Inga Redlund-Johnell

Long-term risk of osteoporotic fracture in Malmö.

Abstract: The objectives of the present study were to estimate long-term risks of osteoporotic fractures. The incidence of hip, distal forearm, proximal humerus and vertebral fracture were obtained from patient records in Malmo¨, Sweden. Vertebral fractures were confined to those coming to clinical attention, either as an inpatient or an outpatient case. Patient records were examined to exclude individuals with prior fractures at the same site. Future mortality rates were computed for each year of age from Poisson models using the Swedish Patient Register and the Statistical Year Book. The incidence and lifetime risk of any fracture were determined from the proportion of individuals fracture-free from the age of 45 years. Lifetime risk of shoulder, forearm, hip and spine fracture were 13.3%, 21.5%, 23.3% and 15.4% respectively in women at the age of 45 years. Corresponding values for men at the age of 45 years were 4.4%, 5.2%, 11.2% and 8.6%. The risk of any of these fractures was 47.3% and 23.8% in women and men respectively. Remaining lifetime risk was stable with age for hip fracture, but decreased by 20–30% by the age of 70 years in the case of other fractures. Ten and 15 year risks for all types of fractures increased with age until the age of 80 years, when they approached lifetime risks because of the competing probabilities of fracture and death. We conclude that fractures of the hip and spine carry higher risks than fractures at other sites, and that lifetime risks of fracture of the hip in particular have been underestimated.

Fracture risk following an osteoporotic fracture

The aim of this study was to examine the pattern of fracture risk following a prior fracture at the spine, shoulder or hip. We studied 1918 patients with fractures at these sites identified from the Department of Radiology in Malmo who were followed for 5 years. Poisson regression was used to compute fracture rates immediately after the initial fracture and at 5 years thereafter in men and women aged 60 or 80 years. Immediate fracture risk was higher than that of the general population, more markedly so at the age of 60 than at 80 years. At the age of 60 years, the risk of hip, forearm and spine fractures were significantly increased following a prior spine, hip or shoulder fracture in men. A similar pattern was seen in women, except that the increase in risk of forearm fracture following a spine or hip fracture was not statistically significant. The incidence of further fractures at the shoulder, spine or hip fell with time after the first fracture, a fall that was significant for all fractures after a shoulder fracture, hip fracture after a spine fracture, and hip and spine fractures after a hip fracture. We conclude that the risk of a subsequent fracture immediately after an osteoporotic fracture is highest immediately after the event. This provides a rationale for very early intervention immediately after fractures to avoid recurrent fractures.

Free Testosterone is an Independent Predictor of BMD and Prevalent Fractures in Elderly Men: MrOS Sweden

The role of androgens for bone health in elderly men is unclear. We show that free testosterone within the normal range is a predictor of BMD at predominantly cortical bone sites and of previous osteoporosis‐related fractures in elderly Swedish men.

Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study.

Abstract The aim of this study was to evaluate whether a prevalent vertebral deformity predicts mortality and fractures in both men and women. In the city of Malmö, 598 individuals (298 men, 300 women; age 50–80 years) were selected from the citys population and were included in the Swedish part of the European Vertebral Osteoporosis Study (EVOS). At baseline the participants answered a questionnaire and lateral spine radiographs were performed. The prevalence of subjects with vertebral deformity was assessed using a morphometric method. The mortality during a 10-year follow-up period was determined through the register of the National Swedish Board of Health and Welfare. Eighty-five men and 43 women died during the study period. The subsequent fracture incidence during the follow-up period was ascertained by postal questionnaires, telephone interviews and by a survey of the archives of the Department of Radiology in the city hospital. Thirty-seven men and 69 women sustained a fracture during the study period. Data are presented as hazard ratios (HR) with 95% confidence interval (95% CI) within brackets. Prevalent vertebral deformity, defined as a reduction by more than 3 standard deviations (SD) in vertebral height ratio, predicted mortality during the forthcoming decade in both men [age-adjusted HR 2.4 (95% CI 1.6–3.9)] and women [age-adjusted HR 2.3 (95% CI 1.3–4.3)]. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. Prevalent vertebral deformity predicted an increased risk of any fracture during the forthcoming decade in both men [age-adjusted HR 2.7 (95% CI 1.4–5.3)] and women [age-adjusted HR 1.8 (95% CI 1.1–2.9)]. Prevalent vertebral deformity predicted an increased risk of any subsequent fragility fracture in women [age-adjusted HR 2.0 (95% CI 1.1–3.5)]; however, in men the increased risk was nonsignificant [age-adjusted HR 1.9 (95% CI 0.7–5.1)]. In summary, a prevalent vertebral deformity can predict both increased mortality and increased fracture incidence during the following decade in both men and women. We conclude that prevalent vertebral deformity could be used as a risk factor in both genders for mortality and future fracture.

