A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada.

Unlabelled: This study evaluated a multi-component intervention (educational materials and outreach visits) to increase knowledge and improve post-fracture care management in five rural communities in Canada. One hundred and twenty-five patients pre- intervention and 149 post-intervention were compared. No significant improvement in post-fracture care was documented suggesting that a more targeted intervention is needed.

The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women.

Background: Bone loss in amenorrheic athletes has been attributed to energy deficiency-related suppression of bone formation, but not increased resorption despite hypoestrogenism.

Objective: To assess the independent and combined effects of energy deficiency and estrogen deficiency on bone turnover markers in exercising women.

Design: PINP, osteocalcin, U-CTX-I, TT3, leptin, and ghrelin were measured repeatedly, and bone mineral density (BMD) was measured once in 44 exercising women.

A prospective study to identify factors affecting adherence to recommended daily calcium intake in women with low bone mineral density.

Objective: Factors that influence calcium intake among women with low bone mass have not been clearly identified. The objective of this study was to evaluate confidence, attitudes and beliefs regarding calcium intake and to identify determinants of adherence to calcium recommendations among women with low bone mineral density (BMD).

Methods: Participants were 104 women with low BMD attending an initial visit to an osteoporosis program.

Fatigue in osteoarthritis: a qualitative study.

Background: Fatigue is recognized as a disabling symptom in many chronic conditions including rheumatic disorders such as rheumatoid arthritis (RA) and lupus. Fatigue in osteoarthritis (OA) is not routinely evaluated and has only been considered in a very limited number of studies. To date, these studies have focused primarily on patients with OA under rheumatological care, which represent the minority of people living with OA.

Comparative evaluation of three semi-quantitative radiographic grading techniques for knee osteoarthritis in terms of validity and reproducibility in 1759 X-rays: report of the OARSI-OMERACT task force.

Objective: The objective of this work was to compare the measurement properties of three categorical X-ray scoring methods of knee osteoarthritis (OA), both on semiflexed and extended views.

Methods: In data obtained from trials and cohorts, X-rays were graded using Kellgren and Lawrence (KL), the OA Research Society International (OARSI) joint space narrowing score, and measurement of joint space width (JSW). JSW was analyzed as a categorical variable.

Management of Chronic Pain: Improving shared decision making in osteoarthritis.

The burden of chronic pain for those who have it and their families is substantial, says (doi: 10.1136/bmj.39520.

Development and preliminary psychometric testing of a new OA pain measure--an OARSI/OMERACT initiative.

Objective: To evaluate the measurement properties of a new osteoarthritis (OA) pain measure.

Methods: The new tool, comprised of 12 questions on constant vs intermittent pain was administered by phone to 100 subjects aged 40+ years with hip or knee OA, followed by three global hip/knee questions, the Western Ontario and McMaster Universities (WOMAC) pain subscale, the symptom subscales of the Hip Disability and OA Outcome Score (HOOS) or Knee Injury and OA Outcome Score (KOOS), and the limitation dimension of the Late Life Function and Disability Instrument (LLFDI). Test-retest reliability was assessed by re-administration after 48-96h.

The effect of patients' sex on physicians' recommendations for total knee arthroplasty.

Background: The underuse of total joint arthroplasty in appropriate candidates is more than 3 times greater among women than among men. When surveyed, physicians report that the patient's sex has no effect on their decision-making; however, what occurs in clinical practice may be different. The purpose of our study was to determine whether patients' sex affects physicians' decisions to refer a patient for, or to perform, total knee arthroplasty.

Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative.

Objective: To examine the pain experience of people with hip or knee osteoarthritis (OA), particularly changes over time and most distressing features.

Method: Focus groups in individuals aged 40+ years with painful hip or knee OA obtained detailed descriptions of OA pain from early to late disease. A modified Patient Generated Index (PGI) was used to assess the features of OA pain that participants found most distressing.

The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative.

Objective: To derive a cross-culturally valid, short measure of physical function using function subscales (daily living and sports and recreation) of the Hip disability and Osteoarthritis Outcome Score (HOOS).

Methods: Rasch analysis was conducted on data from individuals from multiple countries who had hip osteoarthritis (OA). Fit of the data to the Rasch model was evaluated by model chi(2) and item fit statistics (chi(2), size of residual, and F-test).

The development of a short measure of physical function for knee OA KOOS-Physical Function Shortform (KOOS-PS) - an OARSI/OMERACT initiative.

Objective: To develop a short measure of physical function for knee osteoarthritis (OA) using multi-national data from individuals with varying degrees of severity of knee OA.

Methods: Rasch analysis, based on the partial credit model, was conducted on Knee injury and Osteoarthritis Outcome Score and Western Ontario McMaster Universities' Osteoarthritis Index data from individuals with knee OA, ranging from community to pre-total knee replacement samples from five countries. Fit of the data to the Rasch model was evaluated by overall model fit and item-level fit statistics (chi(2), size of residual, F-test).

The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis.

Objective: The intent of this cross-sectional study was to broaden the range of variables examined in relationship to depression in osteoarthritis (OA) to include comorbidity, stressful life events, and the ways people respond to their disease. We examined the relationship of coping behaviors and perceptions, and medical treatments received for OA and depressive symptoms.

Methods: In the fifth year of a prospective cohort study, 1227 individuals >or= 62 years of age with hip/knee OA provided information about sociodemographics (age, sex, living circumstances, education), arthritis severity (WOMAC pain and function; ClinHAQ fatigue), comorbidity, life events, coping behavior, coping efficacy, treatment (pain management, treatment for depression), and depressed mood (Centre for Epidemiological Studies Depression scale, CES-D).

