Socio-economic inequalities in fragility fracture incidence: a systematic review and meta-analysis of 61 observational studies.

Individuals with low socio-economic status (SES) have a more than 25% higher risk of fragility fractures than individuals with high SES. Body mass index and lifestyle appear to mediate the effect of SES on fracture risk. Strategies to prevent fractures should aim to reduce unhealthy behaviours through tackling structural inequalities. INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the impact of socio-economic status (SES) on fragility fracture risk. METHODS: Medline, Embase, and CINAHL databases were searched from inception to 28 April 2021 for studies reporting an association between SES and fragility fracture risk among individuals aged ≥50 years. Risk ratios (RR) were combined in meta-analyses using random restricted maximum likelihood models, for individual-based (education, income, occupation, cohabitation) and area-based (Index of Multiple Deprivation, area income) SES measures. RESULTS: A total of 61 studies from 26 different countries including more than 19 million individuals were included. Individual-based low SES was associated with an increased risk of fragility fracture (RR 1.27 [95% CI 1.12, 1.44]), whilst no clear association was seen when area-based measures were used (RR 1.08 [0.91, 1.30]). The strength of associations was influenced by the type and number of covariates included in statistical models: RR 2.69 [1.60, 4.53] for individual-based studies adjusting for age, sex and BMI, compared with RR 1.06 [0.92, 1.22] when also adjusted for health behaviours (smoking, alcohol, and physical activity). Overall, the quality of the evidence was moderate. CONCLUSION: Our results show that low SES, measured at the individual level, is a risk factor for fragility fracture. Low BMI and unhealthy behaviours are important mediators of the effect of SES on fracture risk. Strategies to prevent fractures and reduce unhealthy behaviours should aim to tackle structural inequalities in society thereby reducing health inequalities in fragility fracture incidence.

Medication before and after a spinal cord lesion.

OBJECTIVE: To map the impact of spinal cord lesion (SCL) on medication. STUDY DESIGN: Registration of medication for 72 patients before SCL and at discharge from the Department for Spinal Cord Injuries. SETTING: Department for Spinal Cord Injuries, East Denmark. METHODS: The changes in medication for each Anatomical Therapeutic Chemical (ATC) Classification System group were registered for all patients, who were discharged from Department for Spinal Cord Injuries during 2010. The changes in medication per se were calculated for different parts of the population: non-traumatic, traumatic patients, men, women, paraplegia, tetraplegia, American Spinal Injury Association Impairment Scale (AIS) A, B or C, AIS D, age 0-45, 46-60 and 60+. In addition, comparisons of changes in medication were made between complementary parts of the population. RESULTS: The overall increase in medication after SCL was 3.29 times (P<0.001). Statistically significant increases were seen for most medicine categories. When studying subgroups of the population, the increase was most constantly seen for the medicine in the groups 'Alimentary tract and metabolism' and 'Nervous system'. The highest overall increases were seen in patients with AIS A, B and C compared with AIS D (P<0.05). There was no difference between traumatic and non-traumatic SCL, men and women, and younger compared with older patients. CONCLUSION: SCL elicits a general massive need for medicine. The relative increase is most pronounced for the more severely injured (AIS A, B and C). The increase in medication may have implications for side effects and for the economy of all involved.

Urachal carcinoma with metastasis to the maxilla: the first reported case.

A case is reported for the first time of a urachal carcinoma with metastasis to the maxilla. The patient presented with a hard swelling along the left upper jaw in the region of 24-27. At the time of onset there were skin changes and signs of metastasis to the brain. The patient died 13 months after the onset of symptoms.

A new method for determination of the rate constant for clearance of radioactive indicators in gamma camera hepatography. Clinical examples with 99mTc-diethyl-IDA and 99mTc-diethyl-iodo-IDA.

Application of Stewart-Hamilton's formula to the activity-time curve recorded over a left ventricular region of interest following an intravenous bolus injection of a radioactive indicator in gamma camera hepatography has resulted in a new method for determination of the clearance rate constant of the indicator (i.e. the ratio of the clearance to the plasma volume). In a group of 19 normal subjects the clearance rate constant was 0.116 +/- 0.036 min-1 (means +/- 1 S.D.) with 99mTc-diethyl-IDA (SOLCO HIDA) and 0.184 +/- 0.037 min-1 (means +/- 1 S.D.) with 99mTc-diethyl-iodo-IDA (SOLCO IODIDA) in 15 normal subjects. The clearance rate constant is assumed to represent mainly hepatic clearance of the radioactive indicator and to a much smaller extent renal clearance. The literature shows diverging results as to the clearance of 99mTc-diethyl-IDA and the reasons for this are discussed. The correlations between the clearance rate constant of 99mTc-diethyl-IDA and a number of laboratory variables with relation to liver function were moderate to non-existent in a group of 16 subjects with abnormal values of at least one of these variables. The rate constant for clearance as described in the paper represents a non-invasive method for rapid evaluation of the uptake capacity of the liver and, in particular, with regard to the polygonal cells of the liver parenchyma when IDA derivatives are employed. The clinical usefulness of the clearance rate constant is probably superior to the group of routine laboratory variables which also describe other functions than liver uptake.

