Search

• Up until now, real-world evidence on treatment adherence for JAK inhibitors is primarily available for tofacitinib, scarce for baricitinib, and non-existent for upadacitinib. • This large observational, population-based analysis, involving 4,500 rheumatoid arthritis patients from a random Australia wide sample, is the first to conduct a head-to-head comparison between the different JAK inhibitors baricitinib, tofacitinib, and upadacitinib, and other biologic DMARDs. • We showed superior persistence rates for upadacitinib, followed by baricitinib and then tofacitinib and TNFi therapy. The superior persistence rate for upadacitinib remained consistent regardless of line of treatment and use of comedication. • This study calls for head-to-head comparison between the different JAK inhibitors to better understand treatment effectiveness, safety, and tolerability in 'real-world practice'. To compare persistence of disease-modifying antirheumatic (DMARDs), with a focus on Janus kinase (JAK) inhibitors in Australian rheumatoid arthritis (RA) patients. A retrospective observational study was conducted among 4,521 RA patients (females n =3,181 [70.4%]), using data from the Services Australia 10% Pharmaceuticals Benefits Scheme (PBS) dataset, aged ≥18 years and initiating a DMARD between 2011 to 2021. Kaplan-Meier analysis was used to estimate persistence rates, defined as occurrence of 6 months gap after the end of a drug dispensing. Twelve-month persistence rates were 72% for upadacitinib, 61% for baricitinib, 58% for subcutaneous tumor necrosis factor-alpha inhibitors (TNFi), 55% for tocilizumab, 53% for tofacitinib, and 49% for abatacept. Median treatment persistence was not reached for upadacitinib (n=574) and baricitinib (n=553); and was 15.0 months for tofacitinib (95% CI 13.5–19.5), 20.5 months for TNFi (95% CI 19.0–22.4), 19.1 months for tocilizumab (95% CI 17.9–23.6), and 12.5 months for abatacept (95% CI 10.4–14.9). Persistence rates on first-line JAK inhibitors were 68% for upadacitinib and baricitinib and 55% for tofacitinib, and 49% for TNFi, 55% for abatacept, and 57% for tocilizumab; rates were sustained for upadacitinib, TNFi, and tocilizumab but dropped to 59% for baricitinib and 47% for abatacept in the second-line treatment. For each b/tsDMARD, persistence rates were higher when combined with methotrexate or other conventional synthetic DMARDs. The median oral glucocorticoid dose decreased from 4.3 mg/day (range:0–40) to 2.3 mg/day (range:0–22) over 2 years. Changes were significant for all RA DMARDs, tofacitinib and baricitinib combined (1–2 years post initiation only), TNFi, abatacept, and tocilizumab. In a real-world setting, we showed highest persistence rates on upadacitinib, followed by baricitinib and then TNFi therapy and was improved by co-therapy. All agents appeared to be corticosteroid sparing. [ABSTRACT FROM AUTHOR]

Research describing recognition pheromones in the social wasp, Polistes dominulus, is presented. In particular the behavior of nestmates after the application of different hydrocarbons to a returning wasp is investigated.

Introduction/Background: Both areal bone mineral density (aBMD) and bone microarchitecture have been associated with vertebral deformity (VD), but there are limited data on the utility of bone microarchitecture measures in combination with aBMD in discriminating VD. This study aimed to describe whether radial bone microarchitecture measures alone or in combinations with radial volumetric bone mineral density (vBMD) or spine aBMD can improve discrimination of VD in adults. Methods: Data on 196 subjects (mean age (standard deviation, SD) = 72 (7) years, female 46%) were utilized. VD of T4-L4 and spine aBMD were measured using dual-energy X-ray absorptiometry. VD was defined if anterior to posterior height ratio was more than 3-SD, 4-SD below, or >25% decrease compared with the sex-matched normal means. Bone microarchitecture parameters at distal radius were collected using high-resolution peripheral quantitative computed tomography and analyzed using StrAx. Results: The strongest associations were seen for the cortical thickness (odds ratios (ORs): 2.63/SD decrease for 25% and 2.38/SD decrease for 3-SD criterion) and compact cortical area (OR: 3.33/SD decrease for 4-SD criterion). The area under the receiver operating characteristic curve (AUC) for spine aBMD for VD was 0.594, 0.597, and 0.634 for 25%, 3-SD and 4-SD criteria, respectively (all p < 0.05). Compact cortical area, cortical thickness and compact cortical thickness alone had the largest AUCs for VD (0.680–0.685 for 25% criterion, 0.659–0.674 for 3-SD criterion, and 0.699–0.707 for 4-SD criterion). Adding spine aBMD or radial vBMD to each cortical measure did not improve VD discrimination (∆ AUC 0.8%–2.1%). Conclusions: Cortical measures had the best utility for discriminating VD when used alone. Adding either spine aBMD or radial vBMD did not improve the utility of cortical measures. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) is characterised by the clustering of central obesity with metabolic abnormalities. We aimed to describe the association of MetS and trajectories of MetS over 10–13 years with knee symptoms in general population-based middle-aged adults. Fasting blood biochemistry, waist circumference and blood pressure measures were collected during Childhood Determinants of Adult Health (CDAH)-1 study (year:2004–6; n = 2447; mean age:31.48 ± 2.60) and after 10–13 year at CDAH-3 (year:2014–2019; n = 1549; mean age:44 ± 2.90). Participants were defined as having MetS as per International Diabetes Federation (IDF) definition. Knee symptoms were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale at CDAH-3 (mid-adulthood). The prevalence of MetS increased from 8 % at young adulthood (female:52.06 %) to 13 % in mid-adulthood (female:53.78 %) over 10–13 years. Presence of MetS at mid-adulthood was associated with knee symptoms at mid-adulthood [ratio of means (RoM): 1.33; 95%CI:1.27,1.39]. Four MetS trajectories were identified—'No MetS' (85.01 %); 'Improved MetS' (2.14 %), 'Incident MetS' (8.81 %), and 'Persistent MetS, (4.04 %). Compared to 'No MetS', 'Persistent MetS' [RoM:1.15; 95%CI:1.06,1.25], 'Incident MetS' [RoM:1.56; 95%CI:1.48,1.65], and 'Improved MetS' [RoM:1.22; 95%CI:1.05,1.41] was associated with higher knee symptoms. Notably, 'Incident MetS' was strongly associated with knee symptoms [RoM: 1.56; 95%CI:1.48,1.65] and pain [RoM:1.52; 95%CI:1.37,1.70] at mid-adulthood. In this sample of middle-aged adults, there was a significant positive association between MetS and knee symptoms. Relative to those without MetS at either life stage, the elevation in mean knee pain scores was more pronounced for those who developed MetS after young adulthood than for those who had MetS in young adulthood. [Display omitted] • Emerging evidence links metabolic syndrome (MetS) with the risk of knee osteoarthritis (OA). • The prevalence of MetS increased from 8 % in young adulthood to 13 % in mid-adulthood over 10–13 years. • MetS at mid-adulthood was associated with knee symptoms in mid-adulthood. • Incident MetS was most strongly associated with knee pain in mid-adulthood. [ABSTRACT FROM AUTHOR]

