Validity of Self-Reported Diagnosis of Osteoporosis in Japan Nurses’ Health Study

Purpose: Although the validity of self-reported osteoporosis is often questioned, validation studies are lacking. This study was performed to investigate how well self-reported diagnoses of osteoporosis agreed with validated clinical information in young and middle-aged women in the Japan Nurses’ Health Study (JNHS), a nationwide prospective cohort study of nursing professionals. Patients and Methods: Data were reviewed for 15,717 subjects from the combined cohorts of the JNHS and a preceding pilot study (Gunma Nurses’ Health Study). The subjects’ mean age at the baseline (BL) survey was 41.6 ± 8.3 years, and the mean follow-up period was 11.5 ± 4.4 years. Participating nurses were mailed a follow-up questionnaire every 2 years. Respondents who self-reported a positive osteoporosis diagnosis during the study period were sent an additional confirmation questionnaire to corroborate the details. Results: The number (proportion) of women with osteoporosis was 884 (5.6%) [primary osteoporosis, 812 (5.2%); secondary osteoporosis, 72 (0.5%)]. The cumulative incidence of osteoporosis at the age of 40, 50, 60, 70, and 80 years was estimated to be 0.1% (95% confidence interval, 0.1– 0.2), 1.1% (0.9– 1.3), 7.7% (7.0– 8.4), 23.6% (21.6– 25.7), and 54.2% (40.2– 68.1), respectively. For BL and regular follow-up + expert review versus BL and regular follow-up + confirmation questionnaire + expert review, the positive predictive value (PPV) was 61.3% versus 85.6% and the negative predictive value (NPV) was 98.9% versus 98.2%, respectively. Conclusion: Self-reporting was associated with a high NPV for the incidence of osteoporosis. Although the PPV was slightly lower, additional corroborations by confirmation questionnaire might improve the PPV

Gastroschisis with multiple atresia and impending rupture of small intestine

We herein report an unusual case of multiple atresia and impending rupture of the small intestine in a patient with gastroschisis. Gradual bowel dilatation and thinning of the bowel wall were confirmed at our institution by fetal imaging, which led to the suspicion of intestinal atresia. The patient underwent repair of the perforation and small intestinal resection, formation of a separate stoma, and primary closure of the abdominal wall defect. The specimen from the impending rupture of the small intestine showed partial absence of the mucosal and muscular layers on the antimesenteric side and irregular thickness of the lamina and tunica muscularis, including the non-dilated intestine. The vascular density was lower in the area with absence of the mucosal and muscular layers than in the area with normal layers. We speculate that the multiple small intestinal lesions resulted from chronic vascular stress and high intestinal internal pressure. Intestinal lesions in patients with gastroschisis cannot be excluded even when dramatic bowel distention and thickening are absent on prenatal ultrasonography. In cases of prenatally diagnosed gastroschisis, cesarean delivery should be performed as soon as possible to minimize the damage caused by intestinal lesions. Keywords: Gastroschisis, Intestinal atresia, Intestinal impending ruptur