C Cooper

University of Oxford, Oxford, England, United Kingdom

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Publications (660)3108.34 Total impact

  • Osteoporosis International 09/2015; DOI:10.1007/s00198-015-3288-6 · 4.17 Impact Factor
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    ABSTRACT: Background Previous studies have shown a relationship between increased number of lifestyle risk factors and adverse health outcomes such as mortality and low physical function. We hypothesised that the number of lifestyle risk factors (out of low physical activity, poor diet, obesity and smoking) may be associated with subsequent hospital admission among community-dwelling older people. Methods From 1998–2004, 2997 community-dwelling men and women (aged 59–73) who participated in the Hertfordshire Cohort Study (HCS) completed a baseline assessment. Physical activity was assessed using a questionnaire with a score ranging from 0–100; diet was assessed using a food frequency questionnaire and a prudent diet score, to indicate compliance with a healthy dietary pattern, was derived using principal component analysis. Smokers were regarded as individuals who were current smokers; obesity was defined as a BMI of 30.0 kg/m2 or more; poor diet was defined as having a prudent diet score in the bottom quarter of the distribution and low physical activity was defined as having a physical activity score of 50 or less. Hospital Episode Statistics and mortality data up to 31/03/10 were linked with the HCS database. Survival analysis models and Poisson regression models were used to examine the association between the number of risk factors and the risk of the following types of hospital admission: any, elective, emergency, long stay (>7 days) and readmission within 30 days. Results There was a graded increase in the risk of all types of admission among men and women as the number of risk factors increased. For example, the unadjusted hazard ratios for emergency admission among men were: one risk factor vs none 1.11[95% CI: 0.96,1.29], two vs none 1.25[95% CI: 1.04,1.49], three or four vs none 1.74[95% CI: 1.40,2.15]; and among women were: one vs none 1.15[95% CI: 0.96,1.38], two vs none 1.44[95% CI: 1.17,1.76], three or four vs none 1.96[95% CI: 1.36,2.81]. Associations for all types of admission remained significant after adjustment for age and number of systems medicated. Although, as in many cohort studies, a healthy participant effect is apparent in HCS, this is unlikely to have affected these results since this analysis was internal. Conclusion This study provides the first evidence that the number of lifestyle risk factors among community-dwelling men and women is associated with risk of subsequent hospital admission. As lifestyle risk factors often coexist and are more prevalent among lower socioeconomic groups, encouraging healthy lifestyles may have the potential to avert admission and reduce inequalities in health.
    Journal of Epidemiology &amp Community Health 09/2015; 69(Suppl 1). DOI:10.1136/jech-2015-206256.126 · 3.50 Impact Factor
  • R. Dodds · H. Syddall · R. Cooper · D. Kuh · C. Cooper · A.A. Sayer
    European geriatric medicine 09/2015; 6:S6. DOI:10.1016/S1878-7649(15)30020-6 · 0.73 Impact Factor
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    ABSTRACT: Background Nausea and/or vomiting in pregnancy (NVP) is reported in the majority of pregnancies. Experiences of NVP vary greatly, but little is known about the consequences of NVP on pregnancy diet. Methods The Southampton Women’s Survey has measured the diet, body composition, physical activity and social circumstances of 12,583 non-pregnant women aged 20 to 34 years living in the city of Southampton, UK. Women who subsequently became pregnant were studied in early pregnancy (median gestation = 11.9 weeks). Before and in early pregnancy dietary intake over the preceding 3 months was assessed using a food frequency questionnaire. Experience of NVP in early pregnancy was graded as none, mild (nausea only), moderate (sometimes sick) or severe (regularly sick, can’t retain meals). Principal component analysis of the dietary data collected before pregnancy identified a ‘prudent’ (healthy) dietary pattern. Prudent diet scores were calculated for each woman in both early and late pregnancy describing their compliance with this pattern; paired scores were available for 2270 women. Results In early pregnancy 89% of women were nauseous, although most commonly the NVP experienced was mild (48%) or moderate (30%); 11% of women had severe NVP symptoms. Women experiencing more nausea were more likely to be from a lower social class, to be more obese, to be younger and to be multiparous. Increasing severity of NVP was non-significantly associated with a fall in energy intake (P = 0.09); after adjustment for confounders women with no nausea had an average energy intake that was 91 kcal/day higher in early pregnancy than before pregnancy, whereas for women with severe nausea, average energy intakes were 14 kcal/day less than before pregnancy. Increasing severity of NVP was associated with a fall in prudent diet score (P < 0.001); after adjustment for confounders women with no nausea had a prudent diet score on average 0.12 SD higher in pregnancy than before pregnancy, whereas those with severe nausea had a prudent diet score on average 0.19 SD lower in early pregnancy than before pregnancy. Conclusion Gestational diet is increasingly recognised as having important consequences for offspring health. The impact of nausea on energy intake is small. Of much greater concern is the potential detrimental effect of nausea on dietary quality as reflected by the prudent diet score. Pregnancy is a time when women face an increase in micronutrient needs and women with more severe nausea may be particularly at risk of poorer quality diets.