Psoriasis is a skin disorder affecting approximately 2–3% of the global population. While research has revealed a strong genetic component, there are few studies exploring the extent to which lifestyle factors influence psoriasis pathogenesis. The aim of this review was to describe the role of lifestyle factors as both a potential cause and treatment for psoriasis. The review also examines the underlying mechanisms through which these lifestyle factors may operate. This narrative review aims to incorporate current knowledge relating to both lifestyle and pathogenetic factors that contribute to and alleviate psoriasis presentation. Studies reporting the effect of an inflammatory diet and potential dietary benefits are reported, as well as insights into the effects of stress, smoking and alcohol, insulin resistance and exercise. Poor nutrition and low Omega 3 fatty acid intake, likely combined with fat malabsorption caused by gut dysbiosis and systemic inflammation, are associated with psoriasis. The data strongly suggest that improvements to disease severity can be made through dietary and lifestyle interventions and increased physical activity. Less conclusive, although worthy of mention, is the beneficial effect of bile acid supplementation. Lifestyle interventions are a promising treatment for psoriasis and its associated co-morbidities. However, gaps and inadequacies exist within the literature, e.g. methodology, absence of a unified scoring system, lack of controlled clinical data and lack of studies without simultaneous usage of biologics or alternative therapies. Future directions should focus on high quality cohort studies and clinical trials. [ABSTRACT FROM AUTHOR]

To describe the associations of glucose homeostasis and metabolic syndrome (MetS) measures with knee cartilage defects and cartilage volume in young adults. Fasting blood biochemistry, waist circumference and blood pressure measures were collected 4–5 years prior to knee magnetic resonance imaging (MRI) scans. Blood measures included levels of glucose, insulin, triglyceride and high-density lipoprotein cholesterol (HDL-C). Homeostatic model assessment 2-insulin resistance (HOMA2-IR), HOMA2-beta cell function (HOMA2-β), HOMA2-insulin sensitivity (HOMA-S) and MetS were calculated or defined. Knee cartilage defects and cartilage volume were measured from MRI scans. Data were analysed using log binomial or linear regressions. Among 328 participants (47.3% were females, aged 26–36 years at baseline), 40 (12.7%) had hyperglycaemia and 21 (6.7%) had MetS. Glucose homeostasis measures (except fasting glucose) were associated with tibiofemoral cartilage defects (fasting insulin: relative risk (RR) 1.05, 95% confidence interval (CI) 1.01 to 1.08; HOMA2-IR: 1.44, 1.08 to 1.92; HOMA2-β: 2.59, 1.33 to 5.07; HOMA2-S: 0.36, 0.18 to 0.72), but not patellar cartilage defects. There were no associations between glucose homeostasis measures and knee cartilage volume. High waist circumference (RR 2.32, 95% CI 1.18 to 4.54) and low HDL-C (RR 1.99, 95% CI 1.08 to 3.69) were associated with tibiofemoral cartilage defects, but no other associations were observed between MetS or its components and cartilage defects or volume. Insulin resistance, high waist circumference and low HDL-C were associated with higher risk of tibiofemoral cartilage defects, suggesting glucose homeostasis and some MetS components may affect early cartilage damage in young adults. [ABSTRACT FROM AUTHOR]

Aging is characterized by progressive decline in physiologic reserves and functions as well as prolonged inflammation, increasing susceptibility to disease. Diet plays an important role in maintaining health, and reducing morbidity and mortality, especially in older populations. This study was designed to determine prospective associations between dietary inflammatory index (DII®) scores and bone health, sarcopenia-related outcomes, falls risk and incident fractures in community-dwelling Australian older adults. A total of 1098 [51% male; age (mean ± SD) 63.0 ± 7.5 years] non-institutionalized older adults who participated in the Tasmanian Older Adult Cohort Study (TASOAC) at baseline, 768 at 5 years, and 566 at 10 years follow-up were included in this analysis. Baseline energy-adjusted DII (E-DII) scores were calculated using a validated Food Frequency Questionnaire. Changes in bone mineral density (BMD) and appendicular lean mass (ALM) were measured over ten years using dual-energy x-ray absorptiometry. Ten-year changes in hand grip, knee extensor and whole lower-limb muscle strength and quality were assessed by dynamometers and change in falls risk score using the Physical Profile Assessment (PPA). Incident fractures at any site and non-vertebral fractures over 10 years were self-reported. The E-DII range was −3.48 to +3.23 in men and −3.80 to +2.74 in women. Higher E-DII score (indicating a more pro-inflammatory diet) was associated with lower total hip (B: −0.009; 95% CI: −0.017, 0.000) and lumbar spine BMD (B: −0.013; 95% CI: −0.024, −0.002), and higher falls risk score (B: 0.040; 95% CI: 0.002, 0.078) over 10 years in men. Women with higher E-DII scores had higher whole lower-limb muscle quality over 10 years (B: 0.109; 95% CI: 0.002, 0.215). For every unit increase in E-DII score, incident fracture rates increased by 9.0% in men (IRR: 1.090; 95% CI: 1.011, 1.175) and decreased by 12.2% in women (IRR: 0.878; 95% CI: 0.800, 0.964) in a fully adjusted model. Higher E-DII scores were associated with lower bone density, higher falls risk, and increased incidence of fractures in community-dwelling older men, but decreased fracture incidence in women, over 10 years. This suggests pro-inflammatory diets may be more detrimental to musculoskeletal health in older men than in women. Additional studies are warranted to elucidate these sex differences. [ABSTRACT FROM AUTHOR]

Objectives: To describe the cross-sectional association between musculoskeletal pain at multiple sites and physical work capacity (PWC) and objectively measured physical activity (PA).Design: Observational study.Methods: Data from a subsample of the UK Biobank were utilised (n=9856; mean age 58.5 years, mean body mass index 30.2kg/m2, 62% female). PWC was measured by a bicycle ergometer and PA by an accelerometer. Pain experienced in hip, knee, back and neck/shoulder was collected by questionnaire. Linear regression modelling was used with adjustment for potential confounders to estimate the association between pain and PWC and PA.Results: Increase in number of painful sites was associated with lower PWC, moderate and vigorous PA and increased low intensity PA in a dose-response relationship (all p-values for trend ≤0.001) before and after adjustment for confounders. In site specific analyses, hip pain was associated with an increased low intensity PA (β 52.8min/week, 95% CI 2.3-103.2) and reduced moderate PA (β -50.1min/week, 95% CI -98.5 to -1.8). Knee pain was only associated with vigorous PA (β -5.7min/week, 95% CI -10.0 to -1.3). Pain at neck/shoulder pain and back were not independently associated with PWC and PA.Conclusions: Greater number of painful sites is consistently associated with poorer PWC, increased low intensity PA and reduced moderate to vigorous PA. Clinicians should address the critical role of being physically active in managing chronic musculoskeletal pain and interventions targeting musculoskeletal pain may be needed to increase PA levels. [ABSTRACT FROM AUTHOR]

Objectives: To identify distinct pain trajectories over 10.7 years and to examine predictors of identified pain trajectories in an older population and those with radiographic knee osteoarthritis (ROA).Methods: 963 participants (aged 50-80 years) from a population-based cohort had baseline demographic, psychological, lifestyle and comorbidities data collected. T1-and T2-weighted magnetic resonance imaging (MRI) of the right knee was performed to measure knee structural pathology-cartilage defects, bone marrow lesions (BMLs) and effusion-synovitis. Group-based trajectory modelling (GBTM) was applied to identify trajectories of knee pain over 10.7 years measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results: Three distinct pain trajectories were defined: 'Minimal pain' (n = 501, 52%), 'Mild pain' (n = 329, 34%) and 'Moderate pain' (n = 165, 14%). In multivariable analysis, having cartilage defects, BMLs and effusion-synovitis were associated with an increased risk of being in the 'Mild pain' (relative risk [RR]: 1.40 to 1.92) and 'Moderate pain' trajectory (RR: 1.72 to 2.26), compared with the 'Minimal pain' trajectory. Being obese and having more painful sites were associated with 'Mild pain' and 'Moderate pain' trajectories, while unemployment, lower education level and presence of emotional problems were associated with 'Moderate pain' trajectory group. Similar results were found for those with ROA.Conclusion: Distinct pain trajectories identified suggest that homogeneous subgroups exist, which might be useful for phenotypic assessment for pain management, particularly in knee osteoarthritis. Structural pathology was associated with worse pain trajectories, suggesting that peripheral stimuli are critical for the development and maintenance of pain severity. Environmental and psychological factors may exacerbate pain perception. [ABSTRACT FROM AUTHOR]

