Cohort Of Retirees Research Articles

The Italian gender gap in pensions: A cohort of birth approach

Introduction: The text discusses the gender pension gap in rich countries, focusing specifically on Italy. The paper delves into the evolution of this gap across different generations, analyzing social security reforms and their impact on retirement incomes. The study emphasizes the importance of understanding these disparities for designing effective pension systems that address gender inequalities and ensure well-being in retirement.Objective: The aim of the article is to investigate the gender pension gap, specifically in the context of Italy, by analyzing the factors contributing to this disparity, including late entry into the job market, wage gaps, and caregiving responsibilities. The study focuses on understanding the impact of social security reforms and the pension system on these gender inequalities, aiming to provide insights for the design of equitable pension systems.Materials and methods: The article utilized administrative data from the Italian National Institute for Social Security (INPS) covering pension payments from 1995 to 2022. The study employed a cohort perspective, analyzing the evolution of the gender pension gap across generations and examining the impact of social security reforms and labor market arrangements.Results: The main conclusion of the study indicates that while the absolute gender disparity in mean retirement income has increased across cohorts of Italian retirees born between 1930 and 1954, the relative gender gap, when considering men's average pension, has decreased over time. Additionally, the impact of survivor's benefits has been significant in reducing the gender disparity in pensions, particularly in the later stages of life. Furthermore, the study found that the impact of social security reforms in Italy has been limited, primarily affecting the youngest cohorts, with most retirees still relying on the dominant defined benefit component for their pensions.

Impact of the transition to retirement on smoking habit: longitudinal results from SHARE project

Abstract Background In an ageing society, the impact of retirement on behavioural risk factors and health status needs to be carefully assessed. There are few longitudinal studies on the short-term and long-term effects of retirement on smoking habits. Methods A longitudinal study was conducted based on data from the Survey on Health, Ageing and Retirement (SHARE) collected between 2004 and 2020 in 27 European countries and Israel. A repeated measure generalized estimating equation (GEE) model was fitted to estimate the relative risks (RR) and corresponding 95% confidence intervals (CI) of smoking status and its intensity at seven different time periods before and after retirement. Results We selected a cohort of 8,998 individuals who were employed at baseline and retired during follow-up (median follow-up: 9 years; maximum: 16 years). Compared to the year of retirement, the RR for smoking was 1.59 (95% CI 1.44-1.76) 10 years before retirement and 1.35 (95% CI 1.25-1.46) from 5 to 9 years before retirement, and 1.18 (95% CI 1.10-1.27) from 1 to 4 years before retirement. Smoking habits decreased steadily after retirement, with a RR of 0.94 (95% CI 0.87-1.01) from 1 to 4 years after retirement, 0.76 (95% CI 0.69-0.84) from 5 to 9 years, and 0.58 (95% CI 0.46 to 0.74) 10 years or more after retirement. For ever-smokers, the estimated daily number of cigarettes smoked decreased from about 27 cigarettes/day at 10 years or more before retirement to 9 cigarettes/day at 10 years or more after retirement (p-trend <0.001). Conclusions Longitudinal data suggest that positive lifestyle changes and adaptations may occur as people reach retirement age. Further research is needed to better guide strategies that promote healthy ageing. Key messages • Our findings indicate that retirement has a positive impact on smoking habits, regardless of geographical and individual sociodemographic factors. • This study is the first to examine the short- and long-term effects of retirement transition on risky behavior among a large European retiree cohort using SHARE data.

Financial literacy and retirees' resource allocation decisions in New Zealand

We investigate the relationship between financial literacy, debt anxiety, risk tolerance, and subsequent resource allocation decisions for cohorts of retirees. Using a survey and the novel comparative method of Multi-Criteria Decision-Making Analysis we prioritise retirement allocation choices of older New Zealanders. Retirees display high financial literacy and together with debt anxiety this is significantly correlated with resource allocation preferences. Financial literacy reduces debt anxiety in men, increases the risk tolerance of women and is associated with a higher preference for KiwiSaver. Greater debt anxiety is associated with debt repayment, and debt avoidance in old age is critical to long-term wellbeing.

