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Osteoporosis: HELP
Articles by Lehana Thabane
Based on 22 articles published since 2010
(Why 22 articles?)
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Between 2010 and 2020, L. Thabane wrote the following 22 articles about Osteoporosis.
 
+ Citations + Abstracts
1 Review An overview of osteoporosis and frailty in the elderly. 2017

Li, Guowei / Thabane, Lehana / Papaioannou, Alexandra / Ioannidis, George / Levine, Mitchell A H / Adachi, Jonathan D. ·Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. lig28@mcmaster.ca. · St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. lig28@mcmaster.ca. · Programs for Assessment of Technology in Health, Centre for Evaluation of Medicines, Hamilton, ON, L8N 1Y3, Canada. lig28@mcmaster.ca. · Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. · St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. · Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. · Programs for Assessment of Technology in Health, Centre for Evaluation of Medicines, Hamilton, ON, L8N 1Y3, Canada. · St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. jd.adachi@sympatico.ca. · Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. jd.adachi@sympatico.ca. ·BMC Musculoskelet Disord · Pubmed #28125982.

ABSTRACT: Osteoporosis and osteoporotic fractures remain significant public health challenges worldwide. Recently the concept of frailty in relation to osteoporosis in the elderly has been increasingly accepted, with emerging studies measuring frailty as a predictor of osteoporotic fractures. In this overview, we reviewed the relationship between frailty and osteoporosis, described the approaches to measuring the grades of frailty, and presented current studies and future research directions investigating osteoporosis and frailty in the elderly. It is concluded that measuring the grades of frailty in the elderly could assist in the assessment, management and decision-making for osteoporosis and osteoporotic fractures at a clinical research level and at a health care policy level.

2 Review The relative efficacy of nine osteoporosis medications for reducing the rate of fractures in post-menopausal women. 2011

Hopkins, Robert B / Goeree, Ron / Pullenayegum, Eleanor / Adachi, Jonathan D / Papaioannou, Alexandra / Xie, Feng / Thabane, Lehana. ·Department of Clinical Epidemiology and Biostatistics, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada. hopkinr@mcmaster.ca ·BMC Musculoskelet Disord · Pubmed #21943363.

ABSTRACT: BACKGROUND: In the absence of head-to-head trials, indirect comparisons of randomized placebo-controlled trials may provide a viable option to assess relative efficacy. The purpose was to estimate the relative efficacy of reduction of fractures in post-menopausal women, and to assess robustness of the results. METHODS: A systematic literature review of multiple databases identified randomized placebo-controlled trials with nine drugs for post-menopausal women. Odds ratio and 95% credibility intervals for the rates of hip, non-vertebral, vertebral, and wrist fractures for each drug and between drugs were derived using a Bayesian approach. A drug was ranked as the most efficacious if it had the highest posterior odds ratio, or had the highest effect size. RESULTS: 30 studies including 59,209 patients reported fracture rates for nine drugs: alendronate (6 studies), denosumab (1 study), etidronate (8 studies), ibandronate (4 studies), raloxifene (1 study), risedronate (7 studies), strontium (2 study), teriparatide (1 study), and zoledronic acid (1 study). The drugs with the highest probability of reducing non-vertebral fractures was etidronate and teriparatide while the drugs with the highest probability of reducing vertebral, hip or wrist fractures were teriparatide, zoledronic acid and denosumab. The drugs with the largest effect size for vertebral fractures were zoledronic acid, teriparatide and denosumab, while the drugs with the highest effect size for non-vertebral, hip or wrist fractures were alendronate or risedronate. Estimates were consistent between Bayesian and classical approaches. CONCLUSION: Teriparatide, zoledronic acid and denosumab have the highest probabilities of being most efficacious for non-vertebral and vertebral fractures, and having the greatest effect sizes. The estimates from indirect comparisons were robust to differences in methodology.

3 Clinical Trial Frailty Change and Major Osteoporotic Fracture in the Elderly: Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton Cohort. 2016

Li, Guowei / Papaioannou, Alexandra / Thabane, Lehana / Cheng, Ji / Adachi, Jonathan D. ·Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. · Department of Medicine, McMaster University, Hamilton, Canada. · St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Canada. ·J Bone Miner Res · Pubmed #26547825.

ABSTRACT: Investigating the cumulative rate of deficits and the change of a frailty index (FI) chronologically is helpful in clinical and research settings in the elderly. However, limited evidence for the change of frailty before and after some nonfatal adverse health event such as a major osteoporotic fracture (MOF) is available. Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton cohort were used in this study. The changes of FI before and after onset of MOF were compared between the women with and without incident MOF. We also evaluated the relationship between risk of MOF, falls, and death and the change of FI and the absolute FI measures. There were 3985 women included in this study (mean age 69.4 years). The change of FI was significantly larger in the women with MOF than those without MOF at year 1 (0.085 versus 0.067, p = 0.036) and year 2 (0.080 versus 0.052, p = 0.042) post-baseline. The FI change was not significantly related with risk of MOF independently of age. However, the absolute FI measures were significantly associated with increased risk of MOF, falls, and death independently of age. In summary, the increase of the FI is significantly larger in the elderly women experiencing a MOF than their peer controls, indicating their worsening frailty and greater deficit accumulation after a MOF. Measures of the FI change may aid in the understanding of cumulative aging nature in the elderly and serve as an instrument for intervention planning and assessment.

4 Article Describing the resource utilisation and costs associated withvertebral fractures: the Build Better Bones with Exercise (B3E) Pilot Trial. 2020

Hassan, S / Seung, S J / Clark, R E / Gibbs, J C / McArthur, C / Mittmann, N / Thabane, L / Kendler, D / Papaioannou, A / Wark, J D / Ashe, M C / Adachi, J D / Templeton, J A / Giangregorio, L M. ·HOPE Research Centre, Sunnybrook Research Institute, Toronto, Ontario, M4N 3M5, Canada. shazia.hassan@sunnybrook.ca. · HOPE Research Centre, Sunnybrook Research Institute, Toronto, Ontario, M4N 3M5, Canada. · University of Waterloo, Waterloo, Canada. · McGill University, Montreal, Quebec, Canada. · McMaster University, Hamilton, Canada. · Cancer Care Ontario, Toronto, Canada. · University of British Columbia, Vancouver, Canada. · University of Melbourne, Melbourne, Australia. ·Osteoporos Int · Pubmed #32219499.

