Differences in bone mineral density and geometry in men and women: the Newcastle Thousand Families Study at 50 years old.

In 1947 Sir James Spence initiated the Newcastle Thousand Families study, which recruited all 1142 children born in the city between May and June that year. At the age of 50 years, 832 survivors were traced and invited to attend for measurement of bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA). The aim was to compare BMD measurements of men and women in this cohort, before and after adjustment for skeletal size. The femoral neck shaft angles (NSA) were also measured manually from the DXA scan printouts. A total of 171 men and 218 women agreed to participate. As expected men had greater bone mineral content and bone area at all sites (p<0.0001) and were taller and heavier (p<0.0001) than women. Men also had significantly higher BMD than women at all regions (p<0.0002), except at the femoral neck or lumbar spine. After correction for skeletal size and body weight, men had statistically significantly lower volumetric BMD at all sites. The measurement of NSA had good intra/interobserver errors and precision (coefficient of variations 0.79%, 1.2% and 1.2%). Men had significantly larger NSAs (mean 130 degrees , range 121-138 degrees ) than women (mean 128 degrees , range 119-137 degrees ). We conclude that there are gender differences in BMD, skeletal size and geometry in middle aged men and women, which together with the subsequent rate of bone loss, may influence fracture risk in later life.

Hip pain onset in relation to cumulative workplace and leisure time mechanical load: a population based case-control study.

OBJECTIVE: In an unselected community sample of adults, to assess the role and importance of exposure to mechanical factors both at work and leisure in the aetiology of hip pain. METHOD: A population based prevalence case-control study. Cases and controls were identified from a population survey of 3847 subjects registered with two general practices in Cheshire, United Kingdom. All subjects received a postal questionnaire which inquired about hip pain during the past month. An occupational history was obtained, including exposure to each of seven physical demands. Information was also obtained on history of participation in eight common sporting activities. RESULTS: 88% of those invited to participate returned a completed questionnaire. The 352 subjects with hip pain were designated as cases, and the remaining 3002 subjects as controls. In people ever employed, hip pain was significantly associated with high cumulative workplace exposure (before onset) of walking long distances over rough ground, lifting/moving heavy weights, sitting for prolonged periods, walking long distances, frequent jumping between different levels, and standing for prolonged periods. Odds ratios (ORs) in the higher exposure categories ranged from 1.46 to 2.65. Cumulative exposure to three sporting activities was significantly associated with hip pain: track and field sports, jogging, and walking, with odds ratios varying between 1.57 to 1.94. On multivariate analysis three factors were independent predictors of hip pain onset: cumulative exposure of sitting for prolonged periods (higher exposure v not exposed: OR=1.82, 95% confidence interval (CI) 1.13 to 2.92), lifting weights >50 lb (23 kg) (OR=1.74, 95% CI 1.06 to 2.86) (both relating to the workplace), and walking as a leisure activity (OR=1.97, 95% CI 1.32 to 2.94). The population attributable risk associated with each of these activities was 21%, 13%, and 16%, respectively CONCLUSIONS: Cumulative exposure to some workplace and sporting "mechanical" risk factors for hip osteoarthritis (OA) appear to be related to hip pain in general-some (but not all) have previously been related to hip OA. Because these are common workplace or leisure time activities their attributable risk is high.

How does the short form 36 health questionnaire (SF-36) in rheumatoid arthritis (RA) relate to RA outcome measures and SF-36 population values? A cross-sectional study.

