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  • 1
    Electronic Resource
    Electronic Resource
    Secular trends in the incidence of postmenopausal vertebral fractures (1992)
    Springer
    Calcified tissue international 51 (1992), S. 100-104 
    Details
    ISSN: 1432-0827
    Keywords: Epidemiology ; Vertebral fracture ; Hip fracture ; Osteoporosis ; Time trend
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine , Physics
    Notes: Summary Several studies suggest secular increases in hip fracture incidence through this century, but little is known about such trends for vertebral fracture. We have examined changes in the incidence of clinically ascertained vertebral fractures among Rochester, Minnesota residents aged 35–69 years, that were first diagnosed between 1950 and 1989. Our results indicate no overall increase in incidence over the 40-year period. Categorization of fractures according to the level of preceding trauma, however, revealed a significant increase in the incidence of fractures following moderate trauma among women aged 60–69 years. This increase occurred between 1950 and 1964, and leveled off thereafter. Rates for severe trauma fractures among postmenopausal women, and for vertebral fractures from any cause among younger men and women, remained stable. The rise in moderate trauma fractures in postmenopausal women paralleled that for hip fractures in Rochester and began to plateau at around the same time. It might have resulted from increased diagnosis of vertebral fractures, but the increase in hip fracture incidence is inconsistent with this explanation. An increase in the prevalence of osteoporosis, however, might account for the trend in both types of fractures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00298496
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Epidemiology of Osteoporosis: Predicting Who is at Risk (1990)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of the New York Academy of Sciences 592 (1990), S. 0 
    Details
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1749-6632.1990.tb30341.x
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  • 3
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    Is Diabetes Mellitus An Independent Risk Factor for Incident Venous Thromboembolism (VTE)? a Population-Based Case-Control Study (2008)
    American Society of Hematology
    Details
    Publication Date: 2008-11-16
    Description: Introduction: Diabetes mellitus is often cited as a VTE risk factor. However, persons with diabetes are frequently hospitalized for medical illness or undergo surgery, both major VTE risk factors. Thus, the association of VTE with diabetes independent of surgery or hospitalization is uncertain. Methods: Using longitudinal, population-based Rochester Epidemiology Project resources, we identified all Olmsted County, MN residents who met objective criteria for incident VTE over the 25-year period, 1976–2000 (n=1922), and one to two controls per case, matched on age, gender, Olmsted County residency, and length of medical history (n=2115). For cases and controls, we reviewed their complete medical history in the community for baseline characteristics previously identified as independent VTE risk factors, including clinically-diagnosed diabetes mellitus. We tested diabetes as a potential VTE risk factor both alone and after adjusting for other baseline characteristics, and in the subset of cases with idiopathic VTE, using conditional logistic regression. Results: Among all cases and controls, 231 (12%) and 199 (9.4%) had diabetes, respectively. Univariately, diabetes was associated with overall VTE (odds ratio [OR]=1.32; 95% CI: 1.07, 1.62; p=0.009). However, after controlling for body mass index (OR=1.04, p
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    Electronic ISSN: 1528-0020
    Topics: Biology , Medicine
    Published by American Society of Hematology
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  • 4
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    Immunoglobulin Free Light Chain Ratio Is an Independent Risk Factor for Progression of Smoldering Multiple Myeloma. (2007)
    American Society of Hematology
    Details
    Publication Date: 2007-11-16
