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The purpose of this paper is to describe rates of forearm fractures in adults in Norway 2008-2019. Incidence rate of distal forearm fractures declined over time in both sexes. Forearm fracture constitute a significant health burden and prevention strategies are needed. PURPOSE: To assess age- and sex-specific incidence rates, and time trends for forearm fractures in Norway, and compare these with incidence rates in other Nordic countries. METHODS: Data on all patients aged 20-107 years with forearm fractures treated in Norwegian hospitals from 2008 to 2019 was retrieved from the Norwegian Patient Registry. Fractures were identified based on International Classification of Disease 10th revision code S52. Age- and sex-specific incidence rates and changes in incidence rates were calculated. RESULTS: We identified 181,784 forearm fractures in 45,628,418 person-years. Mean annual forearm fracture incidence rates per 100,000 person-years were 398 (95% CI 390-407) for all, 565 (95% CI 550-580) for women, and 231 (95% CI 228-234) for men above 20 years. Mean annual number of forearm fractures was 15,148 (95% CI 14,575-15,722). From 2008 to 2019, age-adjusted total incidence rates of forearm fractures S52 diagnoses declined by 3.5% (incidence rate ratio (IRR) of 0.997 (95% CI 0.994-0.999)) in men. The corresponding decline in women was not significant (IRR: 0.999 (95% CI 0.997-1.002)). In the same period, the age-adjusted incidence rates of distal forearm fractures declined by 7.0% in men (IRR = 0.930; 95% CI 0.886-0.965) and 4.7% in women (IRR = 0.953; 95% CI 0.919-0.976). The incidence rates of distal forearm fractures were similar to rates in Sweden and Finland. CONCLUSION: Age-adjusted incidence rates of distal forearm fractures in both sexes declined over time.
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Anilidas , Traumatismos do Antebraço , Fraturas Ósseas , Fraturas do Quadril , Fraturas do Punho , Adulto , Masculino , Humanos , Feminino , Antebraço , Distribuição por Idade , Fraturas Ósseas/epidemiologia , Traumatismos do Antebraço/epidemiologia , Noruega/epidemiologia , Incidência , Fraturas do Quadril/epidemiologiaRESUMO
OBJECTIVE: Norway has a high incidence of forearm fractures, however, the incidence rates based on secondary care registers can be underestimated, as some fractures are treated exclusively in primary care. We estimated the proportion of forearm fracture diagnoses registered exclusively in primary care and assessed the agreement between diagnosis for forearm fractures in primary and secondary care. DESIGN: Quality assurance study combining nationwide data from 2008 to 2019 on forearm fractures registered in primary care (Norwegian Control and Payment of Health Reimbursement) and secondary care (the Norwegian Patient Registry). SETTING AND PATIENTS: Forearm fracture diagnoses in patients aged ≥20 treated in primary care (n = 83,357) were combined with injury diagnoses for in- and outpatients in secondary care (n = 3,294,336). MAIN OUTCOME MEASURES: Proportion of forearm fractures registered exclusively in primary care, and corresponding injury diagnoses for those registered in both primary and secondary care. RESULTS: Of 189,105 forearm fracture registrations in primary and secondary care, 13,948 (7.4%) were registered exclusively in primary care. The proportion ranged from 4.9% to 13.5% on average between counties, but was higher in some municipalities (>30%). Of 66,747 primary care forearm fractures registered with a diagnosis in secondary care, 62% were incident forearm fractures, 28% follow-up controls, and 10% other fractures or non-fracture injuries. CONCLUSION: An overall small proportion of forearm fractures were registered only in primary care, but it was larger in some areas of Norway. Failing to include fractures exclusively treated in primary care could underestimate the incidence rates in these areas.
Norwegian forearm fracture incidence based on secondary care may be underestimated by not including fractures treated exclusively in primary care.The mean proportion of forearm fractures exclusively handled in primary care is 7% and varies from 5% to 14% between counties.Fractures treated in primary care can be considered for more accurate national incidence rates. Correct fracture diagnosis needs further investigation.
