Does levator avulsion cause distension of the genital hiatus and perineal body?

Introduction and hypothesis

Levator avulsion is associated with prolapse and prolapse recurrence after reconstructive surgery. We set out to determine whether clinical measurement of the genital hiatus and the perineal body (gh + pb) on maximum Valsalva can predict levator avulsion.

Methods

A total of 295 women attending a tertiary referral service underwent 4D translabial ultrasound imaging and clinical examination using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification system (POP-Q). Analysis of ultrasound data sets for levator avulsion was performed using tomographic ultrasound imaging. The predictive performance of gh + pb for avulsion was tested using receiver-operating characteristic curves.

Results

Optimal sensitivity [70 %, 95 % confidence interval (CI) 59–79 %] and specificity (70 %, 95 % CI 66–72 %) were achieved with a cut-off of 8.5 cm for gh + pb.

Conclusions

A gh + pb measurement ≥ 8.5 cm may help to identify women with levator avulsion who are at increased risk of prolapse recurrence.     

Increased Use of Partial-Breast Irradiation Has Not Improved Radiotherapy Utilization for Early-Stage Breast Cancer

Background

Radiotherapy (RT) reduces local recurrence after breast-conserving surgery (BCS) for breast cancer, but under-utilization of RT has been reported. Accelerated partial-breast irradiation (PBI) improves RT accessibility, but it is uncertain if this has improved RT utilization.

Methods

The Surveillance, Epidemiology and End Results registry was used to identify women who underwent BCS for stage 0 or 1 breast cancer from 2000 to 2009. Temporal trends in RT utilization and RT modality were determined. Chi-square analysis and multivariate logistic regression identified predictors of RT utilization and modality.

Results

Of 180,219 study patients, 131,343 (73 %) received RT; 123,703 (94 %) of RT recipients received whole-breast irradiation (WBI) and 6,251 (5 %) received PBI. PBI rates increased dramatically during the study period (0.32 % in 2000 vs. 6.5 % in 2009), but overall RT utilization remained relatively stable because of a decline in WBI (69.8 % in 2000 vs. 62.4 % in 2009). RT utilization was unchanged in rural counties, and declined for women <40 and ≥70 years of age, and for Native American, Asian and Hispanic patients. White and Black women used PBI most frequently (4 % each) and were the only race groups with improved RT utilization over time. Predictors of RT usage included age, race, marital status, tumor size, grade, hormone receptor status, lymph node evaluation, geographic region, metropolitan status, education, and employment status.

Conclusions

Women who undergo RT are opting for PBI more frequently, but the increased use of this modality has not improved overall RT utilization for patients with early-stage breast cancer.     

Breast-Conserving Surgery With or Without Radiotherapy in Older Breast Patients With Early Stage Breast Cancer: A Systematic Review and Meta-analysis

Background

In early stage breast cancer, radiotherapy is an integral part of locoregional treatment with breast-conserving surgery. However, few older patients are included in the clinical trials upon which these recommendations are based. Therefore, we performed a systematic review and meta-analysis to evaluate outcomes of radiotherapy after breast-conserving surgery in older patients.

Methods

A systematic search of PubMed and Embase was undertaken. Inclusion was restricted to randomized controlled trials in postmenopausal breast cancer patients. Pooled odds ratios were calculated for locoregional recurrence, distant recurrence, and overall survival.

Results

We included 5 randomized clinical trials comprising 3,190 patients. Overall, 39 % of the patients were ≥70 years old, and most had hormone receptor–positive T1 tumors without nodal involvement. All patients received adjuvant systemic therapy. Patients who received radiotherapy had a lower relative risk of locoregional recurrence (pooled odds ratio [OR] 0.36; 95 % confidence interval [CI] 0.25–0.50). The 5-year absolute risk was 2.2 % (95 % CI 1.6–3.1) among patients who received radiotherapy, versus 6.5 % (95 % CI 5.3–7.9) among patients who did not. The absolute risk difference was 4.3 % (95 % CI 2.9–5.7), corresponding with a number needed to treat of 24. No differences were observed for distant recurrence or overall survival.