Managing Retirement Incomes

In this article we discuss the state of the literature relating to the decumulation of retirement wealth and the management of retirement incomes. On the one hand, life-cycle models that allow for strong bequest motives and for the effects of medical expense risks have been shown to be able to rationalize retirees’ wealth, income, and consumption trajectories. On the other, studies of individual asset choices and portfolio decisions seem to suggest low levels of financial literacy and engagement as well as non-negligible consequences of age-related cognitive decline on financial decision making. We argue that future work should try to reconcile these two sets of conflicting findings into a coherent and holistic evidence base to inform policy, because issues concerning the management of retirement incomes, and insurance against different risks in retirement more generally, will become increasingly important for future cohorts of retirees.

Progressive Pension Formula and Life Expectancy Heterogeneity

An increasing number of empirical studies have shown a positive relationship between lifetime income and life expectancy at retirement. One’s income during the active part of one’s career translates into the amount of retirement benefits one might receive, leading to actuarial unfairness inside cohorts of retirees. In order to discuss unfairness and sustainability issues, the Belgium pension reform committee issued a proposal for a point system designed to be both sustainable and adequate. In this paper, we use a similar defined benefit framework in order to set out a compensation mechanism linked to life expectancy heterogeneity during the active part of the career, aiming to reduce unfairness once reaching retirement. This method is based on the progressivity of pension benefit formulae. We implement these ideas in a simple demographic context in order to capture the constraints related to the model.

A Novel HR-pQCT Image Registration Approach Reveals Sex-Specific Changes in Cortical Bone Retraction With Aging.

ABSTRACTDuring aging, changes in endosteal and periosteal boundaries of cortical bone occur that differ between men and women. We here develop a new procedure that uses high‐resolution peripheral quantitative CT (HR‐pQCT) imaging and 3D registration to identify such changes within the timescale of longitudinal studies. A first goal was to test the sensitivity of the approach. A second goal was to assess differences in periosteal/endosteal expansion over time between men and women. Rigid 3D registration was used to transform baseline and all follow‐up (FU) images to a common reference configuration for which the region consisting of complete slices (largest common height) was determined. Periosteal and endosteal contours were transformed to the reference position to determine the net periosteal and endosteal expansion distances. To test the sensitivity, images from a short‐term reproducibility study were used (15 female, aged 21 to 47 years, scanned three times). To test differences between men and women, images from a subset of the Geneva Retirees Cohort were used (248 female, 61 male, average age 65 years, 3.5 and 7 years FU). The sensitivity study indicated a least significant change for detecting periosteal/endosteal expansion of 41/31 microns for the radius and 17/26 microns for the tibia. Results of the cohort study showed significant net endosteal retraction only in females at the radius and tibia after 3.5 years (38.0 and 38.4 microns, respectively) that further increased at 7 years FU (70.4 and 70.8 microns, respectively). No significant net periosteal changes were found for males or females at 7 years. The results demonstrate that it is possible to measure changes in endosteal contours in longitudinal studies within several years. For the investigated cohort, significant endosteal retraction was found in females but not in males. Whether these changes in cortical geometry are related to fracture risk remains to be investigated in larger cohorts © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Retirement lifestyle conceptualization and well-being in recent retirees

ABSTRACT The retirement literature contains four distinct conceptualizations of retirement lifestyle. Retirement can be seen as an opportunity to make a new start, the continuation of a pre-retirement lifestyle, an unwelcome imposed disruption, and a transition to old age. This research examines the conceptualizations of retirement lifestyle and how they relate to retirement adjustment and well-being in recent retirees (N = 173). A factor analysis confirmed the existence of four factors identifying four retirement conceptualizations. Although previous studies have presented retirement conceptualizations as mutually incompatible, significant relationships were found between them in this research, indicating that recent retirees can synchronously conceptualize seemingly distinct lifestyles. The cluster analysis identified three types of retirees in the sample. These types were labeled to reflect the prevailing retirement lifestyle concepts. The first type of retiree (N = 90) is “New beginning and continuation,” the second (N = 44) is “Imposed disruption without hope,” and the third is (N = 39) “Accepted disruption and ending.” The analysis of variance revealed the three types differ significantly in the level of satisfaction in retirement, subjective happiness, and life meaningfulness – with the highest level being found in the first retiree type and the lowest level in the second retiree type. The findings suggest that conceptualizations of retirement lifestyle change over time and affect psychological well-being in the recent retiree cohort. The theoretical and practical implications of the results are outlined.

