Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults:a prospective cohort study

Background: Vertebral fractures, an increased thoracic kyphosis and a flexed posture are associated with falls. However, this was not confirmed in prospective studies. We performed a prospective cohort study to investigate the association between vertebral fractures, increased thoracic kyphosis and/or flexed posture with future fall incidents in older adults within the next year. Methods: Patients were recruited at a geriatric outpatient clinic. Vertebral fractures were evaluated on lateral radiographs of the spine with the semi-quantitative method of Genant; the degree of thoracic kyphosis was assessed with the Cobb angle. The occiput-to-wall distance was used to determine a flexed posture. Self-reported falls were prospectively registered by monthly phone contact for the duration of 12 months. Results: Fifty-one older adults were included; mean age was 79 years (SD = 4.8). An increased thoracic kyphosis was independently associated with future falls (OR 2.13; 95% CI 1.10-4.51). Prevalent vertebral fractures had a trend towards significancy (OR 3.67; 95% CI 0.85-15.9). A flexed posture was not significantly associated with future falls. Conclusion: Older adults with an increased thoracic kyphosis are more likely to fall within the next year. We suggest clinical attention for underlying causes. Because patients with increased thoracic curvature of the spine might have underlying osteoporotic vertebral fractures, clinicians should be aware of the risk of a new fracture

Estimating the Time to Benefit for Preventive Drugs with the Statistical Process Control Method:An Example with Alendronate

For physicians dealing with patients with a limited life expectancy, knowing the time to benefit (TTB) of preventive medication is essential to support treatment decisions. The aim of this study was to investigate the usefulness of statistical process control (SPC) for determining the TTB in relation to fracture risk with alendronate versus placebo in postmenopausal women. We performed a post hoc analysis of the Fracture Intervention Trial (FIT), a randomized, controlled trial that investigated the effect of alendronate versus placebo on fracture risk in postmenopausal women. We used SPC, a statistical method used for monitoring processes for quality control, to determine if and when the intervention group benefited significantly more than the control group. SPC discriminated between the normal variations over time in the numbers of fractures in both groups and the variations that were attributable to alendronate. The TTB was defined as the time point from which the cumulative difference in the number of clinical fractures remained greater than the upper control limit on the SPC chart. For the total group, the TTB was defined as 11 months. For patients aged a parts per thousand yen70 years, the TTB was 8 months [absolute risk reduction (ARR) = 1.4 %]; for patients aged <70 years, it was 19 months (ARR = 0.7 %). SPC is a clear and understandable graphical method to determine the TTB. Its main advantage is that there is no need to define a prespecified time point, as is the case in traditional survival analyses. Prescribing alendronate to patients who are aged a parts per thousand yen70 years is useful because the TTB shows that they will benefit after 8 months. Investigators should report the TTB to simplify clinical decision making

The Quality of Dying in Frail Institutionalized Older Patients After Nonoperative and Operative Management of a Proximal Femoral Fracture:An In-Depth Analysis

Proximal femoral fractures in frail patients have a poor prognosis. Despite the high mortality, little is known about the quality of dying (QoD) while this is an integral part of palliative care and could influence decision making on nonoperative- (NOM) or operative management (OM). To identify the QoD in frail patients with a proximal femoral fracture. Data from the prospective FRAIL-HIP study, that studied the outcomes of NOM and OM in institutionalized older patients ≥70 years with a limited life expectancy who sustained a proximal femoral fracture, was analyzed. This study included patients who died within the 6-month study period and whose proxies evaluated the QoD. The QoD was evaluated with the Quality of Dying and Death (QODD) questionnaire resulting in an overall score and 4 subcategory scores (Symptom control, Preparation, Connectedness, and Transcendence). In total 52 (64% of NOM) and 21 (53% of OM) of the proxies responded to the QODD. The overall QODD score was 6.8 (P25-P75 5.7-7.7) (intermediate), with 34 (47%) of the proxies rating the QODD ‘good to almost perfect’. Significant differences in the QODD scores between groups were not noted (NOM; 7.0 (P25-P75 5.7-7.8) vs OM; 6.6 (P25-P75 6.1-7.2), P =.73). Symptom control was the lowest rated subcategory in both groups. The QoD in frail older nursing home patients with a proximal femoral fracture is good and humane. QODD scores after NOM are at least as good as OM. Improving symptom control would further increase the QoD.</p

First search for gravitational waves from the youngest known neutron star

We present a search for periodic gravitational waves from the neutron star in the supernova remnant Cassiopeia A. The search coherently analyzes data in a 12 day interval taken from the fifth science run of the Laser Interferometer Gravitational-Wave Observatory. It searches gravitational-wave frequencies from 100 to 300 Hz and covers a wide range of first and second frequency derivatives appropriate for the age of the remnant and for different spin-down mechanisms. No gravitational-wave signal was detected. Within the range of search frequencies, we set 95% confidence upper limits of (0.7–1.2) × 10^(−24) on the intrinsic gravitational-wave strain, (0.4–4) × 10^(−4) on the equatorial ellipticity of the neutron star, and 0.005–0.14 on the amplitude of r-mode oscillations of the neutron star. These direct upper limits beat indirect limits derived from energy conservation and enter the range of theoretical predictions involving crystalline exotic matter or runaway r-modes. This paper is also the first gravitational-wave search to present upper limits on the r-mode amplitude

Search for Gravitational-wave Inspiral Signals Associated with Short Gamma-ray Bursts During LIGO's Fifth and Virgo's First Science Run

Progenitor scenarios for short gamma-ray bursts (short GRBs) include coalescenses of two neutron stars or a neutron star and black hole, which would necessarily be accompanied by the emission of strong gravitational waves. We present a search for these known gravitational-wave signatures in temporal and directional coincidence with 22 GRBs that had sufficient gravitational-wave data available in multiple instruments during LIGO's fifth science run, S5, and Virgo's first science run, VSR1. We find no statistically significant gravitational-wave candidates within a [ – 5, + 1) s window around the trigger time of any GRB. Using the Wilcoxon-Mann-Whitney U-test, we find no evidence for an excess of weak gravitational-wave signals in our sample of GRBs. We exclude neutron star-black hole progenitors to a median 90% confidence exclusion distance of 6.7 Mpc