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  • 1
    Online Resource
    Online Resource
    Wiley ; 2011
    In:  Journal of Bone and Mineral Research Vol. 26, No. 2 ( 2011-02), p. 414-419
    In: Journal of Bone and Mineral Research, Wiley, Vol. 26, No. 2 ( 2011-02), p. 414-419
    Abstract: Fragility fracture is a serious public health problem in the world. The risk of fracture is determined by genetic and nongenetic clinical risk factors. This study sought to quantify the contribution of genetic profiling to fracture prognosis. The study was built on the ongoing Dubbo Osteoporosis Epidemiology Study, in which fracture and risk factors of 858 men and 1358 women had been monitored continuously from 1989 and 2008. Fragility fracture was ascertained by radiologic reports. Bone mineral density at the femoral neck was measured by dual‐energy X‐ray absorptiometry (DXA). Fifty independent genes with allele frequencies ranging from 0.01 to 0.60 and relative risks (RRs) ranging from 1.01 to 3.0 were simulated. Three predictive models were fitted to the data in which fracture was a function of (1) clinical risk factors only, (2) genes only, and (3) clinical risk factors and 50 genes. The area under the curve ( AUC ) for model 1 was 0.77, which was lower than that of model II ( AUC  = 0.82). Adding genes into the clinical risk factors model (model 3) increased the AUC to 0.88 and improved the accuracy of fracture classification by 45%, with most (41%) improvement in specificity. In the presence of clinical risk factors, the number of genes required to achieve an AUC of 0.85 was around 25. These results suggest that genetic profiling could enhance the predictive accuracy of fracture prognosis and help to identify high‐risk individuals for appropriate management of osteoporosis or intervention. © 2011 American Society for Bone and Mineral Research.
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2011
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  • 2
    In: Obesity, Wiley, Vol. 18, No. 6 ( 2010-06), p. 1242-1246
    Type of Medium: Online Resource
    ISSN: 1930-7381
    Language: English
    Publisher: Wiley
    Publication Date: 2010
    detail.hit.zdb_id: 2027211-X
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  • 3
    Online Resource
    Online Resource
    Wiley ; 2005
    In:  Journal of Bone and Mineral Research Vol. 20, No. 11 ( 2005-11), p. 1921-1928
    In: Journal of Bone and Mineral Research, Wiley, Vol. 20, No. 11 ( 2005-11), p. 1921-1928
    Abstract: In this 14‐year prospective study, men and women were found to share a common set of risk factors for hip fracture: low BMD, postural instability and/or quadriceps weakness, a history of falls, and prior fracture. The combination of these risk factors accounted for 57% and 37% of hip fractures in women and men, respectively. Introduction : Risk factors for hip fracture, including low BMD, identified in women, have not been shown to be useful in men. It is also not known whether fall‐related factors (muscle strength and postural instability) predict hip fracture. This study examined the association between falls‐related factors and hip fractures in elderly men and women. Materials and Methods : This is an epidemiologic, community‐based prospective study, which included 960 women and 689 men ≥60 years of age who have been followed for a median of 12 years (interquartile range, 6–13). The number of person‐years was 9961 for women and 4463 for men. The outcome measure was incidence of hip fracture. Risk factors were femoral neck BMD (FNBMD), postural sway, quadriceps strength, prior fracture, and fall. Results : Between 1989 and 2003, 115 (86 women) sustained a hip fracture. The risk of hip fracture (as measured by hazards ratio [HR]) was increased by 3.6‐fold (95% CI: 2.6–4.5) in women and 3.4‐fold (95% CI: 2.5–4.6) in men for each SD (0.12 g/cm 2 ) reduction in FNBMD. After adjusting for BMD, the risk of hip fracture was also increased in individuals with the highest tertile of postural sway (HR: 2.7; 95% CI: 1.6–4.5) and low tertiles of quadriceps strength (HR: 3.0; 95% CI: 1.3–6.8). Furthermore, a history of fall during the preceding 12 months and a history of fracture were independent predictors of hip fracture. For each level of BMD, the risk of hip fracture increased linearly with the number of non‐BMD risk factors. Approximately 57% and 37% of hip fracture cases in women and men, respectively, were attributable to the presence of risk factors, osteoporosis (BMD T score ≤ −2.5), and advancing age. Conclusions : Men and women had a common set of risk factors for hip fracture: low BMD, postural instability and/or quadriceps weakness, a history of falls, and prior fracture. Preventive strategies should simultaneously target reducing falls and improvement of bone strength in both men and women.
