Measures of Physical Performance and Muscle Strength as Predictors of Fracture Risk Independent of FRAX, Falls, and aBMD: A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study.

Measures of muscle mass, strength, and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX (fracture risk assessment tool) probability. In the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, United States), we investigated whether measures of physical performance/appendicular lean mass (ALM) by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck aBMD, and calculated FRAX probabilities.

Intra-observer repeatability when assessing the foetal urinary bladder volume by the Virtual Organ Computer-aided AnaLysis and SUM-OF-CYLINDERS methods: A pilot study.

Introduction: The aim of this study was to compare the intra-observer repeatability when using two different methods for estimating the volume of foetal urinary bladders.

Method: The urinary bladders of 20 foetuses were documented by three-dimensional ultrasound. Standard deviation was compared when the volumes of identical bladder images were repeatedly estimated using the Virtual Organ Computer-aided AnaLysis and the experimental SUM-OF-CYLINDERS methods.

Falls Predict Fractures Independently of FRAX Probability: A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study.

Although prior falls are a well-established predictor of future fracture, there is currently limited evidence regarding the specific value of falls history in fracture risk assessment relative to that of other clinical risk factors and bone mineral density (BMD) measurement. We therefore investigated, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether past falls predicted future fracture independently of FRAX and whether these associations varied with age and follow-up time. Elderly men were recruited from MrOS Sweden, Hong Kong, and USA.

Total Hip Bone Area Affects Fracture Prediction With FRAX® in Canadian White Women.

Context: Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to the FRAX® tool (Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom), but it is unknown whether performance is affected by hip area.

Objective: To examine whether fracture prediction by FRAX® is affected by hip area.

FRAX Update.

The fracture risk assessment tool, FRAX, was released in 2008 and provides country-specific algorithms for estimating individualized 10-year probability of hip and major osteoporotic fracture (hip, clinical spine, distal forearm, and proximal humerus). Since its release, models are now available for 63 countries, covering 79% of the world population. The website receives approximately 3 million visits annually.

Overview of Fracture Prediction Tools.

The characterization of risk factors for fracture that contribute significantly to fracture risk, over and above that provided by the bone mineral density, has stimulated the development of risk assessment tools. The more adequately evaluated tools, all available online, include the FRAX® tool, the Garvan fracture risk calculator and, in the United Kingdom only, QFracture®. Differences in the input variables, output, and model construct give rise to marked differences in the computed risks from each calculator.

The Effect of Abaloparatide-SC on Fracture Risk Is Independent of Baseline FRAX Fracture Probability: A Post Hoc Analysis of the ACTIVE Study.

Daily subcutaneous (SC) injections of the investigational drug abaloparatide-SC (80 mcg) for 18 months significantly decrease the risk of vertebral and nonvertebral fracture compared with placebo in postmenopausal women. We examined the efficacy of abaloparatide-SC as a function of baseline fracture risk, assessed using the FRAX tool. Baseline clinical risk factors (age, body mass index [BMI], prior fracture, glucocorticoid use, rheumatoid arthritis, and smoking) were entered into country-specific FRAX models to calculate the 10-year probability of major osteoporotic fractures, with or without femoral neck bone mineral density (BMD).

Association of Mental Disorders and Related Medication Use With Risk for Major Osteoporotic Fractures.

Importance: Osteoporotic fractures are a leading cause of disability, costs, and mortality. FRAX is a tool used to assess fracture risk in the general population. Mental disorders and medications to treat them have been reported to adversely affect bone health, but, to date, they have not been systematically studied in relation to osteoporotic fractures.

Clinical Utility of Using Lumbar Spine Trabecular Bone Score to Adjust Fracture Probability: The Manitoba BMD Cohort.

Decreased lumbar spine trabecular bone score (TBS), a dual-energy X-ray absorptiometry (DXA)-derived image texture measurement, is a risk factor for major osteoporotic fracture (MOF) and hip fracture (HF) independent of 10-year fracture probability estimated using FRAX. We determined how often applying the TBS adjustment to fracture probability altered treatment qualification. Using a population-based registry containing all clinical DXA results for Manitoba, Canada, we identified 34,316 women with baseline spine and hip DXA, FRAX-based fracture probability measurements (computed with femoral neck bone mineral density), lumbar spine TBS, and minimum 5 years of observation (mean 8.

Longer Duration of Diabetes Strongly Impacts Fracture Risk Assessment: The Manitoba BMD Cohort.

Context: Type 2 diabetes is associated with a higher risk for major osteoporotic fracture (MOF) and hip fracture than predicted by the World Health Organization fracture risk assessment (FRAX) tool.

Objective: The objective of the study was to examine the impact of diabetes duration on fracture risk.

Methods: Using a clinical dual-energy x-ray absorptiometry registry linked with the Manitoba administrative databases, we identified all women age 40 years or older with 10 or more years of prior health care coverage undergoing hip dual-energy x-ray absorptiometry measurements (1996-2013).

Fall Risk Assessment Predicts Fall-Related Injury, Hip Fracture, and Head Injury in Older Adults.

Objectives: To investigate the role of a fall risk assessment, using the Downton Fall Risk Index (DFRI), in predicting fall-related injury, fall-related head injury and hip fracture, and death, in a large cohort of older women and men residing in Sweden.