Conclusions

Although patients who received radiotherapy had a lower relative risk of locoregional recurrence, the absolute risk was low, and overall survival was not affected. We propose that the debate should not only focus on the relative risk but also on the absolute benefit of radiotherapy and the number needed to treat. Both treatment options may be reasonable in clinical practice.     

Illness-Related Distress in Women with Clinically Localized Cutaneous Melanoma

Background

Women may experience distress or changes in their quality of life following treatment for early-stage melanoma. In order to plan future interventions and identify areas of primary concern, we conducted a cross-sectional survey to describe the experiences of women treated for clinically localized melanoma.

Methods

We examined quality of life, levels of distress, appearance perceptions, body image, fear of recurrence, and reproductive concerns in 100 patients (age 21–90 years, M = 54.34 years). Most (61 %) had melanoma of the extremity, with a median depth of 1.1 mm (range, 0–10.5 mm).

Results

Significant depressive symptomatology occurred in 10 % of patients, and 12 % reported a clinically established high level of intrusive thoughts related to melanoma. Quality-of-life scores indicated more disruption on psychological, compared with social and physical functioning. Also, 64 % of women rated their appearance as worse post-treatment; 23 % were unsatisfied with the appearance of the surgical site. Recurrence concerns indicated significant worry about health and death. Most patients (>85 %) were not concerned about fertility, but 52 % worried that future children would have an increased risk of cancer.

Conclusions

Some women treated for clinically localized melanoma reported high levels of distress associated with their altered body image and fear of recurrence. Improvements in patient education prior to surgical intervention may reduce the distress associated with the diagnosis and treatment of melanoma.     

Is Perineural Invasion More Accurate Than Other Factors to Predict Early Recurrence after Pancreatoduodenectomy for Pancreatic Head Adenocarcinoma?

Background

Some patients operated by pancreaticoduodenectomy for resectable pancreatic head adenocarcinoma will present with a recurrence during the first year (early recurrence).

Objective

The aim of this study was to determine prognostic factors associated with early recurrence in a large retrospective study.

Methods

From January 1995 to November 2010, all patients operated by pancreaticoduodenectomy for pancreatic head adenocarcinoma in our institution were retrospectively included. Univariate and multivariate analyses were performed to determine factors associated with early recurrence.

Results

A total of 166 patients were included; 57 patients (34 %) developed early recurrence. In univariate analysis, factors associated with early recurrence were perineural invasion (p = 0.0002), preoperative bilirubin (p = 0.01), lymph node ratio (LNR) ≥0.2 (p = 0.009), and T stage (p = 0.02). In multivariate analysis, perineural invasion (odds ratio [OR] 3.31; 95 % confidence interval [CI] 1.42–7.72; p = 0.005), LNR ≥0.2 (OR 2.55; 95 % CI 1.17–5.52; p = 0.02), and preoperative bilirubin (OR 1.04; 95 % CI 1.01–1.07; p = 0.03) were independent factors associated with early recurrence. Perineural invasion was also associated with poor overall survival (p = 0.001) and poor disease-free survival (p = 0.07).

Conclusion

In our study, perineural invasion (OR 3.31) is more accurate than T stage and lymph node status (OR 2.55) to predict early recurrence after pancreatoduodenectomy for pancreatic head adenocarcinoma.     

A Meta-analysis of the Effect of Prophylactic Central Compartment Neck Dissection on Locoregional Recurrence Rates in Patients with Papillary Thyroid Cancer

Background

It is not known whether prophylactic central compartment neck dissection (pCCND) in conjunction with total thyroidectomy decreases rates of locoregional recurrence in patients with papillary thyroid cancer (PTC).

Methods

A meta-analysis was performed of reported recurrence rates of clinically node-negative PTC in patients treated with total thyroidectomy (TT) alone, or TT and pCCND. The primary outcome was locoregional recurrence of PTC.

