ORCID Profile
0000-0002-2718-6592
Current Organisation
University of Melbourne
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Publisher: Wiley
Date: 03-2017
DOI: 10.1111/AJAG.12408
Abstract: Evidence regarding the efficacy and dosing of vitamin D on fall and fracture prevention, with or without calcium, is characterised by uncertainty. A panel of experts was organised at the First Australasian Conference on Sarcopenia and Frailty in Melbourne, Australia, in November 2016 to provide an interpretation of the current evidence and to give their opinions regarding the supplementation of vitamin D in three hypothetical cases. The authors conclude that (i) target serum 25(OH)D concentration should be 50 to 60 nmol/L year round, with a conservative upper limit <100 nmol/L (ii) change in serum concentrations at any given dose is highly variable among in iduals (iii) dosing interval may need to be <2 months to have a continuous benefit (iv) a loading dose can raise levels to target quickly, but there is no evidence yet that this has any positive effect on falls or fracture outcomes and (v) a maintenance dose of 1000 IU/day, or given as an equivalent dose weekly or monthly, is sufficient for most in iduals.
Publisher: Wiley
Date: 13-03-2014
DOI: 10.1002/OBY.20734
Abstract: To determine whether obesity concurrent with sarcopenia (low muscle mass) or dynapenia (low muscle strength) is associated with increased falls risk in middle-aged and older adults. 5-year prospective cohort study including 674 community-dwelling volunteers (mean ± SD age 61.4 ± 7.0 years 48% female). Sarcopenia and dynapenia were defined as lowest sex-specific tertiles for dual-energy X-ray (DXA)-assessed appendicular lean mass (adjusted for height and fat mass) or lower-limb strength, respectively. Obesity was defined as the highest tertiles of DXA-assessed total or trunk fat mass. Change in falls risk was calculated using the Physiological Profile Assessment (z-scores: 0-1 = mild increased risk 1-2 = moderate increased risk >2 = marked increased risk). Multivariable linear regression analyses revealed mild but significantly increased falls risk scores for dynapenic obesity (change in mean z-score compared to non-dynapenic, non-obese group: 0.33, 95% CI 0.06-0.59 [men] and 0.46, 95% CI 0.21-0.72 [women]) and dynapenia (0.25, 95% CI 0.05-0.46 [women only]). Dynapenic obesity, but not sarcopenic obesity, is predictive of increased falls risk score in middle-aged and older adults. In clinical settings, muscle function assessments may be useful for predicting falls risk in obese patients.
Publisher: The Endocrine Society
Date: 02-2015
DOI: 10.1210/JC.2014-3519
Abstract: High vitamin D and physical activity (PA) levels are independently associated with improved body composition and muscle function in older adults. The objective of this study was to investigate the interaction of 25-hydroxyvitamin D (25OHD) and PA status in maintenance of body composition and muscle function in older adults. This was a 5-year prospective population-based study of Australian community-dwelling older adults. Participants in the study included 615 community-dwelling volunteers aged 50 years old or older [61.4 ± 6.9 (mean ± SD) y 48% female] randomly selected from electoral rolls and categorized according to baseline serum 25OHD (≥ or & nmol/L) and PA (≥ or & 000 pedometer determined steps/d) levels as follows: high 25OHD and high PA (VitD+PA+) high 25OHD and low PA (VitD+PA−) low 25OHD and high PA (VitD-PA+) and low 25OHD and low PA (VitD-PA−). A subset of 518 participants completed accelerometer assessments during follow-up. Changes in dual-energy X-ray absorptiometry-assessed body composition and lower-limb muscle function were measured. VitD+PA+ had significantly smaller increases in body fat over 5 years compared with other groups (all P & .05). Higher baseline pedometer-determined PA resulted in declines in total body fat (β = −.23 kg per 100 steps/d, P = .001) over 5 years for participants with high 25OHD but not those with low 25OHD (P & .05). Among participants with accelerometer data, these associations were generally mediated by higher levels of moderate/vigorous PA. High vitamin D status appears to enhance PA-related declines in body fat during aging, but the mechanism may be greater amounts of outdoor moderate/vigorous PA rather than a direct effect of 25OHD.
Publisher: Springer Science and Business Media LLC
Date: 09-1999
Abstract: There is little population-based data concerning fracture rates in Australia. We ascertained all fractures occurring during 2 years in adults aged 35 years and over residing within a defined region (population 218 000), representative of the Australian population. The major strength of this study is the comprehensive ascertainment of fractures, which was ensured by regular searches of the only two radiologic providers in the Geelong Osteoporosis Study region. Nevertheless, vertebral fractures are likely to be underestimated since our ascertainment relied on a clinical indication for a medical imaging procedure. Among those aged 35-55 years, the fracture rate (persons per 10,000/year) in men was about double the rate in women (65 vs 35). The fracture rate was almost 7 times higher in women over 60 years versus women less than 55 years of age. In contrast, the fracture rate in men over 60 years was only 50% higher than in men less than 55 years of age (72 vs 104). Fracture rates in women and men were highest at the hip (28 and 10 respectively), spine (21 and 7), distal forearm (Colles') (18 and 4) and humerus (11 and 3), and were 3-4 times higher in women than men. These fractures accounted for 63% of all fractures in women and 32% in men. By contrast, the rate of lower leg and ankle fractures was less than 10 per 10,000 in both women and men and did not increase to the same extent with age. Hip fracture rates appear high, particularly among the older age strata, compared with retrospective ascertainment in other populations. In Australia, as in many other countries, there is an increasing longevity of the population. The number of women aged 90 years and over increased by 32% and the number of men of this age increased by 48% in the 5 years between the Australian national census of 1991 and 1996. Given stable fracture rates, the substantial health burden imposed by age-related fractures, particularly hip fractures, will continue to escalate in both women and men.
Publisher: Wiley
Date: 03-2017
DOI: 10.1111/AJAG.12407
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.CLNU.2016.09.024
Abstract: Limited data are available on the relationship of protein from different food sources with metabolic syndrome (MetS) or changes in its components. We aimed to prospectively examine the relationships of protein intakes from animal, plant and major food groups with incident MetS and changes in its components. 5324 participants from the Melbourne Collaborative Cohort Study, who were free of cardiovascular disease, cancer, hyperlipidaemia, elevated plasma glucose, elevated blood pressure and elevated waist circumference (WC) at baseline (1990-1994), were included in the present investigation. Dietary intake was assessed using a validated 121-item Food Frequency Questionnaire and MetS components were measured at baseline and follow-up (2003-2007). We documented 459 new cases of MetS during a mean of 11.2 years' follow-up. Multivariate-adjusted odds ratios (ORs) (95% CI) of incident MetS for the highest compared with lowest quartile of percentage energy intake from total, animal and plant protein were 1.46 (1.01-2.10), 1.67 (1.13-2.48) and 0.60 (0.37-0.97), respectively. Positive associations with incident MetS were seen for protein from chicken (OR (95% CI): 1.37 (1.00, 1.87)) and red meat (OR (95% CI): 1.47 (1.01, 2.15)), while inverse associations with incident MetS were observed for protein from grains (OR (95% CI): 0.62 (0.40, 0.97)), legumes and nuts (OR (95% CI): 0.74 (0.53, 1.04)). Each 5% increment in energy intake from animal protein was associated with a 0.97 cm (95% CI: 0.50, 1.45) increase in WC, a 0.97 mmHg (95% CI: 0.13, 1.82) increase in systolic blood pressure, and a 0.94 kg (95% CI: 0.57, 1.32) increase in weight over 11 years. However, an inverse association between plant protein and change in WC (-1.38 cm (95% CI: -2.68, -0.07)) and weight (-1.97 kg (95% CI: -3.00, -0.94)) was identified. Our findings suggest that higher plant protein and lower animal protein consumption may help to prevent MetS.