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Traumatismos do Antebraço , Fraturas Ósseas , Humanos , Antebraço , Fraturas Ósseas/epidemiologia , Traumatismos do Antebraço/diagnóstico , Traumatismos do Antebraço/epidemiologia , Traumatismos do Antebraço/terapia , Incidência , Atenção Primária à SaúdeRESUMO
INTRODUCTION: Low birthweight is associated with diseases later in life. The mechanisms for these associations are not well known. If the hypothesis concerning "maternal constraint" is correct for humans, as shown in animal experiments, we expect the maternal, not paternal, body proportions to influence antenatal growth and those of both parents to influence postnatal growth. We aimed to study the effect of maternal and paternal height and weight on fetal femur length antenatally (gestational weeks 20 and 30) and body length and weight at birth and postnatally (12 and 24 months old) in both sexes. MATERIAL AND METHODS: In this prospective cohort study, 399 healthy pregnant women aged 20-42 years were recruited at The Mercy Hospital for Woman, Melbourne, Australia from 2008 to 2009. Fetal femur length was measured using antenatal ultrasound (gestational weeks 20 and 30). Body length and weight were measured for parents and offspring at birth and postnatally (12 and 24 months). RESULTS: Each standard deviation (SD) rise in maternal weight (15.5 kg) was associated with 0.24 SD (0.5 mm) and 0.18 SD (0.4 mm) longer femur length in female and male fetuses at week 20 and 0.17 SD (0.5 mm) and 0.38 SD (1.1 mm) longer femur length in female and male fetuses at week 30, respectively. In girls, each SD rise in paternal height (7.2 cm) was associated with 0.29 SD (0.6 cm) longer birth length. In boys, each SD rise in maternal height (6.7 cm) was associated with 0.23 SD (0.5 cm) longer birth length. In both sexes, parental height and weight were associated with offspring length and weight at 12 and 24 months (SD ranging from 0.20 to 0.38, length from 0.7 to 1.5 cm and weight from 0.3 to 0.6 kg). The multivariable linear regression analyses were adjusted for parental age, height and weight, maternal smoking, alcohol intake, parity, and ethnicity, all P < 0.05. CONCLUSIONS: Maternal, not paternal, body proportions determined fetal growth in both sexes. Paternal height predicted birth length in girls. In contrast, maternal height predicted birth length in boys. Both parents predicted postnatal body proportions at 12 and 24 months in both sexes.
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Peso ao Nascer/fisiologia , Estatura/fisiologia , Peso Corporal/fisiologia , Fêmur/embriologia , Pais , Adulto , Feminino , Fêmur/diagnóstico por imagem , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Prospectivos , Ultrassonografia Pré-NatalRESUMO
BACKGROUND: The aim was to investigate the prevalence of gestational diabetes and pregnancy outcomes in women with gestational diabetes in Nordland and Troms counties. MATERIAL AND METHOD: We included all 1 067 women with type 1 diabetes, type 2 diabetes and gestational diabetes among 34 915 births at four hospitals in Nordland and Troms counties from 2004 to 2015. Prevalence of diabetes was calculated based on ICD-10 codes in patient records for women with diabetes in Nordland and Troms counties, and compared with national prevalence figures from the Medical Birth Registry of Norway. Prevalence of pre-eclampsia, macrosomia (birth weight > 4 500 grams) and caesarian section was calculated for all women with diabetes and all those giving birth in the same region. RESULTS: Prevalence of type 1 diabetes and type 2 diabetes remained stable. Prevalence of gestational diabetes increased from 1.0 % to 4.0 % in Nordland and Troms counties and from 1.0 % to 3.8 % nationally. Prevalence of pre-eclampsia among all women with diabetes fell from 18.8 % in 2004-06 to 12.4 % in 2013-15. In women with diabetes, the prevalence of pre-eclampsia was 4.6 times higher, that of macrosomia was 3.5 times higher, and the proportion of caesarian sections was 2.3 times higher than in the background population. INTERPRETATION: Prevalence of gestational diabetes increased in Nordland and Troms counties, as it did nationally. Prevalence of pre-eclampsia among pregnant women with diabetes fell, but prevalence of pre-eclampsia, macrosomia and caesarean section was higher than in the background population.
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Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Cesárea , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Noruega/epidemiologia , Gravidez , Resultado da Gravidez , PrevalênciaRESUMO
BACKGROUND AND AIMS: High levels of inflammatory markers shortly after an ischemic stroke are associated with a worse prognosis. Whether inflammatory markers predict long-term mortality in stroke-survivors is less clear. We examined whether a persisting inflammatory response (levels of inflammatory markers >1 year after the stroke event) was associated with long-term mortality. METHODS: We recruited participants from the Tromsø Study, Norway, in a nested case-control design. At baseline in 1997, white blood cell count (WBC), serum levels of fibrinogen, interleukin 6 (IL-6) and high sensitive C-reactive protein (hs-CRP) were analysed in 187 stroke-survivors, a median of 7.0 years (range 1-43) after the first-ever ischemic stroke, and in 243 stroke-free subjects. Cox proportional hazard regression model was used to examine whether inflammatory markers predicted all-cause mortality in both groups from 1997 to 2013. RESULTS: During an average of 16 years follow-up, 117 (62.5 %) stroke-survivors and 107 (44.0 %) stroke-free subjects deceased (p for differences 0.005). In stroke-survivors, fibrinogen and log IL-6 predicted all-cause mortality after adjustment for age, sex, BMI, smoking, Frenchay activity index, comorbidity and use of statins (HRs 1.26; 9 5 % CI 1.05-1.51 and 2.02; 95 % CI 1.12-3.64, respectively). In stroke-free subjects log hs-CRP predicted all-cause mortality after additionally accounting for levels of cholesterol, blood pressure and use of blood pressure lowering drugs (HR 1.95; 95 % CI 1.26-2.99). CONCLUSIONS: Fibrinogen and IL-6 were independent predictors of mortality in long-term stroke-survivors, whereas elevated hs-CRP predicted mortality in stroke-free subjects. Mortality risk prediction in stroke-survivors differed from that of stroke-free subjects.