Results

Eleven studies capturing 2,318 patients met the inclusion criteria. Overall, the recurrence rate for patients undergoing TT/pCCND was 3.8 % [95 % confidence interval (CI) 2.3–5.8]. In the six comparative studies, which included 1,740 patients, 995 patients undergoing TT and 745 patients undergoing TT/pCCND, the overall recurrence rate was 7.6:7.9 % in the TT group and 4.7 % in the TT/pCCND group. The relative risk of recurrence was 0.59 (95 % CI 0.33–1.07), favoring a lower recurrence rate in the TT/pCCND arm. The number of patients that would need to be treated (NNT) in order to prevent a single recurrence is 31. The relative risk for permanent hypocalcemia was 1.82 (95 % CI 0.51–6.5) and for permanent recurrent laryngeal nerve injury was 1.14 (95 % CI 0.46–2.83).

Conclusions

There was no difference in recurrence or long-term complication rates between patients undergoing TT or TT/pCCND. There was a trend toward lower recurrence rates in TT/pCCND patients, with a NNT of 31 patients. On the basis of these data, routine pCCND might be considered in the hands of high-volume surgeons treating patients with clinically node-negative PTC.     

Locoregional Recurrence Following Accelerated Partial Breast Irradiation for Early-Stage Invasive Breast Cancer: Significance of Estrogen Receptor Status and Other Pathological Variables

Background

Understanding risk factors for locoregional recurrence (LRR) after accelerated partial breast irradiation (APBI) can help to guide patient selection for treatment with APBI. Published findings to date have not been consistent. More data are needed as these risk factors continue to be defined.

Methods

A total of 277 women with early-stage invasive breast cancer underwent lumpectomy and were treated adjuvantly at our institution with APBI using high-dose rate brachytherapy. APBI was delivered using multicatheter interstitial brachytherapy (91 %) or single-entry catheter brachytherapy (9 %) to a dose of 32–34 Gy in 8–10 twice daily fractions. Failure patterns and risk factors for recurrence were analyzed.

Results

With a median follow-up of 61 months, the 5-year locoregional control rate was 94.4 %. Negative estrogen receptor (ER) status was strongly associated with LRR on multivariate analysis (p < 0.005). Lobular histology, the presence of an extensive intraductal component, and lymphovascular invasion also were significant but to a lesser degree than ER-negative status. Patients with multiple risk factors were at highest risk for LRR. Age was not significantly associated with increased risk for LRR.

Conclusions

The presence of specific pathological features, particularly ER negative status, was associated with increased risk of LRR in this cohort of women treated with APBI. Further investigation is warranted to determine whether patients with adverse pathological risk factors are at higher risk of LRR after APBI than after conventional whole breast irradiation (WBI), as these same features also may place women at risk for LRR after WBI.     

Transanal endoscopic microsurgery for rectal tumors: experience at Korea’s National Cancer Center

Background

Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to transanal excision, enabling complete local excision of selected benign or malignant rectal tumors. This study aimed to determine the surgical and oncologic results for rectal tumors excised by TEM.

Methods

From November 2001 to October 2007, 45 patients underwent TEM for excision of adenoma (13 patients), carcinoid tumor (6 patients), and carcinoma (26 patients). The patients included 27 men and 18 women with a median age of 52 years (range, 22–72 years).

Results

The median tumor distance from the anal verge was 7 cm (range, 3–15 cm), and the median tumor size was 17 mm (range, 2–60 mm). There was no procedure-related morbidity or mortality. However, one patient with rectal carcinoma died of lung cancer during the follow-up period. Of 13 patients with adenomas, 1 patient (7.7%, 1/13) experienced local recurrence 5 months after surgery. No recurrence occurred for six patients with carcinoid tumors. Histologic examination of the carcinomas showed pathologic tumor (pT) stage 0 (ypT0) in 2 patients, pT1 in 17 patients (including ypT1 in 1 patient), pT2 in 6 patients, and pT3 in 1 patient. Immediate salvage surgery was performed for five patients (19%, 5/26). During a median follow-up period of 37 months (range, 5–72 months), one patient (3.8%, 1/26) experienced local recurrence. The overall and disease-free 5-year survival rates for patients with carcinoma were 96.2% and 88.5%, respectively.

Conclusions

The TEM procedure is a safe and appropriate surgical treatment option for benign rectal tumors. With strict patient selection, it is oncologically safe for early-stage rectal carcinomas.     

