Patrick Haentjens

Menarche, oral contraceptives, pregnancy and progression of disability in relapsing onset and progressive onset multiple sclerosis

Female gender and hormones have been associated with disease activity in multiple sclerosis (MS). We investigated age at menarche, use of oral contraceptives and pregnancy in relation to progression of disability in relapsing onset and progressive onset MS. We conducted a cross-sectional survey among individuals with MS, registered by the Flemish MS Society in Belgium. A time-to-event analysis and Cox proportional hazard regression were performed with time to Expanded Disability Status Score (EDSS) of 6 (requires a cane) as outcome measure. Hazard ratios for the time from onset and the time from birth were adjusted for age at onset and immunomodulatory treatment. Data on 973 women with definite MS were collected. In the relapsing onset group, women with at least two pregnancies had a reduced risk to reach EDSS 6 compared with nulliparous women. In the progressive onset group, later age at menarche was associated with a reduced risk to reach EDSS 6, whereas oral contraceptive use was associated with a higher risk of reaching EDSS 6. Our study corroborates the association of pregnancies with a reduced progression of disability in relapsing onset MS. In progressive onset MS, a slower progression was found in women with a later onset of menarche and a more rapid progression occurred when women reported the use of oral contraceptives.

Preventing osteoporotic fractures with antiresorptive therapy: implications of microarchitectural changes

Prospective studies have demonstrated that low bone mass correlates well with increased risk of osteoporotic fractures at various skeletal sites. Trials have likewise confirmed that enhancing bone mass with antiresorptive therapy reduces fracture incidence in individuals at risk. However, correlation of bone mineral density (BMD) increases with therapeutic risk reduction has proved less consistent than correlation of BMD decreases with greater fracture risk in the untreated. Indeed, various analyses have indicated that – even during treatment with potent bisphosphonates like alendronate and risedronate – BMD changes from baseline account for <30% of the reduction in vertebral fractures in treated women. It is clearly, therefore, that factors other than BMD are involved in the reduction of fracture risk achieved by antiresorptive therapies. According to recent micro‐computed tomography imaging and other studies, antiresorptive therapy can help rebuild the microarchitecture of bone as well as strengthen the materials that go into it. When treating individuals with osteoporosis, these microarchitectural changes contribute to the reduction of fracture risk achieved by antiresorptive therapies.

Sunlight exposure and sun sensitivity associated with disability progression in multiple sclerosis

Background: Sunlight and vitamin D have been inversely associated with the risk of multiple sclerosis (MS). Objective: We investigated sunlight exposure and sun sensitivity in relation to disability progression in MS. Methods: We conducted a survey among persons with MS, registered by the Flemish MS society, Belgium, and stratified data according to relapsing-onset and progressive-onset MS. We used Kaplan–Meier survival and Cox proportional hazard regression analyses with time to Expanded Disability Status Scale (EDSS) 6 as outcome measure. Hazard ratios for the time from onset and from birth were calculated for the potentially predictive variables, adjusting for age at onset, gender and immunomodulatory treatment. Results: 704 (51.3%) of the 1372 respondents had reached EDSS 6. In relapsing-onset MS, respondents reporting equal or higher levels of sun exposure than persons of the same age in the last 10 years had a decreased risk of reaching EDSS 6. In progressive-onset MS, increased sun sensitivity was associated with an increased hazard of reaching EDSS 6. Conclusion: The association of higher sun exposure with a better outcome in relapsing-onset MS may be explained by either a protective effect or reverse causality. Mechanisms underlying sun sensitivity might influence progression in progressive-onset MS.

Osteoporosis management: a perspective based on bisphosphonate data from randomised clinical trials and observational databases.

Aims:  The efficacy of treatments for osteoporosis can be evaluated using a variety of study designs. This article aims to comprehensively review the evidence for bisphosphonate anti‐fracture efficacy in postmenopausal women, discussing the strengths and limitations associated with each study method.

Clinical Risk Factors for Hip Fracture in Elderly Women : A Case-Control Study

Objectives To evaluate the strength of the association between clinical risk factors and hip fracture occurrence in elderly women. Design A case–control study. Patients/Participants Medical and social characteristics of 159 women with a first hip fracture (cases) were compared with 159 women without a hip fracture (controls) who were matched on age and residence. Methods Using conditional logistic regression modeling, the odds ratio (OR) and the 95 percent confidence interval (95 percent CI) were estimated as measures of the relative hip fracture risk. Results The highest hip fracture risk was associated with the self-perceived safety of the residence at the time of injury: if it were thought that the residence was not adequately equipped to allow safe motion or to perform the activities of daily living safely, this was associated with an almost sixfold increase in hip fracture risk (OR 5.8, 95 percent CI 2.5 to 13.4). The hip fracture risk was also increased by a report of two or more other fractures before the first hip fracture (OR 2.6, 95 percent CI 1.1 to 6.3), any tendency to fall within one year of the injury date (OR 2.3, 95 percent CI 1.8 to 4.1), and the chronic use of psychotropic drugs (OR 2.0, 95 percent CI 1.1 to 3.7). In contrast, ability to read a newspaper was protective against hip fracture (OR 0.3, 95 percent CI 0.2 to 0.7). Conclusions This study suggests that these factors may be useful for an easy identification of women at high risk for hip fracture in the short term and, thus, who should benefit in priority from hip fracture prevention strategies.

Clinical Risk Factors for Osteoporotic Hip Fracture in Elderly Women – Implications for Fracture Prevention

Of all fractures being linked with osteoporosis, those of the hip are the most important in terms of early death, functional dependence, and costs of care. Reduction of these adverse outcomes depends on preventing hip fractures caused by a fall on a biomechanically compromised proximal femur. In order to allow targeting of preventive care, there is considerable interest in predicting the risk of hip fracture. Bone densitometry is an established method to determine the risk of developing fractures. Recent studies, however, have identified additional factors which contribute to fracture risk independently of bone mass, suggesting that, in addition to taking measures that maintain bone density, risk factor modification may prove to be an effective strategy for preventing hip fracture. The aim of this article is to review current knowledge on clinical risk factors for hip fracture in elderly women.

Pharmacologic and Non-pharmacologic Strategies to Prevent Hip Fracture in Old Age

Strategies for the prevention of hip fracture should focus on the frequency of falling as well as on the prevalence of compromised femoral integrity as a consequence of bone loss. Given the high prevalence of falls among the elderly, a performance-oriented functional assessment should be targeted at all patients over 75 years of age. As the risk of falling increases with the number of risk factors, risk may be reduced by modifying even a few contributing factors. Intervention studies have indicated the need to provide adequate supply of both calcium (1500mg daily) and vitamin D (400–800 IU daily) in old age, particularly in housebound elderly and nursing home residents. Bisphosphonate treatment reduces the risk of hip fracture among elderly women with confirmed osteoporosis but is not more effective than calcium and vitamin D alone in women identified primarily on the basis of risk factors other than low BMD.