Lund University Publications
https://lup.lub.lu.se/search
Lund University Lund University Publications2000-01-01T00:00+00:001dailyExcess mortality after hospitalisation for vertebral fracture
https://lup.lub.lu.se/search/publication/a8c20eef-6a68-4c7c-a53f-a2b19ada0a00
Kanis, JAOden, AJohnell, OlofDe Laet, CJonsson, B2004An excess mortality is well described after vertebral fracture. Deaths are in part related to co-morbidity, but could also be due to the fracture event itself, either directly or indirectly. The aim of this study was to examine the quantum and pattern of mortality following vertebral fracture. We identified 16,051 men and women aged 50 years or more with a vertebral fracture that required hospitalization in 28.8 million person years from the patient register of Sweden. Mortality after vertebral fracture was examined using Poisson models applied to fracture patients and compared to that of the general population. At all ages, the risk of death was markedly increased immediately after the event. After a short period of declining risk, the risk increased with age at a rate that was higher than that of the general population and comparable to that 1 year after hip fracture. The latter function was assumed to be due to deaths related to co-morbidity and the residuum assumed to be due to the vertebral fracture. Causally related deaths comprised 28% of all deaths associated with vertebral fracture (depending on age). We conclude that a minority of deaths following hospitalization for vertebral fracture are attributable to the fracture itself under the assumptions we used.http://lup.lub.lu.se/record/899494http://dx.doi.org/10.1007/s00198-003-1516-ypmid:14598026wos:000188244200004scopus:1342289957engOsteoporosis International; 15(2), pp 108-112 (2004)ISSN: 1433-2965Orthopedicsvertebral fracturemortalityExcess mortality after hospitalisation for vertebral fracturecontributiontojournal/articleinfo:eu-repo/semantics/articletextMortality after osteoporotic fractures.
https://lup.lub.lu.se/search/publication/a52b1d42-6a33-4e20-afe0-0067a995a3fc
Johnell, OlofKanis, J. A.Odén, A.Sernbo, I.Redlund-Johnell, IngaPetterson, C.De Laet, C.Jönsson, B.2004http://lup.lub.lu.se/record/118120http://dx.doi.org/10.1007/s00198-003-1490-4wos:000188079200007pmid:14593451scopus:1342268230engOsteoporosis International; 15(1), pp 38-42 (2004)ISSN: 1433-2965OrthopedicsMortality after osteoporotic fractures.contributiontojournal/articleinfo:eu-repo/semantics/articletextThe impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach
https://lup.lub.lu.se/search/publication/910b4a05-7813-4089-95dd-de17c8155912
De Laet, COden, AJohansson, HJohnell, OlofJonsson, BKanis, JA2005The value of bone mineral density (BMD) measurements to stratify fracture probability can be enhanced in a case-finding strategy that combines BMD measurement with independent clinical risk indicators. Putative risk indicators include age and gender, BMI or weight, prior fracture, the use of corticosteroids, and possibly others. The aim of the present study was to develop a mathematical framework to quantify the impact of using combinations of risk indicators with BMD in case finding. Fracture probability can be expressed as a risk gradient, i.e. a relative risk (RR) of fracture per standard deviation (SD) change in BMD. With the addition of other continuous or categorical risk indicators a continuous distribution of risk indicators is obtained that approaches a normal distribution. It is then possible to calculate the risk of individuals compared with the average risk in the population, stratified by age and gender. A risk indicator with a gradient of fracture risk of 2 per SD identified 36% of the population as having a higher than average fracture risk. In individuals so selected, the risk was on average 1.7 times that of the general population. Where, through the combination of several risk indicators, the gradient of risk of the test increased to 4 per SD, a smaller proportion (24%) was identified as having a higher than average risk, but the average risk in this group was 3.1 times that of the population, which is a much better performance. At higher thresholds of risk, similar phenomena were found. We conclude that, whereas the change of the proportion of the population detected to be at high risk is small, the performance of a test is improved when the RR per SD is higher, indicated by the higher average risk in those identified to be at risk. Case-finding strategies that combine clinical risk indicators with BMD have increased efficiency, while having a modest impact on the number of individuals requiring treatment. Therefore, the cost-effectiveness is enhanced.http://lup.lub.lu.se/record/897380http://dx.doi.org/10.1007/s00198-004-1689-zwos:000227237700011pmid:15241584scopus:15044355611engOsteoporosis International; 16(3), pp 313-318 (2005)ISSN: 1433-2965Orthopedicscase findingriskosteoporosisfracturesmathematical modelThe impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approachcontributiontojournal/articleinfo:eu-repo/semantics/articletextIntervention thresholds for osteoporosis in men and women: a study based on data from Sweden
https://lup.lub.lu.se/search/publication/397275ec-56c5-4e54-a7bc-723ec4b199d4
Kanis, JAJohnell, OlofOden, ABorgstrom, FJohansson, HDe Laet, CJonsson, B2005The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect for a further 5 years. Sensitivity analyses included a range of effectiveness (10-50%) and a range of intervention costs ($200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk.http://lup.lub.lu.se/record/897675http://dx.doi.org/10.1007/s00198-004-1623-4wos:000226284900002pmid:15103452scopus:13244251126pmid:15103452engOsteoporosis International; 16(1), pp 41439-41439 (2005)ISSN: 1433-2965Orthopedicsthresholdosteoporotic fractureinterventionhip fracturecost of added yearscost-effectivenessIntervention thresholds for osteoporosis in men and women: a study based on data from Swedencontributiontojournal/articleinfo:eu-repo/semantics/articletextThe use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women
