Claude Baudoin

BMD Is Reduced in HIV-Infected Men Irrespective of Treatment†

Osteoporosis has be reported to be a complication of active antiretroviral therapy of HIV infection. We studied 148 HIV‐infected men stratified according to their treatment. Our data show that these patients have an average 9% decreased BMD, irrespective of their treatment. Low body mass index and high resorption markers were associated with low bone density.

Clinical Outcomes and Mortality After Hip Fracture: A 2-Year Follow-up Study

The aim of this study was to evaluate the burden of hip fractures, which occurred in the French region of Picardie, in 1992, among 1103 women and 356 men, whether the fractures occurred at home or in a community (i.e., patients who depended on a collective service). The data are part of the PICAROS study, which was designed to assess prospectively the outcome of patients as judged by clinical, economical, and quality of life factors. Patients and/or proxies were questioned during the 2nd or 3rd week following the fracture, and again at 3, 6, 12, and 24 months after the fracture. The survey was conducted by home interview. Recruitment criteria were: 1) all patients with a hip fracture as defined by the International Classification of Disease (ICD); 2) 20 years of age and over; 3) admitted to one of the 34 surgical units from the region, public and private, and had an operation or not. Patients with metastatic or myelomatous fractures or fractures on prothesis device were not included. For the present analysis, patients under 50 years of age were excluded. Among people aged 50 years and over, 3% of the general population lived in a community; 32% of hip fractures were from a community. Patients in a community, aged 60-69, had 15 times more risk of having a hip fracture than subjects of the same age at home. The excess risk decreased with age and stabilized over 85 years of age at two to threefold. During the 24 month follow-up, 394 women and 173 men died. Among those surviving, 87% were interviewed at 2 years. We analysed seven classes of complications, according to the ICD: (1) pressure sores and blisters; (2) pulmonary infections; (3) urinary infections; (4) surgical complications; (5) orthopedic complications; (6) thrombosis and embolisms; and (7) secondary hip fractures. Patients coming from a community had a higher risk of mortality, pressure sores, surgical complications, and pulmonary and urinary infections. From an economical perspective, the institutionalized population would seem to be a profitable target for the prevention of fractures and their complications.

Bone mass in middle-aged osteoporotic men and their relatives : Familial effect

Severe idiopathic osteoporosis in middle‐aged men is still poorly understood. The aim of this study was to assess the contribution of genetic factors in these patients. We studied 38 men (mean age ± SD, 50 ± 11 years) presenting with vertebral or peripheral bone fractures due to primary osteoporosis and 73 of their relatives divided into four subgroups: 19 brothers, 22 sisters, 13 sons, and 19 daughters. The control group comprised 199 age‐matched subjects. In all subjects, we measured bone mineral density (BMD) and calculated the Z score at the lumbar spine (LS) and femoral neck (FN) based on the fitted BMD value in the controls. LS BMD values were lower in each of the four subgroups compared with the age‐matched controls. The mean Z score for the overall group of 73 relatives was decreased compared with the age‐matched controls (−1.28 ± 1.48 at the LS and −1.03 ± 1.19 at the FN) and was not influenced by gender or by whether the relatives were siblings or children. An LS Z score < −1) was found in 54.8% of the relatives of osteoporotic patients versus 17.4% of the control subjects (risk ratio, 3.2). Alcohol and tobacco abuse are well‐known risk factors for osteoporosis in men. Among the 38 osteoporotic patients, 7 were heavy smokers (>20 pack‐years), 8 were both heavy smokers and drinkers (>80 g/day for at least 10 years and γGT > 40 UI/l), and 23 had neither of these risk factors. BMD, Z score, and anthropometric data were the same in patients with and without risk factors. Decreases in LS and FN Z scores were similar in relatives of patients with and without risk factors. In conclusion, low BMD is observed in relatives of osteoporotic men with or without risk factors for osteoporosis, indicating that familial factors contribute to primary osteoporosis in middle‐aged men.

Osteoporosis in Patients on Long-Term Home Parenteral Nutrition: A Longitudinal Study†

The prevalence of osteoporosis was investigated in 88 patients with intestinal failure (IF). Osteoporosis was found in 67%, dependent of body mass index and age when IF occurred. In 56 patients on HPN, followed prospectively, changes in bone density were dependent on the duration of HPN; older patients had a higher increase.

Fractures of the proximal femur in Picardy, France, in 1987

Between 1 January and 31 December 1987, 1178 hip fractures were recorded in the 28 clinical centres, public and private, of the Picardy region (19443 km2, 1.8 million inhabitants). Patients under 20 years and those with metastatic cancer and myelomatous fractures were excluded. Women sustained 853 fractures (age mean ± SD: 80.2±10.4 years) and men 325 (age 69.7±16.0 years). The crude incidence rate per 10 000 person years was 13.4 for women and 5.4 for men (female/male ratio 2.6). These incidences are among the lowest recorded in Northern Europe. Women with trochanteric fractures were older than those with cervical ones, but no difference was observed for men. After adjusting for age and sex, the incidence of hip fracture was greater in urban (10.5 per 10 000 person years) and semi-rural areas (8.2) than in rural areas (5.3). The mean bed-days per patient (±SD) was 21.6±16.0 (quartiles: 13–17–26 days); no difference was observed between sex or age classes. The in-hospital mortality rate was 8.7%, it increased with age and was higher in men, whatever their age. We review the data in different countries, mostly European, to compare with the Picardy region.

