An experience- and preference-based EQ-5D-3L value set derived using 18 months of longitudinal data in patients who sustained a fracture: results from the ICUROS.

INTRODUCTION: EQ-5D-3L preference-based value sets are predominately based on hypothetical health states and derived in cross-sectional settings. Therefore, we derived an experience-based value set from a prospective observational study. METHODS: The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) was a multinational study on fragility fractures, prospectively collecting EQ-5D-3L and Time trade-off (TTO) within two weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months thereafter. We derived an EQ-5D-3L value set by regressing the TTO values on the ten impairment levels in the EQ-5D-3L. We explored the potential for response shift and whether preferences for domains vary systematically with prior impairment in that domain. Finally, we compared the value set to 25 other EQ-5D-3L preference-based value sets. RESULTS: TTO data were available for 12,954 EQ-5D-3L health states in 4683 patients. All coefficients in the value set had the expected sign, were statistically significant, and increased monotonically with severity of impairment. We found evidence for response shift in mobility, self-care, and usual activities. The value set had good agreement with the only other experience- and preference-based value set, but poor agreement with all hypothetical value sets. CONCLUSIONS: We present an experience- and preference-based value set with high face validity. The study indicates that response shift may be important to account for when deriving value sets. Furthermore, the study suggests that perspective (experienced versus hypothetical) is more important than country setting or demographics for valuation of EQ-5D-3L health states.

Associations between Physical Function, Bone Density, Muscle Mass and Muscle Morphology in Older Men with Sarcopenia: A Pilot Study.

Background and Objectives: It is thought that muscle and bone interact only on a biomechanical level, however, some research is now emerging that links bone and muscle on a cellular level. The aim of this study was to explore associations between physical function, muscle mass and bone density in community-dwelling elderly men with sarcopenia. A secondary goal was to analyze if muscle morphology was associated with bone density and physical functioning. Materials and Methods: Body composition was measured by dual-energy X-ray absorptiometry (DXA). Bone density was evaluated according to WHO criteria. Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People (EWGSOP) criteria: low muscle mass and low muscle strength or low physical performance. Microbiopsy of musculus vastus lateralis was performed with a disposable muscle microbiopsy system. The perimeter and cross-sectional area of muscle fibers were calculated using image analysis software in whole slide images; type of fibers and their distribution were evaluated as well. Results: A total of 151 men, 60 years or older were included in this study. Mean age of the subjects was 72.9 ± 8.02 years. Sarcopenia was diagnosed in 45 (29.8%) men. Multiple significant correlations were found between bone mineral density, lean mass, appendicular lean mass, arm and leg lean mass, gait speed, balance test and handgrip strength in sarcopenic men. Lean mass was associated with femoral neck BMD (bone mineral density; r = 0.418, p = 0.006) and handgrip strength (r = 0.553, p < 0.001). In the sarcopenia group, 25 muscle biopsies were examined. In 9 sarcopenic men with T-scores equal or below -2.5, the muscle fiber area had a significant correlation with the balance test (r = 0.73, p = 0.025). Conclusions: In men with sarcopenia, low lean muscle mass was associated with low femoral neck BMD and low muscle strength. In sarcopenic men with osteoporosis, low muscle fiber area was associated with low scores in a balance test.

Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-off: results from the ICUROS.

INTRODUCTION: The International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-off (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set. METHODS: Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers. RESULTS: In total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analysis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13-18 months after distal forearm fracture, EQ-5D-3L generated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked differences between the three approaches were observed immediately after the fracture. CONCLUSIONS: The approach to derive QoL markedly influences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-effectiveness analysis of fracture prevention.

Reliability and Validity of the Lithuanian Version of CASP-19: A Quality of Life Questionnaire for the Elderly.

