Julie E. Dunn

Increased Risk of Fracture in Patients Receiving Solid Organ Transplants

The success of organ transplantation is related to advances in immunosuppressive therapy. These medications are associated with medical complications including bone damage. The objective of this study was to estimate and compare age, gender‐specific fracture incidence between transplant recipients, and a large sample representative of the civilian noninstitutionalized United States population using the 1994 National Health Interview Survey (NHIS). This was a cohort study set in tertiary care centers. Five hundred and thirty‐nine individuals who received abdominal organ and 61 heart transplants surviving at least 30 days at our institution from 1986 to 1996 were included in the study. Incident fractures were ascertained by mail, in‐person interview, telephone survey, or medical record review. All fractures were verified. Organ‐, age‐, and gender‐specific fracture numbers and rates and person‐years of observation, were calculated for the transplant patients. Weighted age‐ and gender‐specific fracture rates from the 1994 NHIS were applied to the number of person‐years of observation for each organ‐specific age and gender category of transplant patients to generate an expected number of fractures. The ratio of observed to expected number of fractures was used to compare fracture experience of transplant patients to that of the national sample from the 1994 NHIS. Fifty‐six of 600 (9.3%) patients had at least one fracture following 1221 person‐years of observation. The sites of initial symptomatic fracture were as follows: foot (n = 22), arm (n = 8), leg (n = 7), ribs (n = 6), hip (n = 4), spine (n = 3), fingers (n = 3), pelvis (n = 2), and wrist (n = 1). Fracture incidence was 13 times higher than expected in male heart recipients age 45–64 years; nearly 5 times higher in male kidney recipients age 25–44 and age 45–64 years; and 18 times and 34 times higher in female kidney recipients age 25–44 years and 45–64 years compared with NHIS data. We have shown an increased incidence of fractures and estimated the magnitude of this problem in patients undergoing solid organ transplantation. Our work defines the need for a long‐term prospective study of fracture risk in these patients.

Frequency of fractures in women with systemic lupus erythematosus: Comparison with united states population data

OBJECTIVE To describe the frequency of self-reported fractures in a large population-based cohort of women with lupus, to compare the frequency of self-reported fractures between lupus patients and women of similar age in the general population by use of data from the 1994 National Health Interview Survey (NHIS), and to describe the associated risk factors for fracture in women with lupus. This study is a secondary analysis of data collected to assess cardiovascular risk in women with lupus. METHODS Fractures and associated risk factors were ascertained by self report in this retrospective cohort study of 702 living women with lupus who were followed up for 5,951 person-years. Self-reported fractures were verified in a subset of patients. A Weibull regression model was used to assess risk factors associated with time from lupus diagnosis to fracture in the univariate and multivariate analyses. Age-specific standard morbidity ratios (SMRs) were calculated to determine whether fracture occurrence was greater than expected in women with lupus. RESULTS Eighty-six (12.3%) of 702 women reported at least 1 fracture following the diagnosis of lupus. The sites of the first fracture were the leg (n = 32), foot (n = 16), arm (n = 15), spine (n = 9), rib (n = 7), hip (n = 2), pelvis (n = 2), hand (n = 1), shoulder (n = 1), and finger (n = 1). Fracture risk was increased in the lupus cohort compared with women of similar age from the United States population, using weighted data from the 1994 NHIS (SMR 4.7; 95% confidence interval 3.8, 5.8). Variables in the univariate analysis that were significantly associated (P < 0.05) with time from lupus diagnosis to fracture were older age at lupus diagnosis, longer disease duration, longer duration of corticosteroid use, less use of oral contraceptives, and menopause status. In the multivariate analysis, independent determinants of time from lupus diagnosis to fracture were older age at lupus diagnosis and longer duration of corticosteroid use. CONCLUSION Fractures occurred in 12.3% of lupus patients who were followed up for 5,951 person-years. There was nearly a 5-fold increase in fracture occurrence in the women with lupus compared with women from the US population. Older age at lupus diagnosis and longer use of corticosteroids were associated with time from lupus diagnosis to fracture. With increased life expectancy of lupus patients, fracture occurrence is a major threat to the health of these women. Prevention strategies must be directed toward minimizing the occurrence of fractures in these patients.

