a model containing age and total hip BMD, there was a small improvement in hip fracture prediction (ROC area under the curve 0.832 +/- 0.013 vs 0.823 +/- 0.013; P = 0.001).
HAL and SI made a small but statistically significant contribution to hip fracture prediction that was independent of age and BMD measurement.
Osteoporosis International 03/2009; 20(10):1767-74. · 4.58 Impact Factor
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ABSTRACT: High BMD is an infrequent finding. In this retrospective cohort study of women 50 years and older, we documented a strong association between high BMD and high BMI.
High bone mineral density (BMD) has been associated with genetic disorders and a variety of dietary, endocrine, metabolic, infectious and neoplastic diseases that in many cases warrant medical attention. Since body mass index (BMI) is closely correlated with BMD, we sought to explore the relationship between these two parameters in older women.
We conducted a retrospective clinical cohort study of 16,500 women 50 years and older who underwent baseline BMD testing between May 1998 and October 2002. Mean T-scores and Z-scores, and the proportions of women with high BMD (T-score +2.5 or greater, Z-score +2.0 or greater), were assessed according to BMI category.
Higher BMI category was associated with higher mean T-scores and Z-scores at all sites (P < 0.001). The proportion of women with high BMD increased with each BMI category (P for trend <0.05). In women with a lumbar spine T-score of +2.5 or more, 43.5% were obese with BMI > 30 kg/m(2) (55.6% for the femoral neck and 73.1% for the total hip). For women with a lumbar spine Z-score of +2.0 or more, 37.2% were obese (42.0% for the femoral neck and 50.9% for the total hip). There was no evidence of a paradoxical increase in fracture rates in women with high BMD.
High BMD is closely associated with elevated BMI in women. This should be taken into consideration prior to initiating extensive investigations for rare pathologies.
Osteoporosis International 12/2008; 20(7):1267-71. · 4.58 Impact Factor
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ABSTRACT: Osteoporosis treatment initiation was assessed during the year after baseline BMD testing in 8,689 previously untreated women. Treatment initiation increased progressively as BMD T-scores decreased, but there was a gradient response rather than step increases at conventional T-score intervention thresholds.
Bone mineral density (BMD) testing is used to identify those at high fracture risk and guide osteoporosis treatment (OTx) initiation. Clinical guidelines have used the World Health Organization T-score diagnostic cutoffs as thresholds for treatment intervention. Our objective was to assess whether OTx initiation tracks these T-score cutoffs.
Eight thousand six hundred and eighty-nine women age > or = 50 years who had not been dispensed any OTx medication in the year prior to baseline BMD were identified from a regionally based database in the Province of Manitoba, Canada, and OTx initiation rates were analyzed.
Forty-four percent of women were dispensed OTx in the year after BMD. OTx initiation increased progressively as BMD T-scores decreased (8.2% normal, 41.0% osteopenic, 78.5% osteoporotic, p-for-trend < 0.0001). There was a gradient response to OTx initiation, rather than step increases at conventional T-score intervention thresholds. BMD was strongly associated with OTx (p < 0.0001) while age, weight, and fracture in the last year were not.
Physicians rely heavily on BMD T-score to decide on OTx initiation. Although guidelines suggest using clinical risk factors to guide decision making, we did not see evidence of this. More explicit methods of reporting fracture risk may help physicians select patients who are likely to derive the largest benefit from OTx.
Osteoporosis International 12/2008; 20(9):1621-5. · 4.58 Impact Factor
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A Papaioannou,
C C Kennedy,
A Cranney,
G Hawker,
J P Brown,
S M Kaiser, W D Leslie,
C J M O'Brien,
A M Sawka,
A Khan,
K Siminoski,
G Tarulli,
D Webster,
J McGowan,
J D Adachi
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ABSTRACT: In this systematic review, we summarize risk factors for low bone mineral density and bone loss in healthy men age 50 years or older. Consistent risk factors were: age, smoking, low weight, physical/functional limitations, and previous fracture. Data specific to men has clinical and policy implications.
Osteoporosis is a significant health care problem in men as well as women, yet the majority of evidence on diagnosis and management of osteoporosis is focused on postmenopausal women. The objective of this systematic review is to examine risk factors for low bone mineral density (BMD) and bone loss in healthy men age 50 years or older.
A systematic search for observational studies was conducted in MEDLINE, Cochrane Database of Systematic Reviews, DARE, CENTRAL, CINAHL and Embase, Health STAR. The three main search concepts were bone density, densitometry, and risk factors. Trained reviewers assessed articles using a priori criteria.
Of 642 screened abstracts, 299 articles required a full review, and 25 remained in the final assessment. Consistent risk factors for low BMD/bone loss were: advancing age, smoking, and low weight/weight loss. Although less evidence was available, physical/functional limitations and prevalent fracture (after age 50) were also associated with low BMD/bone loss. The evidence was inconsistent or weak for physical activity, alcohol consumption, calcium intake, muscle strength, family history of fracture/osteoporosis, and height/height loss.