Introduction: Ageing is associated with several physical, psychological, and behavioral changes. These changes are closely related with general health problems and quality of life in old age. The CASP-19 multidimensional instrument was specially designed to measure quality of life in the elderly. The different language versions of this scale have been used in more than 20 countries. However, Lithuanian translation was not available. The objective of our study was to test psychometric properties of the Lithuanian version of the CASP-19 questionnaire. Materials and methods: A cross-sectional study was performed with ambulatory men and women aged 60 and older, living in a community in Vilnius, Lithuania. Exclusion criteria were current acute illness, malignant tumor, and Mini-Mental State Examination (MMSE) score < 25 points. Psychometric properties of CASP-19 were tested using reliability and validity methods. Results: The study sample consisted of 132 participants, 28 (21.8%) of them were men and 103 (78.2%) women. Analysis of psychometric properties of the Lithuanian version of CASP-19 showed high internal consistency (Cronbach's alpha 0.85), good agreement between test-retest measures with an ICC of 0.82 (95% CI 0.79⁻0.85) and good convergent and divergent construct validity. Conclusions: The psychometric properties indicated that the Lithuanian version of CASP-19 was reliable and valid. As such, it might be used to evaluate quality of life in elderly people.

Self-reported consequences and healthcare costs of falls among elderly women.

BACKGROUND AND OBJECTIVE: Although the falls in elderly people lead to serious health consequences, the economic burden is underestimated. The aim of this study was to calculate the medical costs of fall consequences in elderly women. MATERIALS AND METHODS: Women aged 65 years and older were interviewed by phone recording the consequences and healthcare procedures related to every fall sustained during the previous 12 months. The healthcare costs were estimated by calculating the sum of costs for all self-reported contacts with medical care providers: ambulance, emergency department, visits to family doctor and other specialists, hospitalisations, and rehabilitation. RESULTS: The study population consisted of 878 community-dwelling women (mean age 72.2±4.8 years). Falls were reported by 310 (35.3%) women; one in three of them had fallen twice or more. Of all women who fell, 280 (90.3%) reported their fall resulted in an injury, and 77 (15.3%) falls led to bone fractures. Fear of falling was reported by 72.9% of women. Fall-related medical care was provided to 135 women (43.5% of those fallen), and 18 (5.8%) subjects were hospitalised, mostly for the fracture. The mean estimated healthcare cost was 254 EUR per patient receiving fall-related medical care, and 116 EUR per women fallen. The highest mean cost (1289 EUR) was estimated in falls resulted in hip fracture; the lowest (135 EUR), in nonfracture injury. CONCLUSION: The data on the self-reported consequences of falls in elderly women showed a significant number of fall-related injuries and a high cost of healthcare.

Association Between Polymorphisms of VDR, COL1A1, and LCT genes and bone mineral density in Belarusian women with severe postmenopausal osteoporosis.

BACKGROUND AND OBJECTIVE. Variation of osteoporosis in the population is the result of an interaction between the genotype and the environment, and the genetic causes of osteoporosis are being widely investigated. The aim of this study was to analyze the association between the polymorphisms of the vitamin D receptor (VDR), type I collagen (COL1A1), and lactase (LCT) genes and severe postmenopausal osteoporosis as well as bone mineral density (BMD). MATERIAL AND METHODS. A total of 54 women with severe postmenopausal osteoporosis and 77 controls (mean age, 58.3 years [SD, 6.2] and 56.7 years [SD, 7.42], respectively) were included into the study. The subjects were recruited at the City Center for Osteoporosis Prevention (Minsk, Belarus). Dual-energy x-ray absorptiometry was used to measure bone mineral density at the lumbar spine and the femoral neck. Severe osteoporosis was diagnosed in the women with the clinical diagnosis of postmenopausal osteoporosis and at least 1 fragility fracture. The control group included women without osteoporosis. Polymorphic sites in osteoporosis predisposition genes (ApaI, BsmI, TaqI, and Cdx2 of the VDR gene, G2046T of the COL1A1 gene, and T-13910C of the LCT gene) were determined using the polymerase chain reaction on the deoxyribonucleic acid isolated from dried bloodspots. RESULTS. The data showed that the ApaI and BsmI polymorphisms of the VDR gene and T- 13910C of the LCT gene were associated with severe postmenopausal osteoporosis in the analyzed Belarusian women (P<0.01). A statistically significant positive correlation between the VDR risk genotypes ApaI and TaqI and bone mineral density was found (P<0.05). CONCLUSIONS. The findings of this study suggest that at least the ApaI and BsmI polymorphisms of the VDR gene and T-13910C of the LCT gene are associated with the risk of postmenopausal osteoporosis in our sample of the Belarusian women.

Incidence and direct hospitalisation costs of hip fractures in Vilnius, capital of Lithuania, in 2010.

