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Fiber Bragg grating (FBG)-based shape sensing is an emerging technology used for the navigation of flexible medical instruments, such as needles, catheters, and endoscopes. FBG-based sensors operate by measuring strain-induced wavelength shifts in the reflected light, which are used to determine the curvature along a fiber’s length. While an increased number of gratings enhances shape-sensing accuracy, incorporating many within a fixed spectrum can induce interference in wavelength shifts, specifically during high curvature bending, limiting the detectable bending range. Such interference severely compromises shape estimation, posing challenges for instruments requiring high curvature bends. In this article, we study this tradeoff between resolution and bending curvature. Next, we introduce an algorithm that leverages the reflectivity and full-width half maximum (FWHM) of FBG nodes for improved bend estimation, even in high-curvature scenarios. To this end, first, we provide a model of reflectivity of uniform gratings using coupled-mode theory. The model is used to match spectrum measurements with FBG nodes. Second, we develop an algorithm using the proposed model and random walk model to estimate the relative probability of a given reflected wavelength corresponding to each FBG node. This algorithm then uses variants of the Hungarian algorithm to solve an assignment problem and classify FBG nodes. We then collected three datasets with FBGs experiencing varying curvature. One of the datasets validates the proposed model and the latter two demonstrate that relative to a commercially available interrogator, our approach classifies FBG nodes with 14% higher accuracy, 13% higher precision, 35% higher recall, and 4% higher specificity.

Background: A set of nomograms based on the Dubbo Osteoporosis Epidemiology Study predicts the five- and ten-year absolute risk of fracture using age, bone mineral density and history of falls and low-trauma fracture. We assessed the discrimination and calibration of these nomograms among participants in the Canadian Multicentre Osteoporosis Study. Methods: We included participants aged 5595 years for whom bone mineral density measurement data and at least one year of follow-up data were available. Self-reported incident fractures were identified by yearly postal questionnaire or interview (years 3, 5 and 10). We included low-trauma fractures before year 10, except those of the skull, face, hands, ankles and feet. We used a Cox proportional hazards model. Results: Among 4152 women, there were 583 fractures, with a mean follow-up time of 8.6 years. Among 1606 men, there were 116 fractures, with a mean follow-up time of 8.3 years. Increasing age, lower bone mineral density, prior fracture and prior falls were associated with increased risk of fracture. For low-trauma fractures, the concordance between predicted risk and fracture events (Harrell C) was 0.69 among women and 0.70 among men. For hip fractures, the concordance was 0.80 among women and 0.85 among men. The observed fracture risk was similar to the predicted risk in all quintiles of risk except the highest quintile of women, where it was lower. The net reclassification index (19.2%, 95% confidence interval [CI] 6.3% to 32.2%), favours the Dubbo nomogram over the current Canadian guidelines for men. Interpretation: The published nomograms provide good fracture-risk discrimination in a representative sample of the Canadian population., Current recommendations for the treatment of osteoporosis are in transition. The T-score-based definition of osteoporosis and osteopenia by the expert committee of the World Health Organization on bone mineral density [...]

Since the publication of the Osteoporosis Canada guidelines in 2002, there has been a paradigm shift in the prevention and treatment of osteoporosis and fractures. (1,2) The focus now is [...]

See also the summary article by Hanley and colleagues The 2002 guidelines for the management of osteoporosis published by Osteoporosis Canada (1) identified adequate vitamin D status, in addition to [...]

Background: Fractures have largely been assessed by their impact on quality of life or health care costs. We conducted this study to evaluate the relation between fractures and mortality. Methods: A total of 7753 randomly selected people (2187 men and 5566 women) aged 50 years and older from across Canada participated in a 5-year observational cohort study. Incident fractures were identified on the basis of validated self-report and were classified by type (vertebral, pelvic, forearm or wrist, rib, hip and "other"). We subdivided fracture groups by the year in which the fracture occurred during follow-up; those occurring in the fourth and fifth years were grouped together. We examined the relation between the time of the incident fracture and death. Results: Compared with participants who had no fracture during follow-up, those who had a vertebral fracture in the second year were at increased risk of death (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.1-6.6); also at risk were those who had a hip fracture during the first year (adjusted HR 3.2, 95% CI 1.4-7.4). Among women, the risk of death was increased for those with a vertebral fracture during the first year (adjusted HR 3.7, 95% CI 1.1-12.8) or the second year of follow-up (adjusted HR 3.2, 95% CI 1.2-8.1). The risk of death was also increased among women with hip fracture during the first year of follow-up (adjust ed HR 3.0, 95% CI 1.0-8.7). Interpretation: Vertebral and hip fractures are associated with an increased risk of death. Interventions that reduce the incidence of these fractures need to be implemented to improve survival. Une version francaise de ce resume est disponible a l'adresse www.cmaj.ca/cgi/content/full/cmaj.081720/DC1, Osteoporosis-related fractures are a major health concern, affecting a growing number of individuals worldwide. The burden of fracture has largely been assessed by the impact on health-related quality of life [...]