In this systematic review, we identified several risk factors for low BMD/bone loss in men that are measurable in primary practice.
Osteoporosis International 09/2008; 20(4):507-18. · 4.58 Impact Factor
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ABSTRACT: Patients with severe chronic obstructive pulmonary disease (COPD) commonly develop weight loss, muscle wasting, and consequently poor survival. Nutritional supplementation and anabolic steroids increase lean body mass, improve muscle strength, and survival in patients enrolled in comprehensive rehabilitation programs. Whether anabolic steroids are effective outside an intensive rehabilitation program is not known. We conducted a prospective, double-blind, placebo-controlled, 16-week trial to study the benefits of anabolic steroids in patients with severe COPD who did not participate in a structured rehabilitation program. Biweekly intramuscular injections of either the drug (nandrolone decanoate) or placebo were administered. Sixteen patients with severe COPD were randomized to either placebo or nandrolone decanoate. The placebo group weighed 55.32 +/- 11.33 kg at baseline and 54.15 +/- 10.80 kg at 16 weeks; the treatment group weighed 68.80 +/- 6.58 at baseline and 67.92 +/- 6.73 at 16 weeks. Lean body mass remained unchanged, 71 +/- 6 vs. 71 +/- 7 kg in placebo group and 67 +/- 7 vs. 67 +/- 7 in treatment group, at baseline and 16 weeks respectively. The distance walked on 6 min was unchanged at baseline, 8 weeks, and 16 weeks in placebo (291.17 +/- 134.83, 282.42 +/- 115.39, 286.00 +/- 82.63 m) and treatment groups (336.13 +/- 127.59, 364.83 +/- 146.99, 327.00 +/- 173.73 m). No improvement occurred in forced expiratory volume in one second, forced vital capacity, maximal inspiratory pressure, maximal expiratory pressure, VO(2) max or 6-min walk distance or health related quality of life. Administration of anabolic steroids (nandrolone decanoate) outside a dedicated rehabilitation program did not lead to either weight gain, improvement in physiological function, or better quality of life in patients with severe COPD.
Chronic Respiratory Disease 02/2008; 5(3):169-76.
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A A Khan,
J Brown,
K Faulkner,
D Kendler,
B Lentle, W Leslie,
P D Miller,
L Nicholson,
W P Olszynski,
N B Watts,
D Hanley,
A Hodsman,
R Josse,
T M Murray,
K Yuen
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ABSTRACT: The International Society for Clinical Densitometry (ISCD) is a multidisciplinary nonprofit global organization formed to ensure excellence in densitometry imaging, interpretation, and application. The Canadian panel of the ISCD represents ISCD in Canada and oversees Canadian bone densitometry certification programs. The standards of care from the Canadian panel of the ISCD have been developed in order to establish the minimum level of acceptable performance for the practice of bone densitometry in Canada. A variety of techniques are available for skeletal assessment of bone mineral density, which vary in accuracy, precision, and clinical utility as well as availability. This article focuses on central dual X-ray absorptiometry in adults and does not address densitometry in the pediatric population. Other technologies will be addressed in a subsequent article.
Journal of Clinical Densitometry 02/2002; 5(3):247-57. · 1.29 Impact Factor
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ABSTRACT: The International Society for Clinical Densitometry (ISCD) is a multidisciplinary nonprofit global organization formed to ensure excellence in densitometry imaging, interpretation, and application. The Canadian panel of the ISCD represents ISCD in Canada and oversees Canadian bone densitometry certification programs. The standards of care from the Canadian panel of the ISCD have been developed in order to establish the minimum level of acceptable performance for the practice of bone densitometry in Canada. A variety of techniques are available for skeletal assessment of bone mineral density, which vary in accuracy, precision, and clinical utility as well as availability. This article focuses on central dual X-ray absorptiometry in adults and does not address densitometry in the pediatric population. Other technologies will be addressed in a subsequent article.
Journal of Clinical Densitometry 02/2002; 5(4):435-45. · 1.29 Impact Factor
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ABSTRACT: The clinical significance of the high prevalence of osteopenia in inflammatory bowel disease is unclear.
To determine whether persons with inflammatory bowel disease have increased incidence of fracture.
Population-based matched cohort study.
Manitoba, Canada.
Patients with inflammatory bowel disease in the University of Manitoba IBD Database (n = 6027) were matched to 10 randomly selected persons in the general population without inflammatory bowel disease (n = 60 270) by year, age, sex, and postal area of residence.
The incidence of hospitalization for hip fracture was determined on the basis of hospital discharge abstracts. Outpatient medical billing records and hospital discharge abstracts were used to calculate the incidence of spine, rib, and forearm fractures. Rates were calculated on the basis of person-years of follow-up for 1984 to 1997.
