Ligamentum Teres Lesions Are Associated With Poorer Patient Outcomes in a Large Primary Hip Arthroscopy Cohort of 1,935 Patients.

Purpose: To retrospectively evaluate the prevalence and characteristics of ligamentum teres (LT) lesions identified in a single-surgeon hip arthroscopy cohort and to compare surgical outcomes of those with, and without, identified LT lesions. Methods: Patients who underwent primary hip arthroscopy between 2005 and 2018 in one surgeon's clinic were identified. Those with a history involving extra-articular scoping or any previous surgery on the ipsilateral hip were excluded. Patient-reported outcome measures completed before and after surgery included the Hip Disability and Osteoarthritis Outcome Score, Nonarthritic Hip Score, and 12-item International Hip Outcome Tool. Conversion to hip joint replacement was ascertained through a national register. Results: A total of 1,935 primary hip arthroscopies (from 1,607 different patients) were included in this study. In total, 323 LT lesions were identified. Those with LT lesions were older than those without (40.3 ± 11.3 years compared with 33.9 ± 12.1 years; P < .001), and more frequently female (58.2% vs 41.8%; P = .001). Hips with lesions had a smaller lateral center-edge angle than other hips (33.0 ± 6.8° vs 34.1 ± 6.0°; P = .004). All patient-reported outcome measures improved significantly (P < .001) from pre- to post-surgery for patients with and without LT lesions. However, patients with LT lesions reported less improvement in the 12-item International Hip Outcome Tool (difference -5.60; P = .004) and in Hip Disability and Osteoarthritis Outcome Score symptoms (-4.41; P = .004), sports (-7.81; P < .001), and quality of life subscales (-8.85; P < .001) than those without lesions. Hips with LT lesions also had a 6.2% 2-year rate of subsequent hip replacement (20/323 hips) compared with those without lesions (0.9%; 14/1612 hips; P < .001). Conclusions: In this single-surgeon hip arthroscopy cohort, identification of LT lesions was associated with poorer patient-reported outcomes and increased likelihood of conversion to arthroplasty within 2 years. These findings suggest a poorer prognosis for patients with LT injury compared with those without. Level of Evidence: Level III, retrospective cohort study.

Traumatic surfing injuries in New Zealand: a descriptive epidemiology study.

BACKGROUND: New Zealand (NZ) has nearly 14,000 km of coastline and a surfing population of approximately 315,000 surfers. Given its popularity, surfing has a high frequency of injury claims, however, there remains a lack of data on traumatic surfing-related injuries from large population studies. The primary purpose of this study was to examine traumatic surfing injuries in NZ specific to injury incidence, duration, location, type, mechanism of injury and associated risk factors. METHODS: A sample of self-identified surfers currently living in NZ participated in an online retrospective cross-sectional survey between December 2015 and July 2016. Demographic and surfing injury data were collected and analysed. RESULTS: The survey yielded 1,473 respondents (18.3% female); a total of 502 surfers reported 702 major traumatic injuries with an overall incidence proportion of 0.34 (95% CI [0.32-0.37]). When comparing the number of injured surfers who sustained an injury at various body locations, a significantly higher proportion of competitive surfers, compared to recreational surfers, had an injury at the neck (6.8% vs 4%, χ 2 (1,1473) = 5.84, P = 0.019); shoulder (7.4% vs 4.3%, χ 2 (1,1473) = 6.34, P = 0.017), upper back (1% vs 2.4%, χ 2 (1,1473) = 4.77, P = 0.043), lower back (7% vs 3.1%, χ 2 (1,1473) = 11.98, P = 0.001) and knee (7% vs 3.4%, χ 2 (1,1473) = 9.67, P = 0.003). A significantly higher proportion of surfers who performed aerial manoeuvres compared to those who did not reported a higher proportion of knee injuries (9.7% vs 3.9%, χ 2 (1,1473) = 13.00, P = 0.001). With respect to injury duration, the shoulder represented the largest proportion of chronic injuries (>3 months) (44.4%), and the head and face represented the largest proportion of acute injuries (≤3 months) (88%). Muscle and tendon injuries were reported most frequently (25.6%) and direct contact injuries accounted for 58.1% of all injury mechanisms. Key risk factors for traumatic injury included: competitive compared to recreational status (41.0% vs 30.1%, Relative Risk (RR) = 1.36, P < 0.001), ability to perform aerial manoeuvres (48.1% vs 31.8%, RR = 1.51, P < 0.001) and intermediate or above skill level surfers compared to beginner surfers (35.8% vs 22.7%, RR = 1.58, P < 0.001). CONCLUSION: One third of recreational surfers sustained a major traumatic injury in the previous 12 months. For competitive or aerialist surfers the risk was greater, with this proportion approximately half. Overall, the head/face was the most common location of traumatic injury, with competitive surfers being more likely to sustain a neck, shoulder, lower back, and knee injury compared to recreational surfers. The shoulder was associated with the highest proportion of injuries of chronic duration. Future research should investigate injury mechanisms and causation using prospective injury monitoring to better underpin targeted injury prevention programs.

