Is vascular calcification associated with bone mineral density and osteoporotic fractures in ambulatory, elderly women?

UNLABELLED: We analyzed the relationship between aortic calcification and two osteoporotic parameters (bone mineral density (BMD) and incident osteoporotic fractures) in 667 ambulatory, elderly women from the Epidemiology of Osteoporosis (EPIDOS) cohort (mean age, 80 years; range, 72-94 years). We did not find any correlation between the aortic calcification score and BMD or osteoporotic fractures. INTRODUCTION: The aging process is associated with osteoporosis and aortic calcification; conditions which may have similar disease mechanisms. However, the relationship between these two settings remains to be elucidated. We analyzed the relationship between aortic calcification and osteoporotic parameters (BMD and incident osteoporotic fractures) in a cohort of ambulatory, elderly women. METHODS: The study included 667 ambulatory women from the EPIDOS cohort (mean age, 80 years; age range, 72-94 years). The baseline examination included bone investigations, a clinical and functional examination, and a comprehensive questionnaire on health status and lifestyle. Semiquantitative methods were used to determine the abdominal aortic calcification score on baseline radiographs. Incident fractures were recorded via postal questionnaires issued every 4 months for about 4 years. RESULTS: Five hundred three women (75%) had aortic calcification. The mean aortic calcification score was 5.5 (median, 4). During the follow-up period, 186 (28%) women reported one or more incident osteoporotic fractures. We did not find any correlation between the aortic calcification score on one hand and the BMD or the occurrence of incident osteoporotic fractures on the other. Only age and systolic blood pressure were found to be independently associated with the aortic calcification score. Osteoporotic fractures were independently associated with age and BMD. CONCLUSIONS: Osteoporosis and aortic calcification appear to be independent processes in a cohort of ambulatory, elderly women. However, potential confounding factors may be present and prospective studies are needed to investigate this situation further.

Is it possible to identify early predictors of the future cost of chronic arthritis? The VErA project.

This study was conducted to identify early predictors of the total cost of inflammatory arthritis (IA). One hundred and eighty patients affected by undifferentiated arthritis (UA) or rheumatoid arthritis (RA) were included in the French Very Early rheumatoid Arthritis (VErA) cohort between 1998 and 2001. Health economic data for 2003 were collected using a patient self-questionnaire. Results were analysed in terms of direct, indirect and total costs in 2003 euros (2003euro) for the population as a whole and in diagnostic subgroups. A payor perspective (the French National Health Insurance, in this case) was adopted. Multiple linear regression models were used to identify predictors of total cost from among the criteria assessed on recruitment. Results of the study showed that for the study population as a whole, the mean total cost was euro4700 per patient. The costs attributable to the RA and UA sub-groups were euro5928 and euro2424 per patient, respectively. In a univariate analysis, certain parameters were significantly correlated with a higher cost of illness. In the multivariate analysis, some of these parameters were further identified as being predictive of higher cost. Two strong significant, early predictors of total cost were identified: higher pain (P = 0.002) and the presence of rheumatoid factor (P = 0.004). In the RA sub-group, lower grip strength of the dominant hand (P = 0.039) was another predictor of the illness's subsequent economic impact. In conclusion, our data show that simple clinical and laboratory parameters can be used early in the course of IA to predict the condition's impact on healthcare budgets.

[Acetylcholinesterase inhibitor treatment for Alzheimer's disease: the experience in Picardy]. / Traitement anticholinestérasique de la maladie d'Alzheimer en Picardie.

INTRODUCTION: Despite numerous advances in the management of patients with Alzheimer's disease (AD), the proportion of patients treated according to current recommendations remains unknown. METHODS: In order to examine this point, we performed a study assessing the proportion of AD patients receiving one acetylcholinesterase inhibitor. This study was performed in Picardy (1.9 millions of inhabitants) in 2000 and 2001. The number of patients receiving one acetylcholinesterase inhibitor (tacrine, donepezil, rivastigmine and galantamine) was determined using data from health insurance and from pharmaceutical companies. RESULTS: The prevalence of AD was estimated to vary from 10751 patients in 2000, to 10990 in 2001. The number of treated patients was 1798 in 2000 and 2572 in 2001 and this corresponded to 16.7 percent (95CI: 2.5) and 23.4 percent (95CI: 3.4) of prevalent cases, respectively. Following the exclusion of patients with moderate to severe AD (estimated to represent 25 percent of patients), the proportion of treated patients reached 22.4 percent (95CI: 2.3) in 2000 and 31.3 percent (95CI: 3.1) in 2001. CONCLUSIONS: Despite a significant increase between 2000 and 2001, this study shows that less than a third of AD patients with mild to moderate dementia were treated with acetylcholinesterase inhibitors. Although numerous factors might have affected our estimations, this study shows that effective care of AD patients remains largely insufficient.