Study Of Osteoporotic Fractures Research Articles

The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report.

Using race and ethnicity in clinical algorithms potentially contributes to health inequities. The American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee convened the ASBMR Task Force on Clinical Algorithms for Fracture Risk to determine the impact of race and ethnicity adjustment in the US Fracture Risk Assessment Tool (US-FRAX). The Task Force engaged the University of Minnesota Evidence-based Practice Core to conduct a systematic review investigating the performance of US-FRAX for predicting incident fractures over 10years in Asian, Black, Hispanic, and White individuals. Six studies from the Women's Health Initiative (WHI) and Study of Osteoporotic Fractures (SOF) were eligible; cohorts only included women and were predominantly White (WHI > 80% and SOF > 99%), data were not consistently stratified by race and ethnicity, and when stratified there were far fewer fractures in Black and Hispanic women vs White women rendering area under the curve (AUC) estimates less stable. In the younger WHI cohort (n = 64 739), US-FRAX without bone mineral density (BMD) had limited discrimination for major osteoporotic fracture (MOF) (AUC 0.53 (Black), 0.57 (Hispanic), and 0.57 (White)); somewhat better discrimination for hip fracture in White women only (AUC 0.54 (Black), 0.53 (Hispanic), and 0.66 (White)). In a subset of the older WHI cohort (n = 23 918), US-FRAX without BMD overestimated MOF. The Task Force concluded that there is little justification for estimating fracture risk while incorporating race and ethnicity adjustments and recommends that fracture prediction models not include race or ethnicity adjustment but instead be population-based and reflective of US demographics, and inclusive of key clinical, behavioral, and social determinants (where applicable). Research cohorts should be representative vis-à-vis race, ethnicity, gender, and age. There should be standardized collection of race and ethnicity; collection of social determinants of health to investigate impact on fracture risk; and measurement of fracture rates and BMD in cohorts inclusive of those historically underrepresented in osteoporosis research.

A Case Study of Spontaneous Osteoporotic Vertebral Compression Fracture in an Elderly Man, Misdiagnosed in Initial Visits: Case Report

A Case Study of Spontaneous Osteoporotic Vertebral Compression Fracture in an Elderly Man, Misdiagnosed in Initial Visits: Case Report

Hybrid Optimization Model Integrating Gradient Descent and Stochastic Descent for Enhanced Osteoporosis and Osteopenia Recognition

Osteoporosis and osteopenia, prevalent bone diseases affecting millions of people globally, necessitate accurate early diagnosis for effective treatment and fracture prevention. This paper proposes a novel hybrid optimization algorithm tailored for classifying these conditions based on Bone Mineral Density (BMD) measurements. The algorithm, a customized Mini-Batch Gradient Descent (MBGD), blends the advantages of Gradient Descent (GD) and Stochastic Gradient Descent (SGD), addressing specific needs for osteoporosis and osteopenia classification. Utilizing a dataset comprising BMD measurements and clinical risk factors from the Osteoporotic Fractures in Men (MrOS), Study of Osteoporotic Fractures (SOF), and Fracture Risk Assessment (FRAX), the model achieves an impressive accuracy of 99.01%. The proposed model outperforms existing methods, demonstrating superior accuracy compared to the accuracy obtained in Gradient Descent of 97.26%, Stochastic Gradient Descent of 97.23%, and other optimization algorithms such as Adam of 96.45% and the RMSprop of 96.23%. This hybrid model presents a robust framework for early diagnosis of Osteoporosis and osteopenia, and hence there is an enhancement in quality of life.

Balancing fracture risk versus risk of mortality before fracture among women aged 80 years or older.

Most fractures occur in women aged ≥80 years but competing mortality unrelated to fracture may limit the benefit of osteoporosis drug therapy for some women in late life. Our primary aim was to develop separate prediction models for non-spine fracture (NSF) and mortality before fracture to identify subsets of women with varying fracture versus mortality risks. Separate prediction models were developed for NSF and mortality before NSF for 4895 women aged ≥80 years enrolled in the Study of Osteoporotic Fractures (SOF) or the Health Aging and Body Composition (HABC) study. Proportional hazards models modified to account for competing mortality were used to identify candidate risk factors for each outcome. Predictors associated with NSF or mortality (p < 0.2) were included in separate competing risk models to estimate the cumulative incidence of NSF and mortality before NSF during 5 years of follow-up. This process was repeated to develop separate prediction models for hip fracture and mortality before hip fracture. Significant predictors of NSF (race, total hip BMD, grip strength, prior fracture, falls, and use of selective serotonin reuptake inhibitors, benzodiazepines, or oral/transdermal estrogen) differed from predictors of mortality before NSF (age, walking speed, multimorbidity, weight change, shrinking, smoking, self-rated health, dementia, and use of warfarin). Within nine subsets of women defined by tertiles of risk, 5-year outcomes varied from 28% NSF and 8% mortality in the high-risk NSF/low-risk mortality subset, to 9% NSF and 22% mortality in the low-risk NSF/high-risk mortality subset. Similar results were seen for predictors of hip fracture and mortality before hip fracture. Considerable variation in 5-year competing mortality risk is present among women in late life with similar 5-year NSF risk. Both fracture risk and life expectancy should inform shared clinical decision-making regarding initiation or continuation of osteoporosis drug therapy for women aged ≥80 years.