Peri-operative platelet-rich plasma in arthroscopic femoroacetabular impingement surgery: a randomized controlled trial.

This study aimed to determine whether the addition of platelet-rich plasma (PRP) during hip arthroscopy improves functional outcomes in femoroacetabular impingement (FAI) surgery. This was a prospective randomized single-blinded trial of arthroscopic hip patients aged between 16 and 50 years with a diagnosis of FAI conducted at a single centre. Patients with any previous hip surgery and significant osteoarthritic changes (Tonnis grade > 2) were excluded. Before surgery, patients were randomly assigned to receive either a PRP injection or a saline placebo. Efficacy was evaluated at 6 months, 1 year and 2 years post-surgery using patient-reported outcomes. The short version International Hip Outcome Tool (iHOT12) was the primary outcome. Recruited patients (n = 113) were aged 36.0 ± 10.5 (mean ± standard deviation) years and 56% male. At baseline, iHOT12 scores of the PRP (mean 43.8 ± 22.4) and placebo groups (mean 45.2 ± 21.5) were similar. At a minimum follow-up of 2 years, both groups had improved iHOT12 scores (PRP: mean 83.6 ± 13.4, control: mean 77.1 ± 23.3), with no significant difference in change between the two groups (P = 0.19). There were no significant group differences for the change in Non-Arthritic Hip and Hip Disability and Osteoarthritis Outcome Score-Shortform scores between the two groups (P = 0.22 and 0.46, respectively). The present study does not support the peri-operative use of PRP in arthroscopic surgery for FAI for mid-term improvement. There were no significant differences in outcome between PRP and placebo groups at 2-year minimum follow-up after surgery.

Pre-existing osteoarthritis remains a key feature of arthroscopy patients who convert to total hip arthroplasty.

OBJECTIVES: To determine the rate of conversion to total hip arthroplasty following ipsilateral hip arthroscopy by a single surgeon in New Zealand and to describe patient-related and surgical characteristics of patients who converted. METHODS: A retrospective cohort analysis of hip arthroscopy patients with 2 years of minimum follow-up identified the total hip arthroplasty conversion rate using the New Zealand National Joint Registry. Prospective data collected from patients who subsequently converted to hip arthroplasty included: sex, age at arthroscopy, body mass index, side of hip arthroscopy and arthroplasty, duration of symptoms and patient-reported outcome measures. Imaging (Tönnis grade and lateral centre-edge angle) and surgical findings (labral, ligamentum teres and osteochondral pathology) along with the arthroscopic procedures performed were also documented. RESULTS: Sixty-six out of 1856 (3.56%) primary hip arthroscopies were followed by an ipsilateral hip arthroplasty during the follow-up period (mean 87 ± 29 months). Most patients had pre-existing osteoarthritis and/or chondral lesions (n=51). Dysplasia and over-resection of the acetabulum were also identified as contributing factors. CONCLUSION: Conversion rate by a high-volume surgeon in New Zealand was relatively low. Most patients had pre-existing osteoarthritis and/or chondral lesions that became apparent at arthroscopy. Dysplasia is also a factor to be cautious of when selecting patients for arthroscopy. Acetabular resection must be approached cautiously. LEVEL OF EVIDENCE: Level IV.

Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as Compared With Matched Controls.

BACKGROUND: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis. PURPOSE: To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA >40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty. RESULTS: A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups (P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points (P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty. CONCLUSION: Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.

Microinstability of the hip: a systematic review of the imaging findings.

