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1.
Osteoporos Int ; 31(6): 1145-1153, 2020 Jun.
Article de Anglais | MEDLINE | ID: mdl-32034452

RÉSUMÉ

We examined the underlying relationship between fracture risk factors and their imminent risk. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher imminent fracture risk. Past year falls indirectly predicted imminent risk through physical functioning and general health. INTRODUCTION: This study aimed to examine direct and indirect effects of several factors on imminent (1 year) fracture risk. METHODS: Data from women age 65 and older from population-based Canadian Multicentre Osteoporosis Study were used. Predictors were identified from study years 5 and 10, and imminent fracture data (1-year fracture) came from years 6 and 11 (year 5 predicts year 6, year 10 predicts year 11). A structural equation model (SEM) was used to test the theoretical construct. General health and physical functioning were measured as latent variables using items from the 36-Item Short Form Health Survey (SF-36) and bone mineral density (BMD) T-score was a latent variable based on observed site-specific BMD data (spine L1-L4, femoral neck, total hip). Observed variables were fractures and falls. Model fit was evaluated using root mean square error of approximation (RMSEA), Tucker Lewis index (TLI), and comparative fit index (CFI). RESULTS: The analysis included 3298 women. Model fit tests showed that the SEM fit the data well; χ2(172) = 1122.10 < .001, RMSEA = .03, TLI = .99, CFI = .99. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher risk of fracture in the subsequent year (p < .001). Past year falls had a statistically significant but indirect effect on imminent fracture risk through physical functioning and general health (p < .001). CONCLUSIONS: We found several direct and indirect pathways that predicted imminent fracture risk in elderly women. Future studies should extend this work by developing risk scoring methods and defining imminent risk thresholds.


Sujet(s)
Densité osseuse , Fractures osseuses/épidémiologie , Ostéoporose/épidémiologie , Sujet âgé , Canada/épidémiologie , Études de cohortes , Femelle , Humains , Modèles théoriques , Facteurs de risque
2.
Clin Endocrinol (Oxf) ; 86(4): 520-525, 2017 Apr.
Article de Anglais | MEDLINE | ID: mdl-28090669

RÉSUMÉ

OBJECTIVE: To determine whether sclerostin is associated with fasting glucose, insulin levels, insulin resistance or increased risk of incident type 2 diabetes. BACKGROUND: Type 2 diabetic patients have a higher risk of fractures. Recent studies suggest sclerostin, a regulator of osteoblast activity, is associated with diabetes. MATERIALS AND METHODS: Sclerostin levels were obtained from 1778 individuals with no history of type 2 diabetes participating in the population-based Canadian Multicentre Osteoporosis Study (CaMos) cohort. Participants were followed until diagnosis of type 2 diabetes, death or end of the study period (31 December 2013). The relationship of sclerostin with fasting glucose, insulin levels and homoeostatic model assessment-insulin resistance (HOMA-IR) was studied in linear regression models. Cox proportional hazards models were used to determine the association of sclerostin levels and the risk of incident type 2 diabetes during a mean 7·5 years of follow-up. RESULTS: Fasting glucose, fasting insulin levels and HOMA-IR were weakly correlated with sclerostin levels (Spearman's correlation coefficient: 0·11, P < 0·05; -0·09, P < 0·05; and -0·07, P = 0·02, respectively). Multiple linear regression analyses confirmed a significant association between sclerostin and fasting insulin and HOMA-IR but no significant association with fasting glucose levels. Sclerostin levels were not found to be significantly associated with the risk of incident type 2 diabetes (HR: 1·30; 95% CI: 0·37-4·57). CONCLUSIONS: We observed an association between sclerostin levels with fasting insulin levels and HOMA-IR, but there was no clear association with type 2 diabetes risk. Further studies are needed to understand the role of sclerostin in type 2 diabetes.


Sujet(s)
Protéines morphogénétiques osseuses/sang , Diabète de type 2/sang , Protéines adaptatrices de la transduction du signal , Sujet âgé , Canada , Études de cohortes , Jeûne/sang , Marqueurs génétiques , Homéostasie , Humains , Incidence , Insuline/sang , Insulinorésistance , Adulte d'âge moyen , Risque
3.
Osteoporos Int ; 27(7): 2231-2240, 2016 07.
Article de Anglais | MEDLINE | ID: mdl-26879201

