Calibration of FRAX ® 3.1 to the Dutch population with data on the epidemiology of hip fractures

SummaryThe FRAX tool has been calibrated to the entire Dutch population, using nationwide (hip) fracture incidence rates and mortality statistics from the Netherlands. Data used for the Dutch model are described in this paper.IntroductionRisk communication and decision making about whether or not to treat with anti-osteoporotic drugs with the use of T-scores are often unclear for patients. The recently developed FRAX models use easily obtainable clinical risk factors to estimate an individual's 10-year probability of a major osteoporotic fracture and hip fracture that is useful for risk communication and subsequent decision making in clinical practice. As of July 1, 2010, the tool has been calibrated to the total Dutch population. This paper describes the data used to develop the current Dutch FRAX model and illustrates its features compared to other countries.MethodsAge- and sex-stratified hip fracture incidence rates (LMR database) and mortality rates (Dutch national mortality statistics) for 2004 and 2005 were extracted from Dutch nationwide databases (patients aged 50+ years). For other major fractures, Dutch incidence rates were imputed, using Swedish ratios for hip to osteoporotic fracture (upper arm, wrist, hip, and clinically symptomatic vertebral) probabilities (age- and gender-stratified). The FRAX tool takes into account age, sex, body mass index (BMI), presence of clinical risk factors, and bone mineral density (BMD).ResultsFracture incidence rates increased with increasing age: for hip fracture, incidence rates were lowest among Dutch patients aged 50–54 years (per 10,000 inhabitants: 2.3 for men, 2.1 for women) and highest among the oldest subjects (95–99 years; 169 of 10,000 for men, 267 of 10,000 for women). Ten-year probability of hip or major osteoporotic fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age, and a decreased BMD T-score. Parental hip fracture accounted for the greatest increase in 10-year fracture probability.ConclusionThe Dutch FRAX tool is the first fracture prediction model that has been calibrated to the total Dutch population, using nationwide incidence rates for hip fracture and mortality rates. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Dutch FRAX tool a good candidate for implementation into clinical practice

The impact of diabetes on the pathogenesis of sepsis

Diabetes is associated with an increased susceptibility to infection and sepsis. Conflicting data exist on whether the mortality of patients with sepsis is influenced by the presence of diabetes, fuelling the ongoing debate on the benefit of tight glucose regulation in patients with sepsis. The main reason for which diabetes predisposes to infection appears to be abnormalities of the host response, particularly in neutrophil chemotaxis, adhesion and intracellular killing, defects that have been attributed to the effect of hyperglycaemia. There is also evidence for defects in humoral immunity, and this may play a larger role than previously recognised. We review the literature on the immune response in diabetes and its potential contribution to the pathogenesis of sepsis. In addition, the effect of diabetes treatment on the immune response is discussed, with specific reference to insulin, metformin, sulphonylureas and thiazolidinediones

Anti-inflammatory Components from Functional Foods for Obesity

Obesity, defined as excessive fat accumulation that may impair health, has been described throughout human history, but it has now reached epidemic proportions with the WHO estimating that 39% of the world’s adults over 18 years of age were overweight or obese in 2016. Obesity is a chronic low-grade inflammatory state leading to organ damage with an increased risk of common diseases including cardiovascular and metabolic disease, non-alcoholic fatty liver disease, osteo-arthritis and some cancers. This inflammatory state may be influenced by adipose tissue hypoxia and changes in the gut microbiota. There has been an increasing focus on functional foods and nutraceuticals as treatment options for obesity as drug treatments are limited in efficacy. This chapter summarises the importance of anthocyanin-containing fruits and vegetables, coffee and its components, tropical fruit and food waste as sources of phytochemicals for obesity treatment. We emphasise that preclinical studies can form the basis for clinical trials to determine the effectiveness of these treatments in humans

