Publications by authors named "Kanis J"

Background: Electronic Health Records (EHRs) have significantly impacted healthcare improving access to patient information and enhancing communication among the health care team. However, lack of usability and increased documentation burden has greatly contributed to clinician burnout. Improvements in EHR design that include physician input is critical to develop specific changes that make EHRs less cumbersome; however, it can be challenging to gather input from physicians with full clinical workloads.

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Objective: Few studies have explored specific trajectories or patterns of falls over time in older adults, and the role of sex and self-reported risk factors for these trajectories were overlooked. This study aimed to identify sex-specific fall trajectories over 3 years and the self-reported risk factors associated with each trajectory in European older adults.

Design: Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial.

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Osteoporosis and osteoarthritis are key diseases of musculoskeletal ageing and are increasing in prevalence and burden with the progressively ageing population worldwide. These conditions are thus particularly common in 'the oldest old', and there are complexities of managing them within the context of extensive multimorbidity, physical and mental disability, and polypharmacy, the rates for all of which are high in this population. In this narrative review, we explore the epidemiology of osteoporosis and osteoarthritis in the oldest old before examining trials and real-world data relating to the pharmacological treatment of these diseases in older adults, including anti-resorptives and bone-forming agents in osteoporosis and symptomatic slow-acting drugs for osteoarthritis, paracetamol, and non-steroidal anti-inflammatory drugs in osteoarthritis, recognising that the oldest old are usually excluded from clinical trials.

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Unlabelled: A surrogate FRAX® model for Mongolia has been constructed using age- and sex-specific hip fracture rates for mainland China and age- and sex-specific mortality rates from Mongolia.

Introduction: FRAX models are frequently requested for countries with little or no data on the incidence of hip fracture. In such circumstances, the development of a surrogate FRAX model is recommended based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country.

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Unlabelled: The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®.

Introduction: RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm.

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FRAX, a risk calculator that provides individualized 10-year probabilities of hip and major osteoporotic fracture, has been widely used for fracture risk assessment since its launch in 2008. It is now incorporated into very many guidelines worldwide to inform osteoporosis management. In this review, we explore the development of FRAX and how it enhances fracture risk prediction as compared to use of bone mineral density alone, as well as approaches to utilizing FRAX in determining intervention and assessment thresholds.

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Mild cognitive impairment, dementia and osteoporosis are common diseases of ageing and, with the increasingly ageing global population, are increasing in prevalence. These conditions are closely associated, with shared risk factors, common underlying biological mechanisms and potential direct causal pathways. In this review, the epidemiological and mechanistic links between mild cognitive impairment, dementia and skeletal health are explored.

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Context: Sclerostin inhibits canonical Wnt signaling, a pathway promoting bone formation. The effects of vitamin D3, omega-3 fatty acids (omega-3s), and exercise on serum sclerostin levels and bone metabolism are unclear.

Objective: To investigate the effects of 2000 IU/d vitamin D3, 1g/d omega-3s, and a simple home-based strength exercise program (SHEP), alone or in combination, on serum sclerostin and bone turnover marker levels.

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Importance: Fragility fractures are often defined as those that occur after a certain age (eg, 40-50 years). Whether fractures occurring in early adulthood are equally associated with future fractures is unclear.

Objective: To examine whether the age at which a prior fracture occurred is associated with future fracture risk.

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Article Synopsis
  • - The guidelines update the International Osteoporosis Foundation's (IOF) 20-year-old position paper on bone markers, reflecting advancements in bone biology and disorders.
  • - The authors introduce a new classification called Bone Status Indices (BSI) to replace outdated terms like bone turnover markers and metabolic markers for better clarity.
  • - The proposal includes standardized nomenclature, abbreviations, and measurement units for these indices to ensure consistency in the study and treatment of bone health.
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Background: We aimed to investigate the effect of daily supplemental vitamin D, omega-3s, and a thrice-weekly home exercise program, alone or in combination, on change of appendicular lean muscle mass index (ALMI) and incident sarcopenia in older adults.

Methods: This is a secondary endpoint analysis of a 3-year randomized, double-blind, placebo-controlled trial with a 2 × 2 × 2 factorial design among 2157 community-dwelling, healthy adults aged 70 + years, from 2012 to 2018 (DO-HEALTH). Participants were randomized to 2000 IU/d vitamin D and/or 1 g/d marine omega-3s and/or exercise.

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Unlabelled: A surrogate FRAX® model for Nepal has been constructed using age- and sex-specific hip fracture rates for Indians living in Singapore and age- and sex-specific mortality rates from Nepal.