RÉSUMÉ

UNLABELLED: Muscle density is a risk factor for fractures in older adults; however, its association with falls is not well described. After adjusting for biologically relevant confounding factors, a unit decrease in muscle density was associated with a 17 % increase in odds of reporting a fall, independent of functional mobility. INTRODUCTION: Falls are the leading cause of injury, disability, and fractures in older adults. Low muscle density (i.e., caused by muscle adiposity) and functional mobility have been identified as risk factors for incident disability and fractures in older adults; however, it is not known if these are also independently associated with falls. The purpose of this study was to explore the associations of muscle density and functional mobility with fall status. METHODS: Cross-sectional observational study of 183 men and women aged 60-98 years. Descriptive data, including a 12-month fall recall, Timed Up and Go (TUG) test performance, lower leg muscle area, and density. Odds ratio (OR) of being a faller were calculated, adjusted for age, sex, body mass index, general health status, diabetes, and comorbidities. RESULTS: Every mg/cm(3) increase in muscle density (mean 70.2, SD 2.6 mg/cm(3)) independently reduced the odds of being a faller by 19 % (OR 0.81 [95 % CI 0.67 to 0.97]), and every 1 s longer TUG test time (mean 9.8, SD 2.6 s) independently increased the odds by 17 % (OR 1.17 [95 % CI 1.01 to 1.37]). When both muscle density and TUG test time were included in the same model, only age (OR 0.93 [95 % CI 0.87 to 0.99]) and muscle density (OR 0.83 [95 % CI 0.69 to 0.99]) were independently associated with fall status. CONCLUSIONS: Muscle density was associated with fall status, independent of functional mobility. Muscle density may compliment functional mobility tests as a biometric outcome for assessing fall risk in well-functioning older adults.


Sujet(s)
Chutes accidentelles , Muscles squelettiques/physiologie , Sujet âgé , Sujet âgé de 80 ans ou plus , Études transversales , Femelle , Évaluation gériatrique , Humains , Vie autonome , Mâle , Adulte d'âge moyen , Facteurs de risque
4.
Am J Med ; 129(2): 221.e1-10, 2016 Feb.
Article de Anglais | MEDLINE | ID: mdl-26524708

RÉSUMÉ

Vertebral fractures are common and can result in acute and chronic pain, decreases in quality of life, and diminished lifespan. The identification of vertebral fractures is important because they are robust predictors of future fractures. The majority of vertebral fractures do not come to clinical attention. Numerous modalities exist for visualizing suspected vertebral fracture. Although differing definitions of vertebral fracture may present challenges in comparing data between different investigations, at least 1 in 5 men and women aged >50 years have one or more vertebral fractures. There is clinical guidance to target spine imaging to individuals with a high probability of vertebral fracture. Radiology reports of vertebral fracture need to clearly state that the patient has a "fracture," with further pertinent details such as the number, recency, and severity of vertebral fracture, each of which is associated with risk of future fractures. Patients with vertebral fracture should be considered for antifracture therapy. Physical and pharmacologic modalities of pain control and exercises or physiotherapy to maintain spinal movement and strength are important components in the care of vertebral fracture patients.


Sujet(s)
Fractures ostéoporotiques , Fractures du rachis , Sujet âgé , Dorsalgie/étiologie , Canada/épidémiologie , Femelle , Humains , Mâle , Adulte d'âge moyen , Fractures ostéoporotiques/complications , Fractures ostéoporotiques/imagerie diagnostique , Fractures ostéoporotiques/épidémiologie , Fractures ostéoporotiques/prévention et contrôle , Prévalence , Qualité de vie , Radiographie , Facteurs de risque , Fractures du rachis/complications , Fractures du rachis/imagerie diagnostique , Fractures du rachis/épidémiologie , Fractures du rachis/prévention et contrôle
5.
Clin Endocrinol (Oxf) ; 82(3): 359-68, 2015 Mar.
Article de Anglais | MEDLINE | ID: mdl-25059283

RÉSUMÉ

CONTEXT: PTH is an essential regulator of mineral metabolism; PTH hypersecretion may result in hyperparathyroidism including normocalcaemic, primary and secondary hyperparathyroidism. OBJECTIVE: To examine the characteristics of participants with hyperparathyroid states and the relationship to bone mineral density (BMD). DESIGN AND PARTICIPANTS: A cross-sectional study of 1872 community-dwelling men and women aged 35+ years (mostly Caucasian) with available serum PTH from Year 10 Canadian Multicentre Osteoporosis Study follow-up (2005-07). PTH was determined using a second-generation chemiluminescence immunoassay. OUTCOME MEASURES: L1-L4, femoral neck and total hip BMD. RESULTS: We established a PTH reference range (2·7-10·2 pmol/l) based on healthy participants (i.e. normal serum calcium, serum 25-hydroxyvitamin D, kidney function and body mass index, who were nonusers of antiresorptives, glucocorticoids and diuretics and not diagnosed with diabetes or thyroid disease). Participants with PTH levels in the upper reference range (5·6-10·2 pmol/l), representing a prevalence of 10·7%, had lower femoral neck and total hip BMD, by 0·030 g/cm(2) [95% confidence interval: 0·009; 0·051] and 0·025 g/cm(2) (0·001; 0·049), respectively, than those with levels 2·7-5·6 pmol/l. Participants with normocalcaemic and secondary hyperparathyroidism also had lower total hip BMD than those with levels 2·7-5·6 pmol/l, and CaMos prevalences of normocalcaemic, primary and secondary hyperparathyroidism were 3·3%, 1·4% and 5·2%, respectively. CONCLUSION: We found reduced BMD in participants with accepted hyperparathyroid states but also a notable proportion of other participants that might benefit from having lower PTH levels.