Purpose: To describe the cross-sectional associations between proximal tibiofibular joint (PTFJ) type configurations and knee joint structural abnormalities in older adults.Methods: A total of 967 community-based participants were studied. T1-weighted fat-suppressed magnetic resonance image (MRI) with spoiled gradient recalled echo sequence was utilized to assess the PTFJ type configurations. Knee cartilage volume, cartilage defects, bone marrow lesions and osteophytes were measured. Linear regression and binary logistic regression analyses were used to examine the associations between PTFJ type configurations and knee joint cartilage volume as well as knee structural abnormalities, respectively, after adjustment for potential confounders.Results: Seven PTFJ types including plane (49.4%), trochoid (31.9%), double trochoid (4.3%), saddle (5.4%), condylar (5.3%), trochlear (3.5%) and ball & socket (0.2%) were observed. Plane type was used as the comparator. In multivariable analyses, irregular joint types (comprising the five uncommon joint types) were associated negatively with cartilage volume, and positively with knee cartilage defects, bone marrow lesions and osteophytes in the lateral (but not medial) compartments. In contrast, trochoid type was only associated with reduced femoral cartilage volume, but not with knee cartilage defects, bone marrow lesions and osteophytes.Conclusions: Irregular PTFJ joint shapes are associated with osteoarthritic changes in the lateral, but not medial, tibiofemoral compartment in older adults. The causal relationship needs to be examined in future longitudinal studies. [ABSTRACT FROM AUTHOR]

Objective: To describe cross-sectional and longitudinal associations between magnetic resonance imaging (MRI)-detected osteophytes (OPs) and knee structural abnormalities and knee pain in older adults.Method: A prospective population-based cohort study of 895 participants aged 50-80 years (mean age 62 years, 50% female) was performed. T1-or T2-weighted fat suppressed MRI was used to assess knee OPs, cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and after 2.6 years. Radiographically-detected OPs were scored according to the Osteoarthritis Research Society International (OARSI) atlas. Knee pain was assessed using a self-administered questionnaire at baseline, 2.6 and 5 years later.Results: 85% of participants had MRI-detected OPs at baseline, while 10% of participants had radiographically-detected OPs. Cross-sectionally, higher gardes of MRI-detected OPs in all compartments were significantly, independently and site-specifically associated with higher prevalences of cartilage defects and BMLs, lower cartilage volume and higher prevalence of knee pain. Longitudinally, higher gardes of baseline MRI-detected OPs site-specifically predicted greater risks of any increase in cartilage defects or BMLs, and loss of cartilage volume in medial and lateral tibiofemoral (LTF) and total compartments over 2.6 years in multivariable analyses. These significant associations were similar in those without radiographically-detected OPs. MTF and total OP scores were significantly associated with change in total knee pain over 2.6 and 5 years but these became non-significant after adjustment for cartilage defects and BMLs.Conclusion: MRI-detected knee OPs are common and appear to be clinically relevant to knee structural changes in older adults. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the associations between an objective measure of different intensities of physical activity, upper- and lower-limb muscle strength and psychomotor performance and set-shifting domains of cognitive executive function in older adults.Design: A cross-sectional study.Methods: From the Tasmanian Older Adult Cohort Study, 188 community-dwelling older adults (53.7% female; mean age±SD 63.98±7.3 years) undertook 7-day physical activity behaviour monitoring using an accelerometer. Dynamometers were used to assess leg extension strength. The Trail Maker Tests were used to measure psychomotor processing speed and set-shifting performance.Results: When controlling for age, smoking history, alcohol intake, educational achievement and neuropsychological functioning, higher levels of light physical activity, but not sedentary behaviour or moderate or vigorous physical activity, was found to be associated with better set-shifting performance. Neither physical activity behaviour or muscle strength were found to be associated with psychomotor performance. In addition, older age, greater alcohol intake, and lower levels of educational attainment, verbal learning and memory performance were significantly associated with lower scores on the set-shifting task; whereas older age and reduced neuropsychological functioning were associated with lower psychomotor processing speed scores.Conclusions: Light physical activity is associated with higher executive functioning in community-dwelling older adults and this strengthens the evidence supporting exercise as a neuroprotective agent. Further studies are needed to understand why light physical activity behaviour positively influences executive functioning, and how such physical activity can be implemented into the daily routine of older adults. [ABSTRACT FROM AUTHOR]

To evaluate the effect of annual infusions of zoledronic acid (ZA) with or without a single injection of methylprednisolone, compared to placebo, on quantitative magnetic resonance imaging 3-D bone area and bone shape in participants with symptomatic knee osteoarthritis (OA). This was a post-hoc analysis of the ZAP2 trial. Active appearance modelling was used to assess bone area (mm2) and femur bone shape (B-score) in 262 participants (mean 61.8 ± 8.0 years, 51% female) at baseline, 6, and 24 months. Radiographic joint space narrowing (JSN) was measured at baseline. An 'OA shape' was defined as a B-score of >1.96. At baseline 65% of participants demonstrated an OA shape. Treatment with ZA plus methylprednisolone but not ZA alone, compared to placebo, was associated with significantly slower expansion in bone area at the medial femoral (-33.9 mm2, 95% confidence interval [CI] -61.8 to -6.0) and lateral femoral (-22.0 mm2, 95%CI -40.7 to -3.4) compartments over 24 months. B-score increased in all groups, with no significant between-group differences. There were significant interactions of JSN (grade 0 vs grade 1–2) and B-score (≤1.96 vs >1.96) with treatment effect on bone area (p < 0.05), such that ZA plus methylprednisolone slowed the expansion of medial and lateral femoral bone area over 24 months in participants with JSN grade 1–2 or a B-score of >1.96. ZA plus methylprednisolone may retard expansion of bone area over 24 months, but ZA alone may not. Neither ZA with or without methylprednisolone slowed progression of bone shape over 6 or 24 months. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to describe the longitudinal relationship between adiposity and change in knee pain. Methods A total of 1099 participants aged 50–79 were randomly selected from the local community in Southern Tasmania, of which 767 were followed up on average 5.1 years later. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at each time point. Consistent knee pain was defined as knee pain at all three time-points. The five pain subscales were grouped into weight-bearing pain and non-weight-bearing pain according to the nature of pain. Body fat and lean mass were assessed using dual energy x-ray absorptiometry (DXA). Results Baseline body mass index (BMI) and body fat mass were deleteriously associated with consistent knee pain over follow-up. BMI was consistently associated with increases in weight-bearing and non-weight-bearing pain. Fat mass was associated with an increase in non-weight-bearing pain. In mixed-model analyses, WOMAC total pain score was associated with BMI ( β = 1.27) and body fat mass ( β = 1.17). The association of lean mass was not significant after adjustment for fat mass. Conclusion BMI is the most consistent correlate of knee pain in older adults. Fat mass is associated with non-weight-bearing knee pain suggesting systemic mechanisms are involved. [ABSTRACT FROM AUTHOR]

