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Ankle fractures do not predict osteoporotic fractures in women with or without diabetes.

https://arctichealth.org/en/permalink/ahliterature134581
Source
Osteoporos Int. 2012 Mar;23(3):957-62
Publication Type
Article
Date
Mar-2012
Author
J M Pritchard
L M Giangregorio
G. Ioannidis
A. Papaioannou
J D Adachi
W D Leslie
Author Affiliation
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. pritcjm@mcmaster.ca
Source
Osteoporos Int. 2012 Mar;23(3):957-62
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Aged
Ankle Injuries - epidemiology - physiopathology
Body mass index
Bone Density - physiology
Diabetes Mellitus - epidemiology
Female
Fractures, Bone - epidemiology - physiopathology
Humans
Manitoba - epidemiology
Middle Aged
Osteoporosis, Postmenopausal - complications - diagnosis - epidemiology - physiopathology
Osteoporotic Fractures - epidemiology - etiology - physiopathology
Risk factors
Abstract
It is not clear whether ankle fractures predict future osteoporotic fractures in women, and whether diabetes influences this relationship. We found that a prior ankle fracture does not predict subsequent osteoporotic fractures in women with or without diabetes.
We aimed to determine: (1) whether a prior ankle fracture was a risk factor for a subsequent major osteoporotic fracture in older women; (2) whether this risk was modified by the presence of diabetes; (3) the risk factors for ankle fracture in older women.
We identified 3,054 women age 50 years and older with diabetes and 9,151 matched controls using the Manitoba Bone Density Program database. Multivariable regression models were used to examine factors associated with prior ankle fracture, and the importance of prior ankle fracture as a predictor of subsequent major osteoporotic fracture during a mean 4.8 years of observation.
A prior ankle fracture was not a significant predictor of subsequent major osteoporotic fracture for women with diabetes (hazard ratio [HR] 1.13; 95% confidence interval [CI], 0.68-1.83; p = 0.623) or women without diabetes (HR 1.16; 95% CI, 0.79-1.71; p = 0.460), and there was no interaction between diabetes and ankle fracture after pooling all women in the cohort (p = 0.971). The presence of diabetes was not independently associated with prior ankle fracture (adjusted odds ratio [OR] 1.14 [95% CI, 0.93-1.38], p = 0.200), whereas higher body mass index (adjusted OR 1.04 per standard deviation increase [95% CI, 1.03-1.06], p 6 ambulatory diagnostic groups) (adjusted OR 1.81 [95% CI, 1.40-2.36], p
PubMed ID
21562874 View in PubMed
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Associations among disease conditions, bone mineral density, and prevalent vertebral deformities in men and women 50 years of age and older: cross-sectional results from the Canadian Multicentre Osteoporosis Study.

https://arctichealth.org/en/permalink/ahliterature186024
Source
J Bone Miner Res. 2003 Apr;18(4):784-90
Publication Type
Article
Date
Apr-2003
Author
D A Hanley
J P Brown
A. Tenenhouse
W P Olszynski
G. Ioannidis
C. Berger
J C Prior
L. Pickard
T M Murray
T. Anastassiades
S. Kirkland
C. Joyce
L. Joseph
A. Papaioannou
S A Jackson
S. Poliquin
J D Adachi
Author Affiliation
Department of Medicine, University of Calgary. Calgary, Alberta, Canada. dahanley@ucalgary.ca
Source
J Bone Miner Res. 2003 Apr;18(4):784-90
Date
Apr-2003
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Density
Canada - epidemiology
Cohort Studies
Cross-Sectional Studies
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 2 - complications
Female
Humans
Hypertension - complications
Kidney Calculi - complications
Male
Middle Aged
Osteitis Deformans - complications
Osteoporosis - complications - epidemiology
Spine - abnormalities
Abstract
This cross-sectional cohort study of 5566 women and 2187 men 50 years of age and older in the population-based Canadian Multicentre Osteoporosis Study was conducted to determine whether reported past diseases are associated with bone mineral density or prevalent vertebral deformities. We examined 12 self-reported disease conditions including diabetes mellitus (types 1 or 2), nephrolithiasis, hypertension, heart attack, rheumatoid arthritis, thyroid disease, breast cancer, inflammatory bowel disease, neuromuscular disease, Paget's disease, and chronic obstructive pulmonary disease. Multivariate linear and logistic regression analyses were performed to determine whether there were associations among these disease conditions and bone mineral density of the lumbar spine, femoral neck, and trochanter, as well as prevalent vertebral deformities. Bone mineral density measurements were higher in women and men with type 2 diabetes compared with those without after appropriate adjustments. The differences were most notable at the lumbar spine (+0.053 g/cm2), femoral neck (+0.028 g/cm2), and trochanter (+0.025 g/cm2) in women, and at the femoral neck (+0.025 g/cm2) in men. Hypertension was also associated with higher bone mineral density measurements for both women and men. The differences were most pronounced at the lumbar spine (+0.022 g/cm2) and femoral neck (+0.007 g/cm2) in women and at the lumbar spine (+0.028 g/cm2) in men. Although results were statistically inconclusive, men reporting versus not reporting past nephrolithiasis appeared to have clinically relevant lower bone mineral density values. Bone mineral density differences were -0.022, -0.015, and -0.016 g/cm2 at the lumbar spine, femoral neck, and trochanter, respectively. Disease conditions were not strongly associated with vertebral deformities. In summary, these cross-sectional population-based data show that type 2 diabetes and hypertension are associated with higher bone mineral density in women and men, and nephrolithiasis may be associated with lower bone mineral density in men. The importance of these associations for osteoporosis case finding and management require further and prospective studies.
