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Pj Meunier - One of the best experts on this subject based on the ideXlab platform.
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markers of bone resorption predict Hip Fracture in elderly women the epidos prospective study
Journal of Bone and Mineral Research, 2009Co-Authors: Patrick Garnero, Pj Meunier, C Cormier, G Breart, H Grandjean, E Hausherr, M C Chapuy, C Marcelli, C Muller, P D DelmasAbstract:Increased bone turnover has been suggested as a potential risk factor for osteoporotic Fractures. We investigated this hypothesis in a prospective cohort study performed on 7598 healthy women more than 75 years of age. One hundred and twenty-six women (mean years 82.5) who sustained a Hip Fracture during a mean 22-month follow-up were age-matched with three controls who did not Fracture. Baseline samples were collected prior to Fracture for the measurement of two markers of bone formation and three urinary markers of bone resorption : type I collagen cross-linked N- (NTX) or C-telopeptide (CTX) and free deoxypyridinoline (free D-Pyr). Elderly women had increased bone formation and resorption compared with healthy premenopausal women. Urinary excretion of CTX and free D-Pyr, but not other markers, was higher in patients with Hip Fracture than in age-matched controls (p = 0.02 and 0.005, respectively). CTX and free D-Pyr excretion above the upper limit of the premenopausal range was associated with an increased Hip Fracture risk with an odds ratio (95% confidence interval) of 2.2 (13-3.6) and 1.9 (1.1-3.2), respectively, while markers of formation were not. Increased bone resorption predicted Hip Fracture independently of bone mass, i.e., after adjustment for femoral neck bone mineral density (BMD) and independently of mobility status assessed by the gait speed. Women with both a femoral BMD value of 2.5 SD or more below the mean of young adults and either high CTX or high free D-Pyr levels were at greater risk of Hip Fracture, with an odds ratio of 4.8 and 4.1, respectively, than those with only low BMD or high bone resorption. Elderly women are characterized by increased bone turnover, and some markers of bone resorption predict the subsequent risk of Hip Fracture independently of Hip BMD. Combining the measurement of BMD and bone resorption may be useful to improve the assessment of the risk of Hip Fracture in elderly women.
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effect of risedronate on the risk of Hip Fracture in elderly women
The New England Journal of Medicine, 2001Co-Authors: Piet Geusens, Pd Miller, Hartmut Zippel, Wg Bensen, C Roux, S Adami, Ignac Fogelman, Terrence H Diamond, R Eastell, Pj MeunierAbstract:Background Risedronate increases bone mineral density in elderly women, but whether it prevents Hip Fracture is not known. Methods We studied 5445 women 70 to 79 years old who had osteoporosis (indicated by a T score for bone mineral density at the femoral neck that was more than 4 SD below the mean peak value in young adults [-4] or lower than -3 plus a nonskeletal risk factor for Hip Fracture, such as poor gait or a propensity to fall) and 3886 women at least 80 years old who had at least one nonskeletal risk factor for Hip Fracture or low bone mineral density at the femoral neck (T score, lower than -4 or lower than -3 plus a Hip-axis length of 11.1 cm or greater). The women were randomly assigned to receive treatment with oral risedronate (2.5 or 5.0 mg daily) or placebo for three years. The primary end point was the occurrence of Hip Fracture. Results Overall, the incidence of Hip Fracture among all the women assigned to risedronate was 2.8 percent, as compared with 3.9 percent among those assigned to placebo (relative risk, 0.7; 95 percent confidence interval, 0.6 to 0.9; P=0.02). In the group of women with osteoporosis (those 70 to 79 years old), the incidence of Hip Fracture among those assigned to risedronate was 1.9 percent, as compared with 3.2 percent among those assigned to placebo (relative risk, 0.6; 95 percent confidence interval, 0.4 to 0.9; P=0.009). In the group of women selected primarily on the basis of nonskeletal risk factors (those at least 80 years of age), the incidence of Hip Fracture was 4.2 percent among those assigned to risedronate and 5.1 percent among those assigned to placebo (P=0.35). Conclusions Risedronate significantly reduces the risk of Hip Fracture among elderly women with confirmed osteoporosis but not among elderly women selected primarily on the basis of risk factors other than low bone mineral density.
