The Impact of Small Spinal Curves in Adolescents That Have Not Presented to Secondary Care:A Population-Based Cohort Study

Study Design: A prospective, population-based, birth cohort study. Objective: The aim of this study was to identify whether there is any hidden burden of disease associated with smaller spinal curves. Summary of Background Data: Adolescent idiopathic scoliosis is present in 3% to 5% of the general population. Large curves are associated with increased pain and reduced quality of life. However, no information is available on the impact of smaller curves, many of which do not reach secondary care. Methods: The Avon Longitudinal Study of Parents and Children (ALSPAC) recruited over 14,000 pregnant women from the Bristol area of South-West England between 1991 and 1992 and has followed up their offspring regularly. At age 15, presence or absence of spinal curvature ≥6 degrees in the offspring was identified using the validated dual-energy X-ray absorptiometry Scoliosis Measure on 5299 participants. At age 18, a structured pain questionnaire was administered to 4083 participants. Logistic regression was used to investigate any association between presence of a spinal curve at age 15 and self-reported outcomes at age 18 years. Results: Full data were available for 3184 participants. Two hundred two (6.3%) had a spinal curve ≥6 degrees and 125 (3.9%) had a curve ≥10 degrees (median curve size of 11 degrees). About 46.3% reported aches and pains that lasted for a day or longer in the previous month. About 16.3% reported back pain. Those with spinal curves were 42% more likely to report back pain than those without (odds ratio 1.42, 95% confidence interval 1.00–2.02, P = 0.047). Those with spinal curves had more days off school and were more likely to avoid activities that caused their pain. Conclusion Our results highlight that small scoliotic curves may be less benign than previously thought. Teenagers with small curves may not present to secondary care, but are nonetheless reporting increased pain, more days off school, and avoidance of activities. These data suggest that we should reconsider current scoliosis screening and treatment practices. Level of Evidence: 2 </p

Age at puberty and accelerometer-measured physical activity:findings from two independent UK cohorts

Background It is unclear if puberty timing influences future physical activity (PA). Aim To investigate the association of puberty timing with PA across adolescence and adulthood. Subjects and methods Data were from two British cohorts. Participants from an adolescent birth cohort (females = 2349, males = 1720) prospectively reported age at menarche and voice break and had PA recorded by Actigraph accelerometers at ages 14 years and 16 years. A cohort of middle-aged and older adults (40–70 years; females = 48,282; males = 36,112) recalled their age at puberty and had PA (mean acceleration; mg) measured by AxivityAX3 accelerometers. Results After adjustment for age, education, smoking and BMI, per 1-year older age at menarche was associated with higher mean counts/minute at age 14 years (0.07 SD counts/minute; 95% CI = 0.04–0.11) with associations attenuated at age 16 years (0.02; −0.03–0.07). Differences in mean acceleration per older year at menarche were close to the null in women aged 40–49 years (0.02 mg; 0.01–0.03), 50–59 years (0.01; 0.00–0.02) and 60–70 years (0.01; 0.00–0.01). Age at voice break and PA associations were close to the null in both cohorts. Conclusion We found a positive association between puberty timing and PA in females which weakened at older ages and limited evidence of an association at any age in males

Randomized controlled trial of a primary care–based screening program to identify older women with prevalent osteoporotic vertebral fractures: Cohort for skeletal health in Bristol and Avon (COSHIBA)

Approximately 12% of postmenopausal women have osteoporotic vertebral fractures (VFs); these are associated with excess morbidity and mortality and a high risk of future osteoporotic fractures. Despite this, less than one-third come to clinical attention, partly due to lack of clear clinical triggers for referral for spinal radiographs. The aim of this study was to investigate whether a novel primary care–based screening tool could be used to identify postmenopausal women with osteoporotic VFs and increase appropriate management of osteoporosis. A randomized controlled trial was undertaken in 15 general practices within the Bristol area of the UK. A total of 3200 women aged 65 to 80 years were enrolled, with no exclusion criteria. A simple screening tool was carried out by a nurse in primary care to identify women at high risk of osteoporotic VFs. All identified high-risk women were offered a diagnostic thoracolumbar radiograph. Radiographs were reported using standard National Health Service (NHS) reporting, with results sent back to each participant's general practitioner (GP). Participants in the control arm did not receive the screening tool or radiographs. The main outcome measure was self-reported prescription of medication for osteoporosis at 6 months with a random 5% subsample verified against electronic GP records. Secondary outcome was self-reported incidence of new fractures. Results showed that allocation to screening increased prescription of osteoporosis medications by 124% (odds ratio [OR] for prescription 2.24 at 6 months; 95% confidence interval [CI], 1.16 to 4.33). Allocation to screening also reduced fracture incidence at 12-month follow-up (OR for new fracture 0.60; 95% CI, 0.35–1.03; p = 0.063), although this did not reach statistical significance. This study supports the use of a simple screening tool administered in primary care to increase appropriate prescription of medications for osteoporosis in postmenopausal women in the UK. © 2012 American Society for Bone and Mineral Researc

Increased development of radiographic hip osteoarthritis in individuals with high bone mass: a prospective cohort study.

