Sex-matched Reference Population Research Articles

Bone mineral density in children with moderate to severe atopic dermatitis

Low bone mineral density (BMD) has been reported in 30.4% of adult patients with atopic dermatitis (AD). The aim of this study was to determine the prevalence of low BMD in children with moderate to severe AD and to investigate the relation between BMD and corticosteroid and cyclosporine therapy. Lumbar spine BMD was measured by dual-energy X-ray absorptiometry in 60 children (age 5-16 years) with moderate to severe AD. BMD (in g/cm(2)) was expressed in Z-scores, the number of SD above or below the mean value of an age- and sex-matched reference population. In children, low BMD was defined as a Z-score less than -2. Information on lifestyle parameters and bone fractures were collected by use of a standardized questionnaire. The cumulative dose of corticosteroids and cyclosporine therapy was calculated for the previous 5-year period. Three patients (5%) had low BMD; one patient (1.7%) had osteoporosis. The observed prevalence of low BMD in this study (6.7%; 95% confidence interval 1.8%-16.2%) does not differ from the expected prevalence of low BMD in the general population (P = .06). Overall, use of topical corticosteroids in the previous 5 years was not associated with a decrease in BMD (Z-score). When children received additional systemic treatment (oral corticosteroids and/or cyclosporine) in the previous 5 years, BMD decreased, although the decrease was not statistically significant. Correction for lifestyle parameters did not change these associations. The number of patients studied was limited. The cumulative dose of corticosteroids and cyclosporine therapy was only registered for the previous 5 years, and relatively low amounts of topical corticosteroids were used. The definition of low BMD differs between adults (Z-score < -1) and children (Z-score < -2). Because there is no Dutch BMD reference population for children, normative BMD references were obtained from a different population (US children). Low BMD did not occur more frequently in this population of children with moderate to severe AD compared with the general population. Use of topical corticosteroids in the previous 5 years was not associated with a decrease in BMD.

Quality-Adjusted Life Expectancy (QALE) and Loss of QALE for Patients With Ischemic Stroke and Intracerebral Hemorrhage

Few studies have evaluated the long-term health impact of stroke as categorized into different subtypes. The aim of this study is to quantify the loss of quality-adjusted life expectancy related to ischemic stroke and intracerebral hemorrhage. The hospital-based cohort, which consisted of 13,194 patients with first-ever stroke onset dates between 1995 and 2007, was classified into lacunar and nonlacunar infarctions and intracerebral hemorrhages. After linking with the National Mortality Registry, survival functions were determined and extrapolated over a 50-year period based on the survival ratio between the patients' survival and age- and sex-matched reference population's as calculated from the vital statistics of Taiwan. The survival functions were then multiplied by the quality of life assessed under the EuroQol 5-dimension (EQ-5D) questionnaire based on a sample of 486 patients with stroke. The quality-adjusted life expectancy for a patient with ischemic stroke was 8.7 quality-adjusted life-years with an average loss of 8.3 quality-adjusted life-years, and there appeared to be no difference between lacunar and nonlacunar infarctions. Patients with intracerebral hemorrhage had a similar quality-adjusted life expectancy as those with ischemic stroke but with a significantly greater loss relative to the reference population (14.1 quality-adjusted life-years) because of younger ages. The lifelong health burden due to stroke was approximately 9.5 quality-adjusted life-years and should be considered in future cost-effectiveness analyses for prevention.

Changes in Quality of Life After Lung Surgery in Old and Young Patients: Are They Similar?

The aim of the study was to compare the changes in health-related quality of life (QOL) after lung surgery between young and old patients. We performed a prospective, population-based, cohort study to investigate health-related QOL before and 6 months after lung surgery. We used the validated instrument Short Form-36 (SF-36), to investigate QOL. The main outcome measures were fractional change in the SF-36 physical (DeltaPCS%) and mental (DeltaMCS%) component summary scores. We also compared the two age groups to age- and sex-matched reference populations. We included 249 patients: 166 young (<70 years) and 83 old (> or =70 years) patients. The overall response rate at 6 months was 84%. There was no significant difference in the primary outcome measures between young and old patients (DeltaPCS% -13 vs. -16, p = 0.55; DeltaMCS% 9 vs. 1, p = 0.22). The 2-year survivals (mean follow-up 2.1 years) were 83% and 84% in young and old patients, respectively (p = 0.72). In both groups, physical and mental QOL were lower than in the reference populations. We found that at 6 months after lung surgery old patients experienced deterioration in physical and mental health-related QOL similar to that of young patients. Survival also was similar in the two groups.