ABSTRACT: This analysis examined costs/resources of 141 women with vertebral fractures, randomised to a home exercise programme or control group. Total, mean costs and the incremental cost-effectiveness ratio (ICER) were calculated. Quality of life was collected. Cost drivers were caregiver time, medications and adverse events (AEs). Results show adding an exercise programme may reduce the risk of AEs. INTRODUCTION: This exploratory economic analysis examined the health resource utilisation and costs experienced by women with vertebral fractures, and explored the effects of home exercise on those costs. METHODS: Women ≥ 65 years with one or more X-ray-confirmed vertebral fractures were randomised 1:1 to a 12-month home exercise programme or equal attention control group. Clinical and health system resources were collected during monthly phone calls and daily diaries completed by participants. Intervention costs were included. Unit costs were applied to health system resources. Quality of life (QoL) information was collected via EQ-5D-5L at baseline, 6 and 12 months. RESULTS: One hundred and forty-one women were randomised. Overall total costs (CAD 2018) were $664,923 (intervention) and $614,033 (control), respectively. The top three cost drivers were caregiver time ($250,269 and $240,811), medications ($151,000 and $122,145) and AEs ($58,807 and $71,981). The mean cost per intervention participant of $9365 ± $9988 was higher compared with the mean cost per control participant of $8772 ± $9718. The mean EQ-5D index score was higher for the intervention participants (0.81 ± 0.11) compared with that of controls (0.79 ± 0.13). The differences in quality-adjusted life year (QALY) (0.02) and mean cost ($593) were used to calculate the ICER of $29,650. CONCLUSIONS: Women with osteoporosis with a previous fracture experience a number of resources and associated costs that impact their care and quality of life. Caregiver time, medications and AEs are the biggest cost drivers for this population. The next steps would be to expand this feasibility study with more participants, longer-term follow-up and more regional variability.

5 Article The Effects of Home Exercise in Older Women With Vertebral Fractures: A Pilot Randomized Controlled Trial. 2020

Gibbs, Jenna C / McArthur, Caitlin / Wark, John D / Thabane, Lehana / Scherer, Samuel C / Prasad, Sadhana / Papaioannou, Alexandra / Mittmann, Nicole / Laprade, Judi / Kim, Sandra / Khan, Aliya / Kendler, David L / Hill, Keith D / Cheung, Angela M / Bleakney, Robert / Ashe, Maureen C / Adachi, Jonathan D / Giangregorio, Lora M. ·Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada; and GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, Ontario, Canada. · Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; and Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia. · Department of Health Research Methods, Evidence, and Impact, McMaster University. · Department of Medicine, University of Melbourne; Royal Melbourne Hospital; and Broadmeadows Health Services, Northern Health, Melbourne, Australia. · Department of Medicine, McMaster University. · Department of Medicine, McMaster University; GERAS Centre for Aging Research, Hamilton Health Sciences; and Department of Health Research Methods, Evidence, and Impact, McMaster University. · Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Department of Surgery, University of Toronto, Toronto, Ontario, Canada; and Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, Ontario, Canada. · Department of Medicine, University of Toronto; and Centre for Osteoporosis and Bone Health, Women's College Hospital, Toronto, Ontario, Canada. · Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Grad Dip Physio, BAppSc (Physio), School of Primary and Allied Health Care, Peninsula Campus, Monash University, Frankston, Australia. · Department of Medicine, University of Toronto; and Osteoporosis Program and Centre of Excellence in Skeletal Health Assessment, University Health Network and Sinai Health System, Toronto, Ontario, Canada. · Department of Medical Imaging, University of Toronto; and Centre of Excellence in Skeletal Health Assessment, University Health Network and Sinai Health System. · Department of Family Practice, University of British Columbia; and Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada. · Department of Kinesiology, University of Waterloo; and Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada; and KITE, Toronto Rehab-University Health Network, Toronto, Ontario, Canada. ·Phys Ther · Pubmed #31899499.

ABSTRACT: BACKGROUND: Regular exercise is advocated in osteoporosis guidelines to prevent fractures. Few studies have evaluated the effect of exercise on functional performance, posture, and other outcomes that are important to patients after vertebral fractures. OBJECTIVE: This pilot study will explore the effect of home exercise versus control on functional performance, posture, and patient-reported outcome measures. DESIGN: This study was a parallel 2-arm pilot feasibility trial with 1:1 randomization to exercise or attentional control groups. SETTING: This study took place in 5 Canadian and 2 Australian academic or community hospitals/centers. PARTICIPANTS: This study included 141 women ≥65 years of age with radiographically confirmed vertebral fractures. INTERVENTION: A physical therapist delivered exercise and behavioral counseling in 6 home visits over 8 months and monthly calls. Participants were to exercise ≥3 times weekly. Controls received equal attention. MEASUREMENTS: Functional performance, posture, quality of life, pain, and behavior-change outcomes were assessed at baseline and after 6 (questionnaires only) and 12 months. Adherence to exercise was assessed by calendar diary. All t tests examined between-group mean differences (MD) in change from baseline in intention-to-treat and per-protocol analyses. RESULTS: There was a small effect of exercise on 5 times sit-to-stand test versus control (MD = -1.58 [95% CI = -3.09 to -0.07], intention-to-treat; MD = -1.49 [95% CI = -3.12 to 0.16], per-protocol). There were no other major or statistically significant MDs for any other measured outcomes after follow-up. Adherence declined over time. LIMITATIONS: Treatment effects on variables may have been underestimated due to multiple comparisons and underpowered analyses. CONCLUSIONS: Our exploratory estimate of the effect of exercise on functional leg muscle strength was consistent in direction and magnitude with other trials in individuals with vertebral fractures. Declining adherence to home exercise suggests that strategies to enhance long-term adherence might be important in future confirmatory trials.

