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  • 1
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    Serum 25(OH)D is associated with an altered bone turnover marker response after a hip fracture
    Wiley ; 2019
    In:  Journal of Orthopaedic Research Vol. 37, No. 3 ( 2019-03), p. 535-540
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 37, No. 3 ( 2019-03), p. 535-540
    Abstract: C‐terminal telopeptide of type I collagen (CTX) and procollagen type 1 N‐terminal propeptide (P1NP) are bone turnover markers (BTMs) that are promising surrogate measures of fracture healing; however, it is unknown if their response is affected by other bone healing metabolites. Since 70% of fracture patients are reported to have insufficient serum vitamin D, we sought to determine if serum 25(OH)D levels are associated with differential changes in CTX and P1NP concentrations after hip fracture. This prospective cohort included hip fracture patients 65 years of age or older admitted to one of eight Baltimore‐area hospitals. Serum samples were collected at baseline, 2‐, 6‐, and 12‐month post‐fracture. A mixed‐effects repeated‐measures analysis was used to determine the longitudinal association between vitamin D deficiency (25(OH)D  〈  20 ng/ml) and CTX and P1NP. Baseline lab values were obtained for 296 participants (mean age, 80.8 years; 51% male; 55% 25(OH)D  〈  20 ng/ml). During the acute fracture healing period P1NP concentrations increased by 14% (95%CI: 7–21%, p   〈  0.01) while CTX levels did not change ( p  = 0.07). Both CTX and P1NP decreased below baseline at 6 and 12 months. CTX levels were higher in participants with baseline 25(OH)D  〈  20 ng/ml ( p  = 0.01). There was no association between 25(OH)D  〈  20 ng/ml and P1NP levels over the study duration ( p  = 0.33). Data from this large, longitudinal cohort support claims that CTX and P1NP concentrations change during fracture healing; however, the differential response of CTX among vitamin D deficient patients highlights important questions for its utility as a reliable surrogate marker of fracture healing. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jorr.v37.3
    DOI: 10.1002/jor.24200
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2050452-4
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  • 2
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    Recovery of Walking Ability and Return to Community Living within 60 Days of Hip Fracture Does Not Differ Between Male and Female Survivors
    Wiley ; 2015
    In:  Journal of the American Geriatrics Society Vol. 63, No. 8 ( 2015-08), p. 1640-1644
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 63, No. 8 ( 2015-08), p. 1640-1644
    Abstract: To compare risk‐adjusted differences between men and women 30 and 60 days after hip fracture surgery in not walking, ability to return home in a community‐dwelling subset, not walking in a nursing home resident subset, and mortality within 60 days. Design Cohort study. Setting Data were from a randomized clinical trial that compared two blood transfusion protocols after hip fracture. Participants Individuals with hip fracture (N = 2,016; 489 (24%) male). Measurements Walking, dwelling, and mortality were determined in telephone follow‐up 30 and 60 days after randomization, which occurred within 3 days of surgery. Sex differences for each outcome were compared using univariate and multivariate regression adjusting for potential confounders. Results Men were younger ( P   〈  .001) and more likely to have comorbidity ( P  = .003) than women at the time of hip fracture and to die within 60 days, even after risk adjustment (odds ratio ( OR ) = 1.76, 95% confidence interval ( CI ) = 1.15–2.69). After risk adjustment, male survivors were as likely as female survivors not to walk ( OR  = 1.03, 95% CI  = 0.78–1.34) and no less likely to return home ( OR  = 0.90, 95% CI  = 0.69–1.17) 60 days after hip fracture. No differences were noted between male and female nursing home residents in not walking within 60 days ( OR  = 0.95, 95% CI  = 0.32–2.86). Conclusion Although men experience higher mortality, male survivors can expect recovery of walking ability similar to that of female survivors and are as likely to return to community living.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2015.63.issue-8
    DOI: 10.1111/jgs.13535
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2040494-3
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  • 3
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    Stability of Postoperative Delirium Psychomotor Subtypes in Individuals with Hip Fracture
    Wiley ; 2015
    In:  Journal of the American Geriatrics Society Vol. 63, No. 5 ( 2015-05), p. 970-976
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 63, No. 5 ( 2015-05), p. 970-976
