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  • 1
    Electronic Resource
    Electronic Resource
    Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report (1994)
    Springer
    Osteoporosis international 4 (1994), S. 368-381 
    Details
    ISSN: 1433-2965
    Keywords: Bone mineral measurement ; Fractures ; Osteoporosis ; Screening
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The criteria required for an effective screening strategy for osteoporosis are largely met in Caucasian women. The disease is common and readily diagnosed by the measurement of bone mineral with single- or dual-energy absorptiometry. Such measurements have high specificity but lower sensitivity, so that the value of the technique is greater for those identified as being at higher risk. Against this background there is little evidence that osteoporosis can usefully be tackled by a public health policy to influence risk factors such as smoking, exercise and nutrition. This suggests that it is appropriate to consider targetting of treatment with agents affecting bone metabolism to susceptible individuals. Since the main benefits of the use of hormone replacement therapy (HRT) are probably on cardiovascular morbidity, the major role for selective screening is to direct non-HRT interventions. An appropriate time to consider screening and intervention is at the menopause, but screening at later ages is also worthy of consideration. Since the cost of screening is low and that of bone-active drugs is high, the selective use of screening techniques will improve the cost-benefit ratio of intervention.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01622200
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  • 2
    Electronic Resource
    Electronic Resource
    Bone loss in the elderly (1994)
    Springer
    Osteoporosis international 4 (1994), S. S59 
    Details
    ISSN: 1433-2965
    Keywords: Bone loss ; Elderly ; Osteoporosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A large number of cross-sectional studies suggest that rates of bone loss decrease in the elderly, particularly at the spine and radius. For this reason it has been argued that bone mass measurements are unhelpful in assessing fracture risk in the elderly and that drugs affecting bone metabolism are less likely to be of benefit in reducing this risk. This paper reviews the assumptions on which these conclusions are based and argues that in many instances they are flawed. Indeed, studies examining rates of bone loss in the elderly either directly or by biochemical indices of bone turnover suggest that bone loss continues throughout life and may even accelerate after the age of 70 years. This conclusion supports the view that identification of patients at risk and subsequent treatment is of value in all age groups.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623438
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  • 3
    Electronic Resource
    Electronic Resource
    The incidence of hip fracture in Europe (1993)
    Springer
    Osteoporosis international 3 (1993), S. 10-15 
    Details
    ISSN: 1433-2965
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract 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 socioeco-nomic 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01621853
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  • 4
    Electronic Resource
    Electronic Resource
    Guidelines for clinical trials in Osteoporosis (1991)
    Springer
    Osteoporosis international 1 (1991), S. 182-188 
    Details
    ISSN: 1433-2965
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01625451
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  • 5
    Electronic Resource
    Electronic Resource
    The assessment of vertebral deformity: A method for use in population studies and clinical trials (1993)
    Springer
    Osteoporosis international 3 (1993), S. 138-147 
    Details
    ISSN: 1433-2965
    Keywords: Incidence ; Morphometry ; Prevalence ; Sensitivity ; Specificity ; Vertebral fracture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The absence of specific criteria for the definition of vertebral fracture has major implications for assessing the apparent prevalence and incidence of vertebral deformity. Also, little is known of the effect of using different criteria for new vertebral fractures in clinical studies. We therefore developed radiological criteria for vertebral fracture in women for assessing both the prevalence and the incidence of vertebral osteoporosis in population and in prospective studies and compared these with several other published methods. Normal ranges for vertebral shape were obtained from radiographs in 100 women aged 45–50 years. These included ranges for the ratios of anterior/posterior, central/posterior and posterior/predicted posterior vertebral heights from T4 to L5. The predicted posterior height was calculated from adjacent vertebrae. In contrast to other methods, our definition of fracture required the fulfilment of two criteria at each vertebral site, and was associated with a lower apparent prevalence of fracture in the control women due to a lower false positive rate. The prevalence and incidence of vertebral deformity using different criteria were then compared in a series of women with skeletal metastases from breast cancer in whom radiographs were obtained 6 months apart. The prevalence of vertebral deformity and the specificity for deformity varied markedly with differing criteria. Using a cut-off of 3 standard deviations the prevalence of vertebral deformity in the women with breast cancer was 46%. Using other methods, the prevalences of deformity ranged from 33% to 74%. Over a 6-month interval 25% of patients with breast cancer sustained 61 deformities using our method, of which only 8% resulted from errors in reproducibility. The number of patients sustaining new deformities was increased twofold when assessed by other methods (45%–53%), but errors of reproducibility may have accounted for 21% of the new deformities. The magnitude and distribution of these errors have important implications for the apparent therapeutic efficacy of agents in clinical trials of osteoporosis. The rapid semi-automated technique for assessing vertebral deformities on lateral spine radiographs that we have developed has a high specificity, and reduces the impact of errors of reproducibility on estimates of prevalence and incidence. The method should prove a value in assessing vertebral deformity both in population studies and in prospective clinical trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623275