The aim of the study was to show that the SF-36 is a practical tool for use on outpatients with RA, to examine the relationship between the SF-36 and indices of outcome in RA, and to compare the results with population norms and other disease states. Eighty-six consecutive RA patients attending the Haywood Hospital in Stoke-on-Trent and starting or changing second-line therapy were enrolled. Disease outcome was assessed using the American College of Rheumatology core set and all subjects completed the SF-36 health questionnaire. The cohort had moderately active disease (median ESR 46) and appreciable disability (median HAQ 1.875). Impairment of health status was moderate to marked by the SF-36, with significant differences from population norms and chronic disease states such as low back pain. Good correlations were observed between HAQ and physical function (r>0.75, p<10(-6)) and HAQ and social function (r>0.61, p<10(-6)). In contrast, SF-36 scales for physical and emotional role showed no association with activity measures. We concluded that, SF-36 is a practical tool for use in patients with RA. HAQ is associated with its physical and social function scales. Other SF-36 scales, such as physical and emotional role, are not associated with activity core set measures; this suggests different information is involved. RA has a considerable impact on health status compared to other diseases.

Why not use OSRA? A comparison of Overall Status in Rheumatoid Arthritis (RA) with ACR core set and other indices of disease activity in RA.

OBJECTIVE: The Overall Status in Rheumatoid Arthritis (OSRA) is a recently validated measure designed for routine immediate clinical use in patients with rheumatoid arthritis (RA). It is composed of demographic data, activity score (activity total), damage score (damage total), and drug treatment. We tested the hypothesis that this tool relates to existing measures and pooled indices of disease activity, including the SF-36. METHODS: Demographic information, OSRA, SF-36, and the ACR core set [inflammatory indicators (ESR, CRP), tender and swollen joints, visual analog scale for pain, Patient and Physician Global Assessment, and Health Assessment Questionnaire (HAQ)] were collected for 86 consecutive outpatients with RA who were starting or changing second-line therapy and again at 6 months. OSRA measures were examined for their relationship to all core set variables (SF-36, HAQ, Stoke Index, Disease Activity Score, and Mallya-Mace) using Spearman's rank correlation. OSRA was used to audit 246 consecutive outpatients with RA to determine its clinical utility. RESULTS: The median age was 58 years (range 29-82); median disease duration 63 mo (range 3-384); OSRA disease activity (mean 3.8, range 0-8) and damage (mean 2.7, range 0-7) scores were strongly associated with specific ACR core set and SF-36 measures, and all pooled indices examined. OSRA disease activity was significantly higher in outpatients in whom second-line therapy was changed. CONCLUSION: (1) The OSRA was highly correlated with HAQ and core set measures of disease activity: (2) the OSRA damage total was strongly associated with HAQ and correlated strongly with both duration and Larsen score; (3) OSRA scores also correlated well with specific SF-36 measures (activity total with Physical Functioning and Bodily Pain; damage total with Physical and Social Functioning); (4) OSRA shows good correlation with pooled indices that cannot be performed immediately in clinic; and (5) the OSRA activity score shows a strong association with clinical decisions made in the outpatient department.

High prevalence of joint laxity in West Africans.

Previous surveys have suggested marked ethnic and geographical variation in the occurrence of joint hypermobility. We investigated the prevalence of joint hypermobility and the influences of age, sex, body mass and occupation in a rural Yoruba population in Nigeria. The study sample consisted of 204 individuals aged 6-66 yr from the townships of Igbo-ora and Eruwa in south western Nigeria. Sixty-eight had reported joint pain as part of a population survey of arthritic disorders and each was age and sex matched with one household and one neighbour control. Joint hypermobility was assessed, at four peripheral sites bilaterally and forward flexion of the trunk, by a single observer using the Beighton score. Each subject had weight and height recorded, answered a brief questionnaire about occupation and joint symptoms and was examined for peripheral joint disease. Only 11 (5%) of the subjects were negative at all five sites whereas 111 (54%) were hypermobile at three or more sites including 23 (11%) positive at all five. Using a score of 4/9 or greater as a cutoff, 88 (43%) were positive, including 35% of males and 57% of females. There was a linear decline with age in females but a more rapid decline only to age 35 yr in males. There was no relation to body mass or occupation. We conclude that joint hypermobility amongst this population is substantially greater than that recorded for other groups but is not associated with joint pain.