Publisher: Massachusetts Medical Society
Date: 05-07-2012
Publisher: BMJ
Date: 22-07-2010
DOI: 10.1136/EBM1107
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.GAITPOST.2016.04.031
Abstract: People with knee osteoarthritis (OA) are at twice the risk of falling compared to older people without knee OA, however the mechanism for this is poorly understood. This study investigated the biomechanical response of the trunk and lower limb joints during a forward induced fall under different task conditions in people with and without knee OA. Twenty-four participants with OA (68.6±6.2 years) and 15 asymptomatic controls (72.4±4.8 years) participated in the study. Forward fall was induced by releasing participants from a static forward leaning position. Participants were required to recover balance during three conditions: normal, physical (obstacle clearance) and cognitive dual tasks (counting backwards). Spatiotemporal parameters, lower limb joint kinematics and kinetics of the recovery limb were compared between the two groups and across the three task conditions. The OA group demonstrated slower spatio-temporal characteristics and reduced hip and knee flexion angles, joint moments owers and reduced muscle negative work at the knee and ankle (p<0.05). Cognitive dual task resulted in reduced centre of mass velocity and step length (p=0.03) compared to the physical dual task condition. Reduced knee (p=0.02) and hip joint powers (p=0.03) were demonstrated in the OA group in the physical task condition. When simulating a forward fall, participants with OA demonstrated difficulty in absorbing the impact and slowing down the forward momentum of the body during a recovery step. Moreover, poor dynamic postural control was demonstrated as task complexity increased.
Publisher: Springer Science and Business Media LLC
Date: 03-07-2012
DOI: 10.1007/S12603-018-1113-6
Abstract: Globally there are several operational definitions for sarcopenia, complicating clinical and research applications. The objective of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Task Force on Diagnostic Criteria for Sarcopenia was to reach consensus on the operational definition of sarcopenia for regional use by clinicians and researchers. A four-Phase modified Delphi process was undertaken in which 24 in iduals with expertise or a recognised interest in sarcopenia from different fields across Australia and New Zealand were invited to be Task Force members. An initial face-to-face meeting was held in Adelaide, South Australia, in November 2017, followed by two subsequent online Phases conducted by electronic surveys. A final Phase was used to approve the final statements. Responses were analysed using a pre-specified strategy. The level of agreement required for consensus was 80%. In Phase 2, 94.1% of Task Force respondents voted in favour of adopting an existing operational definition of sarcopenia. In Phase 3, 94.4% of respondents voted in favour of adopting the European Working Group on Sarcopenia in Older People (EWGSOP) definition as the operational definition for sarcopenia in Australia and New Zealand. With consensus achieved, the ANZSSFR will adopt, promote and validate the EWGSOP operational definition of sarcopenia for use by clinicians and researchers in Australia and New Zealand.
Publisher: Springer Science and Business Media LLC
Date: 11-12-2017
DOI: 10.1007/S00198-017-4317-4
Abstract: This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months. The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture. Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture. Among 5456 patients enrolled using convenience s ling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types. Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.
Publisher: Cambridge University Press (CUP)
Date: 06-01-2012
DOI: 10.1017/S1041610211002511
Abstract: Background: This review examines the associations between low vitamin B12 levels, neurodegenerative disease, and cognitive impairment. The potential impact of comorbidities and medications associated with vitamin B12 derangements were also investigated. In addition, we reviewed the evidence as to whether vitamin B12 therapy is efficacious for cognitive impairment and dementia. Methods: A systematic literature search identified 43 studies investigating the association of vitamin B12 and cognitive impairment or dementia. Seventeen studies reported on the efficacy of vitamin B12 therapy for these conditions. Results: Vitamin B12 levels in the subclinical low-normal range ( ρmol/L) are associated with Alzheimer's disease, vascular dementia, and Parkinson's disease. Vegetarianism and metformin use contribute to depressed vitamin B12 levels and may independently increase the risk for cognitive impairment. Vitamin B12 deficiency ( ρmol/L) is associated with cognitive impairment. Vitamin B12 supplements administered orally or parenterally at high dose (1 mg daily) were effective in correcting biochemical deficiency, but improved cognition only in patients with pre-existing vitamin B12 deficiency (serum vitamin B12 levels ρmol/L or serum homocysteine levels .9 μmol/L). Conclusion: Low serum vitamin B12 levels are associated with neurodegenerative disease and cognitive impairment. There is a small subset of dementias that are reversible with vitamin B12 therapy and this treatment is inexpensive and safe. Vitamin B12 therapy does not improve cognition in patients without pre-existing deficiency. There is a need for large, well-resourced clinical trials to close the gaps in our current understanding of the nature of the associations of vitamin B12 insufficiency and neurodegenerative disease.
Publisher: The Endocrine Society
Date: 10-2015
DOI: 10.1210/JC.2015-1794
Abstract: Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent, but severely debilitating condition. Given the significant morbidity attributable to MRONJ and the challenges associated with its management, prevention is crucial. We sought to evaluate the effectiveness of an active dental intervention in reducing MRONJ incidence. We identified all patients who received antiresorptive drug therapy at a specialized cancer center between January 2003 and December 2013 through hospital pharmacy records, whereas confirmed cases of MRONJ were identified through a hospital database. The incidence of MRONJ before and after the implementation of active dental intervention in July 2008 was quantified and compared. A total of 1243 patients received antiresorptive drug therapy, with 34 confirmed cases of MRONJ (crude overall incidence, 2.7%). The incidence of MRONJ was significantly lower in patients who received antiresorptive therapy after the implementation of guidelines that emphasized active dental input (0.8 vs 4.6% χ(2) = 16.2 P = .00006). Using a binominal logistic regression model that adjusted for the number of doses of antiresorptive drug received, patients who received active dental input had an odds ratio of developing MRONJ of 0.24 (95% confidence interval, 0.09, 0.61 P = .004). The likelihood of developing MRONJ can be minimized through the implementation of prophylactic dental assessment and active dental intervention. This reinforces the importance of increased dental awareness and enhanced dental intervention in the prevention of MRONJ.
