Biomedical subjects

W M O'Fallon

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

At least 163 records · Page 9Linked to original sources

PubMed1994

How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis?

OBJECTIVE: To determine the effect of previous corticosteroid treatment on the results of temporal artery biopsy. DESIGN: Consecutive case series. SETTING: Tertiary care center. PATIENTS: A consecutive cohort of 535 patients who had temporal artery biopsies at Mayo Clinic, Rochester, Minnesota, between 1 January 1988 and 31 December 1991. MEASUREMENTS AND RESULTS: The dose and duration of corticosteroid treatment received before temporal artery biopsy and detailed clinical and laboratory data were obtained from the patients' medical records. All temporal artery biopsy slides were re-evaluated by a pathologist blinded to clinical data, previous corticosteroid treatment information, and the original pathologic diagnosis. Biopsy specimens were classified as negative for arteritis, positive for typical temporal arteritis, or positive for atypical temporal arteritis. Biopsy results were positive for 31% of patients (89 of 286) who did not receive corticosteroids before biopsy and for 35% of those (86 of 249) who did receive corticosteroids before biopsy (P = 0.4; 95% confidence interval for the difference, -4.7% to 11.5%). Patients who received corticosteroids before biopsy tended to have clinical features more suggestive of arteritis. A multiple logistic regression analysis model, controlling for these differences in clinical and laboratory features, showed that the biopsy positivity rate was unrelated to previous corticosteroid treatment. CONCLUSIONS: Although these results do not prove that histologic features are unaffected by corticosteroids, they show that, in this large, consecutive sample, the positivity rates of temporal artery biopsy were similar in untreated and corticosteroid-treated patients. Temporal artery biopsy may show arteritis even after more than 14 days of corticosteroid therapy in the presence of clinical indications of active disease.

Adrenal Cortex Hormones↗

PubMed1994

The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community.

BACKGROUND: Despite the significant public health burden of lower-extremity amputations in diabetes mellitus, few data are available on the epidemiology of lower-extremity amputations in diabetes mellitus in the community setting. METHODS: A retrospective incidence cohort study based in Rochester, Minn, was conducted. RESULTS: Among the 2015 diabetic individuals free of lower-extremity amputation at the diagnosis of diabetes mellitus, 57 individuals underwent 79 lower-extremity amputations (incidence, 375 per 100,000 person-years; 95% confidence interval, 297 to 467). Among the 1826 patients with non-insulin-dependent diabetes mellitus, 52 underwent 73 lower-extremity amputations, and the subsequent incidence of lower-extremity amputation among these residents was 388 per 100,000 person-years (95% confidence interval, 304 to 487). Of the 137 insulin-dependent diabetic patients, four subsequently underwent five lower-extremity amputations (incidence, 283 per 100,000 person-years; 95% confidence interval, 92 to 659). Twenty-five years after the diagnosis of diabetes mellitus, the cumulative risk of one lower-extremity amputation was 11.2% in insulin-dependent diabetes mellitus and 11.0% in non-insulin-dependent diabetes mellitus. When compared with lower-extremity amputation rates for Rochester residents without diabetes, patients with non-insulin-dependent diabetes mellitus were nearly 400 times more likely to undergo an initial transphalangeal amputation (rate ratio, 378.8) and had almost a 12-fold increased risk of a below-knee amputation (rate ratio, 11.8). In this community, more than 60% of lower-extremity amputations were attributable to non-insulin-dependent diabetes mellitus. CONCLUSIONS: These population-based data document the magnitude of the elevated risk of lower-extremity amputation among diabetic individuals. Efforts should be made to identify more precisely risk factors for amputation in diabetes and to intervene in the processes leading to amputation.

Amputation, Surgical↗

PubMed1994

Recurrent spontaneous cervical-artery dissection.

BACKGROUND: Spontaneous dissection of the internal carotid and vertebral arteries is increasingly recognized as a cause of ischemic stroke in young people. An underlying arteriopathy is often suspected in the pathogenesis of such dissection, but the frequency of recurrent dissection is unknown. METHODS: We describe the long-term follow-up of 200 consecutive patients (104 women and 96 men) with spontaneous cervical-artery dissections evaluated at the Mayo Clinic between 1970 and 1990. All diagnoses were confirmed by angiography. RESULTS: The mean age of the patients was 44.9 years (range, 16 to 76). Internal carotid arteries were affected in 150 patients, vertebral arteries in 37, and both in 13. Multivessel dissections were present in 28 percent of the patients. The mean follow-up was 7.4 years. Recurrent dissection occurred only in arteries not previously involved by dissection. A recurrent arterial dissection developed in 16 patients (8 percent)--within a month after the initial dissection in 4 patients (2 percent) and between 1.4 and 8.6 years later in 12 patients (a rate of 1 percent per year). The cumulative rate of recurrent dissection among patients followed for 10 years was 11.9 percent. Younger patients had a greater risk of recurrent dissection. CONCLUSIONS: Although dissections in multiple cervical vessels are common at presentation, after the first month the risk of recurrent dissection is only about 1 percent per year.