OBJECTIVES: To undertake a systematic review of the morphologic features associated with hip microinstability and determine whether there are suggestive or diagnostic imaging findings. METHODS: Four electronic databases were searched up to September 2019 to identify original research reporting morphologic features in individuals with either a clinical diagnosis of hip microinstability (instability without overt subluxation/dislocation) or those with symptomatic laxity demonstrated on imaging (increased femoral head translation/distraction or capsular volume). Studies focussing on individuals with pre-existing hip conditions (including definite dysplasia (lateral centre edge angle < 20°), significant trauma, previous dislocation or surgery were excluded. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS: Twenty-two studies met inclusion criteria (clinical diagnosis of microinstability n = 15 and demonstration of laxity n = 7). Imaging information gathered from the studies includes radiographs (n = 14), MRI (n = 6), MR arthrography (n = 4), CT (n = 1) and intraoperative examination. Most studies exhibited design features associated with an overall high or unclear risk of bias. Some dysplastic features are associated with microinstability or laxity reference measures; however, microinstability is frequently diagnosed in those with a lateral centre edge angle > 25°. Other associated imaging findings reported include impingement morphology, anterior labral tearing, femoral head chondral injury, ligamentum teres tears and capsular attenuation. CONCLUSIONS: The current literature does not provide strong evidence for imaging features diagnostic of microinstability. In the appropriate clinical context, dysplastic morphology, anterior labral tears and ligamentum teres tears may be suggestive of this condition although further research is needed to confirm this. PROSPERO REGISTRATION: CRD42019122406.

Gradual-onset surfing-related injuries in New Zealand: A cross-sectional study.

OBJECTIVES: Gradual-onset injuries associated with surfing have not previously been closely examined. This study investigated the duration, mechanisms, body locations and types of gradual-onset injuries in a sample of New Zealand surfers. DESIGN: Retrospective, cross-sectional online survey. METHODS: Self-identified surfers reported gradual-onset surfing-related injuries experienced in the preceding 12 months. RESULTS: Respondents (n=1473, age range 8-74 years) reported a total of 550 gradual-onset major injuries: 44% acute duration (<3 months) and 56% chronic (≥3 months). The injury incidence proportion was 27%. Shoulder (146 injuries, 64% chronic), low back (115 injuries, 58% chronic) and neck (105 injuries, 46% chronic) were the most commonly reported injury locations. Prolonged paddling was the most commonly reported mechanism of injury (40% of all injuries). Incidence proportion for gradual-onset major injuries was 6% higher for greater surfing abilities compared to lower abilities (p=0.01), and 13% higher for long boarders compared to short boarders (p=0.001). Respondents reporting any gradual-onset surfing injury, compared to those with no injury, averaged 3 more years surfing experience (p<0.001), were 3 years older (p<0.001), and reported 43h more surfing exposure in the preceding 12 months (p<0.001). CONCLUSIONS: The most common gradual-onset surfing injuries involved the shoulder, low back, and neck, most frequently attributable to paddling. Risk factors for these injuries included board type, higher ability, older age, more hours/year, and years of surfing. These findings affirm the existence of sufficient injury burden to justify investigation of surfing injury prevention initiatives.

Gait, cognition and falls over 5 years, and motoric cognitive risk in New Zealand octogenarians: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ.

BACKGROUND: Understanding falls risk in advanced age is critical with people over 80 a rapidly growing demographic. Slow gait and cognitive complaint are established risk factors and together comprise the Motoric Cognitive Risk Syndrome (MCR). This study examined trajectories of gait and cognition and their association with falls over 5 years, and documented MCR in Maori and non-Maori of advanced age living in New Zealand. METHOD: Falls frequency was ascertained retrospectively at annual assessments. 3 m gait speed was measured and cognition was assessed using the Modified Mini-Mental Status Examination (3MS). Frequency of MCR was reported. Gait and cognition trajectories were modelled and clusters identified from Latent Class Analysis. Generalised linear models examined association between changes in gait, cognition, MCR and falls. RESULTS: At baseline, 138 of 408 Maori (34%) and 205 of 512 non-Maori (40%) had fallen. Mean (SD) gait speed (m/s) for Maori was 0.66 (0.29) and 0.82 (0.26) for non-Maori. Respective 3MS scores were 86.2 (15.6) and 91.6 (10.4). Ten (4.3%) Maori participants met MCR criteria, compared with 7 (1.9%) non-Maori participants. Maori men were more likely to fall (OR 1.56; 95% CI 1.0-2.43 (P = 0.04) whilst for non-Maori slow gait increased falls risk (OR 0.40; 95% CI 0.24-0.68(P < 0.001). Non-Maori with MCR were more than twice as likely to fall than those without MCR (OR 2.45; 95% CI 1.06-5.68 (P = 0.03). CONCLUSIONS: Maori and non-Maori of advanced age show a mostly stable pattern of gait and cognition over time. Risk factors for falls differ for Maori, and do not include gait and cognition.