The Value of Allocating to Annuities

This article explores the costs and benefits associated with different approaches a financial advisor could take toward using (or not using) annuities across his or her entire book of clients (i.e., for an entire cohort of retirees). Fees are used to proxy the implied total expenses (or costs) for the two approaches, and not surprisingly, the relative fees between the portfolio and the annuity has a significant impact on the respective benefit of each. For example, a financial advisor would be better off not recommending annuities at all (on average), if the investment-only approach is considered to be low cost and the annuity approach is assumed to be high cost. If the fees for both approaches are assumed to be moderate (i.e., the implied total expenses of the strategies are equal), which is the most realistic scenario for financial advisors providing high-quality advice to clients, the average annuity allocation across scenarios is approximately 30% and helping retirees allocate to annuities optimally generates a total of 73 basis points of alpha-equivalent benefit compared with a financial advisor that does not consider annuities as part of the retirement plan. The marginal alpha-equivalent benefit associated with optimal annuitization strategies, which is estimated by focusing on the total additional benefit generated from allocating to annuities based on the percentage of assets actually used to purchase the annuity, is closer to 150 basis points—a level of increased risk-adjusted performance that would be almost impossible for a financial advisor to overcome using traditional investments (i.e., ignoring annuities). <b>TOPICS:</b>Wealth management, retirement <b>Key Findings</b> • Annuities can help retirees generate guaranteed income for life, something that is impossible for investment-only product. • The potential value of annuities, relative to investment-focused approaches, depends significantly on the assumed costs of the respective strategies. • Not considering annuities for retirees because some annuities are expensive can result in inefficient and imprudent retirement plans.

Doubly Enhanced Annuities (DEANs) and the Impact of Quality of Long-Term Care under a Multi-State Model of Activities of Daily Living (ADL)

The relatively small size of global voluntary immediate life annuity markets seemingly contradicts a well-known result that, under certain conditions, utility-maximizing retirees should annuitize all of their wealth upon retirement. This apparent contradiction contributes to what is called the “annuity puzzle.” The main explanations for the annuity puzzle include adverse selection, bequest motives, and retirees’ fear of health shocks that may require them to need long-term care. To explore a potential solution to this puzzle in the U.S. annuity market, we consider a cohort of retirees who are independent and identical except for a hidden immutable health parameter, , that identifies the retiree’s risk type. We assume that the “average” or “standard” retiree has θ = 1, with larger values of θ denoting less healthy individuals. Because private insurers fear that annuitants may live well beyond their life expectancy—that is, they fear adverse selection—voluntary immediate life annuities are generally priced in a manner that makes them attractive mainly to retirees who believe themselves to be healthier than average. These retirees, however, typically represent a small fraction of their cohort of retirees. To expand annuity markets, we are proposing a hybrid voluntary fixed immediate annuity product called a doubly enhanced annuity (DEAN), which we feel will be attractive to the larger retiree population; that is, retirees with . DEANs are medically underwritten to provide greater annual benefits to annuitants with shorter than average life expectancies, they provide long-term care benefits, and they satisfy a bequest motive through a death benefit. Our underlying model of retiree mortality and morbidity is based on a multi-state Markov process with states representing various levels of an insured retiree’s ability to perform activities of daily living (ADL). A major contribution of our research is to explicitly include in our multi-state Markov model a parameter, α, that reflects the level of quality of long-term care a retiree receives over her lifetime. Our main objectives are to develop a theoretical basis for pricing DEANs for the U.S. market, to determine a retiree’s expected discounted utility gained from these annuities, to determine the optimal choice of quality of care, and to explore some of the quality of life implications. A numerical example is provided.