Publisher: Springer Science and Business Media LLC
Date: 28-10-2014
Publisher: Springer Science and Business Media LLC
Date: 24-02-2007
DOI: 10.1007/S00198-007-0343-Y
Abstract: BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone. INTRODUCTION AND HYPOTHESES: To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD. Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score). CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR = 1.4/SD) and was not markedly increased by the combination (GR = 1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts. The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.ARCHGER.2017.12.006
Abstract: To determine characteristics of sarcopenic obesity that are independently associated with bone health and balance in older adults. Cross-sectional study of 168 community-dwelling older adults (mean age 67.7 ± 8.4 years 55% women). Appendicular lean mass (ALM), whole-body areal BMD (aBMD) and body fat percentage were assessed by dual-energy X-ray absorptiometry. Peripheral quantitative computed tomography assessed muscle density and cortical volumetric BMD (vBMD), area, thickness, and strength-strain index (SSI) at 66% tibial length. Hand grip strength (dynamometry) and balance path length (computerised posturography) were assessed. Obesity was defined as high body fat percentage. Greater lower-leg muscle density was associated with lower balance path length in men (r = -0.36 P < .01) and women (r = -0.40 P = < .01). Obese participants by body fat percentage did not differ to non-obese on bone indices, although a trend towards lower cortical vBMD was observed in obese compared with non-obese men (1041.4 ± 39.8 vs 1058.8 ± 36.1 mg/cm Amongst components of sarcopenic obesity, higher ALM is a consistent independent predictor of better bone health. Low muscle density may also compromise bone health and balance. Interventions which improve muscle mass and composition may lower fracture risk in sarcopenic obesity.
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/J.MEHY.2007.04.001
Abstract: Vitamin D is known to be widely deficient in Western populations. The implications of this in terms of bone health are increasingly understood, yet its impact on other health areas, particularly mental health, is unclear. Recent data suggests that hypovitaminosis D may be common, especially in the elderly. Other studies have suggested that low levels of vitamin D are associated with poor mood. There are a number of trials that have suggested a role for Vitamin D in the supplementary treatment of depression. Dose may be a critical issue, as sun exposure and dietary intake may be low and high doses may be required.
Publisher: AMPCo
Date: 06-2012
DOI: 10.5694/MJA11.10301
Abstract: The prevalence of vitamin D deficiency varies, with the groups at greatest risk including housebound, community-dwelling older and/or disabled people, those in residential care, dark-skinned people (particularly those modestly dressed), and other people who regularly avoid sun exposure or work indoors. Most adults are unlikely to obtain more than 5%-10% of their vitamin D requirement from dietary sources. The main source of vitamin D for people residing in Australia and New Zealand is exposure to sunlight. A serum 25-hydroxyvitamin D (25-OHD) level of ≥ 50 nmol/L at the end of winter (10-20 nmol/L higher at the end of summer, to allow for seasonal decrease) is required for optimal musculoskeletal health. Although it is likely that higher serum 25-OHD levels play a role in the prevention of some disease states, there is insufficient evidence from randomised controlled trials to recommend higher targets. For moderately fair-skinned people, a walk with arms exposed for 6-7 minutes mid morning or mid afternoon in summer, and with as much bare skin exposed as feasible for 7-40 minutes (depending on latitude) at noon in winter, on most days, is likely to be helpful in maintaining adequate vitamin D levels in the body. When sun exposure is minimal, vitamin D intake from dietary sources and supplementation of at least 600 IU (15 µg) per day for people aged ≤ 70 years and 800 IU (20 µg) per day for those aged > 70 years is recommended. People in high-risk groups may require higher doses. There is good evidence that vitamin D plus calcium supplementation effectively reduces fractures and falls in older men and women.
Publisher: Wiley
Date: 02-1994
DOI: 10.1007/BF02537152
Publisher: Wiley
Date: 02-10-2019
DOI: 10.1111/OPN.12276
Abstract: Irrespective of age, communication is a tool of expression and a key daily activity meeting the human need for social interaction and connection. The introduction of consumer-directed care (CDC) emphasises the importance of communication to provide consumers with the opportunity to exercise choice over the care they receive. As consumer-directed care progresses, it is hypothesised that the feasibility of shared decision-making and care planning in residential aged care will be largely determined by the communication opportunities afforded to the residents. Therefore, the aim of this study was to explore resident perceptions of the opportunities they have to communicate, including the opportunity to express their care preferences and contribute opinions about their care. A qualitative inductive design was adopted. An in idual interview format was used to gather the perspectives of 102 residents. Data were analysed using qualitative content analysis to generate themes illustrating patterns in participant views. Overall, residents desired increased involvement in their care planning and increased opportunity for more meaningful communication and social opportunities. Residents described the negative impact of the communication difficulties they face on their communication and the need for support and activities to be tailored to residents' in idual communication needs. To facilitate resident participation in CDC and meet resident desire for increased social communication, further investment in resources to support resident-staff communication and accommodate residents' in idual communication needs is required. By highlighting communication as a stand-alone activity and a priority of residents, the findings of this study raise the profile of communication and demonstrate the need for explicit allocation of care time and specialist services to support resident-staff communication and social communication in residential aged care. Such support must be tailored to meet residents' in idual communication needs and be coupled with increased staff training in providing communication support. Without facilitating resident communication and increasing the opportunity to communicate, shared decision-making and care planning in residential aged care consistent with person-centred and consumer-directed models of care will be limited.
Publisher: Wiley
Date: 24-10-2020
DOI: 10.1002/JBMR.3865
Abstract: Multicomponent exercise programs are recommended to reduce fracture risk however, their effectiveness in real-world community settings remain uncertain. This 18-month randomized controlled trial investigated the effects of a 12-month, community-based, supervised multicomponent exercise program followed by a 6-month "research-to-practice" transition on areal bone mineral density (BMD), trabecular bone microarchitecture, functional performance, and falls in older adults at increased fracture risk. One-hundred and sixty-two adults aged ≥60 years with osteopenia or at increased falls risk were randomized to the Osteo-cise: Strong Bones for Life multicomponent exercise program (n = 81) or a control group (n = 81). Exercise consisted of progressive resistance, weight-bearing impact, and balance training (3-days/week) performed at community leisure centers. Overall 148 (91%) participants completed the trial, and mean exercise adherence was 59% after 12 months and 45% during the final 6 months. After 12 months, there were significant net beneficial effects of exercise on lumbar spine and femoral neck BMD (1.0% to 1.1%, p < 0.05), muscle strength (10% to 13%, p < 0.05), and physical function (timed stair climb 5% four-square step test 6% sit-to-stand 16%, p ranging <0.05 to <0.001), which persisted after the 6-month transition. There were no significant effects of the 18-month intervention on distal femur or proximal tibia trabecular bone microarchitecture or falls incidence, but per protocol analysis (≥66% exercise adherence) revealed there was a significant net benefit of exercise (mean [95% confidence interval] 2.8% [0.2, 5,4]) on proximal tibia trabecular bone volume fraction (Osteo-cise 1.5% [-1.2, 4.2] controls -1.3% [-2.6, 0.1]) after 18 months due to changes in trabecular number (Osteo-cise 1.7% [-0.9, 4.3] controls -1.1% [-2.4, 0.2]) but not trabecular thickness (Osteo-cise - 0.2% [-0.5, 0.2] controls -0.2% [-0.4, 0.0]). In conclusion, this study supports the effectiveness of the Osteo-cise: Strong Bones for Life program as a real-world, pragmatic, evidence-based community exercise program to improve multiple musculoskeletal health outcomes in older adults at increased fracture risk. © 2019 American Society for Bone and Mineral Research.
