Vertebral fracture assessment in Moroccan women: Prevalence and risk factors

Introduction

Vertebral fracture assessment (VFA) is a fast, low-radiation technique which produces images that are of sufficient quality to be used to diagnose the presence of vertebral deformity consistent with fracture.

Objective

To study prevalence and risk factors of vertebral fractures using VFA in asymptomatic Moroccan women.

Methods

The study cohort consists of a population of 328 consecutive women aged over 50 (mean age, weight and BMI of 65 ± 6.5 (50–84) years, 72.0 ± 12.8 (42–125) and 29.4 ± 5.0 (17.1–45.8) kg/m², respectively). Lateral VFA images and scans of the lumbar spine and proximal femur were obtained by two technologists using a GE Healthcare Lunar Prodigy densitometer. Vertebral fractures were defined using a combination of Genant semiquantitative (SQ) approach and morphometry.

Results

68% of vertebrae from T4–L4 and 75% from T8–L4 were adequately visualized on VFA. Vertebral fractures (grades 2 or 3) were detected in 25.6% (84/328) of these women. Thirty-two of women with VFA-identified fracture (38.0%) had only a single vertebral fracture, while the other 61.9% had two or more. Fractures were most common in the mid-thoracic spine and at the thoraco-lumbar junction. As would be expected, the prevalence of VFA-detected fractures increased with age and as BMD declined. Stepwise regression analysis showed that presence of vertebral fracture was mainly related to the spine osteoporotic status, age older than 65, history of peripheral fracture and more than six parities.

Conclusion

Vertebral fractures are common in asymptomatic Moroccan women and are related to age, low BMD, history of fracture and multiparity.     

Prevalence, 1-year incidence and factors associated with urinary incontinence: a population based study of women 50–74 years of age in primary care

Objectives: To study prevalence, incidence, remissions and factors associated with urinary incontinence in women 50–74 years of age. Methods: Cross-sectional study of prevalence and associated factors and a 1-year prospective study of incidence and remissions. A random sample of 698 women were invited for a gynecological examination in general practice in three municipalities in Northern Norway in 1994–1995. Five hundred and seven (73%) met for the first consultation, 489 of them for the second one. Questionnaires were answered by women and doctors during consultations at inclusion and 1 year later. Prevalence was estimated at three levels of evidence. Results: Any leakage was reported by 47% and regularly by 31%. For 19%, leakage was objectively demonstrated and claimed to be a social or hygienic problem. Incontinence was associated with high body weight, with poor ability to contract pelvic floor muscles and with previous gynecological operations excluding hysterectomy. Three women (0.6%) developed regular incontinence during the year of investigation. There was no convincing case of spontaneous remission. Conclusion: Urinary incontinence is very frequent in women aged 50–74 years and about one in five are potential patients needing treatment. Urinary incontinence is an enduring condition with little tendency for remission without treatment.     

PKP治疗骨质疏松性椎体压缩骨折疗效分析

目的总结经皮椎体后凸成形术(Percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折的临床疗效。方法收集2009年08月~2013年08月泰州市中医院骨科采用PKP治疗的72例(80个椎体)患者资料;采用疼痛视觉模拟评分(Visual analogue scale,VAS)进行手术前后疼痛评估,观察Cobb角变化及并发症情况。结果术后随访1年以上;所有病例疼痛症状均缓解,VAS评分术前(8.0±0.82)分、术后(3.7±0.66)分,差异有统计学意义(0.05);Cobb角术前为(23.49±12.75)°,术后(10.35±5.57)°,差异均有统计学意义(0.05);本组病例手术均获得成功,12例患者出现骨水泥渗漏,8例渗漏到椎体旁,未出现椎体后缘渗漏,均未出现神经症状;相邻椎体骨折2例,伤椎再骨折3例。结论 PKP治疗骨质疏松性椎体压缩骨折可快速有效地缓解患者疼痛、恢复病椎高度,术中术后并发症发生率低。     