Mental Illness, Not Weight Status, Predicts Increased Odds of Food Insecurity in the Health and Retirement Study (OR02-06-19)

ObjectivesFood insecurity, or limited and/or uncertain access to adequate nutrition, is increasingly recognized as a determinant of clinical and psychosocial outcomes. While there is considerable research demonstrating an association between food insecurity and having obesity in children and young adults, little is known about this association in the elderly. In order to determine the association between weight status and food insecurity in older Americans, we proposed to examine a national cohort of elderly retirees. MethodsWe conducted an analysis of data from participants aged 65+ years from the Health and Retirement Study, a nationally representative cohort study of aging. We linked 2868 participants’ responses to a food insecurity assessment to their demographic characteristics, body mass index, and medical history, among others. Odds ratio estimates of food insecurity were computed. ResultsThe prevalence of food insecurity was higher among participants with overweight or obesity compared to leaner counterparts. However, weight status was not a significant predictor of food insecurity after adjusting for income, demographic covariates, lifestyle factors, comorbidities, and functional and cognitive status. Instead, a psychiatric diagnosis (OR 2.11, 95% CI 1.08, 4.15), self-report of depression (OR 2.12, 95% CI 1.20, 3.73), current smoking status (OR 1.73, 95% CI 1.11, 2.69), African American race (OR 3.03, 95% CI 1.54, 5.98), and other non-White race (OR 3.84, 95% CI 1.56, 9.45) were all independently associated with increased odds of being food insecure. ConclusionsHaving overweight or obesity was not associated with food insecurity in a cohort of elderly participants. Mental illness, however, either as a self-report of depression or a history of a psychiatric diagnosis, was associated with significantly increased odds of being food insecure, regardless of income. Mental health status, along with racial/ethnic identity and tobacco use should all be key considerations in future intervention studies aimed at addressing food insecurity in older populations. Funding SourcesThis study was supported by the Veterans Health Administration, Office of Research and Development. Supporting Tables, Images and/or Graphs▪▪▪▪▪

Associations between radius low-frequency axial ultrasound velocity and bone fragility in elderly men and women.

Low-frequency velocity (VLF) was measured at the radius using OsCare Sono®, a portable axial transmission ultrasonometer, in 271 community-dwelling postmenopausal women and men (age 71.5 ± 1.4years) from the Geneva Retirees Cohort. Cortical (Ct) and trabecular (Tb) volumetric (v) BMD and microstructure at the distal radius were assessed by HR-pQCT, in addition to areal (a) BMD by DXA, at the same time point. VLF was highly correlated with aBMD at the distal third radius (r = 0.72, p < 0.001). For microstructure parameters, the highest correlation was observed with cortical area (r = 0.59, p < 0.001). VLF also captured bone geometry (total area) and cortical tissue mineral density independently of aBMD. In models adjusted for age and sex, VLF was significantly associated with prevalent low-trauma fractures [OR 95%CI for one SD decrease of VLF 1.50 (1.05, 2.14), p = 0.024], with discrimination performance comparable to femoral neck or distal radius aBMD. Measurement of VLF at the radius captures aBMD, bone size, and cortical tissue mineral density and might be used for screening purposes prior to DXA to evaluate fracture risk.

Life‐Cycle Expenditure and Retirees’ Cost of Living

AbstractThe aim of this paper is twofold. First, we document the expenditure life‐cycle profile in the United Kingdom and show how differences in the consumption bundle of retirees and workers translate into different inflation experiences. Albeit different in given years, the inflation experienced by the two groups is not significantly different over a long time period. We also show how the distribution of household inflation evolved over time, with particular emphasis on the period around the latest financial crisis. Second, we estimate an Exact Affine Stone Index (EASI) demand system and compute the change in the cost of living and the substitution effect for both retirees and workers for the period 1990–2014. Finally, we show how pension income would evolve during that period under three alternative indexation measures for different cohorts of retirees. The indexation measure that results in the highest pension income depends on the time of retirement.

Fermented dairy products consumption is associated with attenuated cortical bone loss independently of total calcium, protein, and energy intakes in healthy postmenopausal women.