6 Article The association between trunk muscle endurance, balance and falls self-efficacy in women with osteoporotic vertebral fractures: an exploratory analysis from a pilot randomized controlled trial. 2019

McArthur, Caitlin / Gibbs, Jenna C / Ashe, Maureen C / Cheung, Angela M / Hill, Keith D / Kendler, David L / Khan, Aliya / Prasad, Sadhana / Thabane, Lehana / Wark, John D / Giangregorio, Lora M. ·Department of Medicine, McMaster University, Hamilton, Canada. · Department of Kinesiology and Physical Activity, McGill University, Montreal, Canada. · Department of Family Medicine, University of British Columbia, Vancouver, Canada. · Department of Medicine, University of Toronto, Toronto, Canada. · Department of Rehabilitation, Ageing and Independent Living, Curtin University, Victoria, Australia. · Department of Medicine, University of British Columbia, Vancouver, Canada. · Department of Medicine, University of Melbourne, Melbourne, Australia. · Department of Kinesiology, University of Waterloo, Waterloo, Canada. · Schlegel-UW Research Institute on Aging, Waterloo, Canada. ·Disabil Rehabil · Pubmed #31786954.

ABSTRACT:

7 Article Are osteoporotic vertebral fractures or forward head posture associated with performance-based measures of balance and mobility? 2019

Ziebart, Christina / Gibbs, Jenna C / McArthur, Caitlin / Papaioannou, Alexandra / Mittmann, Nicole / Laprade, Judi / Kim, Sandra / Khan, Aliya / Kendler, David L / Wark, John D / Thabane, Lehana / Scherer, Samuel C / Prasad, Sadhana / Hill, Keith D / Cheung, Angela M / Bleakney, Robert R / Ashe, Maureen C / Adachi, Jonathan D / Giangregorio, Lora M. ·Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. · University of Western Ontario, London, ON, Canada. · Department of Kinesology and Physical Education, McGill University, Quebec, Canada. · McMaster University, Hamilton, ON, Canada. · GERAS Centre for Aging Research, Hamilton, ON, Canada. · Sunnybrook Health Sciences Centre, Toronto, ON, Canada. · University of Toronto, Toronto, ON, Canada. · Women's College Hospital, Toronto, ON, Canada. · University of British Columbia, Vancouver, British Columbia, Canada. · University of Melbourne, Melbourne, Australia. · Royal Melbourne Hospital, Melbourne, Australia. · St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada. · Broadmeadows Health Service, Melbourne, Australia. · School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia. · Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada. · Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. lmgiangr@uwaterloo.ca. · University Health Network, Toronto, ON, Canada. lmgiangr@uwaterloo.ca. · Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada. lmgiangr@uwaterloo.ca. ·Arch Osteoporos · Pubmed #31243557.

ABSTRACT: The main objective of this study was to explore whether vertebral fracture characteristics or posture is independently associated with physical performance. Posture was significantly associated with physical performance but fracture characteristics were not, suggesting posture should be the focus of physical performance variance. PURPOSE: The main objective of this study was to explore whether vertebral fracture characteristics (number, severity, location) or occiput-to-wall distance (OWD) is independently associated with physical performance. METHODS: This was a secondary data analysis using baseline data from a randomized controlled trial, of community-dwelling women aged 65 years and older with a suspected vertebral fragility fracture. Lateral thoracic and lumbar spine radiographs were used to determine the number, location, and severity of fracture. The dependent variables were timed up and go (TUG), five times sit-to-stand, four-meter walk, and step test. The independent variables were number, severity, location of fracture, and OWD. Pain during movement and age were covariates. Multivariable regression analyses determined the association between each of the dependent and independent variables. RESULTS: Participants' (n = 158) mean (standard deviation [SD]) age was 75.9 (6.5) years. They had a mean (SD) BMI, OWD, and number of fractures of 26.7 (5.3) kg/m CONCLUSION: OWD was significantly associated with physical performance but fracture characteristics were not. These analyses were exploratory and require replication in future studies.

8 Article Exploring the association between number, severity, location of fracture, and occiput-to-wall distance. 2019

Ziebart, Christina / Adachi, Jonathan D / Ashe, Maureen C / Bleakney, Robert R / Cheung, Angela M / Gibbs, Jenna C / Hill, Keith D / Kendler, David L / Khan, Aliya A / Kim, Sandra / McArthur, Caitlin / Mittmann, Nicole / Papaioannou, Alexandra / Prasad, Sadhana / Scherer, Samuel C / Thabane, Lehana / Wark, John D / Giangregorio, Lora M. ·Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. · University of Western Ontario, London, Canada. · McMaster University, Hamilton, Canada. · St Joseph's Healthcare-Hamilton, Hamilton, Canada. · University of British Columbia, Vancouver, Canada. · Centre for Hip Health and Mobility, Vancouver, Canada. · Department of Medicine, University of Toronto, Toronto, Canada. · University Health Network, Toronto, Canada. · School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia. · Women's College Hospital, Toronto, Canada. · Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada. · Sunnybrook Health Sciences Centre, Toronto, Canada. · Broadmeadows Health Service, Broadmeadows, Australia. · University of Melbourne, Melbourne, Australia. · Royal Melbourne Hospital, Parkville, Australia. · Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. lmgiangr@uwaterloo.ca. · University Health Network, Toronto, Canada. lmgiangr@uwaterloo.ca. · Schlegel-UW Research Institute for Aging, Waterloo, Canada. lmgiangr@uwaterloo.ca. ·Arch Osteoporos · Pubmed #30820733.

ABSTRACT: This study of women with a suspected vertebral fracture determined the association between vertebral fracture characteristics and posture. The number of fractures was associated with posture. Severity of fracture was associated with posture when adjusting for pain. Fracture characteristics explain some variability in posture in women with a suspected vertebral fracture. PURPOSE: Osteoporotic vertebral fractures are associated with increased morbidity and mortality. An accumulation of vertebral fractures may lead to forward head posture, which has been independently associated with mortality. It is unclear how fracture characteristics, including the number, severity, and location of fracture, contribute to occiput-to-wall distance (OWD). METHODS: This was a cross-sectional secondary data analysis using baseline data from a randomized controlled trial, in community-dwelling women aged 65 years and older with a suspected vertebral fragility fracture. Lateral thoracic and lumbar spine radiographs were used to determine the number, location, and severity of fracture. Occiput-to-wall distance (OWD) was used to assess forward head posture. Pain during movement (0-10 scale) and age were considered as confounding variables. Multivariable regression models were used to evaluate relationships between fracture variables and OWD. RESULTS: Participants (n = 158) were of mean age 75.9 (SD 6.5) years with a mean (SD) BMI = 26.7 (5.3) kg/m CONCLUSIONS: The number of fractures was significantly associated with OWD in the unadjusted model, explaining more of the variability in OWD than other fracture characteristics. Severity of fracture was associated with OWD in the adjusted model. However, pain may confound the relationship between OWD and fracture characteristics.