Dietary Sodium Restriction and Frailty among Middle-Aged and Older Adults: An 8-Year Longitudinal Study.

Frailty is a common geriatric syndrome. However, there is little information about the relationship between dietary sodium restriction (DSR) and frailty in later life. This study aimed to elucidate the relationship between DSR and frailty in middle-aged and older adults. The 8-year follow-up data from the Taiwan Longitudinal Study on Aging, including 5131 individuals aged ≥50 years, were analyzed using random-effects panel logit models. DSR was evaluated by assessing whether the participants were told by a physician to reduce or avoid sodium intake from food. Three indices were used to measure frailty: the Study of Osteoporotic Fractures (SOF) index, the Fried index, and the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) index. Individuals with DSR were more likely to report frailty compared with those with non-DSR (SOF: adjusted odds ratio [AOR] = 1.82, 95% confidence interval [CI] = 1.46-2.27; Fried: AOR = 2.55, 95% CI = 1.64-3.98; FRAIL: AOR = 2.66, 95% CI = 1.89-3.74). DSR was associated with a higher likelihood of SBF (AOR = 2.61, 95% CI = 1.61-4.22). We identified a temporal trajectory in our study, noting significant participant reactions to both short- and mid-term DSR. Future research should address the balance between frailty risk and cardiovascular risk related to DSR.

Cystic Fibrosis in Adults: A Paradigm of Frailty Syndrome? An Observational Study.

This study aimed to assess the main clinical and anamnestic characteristics of adult Cystic Fibrosis (CF) patients and to evaluate the association of frailty with the CF genotyping classification. In an observational cross-sectional study, all ambulatory CF patients over 18 years old who received a diagnosis at the Regional Cystic Fibrosis Center for adults were enrolled and assessed by spirometry for respiratory function, by ADL and IADL for functional status, and by the Study of Osteoporotic Fractures (SOF) Index for frailty. The study population consisted of 139 CF patients (mean age 32.89 ± 10.94 years old, 46% women). Most of the subjects were robust (60.4%). The pre-frail/frail group was more frequently females (p = 0.020), had a lower BMI (p = 0.001), worse respiratory function, a higher number of pulmonary exacerbations/years, cycles of antibiotic therapy, and hospitalization (all p < 0.001) with respect to robust patients. The pre-frail/frail subjects used more drugs and were affected by more CF-related diseases (all p < 0.001). In relation to logistic regression, the best predictor of the pre-frail/frail status was a low FEV1 level. The CF patients show similarities to older pre-frail/frail subjects, suggesting that CF might be considered an early expression of this geriatric syndrome. This finding could help to better define the possible progression of CF, but overall, it could also suggest the usefulness employing of some tools used in the management and therapy of frailty subjects to identify the more severe CF subjects.

A protocol for the prospective study of urinary cadmium with risk of fracture, bone loss, and muscle loss.

Cadmium (Cd) is a heavy metal and natural element found in soil and crops with increasing concentrations linked to phosphate fertilizers and sewage sludge applied to crop lands. A large fraction of older US men and woman have documented Cd exposure. Cd exposure has proven health concerns such as risk of lung cancer from inhalation and impaired renal function; however, growing evidence suggests it also influences bone and muscle health. Given that low levels of Cd could affect bone and muscle, we have designed prospective studies using the two largest and most detailed US studies of bone health in older men and women: the Osteoporotic Fractures in Men Study and the Study of Osteoporotic Fractures. We are investigating the association of urinary cadmium (U-Cd), as a surrogate for long-term Cd exposure, with bone and muscle health. Building off suggestive evidence from mechanistic and cross-sectional studies, this will be the first well-powered prospective study of incident fracture outcomes, bone loss, and muscle loss in relation to U-Cd, an established biomarker of long-term Cd exposure. The following is a proposed protocol for the intended study; if successful, the proposed studies could be influential in directing future US policy to decrease Cd exposure in the US population similar to recent policies adopted by the European Union to limit Cd in fertilizers.