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Proteína C-Reativa/análise , Fibrinogênio/análise , Inflamação/sangue , Interleucina-6/análise , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/mortalidade , Sobreviventes , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de RiscoAssuntos
Osteoporose , Complicações na Gravidez , Fraturas da Coluna Vertebral , Densidade Óssea , Aleitamento Materno , Feminino , Humanos , Lactação , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Gravidez , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologiaRESUMO
Higher stature and lower weight are associated with increased risk of fracture. However, the pathophysiology for the associations of height and weight with bone microarchitecture and geometry is unclear. We examined whether these associations were consistent with causation and/or with shared familial factors. In this cross-sectional study of 566 female twins aged 26-76 yr, a regression analysis for twin data, Inference about Causation by Examination of FAmilial CONfounding (ICE FALCON), was used for testing causation. The bone microarchitecture and geometry of the distal tibia was assessed using HR-pQCT and the StrAx1.0 software. Higher stature was associated with larger total bone cross-sectional area (CSA), lower total bone volumetric bone mineral density (vBMD), larger cortical CSA, thinner cortices, higher porosity of the total cortex, compact cortex, outer and inner transitional zone (TZ), lower cortical vBMD, and larger medullary CSA (regression coefficients (ß) ranging from -.37 to .60, all p<.05). Using ICE FALCON, the cross-pair cross-trait associations attenuated toward zero after adjusting for the within-individual association (absolute values of ß ranging from .05 to .31, all p<.001). Higher weight was associated with higher total bone vBMD, larger cortical CSA and thicker cortices, lower porosity of the total cortex and inner TZ, and higher cortical vBMD (ß ranging from -.23 to .34, all p<.001), and thinner trabeculae, higher trabecular number, lower trabecular separation, and higher trabecular vBMD (ß ranging from -.31 to .39, all p<.05). Only cortical CSA attenuated toward zero after adjusting for the within-individual association between weight and bone microarchitecture (ß = .042, p=.046). Higher stature was associated with a weaker cortical, not trabecular bone traits, whereas higher weight was associated with stronger cortical and trabecular bone traits. The results were consistent with height having a causal effect on weaker cortical bone structure, whereas weight had a casual effect on the larger cortical CSA.
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The current study investigated subsequent fracture risk following a forearm fracture in three country of birth categories: Norway, Europe and North America, and other countries. Subsequent fracture risk was modestly higher in Norwegian-born individuals compared to the two other groups. Secondary fracture prevention should be recommended regardless of country background. BACKGROUND: Fracture risk is higher in patients with a previous fracture, but whether subsequent fracture risk differs by origin of birth is unknown. This study explores subsequent fracture risk in patients with an index forearm fracture according to region of birth. METHODS: Nationwide data on forearm fractures in patients ≥ 18 years in 2008-2019 were obtained from the Norwegian Patient Registry and Statistics Norway. Index fractures were identified by ICD-10 code S52, whereas subsequent fractures included any ICD-10 fracture code. Data on country of birth were from Statistics Norway and included three regional categories: (1) Norway, (2) other Europe and North America and (3) other countries. Direct age standardization and Cox proportional hazard regression were used to analyse the data. RESULTS: Among 143,476 individuals with an index forearm fracture, 35,361 sustained a subsequent fracture. Norwegian-born forearm fracture patients had the highest subsequent fracture rates (516/10,000 person-years in women and 380 in men). People born outside Europe and North America had the lowest rates (278/10,000 person-years in women and 286 in men). Compared to Norwegian-born individuals, the hazard ratios (HRs) of subsequent fracture in individuals from Europe and North American were 0.93 (95% CI 0.88-0.98) in women and 0.85 (95% CI 0.79-0.92) in men. The corresponding HRs in individuals from other countries were 0.76 (95% CI 0.70-0.84) in women and 0.82 (95% CI 0.74-0.92) in men. CONCLUSION: Individuals born outside Norway had a lower subsequent fracture risk than Norwegian-born individuals; however, subsequent fracture risk increased with age in all groups. Our results indicate that secondary fracture prevention should be recommended regardless of region of origin.