Survival After Recurrent Esophageal Carcinoma Has Not Improved Over the Past 18 Years

Background

Numerous patients will develop recurrent disease after esophagectomy for esophageal carcinoma (EC). In literature, survival after recurrent EC is poor with 6–8 months. In these studies, diagnostic imaging during follow-up (FU) is routinely performed. In the Netherlands, routine imaging is not part of FU and only performed on indication. The aim of this study was to determine survival after diagnosis of recurrent disease in patients after esophagectomy without routine imaging during FU.

Methods

All EC patients who underwent esophagectomy between 1993 and 2010 were included and followed for clinical evidence of recurrent EC. Location, symptoms, diagnosis, and treatment of recurrent disease were registered. Pattern of recurrence was compared between patients who underwent neoadjuvant therapy and patients who underwent surgery alone. Survival after detection of recurrence was determined in all patients and related to the year of surgery.

Results

A total of 493 of 1,088 patients (45 %) who underwent esophagectomy between 1993 and 2010 developed recurrent disease. Median interval between esophagectomy and recurrence was 10.5 months. Within the first 2 years after surgery, 33 % of patients developed recurrent EC. The majority of patients (51 %) were diagnosed with distant metastases. Locoregional recurrence occurred significantly less often among patients who underwent neoadjuvant therapy (6 vs 16 %, p = .017). Median survival after diagnosis of recurrent disease was 3 months. No relation was observed between the year of surgery and survival after recurrent disease (p = .931).

Conclusions

Survival after recurrent EC in patients who undergo FU without routine imaging after esophagectomy is approximately 3 months and has not improved over the past 18 years.     

PSA-nadir at 1 year as a sound contemporary prognostic factor for low-dose-rate iodine-125 seeds brachytherapy

Objectives

To identify predictors of outcomes in patients with localized prostate cancer treated with iodine-125 brachytherapy in a longitudinal uncontrolled study.

Methods

Between 2000 and 2011, 560 histologically confirmed patients were treated with brachytherapy of whom 305 with ≥24-month follow-up and localized tumor were evaluated after exclusion of those locally advanced and under androgen ablation.

Results

Patients’ mean age was 63.93 years (44–88), mean pretreatment prostate-specific antigen (PSA) was 6.34 ng/mL (0.67–33.09), overall median follow-up was 75.35 months (24–158.37), biochemical recurrence occurred in 17 patients (5.57 %), cancer-specific survival was 100 %, and overall survival was 98.03 %. At multivariate analyses, only PSA-nadir at 1 year and age were related to disease-free survival: To each unit of PSA-nadir, the risk increases 87.3 %—OR 1.87 (p < 0.001; 95 % CI 1.31–2.67), and risk was 4.7 times higher for those under 50 years (vs. >70)—OR 4.69 (p = 0.04; 95 % CI 1.39–18.47). Best cutoff for PSA-nadir at one year was 0.285 (AUC = 0.78; p < 0.001; 95 % CI 0.68–0.89). Kaplan–Meier analysis confirmed PSA-nadir (p < 0.001) as prognostic, while D’Amico’s classification failed (p = 0.24). No grade 3 or 4 complication was reported, and only 31.4 % of patients had grade 2 urinary or rectal toxicity. PSA bounce ≥0.4 ng/mL occurred in 18.4 % with no impact on biochemical recurrence.

Conclusions

Half (50.49 %) of patients in the scenario of localized prostate cancer treated with iodine-125 brachytherapy reach PSA-nadir at 1 year <0.285, recognized as a key independent prognostic factor.

Graphical Abstract

[Receiver Operating Characteristic curve analysis for PSA-nadir at 1 year]      

Outcome Analyses of Unusual Site Neck Recurrence in Oral Cavity Cancer

Aim

To understand the frequency, clinical significance, and benefits of salvage therapy in oral cavity squamous cell carcinoma (OSCC) patients with regional nodal recurrence at unusual sites (prelaryngeal area, parotid area, and retropharyngeal area).

Methods

We examined 178 patients with neck recurrence at levels I–V (usual group) and 26 patients outside levels I–V (unusual group). The 5-year survival rates served as the main outcome measure.