PROSPECTIVE MULTI-OMIC ANALYSIS OF HUMAN LONGEVITY COHORTS IDENTIFIES ANALYTE NETWORKS ASSOCIATED WITH LONGEVITY

Abstract Serum based biomarkers of longevity have long been sought to explain the mechanisms of healthy aging and longevity. Using a 1:3 case cohort design, the Longevity Consortium has produced untargeted mass spectrometry based proteomic and metabolomic datasets from serum of four cohorts with longevity status, defined as those that reached the age corresponding to the 98th percentile of survival using sex specific and birth cohort specific survival percentiles. The cohorts are the Osteoporotic Fractures in Men study, the Study of Osteoporotic Fractures, the Health, Aging, and Body Composition Study, and the Cardiovascular Health Study. In this study, we integrate metabolomics and proteomics using machine learning and system biology approaches to construct multi-omic signatures predictive of longevity and healthy aging. We identify networks enriched for biomarkers previously shown to be associated with longevity such as apolipoproteins, along with novel associations, and we further compare with our findings in a mouse omics LC dataset of molecular changes induced by life-extending interventions. We show substantial differences between male and female longevity networks. The study highlights the effectiveness of using integrative systems biology methods to capture the heterogeneity of underlying molecular aging phenotypes, in order to generate a robust signature of longevity. The identified biomarker signatures may have significant implications for the development of personalized interventions aimed at promoting healthy aging and preventing age-related diseases.

ASSOCIATION BETWEEN MULTIPLE FRAILTY INDICES AND CVD MORTALITY

Abstract Introduction Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk. Which frailty tool is ideal for risk stratification remains unclear. We calculated three frailty scores from the Million Veteran Program (MVP) and examined their association with mortality and CVD in older Veterans. Methods Participants were from MVP - a large, contemporary Veteran cohort study - and aged ≥50 years at baseline (2011-2018). The frailty scores used were: MVP-FI (36-item questionnaire deficit accumulation frailty index), VA-FI (31-item EHR index), and modified Study of Osteoporotic Fractures (mSOF; a physical frailty score). MVP-FI and VA-FI scores of ≤0.10 were robust, 0.11-0.20 pre-frail, and ≥0.21 frail; mSOF scores of 0 were robust, 1 pre-frail and ≥2 frail. Primary outcomes were all-cause and CVD mortality. Secondary outcomes were incident stroke, myocardial infarction (MI), and heart failure (HF). Cox regression was used to evaluate the association of frailty with outcomes. Results Among 190,688 participants, mean age was 69 ±9, 94% were male. By MVP-FI, 29% were robust, 42% pre-frail, and 29% frail. Hazard ratios (HR, 95% CI) for all-cause mortality were 1.66 (1.61-1.72) and 3.05 (2.95-3.16) for pre-frailty and frailty, respectively. For CVD mortality, HRs were 1.76 (1.65-1.88) and 3.65 (3.43-3.90) for pre-frailty and frailty. Hazards of stroke, MI, and HF also increased with greater frailty. VA-FI and mSOF yielded concordant results. Conclusion Irrespective of measure, frailty is associated with increased all-cause mortality and CVD event risk. Clinicians and researchers may consider the most convenient tool for available data to incorporate frailty into practice.

Combined Prognostic Impact of Two Quick Frailty Assessments in Acute Heart Failure

Introduction: We aimed to investigate the prognostic impact of frailty (defined by the Study of Osteoporotic Fracture [SOF] index and the Clinical Frailty Scale [CFS]) in hospitalized patients with acute decompensated heart failure (HF). Methods: A total of 1,053 patients over 75 years of age, who were primarily admitted to hospital with a diagnosis of acute decompensated HF, were enrolled. The prognostic value of frailty by the two tools for predicting all-cause mortality was analyzed using multivariate Cox regression models. Results: The incidence of frailty was 57.1% when using the SOF index, 37.6% when using the CFS, and 23.3% when using both tools. Frailty, via the SOF index or CFS, was an independent predictor of all-cause mortality in model 1, after adjustment for significantly associated factors by univariate analysis (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.04–1.84, p = 0.027; HR 1.53, 95% CI 1.15–2.05, p = 0.003, respectively), and in model 2, after adjustment for previously reported prognostic factors (HR 1.42, 95% CI 1.07–1.89, p = 0.015; HR 1.56, 95% CI 1.17–2.07, p = 0.002, respectively). Compared to non-frail patients, frail patients via both tools had a significantly higher incidence of all-cause mortality in models 1 (adjusted HR 2.16, 95% CI 1.42−3.29, p < 0.001) and 2 (adjusted HR 2.30, 95% CI 1.51−3.50, p < 0.001). Conclusions: Combined frailty screening using the SOF index and CFS contributed to stratify the risk of mortality in patients with acute decompensated HF.