Fermented dairy products (FDP), including yogurts, provide calcium, phosphorus, and proteins together with prebiotics and probiotics, all being potentially beneficial for bone. In this prospective cohort study, we investigated whether FDP, milk, or ripened cheese consumptions influence age-related changes of bone mineral density (BMD) and microstructure. Dietary intakes were assessed at baseline and after 3.0 ± 0.5years with a food frequency questionnaire in 482 postmenopausal women enrolled in the Geneva Retirees Cohort. Cortical (Ct) and trabecular (Tb) volumetric (v) BMD and microstructure at the distal radius and tibia were assessed by high-resolution peripheral quantitative computerized tomography, in addition to areal (a) BMD and body composition by dual-energy X-ray absorptiometry, at the same time points. At baseline, FDP consumers had lower abdominal fat mass and larger bone size at the radius and tibia. Parathyroid hormone and β-carboxyterminal cross-linked telopeptide of type I collagen levels were inversely correlated with FDP consumption. In the longitudinal analysis, FDP consumption (mean of the two assessments) was associated with attenuated loss of radius total vBMD and of Ct vBMD, area, and thickness. There was no difference in aBMD and at the tibia. These associations were independent of total energy, calcium, or protein intakes. For other dairy products categories, only milk consumption was associated with lower decrease of aBMD and of failure load at the radius. In this prospective cohort of healthy postmenopausal women, age-related Ct bone loss was attenuated at non-bearing bone sites in FDP consumers, not in milk or ripened cheese consumers, independently of total energy, calcium, or protein intakes. ISRCTN11865958 ( http://www.isrctn.com ).

Interaction between LRP5 and periostin gene polymorphisms on serum periostin levels and cortical bone microstructure

The purpose of this study is to investigate the interaction between periostin gene polymorphisms (SNPs) and other genes potentially responsible for modulating serum periostin levels and bone microstructure in a cohort of postmenopausal women. In 648 postmenopausal women from the Geneva Retirees Cohort, we analyzed 6 periostin SNPs and another 149 SNPs in 14 genes, namely BMP2, CTNNB1, ESR1, ESR2, LRP5, LRP6, PTH, SPTBN1, SOST, TGFb1, TNFRSF11A, TNFSF11, TNFRSF11B and WNT16. Volumetric BMD and bone microstructure were measured by high-resolution peripheral quantitative computed tomography at the distal radius and tibia. Serum periostin levels were associated with radial cortical porosity, including after adjustment for age, BMI, and years since menopause (p=0.036). Sixteen SNPs in the ESR1, LRP5, TNFRSF11A, SOST, SPTBN1, TNFRSF11B and TNFSF11 genes were associated with serum periostin levels (p range 0.03-0.001) whereas 26 SNPs in 9 genes were associated with cortical porosity at the radius and/or at the tibia. WNT 16 was the gene with the highest number of SNPs associated with both trabecular and cortical microstructure. The periostin SNP rs9547970 was also associated with cortical porosity (p=0.04). In particular, SNPs in LRP5, ESR1 and near the TNFRSF11A gene were associated with both cortical porosity and serum periostin levels. Eventually, we identified an interaction between LRP5 SNP rs648438 and periostin SNP rs9547970 on serum periostin levels (interaction p=0.01) and on radial cortical porosity (interaction p=0.005). These results suggest that periostin expression is genetically modulated, particularly by polymorphisms in the Wnt pathway, and is thereby implicated in the genetic variation of bone microstructure.

Evaluation of Radius Microstructure and Areal Bone Mineral Density Improves Fracture Prediction in Postmenopausal Women.