    Description: Background: Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell proliferative disorder with a high risk of progression to symptomatic multiple myeloma. Identification of risk factors that predict progression of SMM to symptomatic MM could identify higher risk patients who might benefit from chemoprevention or more intensive surveillance. We hypothesized that increased monoclonal free kappa or lambda immunoglobulin light chains in smoldering myeloma (SMM), as detected by the serum free light chain (FLC) assay, indicates an increased the risk of progression to active myeloma. Methods: Of 276 pathologically confirmed SMM patients seen at the Mayo Clinic from 1970 to 1995, baseline serum samples obtained within 30 days of diagnosis were available in 273. Results: At a median follow-up of surviving patients of 12.4 years, transformation to active disease has occurred in 161 (59%) patients. An abnormal FLC ratio was present at baseline in 90% of patients. The best break-point for predicting risk of progression was a FLC ratio less than or equal to 0.125 or greater than or equal to 8 (hazard ratio, 2.3; 95% CI, 1.6–3.2) [Figure 1]. The extent of abnormality of FLC ratio was independent of SMM risk categories defined by number of plasma cells in the bone marrow and size of serum M-proteins (bone marrow plasma cells ≥ 10% and serum M protein ≥ 3 g/dL; bone marrow plasma cells ≥ 10% but serum M protein 〈 3 g/dL; and serum M protein ≥ 3 g/dL but bone marrow plasma cells 〈 10%). Incorporating the FLC ratio into the risk model, the division of patients into high-, intermediate-, and low-risk groups is 28, 42, and 30% with 5 year progression rates of 76, 51, and 25%, respectively [Figure 2]. Conclusions: The serum immunoglobulin FLC ratio is an important additional determinant of clinical outcome in patients with SMM. Figure Figure Figure Figure
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    Topics: Biology , Medicine
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  • 5
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    Venous Thromboembolism (VTE) Risk Factors among Nursing Home Residents: A Population-Based Case-Control Study. (2004)
    American Society of Hematology
    Details
    Publication Date: 2004-11-16
    Description: Confinement to a nursing home (NH) is an independent risk factor for VTE and accounts for 13% of all VTE occurring in the community, but the question of which NH residents are at risk is largely unanswered. Objective: To determine VTE risk factors among NH residents. Methods: Using the Minnesota State Case Mix Review Program Public Research Files, we performed a case-control study of all Olmsted County, MN NH patients with an ICD-9 code-identified diagnosis of VTE from 1988–1994. From the same source, we identified one age-, sex-matched control and used conditional logistic regression to estimate odds ratios for an association of VTE with 46 characteristics assessed in the Minnesota Case Mix data. Results: Univariate associations between characteristics and odds of VTE are described below. Significantly increased odds were observed for residents assessed following hospitalization (a nearly 4-fold increase, p=0.002, Table) and residents considered incapable of self-preservation (i.e., unable to cope with potentially harmful situations) (〉 2.0 fold increase, p=0.03). Non-significant 2–3 fold increased odds were observed for limitations in certain specific Activities of Daily Living (ADL) (including walking and dressing) and for limitations in more than 3 ADLs. Similar increased odds were observed for residents using a wheelchair, taking more than 3 oral medications, enrolled in professional activity programs, and needing behavior management. Conclusions: Need for assistance (especially problems with immobility), lack of self preservation, and recent hospitalization may identify a subset of NH residents that are at especially high VTE risk and who may warrant consideration of prophylaxis. Univariate VTE Risk Factors for Nursing Home Residents Characteristic Odds Ratio 95% CI P-value Oral medications 〉 3 3.00 0.97-9.30 0.06 Activities of Daily Living High/Medium (4-8) vs. low (0-3) 2.20 0.76-6.33 0.14 Help dressing 2.75 0.88-8.64 0.08 Help walking 3.00 0.61-14.86 0.18 Wheelchair use 2.50 0.97-6.44 0.58 Needs behavior management 3.00 0.62-14.86 0.18 Help toileting 2.00 0.68-5.85 0.20 Lack of self-preservation 2.33 1.07-5.10 0.03 Transfer from hospital 3.86 1.68-8.86 0.0015 Anti-depressant drugs 0.50 0.19-1.33 0.16 Professional activity program 2.25 0.69-7.3 0.18
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    Topics: Biology , Medicine
    Published by American Society of Hematology
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  • 6
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    Long-term follow-up of IgM monoclonal gammopathy of undetermined significance (2003)
    American Society of Hematology
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    Publication Date: 2003-11-15