PubMed ID
12674340 View in PubMed
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Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada.

https://arctichealth.org/en/permalink/ahliterature120144
Source
J Med Econ. 2012;15 Suppl 1:3-14
Publication Type
Article
Date
2012
Author
D. Chau
D L Becker
M E Coombes
G. Ioannidis
J D Adachi
R. Goeree
Author Affiliation
Amgen Canada Inc, Mississauga, Ontario, Canada.
Source
J Med Econ. 2012;15 Suppl 1:3-14
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alendronate - economics - therapeutic use
Antibodies, Monoclonal, Humanized - economics - therapeutic use
Bone Density Conservation Agents - economics - therapeutic use
Cohort Studies
Cost-Benefit Analysis
Etidronic Acid - analogs & derivatives - economics - therapeutic use
Female
Humans
Markov Chains
Middle Aged
Models, Econometric
Ontario
Osteoporosis, Postmenopausal - drug therapy
Quality-Adjusted Life Years
Abstract
Denosumab is a novel biologic agent approved in Canada for treatment of post-menopausal osteoporosis (PMO) in women at high risk for fracture or who have failed or are intolerant to other osteoporosis therapies. This study estimated cost-effectiveness of denosumab vs usual care from the perspective of the Ontario public payer.
A previously published PMO Markov cohort model was adapted for Canada to estimate cost-effectiveness of denosumab. The primary analysis included women with demographic characteristics similar to those from the pivotal phase III denosumab PMO trial (FREEDOM; age 72 years, femoral neck BMD T-score -2.16 SD, vertebral fracture prevalence 23.6%). Three additional scenario sub-groups were examined including women: (1) at high fracture risk, defined in FREEDOM as having at least two of three risk factors (age 70+; T-score = -3.0 SD at lumbar spine, total hip, or femoral neck; prevalent vertebral fracture); (2) age 75+; and (3) intolerant or contraindicated to oral bisphosphonates (BPs). Analyses were conducted over a lifetime horizon comparing denosumab to usual care ('no therapy', alendronate, risedronate, or raloxifene [sub-group 3 only]). The analysis considered treatment-specific persistence and post-discontinuation residual efficacy, as well as treatment-specific adverse events. Both deterministic and probabilistic sensitivity analyses were conducted.
The multi-therapy comparisons resulted in incremental cost-effectiveness ratios for denosumab vs alendronate of $60,266 (2010 CDN$) (primary analysis) and $27,287 per quality-adjusted life year gained for scenario sub-group 1. Denosumab dominated all therapies in the remaining scenarios.
Key limitations include a lack of long-term, real-world, Canadian data on persistence with denosumab as well as an absence of head-to-head clinical data, leaving one to rely on meta-analyses based on trials comparing treatment to placebo.
Denosumab may be cost-effective compared to oral PMO treatments for women at high risk of fractures and those who are intolerant and/or contraindicated to oral BPs.
PubMed ID
23035625 View in PubMed
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Fracture prediction and calibration of a Canadian FRAX® tool: a population-based report from CaMos.