A majority of low-trauma fractures occur in subjects with only moderate decrease of areal bone mineral density (aBMD), ie, osteopenia, assessed by dual-energy X-ray absorptiometry (DXA) or low fracture probability assessed by FRAX. We investigated whether peripheral bone microstructure and estimated strength improve the prediction of incident fractures beyond central DXA and FRAX. In this population-based study of 740 postmenopausal women (aged 65.0 ± 1.4 years) from the Geneva Retirees Cohort (ISRCTN registry 11865958), we assessed at baseline cortical (Ct) and trabecular (Tb) volumetric bone mineral density (vBMD) and microstructure by peripheral quantitative computed tomography (HR-pQCT); bone strength by micro-finite element analysis; aBMD and trabecular bone score (TBS) by DXA; and FRAX fracture probability. Eighty-five low-trauma fractures occurred in 68 women over a follow-up of 5.0 ± 1.8 years. Tb and Ct vBMD and microstructure predicted incident fractures, independently of each other and of femoral neck (FN) aBMD and FRAX (with BMD ± TBS). However, the associations were markedly attenuated after adjustment for ultra-distal radius aBMD (same bone site). The best discrimination between women with and without fracture was obtained at the radius with total vBMD, the combination of a Tb with a Ct parameter, or with failure load, which improved the area under the curve (AUC) for major osteoporotic fracture when added to FN aBMD (0.760 versus 0.695, p = 0.022) or to FRAX-BMD (0.759 versus 0.714, p = 0.015). The replacement of failure load by ultra-distal aBMD did not significantly decrease the AUC (0.753, p = 0.747 and 0.750, p = 0.509, respectively). In conclusion, peripheral bone microstructure and strength improve the prediction of fractures beyond central DXA and FRAX but are partially captured in aBMD measured by DXA at the radius. Because HR-pQCT is not widely available for clinical purposes, assessment of ultra-distal radius aBMD by DXA may meanwhile improve fracture risk estimation. © 2017 American Society for Bone and Mineral Research.

Serum Levels of a Cathepsin-K Generated Periostin Fragment Predict Incident Low-Trauma Fractures in Postmenopausal Women Independently of BMD and FRAX.

Periostin is a matricellular protein involved in bone formation and bone matrix organization, but it is also produced by other tissues. Its circulating levels have been weakly associated with bone microstructure and prevalent fractures, possibly because periostin measured by the current commercial assays does not specifically reflect bone metabolism. In this context, we developed a new ELISA for a periostin fragment resulting from cathepsin K digestion (K-Postn). We hypothesized that circulating K-Postn levels could be associated with bone fragility. A total of 695 women (age 65.0 ± 1.5 years), enrolled in the Geneva Retirees Cohort (GERICO), were prospectively evaluated over 4.7 ± 1.9 years for the occurrence of low-trauma fractures. At baseline, we measured serum periostin, K-Postn, and bone turnover markers (BTMs), distal radius and tibia microstructure by HR-pQCT, hip and lumbar spine aBMD by DXA, and estimated fracture probability using the Fracture Risk Assessment Tool (FRAX). Sixty-six women sustained a low-trauma clinical fracture during the follow-up. Total periostin was not associated with fractures (HR [95% CI] per SD: 1.19 [0.89 to 1.59], p = 0.24). In contrast, K-Postn was significantly higher in the fracture versus nonfracture group (57.5 ± 36.6 ng/mL versus 42.5 ± 23.4 ng/mL, p < 0.001) and associated with fracture risk (HR [95%CI] per SD: 2.14 [1.54 to 2.97], p < 0.001). After adjustment for aBMD, FRAX, bone microstructure, or BTMs, K-Postn remained significantly associated with fracture risk. The performance of the fracture prediction models was improved by adding K-Postn to aBMD or FRAX (Harrell C index for fracture: 0.70 for aBMD + K-Post versus 0.58 for aBMD alone, p = 0.001; 0.73 for FRAX + K-Postn versus 0.65 for FRAX alone, p = 0.005). Circulating K-Postn predicts incident fractures independently of BMD, BTMs, and FRAX in postmenopausal women. Hence measurement of a periostin fragment resulting from in vivo cathepsin K digestion may help to identify subjects at high risk of fracture. © 2017 American Society for Bone and Mineral Research.

Development of a New Immunoassay for Human Cathepsin K-Generated Periostin Fragments as a Serum Biomarker for Cortical Bone.