https://lup.lub.lu.se/search/publication/b819da38-8ada-497f-a0f7-a70116a74105
Kanis, J. A.Oden, A.Johnell, OlofJohansson, H.De Laet, C.Brown, J.Burckhardt, P.Cooper, C.Christiansen, C.Cummings, S.Eisman, J. A.Fujiwara, S.Glueer, C.Goltzman, D.Hans, D.Krieg, M.-A.La Croix, A.McCloskey, E.Mellstrom, D.Melton, L. J., IIIPols, H.Reeve, J.Sanders, K.Schott, A.-M.Silman, A.Torgerson, D.van Staa, T.Watts, N. B.Yoshimura, N.2007BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone. Introduction and hypotheses To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD. Methods Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score). Results CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR=1.4/SD) and was not markedly increased by the combination (GR=1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts. Conclusions The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction.http://lup.lub.lu.se/record/648698http://dx.doi.org/10.1007/s00198-007-0343-ywos:000247786600003scopus:34347372696pmid:17323110engOsteoporosis International; 18(8), pp 1033-1046 (2007)ISSN: 1433-2965Orthopedicsfractureosteoporoticmeta-analysisbone mineral densityhip fracturerisk assessmentThe use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and womencontributiontojournal/articleinfo:eu-repo/semantics/articletextFracture risk following an osteoporotic fracture.
https://lup.lub.lu.se/search/publication/ff3294db-bc3d-4c72-a8ee-b0f75ab90fca
Johnell, OlofKanis, J. A.Odén, A.Sernbo, I.Redlund-Johnell, IngaPetterson, C.De Laet, C.Jönsson, B.2003http://lup.lub.lu.se/record/119410http://dx.doi.org/10.1007/s00198-003-1514-0wos:000187515400133scopus:1642301168engOsteoporosis International; 15(3), pp 46-46 (2003)ISSN: 1433-2965Radiology, Nuclear Medicine and Medical ImagingOrthopedicsFracture risk following an osteoporotic fracture.contributiontojournal/articleinfo:eu-repo/semantics/articletextA meta-analysis of milk intake and fracture risk: low utility for case finding
https://lup.lub.lu.se/search/publication/2acc598f-bf09-4f85-9567-09be0ff2911a
Kanis, JAJohansson, HOden, ADe Laet, CJohnell, OlofEisman, JAMc Closkey, EMellstrom, DPols, HReeve, JSilman, ATenenhouse, A2005A low intake of calcium is widely considered to be a risk factor for future fracture. The aim of this study was to quantify this risk on an international basis and to explore the effect of age, gender and bone mineral density (BMD) on this risk. We studied 39,563 men and women (69% female) from six prospectively studied cohorts comprising EVOS/EPOS, CaMos, DOES, the Rotterdam study, the Sheffield study and a cohort from Gothenburg. Cohorts were followed for 152,000 person-years. The effect of calcium intake as judged by the intake of milk on the risk of any fracture, any osteoporotic fracture and hip fracture alone was examined using a Poisson model for each sex from each cohort. Covariates examined were age and BMD. The results of the different studies were merged by using the weighted beta-coefficients. A low intake of calcium (less than 1 glass of milk daily) was not associated with a significantly increased risk of any fracture, osteoporotic fracture or hip fracture. There was no difference in risk ratio between men and women. When both sexes were combined there was a small but non-significant increase in the risk of osteoporotic and of hip fracture. There was also a small increase in the risk of an osteoporotic fracture with age which was significant at the age of 80 years (RR=1.15; 95% CI=1.02-1.30) and above. The association was no longer significant after adjustment for BMD. No significant relationship was observed by age for low milk intake and hip fracture risk. We conclude that a self-reported low intake of milk is not associated with any marked increase in fracture risk and that the use of this risk indicator is of little or no value in case-finding strategies.http://lup.lub.lu.se/record/895127http://dx.doi.org/10.1007/s00198-004-1755-6wos:000230175800012pmid:15502959scopus:21644479918engOsteoporosis International; 16(7), pp 799-804 (2005)ISSN: 1433-2965Orthopedicship fracturemeta-analysisosteoporotic fracturemilkcalcium intakeA meta-analysis of milk intake and fracture risk: low utility for case findingcontributiontojournal/articleinfo:eu-repo/semantics/articletextAssessment of fracture risk
https://lup.lub.lu.se/search/publication/d81e70fa-72f0-426f-986d-d163ebb46174
Kanis, JABorgstrom, FDe Laet, CJohansson, HJohnell, OlofJonsson, BOden, AZethraeus, NPfleger, BKhaltaev, N2005The diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD). There are a number of clinical risk factors that provide information on fracture risk over and above that given by BMD. The assessment of fracture risk thus needs to be distinguished from diagnosis to take account of the independent value of the clinical risk factors. These include age, a prior fragility fracture, a parental history of hip fracture, smoking, use of systemic corticosteroids, excess alcohol intake and rheumatoid arthritis. The independent contribution of these risk factors can be integrated by the calculation of fracture probability with or without the use of BMD. Treatment can then be offered to those identified to have a fracture probability greater than an intervention threshold.http://lup.lub.lu.se/record/895367http://dx.doi.org/10.1007/s00198-004-1780-5pmid:15616758wos:000229508600001scopus:21244471020engOsteoporosis International; 16(6), pp 581-589 (2005)ISSN: 1433-2965Orthopedicscase-findingthresholdinterventionclinical risk factorsfracture probabilityAssessment of fracture riskcontributiontojournal/systematicreviewinfo:eu-repo/semantics/articletextThe burden of hospitalised fractures in Sweden.