Mid-clavicle fractures in adults: end result study after conservative treatment.

OBJECTIVE The aim of the present study was to analyze the long-term outcome of mid-clavicle fractures in adults and to evaluate the clinical importance of displacement and fracture comminution. DESIGN Two hundred twenty-five mid-clavicular fractures that had been nonsurgically treated at Malmö University Hospital were retrospectively evaluated, both clinically and radiographically, an average of seventeen years after injury. There were seventy-one undisplaced fractures, sixty-nine displaced two-fragment fractures, and eighty-five displaced and comminuted fractures. The average patient age at the time of trauma was thirty-three years (range 15 to 70 years). Patients were interviewed, and careful clinical and radiological examination of their shoulders was performed. Two patients had experienced transient neuritis, and another two underwent operative treatment because of progressive neuropathy. SETTING All 225 consecutive patients were treated primarily at the Malmö University Hospital, which serves the Malmö city population (250,000). PATIENTS/PARTICIPANTS Since the beginning of this century, all radiographs taken at the Malmö University Hospital have been classified and filed for easy retrieval. In this retrospective study, all patients treated between 1970 and 1979 were identified, and those still living were called for follow-up examination. INTERVENTION Of the 225 fractures reviewed, 197 fractures were originally treated with a figure-of-eight splint for an average period of three weeks without any attempt to reduce the displaced fractures; twenty-four patients were allowed immediate free shoulder mobilization. MAIN OUTCOME MEASUREMENTS Clinical rating and healing were the main outcome measurements. RESULTS At follow-up, 185 shoulders were asymptomatic. Thirty-nine shoulders had moderate pain and were rated as fair, and one patient was rated as poor. One hundred twenty-five of the fractures had healed normally, fifty-three were malunited with persistent fracture displacement, and seven were nonunions; nonunion was significantly more prevalent in cases with displaced fractures. Forty malunited fractures and three nonunions were rated as good. CONCLUSIONS This review demonstrates that few patients with fractures of the mid-part of the clavicle require operative treatment.

Femoral neck geometry and radiographic signs of osteoporosis as predictors of hip fracture

A total of 125 consecutive hip fracture patients were investigated regarding hip geometry. There were 33 men of mean age 76 +/- 10 years, and 92 women of mean age 78 +/- 9 years. Patients with previous hip surgery were excluded. Hip geometry (hip-axis length, width of collum femoris, and femoral shaft and neck-shaft angle) were registered on both plain radiographs and DEXA scans performed within 2 weeks after fracture. On the radiographs, the calcar femorale, the Singh index, and the femoral neck index (FNI) were also calculated and compared with earlier published values of bone mineral density hip in the hip fracture patients. The fracture cases were compared with controls, 192 DEXA scans and 163 radiographs, in patients without hip surgery or known hip disease. As measured on the DEXA scans we found a wider collum femoris and a wider femoral shaft in both the male and female fracture cases, compared to controls. Also, the fracture cases showed signs of osteoporosis as measured by the calcar femorale, the Singh index, and the femoral neck index. These measurements showed good correlation with bone mineral density of the hip as measured by the DEXA scans.