Polysomnography derived sleep metrics and cognition in the Sleep and Dementia Consortium (SDC): a study of 5 population‐based cohorts

AbstractBackgroundGood sleep is essential for health, yet the role of sleep in dementia risk is incompletely understood. The Sleep and Dementia Consortium (SDC) was established to study associations between polysomnography (PSG)‐derived sleep metrics and the risk of dementia and related cognitive and brain MRI endophenotypes. This study presents the associations of sleep architecture and obstructive sleep apnea (OSA) with cognitive function across participating cohorts.MethodThe SDC curates data from five population‐based cohorts with methodologically consistent, overnight, home‐based PSG and neuropsychological assessments over 5 years of follow‐up. Cohorts include the Atherosclerosis Risk in Communities (ARIC) study, Cardiovascular Health Study (CHS), Framingham Heart Study (FHS), Osteoporotic Fractures in Men Study (MrOS), and Study of Osteoporotic Fractures (SOF). Global cognitive composite scores were derived from principal component analysis as the primary outcome. All sleep metrics were harmonized centrally and then distributed to the participating cohorts for cohort‐specific analysis using linear regression; study‐level estimates were pooled in random effects meta‐analyses. Results are adjusted for demographic variables, the time interval between the PSG and neuropsychological assessment (0‐5 years), body mass index, antidepressant use, and sedative medication use.ResultThe mean age of the cohorts ranged from 58 to 89 years (Figure 1) with a pooled sample of 5,946 participants. As shown in Figure 2, across cohorts, higher REM sleep percentage (pooled β±SE = 0.49±0.18 per % increase; p = 0.008) and Sleep Maintenance Efficiency (pooled β±SE = 0.08±0.03 per % increase; p = 0.01) were associated with better global cognition whereas OSA (Apnea‐hypopnea index [AHI] ≥ 5) was associated with worse global cognition (pooled β±SE = ‐0.06±0.02 vs. AHI&lt;5; p = 0.03). Differences in N3 sleep were not associated with cognition.ConclusionBetter sleep consolidation and higher REM sleep percentage were associated with better cognition whereas OSA was associated with worse cognition over 5‐years follow‐up. The role of interventions to improve sleep for maintaining cognitive function and potentially reduce dementia risk requires investigation.

Comparing four frailty assessment tools against seven-year mortality in the Malaysian elders longitudinal research study

AimSeveral frailty assessment tools are currently used in clinics and research, however, there appears to be a lack of head-to-head comparisons between these tools among older adults in developing countries. This study compared the Cardiovascular Health Study, Study of Osteoporotic Fractures, the Tilburg Frailty Indicator and the Canadian Study of Health and Aging frailty assessment tools and evaluated performance of these individual frailty assessment tools with mortality. MethodsThis prospective cohort study utilized stratified simple random sampling to recruit 1614 participants from the Malaysian Elders Longitudinal Research aged above 55 years within the Klang Valley region from 2013 to 2015. Individual items for the frailty tools, alongside baseline physical and cognitive measures were extracted from the initial survey. Mortality data up to 31 December 2020 were obtained through data linkage from the death registry data obtained from the Malaysian National Registration Department. ResultsData were available for over 1609 participants, age (68.92 ± 7.52) years and 57 % women, during recruitment. Mortality data revealed 13.4 % had died as of 31 December 2020. Five to 25 % of our study population fulfilled the criteria for frailty using all four frailty tools. This study found an increased risk of mortality with frailty following adjustments for potential factors of falls, total number of illnesses and cognitive impairment, alongside moderate to strong correlation and agreement between frailty tools. ConclusionFrailty was associated with increased mortality. All four frailty assessment tools can be used to assess frailty within the Malaysian older adult population. The four available tools, however, may not be interchangeable.