ABSTRACTReducing fracture risk is the objective of osteoporosis treatment. Bone-forming osteoporosis drugs increase bone mass, restore bone microarchitecture, and reduce fracture risk more effectively than oral bisphosphonates, providing strong justification for the use of these agents as the initial therapy or after anti-remodeling agents in patients at very high risk of fracture. At the end of a 12-to-24-month course of osteoanabolic therapy, transitioning to a potent anti-remodeling agent maintains and enhances the treatment benefit. This review describes the clinical applications of osteoanabolic therapy for osteoporosis.

Background: Many residents of the United States and Canada depend on dietary sources of vitamin D to help maintain vitamin D status. Because few natural food sources contain vitamin D, fortified foods may be required. Objective: We aimed to determine the effects of vitamin D-fortified foods on serum 25-hydroxyvitamin D [25(OH)D] concentrations. Design: We searched MEDLINE (1966 to June Week 3 2006), Embase, CINAHL, AMED, Biological Abstracts, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) comparing vitamin D-fortified foods with a control and reporting serum 25(OH)D concentrations. Two reviewers independently determined study eligibility, assessed trial quality, and extracted relevant data. Disagreements were resolved by consensus. Meta-analyses of absolute mean change in 25(OH)D were conducted by using a random-effects model, with evaluation of heterogeneity. Results: Nine RCTs (n = 889 subjects) were included, of which 8 consistently showed a significant beneficial effect of food fortification on 25(OH)D concentrations. Although 7 RCTs (n = 585 subjects) potentially were meta-analyzable, we were unable to combine the overall results because of significant heterogeneity. The individual treatment effects ranged from 14.5 (95% CIs: 10.6, 18.4) nmol/L to 34.5 (17.64, 51.36) nmol/L (3.4-25 [micro]g vitamin D/d). Subgroup analyses showed a reduction in heterogeneity and significant treatment effect when 4 trials that used milk as the fortified food source were combined. Conclusion: Most trials were small in size and inadequately reported allocation concealment, but results showed that vitamin D-fortified foods improved vitamin D status in adults.

Background: The acid-ash diet hypothesis of osteoporosis suggests that acid from the modern diet causes a demineralization of the skeleton, and mobilized bone calcium is excreted. A systematic approach has not been used to summarize the findings of the numerous studies about the hypothesis. Objectives: The purpose of this meta-analysis was to estimate the quantity of net acid excretion and calciuria associated with the modern diet, to assess the association between acid excretion and calcium excretion, and to assess the influence of urine preservatives on calcium measurement. Design: We systematically searched for trials of the acid-ash hypothesis and conducted a meta-analysis. Results: Twenty-five of 105 studies met the inclusion criteria. The estimated quantity of net acid excretion from the weighted average of the control diets from 11 studies was 47 mEq/d. The increase in urinary calcium with a change in renal net acid excretion depended on whether the urine was acidic or alkaline (P < 0.001). A significant linear relation was observed between net acid excretion and calcium excretion for both acidic and alkaline urine (P < 0.001). The estimated change in urine calcium associated with a change of 47 mEq of net acid excretion in acidic urine was 1.6 mmol/d (66 mg/d) of calcium. Conclusion: Evidence suggests a linear association between changes in calcium excretion in response to experimental changes in net acid excretion. However, this finding is not evidence that the source of the excreted calcium is bone or that this calciuria contributes to the development of osteoporosis.

ABSTRACT Background: Measurement of bone mineral density is the most common method of diagnosing and assessing osteoporosis. We sought to estimate the average rate of change in bone mineral density [...]

Abstract Background: Older patients who experience a fragility fracture are at high risk of future fractures but are rarely tested or treated for osteoporosis. We developed a multifaceted intervention directed [...]