Background Marked weight loss reduces lean body mass and quadriceps thickness. It is unclear whether muscle loss varies according to the method of weight loss. Objective This study compared the association of surgical versus nonsurgical weight loss with change in vastus medialis (VM) properties in obese adults. Methods Twenty obese patients (body mass index≥30 kg/m 2 ) who lost weight via laparoscopic gastric banding were matched for weight loss with obese patients who lost weight nonsurgically. The thickness and fat infiltration of VM were assessed at baseline and a mean of 2.4 years later. Results After adjusting for confounders, the annual change in VM thickness was –2.9% in the surgical group and –.5% for the nonsurgical group ( P = .02). There was also a tendency toward an increased risk for VM fat infiltration to be reduced when weight loss occurred nonsurgically (OR 5.1, 95% CI .8–32.8; P = .09). Conclusions Compared with nonsurgical weight loss, laparoscopic gastric banding was associated with greater VM muscle thickness loss. Relative to laparoscopic gastric banding, there was also a tendency toward an increased risk for VM fat infiltration to be reduced with nonsurgical weight loss. Close attention to preserving muscle properties at the knee when significant amounts of weight loss have occurred is required. Physical therapy may be important in the management of patients after laparoscopic gastric banding in an attempt to preserve skeletal muscle mass. [ABSTRACT FROM AUTHOR]

Summary The sophisticated organization of eusocial insect societies is largely based on the regulation of complex behaviors by hydrocarbon pheromones present on the cuticle. We used electrophysiology to investigate the detection of cuticular hydrocarbons (CHCs) by female-specific olfactory sensilla basiconica on the antenna of Camponotus floridanus ants through the utilization of one of the largest family of odorant receptors characterized so far in insects. These sensilla, each of which contains multiple olfactory receptor neurons, are differentially sensitive to CHCs and allow them to be classified into three broad groups that collectively detect every hydrocarbon tested, including queen and worker-enriched CHCs. This broad-spectrum sensitivity is conserved in a related species, Camponotus laevigatus , allowing these ants to detect CHCs from both nestmates and non-nestmates. Behavioral assays demonstrate that these ants are excellent at discriminating CHCs detected by the antenna, including enantiomers of a candidate queen pheromone that regulates the reproductive division of labor. [ABSTRACT FROM AUTHOR]

This is 12-yr follow-up of a randomized controlled trial aimed to evaluate the long-term effects of bone density feedback and osteoporosis education on osteoporosis knowledge and self-efficacy. We examined the effects of feedback of bone density-defined fracture risk (high [T-score <0] vs normal [T-score ≥0] risk) and 2 different educational interventions (the group-based Osteoporosis Prevention and Self-Management Course [OPSMC] vs an osteoporosis leaflet) on osteoporosis knowledge and self-efficacy in women aged 25–44. Seventy-four percent (N = 347) of 470 participants at baseline participated at 12 yr. Overall, the scores were higher for osteoporosis knowledge but lower for self-efficacy at 12 yr. However, neither intervention had an effect on the change in knowledge (T-score, β = 0.4, 95% confidence interval [CI] = −0.3 to 1.1; OPSMC, β = 0.2, 95% CI = −0.5 to 0.9) or self-efficacy (T-score, β = −1.1, 95% CI = −2.5 to 0.4; OPSMC, β = −0.2, 95% CI = −1.6 to 1.3). Women in households with an unemployed main financial provider had a decrease in knowledge at 12 yr compared with those in households with an employed main financial provider in whom knowledge increased (β = −1.95, 95% CI = −3.40 to −0.50), but there were no other predictors of change identified for knowledge or self-efficacy. In conclusion, beneficial effects of both OPSMC and feedback of high fracture risk on osteoporosis knowledge seen previously at 2 yr were not sustained after 12 yr although overall knowledge was still significantly higher than at baseline. Neither intervention improved osteoporosis self-efficacy. More frequent osteoporosis education and bone density feedback may be required to maintain knowledge, and other approaches to improve self-efficacy are necessary. [ABSTRACT FROM AUTHOR]

Abstract: The ISCD 2007 Pediatric Official Positions define osteoporosis in children on the basis of fracture history and low bone density, adjusted as appropriate for age, gender, and body size. The task force on fracture prediction and osteoporosis definition has reviewed these positions and suggests modifications with respect to vertebral fracture and the definition of a significant fracture history and draws attention to the need to consider degree of trauma as a factor that may modify fracture risk prediction. [Copyright &y& Elsevier]

Purpose: The JOINT I (United States) and JOINT II (Australia and Europe) studies evaluated the efficacy and safety of collagenase clostridium histolyticum (CCH) injection for the treatment of Dupuytren contracture. Methods: Both studies used identical open-label protocols. Patients with fixed-flexion contractures of metacarpophalangeal (MCP) (20° to 100°) or proximal interphalangeal (PIP) joints (20° to 80°) could receive up to three 0.58-mg CCH injections per cord (up to 5 total injections per patient). We performed standardized finger extension procedures to disrupt injected cords the next day, with follow-up 1, 2, 6, and 9 months thereafter. The primary end point (clinical success) was reduction in contracture to within 0° to 5° of full extension 30 days after the last injection. Clinical improvement was defined as 50% or more reduction from baseline contracture. Results: Dupuytren cords affecting 879 joints (531 MCP and 348 PIP) in 587 patients were administered CCH injections at 14 U.S. and 20 Australian/European sites, with similar outcomes in both studies. Clinical success was achieved in 497 (57%) of treated joints using 1.2 ± 0.5 (mean ± SD) CCH injections per cord. More MCP than PIP joints achieved clinical success (70% and 37%, respectively) or clinical improvement (89% and 58%, respectively). Less severely contracted joints responded better than those more severely contracted. Mean change in contracture was 55° for MCP joints and 25° for PIP joints. With average contracture reductions of 73% and improvements in range of motion by 30°, most patients (92%) were “very satisfied” (71%) or “quite satisfied” (21%) with treatment. Physicians rated change from baseline as “very much improved” (47%) or “much improved” (35%). The CCH injections were well tolerated, causing no tendon ruptures or systemic reactions. Conclusions: Collagenase clostridium histolyticum was an effective, minimally invasive option for the treatment of Dupuytren contracture of a broad range of severities. Most treated joints (625 of 879) required a single injection. Treatment earlier in the course of disease provided improved outcomes. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

Summary: Background & aims: The role of excessive salt on bone metabolism in children is uncertain. The aim of this 6-week prospective study was to describe the association between urinary electrolytes and bone turnover markers in a convenience sample of adolescent boys (N=136, mean age 16yr). Methods: Urinary electrolytes (sodium, potassium, calcium and magnesium) were assessed on spot overnight urines on three occasions to minimise regression dilution bias. Bone turnover was assessed by bone specific alkaline phosphatase (BAP) and urinary pyridinoline (PYR) at baseline and follow up. Results: In multivariate analysis, urinary sodium (but not other electrolytes) was positively associated with both PYR and BAP both before and after taking short-term growth into account (both p<0.05) and explained 3–6% of the variation in bone turnover markers. Urinary sodium was associated with urinary magnesium (r=+0.26, p<0.05) but only weakly with calcium (r=+0.18, p=0.08). Urinary potassium was significantly associated with urinary magnesium (r=−0.24, p<0.05). Conclusion: High urinary sodium (which largely reflects dietary sodium intake in our location) results in a high bone turnover state in adolescent boys which is most likely detrimental for bone. Other urinary electrolytes are not related to bone turnover but may influence bone via other pathways. [Copyright &y& Elsevier]