Publisher: Springer Science and Business Media LLC
Date: 23-09-2017
DOI: 10.1007/S11657-017-0378-4
Abstract: The association between vitamin D and muscle function associated with balance recovery and falls in people with knee osteoarthritis is unclear. Those with vitamin D insufficiency demonstrated poorer knee function during balance recovery, greater pain and locomotor dysfunction. Vitamin D insufficiency may have an adverse effect on muscle power function. Low vitamin D status in people with knee osteoarthritis (OA) is often reported to be associated with increased pain and locomotor dysfunction. However, despite the growing evidence of the effect of vitamin D on the pathogenesis of knee OA, its role remains conflicting. Importantly, muscle function is important for knee joint health however, the association between vitamin D levels and muscle function associated with balance recovery and falls is unclear. This study investigated the effect of circulating 25-hydroxyvitamin D (25 (OH) D) on pain, quadriceps strength, lower limb muscle mass and knee power function during balance recovery in people with knee OA. Twenty-four participants with clinical symptoms of knee OA (68.6 ± 6.2 years) participated in the study. Serum levels of 25 (OH) D were assessed and participants were classified as follows: vitamin D insufficiency ≤ 50 nmol/L and vitamin D sufficiency > 50 nmol/L. The groups were compared on knee function during balance recovery tasks, lower limb strength and muscle mass as well as perceived pain and function. Seven patients (29.1%) were classified as vitamin D-insufficient. Vitamin D insufficiency was associated with reduced knee muscle function during the balance recovery task, increased pain (Western Ontario and McMasters University Osteoarthritis Index (WOMAC) subscore), dysfunction (WOMAC subscore) and total WOMAC score (p < 0.05). People with knee OA with vitamin D insufficiency demonstrated poorer knee function during balance recovery, greater pain and locomotor dysfunction. Vitamin D insufficiency may have an adverse effect on muscle power function.
Publisher: Wiley
Date: 30-01-2014
DOI: 10.1111/CEN.12392
Abstract: Selenium is effective in improving quality of life and reducing the progression of active Graves' orbitopathy. The effect of correcting relative selenium deficiency on improving Graves' orbitopathy is unknown, as baseline selenium levels have not previously been measured. The study aims to determine whether serum selenium levels are reduced in patients with Graves' disease with orbitopathy (GO) compared with without orbitopathy (GD). A prospective, case-control study performed between 2009 and 2012 at endocrine and ophthalmology clinics in Australia. A total of 198 patients with Graves' disease participated in the study: 101 with Graves' orbitopathy and 97 without Graves' orbitopathy. Serum selenium levels in both groups. Mean serum selenium levels were significantly lower in GO (1·10 ± 0·18 μm) than in GD (1·19 ± 0·20 μm) (P = 0·001). Mean selenium levels appeared to decrease in parallel with increasing severity of GO selenium level was 1·19 ± 0·20 μm in GD, 1·10 ± 0·19 μm in moderate-to-severe GO and 1·09 ± 0·17 μm in sight-threatening GO (P = 0·003). Serum selenium levels remained significantly lower in GO after adjusting for age, smoking status, thyroidectomy, radioactive iodine treatment and residential location. Serum selenium levels are lower in patients with GO compared with GD in an Australian study population with marginal selenium status. Relative selenium deficiency may be an independent risk factor for orbitopathy in patients with Graves' disease.
Publisher: Wiley
Date: 19-12-2013
DOI: 10.1002/JBMR.2014
Abstract: Multimodal exercise programs incorporating traditional progressive resistance training (PRT), weight-bearing impact training and/or balance training are recommended to reduce risk factors for falls and fracture. However, muscle power, or the ability to produce force rapidly, has emerged as a more crucial variable to functional decline than muscle strength or mass. The aim of this 12-month community-based randomized controlled trial, termed Osteo-cise: Strong Bones for Life, was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT, combined with an osteoporosis education and behavioral change program, on bone mineral density (BMD), body composition, muscle strength and functional muscle performance in older adults. Falls incidence was evaluated as a secondary outcome. A total of 162 older adults (mean ± SD 67 ± 6 years) with risk factors for falls and/or low BMD were randomized to the Osteo-cise program (n = 81) or a control group (n = 81). Exercise consisted of fitness center-based HV-PRT, weight-bearing impact and challenging balance/mobility activities performed three times weekly. After 12 months, the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD (1.0% to 1.1%, p < 0.05), muscle strength (10% to 13%, p < 0.05), functional muscle power (Timed Stair Climb, 5%, p < 0.05) and dynamic balance (Four Square Step Test 6%, p < 0.01 Sit-to-Stand, 16%, p < 0.001) relative to controls. There was no effect on total body lean mass or mobility (timed-up-and-go), and no difference in falls rate (incidence rate ratio [IRR], 1.22 95% confidence interval [CI], 0.72-2.04). In conclusion, this study demonstrates that the Osteo-cise: Strong Bones for Life community-based, multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and/or low BMD. Although this did not translate into a reduction in the rate of falls, further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture.
Publisher: Springer Science and Business Media LLC
Date: 26-06-2014
DOI: 10.1007/S00198-013-2431-5
Abstract: Sarcopenia may be diagnosed in the clinic using operational definitions based on low muscle mass or function. This prospective, population-based study revealed that sex-specific associations may exist between operational definitions of sarcopenia and falls in community-dwelling middle-aged and older adults. The objective of this study is to verify associations between sarcopenia and falls risk and to determine changes in sarcopenia prevalence over 5 years in middle-aged and older men and women according to different anthropometric and performance-based operational definitions. N = 681 volunteers (48% female mean ± SD age 61.4 ± 7.0 years) participated in baseline and follow-up assessments (mean 5.1 ± 0.5 years later). Appendicular lean mass (ALM) was assessed by dual-energy X-ray absorptiometry, hand grip (HGS) and lower-limb (LLS) strength were assessed by dynamometry, and falls risk was determined using the physiological profile assessment. Anthropometric definitions (ALM/height squared [ALM-H], ALM/weight × 100 and a residuals method [ALM-R]) and performance-based definitions (HGS, LLS and upper- and lower-limb muscle quality [LMQ]) of sarcopenia were examined. The lowest 20% of the sex-specific distribution for each definition at baseline was classified as sarcopenia. Sarcopenia prevalence increased after 5 years for all operational definitions except ALM-H (men: -4.0% women: -5.5%). Men classified with sarcopenia according to anthropometric definitions, and women classified with sarcopenia according to performance-based definitions, had significant increases in falls risk over 5 years (all P < 0.05) compared to in iduals without sarcopenia. Significant sex interactions were observed for ALM-R, LLS and LMQ (all P < 0.05) definitions. Sarcopenia prevalence generally increases at a higher rate when assessed using performance-based definitions. Sarcopenia is associated with increases in falls risk over 5 years in community-dwelling middle-aged and older adults, but sex-specific differences may exist according to different anthropometric or performance-based definitions.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2018
Publisher: American Physiological Society
Date: 12-2009
DOI: 10.1152/JAPPLPHYSIOL.00392.2009
Abstract: Limited data have suggested that the consumption of fluid milk after resistance training (RT) may promote skeletal muscle hypertrophy. The aim of this study was to assess whether a milk-based nutritional supplement could enhance the effects of RT on muscle mass, size, strength, and function in middle-aged and older men. This was an 18-mo factorial design (randomized control trial) in which 180 healthy men aged 50–79 yr were allocated to the following groups: 1) exercise + fortified milk, 2) exercise, 3) fortified milk, or 4) control. Exercise consisted of progressive RT with weight-bearing impact exercise. Men assigned to the fortified milk consumed 400 ml/day of low-fat milk, providing an additional 836 kJ, 1000 mg calcium, 800 IU vitamin D 3 , and 13.2 g protein per day. Total body lean mass (LM) and fat mass (FM) (dual-energy X-ray absorptiometry), midfemur muscle cross-sectional area (CSA) (quantitative computed tomography), muscle strength, and physical function were assessed. After 18 mo, there was no significant exercise by fortified milk interaction for total body LM, muscle CSA, or any functional measure. However, main effect analyses revealed that exercise significantly improved muscle strength (∼20–52%, P 0.001), LM (0.6 kg, P 0.05), FM (−1.1 kg, P 0.001), muscle CSA (1.8%, P 0.001), and gait speed (11%, P 0.05) relative to no exercise. There were no effects of the fortified milk on muscle size, strength, or function. In conclusion, the daily consumption of low-fat fortified milk does not enhance the effects of RT on skeletal muscle size, strength, or function in healthy middle-aged and older men with adequate energy and nutrient intakes.