    Description: Little effort has been made to quantitate adverse outcomes of monoclonal gammopathy of undetermined significance (MGUS) of the immunoglobulin M (IgM) class, which progresses to lymphoma or Waldenström macroglobulinemia, whereas IgA and IgG MGUS progress to multiple myeloma, primary amyloidosis (AL), or a related plasma cell disorder. From 1960 to 1994, IgM MGUS was diagnosed in 213 patients in southeastern Minnesota. The end point was progression to lymphoma or a related disorder, as assessed with the Kaplan-Meier method. The 213 patients were followed up for 1567 person-years (median, 6.3 years per patient). Lymphoma developed in 17 patients (relative risk [RR], 14.8), Waldenström macroglobulinemia in 6 (RR, 262), primary amyloidosis in 3 (RR, 16.3), and chronic lymphocytic leukemia in 3 (RR, 5.7). The relative risk of progression was 16-fold higher in the patients with IgM MGUS than in the white population of the Iowa Surveillance, Epidemiology, and End Results Program. Cumulative incidence of progression was 10% at 5 years, 18% at 10 years, and 24% at 15 years. On multivariate analysis, the serum monoclonal protein and serum albumin concentrations at diagnosis were the only risk factors for progression to lymphoma or a related disorder. Risk for progression to lymphoma or a related disorder at 10 years after the diagnosis of MGUS was 14% with an initial monoclonal protein concentration of 0.5 g/dL or less, 26% with 1.5 g/dL, 34% for 2.0 g/dL, and 41% for more than 2.5 g/dL. (Blood. 2003;102:3759-3764)
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  • 7
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    Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance (2005)
    American Society of Hematology
    Details
    Publication Date: 2005-08-01
    Description: We hypothesized that the presence of monoclonal free kappa or lambda immunoglobulin light chains in monoclonal gammopathy of undetermined significance (MGUS), as detected by the serum free light chain (FLC) assay increases the risk of progression to malignancy. Of 1384 patients with MGUS from Southeastern Minnesota seen at the Mayo Clinic from 1960 to 1994, baseline serum samples obtained within 30 days of diagnosis were available in 1148. At a median follow-up of 15 years, malignant progression had occurred in 87 (7.6%) patients. An abnormal FLC ratio (kappa-lambda ratio 〈 0.26 or 〉 1.65) was detected in 379 (33%) patients. The risk of progression in patients with an abnormal FLC ratio was significantly higher compared with patients with a normal ratio (hazard ratio, 3.5; 95% confidence interval [CI], 2.3-5.5; P 〈 .001) and was independent of the size and type of the serum monoclonal (M) protein. Patients with an abnormal serum FLC ratio, non–immunoglobulin G (non-IgG) MGUS, and a high serum M protein level (≥ 15 g/L) had a risk of progression at 20 years of 58% (high-risk MGUS) versus 37% with any 2 of these risk factors (high-intermediate risk), 21% with one risk factor (low-intermediate risk), and 5% when none of the risk factors were present (low risk).
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    Topics: Biology , Medicine
    Published by American Society of Hematology
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  • 8
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    Immunoglobulin free light chains and solitary plasmacytoma of bone (2006)
    American Society of Hematology
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    Publication Date: 2006-09-15
    Description: An abnormal serum immunoglobulin free light chain (FLC) ratio at diagnosis may identify risk of progression to myeloma in patients with solitary bone plasmacytoma (SBP). In the cohort of 116 patients, 43 have progressed to myeloma, with a median time to progression of 1.8 years. The FLC ratio was determined in all 116 patients on serum collected at time of diagnosis and was abnormal in 54 patients (47%). An abnormal FLC ratio was associated with a higher risk of progression to myeloma (P = .039). The risk of progression at 5 years was 44% in patients with an abnormal serum FLC ratio at diagnosis compared with 26% in those with a normal FLC ratio. One to 2 years following diagnosis, a persistent serum M protein level of 5 g/L (0.5 g/dL) or higher was an additional risk factor for progression. A risk stratification model was constructed using the 2 variables of FLC ratio and M protein level: patients with a normal FLC ratio at baseline and M protein level less than 5 g/L (0.5 g/dL) at 1 to 2 years following diagnosis (low risk, n = 31); with either risk factor abnormal (intermediate risk, n = 26); and with both an abnormal FLC ratio and M protein level of 5 g/L (0.5 g/dL) or higher (high risk, n = 18). The corresponding progression rates at 5 years were significantly different in the low, intermediate, and high groups: 13%, 26%, and 62%, respectively (P 〈 .001).