9 Article Frailty and Risk of Fractures in Patients With Type 2 Diabetes. 2019

Li, Guowei / Prior, Jerilynn C / Leslie, William D / Thabane, Lehana / Papaioannou, Alexandra / Josse, Robert G / Kaiser, Stephanie M / Kovacs, Christopher S / Anastassiades, Tassos / Towheed, Tanveer / Davison, K Shawn / Levine, Mitchell / Goltzman, David / Adachi, Jonathan D / Anonymous531028. ·Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China lig28@mcmaster.ca. · Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. · St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. · Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, University of Toronto, Toronto, Ontario, Canada. · Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. · Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada. · Department of Medicine, Queen's University, Kingston, Ontario, Canada. · Saskatoon Osteoporosis and CaMos Centre, Saskatoon, Saskatchewan, Canada. · Department of Medicine, McGill University, Montréal, Québec, Canada. ·Diabetes Care · Pubmed #30692240.

ABSTRACT: OBJECTIVE: We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures. RESEARCH DESIGN AND METHODS: Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; secondary outcomes included time to hip fracture and to clinical spine fracture. Frailty status was measured by a Frailty Index (FI) of deficit accumulation. The Cox model incorporating an interaction term (frailty × diabetes) was used for analyses. RESULTS: The analysis included 3,149 (70% women) participants; 138 (60% women) had diabetes. Higher bone mineral density and FI were observed in participants with diabetes compared with control subjects. A significant relationship between the FI and the risk of incident fragility fractures was found, with a hazard ratio (HR) of 1.02 (95% CI 1.01-1.03) and 1.19 (95% CI 1.10-1.33) for per-0.01 and per-0.10 FI increase, respectively. The interaction was also statistically significant ( CONCLUSIONS: Participants with type 2 diabetes were significantly frailer than individuals without diabetes. Frailty increases the risk of fragility fracture and enhances the effect of diabetes on fragility fractures. Particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail.

10 Article Build better bones with exercise (B3E pilot trial): results of a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in older women with vertebral fracture. 2018

Giangregorio, L M / Gibbs, J C / Templeton, J A / Adachi, J D / Ashe, M C / Bleakney, R R / Cheung, A M / Hill, K D / Kendler, D L / Khan, A A / Kim, S / McArthur, C / Mittmann, N / Papaioannou, A / Prasad, S / Scherer, S C / Thabane, L / Wark, J D. ·Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. lmgiangr@uwaterloo.ca. · Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. lmgiangr@uwaterloo.ca. · Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada. lmgiangr@uwaterloo.ca. · Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. · McMaster University, Hamilton, Ontario, Canada. · St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada. · University of British Columbia, Vancouver, Canada. · Centre for Hip Health and Mobility, Vancouver, Canada. · University of Toronto, Toronto, Ontario, Canada. · School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia. · Women's College Hospital, Toronto, Ontario, Canada. · Geriatric Education and Research in Aging Sciences Centre, Hamilton, Ontario, Canada. · Sunnybrook Health Sciences Centre, Toronto, Canada. · Broadmeadows Health Service, Broadmeadows, Australia. · University of Melbourne, Melbourne, Australia. · Royal Melbourne Hospital, Parkville, Australia. ·Osteoporos Int · Pubmed #30091064.

ABSTRACT: We pilot-tested a trial of home exercise on individuals with osteoporosis and spine fracture. Our target enrollment was met, though it took longer than expected. Participants stayed in the study and completed the exercise program with no safety concerns. Future trials should expand the inclusion criteria and consider other changes. PURPOSE: Osteoporotic fragility fractures create a substantial human and economic burden. There have been calls for a large randomized controlled trial examining the effect of exercise on fracture incidence. The B3E pilot trial was designed to evaluate the feasibility of a large trial examining the effects of home exercise on individuals at high risk of fracture. METHODS: Community-dwelling women ≥ 65 years with radiographically confirmed vertebral compression fractures were recruited at seven sites in Canada and Australia. We randomized participants in a 1:1 ratio to a 12-month home exercise program or equal attention control group, both delivered by a physiotherapist (PT). Participants received six PT home visits in addition to monthly phone calls from the PT and a blinded research assistant. The primary feasibility outcomes of the study were recruitment rate (20 per site in 1 year), retention rate (75% completion), and intervention adherence rate (60% of weeks meeting exercise goals). Secondary outcomes included falls, fractures and adverse events. RESULTS: One hundred forty-one participants were recruited; an average of 20 per site, though most sites took longer than anticipated. Retention and adherence met the criteria for success: 92% of participants completed the study; average adherence was 66%. The intervention group did not differ significantly in the number of falls (IRR 0.97, 95% CI 0.58 to 1.63) or fragility fractures (OR 1.11, 95% CI 0.60 to 2.05) compared to the control group. There were 18 serious adverse events in the intervention group and 12 in the control group. CONCLUSION: An RCT of home exercise in women with vertebral fractures is feasible but recruitment was a challenge. Suggestions are made for the conduct of future trials.

