scholarly journals Use of age-dependent FRAX-based intervention thresholds for Singapore

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
John A. Kanis ◽  
Manju Chandran ◽  
Siok Bee Chionh ◽  
Ganga Ganeson ◽  
Nicholas C Harvey ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Population Based ◽  
Health Study ◽  
Specific Intervention ◽  
Mineral Density ◽  
Treatment Pathways ◽  
Intervention Thresholds ◽  
Age Dependent ◽  
Singapore Chinese ◽  
The Uk

Abstract Summary Assessment and treatment pathways based on age-specific intervention thresholds in Singapore using FRAX paths can be used to identify patients at high risk of fracture and avoid unnecessary treatment in those at low risk. Purpose Intervention thresholds for the treatment of osteoporosis have been based historically on the measurement of bone mineral density. The development of FRAX® has permitted a more accurate assessment of fracture risk. The aim of the present study was to explore treatment paths and characteristics of women selected for treatment in Singapore based on FRAX. Methods The approach to the setting of intervention and assessment thresholds used the methodology adopted by the National Osteoporosis Guideline Group for FRAX-based guidelines in the UK but based on the epidemiology of fracture and death in Singapore. The methodology was applied to women age 50 years or more drawn from the population-based Singapore Chinese Health Study (SCHS) cohort. Missing data for the calculation of FRAX was simulated using data from Chinese cohorts from Hong Kong. Results Intervention thresholds expressed as a 10-year probability of a major osteoporotic fracture ranged from 2.9% at the age of 50 years increasing to 32% at the age of 90 years. A total of 1927 of 29,323 women (7%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 3019 women (10.3%) would be eligible for treatment on the basis of age-dependent thresholds. The mean BMD T-score of women so selected was −2.94. Conclusion Probability-based assessment of fracture risk using age-specific intervention thresholds was developed for Singapore to help guide decisions about treatment.

scholarly journals Possibilities of using a FRAX® risk calculator for 10-year probability of fractures assessment in patients with rheumatoid arthritis

2019 ◽  
Vol 57 (3) ◽  
pp. 284-288
Author(s):  
O. A. Nikitinskaya ◽  
N. V. Toroptsova ◽  
E. L. Nasonov
Keyword(s):  
Rheumatoid Arthritis ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Therapeutic Intervention ◽  
Osteoporotic Fractures ◽  
Mineral Density ◽  
Intervention Thresholds ◽  
Diagnostic Characteristics ◽  
Lower Accuracy ◽  
Age Dependent

Rheumatoid arthritis (RA) and glucocorticoid use are the most common causes of secondary osteoporosis (OP). Early detection of individuals at high risk for osteoporotic fractures among RA patients allows timely prevention of OP and its complications.Objective: to evaluate the diagnostic possibilities of using a FRAX® calculator without introducing femoral neck bone mineral density (BMD) into the algorithm, as well as different therapeutic intervention thresholds to identify RA patients who need anti-osteoporotic therapy.Subjects and methods. The investigation enrolled 97 RA patients aged over 50 years. A questionnaire survey and axial skeletal densitometry were made; the 10-year fracture risk was calculated using the FRAX® calculator with and without femoral neck BMD. The diagnostic characteristics (sensitivity, specificity, ROC-curves) of different therapeutic intervention thresholds (Russian and European age-dependent intervention thresholds; 20% and 10%) for FRAX) were studied.Results and discussion. The capabilities of the Russian FRAX® model with and without femoral neck BMD to identify patients requiring treatment for OP were very good (AUC=0.878±0.036 and AUC=0.872±0.040, respectively). Lumbar spine dual-energy X-ray absorptiometry also identified very well RA patients who should undergo prophylaxis against OP and related fractures (AUC=0.837±0.063), while femoral neck and whole hip BMD values showed lower accuracy in detecting these patients (AUC=0.587±0.102 and AUC=0.625±0.092, respectively). The Russian age-dependent threshold showed 79.7% sensitivity and 63.7% specificity in evaluating the FRAX® algorithm without BMD; these figures for FRAX® with BMD were 82.2 and 65.2%, respectively. The use of FRAX® without and with BMD revealed no significant differences in the identification of persons in need of treatment (χ2=0.22; p=0.64). The sensitivity and specificity of other therapeutic intervention thresholds in determining the fracture risk with and without BMD were as follows: 90.4-94.6 and 17.4-21.7% for the European threshold; 58.8 and 93.8% for 20%, and 96.5% and 0 for 10%, respectively.Conclusion. The FRAX® calculator can be used to assess a fracture risk without entering the femoral neck BMD data into the algorithm for RA patients aged 50 years and older. Fracture risk should be assessed using the Russian agedependent threshold that adequately identifies those who need OP treatment among RA patients.