https://lup.lub.lu.se/search/publication/7c296303-89c8-4c95-a0c7-59f55e25bb15
Johnell, OlofKanis, J. A.Jonsson, B.Oden, A.Johansson, H.De Laet, C.2005http://lup.lub.lu.se/record/126014http://dx.doi.org/10.1007/s00198-004-1686-2wos:000226554500016pmid:15232678scopus:13244298291engOsteoporosis International; 16(2), pp 222-228 (2005)ISSN: 1433-2965OrthopedicsThe burden of hospitalised fractures in Sweden.contributiontojournal/articleinfo:eu-repo/semantics/articletextBody mass index as a predictor of fracture risk: A meta-analysis
https://lup.lub.lu.se/search/publication/b94f7fc6-4b10-4f4c-9479-d8e613faccee
De Laet, CKanis, JAOden, AJohanson, HJohnell, OlofDelmas, PEisman, JAKroger, HFujiwara, SGarnero, PMcCloskey, EVMellstrom, DMelton, LJMeunier, PJPols, HAPReeve, JSilman, ATenenhouse, A2005Low body mass index (BMI) is a well-documented risk factor for future fracture. The aim of this study was to quantify this effect and to explore the association of BMI with fracture risk in relation to age, gender and bone mineral density (BMD) from an international perspective using worldwide data. We studied individual participant data from almost 60,000 men and women from 12 prospective population-based cohorts comprising Rotterdam, EVOS/EPOS, CaMos, Rochester, Sheffield, Dubbo, EPIDOS, OFELY, Kuopio, Hiroshima, and two cohorts from Gothenburg, with a total follow-up of over 250,000 person years. The effects of BMI, BMD, age and gender on the risk of any fracture, any osteoporotic fracture, and hip fracture alone was examined using a Poisson regression model in each cohort separately. The results of the different studies were then merged. Without information on BMD, the age-adjusted risk for any type of fracture increased significantly with lower BMI. Overall, the risk ratio (RR) per unit higher BMI was 0.98 (95% confidence interval [CI], 0.97-0.99) for any fracture, 0.97 (95% CI, 0.96-0.98) for osteoporotic fracture and 0.93 (95% CI, 0.91-0.94) for hip fracture (all p < 0.001). The RR per unit change in BMI was very similar in men and women ( p > 0.30). After adjusting for BMD, these RR became 1 for any fracture or osteoporotic fracture and 0.98 for hip fracture (significant in women). The gradient of fracture risk without adjustment for BMD was not linearly distributed across values for BMI. Instead, the contribution to fracture risk was much more marked at low values of BMI than at values above the median. This nonlinear relation of risk with BMI was most evident for hip fracture risk. When compared with a BMI of 25 kg/m(2), a BMI of 20 kg/m(2) was associated with a nearly twofold increase in risk ratio (RR=1.95; 95% CI, 1.71-2.22) for hip fracture. In contrast, a BMI of 30 kg/m(2), when compared with a BMI of 25 kg/m(2), was associated with only a 17% reduction in hip fracture risk (RR=0.83; 95% CI, 0.69-0.99). We conclude that low BMI confers a risk of substantial importance for all fractures that is largely independent of age and sex, but dependent on BMD. The significance of BMI as a risk factor varies according to the level of BMI. Its validation on an international basis permits the use of this risk factor in case-finding strategies.http://lup.lub.lu.se/record/898772http://dx.doi.org/10.1007/s00198-005-1863-ypmid:15928804wos:000232907600004scopus:27444442003engOsteoporosis International; 16(11), pp 1330-1338 (2005)ISSN: 1433-2965Orthopedicsriskprospective studiesosteoporosismeta-analysisBMIfracturesBody mass index as a predictor of fracture risk: A meta-analysiscontributiontojournal/articleinfo:eu-repo/semantics/articletext