11 Article Osteoporotic fractures and obesity affect frailty progression: a longitudinal analysis of the Canadian multicentre osteoporosis study. 2018

Gajic-Veljanoski, Olga / Papaioannou, Alexandra / Kennedy, Courtney / Ioannidis, George / Berger, Claudie / Wong, Andy Kin On / Rockwood, Kenneth / Kirkland, Susan / Raina, Parminder / Thabane, Lehana / Adachi, Jonathan D / Anonymous2310932. ·Department of Medicine, McMaster University, Hamilton, ON, Canada. · Hamilton Health Sciences-Geriatric Education and Research in Aging Sciences (GERAS) Centre, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada. · Department of Medicine, McMaster University, Hamilton, ON, Canada. papaioannou@hhsc.ca. · Hamilton Health Sciences-Geriatric Education and Research in Aging Sciences (GERAS) Centre, 88 Maplewood Ave, Hamilton, ON, L8M 1W9, Canada. papaioannou@hhsc.ca. · CaMos - McGill University, Montreal, Québec, Canada. · Osteoporosis and Women's Health Program, University Health Network, Toronto, ON, Canada. · Dalhousie University, Halifax, NS, Canada. · St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. ·BMC Geriatr · Pubmed #29304836.

ABSTRACT: BACKGROUND: Despite knowing better how to screen older adults, understanding how frailty progression might be modified is unclear. We explored effects of modifiable and non-modifiable factors on changes in frailty in community-dwelling adults aged 50+ years who participated in the Canadian Multicentre Osteoporosis Study (CaMos). METHODS: Rates of change in frailty over 10 years were examined using the 30-item CaMos Frailty Index (CFI). Incident and prevalent low-trauma fractures were categorized by fracture site into hip, clinical vertebral and non-hip-non-vertebral fractures. Multivariable generalized estimating equation models accounted for the time of frailty assessment (baseline, 5 and 10 years), sex, age, body mass index (BMI, kg/m RESULTS: The cohort included 5566 women (mean ± standard deviation: 66.8 ± 9.3 years) and 2187 men (66.3 ± 9.5 years) with the mean baseline CFI scores of 0.15 ± 0.11 and 0.12 ± 0.10, respectively. Incident fractures and obesity most strongly predicted frailty progression in multivariable analyses. The impact of fractures differed between the sexes. With each incident hip fracture, the adjusted mean CFI accelerated per 5 years by 0.07 in women (95% confidence interval [CI]: 0.03 to 0.11) and by 0.12 in men (95% CI: 0.08 to 0.16). An incident vertebral fracture increased frailty in women (0.05, 95% CI: 0.02 to 0.08) but not in men (0.01, 95% CI: -0.07 to 0.09). Irrespective of sex and prevalent fractures, baseline obesity was associated with faster frailty progression: a 5-year increase in the adjusted mean CFI ranged from 0.01 in overweight (BMI: 25.0 to 29.9 kg/m CONCLUSIONS: Older women and men with new vertebral fractures, hip fractures or obesity represent high-risk groups that should be considered for frailty interventions.

12 Article Muscle Density and Bone Quality of the Distal Lower Extremity Among Individuals with Chronic Spinal Cord Injury. 2015

Gibbs, Jenna C / Craven, B Catharine / Moore, Cameron / Thabane, Lehana / Adachi, Jonathan D / Giangregorio, Lora M. ·Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada. · Lyndhurst Centre, University Health Network-Toronto Rehabilitation Institute, Toronto, Ontario, Canada. · Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Schlegel Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada. ·Top Spinal Cord Inj Rehabil · Pubmed #26689693.

ABSTRACT: BACKGROUND: Understanding the related fates of muscle density and bone quality after chronic spinal cord injury (SCI) is an important initial step in determining endocrine-metabolic risk. OBJECTIVE: To examine the associations between muscle density and indices of bone quality at the distal lower extremity of adults with chronic SCI. METHODS: A secondary data analysis was conducted in 70 adults with chronic SCI (C2-T12; American Spinal Injury Association Impairment Scale [AIS] A-D; ≥2 years post injury). Muscle density and cross-sectional area (CSA) and bone quality indices (trabecular bone mineral density [TbBMD] at the distal tibia [4% site] and cortical thickness [CtTh], cortical area [CtAr], cortical BMD [CtBMD], and polar moment of inertia [PMI] at the tibial shaft [66% site]) were measured using peripheral quantitative computed tomography. Calf lower extremity motor score (cLEMS) was used as a clinical measure of muscle function. Multivariable linear regression analyses were performed to determine the strength of the muscle-bone associations after adjusting for confounding variables (sex, impairment severity [AIS A/B vs AIS C/D], duration of injury, and wheelchair use). RESULTS: Muscle density was positively associated with TbBMD (b = 0.85 [0.04, 1.66]), CtTh (b = 0.02 [0.001, 0.034]), and CtBMD (b = 1.70 [0.71, 2.69]) (P < .05). Muscle CSA was most strongly associated with CtAr (b = 2.50 [0.12, 4.88]) and PMI (b = 731.8 [161.7, 1301.9]) (P < .05), whereas cLEMS was most strongly associated with TbBMD (b = 7.69 [4.63, 10.76]) (P < .001). CONCLUSIONS: Muscle density and function were most strongly associated with TbBMD at the distal tibia in adults with chronic SCI, whereas muscle size was most strongly associated with bone size and geometry at the tibial shaft.

13 Article Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. 2015

Kennedy, Courtney C / Ioannidis, George / Thabane, Lehana / Adachi, Jonathan D / Marr, Sharon / Giangregorio, Lora M / Morin, Suzanne N / Crilly, Richard G / Josse, Robert G / Lohfeld, Lynne / Pickard, Laura E / van der Horst, Mary-Lou / Campbell, Glenda / Stroud, Jackie / Dolovich, Lisa / Sawka, Anna M / Jain, Ravi / Nash, Lynn / Papaioannou, Alexandra. ·McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. kennedyc@hhsc.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. g.ioannidis@sympatico.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. thabanl@mcmaster.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. adachi@sympatico.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. marrs@mcmaster.ca. · University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. lmgiangr@uwaterloo.ca. · McGill University, 845Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada. suzanne.morin@mcgill.ca. · Western University, Parkwood Hospital, 801 Commissioners Road East, London, ON, N6C 5 J1, Canada. crilly@sjhc.london.on.ca. · University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. josser@smh.toronto.on.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. lohfeld@mcmaster.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. pickardl@hhsc.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. dhm9@xplornet.com. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. ecampbell49@quickclic.net. · Medical Pharmacies Group Limited, 590 Granite Crt, Pickering, ON, L1W 3X6, Canada. jstroud@medicalpharmacies.com. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. ldolovic@mcmaster.ca. · University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. sawka@uhn.on.ca. · Osteoporosis Canada, Suite 301, 1090 Don Mills Road, Toronto, ON, M3C 3R6, Canada. RJain@osteoporosis.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. nashl@mcmaster.ca. · McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. papaioannou@hhsc.ca. · Division of Geriatrics, Department of Medicine, McMaster University, Geriatric Education and Research in Aging Sciences (GERAS) Centre, St. Peter's Hospital, Room 151, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada. papaioannou@hhsc.ca. ·Trials · Pubmed #25962885.