Sujet(s)
Hyperparathyroïdie primitive/sang , Hyperparathyroïdie primitive/métabolisme , Hyperparathyroïdie secondaire/sang , Hyperparathyroïdie secondaire/métabolisme , Marqueurs biologiques/sang , Marqueurs biologiques/métabolisme , Densité osseuse/physiologie , Calcium/sang , Canada , Études transversales , Humains , Hyperparathyroïdie primitive/physiopathologie , Hyperparathyroïdie secondaire/physiopathologie , Dosage immunologique , Ostéoporose/sang , Ostéoporose/métabolisme , Ostéoporose/physiopathologie , Vitamine D/analogues et dérivés , Vitamine D/sang
6.
J Musculoskelet Neuronal Interact ; 13(4): 470-9, 2013 Dec.
Article de Anglais | MEDLINE | ID: mdl-24292617

RÉSUMÉ

OBJECTIVES: Our objective was to study changes in calcium and vitamin D intakes over time, and their cross-sectional and longitudinal associations with bone mineral density (BMD). METHODS: We followed 9382 women and men aged ≥25 and 899 aged 16-24, for 10 and 2 years respectively. RESULTS: Calcium and vitamin D intakes increased over time in adults, but decreased in women aged 16-18. The increased intakes in adults were largely attributable to the increased use of calcium and/or vitamin D supplements. Both the percentage of supplement users and average dose among users increased over time. There was nevertheless a high prevalence of calcium and vitamin D intake below the estimated average requirement. At baseline, higher calcium and vitamin D intakes were associated with higher total hip and femoral neck BMD in young men, and cumulatively high levels of calcium and vitamin D intakes over time contributed to better BMD maintenance at lumbar spine and hip sites in adult women. CONCLUSIONS: Although total intakes, particularly of vitamin D, frequently fell below the Institute of Medicine recommendations despite an increase over time in supplement use, we found some positive associations between total calcium and vitamin D intake and bone health.


Sujet(s)
Densité osseuse/physiologie , Calcium alimentaire/administration et posologie , Compléments alimentaires , Ostéoporose/imagerie diagnostique , Vitamine D/administration et posologie , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Canada , Femelle , Col du fémur/imagerie diagnostique , Hanche/imagerie diagnostique , Humains , Études longitudinales , Vertèbres lombales/imagerie diagnostique , Mâle , Adulte d'âge moyen , Études prospectives , Radiographie
7.
Med Eng Phys ; 34(4): 478-84, 2012 May.
Article de Anglais | MEDLINE | ID: mdl-21959170

RÉSUMÉ

A decrease in bone density at the hip or spine has been shown to increase the risk of fracture. A limitation of the bone mineral density (BMD) measurement is that it provides only a measure of a bone sample's average density when projected onto a 2D surface. Effectively, what determines bone fracture is whether an applied load exceeds ultimate strength, with both bone tissue material properties (can be approximated through bone density), and geometry playing a role. The goal of this project was to use bone geometry and BMD obtained from radiographs and DXA measurements respectively to estimate fracture risk, using a two-dimensional finite element model (FEM) of the sagittal plane of lumbar vertebrae. The Canadian Multicentre Osteoporosis Study (CaMos) data was used for this study. There were 4194 men and women over the age of 50 years, with 786 having fractures. Each subject had BMD testing and radiographs of their lumbar vertebrae. A single two dimensional FEM of the first to fourth lumbar vertebra was automatically generated for each subject. Bone tissue stiffness was assigned based on the BMD of the individual vertebrae, and adjusted for patient age. Axial compression boundary conditions were applied with a force proportional to body mass. The resulting overall strain from the applied force was found. Men and women were analyzed separately. At baseline, the sensitivity of BMD to predict fragility fractures in women and men was 3.77% and 0.86%, while the sensitivity of FEM to predict fragility fractures for women and men was 10.8% and 11.3%. The FEM ROC curve demonstrated better performance compared to BMD. The relative risk of being considered at high fracture risk using FEM at baseline, was a better predictor of 5 year incident fragility fracture risk compared to BMD.


Sujet(s)
Analyse des éléments finis , Fractures osseuses , Absorptiométrie photonique , Adulte , Sujet âgé , Densité osseuse , Études de cohortes , Module d'élasticité , Femelle , Fractures osseuses/diagnostic , Fractures osseuses/imagerie diagnostique , Fractures osseuses/physiopathologie , Humains , Vertèbres lombales/imagerie diagnostique , Vertèbres lombales/physiologie , Vertèbres lombales/physiopathologie , Mâle , Adulte d'âge moyen , Courbe ROC , Appréciation des risques , Facteurs temps
8.
Osteoporos Int ; 23(6): 1757-68, 2012 Jun.
Article de Anglais | MEDLINE | ID: mdl-21927921