    Journal of Epidemiology &amp Community Health 09/2015; 69(Suppl 1). DOI:10.1136/jech-2015-206256.36 · 3.50 Impact Factor
  • D Kuh · R Cooper · J Adams · A Moore · K MacKinnon · S Muthuri · C Cooper · K Ward · R Hardy
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    ABSTRACT: Background While many comparisons of the bone health of pre- and post-menopausal women, and studies of the effect of hormone therapy (HT) use on bone, suggest that oestrogen status is a key determinant of the rate of bone loss in post-menopausal women, studies have shown only a limited effect of timing of menopause on bone health. The MRC National Survey of Health and Development (NSHD), a British cohort born in 1946, has the advantage of a large sample of the same age, pQCT as well as DXA-derived bone measurements, a full HT history, and follow-up into early old age. Methods Up to 866 women from the NSHD who repeatedly provided information about the menopausal transition from age 43 and had a bone scan at the 60–64 year clinic examination were included in analyses. DXA derived measurements were areal bone mineral density (aBMD) for lumbar spine and total hip. The pQCT scans at the distal 4% site provided measures of trabecular and total volumetric BMD (vBMD) and distal cross-sectional area (CSA), and at the 50% site provided CSA of the diaphysis and the medullary cavity (medullary CSA) and cortical vBMD; polar strength strain index (SSI) (mm3), an estimate of bone strength, was extracted. Regression models with outcomes transformed using natural logarithms were fitted so that the coefficients give the percentage difference for each bone parameter between women with natural or surgical menopause, or for a ten year difference in timing of natural menopause or hysterectomy. Models were adjusted for current height and weight, indicators of HT use, and other behavioural and socioeconomic factors. Results Women who had a later natural menopause had higher spine aBMD (8.9% difference, confidence intervals (CI)5.2%,12.6%), hip aBMD (6.4%, CI 0.3%,9.5%), trabecular vBMD, (9.4%, CI 0.3%,16.3%), and total vBMD (6.8%, CI 0.1%,12.2%) than women with an age of menopause ten years earlier, even after adjusting for potential confounders. In contrast, timing of hysterectomy had no clear association with bone health. Women who had a hysterectomy had greater hip and spine aBMD, total and trabecular vBMD, and polar SSI than women who had a natural menopause: however, these differences were mainly accounted for by body size and HT use. Conclusion These findings indicate that the association between the timing of natural menopause and bone mineral density persists into early old age.