Results

Of the 26 unusual group patients, the neck recurrence sites were as follows: 5 at the prelaryngeal area, 13 at the parotid area, and 8 at the retropharyngeal area. Multivariate analyses demonstrated that poor differentiation, pN2, extracapsular spread (ECS), tumor depth ≥10 mm, relapse time ≤10 months, local recurrence, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year disease-specific survival (DSS), whereas pN2, ECS, tumor depth ≥10 mm, relapse time ≤10 months, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year overall survival (OS). The 6-month and 18-month survival rates after the N-relapse date for the salvaged-usual group, the salvaged-unusual group, and the nonsalvaged patients were 73 %/46 %, 40 %/0 %, and 10 %/0 % (P < 0.0001), respectively [DSS: salvaged-unusual group (hazard ratio/95 % confidence interval), 2.060/1.058–4.008, P = 0.033; salvaged-usual group, 6.420/4.340–9.496, P < 0.001; OS: salvaged-unusual group, 2.100/1.080–4.081, P = 0.029; salvaged-usual group, 6.514/4.418–9.606, P < 0.001].

Conclusions

Our findings demonstrate that OSCC patients with regional nodal recurrence at unusual sites had poor outcomes.     

Prevalence of renal impairment among osteoporotic women in the USA,NHANES 2005–2008: Is treatment with bisphosphonates an option?

Summary

Bisphosphonates are the first-line treatment for osteoporotic (OP) women; however, therapy is not recommended in severe renal impairment (RI). This study examined RI prevalence among OP women. Nearly a quarter of women had moderate RI, and 3.59 % would not be recommended for bisphosphonates, demonstrating a need for better therapeutic alternatives.

Introduction

Bisphosphonates are the recommended first-line treatment for postmenopausal women with OP. However, bisphosphonates are cleared through the kidney, and therapy is not recommended in severe RI due to adverse treatment effects observed with intravenous formulations. The objective of this study was to examine the prevalence of RI among women with OP aged ≥50 years in the USA.

Methods

Women with OP aged ≥50 years were identified using the 2005–2008 National Health and Nutrition Examination Survey (NHANES) data. OP was defined as prior OP diagnosis, previous hip or spine fracture, or measured lumbar spine/femoral neck bone mineral density (BMD) T-score <?2.5. The 2005 Modification of Diet in Renal Disease (MDRD) formula was used to calculate the glomerular filtration rate (GFR). Moderate and severe RI was defined as GFR 30–59 and 15–29 mL/min, respectively. Bisphosphonate therapy was considered not recommended among women with OP if GFR was <35 mL/min.

Results

The prevalence of OP among women in USA aged ≥50 years was 27 % (12.7 million). Nearly a quarter of women with OP (23.54?±?2.02 %; 2.9 million) had moderate RI and 1.88?±?0.28 % (230,000) had severe RI. Correspondingly, bisphosphonate therapy would not be recommended for an estimated 439,000 women with OP (3.59?±?0.73 %).

Conclusions

Nearly a quarter of postmenopausal women with OP have moderate RI, and over 3 % would not be recommended for bisphosphonate treatment. These data reveal a need for better therapeutic alternatives that can be used in this patient population.     

Lower urinary tract injuries during hysterectomy in women with a history of two or more cesarean deliveries: a secondary analysis

Introduction and hypothesis

To evaluate lower urinary tract injuries in women with ≥2 prior cesarean deliveries (CD) undergoing benign hysterectomies.

Methods

This is a planned secondary analysis of all hysterectomies performed from 2000 to 2009 at Grady Memorial Hospital. Demographic, operative and postoperative data were reviewed. Women undergoing benign hysterectomies with ≥2 CD were compared with women with no prior CD. Categorical variables were analyzed using Chi-squared or Fisher’s exact test, while Student’s t test was used for continuous variables. Logistic regression was used for multivariate analysis.

Results

2,214 women met the inclusion criteria (284 with ≥2 CD, 1,930 with no CD). The proportion of women having vaginal hysterectomy, abdominal hysterectomy, and laparoscopically assisted vaginal hysterectomy were 38 %, 53 %, and 9 % respectively. Women with multiple CD had greater blood loss and longer operative times. They also required more transfusions (23 % vs 15 %, P?=?0.001) and developed more abdominal wounds (6 % vs 3 %, P?=?0.002) or urinary infections (6 % vs 3 %, P?=?0.03). Women with ≥2 CD were at greater risk of incidental cystotomies (OR: 8.55, 95 % CI: 3.98–18.36).