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    Published by American Society of Hematology
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  • 9
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    Incidence of Cancer-Associated Venous Thromboembolism (VTE): A Population-Based Cohort Study (2008)
    American Society of Hematology
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    Publication Date: 2008-11-16
    Description: Background: Active cancer without or with chemotherapy is associated with a 4- to 6.5-fold increased risk for VTE 1. However, cancer-associated VTE incidence may be under- or overestimated by reports that linked cancer registry data to an anticoagulation clinic database or to hospital discharge diagnosis codes 2–5. Objective: To estimate the incidence of VTE in active cancer in a well-defined geographic population that includes the full spectrum of VTE events (including rapidly fatal events) occurring in the community. Methods: Using the longitudinal resources of the Rochester Epidemiology Project and Mayo Clinic Tumor Registry, we identified all Olmsted County, MN residents with incident VTE by review of their complete medical records in the community 6, and all residents with active cancer (by cancer site), over the 28-year period, 1973–2000. Using residents with active cancer within the three months prior or subsequent to incident VTE as the numerator, and all residents with active cancer as the denominator, we estimated the incidence of VTE in active cancer, both overall and for the subsets of pancreatic cancer, brain cancer and lymphoma. Results: Over 78,236 active-cancer person-years, 595 Olmsted County residents developed incident VTE. The overall active cancer-associated VTE incidence was 760 per 100,000 person-years (95% CI: 701, 824), about 6.5-fold higher than the general population 7. Over 473, 983 and 4,258 pancreatic cancer, brain cancer and lymphoma person-years, respectively, 51, 18 and 46 residents developed incident VTE. The pancreatic cancer-, brain cancer- and lymphoma-associated VTE incidence rates were 10,784 (95% CI: 8029, 14,179), 1,831 (95% CI: 1085, 2,893) and 1,080 (95% CI: 791, 1,441) per 100,000, respectively. Overall, cancer-associated VTE incidence increased with age, and for all ages, men had a higher VTE rate than women. We observed a much higher pancreatic cancer-associated VTE incidence than previously reported. Conclusions: The incidence of VTE in individuals with active cancer (especially pancreatic cancer) is higher than the general population. The incidence of VTE in patients with pancreatic cancer is higher than previously estimated.
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  • 10
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    Trends in the Incidence of Deep Vein Thrombosis and Pulmonary Embolism: A 35-Year Population-Based Study. (2006)
    American Society of Hematology
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    Publication Date: 2006-11-16
    Description: Background: Recent trends in the incidence of venous thromboembolism (VTE), including idiopathic vs. non-idiopathic VTE, have not been well described. Objective: To estimate the incidence of deep vein thrombosis (DVT) and pulmonary embolism with or without DVT (PE), and describe trends in incidence. Methods: Using the resources of the Rochester Epidemiology Project, we identified all Olmsted County, MN residents with an incident DVT and PE over the 35-year period, 1966–2000 (n=3342). For all cases, the complete medical records in the community were reviewed for demographic and baseline characteristics previously identified as risk factors for VTE. Generalized linear models assuming a Poisson error structure, and using a log link function, and a log (population) offset will be used to assess the relationship of crude incidence rates to gender, year of diagnosis and age at diagnosis. Results: The overall average age- and sex-adjusted annual VTE incidence was 122 per 100,000 person-years (DVT, 56 per 100,000; PE, 66 per 100,000), with higher age-adjusted rates among men than women (134 versus 115 per 100,000, respectively). VTE incidence rates increased exponentially with age for both genders, ranging from 4 to 1110 per 100,000 for age groups 0–19 to 90–110 years. Compared to the 5-year period, 1981–85 (when non-invasive diagnostic testing became routinely available), the overall VTE incidence through 2000 remains unchanged. However, the DVT incidence and the PE incidence significantly increased and decreased, respectively, adjusting for age and gender (p
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