Persons with inflammatory bowel disease had significantly increased incidence of fractures at the spine (incidence rate ratio [IRR], 1.74 [95% CI, 1.34 to 2.24]; P < 0.001), hip (IRR, 1.59 [CI, 1.27 to 2.00]; P < 0.001), wrist/forearm (IRR, 1.33 [CI, 1.11 to 1.58]; P = 0.001), and rib (IRR, 1.25 [CI, 1.02 to 1.52]; P = 0.03) and of any of these fractures (IRR, 1.41 [CI, 1.27 to 1.56]; P < 0.001).
The incidence of fracture among persons with inflammatory bowel disease is 40% greater than that in the general population.
Annals of internal medicine 11/2000; 133(10):795-9. · 16.73 Impact Factor
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ABSTRACT: To compare the effects of a 6-month treatment with intravenous pamidronate (30-mg infusion once per month) to conventional rehabilitation without pamidronate on bone density of the spine and leg bones and on the excretion rate of N-telopeptide, a urinary marker of bone catabolism, in acutely spinal cord injured patients.
A nonrandomized control trial in which 24 spinal cord injured subjects entered the study within 6 weeks of their injury. Fourteen subjects received pamidronate; 10 did not.
Bone density measurements by dual x-ray absorptiometry were performed before the initial treatment (within 6 weeks of the injury) and at 3, 6, and 12 months postinjury and was the primary efficacy parameter. Urine for N-telopeptide levels was the secondary efficacy parameter.
After acute spinal cord injury, patients treated with intravenous pamidronate had significantly less bone density loss compared with those who did not receive pamidronate (parametric ANOVA, p<.02). Also, ambulatory subjects had significantly less bone density loss over the study period (p<.05) than nonambulatory subjects. In general, a high excretion level of the urinary bone-breakdown product N-telopeptide was found before intravenous pamidronate treatment, followed by a dramatic reduction in excretion after pamidronate treatment. Ambulatory subjects excreted significantly less N-telopeptide than motor-complete subjects at all time points.
Intravenous pamidronate treatment and ambulatory ability in the first 6 months after an acute spinal cord injury prevents bone density loss.
Archives of Physical Medicine and Rehabilitation 03/1999; 80(3):243-51. · 2.28 Impact Factor
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ABSTRACT: We present an unusual case of a 41-year-old woman with a known glomus tumor, an adrenal mass, hypertension, and elevated catecholamines. The glomus tumor was shown to be the site of excessive catecholamine production in what we believe to be one of the few descriptions of 123I-metaiodobenzylguanidine (MIBG) scanning for this uncommon tumor. The diagnostic difficulties of such a case are discussed. A literature review of catecholamine-secreting glomus tumors and a systematic approach to catecholamine-secreting tumor localization in such patients is presented. Therapeutic options of surgery, radiation therapy, and embolization are reviewed. We conclude that the management of patients with functioning glomus tumors needs to be individualized. A careful, systematic approach is required if needless surgery is to be avoided. Further, the use of 123I-MIBG scanning deserves consideration to help localize catecholamine production in such patients.
American Journal of Hypertension 02/1998; 11(2):258-62. · 3.18 Impact Factor
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ABSTRACT: Calciphylaxis is a rare disease associated with hemodialysis or transplantation, high parathyroid hormone values, and increased serum calcium x phosphate (Ca x P) product. Only four patients on continuous ambulatory peritoneal dialysis have been reported with this condition. We report five cases presenting within a 2-year period with severe calf pain and tenderness with extensive nonulcerating large, hard, and tender subcutaneous plaques in the calves. Calcium deposition was confirmed radiologically and by bone scanning. Four patients were on continuous ambulatory peritoneal dialysis, and the other was not yet on dialysis. High serum Ca x P product was found in three of these patients at onset of the condition. Two patients had normal parathyroid hormone levels at onset. Calcium salts and/or calcitriol had been taken prior to onset in three patients. When presenting in this fashion, the diagnosis can be easily made by the uniqueness of the physical findings in the legs. Our observation suggests that the condition should no longer be considered rare and is not confined to hemodialysis patients. Furthermore, it can occur in predialysis patients.
American Journal of Kidney Diseases 04/1995; 25(3):498-502. · 5.43 Impact Factor
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ABSTRACT: A 68-year-old man known to have the lupus anticoagulant presented with adrenal failure several weeks after undergoing a surgical procedure. Computerized tomography initially showed bilateral enlargement of the adrenal glands, but subsequently demonstrated adrenal atrophy and calcification. It is suggested that thrombosis of the adrenal vessels due to the presence of the lupus anticoagulant may have occurred. In unexplained primary hypoadrenalism with enlargement of the adrenal glands, the presence of the lupus anticoagulant should be excluded.
The Journal of Rheumatology 11/1990; 17(10):1405-7. · 3.69 Impact Factor