Publisher: Elsevier BV
Date: 11-2016
Abstract: Reported associations between protein intake from different sources and type 2 diabetes (T2D) have been inconsistent. We prospectively examined the relations of total, animal, and plant protein intakes with incident T2D. We followed 21,523 participants (women: 61.7%) between 1990 and 2007 from the Melbourne Collaborative Cohort Study who were free of diabetes, cardiovascular disease, cancer, and kidney stones at baseline. We also conducted a meta-analysis that included the results from our cohort and from 10 previous prospective studies. A total of 929 new cases (4.3%) of T2D were documented during a mean of 11.7 y of follow-up. Multivariate-adjusted ORs for incident T2D in the highest compared with lowest quintiles of total and animal protein intakes as percentages of energy were 1.23 (95% CI: 0.96, 1.56 P-trend = 0.029) and 1.29 (95% CI: 0.99, 1.67 P-trend = 0.014), respectively. These associations appeared to be greater in men and in participants with normal baseline plasma glucose, body mass index, or blood pressure. Plant protein intake was inversely associated with incident T2D in women only (OR 0.60 95% CI: 0.37, 0.99). In the meta-analysis of 11 prospective cohort studies with 505,624 participants and 37,918 T2D cases (follow-up range: 5-24 y), pooled RRs for the comparison of the highest with lowest categories of total, animal, and plant protein intakes were 1.09 (95% CI: 1.06, 1.13), 1.19 (95% CI: 1.11, 1.28), and 0.95 (95% CI: 0.89, 1.02), respectively. Associations between animal protein intake and T2D were similar across sex, geographic region, length of follow-up, study quality, and method of expressing protein intake. An inverse association between plant protein intake and T2D was observed in women (RR: 0.93 95% CI: 0.85, 1.00) and in US populations (RR: 0.91 95% CI: 0.84, 0.97). Higher intakes of total and animal protein were both associated with increased risks of T2D, whereas higher plant protein intake tended to be associated with lower risk of T2D.
Publisher: Wiley
Date: 14-10-2020
DOI: 10.1002/JBMR.4181
Publisher: Springer Science and Business Media LLC
Date: 16-07-2016
Publisher: Springer Science and Business Media LLC
Date: 05-10-2015
DOI: 10.1007/S00198-015-3322-8
Abstract: Non-hip, non-vertebral fractures (NHNVF) were compared with hip, vertebral and controls. NHNVF were younger and heavier than controls and hip/vertebral fractures in both men and women, respectively. Falls and prior fractures were less common in NHNVF than hip fractures. Glucocorticoid use was lower in NHNVF compared to vertebral fracture (VF) in men. Although hip fracture (HF) and vertebral fractures (VF) receive the most attention in the literature and are the targeted sites for fracture prevention, non-hip, non-vertebral fracture (NHNVF) sites account for a greater proportion of fractures than the hip or vertebrae. This study aimed to assess risk factors for NHNVF and compare them with those for HF, VF and controls. Incident fractures during 2005-2007 for men and 1994-1996 for women were identified using computerised keyword searches of radiological reports, and controls were selected at random from electoral rolls for participation in the Geelong Osteoporosis Study. Participants aged 60+ years were included in this study. Compared to controls, men and women with NHNVF were younger (ORs, 0.90, 95% CI 0.86-0.94 and 0.96, 0.93-0.98, respectively) and had a lower femoral neck bone mineral density (BMD) T-score (age-adjusted difference [men] 0.383, P = 0.002 [women] 0.287, P = 0.001). Compared to HF, men and women with NHNVF were heavier (difference [men] 9.0 kg, P = 0.01 [women] 7.6 kg, P < 0.001). Heavier weight was also a risk factor for women with NHNVF compared to VF (1.03, 1.01-1.06). In men with NHNVF, falls (0.37, 0.14-0.97) and prior fractures (0.38, 0.15-0.98) were less common compared to HF and glucocorticoid use was less common for NHNVF (0.30, 0.11-0.85) compared to VF. Given the high numbers of NHNVF sustained by men and women in this study, fracture prevention strategies should focus on in iduals with high risk of sustaining these types of fractures, as well as on in iduals who are more likely to sustain a HF or VF.
Publisher: Springer Science and Business Media LLC
Date: 28-05-2012
Abstract: Osteoporosis affects over 220 million people worldwide, and currently there is no ‘cure’ for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition. The Osteo-cise: Strong Bones for Life study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged ≥60 years will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month ‘research to practise’ translational phase. Participants will be randomly assigned to either the Osteo-cise intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test). Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back maximal muscle strength, balance and function (four square step test, functional reach test, timed up-and-go test and 30-second sit-to-stand), falls incidence and health-related quality of life. Cost-effectiveness will also be assessed. The findings from the Osteo-cise: Strong Bones for Life study will provide new information on the efficacy of a targeted multi-modal community-based exercise program incorporating high velocity resistance training, together with an osteoporosis education and behavioural change program for improving multiple risk factors for falls and fracture in older adults at risk of fragility fracture. Australian New Zealand Clinical Trials Registry reference ACTRN12609000100291
Publisher: Springer Science and Business Media LLC
Date: 24-05-2016
DOI: 10.1007/S12603-016-0738-6
Abstract: This study aimed to examine the association between baseline and changes in dietary quality assessed by the Alternative Healthy Eating Index-2010 (AHEI-2010) and abdominal aortic calcification (AAC) among community-dwelling older adults. Population-based longitudinal study. A subset of the Melbourne Collaborative Cohort Study (MCCS). 262 community-dwelling adults (60% female) aged 53 ± 5 years at baseline. Dietary intake was assessed using validated Food Frequency Questionnaires at baseline (1990-1994) and follow-up (2010-2011). AAC was evaluated by radiography and dual-energy x-ray absorptiometry (DXA) at follow-up. Higher baseline AHEI-2010 score was associated with lower AAC severity by radiography [OR (95% CI) for Tertile 3 VS Tertile 1: 0.53 (0.29-0.99)] after adjustment for gender, age, physical activity, smoking, BMI, systolic blood pressure, plasma total cholesterol, calcium and energy intake. The association between AHEI-2010 and AAC severity by DXA was also significant in the multivariate-adjusted model [OR (95% CI) for Tertile 3 VS Tertile 1: 0.38 (0.20-0.70)]. Changes in AHEI-2010 over 18 years were not associated with AAC severity. Baseline but not the changes in AHEI-2010 was inversely associated with the risk of AAC severity suggesting that a high quality diet might help prevent or delay the progression of AAC in community-dwelling older adults and the benefits might be manifested over the long-term.