scholarly journals Are Twins and Singletons Comparable? A Study of Disease-related and Lifestyle Characteristics in Adult Women

Twin Research ◽  
2001 ◽  
Vol 4 (6) ◽  
pp. 464-477 ◽  
Author(s):  
Toby Andrew ◽  
Deborah J. Hart ◽  
Harold Snieder ◽  
Marlies de Lange ◽  
Tim D. Spector ◽  
...  
Keyword(s):  
Complex Disease ◽  
Menopausal Status ◽  
Twin Studies ◽  
Tobacco Consumption ◽  
Population Based ◽  
Adult Women ◽  
Mineral Density ◽  
Twin Design ◽  
Hypertensive Drug ◽  
The Uk

AbstractThe classic twin study is sometimes described as “the perfect natural experiment” for the investigation of the aetiology of complex disease, but assumptions of the twin design need to be empirically tested if their results are to be considered unbiased and representative of singleton populations. In this study comparisons of disease and prevalence of lifestyle characteristics have been made between twin participants in the St Thomas' Hospital UK adult twin registry, the largest twin volunteer register in the UK for the study of diseases of ageing, and a parallel population-based study of singleton women. The only differences found were for weight, where monozygotic (MZ) twins were lighter and had a smaller variance than dizygotic (DZ) twins and singletons. For the other variables studied, volunteer twins were not found to differ from age-matched singleton women in distribution or prevalence of: bone mineral density, osteoarthritis, blood pressure, hypertensive drug use, height, history of hysterectomy and ovariectomy, menopausal status and current alcohol and overall tobacco consumption. We conclude that the results of twin studies can be generalised to singleton populations for these measures and disease outcomes.

Association of PLOD1 polymorphisms with bone mineral density in a population-based study of women from the UK

2006 ◽  
Vol 17 (7) ◽  
pp. 1078-1085 ◽  
Author(s):  
P. N. Tasker ◽  
H. MacDonald ◽  
W. D. Fraser ◽  
D. M. Reid ◽  
S. H. Ralston ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Population Based ◽  
Mineral Density ◽  
Population Based Study ◽  
The Uk

scholarly journals Emergency Department Admissions Among Older Adults Living Alone With Multimorbidity

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 583-584
Author(s):  
Jon Barrenetxea ◽  
Cynthia Chen ◽  
Woon-Puay Koh ◽  
Feng Qiushi ◽  
Kelvin Bryan Tan ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Living Arrangements ◽  
Population Based ◽  
Living Alone ◽  
Health Study ◽  
Risk Of Mortality ◽  
Hospitalization Costs ◽  
Singapore Chinese ◽  
One Year

Abstract Older adults living alone are at higher risk of mortality, morbidity and healthcare utilization. As more older adults live alone, Emergency Department (ED) admissions could rapidly increase, particularly among those with multimorbidity. We studied the association of living alone on ED admissions among older adults with multimorbidity. We used data from 16,785 older adults of the population-based Singapore Chinese Health Study (mean age: 73 years, range: 61-96 years) who were interviewed in 2014-2016 for living arrangements and medical history. Participants were followed-up for one year on ED admission outcomes (number of admissions, inpatient days and hospitalization costs). We used multivariable logistic regression to study the association between living alone and ED admission, and ran two-part models (probit & generalised linear model) to estimate the association of living alone on inpatient days and hospitalization cost. We found that compared to living with others, living alone was associated with a higher odds of ED admissions [Odds Ratio (OR) 1.28, 95% Confidence Interval (CI) 1.08-1.51)], longer inpatient days (+0.61, 95% CI 0.25-0.97) and higher hospitalization costs (+322 USD, 95% CI 54-591). Compared to those living with others without multimorbidity, living alone with multimorbidity was associated with higher odds of ED admission (OR 1.64 95% CI 1.33-2.03), longer inpatient days (+0.73, 95% CI 0.29-1.17) and higher hospitalization costs (+567 USD, 95% CI 230-906). In conclusion, living alone is associated with higher odds of ED admission, longer inpatient days and higher hospitalization costs among older adults, particularly among those with multimorbidity.

scholarly journals Does thyroid function influence fracture risk? Prospective data from the HUNT2 study, Norway

2013 ◽  
Vol 169 (6) ◽  
pp. 845-852 ◽  
Author(s):  
Anders Svare ◽  
Tom Ivar Lund Nilsen ◽  
Bjørn Olav Åsvold ◽  
Siri Forsmo ◽  
Berit Schei ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Fracture Risk ◽  
Reference Group ◽  
Positive Association ◽  
Population Based ◽  
Health Study ◽  
Thyroid Peroxidase ◽  
Forearm Fractures ◽  
Hip Fracture Risk ◽  
Increased Risk

