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Biomedical subjects

W M O'Fallon

Publications and source records attributed to W M O'Fallon.

At least 109 records · Page 6Linked to original sources
PubMed1997

Complications leading to surgery after breast implantation.

BACKGROUND: Local complications that require additional surgical procedures are an important problem for women with breast implants. METHODS: We studied 749 women who lived in Olmsted County, Minnesota, and received a first breast implant at the Mayo Clinic between 1964 and 1991. We identified complications that occurred after the initial procedure and after any subsequent implantation. A complication was defined as a surgical procedure performed for any of the following reasons: capsular contracture; rupture of the implant; hematoma or bleeding; infection or seroma of the wound; chronic pain; extrusion, leakage, or sweating of the implant; necrosis of the nipple, areola, or flap; malfunction of the filler port of a tissue expander; and wound dehiscence. RESULTS: During follow-up (mean, 7.8 years; range, 0 to 25.8), 208 (27.8 percent) of the women underwent 450 additional implant-related surgical procedures. Ninety-one (20.2 percent) were anticipated, staged procedures or were done because the patient requested a size change or aesthetic improvement, and 359 procedures (79.8 percent) had at least one clinical indication (thus constituting a complication). Complications occurred in 178 (23.8 percent) of the 749 women and involved 274 (18.8 percent) of the 1454 breasts with implants and 321 (18.8 percent) of the 1703 implants. The most frequent problem was capsular contraction (272 cases), followed by rupture of the implant (60), hematoma (55), and wound infection (23). The rate of complications was significantly lower (P<0.001) among women with cosmetic implants (6.5 percent at one year, 12 percent at five years) than among women who underwent implantation after mastectomy for breast cancer (21.8 percent at one year, 34 percent at five years) or prophylactic mastectomy (17.3 percent at one year, 30.4 percent at five years). CONCLUSIONS: Women who have had breast implantation frequently experience local complications during the subsequent five years. Complications were significantly less frequent among patients who received implants for cosmetic reasons than among those who received implants after mastectomy for cancer or for cancer prophylaxis.

Adult↗
PubMed1997

Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica.

OBJECTIVE: To evaluate the incidence and risks of adverse events associated with therapy (both corticosteroids [CS] and nonsteroidal antiinflammatory drugs [NSAIDs]) among a previously identified, population-based cohort of patients first diagnosed with polymyalgia rheumatica (PMR) between 1970 and 1991 who were followed up over the long term. METHODS: Information on demographics, PMR diagnosis, disease course, and drug therapy, in addition to data on adverse events commonly associated with CS and NSAID treatment, was obtained from the Rochester Epidemiology Project database. Cox proportional hazards and regression analysis models were used to evaluate the relationship between the occurrence of these events and therapy. RESULTS: Of the 232 patients (69 male, 163 female) included in the study, the mean age at PMR diagnosis was 72.9 years, the average followup was 8.0 years, and 30 patients were also diagnosed with giant cell (temporal) arteritis. Among the 175 patients (49 male, 126 female) treated with CS, the mean duration of CS therapy was 2.4 years, the average daily dose was 9.6 mg, and the mean cumulative dose was 8.4 gm. In total, 65% of the 124 patients treated with CS alone experienced at least 1 adverse event, compared with 67% of the 57 patients treated with NSAIDs alone and 80% of the 51 patients treated with CS and NSAIDs. The average time from initiation of therapy to the first adverse event was 1.6 years (n = 160). Proportional hazards modeling identified 3 variables that independently increased the risk of adverse events: age at PMR diagnosis, a cumulative dose of prednisone > or = 1,800 mg, and female sex. Person-year analysis revealed that the risks of diabetes mellitus, vertebral fractures, femoral neck fractures, and hip fractures were 2-5 times greater among PMR patients compared with age- and sex-matched individuals from the same population. Medical care or consultation by a rheumatologist was a highly significant predictor of a lower initial CS dose. CONCLUSION: The use of CS and NSAIDs in the treatment of PMR is associated with important long-term morbidity.

Adrenal Cortex Hormones↗
PubMed1997

Psychosocial outcomes and health status of adults who have had juvenile rheumatoid arthritis: a controlled, population-based study.