    Abstract: To determine the stability of psychomotor subtypes of delirium over time and identify characteristics associated with delirium psychomotor subtypes in individuals undergoing surgical repair of hip fracture. Design Prospective cohort study. Setting The Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair Cognitive Ancillary Study was conducted at 13 participating sites from 2008 to 2009. Participants Individuals who had undergone surgical repair of hip fracture (N = 139). Measurements Delirium was assessed up to four times postoperatively using the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale. Psychomotor subtypes of delirium were categorized as hypoactive, hyperactive, mixed, and normal psychomotor activity. Results Incidence of postoperative delirium was 41% (n = 57). Of 90 CAM–positive (CAM+) observations, 56% were hypoactive, 10% were hyperactive, 21% were mixed, and 14% had normal psychomotor symptoms. Of 26 participants with more than one CAM+ assessment, 50% maintained subtype stability over time. Participants with hypoactive or normal psychomotor symptoms (n = 31) were less likely to have chart documentation of delirium than participants with any hyperactive symptoms (n = 19) (22% vs 58%, P  = .009). Conclusion Psychomotor subtypes of delirium often fluctuate from assessment to assessment, rather than representing fixed categories of delirium. Hypoactive delirium is the most common presentation of delirium but is the least likely to be documented by healthcare providers.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2015.63.issue-5
    DOI: 10.1111/jgs.13334
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2040494-3
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  • 4
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    Persistence of depressive symptoms and gait speed recovery in older adults after hip fracture
    Wiley ; 2018
    In:  International Journal of Geriatric Psychiatry Vol. 33, No. 7 ( 2018-07), p. 875-882
    Details
    In: International Journal of Geriatric Psychiatry, Wiley, Vol. 33, No. 7 ( 2018-07), p. 875-882
    Abstract: Depression after hip fracture in older adults is associated with worse physical performance; however, depressive symptoms are dynamic, fluctuating during the recovery period. The study aim was to determine how the persistence of depressive symptoms over time cumulatively affects the recovery of physical performance. Methods Marginal structural models estimated the cumulative effect of persistence of depressive symptoms on gait speed during hip fracture recovery among older adults (n = 284) enrolled in the Baltimore Hip Studies 7th cohort. Depressive symptoms at baseline and at 2‐month and 6‐month postadmission for hip fracture were evaluated by using the Center for Epidemiological Studies Depression Scale, and persistence of symptoms was assessed as a time‐averaged severity lagged to standardized 3 m gait speed at 2, 6, and 12 months. Results A 1‐unit increase in time‐averaged Center for Epidemiological Studies Depression score was associated with a mean difference in gait speed of −0.0076 standard deviations (95% confidence interval [CI]: −0.0184, 0.0032; P  = .166). The association was largest in magnitude from baseline to 6 months: −0.0144 standard deviations (95% CI: −0.0303, 0.0015; P  = 0.076). Associations for the other time intervals were smaller: −0.0028 standard deviations (95% CI: −0.0138, 0.0083; P  = .621) at 2 months and −0.0121 standard deviations (95% CI: −0.0324, 0.0082; P  = .238) at 12 months. Conclusion Although not statistically significant, the magnitude of the numerical estimates suggests that expressing more depressive symptoms during the first 6 months after hip fracture has a meaningful impact on functional recovery.
    Type of Medium: Online Resource
    ISSN: 0885-6230 , 1099-1166
    URL: Issue
    URL: Article
    DOI: 10.1002/gps.v33.7
    DOI: 10.1002/gps.4864
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 1500455-7
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  • 5
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    Effects of Prefracture Depressive Illness and Postfracture Depressive Symptoms on Physical Performance After Hip Fracture
    Wiley ; 2016
    In:  Journal of the American Geriatrics Society Vol. 64, No. 11 ( 2016-11)
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 64, No. 11 ( 2016-11)