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Emigrantes e Imigrantes , Traumatismos do Antebraço , Humanos , Masculino , Noruega/epidemiologia , Feminino , Pessoa de Meia-Idade , Idoso , Traumatismos do Antebraço/epidemiologia , Adulto , Emigrantes e Imigrantes/estatística & dados numéricos , Estudos de Coortes , Sistema de Registros , Fatores de Risco , Idoso de 80 Anos ou mais , Europa (Continente)/epidemiologia , Europa (Continente)/etnologia , Adulto Jovem , Fraturas da Ulna/epidemiologia , América do Norte/epidemiologia , AdolescenteRESUMO
Musculoskeletal research should synergistically investigate bone and muscle to inform approaches for maintaining mobility and to avoid bone fractures. The relationship between sarcopenia and osteoporosis, integrated in the term 'osteosarcopenia', is underscored by the close association shown between these two conditions in many studies, whereby one entity emerges as a predictor of the other. In a recent workshop of Working Group (WG) 2 of the EU Cooperation in Science and Technology (COST) Action 'Genomics of MusculoSkeletal traits Translational Network' (GEMSTONE) consortium (CA18139), muscle characterization was highlighted as being important, but currently under-recognized in the musculoskeletal field. Here, we summarize the opinions of the Consortium and research questions around translational and clinical musculoskeletal research, discussing muscle phenotyping in human experimental research and in two animal models: zebrafish and mouse.
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Fenótipo , Animais , Humanos , Músculo Esquelético/metabolismo , Peixe-Zebra , Camundongos , Sarcopenia/metabolismo , Sarcopenia/fisiopatologia , Doenças Musculoesqueléticas/fisiopatologia , Doenças Musculoesqueléticas/genética , Osteoporose/metabolismo , Osteoporose/patologiaRESUMO
The reasons for the association between physical activity (PA) and bone microarchitecture traits are unclear. We examined whether these associations were consistent with causation and/or with shared familial factors using a cross-sectional study of 47 dizygotic and 93 monozygotic female twin pairs aged 31-77 years. Images of the nondominant distal tibia were obtained using high-resolutionperipheral quantitative computed tomography. The bone microarchitecture was assessed using StrAx1.0 software. Based on a self-completed questionnaire, a PA index was calculated as a weighted sum of weekly hours of light (walking, light gardening), moderate (social tennis, golf, hiking), and vigorous activity (competitive active sports) = light + 2 * moderate + 3 * vigorous. We applied Inference about Causation through Examination of FAmiliaL CONfounding (ICE FALCON) to test whether cross-pair cross-trait associations changed after adjustment for within-individual associations. Within-individual distal tibia cortical cross-sectional area (CSA) and cortical thickness were positively associated with PA (regression coefficients [ß] = 0.20 and 0.22), while the porosity of the inner transitional zone was negatively associated with PA (ß = -0.17), all p < 0.05. Trabecular volumetric bone mineral density (vBMD) and trabecular thickness were positively associated with PA (ß = 0.13 and 0.14), and medullary CSA was negatively associated with PA (ß = -0.22), all p ≤ 0.01. Cross-pair cross-trait associations of cortical thickness, cortical CSA, and medullary CSA with PA attenuated after adjustment for the within-individual association (p = 0.048, p = 0.062, and p = 0.028 for changes). In conclusion, increasing PA was associated with thicker cortices, larger cortical area, lower porosity of the inner transitional zone, thicker trabeculae, and smaller medullary cavities. The attenuation of cross-pair cross-trait associations after accounting for the within-individual associations was consistent with PA having a causal effect on the improved cortical and trabecular microarchitecture of adult females, in addition to shared familial factors. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Densidade Óssea , Osso e Ossos , Feminino , Humanos , Absorciometria de Fóton , Osso e Ossos/diagnóstico por imagem , Estudos Transversais , Exercício Físico , Rádio (Anatomia) , Tíbia/diagnóstico por imagem , Adulto , Pessoa de Meia-Idade , IdosoRESUMO
The validity of forearm fracture diagnoses recorded in five Norwegian hospitals was investigated using image reports and medical records as gold standard. A relatively high completeness and correctness of the diagnoses was found. Algorithms used to define forearm fractures in administrative data should depend on study purpose. PURPOSE: In Norway, forearm fractures are routinely recorded in the Norwegian Patient Registry (NPR). However, these data have not been validated. Data from patient administrative systems (PAS) at hospitals are sent unabridged to NPR. By using data from PAS, we aimed to examine (1) the validity of the forearm fracture diagnoses and (2) the usefulness of washout periods, follow-up codes, and procedure codes to define incident forearm fracture cases. METHODS: This hospital-based validation study included women and men aged ≥ 19 years referred to five hospitals for treatment of a forearm fracture during selected periods in 2015. Administrative data for the ICD-10 forearm fracture code S52 (with all subgroups) in PAS and the medical records were reviewed. X-ray and computed tomography (CT) reports from examinations of forearms were reviewed independently and linked to the data from PAS. Sensitivity and positive predictive values (PPVs) were calculated using image reports and/or review of medical records as gold standard. RESULTS: Among the 8482 reviewed image reports and medical records, 624 patients were identified with an incident forearm fracture during the study period. The sensitivity of PAS registrations was 90.4% (95% CI: 87.8-92.6). The PPV increased from 73.9% (95% CI: 70.6-77.0) in crude data to 90.5% (95% CI: 88.0-92.7) when using a washout period of 6 months. Using procedure codes and follow-up codes in addition to 6-months washout increased the PPV to 94.0%, but the sensitivity fell to 69.0%. CONCLUSION: A relatively high sensitivity of forearm fracture diagnoses was found in PAS. PPV varied depending on the algorithms used to define cases. Choice of algorithm should therefore depend on study purposes. The results give useful measures of forearm fracture diagnoses from administrative patient registers. Depending on local coding practices and treatment pathways, we infer that the findings are relevant to other fracture diagnoses and registers.