https://arctichealth.org/en/permalink/ahliterature138603
Source
Osteoporos Int. 2011 Mar;22(3):829-37
Publication Type
Article
Date
Mar-2011
Author
L-A Fraser
L. Langsetmo
C. Berger
G. Ioannidis
D. Goltzman
J D Adachi
A. Papaioannou
R. Josse
C S Kovacs
W P Olszynski
T. Towheed
D A Hanley
S M Kaiser
J. Prior
S. Jamal
N. Kreiger
J P Brown
H. Johansson
A. Oden
E. McCloskey
J A Kanis
W D Leslie
Author Affiliation
Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada.
Source
Osteoporos Int. 2011 Mar;22(3):829-37
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Aged
Bone Density
Calibration
Canada - epidemiology
Female
Femur Neck - radiography
Hip Fractures - epidemiology
Humans
Male
Middle Aged
Multicenter Studies as Topic
Osteoporotic Fractures - epidemiology
Predictive value of tests
Prospective Studies
Reproducibility of Results
Risk Assessment - methods
Risk factors
World Health Organization
Abstract
A new Canadian WHO fracture risk assessment (FRAX®) tool to predict 10-year fracture probability was compared with observed 10-year fracture outcomes in a large Canadian population-based study (CaMos). The Canadian FRAX tool showed good calibration and discrimination for both hip and major osteoporotic fractures.
The purpose of this study was to validate a new Canadian WHO fracture risk assessment (FRAX®) tool in a prospective, population-based cohort, the Canadian Multicentre Osteoporosis Study (CaMos).
A FRAX tool calibrated to the Canadian population was developed by the WHO Collaborating Centre for Metabolic Bone Diseases using national hip fracture and mortality data. Ten-year FRAX probabilities with and without bone mineral density (BMD) were derived for CaMos women (N?=?4,778) and men (N?=?1,919) and compared with observed fracture outcomes to 10 years (Kaplan-Meier method). Cox proportional hazard models were used to investigate the contribution of individual FRAX variables.
Mean overall 10-year FRAX probability with BMD for major osteoporotic fractures was not significantly different from the observed value in men [predicted 5.4% vs. observed 6.4% (95%CI 5.2-7.5%)] and only slightly lower in women [predicted 10.8% vs. observed 12.0% (95%CI 11.0-12.9%)]. FRAX was well calibrated for hip fracture assessment in women [predicted 2.7% vs. observed 2.7% (95%CI 2.2-3.2%)] but underestimated risk in men [predicted 1.3% vs. observed 2.4% (95%CI 1.7-3.1%)]. FRAX with BMD showed better fracture discrimination than FRAX without BMD or BMD alone. Age, body mass index, prior fragility fracture and femoral neck BMD were significant independent predictors of major osteoporotic fractures; sex, age, prior fragility fracture and femoral neck BMD were significant independent predictors of hip fractures.
The Canadian FRAX tool provides predictions consistent with observed fracture rates in Canadian women and men, thereby providing a valuable tool for Canadian clinicians assessing patients at risk of fracture.
PubMed ID
21161508 View in PubMed
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Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study.

https://arctichealth.org/en/permalink/ahliterature141740
Source
Osteoporos Int. 2011 Mar;22(3):789-96
Publication Type
Article
Date
Mar-2011
Author
L-A Fraser
G. Ioannidis
J D Adachi
L. Pickard
S M Kaiser
J. Prior
J P Brown
D A Hanley
W P Olszynski
T. Anastassiades
S. Jamal
R. Josse
D. Goltzman
A. Papaioannou
Author Affiliation
Departments of Epidemiology and Medicine, Hamilton Health Sciences-Chedoke Site, McMaster University, 1200 Main Street West, Hamilton, ON L8N3Z5, Canada.
Source
Osteoporos Int. 2011 Mar;22(3):789-96
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Density
Bone Density Conservation Agents - therapeutic use
Canada - epidemiology
Delivery of Health Care - trends
Diphosphonates - therapeutic use
Estrogen Replacement Therapy
Female
Fractures, Spontaneous - epidemiology - prevention & control
Guideline Adherence
Humans
Middle Aged
Osteoporosis, Postmenopausal - drug therapy - epidemiology
Osteoporotic Fractures - epidemiology - prevention & control
Physician's Practice Patterns - statistics & numerical data
Prospective Studies
Abstract
Canadian women over 50 years old were studied over a 10-year period to see if those who sustained a fracture (caused by minimal trauma) were receiving the recommended osteoporosis therapy. We found that approximately half of these women were not being treated, indicating a significant care gap in osteoporosis treatment.