OBJECTIVE: The goal of this study was to evaluate the physical and psychosocial impact of juvenile rheumatoid arthritis (JRA) among a population-based cohort of adults who had the disease during childhood, compared with a control cohort of subjects with no history of JRA. METHODS: The Rochester Epidemiology Project database was used to identify all cases of JRA (based on the American College of Rheumatology [formerly, the American Rheumatism Association] 1977 criteria) among Rochester, Minnesota residents first diagnosed between January 1, 1960 and December 31, 1993. Controls were age- and sex-matched to the cases as of the date of diagnosis of JRA. A pretested postal survey was mailed to all adult cases (whose date of birth was before December 31, 1975) and matched controls from the same population, to obtain information on socioeconomic issues and functional status (using the Health Assessment Questionnaire and the Health Status Questionnaire). The complete medical records of all cases and controls were reviewed to obtain information on demographics and clinical manifestations of JRA. RESULTS: Of the 50 eligible cases, 44 (88%) responded to the survey. There were 102 age- and sex-matched controls (2-3 per case) who responded to the survey. Seventy-three percent of the cases had pauciarticular-onset JRA, 16% had polyarticular-onset JRA, and 11% had systemic-onset JRA. Average followup was 24.7 years and 24.5 years after the index date for cases and controls, respectively. Greater disability (P = 0.0002), more bodily pain (P = 0.0002), increased fatigue (P = 0.0112), poorer health perception (P = 0.0004), and decreased physical functioning (P = 0.0002) were reported by the cases compared with the controls. JRA cases reported significantly lower rates of employment (P = 0.015) and lower levels of exercise (P = 0.0002) than did controls. Level of educational achievement, annual income, health insurance status, and rate of pregnancy and childbirth were similar for both cases and controls. CONCLUSION: Adults who have had JRA during childhood experience long-term physical and psychosocial impairment.

Adolescent↗
PubMed1997

Attained adult height after childhood asthma: effect of glucocorticoid therapy.

BACKGROUND: Although oral and inhaled glucocorticoid therapy may impair growth in children with asthma, the effect of glucocorticoid therapy and asthma on attained adult height has not been extensively studied in representative children in the community. OBJECTIVES: The study was designed to compare the attained adult height of children with asthma with the attained adult height of nonasthmatic children and to compare the attained adult height of asthmatic children treated with glucocorticoids with the attained adult height of asthmatic children who did not receive glucocorticoids. METHODS: Residents of Rochester, Minnesota, with onset of asthma from 1964 to 1987 and age- and sex-matched non-asthmatic residents of Rochester were studied. Glucocorticoid exposure was assessed from medical records. The mean of 5 stadiometer measurements of adult height, adjusted for sex and parental height, was analyzed. RESULTS: One hundred fifty-three patients with asthma (mean age at onset, 6.1 +/- 4.8 years) and 153 age- and sex-matched nonasthmatic subjects were studied. Adult height of patients with asthma (mean age at measurement, 25.7 +/- 5.2 years) was not significantly different from the adult height of non-asthmatic subjects; the overall difference, adjusted for mid-parental height, was -0.20 cm (95% confidence interval from -0.27 to 1.64). The adult height of asthmatic children treated with glucocorticoids was not significantly different from the adult height of patients with asthma not treated with glucocorticoids; the difference after adjusting for mid-parental height was -0.2 cm (95% confidence interval from -0.1 to 0.6). CONCLUSIONS: We conclude that the attained adult height of patients with asthma is not different from the adult height of age- and sex-matched nonasthmatic subjects and that the attained adult height of asthmatic children treated with glucocorticoids is not significantly different from the adult height of children not treated with glucocorticoids.

Administration, Inhalation↗
PubMed1997

Relationship of bone turnover to bone density and fractures.

