Jochen Schumacher

[Prevalence of musculoskeletal complaints and self-reported joint osteoarthritis in the population of Herne : a telephone survey].

BACKGROUND Musculoskeletal pain is among the most common symptoms in the population and osteoarthritis is the most important underlying disease. Due to demographic changes, an increase in problems with arthritis is to be expected. To assess the impact on individuals affected and the community, data on the prevalence of musculoskeletal pain and osteoarthritis are essential. METHODS We performed a telephone survey in a sample of 1,270 inhabitants of the City of Herne, Germany, aged 40 years and older. Participants were asked to give their experience on musculoskeletal pain at the time of the questionnaire and during the last 4 weeks and 12 months. Further questions were whether the knee or hip were the site of most severe pain and if osteoarthritis was ever diagnosed by a physician. Standardized prevalences are reported according to age. RESULTS A total of 862 (67.9%) persons participated and participants were significantly older and more often female. Musculoskeletal pain on the day of the questionnaire, during the past 4 weeks and the past 12 months was reported in 37.4%, 53.0% and 60.0%, respectively. The knee and hip were predominantly affected in 35.9% and 16.1%, respectively and 26.2% reported that a physician had previously diagnosed osteoarthritis. The prevalences were related to age and gender. CONCLUSIONS Musculoskeletal pain and osteoarthritis affect an important part of the adult urban population. We found associations between self-reported musculoskeletal pain, osteoarthritis, age and gender. Further studies should evaluate the interference of pain with activities of daily living as well as the use of health services by affected patients.

Prävalenz von muskuloskelettalen Beschwerden und selbstberichteter Gelenkarthrose in der Herner Bevölkerung

BACKGROUND Musculoskeletal pain is among the most common symptoms in the population and osteoarthritis is the most important underlying disease. Due to demographic changes, an increase in problems with arthritis is to be expected. To assess the impact on individuals affected and the community, data on the prevalence of musculoskeletal pain and osteoarthritis are essential. METHODS We performed a telephone survey in a sample of 1,270 inhabitants of the City of Herne, Germany, aged 40 years and older. Participants were asked to give their experience on musculoskeletal pain at the time of the questionnaire and during the last 4 weeks and 12 months. Further questions were whether the knee or hip were the site of most severe pain and if osteoarthritis was ever diagnosed by a physician. Standardized prevalences are reported according to age. RESULTS A total of 862 (67.9%) persons participated and participants were significantly older and more often female. Musculoskeletal pain on the day of the questionnaire, during the past 4 weeks and the past 12 months was reported in 37.4%, 53.0% and 60.0%, respectively. The knee and hip were predominantly affected in 35.9% and 16.1%, respectively and 26.2% reported that a physician had previously diagnosed osteoarthritis. The prevalences were related to age and gender. CONCLUSIONS Musculoskeletal pain and osteoarthritis affect an important part of the adult urban population. We found associations between self-reported musculoskeletal pain, osteoarthritis, age and gender. Further studies should evaluate the interference of pain with activities of daily living as well as the use of health services by affected patients.

Vitamin D and parathyroid hormone: a tool to determine assay specific cutoff values for vitamin D 1

Abstract> Vitamin D has been attributed a role in the pathogenesis of various chronic diseases. Vitamin D status is best assessed by measuring serum 25-hydroxyvitamin D(25[OH]D). Serum 25(OH)D concentrations far above the deficiency threshold for skeletal health may be suboptimal with respect to long-term health consequences. No final consensus has so far been reached regarding an appropriate cutoff value. Diagnostic work-up in the clinical setting as well as the interpretation of scientific evidence are hampered by a lack of standardization in 25(OH)D assays. The present study compares quantification of serum 25(OH)D by means of three different assays: an in-house high-performance liquid chromatograph (HPLC)-method, and two chemiluminescence immunoassays (CLI) from different manufacturers (DiaSorin, Nichols). In addition, serum intact parathyroid hormone (iPTH) was measured using two different methods (CLI, DiaSorin; electrochemiluminescence immunoassay [ECL], Roche). Based on the inverse relationship between vitamin D and PTH in the regulation of serum calcium, receiver operating characteristic (ROC) analyses were used to determine assay specific serum 25(OH)D cutoff values that distinguished at best between normal and elevated serum iPTH according to the manufacturers given reference ranges. Obtained cutoff values identified varied from 22.9 μg/L for the HPLC method to 19.5μg/L for the CLI (Nichols) and to 14.4 μg/L for the CLI (DiaSorin), respectively. While these values need to be considered as warning thresholds, they fall within published reference limits for the investigated 25(OH)D assays. Serum iPTH-based cutoff values for serum 25(OH)D are not apt to substitute for assay-specific reference limits for the various long-term adverse health outcomes that may be linked to vitamin D insufficiency.