Background: Recombinant human parathyroid hormone (1-84) (PTH) increases bone mass and strength and improves bone quality by stimulating new bone formation. Objective: To determine the safety of PTH and its effect on the incidence of vertebral fractures in postmenopausal women with osteoporosis. Design: 18-month, randomized, double-blind, placebo-controlled, parallel-group study. Setting: 168 centers in 9 countries. Patients: 2532 postmenopausal women with low bone mineral density at the hip or lumbar spine. Interventions: Women received 100 [micro]g of recombinant human PTH or placebo daily by subcutaneous injection. All received calcium, 700 rag/d, and vitamin D[sup.3], 400 U/d. Measurements: New or worsened vertebral fractures (primary outcome) and changes in bone mineral density and safety (secondary outcomes). Results: 67.2% of patients who received at least 1 dose of the study drug completed the study. Parathyroid hormone reduced the risk for new or worsened vertebral fractures, but in sensitivity analyses, the magnitude of the reduction was changed with assumptions about fracture incidence in patients who did not complete the study (relative risk assuming no fractures, 0.42 [95% CI, 0.24 to 0.72] [P = 0.001]; relative risk assuming fracture incidence observed in all patients who completed the trial, 0.60 [CI, 0.36 to 1.00] [P = 0.05]; relative risk assuming fracture incidence observed in the placebo group, 0.62 [CI, 0.37 to 1.04] [P = 0.07]). Compared with placebo, mean bone mineral density increased at the spine by 6.9% (CI, 6.4% to 7.4%) and at the hip by 2.1% (CI, 1.7% to 2.5%) but decreased at the forearm in the PTH-treated group. Parathyroid hormone treatment increased the percentage of participants with hypercalciuria, hypercalcemia, and nausea by 24% (CI, 20% to 27%), 23% (CI, 21% to 26%), and 14% (CI, 11% to 16%), respectively, compared with placebo. Limitations: Baseline serum PTH and vitamin D levels were not measured. Many patients discontinued the trial prematurely. Conclusions: Parathyroid hormone (1-84) reduced the overall risk for new or worsened vertebral fracture in postmenopausal women with osteoporosis. Hypercalciuria, hypercalcemia, and nausea were more common in women who took the drug. Although the magnitude of the reduction was sensitive to assumptions about fracture incidence in patients who did not complete the study, the findings suggest that PTH provides an alternative therapeutic option for fracture prevention.

Abstract Background: Human parathyroid hormone (hPTH)(1-34) was approved in 2004 for the treatment of severe osteoporosis. Members of the Osteoporosis Canada clinical guidelines committee conducted a systematic review of randomized [...]

Background: Despite the high risk for future fractures and the availability of effective treatments, fewer than 10% to 20% of patients who sustain a fragility fracture are tested or treated for osteoporosis. Objectives: To improve rates of testing and treatment for osteoporosis in patients with wrist fractures who are seen in the emergency department. Design: Nonrandomized, controlled trial with blinded ascertainment of outcomes. Setting: Emergency departments in Edmonton, Alberta, Canada. Patients: Persons 50 years of age or older who were treated for a wrist fracture and their physicians. Patients admitted to the hospital or treated for osteoporosis were excluded. Overall, 572 consecutive patients with fractures were screened, and 102 patients (55 intervention, 47 control) and 101 physicians were studied. Measurements: The primary end point was the prescription of osteoporosis treatment 6 months after fracture. Secondary end points included rates of testing for bone mineral density and patients' knowledge, satisfaction, and quality of life. Intervention: Faxed physician reminders that contained osteoporosis treatment guidelines endorsed by local opinion leaders and patient education. Control patients received usual care and information about falls and home safety. Results: The median patient age was 66 years. Most patients were female (78%) and white (79%); 70% of patients reported a previous fracture, and 22% had a fall with injury in the previous year. The intervention increased the rates of testing for bone mineral density to 62% (vs. 17% for controls; adjusted relative increase, 3.6 [P < 0.001]) and the rates of osteoporosis treatment to 40% (vs. 10% for controls; adjusted relative increase, 3.8 [P = 0.002]) within 6 months of fracture. Intervention patients were more likely to report a diagnosis of osteoporosis, but other patient-reported outcomes did not differ significantly between groups. Limitations: This was a small, nonrandomized, controlled study with process-based outcomes. Conclusions: In a multifaceted intervention directed at patients and their physicians, the rates of testing and treatment for osteoporosis after emergency department care for a fragility fracture were more than 3 times those of controls.

In the case reported by Auguste and colleagues, (1) we believe that the patient experienced vitamin D intoxication because of an underlying pathologic condition that the authors failed to recognize. [...]

The price of influence is that we do not leave the U.S. to face the tricky issues alone. I mean the ones which people wish weren't there, don't want to […]

Although areal bone mineral density (aBMD) assessed by dual-energy x-ray absorptiometry (DXA) is the clinical standard for determining fracture risk, most older adults who sustain a fracture have T scores greater than −2·5 and thus do not meet the clinical criteria for osteoporosis. Importantly, bone fragility is due to low BMD and deterioration in bone structure. We assessed whether indices of high-resolution peripheral quantitative CT (HR-pQCT) were associated with fracture risk independently of femoral neck aBMD and the Fracture Risk Assessment Tool (FRAX) score.

