Comparison of osteoporosis in US adults with type 1 and type 2 diabetes mellitus.

PURPOSE: We examined bone mineral density (BMD) and osteoporosis prevalence in those with type 1 compared to type 2 diabetes derived from a nationally representative sample from the civilian community in the United States. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) for 2005-2006, 2007-2008, 2009-2010, and 2013-2014 were merged to obtain a large sample of diabetics at least 20 years of age with participation in the interview and medical examination. Osteoporosis status was defined by BMD at the total femur, femoral neck, or total lumbar spine. Self-reported diabetics that were prescribed insulin within the first year of diagnosis, are currently taking insulin, and reported no prescriptions for any diabetic pills were classified as type 1. Remaining self-reported diabetics were deemed as having type 2. RESULTS: A total of 2050 diabetics were included in which 87 (4%) were classified as type 1. Type 1 diabetics were found to have a significantly lower BMD at the total femur and femoral neck, but not at the lumbar spine in the adjusted models. Diabetics with type 1 were 4.7 times more likely to have osteoporosis than those with type 2. There was no significant relationship between diabetes type and BMD or osteoporosis prior to adjustment for confounders. CONCLUSIONS: Although our results show an increased likelihood of osteoporosis among those with type 1 diabetes, future studies including a larger sample from a community population are needed. It may benefit diabetics, especially those with type 1, to initiate osteoporosis screening methods including evaluation of fracture risk, bone quality, and BMD measurements at multiple sites earlier than recommended.

The impact of osteoporotic fractures compared with other health conditions in older adults living in Virginia, United States.

UNLABELLED: This study compared length of stay, hospital costs, 30-day readmission, and mortality for patients admitted primarily for osteoporotic fractures to those admitted for five other common health conditions. The results indicated that osteoporotic fractures were associated with highest hospital charges and the second highest hospital stay after adjusting for confounders. INTRODUCTION: This study aimed to compare the effect of osteoporotic fractures and other common hospitalized conditions in both men and women age 55 years and older on a large in-patient sample. METHODS: De-identified patient level and readmission and transfer data from the Virginia Health Information (VHI) system for 2008 through 2014 were merged. Logistic regression models were used to assess mortality and 30-day readmission, while generalized linear models were fitted to assess LOS and hospital charges. RESULTS: After adjustment for confounders, osteoporotic fractures had the second longest LOS (6.0 days, 95 % CI = 5.9-6.0) and the highest average total hospital charges ($47,386.0, 95 % CI = $46,707.0-$48,074.0) compared to the other five common health problems. CONCLUSION: Recognizing risk and susceptibility to osteoporotic fractures is an important motivator for individual behaviors that mitigate this disease. Furthermore, acknowledging the economic impact and disabling burden of osteoporotic fractures on society are compelling reasons to promote bone health as well as to prevent, diagnose, and manage osteoporosis.

Association of CMV, HBV, or HCV co-infection with vaccine response in adults with well-controlled HIV infection.

Even after CD4 count recovery on antiretroviral therapy, HIV infection is associated with decreased response to most vaccines compared to the general population. Chronic infections with viruses such as cytomegalovirus (CMV), hepatitis B virus (HBV), and hepatitis C virus (HCV), which are more prevalent in HIV-infected populations, have been linked to immune dysfunction and decreased vaccine response in the general population. However, whether co-infection with these other viruses contributes to the decreased vaccine response seen in adults with well-controlled HIV infection is unknown. We conducted a secondary analysis of data and serum from adults with well-controlled HIV infection from an inactivated polio vaccine trial (224 subjects) and a pneumococcal conjugate vaccine study (128 subjects). We evaluated the association of CMV, HBV, or HCV co-infection with post-vaccination antibody levels using both univariate and multivariate analyses, controlling for factors such as age, race, CD4 count, comorbidities, smoking status, and baseline antibody levels. Ninety-three percent, 7%, and 14% of subjects were co-infected with CMV, HBV, and HCV respectively. On both univariate and multivariate analysis, neither CMV nor HCV co-infection were significantly associated with post-vaccination antibody levels to either vaccine. HBV co-infection was significantly associated with post-vaccination antibody concentrations for pneumococcal serotype 7F on univariate analysis and 6A on multivariate analysis, but the association was with higher antibody concentrations. In conclusion, co-infection with CMV, HBV, or HCV does not appear to contribute to the decreased vaccine response seen in adults with well-controlled HIV infection.

Osteoporosis treatment disparities: a 6-year aggregate analysis from national survey data.