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ultrasonographic heel measurements to predict Hip Fracture in elderly women the epidos prospective study
The Lancet, 1996Co-Authors: D Hans, Patricia Dargentmolina, A M Schott, J L Sebert, C Cormier, P O Kotzki, P D Delmas, Jeanmichel Pouilles, G Breart, Pj MeunierAbstract:Summary Background The ability of ultrasonographic measurements to discriminate between patients with Hip Fracture and age-matched controls has until now been tested mainly through cross-sectional studies. We report the results of a prospective study to assess the value of measurements with ultrasound in predicting the risk of Hip Fracture. Methods 5662 elderly women (mean age 80 4 years) had both baseline calcaneal ultrasonography measurements and femoral radiography (dual-photon X-ray absorptiometry, DPXA) to assess their bone quality. Follow-up every 4 months enabled us to identify incident Fractures. 115 Hip Fractures were recorded during a mean follow-up duration of 2 years. Findings Low calcaneal ultrasonographic variables (obtained from measurements of broadband ultrasound attenuation by, and speed of sound through the bone) were able to predict an increased risk of Hip Fracture, with similar accuracy to low femoral bone mineral density (BMD) obtained by DPXA. The relative risk of Hip Fracture for 1 SD reduction was 20 (95% CI 16-24) for ultrasound attenuation and 17 (1 4–2 1) for speed of sound, compared with 19 (16-2 4) for BMD. After control for the femoral neck BMD, ultrasonographic variables remained predictive of Hip Fracture. The incidence of Hip Fracture among women with values above the median for both calcaneal ultrasound attenuation and femoral neck BMD was 2 7 per 1000 woman-years, compared with 19 6 per 1000 woman-years for those with values below the median for both measures. Interpretation Ultrasonographic measurements of the os calcis predict the risk of Hip Fracture in elderly women living at home as well as DPXA of the Hip does, and the combination of both methods makes possible the identification of women at very high or very low risk of Fracture.
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fall related factors and risk of Hip Fracture the epidos prospective study
The Lancet, 1996Co-Authors: Patricia Dargentmolina, Pj Meunier, A M Schott, F Favier, H Grandjean, C Baudoin, E Hausherr, G BreartAbstract:Summary Background Most Hip Fractures result from falls. However, the role of fall-related factors has seldom been examined. Comparison of the predictive value of these factors with that of bone mineral density (BMD) has important implications for the prevention of Hip Fractures. Methods We assessed femoral-neck BMD by dual-photon X-ray absorptiometry and potential fall-related risk factors, which included self-reported physical capacity, neuromuscular function, mobility, visual function, and use of medication in 7575 women, aged 75 years or older, with no history of Hip Fracture recruited at five centres in France. We followed up these women every 4 months to record incident Hip Fractures. During an average of 1·9 years of follow-up, 154 women suffered a first Hip Fracture. Findings In age-adjusted multivariate analyses, we found four independent fall-related predictors of Hip Fracture: slower gait speed (relative risk=1.4 for 1 SD decrease [95% CI 1.1-1.6]); difficulty in doing a tandem (heel-to-toe) walk (1.2 for 1 point on the difficulty score [1.0-1.5]); reduced visual acuity (2.0 for acuity ≤2/10 [1.1-3.7]); and small calf circumference (1.5 [1.0-2.2]). After adjustment for femoral-neck BMD, neuromuscular impairment—gait speed, tandem walk—and poor vision remained significantly associated with an increased risk of subsequent Hip Fracture. With high risk defined as the top quartile of risk, the rate of Hip Fracture among women classified as high risk based on both a high fall-risk status and low BMD was 29 per 1000 woman-years, compared with 11 per 1000 for women classified as high risk by either a high fall-risk status or low BMD; for women classified as low risk based on both criteria the rate was five per 1000. Interpretation We conclude that neuromuscular and visual impairments, as well as femoral-neck BMD, are significant and independent predictors of the risk of Hip Fracture in elderly mobile women, and that their combined assessment improves the prediction of Hip Fractures.
