Olaf Johnell

..Epidemiological observations suggest that sunlight exposure is an important determinant of hip fracture risk. The aim of this ecological study was to examine the relationship between latitude and hip fracture probability...

..The best risk assessment is achieved by taking into account both clinical risk factors and bone density...

..We examined whether past use of hormone therapy influences the effects of raloxifene on the risk of new vertebral fracture, cardiovascular events, or breast cancer...

..These new data on the cost of vertebral fractures will have an impact on health economy calculations. In the future it may be be cost-effective only to prevent vertebral fractures...

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..Health economic studies have shown that the treatment of these high-risk patients is cost-effective...

..Postmenopausal women treated with corticosteroids are regarded as a high-risk group due to the effect of both natural bone loss and possible adverse effects of treatment with inhaled corticosteroids (IC)...

..55; for men aged 50-54 years, the incidence of hip fractures should be multiplied by 4.48, and for those aged 80-84 years by 1.50...

..8 percentage points (95% CI 0.2-1.4). CONCLUSIONS: The use of oestrogen seems to reduce the rate of bone loss over a period of 23 years, and the longer the duration of the therapy, the less bone loss...

..Since the menopause is followed by an increase in bone loss, the size of the medullary cavity should theoretically increase during the postmenopausal period. If so, this might affect the long-term fixation of hip prostheses...

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..Its validation on an international basis permits its use in case finding strategies. Its use should, however, take account of the variations in predictive value with age and BMD...

..In women, it is more difficult to estimate the combined result of the confounding factors. Conclusions based on the EVOS participants may not be applicable to the whole population at risk...

..Considering the very much higher failure rate after internal fixation--leading to increased suffering for these patients--primary arthroplasty stands out as the best method for displaced fractures of the femoral neck...

..Whether bone size increases as a result of periosteal apposition and whether a strength index accounting for both bone density and bone size might predict the risk of fracture better than bone density alone are unclear...

..There is however a disturbing lack of scientific evidence regarding the efficacy of the procedures, no controlled studies are published. An ongoing prospective randomised study is presented...

..006) and lower LS BMD values (p = 0.008) at baseline. These data suggest that the efficacy of raloxifene in reducing vertebral fractures is largely independent of the presence of clinical risk factors for osteoporotic fractures...

..However, the costs per QALY gained for all populations studied were below generally accepted thresholds for cost effectiveness...

..RLX+ALN reduced bone turnover more than either drug alone, resulting in greater BMD increment, but whether this difference reflects better fracture risk reduction was not assessed in this study...

..The findings indicate that those suffering a hip fracture before the age of 75 have a shorter life expectancy, suggesting that hip fractures affect the less healthy segment of the population...

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..We conclude that reported intake of alcohol confers a risk of some importance beyond that explained by BMD. The validation of this risk factor on an international basis permits its use in case-finding strategies...

..We conclude that a self-reported low intake of milk is not associated with any marked increase in fracture risk and that the use of this risk indicator is of little or no value in case-finding strategies...

..The gender-related differences reported in this analysis should be taken into account when designing screening and treatment strategies for prevention of hip fracture in men...

..This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral, and wrist fracture 13-18 months after the fracture, based on 684 patients surviving 18 months after fracture...

..The Multiple Outcomes of Raloxifene Evaluation (MORE) study showed that treatment with raloxifene reduces the risk of vertebral fracture and breast cancer in postmenopausal women with osteoporosis...

..Thus, they have the unique opportunity to serve as primary advocates to ensure that appropriate action is taken to reduce the risk of future fracture...

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..Development of a simple clinical pathway from evidence-based guidelines is an important step to ensure that optimal care is provided for patients with fragility fractures...

..Case-finding strategies that combine clinical risk indicators with BMD have increased efficiency, while having a modest impact on the number of individuals requiring treatment. Therefore, the cost-effectiveness is enhanced...

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..During the last decades, there has been increased concern about the association between oral corticosteroid (OC) therapy and osteoporosis...

..In women, early menopause, current smoking, and walking aid use are additional independent risk factors for incident vertebral fractures...

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..We show that free testosterone within the normal range is a predictor of BMD at predominantly cortical bone sites and of previous osteoporosis-related fractures in elderly Swedish men...

..To clarify this, detailed individual information on exposure and potential confounders has to be ascertained...

..Assuming no further change in the age- and sex-specific arthroplasty rates, the predicted annual number of total hip replacements by the year 2020 will increase by at least one fourth in Sweden and almost one half in The Netherlands...

..The categorization of hip fracture probabilities can be used to adjust intervention thresholds based on age, sex, and relative risk from a reference population such as Sweden...

..We conclude that a minority of deaths following hospitalization for vertebral fracture are attributable to the fracture itself under the assumptions we used...

..Similar effects of alendronate were observed in men in some other trials. There are also results demonstrating alendronate to be cost-effective in the treatment of osteoporosis in women...

..These findings need to be validated in other cohorts at different ages and from different regions of the world...

..To better compete for these resources, efforts should be made to lower the cost of osteoporosis interventions. Additionally, evidence is needed that these interventions are really effective in reducing fractures in the community...

..Treatment can then be offered to those identified to have a fracture probability greater than an intervention threshold...

..Current and past use of corticosteroids was an important predictor of fracture risk that was independent of prior fracture and BMD...

..Additional research should include appropriate, incidence-based studies to investigate the potential benefit of an intervention for preventing bone fracture in this increasingly large patient population...

..The magnitude of LBP as a health problem justifies a closer look at its burden of illness to society...