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Traumatismos do Antebraço , Fraturas Ósseas , Feminino , Humanos , Masculino , Algoritmos , Antebraço , Traumatismos do Antebraço/diagnóstico , Traumatismos do Antebraço/epidemiologia , Hospitais , AdultoRESUMO
Our aim was to examine associations between leisure time physical activity and risk of non-vertebral fractures in men and women aged ≥55 years, with focus on the anatomical fracture location. Self-reported physical activity was registered in 3,450 men and 4,072 women aged 55-97 years at baseline in the Tromsø Study, Norway, in 1994-1995. Non-vertebral fractures were registered through December 31, 2009. During 75,546 person-years at risk, 1,693 non-vertebral fractures were identified. Risk of any non-vertebral fracture decreased with increasing physical activity level in men (P (trend) = 0.006) and non-significantly in women (P (trend) = 0.15), after adjustment for age, body mass index, height, smoking, and previous fracture. The reduced fracture risk was due to a reduced risk in the weight-bearing skeleton, particular at the hip, whereas risk of fracture in the non-weight-bearing skeleton was not related to physical activity. At weight-bearing sites, an inverse relationship between physical activity and fracture risk was present in both sexes (P (trend) ≤ 0.013). Compared with sedentary subjects, the most active men and women had respectively 37% (HR = 0.63, 95% CI: 0.45, 0.88) and 23% (HR = 0.77, 95% CI: 0.62, 0.95) reduced fracture risk in the weight-bearing skeleton. Physical activity is associated with reduced fracture risk at weight-bearing sites, with no associations at non-weight-bearing sites, in both sexes. Habitual physical activity is an important amendable approach to prevent hip fracture.
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Exercício Físico/fisiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Recreação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pesos e Medidas Corporais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Medição de Risco , Fatores Sexuais , Suporte de CargaRESUMO
PURPOSE: Fracture risk is most frequently assessed using Dual X-ray absorptiometry to measure areal bone mineral density (aBMD) and using the Fracture Risk Assessment Tool (FRAX). However, these approaches have limitations and additional bone measurements may enhance the predictive ability of these existing tools. Increased cortical porosity has been associated with incident fracture in some studies, but not in others. In this prospective study, we examined whether cortical bone structure of the proximal femur predicts incident fractures independent of aBMD and FRAX score. METHODS: We pooled 211 postmenopausal women with fractures aged 54-94 years at baseline and 232 fracture-free age-matched controls based on a prior nested case-control study from the Tromsø Study in Norway. We assessed baseline femoral neck (FN) aBMD, calculated FRAX 10-year probability of major osteoporotic fracture (MOF), and quantified femoral subtrochanteric cortical parameters: porosity, area, thickness, and volumetric BMD (vBMD) from CT images using the StrAx1.0 software. Associations between bone parameters and any incident fracture, MOF and hip fracture were determined using Cox's proportional hazard models to calculate hazard ratio (HR) with 95% confidence interval. RESULTS: During a median follow-up of 7.2 years, 114 (25.7%) of 443 women suffered one or more incident fracture. Cortical bone structure did not predict any incident fracture or MOF after adjustment for age, BMI, and previous fracture. Each SD higher total cortical porosity, thinner cortices, and lower cortical vBMD predicted hip fracture with increased risk of 46-62% (HRs ranging from 1.46 (1.01-2.11) to 1.62 (1.02-2.57)). After adjustment for FN aBMD or FRAX score no association remained significant. Both lower FN aBMD and higher FRAX score predicted any incident fracture, MOF and hip fractures with HRs ranging from 1.45-2.56. CONCLUSIONS: This study showed that cortical bone measurements using clinical CT did not add substantial insight into fracture risk beyond FN aBMD and FRAX. We infer from these results that fracture risk related to the deteriorated bone structure seems to be largely captured by a measurement of FN aBMD and the FRAX tool.