BACKGROUND: Few epidemiological data on hip fractures were previously available in Lithuania. The aim of this study was to estimate the incidence and hospital costs of hip fractures in Vilnius in 2010. METHODS: Data were collected from the medical charts of all patients admitted to hospitals in Vilnius (population, 548,835) due to new low-energy trauma hip fracture, during 2010. The estimated costs included ambulance transportation and continuous hospitalisation immediately after a fracture, which are covered by the Lithuanian healthcare system. RESULTS: The incidence of new low-energy trauma hip fractures was 252 (308 women and 160 men) per 100,000 inhabitants of Vilnius aged 50-years or more. There was an exponential increase in the incidence with increasing age. The overall estimated cost of hip fractures in Vilnius was 1,114,292 EUR for the year 2010. The greatest part of the expenditure was accounted for by fractures in individuals aged 65-years and over. The mean cost per case was 2,526.74 EUR, and cost varied depending on the treatment type. Hip replacement did not affect the overall mean costs of hip fracture. The majority of costs were incurred for acute (53%) and long-term care (35%) hospital stays, while medical rehabilitation accounted for only 12% of the overall cost. The costs of hip fracture were somewhat lower than those found in other European countries. CONCLUSION: The data on incidence and costs of hip fractures will help to assess the importance of interventions to reduce the number of fractures and associated costs.

Bone metabolism genes variation and response to bisphosphonate treatment in women with postmenopausal osteoporosis.

INTRODUCTION: Long-term treatment is used in patients with osteoporosis, and bisphosphonates (BPs) are the most commonly prescribed medications. However, in some patients this therapy is not effective, cause different side effects and complications. Unfortunately, at least one year is needed to identify and confirm an ineffectiveness of BPs therapy on bone mineral density (BMD). Among other factors, a response to BPs therapy may also be explained by genetic factors. The aim of this study was to analyze the influence of SOST, PTH, FGF2, FDPS, GGPS1, and LRP5 gene variants on the response to treatment with aminobisphosphonates. MATERIALS AND METHODS: Women with postmenopausal osteoporosis were included to this study if they used aminobisphosphonates for at least 12 months. Exclusion criteria were: persistence on BPs therapy less than 80%, bone metabolic diseases, diseases deemed to affect bone metabolism, malignant tumours, using of any medications influencing BMD. The study protocol was approved by the local ethics committee. The BMD at the lumbar spine and femoral neck were measured using dual x-ray absorptiometry (GE Lunar) before and at least 12 months after treatment with BPs. According to BMD change, patients were divided in two groups-responders and non-responders to BPs terapy. Polymorphic variants in SOST, PTH, FGF2, FDPS, GGPS1, and LRP5 genes were determined using PCR analysis with TaqMan probes (Thermo Scientific). RESULTS: In total, 201 women with BPs therapy were included in the study. No statistically significant differences were observed in age, age at menopause, weight, height, BMI and baseline BMD levels between responders (122 subjects) and non-responders (79 subjects). As single markers, the SOST rs1234612 T/T (OR = 2.3; P = 0.02), PTH rs7125774 T/T (OR = 2.8, P = 0.0009), FDPS rs2297480 G/G (OR = 29.3, P = 2.2×10-7), and GGPS1 rs10925503 C/C+C/T (OR = 2.9; P = 0.003) gene variants were over-represented in non-responders group. No significant association between FGF2 rs6854081 and LRP5 rs3736228 gene variants and response to BPs treatment was observed. The carriers of T-T-G-C allelic combination (constructed from rs1234612, rs7125774, rs2297480, and rs10925503) were predisposed to negative response to BPs treatment (OR = 4.9, 95% CI 1.7-14.6, P = 0.005). The C-C-T-C combination was significantly over-represented in responders (OR = 0.1, 95% CI 0.1-0.5, P = 0.006). CONCLUSIONS: Our findings highlight the importance of identified single gene variants and their allelic combinations for pharmacogenetics of BPs therapy of osteoporosis. Complex screening of these genetic markers could be used as a new strategy for personalized antiresorptive therapy.

Validation of the Lithuanian version of sarcopenia-specific quality of life questionnaire (SarQoL®).