Abstract: The interpretation of bone density measurement in children is difficult due to a number of factors including rapid change in body size and uncertain clinical significance of bone density in children. This study asked two questions. (1) Is there a preferred bone density measurement site or type for fracture risk in children? (2) What is the best way to interpret bone density in children? This population-based case control study included 321 upper limb fracture cases and 321 class- and sex- matched randomly selected controls. Bone density at the hip, spine, and total body (including the arm) was measured by a Hologic QDR2000 densitometer (Waltham, MA) and examined as bone area (BA), bone mineral content (BMC), bone mineral density (BMD), bone mineral apparent density (BMAD), and BMC/lean mass (BMCLM). The only dual-energy X-ray absorptiometry (DXA) variables that were consistently associated with fracture risk in both boys and girls were spine BMD and BMAD for total upper limb fractures, and spine and hip BMAD for wrist and forearm fractures. No significant associations were observed for BA and BMCLM and inconsistent associations for BMC and other BMD sites. Five-yr fracture risk varied from 15–24% depending on site and gender in a child with a Z-score of -3. In the controls, all DXA variables were associated with age, height, and weight, but the weakest associations were with BMAD. In conclusion, in this study the spine BMAD had the strongest and most consistent association with upper limb fracture risk in children. The associations with age and body size imply that age specific Z-scores will be the most convenient for interpretation of DXA measures in children. Five-yr wrist and forearm fracture risk has potential as a clinical endpoint of immediate relevance. [Copyright &y& Elsevier]

Summary: Objective: To resolve uncertainty regarding sex differences in osteoarthritis (OA) by performing a meta-analysis of sex differences in OA prevalence, incidence and severity. Methods: Standard search strategies for population-based studies of OA providing sex-specific data. Random effects meta-analysis to provide pooled male vs female risk and rate ratios for prevalent and incident OA, and standardized mean differences (SMD) for OA severity. Meta-regression was used to investigate sources of heterogeneity. Results: Males had a significantly reduced risk for prevalent OA in the knee [Risk Ratio (RR) 0.63, 95% CI 0.53–0.75] and hand [RR 0.81, 95% CI 0.73–0.90] but not for other sites. Males aged <55 years had a greater risk of prevalent cervical spine OA [RR 1.29, 95% CI 1.18–1.41]. Males also had significantly reduced rates of incident OA in the knee [Incidence Rate Ratio (IRR) 0.55, 95% CI 0.32–0.94] and hip [IRR 0.64, 95% CI 0.48–0.86], with a trend for hand [IRR 0.65, 95% confidence interval (CI) 0.35–1.20]. Females, particularly those ≥55 years, tended to have more severe OA in the knee but not other sites. Heterogeneity in the estimates of sex differences in prevalence was substantially explained by age and other study design factors including method of OA definition. Conclusions: The results demonstrate the presence of sex differences in OA prevalence and incidence, with females generally at a higher risk. Females also tend to have more severe knee OA, particularly after menopausal age. The site differences indicate the need for further studies to explore mechanisms underlying OA. [Copyright &y& Elsevier]

Abstract: The aim of this population-based case-control study was to describe the association among skeletal age deviation (SAD), bone density, and upper limb fracture risk in male and female children aged 9–16 years. A total of 321 fracture cases and 321 randomly selected individually matched controls were studied. Skeletal age was assessed by standard atlas. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) and metacarpal index (MI). There were no significant differences in mean skeletal age or chronological age between fracture cases and controls. However, SAD was associated with total, hand, and female fracture risk (all P &#60; 0.05). The fracture associations became nonsignificant after adjustment for BMD and MI in all subgroups with the exception of hand fractures (OR, 0.67/year; 95% CI, 0.47–0.96). SAD was also positively associated with BMD at all sites (r = 0.33–0.35, all P &#60; 0.05) and MI (r = 0.20, P &#60; 0.05). The strength of association reduced but remained significant at most sites after adjustment for body size, maturity, age, and sex. In conclusion, SAD is positively associated with measures of bone strength and negatively associated with upper limb fracture risk (especially those of the hand) in children. SAD is simple to measure and gives additional information regarding bone health and fracture risk in children. [Copyright &y& Elsevier]

Background: Our understanding of the role of nutrients in bone development in children is limited. Objective: We examined the associations between urinary potassium, urinary sodium, usual dietary intake, and bone mineral density (BMD) in prepubertal children. Design: This was a cross-sectional study of 330 boys and girls aged 8 y. Urinary measures were assessed in a single, timed, overnight urine specimen. Usual diet was assessed with a food-frequency questionnaire completed by a parent or guardian. BMD at the femoral neck, lumbar spine, and total body was measured by dual-energy X-ray absorptiometry. Results: Urinary potassium correlated significantly with BMD at all sites (femoral neck: r = 0.20, P < 0.001; lumbar spine: r = 0.19, P = 0.001; total body: r = 0.24, P < 0.001). After adjustment for confounders (primarily lean body mass), this association was lower in magnitude but remained significant at 2 sites with a consistent trend at the third (femoral neck: P = 0.15; lumbar spine: P = 0.046; total body: P = 0.028). Urinary sodium was not associated with BMD at any site. No nutrient or food intake estimate was associated with BMD, although urinary potassium correlated significantly with potassium intake (r = 0.14, P = 0.016) and fruit and vegetable intake (r = 0.12, P = 0.033). Conclusions: Urinary potassium was associated with both dietary intake and BMD independent of lean body mass in these well-nourished, calcium-replete young children. These findings should be confirmed in further longitudinal studies. Nevertheless, this association is likely to represent dietary intake of potassium and suggests that measurement of urinary potassium is superior to food-frequency questionnaires for assessing potassium intake in this age group. [ABSTRACT FROM AUTHOR]

Objective: To describe the association between fractures sustained at different stages of growth and bone measures in early adulthood.Study Design: Participants (n = 201) in southern Tasmania were at birth at a higher risk of sudden infant death syndrome; they were followed to age 25. Outcomes were areal bone mineral density at the spine, hip, and total body (by dual-energy x-ray absorptiometry) and trabecular and cortical bone measures at the radius and tibia (by high-resolution peripheral quantitative computed tomography). Fractures were self-reported and confirmed by radiographs at 8, 16, and 25 years of age. Multivariable linear regression was used to analyze the association of the occurrence of prepubertal (<9 years of age), pubertal (9-16 years of age), and postpubertal (17-25 years of age) fractures with all bone measures.Results: Over 25 years, 99 participants had at least 1 fracture. For high-resolution peripheral quantitative computed tomography measures at age 25, prepubertal fractures were negatively associated with cortical and trabecular volumetric bone mineral density and most microarchitecture measures at both the tibia and radius. Prepubertal fractures had a significant association with smaller increase of areal bone mineral density from age 8 to 16 years and at 25 years of age compared with participants with no fractures. Pubertal fractures had no association with any bone measures and postpubertal fractures were only associated with a lower trabecular number at the tibia.Conclusions: Prepubertal fractures are negatively associated with areal bone mineral density increases during growth and high-resolution peripheral quantitative computed tomography bone measures in young adulthood. There is little evidence that fractures occurring from age 8 years onward with bone measures in young adulthood, implying that prepubertal fractures may be associated with bone deficits later in life. [ABSTRACT FROM AUTHOR]