Adolescent↗

PubMed1994

Primary head and neck cancer. Histopathologic predictors of recurrence after neck dissection in patients with lymph node involvement.

OBJECTIVE: Retrospectively analyze several histopathologic variables that may predict neck recurrence after neck dissection. DESIGN: From 1970 through 1980, 284 patients with pathologically confirmed metastatic squamous cell carcinoma underwent neck dissection and received no adjuvant therapy. Kaplan-Meier evaluation estimated a 74% 2-year neck recurrence-free rate. After adjusting for the standard covariates of age, gender, neck stage, and tumor grade, we also controlled for the time-dependent covariates of primary recurrence, occurrence in the side of the neck not operated on, or development of new head and neck primary disease. SETTING: A large referral-based practice. RESULTS: The number of lymph nodes involved, invasion of vascular/lymphatic space, invasion of soft tissue, and desmoplastic lymph node pattern adversely affect neck recurrence. A desmoplastic stromal pattern was associated with almost a sevenfold increased risk of neck recurrence. To our knowledge, this finding has not been reported previously. CONCLUSION: Histopathologic evaluation of metastatically involved cervical nodes can identify patients with head and neck cancer who are at high risk for recurrence.

Adult↗

PubMed1994

A cost-utility analysis of misoprostol prophylaxis for rheumatoid arthritis patients receiving nonsteroidal antiinflammatory drugs.

OBJECTIVE: To determine the cost-utility of low-dose misoprostol prophylaxis in rheumatoid arthritis (RA) patients treated with nonsteroidal antiinflammatory drugs (NSAIDs). METHODS: Prospectively collected, population-based data on 57 RA patients' preferences (obtained using the category scaling and time trade-off techniques), charge data from a consecutive, population-based cohort of 36 RA patients with NSAID-related gastric ulcer, and literature-derived probability estimates were incorporated into a decision analysis model. RESULTS: Probabilistic sensitivity analysis using 10,000 Monte Carlo simulations demonstrated that, on average, prophylaxis resulted in modest additional costs and no additional quality-of-life benefits. At best, the incremental cost per quality-adjusted life year gained was $9,333. At worst, prophylaxis reduced quality of life. Prophylaxis was cost-saving if the ulcer complication rate was > 1.5%, or if the 3-month price of misoprostol was < or = $95. CONCLUSION: Whereas prophylaxis may be cost-saving among high-risk NSAID users, from some patients' perspective, it reduces quality of life. Although these data may not be generalizable to other clinical populations, they illustrate the importance of incorporating patient preferences into economic evaluations.

Adult↗

PubMed1994

Clinical trial of fluoride therapy in postmenopausal osteoporotic women: extended observations and additional analysis.

In a 4 year clinical trial in 202 postmenopausal osteoporotic women receiving NaF at 75 mg/day or placebo (both groups received supplementary calcium at 1500 mg/day), we found (N Engl J Med 322:801, 1990) that NaF increased bone mineral density in the lumbar spine (LS-BMD) substantially but did not decrease vertebral fracture rate (VFR), and it increased the nonvertebral fracture rate. Additional analyses and extended observations are now available on 50 women from the NaF group followed for up to 6 years of treatment. In these women, LS-BMD increased linearly over the 6 years (median rate, 8.7%/year or 0.063 g/cm2/year). Because during the 4 year trial the NaF dosage was decreased (because of side effects) in 54 of the 101 women randomized to NaF, dose-response relationships could be evaluated. For the entire study population, serum F level correlated directly with increase in LS-BMD (r = 0.61, P < 0.001). When individual person-years of observation were grouped by deciles of LS-BMD, VFR (per 100 person-years) decreased to a nadir of 24 as mean LS-BMD for the group increased from 0.6 to 1.2 g/cm2 and then doubled to 52 in the group with mean LS-BMD of 1.6 g/cm2. Multivariate analyses and inspection of three-dimensional plots revealed a complex pattern in which VFR was influenced by interaction of several variables. When the effects of LS-BMD, changes in LS-BMD, and serum F were assessed simultaneously, VFR was seen to decrease with increasing LS-BMD except when the higher LS-BMD was associated with rapid rate of increase in LS-BMD or a large increase from baseline serum F. For some patients (noncompliers or nonresponders), serum F or LS-BMD failed to increase. Thus, it is possible that lower dosages of NaF produce moderate decreases in VFR.