Prevalent fragility fracture strongly predicts future fracture. Previous studies have indicated that women with fragility fractures are not receiving the indicated treatment. We aimed to describe post fracture care in Canadian women using a large, population-based prospective cohort that began in 1995-1997.
We followed 5,566 women over 50 years of age from across Canada over a period of 10 years in the Canadian Multicentre Osteoporosis Study. Information on medication use and incident clinical fragility fractures was obtained during a yearly questionnaire or interview and fractures were confirmed by radiographic/medical reports.
Over the 10-year study period, 42-56% of women with yearly incident clinical fragility fractures were not treated with an osteoporosis medication. During year 1 of the study, 22% of the women who had experienced a fragility fracture were on treatment with a bisphosphonate and 26% were on hormone therapy (HT). We were not able to differentiate HT use for menopause symptoms vs osteoporosis. Use of bisphosphonate therapy increased over time; odds ratio (OR) for use at year 10 compared to use at year 1 was 3.65 (95% confidence interval (CI) 1.83-7.26). In contrast, HT use declined, with an OR of 0.07 (95%CI 0.02-0.24) at year 10 compared to year 1 of the study.
In a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures. Although bisphosphonate therapy usage improved over time, a substantial gap remains.
PubMed ID
20683706 View in PubMed
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Health-related quality of life measurements in elderly Canadians with osteoporosis compared to other chronic medical conditions: a population-based study from the Canadian Multicentre Osteoporosis Study (CaMos).

https://arctichealth.org/en/permalink/ahliterature173105
Source
Osteoporos Int. 2005 Dec;16(12):1836-40
Publication Type
Article
Date
Dec-2005
Author
A M Sawka
L. Thabane
A. Papaioannou
A. Gafni
G. Ioannidis
E A Papadimitropoulos
W M Hopman
A. Cranney
D A Hanley
L. Pickard
J D Adachi
Author Affiliation
Division of Endocrinology and Department of Medicine, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada. sawkaam@yahoo.com
Source
Osteoporos Int. 2005 Dec;16(12):1836-40
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Aged
Arthritis - epidemiology
Canada - epidemiology
Chronic Disease
Diabetes Mellitus - epidemiology
Female
Heart Diseases - epidemiology
Humans
Hypertension - epidemiology
Male
Osteoporosis - epidemiology
Population Surveillance - methods
Pulmonary Disease, Chronic Obstructive - epidemiology
Quality of Life
Sex Distribution
Abstract
The objective of this research was to determine the relative decrement in health-related quality of life, as measured by the health utilities index mark 3 (HUI3), in osteoporosis compared to other chronic medical conditions. The impact of chronic medical conditions other than osteoporosis on HUI3 measurements had been previously established in the 1996/1997 Canadian National Population Health Survey (NPHS). The Canadian Multicentre Osteoporosis Study (CaMos) is a national population-based study in which regional participants were randomly recruited, regardless of presence of osteoporosis. We analyzed data from participants aged > or = 65 years who completed a baseline HUI3 questionnaire and provided information on their medical history (n=3,750). We determined the age- and gender-adjusted mean decrement in HUI3 for several chronic medical conditions, including osteoporosis. The mean changes in HUI3 adjusted for age and gender (with 95% confidence intervals) were as follows: arthritis -0.10 (-0.11, -0.09), chronic obstructive pulmonary disease (COPD) -0.07 (-0.09, -0.05), diabetes mellitus -0.05 (-0.08, -0.03), heart disease -0.06 (-0.08, -0.04), hypertension -0.02 (-0.03, -0.01), and osteoporosis -0.08 (-0.11, -0.06), respectively (model r2=0.17; P
PubMed ID
16133651 View in PubMed
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The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study.