RÉSUMÉ

UNLABELLED: This study determined the cost of treating fractures at osteoporotic sites (except spine fractures) for the year following fracture. While the average cost of treating a hip fracture was the highest of all fractures ($46,664 CAD per fracture), treating other fractures also accounted for significant expenditures ($5,253 to $10,410 CAD per fracture). INTRODUCTION: This study aims to determine the mean direct medical cost of treating fractures at peripheral osteoporotic sites in the year post-fracture (through 2 years post-hip fracture). METHODS: Health administrative databases from the province of Quebec, Canada were used to estimate the cost of treating peripheral fractures at osteoporotic sites for the year following fracture (through 2 years for hip fractures). Included in costs analyses were physician claims, emergency and outpatient clinic costs, hospitalization costs, and subsequent costs for treatment of complications. RESULTS: A total of 15,827 patients (mean age 72 years) who suffered one fracture at an osteoporotic site had data for analyses. Hip/femur fractures had the highest rate of hospital stays related to fracture (91%) and the highest rate of hospital stays associated with a post-fracture complication (8%). In the year following fracture, the mean (SD) costs (2009 Canadian dollars) of treating acute fractures and post-fracture complications were: hip/femur fracture $46,664 ($43,198), wrist fracture $5,253 ($18,982), and fractures at other peripheral sites $10,410 ($27,641). The average (SD) cost of treating post-fracture complications at the hip/femur in the second year post-fracture was $1,698 ($12,462). Hospitalizations associated with the fracture accounted for 88% of the total cost of fracture treatment. CONCLUSIONS: The treatment of hip fractures accounts for a significant proportion of the costs associated with the treatment of peripheral osteoporotic fractures. Interventions to reduce the incidence of fractures, particularly hip fractures, would result in significant cost savings to the health care system and would preserve quality of life in many patients.


Sujet(s)
Coûts des soins de santé/statistiques et données numériques , Hospitalisation/économie , Ostéoporose post-ménopausique/économie , Fractures ostéoporotiques/économie , Sujet âgé , Sujet âgé de 80 ans ou plus , Coûts et analyse des coûts , Femelle , Fractures de la hanche/économie , Fractures de la hanche/thérapie , Humains , Adulte d'âge moyen , Fractures ostéoporotiques/thérapie , Post-ménopause , Complications postopératoires/économie , Québec , Traumatismes du poignet/économie , Traumatismes du poignet/thérapie
9.
Bone ; 50(1): 401-8, 2012 Jan.
Article de Anglais | MEDLINE | ID: mdl-22154839

RÉSUMÉ

BACKGROUND: Physical activity (PA) is an important modifiable risk factor for both bone mineral density (BMD) and body mass index (BMI). However, BMI is itself strongly predictive of BMD. Our aim was to determine the association between PA and BMD, with consideration of BMI as a potential mediating factor. METHODS: The Canadian Multicentre Osteoporosis Study (CaMos) is a population-based prospective cohort study of Canadian women and men. PA was determined from interviewer-administered questionnaires at baseline and Year 5 and summarized as daily energy expenditure in total metabolic equivalents of the task multiplied by minutes/day (MET*m/d). Height, weight, and total hip and lumbar spine BMD were measured at baseline and Year 5. General linear models assessed relationships between PA and BMD, both cross-sectionally (baseline PA with baseline BMD) and longitudinally (average PA and change in PA with change in BMD). BMI was considered as a mediating factor. Potential confounders included age, center, education, caffeine intake, alcohol exposure, smoking history, history of weight-cycling, age at menarche, past use of oral contraceptives, history of >3 months missed menstruation, menopausal status, and antiresorptive use, as relevant. RESULTS: The study included 2855 men and 6442 women. PA was inversely associated with BMI at baseline, and an increase in PA between baseline and Year 5 was associated with a decrease in BMI, with 0.41 (95% CI: 0.22, 0.60) kg/m(2) loss per 1000 MET*m/d increase (in men) and 0.40 (95% CI: 0.23, 0.57) kg/m(2) loss per 1000 MET*m/d increase (in women). BMI was strongly associated with BMD, both cross-sectionally and longitudinally. However, increased PA was associated with a small increase in total hip BMD, 0.004 (95% CI: 0.000-0.008) g/cm(2) per 1000 MET*m/d (in men) and 0.003 (95% CI: 0.000-0.007) g/cm(2) per 1000 MET*m/d (in women). Average PA was associated with an increase in lumbar spine BMD in women, but not in men; it was not associated with change in total hip BMD in either sex. CONCLUSION: Increased PA is associated with an increase in BMD and a concomitant decrease in BMI. These findings suggest that population-level interventions to increase PA would favorably impact bone and other health outcomes.


Sujet(s)
Indice de masse corporelle , Densité osseuse , Activité motrice , Ostéoporose/physiopathologie , Canada , Études de cohortes , Femelle , Humains , Études longitudinales , Mâle , Études prospectives , Facteurs de risque , Enquêtes et questionnaires
10.
Osteoporos Int ; 22(12): 2963-72, 2011 Dec.
Article de Anglais | MEDLINE | ID: mdl-21311871