Interest of biochemical markers of bone turnover for long-term prediction of new vertebral fracture in postmenopausal osteoporotic women

Objective: To analyse the interest of baseline levels and short-term (3-months) changes in serum osteocalcin (BGP), serum bone-specific alkaline phosphatase (BALP) and urinary C-telopeptide of type I collagen/creatinine ratio (U-CTX) to predict 3-years changes in bone mineral density (BMD) and spinal deformity index (SDI) in postmenopausal osteoporotic women. Methods: Data were derived from a cohort of 603 osteoporotic women corresponding to the placebo arm of a 3-years prospective, double-blind study. Results: Baseline values of BALP, BGP and U-CTX were negatively and significantly correlated with baseline spinal BMD. Significant correlations were also observed between the changes in BMD observed after 36 months at the spine and baseline BALP (r=0.20, P=0.0001), BGP (r=0.09, P=0.05) and U-CTX (r=−0.11, P=0.02). At 3 years, 71 women (15.9%) showed an increase in their SDI, corresponding to the occurrence of at least one new vertebral deformity. Baseline values of the four bone turnover markers (BTM) were not significantly related to the occurrence of new vertebral deformities. However, when considering the changes in the BTM observed after 3-months of follow-up, BGP (P=0.003) and U-CTX (P=0.047) were identified as significant predictors of an increase of SDI. The associated odds ratios (95% confidence interval (CI)) were 10.922 (2.218–53.78) for unit changes of log BGP and 1.369 (1.003–1.867) for unit changes of log U-CTX. The relative risk (RR) (IC 95%) of having a new vertebral fracture over 36 months was 0.31 (0.15–0.65) when being in the lowest quartile of 3-months changes in BGP as compared with the highest. Conclusion: We conclude that two sequential measurements of BGP and U-CTX performed at 3-months intervals could be of interest to identify postmenopausal osteoporotic women with the highest risk to present new vertebral deformities.     

Influence of parity on bone mineral density and peripheral fracture risk in Moroccan postmenopausal women

The aims of the study were to determine: (1) the relationship between parity and bone mineral density (BMD); (2) the relationship between parity and osteoporotic peripheral fractures.

Material and methods

The group studied included 730 postmenopausal women. Patients were separated into four groups according to the number of fullterm pregnancies, group 1: nulliparae, group 2: one to three pregnancies, group 3: four to five pregnancies, and group 4: six and more pregnancies. Additionally, patients were separated into three groups according to their ages, as <50 years, 50–59 years and ≥60 years.

Results

The median parity was 4 [0–20]. All the patients with parity greater than six had spine and hip BMD values significantly lower than values in the other groups (p < 0.001). After adjustment for age and body mass index (BMI), decreased lumbar and total hip BMD were still associated to increased parity (analysis of covariance (ANCOVA), p = 0.04 and 0.023, respectively). The relation between parity and lumbar BMD was highly significant among women aged <50 years (age-adjusted p = 0.022), while there was no parity-spine BMD association in the other age groups. The relation between parity and hip BMD was seen only in the group 50–59 years (age-adjusted p = 0.042). A positive history for peripheral fractures was present in 170 (23%) patients. There was relationship between parity and peripheral fractures neither in the whole population nor in the sub-groups according to age.

Discussion

The present study suggests that the BMD of the spine and hip decreases with an increasing number of pregnancies, and this situation shows variations in different age groups. However, there was no correlation between parity level and peripheral fractures.     

Vitamin D insufficiency: A risk factor to vertebral fractures in community-dwelling elderly women

Objective

To determine the risk factors for the presence of moderate/severe vertebral fracture, specifically 25-hydroxyvitamin D (25-OHD).

Study design

Cross-sectional study conducted for 2 years in the city of São Paulo, Brazil including community-dwelling elderly women.