ABSTRACT: BACKGROUND: Few studies have systematically examined whether knowledge translation (KT) strategies can be successfully implemented within the long-term care (LTC) setting. In this study, we examined the effectiveness of a multifaceted, interdisciplinary KT intervention for improving the prescribing of vitamin D, calcium and osteoporosis medications over 12-months. METHODS: We conducted a pilot, cluster randomized controlled trial in 40 LTC homes (21 control; 19 intervention) in Ontario, Canada. LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider. Participants were interdisciplinary care teams (physicians, nurses, consultant pharmacists, and other staff) who met quarterly. Intervention homes participated in three educational meetings over 12 months, including a standardized presentation led by expert opinion leaders, action planning for quality improvement, and audit and feedback review. Control homes did not receive any additional intervention. Resident-level prescribing and clinical outcomes were collected from the pharmacy database; data collectors and analysts were blinded. In addition to feasibility measures, study outcomes were the proportion of residents taking vitamin D (≥800 IU/daily; primary), calcium ≥500 mg/day and osteoporosis medications (high-risk residents) over 12 months. Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes. RESULTS: At baseline, 5,478 residents, mean age 84.4 (standard deviation (SD) 10.9), 71% female, resided in 40 LTC homes, mean size = 137 beds (SD 76.7). In the intention-to-treat analysis (21 control; 19 intervention clusters), the intervention resulted in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D (odds ratio (OR) 1.82, 95% confidence interval (CI): 1.12, 2.96) and calcium (OR 1.33, 95% CI: 1.01, 1.74), but not for osteoporosis medications (OR 1.17, 95% CI: 0.91, 1.51). In secondary analyses, excluding seven nonparticipating intervention homes, ORs were 3.06 (95% CI: 2.18, 4.29), 1.57 (95% CI: 1.12, 2.21), 1.20 (95% CI: 0.90, 1.60) for vitamin D, calcium and osteoporosis medications, respectively. CONCLUSIONS: Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01398527 . Registered: 19 July 2011.

14 Article Osteoporosis prescribing in long-term care: impact of a provincial knowledge translation strategy. 2015

Kennedy, Courtney C / Ioannidis, George / Thabane, Lehana / Adachi, Jonathan D / O'Donnell, Denis / Giangregorio, Lora M / Pickard, Laura E / Papaioannou, Alexandra. ·Department of Medicine,McMaster University. · Clinical Epidemiology and Biostatistics,McMaster University. · Medical Pharmacies Group Limited. · Department of Kinesiology,University of Waterloo. ·Can J Aging · Pubmed #25850439.

ABSTRACT: This study described prescribing trends before and after implementing a provincial strategy aimed at improving osteoporosis and fracture prevention in Ontario long-term care (LTC) homes. Data were obtained from a pharmacy provider for 10 LTC homes in 2007 and 166 homes in 2012. We used weighted, multiple linear regression analyses to examine facility-level changes in vitamin D, calcium, and osteoporosis medication prescribing rates between 2007 and 2012. After five years, the estimated increase in vitamin D, calcium, and osteoporosis medication prescribing rates, respectively, was 38.2 per cent (95% confidence interval [CI]: 29.0, 47.3; p < .001), 4.0 per cent (95% CI: -3.9, 12.0; p = .318), and 0.2 per cent (95% CI: -3.3, 3.7; p = .91). Although the study could not assess causality, findings suggest that wide-scale knowledge translation activities successfully improved vitamin D prescribing rates, although ongoing efforts are needed to target homes with low uptake.

15 Article Comparison between frailty index of deficit accumulation and phenotypic model to predict risk of falls: data from the global longitudinal study of osteoporosis in women (GLOW) Hamilton cohort. 2015

Li, Guowei / Thabane, Lehana / Ioannidis, George / Kennedy, Courtney / Papaioannou, Alexandra / Adachi, Jonathan D. ·Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada. · Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada. ·PLoS One · Pubmed #25764521.

ABSTRACT: OBJECTIVES: To compare the predictive accuracy of the frailty index (FI) of deficit accumulation and the phenotypic frailty (PF) model in predicting risks of future falls, fractures and death in women aged ≥55 years. METHODS: Based on the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort (n = 3,985), we compared the predictive accuracy of the FI and PF in risks of falls, fractures and death using three strategies: (1) investigated the relationship with adverse health outcomes by increasing per one-fifth (i.e., 20%) of the FI and PF; (2) trichotomized the FI based on the overlap in the density distribution of the FI by the three groups (robust, pre-frail and frail) which were defined by the PF; (3) categorized the women according to a predicted probability function of falls during the third year of follow-up predicted by the FI. Logistic regression models were used for falls and death, while survival analyses were conducted for fractures. RESULTS: The FI and PF agreed with each other at a good level of consensus (correlation coefficients ≥ 0.56) in all the three strategies. Both the FI and PF approaches predicted adverse health outcomes significantly. The FI quantified the risks of future falls, fractures and death more precisely than the PF. Both the FI and PF discriminated risks of adverse outcomes in multivariable models with acceptable and comparable area under the curve (AUCs) for falls (AUCs ≥ 0.68) and death (AUCs ≥ 0.79), and c-indices for fractures (c-indices ≥ 0.69) respectively. CONCLUSIONS: The FI is comparable with the PF in predicting risks of adverse health outcomes. These findings may indicate the flexibility in the choice of frailty model for the elderly in the population-based settings.