RÉSUMÉ

UNLABELLED: This study assessed whether osteoporosis diagnosis and treatment after an osteoporotic fracture can be increased by providing osteoporosis reading material to patients and family doctors or by watching a videocassette about osteoporosis. Educating patients about osteoporosis had little impact on whether a woman received an osteoporosis diagnosis or treatment. INTRODUCTION: The purpose of this study was to investigate the impact of two education-based interventions on osteoporosis diagnosis and treatment in women ≥ 50 years of age after fragility fracture. METHODS: Six to eight months after fracture, women were randomized into three groups: (1) control, (2) written materials, or (3) videocassette and written materials. Written materials for both the patient and physician detailed osteoporosis, fragility fracture, and available treatments; written materials for physicians were provided through patients. The educational videocassette presented similar information as the written material, but in greater depth. Rates of osteoporosis diagnosis and treatment following intervention were compared among groups using survival analysis methods. Statistical significance was set at p < 0.0167. RESULTS: At randomization, 1,174 women were without osteoporosis diagnosis and treatment, and after follow-up, 12% of the control group, 15% of the written materials group (p = 0.073), and 16% (p = 0.036) of the videocassette and written materials group were diagnosed with osteoporosis (statistical comparisons to control). Treatment rates were 8% for the control group, 12% for the written materials group (p = 0.052), and 11% for the videocassette and written materials group (p = 0.157). At randomization, 1,314 women were without treatment and after follow-up therapy was initiated in 10% of the control group, 13% of the written materials group (p = 0.107), and 13% of the videocassette and written materials group (p = 0.238). CONCLUSIONS: The educational interventions assessed in this trial were not satisfactory to increase osteoporosis diagnosis or treatment in recently fractured women to a clinically meaningful degree.


Sujet(s)
Fractures spontanées/diagnostic , Ostéoporose post-ménopausique/diagnostic , Fractures ostéoporotiques/diagnostic , Éducation du patient comme sujet , Médecins de famille/enseignement et éducation , Sujet âgé , Prestations des soins de santé/méthodes , Femelle , Études de suivi , Fractures spontanées/étiologie , Humains , Adulte d'âge moyen , Ostéoporose post-ménopausique/complications , Ostéoporose post-ménopausique/thérapie , Fractures ostéoporotiques/étiologie , Évaluation de programme , Publications , Enregistrement sur bande vidéo
12.
Osteoporos Int ; 20(11): 1911-9, 2009 Nov.
Article de Anglais | MEDLINE | ID: mdl-19333675

RÉSUMÉ

UNLABELLED: Treatment rates of osteoporosis after fracture are very low. Women who suffer a fragility fracture have a greater chance of receiving anti-fracture treatment if they had low bone mineral density (BMD), a fracture at the hip, femur or pelvis, administration of calcium and vitamin D supplements and/or an age > or =60 years. INTRODUCTION: This investigation identifies the predictors of osteoporosis treatment 6 to 8 months following fragility fracture in women >50 years of age. METHODS: In this prospective cohort study, women were recruited 0 to 16 weeks following fracture and classified as having experienced fragility or traumatic fractures (phase 1). Six to 8 months following fracture, women completed a questionnaire on demographic features, clinical characteristics and risk factors for osteoporosis (phase 2). Osteoporosis treatment was defined as initiating anti-fracture therapy (bisphosphonate, raloxifene, nasal calcitonin and teriparatide) after fracture in those previously untreated. RESULTS: Of the 1,273 women completing phase 1, 1,001 (79%) sustained a fragility fracture, and of these women, 738 were untreated for osteoporosis at phase 1 and completed the phase 2 questionnaire. Significant predictors of treatment included BMD result, fracture site, administration of calcium and vitamin D supplements at the time of fracture and age > or =60 years. All other risk factors for osteoporosis, such as fracture history after the age of 40 years, family history of osteoporosis and comorbidities did not significantly influence the treatment rate. CONCLUSIONS: Physicians largely based their decision to treat on BMD results and not on the clinical event-fragility fracture.


Sujet(s)
Agents de maintien de la densité osseuse/usage thérapeutique , Ostéoporose post-ménopausique/complications , Ostéoporose post-ménopausique/traitement médicamenteux , Fractures ostéoporotiques/étiologie , Sujet âgé , Densité osseuse , Calcium/usage thérapeutique , Prise de décision , Compléments alimentaires , Utilisation médicament/statistiques et données numériques , Femelle , Humains , Adulte d'âge moyen , Ostéoporose post-ménopausique/physiopathologie , Fractures ostéoporotiques/anatomopathologie , Fractures ostéoporotiques/prévention et contrôle , Sélection de patients , Prévention secondaire , Facteurs socioéconomiques , Vitamine D/usage thérapeutique
13.
Osteoporos Int ; 20(2): 283-90, 2009 Feb.
Article de Anglais | MEDLINE | ID: mdl-18581034

RÉSUMÉ

UNLABELLED: 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. INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.