Methods

Bone mineral density (BMD), serum 25-OHD, intact parathyroid hormone (iPTH), calcium and estimated glomerular filtration rate (eGFR) were examined in 226 women without vertebral fractures (NO FRACTURE group) and 189 women with at least one moderate/severe vertebral fracture (FRACTURE group). Vertebral fracture assessment (VFA) was evaluated using both the Genant semiquantitative (SQ) approach and morphometry.

Results

Patients in the NO FRACTURE group had lower age, increased height, higher calcium intake, and higher BMD compared to those patients in the FRACTURE group (p < 0.05). Of interest, serum levels of 25-OHD in the NO FRACTURE group were higher than those observed in the FRACTURE group (51.73 nmol/L vs. 42.31 nmol/L, p < 0.001). Reinforcing this finding, vitamin D insufficiency (25-OHD < 75 nmol/L) was observed less in the NO FRACTURE group (82.3% vs. 93.65%, p = 0.001). After adjustment for significant variables within the patient population (age, height, race, calcium intake, 25-OHD, eGFR and sites BMD), the logistic-regression analyses revealed that age (OR = 1.09, 95% CI 1.04–1.14, p < 0.001) femoral neck BMD (OR = 0.7, 95% CI 0.6–0.82, p < 0.001) and 25-OHD <75 nmol/L (OR = 2.38, 95% CI 1.17–4.8, p = 0.016) remains a significant factor for vertebral fracture.

Conclusion

Vitamin D insufficiency is a contributing factor for moderate/severe vertebral fractures. This result emphasizes the importance of including this modifiable risk factor in the evaluation of elderly women.     

经皮椎体成形术与经皮椎体后凸成形术治疗重度骨质疏松性椎体压缩骨折的疗效

目的 比较经皮椎体成形术与经皮椎体后凸成形术治疗重度骨质疏松性椎体压缩骨折的临床疗效。方法 选择2018年4月~2019年4月在南昌市新建区人民医院治疗的58例重度骨质疏松性椎体压缩骨折患者,采用随机数字表法分为对照组和观察组,各29例。对照组采用经皮椎体成形术治疗,观察组采用经皮椎体后凸成形术治疗,比较两组手术指标（手术时间、注入骨水泥量、受伤椎体增加高度）疼痛评分、椎体前缘高度、Cobb角、椎管侵占率、并发症发生情况。结果 观察组手术时间、注入骨水泥量、受伤椎体增加高度均大于对照组（P＜0.05）;术后两组VAS评分均低于术前,且观察组与对照组比较,差异无统计学意义（P＞0.05）;术后两组Cobb角、椎管侵占率均低于术前,且观察组低于对照组（P＜0.05）;观察组并发症发生率为6.90%,低于对照组的20.69%（P＜0.05）。结论 经皮椎体后凸成形术治疗重度骨质疏松性椎体压缩骨折疗效良好,在纠正椎体畸形,恢复椎体高度,缓解疼痛方面更优。     