Health status of primary schoolchildren in Sri Lanka

To assess health status of 9-10-year old school children in Sri Lanka. A cross-sectional, descriptive study. Schools were selected to obtain a sample representative at national and provincial levels and 20 children were randomly selected from Grade 5 classes in each school. Children were examined for Bitot's spots and goitre. Height, weight, and visual acuity were measured according to standard procedures. Haemoglobin level was measured using finger-prick blood and a HemoCue meter. Geohelminth infections were quantified by faecal examination using the modified Kato-Katz technique. Height for age Z-scores (HAZ) and body mass index (BMI) were calculated as indicators of nutritional status. Two thousand five hundred and twenty eight children (1351 boys) from 144 schools (140 state schools and four private schools) were examined. Nationally, 15.5% of children were stunted (HAZ lower than -2.0 SD); 52.6% were thin (BMI < 5th centile of age- and sex-matched reference population); 3.1% were overweight (BMI > 85th centile); 12.1% were anaemic; 0.3% had Bitot's spots; 3% had a visible or palpable goitre; 4.6% were shortsighted; and 6.9% had one or more soil-transmitted nematode infection. Among children on whom anthropometry, haemoglobin and faecal examinations were all done, 64.6% (1332/2063) were thin, stunted, anaemic or infected with worms. A much higher proportion of children in the Northern and Eastern provinces had health problems when compared to the other provinces. The majority of older primary schoolchildren in Sri Lanka are undernourished. Anaemia, vitamin A deficiency, iodine deficiency and soil-transmitted nematode infections affect a much smaller proportion of them.

Estimation of Life Expectancy and the Expected Years of Life Lost in Patients with Major Cancers: Extrapolation of Survival Curves under High-Censored Rates

Objectives There exists a lack of extrapolation methods for long-term survival analysis when censored rates are high (25–50%). This study aimed at estimating life expectancy (LE) after the diagnosis of cancer and the expected years of life lost (EYLL) using a newly developed semiparametric method. Methods Patients (n = 425,294) diagnosed with 17 different types of major cancer were enrolled. All of the patients were registered with the Taiwan Cancer Registry between 1990 and 2001; their survivals were followed through the end of 2004. The survival function for an age- and sex-matched reference population was generated using the Monte Carlo method from the life table of the general population. Lifetime survival of the cancer patients (up to 50 years) were obtained using linear extrapolation of a logit-transformed curve of the survival ratio between the cancer and reference populations. The estimates were compared with the results from the extrapolation of fitted Weibull models. Results The 15-year survival, LE, and EYLL for 17 different types of cancer were determined, of which the LE of breast, cervical, ovarian, and skin cancers exceeded 15 years; nasopharyneal, leukemia, bladder, kidney, and colorectal cancers exceeded 10 years. Validity tests indicated that the relative biases of the extrapolated estimates were usually <5% under high censoring rates. Conclusions The newly developed method is feasible and relatively accurate to project LE and EYLL, which could also be merged with data pertaining to quality of life, for a more detailed outcome assessment in the future.

Body mass index in male and female children with pervasive developmental disorders

The aim of the present study was to evaluate body mass index (BMI) of children with a pervasive developmental disorder (PDD) attending two university clinics during the 1960-84 period. BMI derived from medical records of 83 consecutively admitted children with atypical autism and 115 children with Asperger syndrome were compared with the corresponding BMI percentiles in an age- and sex-matched reference population. The BMI distribution of the boys, but not the girls, in both diagnostic categories was significantly lower than those of the age-matched reference populations. Approximately 15% of the boys had a BMI below the fifth percentile. The present findings are comparable to the results of other studies. Particular attention is given to low BMI as a potential endophenotype in boys with PDD.