    Journal of Epidemiology &amp Community Health 09/2015; 69(Suppl 1). DOI:10.1136/jech-2015-206256.122 · 3.50 Impact Factor
  • C Vogel · G Ntani · M Barker · H Inskip · S Cummins · C Cooper · G Moon · J Baird
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    ABSTRACT: Background Supermarkets are a major source of food for families. Food choices are influenced by in-store factors including the variety, price, placement and promotion of food products. Recent trends show families are shopping more at discount supermarkets. A greater understanding of the effect of the supermarket environment on dietary quality and socioeconomic disparities in dietary quality is needed. We examined the relationship between mothers’ dietary quality and the in-store environment of the supermarket where they did most of their food shopping, and assessed whether this relationship differed according to socioeconomic position. Methods A validated food frequency questionnaire (FFQ) was used to generate a standardised dietary quality score for 829 mothers with young children in Hampshire. An in-store survey of the 49 supermarkets in which they shopped assessed the availability, variety, price, quality, promotions, placement and nutrition information of seven healthy and five less healthy foods from the FFQ. These measures were combined to create a standardised ‘healthfulness’ score for each supermarket. The relationship between supermarket healthfulness and mothers’ dietary quality was assessed using linear regression. An interaction term for educational attainment was added to the regression model to determine socioeconomic differences in the relationship. Results Univariate analysis showed no relationship between dietary quality and the healthfulness of main supermarket (β = 0.19; 95% CI: –0.02, 0.40) for the full sample of mothers. However, the effect of main supermarket’ environment differed according to mothers’ level of educational attainment (interaction p = 0.004). Stratified analyses showed a strong positive relationship between dietary quality and supermarket healthfulness among mothers who left school at 16 years (β = 0.36; 95% CI: 0.10, 0.61) and an inverse association among mothers with degrees (β = –0.54; 95% CI: –1.08, –0.00). After adjustment for confounding factors associations were β = 0.34; 95% CI: 0.11, 0.58 and β = –0.59; 95% CI: –1.19, 0.02 respectively. These associations equate to disadvantaged mothers, who shopped at less healthful supermarkets, consuming crisps four times more and vegetable dishes four times less each week than more advantaged mothers shopping at similar stores. Conclusion These findings suggest that mothers of lower socioeconomic position were more susceptible to the effects of less healthful supermarkets than mothers of higher position. The market share of discount supermarkets is increasing, so improving the environment of less healthful supermarkets is important. Expanding policy initiatives, such as the UK Public Health Responsibility Deal, to include cheaper pricing and greater variety of healthy foods, is needed to address dietary inequalities.
    Journal of Epidemiology &amp Community Health 09/2015; 69(Suppl 1). DOI:10.1136/jech-2015-206256.87 · 3.50 Impact Factor
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    ABSTRACT: Background Sarcopenia, the loss of skeletal muscle mass and function with age, is common among older people. Grip strength is a frequently-used, simple, reproducible clinical measure of muscle strength, and a marker of sarcopenia, which has been shown to be an independent predictor of disability and mortality in later life. Given its prognostic importance, it is crucial to understand its determinants. There is some evidence that leisure time physical activity is a positive determinant of grip strength, but little is known about the role of physical occupational activity. We aimed to investigate the role of lifetime occupational physical activity on grip strength measured at retirement age. Methods Data come from the Hertfordshire Cohort Study where information on lifetime exposure to three heavy physical workload measures (standing/walking ≥4 h/day; lifting ≥25 kg; and work sufficiently physical to induce sweating) was collected. Grip strength was measured three times on each hand and then the maximum value was used. Multivariable linear regression was used to investigate the cross-sectional associations between occupational activities and grip strength, controlling for age, body size measurements, social class, smoking, diet, and age upon leaving full time education. Results Analysis was restricted to 1,419 men with complete data who had worked at least 20 years. Among men who reported medium exposure to heavy lifting in their occupation, grip strength was significantly reduced compared with men reporting low levels of exposure, and this association persisted after full adjustment for confounders (β = –1.22; 95% CI = –2.21 to –0.24). Men who reported standing/walking ≥4 h/day for at least 36 years of working life (medium/high exposure), had significantly worse grip strength than men reporting low levels of this exposure, but after adjustment for potential confounders these associations were lost. Similarly, working at physical intensity enough to induce sweating was not significantly associated after adjustment for confounders. Conclusion Heavy occupational activities are negatively associated with grip strength at retirement age. We hypothesise that any potential beneficial effect of intensive physical work is offset by the negative impact of other socio-economic factors (diet/lifestyle/deprivation/education) that determine career opportunities.