Publisher: Wiley
Date: 09-09-2014
DOI: 10.1111/CEN.12567
Abstract: Prospective observational studies uniformly link vitamin D deficiency with the incidence of type 2 diabetes mellitus (T2DM), yet trials supplementing participants at risk of T2DM with vitamin D to reduce progression to T2DM have yielded inconsistent results. Inconsistencies between supplementation trials may be due to insufficient dosing or small s le sizes. Observational studies may also have reported spurious associations due to uncontrolled confounding by lifestyle or genetic factors. Alternatively, observational and intervention studies may not be entirely comparable. Observational studies show an association between higher vitamin D status, which is predominantly derived from sun exposure, and decreased incidence of T2DM. Trials intervene with vitamin D supplementation, and therefore may be missing alternate causes of the effect of sun exposure, as seen in observational studies. We propose that sun exposure may be the driving force behind the associations seen in observational studies sun exposure may have additional benefits beyond increasing serum 25-hydroxyvitamin D (25OHD) levels. We performed an electronic literature search to identify articles that examined associations between sun exposure and T2DM and/or glucose metabolism. A best evidence synthesis was then conducted using outcomes from analyses deemed to have high methodological quality. Ten eligible full-text articles were identified, yielding 19 T2DM-related outcomes. The best evidence analysis considered 11 outcomes which were grouped into six outcome types: T2DM, fasting glucose, glucose tolerance, fasting insulin, insulin secretion and insulin sensitivity. There was moderate evidence to support a role of recreational sun exposure in reducing odds of T2DM incidence. High-level evidence was lacking evidence presented for other outcomes was of low or insufficient level. This review highlights significant gaps in research pertaining to sun exposure and T2DM-related outcomes. Further research is encouraged as we aim to identify novel preventative strategies for T2DM.
Publisher: American College of Physicians
Date: 21-09-2010
Publisher: Springer Science and Business Media LLC
Date: 31-05-2016
DOI: 10.1007/S10554-016-0920-2
Abstract: To determine whether adiposity assessed by dual-energy X-ray absorptiometry (DXA) compared to simple anthropometric assessments, are more predictive of abdominal aortic calcification (AAC), a risk factor for atherosclerosis. A cross-sectional study of 312 participants (60.3 % female) aged 70.6 ± 5.6 years was conducted in 2010-2011. AAC was assessed by radiography. Adiposity was estimated for whole body, trunk, android, gynoid and visceral regions using DXA in addition to body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR). WHR [tertile 1 as reference, OR (95 % CI) for tertile 3: 3.62 (1.35-9.72)] and android to gynoid fat ratio [tertile 3: 2.87 (1.03-8.01)] were independent predictors of AAC severity among men. Positive associations with AAC severity were observed for WC [tertile 1 as reference, OR for tertile 3: 2.46 (1.12-5.41)], % trunk fat mass [tertile 2: 3.26 (1.52-7.03)], % android fat mass [tertile 2: 2.42 (1.13-5.18), tertile 3: 2.20 (1.02-4.73)] and visceral fat area [tertile 2: 2.28 (1.06-4.87), tertile 3: 2.32 (1.01-5.34)] among women. Indices of total body composition, BMI and % body fat mass were not associated with AAC severity in either men or women. Simple anthropometric measures, WHR and WC were the best predictors of AAC severity in men and women respectively, although higher android to gynoid fat ratio and central fat, assessed by DXA, were also predictive of higher risks of AAC severity in men and women respectively. Our findings add to existing evidence that relatively inexpensive and easily obtained anthropometric measures can be clinically useful indicators of atherosclerosis risk.
Publisher: Wiley
Date: 20-06-2016
Publisher: American Medical Association (AMA)
Date: 25-08-2010
Publisher: Springer Science and Business Media LLC
Date: 12-05-2017
DOI: 10.1007/S11136-017-1592-7
Abstract: We compared health-related quality of life (HRQOL) in incident (≤1 year since diagnosis), mid-term (>1-5 years since diagnosis), and long-term (>5 years since diagnosis) cases of mental and physical chronic illness with the general population and assessed the modifying effects of age and gender on the association between HRQOL and illness duration. Data from the 2007 Australian National Health and Mental Wellbeing Survey were used. HRQOL was captured by the Assessment of Quality of Life Scale 4D. Multivariable linear regression analyses compared HRQOL of in iduals with different duration of illnesses with those who did not have the condition of interest. The 8841 survey respondents were aged 16-85 years (median 43 years, 50.3% female). For the overall s le, worse HRQOL was associated with incident (P = 0.049) and mid-term (P = 0.036) stroke and long-term depression (P < 0.001) and anxiety (P = 0.001). Age had moderating effect on the associations between HRQOL and duration of asthma (P < 0.001), arthritis (P = 0.001), diabetes (P = 0.004), stroke (P = 0.009), depression (P < 0.001), bipolar disorder (P < 0.001), and anxiety (P < 0.001), but not heart disease (P = 0.102). In older ages, the greatest loss in HRQOL was associated with incident asthma, depression, and bipolar disorder. In younger ages, the greatest loss in HRQOL was associated with arthritis (any duration) and incident diabetes and anxiety. Additionally, gender moderated the association between HRQOL and arthritis, with worse HRQOL among men with incident arthritis (P = 0.047). Loss of HRQOL associated with longer duration of chronic illness is most apparent in stroke and mental illness and differs between age groups.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2017
DOI: 10.1007/S11136-017-1748-5
Abstract: The International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-off (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set. Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers. In total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analysis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13-18 months after distal forearm fracture, EQ-5D-3L generated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked differences between the three approaches were observed immediately after the fracture. The approach to derive QoL markedly influences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-effectiveness analysis of fracture prevention.
Publisher: Springer Science and Business Media LLC
Date: 12-06-2018
Publisher: Wiley
Date: 02-2000
DOI: 10.1111/J.1445-5994.2000.TB01049.X
Abstract: Dietary calcium deficiency may be a risk factor for osteoporosis. To estimate habitual calcium intakes and prevalence of calcium supplementation among free-living Australian women and validate a calcium-specific food-frequency questionnaire. Calcium intakes for 1045 randomly selected women (20-92 years) were estimated by questionnaire which was tested against estimates from four day weighed records kept by 32 randomly selected women. The mean difference between calcium estimates was not statistically significantly different from zero (mean difference=121 mg standard deviation of differences=357 mg p>0.05). There was moderate agreement (weighted kappa=0.4) between methods in ranking subjects into tertiles of calcium intake. Mean dietary calcium intakes were 615 mg/day for 20-54 years, 646 mg/day for 55-92 years and 782 mg/day for lactating women. Seventy-six per cent of women aged 20-54 years, 87% of older and 82% of lactating women had intakes below the recommended dietary intake (RDI). There was no association detected between calcium intake and age. Dairy foods provided 79.0% of dietary calcium intake. Calcium supplements were used by 6.6% and multivitamins by a further 4.3% of women. Supplementation was independent of dietary calcium intake and more likely used by postmenopausal women. Our results suggest that 76% of women consume less than the RDI even when supplemental calcium is included. Furthermore, 14% have less than the minimal requirement of 300 mg/day and would, therefore, be in negative calcium balance and at risk of bone loss. Despite advertising c aigns promoting better nutrition and increased awareness of osteoporosis, many women are failing to achieve an adequate calcium intake.