The impact of severe haemophilia on the social status and quality of life among Austrian haemophiliacs

Although many studies of the impact of haemophilia on the quality of life were conducted, there is hardly any data on the social status of haemophiliacs. It was the aim of our study to obtain data on the social status of Austrian haemophiliacs and to compare these with an age- and sex-matched reference population. Furthermore, we collected data on the quality of life of haemophilia patients. We conducted a case-control study in two Austrian haemophilia centres with 53 patients (mean age 36.7 +/- 10.6 years) and 104 male controls (mean age 36.7 +/- 11.1 years). Socio-demographic data were collected using a standardized questionnaire and quality-of-life data using the SF-36. More patients (56.6%) than controls (37.5%) were married (P = 0.023), whereas more controls (17.3%) than patients (3.8%) had a partner with whom they were not married (P = 0.016). The percentage having children was equivalent in both groups (47% and 41% respectively), but controls had more children (mean number 1.5 in patients and 2.1 in controls, P < 0.007). A greater number of patients was unemployed (34% of patients, 9% of controls, P < 0.001) as well as retired (23% and 4% respectively; P < 0.001). Patients had worse scores regarding physical functioning, role-physical, bodily pain and general health (P < 0.001), whereas vitality, social functioning, role-emotional and mental health were similar in both groups. Despite their disability, most of the Austrian haemophiliacs share a sound family environment. This suggests that they are highly capable of coping with their chronic disease and is indicated by good scores for role-emotional and mental health.

Prospective assessment of quality of life of octogenarians after cardiac surgery: factors predicting long-term outcome

Our objective was to assess the long-term prognosis and quality of life (QoL) of elderly patients after cardiac surgery. The Nottingham Health Profile (NHP) QoL data were recorded from 104 patients who were older than 70 years at the time of primary cardiac surgery in 1993. All living patients were controlled at 15+/-3.2 months and 8.2+/-0.27 years after discharge. The 1-year, 5-year and actual survival rates were 94%, 76%, and 59%, respectively. Risk factors for death were urgency of the operation (relative risk ratio, 2.0; 95% confidence interval, 1.2-3.6), ejection fraction below 50% (2.1; 1.1-3.9), and preoperative renal failure (2.1; 1.0-4.0). Cardiac operated octogenarians took advantage from age and sex matched reference populations at 15 months in the NHP dimension of pain (P=0.001). The QoL decreased gradually during the follow-up similarly in both groups in dimensions describing energy (P=0.001), pain (P=0.003), and mobility (P=0.042). Diabetes, low energy score and high pain score at 15 months, treatment in intensive care unit >3 days, and duration of symptoms >120 days preoperatively were associated with impaired QoL. Survival and QoL were similar for cardiac operated octogenarians and age and sex matched controls at 15 months and 8.2 years after cardiac surgery.

Mitral Valve Replacement Versus Repair: Propensity-Adjusted Survival and Quality-of-Life Analysis

We investigated whether mitral valve repair (MVP) is superior to mitral valve replacement (MVR) in terms of survival and quality of life during the long-term follow-up. One hundred eighty-four consecutive patients underwent MVP or MVR for mitral regurgitation with or without concomitant coronary artery bypass grafting. Clinical data were recorded prospectively, and the data for the Nottingham Health Profile quality-of-life analysis was collected cross-sectionally. Propensity score analysis was used for the study group matching. The mean follow-up time was 7.3 +/- 1.4 years. After adjustment for baseline characteristics by the propensity score method, there was a statistically significant survival benefit for the patients who underwent MVP (p = 0.02). Risk factors for death were preoperative unstable angina pectoris (relative risk ratio, 4.4; 95% confidence interval, 2.2 to 8.8), age older than 60 years (relative risk ratio, 1.1; 95% confidence interval, 1.0 to 1.1), use of mitral prosthesis (relative risk ratio, 2.7; 95% confidence interval, 1.4 to 5.3), preoperative renal insufficiency (relative risk ratio, 1.0; 95% confidence interval, 1.0 to 1.007), and preoperative cerebrovascular disorder (relative risk ratio, 2.7; 95% confidence interval, 1.0 to 5.3). The quality of life of the MVP and MVR groups did not differ from each other, but the MVP and the MVR patients had lower energy and mobility scores than an age- and sex-matched reference population. Survival is longer after MVP than after MVR. The quality of life of MVP and MVR patients does not differ from each other. In terms of most quality-of-life variables, patients who undergo mitral valve operations cope similarly to an age- and sex-matched reference population. Only the scores reflecting energy and mobility were lower in the patients who were operated on than in the reference population.