Introduction: FRAX models are frequently requested for countries with little or no data on the incidence of hip fractures. In such circumstances, the development of a surrogate FRAX model is recommended based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country.

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Article Synopsis
  • The study investigates the acceptance of osteoporosis medication among postmenopausal women across nine countries, focusing on how various factors like age and fracture history influence this willingness.
  • Findings reveal that 79.2% of participants accepted treatment at fracture probabilities equal to or below the recommended threshold, highlighting a potential gap in fracture risk communication.
  • Higher numeric literacy was linked to a greater willingness to accept treatment compared to those with lower literacy levels, suggesting that improving patient understanding of risk could enhance treatment acceptance.
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Unlabelled: Sequential romosozumab-to-alendronate or sequential teriparatide-to-alendronate can be a cost-effective treatment option for postmenopausal women at very high risk of fracture.

Purpose: To estimate the 10-year probability of a major osteoporotic fracture (MOF) at which sequential treatment with romosozumab or teriparatide followed by alendronate, compared with alendronate alone, becomes cost-effective in a UK setting.

Methods: A microsimulation model with a Markov structure was used to simulate fractures, costs, and quality-adjusted life years (QALYs), in women receiving sequential treatment with either romosozumab or teriparatide followed by alendronate, compared with alendronate alone.

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Importance: The Fracture Risk Assessment Tool (FRAX) is a fracture risk prediction tool for 10-year probability of major osteoporotic fracture (MOF) and hip fracture in the general population. Whether FRAX is useful in individuals with cancer is uncertain.

Objective: To determine the performance of FRAX for predicting incident fractures in individuals with cancer.

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Unlabelled: Associations between different sarcopenia definitions and the risk of injurious falls were investigated in 75-80-year-old women in the Swedish SUPERB cohort. Only sarcopenia according to the Sarcopenia Definitions and Outcomes Consortium (SDOC) definition was associated with incident injurious falls with and without fractures in older women.

Purpose: To investigate the association between three commonly used sarcopenia definitions and the risk of injurious falls in a population of older Swedish women.

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Article Synopsis
  • * The authors advocate for keeping ethnic and race-specific FRAX models in the US, suggesting they should be based on updated data related to fracture and death risks.
  • * The position opposing fixed bone mineral density thresholds is supported by the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), emphasizing the need for equity in fracture risk assessment.
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Article Synopsis
  • - The International Osteoporosis Foundation (IOF) has published a position paper addressing partnerships with scientists from countries involved in armed conflicts.
  • - A commission within the IOF has assessed and recommended guidelines for such collaborations to ensure ethical considerations are met.
  • - The IOF Board has unanimously adopted these findings and recommendations, emphasizing a commitment to responsible engagement in scientific partnerships.
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Background: Low grip strength and gait speed are associated with mortality. However, investigation of the additional mortality risk explained by these measures, over and above other factors, is limited.

Aim: We examined whether grip strength and gait speed improve discriminative capacity for mortality over and above more readily obtainable clinical risk factors.

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Article Synopsis
  • Researchers developed a protein-based risk score for predicting hip fractures using an aptamer-based proteomic platform that showed promise in initial studies.
  • The risk score demonstrated strong predictive capabilities and improved fracture discrimination when validated in additional health study cohorts and in a UK Biobank cohort.
  • While the proteomic risk score outperformed existing tools, including the FRAX assessment, its clinical usefulness beyond current methods and the modest improvement in prediction need further evaluation.
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Objective: Although aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults.

Design: Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial.

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Osteoporosis and cardiovascular disease (CVD) are highly prevalent in older women, with increasing evidence for shared risk factors and pathogenesis. Although FRAX was developed for the assessment of fracture risk, we hypothesized that it might also provide information on CVD risk. To test the ability of the FRAX tool and FRAX-defined risk factors to predict incident CVD in women undergoing osteoporosis screening with DXA, we performed a retrospective prognostic cohort study which included women aged 50 yr or older with a baseline DXA scan in the Manitoba Bone Mineral Density Registry between March 31, 1999 and March 31, 2018.

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Article Synopsis
  • A study examined the effects of vitamin D3, omega-3s, and a home-based exercise program (SHEP) on bone mineral density (BMD) in healthy older adults aged 70 and above over three years.
  • Results showed no significant benefits from omega-3s or SHEP, but vitamin D3 improved total hip BMD and lumbar spine BMD in men with modest gains.
  • While there were some positive effects of vitamin D treatment, the overall clinical significance of these findings remains uncertain.
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