Cyrus Cooper

The Epidemiology of Fractures

Fractures are a major cause of morbidity and mortality throughout the life course but particularly in the elderly. This article focuses on the epidemiology of fragility fractures that include hip, vertebral, forearm, and other fractures caused due to defects in bone strength. The cost of fragility fractures is large in terms of not only the health of individuals but also the cost to health-care systems, with hip fractures alone estimated to cost in excess of

Within-Person Pain Variability and Mental Health in Older Adults With Osteoarthritis: An Analysis Across 6 European Cohorts

130 billion worldwide. The rate of fracture according to sex fluctuates throughout the life course with fractures in females being more common overall but more common in younger males than females due to more forceful, physical trauma. We will cover the epidemiology of hip, vertebral, and distal forearm fractures, as well as pediatric fractures; clustering of fractures; financial implications; and future directions of interest in this complex and important area of research.

Parental Determinants of Neonatal Anthropometry

Pain is a key symptom of osteoarthritis (OA) and has been linked to poor mental health. Pain fluctuates over time within individuals, but a paucity of studies have considered day-to-day fluctuations of joint pain in relation to affective symptoms in older persons with OA. This study investigated the relationship of pain severity as well as within-person pain variability with anxiety and depression symptoms in 832 older adults with OA who participated in the European Project on OSteoArthritis (EPOSA): a 6-country cohort study. Affective symptoms were examined with the Hospital Anxiety and Depression Scale, pain severity was assessed with the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand Osteoarthritis Index, and intraindividual pain variability was measured using pain calendars assessed at baseline, 6, and 12 to 18 months. Age-stratified multiple linear regression analyses adjusted for relevant confounders showed that more pain was associated with more affective symptoms in older-old participants (74.1-85 years). Moreover, older-old participants experienced fewer symptoms of anxiety (ratiou2009=u2009.85, 95% confidence interval [CI], .77-.94), depression (ratiou2009=u2009.90, 95% CI, .82-.98), and total affective symptoms (ratiou2009=u2009.87, 95% CI, .79-.94) if their pain fluctuated more. No such association was evident in younger-old participants (65-74.0 years). These findings imply that stable pain levels are more detrimental to mental health than fluctuating pain levels in older persons.nnnPERSPECTIVEnThis study showed that more severe and stable joint pain levels were associated with anxiety and depressive symptoms in older persons with OA. These findings emphasize the importance of measuring pain in OA at multiple time points, because joint pain fluctuations may be an indicator for the presence of affective symptoms.

The intrauterine programming of osteoporosis

Evidence is accruing that growth early in life has a profound effect on that individual’s risk of many chronic diseases in late adulthood. This chapter attempts to unravel the various ways in which parents influence the anthropometry of their offspring. Much research has been undertaken in this area over the years and there is information linking a myriad of factors with foetal growth. It is the following factors, however, that are the most important and will be discussed here: age, race, parental birth anthropometry, parental height, parental weight, maternal weight gain during pregnancy, maternal activity, diet including calorie, protein and micronutrient intake, parity and interpregnancy interval, socioeconomic status, maternal pathology (hypertension, malaria, anaemia and diabetes) and lastly exposure to toxins (cigarette smoke and alcohol). The literature has been reviewed and a summary is presented to the reader. Where possible, conclusions are drawn as to the relative importance of each factor in determining neonatal anthropometry. The sections also include putative biological mechanisms that may underpin any such link where known, and the potential implications the research has on child health, where this is appropriate. The chapter concludes by briefly examining the debate surrounding the evolutionary origins of the parental determinants of neonatal anthropometry.

Age at first major osteoporotic fracture in Danes aged 50 and over: influence of diabetes on mean age at fracture and 1 year mortality

Osteoporosis is a skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in the risk of fracture. These fractures typically occur at the hip, spine, and distal forearm; the annual cost attributable to them in England and Wales is £1.7 billion, with over 90% of this figure ascribed to hip fracture [1]. Figure 1 shows the history of advances in the field of osteoporosis over the previous three millennia. The recognition that fractures might be a consequence of bone fragility was initiated in the writings of Hippocrates; palaeopathological studies of bone specimens removed from burial sites dating as early at the 8th century AD confirm that osteoporotic vertebral collapse has occurred among elderly individuals throughout the ages. Our recent enhanced understanding of the disorder, however, stems from the work of orthopedic surgeons such as Sir Astley Cooper in 1825, who documented the descriptive characteristics of age-related fractures, and the observations of histopathologists in France and Germany at around the same time, who first coined the time “osteoporosis” to denote the rarification of trabecular architecture observed in the central part of vertebral bodies from patients who were elderly, when compared with those who had died at younger ages. The modern era of osteoporosis research originated in the research of Dr. Albright in the United States, who first documented osteoporotic vertebral deformity as a consequence of estrogen deficiency in postmenopausal women.