C Cooper - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of Hip Fracture incidence and probability of Fracture worldwide
Osteoporosis International, 2012Co-Authors: J A Kanis, Anders Oden, E V Mccloskey, Helena Johansson, D A Wahl, C CooperAbstract:The country-specific risk of Hip Fracture and the 10-year probability of a major osteoporotic Fracture were determined on a worldwide basis from a systematic review of literature. There was a greater than 10-fold variation in Hip Fracture risk and Fracture probability between countries. The present study aimed to update the available information base available on the heterogeneity in the risk of Hip Fracture on a worldwide basis. An additional aim was to document variations in major Fracture probability as determined from the available FRAX models. Studies on Hip Fracture risk were identified from 1950 to November 2011 by a Medline OVID search. Evaluable studies in each country were reviewed for quality and representativeness and a study (studies) chosen to represent that country. Age-specific incidence rates were age-standardised to the world population in 2010 in men, women and both sexes combined. The 10-year probability of a major osteoporotic Fracture for a specific clinical scenario was computed in those countries for which a FRAX model was available. Following quality evaluation, age-standardised rates of Hip Fracture were available for 63 countries and 45 FRAX models available in 40 countries to determine Fracture probability. There was a greater than 10-fold variation in Hip Fracture risk and Fracture probability between countries. Worldwide, there are marked variations in Hip Fracture rates and in the 10-year probability of major osteoporotic Fractures. The variation is sufficiently large that these cannot be explained by the often multiple sources of error in the ascertainment of cases or the catchment population. Understanding the reasons for this heterogeneity may lead to global strategies for the prevention of Fractures.
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epidemiology of Hip Fracture worldwide geographic variation
Indian Journal of Orthopaedics, 2011Co-Authors: Dinesh Kumar Dhanwal, Elaine M Dennison, Nicholas C Harvey, C CooperAbstract:Osteoporosis is a major health problem, especially in elderly populations, and is associated with fragility Fractures at the Hip, spine, and wrist. Hip Fracture contributes to both morbidity and mortality in the elderly. The demographics of world populations are set to change, with more elderly living in developing countries, and it has been estimated that by 2050 half of Hip Fractures will occur in Asia. This review conducted using the PubMed database describes the incidence of Hip Fracture in different regions of the world and discusses the possible causes of this wide geographic variation. The analysis of data from different studies show a wide geographic variation across the world, with higher Hip Fracture incidence reported from industrialized countries as compared to developing countries. The highest Hip Fracture rates are seen in North Europe and the US and lowest in Latin America and Africa. Asian countries such as Kuwait, Iran, China, and Hong Kong show intermediate Hip Fracture rates. There is also a north-south gradient seen in European studies, and more Fractures are seen in the north of the US than in the south. The factors responsible of this variation are population demographics (with more elderly living in countries with higher incidence rates) and the influence of ethnicity, latitude, and environmental factors. The understanding of this changing geographic variation will help policy makers to develop strategies to reduce the burden of Hip Fractures in developing countries such as India, which will face the brunt of this problem over the coming decades.
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Excess mortality following Hip Fracture: a systematic epidemiological review
Osteoporosis International, 2009Co-Authors: B. Abrahamsen, T. Staa, R. Ariely, M. Olson, C CooperAbstract:This systematic literature review has shown that patients experiencing Hip Fracture after low-impact trauma are at considerable excess risk for death compared with nonHip Fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlighting the need for interventions to reduce this risk. Patients experiencing Hip Fracture after low-impact trauma are at considerable risk for subsequent osteoporotic Fractures and premature death. We conducted a systematic review of the literature to identify all studies that reported unadjusted and excess mortality rates for Hip Fracture. Although a lack of consistent study design precluded any formal meta-analysis or pooled analysis of the data, we have shown that Hip Fracture is associated with excess mortality (over and above mortality rates in nonHip Fracture/community control populations) during the first year after Fracture ranging from 8.4% to 36%. In the identified studies, individuals experienced an increased relative risk for mortality following Hip Fracture that was at least double that for the age-matched control population, became less pronounced with advancing age, was higher among men than women regardless of age, was highest in the days and weeks following the index Fracture, and remained elevated for months and perhaps even years following the index Fracture. These observations show that patients are at increased risk for premature death for many years after a fragility-related Hip Fracture and highlight the need to identify those patients who are candidates for interventions to reduce their risk.
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Risk Factors for Hip Fracture
The New England Journal of Medicine, 1995Co-Authors: C Cooper, David J. P. BarkerAbstract:Hip Fractures are among the most important causes of ill health and death among elderly people. Of white North American women 50 years of age, 17.5 percent will have a Hip Fracture during their rem...