Conclusions

Multiple prior cesarean deliveries increase a woman’s risk of cystotomy during hysterectomy. They also require more transfusions and develop more urinary or abdominal wound infections.     

Molecular Staging of Surgical Margins in Oral Squamous Cell Carcinoma Using Promoter Methylation of p16INK4A, Cytoglobin, E-cadherin, and TMEFF2

Background

Local recurrence in oral squamous cell carcinoma (OSCC) despite clear surgical margins may indicate the presence of residual, sub-microscopic disease. Molecular assessment of surgical margins may provide a greater prognostic sensitivity compared to histopathology. We aimed to determine whether promoter methylation in deep and mucosal resection margins can predict recurrence in OSCC.

Methods

Forty-eight consecutive OSCC cases were recruited and a 5 mm³ tumor sample plus 5 deep and 5 mucosal margin samples were snap frozen. Clinical, pathological, adjuvant therapy, and outcome data were recorded. Tumors were informative if >5 % promoter methylation was found for ≥1 of 4 genes using qMSP. Margins were declared molecularly positive if >1 % promoter methylation was found in any margin.

Results

Thirty (63 %) of 48 cases were methylation informative. Mucosal margin samples were largely positive for methylation (26 of 30, 87 %), indicating the presence of field cancerization. Methylation at ≥1 gene promoters in ≥1 deep margin correlated with the presence of close/involved mucosal margins (P = 0.027) and increased pT status (P = 0.027) but not the status of deep margins, recurrence, or survival.

Conclusions

The current gene panel did not add prognostic information to histopathological reporting of resection margins. Future efforts should concentrate on improving gene selection, informativity, and assay performance in the patient group with intermediate indications for adjuvant therapy.     

Long-term follow-up of porcine dermis pubovaginal slings

Introduction and hypothesis

Outcomes of xenografts in incontinence surgery are uncommon. Our objective was to report long-term outcomes of women after porcine dermis (PD) bladder neck sling.

Methods

Seventy women completed a mean follow-up of 62.1 months. “Global cure” equaled SEAPI subjective composite = 0 and visual analog score ≥8. “Stress urinary incontinence (SUI) cure” equaled SEAPI-subjective (S) subset = 0 and negative cough stress test.

Results

The SUI cure rate was 42.9 % and global cure rate was 11.4 %. Perioperative complications were seen in <10 % of women. The mean time to SUI recurrence was 10.4 months, with 30 of 40 women redeveloping SUI <12 months after sling. Twenty women (28.6 %) have since undergone additional anti-incontinence procedures. There was a significant postoperative improvement in SEAPI scores, daily pad use, and quality of life (QOL) indices.

Conclusions

At long-term follow-up, PD is not a durable material in sling surgery. Although QOL generally improves after surgery, most SUI recurrences occurred soon after surgery.     

Is lower income associated with an increased likelihood of qualification for treatment for osteoporosis in Canadian women?

Summary

We examined whether low income was associated with an increased likelihood of treatment qualification for osteoporotic fracture probability determined by Canada FRAX in women aged ≥50 years. A significant negative linear association was observed between income and treatment qualification when FRAX included bone mineral density (BMD), which may have implications for clinical practice.

Introduction

Lower income has been associated with increased fracture risk. We examined whether lower income in women was associated with an increased likelihood of treatment qualification determined by Canada FRAX®.

Methods

We calculated 10-year FRAX probabilities in 51,327 Canadian women aged ≥50 years undergoing baseline BMD measured by dual energy x-ray absorptiometry 1996–2001. FRAX probabilities for hip fracture ≥3 % or major osteoporotic fracture (MOF) ≥20 % were used to define treatment qualification. Mean household income from Canada Census 2006 public use files was used to categorize the population into quintiles. Logistic regression analyses were used to model the association between income and treatment qualification.