UNLABELLED: We studied factors to determine the receipt of osteoporosis treatment in individuals with osteoporosis. Treatment was associated with age, gender, race, body mass index (BMI), family history, arthritis and thyroid problems, daily glucocorticoid use, number of prescriptions and healthcare visits, and insurance type. INTRODUCTION: Osteoporosis is underrecognized and undertreated. Few studies have examined factors associated with osteoporosis treatment in a large, national sample of men and women. METHODS: We aggregated National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2010 and created a subsample which included individuals 50 years or older who were identified to have osteoporosis either by self-report data or by bone density measurements. The primary outcome was the receipt of osteoporosis treatment either from self-report or from prescription records. Covariates included sociodemographics, clinical characteristics, and access to healthcare variables. Logistic regression analyses were performed to determine factors that associate with osteoporosis treatment. RESULTS: From a sample of 31,0134 participants, 1,133 subjects (3.65 %) met the study criteria. Treatment was associated with age (odds ratio (OR) = 1.14), gender (OR = 13.25), race (OR = 2.23, White vs. Black; OR = 1.76, other vs. Black), BMI (OR = 1.67, normal vs. obese; OR = 2.68, overweight vs. obese), family history of osteoporosis (OR = 1.94), arthritis (OR = 1.43), daily glucocorticoid use (OR = 1.43), number of prescriptions (OR = 1.01), and number of healthcare visits in the past year (OR = 1.44, 4-9 vs. 0-3 visits). All odds ratios were statistically significant. CONCLUSION: A large number of individuals diagnosed with osteoporosis above the age of 50 remain untreated. It is important for healthcare providers to better assess older adults with osteoporosis, including individuals who frequently receive medical care.

High-performance liquid chromatographic analysis of biogenic amines in biological materials as o-phthalaldehyde derivatives.

A remarkably sensitive, simple and selective reversed-phase high-performance liquid chromatographic (HPLC) method has been developed, allowing, for the first time, the direct measurement of histamine, norepinephrine, octopamine, normetanephrine, dopamine, serotonin and tyramine in a single sample of plasma (2 ml), tissue (0.2 g), or urine. The biogenic amines were modified by pre-column derivatization with o-phthalaldehyde which stabilizes the molecules, aids in extraction, and improves HPLC detection at the nanogram level. To minimize losses during the sampling procedure a careful collection procedure was designed. We developed a simple sample cleanup in which the samples were thawed, neutralized with KOH, immediately derivatized, extracted into ethyl acetate (EtOAc) and then chromatographed by HPLC. The derivatives were stable in EtOAc for more then 24 h. Interfering amino acids were removed from the EtOAc by partitioning twice with Na2HPO4 buffer (pH 10.0). Complete separation was achieved in ca. 60--90 min on a muBondapak phenyl column using a stepwise gradient of acetonitrile and/or methanol-phosphate buffer (pH 5.1). A variable wavelength fluorometer with a 5-microliter flow-cell was used (excitation 340 nm; emission 480 nm). Linearity ranged from 200 pg to 50 ng onto the column. Precision (R.S.D.) for retention times was 1% and for derivatization and injection 2.5%. Recoveries of the seven biogenic amines from plasma spiked with 25 ng/ml averaged 70%, with a relative standard deviation of 6%. Separation studies were also done using a muBondapak C18 column. The effects of various eluents are presented. Gas-liquid chromatography was also investigated but lacked the sensitivity achieved by HPLC. The HPLC method is used routinely for the determination of biogenic amines in plasma from pigs with malignant hyperthemia and thermally stressed bovine. Significant differences in levels of biogenic amines were noted between stressed and non-stressed animals. Data on rat brain tissue samples were compared with the trihydroxyindole method and canine heart tissue was analyzed for ventricular norepinephrine and dopamine. Application of the method to urine from normal persons and a patient with a brain tumor has been demonstrated.

High-performance liquid-chromatographic separation and fluorescence measurement of biogenic amines in plasma, urine, and tissue.

We describe a high-performance liquid-chromatographic method for measuring histamine, norepinephrine, octopamine, normetanephrine, dopamine, serotonin, and tyramine in plasma (2 ml), brain (0.2 g), or urine. These amines are modifed by pre-column derivatization with o-phthalaldehyde, which stabilizes the molecules, facilitates extraction, and improves detection of nanogram amounts. Before separation, samples were neutralized with KOH and immediately derivatized and extracted into ethyl acetate, in which derivatives were stable for longer than 24 h. Interfering amino acids were removed from ethyl acetate by partitioning twice with Na2HPO4 buffer (pH 10.0). Separation was complete in about 90 min on a ""mu Bondapak/phenyl" column, with which a stepwise gradient of methanol/phosphate buffer (pH 5.1) was used. A variable-wavelength fluorometer was used (exciting wavelength, 340 nm; emission wavelength, 480 nm). Amount and response were linearly related from 1 to 200 pmol. Precision (CV) for retention times was 1%, for derivatization and injection 2.5%. Analytical recoveries of the seven amines from 2 ml of plasma fortified with 200 pmol averaged 65% (CV approximately 8%). Data on rat-brain tissue samples are compared with results by the trihydroxyindole method. Application of the method to urine from normal persons and a patient with a brain tumor is demonstrated.