Osteoporose und Sturz: medizinische Versorgung älterer Menschen mit einem erhöhten Frakturrisiko in Deutschland

Zusammenfassung Frakturen stellen besonders im Alter eine erhebliche Gefahr fur Patienten dar. Von besonderer klinischer und gesundheitsokonomischer Bedeutung ist die proximale Femurfraktur. Funktionelle Defizite, erhohte Pflegebedurftigkeit und Einschrankung der Lebensqualitat nach Fraktur fuhren zu erhohter Morbiditat und Mortalitat zuvor uberwiegend selbststandig lebender Patienten. Das Risiko, eine proximale Femurfraktur zu erleiden, wird ganz wesentlich vom Vorliegen der zwei Risikofaktoren Osteoporose und Sturzkrankheit beeinflusst. Beide Risikofaktoren sind beeinflussbar und somit einer Intervention zuganglich. Zur Diagnostik und Therapie existieren nationale und internationale Leitlinien, die bislang Defizite der Knochenstabilitat und der neuromuskularen Funktion getrennt voneinander betrachtet haben. In der aktuellen Leitlinie des Dachverbandes Osteologie (DVO) 2006 werden beide Aspekte erstmals gemeinsam berucksichtigt und hieran Empfehlungen zur individuellen Diagnostik und Therapie in Abhangigkeit vom 10-Jahres-Frakturrisiko geknupft. Eine zuverlassige Bewertung der aktuellen Versorgungssituation bei Osteoporose und Sturz ist weder national noch international umfassend moglich. Lediglich die Versorgung mit apparativer Diagnostik und medikamentoser Therapie bei Osteoporose lasst sich beurteilen. In diesen Bereichen zeichnet sich eine Unterversorgung ab. Es sind standardisierte Erhebungen zur Implementierung der Leitlinien erforderlich, die Moglichkeiten zur Verbesserung der Versorgung aufzeigen konnen.

[Age-related differences in functional tests to assess the risk of falling in patients with knee pain].

ZusammenfassungIn einer Querschnittsuntersuchung wurden die Ergebnisse von drei Tests zur Einschätzung des Sturzrisikos auf einen Zusammenhang mit dem Alter der Teilnehmer untersucht. Bei jedem der 188 Teilnehmer aus einem Kollektiv mobiler Menschen ab dem 40. Lebensjahr mit Kniegelenksbeschwerden wurden ein Timed-Up-And-Go-Test, ein leistungsorientiertes Mobilitätsassessment (POMA, sog. Tinetti-Test) und ein noch wenig etablierter einfacher Test zur dynamischen Balance, der Schritt-Test in vier Quadraten (Four-Square-Step-Test, FSST) durchgeführt. Die aus anderen Untersuchungen bekannte Altersabhängigkeit des Tinetti-Tests und des Timed-Up- And-Go-Tests konnten in diesem Kollektiv ebenfalls nachgewiesen werden. Für den Four-Square-Step-Test wurde ein Zusammenhang zwischen Testergebnis und Alter in dieser Studie erstmalig gezeigt. Weitere Untersuchungen sind erforderlich, um die klinimetrische Qualität der drei Tests zur Identifikation eines hohen Sturzrisikos bei Patienten mit Kniegelenksbeschwerden zu beurteilen.SummaryIn the present crosssectional study the results of three tests to assess the risk of falling were examined for a correlation with advancing age of the participants. Each of the 188 communitydwelling active participants aged 40 years or older with a history of knee pain performed the Timed Up and Go (TUG), the Performance Oriented Mobility Assessment (POMA, “Tinetti Test”) and a less established simple test of dynamic balance, the Four Square Step Test (FSST). Age-related differences in performance in the Timed Up and Go and the Performance Oriented Mobility Assessment have been shown in previous studies and are also present in this sample. For the Four Square Step Test an association of test performance and age has been shown for the first time in this study. Further investigation is required to determine the quality of these three tests regarding their ability to assess the risk of falling in patients with knee pain.