Lifetime prevalence of exostoses in New Zealand surfers.

INTRODUCTION External auditory exostosis (EAE) is a benign, irreversible bony outgrowth that arises from the temporal bone. EAE projects into the external ear canal, potentially causing recurrent otitis externa and conductive hearing loss. AIM To determine lifetime prevalence of EAE in New Zealand (NZ) surfers. METHODS This study used an online national survey. RESULTS Respondents were 1376 NZ surfers (recreational = 868, competitive = 508). Mean surfing experience was 16.2 years. Most self-classified as advanced surfers (36.5%), followed by intermediate (30.2%), expert (20.1%) and beginner (13.2%). Surfers reported an average of 214.2 h surfing (28.6% during winter) for the previous year. Overall lifetime prevalence of EAE was 28.9% (32.1% male, 14.6% female; P < 0.001), with the highest proportion of EAE was observed bilaterally (21.3%). Competitive surfers reported a significantly (P < 0.001) higher lifetime prevalence of EAE than recreational surfers (45.3% vs. 19.2%). A significantly higher (P < 0.001) lifetime prevalence of EAE was identified as skill level increased (7.1% in beginners to 55.6% in experts) and a two-fold increase (P < 0.001) of EAE in the highest (vs. lowest) quartile of surfing exposure. Neither winter surfing exposure nor which Island surfed were associated with EAE prevalence. DISCUSSION Although not as prevalent as in previous NZ research using otologic examinations, this study indicated that almost one-third of NZ surfers reported having had a diagnosis of EAE. Regular general practitioner otologic assessment and advice on appropriate prevention strategies for patients who surf may help prevent large lesions, recurrent ear infections and progressive hearing loss.

Predictors of functional improvement in people with chronic low back pain following a graded Pilates-based exercise programme.

BACKGROUND: Several studies have investigated subgroups of patients with low back pain (LBP) most likely to benefit from Pilates or movement control exercises, but none have determined prognostic factors specifically for chronic LBP. This prospective cohort study aimed to determine predictors of change in disability in people with chronic LBP following a Pilates-based exercise programme and reports summarised integrated prediction statistics to aid clinical utility for determination of subgroups likely to benefit or not benefit from treatment. METHODS: Healthy adults (n = 55) with non-specific chronic LBP undertook a graded 6-week programme involving two 1-hour Pilates sessions/week (1 mat and 1 equipment-based) led in small groups by a trained Pilates instructor. Predictors of change in Patient-Specific Functional Scale (PSFS) were identified through regression analysis and used to develop clinical prediction statistics. RESULTS: Clinically important improvement (n = 14 of 48 analysed) was predicted by four variables: gradual rather than sudden onset of LBP, PSFS <3.7 points, absence of aberrant motions on forward bending, and body mass index >24.5 kg/m2. Presence of ≥3 improved probability of success from 29% to 73%. Failure to improve (n = 18) was predicted by three variables: sudden onset of low back pain, patient-specific functional score ≥3.7, and difference between left and right active straight leg raise >7°. Presence of all three increased probability of failure from 38% to 80%. CONCLUSIONS: A combination of five, easily measured variables were able to predict disability outcome following a graded programme of Pilates-based exercises in people with chronic LBP. Two common movement deficits were inversely related to positive changes in function which may call into question the structural mechanism of improvements observed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12616001588482.

Falls and depression in octogenarians - life and living in advanced age: a cohort study in New Zealand.