Identification of the risk factors for osteoporosis among postmenopausal women

ObjectivesThe aim of this study was to determine the effect of different durations of menopause at the time of bone mineral density (BMD) measurement and of different age at menopause intervals on the prevalence of osteopenia and osteoporosis among untreated postmenopausal women. We also assessed related factors leading to low BMD.MethodsA total of 2769 postmenopausal women who had not taken any anti-osteoporosis treatment and/or hormone replacement therapy were divided into three groups according to duration of menopause at the time of BMD measurement. The women were also evaluated in four different age groups according to their age at menopause onset. Multinomial logistic regression analysis was used to determine related factors leading to low BMD. Investigated parameters include demographic characteristics, plasma glucose, lipids, and lipoproteins.ResultsAccording to World Health Organization (WHO) criteria, among 2769 patients, 449 (16.2%) were identified as having osteoporosis, 1085 (39.2%) as having osteopenia, and 1235 (44.6%) as having normal BMD. Osteoporosis was determined in 10.6% and 16.2% of women with menopause duration of 0–3 years and 4–7 years, respectively, whereas this rate was 31.9% in women with menopause duration of over 7 years (p = 0.001). The percentages for osteopenia remained constant among the three different menopause durations (0–3 years: 37.2%, 4-7 years: 42.1%, and >7 years: 40.9%). Thirty percent of women with age at onset of <40 years were osteoporotic. However, the percentages of women with osteoporosis among the other age groups were similar (40–46 years: 18.3%, 47–52 years: 14.1%, and >52 years: 15.4%). The percentages for osteopenia remained relatively constant among the four age groups (36.7, 40, 39.1 and 39%). According to the multinomial logistic regression analysis, duration of menopause at the time of BMD test and parity were positively correlated with both osteoporosis and osteopenia, while glucose level was negatively correlated with both osteoporosis and osteopenia. Age at menopause was negatively correlated only for osteoporosis. Low-density lipoprotein cholesterol (LDL-c) level may be accepted as a clinically significant factor for osteopenia (OR: 1.01; CI_95%: 1.00–1.02). No differences were determined in the prevalence of osteopenia and osteoporosis in women with menopause duration of >7 years when evaluated according to the four menopause age groups as described before (p = 0.74). Contribution to the regression model was 0.8% by age at menopause, 5.6% by menopause duration at time of BMD measurement, 5.8% by both factors.ConclusionAccording to our results, osteoporosis is related more to the duration of menopause at the time of BMD measurement rather than the age at menopause among untreated postmenopausal women. High parity was determined as another risk factor for low BMD.     

A clinical predictive score for mood disorder risk in low-income primary care settings

Background

Despite availability of validated screening tests for mood disorders, busy general practitioners (GPs) often lack the time to use them routinely. This study aimed to develop a simplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings.

Methods

In a cross-sectional study, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tools for mood disorders: the Patient Health questionnaire (PHQ-9) and the Mood Disorder Questionnaire (MDQ). To determine participants’ current-point mood disorder status, trained clinicians applied a gold-standard diagnostic interview (SCID-I). A simplified clinical predictive model (CM) was developed based on clinical features and selected questions from the screening tools. Using CM, a clinical predictive score (PS) was developed. Full PHQ-9 and GP assessment were compared with PS.

Results

Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for a simplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic=0.80 [95% CI 0.72, 0.85] vs. 0.58 [95% CI 0.52, 0.62] p-value <0.0001), but not as good as the full PHQ-9 (0.89 [95% CI 0.85, 0.93], p-value=0.03). Compared with GP assessment, PS increased sensitivity by 50% at a fixed specificity of 90%. Administered in a typical primary care clinical population, it correctly predicted almost 80% of cases.

Limitations

Further research must verify external validity of the PS.

Conclusion

An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.     

Panoramic radiomorphometry and vertebral fractures in Spanish postmenopausal women

ObjectiveTo evaluate the relationship between panoramic radiomorphometric indexes, and the presence of osteoporotic fractures in a Spanish postmenopausal women.MethodsA sample of 120 women (60 with fragility spine fractures and 60 healthy), aged 55–70 years, with fragility spine fractures, were included in this cross-sectional study that was conducted from 2008 to 2011. All the women were referred to undergo a radiological spine examination, spinal densitometry and a panoramic radiograph for assessing osteoporosis using 3 radiomorphometric indexes: Panoramic Mandibular Index (PMI), Mental Index (MI) and Mandibular Cortical Index (MCI). According to mandibular cortical shape, in MCI, three groups were defined: C3 (osteoporosis), C2 (osteopenia), C1 (health).ResultsSignificant differences were found between all the MCI groups due to their composition between fractures and non-fractures. C1 group (healthy) has less fractures women than C2 (Bonferroni p < 0.001), C1 has less fractures than C3 (Bonferroni p < 0.001) and finally, C2 has less fractures than C3 (Bonferroni p < 0.006). PMI and MI values were significantly lower in cases than in controls (U Mann–Whitney p < 0.001).ConclusionsPanoramic radiomorphometrics mandibular indexes such as MCI, PMI, and MI, may be useful for identifying the population at higher risk for fracture. The relationship between panoramic index and osteoporosis remains unclear and further studies using fragility fracture as a real marker of osteoporosis are warranted to clarify the exact role and effect of one condition on the other and the corresponding clinical implications.     