Altersabhängige Unterschiede bei funktionellen Tests zur Beurteilung des Sturzrisikos bei Patienten mit Kniegelenksbeschwerden

ZusammenfassungIn einer Querschnittsuntersuchung wurden die Ergebnisse von drei Tests zur Einschätzung des Sturzrisikos auf einen Zusammenhang mit dem Alter der Teilnehmer untersucht. Bei jedem der 188 Teilnehmer aus einem Kollektiv mobiler Menschen ab dem 40. Lebensjahr mit Kniegelenksbeschwerden wurden ein Timed-Up-And-Go-Test, ein leistungsorientiertes Mobilitätsassessment (POMA, sog. Tinetti-Test) und ein noch wenig etablierter einfacher Test zur dynamischen Balance, der Schritt-Test in vier Quadraten (Four-Square-Step-Test, FSST) durchgeführt. Die aus anderen Untersuchungen bekannte Altersabhängigkeit des Tinetti-Tests und des Timed-Up- And-Go-Tests konnten in diesem Kollektiv ebenfalls nachgewiesen werden. Für den Four-Square-Step-Test wurde ein Zusammenhang zwischen Testergebnis und Alter in dieser Studie erstmalig gezeigt. Weitere Untersuchungen sind erforderlich, um die klinimetrische Qualität der drei Tests zur Identifikation eines hohen Sturzrisikos bei Patienten mit Kniegelenksbeschwerden zu beurteilen.SummaryIn the present crosssectional study the results of three tests to assess the risk of falling were examined for a correlation with advancing age of the participants. Each of the 188 communitydwelling active participants aged 40 years or older with a history of knee pain performed the Timed Up and Go (TUG), the Performance Oriented Mobility Assessment (POMA, “Tinetti Test”) and a less established simple test of dynamic balance, the Four Square Step Test (FSST). Age-related differences in performance in the Timed Up and Go and the Performance Oriented Mobility Assessment have been shown in previous studies and are also present in this sample. For the Four Square Step Test an association of test performance and age has been shown for the first time in this study. Further investigation is required to determine the quality of these three tests regarding their ability to assess the risk of falling in patients with knee pain.

Prävalenz von muskuloskelettalen Beschwerden und selbstberichteter Gelenkarthrose in der Herner Bevölkerung@@@Prevalence of musculoskeletal complaints and self-reported joint osteoarthritis in the population of Herne: Ein Telefon-Survey@@@A telephone survey

BACKGROUND Musculoskeletal pain is among the most common symptoms in the population and osteoarthritis is the most important underlying disease. Due to demographic changes, an increase in problems with arthritis is to be expected. To assess the impact on individuals affected and the community, data on the prevalence of musculoskeletal pain and osteoarthritis are essential. METHODS We performed a telephone survey in a sample of 1,270 inhabitants of the City of Herne, Germany, aged 40 years and older. Participants were asked to give their experience on musculoskeletal pain at the time of the questionnaire and during the last 4 weeks and 12 months. Further questions were whether the knee or hip were the site of most severe pain and if osteoarthritis was ever diagnosed by a physician. Standardized prevalences are reported according to age. RESULTS A total of 862 (67.9%) persons participated and participants were significantly older and more often female. Musculoskeletal pain on the day of the questionnaire, during the past 4 weeks and the past 12 months was reported in 37.4%, 53.0% and 60.0%, respectively. The knee and hip were predominantly affected in 35.9% and 16.1%, respectively and 26.2% reported that a physician had previously diagnosed osteoarthritis. The prevalences were related to age and gender. CONCLUSIONS Musculoskeletal pain and osteoarthritis affect an important part of the adult urban population. We found associations between self-reported musculoskeletal pain, osteoarthritis, age and gender. Further studies should evaluate the interference of pain with activities of daily living as well as the use of health services by affected patients.