Aged↗

PubMed1994

Risk of hip fracture in women with vertebral fracture.

In a population-based retrospective cohort study, Rochester women aged 35-69 years who were first diagnosed with one or more vertebral fractures in 1950-1979 were followed for the development of a subsequent hip fracture. The 336 women with no history of hip fracture at the time of their vertebral fracture experienced 52 proximal femur fractures in 4788 person-years of follow-up. The standardized morbidity ratio (SMR) of observed to expected hip fractures was 1.8 (95% CI, 1.3-2.4) and was higher for intertrochanteric than cervical femoral fractures (SMR, 2.3 versus 1.3; P = 0.07). Hip fracture risk among women with symptomatic vertebral fractures was slightly less than in those with asymptomatic vertebral fractures (SMR, 1.8 versus 2.3; not significant), and younger women had no higher risk of a subsequent hip fracture than women who were > or = 60 years of age at the time of their vertebral fracture (SMR, 1.4 versus 1.8; not significant). Alternative explanations are possible, but these data are consistent with heterogeneity in the pathogenesis of different osteoporotic fractures.

Adult↗

PubMed1994

Influence of age on effects of endogenous 1,25-dihydroxyvitamin D on calcium absorption in normal women.

Recent reports of increases in serum 1,25-dihydroxyvitamin D [1,25(OH2)D] concentration with aging despite no changes or decreases in calcium absorption suggest that elderly women have intestinal resistance to vitamin D action. Thus, in 15 young adult (30 +/- 1 year) and 15 elderly (74 +/- 1 year) women (mean +/- SE), we assessed the responsiveness of intestinal calcium absorption to increases in circulating 1,25(OH)2D induced by 4 days of an experimental diet (150 mg calcium and 1600 mg phosphorus daily). True fractional calcium absorption (FCA) (44Ca mixed with food and 42Ca given intravenously, then their ratio in urine measured by mass spectrometry) was determined. Baseline serum intact parathyroid hormone (PTH) concentration was higher in the older women (P = 0.01) whereas serum 1,25(OH)2D concentration and true FCA were similar. In both groups, serum 1,25(OH)2D concentrations increased (P < 0.002) on the experimental diet. After 4 days on the diet, serum 1,25(OH)2D increased over baseline by 30.5 and 35.6% and, despite these increases, true FCA was 40 +/- 3 versus 40 +/- 4%/24 hours (NS between groups) in the young and elderly women, respectively. These data suggest that either elderly women have normal intestinal responsiveness to vitamin D or that the resistance to it is too mild to be detected by these methods.

Absorptiometry, Photon↗

PubMed1994

Pamidronate: an unrecognized problem in gastrointestinal tolerability.

Pamidronate (aminohydroxypropylidine bisphosphonate, APD) is an effective agent for treatment of Paget's disease of bone, and it has also been thought to be effective for treatment of osteoporosis. We desired to study a newer, time-release preparation of pamidronate, and carried out a placebo-controlled, double-masked study of postmenopausal osteoporosis. The original formulation was in a rapidly dissolving gelatin capsule. We encountered four episodes of esophagitis in 49 enrolled patients. We therefore discontinued treatment with this preparation and later began the study again using a standard tablet preparation. We encountered an additional case of erosive esophagitis in 1 patient of 40 receiving this tablet preparation. No patient was receiving concomitant medication which could cause esophagitis. Two of the patients gave a past history of hiatal hernia and 1 gave a history of gastric ulcer 27 years previously. The diagnosis of esophagitis was confirmed in all cases by endoscopy. Healing of the esophagitis promptly ensued after discontinuation of the pamidronate and the use of antacid medication.

Aged↗

PubMed1994

Prostate cancer in Rochester, Minnesota (USA), from 1935 to 1989: increases in incidence related to more complete ascertainment.