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Fraturas do Quadril , Fraturas por Osteoporose , Absorciometria de Fóton/efeitos adversos , Densidade Óssea , Estudos de Casos e Controles , Osso Cortical/diagnóstico por imagem , Feminino , Fêmur/diagnóstico por imagem , Colo do Fêmur/diagnóstico por imagem , Fraturas do Quadril/complicações , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Estudos Prospectivos , Medição de Risco/métodosRESUMO
The serum bone turnover markers (BTM) procollagen type 1 N-terminal propeptide (P1NP) and C-terminal cross-linking telopeptide of type 1 collagen (CTX) are recommended for monitoring adherence and response of antiresorptive drugs (ARD). BTM are elevated about 1 year after fracture and therefore BTM target values are most convenient in ARD treatment follow-up of fracture patients. In this prospective cohort study, we explored the cut-off values of P1NP and CTX showing the best discriminating ability with respect to adherence and treatment effects, reflected in bone mineral density (BMD) changes. Furthermore, we explored the ability of BTM to predict subsequent fractures and BTM variation during daytime in patients using ARD or not. After a fragility fracture, 228 consenting patients (82.2% women) were evaluated for ARD indication and followed for a mean of 4.6 years (SD 0.5 years). BMD was measured at baseline and after 2 years. Serum BTM were measured after 1 or 2 years. The largest area under the curve (AUC) for discrimination of patients taking ARD or not was shown for P1NP <30 µg/L and CTX <0.25 µg/L. AUC for discrimination of patients with >2% gain in BMD (lumbar spine and total hip) was largest at cut-off values for P1NP <30 µg/L and CTX <0.25 µg/L. Higher P1NP was associated with increased fracture risk in patients using ARD (hazard ratio [HR]logP1NP = 15.0; 95% confidence interval [CI] 2.7-83.3), p = 0.002. P1NP and CTX were stable during daytime, except in those patients not taking ARD, where CTX decreased by 21% per hour during daytime. In conclusion, P1NP <30 µg/L and CTX <0.25 µg/L yield the best discrimination between patients taking and not taking ARD and the best prediction of BMD gains after 2 years. Furthermore, higher P1NP is associated with increased fracture risk in patients on ARD. BTM can be measured at any time during the day in patients on ARD. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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PURPOSE: Patients with end-stage kidney disease have an increased fracture risk. Whether mild to moderate reductions in kidney function is associated with increased fracture risk is uncertain. Results from previous studies may be confounded by muscle mass because of the use of creatinine-based estimates of the glomerular filtration rate (eGFRcre). We tested the hypothesis that lower eGFR within the normal range of kidney function based on serum cystatin C (eGFRcys) or both cystatin C and creatinine (eGFRcrecys) predict fractures better than eGFR based on creatinine (eGFRcre). METHODS: In the Tromsø Study 1994-95, a cohort of 3016 women and 2836 men aged 50-84 years had eGFRcre, eGFRcys and eGFRcrecys estimated using the Chronic Kidney Disease Epidemiology Collaboration equations. Hazard ratios (HRs) (95% confidence intervals) for fracture were calculated in Cox's proportional hazards models and adjusted for age, height, body mass index, bone mineral density, diastolic blood pressure, smoking, physical activity, previous fracture, diabetes and cardiovascular disease. RESULTS: During a median of 14.6 years follow-up, 232, 135 and 394 women and 118, 35 and 65 men suffered incident hip, proximal humerus and wrist fractures. In women, lower eGFRcre did not predict fracture, but the risk for hip and proximal humerus fracture increased per standard deviation (SD) lower eGFRcys (HRs 1.36 (1.16-1.60) and 1.33 (1.08-1.63)) and per SD lower eGFRcrecys (HRs 1.25 (1.08-1.45) and 1.30 (1.07-1.57)). In men, none of the eGFR estimates were related to increased fracture risk. In contrast, eGFRcys and eGFRcrecys were inversely associated with hip fracture risk (HRs 0.85 (0.73-0.99) and 0.82 (0.68-0.98)). CONCLUSIONS: In women, each SD lower eGFRcys and eGFRcrecys increased the risk of hip and proximal humerus fracture by 25-36%, whereas eGFRcre did not. In men, none of the estimates of eGFR were related to increased fracture risk, and each SD lower eGFRcys and eGFRcrecys decreased the risk of hip fracture by 15-18%. The findings particularly apply to a cohort of generally healthy individuals with a normal kidney function. In future studies, the association of measured GFR using the gold standard method of iohexol clearance with fractures risk should be examined for causal inference. More clinical research is needed before robust clinical inferences can be made.
