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J Dequeker

Publications and source records attributed to J Dequeker.

At least 19 recordsLinked to original sources
PubMed2001

Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study.

The presence of a vertebral deformity increases the risk of subsequent spinal deformities. The aim of this analysis was to determine whether the presence of vertebral deformity predicts incident hip and other limb fractures. Six thousand three hundred and forty-four men and 6788 women aged 50 years and over were recruited from population registers in 31 European centers and followed prospectively for a median of 3 years. All subjects had radiographs performed at baseline and the presence of vertebral deformity was assessed using established morphometric methods. Incident limb fractures which occurred during the follow- up period were ascertained by annual postal questionnaire and confirmed by radiographs, review of medical records and personal interview. During a total of 40348 person-years of follow-up, 138 men and 391 women sustained a limb fracture. Amongst the women, after adjustment for age, prevalent vertebral deformity was a strong predictor of incident hip fracture, (rate ratio (RR) = 4.5; 95% CI 2.1-9.4) and a weak predictor of 'other' limb fractures (RR = 1.6; 95% CI 1.1-2.4), though not distal forearm fracture (RR = 1.0; 95% CI 0.6-1.6). The predictive risk increased with increasing number of prevalent deformities, particularly for subsequent hip fracture: for two or more deformities, RR = 7.2 (95% CI 3.0-17.3). Amongst men, vertebral deformity was not associated with an increased risk of incident limb fracture though there was a nonsignificant trend toward an increased risk of hip fracture with increasing number of deformities. In summary, prevalent radiographic vertebral deformities in women are a strong predictor of hip fracture, and to a lesser extent humerus and 'other' limb fractures; however, they do not predict distal forearm fractures.

Aged↗
PubMed2001

Quantitative ultrasound and trabecular architecture in the human calcaneus.

Relationships between quantitative ultrasound (QUS), density (bone volume density [BV/TV]), and trabecular architecture were investigated in 69 calcaneal cancellous bone cubes. Ultrasound signal velocity, phase velocity, attenuation, and broadband ultrasonic attenuation (BUA) measurements were made along the mediolateral axis. Density and architectural parameters were measured using microcomputed tomography (microCT). Density yielded the best correlations with QUS (r2 = 73-77%). Of the individual architectural parameters, correlations with QUS were highest for the Structure Model Index (SMI), a parameter quantifying the relative proportion of rods and plates (r2 = 57-63%). After adjustment for density, significant associations with QUS remained for SMI, trabecular spacing (Tb.Sp), and trabecular number (Tb.N), although the variance in QUS attributable uniquely to individual architectural parameters was at best 4%. In multivariate regression models, combinations of density and architectural parameters explained 76-82% of the variance in QUS, representing an r2 increase of, at most, 8% compared with using density alone. However, multivariate models using combinations of architectural parameters alone (i.e., density excluded) also had a good predictive ability for QUS (r2 = 73-81%). Thus, although these data show modest but significant density-independent relationships between QUS and trabecular architecture in the human calcaneus for the first time, the causal relationships behind the variation in acoustic properties remain obscure. Given the relative weakness and complexity of the emerging associations between QUS and architecture, it is prudent to regard QUS measurements in calcaneal bone primarily as an indicator of bone density.

Adult↗
PubMed2001

Benign familial hypermobility syndrome and Trendelenburg sign in a painting "The Three Graces" by Peter Paul Rubens (1577-1640).

Clinical features suggestive of hypermobility syndrome and a positive Trendelenburg sign are described in a painting "The Three Graces" (1638-1640) by Peter Paul Rubens, Prado, Madrid. The most obvious findings are scoliosis, positive Trendelenburg sign, and hyperextension of the metacarpal joints, hyperlordosis, and flat feet. The sitters, presumably Hélène Fourment (second wife of Rubens) and her sisters, support the hereditary familial aspect of hypermobility. Manifest hypermobility of the hand has also been found in two other ancient paintings: "Saint Cyriaque" in the Heller Retable by Mathias Grünewald (1450-1528), Frankfurt, and "The wounded man" by Gaspare Traversi, Venice (1732-1769). The finding of signs of hypermobility in ancient paintings shows that artists who are keen observers of nature could describe, or at least record, this condition long before doctors did. The art of the past can be a useful tool in the field of paleopathology.