To assess the influence of bone turnover on bone density and fracture risk, we measured serum levels of osteocalcin (OC), bone alkaline phosphatase (BAP), and carboxy-terminal propeptide of type I procollagen (PICP), as well as 24-h urine levels of cross-linked N-telopeptides of type I collagen (NTx) and the free pyridinium cross-links, pyridinoline (Pyd) and deoxypyridinoline (Dpd), among 351 subjects recruited from an age-stratified random sample of Rochester, Minnesota women, PICP, NTx, and Dpd were negatively associated with age among the 138 premenopausal women. All of the biochemical markers were positively associated with age among the 213 postmenopausal women, and the prevalence of elevated turnover (> 1 standard deviation [SD] above the premenopausal mean) varied from 9% (PICP) to 42% (Pyd). After adjusting for age, most of the markers were negatively correlated with bone mineral density (BMD) of the hip, spine, or forearm as measured by dual-energy X-ray absorptiometry, and women with osteoporosis were more likely to have high bone turnover. A history of osteoporotic fractures of the hip, spine, or distal forearm was associated with reduced hip BMD and with elevated Pyd. After adjusting for lower BMD and increased bone resorption, reduced bone formation as assessed by OC was also associated with prior osteoporotic fractures. These data indicate that a substantial subset of elderly women has elevated bone turnover, which appears to adversely influence BMD and fracture risk. Combined biochemical and BMD screening may provide better prediction of future fracture risk than BMD alone.

Adult↗
PubMed1997

Fractures after thyroidectomy in men: a population-based cohort study.

Bone mass is purportedly reduced by an endogenous or exogenous excess of thyroid hormone or, perhaps, by calcitonin deficiency. Patients who have undergone thyroidectomy could be subject to all of these effects, yet their practical implications in terms of fracture risk are poorly defined. Interpretation is further hampered by the focus on women, where results may be influenced by involutional osteoporosis. Consequently, we assessed the potential for fractures among the 136 Rochester, Minnesota men who underwent thyroidectomy between 1935 and 1979, relative to a group of age-matched control men from the community. With 2194 person-years of follow-up in each group, survival free of any fracture of vertebra, proximal humerus, distal forearm, pelvis, or proximal femur was similar in the two groups (p = 0.23), and the relative risk of any of these fractures for thyroidectomized patients versus their controls was increased only 1.5-fold (95% CI, 0.7-3.2). The difference was entirely accounted for by a statistically significant excess of proximal femur fractures in the men with thyroidectomy. Risk factors for fractures among men with thyroidectomy included greater age at surgery, greater extent of surgery, and the presence of risk factors for secondary osteoporosis. Thus, thyroidectomy, performed mainly for adenoma or goiter, seems to have little overall influence on the risk of age-related fractures in men. However, the association with hip fractures requires further evaluation.

Adult↗
PubMed1997

Indirect and nonmedical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls.

OBJECTIVE: Compared to rheumatoid arthritis (RA), osteoarthritis (OA) is considered much more benign and much less costly. We sought to describe the economic effects of RA and OA, in terms of the indirect and nonmedical expenditures, compared to nonarthritic controls. METHODS: Using our unique population based data resources, we developed a model for estimating and comparing disease specific costs among 2 randomly selected, community based samples of 200 patients each with RA and OA and a control group of 200 individuals from the same community who do not have arthritis. Data were collected using a pretested postal survey. Age and sex adjusted comparisons were conducted across the 3 groups, and predictors of cost and utilization were identified using logistic regression modeling. RESULTS: There were 123, 116, and 94 respondents among the RA, OA, and nonarthritis groups, respectively. The average age and the female-to-male ratios were higher in the OA and RA groups compared to the nonarthritis group. Patients with RA and OA required 3 times more days of care for their conditions compared to nonarthritics (p < 0.0001) and incurred significantly more expenditures for home or child care (p = 0.01) and other services (p = 0.001) (i.e., medical equipment, assistive devices, or home remodeling) compared to nonarthritics. In addition, patients with RA were significantly more likely to have lost their job or to have retired early due to their illness (p = 0.001); were the most likely to have reduced their work hours or stopped working entirely due to their illness (p = 0.003); and were 3 times more likely to have had a reduction in household family income than either individuals with OA or those without arthritis (p = 0.0001). Fifteen percent of respondents with RA were unable to get a job because of their illness, while 3% of respondents with OA and only 1% of nonarthritic respondents reported this experience (p = 0.001). Logistic regression analysis revealed that functional status and pain score, as well as the presence of either RA or OA, were significant predictors of cost and health services utilization. CONCLUSION: Disease specific indirect and nonmedical costs for OA are substantial and approach those for RA. This has important societal implications, given the high prevalence of OA.