Panoramic radiomorphometry and vertebral fractures in Spanish postmenopausal women

Objective

To evaluate the relationship between panoramic radiomorphometric indexes, and the presence of osteoporotic fractures in a Spanish postmenopausal women.

Methods

A sample of 120 women (60 with fragility spine fractures and 60 healthy), aged 55–70 years, with fragility spine fractures, were included in this cross-sectional study that was conducted from 2008 to 2011. All the women were referred to undergo a radiological spine examination, spinal densitometry and a panoramic radiograph for assessing osteoporosis using 3 radiomorphometric indexes: Panoramic Mandibular Index (PMI), Mental Index (MI) and Mandibular Cortical Index (MCI). According to mandibular cortical shape, in MCI, three groups were defined: C3 (osteoporosis), C2 (osteopenia), C1 (health).

Results

Significant differences were found between all the MCI groups due to their composition between fractures and non-fractures. C1 group (healthy) has less fractures women than C2 (Bonferroni p < 0.001), C1 has less fractures than C3 (Bonferroni p < 0.001) and finally, C2 has less fractures than C3 (Bonferroni p < 0.006). PMI and MI values were significantly lower in cases than in controls (U Mann–Whitney p < 0.001).

Conclusions

Panoramic radiomorphometrics mandibular indexes such as MCI, PMI, and MI, may be useful for identifying the population at higher risk for fracture. The relationship between panoramic index and osteoporosis remains unclear and further studies using fragility fracture as a real marker of osteoporosis are warranted to clarify the exact role and effect of one condition on the other and the corresponding clinical implications.     

椎体成形术中明胶海绵填塞治疗椎体前壁破损的 OVCFs的临床疗效观察

目的 分析椎体成形术（PVP）中明胶海绵填塞治疗椎体前壁破损的胸腰椎骨质疏松性骨折（OVCFs）的临床疗效。方法 通过回顾性分析我科2016年1月~2018年10月采用PVP手术治疗老年性OVCFs椎体前壁破裂80例,根据手术方法不同分为明胶绵组和对照组,各40例。明胶体海绵组PVP手术中对椎体前壁破损者联合明胶海绵填塞,对照组行常规PVP手术治疗椎体前壁破损患者。比较两组患者手术时间、单个椎体骨水泥注入量、椎体数、手术前后VAS 评分、ODI指数、椎体前缘高度、Cobb角以及骨水泥前方渗漏率。结果 80例患者均顺利完成手术。两组患者手术时间、单个椎体骨水泥注入量以及椎体数比较,差异无统计学意义（P＞0.05）;两组患者VAS评分、ODI指数、椎体前缘高度和Cobb角手术后比较,差异无统计学意义（P＞0.05）;明胶海绵组术后3 d VAS评分和ODI指数均低于术前[（2.68±1.34）分 vs （7.08±0.61）分,（20.91±6.09）vs（74.59±6.46）],对照组术后3 d VAS评分和ODI指数均低于术前[（2.73±1.28）分 vs （6.81±0.87）分,（21.95±5.20）vs（75.96±5.12）],差异有统计学意义（P＜0.05）。明胶海绵组术后椎体前缘高度大于术前[（22.09±2.41）mm vs （18.05±2.74）mm],Cobb角小于术前[（11.01±2.42）° vs （20.80±5.23）°],对照组术后椎体前缘高度大于术前[（21.81±2.31）mm vs （18.36±2.67）mm],Cobb角小于术前[（12.74±3.06）° vs （22.41±4.48）°],差异有统计学意义（P＜0.05）。明胶海绵组骨水泥前方渗漏率低于对照组（5.00% vs 25.00%）,差异有统计学意义（P＜0.05）。结论 对于椎体前壁破裂者椎体成形术中是否使用明胶海绵填塞与其临床疗效无明显差异,但可有效降低椎体前方骨水泥的渗漏。     