Prostate cancer incidence among White men in the United States climbed steadily from 45 per 10(5) person-years (PY) during 1945-54 to 102 per 10(5) PYs in 1988. To determine whether this increase might be the result of changing diagnostic practices, we examined trends in incidence and method of diagnosis in Rochester, Minnesota (US), from 1935 to 1989. We found a parallel increase in Rochester in non-autopsy diagnoses from 44 (95 percent confidence interval [CI] = 29-58) cases per 10(5) PYs in 1935-44 to 71 (CI = 52-89) cases per 10(5) PYs in 1985-87 which was driven by diagnoses prompted by digital rectal examination. There was no evidence that an increasing proportion of cases was found as the result of procedures to treat the symptoms of benign prostatic hyperplasia. Including autopsy diagnoses, incidence was stable over this extended interval and was 77 per 10(5) PYs (CI = 58-97) in 1935-44 and 72 per 10(5) PYs (CI = 53-91) in 1985-87. Incidence more than doubled after introduction of diagnostic serum prostate-specific antigen (PSA) assay and was 179 per 10(5) PYs (CI = 145-214) in 1988-89. We conclude that prostate-cancer incidence rates are influenced strongly by diagnostic practices and that national increases could reflect, to a large extent, more complete and earlier ascertainment rather than more frequent disease.

Adult↗

PubMed1994

Comparison of respondents and nonrespondents in an osteoporosis study.

We attempted to enroll an age-stratified random sample of Rochester, Minnesota women > or = 30 years of age in a population-based prospective study of the determinants of bone loss. Using the resources of the Rochester Epidemiology Project, 541 women were contacted and 305 agreed to participate. Of 236 nonrespondents, 38 were ineligible and 198 refused to participate resulting in a 61% response rate for eligible subjects. We reviewed community medical records for respondents and nonrespondents (including ineligibles) to determine whether the two groups differed with regard to variables that might be important in osteoporosis research. There was little difference between respondents and nonrespondents for a history of cigarette smoking, hyperthyroidism, thyroidectomy, or age-related fractures. Respondents survived better, were less likely to be obese or have renal failure, and more likely to have had an oophorectomy and consume alcohol (P < 0.01). These data suggest that nonrespondents were less healthy than respondents.

Adult↗

PubMed1994

Vancouver hybrid: preliminary experience in the treatment of Hodgkin's disease in childhood and adolescence.

OBJECTIVE: To describe our preliminary experience with 19 young patients with newly diagnosed Hodgkin's disease who received the Vancouver hybrid chemotherapeutic regimen. DESIGN: We summarized the characteristics of our 19 study patients, the treatment administered (between June 1988 and June 1992), and the outcome. RESULTS: The Vancouver hybrid, which consists of mechlorethamine, vincristine sulfate (Oncovin), procarbazine hydrochloride, prednisone, doxorubicin hydrochloride (Adriamycin), bleomycin, and vinblastine sulfate (MOPP/ABV), was based on the hypothesis of preventing drug resistance by early introduction and alternation of all active agents and was aimed at decreasing the severity and frequency of treatment-related complications. Of our 19 patients with Hodgkin's disease (age range, 6 to 20 years) treated with this regimen, 2 had clinical stage I disease, 10 had stage II, 6 had stage III, and 1 had stage IV. Only two patients had systemic symptoms, and nodular sclerosis was the most common histologic feature. Patients were given four to eight cycles of chemotherapy, depending on the clinical stage of disease. In addition, 10 patients received irradiation, including 6 of 9 patients with bulky disease. In all patients, complete remission was achieved. After a median follow-up of 3.3 years, only two patients had had a relapse; both underwent autologous bone marrow transplantation and were alive and well with no evidence of disease at last follow-up. The treatment was well tolerated, and delivery of treatment was excellent. The only severe toxicity was myelosuppression; 8 patients experienced a total of 15 episodes of fever and neutropenia that necessitated hospitalization and antibiotic therapy, but no systemic infections were confirmed during 104 cycles of therapy. CONCLUSION: The MOPP/ABV hybrid is an effective and well-tolerated therapy in most young patients with Hodgkin's disease. Long-term monitoring is needed to evaluate late effects.

Adolescent↗

PubMed1994

Incidence of leukemia in Olmsted County, Minnesota, 1975 through 1989.