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Fraturas do Quadril , Insuficiência Renal Crônica , Creatinina , Cistatina C , Feminino , Taxa de Filtração Glomerular , Fraturas do Quadril/epidemiologia , Humanos , Úmero , Masculino , Insuficiência Renal Crônica/epidemiologia , Fatores de RiscoRESUMO
A synoptic overview of scientific methods applied in bone and associated research fields across species has yet to be published. Experts from the EU Cost Action GEMSTONE ("GEnomics of MusculoSkeletal Traits translational Network") Working Group 2 present an overview of the routine techniques as well as clinical and research approaches employed to characterize bone phenotypes in humans and selected animal models (mice and zebrafish) of health and disease. The goal is consolidation of knowledge and a map for future research. This expert paper provides a comprehensive overview of state-of-the-art technologies to investigate bone properties in humans and animals - including their strengths and weaknesses. New research methodologies are outlined and future strategies are discussed to combine phenotypic with rapidly developing -omics data in order to advance musculoskeletal research and move towards "personalised medicine".
Assuntos
Osso e Ossos/metabolismo , Genômica/métodos , Fenômenos Fisiológicos Musculoesqueléticos/genética , Animais , Osso e Ossos/patologia , Redes Reguladoras de Genes/fisiologia , Humanos , Camundongos , Modelos Animais , Fenótipo , Proteômica/métodos , Peixe-ZebraRESUMO
It is not known whether the relationships of lean mass (LM) and fat mass (FM) with bone microarchitecture and geometry are causal and/or are because of confounders, including familial confounders arising from genetic and environment effects shared by relatives. We tested the hypotheses that: (i) LM is associated with cortical bone traits, (ii) FM is associated with trabecular bone traits, and (iii) these relationships of LM and FM with bone microarchitecture and geometry have a causal component. Total body composition was quantified for 98 monozygotic (MZ) and 54 dizygotic (DZ) white female twin pairs aged 31 to 77 years. Microarchitecture at the distal tibia and distal radius was quantified using HRpQCT and StrAx software. We applied the Inference about Causation through Examination of FAmiliaL CONfounding (ICE FALCON) method. Within-individuals, distal tibia total bone area, cortical area, cortical thickness, and trabecular number were positively associated with LM (standardized regression coefficient (ß) = 0.13 to 0.43; all p < 0.05); porosity of the inner transitional zone (ITZ) was negatively associated with LM (ß = -0.22; p < 0.01). Trabecular number was positively associated with FM (ß = 0.40; p < 0.001), and trabecular thickness was negatively associated with FM (ß = -0.27; p < 0.001). For porosity of ITZ and trabecular number, the cross-pair cross-trait association with LM was significant before and after adjustment for the within-individual association with LM (all ps < 0.05). For trabecular number, the cross-pair cross-trait association with FM was significant before and after adjustment for the within-individual association with FM (p < 0.01). There were no significant changes in these cross-pair cross-trait associations after adjustment for the within-individual association (p = 0.06 to 0.99). Similar results were found for distal radius measures. We conclude that there was no evidence that the relationships of LM and FM with bone microarchitecture and geometry are causal; they must in part due to by familial confounders affecting both bone architecture and body composition. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
RESUMO
Aim of this study is to estimate the gender- and age-specific 10-year and lifetime absolute risks of non-vertebral and osteoporotic (included hip, distal forearm and proximal humerus) fractures in a large cohort of men and women. This is a population-based 10 years follow-up study of 26,891 subjects aged 25 years and older in Tromsø, Norway. All non-vertebral fractures were registered from 1995 throughout 2004 by computerized search in radiographic archives. Absolute risks were estimated by life-table method taking into account the competing risk of death. The absolute fracture risk at each year of age was estimated for the next 10 years (10-year risk) or up to the age of 90 years (lifetime risk). The estimated 10-year absolute risk of all non-vertebral fracture was higher in men than women before but not after the age of 45 years. The 10-year absolute risk for non-vertebral and osteoporotic fractures was over 10%, respectively, in men over 65 and 70 years and in women over 45 and 50 years of age. The 10-year absolute risks of hip fractures at the age of 65 and 80 years were 4.2 and 18.6% in men, and 9.0 and 24.0% in women, respectively. The risk estimates for distal forearm and proximal humerus fractures were under 5% in men and 13% in women. The estimated lifetime risks for all fracture locations were higher in women than men at all ages. At the age of 50 years, the risks were 38.1 and 24.8% in men and 67.4 and 55.0% in women for all non-vertebral and osteoporotic fractures, respectively. The estimated gender- and age-specific 10-year and lifetime absolute fracture risk were higher in Tromsø than in other populations. The high lifetime fracture risk reflects the increased burden of fractures in this cohort.