Thyroid hormone state and quality of life at long-term follow-up after randomized treatment of Graves’ disease

In a 14-21 year follow-up of health-related quality of life (HRQL) outcome of 179 patients after randomized treatment of Graves' disease (GD) with surgical, medical or radioiodine, we found no differences. The HRQL for Graves' patients, however, was lower compared with a large age- and sex-matched Swedish reference population. We have now studied whether the reported HRQL-scores by Medical Outcome Study 36-item Short-Form Health Status Survey (SF36) and quality of life 2004 (QoL2004) answers were related to the thyroid hormone state of the patient. This report comprises 91 of the original patients in which both the results of SF36 and QoL2004 questionnaire as well as serum thyroid hormones and current use of l-thyroxine treatment were available. A large number of the patients had low or undetectable serum TSH concentrations. SF36 scores and answers to QoL2004 questionnaires were not correlated to TSH levels or associated with suppressed TSH. A low free triiodothyronine was weakly associated with a low GH score (P < 0.02) and elevated thyrotropin receptor antibody with a low physical component summary (P < 0.02). HRQL do not seem to be influenced by the thyroid hormone state of the patient including subclinical thyrotoxicosis. It is possible that the personality of GD patients as such may have resulted both in the development of GD and lower HQRL scores later on in life. Alternatively, the generic SF36 may not be a proper instrument to detect relevant differences in HRQL related to the thyroid state.

Mean HbA1c over 18 years predicts carotid intima media thickness in women with type 1 diabetes

Intima media thickness (IMT) of the common carotid artery (CCA) is a validated surrogate marker of early atherosclerosis. The aim of our study was to assess the association between IMT in CCA and long-term mean HbA1c in type 1 diabetes. We also elucidated the association between carotid IMT and preclinical coronary atherosclerosis. In 39 individuals with type 1 diabetes, HbA1c was measured prospectively over 18 years. The IMT examinations were performed with high-resolution ultrasound. The association between carotid IMT and preclinical coronary atherosclerosis (assessed by intravascular ultrasound [IVUS]) was tested in 29 of the patients. Mean HbA1c over 18 years was 8.2% (range: 6.6-11.3%). Mean age at follow-up after 18 years was 43 years and mean duration of diabetes was 30 years. IMT was significantly higher in diabetic patients than in an age- and sex-matched reference population. The IMT values were at the same level as for controls who were 20 years older. In women, HbA1c was significantly associated with mean average CCA IMT (r2=0.77, p<0.0001 when adjusted for age), whereas there was no significant association for men. Among women, a significant association was also found between carotid IMT and the percentage of coronary vessel area stenosis (r=0.65, p=0.03). The present findings suggest an important role of long-term hyperglycaemia in the development of atherosclerosis, especially in women with type 1 diabetes. Type 1 diabetes patients have earlier development of, and more advanced, atherosclerosis compared with an age- and sex-matched reference population. In women, carotid IMT reflects preclinical coronary atherosclerosis.

Body mass index of children from the United Kingdom diagnosed with pervasive developmental disorders

The aim of the present study was to ascertain the Body Mass Index (BMI) (kg m(-2)) derived from parental reports of height (metres) and weight (kilograms) of a pilot sample of boys born and resident in the UK diagnosed with pervasive developmental disorders (PDD). Analysis of parental reporting of height and weight measurements in boys (n=50) diagnosed with PDD and comparison with age and sex-matched reference populations. The majority of patients were above the 50th percentile for height (70%), weight (74%) and BMI (80%) with 21% exceeding cut-off points for overweight and 10% for clinical obesity. There were no significant differences (P < 0.05) found between PDD subgroups for any of the measures. Further studies are required to validate findings of skewed height, weight and BMI data in PDD.

Right and left ventricular cardiac function in a developed world population with human immunodeficiency virus studied with radionuclide ventriculography

Background Cardiac dysfunction has been reported in a substantial part of patients infected with the human immunodeficiency virus (HIV). However, most studies are from a time before the introduction of highly active antiretroviral treatment (HAART), which has significantly reduced HIV-associated morbidity and mortality rates. Accordingly, the prevalence of HIV-associated cardiac dysfunction may also have changed. The aim of the study was to establish the prevalence of right- and left-sided cardiac dysfunction in a Danish HIV population, most of whom were undergoing HAART, with radionuclide ventriculography. Methods Ninety-five consecutive patients with HIV infection were included. Mean HIV duration was 104 months, and 84% of the patients received HAART. All patients underwent radionuclide ventriculography, and plasma levels of atrial natriuetic peptide (ANP), brain natriuetic peptide (BNP), and endothelin-1 (ET-1) were measured. Thirty age- and sex-matched healthy volunteer subjects were included to establish reference values of radionuclide measurements of left and right ventricular ejection fraction and of left ventricular volume. Results Of 95 patients with HIV, 1 (1%) had a reduced left ventricular ejection fraction and 6 (7%) had a reduced right ventricle ejection fraction (0.35–0.42) compared with reference values from the age- and sex-matched reference population. Patients with HIV and reduced cardiac function did not differ in the duration of HIV, CD4 count, CD4 nadir, or HIV RNA load. No correlations were found between reduced cardiac function and levels of the 3 peptides measured. Conclusions No major dysfunction of the left ventricle is present in a developed world HIV population. However, a small but significant part of this population has modestly reduced right-sided systolic function.