Results

Percentages of women who qualified for treatment based upon high hip fracture probability increased linearly with declining income quintile (all p trend <0.001), but this was partially explained by older age among lower income quintiles (p trend <0.001). Compared to the highest income quintile, women in the lowest income quintile had a greater likelihood of treatment qualification based upon high hip fracture probability determined with BMD (age-adjusted odds ratio [OR], 1.34; 95 % confidence intervals (CI), 1.23–1.47) or high MOF fracture probability determined with BMD (age-adjusted OR, 1.31; 95 % CI, 1.18–1.46). Differences were nonsignificant when FRAX was determined without BMD, implying that BMD differences may be the primary explanatory factor.

Conclusions

FRAX determined with BMD identifies a larger proportion of lower income women as qualifying for treatment than higher income women.     

The association between higher serum ferritin level and lower bone mineral density is prominent in women ≥45 years of age (KNHANES 2008–2010)

Summary

Data gathered from a nationally representative cohort demonstrate that higher serum ferritin levels are significantly associated with lower bone mass at various skeletal sites and the increased prevalence of osteoporosis and fractures, especially in women ≥45 years of age.

Introduction

Despite extensive in vitro and in vivo studies showing the detrimental effects of iron on bone metabolism, the clinical studies relating to osteoporosis-related phenotypes have not been evaluated extensively. In the present study, we investigated and compared the association between serum ferritin and bone mineral density (BMD), depending on the stratified age groups in both genders.

Methods

This is a population-based, cross-sectional study from the Korea National Health and Nutrition Examination Surveys, including 14,017 Koreans (6,817 men and 7,200 women) aged 10–80 years. BMD was measured using dual X-ray absorptiometry, and osteoporosis was diagnosed by the World Health Organization definition.

Results

Initially, we divided the subjects into three age groups, based on the patterns of age-related BMD changes in this national cohort (i.e., ≤24, 25–44, and ≥45 years old). Serum ferritin concentrations were inversely associated with BMD values at all measured sites after adjustment for confounders, only in women ≥45 years of age (P?=?0.041 to <0.001). Furthermore, when we divided these women into serum ferritin quartiles, the odds for prevalent osteoporosis and fractures were 1.55-fold (95 % CI?=?1.09–2.23) and 1.52-fold (95 % CI?=?1.02–2.27) higher, respectively, in subjects in the highest quartile compared with those in the lowest quartile.

Conclusions

These results provide the first clinical evidence that the associations between serum ferritin level and bone parameters could be the most prominent in women ≥45 years of age.     

Epidemiology of distal forearm fractures in Austria between 1989 and 2010

Summary

Only few studies have been published hitherto on country-specific incidence of distal forearm fracture. In the prevailing study, incidences were estimated, and trend analyses were performed for the entire Austrian population aged ≥50á. Incidence decreased significantly in women, but not in men, over the past 12 years of observation.

Introduction

To estimate incidence of distal forearm fracture and assess incidence trends in the entire Austrian population aged ≥50á from 1989–2010 for inpatient fractures and from 1999 to 2010 for all fractures.

Methods

The number of inpatient forearm fractures was obtained from the Austrian Hospital Discharge Register (AHDR) for the entire population aged ≥50á from 1989 to 2010. Total number of distal forearm fractures was modeled using patient-level data on 36,327 patients with distal forearm fractures. Crude and age-standardized incidence rates (cases per 100,000) were estimated in 5-year age intervals. To analyze the change in incidence over time, average annual changes expressed as incidence rate ratios (IRR) were calculated.

Results

For all distal forearm fractures, age-standardized incidence in women in 1999 and 2009 were estimated at 709 (95 % CI 675–743) and 607 (578–637), respectively. The age-standardized incidences in men the same years were estimated at 171 (156–185) and 162 (151–174), respectively. IRR analyses showed a significant decrease in women (?1.1 %, p?p?>?0.05) over the last 12 years (1999–2010).

Conclusion

Incidence of distal forearm fracture in the entire Austrian population is comparable to hip fracture incidence which is known to be among the highest worldwide. However, trend analyses reveal a significant decrease for all distal forearm fractures in women, but not in men, over the last 12 years.