Sujet(s)
Agents de maintien de la densité osseuse/usage thérapeutique , Oestrogénothérapie substitutive , Fractures osseuses/prévention et contrôle , Sujet âgé , Résorption osseuse , Études cas-témoins , Femelle , Études de suivi , Fractures osseuses/physiopathologie , Humains , Adulte d'âge moyen , Odds ratio , Études rétrospectives , Risque , Résultat thérapeutique
14.
Expert Opin Pharmacother ; 9(3): 491-8, 2008 Feb.
Article de Anglais | MEDLINE | ID: mdl-18220499

RÉSUMÉ

BACKGROUND: Men have higher rates of osteoporosis and suffer fragility fractures more often than previously believed. Fracture-related morbidity and mortality in men is substantially higher than in women. OBJECTIVE: To investigate alendronate for treating osteoporosis in men. METHODS: Search limited to 'men' and 'English'; keywords were 'osteoporosis' or 'bone density' or 'fracture' and 'alendronate'. RESULTS/CONCLUSIONS: Alendronate is an amino-bisphosphonate with proved efficacy for increasing bone mineral density in men with idiopathic or secondary osteoporosis and has demonstrated an ability to prevent vertebral fractures in men with low bone mass. There are trends for alendronate to decrease the risk of non-vertebral fracture, but larger trials are needed to conclusively establish this benefit. Alendronate is a well-tolerated and comparatively safe drug with an attractive once-a-week dosing regimen.


Sujet(s)
Alendronate/administration et posologie , Alendronate/usage thérapeutique , Agents de maintien de la densité osseuse/administration et posologie , Agents de maintien de la densité osseuse/usage thérapeutique , Ostéoporose/traitement médicamenteux , Alendronate/pharmacocinétique , Alendronate/pharmacologie , Agents de maintien de la densité osseuse/pharmacocinétique , Agents de maintien de la densité osseuse/pharmacologie , Fractures osseuses/prévention et contrôle , Glucocorticoïdes/effets indésirables , Humains , Mâle , Ostéoporose/induit chimiquement
15.
Osteoporos Int ; 19(1): 79-86, 2008 Jan.
Article de Anglais | MEDLINE | ID: mdl-17641811

RÉSUMÉ

UNLABELLED: In women aged 50 years or more who experienced a fracture, 81% suffered a fragility fracture. Six to eight months after fragility fracture, 79% had either not been investigated for osteoporosis or prescribed anti-fracture therapy. Despite fragility fractures being common in this population osteoporosis is under-diagnosed and under-treated. INTRODUCTION: The objective of this study was to evaluate the diagnostic and treatment rates for osteoporosis six months following fragility fracture. METHODS: This prospective cohort study was set in the general community from the Province of Quebec, Canada. Women at least 50 years of age who suffered a fracture were recruited during their initial visit to the hospital and had their fracture type classified as either fragility or traumatic. Six-to-eight months after fragility fracture, women were again contacted to evaluate the diagnostic and treatment rates of osteoporosis. RESULTS: Of the 2,075 women recruited over a 25 month period 1,688 (81%) sustained a fragility fracture and 387 (19%) sustained a traumatic fracture. Nine hundred and three participants with a fragility fracture were again contacted six-to-eight months after fracture. For the 739 women not on treatment on the recruitment day, only 15.4% initiated pharmacological therapy in the six-to-eight-month period following fracture and 79.0% had either not been investigated for osteoporosis or prescribed anti-fracture treatment. CONCLUSIONS: The proportion of fragility fractures to total fractures is higher than previously reported. Despite the availability of diagnostic modalities, effective treatments, and adequate health care assessments, there is a substantial care gap in the management of osteoporosis.


Sujet(s)
Fractures osseuses/diagnostic , Fractures spontanées/diagnostic , Ostéoporose/diagnostic , Sujet âgé , Sujet âgé de 80 ans ou plus , Continuité des soins , Épisode de soins , Femelle , Fractures osseuses/épidémiologie , Fractures osseuses/thérapie , Fractures spontanées/épidémiologie , Fractures spontanées/thérapie , Humains , Adulte d'âge moyen , Ostéoporose/épidémiologie , Ostéoporose/thérapie , Études prospectives , Québec/épidémiologie
16.
Osteoporos Int ; 19(4): 581-7, 2008 Apr.
Article de Anglais | MEDLINE | ID: mdl-17924051

RÉSUMÉ

UNLABELLED: We examined osteoporosis diagnosis/treatment in 2,187 community dwelling men age 50+. After five years in the study, 90% of men with fragility fractures remained undiagnosed and untreated for osteoporosis. The need to treat fragility fractures is well established in guidelines, and these numbers represent an important care gap. INTRODUCTION: Whether physicians in the community are recognizing and appropriately treating osteoporosis and fragility fractures in men remains unknown. We examined the rate of diagnosis and treatment in community dwelling men participating in the Canadian Multicentre Osteoporosis Study (CaMos). METHODS: Between February 1996 and September 2002, 2,187 participants were recruited from nine sites across Canada and prospectively followed. Information on osteoporosis diagnosis, fractures, medications were collected annually by a detailed questionnaire. DXA examination of lumbar spine (L1-4) and hip were conducted at baseline and year five. RESULTS: Diagnosis and treatment in men with clinical fragility fractures was low: at baseline and year five only 2.3% and 10.3% of men with a clinical fracture reported an osteoporosis diagnosis, respectively. At year five, 90% of men with a clinical fragility fracture were untreated. Hip fractures were the most commonly treated (37.5% by year five). A diagnosis of osteoporosis resulted in greater treatment: 67% of participants with diagnosed osteoporosis were treated with a bisphosphonate and 87% were taking calcium and/or vitamin D (year five). CONCLUSIONS: In this population-based study, both a diagnostic and therapeutic gap existed between knowledge and practice related to fragility fractures and osteoporosis in men aged >or=50 years.


