Despite the importance of fractures as an economic and health problem, and consequent interest in osteoporosis, few workers have previously attempted to define the overall incidence of fracture. This population based study was based in the Accident and Emergency Department of Cardiff Royal Infirmary and identified all patients presenting with fractures of any type. Over a single year a total of 6467 fractures were identified among the 306,600 people who live in the city of Cardiff. This gives an overall fracture incidence of 21.1/1000/year, (23.5/1000/year in males and 18.8/1000/year in females); a result very similar to those from similar work in the USA, Australia and Norway. This result is over twice the previous estimate of fracture incidence in the UK; the figure of 9/1000/year from the only equivalent study performed since the 1960s. In part, this discrepancy appears to reflect our more rigorous definition of the study population, and our improved ascertainment of minor fractures. We believe our result to offer the most accurate estimate of fracture incidence currently available for a UK population.

Adolescent↗

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Stroke prevention in atrial fibrillation: physicians' attitudes to anticoagulation in older people.

The increased prevalence of atrial fibrillation (AF) in older people contributes to an increased risk of stroke. Although clear guidelines exist, there is considerable variation in physicians' approaches to the selection of patients appropriate for warfarin treatment as stroke prevention. We compared attitudes to the anticoagulation of elderly patients with AF, in a postal study of geriatricians and specialist physicians (general physicians with specialist interests in Cardiology, Gastroenterology, Diabetes and Endocrinology, Nephrology and Neurology). A structured questionnaire was mailed to all 108 consultant physicians and geriatricians in South East Wales. This explored their attitude to their patients' age and comorbidity when considering the benefits and risks of warfarin prophylaxis for AF. About 25/30 geriatricians (83%) and 43/78 specialist physicians (55%) responded; an overall response rate of 63%. About 94% of the respondents agreed that patients aged over 75 with atrial fibrillation were at a greater risk of stroke than younger patients. About 68% considered warfarin related bleeds more likely in this age group, despite which most thought that the benefits of warfarin outweighed the risks. In people aged above 75, only 13/25 (52%) geriatricians and 17/43 (40%) specialist physicians viewed lone AF (AF with no underlying risk factor) as an indication for anticoagulation. When considering the use of warfarin, geriatricians' appeared more likely to be influenced by coexisting problems such as disability, falls, cerebrovascular disease and limited life expectancy. Only a history of falls (96% geriatricians vs. 86% specialist physicians) and cerebrovascular disease (79% geriatricians vs. 51% specialist physicians) had a significant influence on prescribing practice (P<0.05, chi(2) test). There appears to be widespread uncertainty about the indications for warfarin as stroke prophylaxis, and ageist attitudes or a lack of conviction of benefit appear to be disadvantaging older people. Patients aged below 65 with lone AF who are at the lowest risk of embolic events are often considered for treatment, whilst the use of warfarin in 75-year-olds with lone AF who are at a moderately high risk of embolic events remains disappointing.

Journal Article↗

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Bone assessment in elderly women: what does a low bone ultrasound result tell us about bone mineral density?

Access to dual energy X-ray absorptiometry (DXA) can prove difficult for frail or elderly patients, and bone ultrasound may offer a practical alternative. Even after adjustment for bone mineral density (BMD), ultrasound readings are able to predict hip fracture in elderly women. We consider how bone ultrasound might contribute to bone assessment in a clinical setting. DXA remains the gold standard for bone assessment, with osteoporosis defined as a BMD result more than 2.5 S.D. below the young adult mean. Using an equivalent approach we defined an osteoporotic ultrasound result as broadband ultrasound attenuation (BUA)<54 dB/MHz. In 73 women aged 29-86 (mean 65) years DXA was used to measure BMD at lumbar spine and hip, and ultrasound to measure BUA at the heel. Correlation of BUA with BMD at femoral neck (r=0.64, P<0.001), and lumbar spine (r=0.55, P<0.001) was consistent with previously reported figures for this ultrasound system. All subjects with BUA below the 54 dB/MHz threshold value were shown to have low femoral neck BMD. Women (42%) aged over 65, but only 18% of younger women had low BUA results. In women over 65 years of age measurements of BUA achieved a sensitivity of 61% and specificity of 100% in prediction of low femoral neck BMD. Although a normal BUA did not exclude an osteoporotic BMD result at hip or lumbar spine, a low BUA appeared a highly specific predictor of low BMD at these sites. Since all those women identified as having a low BUA at the heel also had low BMD results, ultrasound appeared to identify a subgroup of elderly patients at a very high risk of fracture.

Journal Article↗

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Trauma in elderly people: what proportion of fractures are a consequence of bone fragility?

Epidemiologists have tended to equate osteoporotic fractures with those which occur after only moderate trauma, or which affect elderly people. We set out to critically examine this epidemiological approach, because even among elderly people some fractures will be a result of severe trauma and these cannot be assumed to reflect bone fragility. In a population based study of all Cardiff residents aged over 60 we identified everyone who presented with a fracture during 1996. We considered the events that led to each fracture, to establish which fractures were a result of 'severe' trauma: trauma greater than a fall from a standing height. We identified 1335 people who between them sustained a total of 1372 fractures. 168 (12%) of the fractures resulted from severe trauma, but in people aged over 80 only 6% of all fractures, 4% of hip fractures, and 3% of wrist fractures followed severe trauma. In older subjects severe trauma makes only a very small contribution to the causation of fracture, so that the age-sex distribution of fractures following moderate trauma closely resembles that of fractures overall. For epidemiological purposes it does appear justifiable to equate the consequences of bone fragility with the occurrence of osteoporosis associated fractures in elderly people.

Journal Article↗

PubMedDate not supplied

Opinions on and use of alternative medicine among physicians, nurses and clerks in northern Norway.

In February 1997 a questionnaire on alternative medicine was distributed to 172 physicians, 374 nurses and 96 clerks, all employed in hospitals in the northern part of Norway. A response rate of 57% was achieved. The aim of the study was to compare different health professions regarding views on and use of alternative medicine. Among all respondents 56% described themselves as having a positive attitude towards alternative medicine (16% of the physicians, 71% of the nurses and 72% of the clerks). Twelve percent of physicians, 32% of nurses and 46% of clerks had been using alternative medicine. Female physicians and female nurses showed a more positive attitude and were more frequent users of alternative medicine than their male counterparts. Physicians had confidence in acupuncture, herbs and diets, mainly as treatment of muscle-skeletal disorders, and migraine. Nurses and clerks on the other hand tended to believe in various alternative methods against a broad range of disorders. Female physicians and nurses emphasised the importance of more information, knowledge and openness towards alternative treatments more than their male counterparts. They also believed that traditional medicine could benefit from adopting principles from alternative medicine.

Administrative Personnel↗