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2005
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  • 4
    Online Resource
    Online Resource
    Wiley ; 2006
    In:  Journal of Bone and Mineral Research Vol. 21, No. 2 ( 2006-02), p. 340-349
    In: Journal of Bone and Mineral Research, Wiley, Vol. 21, No. 2 ( 2006-02), p. 340-349
    Abstract: In postmenopausal women, the efficacy of bisphosphonates on hip fracture risk is not clear. This Bayesian meta‐analysis quantitatively reviewed data from 12 randomized clinical trials with 18,667 patients and found that bisphosphonate treatment was associated with a reduced risk for hip fracture by 42%. Introduction : The efficacy of antiresorptive bisphosphonates therapy on reducing hip fracture is not clear, because evidence from randomized clinical trials (RCTs) is inconclusive. This study was undertaken to quantitatively assess the effect of bisphosphonates on hip fracture using literature review and meta‐analysis. Materials and Methods : Bayesian methods of meta‐analysis were applied to synthesize data from 12 RCTs available between 1990 and 2004. The trials involved 18,667 postmenopausal women with low BMD or osteoporosis who have been followed or treated for between 1 and 4 years. The medications used were etidronate (two trials) alendronate (six trials), risedronate (three trials), and clodronate (one trial). The primary endpoint was the incidence of hip fracture. Results : When data from all 12 studies were pooled, treatment with bisphosphonates was associated with a reduced risk for hip fracture by 42% (relative risk {RR}, 0.58; 95% credible interval {CrI}, 0.42‐0.80). The absolute rate reduction was 52 hip fractures per 10,000 women (95% CrI, 4–110) for a period of 3‐year treatment. The probability that bisphosphonates are better than placebo (in reducing hip fracture risk by at least 30%) was 0.90. Conclusions : In postmenopausal women with osteoporosis or low BMD, bisphosphonate treatment is associated with reduced risk of hip fracture.
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
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    Language: English
    Publisher: Wiley
    Publication Date: 2006
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  • 5
    Online Resource
    Online Resource
    Wiley ; 2005
    In:  Journal of Bone and Mineral Research Vol. 20, No. 3 ( 2005-03), p. 536-538
    In: Journal of Bone and Mineral Research, Wiley, Vol. 20, No. 3 ( 2005-03), p. 536-538
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
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    Language: English
    Publisher: Wiley
    Publication Date: 2005
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  • 6
    Online Resource
    Online Resource
    Wiley ; 2016
    In:  Journal of Bone and Mineral Research Vol. 31, No. 1 ( 2016-01), p. 208-214
    In: Journal of Bone and Mineral Research, Wiley, Vol. 31, No. 1 ( 2016-01), p. 208-214
    Abstract: The association between muscle weakness and fracture is not well understood. This study sought to examine the contribution of muscle strength at baseline and change in muscle strength to the observed risk of fragility fracture in older people. The study involved 595 men and 1066 women aged 60+ years (median 69 years) who had been followed for a median of 11 years (range, 4 to 22 years). Quadriceps isometric muscle strength (MS) measured at baseline and biennially was adjusted for height. Femoral neck bone mineral density (FNBMD) was measured by DXA. Low‐trauma fracture was ascertained from X‐ray reports and interview. The relationship between baseline MS and serial MS and fracture assessed by time‐invariant and time‐variant Cox's regression models was expressed as hazard ratio (HR) and 95% confidence interval (CI). During the follow‐up period, 282 (26%) women and 89 (15%) men sustained a fragility fracture. From age 60 years, women lost 0.28 kg/m (1.6%) of MS per year, whereas men lost 0.39 kg/m (1.5%) of MS per year. In the time‐variant model, using serial MS, each 1 SD (4.7 kg/m) lower MS was associated with a 27% increase in the risk of fracture in women (HR 1.27; 95% CI, 1.11 to 1.43); and 46% increase in men (HR 1.46; 95% CI, 1.22 to 1.75). After adjusting for FNBMD, age and prior fracture, history of fall and smoking, HR per SD of lower MS was 1.13 (95% CI, 0.99 to 1.28) for women and 1.35 (95% CI, 1.18 to 1.64) for men. These data indicate that muscle weakness is an independent determinant of fracture risk in men, but not in women. This sex difference suggests that apart from mechanical load effect of muscle on bone, there are other muscle‐bone interactions that need to be investigated in future studies. The accuracy of fracture risk prediction for men may be improved by incorporating muscle strength. © 2015 American Society for Bone and Mineral Research.