Foot musculoskeletal disorders, pain, and foot-related functional limitation in older persons

Objectives: To examine whether common musculoskeletal disorders of feet are associated with pain and foot‐related functional limitation.

Are Foot Disorders Associated With Functional Limitation and Disability Among Community-Dwelling Older Adults?

The objectives of this study are to examine whether specific foot disorders and ankle weakness and foot pain are related to functional limitations or disabilities in elders. Community-dwelling adults 65 and older were enrolled in a population-based, cross-sectional study of foot disorders and health outcomes. Demographics, health status, comorbidities, self-reported foot and knee pain, function and disability, and observed structural foot disorders, body mass index, and ankle muscle strength were assessed on 717 participants. The associations of foot disorders, foot pain, and ankle muscle weakness with function and disability were examined with regression analyses. Foot disorders were not associated with functional outcomes or disability. Ankle weakness was associated with performance-based function (p = .005), self-report function (p < .001), and disability (p = .009). Foot pain was associated with self-report function (p = .01) and disability (p = .007). Foot pain and ankle weakness seem to be related to important health outcomes among older adults.

Monounsaturated, Trans, and Saturated Fatty Acids and Cognitive Decline in Women

OBJECTIVES: To prospectively assess effects of select dietary fats on cognitive decline.

Do Falls Predict Institutionalization in Older Persons? An Analysis of Data from the Longitudinal Study of Aging

Data from the Longitudinal Study of Aging (LSOA) were analyzed to estimate the subsequent risk of institutionalization associated with a report of one or more falls, and to determine if the association is affected by controlling for demographic traits, chronic conditions, and disabilities present at baseline. Risk was estimated at two time points, 2 years and 4years after baseline interview. A report of multiple falls at baseline was associated with an increased risk of institutionalization at both 2 years (odds ratio [OR] 3.1; 1.9-5.3) and 4 years (OR 2.6; 1.64.4) of follow-up. The risk was decreased but remained significant in a model controlling for age, sex, marital status, and selected chronic conditions associated with both report of falls and institutionalization. However, multiple falls were not significantly associated with institutionalization when measures of disability (number of difficulties with activities of daily living) were added to the model. These analyses suggest that multiple falls should be regarded as an important sentinel event to alert caregivers to the presence of underlying disease and disability that may require intervention.

Previous vitamin E supplement intake and memory impairment: A women’s health initiative ancillary study

Background: There are plausible mechanisms by which Vitamin E could protect against dementia or cognitive loss, but studies of such associations have been inconsistent. A previous interim cross-sectional analysis of our data found serum alpha tocopherol ( -toc) , but not current Vitamin E supplement use, to be associated with memory impairment in older women. Objective: We examine the association of past supplemental and dietary Vitamin E intake with cognitive impairment in 544 women age 60 and over, who are participants in a Women’s Health Initiative (WHI) Ancillary Study. Methods: Vitamin E supplement intake was ascertained by interview, and dietary intake by food frequency questionnaire, at WHI baseline. Women were enrolled in the cognitive function ancillary study an average of 5.6 (SD 2.2) years later, at which time an extensive cognitive test battery was administered and supplement use practices updated. Cognitive tests were classified by predominant functional domain: Memory, Executive Function, Language, Attention, and Visual Function. Women scoring 2 standard deviations or more below established ageand education-specific norms on one or more tests in a given domain were considered to have signs of impairment in that domain. Results: In bivariate analyses, mean previous supplemental -toc intake was 24-60 mg/day lower in women with memory, executive function, or language impairment compared to those without, but the difference was statistically significant only for memory impairment (mean intake 84 vs 157 mg/day; p .02). In logistic regression models adjusting for age, education, race, and time between -toc and cognitive function measurements, previous supplemental -toc was inversely associated with risk of memory impairment (p .045) such that an additional 100mg/day -toc would be associated with a relative odds of memory impairment of 0.9. In similar models, neither previous dietary, nor current supplemental -toc, were associated with memory impairment. Conclusions: Previous, but not current supplemental -toc intake is associated with a modestly reduced risk of memory impairment in older women. Possible reasons could include: previous intake acting as a surrogate for duration; latency period between -toc exposure and effects on memory or need for exposure to occur at a particular time (e.g. midlife) for maximum benefit.