    Journal of Epidemiology &amp Community Health 09/2015; 69(Suppl 1). DOI:10.1136/jech-2015-206256.5 · 3.50 Impact Factor
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    ABSTRACT: Using a large cohort of hip fracture patients, we estimated hospital costs to be £14,163 and £2139 in the first and second year following fracture, respectively. Second hip and non-hip fractures were major cost drivers. There is a strong economic incentive to identify cost-effective approaches for hip fracture prevention. The purpose of this study was to estimate hospital costs of hip fracture up to 2 years post-fracture and compare costs before and after the index fracture. A cohort of patients aged over 60 years admitted with a hip fracture in a UK region between 2003 and 2013 were identified from hospital records and followed until death or administrative censoring. All hospital records were valued using 2012/2013 unit costs, and non-parametric censoring methods were used to adjust for censoring when estimating average annual costs. A generalised linear model examined the main predictors of hospital costs. A cohort of 33,152 patients with a hip fracture was identified (mean age 83 years (SD 8.2). The mean censor-adjusted 1- and 2-year hospital costs after index hip fracture were £14,163 (95 % confidence interval (CI) £14,008 to £14,317) and £16,302 (95 % CI £16,097 to £16,515), respectively. Index admission accounted for 61 % (£8613; 95 % CI £8565 to £8661) of total 1-year hospital costs which were £10,964 higher compared to the year pre-event (p < 0.001). The main predictors of 1-year hospital costs were second hip fracture, other non-hip fragility fractures requiring hospitalisation and hip fracture-related complications. Total UK annual hospital costs associated with incident hip fractures were estimated at £1.1 billion. Hospital costs following hip fracture are high and mostly occur in the first year after the index hip fracture. Experiencing a second hip fracture after the index fracture accounted for much of the increase in costs. There is a strong economic incentive to prioritise research funds towards identifying the best approaches to prevent both index and subsequent hip fractures.
    Osteoporosis International 08/2015; DOI:10.1007/s00198-015-3277-9 · 4.17 Impact Factor
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    ABSTRACT: Fracture history is an important component of osteoporosis diagnosis in children. One in six parentally reported lifetime fractures in children were not confirmed on review of radiographs. Care should be taken to avoid unnecessary investigations for possible osteoporosis due to parental over-reporting of soft tissue injuries as fractures. The diagnosis of osteoporosis in children requires either a vertebral compression fracture, or a significant fracture history (defined as ≥2 long bone fractures <10 years or ≥3 long bone fractures <19 years, excluding high impact fractures) and low bone mineral density. As children with frequent fractures might benefit from further evaluation, we determined whether parental reports of lifetime fracture were accurate compared to radiological reports and if they appropriately selected children for further consideration of osteoporosis. Parents of children (<18 years) with a musculoskeletal injury completed a questionnaire on their child's fracture history, including age, site and mechanism of previous fracture(s). Radiological reports were reviewed to confirm the fracture. Six hundred sixty parents completed the questionnaire and reported 276 previous fractures in 207 children. An injury treated at our hospital was recorded in 214 of the 276 parentally reported fractures. Thirty-four of 214 (16 %) were not a confirmed fracture. An injury was recorded for all parentally reported fractures in 150 children, but for 21 % children, there were inaccurate details (no evidence of fracture, incorrect site or forgotten fractures) on parent report. Eighteen of 150 children had a significant fracture history on parental report alone, but following review of radiology reports, 2 of 18 (11 %) did not have clinically significant fracture histories. Approximately one in six fractures reported by parents to have occurred in their child's lifetime had not resulted in a fracture. One in nine children with a significant fracture history could have been investigated unnecessarily.
