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Showing papers by "Cyrus Cooper published in 1993"


Journal ArticleDOI
TL;DR: The survival rate of 335 residents of Rochester, Minnesota, who had an initial radiologic diagnosis of vertebral fracture between 1985 and 1989 was worse than expected, and diverged steadily from expected values throughout the course of the study.
Abstract: Vertebral fractures are the most frequent of the fractures associated with osteoporosis, yet little is known of their impact on health in the United States. To aid in this understanding, the authors examined the survival rate of 335 residents of Rochester, Minnesota, who had an initial radiologic diagnosis of vertebral fracture between 1985 and 1989. Seventy-six died during 809 person-years of follow-up. The overall survival rate was worse than expected, and diverged steadily from expected values throughout the course of the study. At 5 years after diagnosis, the estimated survival was 61% compared with an expected value of 76% (relative survival = 0.81, 95% confidence interval (CI) 0.70-0.92). The 5-year relative survival after a hip fracture in Rochester was a comparable 0.82 (95% CI 0.77-0.87), but there was a much greater excess of deaths within the first 6 months as compared with patients with vertebral fractures. The 5-year relative survival rate after a distal forearm fracture was 1.00 (95% CI 0.95-1.05). Clinically diagnosed vertebral fractures are rarely fatal, and the reduced survival seen subsequently could related to comorbid conditions. Nonetheless, the excess mortality should be accounted for in assessing the public health impact of osteoporosis.

1,093 citations


Journal ArticleDOI
TL;DR: It is suggested that over 500 000 white women in the United States develop vertebral deformities for the first time each year and that over 7 million white women aged 50 years and over might be affected at any given time.
Abstract: There is a need to identify vertebral fractures from radiographs taken at a single point in time, but considerable controversy surrounds the methods to be used We extended a data set to comprise baseline radiographs of the thoracic and lumbar spine on an age-stratified random sample of 762 Rochester, Minnesota, women and used revised methods to define vertebral deformities morphometrically Changes in the method of measuring vertebral heights, changes in the source of normal values for vertebral measurements and changes in the criteria for assessing vertebral deformity had little impact on estimated prevalence and incidence in this population The prevalence of any vertebral deformity was estimated at 253 per 100 Rochester women aged 50 years and over (95% CI, 223–282), while the incidence of a new deformity in this group was estimated at 178 per 1000 person-years (95% CI, 160–197) Projected nationally, these data suggest that over 500 000 white women in the United States develop vertebral deformities for the first time each year and that over 7 million white women aged 50 years and over might be affected at any given time These estimates are limited by the absence of a reliable ‘gold standard’ with which to determine false positive and false negative rates associated with this or any other morphometric method Information on the health consequences of vertebral deformities of various sorts would be most helpful in choosing between alternative approaches to defining them

498 citations



Journal ArticleDOI
TL;DR: The purposes of this review are to provide a working definition of osteoporosis, to summarize the epidemiological data concerning the frequency of osteoeporosis and its related fractures, and to determine the impact that the condition has on society.
Abstract: Epidemiology is the study of disease in populations. The discipline thus concerns itself with a wide range of issues, from those that relate to the health of individuals (such as the definition of a particular disorder and the characteristics of the individuals who will suffer from it), to those that concern the entire population (for example, the overall morbid and economic consequences of a disorder to society and the means whereby this burden might be reduced). While all of these applications of epidemiology are relevant to osteoporosis, they cannot all be addressed adequately within the constraints of this contribution. Furthermore, some of the issues will be covered in later sections of this volume. The purposes of this review are to provide a working definition of osteoporosis, to summarize the epidemiological data concerning the frequency of osteoporosis and its related fractures, and to determine the impact that the condition has on society. This information will provide a backdrop against which the pathophysiology and treatment of the condition may be discussed in the chapters that follow. However, the review will close with a brief overview of the approaches to prevention that might be adopted in the general population.

