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L.-A. Fraser,
G. Ioannidis,
J. D. Adachi,
L. Pickard,
S. M. Kaiser,
J. Prior,
J. P. Brown,
D. A. Hanley,
W. P. Olszynski,
T. Anastassiades,
S. Jamal, R. Josse,
D. Goltzman,
A. Papaioannou,
the CaMos Research Group
[show abstract]
[hide abstract]
ABSTRACT: SummaryCanadian women over 50years old were studied over a 10-year period to see if those who sustained a fracture (caused by minimal
trauma) were receiving the recommended osteoporosis therapy. We found that approximately half of these women were not being
treated, indicating a significant care gap in osteoporosis treatment.
IntroductionPrevalent fragility fracture strongly predicts future fracture. Previous studies have indicated that women with fragility
fractures are not receiving the indicated treatment. We aimed to describe post fracture care in Canadian women using a large,
population-based prospective cohort that began in 1995–1997.
MethodsWe followed 5,566 women over 50years of age from across Canada over a period of 10years in the Canadian Multicentre Osteoporosis
Study. Information on medication use and incident clinical fragility fractures was obtained during a yearly questionnaire
or interview and fractures were confirmed by radiographic/medical reports.
ResultsOver the 10-year study period, 42–56% of women with yearly incident clinical fragility fractures were not treated with an
osteoporosis medication. During year1 of the study, 22% of the women who had experienced a fragility fracture were on treatment
with a bisphosphonate and 26% were on hormone therapy (HT). We were not able to differentiate HT use for menopause symptoms
vs osteoporosis. Use of bisphosphonate therapy increased over time; odds ratio (OR) for use at year10 compared to use at
year1 was 3.65 (95% confidence interval (CI) 1.83–7.26). In contrast, HT use declined, with an OR of 0.07 (95%CI 0.02–0.24)
at year10 compared to year1 of the study.
ConclusionIn a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures.
Although bisphosphonate therapy usage improved over time, a substantial gap remains.
KeywordsBisphosphonates–Care gap–Fragility fracture–Osteoporosis–Postmenopausal women
Osteoporosis International 04/2012; 22(3):789-796. · 4.58 Impact Factor
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L-A Fraser,
L Langsetmo,
C Berger,
G Ioannidis,
D Goltzman,
J D Adachi,
A Papaioannou, R Josse,
C S Kovacs,
W P Olszynski, [......],
S M Kaiser,
J Prior,
S Jamal,
N Kreiger,
J P Brown,
H Johansson,
A Oden,
E McCloskey,
J A Kanis,
W D Leslie
[show abstract]
[hide abstract]
ABSTRACT: A new Canadian WHO fracture risk assessment (FRAX®) tool to predict 10-year fracture probability was compared with observed 10-year fracture outcomes in a large Canadian population-based study (CaMos). The Canadian FRAX tool showed good calibration and discrimination for both hip and major osteoporotic fractures.
The purpose of this study was to validate a new Canadian WHO fracture risk assessment (FRAX®) tool in a prospective, population-based cohort, the Canadian Multicentre Osteoporosis Study (CaMos).
A FRAX tool calibrated to the Canadian population was developed by the WHO Collaborating Centre for Metabolic Bone Diseases using national hip fracture and mortality data. Ten-year FRAX probabilities with and without bone mineral density (BMD) were derived for CaMos women (N = 4,778) and men (N = 1,919) and compared with observed fracture outcomes to 10 years (Kaplan-Meier method). Cox proportional hazard models were used to investigate the contribution of individual FRAX variables.
Mean overall 10-year FRAX probability with BMD for major osteoporotic fractures was not significantly different from the observed value in men [predicted 5.4% vs. observed 6.4% (95%CI 5.2-7.5%)] and only slightly lower in women [predicted 10.8% vs. observed 12.0% (95%CI 11.0-12.9%)]. FRAX was well calibrated for hip fracture assessment in women [predicted 2.7% vs. observed 2.7% (95%CI 2.2-3.2%)] but underestimated risk in men [predicted 1.3% vs. observed 2.4% (95%CI 1.7-3.1%)]. FRAX with BMD showed better fracture discrimination than FRAX without BMD or BMD alone. Age, body mass index, prior fragility fracture and femoral neck BMD were significant independent predictors of major osteoporotic fractures; sex, age, prior fragility fracture and femoral neck BMD were significant independent predictors of hip fractures.