OBJECTIVE: To determine the incidence of leukemia in Olmsted County, Minnesota, for a recent 15-year period and to compare the data with reported rates for the previous 40 years. DESIGN: We conducted a population study of leukemia diagnosed between 1975 and 1989 in residents of Olmsted County by review of medical records identified through diagnostic indexes, death certificates, autopsy files, and histologic preparations. MATERIAL AND METHODS: Diagnoses of leukemia were categorized into various subtypes, and age- and sex-specific incidence rates were calculated for leukemia as a whole and for each subtype. In addition, incidence rates were age- and sex-adjusted to the 1970 US white population for comparison with earlier published rates. Age and annual trends as well as sex differences were assessed with the generalized linear interactive model approach. RESULTS: During 1975 through 1989, the mean annual incidence rate for leukemia was 12.3 per 100,000 population in Olmsted County. When adjusted for age and sex, the rate per 100,000 was 13.6, in comparison with a similarly adjusted rate of 11.8 for the previous decade (1965 through 1974). The rates for chronic myelogenous leukemia and acute lymphocytic leukemia remained stable throughout the entire study period; however, rates for acute myelogenous leukemia and chronic lymphocytic leukemia increased, most prominently in patients 50 years of age or older. This increased rate occurred in both males and females, but the incidence rates for both subtypes began increasing earlier for males than for females. CONCLUSION: Although we cannot rule out an actual increase in incidence rates for these types of leukemia in the elderly population, we believe that the increase in persons older than 50 years of age reflects social change in improved health care and its better utilization by elderly persons, as well as the ability to diagnose leukemia earlier than in the past.

Adolescent↗

PubMed1994

Incidence of chronic lymphocytic leukemia in Olmsted County, Minnesota, 1935 through 1989, with emphasis on changes in initial stage at diagnosis.

OBJECTIVE: To determine whether the stage at the time of diagnosis of chronic lymphocytic leukemia (CLL) had changed during a 55-year period. DESIGN: We conducted a study of the cohort of residents of Olmsted County, Minnesota, who had been diagnosed as having CLL during the period from 1935 through 1989. MATERIAL AND METHODS: By analysis of medical records, patients with CLL were characterized by Rai stage, absolute lymphocyte count, age at diagnosis, need for therapy, and reported cause of death in nonsurvivors. Trends for these variables were analyzed by decade throughout the study period. RESULTS: The overall annual incidence rate of CLL per 100,000 population in Olmsted County increased from 2.6 in the 1935 through 1944 period to 5.4 in the 1975 through 1984 period; however, the increasing rate was found only for those 50 years of age or older and was especially dramatic for those 75 years old or older. Analysis of Rai stage over time demonstrated an increase in the proportion of cases diagnosed as Rai stage 0. In addition, the median absolute lymphocyte count decreased, the median time to initiation of therapy increased, and the median age of patients with Rai stage 0 CLL at the time of diagnosis increased over time. Overall, 54% of patients had received therapy for CLL by the time of last follow-up. Among the nonsurvivors, CLL was documented as the underlying or a contributing cause of death in 69%. CONCLUSION: The overall increase in CLL was thought to be due to enhanced methods of early diagnosis and improved health care for the elderly population. Thus, artifact may best explain the observed trend, although we cannot exclude the possibility of an actual increase in incidence rates over time.

Adult↗

PubMed1994

Fractures in an aging population of poliomyelitis survivors: a community-based study in Olmsted County, Minnesota.

OBJECTIVE: To determine the incidence of fractures in a cohort of survivors of paralytic poliomyelitis ("polio"). DESIGN: We conducted a population-based retrospective cohort study of residents of Olmsted County, Minnesota, who had an initial diagnosis of polio between 1935 and 1959 and survived the acute illness. MATERIALS AND METHODS: A comprehensive medical records-linkage system was used to retrieve all diagnoses of poliomyelitis in residents of the county for the specified 25-year period. For the 277 study subjects, the medical records were searched for the occurrence of fracture from the time of initial diagnosis of polio until death or the most recent clinical contact. All fractures were classified on the basis of type of associated injury and skeletal site of involvement. The influence of polio on the incidence of fractures was evaluated by estimating the cumulative incidence of new fractures after the diagnosis of polio and the standardized morbidity ratio. The relative influence of various factors on the risk of fracture was determined. RESULTS: Of the 277 Olmsted County residents with polio, 87 experienced 161 fractures, and the estimated cumulative incidence of any fracture after 40 years was 48%. The cumulative incidence of any limb fracture was 41% and was less than the expected value of 44% (P = 0.001). Only the risk of distal femoral and proximal humeral fractures was significantly higher than that among Olmsted County residents in general. The increased risk seemed to be associated with weakness and disuse of the involved limbs rather than with generalized osteoporosis. Theoretically, a greater capacity for bone remodeling in response to changes in muscle use might have protected patients with polio in childhood, but such persons were as likely to sustain a fracture as those with adult-onset poliomyelitis. CONCLUSION: These data indicate that survivors of paralytic poliomyelitis do not have an unusual risk of fracture except in affected limbs.