经皮椎体成形术对骨质疏松性椎体压缩骨折患者VAS及ODI评分的影响

目的 探讨经皮椎体成形术对骨质疏松性椎体压缩骨折（OVCF）患者视觉模拟评分法（VAS）评分及脊柱功能障碍指数（ODI）的影响。方法 选择2017年1月~2019年1月在我院进行经皮椎体成形术的OVCF患者63例,评估患者手术前后椎体前部高度、Cobb角、VAS、ODI评分及并发症发生率。结果 术后椎体前部高度及Cobb角均低于术前,差异有统计学意义（P＜0.05）;术后VAS评分及ODI评分均低于术前,差异有统计学意义（P＜0.05）;63例患者术后住院期间均无感染、血管栓塞发生,骨水泥渗漏发生率为9.52%。结论 经皮椎体成形术治疗OVCF效果较好,安全性高,可恢复椎体前部高度,矫正后凸畸形,有效缓解患者疼痛,改善脊椎功能障碍。     

The covariation of multiple risk factors in primary care: a latent class analysis

There is a need to advance the quality of healthcare by increasing knowledge about multiple risk factors and how to intervene to improve health outcomes. In an effort to better describe the presentation of multiple risks, this study involved a database review to describe the prevalence and covariation of multiple risk factors in individuals presenting to primary care. Patients with a primary care encounter from January 1, 2005 to June 30, 2005 (N = 10,043) were identified from the Department of Veteran’s Affair’s medical database and information about the following risk factors was extracted: alcohol use, psychiatric distress, body mass, smoking status, blood pressure, and posttraumatic stress. Exploratory and confirmatory latent class analyses identified three classes of individuals. Class 1 consisted of individuals with an overall lower level of risk for health problems, but a moderately high likelihood of elevated blood pressure. Individuals in Class 2 appeared to have the greatest need for intervention because they had a moderate to high likelihood of reporting at risk alcohol use, smoking, depression, and posttraumatic stress. Class 3 consisted of individuals reporting the co-occurrence of at risk alcohol use, smoking, and elevated blood pressure. Similar to past research, the findings highlight the need for addressing multiple risk factors in primary care. In addition, this study expands on the literature by identifying specific patterns of covariation among different risk factors that suggest avenues for research and program development. All authors have contributed equally to this work.     

Association between depression and bone mineral density in community-dwelling older men and women in Korea

Objectives

Previous research suggested a significant correlation between depression and osteoporosis, but little is known for the elderly Asian population. We investigated an association between depression and bone mineral density (BMD) in the Korean elderly.

Study design

Cross-sectional data analysis of a community-based study, Kangwha Island, South Korea.

Main outcome measures

BMD, measured at the os calcis using a quantitative ultrasound device, was expressed as stiffness index and T-score. Depressive symptoms were evaluated by the Korean version of Beck Depression Inventory (K-BDI). Depression was defined as a K-BDI score of 16 or higher. Participants also completed a questionnaire, including demographic factors, metabolic abnormalities, and health-related lifestyle factors.