The Canadian FRAX tool provides predictions consistent with observed fracture rates in Canadian women and men, thereby providing a valuable tool for Canadian clinicians assessing patients at risk of fracture.
Osteoporosis International 03/2011; 22(3):829-37. · 4.58 Impact Factor
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L-A Fraser,
G Ioannidis,
J D Adachi,
L Pickard,
S M Kaiser,
J Prior,
J P Brown,
D A Hanley,
W P Olszynski,
T Anastassiades,
S Jamal, R Josse,
D Goltzman,
A Papaioannou
[show abstract]
[hide abstract]
ABSTRACT: Canadian women over 50 years old were studied over a 10-year period to see if those who sustained a fracture (caused by minimal trauma) were receiving the recommended osteoporosis therapy. We found that approximately half of these women were not being treated, indicating a significant care gap in osteoporosis treatment.
Prevalent fragility fracture strongly predicts future fracture. Previous studies have indicated that women with fragility fractures are not receiving the indicated treatment. We aimed to describe post fracture care in Canadian women using a large, population-based prospective cohort that began in 1995-1997.
We followed 5,566 women over 50 years of age from across Canada over a period of 10 years in the Canadian Multicentre Osteoporosis Study. Information on medication use and incident clinical fragility fractures was obtained during a yearly questionnaire or interview and fractures were confirmed by radiographic/medical reports.
Over the 10-year study period, 42-56% of women with yearly incident clinical fragility fractures were not treated with an osteoporosis medication. During year 1 of the study, 22% of the women who had experienced a fragility fracture were on treatment with a bisphosphonate and 26% were on hormone therapy (HT). We were not able to differentiate HT use for menopause symptoms vs osteoporosis. Use of bisphosphonate therapy increased over time; odds ratio (OR) for use at year 10 compared to use at year 1 was 3.65 (95% confidence interval (CI) 1.83-7.26). In contrast, HT use declined, with an OR of 0.07 (95%CI 0.02-0.24) at year 10 compared to year 1 of the study.
In a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures. Although bisphosphonate therapy usage improved over time, a substantial gap remains.
Osteoporosis International 03/2011; 22(3):789-96. · 4.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to review the monitoring of strontium ranelate osteoporosis therapy.
The method used in this study was comprehensive literature review with clinical perspectives.
Changes in bone turnover markers (BTM) or bone mineral density (BMD) have been documented in osteoporosis clinical trials. However, neither BMD nor BTM changes fully explain the observed fracture risk reduction in treated patients. If changes in BMD or BTM on therapy would be easily discernable in individual patients, and were strongly associated with fracture risk reduction, monitoring individuals would be more useful. BMD changes in patients on strontium ranelate are of a greater magnitude and hence can be easily determined in an individual patient. In addition, there exists a better correlation between fracture risk reduction and increases in BMD.
The strong correlation between measured BMD increases and fracture risk reduction in patients on strontium ranelate therapy will be of clinical benefit to physicians wishing to evaluate both treatment persistence and fracture risk reduction.
Osteoporosis International 04/2009; 20(7):1101-6. · 4.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Nitrates may have beneficial effects on bone. To determine if nitrates were associated with increased bone mineral density (BMD), we conducted a secondary analysis using data from subjects in a prospective study. Subjects reporting nitrate use had increased BMD compared with non-users, confirming that nitrates have positive BMD effects in women and men.
Prior studies suggest positive associations between nitrates and bone.
We used linear regression models, stratified by gender and adjusted for age, weight, and baseline differences, to determine the association between daily nitrate use and BMD among subjects participating in the Canadian Multicentre Osteoporosis Study. All results are reported as annualised percent change in BMD at the hip and spine among nitrate users compared to non-users.
We included 1,419 men (71 reported daily nitrate use) and 2,587 women (97 reported daily nitrate use). Male non-users had decreased hip BMD (-1.3%; 95% confidence interval [95%CI] = -1.6 to -1.1) and increased spine BMD (2.8%; 95%CI = 2.5 to 3.1). Male nitrate users had increased hip BMD (1.4%; 95%CI = 0.1 to 2.8) and spine BMD (4.5%; 95%CI = 3.2 to 5.7). Among women, non-users had decreased hip BMD (-1.9; 95%CI = -2.1 to -1.7) and increased spine BMD (2.1%; 95%CI = 1.9 to 2.4) whilst users had an increase in hip BMD (2.0%; 95%CI = 1.2 to 2.8) and spine BMD (4.1%; 95%CI = 3.4 to 4.9).