https://arctichealth.org/en/permalink/ahliterature155114
Source
Osteoporos Int. 2009 May;20(5):703-14
Publication Type
Article
Date
May-2009
Author
A. Papaioannou
C C Kennedy
G. Ioannidis
A. Sawka
W M Hopman
L. Pickard
J P Brown
R G Josse
S. Kaiser
T. Anastassiades
D. Goltzman
M. Papadimitropoulos
A. Tenenhouse
J C Prior
W P Olszynski
J D Adachi
Author Affiliation
McMaster University, Hamilton Health Sciences-Chedoke Site, Hamilton, ON, Canada. papaioannou@hhsc.ca
Source
Osteoporos Int. 2009 May;20(5):703-14
Date
May-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Canada
Female
Forearm Injuries - etiology - rehabilitation
Fractures, Bone - etiology - rehabilitation
Health status
Health Status Indicators
Hip Fractures - etiology - rehabilitation
Humans
Male
Middle Aged
Osteoporosis - complications
Pelvic Bones - injuries
Prospective Studies
Quality of Life
Rib Fractures - etiology - rehabilitation
Spinal Fractures - etiology - rehabilitation
Time Factors
Abstract
Using prospective data from the Canadian Multicentre Osteoporosis Study (CaMos), we compared health utilities index (HUI) scores after 5 years of follow-up among participants (50 years and older) with and without incident clinical fractures. Incident fractures had a negative impact on HUI scores over time.
This study examined change in health-related quality of life (HRQL) in those with and without incident clinical fractures as measured by the HUI.
The study cohort was 4,820 women and 1,783 men (50 years and older) from the CaMos. The HUI was administered at baseline and year 5. Participants were sub-divided into incident fracture groups (hip, rib, spine, forearm, pelvis, other) and were compared with those without these fractures. The effects of both time and fracture type on HUI scores were examined in multivariable regression analyses.
Men and women with hip fractures, compared to those without, had lower HUI measures that ranged from -0.05 to -0.25. Both women and men with spine fractures had significant deficits on the pain attributes (-0.07 to -0.12). In women, self-care (-0.06), mobility and ambulation (-0.05) were also negatively impacted. Women with rib fractures had deficits similar to women with spine fractures, and these effects persisted over time. In men, rib fractures did not significantly affect HUI scores. Pelvic and forearm fractures did not substantially influence HUI scores.
The HUI was a sensitive measure of HRQL change over time. These results will inform economic analyses evaluating osteoporosis therapies.
PubMed ID
18802659 View in PubMed
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Source
BMC Musculoskelet Disord. 2004 Apr 6;5:11
Publication Type
Article
Date
Apr-6-2004
Author
A. Papaioannou
L. Giangregorio
B. Kvern
P. Boulos
G. Ioannidis
J D Adachi
Author Affiliation
Department of Medicine, McMaster University, Hamilton, Canada. papaioannou@hhsc.ca
Source
BMC Musculoskelet Disord. 2004 Apr 6;5:11
Date
Apr-6-2004
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon - utilization
Adult
Aged
Aged, 80 and over
Bone Density
Calcitonin - therapeutic use
Calcium - therapeutic use
Canada - epidemiology
Diphosphonates - therapeutic use
Drug Utilization - statistics & numerical data
Estrogen Replacement Therapy
Female
Fractures, Spontaneous - epidemiology - etiology - prevention & control
Humans
Male
Middle Aged
Osteoporosis - complications - diagnosis - drug therapy - epidemiology
Physician's Practice Patterns - statistics & numerical data
Recurrence
Vitamin D - therapeutic use
Abstract
The presence of a fragility fracture is a major risk factor for osteoporosis, and should be an indicator for osteoporosis diagnosis and therapy. However, the extent to which patients who fracture are assessed and treated for osteoporosis is not clear.
We performed a review of the literature to identify the practice patterns in the diagnosis and treatment of osteoporosis in adults over the age of 40 who experience a fragility fracture in Canada. Searches were performed in MEDLINE (1966 to January 2, 2003) and CINAHL (1982 to February 1, 2003) databases.
There is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. The proportion of individuals with a fragility fracture who received an osteoporosis diagnostic test or physician diagnosis ranged from 1.7% to 50%. Therapies such as hormone replacement therapy, bisphosphonates or calcitonin were being prescribed to 5.2% to 37.5% of patients. Calcium and vitamin D supplement intake was variable, and ranged between 2.8% to 61.6% of patients.
Many Canadians who experience fragility fracture are not receiving osteoporosis management for the prevention of future fractures.
Notes
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PubMed ID
15068488 View in PubMed
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The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study.