PURPOSE: The aim of this study was to translate and culturally adapt the SarQoL® questionnaire into Lithuanian and investigate its main psychometric properties. METHODS: A cross-sectional study was performed on community-dwelling Lithuanian people aged ≥ 60 years. The revised criteria of the European Working Group on Sarcopenia in Older People were used. A forward-backward methodology was used for the translation, with a pre-test of the final version of the Lithuanian SarQoL® questionnaire. Adjusted logistic regression analysis was used to compare sarcopenic and non-sarcopenic subjects. Internal consistency was determined using Cronbach's alpha coefficient. The correlation of total score of the SarQoL® and each domain of the Short-form General Health Survey (SF-36) and EuroQol-5D (EQ-5D) questionnaires was measured using Spearman's correlations. Test-retest reliability was measured by the intraclass correlation coefficient. RESULTS: The study was performed on 176 subjects. Fifty-eight subjects were diagnosed with sarcopenia. After adjustment for confounders, the total score of the SarQoL® questionnaire was significantly lower for sarcopenic subjects compared to non-sarcopenic subjects (50.32 ± 8.58 vs 73.75 ± 13.51, p < 0.001). Cronbach's alpha coefficient was 0.95. Neither floor nor ceiling effects were found. The SarQoL® questionnaire revealed good correlation with similar domains of the SF-36 and EQ-5D questionnaires for convergent validity and weak correlations with different domains for divergent validity, confirming its construct validity. An excellent agreement between test and retest was found with an ICC of 0.976 (95% CI 0.959-0.986). CONCLUSIONS: Lithuanian version of the SarQoL® is valid, reliable and consistent and could be used to assess quality of life in sarcopenic population.

Relationship between mandibular cortical bone height and bone mineral density of lumbar spine.

UNLABELLED: The aim of this study was to evaluate the association between lumbar spine bone mineral density and mandible cortical bone height at the mental foramen and at the angle of the jaw. PATIENTS AND METHODS: A total of 130 women living in Lithuania, were examined. None of the participants were known to have endocrine, metabolic or skeletal disorders. Bone mineral density (BMD) was measured in the spine lumbar area L2-L4. The mandibles were examined on panoramic x-ray images. On each radiograph cortical thickness of mandible was measured at the mental foramen and at the angle of the jaw. The results demonstrated a tendency of high probability of osteoporosis in cases were radiomorphometric parameters are low. There was a significant difference between bone mineral density of lumbar spine and cortical bone height of mandible below the foramen mentale and at the angle of the jaw (p<0.01).

Vitamin D Level and Activities of Daily Living in Octogenarians: Cross-Sectional Study.

INTRODUCTION: Despite the growing number of octogenarians, little is known about their vitamin D status and activities of daily living (ADL) relations. OBJECTIVE: The aim of this study was to investigate peculiarities of vitamin D and ADL and to assess their relations in octogenarians. METHODS: A cross-sectional study was performed at the National Osteoporosis Centre located in Vilnius, Lithuania. Community-dwelling ambulatory persons aged ≥80 years were included. Current users of vitamin D supplements were excluded. Total 25 hydroxyvitamin D concentration in serum was measured with Cobas E411. Functional status was assessed by Katz ADL and the Lawton Instrumental Activities of Daily Living (IADL) scales. Subjects were divided into three groups according to age and into two groups according to vitamin D level. One-way analysis of variance with post hoc test was used to determine between-group comparisons. Associations between vitamin D and ADL score, and IADL score were assessed using Spearman's correlation. RESULTS: The study was performed on 153 octogenarians: 81 (52.9%) women and 72 (47.1%) men. The average age of subjects was 83.9 ± 3.2 years. Mean total 25 hydroxyvitamin D concentration was 11.2 ± 7.0 ng/ml; 137 (89.5%) persons had vitamin D deficiency, 12 (7.8%) had insufficiency, and only 4 (2.6%) persons were vitamin D sufficient. Positive weak correlation between total 25 hydroxyvitamin D and ADL score (r = 0.2, p = 0.01) and very weak correlation between total 25 hydroxyvitamin D and IADL score (r = 0.19, p = 0.02) were found. Total 25 hydroxyvitamin D level was correlated with ADL score in women (r = 0.23, p = 0.04). In the 80-84 years group ADL score correlated with total 25 hydroxyvitamin D level (r = 0.23, p = 0.02). CONCLUSION: The majority of investigated octogenarians had vitamin D deficiency. The level of vitamin D was associated with the ADL score. There was no association between the vitamin D level and the IADL score, although a weak correlation was found between vitamin D level and category of food preparation.