Abstract: It has been hypothesized that bone density tracks but long term studies in children are lacking. As such, the aim of this study was to describe tracking of dual X-ray absorptiometry measures from age 8 to age 16 years, whether this was independent of change in body size and whether deviation from tracking could be predicted. 116 males and 67 females had anthropometric (height and weight), questionnaire (medication use, sports, breastfeeding), fitness (PWC170) and DXA measures (bone free lean mass [LM], fat mass [FM] and bone mass) at baseline and follow-up. BMC and aBMD were assessed at the spine and hip and total body and bone mineral apparent density (BMAD) at the spine and hip. We found all DXA measures tracked significantly after adjustment for change in height and change in weight (males: R 2: BMC 24–62%; aBMD 41–48%; BMAD 30–37%, females: R 2: BMC 45–72%; aBMD 36–56%; BMAD 30–48%). Factors that predicted subjects would deviate positively, that is improve in tertile or remain in the highest tertile of spine and hip aBMD included having been breastfed, increase in LM, PWC170 at age 8 and sport participation in males. LM at age 8 was beneficial in males while in females; FM at age 8 predicted subjects would deviate positively. Boys who gained absolute and percent FM and girls who gained percent FM, were more likely to deviate negatively, that is, decrease in tertile or remain in the lowest tertile of spine and hip aBMD. ICS use at age 8 also predicted subjects, particularly males would not improve in bone mass relative to their peers. In conclusion, DXA measures track moderately to strongly from childhood to adolescence. This was independent of linear growth and sex indicating bone development and physical growth are under largely separate mechanistic control. Body composition was the main predictor of altered tracking but environmental factors also appear important. [Copyright &y& Elsevier]

Objective: To describe the association of reproductive and hormonal factors with the presence and severity of hand osteoarthritis (OA) in Tasmanian women. Methods: Cross-sectional study of 348 women from 76 families. A structured questionnaire collected information regarding reproductive history and the use of estrogen containing medications. Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal (DIP) and carpometacarpal (CMC) joints, as well as Heberden''s nodes (HN) based on hand photography. Results: The prevalence of hand OA was high in this sample at 65–70%. Parity, increasing age at menopause and years of menstruation were associated with both symptomatic hand OA and a more severe DIP score (but not presence of radiographic disease) while both current and ever use of hormone replacement therapy (HRT) were significantly associated with increased prevalence of HN and severity of HN and DIP OA (all P<0.05). HRT usage less than 5 years was associated with increased severity of both DIP disease and HN. No factors were associated with CMC disease apart from ever breast-feeding which was protective (OR 0.37, 95% CI 0.18–0.79). Conclusions: These results require confirmation in clinical trials or carefully controlled longitudinal studies but suggest that estrogen exposure around the time of disease onset (either endogenous or exogenous) may have a “priming” effect on the severity of DIP OA while breast-feeding in earlier life may be protective for CMC OA. [Copyright &y& Elsevier]

Glucosamine is widely used by patients with osteoarthritis (OA) to provide symptomatic relief and to delay disease progression. However, clinical studies have reported inconsistent clinical outcomes. The current study hypothesized that the reported inconsistent clinical results could be, in part, due to variable bioavailability and elimination of glucosamine. This study therefore aimed to determine steady-state minimum plasma concentrations (C ss min) of glucosamine to examine the variability among patients taking the supplement. Patients with OA who had been taking glucosamine for at least 1 week were recruited. Patients' blood samples were collected 24 h after the ingestion of the previous dose to determine Observed C ss min and after a 5-day washout period to determine the endogenous glucosamine levels (GlcN end). The Actual C ss min was calculated by using the following equation: Actual C ss min = Observed C ss min – GlcN end. The glucosamine plasma concentrations were determined by using a previously developed HPLC method. Ninety-one participants (age range, 42–89 years; mean [SD] age, 68.2 [7.6] years) were recruited (70% females). There was substantial (106-fold) variation, with a 45% coefficient of variation, between the Actual C ss min levels (3–320 ng/mL) in participants. No significant association of Actual C ss min was observed with various dose- and patient-related variables. The observed high variability in steady-state plasma concentrations indicates substantial inter-patient differences in the absorption and elimination of glucosamine, which could be a cause for inconsistent clinical outcomes in patients with OA. • Glucosamine is widely used in osteoarthritis (OA), despite variable clinical outcomes. • High variability observed in glucosamine plasma levels among OA patients taking standardised doses. • Variable pharmacokinetics of glucosamine could be a cause for inconsistent outcomes. [ABSTRACT FROM AUTHOR]

Resistin acts as an endogenous ligand of Toll-like receptor (TLR)-4 that triggers major inflammatory pathways and mediates inflammatory processes. The role of resistin in osteoarthritis (OA) pathogenesis is unclear. The aim of this study is to describe the longitudinal associations of serum levels of resistin with knee synovitis measures and structural abnormalities in patients with knee OA. A prospective cohort study. Patients (n = 200) with symptomatic knee OA (mean age 63.1 years, range 49-79; female 46.5%) participated. All measures were performed at baseline and 2 years later. Serum resistin was measured using enzyme-linked immunosorbent assay. Infrapatellar fat pad (IPFP) high signal intensity alteration and effusion synovitis were measured from magnetic resonance imaging (MRI). Knee structures including cartilage volume, cartilage defects, and bone marrow lesions (BMLs) were also assessed by MRI semiquantitatively or quantitatively. Linear or logistic mixed effects regression analyses were used in longitudinal analyses. Serum resistin was positively associated with high signal intensity alteration measures of IPFP as well as the presence [relative risk = 1.06, 95% confidence interval (CI) 1.02, 1.10] and volume (β = 0.77, 95% CI 0.01, 1.53) of effusion synovitis in multivariable analyses. Serum levels of resistin were also positively associated with higher tibiofemoral cartilage defect (β = 1.98, 95% CI 0.34, 3.57) and BML scores (β = 3.18, 95% CI 0.99, 5.37) after adjustment for covariates. Higher serum levels of resistin are associated with knee synovitis surrogate measures and structural abnormalities, suggesting that obesity may promote OA not only by increasing weight loading on joints but also by triggering 1 or more inflammatory pathways. [ABSTRACT FROM AUTHOR]

Highlights • Osteodynapenia but not osteosarcopenia increased the risk of fracture. • Osteodynapenia did not lead to a significantly greater fracture risk compared to having osteopenia or dynapenia alone. • Osteosarcopenia but not osteodynapenia increased the risk of mortality. • Osteosarcopenia did not lead to a significantly greater mortality risk compared to having osteopenia or sacropenia alone. Abstract Aim: To determine whether older adults with low muscle mass (sarcopenia) and strength (dynapenia), in the presence of osteoporosis/osteopenia, have an increased risk of fracture and mortality over 10 years, compared to those with low muscle or low bone mass alone or with neither condition. Methods: 1032 participants (52% women; mean age 62.9 ± 7.4 years) were prospectively followed for 10 years. Mortality was ascertained from the death registry and fractures were self-reported. Baseline appendicular lean mass (ALM) was assessed using dual-energy X-ray absorptiometry and normalised to body mass index (BMI). Hand grip strength (HGS) was assessed by dynamometer. Osteosarcopenia and osteodynapenia were defined as having T-scores of the total hip and/or lumbar spine bone mineral density (BMD) < –1 combined with being in the lowest 20% of the sex-specific distribution for ALM/BMI or HGS respectively. Results: Incident fracture risk was significantly higher in participants who were osteodynapenic (RR = 2.07, 95% CI: 1.26–3.39), dynapenic alone (RR = 1.74, 95% CI: 1.05–2.87), and osteopenic alone (RR = 1.63, 95% CI: 1.15–2.31), compared to those without dynapenia or osteopenia. Mortality risk was significantly higher only in participants with osteosarcopenia (RR = 1.49, 95% CI: 1.01–2.21) compared to those without sarcopenia or osteopenia. However, osteosarcopenia and osteodynapenia did not lead to a significantly greater fracture or mortality risk compared to having these conditions on their own. Conclusion: These findings suggest that the combined effect of osteopenia and sarcopenia or dynapenia on fracture and mortality risk, respectively, may not be greater than that of each individual condition. [ABSTRACT FROM AUTHOR]