Female↗
PubMed2000

Polymorphisms of the VDR, ER and COLIA1 genes and osteoporotic hip fracture in elderly postmenopausal women.

In view of the reported associations between osteoporosis and polymorphisms of the vitamin D receptor (VDR), collagen Ialpha1 (COLIA1) and estrogen receptor (ER) genes, an association study was performed between VDR, COLLIA1, and ER genotypes and bone mineral density, biochemical markers of bone turnover and hip fracture occurrence in Belgian older postmenopausal women. The gene polymorphisms were evaluated by restriction fragment length polymorphism analyses, using the restriction enzymes BsmI (VDR), AccB7I (COLIA1), and PvuII and XbaI (ER), respectively. As expected, bone mineral density and biochemical analyses demonstrated significant differences between hip fracture patients and elderly controls. However, no significant differences in genotype distributions or allele frequencies were observed between the cases (n = 135, age 78 +/- 9 years) and controls (n = 239, age 76 +/- 4 years) for any of the gene polymorphisms. Stratification of both study populations according to VDR, COLIA1 or ER genotype did not reveal any statistically significant difference in bone density or bone turnover between subgroups with different genotypes. In conclusion, despite its limited statistical power the outcome of this study does not support the hypothesis of a major contribution of the VDR, COLIA1 or ER polymorphisms to explain variations in bone mineral density or bone turnover, or to identify elderly women at risk of osteoporotic hip fracture.

Aged↗
PubMed2000

Ultrasonographic, axial, and peripheral measurements in female patients with benign hypermobility syndrome.

Twenty-five female Caucasians, aged 19-57 years, with the hypermobility syndrome had bone density measurements using established noninvasive techniques such as dual X-ray absorptiometry (DXA), single photon absorptiometry (SPA), heel ultrasound (US), and peripheral computed tomography (pQCT) acquisitions of the radius. As a group, comparisons of the different bone indices with the corresponding age-matched reference population resulted in normal z-scores for the arial densities, however, values for the volumetric total and cortical bone at the radius measured by pQCT were significantly lower than expected (P < 0.0001). Spinal and femoral bone density results were significant after correction for body mass index (BMI). This cross-sectional study shows that the benign hypermobility syndrome patients have lowered t-scores for data reflecting bone structure and bone strength as measured with US and the tomographic technique.

Absorptiometry, Photon↗
PubMed2000

Rheumatoid arthritis and osteoporosis.

Some controversial issues in the current literature in relation to osteoporosis and rheumatoid arthritis are updated and discussed. Because most studies agree that osteoporosis in postmenopausal women and in men with RA is more evident at the hip and radius than at the spine, and that the most important determinants of bone loss are disability, local disease activity, and cumulative corticosteroid dose, osteoporosis is not a common systemic extra-articular manifestation of RA. In early arthritis, periarticular osteoporosis does indeed reflect disease activity because it is closely related to the acute phase reactants, but once periarticular osteoporosis is established it is no longer a marker of disease severity. The threshold dose for corticosteroid-induced osteoporotic fractures is the cumulative rather than the actual dose. Statements based on quantitative tomography concerning the acute effects (and their reversal) of corticosteroids on bone have to be interpreted with care because of important body composition changes, in particular in bone marrow fat, during corticosteroid treatment. At present there is no evidence that anti-resorbing drugs can change the progress of RA erosions, probably because erosions are the result of non-osteoclast mediated mechanisms. Stress fractures in RA are underdiagnosed and are often confused with synovitis, and therefore it is likely that they are more frequent than commonly thought, especially in the lower limbs. Methotrexate osteopathy is known in oncological practice. Whether low dose methotrexate is toxic for bone is not clear, but a number of clinical observations suggest that the occurrence of spontaneous fractures and lower extremity pain is more frequent in methotrexate treated patients than expected. Prospective studies are necessary to confirm these impressions.