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 7
    Online Resource
    Online Resource
    Wiley ; 2009
    In:  Journal of Bone and Mineral Research Vol. 24, No. 11 ( 2009-11), p. 1800-1807
    In: Journal of Bone and Mineral Research, Wiley, Vol. 24, No. 11 ( 2009-11), p. 1800-1807
    Abstract: This study attempted to address the following questions: for an individual who is at present nonosteoporotic, given their current age and BMD level, what is the individual's risk of fracture and when is the ideal time to repeat a BMD measurement? Nonosteoporotic women ( n = 1008) and men ( n = 750) over the age of 60 in 1989 from the Dubbo Osteoporosis Epidemiology Study were monitored until one of the following outcomes occurred: (1) BMD reached “osteoporosis” level (i.e., T‐scores ≤ −2.5) or (2) an incident fragility fracture. During the follow‐up period (average, 7 yr), 346 women (34%) and 160 men (21%) developed osteoporosis or sustained a low‐trauma fracture. The risk of osteoporosis or fracture increased with advancing age (women: RR/10 yr, 1.3; 95% CI, 1.1–1.6; men: RR/10 yr, 2.3; 95% CI, 1.7–2.9) and lower BMD levels (women: RR per −0.12 g/cm 2 , 3.2; 95% CI, 2.6–4.1; RR per −0.12 g/cm 2 , 2.6; 95% CI, 2.0–3.3). Using the predicted risk (of osteoporosis or fracture) of 10% as a cut‐off level for repeating BMD measurement, the estimated time to reach the cut‐off level varied from 1.5 (for an 80‐yr‐old woman with a T‐score of −2.2) to 10.6 yr (for a 60‐yr‐old man with a T‐score of 0). These results suggest that, based on an individual's current age and BMD T‐score, it is possible to estimate the optimal time to repeat BMD testing for the individual. The prognostic model and approach presented in this study may help improve the individualization and management of osteoporosis.