Abstract Aims This study aims to describe the associations of low muscle mass, handgrip (HGS) and lower-limb muscle strength (LMS) with health-related quality of life (HRQoL) over 10 years in community-dwelling older adults. Methods Participants (N = 1002; 51% women; mean age 63 ± 7.4 years) were prospectively followed for 10 years. HRQoL was measured using the validated assessment of quality of life (AQoL) instrument. Appendicular lean mass (ALM) was assessed using dual energy X-ray absorptiometry and normalized to body mass index (BMI). HGS and LMS were assessed using dynamometers. Low ALM/BMI (ALM/BMI LOW), LMS (LMS LOW) and HGS (HGS LOW) at baseline were defined as the lowest 20% of the sex-specific distribution for each measure. Linear mixed effect regression models, adjusting for confounders, were used to estimate the association between ALM/BMI LOW , LMS LOW , and HGS LOW at baseline and HRQoL over 10 years. Results Participants with LMS LOW (β = −0.061, 95% CI: −0.089, −0.033) and women (β = −0.089, 95% CI: −0.129, −0.049) but not men (β = −0.023, 95% CI: −0.064, 0.019) with HGS LOW had clinically meaningful reductions in HRQoL over 10 years compared to those with normal strength. There was a weaker but statistically significant association between ALM/BMI LOW and 10-year HRQoL (β = −0.038, 95% CI: −0.068, −0.008). Conclusions Lower-limb muscle strength and handgrip strength (in women only), which can be easily measured in clinical practice, appear more important than muscle mass for HRQoL. [ABSTRACT FROM AUTHOR]

To estimate the heritability of bone geometry, volumetric bone mineral density (vBMD) and microarchitecture of trabecular (Tb) and cortical (Ct) bone measured by high resolution peripheral quantitative computerised tomography (HRpQCT) at the distal radius and tibia and to investigate the genetic correlations of these measures. Participants were 177 mother-offspring pairs from 162 families (mothers, mean age (SD) = 52.1 (4.7) years; offspring, 25.6 (0.73) years). Trabecular and cortical bone measures were obtained by HRpQCT. Multivariable linear regression was used to analyse the association of bone measures between mother and offspring. Sequential Oligogenic Linkage Analysis Routines (SOLAR) software was utilised to conduct quantitative genetic analyses. All maternal bone measures were independently associated with the corresponding bone measures in the offspring before and after adjustment for age, sex, weight and height. Heritability estimates ranged from 24% to 67% at the radius and from 42% to 74% at the tibia. The relationship for most bone geometry measures was significantly stronger in mother-son pairs ( n  = 107) compared with mother-daughter pairs ( n  = 70) ( p  < 0.05). In contrast, the heritability for most vBMD and microarchitecture measures were higher in mother-daughter pairs. Bivariate analyses found moderate to strong genetic correlations across all measures between radius and tibia (R g  = 0.49 to 0.93). Genetic factors have an important role in the development of bone geometry, vBMD and microarchitecture. These factors are strongly shared for the radius and tibia but vary by sex implying a role for imprinting. [ABSTRACT FROM AUTHOR]

Aims To describe the longitudinal associations between physiological falls risk, and between-person and within-person effects of 25-hydroxyvitamin D (25OHD), physical activity (PA), knee pain and dysfunction in community-dwelling older people. Methods Data for 1053 participants (51% women; mean age 63 ± 7.4 years) studied at baseline, 2.5, 5, and 10 years were analysed. Falls risk (Z-score) was measured using the Physiological Profile Assessment. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Moderate-to-vigorous PA (MVPA) was measured using accelerometer. Linear mixed-effect regression models, with adjustment for confounders, were used to estimate the association between physiological falls risk and between-person and within-person effects of PA, 25OHD and WOMAC score. Results Between-person effects showed that 10-year average physiological falls risk was lower in participants who had a higher 10-year average 25OHD (β = −0.005 per nmol/l, 95% CI: −0.008, −0.002), log-MVPA (β = −0.16 per minute, 95% CI: −0.22, −0.10) and lower mean WOMAC score (β = 0.005 per-unit score, 95% CI: 0.003, 0.01). Within-person effects showed that a higher physiological falls risk at any time-point was associated with higher than average WOMAC score (β = 0.002 per-unit score, 95% CI: 0.0003, 0.004) and lower than average log-MVPA (β = −0.15 per minute, 95% CI: −0.24, −0.06), but not 25OHD, at the same time-point. Conclusion Having higher WOMAC global score above an individual's average increases the risk of falling, whereas, increasing one's own MVPA level further reduces their risk of falling. The presence of between-person but not within-person associations for 25OHD suggests the former may be confounded by other factors. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to determine if beneficial effects of individualized feedback of fracture risk on osteoporosis preventive behaviors and bone mineral density observed in a 2-year trial were sustained long-term.Methods: This was a 10-year follow-up of a 2-year RCT in 470 premenopausal women aged 25-44 years, who were randomized to one of two educational interventions (the Osteoporosis Prevention and Self-Management Course [OPSMC] or an osteoporosis information leaflet) and received tailored feedback of their relative risk of fracture in later life (high versus normal risk groups). Bone mineral density of lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical activity, dietary calcium intake, calcium and vitamin D supplements, and smoking status were measured by questionnaires.Results: From 2 to 12 years, the high-risk group had a smaller decrease in femoral neck bone mineral density (β=0.023, 95% CI=0.005, 0.041 g/cm2) but similar lumbar spine bone mineral density change as the normal-risk group. They were more likely to use calcium (relative risk=1.66, 95% CI=1.22, 2.24) and vitamin D supplements (1.99, 95% CI=1.27, 3.11). The OPSMC had no effects on bone mineral density change. Both high-risk (versus normal-risk) and the OPSMC groups (versus leaflet) had a more favorable pattern of smoking behavior change (relative risk=1.85, 95% CI=0.70, 4.89 and relative risk=2.27, 95% CI=0.86, 6.01 for smoking cessation; relative risk=0.33, 95% CI=0.13, 0.80 and relative risk=0.28, 95% CI=0.10, 0.79 for commenced or persistent smoking).Conclusions: Feedback of high fracture risk to younger women was associated with long-term improvements in osteoporosis preventive behaviors and attenuated femoral neck bone mineral density loss. Therefore, this could be considered as a strategy to prevent osteoporosis.Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) NCT00273260. [ABSTRACT FROM AUTHOR]

Background: Vertebral endplate (Modic) lesions are gaining interest, with varied phenotypes recognised to have distinct clinical and histological correlates. Nevertheless, the natural history of these lesions is unclear. This study examined the natural history of Modic changes and their potential relationship to the intervertebral disc.Methods: Seventy-two community-based adults not selected for low back pain had lumbar spine magnetic resonance imaging (MRI) performed at baseline (2012) and approximately 2 years later to assess Modic lesions. Fifty-six participants completed the study. Intervertebral disc pathology was assessed by disc height and the Pfirrmann grading system at baseline.Results: At baseline, 6 Modic type 1 lesions were present in 3 (4.2%) participants. At follow-up, 4 persisted, 2 changed to a Modic type 2 lesion, and there were 4 incident lesions. Only 1 participant (1.4%) had a baseline Modic type 3 lesion, which persisted at follow-up, with one further incident lesion. Modic type 2 lesions were most common (n=47, in 20 of 72 [27.8%] participants). Resolution of Modic type 2 lesions was uncommon (n=1, with 2 changing to a type 1 lesion). 18 incident lesions occurred in 7 (12.5%) participants, with most occurring both sides of the intervertebral disc. A reduction in the average baseline disc height was associated with an increased risk for type 2 incident lesions (OR 1.9, 95% CI 1.1 to 3.3, P=0.03). Similarly, severe baseline disc degeneration at L3/4, L4/5 and L5/S1 was associated with an increased risk for type 2 incident lesions (all P≤0.05).Conclusion: This longitudinal study has demonstrated that Modic type 2 are the most common of the Modic lesions in community-based adults and while resolution of these lesions is uncommon, incident disease develops on both sides of the intervertebral disc in the setting of severe disc degeneration. These results suggest that type 2 Modic changes are a sequel of disc degeneration. [ABSTRACT FROM AUTHOR]