INTRODUCTION Falls and injury have the most devastating consequences for very old people. Depression may be a significant cause and consequence of falls. AIM To examine the association between falls and depression in octogenarians. METHODS LiLACS NZ (Life and Living in Advanced Age: A Cohort Study in New Zealand), cohort study data of Maori (aged 80-90 years, 11-year age band) and non-Maori (aged 85 years, 1-year age band) followed for 3 years was used to describe the incidence and prevalence of falls and depression. Falls by self-report were accumulated over 3 years. Geriatric depression score (GDS) was ascertained at baseline. RESULTS Over 3 years, fewer Maori (47%) than non-Maori (57%) fell; 19% of non-Maori and 20% of Maori scored 5+ (depressed) on the GDS. For non-Maori and Maori, people with depression were more likely to fall than Maori not diagnosed with depression (OR 2.72, CI 1.65-4.48 for non-Maori and OR 2.01, CI 1.25-3.25 for Maori). This remained significant, adjusted for age and sex. Depression was a significant predictor of hospitalisations from falls for Maori (OR 5.59, CI 2.4-12.72, adjusted for age and sex) and non-Maori (OR 4.21, 2.3-7.44, adjusted for sex). CONCLUSION Depression and falls are common and co-exist in octogenarians. GPs thinking about falls should also think about depression and vice versa.

Vitamin D status of Maori and non-Maori octogenarians in New Zealand: a Cohort Study (LiLACS NZ).

BACKGROUND AND OBJECTIVES: This study assessed vitamin D status and its determinants in a cohort of octogenarians living within New Zealand's Bay of Plenty and Lakes Districts. METHODS AND STUDY DESIGN: Serum 25- hydroxyvitamin D [25(OH)D] concentration was measured in 209 Maori (aged 80-90 years) and 357 non-Maori (85 years), along with demographic, lifestyle, supplement use and other health data. RESULTS: Mean [95% CI] 25(OH)D concentration was 69 [67 to 72] nmol/L, with 15% >100 nmol/L and 6 individuals >150 nmol/L. Concentrations in Maori (59 [55 to 62] 4 nmol/L) were lower than in non-Maori (75 [72 to 78] nmol/L; p<0.001), a difference maintained when adjusted for day-of-year measured. Vitamin D supplementation was reported by 98 participants (18%): including a greater proportion of women (24%) than men (11%; p<0.001) and of non-Maori (24%) than Maori (7%; p<0.001). Of those taking vitamin D, 49% took high oral doses (>=25 µg/day or equivalent) and five individuals took >50 µg/day. Vitamin D supplement use strongly and independently predicted seasonally- adjusted 25(OH)D concentration and was associated with 28 nmol/L higher levels than non-use. Other predictors included Maori ethnicity (10 nmol/L lower concentration than for non-Maori), and female gender (11 nmol/L lower). CONCLUSIONS: Vitamin D status in New Zealand octogenarians appears higher than previously reported, particularly in non-Maori compared to Maori. Prescribed and non-prescribed oral vitamin D supplementation is prevalent in this group and a strong indicator of vitamin D status.

Exploration of clinical changes following a novel mobilisation technique for treatment of chronic low back pain: A single cohort design.

To explore clinical changes following a novel manual mobilisation technique, 24 participants who experienced 'moderate' to 'severe' chronic low back pain were recruited from new patients attending a suburban osteopathy clinic. The intervention was a previously undescribed side-lying mobilisation technique targeting the lumbosacral spine (median of 6 treatment sessions). After 8 weeks reductions were shown in Oswestry Disability Index of 15 points (95% CI: 9.3, 22.7; p < 0.0001 for overall ANOVA); Quadruple Visual Analogue Scale of 2.0 points (95% CI: 1.0, 3.0; p < 0.0001); and Patient Specific Functional Scale of 3.1 points (95% CI: 1.9, 4.3; p < 0.0001). The results indicate that pain intensity, disability and function improved in most participants following treatment. Further investigation is indicated using more robust research designs to compare this approach with other treatment approaches and usual care for the treatment of chronic low back pain.

Intramolecular N-coordination in ketiminoboranes.

Treatment of the imine PhC(=NSiMe3)py with Et2BOMe or BF3·Et2O afforded bicyclic ketiminoboranes and via intramolecular N-coordination. The basicity of the imine N is evidenced by their reactivity towards Brønsted and Lewis acids and the structures of ·HCl and ·BF3 are reported as well as the dipyridyl imine derivative ·HCl.

The effect of cervical spine manipulation on postural sway in patients with nonspecific neck pain.