120 citations


Journal ArticleDOI
TL;DR: Bone strength depends not only upon bone mass but also upon a variety of qualitative aspects of bone structure, including its architecture, the amount of fatigue damage it has sustained, and changes in its bulk material properties, indices that are collectively subsumed into the term "bone quality".
Abstract: Fragility fractures, particularly those of the hip, vertebrae, and distal forearm, constitute a major public health problem. The two ultimate determinants of fracture are bone strength and propensity to trauma. Bone strength depends not only upon bone mass but also upon a variety of qualitative aspects of bone structure. These include its architecture, the amount of fatigue damage it has sustained, and changes in its bulk material properties, indices that are collectively subsumed into the term “bone quality” Fragility fractures show differences in their patterns of incidence by age, sex, ethnic group, geographic area, and season. Many of these differences are currently unexplained, and disorders of bone quality might contribute to them. There are two fracture sites at which evidence implicates bone quality more directly—the spine and proximal femur. Many vertebral compression fractures follow minimal trauma, and controlled studies suggest that vertebral microarchitecture contributes to fracture risk independently of vertebral bone mass. At the hip, observational studies have pointed to a role for disordered trabecular architecture, accumulation of microfractures (fatigue damage), and the accumulation of osteoid. The extent to which these phenomena act independently of bone mass, however, remains uncertain.

90 citations


Journal ArticleDOI
TL;DR: The results demonstrate the importance of early environment in determining the susceptibility to autoimmune thyroid disease and the contrasting effects of adult body mass index and waist to hip ratio on antibody prevalence could be explained by their associations with different hormonal environments.
Abstract: To determine whether fetal and infant growth could influence susceptibility to autoimmune disease in adults, the occurrence of thyroid autoantibodies and autoimmune thyroiditis was studied in 305 women, aged 60-71, born in Hertfordshire and for whom details of birthweight, infant growth, and feeding were routinely recorded. Thyroglobulin autoantibody was detected in 37% of the women, thyroid peroxidase autoantibody in 41%, and autoimmune thyroiditis, defined as biochemical or clinical hypothyroidism in association with thyroid autoantibodies, in 5.6%. The proportion of women with thyroglobulin and thyroid peroxidase autoantibodies fell with increasing birthweight but was not related to weight at 1 year of age or the method of infant feeding. The prevalence of both autoantibodies rose with increasing adult body mass index but fell as the waist to hip ratio increased. These results demonstrate the importance of early environment in determining the susceptibility to autoimmune thyroid disease. The contrasting effects of adult body mass index and waist to hip ratio on antibody prevalence could be explained by their associations with different hormonal environments.

80 citations


Journal ArticleDOI
TL;DR: Standing height and sitting height were related to 18-month reported prevalence of 'sciatica, lumbago or severe backache' in both men and women and explanations for these findings are investigated using previously collected data on childhood growth and detailed lifetime occupational histories.
Abstract: Back pain is an important public health problem but there is a paucity of knowledge about risk factors and causal mechanisms. Previous studies have shown that tall men are more at risk of back pain, although observations in women have been less consistent. This paper presents findings from a national longitudinal study of 3262 men and women aged 43 yr. Standing height and sitting height were related to 18-month reported prevalence of 'sciatica, lumbago or severe backache' in both men and women. The paper investigates explanations for these findings using previously collected data on childhood growth and detailed lifetime occupational histories. Neither greater susceptibility of tall men to heavy lifting, nor the timing of growth, were able to account for these relationships. To assess further the association between height and back pain, information is needed on the relationship between stature and characteristics of spinal structure.

38 citations



Journal ArticleDOI
TL;DR: Enhancement of intraperitoneal fluid is a common and often striking finding on delayed CT scans after administration of IV contrast material, occurring in a wide spectrum of clinical conditions.
Abstract: Enhancing peritoneal fluid has been described as an uncommon finding resulting from active extravasation of contrast material from the bowel, urinary tract, or blood vessels. We have noted that enhancing peritoneal fluid occurs in other clinical settings. The CT number of ascites frequently increases between initial images obtained during bolus injection of IV contrast material and delayed images obtained after completion of the routine study. The objective of this study was to define the frequency and clinical significance of this phenomenon.Fifty patients (32 with malignant disease and 18 with benign disease) with free intraperitoneal fluid were examined with abdominal CT with IV contrast material. Active intraperitoneal bleeding or perforation of the bowel or bladder was not clinically suspected in any patient studied. When intraperitoneal fluid was detected on review of initial dynamic scans, a limited number of delayed scans were obtained also. Significant enhancement was determined by comparing the ...