Arthritis, Rheumatoid↗
PubMed1997

The epidemiology of morphea (localized scleroderma) in Olmsted County 1960-1993.

OBJECTIVE: To determine the incidence, prevalence, survival rates, clinical manifestations, and longterm outcome of patients with morphea (localized scleroderma) and its subtypes over a 33 year period in Olmsted County, Minnesota. METHODS: We used the unique data resources of the Rochester Epidemiology Project to review all Olmsted County medical records with any potential diagnosis consistent with morphea (including plaque, generalized, bullous, linear, and deep entities) from 1960 through 1993. RESULTS: We screened 1030 medical records and identified 82 (59 female; 23 male) cases of morphea first diagnosed between 1960 and 1993. All cases were followed until death or migration from Olmsted County, a total of 754 person-years of observation. The annual age and sex adjusted incidence rate per 100,000 population was 2.7 (95% confidence interval 2.1, 3.3). The incidence rate increased significantly over the 33 years (p = 0.0037) on an average of 3.6% per year. The prevalence (estimated using cumulative incidence) at 80 years of age was about 2/1000. 50% of the patients had a cutaneous softening or evidence of disease resolution by 3.8 years' duration. The shortest active disease duration was found in the plaque group (50% resolution or skin softening by 2.7 years) compared to 5.5 years in the deep group. Arthralgias, synovitis, uveitis, and joint contractures were more frequent in the linear and deep categories. Although 9 patients (11%) developed some disease related disability over the followup period, this was common (44%) in the deep group. No case of morphea developed severe internal organ involvement and none progressed to systemic sclerosis. The survival rate was not significantly different from the general population (p = 0.409). CONCLUSION: Morphea, and its subtypes, are more common than previously recognized, and can lead to important disability.

Adolescent↗
PubMed1997

Direct medical costs unique to people with arthritis.

OBJECTIVE: We report the results of a population based analysis of all health services used and charges incurred over a one-year period among a community based cohort of persons with a diagnosis of arthritis [including both osteoarthritis (OA) and rheumatoid arthritis (RA)] compared to a similar cohort of individuals from the same community who have never had a diagnosis of arthritis (NA), to examine the attributable costs of this chronic condition. METHODS: The unique resources of the Rochester Epidemiology Project were used to assemble the arthritis prevalence cohorts and the population based control cohort. The Olmsted County Health Care Utilization and Expenditures Database was used to collect information on health services utilization and charges. RESULTS: The average direct medical charges for the RA, OA, and NA cohorts were $3,802.05, $2,654.51, and $1,387.83, respectively (age and sex adjusted, p < 0.0001 for both the RA vs NA and OA vs NA comparisons). The median charges for these 3 groups were $1,050.00, $663.55, and $232.04 for the RA, OA, and NA groups, respectively (age and sex adjusted p < 0.0001 for both the RA vs NA and OA vs NA comparisons). These analyses indicated that, compared to the NA cohort both the OA and the RA prevalence cohorts incurred statistically significantly more charges, not only for the musculoskeletal disease care, but also for the care of numerous other conditions including respiratory, cardiovascular, gastrointestinal, neurological, and psychiatric conditions; and for general medical care. Individuals with arthritis (both OA and RA) also incurred statistically significantly more charges for diagnostic and therapeutic procedures, in-hospital care, imaging studies, physician services, equipment, and laboratory studies. Use of prescription medications was statistically significantly more common in the RA and OA groups compared to NA (96.3, 96, and 83%, respectively; age and sex adjusted p = 0.006 for the OA vs NA comparison and p = 0.015 for RA vs NA). CONCLUSION: These results emphasize the importance of considering all health services utilization (rather than only disease specific use) when estimating the economic effect of a chronic illness such as arthritis.

Adult↗
PubMed1996

Peripheral blood monoclonal plasma cells as a predictor of survival in patients with multiple myeloma.