EVERYONE KNOWS that aside from the underwriting department, information technology is one of the last places an insurance company should take unnecessary risk, and right now, open source technologies are [...]

Normative data for the SF-36 measure of health-related quality of life (HRQOL) exist for those over 25 years of age, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos). CaMos recently recruited a sample of young Canadians aged between 16 and 24 years. The purpose of this study was to develop normative SF-36 data for this age group. After direct standardization to the Canadian population, means, standard deviations (SD), 95% confidence intervals and percentage at floor and ceiling were produced for the eight domain and two summary scores of the SF-36. Domains are scored from 0 (poor) to 100 (excellent). Summary scores are standardized to a mean of 50, with scores over 50 representing better than average and below 50 poorer than average function. Separate analyses were completed for men and women, and for those 16–19 years and 20–24 years. The 1,001 community-based participants consisted of 474 men and 527 women from nine CaMos centres across Canada. Mean Physical Component Summary scores were 53.9 (SD=6.9) and 53.3 (SD=5.7) for young men and women, respectively. The equivalent Mental Component Summary scores were 49.3 (SD=9.7) and 48.8 (SD=8.9). In general, men scored somewhat higher than women, and younger (16–19 years) women scored higher than older (20–24 years) women, although the differences were small. HRQOL is good in this cohort of young Canadians. Both men and women scored somewhat better on physically than mentally oriented domains. In general, Canadian scores were similar to those of the US, while a comparable Swedish sample scored higher than both countries on most domains. Results underscore the importance of taking country, age and gender into consideration when using normative data. Des données normatives sur la qualité de vie liée à la santé (QVLS) dans le questionnaire sur l’état de santé SF-36 existent déjà pour les personnes de plus de 25 ans grâce aux données représentatives de l’Étude canadienne multicentrique sur l’ostéoporose (CaMos). La CaMos a recruté récemment un échantillon de jeunes Canadiens âgés de 16 à 24 ans. Le but de notre étude était d’élaborer des données normatives SF-36 pour ce groupe d’âge. Après avoir effectué une standardisation directe à partir de la population canadienne, nous avons calculé les moyennes, les écarts-types (ET), les intervalles de confiance de 95% et le pourcentage minimum et maximum pour les huit domaines et les deux notes globales du SF-36. Les domaines sont notés de 0 (mauvais) à 100 (excellent). Les notes globales sont standardisées selon une moyenne de 50, les notes de plus de 50 indiquant des fonctions supérieures à la moyenne, et les notes de moins de 50, des fonctions inférieures à la moyenne. Nous avons analysé séparément les hommes des femmes, et le groupe des 16 à 19 ans de celui des 20 à 24 ans. Les 1 001 participants sélectionnés dans la communauté comprenaient 474 hommes et 527 femmes des neuf centres CaMos du Canada. Les notes globales moyennes pour la composante santé physique étaient de 53,9 (ET=6,9) et de 53,3 (ET=5,7) pour les jeunes hommes et les jeunes femmes, respectivement. Les notes équivalentes pour la composante santé mentale étaient de 49,3 (ET=9,7) et de 48,8 (ET=8,9). En général, les hommes ont obtenu des notes un peu meilleures que celles des femmes, et les femmes plus jeunes (16 à 19 ans), de meilleures notes que leurs aînées (20 à 24 ans), mais ces différences étaient faibles. La QVLS est bonne dans cette cohorte de jeunes Canadiens. Tant les hommes que les femmes ont obtenu des notes un peu meilleures pour la santé physique que pour la santé mentale. En général, les notes canadiennes étaient semblables à celles des États-Unis, mais un échantillon suédois comparable a obtenu des notes plus élevées que ces deux pays dans la plupart des domaines. Ces résultats soulignent l’importance de tenir compte du pays, de l’âge et du sexe lorsqu’on utilise des données normatives.

Protection from overcurrent conditions is a common requirement for all portable electronic products. Overcurrent conditions can damage expensive electronic circuits and can even cause a fire. For these reasons, overcurrent […]

