C Cooper

University of Oxford, Oxford, England, United Kingdom

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Publications (665)3061.91 Total impact

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    ABSTRACT: Hip fracture is the most significant complication of osteoporosis in terms of mortality, long-term disability and decreased quality of life. In the recent years, different techniques have been developed to assess lower limb strength and ultimately fracture risk. Here we examine relationships between two measures of lower limb bone geometry and strength; proximal femoral geometry and tibial peripheral quantitative computed tomography. We studied a sample of 431 women and 488 men aged in the range 59-71 years. The hip structural analysis (HSA) programme was employed to measure the structural geometry of the left hip for each DXA scan obtained using a Hologic QDR 4500 instrument while pQCT measurements of the tibia were obtained using a Stratec 2000 instrument in the same population. We observed strong sex differences in proximal femoral geometry at the narrow neck, intertrochanteric and femoral shaft regions. There were significant (p < 0.001) associations between pQCT-derived measures of bone geometry (tibial width; endocortical diameter and cortical thickness) and bone strength (strength strain index) with each corresponding HSA variable (all p < 0.001) in both men and women. These results demonstrate strong correlations between two different methods of assessment of lower limb bone strength: HSA and pQCT. Validation in prospective cohorts to study associations of each with incident fracture is now indicated.
    Calcified Tissue International 11/2015; DOI:10.1007/s00223-015-0081-7 · 3.27 Impact Factor
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    ABSTRACT: Purpose: Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH. Methods: Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index. Results: The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function. Conclusions: Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care.
    Quality of Life Research 11/2015; DOI:10.1007/s11136-015-1171-8 · 2.49 Impact Factor
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    ABSTRACT: Objective: To perform an external validation of FRAX algorithm thresholds for reporting level of risk of fracture in Spanish women (low <5%; intermediate ≥5% and <7.5%; high ≥7.5%) taken from a prospective cohort "FRIDEX". Methods: A retrospective study of 1090 women aged ≥40 and ≤90 years old obtained from the general population (FROCAT cohort). FRAX was calculated with data registered in 2002. All fractures were validated in 2012. Sensitivity analysis was performed. Results: When analyzing the cohort (884) excluding current or past anti osteoporotic medication (AOM), using our nominated thresholds, among the 621 (70.2%) women at low risk of fracture, 5.2% [CI95%: 3.4-7.6] sustained a fragility fracture; among the 99 at intermediate risk, 12.1% [6.4-20.2]; and among the 164 defined as high risk, 15.9% [10.6-24.2]. Sensitivity analysis against model risk stratification FRIDEX of FRAX Spain shows no significant difference. By including 206 women with AOM, the sensitivity analysis shows no difference in the group of intermediate and high risk and minimal differences in the low risk group. Conclusions: Our findings support and validate the use of FRIDEX thresholds of FRAX when discussing the risk of fracture and the initiation of therapy with patients.
    Maturitas 11/2015; DOI:10.1016/j.maturitas.2015.10.002 · 2.94 Impact Factor
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    ABSTRACT: Methods: Four subgroups from the prospective community-based Chingford Cohort Study were identified based on presence/absence of pain and ROA at baseline: (Pain-/ROA-; Pain+/ROA-; Pain-/ROA+; Pain+/ROA+). Pain was defined as side-specific pain in the preceding month, while side-specific ROA was defined as Kellgren-Lawrence grade ≥2. All-cause, cardiovascular disease (CVD) and cancer-related mortality over the 23-year follow-up was based on information collected by the Office for National Statistics. Associations between subgroups and all-cause/cause-specific mortality were assessed using Cox regression, adjusting for age, body mass index, typical cardiovascular risk factors, occupation, past physical activity, existing CVD disease, glucose levels and medication use. Results: 821 and 808 women were included for knee and hand analyses, respectively. Compared with the knee Pain-/ROA- group, the Pain+/ROA- group had an increased risk of CVD-specific mortality (HR 2.93 (95% CI 1.47 to 5.85)), while the knee Pain+/ROA+ group had an increased HR of 1.97 (95% CI 1.23 to 3.17) for all-cause and 3.57 (95% CI 1.53 to 8.34) for CVD-specific mortality. We found no association between hand OA and mortality. Conclusion: We found a significantly increased risk of all-cause and CVD-specific mortality in women experiencing knee pain with or without ROA but not ROA alone. No relationship was found between hand OA and mortality risk. This suggests that knee pain, more than structural changes of OA is the main driver of excess mortality in patients with OA.
    Annals of the rheumatic diseases 11/2015; DOI:10.1136/annrheumdis-2015-208056 · 10.38 Impact Factor
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    ABSTRACT: We examine the mechanistic basis and wider implications of adopting a developmental perspective on human ageing. Previous models of ageing have concentrated on its genetic basis, or the detrimental effects of accumulated damage, but also raised issues about whether ageing can be viewed as adaptive itself, or a consequence of other adaptive processes, for example if maintenance and repair processes in the period up to reproduction are traded off against later decline in function. A life course model places ageing in the context of the attainment of peak capacity for a body system, starting in early development when plasticity permits changes in structure and function induced by a range of environmental stimuli, followed by a period of decline, the rate of which depends on the peak attained as well as the later life conditions. Such path dependency in the rate of ageing may offer new insights into its modification. Focusing on musculoskeletal and cardiovascular function, we discuss this model and the possible underlying mechanisms, including endothelial function, oxidative stress, stem cells, and nutritional factors such as vitamin D status. Epigenetic changes induced during developmental plasticity, and immune function may provide common mechanistic process underlying a life course model of ageing. The life course trajectory differs in high and low resource settings. New insights into the developmental components of the life course model of ageing may lead to the design of biomarkers of later chronic disease risk and to new interventions to promote healthy ageing, with important implications for public health. This article is protected by copyright. All rights reserved.
    The Journal of Physiology 10/2015; DOI:10.1113/JP270579 · 5.04 Impact Factor