The purpose of this study was to quantitate the number and labeling index of monoclonal plasma cells in the blood of patients with newly diagnosed multiple myeloma (MM) to learn if these values were independent prognostic factors for survival. Patients were candidates for this study if they had untreated myeloma requiring therapy, were evaluated at our institution between 1984 and 1993, and had a sample of blood analyzed with a sensitive immunofluorescence technique for monoclonal plasma cells and the blood B-cell labelling index (BLI). The % blood monoclonal plasma cells (%BPC) and the BLI were analyzed along with stage, marrow plasma cell LI, % marrow plasma cells, calcium, creatinine, albumin, beta-2-microglobulin, and C-reactive protein as univariate and multivariate factors for survival. Eighty percent of the 254 patients accrued to this study had monoclonal BPC detected. The median % BPC was 6% and 57% (144 of 254) of patients had a high number (> or = 4%). Patients with > or = 4% BPC had a median survival of 2.4 years vs 4.4 years for those with < 4% BPC (P < .001). The BLI was also prognostic (P = .008). In a multivariate analysis, the % BPC, age, albumin, stage, marrow plasma cell LI, and the BLI were independent factors for survival. The %BPC and the marrow plasma cell LI best separated the group into low, intermediate, and high risk myeloma with median survivals of 52, 35, and 26 months, respectively. Patients with high %BPC were less likely to have lytic bone disease from their MM (P = .002). The %BPC and the BLI are independent prognostic factors for survival and are useful in identifying patients as low, intermediate, and high risk. Clonal cells in the blood should be quantified in future clinical trials for myeloma.

Adult↗
PubMed1996

Juvenile rheumatoid arthritis in Rochester, Minnesota 1960-1993. Is the epidemiology changing?

OBJECTIVE: To examine trends in the incidence and prevalence of juvenile rheumatoid arthritis (JRA) in Rochester, Minnesota, over 33 years. METHODS: The diagnostic retrieval system of the Rochester Epidemiology Project was utilized to screen medical records of all Rochester residents with any potential diagnoses of JRA from 1978 to 1993 (based on the American College of Rheumatology 1977 revised criteria). In addition, all cases of JRA from our previously identified cohort from 1960-1979 were verified, and the 2 data sets were combined, resulting in an incidence cohort spanning 33 years (1960-1993). RESULTS: Of the 1,240 medical records screened, we identified 65 cases of JRA diagnosed between 1960 and 1993 (48 females, 17 males). The average followup for cases was 12.7 years (range 0-34 years) for a total of 833 person-years of observation. A bimodal distribution of age at diagnosis was observed, with peaks between 0 and 4 years and 9 and 15 years. Seventy-two percent of patients had pauciarticular-onset, 17% had polyarticular-onset, and 11% had systemic-onset disease. Progression of pauciarticular to polyarticular disease occurred in 11% of the cases. The overall age- and sex-adjusted incidence rate was 11.7 per 100,000 population (95% confidence intervals 8.7, 14.8). The incidence rate per 100,000 population was 15.0, 14.1, and 7.8 for the time periods 1960-1969, 1970-1979, and 1980-1993, respectively (P = 0.024). A 3-year, centered, moving average, which was used to display time trends in incidence, suggested a cyclical pattern, with incidence peaks in 1967, 1975, and 1987. CONCLUSION: An overall decrease in the incidence rate over the last decade was observed, most marked in the pauciarticular- and systemic-onset subtypes. This decrease, along with the observed cyclical pattern, suggest that environmental factors may influence disease frequency.

Arthritis, Juvenile↗
PubMed1996

Dietary protein intake and bone mass in women.

Population-based strategies to combat osteoporosis are urgently needed. The role of nutrition in such strategies has been particularly contentious. We examined the relationship among six key nutrients that are thought to affect bone metabolism and bone mineral density in the axial and appendicular skeleton using data from a population-based study in the northern United States. Data on the dietary intake of calcium, phosphorus, vitamin D, protein, fat, and total energy were obtained from a 7-day dietary record. Bone density measurements were made by dual photon absorptiometry in the lumbar spine and proximal femur, and by single photon absorptiometry in the distal and midradius. Among the 72 premenopausal women studied, there was a statistically significant positive association between protein intake and bone mineral in the distal radius and proximal femur, which was not altered by adjustment for age, weight, and physical activity. Among 218 postmenopausal women, no such relationship was found between protein intake and bone mineral, and the only significant findings in this group were negative associations between fat consumption and bone density in the lumbar spine and radius. Our results suggest that dietary protein intake may be a determinant of the peak bone mass attained by premenopausal white women. The relevance of this finding for the design of population strategies to maximize skeletal growth requires further investigation.