Hip fractures in France: The magnitude and perspective of the problem

The incidence of hip fractures increases exponentially with age after 60 years. As the number of elderly will increase considerably in future years, hip fractures will become a major international public health problem [1-3] arousing interest and increased concern. Hip fractures are economically important because they necessitate preventive measures and long-term treatment [4]. This morbidity is accompanied by a loss of autonomy which leads patients to become dependent on medical and social institutions [5]. Despite the progress in anaesthesia and orthopaedic surgery, hip fracture mortality remains high [6-8]. Several studies have documented the impact of hip fracture on the health care system [9], which increases proportionally with its incidence. We studied this problem in France, one of the few European countries where the epidemiological status of hip fracture is poorly known [10-12]. Our purpose was: (1) to bring together and compare the scattered incidence survey data available for France and to synthesize the findings, (2) to evaluate regional differences, (3) to estimate the secular evolution over the last 10 years and estimate the annual number of hip fractures between 1990 and 2050, and (4) to study the impact of this morbidity on direct hospital costs and consumption of health care resources.

Separate and Combined Value of Bone Mass and Gait Speed Measurements in Screening for Hip Fracture Risk: Results from the EPIDOS Study

Abstract: Based on data from the EPIDOS prospective study, we have shown that femoral bone mineral density (BMD), calcaneal ultrasound measurements and fall-related factors are significant predictors of the risk of hip fracture. The goal of the present investigation, in the same cohort of elderly women, was (1) to assess and compare the value of femoral BMD, calcaneal broadband ultrasound attenuation (BUA), gait speed and age for identifying elderly women at high risk of hip fracture and (2) to determine whether combining two or more of these measurements would improve predictive ability over single measures. A total of 5895 elderly women had baseline measurements of femoral neck BMD by dual-energy X-ray absorptiometry, calcaneal BUA and gait speed. During an average of 33 months of follow-up, 170 women suffered a hip fracture. We compared the sensitivity and specificity of single and combined measures for three specific cutoff levels to define high risk, i.e., the median, the top quartile and the top decile of risk. We found that femoral BMD, calcaneal BUA, gait speed and age have approximatively the same discriminant value to identify women at high risk of hip fracture even though certain measures and combinations of measures have a significantly higher sensitivity for certain cutoff levels. The sensitivity of the available screening tools is low, even when they are combined: to obtain a sensitivity of about 80%, approximately 50% of the population must be considered to be at high risk.

Effect of sex and age on the ratio of cervical to trochanteric hip fracture. A meta-analysis of 16 reports on 36,451 cases.

We analyzed 15 published reports and our own data. In women, the ratio of cervical to trochanteric fractures (C/T) evolved in 3 periods. 1) Before the age of 50 years, the annual incidence of cervical fracture is close to that of trochanteric fracture. 2) Between 50 and 60 years, cervical fracture increases markedly, and the C/T ratio is well above unity at an age when the fracture incidence is still very low. 3) This imbalance progressively diminishes to reach unity in the very old, as the result of a progressive increase in trochanteric fractures. In men, cervical fractures are progressively more common with increasing age, and the C/T ratio exceeds unity after 70 years of age. In both genders, the incidence of cervical fracture is thus greater than that of trochanteric fracture during a limited period of time, in the perimenopausal period for women and in elderly men. Several hypotheses on the mechanics of falls and bone strength have been advanced, without any satisfactory explanation for the C/T sex and age changes.

Reduced bone mineral density in postmenopausal women self-reporting premenopausal wrist fractures

Postmenopausal fractures are associated with low bone mass; however, the role of low peak bone mass in young adults in determining subsequent osteoporosis suggests that premenopausal fractures may also be relevant. We therefore sought to determine whether a self-reported previous history of premenopausal wrist and nonwrist fractures could also be associated with bone density and therefore be used to predict osteoporosis. We recruited 453 volunteer women with a median age of 64 years (range 50-83 years), with no metabolic bone disease, previous femoral neck fracture, or prevalent vertebral fracture. Bone density at the femoral neck (FN) and lumbar spine (LS) was measured using a Lunar DPX-L. As expected, the 319 women who did not report any fracture had a higher T score at LS (-0.93 +/- 1.44) than the 134 women who reported a previous fracture at any site and at any age (T score -1.60 +/- 1.21, p < 0.001). The findings for the FN were similar. Compared with fracture-free women, the women who reported a first wrist fracture before menopause now had a lower LS T score (-1.77 +/- 1.20, n = 15, p < 0.05), whereas those who reported a nonwrist fracture showed no significant decrease in their LS T score (-1.26 +/- 1.00, n = 36). When both wrist and nonwrist fractures had occurred after menopause, the T score was significantly lower. Twenty percent of the fracture-free women were osteoporosis patients. After adjusting for body weight, age, hormonal replacement therapy (HRT), and hip fracture in the family, the relative risk (RR) of osteoporosis for premenopausal wrist fractures was 2.7 (95% confidence interval 1.4-4.3) vs. 1.2 (0.7-2.4) for women with premenopausal nonwrist fractures. We conclude that self-reported premenopausal wrist fractures, but no other fractures occurring before menopause, are likely to be associated with osteoporosis at 65 years of age, and therefore constitute strong grounds for screening.

Automatic Detection Of Microaneurysms In Retinopathy Fluoro-Angiogram

A computerized method for detecting microaneurysms is described, based upon the concepts introduced by the Mathematical Morphology. On the grey level image of a fluoroangiogram, magnified by a microscope, a first transformation, searching the regional minima, gives a binary image where appear vessels and microaneurysms. Then the microaneurysms are extracted using a shape criterion which selects almost circular particles among stretched particles in one direction. The most complex part is to discriminate diffusing microaneurysm (leakage of fluorescein) from vessel. The algorithm is tested on 25 angiograms. We obtain a good correlation between the automatic counting and the manual counting performed by three reading-technicians.