Sujet(s)
Agents de maintien de la densité osseuse/usage thérapeutique , Densité osseuse/physiologie , Diphosphonates/usage thérapeutique , Fractures osseuses/prévention et contrôle , Ostéoporose/thérapie , Vitamine D/usage thérapeutique , Attitude envers la santé , Canada , Prestations des soins de santé/normes , Humains , Mâle , Adulte d'âge moyen , Ostéoporose/diagnostic , Ostéoporose/physiopathologie
17.
Osteoporos Int ; 17(2): 217-24, 2006 Feb.
Article de Anglais | MEDLINE | ID: mdl-15997420

RÉSUMÉ

The prevalence of osteoporosis in men is higher than previously assumed; consequently, numerous therapies are being investigated to treat these patients. The Canadian Database of Osteoporosis and Osteopenia patients (CANDOO) was analyzed to examine changes in bone mineral density (BMD) in consecutively seen osteoporotic men administered alendronate, etidronate or no bone-active drugs (control) over 1 year. A total of 244 men attending six Canadian osteoporosis clinics were included in the study (42 alendronate, 102 etidronate and 100 control). Multiple imputation was used to model missing data to provide a more robust statistical model. The imputed datasets (five) were analyzed using multivariable linear regression to determine differences between groups in the percent change of lumbar spine (LS) and femoral neck (FN) BMD from baseline to 1 year. Differences in the percent change in BMD from baseline were most notable at the LS in favor of alendronate (4.3%; 95% CI: 2.1, 6.6 ) and etidronate (2.1%; 95% CI: 0.3, 4.0) therapy when compared with controls. At the LS, alendronate therapy led to significantly greater (2.2%; 95% CI: 0.2, 4.2) gains in BMD as compared to etidronate therapy. Compared to controls, there were no significant differences in FN BMD with alendronate (2.1%; 95% CI: -0.4, 4.7) or etidronate therapy (0.9%; 95% CI: -1.1, 2.8), nor were there significant differences between bisphosphonate groups (1.3%; 95% CI: -1.1, 3.6, in favor of alendronate). While both alendronate and etidronate significantly increased LS BMD in osteoporotic men after 1 year in real-world settings, alendronate therapy resulted in significantly superior gains in LS BMD. The effect of these two bisphosphonates on fractures and FN BMD in osteoporotic men is likely positive, but requires further study.


Sujet(s)
Alendronate/usage thérapeutique , Agents de maintien de la densité osseuse/usage thérapeutique , Acide étidronique/usage thérapeutique , Ostéoporose/traitement médicamenteux , Taille/physiologie , Poids/physiologie , Densité osseuse/physiologie , Col du fémur/physiopathologie , Fractures osseuses/étiologie , Fractures osseuses/physiopathologie , Humains , Mode de vie , Vertèbres lombales/physiopathologie , Mâle , Adulte d'âge moyen , Ostéoporose/physiopathologie , Études prospectives , Analyse de régression , Résultat thérapeutique
18.
J Nutr Health Aging ; 7(5): 296-9, 2003.
Article de Anglais | MEDLINE | ID: mdl-12917743

RÉSUMÉ

BACKGROUND: The optimal intake of calcium and vitamin D for postmenopausal women not taking estrogen is not known. Further, there are indications that excess vitamin A as retinol might be detrimental to bone. OBJECTIVE: We determined whether dietary intakes of calcium and vitamin D were important for maintaining cortical and trabecular bone mineral density (BMD). We also determined whether nutrient supplements increased retinol intake to a level that would reduce BMD. DESIGN: This was a cross-sectional study of 58 women, age 45-75 years. Dietary intakes and lifestyle factors were assessed by retrospective questionnaires. BMD at the whole body, lumbar spine, and proximal femur (including neck, trochanter, and Wards) was measured using dual energy x-ray absorptiometry (DXA) bone densitometry. RESULTS: There were significant (p < 0.05) positive correlations between total calcium intake and BMD at all sites except spine. At the trochanter, the correlation between total vitamin D and BMD was significant while that between total retinol and BMD showed a trend (p < 0.10). In a stepwise multiple regression, a significant proportion of variance of BMD was accounted for by years since menopause (8.0 to 36.2 %) and body weight (14.5 to 27.1%) at most bone sites. Adding total calcium intake (food + supplements) into the model further accounted for a significant proportion of variance of BMD at cortical bone sites such as hip, femoral neck, Wards, and total body ( 5.2 - 8.4 %). There was no dietary calcium effect on BMD at the spine. CONCLUSION: The positive effect of total calcium intake on cortical BMD of postmenopausal women not taking estrogen suggests that supplemental calcium use is critical for maintaining bone mass. Increased retinol intake from nutrient supplements had no adverse effect on BMD.