Adult↗
PubMed1996

A mathematical model that improves the validity of osteoarthritis diagnoses obtained from a computerized diagnostic database.

We developed an algorithm, using recursive partitioning, that utilized information from a computerized, diagnostic database to predict the diagnosis of osteoarthritis as determined by medical record review. The complete (inpatient and outpatient) medical records for a random sample of 400 Olmsted County, Minnesota residents with a database diagnosis consistent with osteoarthritis were reviewed, and confirmation or rejection of the diagnosis was accomplished. Of the 387 patients in our sample, only 232 (a positive predictive value of 60%) fulfilled diagnostic criteria for osteoarthritis following medical record review. A classification tree was created that used information from the diagnostic database to partition the study population according to the proportion of individuals with a "true" diagnosis of osteoarthritis (based on medical record review). The receiver-operating characteristic curve generated from these data illustrated that the algorithm substantially improved the validity of the database diagnosis, yielding a positive predictive value of 89% and a negative predictive value of 70% (sensitivity of 75% and specificity of 86%) at a selected cutoff point. This model also provides the capability of selecting the cutoff point to favor either specificity or sensitivity. These data demonstrate that a mathematical model can substantially improve the validity of computerized diagnostic databases in osteoarthritis.

Adult↗
PubMed1996

Fracture risk following bilateral oophorectomy.

To assess fracture risk following bilateral oophorectomy, we conducted a population-based retrospective cohort study among the 463 Rochester, Minnesota women who underwent bilateral oophorectomy for benign ovarian conditions in 1950-1979. During 7220 person-years of observation, there appeared to be a modest increase in the risk of distal forearm fractures (standardized morbidity ratio [SMR] 1.4; 95% CI 1.0-2.0) and vertebral fractures (SMR 1.9; 95% CI 1.3-2.8) but not hip fractures (SMR] 1.1; 95% CI 0.6-1.9). Although our statistical power was quite limited, there was a suggestion that women who became estrogen deficient at a young age were at greater risk of fracture. However, the youngest women were more likely to be on estrogen replacement therapy, and for longer durations, so that the average age at the onset of estrogen deficiency in this population was 47 years.

Age Factors↗
PubMed1996

Drug therapy for vertebral fractures in osteoporosis: evidence that decreases in bone turnover and increases in bone mass both determine antifracture efficacy.

The conventional belief is that osteopenia is the major cause of vertebral fractures and that drug therapy must induce a substantial increase in vertebral bone mineral density (BMD) before the vertebral fracture rate (VFR) is decreased. We hypothesized that the increased bone turnover in osteoporosis also is a major cause of vertebral fractures because of its adverse effects on the microarchitecture of the vertebrae and, thus, that normalization of bone turnover by antiresorptive drug therapy will decrease VFR substantially. This hypothesis is supported by our reanalysis of data from previous clinical trials with fluoride and with estrogen therapy in postmenopausal osteoporotic women. As evident from computer-generated three-dimensional graphic plots of data from osteoporotic women treated with placebo, VFR increased as bone turnover increased or as vertebral BMD decreased. Estrogen therapy decreased the bone turnover rate to normal and eliminated the relationship between VFR and bone turnover, whereas the inverse relationship with vertebral BMD persisted. In osteoporotic women treated with fluoride, VFR decreased as vertebral BMD increased, provided that patients with high (toxic) serum fluoride levels were not included in the comparison. Over the range of values in the data set, increased vertebral BMD and decreased bone turnover had approximately equal effects in decreasing VFR. Thus, both formation-stimulating and resorption-inhibiting drugs can substantially decrease VFR but do so by different mechanisms.

Bone Density↗
PubMed1996

Changes in quantitative bone histomorphometry in aging healthy men.