Assuntos
Fraturas Ósseas/epidemiologia , Osteoporose/complicações , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Traumatismos do Antebraço/epidemiologia , Fraturas Ósseas/etiologia , Fraturas do Quadril/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Medição de Risco , Fatores de Risco , Fraturas do Ombro/epidemiologiaRESUMO
Advancing age is accompanied by a reduction in bone formation and remodeling imbalance, which produces microstructural deterioration. This may be partly caused by a diversion of mesenchymal cells towards adipocytes rather than osteoblast lineage cells. We hypothesized that microstructural deterioration would be associated with an increased marrow adiposity, and each of these traits would be independently associated with nonvertebral fractures and improve discrimination of women with fractures from controls over that achieved by femoral neck (FN) areal bone mineral density (aBMD) alone. The marrow adiposity and bone microstructure were quantified from HR-pQCT images of the distal tibia and distal radius in 77 women aged 40 to 70 years with a recent nonvertebral fracture and 226 controls in Melbourne, Australia. Marrow fat measurement from HR-pQCT images was validated using direct histologic measurement as the gold standard, at the distal radius of 15 sheep, with an agreement (R2 = 0.86, p < 0.0001). Each SD higher distal tibia marrow adiposity was associated with 0.33 SD higher cortical porosity, and 0.60 SD fewer, 0.24 SD thinner, and 0.72 SD more-separated trabeculae (all p < 0.05). Adjusted for age and FN aBMD, odds ratios (ORs) (95% CI) for fracture per SD higher marrow adiposity and cortical porosity were OR, 3.39 (95% CI, 2.14 to 5.38) and OR, 1.79 (95% CI, 1.14 to 2.80), respectively. Discrimination of women with fracture from controls improved when cortical porosity was added to FN aBMD and age (area under the receiver-operating characteristic curve [AUC] 0.778 versus 0.751, p = 0.006) or marrow adiposity was added to FN aBMD and age (AUC 0.825 versus 0.751, p = 0.002). The model including FN aBMD, age, cortical porosity, trabecular thickness, and marrow adiposity had an AUC = 0.888. Results were similar for the distal radius. Whether marrow adiposity and cortical porosity indices improve the identification of women at risk for fractures requires validation in prospective studies. © 2019 American Society for Bone and Mineral Research.
Assuntos
Adiposidade , Densidade Óssea , Medula Óssea , Colo do Fêmur , Fraturas Ósseas , Adulto , Idoso , Austrália , Medula Óssea/metabolismo , Medula Óssea/patologia , Feminino , Colo do Fêmur/metabolismo , Colo do Fêmur/patologia , Fraturas Ósseas/metabolismo , Fraturas Ósseas/patologia , Humanos , Pessoa de Meia-Idade , PorosidadeRESUMO
PURPOSE: Norway has among the highest incidence rates of fractures in the world. Vertebral fracture assessment (VFA) and trabecular bone score (TBS) provide information about fracture risk, but their importance have not been studied in Norwegian patients with fragility fractures. The objectives of this study were to examine the clinical characteristics of a cohort of women and men with fragility fractures, their prevalence of vertebral fractures using VFA and prevalence of low TBS, and explore the differences between the sexes and patients with and without vertebral fractures. METHODS: This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative (NoFRACT) included 839 patients with fragility fractures. Of these, 804 patients had bone mineral density (BMD) of the total hip, femoral neck and/or spine assessed using dual energy x-ray absorptiometry, 679 underwent concomitant VFA, 771 had TBS calculated and 696 responded to a questionnaire. RESULTS: Mean age was 65.8 (SD 8.8) years and 80.5% were women. VFA revealed vertebral fractures in 34.8% of the patients and 34.0% had low TBS (≤ 1.23), with no differences between the sexes. In all patients with valid measures of both VFA and TBS, 53.8% had either vertebral fractures, low TBS, or both. In the patients with osteopenia at the femoral neck, 53.6% had either vertebral fractures, low TBS, or both. Femoral neck BMD T-scoreâ¯≤â¯-2.5 was found in 13.8% of all patients, whereas the corresponding figure was 27.4% using the skeletal site with lowest T-score. Women exhibited lower BMD at all sites and lower TBS than men (1.27 vs. 1.29), (all pâ¯<â¯0.05). Patients with prevalent vertebral fractures were older (69.4 vs. 64.0â¯years), exhibited lower BMD at all sites and lower TBS (1.25 vs.1.29) than those without vertebral fractures (all pâ¯<â¯0.05). Before assessment, 8.2% were taking anti-osteoporotic drugs (AOD), and after assessment, the prescription rate increased to 56.2%. CONCLUSIONS: More than half of the patients with fragility fractures had vertebral fractures, low TBS or both. The prescription of AOD increased seven fold from before assessment to after assessment, emphasizing the importance of risk assessment after a fragility fracture.