    Osteoporosis International 08/2015; DOI:10.1007/s00198-015-3287-7 · 4.17 Impact Factor
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    ABSTRACT: In contrast to traditional approaches to fracture risk assessment using clinical risk factors and Bone Mineral Density (BMD), a new technique, Reference Point micro-Indentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments. Femoral neck samples were collected at surgery following low trauma hip fracture (n = 46; 17 male, 83 (IQR 77-87) years), and compared, using RPI (Biodent Hfc(TM) ), with 16 cadaveric control samples, free from bone disease (7 male; 65 (IQR 61-74) years). A subset of fracture patients returned for Dual-energy X-ray Absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans. The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p < 0.001), which persisted with adjustment for age, sex, BMI and height (p < 0.001) but was site-dependent, being less pronounced in the inferomedial region. RPI demonstrated good discrimination between fracture and controls using ROC analysis (AUC = 0.79 to 0.89), and a model combining RPI to clinical risk factors or BMD performed better than the individual components (AUC = 0.88 to 0.99). In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment, and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 08/2015; DOI:10.1002/jbmr.2605 · 6.83 Impact Factor
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    ABSTRACT: Sarcopenia is common in later life and may be associated with adverse health outcomes such as disability, falls and fracture. There is no consensus definition for its diagnosis although diagnostic algorithms have been proposed by the European Working Group for Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS) and the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). More recently, Binkley and colleagues devised a score-based system for the diagnosis of "dysmobility syndrome" in an attempt to combine adverse musculoskeletal phenotypes, including sarcopenia and osteoporosis, in order to identify older individuals at particular risk. We applied these criteria to participants from the Hertfordshire Cohort Study to define their prevalence in an unselected cohort of UK community-dwelling older adults and assess their relationships with previous falls and fracture. Body composition and areal bone mineral density were measured using dual-energy X-ray absorptiometry, gait speed was determined by a 3-m walk test and grip strength was assessed with a Jamar hand-held dynamometer. Researcher-administered questionnaires were completed detailing falls and fracture history. The prevalence of sarcopenia in this cohort was 3.3, 8.3 and 2.0 % using the EWGSOP, IWGS and related definition of FNIH, respectively; 24.8 % of individuals had dysmobility syndrome. Individuals with dysmobility reported significantly higher number of falls (last year and since the age of 45 years) (p < 0.01) than those without it, but no increased fracture rate was observed in this group (p = 0.96). Those with sarcopenia as defined by the IWGS reported significantly higher falls in the last year and prevalent fractures (falls in the last year: OR 2.51; CI 1.09-5.81; p = 0.03; fractures OR 2.50; CI 1.05-5.92; p = 0.04) but these significant associations were not seen when the EWGSOP definition was applied. The IWGS definition of sarcopenia appears to be an effective means of identifying individuals at risk of prevalent adverse musculoskeletal events.
    Calcified Tissue International 07/2015; DOI:10.1007/s00223-015-0044-z · 3.27 Impact Factor
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    ABSTRACT: Although a number of reports suggest very low persistence with oral bisphosphonates, there is limited data on persistence with other anti-osteoporosis medications. We compare rates of early discontinuation (in the first year) with all available outpatient anti-osteoporosis drugs in Catalonia, Spain. We conducted a population-based retrospective cohort study using data from the SIDIAP database. SIDIAP contains computerized primary care records and pharmacy dispensing data for >80 % of the population of Catalonia (>5 million people). All SIDIAP participants starting an anti-osteoporosis drug between 1/1/2007 and 30/06/2011 (with 2 years wash-out) were included. We modelled persistence as the time between first prescription and therapy discontinuation (refill gap of at least 6 months) using Fine and Gray survival models with competing risk for death. We identified 127,722 patients who started any anti-osteoporosis drug in the study period. The most commonly prescribed drug was weekly alendronate (N = 55,399). 1-Year persistence ranges from 40 % with monthly risedronate to 7.7 % with daily risedronate, and discontinuation was very common [from 49.5 % (monthly risedronate) to 84.4 % (daily risedronate)] as was also switching in the first year of therapy [from 2.8 % (weekly alendronate) to 10 % (daily alendronate)]. Multivariable-adjusted models showed that only monthly risedronate had better one-year persistence than weekly alendronate and teriparatide equivalent, whilst all other therapies had worse persistence. Early discontinuation with available anti-osteoporosis oral drugs is very common. Monthly risedronate, weekly alendronate, and daily teriparatide are the drugs with the best persistence, whilst daily oral drugs have 40-60 % higher first-year discontinuation rates compared to weekly alendronate.