REFRACTURES IN PATIENTS AT LEAST FORTY-FIVE YEARS OLD

Individuals who sustain a low-energy fracture are at increased risk of sustaining a subsequent low-energy fracture. The incidence of these refractures may be reduced by secondary preventative measures, although justifying such interventions and evaluating their impact is difficult without substantive evidence of the severity of the refracture risk. The aim of this study was to quantify the risk of sustaining another fracture following a low-energy fracture compared with the risk in an age and sex-matched reference population. During the twelve-year period between January 1988 and December 1999, all inpatient and outpatient fracture-treatment events were prospectively audited in a trauma unit that is the sole source of fracture treatment for a well-defined local catchment population. During this time, 22,060 patients at least forty-five years of age who had sustained a total of 22,494 low-energy fractures of the hip, wrist, proximal part of the humerus, or ankle were identified. All refracture events were linked to the index fracture in the database during the twelve-year period. The incidence of refracture in the cohort of patients who had sustained a previous fracture was divided by the "background" incidence of index fractures within the same local population to obtain the relative risk of refracture. Person-years at-risk methodology was used to control for the effect of the expected increase in mortality with advancing age. Within the cohort, 2913 patients (13.2%) subsequently sustained a total of 3024 refractures during the twelve-year period. Patients with a previous low-energy fracture had a relative risk of 3.89 of sustaining a subsequent low-energy fracture. The relative risk was significantly increased for both sexes, but it was greater for men (relative risk = 5.55) than it was for women (relative risk = 2.94). The relative risk was 5.23 in the youngest age cohort (patients between forty-five and forty-nine years of age), and it decreased with increasing age to 1.20 in the oldest cohort (patients at least eighty-five years of age). Individuals who sustain a low-energy fracture between the ages of forty-five and eighty-four years have an increased relative risk of sustaining another low-energy fracture. This increased risk was greater when the index fracture occurred earlier in life; the risk decreased with advancing age. Secondary preventative measures designed to reduce the risk of refracture following a low-energy fracture are likely to have a greater impact on younger individuals.

Lipid profiles in untreated severe congenital isolated growth hormone deficiency through the lifespan.

Growth hormone deficiency (GHD) is associated with adverse changes in lipid profile. However, changes in lipids through life in a homogeneous group of GHD subjects have not been defined. We examined lipid levels in a group of untreated severely GHD patients with a mutation in the GHRH receptor gene from a rural community in North-east Brazil. Lipid profiles in 15 GHD subjects [eight children and adolescents (one male), age (median [range]) 13.2 (5.4-19.9) years; seven adults (one male), age 47 (33-66) years] were compared with those in 29 indigenous controls from the same extended kindred [17 children and adolescents (six male), age 10.2 (5.3-18.4) years; 12 adults (eight male), age 54.5 (33-80) years]. All GHD subjects had a peak GH response of < 0.5 ng/ml in response to an insulin tolerance test and extremely reduced IGF-1 levels (median 5.5 ng/ml). Data were compared between cohorts and with an age- and sex-matched white American reference population. Abnormalities were confined to plasma total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels. More GHD children had levels of plasma TC and LDL-C above the 95th percentile for our reference population (3/8 and 4/7, respectively) compared to controls (0/17 and 1/15, respectively) (P < 0.05). In the adults, median TC and LDL-C levels were higher in the GHD than controls (P < 0.05) (6.3 vs. 4.1 mmol/l; 4.4 vs. 2.7 mmol/l, respectively). Median Z-scores, calculated using values from the reference population, were not different between GHD children and adults for both TC (+0.8 vs.+0.4) and LDL-C (+1.4 vs.+0.7). The lipid profile in children as well as in adults with very severe GHD is adversely modified. There would appear to be no significant worsening of the lipid abnormality with duration of GHD or achievement of adulthood.

Body mass index in male and female children with infantile autism.