Association of Vitamin D Receptor Gene Variation With Osteoporosis Risk in Belarusian and Lithuanian Postmenopausal Women.

Vitamin D receptor (VDR) is one of the main mediators of vitamin D biological activity. VDR dysfunction might substantially contribute to development of postmenopausal osteoporosis (PMO). Numerous studies have revealed the effects of several VDR gene variants on osteoporosis risk, although significant variation in different ethnicities have been suggested. The main purpose of this work was to assess the frequency of distribution of VDR genetic variants with established effect and evaluate their haplotype association with the risk of PMO in a cohort of Belarusian and Lithuanian women. Case group included women with PMO (n = 149), the control group comprised women with normal bone mineral density (BMD) and without previous fragility fractures (n = 172). Both groups were matched for age, height, sex, and BMI-no statistically significant differences observed. VDR gene polymorphic variants (ApaI rs7975232, BsmI rs1544410, TaqI rs731236, and Cdx2 rs11568820) were determined using polymerase chain reaction and restriction fragment length polymorphism. The lumbar spine (L1-L4) and femoral neck BMD was measured using dual-energy X-ray absorptiometry. Association between each VDR variant and PMO risk was assessed using multiple logistic regression. The genotyping revealed statistically significant difference in the rs7975232 genotype frequencies between the patients and the controls (homozygous C/C genotype was overrepresented in patients, p = 0.008). Patients with osteoporosis were also three times more likely to carry the rs1544410 G/G genotype, when compared to controls. We found that rs7975232, rs1544410, and rs731236 variants were in a strong direct linkage disequilibrium (p < 0.0001), suggesting that risk alleles of these markers are preferably inherited jointly. For the bearers of C-G-C haplotype (consisting of rs7975232, rs1544410, and rs731236 unfavorable alleles), the risk of PMO was significantly higher (OR = 4.7, 95% CI 2.8-8.1, p < 0.0001) compared to controls. This haplotype was significantly over-represented in PMO group compared to all other haplotypes. Our findings highlight the importance of identified haplotypes of VDR gene variants. Complex screening of these genetic markers can be used to implement personalized clinical approach for prevention, treatment, and rehabilitation programs.

An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults.

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care-dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture-related conditions, hyposalivation, and oral pre- and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person-related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non-dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.

[The impact of subclinical vertebral fractures on health-related quality of life in women with osteoporosis]. / Slanksteliu neklinikiniu luziu itaka serganciuju osteoporoze gyvenimo kokybei.

The aim of the study was to evaluate the impact of subclinical vertebral fractures on health-related quality of life in women with postmenopausal osteoporosis. A disease-specific instrument, Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) questionnaire, developed to measure quality of life in patients with osteoporosis, was used. A total of 120 postmenopausal women who came for consultation were examined. Subclinical vertebral fractures were identified by standardized lateral radiographs. Patients were divided into three study groups according to bone mineral density and incident fracture status: group 1 (control group)--40 women without osteoporosis, group 2--40 women with osteoporosis, but without vertebral fracture, and group 3--40 women with subclinical osteoporotic vertebral fracture. The last group was divided into two subgroups: with one fracture and with multiple vertebral fractures. The mean total score of the QUALEFFO-41 for the control group was 34.12 (95% CI 30.27-37.96), for the group with osteoporosis, but without vertebral fracture--36.51 (95% CI 33.56-39.45), and for the group with non-clinical osteoporotic vertebral fracture--35.69 (95% CI 32.08-39.29). There were statistically significant differences in domains A (pain) and E (social function) between women with one non-clinical vertebral fracture and control group. Our results showed no statistically significant differences in health-related quality of life, assessed QUALEFFO-41, between women with subclinical vertebral fractures and control group. Women with one subclinical vertebral fracture showed statistically significant worse results in pain, social function, and general health perception domains. Significantly greater changes in body appearance were noted among women with multiple subclinical vertebral fractures.

Evaluation of bone mineral density in postmenopausal women with alterations of the mandible cortical bone.