    Calcified Tissue International 07/2015; DOI:10.1007/s00223-015-0040-3 · 3.27 Impact Factor
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    ABSTRACT: High blood pressure is a major contributor to the global burden of disease and discovering novel causal pathways of blood pressure regulation has been challenging. We tested blood pressure associations with 280 fasting blood metabolites in 3980 TwinsUK females. Survival analysis for all-cause mortality was performed on significant independent metabolites (P<8.9×10(-5)). Replication was conducted in 2 independent cohorts KORA (n=1494) and Hertfordshire (n=1515). Three independent animal experiments were performed to establish causality: (1) blood pressure change after increasing circulating metabolite levels in Wistar-Kyoto rats; (2) circulating metabolite change after salt-induced blood pressure elevation in spontaneously hypertensive stroke-prone rats; and (3) mesenteric artery response to noradrenaline and carbachol in metabolite treated and control rats. Of the15 metabolites that showed an independent significant association with blood pressure, only hexadecanedioate, a dicarboxylic acid, showed concordant association with blood pressure (systolic BP: β [95% confidence interval], 1.31 [0.83-1.78], P=6.81×10(-8); diastolic BP: 0.81 [0.5-1.11], P=2.96×10(-7)) and mortality (hazard ratio [95% confidence interval], 1.49 [1.08-2.05]; P=0.02) in TwinsUK. The blood pressure association was replicated in KORA and Hertfordshire. In the animal experiments, we showed that oral hexadecanedioate increased both circulating hexadecanedioate and blood pressure in Wistar-Kyoto rats, whereas blood pressure elevation with oral sodium chloride in hypertensive rats did not affect hexadecanedioate levels. Vascular reactivity to noradrenaline was significantly increased in mesenteric resistance arteries from hexadecanedioate-treated rats compared with controls, indicated by the shift to the left of the concentration-response curve (P=0.013). Relaxation to carbachol did not show any difference. Our findings indicate that hexadecanedioate is causally associated with blood pressure regulation through a novel pathway that merits further investigation.
    Hypertension 07/2015; 66(2). DOI:10.1161/HYPERTENSIONAHA.115.05544 · 6.48 Impact Factor
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    ABSTRACT: Under current guidelines, based on prior fracture probability thresholds, inequalities in access to therapy arise especially at older ages (≥70 years) depending on the presence or absence of a prior fracture. An alternative threshold (a fixed threshold from the age of 70 years) reduces this disparity, increases treatment access and decreases the need for bone densitometry. Several international guidelines set age-specific intervention thresholds at the 10-year probability of fracture equivalent to a woman of average BMI with a prior fracture. At older ages (≥70 years), women with prior fracture selected for treatment are at lower average absolute risk than those selected for treatment in the absence of prior fracture, prompting consideration of alternative thresholds in this age group. Using a simulated population of 50,633 women aged 50-90 years in the UK, with a distribution of risk factors similar to that in the European FRAX derivation cohorts and a UK-matched age distribution, the current NOGG intervention and assessment thresholds were compared to one where the thresholds remained constant from 70 years upwards. Under current thresholds, 45.1 % of women aged ≥70 years would be eligible for therapy, comprising 37.5 % with prior fracture, 2.2 % with high risk but no prior fracture and 5.4 % selected for treatment after bone mineral density (BMD) measurement. Mean hip fracture probability was 11.3, 23.3 and 17.6 %, respectively, in these groups. Under the alternative thresholds, the overall proportion of women treated increased from 45.1 to 52.9 %, with 8.4 % at high risk but no prior fracture and 7.0 % selected for treatment after BMD measurement. In the latter group, the mean probability of hip fracture was identical to that observed in women with prior fracture (11.3 %). The alternative threshold also reduced the need for BMD measurement, particularly at older ages (>80 years). The alternative thresholds equilibrate fracture risk, particularly hip fracture risk, in those with or without prior fracture selected for treatment and reduce BMD usage at older ages.