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  • 6
    Electronic Resource
    Electronic Resource
    The variable incidence of hip fracture in Southern Europe: The MEDOS study (1994)
    Springer
    Osteoporosis international 4 (1994), S. 253-263 
    Details
    ISSN: 1433-2965
    Keywords: Doubling time ; Excess female morbidity ; Gonadal function ; Hip fracture ; Incidence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We assessed the incidence of hip fracture and ecological correlates in residents of 14 communities in six countries of Southern Europe. Hip fracture cases were recorded prospectively in defined catchment areas over a 1-year interval. A retrospective questionnaire was used to assess ecological differences between communities. During a 1-year period of observation a total of 3629 men and women over the age of 50 years were identified with hip fracture from a catchment of 3 million. In all communities the fracture rate increased exponentially with age. There were large and significant differences between centres in the doubling time for hip fracture risk with age and in crude and age-standardized rates. Greater than 4-fold and 13-fold differences in age-standardized risk were found amongst men and women respectively. The lowest rates were observed from Turkey and the highest from Seville, Crete and Porto. Fractures were significantly more frequent among women than men with the exception of three rural Turkish centres. Indeed, in rural Turkey the normal female/male ratio was reserved. Variations in incidence between regions were greater than the differences within centres between sexes, and there was a close and significant correlation between incidence rates for men and those for women in the regions studied. Excess female morbidity increased progressively from the age of 50 years but attained a plateau after the age of 80 years, suggesting a finite duration of the effect of the menopause. The retrospective questionnaire completed by 80% of cases suggested that differences in incidence between the communities studied could not be explained by differences in gonadal status in women. In both men and women cross-cultural associations were found with factors related to age or socioeconomic prosperity, the majority of which disappeared after adjustment for age. We conclude that there are marked and sizeable differences in the incidence rates of hip fracture throughout Southern Europe. The reasons for these differences are not known but affect both men and women, and are likely to be related to lifestyle or genetic factors rather than to differences in endocrine status.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623349
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  • 7
    Electronic Resource
    Electronic Resource
    The apparent incidence of hip fracture in Europe: A study of national register sources (1992)
    Springer
    Osteoporosis international 2 (1992), S. 298-302 
    Details
    ISSN: 1433-2965
    Keywords: Epidemiology ; Hip fracture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The objective of this study was to examine the apparent incidence of hip fracture from discharge rates in European countries. A request was sent to the Ministries of Health in all European countries, asking for the number of hip fracture patients by age and sex, between the years 1983 and 1985. Seventeen countries responded. As expected, hip fracture was most frequently found amongst the elderly, particularly women. The incidence of hip fracture rose exponentially with age in both sexes. It was higher in women than men and there was a three-fold range between countries in the female to male sex ratio. There was an eleven-fold range in apparent incidence amongst women and a seven-fold range amongst men between the various countries. The highest incidence was found in the northern part of Europe and the lowest in the Mediterranean area. There was a significant positive correlation between the age-standardized incidence rates reported in men from each country and that in women. There was a larger difference in incidence between countries than between sexes, which suggests important genetic or environmental factors in the causation of hip fracture. The extent to which this reflects imperfect capture of data is uncertain but will be important to determine in order to identify reasons for differences and to enable confident projections of the future magnitude of this disorder.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623186
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  • 8
    Electronic Resource
    Electronic Resource
    Quality of life and vertebral osteoporosis (1992)
    Springer
    Osteoporosis international 2 (1992), S. 161-163 
    Details
    ISSN: 1433-2965
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623919
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  • 9
    Electronic Resource
    Electronic Resource
    Rationale for the use of clodronate in osteoporosis (1993)
    Springer
    Osteoporosis international 3 (1993), S. 23-28 
    Details
    ISSN: 1433-2965
    Keywords: Clodronate ; Osteoporosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Bisphosphonates are widely used in disorders associated with increased resorption of bone, particularly in Paget's disease of bone and in the hypercalcemia of malignancy. Because of their undoubted efficacy and relatively low toxicity, bisphosphonates are attractive candidates for the management of osteoporosis. Clodronate, one of the many bisphosphonates being tested in osteoporosis, may be given intravenously or by mouth. In contrast to etidronate, even high doses of clodronate do not impair the mineralization of bone, making it suitable for long-term use in osteoporosis. As do all the bisphosphonates tested thus far, clodronate appears to delay the rate of bone loss in osteoporosis. Long-term studies are relatively few, so that its steady-state effects on bone mass are not yet known. Most data suggest clodronate is capable at least of delaying the rate of bone loss, but several pilot studies with this agent suggest that increments of bone mass might be sustainable for several years. Clodronate is likely to decrease the frequency of osteoporotic fractures, but there is no evidence for this at present. Well-controlled, long-term prospective studies are needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623223
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