Using vital statistics to estimate the population-level impact of osteoporotic fractures on mortality based on death certificates, with an application to France (2000-2004)

Abstract Background We developed a methodology using vital statistics to estimate the impact of osteoporotic fractures on the mortality of an entire population, and applied it to France for the period 2000-2004. Methods Current definitions of osteoporotic fractures were reviewed and their components identified. We used the International Classification of Diseases with national vital statistics data for the French adult population and performed cross-classifications between various components: age, sex, I-code (site) and E-code (mechanism of fracture). This methodology allowed identification of appropriate thresholds and categorization for each pertinent component. Results 2,625,743 death certificates were analyzed, 2.2% of which carried a mention of fracture. Hip fractures represented 55% of all deaths from fracture. Both sexes showed a similar pattern of mortality rates for all fracture sites, the rate increased with age from the age of 70 years. The E-high-energy code (present in 12% of death certificates with fractures) was found to be useful to rule-out non-osteoporotic fractures, and to correct the overestimation of mortality rates. Using this methodology, the crude number of deaths associated with fractures was estimated to be 57,753 and the number associated with osteoporotic fractures 46,849 (1.85% and 1.78% of all deaths, respectively). Conclusion Osteoporotic fractures have a significant impact on overall population mortality.</p

Axial Spondyloarthritis: An Evolving Concept

Axial spondyloarthritis (AxSpA) is the prototype of a family of inter-related yet heterogeneous diseases sharing common clinical and genetic manifestations: the spondyloarthritides (SpAs). The condition mainly affects the sacroiliac joints and axial skeleton, and has a clear classification scheme, wider epidemiological data, and distinct therapeutic guidelines when compared with other SpAs. However, the concept of AxSpA has not been immutable over time and has evolved tremendously on many levels over the past decades. This review identifies the evolution of the AxSpA concept at two levels. First, at the level of classification, the old classifications and rationales leading to the current Assessment of SpondyloArthritis international Society (ASAS) classification are reviewed, and the advantages and drawbacks are discussed. Second, at the therapeutic level, current and future treatments are described and treatment strategies are discussed

Osteoporosis-Related Mortality: Time-Trends and Predictive Factors

Osteoporosis is one of the leading causes of handicap worldwide and a major contributor to the global burden of diseases. In particular, osteoporosis is associated with excess mortality. We reviewed the impact of osteoporosis on mortality in a population by defining three categories: mortality following hip fractures, mortality following other sites of fractures, and mortality associated with low bone mineral density (BMD). Hip fractures, as well as other fractures at major sites are all associated with excess mortality, except at the forearm site. This excess mortality is higher during the first 3-6 months after the fracture and then declines over time, but remains higher than the mortality of the normal population up to 22 years after the fracture. Low BMD is also associated with high mortality, with hazard ratios of around 1.3 for every decrease in 1 standard deviation of bone density at 5 years, independently of fractures, reflecting a more fragile population. Finally predictors of mortality were identified and categorised in demographic known factors (age and male gender) and in factors reflecting a poor general health status such as the number of comorbidities, low mental status, or level of social dependence. Our results indicate that the management of a patient with osteoporosis should include a multivariate approach that could be based on predictive models in the future

Short-term relationships between emergency hospital admissions for respiratory and cardiovascular diseases and fine particulate air pollution in Beirut, Lebanon

International audienceHigh levels of major outdoor air pollutants have been documented in Lebanon, but their health effects remain unknown. The Beirut Air Pollution and Health Effects study aimed to determine the relationship between short-term variations in ambient concentrations of particulate matter (PM10 and PM2.5) and emergency hospital admissions in the city of Beirut, and whether susceptible groups are more greatly affected. An autoregressive Poisson model was used to evaluate the association between daily concentrations of particulate matter and respiratory and cardiovascular emergency hospital admissions after controlling for confounders. All variables were measured during 1 year from January 2012 to December 2012. Relative risks of admissions for respiratory and cardiovascular diseases were calculated for an increase in 10 μg.m−3 of pollutant concentrations. Total respiratory admissions were significantly associated with the levels of PM10 (1.012 [95 % CI 1.004–1.02]) per 10 μg.m−3 rise in daily mean pollutant concentration for PM10 and 1.016 [95 % CI 1.000–1.032] for PM2.5 on the same day. With regard to susceptible groups, total respiratory admissions were associated with PM2.5 and PM10 within the same day in children (relative risk (RR), 1.013 and 1.014; 95 % confidence interval, 0.985–1.042 and 1.000–1.029 for PM2.5 and PM10, respectively). Moreover, a nearly significant association was found between particles and total circulatory admissions for adults and elderly groups in the same day. These results are similar to other international studies. Therefore, air pollution control is expected to reduce the number of admissions of these diseases in Lebanon