    Osteoporosis International 06/2015; DOI:10.1007/s00198-015-3176-0 · 4.17 Impact Factor
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    ABSTRACT: Fracture Liaison Services are the best model to prevent secondary fractures. The International Osteoporosis Foundation developed a Best Practice Framework to provide a quality benchmark. After a year of implementation, we confirmed that a single framework with set criteria is able to benchmark services across healthcare systems worldwide. Despite evidence for the clinical effectiveness of secondary fracture prevention, translation in the real-world setting remains disappointing. Where implemented, a wide variety of service models are used to deliver effective secondary fracture prevention. To support use of effective models of care across the globe, the International Osteoporosis Foundation's Capture the Fracture® programme developed a Best Practice Framework (BPF) tool of criteria and standards to provide a quality benchmark. We now report findings after the first 12 months of implementation. A questionnaire for the BPF was created and made available to institutions on the Capture the Fracture website. Responses from institutions were used to assign gold, silver, bronze or black (insufficient) level of achievements mapped across five domains. Through an interactive process with the institution, a final score was determined and published on the Capture the Fracture website Fracture Liaison Service (FLS) map. Sixty hospitals across six continents submitted their questionnaires. The hospitals served populations from 20,000 to 15 million and were a mix of private and publicly funded. Each FLS managed 146 to 6200 fragility fracture patients per year with a total of 55,160 patients across all sites. Overall, 27 hospitals scored gold, 23 silver and 10 bronze. The pathway for the hip fracture patients had the highest proportion of gold grading while vertebral fracture the lowest. In the first 12 months, we have successfully tested the BPF tool in a range of health settings across the globe. Initial findings confirm a significant heterogeneity in service provision and highlight the importance of a global approach to ensure high quality secondary fracture prevention services.
    Osteoporosis International 06/2015; DOI:10.1007/s00198-015-3192-0 · 4.17 Impact Factor
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    ABSTRACT: Symptomatic knee osteoarthritis (OA) can be viewed as the end result of a molecular cascade which ensues after certain triggers occur and ultimately results in irreversible damage to the articular cartilage. The clinical phenotype that knee OA can produce is variable and often difficult to accurately predict. This is further complicated by the often poor relationship between radiographic OA and knee pain. As a consequence, it can be difficult to compare studies that use different definitions of OA. However, the literature suggests that while there are multiple causes of knee OA, two have attracted particular attention over recent years; occupation related knee OA and OA subsequent to previous knee injury. The evidence of a relationship, and the strength of this association, is discussed in this chapter.
    Bailli&egrave re s Best Practice and Research in Clinical Rheumatology 06/2015; DOI:10.1016/j.berh.2015.05.005 · 2.60 Impact Factor
  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):351.2-352. DOI:10.1136/annrheumdis-2015-eular.3523 · 10.38 Impact Factor
  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):285.3-286. DOI:10.1136/annrheumdis-2015-eular.1496 · 10.38 Impact Factor
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    ABSTRACT: In 27 centres across Europe, the prevalence of deforming spinal Scheuermann's disease in age-stratified population-based samples of over 10,000 men and women aged 50+ averaged 8 % in each sex, but was highly variable between centres. Low DXA BMD was un-associated with Scheuermann's, helping the differential diagnosis from osteoporosis. This study aims to assess the prevalence of Scheuermann's disease of the spine across Europe in men and women over 50 years of age, to quantitate its association with bone mineral density (BMD) and to assess its role as a confounder for the radiographic diagnosis of osteoporotic fracture. In 27 centres participating in the population-based European Vertebral Osteoporosis Study (EVOS), standardised lateral radiographs of the lumbar and of the thoracic spine from T4 to L4 were assessed in all those of adequate quality. The presence of Scheuermann's disease, a confounder for prevalent fracture in later life, was defined by the presence of at least one Schmorl's node or irregular endplate together with kyphosis (sagittal Cobb angle >40° between T4 and T12) or a wedged-shaped vertebral body. Alternatively, the (rare) Edgren-Vaino sign was taken as diagnostic. The 6-point-per-vertebral-body (13 vertebrae) method was used to assess osteoporotic vertebral shape and fracture caseness. DXA BMD of the L2-L4 and femoral neck regions was measured in subsets. We also assessed the presence of Scheuermann's by alternative published algorithms when these used the radiographic signs we assessed. Vertebral radiographic images from 4486 men and 5655 women passed all quality checks. Prevalence of Scheuermann's varied considerably between centres, and based on random effect modelling, the overall European prevalence using our method was 8 % with no significant difference between sexes. The highest prevalences were seen in Germany, Sweden, the UK and France and low prevalences were seen in Hungary, Poland and Slovakia. Centre-level prevalences in men and women were highly correlated. Scheuermann's was not associated with BMD of the spine or hip. Since most of the variation in population impact of Scheuermann's was unaccounted for by the radiological and anthropometric data, the search for new genetic and environmental determinants of this disease is encouraged.