Changes in bone mineral metabolism with aging in healthy men and the roles of various factors in the pathogenesis of age-related changes in quantitative bone histomorphometry in men are poorly defined. To clarify these changes and factors, serum and urinary biochemical parameters and iliac crest bone biopsies were evaluated in 43 healthy men, aged 20-80 yr. The static histomorphometric parameters, cancellous bone volume and osteoblast-osteoid interface, decreased by 40.0% and 19.2%, respectively, between 20-80 yr of age. The dynamic histomorphometric parameters, double and single labeled osteoid, also decreased by 18.6% and 18.0%, respectively, over this period. None of the other static or dynamic histomorphometric parameters changed with age in this population sample of healthy men. Univariate analysis of static bone histomorphometric parameters and biochemical parameters revealed significant correlations between osteoid surface and intact PTH (r = 0.37; P = 0.015); osteoclast surface and serum total testosterone (r = 0.36; P = 0.016), estradiol (r = 0.40; P = 0.009), and FSH (r = 0.49; P = 0.001); osteoblast-osteoid interface and serum phosphate (r = 0.31; P = 0.046); and cortical thickness and serum total calcium (r = 0.38; P = 0.013). Univariate analysis of dynamic bone histomorphometric parameters and biochemical parameters revealed correlations between mineral apposition rate and serum total testosterone (r = 0.32; P = 0.037); total volume-referent bone formation rate and serum osteocalcin (r = 0.43; P = 0.004), total testosterone (r = 0.47; P = 0.001), estradiol (r = 0.35; P = 0.023), and dehydroepinadrosterone sulfate (r = 0.31; P = 0.045); and mean wall thickness and serum total calcium (r = 0.36; P = 0.019) and creatinine clearance (r = 0.42; P = 010). Mineralization lag time and serum phosphate (r = -0.39; P = 0.012) and urinary total pyridinoline (r = 0.36; P = 0.023), and mean wall thickness and urinary total pyridinoline (r = -0.38; P = 0.013), were inversely correlated. Multiple regression analysis using all-subset analysis comparing cancellous bone volume to serum and urinary biochemical parameters in these men indicated that the log free androgen index and body weight best predicted the age-related decline in iliac crest cancellous bone volume (r2 = 0.19; P = 0.015). Multiple regression analysis by the same method, comparing bone density at different skeletal sites to bone histomorphometric parameters, indicated that lumbar spine bone mineral density (BMD) was best predicted by cancellous bone volume and mineral apposition rate (r2 = 0.31; P = 0.001), femoral neck BMD by cancellous bone volume and osteoid surface (r2 = 0.19; P = 0.020), femoral greater trochanter BMD by cortical thickness and single labeled osteoid surface (r2 = 0.13; P = 0.060), and total body BMD by cancellous bone volume and surface-based bone formation rate (r2 = 0.31; P = 0.001). In summary, cancellous bone volume, osteoblast-osteoid interface, and double and single labeled osteoid decreased with age in this sample of healthy men. The lack of detectable change in bone density at some skeletal sites in these men may be due to the small sample size or other confounding factors. Multivariate analysis suggests that different combinations of histomorphometric parameters predict bone density at different skeletal sites, and that cancellous bone volume predicts bone density at the lumbar spine, femoral neck, and total body, but not at the femoral greater trochanter. We conclude that alterations in several biochemical parameters are important in the pathogenesis of age-related bone loss in healthy men.

Adult↗
PubMed1996

Dementia after ischemic stroke: a population-based study in Rochester, Minnesota (1960-1984)

We used the medical records linkage system for the population of Rochester, Minnesota, to identify persons in the community who had their first cerebral infarct without previous dementia. In this cohort (n = 971), the incidence of dementia in the first year was nine times greater than expected, but if we did not observe dementia in the first year, the risk of dementia in the cohort each year thereafter was about twice the risk in the population. After the first year, a 50% increase was observed in Alzheimer's disease in the cohort compared with that in the community. Although the incidence of dementia increased with increasing age, the standardized morbidity ratios decreased with increasing age. Age, sex (male), and second stroke were significant independent predictors of dementia in a multivariate Cox proportional hazards model. There was no effect of location or clinical severity of infarct on the rate of occurrence of dementia.

Aged↗