OBJECTIVE: This crossover study aimed to determine whether a single high-velocity, low-amplitude manipulation of the cervical spine would affect postural sway in adults with nonspecific neck pain. METHODS: Ten participants received, in random order, 7 days apart, a high-velocity, low-amplitude manipulation applied to a dysfunctional spinal segment and a passive head-movement control. Four parameters of postural sway were measured before, immediately after, and at 5 and 10 minutes after each procedure. RESULTS: Results showed no differences between interventions in change in any of the parameters. When changes before and immediately after each procedure were analyzed separately, only the control showed a significant change in the length of center of pressure path (an increase from median, 118 mm; interquartlie range, 93-137 mm to an increase to 132 mm; 112-147; P = .02). CONCLUSION: This study failed to show evidence that single manipulation of the cervical spine influenced postural sway. Given the ability of the postural control system to reweight the hierarchy of sensory information to compensate for inadequacies in any 1 component, it is possible that any improvements in the mechanisms controlling postural sway elicited by the manipulative intervention may have been concealed.

Prevalent dietary supplement use in older New Zealand men.

AIMS: Because of a lack of recent data from New Zealand older men, we examined dietary supplement use in this demographic. METHODS: We surveyed men aged $gt;40 years who were participating in a trial of calcium supplementation on bone and cardiovascular outcomes. RESULTS: Forty-seven percent reported using at least one supplement and 30% of users took more than two different supplements. Amongst users, median monthly expenditure on these products was NZ$20 (interquartile range: $10-$45). The most common supplements used were vitamins or minerals (49%), followed by nutritional oils (22%) (including fish oils, 13%) and glucosamine/chondroitin preparations (13%). Supplements were mainly taken for reasons of non-specific prophylaxis or health maintenance (58% of reasons), although 21% of reasons cited treatment or symptom alleviation for a medical condition. Daily requirements for vitamins A, D and E were exceeded, from supplement intake alone, by 12%, 10% and 40% of supplement users respectively. CONCLUSIONS: Many older New Zealand men spend substantial amounts of money on dietary supplements despite uncertain health benefits. Health professionals should remain alert to supplement use by their patients, including males.

Vitamin D insufficiency and health outcomes over 5 y in older women.

BACKGROUND: Vitamin D insufficiency was shown to be associated with adverse musculoskeletal and nonskeletal outcomes in numerous observational studies. However, some studies did not control for confounding factors such as age or seasonal variation of 25-hydroxyvitamin D [25(OH)D]. OBJECTIVE: We sought to determine the effect of vitamin D status on health outcomes. DESIGN: Healthy community-dwelling women (n = 1471) with a mean age of 74 y were followed in a 5-y trial of calcium supplementation. 25(OH)D was measured at baseline in all women. Skeletal and nonskeletal outcomes were evaluated according to seasonally adjusted vitamin D status at baseline. RESULTS: Fifty percent of women had a seasonally adjusted 25(OH)D concentration <50 nmol/L. These women were significantly older, heavier, and less physically active and had more comorbidities than women with a seasonally adjusted 25(OH)D concentration > or =50 nmol/L. Women with a seasonally adjusted 25(OH)D concentration <50 nmol/L had an increased incidence of stroke and cardiovascular events that did not persist after adjustment for between-group differences in age or comorbidities. Women with a seasonally adjusted 25(OH)D concentration <50 nmol/L were not at increased risk of adverse consequences for any musculoskeletal outcome, including fracture, falls, bone density, or grip strength or any nonskeletal outcomes, including death, myocardial infarction, cancer, heart failure, diabetes, or adverse changes in blood pressure, weight, body composition, cholesterol, or glucose. CONCLUSIONS: Vitamin D insufficiency is more common in older, frailer women. Community-dwelling older women with a seasonally adjusted 25(OH)D concentration <50 nmol/L were not at risk of adverse outcomes over 5 y after control for comorbidities. Randomized placebo-controlled trials are needed to determine whether vitamin D supplementation in individuals with vitamin D insufficiency influences health outcomes. This trial was registered at www.anzctr.org.au as ACTRN 012605000242628.

Effects of calcium supplementation on lipids, blood pressure, and body composition in healthy older men: a randomized controlled trial.