Nitrate use is associated with increased BMD at the hip and spine in men and women.
Osteoporosis International 10/2008; 20(5):737-44. · 4.58 Impact Factor
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A Papaioannou,
C C Kennedy,
G Ioannidis,
A Sawka,
W M Hopman,
L Pickard,
J P Brown, R G Josse,
S Kaiser,
T Anastassiades,
D Goltzman,
M Papadimitropoulos,
A Tenenhouse,
J C Prior,
W P Olszynski,
J D Adachi
[show abstract]
[hide abstract]
ABSTRACT: Using prospective data from the Canadian Multicentre Osteoporosis Study (CaMos), we compared health utilities index (HUI) scores after 5 years of follow-up among participants (50 years and older) with and without incident clinical fractures. Incident fractures had a negative impact on HUI scores over time.
This study examined change in health-related quality of life (HRQL) in those with and without incident clinical fractures as measured by the HUI.
The study cohort was 4,820 women and 1,783 men (50 years and older) from the CaMos. The HUI was administered at baseline and year 5. Participants were sub-divided into incident fracture groups (hip, rib, spine, forearm, pelvis, other) and were compared with those without these fractures. The effects of both time and fracture type on HUI scores were examined in multivariable regression analyses.
Men and women with hip fractures, compared to those without, had lower HUI measures that ranged from -0.05 to -0.25. Both women and men with spine fractures had significant deficits on the pain attributes (-0.07 to -0.12). In women, self-care (-0.06), mobility and ambulation (-0.05) were also negatively impacted. Women with rib fractures had deficits similar to women with spine fractures, and these effects persisted over time. In men, rib fractures did not significantly affect HUI scores. Pelvic and forearm fractures did not substantially influence HUI scores.
The HUI was a sensitive measure of HRQL change over time. These results will inform economic analyses evaluating osteoporosis therapies.
Osteoporosis International 10/2008; 20(5):703-14. · 4.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Observational studies are needed to quantify real-life effectiveness of antiresorptive therapy in the prevention of clinical fractures. Antiresorptive therapies were associated with an overall 32% reduction in low-trauma nonvertebral fracture risk among women 50 and older. Effectiveness may be lower among older women and those without risk factors.
Randomized controlled trials have shown that antiresorptive therapies reduce the risk of fracture in selected populations, but further study is needed to quantify their real-life effectiveness. The study objective was to determine the association between antiresorptive use and low-trauma nonvertebral fracture in women 50 and older.
The design was a retrospective nested case-control study (density-based sampling) within the Canadian Multicentre Osteoporosis Study. There were 5,979 eligible women with 453 cases and 1,304 matched controls.
The current use of antiresorptives was associated with a decreased risk of fracture with OR = 0.68, 95% CI: 0.52-0.91; where OR is the adjusted odds ratio and CI is the confidence interval. Subgroup analysis yielded OR = 0.61, 95% CI: 0.42-0.89 for ages 50-74; OR = 0.76, 95% CI: 0.50-1.17 for ages 75+; OR = 0.58, 95% CI: 0.40-0.83 for those with a major risk factor; and OR = 0.92; 95% CI: 0.59-1.42 for those without a major risk factor. Major risk factors were prevalent low-trauma fracture, vertebral deformity (grade 2+), and BMD T-score < or = -2.5.
Antiresorptive therapy is associated with a clinically important reduction in low-trauma nonvertebral fracture risk among community-dwelling women aged 50 and older. Antiresorptive therapy may be less effective for women 75 and older and women without major risk factors.