Background:The SF-36 is widely used to assess health-related quality of life (HRQOL), but with few longitudinal studies in healthy populations, it is difficult to quantify its natural history. This is important because any measure of change following an intervention may be confounded by natural changes in HRQOL. This paper assesses mean changes in SF-36 scores over a 3-year period in men and women between the ages of 40 and 59 years at baseline. Methods:Subjects were randomly selected from nine Canadian cities. Mean SF-36 changes over a 3-year period (1996/1997-1999/2000) were calculated for each gender within 5-year age categories. Multiple imputation was used to correct for potential bias due to missing data. Results:The baseline cohort included 1,974 women and 975 men between 40 and 59 years. Mean changes in HRQOL tended to be small. Women demonstrated small average declines in 22 of the 32 age and domain groupings (4 age groups, 8 SF-36 domains) while men showed declines in 14/32. Most participants stayed within 10 points of their original baseline score. Interpretation:Mean SF-36 scores change only slightly over three years in middle-aged Canadians, although there is much individual variation. It may be necessary to adjust for the natural evolution of SF-36 scores when interpreting results from longitudinal studies. Contexte:Le SF-36 est un court questionnaire très utilisé pour évaluer la qualité de vie liée à la santé (HRQOL). Toutefois, vu le petit nombre d’études longitudinales menées auprès de populations en bonne santé, il est difficile d’évaluer l’histoire naturelle du SF-36, ce qui est important parce que tout changement noté résultant d’une intervention peut être confondu avec des changements normaux de la qualité de vie liée à la santé. Cet article évalue les changements moyens dans les scores des SF-36 sur une période de trois ans chez les hommes et les femmes qui étaient âgés de 40 à 59 ans lors de leur visite initiale. Méthode:Les sujets ont été choisis au hasard dans neuf villes canadiennes. Les changements moyens dans les résultats du SF-36 sur une période de trois ans (1996–1997 à 1999–2000) ont été calculés par sexe et par groupe d’âge de cinq ans. L’imputation multiple a été utilisée pour corriger tout biais résultant d’informations manquantes. Résultats:La cohorte initiale comportait 1 974 femmes et 975 hommes âgés de 40 à 59 ans. Les changements moyens étaient plutôt légers. Chez les femmes, 22 des 32 groupes d’âge et sous-échelles (quatre groupes d’âge, huit sous-échelles SF-36) présentaient de légères diminutions moyennes, alors que chez les hommes, ce nombre était de 14 groupes sur 32. Le score de la plupart des participants est demeuré en deçà de 10 points du score initial lors de l’entrée dans l’étude. Interprétation:Les scores moyens du SF-36 ne changent que légèrement sur une période de trois ans dans la population canadienne d’âge moyen. Toutefois, il pourrait s’avérer nécessaire de tenir compte de l’évolution naturelle des scores du SF-36 lors de l’interprétation des résultats d’études longitudinales.

Background: Canadian normative data for the Medical Outcomes Study 36-item short form (SF-36) have recently been published. However, there is evidence from other countries to suggest that regional variation in health-related quality of life (HRQOL) may exist. We therefore examined the SF-36 data from nine Canadian centres for evidence of systematic differences. Methods: Bayesian hierarchical modelling was used to compare the differences in the eight SF-36 domains and the two summary component scores within each of the age and gender strata across the nine sites. Results: Five domains and the two summary component scores showed little clinically important variation. Other than a small number of exceptions, there was little overall evidence of HRQOL differences across most domains and across most sites. Interpretation: Our finding of only a few small differences suggests that there is no need to develop region-specific Canadian normative data for the SF-36 health survey. Contexte: Les données normatives canadiennes s’appliquant à la version abrégée du questionnaire sur l’évolution médicale comportant 36 questions (SF-36) ont été publiées récemment. Toutefois, les données recueillies dans d’autres pays suggèrent qu’il peut exister des variations régionales au niveau de la qualité de vie reliée à l’état de santé (HRQOL). Nous avons donc étudié les données du SF-36 provenant de neuf centres canadiens pour démontrer les différences systématiques. Méthodes: Un modèle hiérarchique bayésien a été utilisé pour comparer les différences entre les résultats des huit domaines du SF-36 et des deux composantes sommaires pour chaque strate d’âge et de sexe, et ce, pour les neuf centres. Résultats: Les résultats de cinq domaines et des deux composantes sommaires démontraient des différences peu significatives cliniquement. Outre de rares exceptions, il y avait peu d’évidence de variations du HRQOL entre la plupart des domaines et des centres. Interprétation: Les résultats obtenus, ne démontrant que de légères différences, suggèrent qu’il n’est pas nécessaire d’établir des données normatives spécifiques aux régions du Canada pour le questionnaire de santé SF-36.

Introduction:Daily subcutaneous injections of parathyroid hormone (PTH), and its synthetic peptide fragment, teriparatide(PTH 1-34, TPTD), have a net anabolic effect on bone and prevent osteoporotic fractures. TPTD is currently approved for this indication worldwide. Because of the anabolic effect, there is an interest in a role for TPTD (and, where available, human PTH 1-84) in improving bone healing after a fracture. PTH has been studied in animal fracture healing models and in a limited number of human trials. We have reviewed current literature regarding possible mechanisms and efficacy for PTH and TPTD to improve the healing process in the setting of various types of fractures.Areas covered:Our review focuses first on the role of PTH in normal bone. We then discuss mechanisms of normal bone healing as well as delayed and impaired fracture healing. We summarize pertinent animal data and then review human studies utilizing PTH or TPTD for fracture healing. In particular, we examine unique situations including osteoporotic fractures, diabetes, stress fractures, delayed or poor healing and combination with bisphosphonate therapy.Expert opinion:Available data indicate there is likely an important role for TPTD and PTH in promoting fracture healing in selected patients, but more clinical trial data are needed.