Design: Cross sectional observational study.

Setting: Sweden.

A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation.

Unlabelled: This systematic review identified assessment guidelines for osteoporosis that incorporate FRAX. The rationale for intervention thresholds is given in a minority of papers. Intervention thresholds (fixed or age-dependent) need to be country-specific.

Mortality Is Not Increased in Recombinant Human Growth Hormone-treated Patients When Adjusting for Birth Characteristics.

Objective: This study aimed to investigate whether reported high mortality in childhood recombinant human GH (rhGH)-treated patients was related to birth-characteristics and/or rhGH treatment.

Design And Setting: We sought to develop a mortality model of the Swedish general population born between 1973 and 2010, using continuous-hazard functions adjusting for birth characteristics, sex, age intervals, and calendar year to estimate standardized mortality ratio (SMR) and to apply this model to assess expected deaths in Swedish rhGH-treated patients with idiopathic isolated GH deficiency (IGHD), idiopathic short stature (ISS) or born small for gestational age (SGA).

Participants: The general population: Swedish Medical Birth Register (1973-2010: 1 880 668 males; 1 781 131 females) and Cause of Death Register (1985-2010).

SIGN Guidelines for Scotland: BMD Versus FRAX Versus QFracture.

Scottish Intercollegiate Guidelines Network (SIGN) recently issued guidance on the management of osteoporosis and the prevention of fragility fractures. The aim of this paper was to critically review the guidance. The SIGN guidance utilises risk factors for fracture as an initial step for assessment, but recommends treatment only in individuals with a T-score of -2.

Reference values for spirometry - report from the Obstructive Lung Disease in Northern Sweden studies.

Background: Abnormal lung function is commonly identified by comparing observed spirometric values to corresponding reference values. It is recommended that such reference values for spirometry are evaluated and updated frequently. The aim of this study was to estimate new reference values for Swedish adults by fitting a multivariable regression model to a healthy non-smoking general population sample from northern Sweden.

A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX.

Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS.

Continuous prediction of secondary progression in the individual course of multiple sclerosis.

Background: Prediction of the course of multiple sclerosis (MS) was traditionally based on features close to onset.

Objective: To evaluate predictors of the individual risk of secondary progression (SP) identified at any time during relapsing-remitting MS.

Methods: We analysed a database comprising an untreated MS incidence cohort (n=306) with five decades of follow-up.

Adjusting Hip Fracture Probability in Men and Women Using Hip Axis Length: the Manitoba Bone Density Database.

Most studies report that longer hip axis length (HAL) is associated with increased hip fracture risk in women, but comparable data in men are sparse. Using a registry of all dual-energy X-ray absorptiometry (DXA) results for Manitoba, Canada, we identified 4738 men and 50,420 women aged 40 yr and older with baseline hip DXA results, HAL measurements, and Fracture Risk Assessment Tool (FRAX) hip fracture probability computed with femoral neck bone mineral density (BMD). Population-based health service records were assessed for a subsequent hospitalization with a primary diagnosis of hip fracture.

Adjusting fracture probability by trabecular bone score.

The aim of the present study was to determine the impact of trabecular bone score on the probability of fracture above that provided by the clinical risk factors utilized in FRAX. We performed a retrospective cohort study of 33,352 women aged 40-99 years from the province of Manitoba, Canada, with baseline measurements of lumbar spine trabecular bone score (TBS) and FRAX risk variables. The analysis was cohort-specific rather than based on the Canadian version of FRAX.

Hip axis length is a FRAX- and bone density-independent risk factor for hip fracture in women.

Context: Bone mineral density (BMD) measurement from dual-energy X-ray absorptiometry (DXA) is widely used to assess skeletal strength in clinical practice, but DXA instruments can also measure biomechanical parameters related to skeletal shape.

Objective: The objective of the study was to determine whether DXA-derived hip geometry measures provide information on fracture prediction that is independent of hip fracture probability determined from the fracture risk assessment tool (FRAX) algorithm.

Design And Setting: This was a retrospective registry study using BMD results for Manitoba, Canada.

High nationwide incidence of multiple sclerosis in Sweden.

Over recent years increased MS incidence, primarily in women, has been reported. We recently reported an unexpectedly high MS prevalence of 189/100,000 in Sweden. In the present study we estimated the nationwide age- and gender-specific MS incidence and the sex ratio in Sweden between 2001 and 2008.

Ten-year mortality after severe traumatic brain injury in western Sweden: a case control study.

Primary Objective: Life expectancy may be substantially reduced for many years after severe traumatic brain injury (TBI). This study investigated the patterns of the short- and long-term all-cause mortality and the rates of primary causes of death in patients with severe TBI.

Subjects: This study was of 166 consecutive patients (6-82 years) with severe TBI admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, from 1999-2002.

Can change in FRAX score be used to "treat to target"? A population‐based cohort study.

It is unknown how responsive the Fracture Risk Assessment (FRAX) tool is to osteoporosis treatment (OTX) or whether it can serve as a target for "goal‐directed" treatment. We studied 11,049 untreated women aged ≥50 years undergoing baseline and follow‐up DXA examinations in Manitoba, Canada. We identified clinical risk factors, intervening OTX based on medication possession ratios (MPR),and incident fractures.