Osteoporosis International 06/2008; 20(2):283-90. · 4.58 Impact Factor
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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
[show abstract]
[hide abstract]
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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J P Brown,
W P Olszynski,
A Hodsman,
W G Bensen,
A Tenenhouse,
T P Anastassiades,
L G Ste-Marie,
D L Kendler,
D A Hanley, R Josse,
J G Hanly,
B Lentle,
A Jovaisas,
G Ioannidis,
G F Stephenson,
I Barton,
S Pack,
A Chines,
R Dias,
J D Adachi
[show abstract]
[hide abstract]
ABSTRACT: Following a 52-wk randomized controlled trial of intermittent cyclic etidronate therapy in patients using corticosteroids, we performed a 52-wk open-label trial of calcium alone in 114 corticosteroid-treated patients to determine whether the beneficial effect of etidronate is maintained after the drug is discontinued. All patients were given 500 mg/d of elemental calcium. Sixty-one and 53 patients made up the former placebo and etidronate groups, respectively. A total of 89 (98%) of patients in the former placebo and etidronate groups remained on corticosteroids throughout the second year. The mean (SE) percentage change in bone mineral density of the lumbar spine, femoral neck, and trochanter were compared between groups. The difference between groups in mean percentage change from baseline (wk 0, initiation of etidronate or placebo therapy) in the bone density of the lumbar spine, femoral neck, and trochanter, following 104 wk, was 3.8 (0.9), 3.0 (1.1), and 4.3 (1.1), respectively (p < 0.05, all sites), in favor of the former etidronate group. While not significant, the former placebo group demonstrated a slightly larger rate of decline in bone density over the second year than the former etidronate group at all three sites. Following the discontinuation of etidronate therapy, there was no accelerated bone loss and there was evidence of a residual protective effect in both the lumbar spine and femoral neck for up to 1 yr posttreatment.
Journal of Clinical Densitometry 02/2001; 4(4):363-71. · 1.29 Impact Factor
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[show abstract]
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ABSTRACT: The Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire is a tool to assist physicians to identify women who might require bone densitometry. The purpose of this study was to develop a Canadian SCORE and to assess validity and reliability. Twenty sites enrolled 307 postmenopausal women ages 50-70 yr. SCORE results were compared to hip and lumbar spine bone density assessed by dual X-ray absorptiometry. Sensitivity and specificity of a range of SCORE cut-points were assessed in a receiver operating characteristics analysis to determine the optimal cut-point for SCORE. With low bone density defined as a T-score < or = -2.0, a SCORE cut-point of 6 in women ages 50-59 yr displayed a sensitivity of 0. 96, 95% confidence interval (CI) (0.89, 1.00), a specificity of 0.51, 95% CI (0.43, 0.58). In women ages 60-70 yr, a SCORE cut-point of 8 displayed a sensitivity of 0.90, 95% CI (0.80, 0.97) and a specificity of 0.20, 95% CI (0.11, 0.29). The test-retest reliability (intraclass correlation coefficient) was 0.95. SCORE performed better in women in their fifties than women in ther sixties. Older women require higher SCORE cut-points. The use of SCORE as an initial measure for identifying those at risk for osteoporosis may reduce costs by limiting unnecessary tests.
Journal of Clinical Densitometry 01/2000; 3(3):269-80. · 1.29 Impact Factor
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J D Adachi,
W G Bensen,
J Brown,
D Hanley,
A Hodsman, R Josse,
D L Kendler,
B Lentle,
W Olszynski,
L G Ste-Marie,
A Tenenhouse,
A A Chines
[show abstract]
[hide abstract]
ABSTRACT: Osteoporosis is a recognized complication of corticosteroid therapy. Whether it can be prevented is not known. We conducted a 12-month, randomized, placebo-controlled study of intermittent etidronate (400 mg per day for 14 days) followed by calcium (500 mg per day for 76 days), given for four cycles, in 141 men and women (age, 19 to 87 years) who had recently begun high-dose corticosteroid therapy. The primary outcome measure was the difference in the change in the bone density of the lumbar spine between the groups from base line to week 52. Secondary measures included changes in the bone density of the femoral neck, trochanter, and radius and the rate of new vertebral fractures.
The mean (+/-SE) bone density of the lumbar spine and trochanter in the etidronate group increased 0.61 +/- 0.54 and 1.46 +/- 0.67 percent, respectively, as compared with decreases of 3.23 +/- 0.60 and 2.74 +/- 0.66 percent, respectively, in the placebo group. The mean differences between the groups after one year were 3.72 +/- 0.88 percentage points for the lumbar spine (P = 0.02) and 4.14 +/- 0.94 percentage points for the trochanter (P = 0.02). The changes in the femoral neck and the radius were not significantly different between the groups. There was an 85 percent reduction in the proportion of postmenopausal woman with new vertebral fractures in the etidronate group as compared with the placebo group (1 of 31 patients vs. 7 of 32 patients, P = 0.05), and the etidronate-treated postmenopausal women also had significantly fewer vertebral fractures per patient (P = 0.04).
Intermittent etidronate therapy prevents the loss of vertebral and trochanteric bone in corticosteroid-treated patients.
New England Journal of Medicine 09/1997; 337(6):382-7. · 53.30 Impact Factor