  • Osteoporosis International 10/2015; DOI:10.1007/s00198-015-3340-6 · 4.17 Impact Factor
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    ABSTRACT: Background: To develop services, healthcare professionals must make business cases to managerial bodies within Hospital Trusts and if approved, to commissioning bodies. Patients with hip fracture are at high risk of subsequent fracture. To prevent this, guidance recommends structuring fracture prevention services around coordinator based models. These are known as Fracture Liaison Services (FLS). Methods: 33 semi-structured qualitative interviews were conducted with healthcare professionals with experience of making business cases for FLS. Data was analysed thematically. Results: Challenges in the development of business cases included collecting all the relevant data and negotiating compartmentalised budgets that impeded service development. Participants described communication and cooperation between providers and commissioners as variable. They felt financial considerations were the most important factor in funding decisions, while improved quality of care was less influential. Other factors included national guidelines and political priorities. The personalities of clinicians championing services, and the clinical interests of commissioners were seen to influence the decision-making process, suggesting that participants felt that decisions were not always made on the basis of evidence-based care. Effective strategies included ways of providing support, demonstrating potential cost effectiveness and improved quality of care. Using a range of sources including audit data collected on the successful Glasgow FLS, and improving cooperation between stakeholders was advocated. Participants felt that the work of commissioners and providers should be better integrated and suggested strategies for doing this. Conclusions: This study provides information to healthcare professionals about how best to develop business cases for FLS. We conclude with recommendations on how to develop effective cases. These include using guidance such as toolkits, aligning the aims of FLS with national priorities and benchmarking services against comparators. Introducing a 'Local Champion' to work alongside the service manager and establishing a multi-disciplinary working team would facilitate communication between stakeholders. Involving commissioners in service design would help integrate the roles of purchasers and providers.
    BMC Musculoskeletal Disorders 10/2015; 16(1). DOI:10.1186/s12891-015-0722-z · 1.72 Impact Factor
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    ABSTRACT: Introduction: Older people admitted to hospital are vulnerable to adverse outcomes including prolonged length of stay, reduced mobility, admission to care homes. Cachexia, sarcopenia and inflammaging are age-related conditions associated with poor outcomes but are little characterised in older people admitted to hospital. The aim of this study was to describe in detail a cohort of hospitalised older people with focus on cachexia, sarcopenia, inflammaging and clinical outcomes. Materials and methods: CaSIO was a prospective, cohort study of hospitalised older women, with a follow- up time over 2 years. Participants were recruited from the Medicine for Older People wards at a university hospital in England. Detailed characterisation of cachexia, sarcopenia and the immune- endocrine axis occurred on admission, discharge and at 6 months post-discharge. Outcome data were collected on the length of hospital admission, discharge destination, and longer-term outcomes including functional status at six month follow-up. Mortality data were collected at 6, 12 and 24 months. Results: 145 female participants (58% of eligible patients) were recruited and survived the admission with an average age 86 years; baseline characteristics are provided. 103 (71%) were re-assessed 6 months after discharge (18 (12%) had died; 24 (17%) were lost to follow up); mortality data was ascertained at 12 and 24 months. Conclusion: This study has described cachexia, sarcopenia and inflammaging in relation to clinical outcomes in hospitalised older women with 6 month follow up and mortality data collected for 24 months. This will add to a greater understanding of these conditions within older people. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society.
    European geriatric medicine 10/2015; 6(5):495-501. DOI:10.1016/j.eurger.2015.06.004 · 0.73 Impact Factor

  • Osteoporosis International 09/2015; DOI:10.1007/s00198-015-3288-6 · 4.17 Impact Factor

  • Osteoporosis International 09/2015; DOI:10.1007/s00198-015-3295-7 · 4.17 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
  • SR Crozier · HM Inskip · KM Godfrey · C Cooper · SM Robinson ·
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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: 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
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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; 97(5). DOI:10.1007/s00223-015-0044-z · 3.27 Impact Factor

Publication Stats

30k Citations
3,061.91 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
  • 2000-2015
    • University Hospital Southampton NHS Foundation Trust
      • Department of Medical Physics and Bioengineering
      Southampton, England, United Kingdom
  • 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
  • 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
  • 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