The effect of captopril and metoprolol as monotherapy or combined with bendroflumethiazide on blood lipids.

In a 24-week randomized multicentre single-blind study, including mild to moderate hypertensives free from other diseases, the effect on blood lipids of captopril (n = 51) was studied and compared with that of metoprolol (n = 53). In order to keep the diastolic pressure less than 95 mm Hg, bendroflumethiazide was added to the medication for 11 patients in the captopril group and 11 patients in the metoprolol group. Neither captopril nor metoprolol altered total cholesterol significantly. Captopril as monotherapy increased HDL-cholesterol by 6.2% (P less than 0.01) and decreased triglycerides by 10.6% (P less than 0.05). Metoprolol as monotherapy decreased HDL-cholesterol by 5.6% (P less than 0.01) and increased triglycerides by 10.3% (P less than 0.05). When bendroflumethiazide was added the favourable effect of captopril on the blood lipids disappeared while the undesirable effect of metoprolol became more pronounced.

Follow-up investigation of fresh lunate bone fracture.

In order to evaluate the clinical and radiological aspects of fresh lunate fractures, a follow-up investigation was carried out. In the past thirty-one years (1956-1986), seventeen patients were found to have fresh lunate fractures. Eleven of these cases were clinically and radiologically reexamined, with observation intervals ranging from 1.25 to 31.33 years. The authors found no radiologic evidence of lunatomalacia, osteonecrosis, or osteoarthrosis. Two cases of chip-fractures had not healed, but the bone structure was normal. Clinically, none of the patients presented with pain, muscular atrophy, or reduced power of grip. None of the patients had changed occupation as a result of the fracture.

Dislocation of extensor tendons of the hand caused by focal myoclonic epilepsy.

A case of dislocation of the extensor tendons of the hand caused by focal myoclonic epilepsy is presented. This particular aetiology, which has not previously been reported, is discussed. The tendons were repositioned and there was no sign of recurrence one year later.

Magnesium and acute myocardial infarction. Transient hypomagnesemia not induced by renal magnesium loss in patients with acute myocardial infarction.

Serum magnesium concentrations and the rate of urine magnesium excretion were studied in 24 patients with suspected acute myocardial infarction (AMI). Blood and urine samples were taken on admission, at three-hour intervals for the first 24 hours after admission, and every eight hours for the next 24 hours. Thirteen of the patients were found to have AMI, and the 11 who did not have AMI served as a control. During the first 32 hours, the AMI group had significantly low serum magnesium concentrations. The serum magnesium concentrations were unchanged in the control group. Results of the urine samples disproved our hypothesis that the drop in serum magnesium concentrations was due to an increased renal magnesium loss. These results indicate a magnesium migration associated with AMI, from extracellular to intracellular space.

Cardiac conduction disturbances during carbamazepine therapy.

3 cases of carbamazepine (CBZ)-induced Stokes-Adams attacks caused by intermittent total atrioventricular block, sino-atrial block with junctional escapade-rhytm and intermittent asystolia are reported. After cessation of CBZ treatment, the cardiac conduction disturbances disappeared. In 2 of the patients, the diagnosis was confirmed by resumption of treatment with CBZ after insertion of a demand pacemaker. If syncopes or changes in seizure-type occur in patients treated with CBZ, evaluation of cardiac conduction is recommended. Furthermore, it is recommended that cardiac function is evaluated before CBZ-treatment, especially in elderly patients.

Kinetics of small lymphocytes in normal and nude mice after splenectomy.

Autoradiography and various quantitations on lymphoid tissues have been used to evaluate the kinetics of small lymphocytes in normal (+/nu or +/+) and congenitally athymic nude (nu/nu) NMRI mice 1 month after splenectomy or sham-splenectomy. The results indicate that splenectomy causes depressed thymic activity and diminished numbers of T lymphocytes in peripheral lymphoid tissues. The total number of cells in these tissues as well as the blast cell activity, were within normal limits. Bone marrow lymphocyte numbers and kinetics as well as blood lymphocyte levels in splenectomized and sham-splenectomized normal animals were comparable. Blood lymphocyte numbers were at normal levels in splenectomized nude mice, in spite of reduced numbers of bone marrow and thoracic duct lymphocytes. It is suggested that increased number of newly-formed lymphocytes, found in lymph nodes and blood of splenectomized mice, are released from the lympho-myeloid organs in compensation for the loss of long-lived, thymus-derived cells.