Publisher: The Endocrine Society
Date: 10-2013
DOI: 10.1210/JC.2013-2560
Publisher: Springer Science and Business Media LLC
Date: 26-02-2016
Publisher: Springer Science and Business Media LLC
Date: 10-01-2013
DOI: 10.1007/S00198-012-2240-2
Abstract: The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss. The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS. ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire. The total s le for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not. The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries.
Publisher: Wiley
Date: 2008
DOI: 10.1111/J.1445-2197.2007.04351.X
Abstract: Background: Audit is a compulsory part of practice and all outcomes are now scrutinized. Raw results may be used to compare performance but these may not accurately reflect case and patient mix. Risk stratification tools, such as American Society of Anaesthesiologists (ASA) and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), have been shown to predict morbidity and mortality at the expense of extra data collection. The Special Cooperative Audit of Rural Surgeons reported that two comorbidities increased mortality from 4% to 16, but this finding has not been confirmed. Our aim was to compare risk stratification tools and confirm or refute if comorbidities are accurate predictors of morbidity and mortality. Methods: We made use of an existing colorectal audit, which includes ASA, POSSUM, comorbidities and surgical outcomes. Our anaesthetic department provided data from preoperative cardiopulmonary exercise tests. A poor surgical outcome was defined as death, anastomotic leak and a complication requiring significant intervention. Results: Data collection was complete for comorbidities, but only 79% cases had ASA scores, 72% completed POSSUM sets and 39% anaerobic threshold. POSSUM , ASA III and two comorbidities were all predictors of mortality and grade 3 complications. Anaerobic threshold mL/min/kg did not predict poor surgical outcome. Anastomotic leak was not predicted by any of the scoring systems. Conclusion: ASA, POSSUM and the presence of two comorbidities were significant predictors of mortality and morbidity, excluding anastomotic leaks. Comorbidities are simple to collect and their correlation with outcome compares favourably with POSSUM. Comorbidities are a simple and quick method of risk stratification for colorectal surgery.
Publisher: Wiley
Date: 06-1993
DOI: 10.1007/BF02536084
Publisher: Springer Science and Business Media LLC
Date: 04-2011
DOI: 10.1007/S00421-011-1942-Z
Abstract: We examined the effects of progressive resistance training (PRT) and supplementation with calcium-vitamin D(3) fortified milk on markers of systemic inflammation, and the relationship between inflammation and changes in muscle mass, size and strength. Healthy men aged 50-79 years (n = 180) participated in this 18-month randomized controlled trial that comprised a factorial 2 × 2 design. Participants were randomized to (1) PRT + fortified milk supplement, (2) PRT, (3) fortified milk supplement, or (4) a control group. Participants assigned to PRT trained 3 days per week, while those in the supplement groups consumed 400 ml day(-1) of milk containing 1,000 mg calcium plus 800 IU vitamin D(3). We collected venous blood s les at baseline, 12 and 18 months to measure the serum concentrations of IL-6, TNF-α and hs-CRP. There were no exercise × supplement interactions, but serum IL-6 was 29% lower (95% CI, -62, 0) in the PRT group compared with the control group after 12 months. Conversely, IL-6 was 31% higher (95% CI, -2, 65) in the supplement group compared with the non-supplemented groups after 12 and 18 months. These between-group differences did not persist after adjusting for changes in fat mass. In the PRT group, mid-tibia muscle cross-sectional area increased less in men with higher pre-training inflammation compared with those men with lower inflammation (net difference ~2.5%, p < 0.05). In conclusion, serum IL-6 concentration decreased following PRT, whereas it increased after supplementation with fortified milk concomitant with changes in fat mass. Furthermore, low-grade inflammation at baseline restricted muscle hypertrophy following PRT.
Publisher: Springer Science and Business Media LLC
Date: 04-06-2015
DOI: 10.1007/S11914-015-0274-Z
Abstract: Due to their differing etiologies and consequences, it has been proposed that the term "sarcopenia" should revert to its original definition of age-related muscle mass declines, with a separate term, "dynapenia", describing muscle strength and function declines. There is increasing interest in the interactions of sarcopenia and dynapenia with obesity. Despite an apparent protective effect of obesity on fracture, increased adiposity may compromise bone health, and the presence of sarcopenia and/or dynapenia ("sarcopenic obesity" and "dynapenic obesity") may exacerbate the risk of falls and fracture in obese older adults. Weight loss interventions are likely to be beneficial for older adults with sarcopenic and dynapenic obesity but may result in further reductions in muscle and bone health. The addition of exercise including progressive resistance training and nutritional strategies, including protein and vitamin D supplementation, may optimise body composition and muscle function outcomes thereby reducing falls and fracture risk in this population.
Publisher: The Endocrine Society
Date: 08-2012
DOI: 10.1210/JC.2011-3328
Publisher: Springer Science and Business Media LLC
Date: 02-2001
Abstract: We examined the incidence of fragility fractures in Australian women 50 years of age and over using a Markov process with Monte Carlo simulations. The lifetime risks and the risks of sustaining first and subsequent clinically diagnosed fractures at osteoporotic sites were estimated according to age, nursing home entry and mortality rates. Hip and spine fractures were evaluated in idually and fractures of humerus, forearm, wrist, ribs, pelvis, upper leg (excluding proximal femur) and tibia/fibula were considered in combination. The model predicted that 42.1% of women aged 50 years will sustain at least one fracture in their remaining lifetime, of whom half are expected to sustain multiple fractures. The lifetime risks of sustaining hip, clinical spine and other fractures were 17.0%, 9.6% and 30.4%, with the risks of multiple fractures at these sites estimated at 19.5%, 39.7% and 35.7% respectively. The proportion of women expected to sustain their first fracture increased from 1.9% of the population under 55 years of age up to 49.1% of women over 89 years of age. The 5-year age-specific risks of sustaining any subsequent fractures increased from 2.8% of women under the age of 55 years to 61.6% for women age 89 years and over. The increased risks of new fractures following a first fracture lead to a considerable burden of multiple fractures.