16 Article Implementing a knowledge translation intervention in long-term care: feasibility results from the Vitamin D and Osteoporosis Study (ViDOS). 2014

Kennedy, Courtney C / Thabane, Lehana / Ioannidis, George / Adachi, Jonathan D / Papaioannou, Alexandra / Anonymous1900798. ·Department of Medicine, McMaster University, Hamilton, ON, Canada. · Department of Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. · Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: papaioannou@hhsc.ca. ·J Am Med Dir Assoc · Pubmed #24953541.

ABSTRACT: OBJECTIVES: To evaluate the feasibility of implementing an interdisciplinary, multifaceted knowledge translation intervention within long-term care (LTC) and to identify any challenges that should be considered in designing future studies. DESIGN: Cluster randomized controlled trial. SETTING: Forty LTC homes across the province of Ontario, Canada. PARTICIPANTS: LTC teams composed of physicians, nurses, pharmacists, and other staff. MEASUREMENTS: Cluster-level feasibility measures, including recruitment, retention, data completion, and participation in the intervention. A process evaluation was completed by directors of care indicating which process/policy changes had been implemented. RESULTS: Recruitment and retention rates were 22% and 63%, respectively. Good fidelity with the intervention was achieved, including attendance at educational meetings. After ViDOS, 7 process indicators were being newly implemented by more than 50% of active intervention homes. CONCLUSION: Despite recruitment and retention challenges, the multifaceted intervention produced a number of policy/process changes and had good intervention fidelity. This study is registered at ClinicalTrials.gov NCT01398527.

17 Article Fractures are increased and bisphosphonate use decreased in individuals with insulin-dependent diabetes: a 10 year cohort study. 2014

Fraser, Lisa-Ann / Papaioannou, Alexandra / Adachi, Jonathan D / Ma, Jinhui / Thabane, Lehana / Anonymous880797. ·Department of Medicine, University of Western Ontario, London, Ontario, Canada. Lisaann.Fraser@sjhc.london.on.ca. ·BMC Musculoskelet Disord · Pubmed #24919660.

ABSTRACT: BACKGROUND: Individuals with diabetes have been found previously to be at increased risk of non-traumatic fracture. However, it is unclear if these individuals are being identified and treated for osteoporosis. METHODS: 7753 Canadians over 50 years of age were followed prospectively for 10 years. 606/7753 (7.8%) of had diabetes; 98 were insulin-dependent and 508 were not. Using a cox proportional hazards model, we assessed the association between diabetes status and incident non-traumatic fracture. Using logistic regression we identified factors associated with bisphosphonate use over the 10 year period of study. RESULTS: Mean (SD) age of participants was 66.7(9.4) years and 72% were female. Those with diabetes had higher BMD T-scores at baseline, with a mean (SD) femoral neck T-Score of -0.97 (1.06), compared to -1.24 (0.99) in the general cohort. The adjusted hazard ratio (HR) for incident non-traumatic fracture in individuals with insulin-dependent diabetes over the 10 year study period was 2.50 (95% confidence interval [CI] 1.60, 3.90; p < 0.001). Despite this increased fracture rate, individuals with diabetes (insulin-dependent or non-insulin-dependent) were less likely to be on bisphosphonate therapy at any point over 10 years of prospective follow up compared to other CaMos subjects (odds ratio [OR]: 0.59; 95% CI 0.46-0.75, p < 0.001). CONCLUSIONS: Despite the increased risk of non-traumatic fracture associated with insulin-dependent diabetes, we that found individuals with diabetes are less likely to be treated with a bisphosphonate than those without diabetes. These findings point to a possible care gap in the treatment of non-traumatic fractures in individuals with diabetes in Canada.

18 Article Frailty index of deficit accumulation and falls: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort. 2014

Li, Guowei / Ioannidis, George / Pickard, Laura / Kennedy, Courtney / Papaioannou, Alexandra / Thabane, Lehana / Adachi, Jonathan D. ·Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 L8, Canada. jd.adachi@sympatico.ca. ·BMC Musculoskelet Disord · Pubmed #24885323.

ABSTRACT: BACKGROUND: To investigate the association between frailty index (FI) of deficit accumulation and risk of falls, fractures, death and overnight hospitalizations in women aged 55 years and older. METHODS: The data were from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton Cohort. In this 3-year longitudinal, observational cohort study, women (N=3,985) aged ≥ 55 years were enrolled between May 2008 and March 2009 in Hamilton, Canada. A FI including co-morbidities, activities of daily living, symptoms and signs, and healthcare utilization was constructed using 34 health deficits at baseline. Relationship between the FI and falls, fractures, death and overnight hospitalizations was examined. RESULTS: The FI was significantly associated with age, with a mean rate of deficit accumulation across baseline age of 0.004 or 0.021 (on a log scale) per year. During the third year of follow-up, 1,068 (31.89%) women reported at least one fall. Each increment of 0.01 on the FI was associated with a significantly increased risk of falls during the third year of follow-up (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.02-1.03). The area under the curve (AUC) of the predictive model was 0.69 (95% CI: 0.67-0.71). Results of subgroup and sensitivity analyses indicated the relationship between the FI and risk of falls was robust, while bootstrap analysis judged its internal validation. The FI was significantly related to fractures (hazard ratio [HR]: 1.02, 95% CI: 1.01-1.03), death (OR: 1.05, 95% CI: 1.03-1.06) during the 3-year follow-up period and overnight hospitalizations (incidence rate ratio [IRR]: 1.02, 95% CI: 1.02-1.03) for an increase of 0.01 on the FI during the third year of follow-up. Measured by per standard deviation (SD) increment of the FI, the ORs were 1.21 and 1.40 for falls and death respectively, while the HR was 1.17 for fractures and the IRR was 1.18 for overnight hospitalizations respectively. CONCLUSION: The FI of deficit accumulation increased with chronological age significantly. The FI was associated with and predicted increased risk of falls, fractures, death and overnight hospitalizations significantly.

19 Article The effect of regular physical activity on bone mineral density in post-menopausal women aged 75 and over: a retrospective analysis from the Canadian multicentre osteoporosis study. 2013

Muir, Jeffrey M / Ye, Chenglin / Bhandari, Mohit / Adachi, Jonathan D / Thabane, Lehana. ·Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. drjeffmuir@gmail.com. ·BMC Musculoskelet Disord · Pubmed #23971674.