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
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    Language: English
    Publisher: Wiley
    Publication Date: 2009
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  • 8
    Online Resource
    Online Resource
    Wiley ; 2013
    In:  Journal of Bone and Mineral Research Vol. 28, No. 11 ( 2013-11), p. 2317-2324
    In: Journal of Bone and Mineral Research, Wiley, Vol. 28, No. 11 ( 2013-11), p. 2317-2324
    Abstract: After fracture there is increased risk of refracture and premature mortality. These outcomes, particularly premature mortality following refracture, have not previously been studied together to understand overall mortality risk. This study examined the long‐term cumulative incidence of subsequent fracture and total mortality with mortality calculated as a compound risk and separated according to initial and refracture. Community‐dwelling participants aged 60+ years from Dubbo Osteoporosis Epidemiology Study with incident fractures, followed prospectively for further fractures and deaths from 1989 to 2010. Subsequent fracture and mortality ascertained using cumulative incidence competing risk models allowing four possible outcomes: death without refracture; death following refracture; refracture but alive, and event‐free. There were 952 women and 343 men with incident fracture. Within 5 years following initial fracture, 24% women and 20% men refractured; and 26% women and 37% men died without refracture. Of those who refractured, a further 50% of women and 75% of men died, so that total 5‐year mortality was 39% in women and 51% in men. Excess mortality was 24% in women and 27% in men. Although mortality following refracture occurred predominantly in the first 5 years post–initial fracture, total mortality (post‐initial and refracture) was elevated for 10 years. Most of the 5‐year to 10‐year excess mortality was associated with refracture. The long‐term ( 〉 10 years) refracture rate was reduced, particularly in the elderly as a result of their high mortality rate. The 30% alive beyond 10 years postfracture were at low risk of further adverse outcomes. Refractures contribute substantially to overall mortality associated with fracture. The majority of the mortality and refractures occurred in the first 5 years following the initial fracture. However, excess mortality was observed for up to 10 years postfracture, predominantly related to that after refracture. © 2013 American Society for Bone and Mineral Research.
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 9
    Online Resource
    Online Resource
    Wiley ; 2005
    In:  Journal of Bone and Mineral Research Vol. 20, No. 10 ( 2005-05-31), p. 1820-1827
    In: Journal of Bone and Mineral Research, Wiley, Vol. 20, No. 10 ( 2005-05-31), p. 1820-1827
    Type of Medium: Online Resource
    ISSN: 0884-0431
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2005
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  • 10
    Online Resource
    Online Resource
    Wiley ; 2007
    In:  Journal of Bone and Mineral Research Vol. 22, No. 8 ( 2007-08), p. 1147-1154
    In: Journal of Bone and Mineral Research, Wiley, Vol. 22, No. 8 ( 2007-08), p. 1147-1154
    Abstract: Low baseline BMD, rate of BMD loss, weight loss, and weight fluctuation are significant predictors of all‐cause mortality in elderly men and women, independent of each other and of age, incident fracture, and concomitant diseases. Introduction: Although low BMD has been shown to be associated with mortality in women, the effect of BMD is affected by weight and weight change and the contribution of these factors to mortality risk, particularly in men, is not known. This study examined the association between baseline BMD, rate of bone loss, weight loss, and weight fluctuation and all‐cause mortality risk in elderly men and women. Materials and Methods: Data from 1059 women and 644 men, ≥60 years of age (as of 1989), of white background who participated in the Dubbo Osteoporosis Epidemiology Study were analyzed. All‐cause mortality was recorded annually between 1989 and 2004. BMD at the femoral neck was measured by DXA (GE‐LUNAR) at baseline and at approximately every 2 yr afterward. Data on incident osteoporotic fractures and concomitant diseases, including cardiovascular diseases, all types of cancer, and type I/II diabetes mellitus, was also recorded. Results: In the multivariable Cox's proportional hazards model with adjustment for age, incident fractures, and concomitant diseases, the following variables were independent risk factors of all‐cause mortality in men: rate of BMD loss of at least 1%/yr, rate of weight loss of at least 1%/yr, and weight fluctuation (defined by the CV) of at least 3%. In women, in addition to the significant factors observed in men, lower baseline BMD was also an independent risk factor of mortality. In both sexes, baseline weight was not an independent and significant predictor of mortality risk. Approximately 36% and 22% of deaths in women and men, respectively, were attributable to the four risk factors. Conclusions: These data suggest that, although low BMD was a risk factor of mortality in women, it was not a risk factor of mortality in men. However, high rates of BMD loss, weight loss, and weight fluctuation were also independent predictors of all‐cause mortality in elderly men and women, independent of age, incident fracture, and concomitant diseases.
    Type of Medium: Online Resource
    ISSN: 0884-0431 , 1523-4681
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    Language: English
    Publisher: Wiley
    Publication Date: 2007
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