ObjectiveTo prospectively study the relation between TSH and risk of hip and forearm fractures.DesignA population-based cohort study.MethodsIn a substudy of the second survey of the Nord Trøndelag Health Study, Norway (HUNT2, 1995–97), linked with a hospital-based fracture registry, we investigated the relation between baseline TSH and risk of hip and/or forearm fractures.PopulationA total of 16 610 women and 8595 men aged 40 years or more, without previous self-reported thyroid disease and hip or forearm fractures.ResultsDuring 12.5 years follow-up, a total of 1870 women and 342 men experienced hip or forearm fractures. Overall, there was no relation between baseline TSH and fracture risk. However, there was weak evidence that women with TSH <0.5 and >3.5 mU/l had a slightly increased risk of hip fractures (hazard ratio (HR) 1.30, 95% CI 0.97–1.94 and HR 1.19, 95% CI 0.93–1.52) compared with the reference group with TSH of 1.5–2.4 mU/l. Supplementary analyses showed higher hip fracture risk in women with TSH >4.0 mU/l and negative thyroid peroxidase antibodies (TPOAb) compared with the reference group (HR 1.75, 95% CI 1.24–2.46).ConclusionWe found no statistically significant relation between baseline TSH and subsequent fracture risk, but the data suggest a weak positive association with hip fracture risk among women with both low and high TSH. The latter association was confined to women with negative TPOAb status.

scholarly journals Factors Associated With Social Isolation Among Older Adults: The Singapore Chinese Health Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 168-168
Author(s):  
Jon Barrenetxea ◽  
Yang Yi ◽  
Woon Puay Koh ◽  
Feng Qiushi
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Social Isolation ◽  
Well Being ◽  
Population Based ◽  
Living Alone ◽  
Health Study ◽  
Factors Associated ◽  
Singapore Chinese

Abstract Social isolation is a determinant of mortality and well-being among older people. Factors associated with isolation could be different in societies where older adults live mainly with family, as individuals might feel isolated despite living with others. We studied the factors associated with isolation among 16,948 older adults from follow-up 3 of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age of 73, range: 61-96 years). We defined social isolation as having “zero hour per week” of participation in social activities involving 3 or more people and scoring the lowest decile on the Duke Social Support Scale of perceived social support. We used multivariable logistic regressions to compute odds ratio (OR) and 95% confidence interval (CI) for factors associated with likelihood of social isolation. Although only 14.4% of isolated participants lived alone, living alone remained a significant factor associated with isolation (OR 1.93, 95% CI 1.58-2.35), together with cognitive impairment (OR 1.73, 95% CI 1.46-2.04) and depression (OR 2.44, 95% CI 2.12-2.80). Higher education level was inversely associated with isolation (p for trend&lt;0.001). In stratified analysis, among those living alone, compared to women, men had higher odds of social isolation (OR 2.18, 95% CI 1.43-3.32) than among those not living alone (OR 0.99, 95% CI 0.84-1.17) (p for interaction&lt;0.001). Our results showed that living alone, cognitive impairment and depression were indicators of isolation among older Singaporeans. In addition, among those living alone, men were more likely to experience social isolation than women.

scholarly journals Within-family studies for Mendelian randomization: avoiding dynastic, assortative mating, and population stratification biases

2019 ◽  
Author(s):  
Ben Brumpton ◽  
Eleanor Sanderson ◽  
Fernando Pires Hartwig ◽  
Sean Harrison ◽  
Gunnhild Åberge Vie ◽  
...  
Keyword(s):  
Population Stratification ◽  
Mendelian Randomization ◽  
Genetic Data ◽  
Population Based ◽  
Health Study ◽  
Uk Biobank ◽  
Family Effects ◽  
Family Based ◽  
Using Data ◽  
The Uk

AbstractMendelian randomization (MR) is a widely-used method for causal inference using genetic data. Mendelian randomization studies of unrelated individuals may be susceptible to bias from family structure, for example, through dynastic effects which occur when parental genotypes directly affect offspring phenotypes. Here we describe methods for within-family Mendelian randomization and through simulations show that family-based methods can overcome bias due to dynastic effects. We illustrate these issues empirically using data from 61,008 siblings from the UK Biobank and Nord-Trøndelag Health Study. Both within-family and population-based Mendelian randomization analyses reproduced established effects of lower BMI reducing risk of diabetes and high blood pressure. However, while MR estimates from population-based samples of unrelated individuals suggested that taller height and lower BMI increase educational attainment, these effects largely disappeared in within-family MR analyses. We found differences between population-based and within-family based estimates, indicating the importance of controlling for family effects and population structure in Mendelian randomization studies.

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