https://arctichealth.org/en/permalink/ahliterature160943
Source
Osteoporos Int. 2008 Apr;19(4):581-7
Publication Type
Article
Date
Apr-2008
Author
A. Papaioannou
C C Kennedy
G. Ioannidis
Y. Gao
A M Sawka
D. Goltzman
A. Tenenhouse
L. Pickard
W P Olszynski
K S Davison
S. Kaiser
R G Josse
N. Kreiger
D A Hanley
J C Prior
J P Brown
T. Anastassiades
J D Adachi
Author Affiliation
Division of Geriatric Medicine, McMaster University, Hamilton Health Sciences-Chedoke Site, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada. papaioannou@hhsc.ca
Source
Osteoporos Int. 2008 Apr;19(4):581-7
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Attitude to Health
Bone Density - physiology
Bone Density Conservation Agents - therapeutic use
Canada
Delivery of Health Care - standards
Diphosphonates - therapeutic use
Fractures, Bone - prevention & control
Humans
Male
Middle Aged
Osteoporosis - diagnosis - physiopathology - therapy
Vitamin D - therapeutic use
Abstract
We examined osteoporosis diagnosis/treatment in 2,187 community dwelling men age 50+. After five years in the study, 90% of men with fragility fractures remained undiagnosed and untreated for osteoporosis. The need to treat fragility fractures is well established in guidelines, and these numbers represent an important care gap.
Whether physicians in the community are recognizing and appropriately treating osteoporosis and fragility fractures in men remains unknown. We examined the rate of diagnosis and treatment in community dwelling men participating in the Canadian Multicentre Osteoporosis Study (CaMos).
Between February 1996 and September 2002, 2,187 participants were recruited from nine sites across Canada and prospectively followed. Information on osteoporosis diagnosis, fractures, medications were collected annually by a detailed questionnaire. DXA examination of lumbar spine (L1-4) and hip were conducted at baseline and year five.
Diagnosis and treatment in men with clinical fragility fractures was low: at baseline and year five only 2.3% and 10.3% of men with a clinical fracture reported an osteoporosis diagnosis, respectively. At year five, 90% of men with a clinical fragility fracture were untreated. Hip fractures were the most commonly treated (37.5% by year five). A diagnosis of osteoporosis resulted in greater treatment: 67% of participants with diagnosed osteoporosis were treated with a bisphosphonate and 87% were taking calcium and/or vitamin D (year five).
In this population-based study, both a diagnostic and therapeutic gap existed between knowledge and practice related to fragility fractures and osteoporosis in men aged >or=50 years.
PubMed ID
17924051 View in PubMed
Less detail

Treating osteoporosis in Canada: what clinical efficacy data should be considered by policy decision makers?

https://arctichealth.org/en/permalink/ahliterature152131
Source
Osteoporos Int. 2009 Oct;20(10):1785-93
Publication Type
Article
Date
Oct-2009
Author
J D Adachi
C C Kennedy
A. Papaioannou
G. Ioannidis
W D Leslie
V. Walker
Author Affiliation
Department of Medicine, St Joseph's, Healthcare-McMaster University, 25 Charlton Avenue East, Suite 501, Hamilton, Ontario, L8N 1Y2, Canada. jd.adachi@sympatico.ca
Source
Osteoporos Int. 2009 Oct;20(10):1785-93
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Aged
Bone Density Conservation Agents - therapeutic use
Canada - epidemiology
Decision Making
Epidemiologic Methods
Etidronic Acid - analogs & derivatives - therapeutic use
Female
Humans
Meta-Analysis as Topic
Osteoporosis, Postmenopausal - complications - drug therapy - epidemiology
Osteoporotic Fractures - epidemiology - etiology - prevention & control
Treatment Outcome
Abstract
SAUMMARY: Using a Markov state-transition model, we estimated fractures averted with risedronate using two different types of clinical efficacy data. Summary data, as opposed to individual patient data (IPD), underestimated the number of fractures averted when applied in a specified high risk population. The choice of clinical efficacy data is an important consideration in health economic models evaluating osteoporosis therapies.
This paper contrasts fracture reduction estimates for risedronate utilizing efficacy data from two approaches to meta-analysis: summary data versus individual patient data. We also examined differences in fracture reduction explained by varied cohort selection, especially the inclusion of low- versus high-risk populations.
Using a Markov state-transition model, we compared fractures averted over 3 years in a hypothetical cohort by inputting fracture risk reduction estimates (risedronate versus placebo) from two data sources (summary data versus IPD). The cohort consisted of 100,000 Canadian women, age > or =65 years with osteoporosis (WHO criteria T-score or =65 years with a prevalent vertebral fracture).
PubMed ID
19277810 View in PubMed
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10 records – page 1 of 1.