Vitamin D und Parathormon: Ein Weg zur Bestimmung methodenabhängiger unterer Grenzwerte für Vitamin D / Vitamin D and parathyroid hormone: a tool to determine assay-specific cutoff values for vitamin D

Zusammenfassung Vitamin D wird eine Rolle in der Pathogenese zahlreicher chronischer Erkrankungen zugesprochen. Als Indikator des endogenen Vitamin D Status dient die Bestimmung von 25-Hydoxyvitamin D (25(OH)D). Eine suboptimale Versorgung mit möglichen gesundheitlichen Langzeitfolgen liegt möglicherweise bereits bei Serum-Konzentrationen vor, die weit über einem skelettsensitiven Schwellenwert liegen. Bisher besteht keine Einigung hinsichtlich eines klinisch relevanten Grenzwertes. Erschwerend für die klinische Diagnostik, aber auch die Interpretation von Forschungsergebnissen, wirken sich Standardisierungsdefizite bei den Messmethoden aus. In der vorliegenden Arbeit wurden drei 25(OH)D-Assays miteinander verglichen: eine In-house High-Performance-Liquid-Chromatography (HPLC)-Methode und zwei Lumineszenzassays verschiedener Hersteller (DiaSorin, Nichols). Zusätzlich wurde intaktes Parathormon (iPTH) im Serum mit zwei verschiedenen Methoden bestimmt (Lumineszenzassay, DiaSorin; Elektrochemilumineszenz-Immunoassay, Roche). Basierend auf der gegenläufigen Beziehung zwischen Vitamin D und intaktem Parathomon in der engmaschigen Regulation des Serum-Kalziums wurden mit Hilfe von ROC-Analysen testspezifische Schwellenwerte für Serum-25(OH)D ermittelt, die eine optimale Differenzierung zwischen erhöhten und innerhalb des vom Hersteller angegebenen Referenzbereichs liegenden iPTH-Serumkonzentrationen erlauben. Für die HPLC-Methode lag dieser Wert bei 22,9 μg/L, für den Lumineszenzassay (Nichols) bei 19,5 μg/L und den Lumineszenzassay (DiaSorin) bei 14,4 μg/L. Diese Schwellenwerte sind als untere Alarmgrenze zu verstehen und belegen zugleich, dass sie zum Teil bereits in die etablierten Referenzbereiche der hier untersuchten Methoden für Serum-25(OH)D fallen. Am iPTH-orientierte methodenspezifische Grenzwerte für Serum-25(OH)D ersetzen nicht die Erstellung von Referenzbereichen für die verschiedenen möglichen gesundheitlichen Langzeitfolgen einer Vitamin D Unterversorgung. Abstract Vitamin D has been attributed a role in the pathogenesis of various chronic diseases. Vitamin D status is best assessed by measuring serum 25-hydroxyvitamin [25(OH)D]. Serum 25(OH)D concentrations far above the deficiency threshold for skeletal health may be suboptimal with respect to long-term health consequences. No final consensus has so far been reached regarding an appropriate cutoff value. Diagnostic work-up in the clinical setting and the interpretation of scientific evidence are hampered by a lack of standardization in 25(OH)D assays. The present study compares quantification of serum 25(OH)D by means of three different assays: an in-house high-performance liquid chromatography method, and chemiluminescence immunoassays (CLI) from two different manufacturers (DiaSorin, Nichols). In addition, serum intact parathyroid hormone (iPTH) was measured using two different methods (CLI, DiaSorin; electrochemiluminescence immunoassay, Roche). Based on the inverse relationship between vitamin D and PTH in the regulation of serum calcium, receiver operating characteristic analyses were used to determine assay specific serum 25(OH)D cutoff values that best distinguished between normal and elevated serum iPTH as indicated by the manufacturer. The cutoff values identified varied from 22.9 μg/L for the HPLC method to 19.5 μg/L for the Nichols CLI and 14.4 μg/L for the DiaSorin CLI. Although these values need to be considered as warning thresholds, they fall within published reference limits for the 25(OH)D assays investigated. Serum iPTH-based cutoff values for serum 25(OH)D are not suitable as substitutes for assay-specific reference limits for various long-term adverse health outcomes that may be linked to vitamin D insufficiency.