ABSTRACT: SummaryIncident hip fractures and non-hip osteoporotic fractures were studied in 30,953 women during mean 3.7years 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.
IntroductionIt is uncertain whether bone geometric measures improve fracture prediction independent of conventional areal bone mineral
MethodsWomen aged ≥50years 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 3.7years of observation.
ResultsHAL 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).
ConclusionsHAL and SI made a small but statistically significant contribution to hip fracture prediction that was independent of age
and BMD measurement.
Osteoporosis International 04/2012; 20(10):1767-1774. · 4.58 Impact Factor
ABSTRACT: Weight and body mass index are associated with low bone mineral density and fractures in older women. This retrospective cohort study confirms a similar relationship in women aged 40 to 59 years.
Risk factors for the prediction of osteoporosis and fractures have been less thoroughly studied in younger women. We evaluated the associations between weight, body mass index (BMI), the Osteoporosis Self-Assessment Tool (OST), bone mineral density (BMD) and fracture risk in women aged 40 to 59 years.
Using administrative health management databases, we conducted a retrospective cohort study in 8,254 women aged 40-59 years who had baseline BMD testing. Linear regression and Cox proportional multivariate models were created to examine the associations with weight, BMI, OST, BMD, and subsequent fractures throughout a 3.3-year follow-up.
Body weight, BMI, and OST had a similar overall performance in their ability to classify women with femoral neck T-score < or = -2.5. Throughout 27,256 person years of observation, 225 women experienced one or more fractures. After adjustment for age, prevalent fractures, and use of corticosteroids, each standard deviation decrease in weight was associated with a 19% increase in the risk of incident fracture (95% CI: 1.01-1.35). Femoral neck BMD and the presence of prevalent fractures were also associated with the risk of incident fractures.
Low weight and BMI predict osteoporosis and are associated with increased fracture risk in younger women. The negative impact of low body weight on bone health should be more widely recognized.
Osteoporosis International 03/2009; 20(3):363-70. · 4.58 Impact Factor
ABSTRACT: The aim of this study is to report on the first year experience with infliximab for Crohn's disease.
All Crohn's patients receiving infliximab at our institution in the first year of release were prospectively registered. Disease activity was scored at initial infusion, and at 1, 3, 7, and 12 wk. Results were tabulated separately for patients with luminal (L) or fistulous (F) Crohn's disease. Steroid withdrawal and adverse events were tabulated.
One hundred twenty-nine patients were treated (81 L, 48 F). Mean number of infusions/patient were 2.38 L, 3.23 F. Median time to response and remission was 8 and 9 days L; 9 and 10 days F, respectively. Initial infusion course response and remission rates at 3 wk were 65% and 31% L; 78% and 24% F, respectively. Rates were higher if concurrently treated with 6-mercaptopurine or azathioprine and improved with subsequent infusions. Relapse occurred in 78% at a mean 8.5 wk L and in 71% at a mean of 12.2 wk F. Steroid tapering was seen in >90%, with 54% completely off steroids after a second infusion. Infusion-related reactions were seen in up to 24% of patients. The incidence of side effects did not differ if on concurrent immunomodulatory therapy.
Clinical experience with infliximab closely parallels the results of the controlled clinical trials, and includes steroid-sparing effects.
The American Journal of Gastroenterology 12/2000; 95(12):3469-77. · 7.28 Impact Factor