Abstract 15519: Frailty is Associated With Incident Heart Failure in US Veterans Across Multiple Frailty Indices: The Million Veteran Program

Introduction: Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk via overlapping mechanisms such as inflammation, insulin resistance, and cellular senescence. However, the association of frailty with incident heart failure (HF) has not been well characterized. We calculated three distinct frailty scores and examined their association with HF in the Million Veteran Program (MVP). Methods: Participants comprised U.S. Veterans aged 50 years or older at baseline (2011-2018) enrolled in the prospective MVP study who were free of HF. We calculated frailty using three validated approaches: primarily the 36-item MVP-frailty index (FI) based on questionnaire data, 31-item Veterans Administration-FI (VA-FI) EHR-based index, and the 3-item Study of Osteoporotic Fractures (SOF) physical frailty score. Incident HF was ascertained via ICD-9 and ICD-10 codes. Multivariable-adjusted Cox proportional hazards models were constructed to assess the association between frailty status via each index and incident HF. Results: Among 190,688 Veterans (aged 69 ±9 years, 94% male), using the MVP-FI frailty screening tool, 29% were robust, 42% were pre-frail, and 29% were frail. Frailty prevalence increased by age, from 27% among 50-59-year-olds to 42% among those 90 years or older. Over a mean follow-up of 6±2 years, 15,816 (8.3%) Veterans developed incident HF. Pre-frail and frail compared to robust Veterans had nearly a 1.5-fold and 3-fold hazard of HF, respectively. The VA-FI and SOF indices yielded concordant findings (Table). Conclusion Among US Veterans aged 50 years or older, frailty was associated with incident HF. A graded increase in the hazard of HF occurred with increasing level of frailty, irrespective of frailty tool used. The present analysis lays the groundwork for future studies needed to further define the role of frailty in the pathogenesis of HF and inform clinical interventions for prevention of frailty and downstream HF.

Feasibility of frailty screening among patients with advanced heart failure

BackgroundFrailty is common among patients with advanced heart failure (HF), and screening for frailty to guide care is recommended. Although multiple tools are available to screen for frailty, the feasibility...

Optimal objective measurement of physical function and its predictive capacity for mortality among community-dwelling older women.

Objective measurements of physcial function, including gait speed, handgrip strength, and the chair stand test, have been shown to have predictive capacity for negative health-related outcomes. The aim of this study was to examine campariatively which of these common assessments may be optimal in terms of their predictive capacity for mortality. A total of 9834 community-dwelling older women aged 65-89 years from the Study of Osteoporotic Fractures (SOF) were followed for 20 years. Gait speed, handgrip strength, and the chair stand test were measured every 2-4 years on up to 9 visits. All deaths were adjudicated. All three measurements of physical function were significantly associated with overall, cardiovascular disease and other mortality. Gait speed had the greatest magnitude of hazard ratios (HRs) for all outcomes of interest. A one-unit standard deviation increase in gait speed was associated with a 33% (HR = 0.67, 95% confidence interval [95% CI]: 0.64-0.70) lower risk for overall mortality, a 31% (HR = 0.69, 95% CI: 0.64-0.73) lower risk for cardiovascular disease mortality, a 15% (HR = 0.85, 95% CI: 0.78-0.92) lower risk for cancer mortality and a 42% (HR = 0.58, 95% CI: 0.55-0.62) lower risk for other mortality. Further examination of gait speed identified two cut-points (0.9 and 0.7 m/s) that were strongly indicative of increased mortality risk. Our large prospective study indicates that gait speed possesses a better prediction of mortality among older women compared with handgrip strength or the chair stand test. Using cut-points of 0.9 and 0.7 m/s can help identify older women at higher mortality risk, who may benefit from physical function improvement interventions. Geriatr Gerontol Int 2023; 23: 715-721.

Short Physical Performance Battery and Study of Osteoporotic Fractures Index in the Exploration of Frailty Among Older People in Cameroon.

Objectives: To investigate the relationship between the Short Physical Performance Battery (SPPB) and the Study of Osteoporotic Fractures (SOF) index. Methods: We present data from a cross-sectional survey conducted in Cameroon. Frailty was defined as an SOF index > 0. The sensitivity and specificity of the SPPB were investigated. Principal component analysis (PCA) was performed to assess the contribution of each subtest of the SPPB to the relationship with the SOF. Results: Among 403 people included (49.6% women), average age of 67.1 (±6.2) years, 35.7% were frail according to the SOF. After determining the best SPPB threshold for diagnosing frailty (threshold = 9, Se = 88.9%, Sp = 74.9%), 47.9% were frail according to the SPPB. The first dimension of PCA explained 55.8% of the variability in the data. Among the subtests of the SPPB, the chair stand test item was the component most associated with the SOF index. Conclusion: Despite the overlap between the SOF and the SPPB, our results suggest that a negative result on the five chair-stands test alone would be sufficient to suspect physical frailty.