Adrenal Cortex Hormones↗
PubMed2000

Transplantation osteoporosis and corticosteroid-induced osteoporosis in autoimmune diseases: experience with alfacalcidol.

The effect of alfacalcidol therapy on bone mineral density at the spine and proximal femur was evaluated in 112 transplant recipients (59 heart, 26 liver and 27 lung); 45 transplant cases served as controls (included in a randomised way in a placebo group) and in 42 rheumatoid arthritis cases. Liver and lung transplantation cases had before transplantation a lower bone density at the spine and femur compared to heart transplant cases. Heart transplant cases lost considerably more bone immediately after transplantation than liver and lung transplant recipients. A positive effect of 2 years alfacalcidol treatment (0.5-1 microgram/day) on bone loss was observed in all treated groups. Alfacalcidol was particularly effective against trabecular bone loss at the spine in rheumatoid arthritis patients and transplant recipients. There is a manifest difference in evolution between organ transplant groups and bone sites measured. Liver and lung transplant recipients respond better to therapy than cardiac recipients.

Adjuvants, Immunologic↗
PubMed2000

Hip geometry, bone mineral distribution, and bone strength in European men and women: the EPOS study.

Hip geometry and bone mineral density (BMD) have been shown previously to relate, independently of each other, to risk of hip fracture. We used Lunar DPX "beta" versions of hip strength analysis (HSA) and hip axis length (HAL) software to analyze scans from ten representative age-stratified population samples in the European Prospective Osteoporosis Study (EPOS). All 1617 subjects were >50 years of age, and 1033 were women. The data were modeled with gender and center as categorical variables. The bone mineral density of the upper half of the femoral neck declined at a faster rate with age than that in the lower half. Femoral neck cross-sectional moment of inertia (CSMI), a measure of resistance to bending, showed no significant age reduction in either gender. However, height and weight effects on CSMI were significantly more beneficial in men than in women (0.002 < p < 0.012) and the weight effect appeared to be mediated by bone mineral content (BMC). Compressive stress (Cstress), defined as the stress in the femoral neck at its weakest cross section arising from a standardized fall, was higher in women. Although Cstress increased with body weight when BMC was held constant, in practice it fell through the association and statistical interaction of rising body weight with rising BMC. HAL, as expected, was strongly positively associated with male gender and also height (p < 0.0001). Hip strength-related indices were markedly center-dependent. Significant differences (p < 0.0001) were noted between the centers for all the variables investigated that related to hip geometry. Adjustment for femoral neck bone mineral content (totBMC) showed these center differences to account for >50% of center variation in hip strength, which remained highly significant (p < 0.0001). We conclude that there are substantial geographical differences in femoral neck geometry as well as in BMD. These geometric variations may contribute to the large variations in hip fracture risk across Europe. The effects of aging on hip strength need to be explored in longitudinal studies.

Age Factors↗
PubMed2000

Educational issues in rheumatology.

Musculoskeletal conditions are the most common cause of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. Nearly a quarter of all consultations in primary care are concerned with rheumatic disease, yet undergraduate education in rheumatology is under-developed all over the world and does not get the attention it deserves. This has important consequences for the early diagnosis of rheumatic disease and the proper care of rheumatic patients in general, as well as for the esteem of rheumatology as a profession. Because the high prevalence and impact of rheumatic disease are not reflected in medical curricula, the International League of Associations for Rheumatology developed the Undergraduate Medical Education in Rheumatology 2000 Project. The project embodies three fundamental concepts: (1) to convince medical faculties and schools educating health professionals world wide that skills in examination, a knowledge of the management of musculoskeletal disease and a positive attitude to disability are the basis of good medical practice; (2) that rheumatology is valuable for acquiring skills in problem-solving, clinical reasoning and understanding basic genetic, immunological and biochemical mechanisms, as illustrated by rheumatic disease; and (3) to orient these programmes to the needs of individual patients in the context of the population at large, knowing that 20% of all primary care consultations involve musculoskeletal disease. The movement of doctors throughout the world, especially within Europe, is leading to initiatives to harmonize standards of specialist training. The importance of ensuring the highest standard of clinical care, achieving the greatest gain in health alongside a rapid advance in knowledge and clinical practice, is increasing the priority for continuing medical education and methods to ensure that doctors remain competent at all stages of their career.