Publisher: BMJ
Date: 21-05-2015
Publisher: Elsevier BV
Date: 08-2015
Abstract: Associations of α-linolenic acid (ALA), eicosapentaenoic acid (EPA) plus decosahexaenoic acid (DHA), and total omega-3 (n-3) fatty acid (FA) intakes with abdominal aortic calcification (AAC) are not well understood. This study explored the associations between baseline and long-term changes in ω-3 FA consumption and AAC severity among community-dwelling older men and women. The present study used a subset of the Melbourne Collaborative Cohort Study in which participants were interviewed in 1990-1994 and again in 2010-2011. Dietary intake was evaluated at both baseline and follow-up with use of food-frequency questionnaires. AAC severity was assessed by both lateral thoraco-lumbar radiography and dual-energy X-ray absorptiometry (DXA) at follow-up. A total of 312 participants aged 45-64 y old at baseline were followed for a duration of (mean ± SD) 18 ± 1 y. Baseline energy-adjusted ALA intake tended to be inversely associated with AAC severity by radiography [OR (95% CI) for tertile 3 vs. tertile 1: 0.49 (0.23, 1.02), P-trend: 0.06] and was inversely associated with AAC severity by DXA [OR (95% CI) for tertile 3 vs. tertile 1: 0.37 (0.16, 0.83)] in women, after adjustment for confounders. Women in the third tertile of total ω-3 FA intake had significantly lower AAC severity by radiography [OR (95% CI): 0.33 (0.16, 0.71)] and DXA [OR (95% CI): 0.27 (0.12, 0.62)] than those in the first tertile. Changes in tertile of ω-3 FA intake over 18 y were not found to be associated with AAC severity in either men or women. The results of our study suggest that dietary ALA and total ω-3 FA intakes are both important predictors of the development of AAC in older women, but not in older men.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2019
DOI: 10.1007/S10654-019-00568-5
Abstract: This systematic review aimed to synthesise multimorbidity profiling literature to identify replicable and clinically meaningful groupings of multimorbidity. We searched six electronic databases (Medline, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science) for articles reporting multimorbidity profiles. The identified profiles were synthesised with multidimensional scaling, stratified by type of statistical analysis used in the derivation of profiles. The 51 studies that met inclusion criteria reported results of 98 separate analyses of multimorbidity profiling, with a total of 407 multimorbidity profiles identified. The statistical techniques used to identify multimorbidity profiles were exploratory factor analysis, cluster analysis of diseases, cluster analysis of people, and latent class analysis. Reporting of methodological details of statistical methods was often incomplete. The discernible groupings of multimorbidity took the form of both discrete categories and continuous dimensions. Mental health conditions and cardio-metabolic conditions grouped along identifiable continua in the synthesised results of all four methods. Discrete groupings of chronic obstructive pulmonary disease with asthma, falls and fractures with sensory deficits and of Parkinson's disease and cognitive decline where partially replicable (identifiable in the results of more than one method), while clustering of musculoskeletal conditions and clustering of reproductive systems were each observed only in one statistical approach. The two most replicable multimorbidity profiles were mental health conditions and cardio-metabolic conditions. Further studies are needed to understand aetiology and evolution of these multimorbidity groupings. Guidelines for strengthening the reporting of multimorbidity profiling studies are proposed.
Publisher: Springer Science and Business Media LLC
Date: 08-06-2018
Publisher: Wiley
Date: 07-01-2019
DOI: 10.1002/JBMR.3640
Abstract: Osteoporosis and osteopenia are increasingly prevalent conditions among older adults. Not only do the fractures associated with poor bone health have significant health consequences for the in idual, but also their economic impact is placing increasing financial burden on governments and society. This study aimed to determine the direct economic cost of osteoporosis, osteopenia, and fractures among Australians aged 50 years and older in 2017. This study uses previous Australian data on the incidence and prevalence of osteoporosis and osteopenia together with recent Australian data on health service utilization after fracture to provide an estimate of the economic burden of osteoporosis. A bottom-up costing approach was used to determine the average direct health care and non-health care total costs of a fracture, as well as the average community health service costs of managing in iduals with osteoporosis or osteopenia. The total direct cost of osteoporosis in Australia in 2017 was estimated to be $3.44 billion (AUD 2017, USD 2.77 billion). Treatment of fractures accounted for 68% of total direct costs, and non-fracture management of osteoporosis accounted for 32%. Hip fractures accounted for the highest proportion (43%) of the total direct cost of fractures, although fractures at "other" sites accounted for 38.5%. Fractures among in iduals aged 70 years and older accounted for 74% of the direct costs (55% and 19% in women and men, respectively). Fracture costs in those with osteopenia accounted for 50% of direct fracture treatment costs. This up-to-date cost analysis estimated that costs in 2017 were three times higher than in 2007. These estimates will aid clinicians, policy makers, researchers, and health care organizations to acknowledge the economic importance of reducing osteoporosis-related fractures and associated costs. This provides a strong public health case to promote bone health that will assist in reducing future fracture-related costs. © 2018 American Society for Bone and Mineral Research.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2012
Publisher: Springer Science and Business Media LLC
Date: 02-2014
DOI: 10.1007/S11914-014-0193-4
Abstract: In this commentary, we focus on common 'downstream' links of vitamin D between muscle and bone health. Both direct and indirect effects of 1,25 dihydroxyvitamin D (1,25(OH)D) link the mutual age-related decline in muscle function and bone density, independent of physical activity. Changes in calcium absorption associated with vitamin D deficiency affect both muscle and bone mass. The age-related decline in vitamin D receptor expression and 1,25(OH)D activity impact on proinflammatory cytokines such as tumor necrosis factor -α and interleukin-6 in skeletal muscle and vitamin D deficiency appears to enhance both bone marrow adipogenesis and intramuscular adipose tissue impacting as reduced functionality in both skeletal tissues. Controversial findings on the role of 1,25(OH)D on skeletal muscle may relate to differences in vitamin D receptor expression throughout different stages of muscle cell differentiation. Prolonged vitamin D insufficiency in the elderly is associated with reductions in both bone mineral density and type 2 muscle fibers with the outcomes of skeletal fragility in combination with reduced muscle power, leading to increased risk of falls and fracture.
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Springer Science and Business Media LLC
Date: 27-03-2015
Publisher: Springer Science and Business Media LLC
Date: 14-07-2015
DOI: 10.1007/S00223-015-0039-9
Abstract: In this study, we report the epidemiology and risk factors for humeral fractures (proximal humerus and shaft) among men and women residing in south-eastern Australia. Incident fractures during 2006 and 2007 were identified using X-ray reports (Geelong Osteoporosis Study Fracture Grid). Risk factors were identified using data from case-control studies conducted as part of the Geelong Osteoporosis Study. Median age of fracture was lower in males than females for proximal humerus (33.0 vs 71.2 years), but not for humeral shaft (8.9 vs 8.5 years). For females, proximal humerus fractures occurred mainly in the 70-79 and 80+ years age groups, whereas humeral shaft fractures followed a U-shaped pattern. Males showed a U-shaped pattern for both proximal humerus and humeral shaft fractures. Overall age-standardised incidence rates for proximal humerus fractures in males and females were 40.6 (95% CI 32.7, 48.5) and 73.2 (95% CI 62.2, 84.1) per 100,000 person years, respectively. For humeral shaft fractures, the age-standardised rate was 69.3 (95% CI 59.0, 79.6) for males and 61.5 (95% CI 51.9, 71.0) for females. There was an increase in risk of proximal humerus fractures in men with a lower femoral neck BMD, younger age, prior fracture and higher milk consumption. In pre-menopausal women, increased height and falls were both risk factors for proximal humerus fractures. For post-menopausal women, risk factors associated with proximal humerus fractures included a lower non-milk dairy consumption and sustaining a prior fracture. Humeral shaft fractures in both sexes were sustained mainly in childhood, while proximal humerus fractures were sustained in older adulthood. The overall age-standardised rates of proximal humerus fractures were nearly twice as high in females compared to males, whereas the incidence rates of humeral shaft fractures were similar.
Location: Australia
Start Date: 2010
End Date: 2012
Funder: National Health and Medical Research Council
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