Objectives Aspirin, widely used in the prevention of cardiovascular disease, in low dose, has anti-inflammatory and vasculoprotective effects: both of these processes contribute to the pathogenesis of osteoarthritis. We examined whether use of low dose aspirin affects change in knee cartilage volume in osteoarthritis. Methods Participants from the Melbourne osteoarthritis cohort were classified as users and non-users of aspirin, according to baseline use (≤300 mg/day). Their knees were imaged twice over 2 years. Tibial cartilage volumes were measured and change calculated. Results Twenty one (18%) of 117 eligible participants were aspirin users. Annual change in medial tibial cartilage volume was −43 mm 3 (95% confidence intervals (CI) −93, 10) in aspirin users and −101 mm 3 (95% CI −125, −77) in non-users ( p = 0.043 for difference) after adjusting for age, gender, BMI and radiographic severity. Similar results were seen for annual percentage loss (1.9% vs 5.4%, p = 0.034). No difference was observed for lateral tibial cartilage change and annual change ( p = 0.98, 0.87 respectively) Conclusion Low dose aspirin use was associated with reduced medial tibial cartilage loss over 2 years in people with knee osteoarthritis. This data is hypothesis generating and clinical trials are required to confirm efficacy. If this hypothesis is confirmed, low dose aspirin may be used to reduce the progression of knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of this study was to describe the relationship between accelerometer-determined physical activity (PA) and adiposity in community-dwelling older adults. In addition, we were interested in comparing the extent of correlation between questionnaire and accelerometer determined PA. Methods: 636 community-dwelling older adults (66±7years) were studied. Adiposity was measured using dual-energy X-ray absorptiometry and BMI was calculated. We measured minutes/day spent in sedentary, light, moderate and vigorous intensity activity using both questionnaires and Actigraph GT1M accelerometers. Results: Participants spent a median of 583(IQR 522–646), 225(176–271), 27(12–45) and 0(0–0) minutes in sedentary, light, moderate and vigorous activities respectively. There was a non linear dose–response inverse relationship between activity intensity and adiposity. After adjusting for age, sex and other levels of PA, for every 10minute increase in activity, total body fat decreased by 169g(95% CI 61–277), 905g(632–1178), and 2208g(759–3657) for light, moderate and vigorous activities respectively. There was an interaction between age and activity; as age increased, the magnitude of the effects of light and moderate activities on adiposity decreased. Sedentary minutes were not associated with adiposity after adjusting for time spent at other PA intensities. Questionnaire measures of PA were weakly correlated with body fat measures when compared to accelerometer determined PA. Conclusion: Both the amount and intensity of PA, but not sedentary time, have an independent dose–response association with adiposity. The association is much stronger using objective assessment compared to questionnaire. The magnitude of these associations decrease with age suggesting that physical activity programmes may need to be modified with increasing age. [Copyright &y& Elsevier]

Social disadvantage may contribute to increased prevalence of sarcopenia and obesity. This study investigated if socioeconomic factors are associated with obesity, sarcopenia, or sarcopenic obesity (SO), in community-dwelling older adults. This was a cross-sectional analysis of data from the Tasmanian Older Adult Cohort study. Obesity was defined by body fat percentage (Men: ≥25%; Women: ≥35%) and sarcopenia was defined as the lowest 20% of sex-specific appendicular lean mass (ALM)/height (m2) and handgrip strength. Socioeconomic factors investigated were education (tertiary degree, secondary or no secondary school), occupation (high skilled white-collar, low skilled white-collar, or blue-collar) and residential area (advantaged or disadvantaged area). Multinomial logistic regression analyses yielding odds ratios (95% confidence intervals) were performed and adjusted for potential confounders. Mediation analysis was performed. 1099 older adults (63.0 ± 7.5 years; 51.1% women) participated. Older adults with a tertiary degree were significantly less likely to have obesity (0.68; 0.47, 0.98) and SO (0.48; 0.24, 0.94) compared with those who had no secondary schooling. No associations were found for occupation. Similarly, older adults living in advantaged areas were significantly less likely to have obesity (0.61; 0.39, 0.95). Steps per day mediated the association between residential area and body fat percentage by 51%. Lower educational attainment, but not occupation, was associated with increased likelihood for both obesity and SO in community-dwelling older adults. Low physical activity levels in disadvantaged areas substantially contributed to higher obesity prevalence in this population. Further research is necessary to confirm whether similar associations exist in populations with greater levels of social disadvantage and to design effective community-based interventions. • Lower education is associated with increased risk of obesity and sarcopenic obesity. • Occupation types were not associated with obesity, sarcopenia or sarcopenic obesity. • Disadvantaged area of residence is associated with increased risk of obesity. • Physical activity mediated the association of area of residence with obesity. [ABSTRACT FROM AUTHOR]

Abstract: Background: The associations between oral contraceptive (OC) use, bone mineral density (BMD) and the risk of fractures remain controversial. Study Design: A cross-sectional study of 491 women aged 50–80 years was performed. We assessed OC use and fractures by questionnaire, and BMD and vertebral deformity by dual-energy x-ray absorptiometry. Results: Ever use of OC was associated with significantly higher BMD at the total body (6%, p<.001) and spine (4%; p=.05) (but not hip) after adjustment for confounders. There was also a significant association between duration of OC use and total body and spine BMD. Use of OCs for 5–10 years was associated with reduced vertebral deformity (adjusted odds ratio 0.46, 95% confidence interval 0.22–0.94). Conclusions: Oral contraceptive use and duration were associated with higher total body and spine BMD and a consistent reduction in vertebral deformities, although most associations did not reach significance. [Copyright &y& Elsevier]

Abstract: Objectives: Patellofemoral knee osteoarthritis (OA) is a common disease, and a significant cause of knee pain, however few data have examined longitudinal change at the patellofemoral joint. The aim of this study was to examine factors affecting change in patella cartilage over a longer time period than previously examined. Study design: Longitudinal study of 77 subjects (58% female) with knee OA underwent magnetic resonance imaging (MRI), with a repeat MRI of the same knee obtained approximately 4.5 years later. Main outcome measures: Annual change in patella cartilage volume, and annual percentage change over 4.5 years. Results: After adjusting for age, gender, BMI and patella bone volume at baseline, cartilage change was observed at the rate of 2.5% (95% confidence interval, 2.0, 3.0) per annum over 4.5 years. Cartilage was lost at a higher rate in women compared to men after accounting for age, BMI or bone volume at baseline (3.3% vs. 1.4%, respectively, p =0.03). Increased patella bone volume was associated with increased patella cartilage loss (p =0.02). No measures of radiographic severity of disease affected change in cartilage volume. Conclusions: The increased rate of cartilage loss in women may contribute to the increased prevalence of disease, although the underlying mechanism requires further study. Increased patella bone volume was also associated with increased patella cartilage loss. Whether this is due to biomechanical factors will need to be determined. [ABSTRACT FROM AUTHOR]