Results

A total of 932 local residents (422 men and 510 women) aged 60–80 years completed the questionnaires and baseline BMD evaluation. Men with depression had a significantly lower stiffness index compared to those without depression in an age-adjusted (77.2 ± 5.2 vs. 86.0 ± 1.5, p = 0.002) and a multivariate-adjusted model (78.5 ± 5.2 vs. 85. 9 ± 1.5, p = 0.007). Correspondingly, men with depression had an increased probability of having an osteoporosis (T-score ≤ −2.5) compared to those without depression; the age-adjusted odds ratio was 2.86 (95% CI, 1.36–6.01) and the multivariate-adjusted odds ratio was 2.69 (95% CI, 1.26–5.76). However, no significant association was observed in older women.

Conclusions

Depression was significantly associated with lower BMD in Korean older men, but not in women.     

骨质疏松患者胸腰椎压缩性骨折PKP术后再发骨折的风险因素分析

目的探讨骨质疏松患者胸腰椎压缩性骨折PKP术后再发骨折的风险因素。方法回顾性分析2011年3月~2016年1月于我院因骨质疏松胸腰椎压缩性骨折行PKP术治疗的患者共214例,根据术后随访结果是否发生椎体骨折,分为骨折组和正常组,根据两组患者的一般资料和相关检查结果分析其相关的风险因素。结果共有31例发生椎体骨折,再发骨折的概率为14.5%,年龄(OR:3.512,95%CI:1.452-4.243)、骨密度(OR:4.952,95%CI:1.832-7.523)、手术椎体数(OR:5.642,95%CI:1.677-6.672)、单节骨水泥量(OR:4.576,95%CI:1.434-5.185)、手术前后的高度变化(OR:2.752,95%CI:0.742-3.532)、后凸角变化(OR:3.421,95%CI:0.876-3.014)和骨水泥渗漏(OR:6.562,95%CI:1.522-7.524)均为PKP术后再发骨折的独立风险因素。结论年龄、骨密度、手术椎体数、单节骨水泥量、骨水泥渗漏、手术前后的高度和后凸角变化是PKP术后再发骨折的风险因素。     

Negotiating complementary and alternative medicine use in primary care visits with older patients

Objective

To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits.

Methods

Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning.

Results

Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician–patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment.

Conclusion

Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions.

Practice implications

Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.     

Hip bone mineral density is improved by high-impact aerobic exercise in postmenopausal women and men over 50 years

Fifteen men and women (six men) between the ages of 50 and 73 years were recruited to begin keep-fit classes. They were matched for sex, age, menopausal status and mass to 15 non-exercising controls. The keepfit classes were two to three times a week and included high-impact exercise, including step and jumping exercises specifically to load the proximal femur and spine. Proximal femur, lumbar spine and total body bone mineral density (BMD) were measured at 0 and 12 months. Urinary pyridinoline (Pyr) and deoxypyridinoline (dPyr) crosslinks were measured every 6 months to assess bone resorption. Quadriceps isometric strength was measured every 6 months. BMD increased non-significantly at the femoral neck [1.57 (0.8%] and Wards triangle [1.97 (1.4%], and significantly at the greater trochanter 2.21 (0.9)% (P=0.02) in the exercise group. Femoral neck BMD decreased by −1.9(0.8)% (P=0.049) in the control group, which was significantly different from the change in the exercise group (P=0.009). BMD did not change at the Wards triangle or trochanter in the controls. Lumbar spine BMD did not change in either group. Total body BMD did not change in the exercise group, but decreased by −0.79 (0.3)% (P=0.02) in the controls. Follwing 6 months of the exercise classes, Pyr and dPyr crosslinks were significantly reduced [−19.0 (7.2)%;P=0.0019 and −20.0 (7.7)%;P=0.021 respectively]. There was no significant change in crosslinks after 1 year, and no change at any time in the controls. Quadriceps strength changed by 5.4 (3.7)% in the exercise group and by −6.9 (2.5)% (P=0.01) in the control group after 12 months, being significant between groups (P=0.008). This study suggests that high-impact, aerobic exercise in postmenopausal women and men over 50 years old is feasible and effective at maintaining muscle strength and increasing proximal femur BMD but not spine or total body BMD.