Periostin is a matricellular protein mainly expressed by periosteal cells and osteocytes in bone, but is also present in several other tissues. Available immunoassays use antibodies of unclear specificity. The aim of the study was to develop a bone-specific periostin ELISA based on the detection of fragments generated by the osteoclastic and osteocytic protease cathepsin K. In vitro digestion of human recombinant intact periostin by cathepsin K leads to the generation of multiple fragments. Using LS-MS/MS, it was found that the GSLQPIIK peptide was the most efficiently and abundantly generated periostin fragment. A rabbit polyclonal antibody directed against the synthetic GSLQPIIK sequence was produced. Immunohistochemistry experiments of the tibia showed that the GSLQPIIK fragments localized at the periosteal surface and within the osteocytes. Using the same antibody, we developed an ELISA for the measurement of GSLQPIIK in the serum. This ELISA demonstrated intra- and interassay variability below 14% with a sensitivity allowing accurate determinations in the serum of healthy individuals. Serum GSLQPIIK was measured in 160 healthy postmenopausal women (mean age 65year) participating in the Geneva Retiree Cohort. Serum GSLQPIIK levels did not correlate with total periostin, hip BMD, and the bone markers PINP and CTX. However, GSLQPIIK was negatively correlated (p values ranging from 0.007 to 0.03) with Hr-pQCT measures of tibia and radius cortical bone, but not with trabecular parameters. We have developed the first assay for the detection of periostin fragments generated by cathepsin K. Because serum levels of this new marker significantly correlated with cortical bone measurements in postmenopausal women, it may prove to be useful for the clinical investigation of patients with osteoporosis.

Interrelationships among neuroimaging biomarkers, neuropsychological test data, and symptom reporting in a cohort of retired national football league (nfl) players

ObjectiveTo assess interrelationships among neuroimaging findings with neurocognitive test performance and symptom endorsement in a cohort of retired professional (NFL) football players.DesignProspective cohort study.SettingNeurology clinic.ParticipantsForty-five retired NFL players.InterventionMRI scan assessment of cavum septum pellucidi, global mean score of Fractional Anisotropy (FA), and microhemorrhages.Outcome measuresNine neuropsychological tests and multiple symptom and depression scores. Associations among the three independent neuroimaging results with these outcome measures were assessed utilising Pearson’s, Spearman’s Rank, and Point-Biserial Correlations.ResultsThe retirees reported an average of 6.9 (±6.2) concussions and 13.0 (±7.9) sport-related “dings” in the NFL. Assessment of cavum septum pellucidum yielded a negative finding in 10 subjects (22%), while 32 (71%) had a small, and 3 (7%) had a large one. Four (9%) of the subjects had microhemorrhages present and average FA mean was 0.459 (±0.035). Number of sport-related “dings” was correlated with an increased risk of microhemorrhages (r=0.305, p=0.042). The majority (50.8%) of the correlations obtained among the three neuroimaging parameters and the neurocognitive/symptom scores were below the threshold of a “small” effect size (r&lt;0.10). The remaining (49.2%) correlations fell somewhere between “small” and “medium” effect sizes (0.1&lt; r&lt;0.3). However, all correlations were statistically non-significant.ConclusionsThe current results demonstrate minimal and statistically non-significant correlations among neuroimaging, neurocognitive, and symptom scores examined in a cohort of NFL retirees. While an often-accepted paradigm, certain neuroimaging findings may not relate consistently and directly with neurocognitive test performance and clinical symptom burden.Competing interestsNone.GS Solomon receives consulting fees from the Tennessee Titans (NFL), the Nashville Predators (NHL), and the athletic departments of several universities; all fees paid to institution. In addition he is a member of the ImPACT Scientific Advisory Board and receives reimbursement for expenses to board meetingsAK Sills is a consulting physician to the Nashville Predators (uncompensated) and also serves as an unaffiliated neurotrauma consultant for the NFLExaminations of the NFL retirees were sponsored by the National Football League (NFL) and coordinated with the NFL Players Association (NFLPA). IR Casson served as a member of the NFL MTBI Committee from 1994-2009 and as a co-chair from 2007-2009. He has done consulting for law firms and insurance companies.

Interrelationships Among Neuroimaging Biomarkers, Neuropsychological Test Data, and Symptom Reporting in a Cohort of Retired National Football League Players.