Sujet(s)
Densité osseuse/effets des médicaments et des substances chimiques , Calcium alimentaire/administration et posologie , Ostéoporose post-ménopausique/étiologie , Rétinol/administration et posologie , Vitamine D/administration et posologie , Sujet âgé , Poids/physiologie , Densité osseuse/physiologie , Études de cohortes , Études transversales , Compléments alimentaires , Oestrogènes/administration et posologie , Femelle , Humains , Mode de vie , Adulte d'âge moyen , Ostéoporose post-ménopausique/prévention et contrôle , Post-ménopause , Enquêtes et questionnaires , Facteurs temps , Rétinol/effets indésirables
19.
Can J Physiol Pharmacol ; 80(10): 941-50, 2002 Oct.
Article de Anglais | MEDLINE | ID: mdl-12450060

RÉSUMÉ

The combined and separate effects of exercise training and bisphosphonate (etidronate) therapy on bone mineral in postmenopausal women were compared. Forty-eight postmenopausal women were randomly assigned (double blind) to groups that took intermittent cyclical etidronate; performed strength training (3 d/week) and received matched placebo; combined strength training with etidronate; or took placebo and served as nonexercising controls. Bone mineral, lean tissue, and fat mass were assessed by dual-energy X-ray absorptiometry before and after 12 months of intervention. After removal of outlier results, changes in bone mineral density (BMD) of the lumbar spine and bone mineral content (BMC) of the whole body were greater in the subjects given etidronate (+2.5 and +1.4%, respectively) compared with placebo (-0.32 and 0%, respectively) (p < 0.05), while exercise had no effect. There was no effect of etidronate or exercise on the proximal femur and there was no interaction between exercise and etidronate at any bone site. Exercise training resulted in significantly greater increases in muscular strength and lean tissue mass and greater loss of fat mass compared with controls. We conclude that etidronate significantly increases lumbar spine BMD and whole-body BMC and that strength training has no additional effect. Strength training favourably affects body composition and muscular strength, which may be important for prevention of falls.


Sujet(s)
Composition corporelle/effets des médicaments et des substances chimiques , Densité osseuse/effets des médicaments et des substances chimiques , Acide étidronique/usage thérapeutique , Exercice physique , Post-ménopause , Ration calorique/effets des médicaments et des substances chimiques , Femelle , Humains , Adulte d'âge moyen
20.
Med Sci Sports Exerc ; 33(12): 2111-7, 2001 Dec.
Article de Anglais | MEDLINE | ID: mdl-11740307

RÉSUMÉ

PURPOSE: To study the effect of creatine (Cr) supplementation combined with resistance training on muscular performance and body composition in older men. METHODS: Thirty men were randomized to receive creatine supplementation (CRE, N = 16, age = 70.4 +/- 1.6 yr) or placebo (PLA, N = 14, age = 71.1 +/- 1.8 yr), using a double blind procedure. Cr supplementation consisted of 0.3-g Cr.kg(-1) body weight for the first 5 d (loading phase) and 0.07-g Cr.kg(-1) body weight thereafter. Both groups participated in resistance training (36 sessions, 3 times per week, 3 sets of 10 repetitions, 12 exercises). Muscular strength was assessed by 1-repetition maximum (1-RM) for leg press (LP), knee extension (KE), and bench press (BP). Muscular endurance was assessed by the maximum number of repetitions over 3 sets (separated by 1-min rest intervals) at an intensity corresponding to 70% baseline 1-RM for BP and 80% baseline 1-RM for the KE and LP. Average power (AP) was assessed using a Biodex isokinetic knee extension/flexion exercise (3 sets of 10 repetitions at 60 degrees.s(-1) separated by 1-min rest). Lean tissue (LTM) and fat mass were assessed using dual energy x-ray absorptiometry. RESULTS: Compared with PLA, the CRE group had significantly greater increases in LTM (CRE, +3.3 kg; PLA, +1.3 kg), LP 1-RM (CRE, +50.1 kg; PLA +31.3 kg), KE 1-RM (CRE, +14.9 kg; PLA, +10.7 kg), LP endurance (CRE, +47 reps; PLA, +32 reps), KE endurance (CRE, +21 reps; PLA +14 reps), and AP (CRE, +26.7 W; PLA, +18 W). Changes in fat mass, fat percentage, BP 1-RM, and BP endurance were similar between groups. CONCLUSION: Creatine supplementation, when combined with resistance training, increases lean tissue mass and improves leg strength, endurance, and average power in men of mean age 70 yr.


Sujet(s)
Composition corporelle/effets des médicaments et des substances chimiques , Créatine/pharmacologie , Muscles squelettiques/effets des médicaments et des substances chimiques , Endurance physique/effets des médicaments et des substances chimiques , Haltérophilie/physiologie , Sujet âgé , Sujet âgé de 80 ans ou plus , Créatine/effets indésirables , Diarrhée/induit chimiquement , Méthode en double aveugle , Exercice physique/physiologie , Humains , Mâle , Adulte d'âge moyen , Crampe musculaire/induit chimiquement , Analyse et exécution des tâches
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