    Abstract: To compare the effect of prefracture depressive illness and postfracture depressive symptoms on changes in physical performance after hip fracture. Design Longitudinal observational cohort. Setting Baltimore metropolitan area. Participants Older adults with hip fracture (N = 255). Measurements Prefracture depressive illness (from medical records) at baseline and postfracture depressive symptoms at 2 months (using the Center for Epidemiologic Studies Depression Scale) were measured. Physical performance was measured 2, 6, and 12 months after fracture using the Short Physical Performance Battery ( SPPB ), a composite metric of functional status with a score ranging from 0 to 12. Weighted estimating equations were used to assess mean SPPB over time, comparing participants with and without prefracture depressive illness and subjects with and without postfracture depressive symptoms. Results Participants with prefracture depressive illness had an SPPB increase of 0.4 units (95% confidence interval ( CI ) = −0.5–1.3) from 2 to 6 months, smaller than the increase of 1.0 SPPB unit (95% CI = 0.4–1.6) in those without prefracture depressive illness. Participants with postfracture depressive symptoms had an SPPB increase of 0.2 units (95% CI = −1.0–1.5) from 2 to 12 months, and those without postfracture depressive symptoms had a larger increase of 1.2 units (95% CI = 0.6–1.8) over the same period. Nevertheless, prefracture depressive illness and postfracture depressive symptoms were not significantly associated with SPPB . Conclusions Neither prefracture depressive illness nor postfracture depressive symptoms were significantly associated with changes in physical performance after hip fracture, but the magnitude of estimates suggested possible clinically meaningful effects on functional recovery.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2016.64.issue-11
    DOI: 10.1111/jgs.14487
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 6
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    Low-Magnitude Mechanical Stimulation to Improve Bone Density in Persons of Advanced Age: A Randomized, Placebo-Controlled Trial : LOW-MAGNITUDE MECHANICAL STIMULATION AND BONE DENSITY
    Wiley ; 2015
    In:  Journal of Bone and Mineral Research Vol. 30, No. 7 ( 2015-07), p. 1319-1328
    Details
    In: Journal of Bone and Mineral Research, Wiley, Vol. 30, No. 7 ( 2015-07), p. 1319-1328
    Type of Medium: Online Resource
    ISSN: 0884-0431
    URL: Article
    DOI: 10.1002/jbmr.2448
    RVK:
    XA 52230
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2008867-X
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  • 7
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    Soluble Tumor Necrosis Factor Alpha Receptor 1, Bone Resorption, and Bone Mineral Density in the Year Following Hip Fractures: The Baltimore Hip Studies
    Wiley ; 2018
    In:  Journal of Bone and Mineral Research Vol. 33, No. 9 ( 2018-09), p. 1649-1656
    Details
    In: Journal of Bone and Mineral Research, Wiley, Vol. 33, No. 9 ( 2018-09), p. 1649-1656
    Abstract: Although inflammation is known to influence bone turnover and bone mineral density (BMD), less is known about role of soluble tumor necrosis factor alpha receptor 1 (sTNFα‐R1) in changes in bone turnover and BMD in the year after hip fracture. We studied 245 persons (117 men and 128 women) from the Baltimore Hip Studies. Bone turnover markers of resorption (carboxy‐terminal type I collagen cross‐links [CTX‐I]) and formation (amino‐terminal propeptide type I collagen [P1NP] ), BMD of the contralateral hip, and sTNFα‐R1 were measured within 15 days of hospitalization and 2, 6, and 12 months later. Latent class growth modeling was used to determine sTNFα‐R1 trajectories. Weighted generalized estimating equations were used to examine the association of sTNFα‐R1 trajectories with serum levels of CTX‐I and P1NP and BMD; standardized beta coefficients ( ) are reported. Higher baseline sTNFα‐R1 was significantly associated with a greater rate of CTX‐I change (  = 0.26, p  = 0.004). Four distinct sTNFα‐R1 trajectories were identified. The two groups with higher sTNFα‐R1 levels during the year following fracture had faster increasing levels of CTX‐I compared to the group with lowest sTNFα‐R1 levels (men: group 3:  = 0.76, p  = 0.02; group 4:  = 1.4, p   〈  0.001; women: group 3;  = 0.67, p  = 0.02; group 4:  = 1.3, p  = 0.004). Men in the highest sTNFα‐R1 group had a greater decline in BMD compared to the lowest sTNFα‐R1 group (2‐month  = –0.01, p  = 0.01; 6‐month:  = –0.09, p  = 0.001; 12‐months:  = –0.1, p   〈  0.001). An increasing rate of CTX‐I was associated with a steeper decline in total hip BMD in those within higher sTNFα‐R1 trajectory groups ( p   〈  0.001). CTX‐I was significantly increased with sTNFα‐R1 in both sexes. CTX‐I and the highest sTNFα‐R1 trajectory were significantly associated with declines in total hip BMD in men. Interventions that reduce systemic inflammation should be explored to reduce bone resorption and prevent a decline in BMD after hip fracture. © 2018 American Society for Bone and Mineral Research.