    Osteoporosis International 05/2015; DOI:10.1007/s00198-015-3170-6 · 4.17 Impact Factor
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    ABSTRACT: Poor diet quality in early childhood is inconsistently linked to obesity risk. Understanding may be limited by the use of cross-sectional data and the use of body mass index (BMI) to define adiposity in childhood. The objective of this study is to examine the effects of continued exposure to diets of varying quality across early childhood in relation to adiposity at 6 years. One thousand and eighteen children from a prospective UK birth cohort were studied. Diet was assessed using food frequency questionnaires when the children were aged 6 and 12 months, and 3 and 6 years; diet quality was determined according to scores for a principal component analysis-defined dietary pattern at each age (characterized by frequent consumption of fruits, vegetables and fish). At each age, children were allocated a value of 0/1/2 according to third of the distribution (bottom/middle/top) their diet quality score was in; values were summed to calculate an overall diet quality index (DQI) for early childhood (range 0-8). Obesity outcomes considered at 6 years were dual-energy X-ray absorptiometry-assessed fat mass and BMI. One hundred and seven (11%) children had a DQI=0, indicating a consistently low diet quality, 339 (33%) had a DQI=1-3, 378 (37%) had a DQI=4-6 and 194 (19%) had a DQI=7-8. There was a strong association between lower DQI and higher fat mass z-score at 6 years that was robust to adjustment for confounders (fat mass s.d. per 1-unit DQI increase: β=-0.05 (95% confidence interval (CI): -0.09, -0.01), P=0.01). In comparison with children who had the highest diet quality (DQI=7-8), this amounted to a difference in fat mass of 14% (95% CI: 2%, 28%) at 6 years for children with the poorest diets (DQI=0). In contrast, no independent associations were observed between DQI and BMI. Continued exposure to diets of low quality across early childhood is linked to adiposity at the age of 6 years.International Journal of Obesity advance online publication, 30 June 2015; doi:10.1038/ijo.2015.97.
    International journal of obesity (2005) 05/2015; DOI:10.1038/ijo.2015.97 · 5.00 Impact Factor

Publication Stats

30k Citations
3,108.34 Total Impact Points


  • 2008–2015
    • University of Oxford
      • • Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)
      • • Botnar Research Centre Institute of Musculoskeletal Sciences
      Oxford, England, United Kingdom
    • Circumcision Resource Center
      Boston, Massachusetts, United States
  • 1989–2015
    • University of Southampton
      • • MRC Lifecourse Epidemiology Unit
      • • Developmental Origins of Health and Disease
      • • Institute of Sound and Vibration Research (ISVR)
      Southampton, England, United Kingdom
  • 2010–2014
    • NIHR Oxford Biomedical Research
      Oxford, England, United Kingdom
  • 2013
    • Maulana Azad Medical College
      New Dilli, NCT, India
  • 2000–2013
    • University Hospital Southampton NHS Foundation Trust
      • Department of Medical Physics and Bioengineering
      Southampton, England, United Kingdom
  • 1995–2009
    • University of Cambridge
      • Department of Medicine
      Cambridge, England, United Kingdom
  • 1995–2008
    • Medical Research Council (UK)
      Londinium, England, United Kingdom
  • 2006
    • Utrecht University
      Utrecht, Utrecht, Netherlands
  • 2005
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2004
    • CUNY Graduate Center
      New York City, New York, United States
  • 1992–2000
    • The University of Manchester
      • School of Nursing, Midwifery and Social Work
      Manchester, England, United Kingdom
  • 1999
    • University College London
      • Institute of Child Health
      Londinium, England, United Kingdom
  • 1998
    • VU University Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1995–1998
    • Newcastle University
      Newcastle-on-Tyne, England, United Kingdom
  • 1996
    • University of Amsterdam
      • Department of Endocrinology
      Amsterdamo, North Holland, Netherlands
  • 1994–1995
    • Mayo Clinic - Rochester
      • Department of Health Science Research
      Rochester, MN, United States
    • Royal National Hospital For Rheumatic Diseases NHS Foundation Trust
      Bath, England, United Kingdom
  • 1991
    • The Chinese University of Hong Kong
      Hong Kong, Hong Kong