OBJECTIVE: Menopause affects the bone quality and quantity of jaw bone. The aim of this study was to evaluate the validity of mandibular cortical measurements in the diagnosis of low bone mineral density (BMD) in postmenopausal women. METHODS: A total of 113 postmenopausal women (mean age 63.15±6.05 years), living in Lithuania, were examined. Participants were categorized as either normal BMD, or low BMD according to the WHO classification in relation to their spine BMD determined by dual energy x-ray absorptiometry. None of the participants were known to have endocrine, metabolic or skeletal disorders. BMD was measured in the spine lumbar area L2-L4. The mandibles were examined on panoramic x-ray images. The following radiomorphometric indices were measured: the height of the mandibular inferior cortex below foramen mentalae (IC) and cortical thickness at the angle of the mandible (Panoramic Angular Index (PA)). Receiver operating characteristics (ROC) curve analysis was used to determine the validity of cortical measurements in the diagnosis of low BMD obtained and the area under the ROC curve (AUC) was calculated. RESULTS: Significant associations were found between IC and PA, and low BMD. The areas under the ROC (AUC) of PA was 0.753 (95% CI, 0.645-0.861) and of IC was 0.709 (95% CI, 0.601-0.816). High levels of intra- and interobserver agreement were demonstrated. CONCLUSIONS: Postmenopausal women with spinal low BMD can be identified moderately accurately by mandibular cortical findings.

Comparison of self-management methods for osteoarthritis and rheumatoid arthritis.

OBJECTIVE: To determine and compare self-management methods used for osteoarthritis and rheumatoid arthritis and to determine which methods patients consider most effective. METHODS: Patients with osteoarthritis and rheumatoid arthritis were questioned about self-management methods and asked to indicate the most effective ones. RESULTS: Twenty-seven patients with osteoarthritis and 26 with rheumatoid arthritis were interviewed. Exercise, joint protection, assistive devices and heat were the methods most commonly used. More patients with osteoarthritis than with rheumatoid arthritis used assistive devices (p=0.042). Exercise, assistive devices and heat were considered the most effective self-management methods. More patients with osteoarthritis than with rheumatoid arthritis considered assistive devices to be the most effective method (p=0.016). CONCLUSION: More patients with osteoarthritis than with rheumatoid arthritis used and indicated assistive devices as the most effective self-management method. Similar numbers of patients in both groups used other self-management methods.

[The efficiency of home and outpatient exercise program in patients with rheumatoid arthritis]. / Namuose ir ambulatoriskai atliekamu fiziniu pratimu efektyvumas sergant reumatoidiniu artritu.

OBJECTIVE: To compare the efficiency of home and outpatient exercise program in patients with rheumatoid arthritis. METHODS: Patients with rheumatoid arthritis were randomly assigned to home exercise program group and outpatient exercise program group. Variables of muscle and hand strength, joint mobility, visual analog scale of pain were assessed before and after the 3 months exercise course. RESULTS: Out of 43 patients, 31 completed the study. Both groups improved in measures of muscle strength, joint mobility and pain. Differences between groups were statistically significant for measures of grip strength in the home exercise group (p=0.0001), and joint mobility--in the outpatient exercise group (p=0.047). CONCLUSIONS: Exercise program was more effective in improving grip strength in the home exercise program group and joint mobility improved more in the outpatient exercise group.

[Bone mineral density in healthy Lithuanian women]. / Sveiku Lietuvos moteru kaulu mineralu tankis.

OBJECTIVE: The purposes of this investigation were to determine spine and femoral bone mineral density for a representative sample of healthy women of Lithuanian descent and to compare these results with US/European reference data. METHODS: We randomly selected 1200 women aged 20-79 years from Lithuanian population registers. Densitometry of the lumbar spine and left proximal femur was determined by a LUNAR DPX-IQ system (Lunar corp., Madison, WI). The general exclusion criteria for the construction of representative samples of Lithuanian women included early menopause and diseases, use of drugs and toxic habits such as smoking and alcoholism, known to affect bone and mineral metabolism. RESULTS: Eight-hundred-seven women completed the study. The bone mineral density results were grouped into 10-year age cohorts. A comparison between the Lithuanian and Caucasian data, using the two-tailed t-test, showed that there was no statistically significant difference between them for all age groups at the P<0.05 level. The Lithuanian women show the expected gradual reduction of bone mineral density with age, after peaking at 20-39. The bone mineral density of Lithuanian women tends to mirror rates of loss established for US/European subjects. CONCLUSION: Our bone mineral density measurements for healthy Lithuanian females are not significantly different from the normative Caucasian female reference data both in terms of average values and degree of spread.