Background:Many medications used in older adults have strong anticholinergic (ACH) properties, which may increase the risk of falls and fractures. Use of these medications was identified in a population-based Canadian cohort. Objective:To identify the fall and fracture risk associated with ACH medication use. Methods:Data collection and analysis were conducted at baseline, year 5, and year 10. Cross-sectional analyses were performed to examine associations between ACH medication use and falls. Time-dependent Cox regression was used to examine time to first nontraumatic fracture. Finally, change in bone mineral density (BMD) over 10 years was compared in ACH medication users versus nonusers. Results:Strongly ACH medications were used by 618 of 7753 participants (8.0%) at study baseline, 592 (9.5%) at year 5, and 334 (7.7%) at year 10. Unadjusted ACH medication use was associated with falls at baseline (odds ratio = 1.50; 95% CI = 1.14-1.98; P= 0.004), but the association was no longer significant after covariate adjustment. Similar results occurred at years 5 and 10. ACH medication use was associated with increased incident fracture risk before (hazard ratio = 1.22; CI = 1.13-1.32; P< 0.001) but not after covariate adjustment. Mean (SD) change in femoral neck BMD T-score over 10 years, in those using ACH medications at both years 0 and 5, was −0.60 (0.63) in ACH users versus −0.49 (0.45) in nonusers (P= 0.041), but this was not significant after covariate adjustment. Conclusions:ACH medications were not found to be independently associated with an increased risk of falling, fractures, or BMD loss. Rather, factors associated with ACH medication use explained the apparent associations.

While clearly an élection de confirmation, the legislative contest of 2012 was also essentially about party strengths and prospects. A low-key campaign by the left and some increasingly desperate barrel-scraping by the right led to the expected result: a working majority for Hollande, independent of Greens or Front de Gauche. Individual party trajectories can be analysed under the three headings of the title. The PS completed its long march through the conquest of sub-national levels of power to take the ultimate prize, while the FN did enough to suggest that its own journey can be extended profitably. The Greens have now advanced to the status of an established parliamentary party. Terminal decline seems inevitable for the PCF and FG, despite Mélenchon's presidential flicker, and sadly also for the remains of the Christian democrat tradition hiding under the Modem label. Smaller parties of left and right have learned to bargain for a vassal's place and be grateful for the niche which the bipolar system allows them, for the time being at least.

Thoracic kyphosis is one of the manifestations of spinal osteoporosis. Since kyphosis is associated with patient symptoms and is a risk factor for loss of function, it would be beneficial to have simple, noninvasive measurement techniques that can be applied in clinical practice. The purpose of this study was to assess the test–retest reliability of the measurement of thoracic kyphosis using the flexicurve ruler in individuals with osteoporosis. Twenty-six females (mean age, 67 yr) diagnosed with osteoporosis had measurements of kyphosis taken in standing by aligning a flexible drafting ruler before and after a 12-week exercise program. The time period was chosen to be consistent with the duration of a physiotherapy intervention. Measures of kyphosis height (cm), length (cm), and an index of kyphosis (height/length) were recorded. Data analysis (intraclass correlation coefficients [ICC]) indicated that the reliability between the trials of the measurement of kyphosis height (0.89) and index of kyphosis (0.93) were high; however, the reliability estimate of kyphosis length was less with an ICC value of (0.54). This study supports the use of the flexicurve ruler for the measurement of kyphosis in elderly women with osteoporosis based on reliability outcomes and the fact that it is noninvasive, inexpensive, and easy to use in a clinical setting. The measurement of kyphosis may be used to determine the response to a therapeutic intervention and in monitoring kyphotic progression.