Biomechanical Factors Influencing the Performance of Elite Alpine Ski Racers

BackgroundAlpine ski racing is a popular international winter sport that is complex and challenging from physical, technical, and tactical perspectives. Despite the vast amount of scientific literature focusing on this sport, including topical reviews on physiology, ski-snow friction, and injuries, no review has yet addressed the biomechanics of elite alpine ski racers and which factors influence performance. In World Cup events, winning margins are often mere fractions of a second and biomechanics may well be a determining factor in podium place finishes. Objective The aim of this paper was to systematically review the scientific literature to identify the biomechanical factors that influence the performance of elite alpine ski racers, with an emphasis on slalom, giant slalom, super-G, and downhill events. Methods Four electronic databases were searched using relevant medical subject headings and key words, with an additional manual search of reference lists, relevant journals, and key authors in the field. Articles were included if they addressed human biomechanics, elite alpine skiing, and performance. Only original research articles published in peer-reviewed journals and in the English language were reviewed. Articles that focused on skiing disciplines other than the four of primary interest were excluded (e.g., mogul, ski-cross and freestyle skiing). The articles subsequently included for review were quality assessed using a modified version of a validated quality assessment checklist. Data on the study population, design, location, and findings relating biomechanics to performance in alpine ski racers were extracted from each article using a standard data extraction form. Results A total of 12 articles met the inclusion criteria, were reviewed, and scored an average of 69 ± 13 % (range 40–89 %) upon quality assessment. Five of the studies focused on giant slalom, four on slalom, and three on downhill disciplines, although these latter three articles were also relevant to super-G events. Investigations on speed skiing (i.e., downhill and super-G) primarily examined the effect of aerodynamic drag on performance, whereas the others examined turn characteristics, energetic principles, technical and tactical skills, and individual traits of high-performing skiers. The range of biomechanical factors reported to influence performance included energy dissipation and conservation, aerodynamic drag and frictional forces, ground reaction force, turn radius, and trajectory of the skis and/or centre of mass. The biomechanical differences between turn techniques, inter-dependency of turns, and abilities of individuals were also identified as influential factors in skiing performance. In the case of slalom and giant slalom events, performance could be enhanced by steering the skis in such a manner to reduce the ski-snow friction and thereby energy dissipated. This was accomplished by earlier initiation of turns, longer path length and trajectory, earlier and smoother application of ground reaction forces, and carving (rather than skidding). During speed skiing, minimizing the exposed frontal area and positioning the arms close to the body were shown to reduce the energy loss due to aerodynamic drag and thereby decrease run times. In actual races, a consistently good performance (i.e., fast time) on different sections of the course, terrains, and snow conditions was a characteristic feature of winners during technical events because these skiers could maximize gains from their individual strengths and minimize losses from their respective weaknesses. Limitations Most of the articles reviewed were limited to investigating a relatively small sample size, which is a usual limitation in research on elite athletes. Of further concern was the low number of females studied, representing less than 4 % of all the subjects examined in the articles reviewed. In addition, although overall run time is the ultimate measure of performance in alpine ski racing, several other measures of instantaneous performance were also employed to compare skiers, including the aerodynamic drag coefficient, velocity, section time, time lost per change in elevation, and mechanical energy behaviours, which makes cross-study inferences problematic. Moreover, most studies examined performance through a limited number of gates (i.e., 2–4 gates), presumably because the most commonly used measurement systems can only capture small volumes on a ski field with a reasonable accuracy for positional data. Whether the biomechanical measures defining high instantaneous performance can be maintained throughout an entire race course remains to be determined for both male and female skiers. Conclusions Effective alpine skiing performance involves the efficient use of potential energy, the ability to minimize ski-snow friction and aerodynamic drag, maintain high velocities, and choose the optimal trajectory. Individual tactics and techniques should also be considered in both training and competition. To achieve better run times, consistency in performance across numerous sections and varied terrains should be emphasized over excellence in individual sections and specific conditions.Publ online 28 Dec 2013Swedish Winter Sports Research Centr