Education, Medical↗
PubMed2000

A pooled data analysis on the use of intermittent cyclical etidronate therapy for the prevention and treatment of corticosteroid induced bone loss.

OBJECTIVE: To conduct a pooled data analysis in a group of patients defined by sex, menopausal status, and underlying disease in order to examine the effect of intermittent cyclical etidronate in the prevention and treatment of corticosteroid induced osteoporosis. METHODS: We selected 5 randomized, placebo controlled studies that examined the efficacy of intermittent cyclical etidronate therapy in which the raw data were available for analysis. Three were prevention studies and 2 treatment studies. The primary outcome was the difference between treatment groups in the percentage change from baseline in lumbar spine bone density. Secondary outcomes included the difference between treatment groups in the percentage change from baseline in femoral neck and trochanter bone density, and vertebral fracture rates. RESULTS: Results are separately pooled for the prevention and treatment studies. The prevention studies had significant mean differences (95% CI) between groups in mean percentage change from baseline in lumbar spine, femoral neck, and trochanter bone density of 3.7 (2.6 to 4.7), 1.7 (0.4 to 2.9), and 2.8% (1.3 to 4.2) after one year of treatment, in favor of the etidronate group. The treatment studies displayed a mean difference between groups in mean percentage change from baseline in lumbar spine bone density of 4.8 (2.7 to 6.9) and 5.4% (2.5 to 8.4) after one and 2 years of therapy. In the prevention studies, a reduced fracture incidence was observed in the etidronate group compared with the placebo group (relative risk 0.50; CI 0.21 to 1.19). CONCLUSION: Etidronate therapy was effective in preventing bone loss in the prevention studies and in preventing or slightly increasing bone mass in the treatment studies. A fracture benefit was observed in postmenopausal women treated with etidronate in the prevention studies.

Adult↗
PubMed1999

Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study.

The aims of this study were to identify risk factors for hip fracture in men aged 50 years or more. We identified 730 men with hip fracture from 14 centers from Portugal, Spain, France, Italy, Greece and Turkey during the course of a prospective study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers. The questionnaire examined aspects of work, physical activity past and present, diseases and drugs, height, weight, indices of co-morbidity and consumption of tobacco, alcohol, calcium, coffee and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), low sunlight exposure, a low degree of recreational physical activity, low consumption of milk and cheese, and a poor mental score. Co-morbidity including sleep disturbances, loss of weight, impaired mental status and poor appetite were also significant risk factors. Previous stroke with hemiplegia, prior fragility fractures, senile dementia, alcoholism and gastrectomy were associated with significant risk, whereas osteoarthrosis, nephrolithiasis and myocardial infarction were associated with lower risks. Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of anti-epileptic agents. Of the potentially 'reversible' risk factors, BMI, leisure exercise, exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis, accounting for 54% of hip fractures. Excluding BMI, 46% of fractures could be explained on the basis of the risk factors sought. Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks (14% and 9% respectively). The use of risk factors to predict hip fractures had relatively low sensitivity and specificity (59.6% and 61.0% respectively). We conclude that lifestyle factors are associated with significant differences in the risk of hip fracture. Potentially remediable factors including a low degree of physical exercise and a low BMI account for a large component of the total risk.

Aged↗