A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women.

Background: Cognitive dietary restraint (CDR) may mediate subclinical ovulatory disturbances, which may result in loss of bone mineral density (BMD). CDR is associated with greater physical activity, which may modify the effect of CDR and ovulatory disturbances on bone mass.

Objective: We aimed to investigate the relations among CDR, ovulatory disturbances, and physical activity and their effect on BMD in healthy premenopausal women over a 2-y period.

Minimal error in self-report of having had DXA, but self-report of its results was poor.

Objective: To examine the validity of both self-report of having had dual-energy x-ray absorptiometry (DXA) and self-reported DXA test results.

Methods: Participants were recruited in 2003 and 2004 from a population-based study of women aged 65-90 years examining osteoporosis management in Ontario, Canada (N=871). Women reporting having had a DXA were eligible and asked to report the results of their most recent test.

Classification criteria in rheumatic diseases: a review of methodologic properties.

Objective: To identify classification criteria for the rheumatic diseases and to evaluate their measurement properties and methodologic rigor using current measurement standards.

Methods: We performed a systematic review of published literature and evaluated criteria sets for stated purpose, derivation and validation sample characteristics, methods of criteria generation and reduction, and consideration of validity, and reliability.

Results: We identified 47 classification criteria sets encompassing 13 conditions.

Hip fractures in users of first- vs. second-generation bisphosphonates.

Unlabelled: This study compared population hip fracture rates for women with a prior fragility fracture who were treated with first-generation versus second-generation bisphosphonate therapies. The observational study found that, relative to women treated with etidronate, a first-generation bisphosphonate, women treated with the second-generation therapies 'alendronate' or 'risedronate' were equally likely to be admitted to hospital for hip fracture. Our findings must be confirmed in large randomized head-to-head controlled trials.

Access to osteoporosis treatment is critically linked to access to dual-energy x-ray absorptiometry testing.

Objective: To determine if inequities in access to osteoporosis investigation [dual-energy x-ray absorptiometry (DXA) testing] and treatment (bisphosphonate, calcitonin, and/or raloxifene) exist among older women in a region with universal health care coverage.

Methods: Community-dwelling women aged 65-89 years residing within 2 regions of Ontario, Canada were randomly sampled. Data were collected by standardized telephone interview.

Classification criteria for systemic sclerosis subsets.

Objective: To evaluate the measurement properties of criteria for systemic sclerosis (SSc) subsets for classification of patients in SSc trials, and to determine if any one criteria set confers measurement advantage over others.

Methods: A systematic review of articles describing classification criteria for SSc subsets was performed. Evidence supporting the sensibility (statement of purpose for which the criteria will be used, population, setting, face and content validity, and feasibility), validity, and reliability of the criteria was evaluated.

Complementary and alternative medicine use by osteoporosis clinic patients.

Unlabelled: We describe complementary and alternative medicine use (CAM) in 360 patients attending osteoporosis clinics. Of these patients, 57% were CAM users. Predictors of CAM use included lower mental quality of life, younger age and higher education.

Predictors of locating women six to eight years after contact: internet resources at recruitment may help to improve response rates in longitudinal research.

Background: The ability to locate those sampled has important implications for response rates and thus the success of survey research. The purpose of this study was to examine predictors of locating women requiring tracing using publicly available methods (primarily Internet searches), and to determine the additional benefit of vital statistics linkages.

Methods: Random samples of women aged 65-89 years residing in two regions of Ontario, Canada were selected from a list of those who completed a questionnaire between 1995 and 1997 (n = 1,500).

OMERACT/OARSI initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis.

Objective: Time to theoretical indication of joint replacement surgery has been proposed as a primary outcome for potential structure-modifying interventions for osteoarthritis (OA). The objectives of this OMERACT/OARSI Working Group were to identify pain, physical function, and structure states that represent the progression from early to late disease for individuals with OA of the hip and knee, and to create a composite measure of these 3 domains to define states of OA severity and a surrogate measure of "need for joint replacement surgery."

Methods: For pain, focus groups and one-on-one interviews were used.

The risk of hip fractures in older individuals with diabetes: a population-based study.

Objective: Compared with men and women without diabetes, individuals with type 2 diabetes have higher bone mineral density (BMD). However, they may still be at increased risk for hip fractures. Using population-based Ontario health care data, we compared the risk of hip fractures among men and women with and without diabetes.

Validation of a phytoestrogen food frequency questionnaire with urinary concentrations of isoflavones and lignan metabolites in premenopausal women.

Objective: The purpose of this study was to examine the association between dietary intake of phytoestrogens estimated by a food frequency questionnaire (FFQ) with urinary metabolites.

Methods: Participants were 26 premenopausal, Caucasian women aged 25 to 42 years. Dietary intake of isoflavones (genistein and daidzein) and lignans (secoisolariciresinol and matairesinol) were estimated by a 53-item interviewer-administered FFQ on two occasions, reflecting 'habitual' (previous 2 months) and 'recent' (previous 2 days) dietary intake.

Psychometric properties of the "Osteoporosis and You" questionnaire: osteoporosis knowledge deficits among older community-dwelling women.

Unlabelled: In older women, knowledge about risk factors for osteoporosis was good, with over 75% responding correctly to questions about lifestyle factors, family history, height loss, and menopausal status. However, significant knowledge deficits were identified regarding osteoporosis "consequences" and "prevention and treatment."

Introduction: We examined osteoporosis knowledge by testing the psychometric properties of the 10-item knowledge component of the "Osteoporosis and You" questionnaire.