BACKGROUND: Individuals with high bone mass (HBM) have a greater odds of prevalent radiographic hip osteoarthritis (OA), reflecting an association with bone-forming OA sub-phenotypes (e.g. osteophytosis, subchondral sclerosis). As the role of bone mineral density (BMD) in hip OA progression is unclear, we aimed to determine if individuals with HBM have increased incidence and/or progression of bone-forming OA sub-phenotypes. METHODS: We analysed an adult cohort with and without HBM (L1 and/or total hip BMD Z-score > + 3.2) with pelvic radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Superior/inferior acetabular/femoral osteophyte and medial/superior joint space narrowing (JSN) grades were summed and Δosteophyte and ΔJSN derived. Pain and functional limitations were quantified using the WOMAC questionnaire. Associations between HBM status and change in OA sub-phenotypes were determined using multivariable linear/logistic regression, adjusting for age, sex, height, total body fat mass, follow-up time and baseline sub-phenotype grade. Generalised estimating equations accounted for individual-level clustering. RESULTS: Of 136 individuals, 62% had HBM at baseline, 72% were female and mean (SD) age was 59 (10) years. HBM was positively associated with both Δosteophytes and ΔJSN (adjusted mean grade differences between individuals with and without HBM βosteophyte = 0.30 [0.01, 0.58], p = 0.019 and βJSN = 0.10 [0.01, 0.18], p = 0.019). Incident subchondral sclerosis was rare. HBM individuals had higher WOMAC hip functional limitation scores (β = 8.3 [0.7, 15.98], p = 0.032). CONCLUSIONS: HBM is associated with the worsening of hip osteophytes and JSN over an average of 8 years, as well as increased hip pain and functional limitation

Metabolomics analysis in adults with High Bone Mass identifies a relationship between bone resorption and circulating citrate which replicates in the general population

Objective: Bone turnover, which regulates bone mass, may exert metabolic consequences, particularly on markers of glucose metabolism and adiposity. To better understand these relationships, we examined cross-sectional associations between bone turnover markers (BTMs) and metabolic traits in a population with high bone mass (HBM, BMD Z-score>+3.2). Design: β-C-terminal telopeptide of type-I collagen (β-CTX), procollagen type-1 amino-terminal propeptide (P1NP) and osteocalcin were assessed by electrochemiluminescence immunoassays. Metabolic traits, including lipids and glycolysis-related metabolites, were measured using Nuclear Magnetic Resonance spectroscopy. Associations of BTMs with metabolic traits were assessed using Generalized Estimating Equation linear regression, accounting for within-family correlation, adjusting for potential confounders (age, sex, height, weight, menopause, bisphosphonate and oral glucocorticoid use). Results: 198 adults with HBM had complete data, mean [SD] age 61.6 [13.7] years; 77% female. Of 23 summary metabolic traits, citrate was positively related to all BTMs: adjusted ββ-CTX=0.050 (95% CI 0.024,0.076),p=1.71x10-4, βosteocalcin=6.54x10-4 (1.87x10-4,0.001),p=0.006 and βP1NP=2.40x10-4 (6.49x10-5,4.14x10-4),p=0.007 (β= increase in citrate (mmol/L) per 1μg/L BTM increase). Inverse relationships of β-CTX (β=-0.276 -0.434,-0.118],p=6.03x10-4) and osteocalcin (-0.004 [-0.007,-0.001],p=0.020) with triglycerides were also identified. We explored the generalizability of these associations in 3,664 perimenopausal women (age 47.9 [4.4] years) from a UK family cohort. We confirmed a positive, albeit lower magnitude, association between β-CTX and citrate (adjusted βwomen=0.020 [0.013,0.026],p=1.95x10-9) and an inverse association of similar magnitude between β-CTX and triglycerides (β=-0.354 [-0.471,-0.237],p=3.03x10-9). Conclusions: Bone resorption is positively related to circulating citrate and inversely related to triglycerides. Further studies are justified to determine whether plasma citrate or triglyceride concentrations are altered by factors known to modulate bone resorption, such as bisphosphonates

The Impact of Social Desirability Pressures on Whites’ Endorsement of Racial Stereotypes: A Comparison Between Oral and ACASI Reports in a National Survey

In the last 60 years, the proportion of white Americans expressing anti-black prejudice in face-to-face survey interviews has declined dramatically. To test whether social desirability pressures affect the expression of anti-black prejudice, we analyzed a within-subjects experiment in the 2008 American National Election Study in which white respondents first reported their endorsement of stereotypes of blacks confidentially via audio computer-assisted self-interviewing (ACASI) and weeks or months later orally during second interviews. Shifting to ACASI led to a small but significant increase in negative views of blacks. Unexpectedly, shifting to ACASI also led to a similarly large increase in negative views of whites. Furthermore, the ACASI reports had no more predictive validity than did the oral reports. This evidence suggests that social desirability pressures do not seriously compromise oral reports of racial stereotypes in face-to-face interviews

Relation of maternal prepregnancy body mass index with offspring bone mass in childhood: is there evidence for an intrauterine effect?1234

Background: Evidence indicates that intrauterine skeletal development has implications for bone mass in later life and that maternal fat stores in pregnancy are important for fetal bone mineral accrual