Risk factors for fracture in a UK population: a prospective cohort study.

BACKGROUND: Common clinical risk factors for fracture in older women have been identified. To date, most of these risk factors have not been confirmed in a UK population. AIM: To confirm the important risk factors for fracture in older women. DESIGN: Comprehensive cohort study (CCS) with a nested randomized controlled trial. METHODS: The CCS included 4292 women aged >70 years. We assessed potential risk factors for fracture, and followed-up participants for 24 months for incidence of non-vertebral fractures. RESULTS: Odds ratios (ORs) for predicting any non-vertebral fracture were: previous fracture, 2.67 (95%CI 2.10-3.40); a fall in the last 12 months, 2.06 (95%CI 1.63-2.59); and age (per year increase), 1.03 (95%CI 1.01-1.05). ORs for predicting hip fracture were: previous fracture, 2.31 (95%CI 1.31-4.08); low body weight (<58 kg), 2.20 (95%CI 1.28-3.77); maternal history of hip fracture, 1.68 (95%CI 0.85-3.31); a fall in the last 12 months, 2.92 (95%CI 1.70-5.01); and age (per year increase), 1.09 (95%CI 1.04-1.13). ORs for predicting wrist fracture were: previous fracture, 2.29 (95%CI 1.56-3.34); and a fall in the last 12 months, 1.60 (95%CI 1.10-2.31). Being a current smoker was not associated with an increase in risk, and was consistent across all fracture types. DISCUSSION: Older women with the clinical risk factors identified in this study should be investigated for osteoporosis or offered preventive treatment.

Pharmaceutical treatment of symptomatic vertebral fractures in primary care.

BACKGROUND: Vertebral fractures are associated with a reduction in quality of life and are an important predictor of other non-spine fractures. Previous work has shown that up to 60% of patients with a vertebral fracture identified in primary care remain untreated. OBJECTIVE: To examine the prevalence of pharmaceutical treatment and predictors of treatment in a primary care setting. METHODS: Case-control study using the general practice research database (GPRD). All women aged 50 years and over with a first diagnosis of a vertebral fracture since 1990 were identified and matched with a control by age and practice. Appropriate use of a pharmaceutical agent was defined as a prescription occurring within 30 days of the diagnosis being recorded. RESULTS: We identified 2719 women with the same number of controls. Within 30 days of diagnosis 61% of women were prescribed treatment, compared with only 3% of the controls. Bisphosphonate was the single most important treatment prescribed. Predictors of any drug treatment included: year of fracture (most recent year increased the likelihood of treatment); age (younger patients were more likely to receive treatment); history of back pain; low body weight; history of steroid use. CONCLUSIONS: Treatment of diagnosed vertebral fractures is becoming more common. Treated patients tend to be younger but to have a higher prevalence of clinical risk factors than untreated patients. There remain significant numbers of patients who are not offered treatment.

Career professionals who volunteer: should their motives be accepted or managed?

Career professionals, such as business executives who devote their time and talents to committee work in voluntary organizations, are highly valued as volunteers. These professionals have a variety of motives for adding volunteer work to their demanding schedules. Should volunteer agency administrators accept and reward these motives indiscriminately, or should they try to mold them to conform to agency values? The answer, according to this study, is yes to both alternatives, depending on whether the aim is to improve these volunteers' attitudes or their performance.