Morphometry, the measurement of forms, is an ancient practice. Recently, evidence has grown to support the notion that aberrant neurodevelopment may play a role in the pathophysiology of autism. Is the body, like the brain, affected by abnormal development in these patients? The aim of this study was to evaluate body mass index (BMI) of children with infantile autism, by comparing the BMI of 117 children with infantile autism with the corresponding BMI percentiles in an age- and sex-matched reference population. The BMI distribution of the male, but not female, children with infantile autism was significantly lower than that of the age-matched reference population. There was no evidence that BMI was associated with intelligence or socioeconomic status among children with infantile autism.

Mild Hyperhomocysteinemia is Associated with Impaired Renal Function but not with Progression of Small Abdominal Aortic Aneurysms

To study the possible role of homocysteine in aneurysmatic progression, in 1994, 112 of 141 male patients with abdominal aortic aneurysm (AAA) diagnosed by population screening were interviewed and examined. Creatinine clearance estimated and total plasma homocysteine (P-tHcy) was measured by gas chromatography-mass spectrometry. Of the 112 cases, 99 were followed with annual ultrasonography and blood pressure measurements for 1–5 years (mean 2.5 years). The mean creatinine clearance was 70.8+/-23.1 ml/min, while the mean P-tHcy was 16.0+/-10.6 mmol/l, significantly increased compared with an age- and sex-matched reference population (P < 0.01). However, no trend of correlation with AAA size or aneurysmal progression was found concerning creatinine clearance and homocysteine level. There were still no trend after adjustment for age, smoking, diastolic blood pressure, and initial ankle blood pressure index. However, the homocysteine level was positively correlated with decreasing creatinine clearance (r = 0.36,P < 0.01), and this correlation was still present after the same adjustments. A large proportion of men with AAA have mild hyperhomocysteinemia; this does not influence aneurysmal progression and may be due to coexisting impaired renal function. The finding might explain why prospective and intervention studies cannot prove for certain that hyperhomocysteinemia influences atherosclerotic progression, or that treatment is beneficial.

Mild hyperhomocysteinemia is associated with impaired renal function but not with progression of small abdominal aortic aneurysms

To study the possible role of homocysteine in aneurysmatic progression, in 1994, 112 of 141 male patients with abdominal aortic aneurysm (AAA) diagnosed by population screening were interviewed and examined. Creatinine clearance estimated and total plasma homocysteine (P-tHcy) was measured by gas chromatography-mass spectrometry. Of the 112 cases, 99 were followed with annual ultrasonography and blood pressure measurements for 1–5 years (mean 2.5 years). The mean creatinine clearance was 70.8+/-23.1 ml/min, while the mean P-tHcy was 16.0+/-10.6 mmol/l, significantly increased compared with an age- and sex-matched reference population (P < 0.01). However, no trend of correlation with AAA size or aneurysmal progression was found concerning creatinine clearance and homocysteine level. There were still no trend after adjustment for age, smoking, diastolic blood pressure, and initial ankle blood pressure index. However, the homocysteine level was positively correlated with decreasing creatinine clearance (r = 0.36,P < 0.01), and this correlation was still present after the same adjustments. A large proportion of men with AAA have mild hyperhomocysteinemia; this does not influence aneurysmal progression and may be due to coexisting impaired renal function. The finding might explain why prospective and intervention studies cannot prove for certain that hyperhomocysteinemia influences atherosclerotic progression, or that treatment is beneficial.

Bone mineral density in women and men with early rheumatoid arthritis.

Objective: To study bone mineral density (BMD) in patients with early rheumatoid arthritis. Methods: Dual x-ray absorptiometry was performed in 227 patients, 149 women and 78 men, with rheumatoid arthritis (RA) of no more than 12 months duration. Results: Women, as well as men above 60 years of age, had a BMD at spine and hip comparable with age and sex matched reference populations. Men younger than 60 years had a tendency to lower BMD. Although the proportion of female patients with osteoporosis was not higher than in the reference, population the proportion of patients with reduced bone mass was increased, and this was found also in men. There was no significant association between BMD and disease duration, disease activity or disability. Conclusion: Untreated patients with early RA have a BMD in spine and hip not significantly different from that of normal reference populations. However, an increased number of the patients had reduced bone mass already at disease onset.

Cadmium may be a risk factor for osteoporosis.

OBJECTIVES: The primary study aim was to examine the possible role of cadmium as a risk factor for osteoporosis by determining the bone mineral density (BMD) in workers previously exposed...