BACKGROUND: Calcium supplementation has been suggested to have beneficial effects on serum lipids, blood pressure, and body weight, but these possibilities have not been rigorously assessed in men. OBJECTIVE: This study evaluated the effect of calcium supplementation on the change in the ratio of HDL to LDL cholesterol (primary endpoint) and on changes in cholesterol fractions, triglycerides, blood pressure, and body composition (secondary endpoints). DESIGN: We carried out a randomized controlled trial of calcium supplementation in 323 generally healthy men over a period of 2 y. Subjects were randomly assigned to take placebo, 600 mg Ca/d, or 1200 mg Ca/d. RESULTS: There was no significant treatment effect on the ratio of HDL to LDL cholesterol (P = 0.47) nor on weight, fat mass, lean mass, triglycerides, or total, LDL, or HDL cholesterol (P > 0.28 for all). There were downward trends in systolic and diastolic blood pressures within the calcium-supplemented groups, but there were no significant treatment effects over the whole trial period (P > 0.60). In a post hoc analysis of those with baseline calcium intakes below the median value (785 mg/d), blood pressures showed borderline treatment effects (P = 0.05-0.06 for changes at 2 y in those who received 1200 mg Ca/d compared with placebo: systolic, -4.2 mm Hg; diastolic, -3.3 mm Hg). Low magnesium intake showed a similar interaction. No treatment effects on weight or body composition were found. CONCLUSIONS: These data do not show significant effects of calcium supplementation on serum lipids or body composition. Calcium supplementation in those with low dietary intakes may benefit blood pressure control. This trial was registered with the Australian Clinical Trials Registry as ACTRN 012605000274673.

The effects of seasonal variation of 25-hydroxyvitamin D on diagnosis of vitamin D insufficiency.

AIMS: To explore the effects of seasonal variation on the diagnosis of vitamin D sufficiency and to determine whether age, gender, and ethnicity modify these effects. METHODS: 21,987 adults had a measurement of serum 25-hydroxyvitamin D (25OHD) at Labplus, Auckland City Hospital, between January 2002 and September 2003, and sine curves were fitted for 25OHD versus day of year to predict the 25OHD nadir for each individual. RESULTS: 48% (range: 30-63%) of individuals had 25OHD <50 nmol/L in the month of measurement, but 63% were predicted to have 25OHD <50 nmol/L in late winter or early spring based on expected seasonal variation. The 25OHD levels required to ensure 25OHD levels >50 nmol/L throughout the year varied substantially by season (in summer at least 60-75 nmol/L), and tended to be higher in men than women, decrease with age, and vary with ethnicity. Mean 25OHD levels were very low (<40 nmol/L) in people of Indian, Middle Eastern, and African descent. CONCLUSION: Seasonal variation in 25OHD affects the diagnosis of vitamin D sufficiency. Clinicians should consider the month of sampling when interpreting the results of 25OHD measurements. In New Zealand, a summertime 25OHD <60-75 nmol/L is generally required to ensure year-round 25OHD levels <50 nmol/L.

Randomized controlled trial of calcium supplementation in healthy, nonosteoporotic, older men.

BACKGROUND: There is no consistent evidence, to our knowledge, that calcium supplementation affects bone mineral density (BMD) in men, despite male osteoporosis being a common clinical problem. METHODS: To determine the effects of calcium supplementation (600 mg/d, 1200 mg/d, or placebo) on BMD in men, we conducted a double-blind, randomized controlled trial for a 2-year period at an academic clinical research center. A total of 323 healthy men at least 40 years old (mean age, 57 years) were recruited by newspaper advertisement. Complete follow-up was achieved in 96% of subjects. RESULTS: The BMD increased at all sites in the group receiving calcium, 1200 mg/d, by 1% to 1.5% more than those receiving placebo. The results for the group receiving calcium, 600 mg/d, were not different from the placebo group at any BMD site. There was no interaction between the BMD treatment effect and either age or dietary calcium intake. There were dosage-related, sustained decreases in serum parathyroid hormone (P < .001), total alkaline phosphatase activity (P = .01), and procollagen type 1 N-terminal propeptide (P < .001) amounting to 25%, 8%, and 20%, respectively, in the group receiving calcium, 1200 mg/d, at 2 years. Tooth loss, constipation, and cramps were unaffected by calcium supplementation, falls tended to be less frequent in the group receiving calcium, 1200 mg/d, but vascular events tended to be more common in the groups receiving calcium vs the group receiving placebo. CONCLUSION: Calcium, 1200 mg/d, has effects on BMD in men comparable with those found in postmenopausal women but a dosage of 600 mg/d is ineffective for treating BMD. TRIAL REGISTRATION: actr.org.au Identifier: 012605000274673.