Preoperative and postoperative instability in lumbar spinal stenosis

Sixty-one patients operated on for spinal stenosis, without a fusion, were studied retrospectively. Preoperative instability, as revealed by functional myelography, was found to predict a poor prognosis (P < 0.01). Women had less favorable results (P < 0.05). The “slipping” group was significantly more often radically decompressed than the “nonslipping” group (P < 0.01). Postoperative slipping was found in 26 patients, significantly more often in those with unsatisfactory results (P < 0.001).

Changes in the incidence of fracture of the upper end of the humerus during a 30-year period. A study of 2125 fractures

The incidence of fracture of the upper end of the humerus by age group and sex was studied for a 32-year period from 1950 to 1982. The following numbers of humeral fractures occurred: 1950-1954, 411 fractures; 1961-1964, 552 fractures; 1971-1973, 639 fractures; and 1981-1982, 523 fractures. There was a progressive increase in the age-related incidence in older persons, especially in women. There was a higher incidence of fractures classified as severe in the 1980s compared with the 1950s.

Changes in incidence and prevalence of vertebral fractures during 30 years

SummaryThe age and sex-specific incidence and prevalence of vertebral compression fractures were compared between the 1950s and 1980s in an urban population. In women over 80 years of age the incidence of symptomatic vertebral fractures has increased approximately four times; in elderly men even more. Mainly, low-energy trauma has caused these fractures. Thus, one clinical manifestation of osteoporosis-vertebral fracture-has increased in number, incidence, and prevalence over the last 30 years.

Long-Term Morbidity and Mortality After a Clinically Diagnosed Vertebral Fracture in the Elderly-a 12- and 22-Year Follow-up of 257 Patients.

The objective of this study was to analyze the long-term morbidity and mortality in patients with a clinically diagnosed vertebral fracture. Seventy men with a mean age of 70 years (range 50–91 years) and 187 women with a mean age of 72 years (range 50–96 years) were radiographically diagnosed as having a vertebral fracture in the thoracic or lumbar spine at the Malmö University Hospital (Sweden) during 1979. At the time of a follow-up examination 12 years later, 56 of the 76 patients who were still alive participated in an investigation that evaluated back pain and subjective health status by a questionnaire. Forty-four of these subjects also participated in a further radiologic examination of the spine. Serving as controls were age- and gender-matched subjects from the Malmö cohort of the European Vertebral Osteoporosis Study (EVOS). A mortality analysis was also conducted, covering 22 years following the baseline fracture. There were more female patients, who, in comparison with the controls, 12 years after the diagnosis, had had back pain during the year preceding the follow-up (72% vs 33%, P < 0.001), had current back pain (42% vs. 19%, P = 0.006), and had a subjectively impaired health status (44% vs. 17%, P < 0.001). The corresponding differences in men reached only a borderline significance, for both back pain during the year preceding the follow-up (60% vs. 28%, P = 0.07) and current back pain (40% vs. 15%, P = 0.09), whereas there was no difference in subjective health status. The incidence of new vertebral fractures in individuals with a clinically diagnosed vertebral fracture during the following 12 years was in men 25 per 1,000 person-years and in women 49 per 1000 person-years. There were more women with a new vertebral fracture at the 12-year follow-up examination who, in comparison with women without a new fracture, had had back pain during the year preceding the follow-up examination (90% vs. 50%, age-adjusted P = 0.02) and had current back pain (65% vs. 21%, age-adjusted P = 0.03). Women with a new vertebral fracture at the 12-year follow-up examination had a higher subsequent mortality rate in the next 10 years [age-adjusted hazard ratio 2.8 (95% CI 1.0–7.9)] as compared with women without. The mortality rate during the 22 years following the diagnosis among the male patients was 111.7 per 1,000 person-years as compared with 73.4 per 1,000 person-years among the male population at risk. The mortality rate among the female patients was 95.1 per 1,000 person-years as compared with 62.0 per 1,000 person-years among the female population at risk. We conclude that a clinically diagnosed thoracic or lumbar vertebral fracture in the elderly can be regarded as a risk factor for subsequent, long-term morbidity, especially in women, and for mortality in both genders.