Influence of arthritis and non-arthritis related factors on areal bone mineral density (BMDa) in women with longstanding inflammatory polyarthritis: a primary care based inception cohort

<p>Abstract</p> <p>Background</p> <p>The aim of this analysis was to determine the relative influence of disease and non-disease factors on areal bone mineral density (BMD_a) in a primary care based cohort of women with inflammatory polyarthritis.</p> <p>Methods</p> <p>Women aged 16 years and over with recent onset inflammatory polyarthritis were recruited to the Norfolk Arthritis Register (NOAR) between 1990 and 1993. Subjects were examined at both baseline and follow up for the presence of tender, swollen and deformed joints. At the 10^thanniversary visit, a sub-sample of women were invited to complete a bone health questionnaire and attend for BMD_a(Hologic, QDR 4000). Linear regression was used to examine the association between BMD_awith both (i) arthritis-related factors assessed at baseline and the 10^thanniversary visit and (ii) standard risk factors for osteoporosis. Adjustments were made for age.</p> <p>Results</p> <p>108 women, mean age 58.0 years were studied. Older age, decreasing weight and BMI at follow up were all associated with lower BMD_aat both the spine and femoral neck. None of the lifestyle factors were linked. Indices of joint damage including 10^thanniversary deformed joint count and erosive joint count were the arthritis-related variables linked with a reduction in BMD_aat the femoral neck. By contrast, disease activity as determined by the number of tender and or swollen joints assessed both at baseline and follow up was not linked with BMD_aat either site.</p> <p>Conclusion</p> <p>Cumulative disease damage was the strongest predictor of reduced femoral bone density. Other disease and lifestyle factors have only a modest influence.</p

Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: A randomized trial

Long-term use of high-dose corticosteroids often results in bone loss, which may lead to osteoporosis-related fractures. This was a multicenter, double-blind study in which 290 ambulatory men and women receiving high-dose oral corticosteroid therapy (prednisone greater than or equal to 7.5 mg/day or equivalent) for 6 or more months were randomized to receive placebo, risedronate 2.5 mg/day, or risedronate 5 mg/day for 12 months. All patients received calcium 1 g and vitamin D 400 IU daily. The primary endpoint was lumbar spine bone mineral density (BMD) at month 12, Additional measurements included BMD at the femoral neck and trochanter and the incidence of vertebral fractures, Overall, there were statistically significant treatment effects on BMD at 12 months at the lumbar spine (p < 0.001), femoral neck (p = 0.004), and trochanter (p = 0.010), Risedronate 5 mg increased BMD at 12 months by a mean (SEM) of 2.9% (0.49%) at the lumbar spine, 1.8% (0.46%) at the femoral neck, and 2.4% (0.54%) at the trochanter, whereas BMD was maintained only in the control group, Although not powered to show fracture efficacy, we observed a reduction in the incidence of vertebral fractures of 70% in the combined risedronate treatment groups, relative to placebo (p = 0.042), Risedronate was well tolerated, had a good safety profile, and was not associated with gastrointestinal adverse events. We conclude that risedronate increases BMD and potentially reduces the incidence of vertebral fractures in patients,vith corticosteroid-induced osteoporosis

Calculations of provincial environmental costs with RIM+. A pilot study for Limburg

De resultaten werden beschreven van een haalbaarheidsstudie met als doel om na te gaan of het RIM+ (Reken en informatiesysteem Milieuhygiene) dat nu door het RIVM wordt gebruikt voor het doorrekenen van nationale milieukosten, ook geschikt is voor het maken van provinciale milieukostenberekeningen. Hiertoe zijn voor een provincie (Limburg) de benodigde gegevens verzameld en ingevoerd in RIM+, waarna milieukosten met RIM+ zijn berekend. Resultaat van de pilot is dat het inderdaad mogelijk is provinciale milieukosten te berekenen met het RIM+. De uitkomsten zijn wat methodiek, soort resultaten en kwaliteit betreft vergelijkbaar met de kostenberekeningen die TME in 1994 voor de provincies heeft uitgevoerd. Tijdens de pilot is een aantal knelpunten onderkend, waarmee in een eventuele vervolgfase rekening moet worden gehouden. Behalve met het model RIM+ hebben deze knelpunten betrekking op de organisatie van provinciale kostenberekeningen en de methodiek en databehoefte van een provinciaal kostenmodel. Drie opties voor een provinciaal milieukostenmodel worden geevalueerd. Uiteindelijk wordt een voorstel gepresenteerd, dat zoveel mogelijk de positieve punten van de verschillende opties combineert.As a first step in the cooperation between provinces and RIVM in developing a model for calculations of environmental costs, a pilot study was carried out to calculate the environmental costs to the Dutch province of Limburg using the model RIM+. This model, already used by RIVM for calculations of environmental costs on a national level, had to be partly adapted. The pilot shows that it is indeed possible to use RIM+ for provincial cost calculations. In carrying out the pilot, insight was gained into detailed desires and requirements related to input, output, methods and organisational aspects. Based on the results three options for the future are evaluated, in an advice for future actions.provincie LimburgDG