ABSTRACT: BACKGROUND: Physical activity is known to benefit many physiological processes, including bone turnover. There are; however, currently no clinical guidelines regarding the most appropriate type, intensity and duration of activity to prevent bone loss. METHODS: To help address this gap in the literature, we performed a retrospective analysis of data from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective cohort of 9423 adult patients, to determine the relationship between the amount of regular daily physical activity performed and bone mineral density. A total of 1169 female participants aged 75 and over provided information regarding their daily activity levels, including the amount of time spent each week performing physical activity at varying levels of intensity. Multiple and linear regression analyses were used to determine the effect of increasing amounts of this regular physical activity on bone mineral density. RESULTS: The results indicate that a step increase in the amount of physical activity performed each day resulted in a positive effect on bone mineral density at the hip, Ward's triangle, trochanter and femoral neck (B = 0.006 to 0.008, p < 0.05). Possible confounding factors such as the use of anti-resorptive therapy, body mass index and age were included in the analysis and suggested that age had a negative effect on bone density while body mass index had a positive effect. Anti-resorptive therapy provided a protective effect against loss of bone density. CONCLUSIONS: The data indicate that a step increase in the amount of daily activity, using simple, daily performed tasks, can help prevent decreases in post-menopausal bone mineral density.

20 Article Estimating the excess costs for patients with incident fractures, prevalent fractures, and nonfracture osteoporosis. 2013

Hopkins, R B / Tarride, J E / Leslie, W D / Metge, C / Lix, L M / Morin, S / Finlayson, G / Azimaee, M / Pullenayegum, E / Goeree, R / Adachi, J D / Papaioannou, A / Thabane, L. ·Department of Clinical Epidemiology and Biostatistics, Faculty of Health Science, McMaster University, Hamilton, ON, Canada. hopkinr@mcmaster.ca ·Osteoporos Int · Pubmed #22572964.

ABSTRACT: SUMMARY: Based on a population age 50+, significant excess costs relative to matched controls exist for patients with incident fractures that are similar in relative magnitude to other chronic diseases such as stroke or heart disease. Prevalent fractures also have significant excess costs that are similar in relative magnitude to asthma/chronic obstructive pulmonary disease. INTRODUCTION: Cost of illness studies for osteoporosis that only include incident fractures may ignore the long-term cost of prevalent fractures and primary preventive care. We estimated the excess costs for patients with incident fractures, prevalent fractures, and nonfracture osteoporosis relative to matched controls. METHODS: Men and women age 50+ were selected from administrative records in the province of Manitoba, Canada for the fiscal year 2007-2008. Three types of cases were identified: (1) patients with incident fractures in the current year (2007-2008), (2) patients with prevalent fractures in previous years (1995-2007), and (3) nonfracture osteoporosis patients identified by specific pharmacotherapy or low bone mineral density. Excess resource utilization and costs were estimated by subtracting control means from case means. RESULTS: Seventy-three percent of provincial population age 50+ (52 % of all men and 91 % of all women) were included (121,937 cases, 162,171 controls). There were 3,776 cases with incident fracture (1,273 men and 2,503 women), 43,406 cases with prevalent fractures (15,784 men and 27,622 women) and 74,755 nonfracture osteoporosis cases (7,705 men and 67,050 women). All incident fractures had significant excess costs. Incident hip fractures had the highest excess cost: men $44,963 (95 % CI: $38,498-51,428) and women $45,715 (95 % CI: $36,998-54,433). Prevalent fractures (other than miscellaneous or wrist fractures) also had significant excess costs. No significant excess costs existed for nonfracture osteoporosis. CONCLUSION: Significant excess costs exist for patients with incident fractures and with prevalent hip, vertebral, humerus, multiple, and traumatic fractures. Ignoring prevalent fractures underestimate the true cost of osteoporosis.

21 Article An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. 2012

Kennedy, Courtney C / Ioannidis, George / Giangregorio, Lora M / Adachi, Jonathan D / Thabane, Lehana / Morin, Suzanne N / Crilly, Richard G / Marr, Sharon / Josse, Robert G / Lohfeld, Lynne / Pickard, Laura E / King, Susanne / van der Horst, Mary-Lou / Campbell, Glenda / Stroud, Jackie / Dolovich, Lisa / Sawka, Anna M / Jain, Ravi / Nash, Lynn / Papaioannou, Alexandra. ·Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. kennedyc@hhsc.ca ·Implement Sci · Pubmed #22624776.

ABSTRACT: BACKGROUND: Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes. METHODS AND DESIGN: The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel. DISCUSSION: Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.

22 Article Osteoporosis knowledge among individuals with recent fragility fracture. 2010

Giangregorio, L / Thabane, L / Cranney, A / Adili, A / deBeer, J / Dolovich, L / Adachi, J D / Papaioannou, A. ·Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada. ·Orthop Nurs · Pubmed #20335769.

ABSTRACT: BACKGROUND: To evaluate osteoporosis knowledge among patients with fractures and to evaluate factors associated with osteoporosis knowledge. METHODS: Patients with fragility fractures participated in a telephone interview. Participants were asked what they thought osteoporosis was. Unadjusted odds ratios (OR, 95% CI) were calculated to identify factors associated with a correct definition. Predictors identified in univariate analysis were entered into multivariable logistic regression models. A subset also completed the Facts on Osteoporosis Quiz. RESULTS: One hundred twenty-seven patients (82% women) participated in the study, with mean (SD) age being 67.5 (12.7) years. Ninety-five (75%) respondents gave correct osteoporosis definitions. The odds of an individual providing a correct definition of osteoporosis were higher for those who reported a diagnosis of osteoporosis or those who reported higher education levels, but the odds decreased with increasing age. A total of 49 (39%) respondents completed the Facts on Osteoporosis Quiz; the average score was 13.6 (3.8) of 21. Areas that respondents scored poorly on were related to key risk factors. CONCLUSION: Many patients with fractures are unaware of important risk factors. Education initiatives aimed at improving osteoporosis knowledge should be directed at individuals at high risk of fracture. Nurses and other allied healthcare providers working in fracture clinics, acute care, and rehabilitation settings are in an ideal position to communicate information about osteoporosis and fracture risk to individuals with a recent fragility fracture.