Adolescent↗

PubMed1994

Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990.

An epidemiological survey of cervical radiculopathy in Rochester, Minnesota, 1976-90, through the records-linkage system of the Mayo Clinic ascertained 561 patients (332 males and 229 females). Ages ranged from 13 to 91 years; the mean age +/- SD was 47.6 +/- 13.1 years for males and 48.2 +/- 13.8 years for females. A history of physical exertion or trauma preceding the onset of symptoms occurred in only 14.8% of cases. A past history of lumbar radiculopathy was present in 41%. The median duration of symptoms prior to diagnosis was 15 days. A monoradiculopathy involving C7 nerve root was the most frequent, followed by C6. A confirmed disc protrusion was responsible for cervical radiculopathy in 21.9% of patients; 68.4% were related to spondylosis, disc or both. During the median duration of follow-up of 4.9 years, recurrence of the condition occurred in 31.7%, and 26% underwent surgery for cervical radiculopathy. A combination of radicular pain and sensory deficit, and objective muscle weakness were predictors of a decision to operate. At last follow-up 90% of our population-based patients were asymptomatic or only midly incapacitated due to cervical radiculopathy. The average annual age-adjusted incidence rates per 100,000 population for cervical radiculopathy in Rochester were 83.2 for the total, 107.3 for males and 63.5 for females. The age-specific annual incidence rate per 100,000 population reached a peak of 202.9 for the age group 50-54 years.

Adolescent↗

PubMed1994

Detection of peripheral blood plasma cells as a predictor of disease course in patients with smouldering multiple myeloma.

We evaluated the number and labelling index of circulating peripheral blood monoclonal plasma cells (PBPC) in 57 patients with newly diagnosed smouldering multiple myeloma (SMM) to determine if these measurements could distinguish SMM from active multiple myeloma (MM). The PBPC were detected by a sensitive slide-based immunofluorescence procedure that identified PC by their morphology and monoclonal light chain staining. The presence of abnormal PBPC (defined as an increase in number or proliferative rate of circulating monoclonal plasma cells) was correlated with patient status at 6 and 12 months after testing. 16 of the 57 patients progressed within 12 months and 63% of these had abnormal PBPC. In contrast, only 10% (4/41) of those patients who remained stable had abnormal PBPC. The median time to progression for patients with abnormal PBPC was 0.75 years, compared to 2.5 years for those patients without abnormal PBPC (P < 0.01). The detection of PBPC is important and helps to identify patients with active MM when other parameters suggest SMM. The lack of abnormal PBPC suggests SMM, and these patients may have a stable course without the need for immediate chemotherapy.

Adult↗

PubMed1994

Fracture risk in patients with Alzheimer's disease.

OBJECTIVE: To assess the risk of fracture following onset of Alzheimer's disease. DESIGN: Retrospective (historical) cohort study. SETTING: Population-based in Rochester, Minnesota. PARTICIPANTS: All 543 Rochester residents with onset of Alzheimer's disease during the 10-year period, 1975-84, and an equal number of age- and sex-matched controls from the community. MEASUREMENTS: Fractures were assessed through review of each subject's complete (inpatient and outpatient) medical records in the community. MAIN RESULTS: Rochester residents with Alzheimer's disease were no more likely to have a history of fracture prior to onset than were matched controls from the same population. During the year of onset, there was a 2-fold excess of fractures at various sites among those with Alzheimer's disease. The risk ratio for any fracture subsequently was 1.1 (95% CI 0.9, 1.3), and this slight increase was accounted for entirely by a 2.7-fold increase in the risk of hip fracture (95% CI 1.8, 4.2). CONCLUSIONS: Fracture risk was not increased before the onset of Alzheimer's disease, although there was an excess of fractures around the time that Alzheimer's disease came to clinical attention. Fracture risk was not elevated thereafter except for a substantial increase in the risk of hip fracture. This suggests a link with certain falls rather than generalized disuse osteoporosis.

Adult↗