Background:Structural brain changes, potentially resulting from repetitive brain trauma (RBT), have been correlated with neurocognitive decline and increased symptom reporting in retired athletes.Hypothesis:In a cohort of retired National Football League (NFL) players, the relationships between 3 neuroimaging parameters, neuropsychological testing, and symptom scores will be significantly correlated.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:Comprehensive magnetic resonance imaging was performed in 45 retired NFL players. Three neuroanatomical parameters were assessed by board-certified radiologists blinded to the purpose of the study: (1) the absence or presence of small or large cavum septum pellucidum, (2) a global mean score of fractional anisotropy (FA), and (3) the presence or absence of microhemorrhages. The subjects underwent a battery of 9 paper-and-pencil neuropsychological tests, a computerized neurocognitive test, and multiple symptom and depression scales. The associations among the neuroimaging results with these outcome measures were assessed utilizing Pearson, Spearman rank, and point-biserial correlations.Results:The 45 subjects (mean age, 46.7 ± 9.1 years) reported a mean 6.9 (±6.2) concussions and 13.0 (±7.9) “dings” in the NFL. Ten (22%) did not have a cavum septum pellucidum, while 32 (71%) had a small and 3 (7%) had a large one. Four (9%) had microhemorrhages. Global FA mean was 0.459 (±0.035). The majority (50.8%) of correlations among the neuroimaging parameters and neurocognitive/symptom scores fell below the threshold of “small” effect size (r < 0.10). The remaining (49.2%) correlations were between “small” and “medium” effect sizes (0.1 < r < 0.3). However, all correlations were statistically nonsignificant.Conclusion:There were minimal and statistically nonsignificant correlations among the neuroimaging, neurocognitive, and symptom scores examined in this cohort of NFL retirees.Clinical Relevance:Associating the severity of structural brain changes to neurocognitive performance and symptom burden after RBT is complex may involve other moderating variables or biomarkers, and demands further study.

184 Interrelationships Among Neuroimaging Biomarkers, Neuropsychological Test Data, and Symptom Reporting in a Cohort of Retired National Football League Players

INTRODUCTION: Repetitive brain trauma (RBT) in American football has become a topic of recent interest. The objective of this study was to assess the interrelationships among neuroimaging findings with neurocognitive test performance and symptom endorsement in a cohort of retired professional (National Football League [NFL]) football players. METHODS: Magnetic resonance imaging (MRI) scans were performed in 45 retired NFL players. Three neuroimaging parameters were recorded by blinded, board-certified neuroradiologists: (1) the absence or presence of or large cavum septum pellucidum; (2) a global mean score of fractional anisotropy (FA); and (3) the presence or absence of microhemorrhages (microbleeds). The subjects underwent a battery of 9 paper-and-pencil neuropsychological tests (yielding 12 separate scores), a computerized neurocognitive test, and multiple (4) symptom and depression scales. The associations among the 3 independent neuroimaging results with these outcome measures were assessed using Pearson, Spearman Rank, and Point-Biserial Correlations. RESULTS: Data from 45 retired NFL players (average age: 46.7 years) were analyzed. The retirees reported an average of 6.9 (±6.2) concussions and 13.0 (±7.9) sport-related dings in the NFL. Assessment of cavum septum pellucidum yielded a negative finding in 10 subjects (22%), while 32 (71%) had a small, and 3 (7%) had a large one. Four (9%) of the subjects had microhemorrhages present and average FA mean was 0.459 (±0.035). Number of sport-related dings was correlated with an increased risk of microhemorrhages (r = 0.305, P =.042). The majority (50.8%) of the correlations obtained among the 3 neuroimaging parameters and the neurocognitive/symptom scores were below the threshold of a small effect size (r CONCLUSION: The current results demonstrate minimal and statistically nonsignificant correlations among neuroimaging, neurocognitive, and symptom scores in a cohort of NFL retirees. The results indicate that, in this cohort, neuroimaging findings do not relate directly to neurocognitive test performance and clinical symptom burden. Although an often-accepted paradigm, associating the severity of structural brain changes with neurocognitive performance and symptom presentation after chronic RBT is complex, may involve other moderating variables, and requires further study. Language: en