Paul W. Thompson

The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK.

Adults who suffer fractures of the distal radius are at increased risk of further osteoporosis related fractures and represent a high-risk group in whom therapies are available to reduce the risk. We have undertaken a prospective study of distal radius fracture patients over the age of 25 years to establish the extent of the problem in Dorset. All patients presenting with any forearm fracture to hospitals serving Dorset residents during 1 year were identified. Fracture type was assessed following scrutiny of the hospital notes. Analysis included calculation of rates per 10,000 population using Dorset Health Authority population estimates and seasonal variation. Ninety-six percent of all patients presented to three of the seven hospitals. One thousand six hundred and eighty-eight individuals with a diagnosis of forearm fracture were identified but only 1300 had a fracture of the distal radius. There was a female:male ratio of 3.9:1. In women, the incidence of distal radius fracture rose from a premenopausal baseline of 10 per 10,000 population per year to a peak of 120 per 10,000 population per year over 85 years. In men, the fracture incidence gradually increased from 10 per 10,000 before 65 years to 33 per 10,000 after 85 years. There was a detectable seasonal variation. Our data are in keeping with recent surveys in Europe and suggest that a change in the incidence of fracture of the distal radius with age has occurred over the last 30 years.

Quantitative heel ultrasound in 3180 women between 45 and 75 years of age : Compliance, normal ranges and relationship to fracture history

Abstract: There is growing evidence to support the use of quantitative ultrasound (QUS) to identify fracture risk in late postmenopausal women but few data are available in younger women. In order to address this issue all women between 45 and 75 years of age registered in two general practices in Bournemouth, Dorset, UK were invited to attend for heel QUS. Measurements were made in 79% of the 4018 women identified. The mean QUS results for 5-year age groups were very similar to those from reported reference ranges from North America and the north of England. The odds ratios (95% confidence limits) for self-reported fractures after 45 years per standard deviation of age-adjusted QUS parameters were: broadband ultrasound attenuation (BUA) = 1.40 (1.26–1.56), speed of sound (SOS) = 1.56 (1.41–1.74) and Stiffness = 1.52 (1.37–1.68). The results suggest that QUS is associated with fracture history in early postmenopausal women.

Use of clinical risk factors to identify postmenopausal women with vertebral fractures

Introduction and hypothesisPrevious studies have been unable to identify risk factors for prevalent vertebral fractures (VF), which are suitable for use in selection strategies intended to target high-risk sub-groups for diagnostic assessment. However, these studies generally consisted of large epidemiology surveys based on questionnaires and were only able to evaluate a limited number of risk factors. Here, we investigated whether a stronger relationship exists with prevalent VF when conventional risk factors are combined with additional information obtained from detailed one-to-one assessment.MethodsWomen aged 65–75 registered at four geographically distinct GP practices were invited to participate (n=1,518), of whom 540 attended for assessment as follows: a questionnaire asking about risk factors for osteoporosis such as height loss compared to age 25 and history of non-vertebral fracture (NVF), the get-up-and-go test, Margolis back pain score, measurement of wall-tragus and rib-pelvis distances, and BMD as measured by the distal forearm BMD. A lateral thoraco-lumbar spine X-ray was obtained, which was subsequently scored for the presence of significant vertebral deformities.ResultsOf the 509 subjects who underwent spinal radiographs, 37 (7.3%) were found to have one or more VF. Following logistic regression analysis, the four most predictive clinical risk factors for prevalent VF were: height loss (P=0.006), past NVF (P=0.004), history of back pain (P=0.075) and age (P=0.05). BMD was also significantly associated with prevalent VF (P=0.002), but its inclusion did not affect associations with other variables. Factors elicited from detailed one-to-one assessment were not related to the risk of one or more prevalent VFs. The area under ROC curves derived from these regressions, which suggested that models for prevalent VF had modest predictive accuracy, were as follows: 0.68 (BMD), 0.74 (four clinical risk factors above) and 0.78 (clinical risk factors + BMD). Analyses were repeated in relation to the subgroup of 13 patients with two or more VFs, which revealed that in this instance, the Margolis back pain score and rib-pelvis distance were associated with the presence of multiple VFs (P=0.022 and 0.026, respectively). Moreover, the predictive value as reflected by the ROC curve area was improved: 0.80 (BMD), 0.88 (the four most predictive clinical risk factors consisting of the height loss, past NVF, Margolis back pain score and rib-pelvis distance) and 0.91 (clinical risk factors + BMD).ConclusionsEvaluation of additional risk factors from detailed one-to-one assessment does not improve the predictive value of risk factors for one or more prevalent vertebral deformities in postmenopausal women. However, the use of factors such as the Margolis back pain score and rib-pelvis distance may be helpful in identifying postmenopausal women at high risk of multiple prevalent VFs.

DAS28 and Rheumatoid Arthritis: The Need for Standardization.

Disease Activity Score in 28 Joints (DAS28) scoring in rheumatoid arthritis (RA) is now recommended as a basis for clinical decisions about treatment initiation and alteration. The British Society of Rheumatology suggests that most RA patients should have a DAS28 assessment at every clinic visit, to monitor disease activity and the impact of therapy. Establishing an accurate baseline assessment of DAS28, with regular re-evaluation, is considered crucial, so that progress towards a defined target of remission (or low disease activity) can be measured. The Treat-to-Target initiative, launched in March 2010, is now impacting on clinical practice throughout the UK and Europe. One of its key recommendations is that patients should be regularly monitored using validated composite measures of disease activity that include joint assessments. DAS28 is recommended as one of the most useful of these methods but, although it is becoming more widely adopted and training is ongoing, supported by materials produced by the European League Against Rheumatism (EULAR), the variability inherent in the four components of DAS28 means that standardization of practice methods is now an important issue. This short report details some of the pitfalls that can occur when applying DAS28 in clinical practice and suggests some workable solutions to enable departments to set up their own standard operating procedure.

Pain in the rheumatic diseases

We were very interested to read Professor Croft’s article1 about pain in the rheumatic diseases because we are interested in studying the relation between patients’ perception of disease and objective signs.2 In the daily management of a cohort of approximately 600 patients with inflammatory arthritis at Poole Hospital we noticed a dissociation between reported pain and objective measures of disease activity in a number of patients. To further study this …

Trochanteric hip protectors in the institutionalised elderly: A compliance study

The goal of this research was to study the prevalence and the structures of the fractures~ at the examined group and at the population in general.The examined group includes 600 people (300 males and 300 females) at the age of 50 and older. 153(51%) males and 95(32%)females had some fractures.Most of vertebral fractures took place in subjects after 40 years old.We usually qualified these fractures as number 3 degree. It is interesting that only 2 women had femoral fractures after the age of 50-65 years old with second degree.As far as it concerns men thay had I0 femoral fractures: 6 before 40 years old and 4 after 40 years old; most of them had the third degree.The arms frequently were broken in women(ll%) at the age of 40 and older. The other fractures such as shin, fingers, toes and other more frequently broken in men than in women.ll males and 18 females stated that their relatives had femoral fractures at the age of 50 and older.The population of Yaroslavl is about 700 000 people.1864 persons at the age of 50 and older had femoral fractures for the period from 1981 to 1994.The prevalence of these fractures was 36,4-82,7 for 100 000 of people.The frequency of the femoral fractures increased with age in women.The distinct increase of the prevalence of these fractures in men was only from the age of 65-69 years old.