26 citations


Journal ArticleDOI
22 May 1993-BMJ
TL;DR: The GMC are anxious to head off any proposal to scrap the council and introduce a new organisation dominated by lay people, so the question that immediately arises is whether these people should be appointed in the traditional way or whether they should be elected.
Abstract: of the GMC are anxious to head off any proposal to scrap the council and introduce a new organisation dominated by lay people. At the moment there are 11 lay members-appointed by the Privy Council on the advice of the health departments. Trying to spot the reasoning behind the appointments is a favourite game, but by custom rather than law two members in recent years have been members of parliament. One radical possibility would be to make lay members the majority, but the council is not ready for this. The council is thus likely to go for a much more modest increase-to something like 20. The question that immediately arises is whether these people should be appointed in the traditional way or whether they should be elected. If the aim is increased accountability it would obviously make sense to have the lay members elected rather than plucked from Hampstead dinner tables or from among Bradford butchers. But how? Tacking a poll on to public elections seems impractical, and electing members from unelected bodies like the Association of Community Health Councils or the Patients Association might decrease rather than increase representativeness. But elected lay members would surely be better than appointed ones. Once the council has increased its lay members it must think whom to discard if it is to shrink rather than expand. The choice lies among the 21 members from the universities, the 14 from the other bodies producing registrable qualifications (the royal colleges and faculties and the Society of Apothecaries), the two chief medical officers, and the 54 elected members who are needed to make sure that they have a comfortable enough majority not to need a byelection every time one ofthe members resigns or dies. It's a matter of arithmetic, and the officers of the council and its members have been occupying themselves with it for some time. The rules of the game are that there must be an overall majority of doctors who have been elected (the idea that history might be rolled back and the elected members reduced to a minority was quickly killed), an increase in lay members, somebody from the government, somebody representing those granting registrable qualifications, and as small a council as possible. Another complication is that there should surely be at least somebody representing the consumers of undergraduate medical education-medical students. Most university authorities now have students represented, and the BMA's council includes students. At least two students should be elected: they would need mutual support. One possible formula would be 20 lay members, one chief medical officer, four representatives from the universities and two from the other bodies producing registrable qualifications, two medical students, and 32 elected doctors-a total of 61. Better still might be to reduce the lay membership to eight and shrink the overall council even further, meaning that lay membership would increase proportionately. This could lead to a council of 30, saving doctors money (at a time when the retention fee looks set to explode) and increasing the effectiveness ofthe council. RICHARD SMITH Editor

14 citations




Journal Article
TL;DR: It is suggested that prolonged or repeated knee bending is a risk factor for knee OA, and that risk may be higher in jobs which entail both knee bending and mechanical loading.
Abstract: OBJECTIVES--To test the hypothesis that specific occupational physical activities are risk factors for knee osteoarthritis (OA). METHODS--A population-based case-control study of knee osteoarthritis was carried out in which 109 men and women with painful, radiographically confirmed knee OA were compared with 218 age and sex matched controls who had not suffered knee pain and had normal radiographs. Information collected included a lifetime occupational history and details of specific workplace physical activities. RESULTS--After adjustment for obesity and Heberden's nodes, the risk of knee OA was significantly elevated in subjects whose main job entailed more than 30 minutes per day squatting (OR 6.9, 95% CI 1.8-26.4) or kneeling (OR 3.4, 95% CI 1.3-9.1), or climbing more than ten flights of stairs per day (OR 2.7, 95% CI 1.2-6.1). The increase in risk associated with kneeling or squatting appeared to be more marked in subjects whose jobs entailed heavy lifting, but the size of the study did not permit precise delineation of any such interaction. CONCLUSIONS--These data suggest that prolonged or repeated knee bending is a risk factor for knee OA, and that risk may be higher in jobs which entail both knee bending and mechanical loading.

Journal ArticleDOI
23 Oct 1993-BMJ
TL;DR: Henshaw et al. as mentioned in this paper showed that computed tomography of the pelvis has not been subjected to large clinical trials, and there is no logical reason to suppose that it will be any more effective than conventional x ray pelvimetry in predicting the ability of a woman to have a future safe vaginal delivery.
Abstract: over 70% of women with cephalopelvic disproportion delivered vaginally in subsequent pregnancies.45 In addition, 31% of those women achieving vaginal delivery after caesarean section for cephalopelvic disproportion had larger babies than the one delivered by caesarean section.' x Ray pelvimetry does not prevent scar rupture in a subsequent labour,l nor is there any benefit with regard to perinatal mortality. Although computed tomography of the pelvis has not been subjected to large clinical trials, there is no logical reason to suppose that it will be any more effective than conventional x ray pelvimetry in predicting the ability of a woman to have a future safe vaginal delivery. x Ray pelvimetry is not routinely indicated postnatally after a first caesarean section. It is an unnecessary investigation with no prognostic significance for delivery in subsequent pregnancies and will result in a needless increase in the already high rate of caesarean section. PJ DANIELIAN R C HENSHAW H K S HINSHAW