Ankylosing spondylitis confers substantially increased risk of clinical spine fractures: a nationwide case-control study

SummaryAnkylosing spondylitis (AS) leads to osteopenia/osteoporosis and spine rigidity. We conducted a case-control study and found that AS-affected patients have a 5-fold and 50 % increased risk of clinical spine and all clinical fractures, respectively. Excess risk of both is highest in the first years and warrants an early bone health assessment after diagnosis.IntroductionAnkylosing spondylitis (AS) is related to spine rigidity and reduced bone mass, but data on its impact on fracture risk are scarce. We aimed to study the association between AS and clinical fractures using a case-control design.MethodsFrom the Danish Health Registries, we identified all subjects who sustained a fracture in the year 2000 (cases) and matched up to three controls by year of birth, gender and region. Clinically diagnosed AS was identified using International Classification of Diseases, 8th revision (ICD-8; 71249), and International Classification of Diseases, 10th revision (ICD-10; M45) codes. We also studied the impact of AS duration. Conditional logistic regression was used to estimate crude and adjusted odds ratios (ORs) for non-traumatic fractures (any site, clinical spine and non-vertebral) according to AS status and time since AS diagnosis. Multivariate models were adjusted for fracture history, socio-economic status, previous medical consultations, alcoholism and use of oral glucocorticoids.ResultsWe identified 139/124,655 (0.11 %) AS fracture cases, compared to 271/373,962 (0.07 %) AS controls. Unadjusted (age- and gender-matched) odds ratio (OR) were 1.54 [95 % confidence interval (95 %CI) 1.26–1.89] for any fracture, 5.42 [2.50–11.70] for spine and 1.39 [1.12–1.73] for non-vertebral fracture. The risk peaked in the first 2.5 years following AS diagnosis: OR 2.69 [1.84–3.92] for any fracture.ConclusionsPatients with AS have a 5-fold higher risk of clinical spine fracture and a 35 % increased risk of non-vertebral fracture. This excess risk peaks early, in the first 2.5 years of AS disease. Patients should be assessed for fracture risk early after AS diagnosis.<br/

Incidence and predictors of multiple fractures despite high adherence to oral bisphosphonates: a binational population-based cohort

Oral bisphosphonates (BPs) are highly effective in preventing fractures and are recommended first-line therapies for patients with osteoporosis. We identified the incidence and predictors of oral BP treatment failure, defined as the incidence of ?2 fractures while on treatment (?2 FWOT) among users with high adherence. Fractures were considered after six months from treatment initiation and up to six months after discontinuation. Data from computerized records and pharmacy invoices were obtained from Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) (Catalonia, Spain) and Danish Health Registries (Denmark) for all incident users of oral BPs in 2006-2007 and 2000-2001 respectively. Fine and Gray survival models using backward-stepwise selection (p-entry 0.049; p-exit 0.10) and accounting for the competing risk of therapy cessation were used to identify predictors of ?2 FWOT among patients having persisted with treatment ?6months with overall medication possession ratio (MPR) ?80%. Incidence of ?2 FWOT was 2.4 (95% Confidence Interval (CI): 1.8-3.2) and 1.7 (95% CI: 1.2-2.2) per 1000 Person Years (PYs) within Catalonia and Denmark respectively. Older age was predictive of ?2FWOT in both Catalonian and Danish cohorts: subhazard ratio (SHR)?=?2.28 (95% CI: 1.11-4.68) and SHR?=?2.61 (95% CI: 0.98-6.95) respectively for 65 to &lt;80 years and SHR?=?3.19 (95% CI: 1.33-7.69) and SHR?=?4.88 (95% CI: 1.74-13.7) respectively for ?80 years. Further significant predictors of ?2 FWOT identified within only one cohort were dementia, SHR?=?4.46 (95% CI: 1.02-19.4) (SIDIAP) and history of recent or older fracture, SHR?=?3.40 (95% CI: 1.50-7.68) and SHR?=?2.08 (95% CI: 1.04-4.15) respectively (Denmark). Even among highly adherent users of oral BP therapy, a minority sustain multiple fractures while on treatment. Older age was predictive of increased risk within both study populations, as was history of recent/old fracture and dementia within one but not both populations. Additional and/or alternative strategies should be investigated for these patients

Conducting qualitative research in audiology: A tutorial

Objective: Qualitative research methodologies are being used more frequently in audiology as it allows for a better understanding of the perspectives of people with hearing impairment. This article describes why and how international interdisciplinary qualitative research can be conducted. Design: This paper is based on a literature review and our recent experience with the conduction of an international interdisciplinary qualitative study in audiology. Results: We describe some available qualitative methods for sampling, data collection, and analysis and we discuss the rationale for choosing particular methods. The focus is on four approaches which have all previously been applied to audiologic research: grounded theory, interpretative phenomenological analysis, conversational analysis, and qualitative content analysis. Conclusions: This article provides a review of methodological issues useful for those designing qualitative research projects in audiology or needing assistance in the interpretation of qualitative literature