J A Kanis - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of Hip Fracture incidence and probability of Fracture worldwide
Osteoporosis International, 2012Co-Authors: J A Kanis, Anders Oden, E V Mccloskey, Helena Johansson, D A Wahl, C CooperAbstract:The country-specific risk of Hip Fracture and the 10-year probability of a major osteoporotic Fracture were determined on a worldwide basis from a systematic review of literature. There was a greater than 10-fold variation in Hip Fracture risk and Fracture probability between countries. The present study aimed to update the available information base available on the heterogeneity in the risk of Hip Fracture on a worldwide basis. An additional aim was to document variations in major Fracture probability as determined from the available FRAX models. Studies on Hip Fracture risk were identified from 1950 to November 2011 by a Medline OVID search. Evaluable studies in each country were reviewed for quality and representativeness and a study (studies) chosen to represent that country. Age-specific incidence rates were age-standardised to the world population in 2010 in men, women and both sexes combined. The 10-year probability of a major osteoporotic Fracture for a specific clinical scenario was computed in those countries for which a FRAX model was available. Following quality evaluation, age-standardised rates of Hip Fracture were available for 63 countries and 45 FRAX models available in 40 countries to determine Fracture probability. There was a greater than 10-fold variation in Hip Fracture risk and Fracture probability between countries. Worldwide, there are marked variations in Hip Fracture rates and in the 10-year probability of major osteoporotic Fractures. The variation is sufficiently large that these cannot be explained by the often multiple sources of error in the ascertainment of cases or the catchment population. Understanding the reasons for this heterogeneity may lead to global strategies for the prevention of Fractures.
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an estimate of the worldwide prevalence mortality and disability associated with Hip Fracture
Osteoporosis International, 2004Co-Authors: Olof Johnell, J A KanisAbstract:The aim of this study was to quantify the global burden of osteoporosis as judged by Hip Fracture and the burden in different socio-economic regions of the world. The population mortality in 1990 and the incidence of Hip Fracture in different regions were identified, where possible in 1990. Excess mortality from Hip Fracture used data for Sweden, and disability weights were assigned to survivors from Hip Fracture. In 1990 there were an estimated 1.31 million new Hip Fractures, and the prevalence of Hip Fractures with disability was 4.48 million. There were 740,000 deaths estimated to be associated with Hip Fracture. There were 1.75 million disability adjusted life-years lost, representing 0.1% of the global burden of disease world-wide and 1.4% of the burden amongst women from the established market economies. We conclude that Hip Fracture is a significant cause of morbidity and mortality worldwide.
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the components of excess mortality after Hip Fracture
Bone, 2003Co-Authors: J A Kanis, Anders Oden, Olof Johnell, C De Laet, Bengt Jonsson, Alan OglesbyAbstract:Abstract A high excess mortality is well described after Hip Fracture. Deaths are in part related to comorbidity and in part due directly or indirectly to the Hip Fracture event itself (causally related deaths). The aim of this study was to examine the quantum and pattern of mortality following Hip Fracture. We studied 160,000 Hip Fractures in men and women aged 50 years or more, in 28.8 million person-years from the patient register of Sweden, using Poisson models applied to Hip Fracture patients and the general population. At all ages the risk of death was markedly increased compared with population values immediately after the event. Mortality subsequently decreased over a period of 6 months, but thereafter remained higher than that of the general population. The latter function was assumed to account for deaths related to comorbidity and the residuum assumed to be due to the Hip Fracture. Causally related deaths comprised 17–32% of all deaths associated with Hip Fracture (depending on age) and accounted for more than 1.5% of all deaths in the population aged 50 years or more. Hip Fracture was a more common cause for mortality than pancreatic or stomach cancer. Thus, interventions that decreased Hip Fracture rate by, say, 50% would avoid 0.75% or more of all deaths.
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The incidence of Hip Fracture in Europe.
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteopor, 1993Co-Authors: J A KanisAbstract:Fragility Fractures are now recognized as a major public health problem. Although the prevalence of all Fractures is similar among men and women, the vast majority of osteoporotic Fractures occur in elderly women. These comprise vertebral compression Fractures, Colles' Fracture at the wrist and Hip Fracture, and to a lesser extent Fractures at other sites. The Fracture of greatest socioeconomic consequence in Europe is Hip Fracture, which increases exponentially in incidence with age. The reasons for differences in age- and sex-specific incidence relate in part to the lower bone density of women at the time of maturity (peak bone density) and the accelerated bone loss that occurs after the menopause. Women live significantly longer than men, so that the prevalence of osteoporosis amongst elderly women is six-fold that of men. The age-specific incidence of Hip Fracture is rising in men and women in many countries, and if the current trends in the United Kingdom continue then the number of Hip Fractures occurring each year will more than double over the next 20 years. There is a marked geographic distribution in the incidence of Hip Fractures, even in Europe. Indeed the differences in incidence between communities is greater than the differences in incidence between sexes within communities. This suggests that the importance of gonadal insufficiency in women has been overemphasized and that other factors, probably relating to genetic or lifestyle factors affecting peak bone density, account for ecological differences in incidence of Hip Fracture between communities.