Background Suboptimal vitamin D status is common in elderly individuals. However, the extent of vitamin D inadequacy in men and women being treated for osteoporosis in a family practice setting has not been well characterized.Objective: To describe the distribution of serum 25-hydroxyvitamin D (25-[OH] D) in Canadian men and postmenopausal women with osteoporosis taking 400 IU or less of vitamin D daily and to evaluate the safety, tolerability, and impact of vitamin D3supplementation 400 IU daily taken concurrently with alendronate sodium 70 mg weekly.Methods: This was a prospective, single-cohort, open-label, multicenter study. Community-dwelling men and postmenopausal women with osteoporosis were recruited at 197 sites across Canada. Patients received vitamin D3400 IU/day supplementation coadministered with alendronate 70 mg/wk for 16 weeks. The primary outcome was the distribution of serum 25-(OH) D at baseline. Secondary outcome measures included changes from baseline in serum 25-(OH) D levels, adherence to study treatments, and incidence of treatment-related adverse events (AEs).Results: Of the 681 patients included in the analysis, 485 (71.2%) completed the study. Patients were predominantly female (83.1%) with a mean (SD) age of 67.6 (10.7) years. At baseline, mean (SD) serum 25-(OH) D concentration was 25.4 (9.9) ng/mL and 68.0% of the patients had inadequate (less than 30 ng/mL) vitamin D status. At week 16, concentrations increased by 35.1% to 31.2 (9.2) ng/mL (p < 0.001) and the proportion of patients with inadequate 25-(OH) D levels was reduced to 47.0%. Adherence to the treatment regimen was high (greater than 95%). Gastrointestinal disorders were the most frequently reported (6.9%) treatment-related AEs.Conclusions: About two thirds of patients previously diagnosed with osteoporosis have inadequate vitamin D status. A treatment regimen consisting of alendronate 70 mg/wk administered with daily vitamin D3400 IU supplementation significantly increased patients' serum 25-(OH) D levels, but 47% did not achieve optimal levels. These results support both the National Osteoporosis Foundation and Osteoporosis Canada recommendations for higher vitamin D supplement doses (at least 800 IU daily) in osteoporotic patients receiving pharmacologic therapy for osteoporosis and for monitoring their serum 25-(OH) D response.

Most low-trauma fractures occur among women with osteopenic bone mineral density (BMD), a population considered to have moderate absolute fracture risk. Our purpose was to refine the fracture risk prediction in women with osteopenic BMD to determine the subgroups at lowest and highest risk.

In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%–12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention.

ObjectiveWe previously demonstrated that a case manager intervention improved osteoporosis OP treatment within 6 months of hip fracture compared with usual care. The second phase of the randomized trial compared a less intensive intervention, facilitated bone mineral density BMD testing, with usual care and the case manager intervention.MethodsWe initially randomized 220 hip fracture patients to either an OP case manager intervention or usual care. After completing the original trial at 6 months postfracture, usual care patients were reallocated to facilitated BMD testing; BMD tests were arranged and results sent to primary care physicians. Main outcomes bisphosphonate treatment, BMD tests, receipt of appropriate care were reascertained 1 year following hip fracture and compared with outcomes achieved by the OP case manager intervention and usual care.ResultsCompared with usual care, facilitated BMD testing increased testing from 29 to 68 P< 0.001, bisphosphonate use from 22 to 38 P< 0.001, and receipt of appropriate care from 26 to 45 P< 0.001. The more intensive 70 versus 30 minutes and expensive 56 versus 24 Canadian per patient OP case manager intervention led to significantly higher bisphosphonate use 54 versus 38; P 0.03, receipt of appropriate care 71 versus 45; P< 0.001, and more BMD testing 80 versus 68; P 0.06 than usual care followed by facilitated BMD testing.ConclusionCompared with usual care, 2 different inexpensive interventions resulted in significant increases in appropriate management of OP after hip fracture. The magnitude of improvements achieved was directly related to the intensity of the interventions.

The article presents the special precautions used in the interpretation of bone mineral density (BMD) measurement which can be both central dual energy X-ray absorptiometry (DXA) or peripherally with calcaneal ultrasonography. It is also discussed that one of the risk factors for fracture is inadequate bone mineral density in older adults. Different tables related to BMD measurement are also presented.