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
    URL: Issue
    URL: Article
    DOI: 10.1002/jbmr.v33.9
    DOI: 10.1002/jbmr.3457
    RVK:
    XA 52230
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2008867-X
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  • 8
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    Cognitive Differences between Men and Women who Fracture their Hip and Impact on Six‐Month Survival
    Wiley ; 2017
    In:  Journal of the American Geriatrics Society Vol. 65, No. 3 ( 2017-03)
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 65, No. 3 ( 2017-03)
    Abstract: There is limited research in cognition and its relationship to mortality after hip fracture among men compared to women. Therefore, the goals of this study were to: (1) compare men and women who fractured their hip on cognition after hospital discharge, and (2) examine the impact of cognition on the differential risk of 6‐month mortality between men and women post fracture. Design Prospective cohort study. Setting Eight hospitals in Baltimore, Maryland. Participants Frequency matched 168 male and 171 female hip fracture patients, ages 65 or older, living in the community before fracture. Measurements Cognition assed by Modified Mini‐Mental State Examination (3 MS , and derived MMSE score), Hooper Visual Organization test ( HVOT ), and Trail‐making test (Trails A & B) within 22 days of hospital admission, and 6‐month mortality. Results Men had more impaired cognitive scores on 3 MS , MMSE , HVOT , and Trails A ( P 〈 .05) at baseline. These statistically significant differences between men and women remained on MMSE and HVOT after controlling for pre‐fracture dementia, in‐hospital delirium, age, education, race, and comorbidity. Men had higher 6‐month mortality rates ( HR = 4.4, P 〈 .001). Cognitive measures were also significantly associated with mortality, including 3 MS , HVOT , and Trails B. Among the cognitive measures, higher 3 MS was most protective for mortality ( HR = 0.98, P 〈 .001), both unadjusted and adjusted for other cognitive scales, comorbidity, delirium, and pre‐existing dementia. The highest mortality was among men with 3 MS 〈 78, with 26.3% dying within 6 months. The effects of cognition on mortality did not differ by sex. Conclusion Men display greater levels of cognitive impairment within the first 22 days of hip fracture than women, and cognitive limitations increase the risk of mortality in both men and women.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2017.65.issue-3
    DOI: 10.1111/jgs.14674
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2040494-3
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  • 9
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    Gait Speed and Mobility Disability: Revisiting Meaningful Levels in Diverse Clinical Populations
    Wiley ; 2018
    In:  Journal of the American Geriatrics Society Vol. 66, No. 5 ( 2018-05), p. 954-961
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 66, No. 5 ( 2018-05), p. 954-961
    Abstract: To investigate the heterogeneity of clinically meaningful levels of gait speed relative to self‐reported mobility disability (SR‐MD). Design Five longitudinal studies with older adults in different health states (onset of acute event, presence of chronic condition, sedentary, community living) were used to explore the relationship between gait speed and SR‐MD. Setting Lifestyle Interventions and Independence for Elders Pilot (LIFE‐P), LIFE, Trial of Angiotensin‐Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN), Baltimore Hip Fracture Study (BHS2), Invecchiare in Chianti (InCHIANTI). Participants Individuals aged 65 and older (N=3,540): sedentary, community dwelling (LIFE‐P/LIFE), with hip fracture (BHS2), random population‐based sample (InCHIANTI), high cardiovascular risk (TRAIN). Measurements Usual‐pace gait speed across 3 to 4 m and SR‐MD, defined as inability to walk approximately 1 block or climb 1 flight of stairs. Results The mean gait speed of participants without SR‐MD was greater than 1.0 m/s in InCHIANTI and TRAIN, 0.79 m/s in LIFE‐P/LIFE, and 0.46 m/sec in BHS2. Of individuals with SR‐MD, mean gait speed was 0.08 m/s slower in LIFE‐P/LIFE, 0.19 m/s slower in TRAIN, 0.22 m/s slower in BHS2, and 0.36 m/s slower in InCHIANTI. The optimal gait speed cutpoint for minimizing SR‐MD misclassification rates ranged from 0.3 m/s in BHS2 to 1.0 m/s in TRAIN. In longitudinal analyses, development of SR‐MD was dependent on initial gait speed and change in gait speed (p 〈 .001). Conclusion The relationship between absolute levels of gait speed and SR‐MD may be context specific, and there may be variations between populations. Across diverse clinical populations, clinical interpretations of how change in usual pace gait speed relates to development of SR‐MD depend on where on the gait speed continuum change occurs.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2018.66.issue-5
    DOI: 10.1111/jgs.15331
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 10
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    Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions
    Wiley ; 2017
    In:  Journal of the American Geriatrics Society Vol. 65, No. 7 ( 2017-07), p. 1549-1553
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 65, No. 7 ( 2017-07), p. 1549-1553
    Abstract: To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions ( MCC s). Design Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCC s. Setting Survey conducted through the Health Care Systems Research Network ( HCSRN ) and Claude D. Pepper Older Americans Independence Centers ( OAIC s) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAIC s. Participants Individuals affiliated with the HCSRN or OAIC s and national MCC experts, including individuals affiliated with funding agencies having MCC ‐related grant portfolios. Measurements A “top box” methodology was used, counting the number of respondents selecting the top response on a 5‐point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. Results The highest‐ranked research topics relevant to the health and healthcare of older adults with MCC s were health‐related quality of life in older adults with MCC s; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision‐making to enhance care planning; and tools to improve clinical decision‐making. Conclusion Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this “high‐need, high‐cost” population and the healthcare delivery systems responsible for serving it.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2017.65.issue-7
    DOI: 10.1111/jgs.14943
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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