J. M. Huddleston - One of the best experts on this subject based on the ideXlab platform.
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Secular trends in Hip Fracture incidence and recurrence
Osteoporosis International, 2009Co-Authors: L. J. Melton, Terry M. Therneau, A. E. Kearns, E. J. Atkinson, M. E. Bolander, S. J. Achenbach, J. M. Huddleston, C. L. LeibsonAbstract:The decline in Hip Fracture incidence is now accompanied by a further reduction in the likelihood of a recurrent Hip Fracture among survivors of the first Fracture. Introduction Hip Fracture incidence is declining in North America, but trends in Hip Fracture recurrence have not been described. Methods All Hip Fracture events among Olmsted County, Minnesota residents in 1980–2006 were identified. Secular trends were assessed using Poisson regression, and predictors of recurrence were evaluated with Andersen–Gill time-to-Fracture regression models. Results Altogether, 2,752 Hip Fractures (median age, 83 years; 76% female) were observed, including 311 recurrences. Between 1980 and 2006, the incidence of a first-ever Hip Fracture declined by 1.37%/year for women ( p
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secular trends in Hip Fracture incidence and recurrence
Osteoporosis International, 2009Co-Authors: L. J. Melton, Terry M. Therneau, A. E. Kearns, E. J. Atkinson, M. E. Bolander, S. J. Achenbach, J. M. Huddleston, C. L. LeibsonAbstract:Summary The decline in Hip Fracture incidence is now accompanied by a further reduction in the likelihood of a recurrent Hip Fracture among survivors of the first Fracture.
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effects of a hospitalist model on elderly patients with Hip Fracture
JAMA Internal Medicine, 2005Co-Authors: David J Vanness, Dirk R. Larson, Joseph L Melton, Kirsten Hall Long, Cathy D Schleck, Paul M Huddleston, J. M. HuddlestonAbstract:Background Hospitalists’ increased role in perioperative medicine allows for examination of their effects on surgical patients. This study examined the effects of a hospitalist service created to medically manage elderly patients with Hip Fracture. Methods During a 2-year historical cohort study of 466 patients 65 years or older admitted for surgical repair of Hip Fracture, we examined outcomes 1 year prior to and subsequent to the change from the standard to the hospitalist model. Results The mean (SD) time to surgery (38 [47] vs 25 [53] hours; P P = .04), and length of stay (10.6 [9] vs 8.4 [6] days; P P = .002), older age ( P = .01), and fall as the mechanism of Fracture ( P P P P P P Conclusion In elderly patients with Hip Fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.
C. L. Leibson - One of the best experts on this subject based on the ideXlab platform.
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Secular trends in Hip Fracture incidence and recurrence
Osteoporosis International, 2009Co-Authors: L. J. Melton, Terry M. Therneau, A. E. Kearns, E. J. Atkinson, M. E. Bolander, S. J. Achenbach, J. M. Huddleston, C. L. LeibsonAbstract:The decline in Hip Fracture incidence is now accompanied by a further reduction in the likelihood of a recurrent Hip Fracture among survivors of the first Fracture. Introduction Hip Fracture incidence is declining in North America, but trends in Hip Fracture recurrence have not been described. Methods All Hip Fracture events among Olmsted County, Minnesota residents in 1980–2006 were identified. Secular trends were assessed using Poisson regression, and predictors of recurrence were evaluated with Andersen–Gill time-to-Fracture regression models. Results Altogether, 2,752 Hip Fractures (median age, 83 years; 76% female) were observed, including 311 recurrences. Between 1980 and 2006, the incidence of a first-ever Hip Fracture declined by 1.37%/year for women ( p
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secular trends in Hip Fracture incidence and recurrence
Osteoporosis International, 2009Co-Authors: L. J. Melton, Terry M. Therneau, A. E. Kearns, E. J. Atkinson, M. E. Bolander, S. J. Achenbach, J. M. Huddleston, C. L. LeibsonAbstract:Summary The decline in Hip Fracture incidence is now accompanied by a further reduction in the likelihood of a recurrent Hip Fracture among survivors of the first Fracture.