OBJECTIVE: Following publication of the first reports of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates in 2003, a call for national multidisciplinary guidelines based upon a systematic review of the current evidence was made by the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS) in association with national and international societies concerned with ONJ. The purpose of the guidelines is to provide recommendations regarding diagnosis, identification of at-risk patients, and prevention and management strategies, based on current evidence and consensus. These guidelines were developed for medical and dental practitioners as well as for oral pathologists and related specialists. METHODS: The multidisciplinary task force established by the CAOMS reviewed all relevant areas of research relating to ONJ associated with bisphosphonate use and completed a systematic review of current literature. These evidence-based guidelines were developed utilizing a structured development methodology. A modified Delphi consensus process enabled consensus among the multidisciplinary task force members. These guidelines have since been reviewed by external experts and endorsed by national and international medical, dental, oral surgery, and oral pathology societies. RESULTS: Recommendations regarding diagnosis, prevention, and management of ONJ were made following analysis of all current data pertaining to this condition. ONJ has many etiologic factors including head and neck irradiation, trauma, periodontal disease, local malignancy, chemotherapy, and glucocorticoid therapy. High-dose intravenous bisphosphonates have been identified as a risk factor for ONJ in the oncology patient population. Low-dose bisphosphonate use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of ONJ. Prevention, staging, and treatment recommendations are based upon collective expert opinion and current data, which has been limited to case reports, case series, surveys, retrospective studies, and 2 prospective observational studies. Recommendations: In all oncology patients, a thorough dental examination including radiographs should be completed prior to the initiation of intravenous bisphosphonate therapy. In this population, any invasive dental procedure is ideally completed prior to the initiation of high-dose bisphosphonate therapy. Non-urgent procedures are preferably delayed for 3 to 6 months following interruption of bisphosphonate therapy. Osteoporosis patients receiving oral or intravenous bisphosphonates do not require a dental examination prior to initiating therapy in the presence of appropriate dental care and good oral hygiene. Stopping smoking, limiting alcohol intake, and maintaining good oral hygiene should be emphasized for all patients receiving bisphosphonate therapy. Individuals with established ONJ are most appropriately managed with supportive care including pain control, treatment of secondary infection, removal of necrotic debris, and mobile sequestrate. Aggressive debridement is contraindicated. CONCLUSION: Our multidisciplinary guidelines, which provide a rational evidence-based approach to the diagnosis, prevention, and management of bisphosphonate-associated ONJ in Canada, are based on the best available published data and the opinion of national and international experts involved in the prevention and management of ONJ.

Objective:Breast cancer survivors with osteoporosis or osteopenia are commonly encountered in primary care and gynaecology Practices. Our objective was to determine whether treatment with oral bisphosphonates (alendronate or cyclic etidronate) was more effective than calcium with vitamin D in improving lumbar spine bone mineral density BMD within one year in breast cancer survivors.

OBJECTIVE: To determine if there are differences between men and women referred for treatment of osteoporosis in Canada. METHODS: We performed an observational study of 1588 patients (163 men, 1425 women), 50 years of age and older, who were prescribed cyclic etidronate or alendronate for treatment of osteoporosis or osteopenia and had at least 2 years of followup registered in the Canadian Database for Osteoporosis and Osteopenia Patients (CANDOO). Comparisons of characteristics between men and women were performed using Pearson chi-square test, Student's t test, or a Kruskal-Wallis test, whichever was most appropriate. RESULTS: Mean baseline femoral neck and lumbar spine bone mineral densities were significantly higher in men than women at both the femoral neck and lumbar spine (p < 0.05, respectively). Men had double the rate of prevalent vertebral fractures (44%, 72/163) compared to women (22%, 315/1425; p < 0.001) and triple the rate of multiple prevalent vertebral fractures (10%, 17/163) compared to women (3%, 37/1425, p < 0.001). Furthermore, men were twice as likely as women to sustain a fracture within 2 years of starting treatment during observation in the CANDOO study (men: 4%, 7/163, women: 2%, 24/1425, p = 0.033). CONCLUSION: Osteoporosis may be under-recognized in men until the condition is at an advanced stage. A form of gender bias may exist in recognition and treatment (or referral for treatment) of osteoporosis in men.

To provide evidence for or against allowing a health claim for calcium in Canada, we undertook a review of the current U.S. health claim for calcium and osteoporosis, and also reviewed the scientific literature published since that health claim was first proposed and reviewed by the U.S. Food and Drug Administration in 1991 and adopted in 1993. Our objectives were 1) to determine if the science behind the claim was still valid, and if so, 2) to recommend any new wording to the claim, if warranted, prior to implementation in Canada. Based on a review of the evidence (to May 2000) related to the various claim elements, the following health claim for calcium has been established in Canada: A healthy diet with adequate calcium and vitamin D, and regular physical activity, help to achieve strong bones and may reduce the risk of osteoporosis. The compositional criteria for foods bearing this claim are that the food must provide at least 200 mg calcium per serving and that the phosphorus content (excluding that provided by phytate) must be less than the calcium content.

Investigates Canada's decline as a world contributor to peace and security as of 2003. Reduction in the defense budget; Position on the U.S. war with Iraq; Relationship with the United Nations; Criticisms on the political leadership of Prime Minister Jean Chrétien.

The Canadian Multicentre Osteoporosis Study (CaMos) is a five‐year prospective study of the skeletal health of a randomly selected population of women and men ≥ 25 years from nine centres across Canada. It will assess the relationship between low‐trauma fractures and various characteristics of bone including Dual Energy X‐ray Absorptiometry (DEXA) and risk factors. The immediate objectives are to determine the dimensions of osteoporosis and fracture in Canada and to determine the environmental risk factors for these diseases. The long‐term objectives are to develop methods for the accurate detection of those at increased risk to fracture and to develop strategies for fracture prevention.