Objective assessment of the association between frailty and sedentary behavior in older adults: a cross-sectional study

BackgroundGiven the inconsistent findings of the association between frailty and sedentary behavior in older adults, this cross-sectional study investigated the aforementioned association using four different frailty criteria and two sedentary behavior indices in older adults.MethodsData from older adults (age ≥ 65 y) who participated in health examinations or attended outpatient integrated clinics at a medical center in Taipei, Taiwan, were collected. Frailty was measured using the modified Fried Frailty Phenotype (mFFP), Clinical Frailty Scale in Chinese Translation (CFS-C), Study of Osteoporotic Fractures (SOF) index, and Clinical Frailty-Deficit Count (CF-DC) index; sedentary behavior was assessed with a waist-worn accelerometer. Adjusted linear regression ascertained the association between frailty and both sedentary behavior outcomes.ResultsAmong the 214 participants (mean age 80.82 ± 7.14 y), 116 were women. The average total sedentary time and number of sedentary bouts were 609.74 ± 79.29 min and 5.51 ± 2.09 times per day, respectively. Frail participants had a longer total sedentary time (odds ratio [OR]: 30.13, P = .01 and 39.43, P < .001) and more sedentary bouts (OR: 3.50 and 5.86, both P < .001) on mFFP and CFS-C assessments, respectively. The SOF index revealed more sedentary bouts among frail than in robust participants (OR: 2.06, P = .009), without a significant difference in the total sedentary time. Frail participants defined by the CF-DC index were more likely to have frequent sedentary bouts (OR: 2.03, P = .016), but did not have a longer total sedentary time.ConclusionsRegardless of the frailty criteria adopted, frailty was positively associated with the number of sedentary bouts per day in older adults. A significant correlation between frailty and total sedentary time was detected only with mFFP and CFS-C indices. Further research may target decreasing the sedentary bouts in older adults as a strategy to improve frailty.

Sleep Architecture, Obstructive Sleep Apnea, and Cognitive Function in Adults

Good sleep is essential for health, yet associations between sleep and dementia risk remain incompletely understood. The Sleep and Dementia Consortium was established to study associations between polysomnography (PSG)-derived sleep and the risk of dementia and related cognitive and brain magnetic resonance imaging endophenotypes. To investigate association of sleep architecture and obstructive sleep apnea (OSA) with cognitive function in the Sleep and Dementia Consortium. The Sleep and Dementia Consortium curated data from 5 population-based cohorts across the US with methodologically consistent, overnight, home-based type II PSG and neuropsychological assessments over 5 years of follow-up: the Atherosclerosis Risk in Communities study, Cardiovascular Health Study, Framingham Heart Study (FHS), Osteoporotic Fractures in Men Study, and Study of Osteoporotic Fractures. Sleep metrics were harmonized centrally and then distributed to participating cohorts for cohort-specific analysis using linear regression; study-level estimates were pooled in random effects meta-analyses. Results were adjusted for demographic variables, the time between PSG and neuropsychological assessment (0-5 years), body mass index, antidepressant use, and sedative use. There were 5946 participants included in the pooled analyses without stroke or dementia. Data were analyzed from March 2020 to June 2023. Measures of sleep architecture and OSA derived from in-home PSG. The main outcomes were global cognitive composite z scores derived from principal component analysis, with cognitive domains investigated as secondary outcomes. Higher scores indicated better performance. Across cohorts, 5946 adults (1875 females [31.5%]; mean age range, 58-89 years) were included. The median (IQR) wake after sleep onset time ranged from 44 (27-73) to 101 (66-147) minutes, and the prevalence of moderate to severe OSA ranged from 16.9% to 28.9%. Across cohorts, higher sleep maintenance efficiency (pooled β per 1% increase, 0.08; 95% CI, 0.03 to 0.14; P < .01) and lower wake after sleep onset (pooled β per 1-min increase, -0.07; 95% CI, -0.13 to -0.01 per 1-min increase; P = .02) were associated with better global cognition. Mild to severe OSA (apnea-hypopnea index [AHI] ≥5) was associated with poorer global cognition (pooled β, -0.06; 95% CI, -0.11 to -0.01; P = .01) vs AHI less than 5; comparable results were found for moderate to severe OSA (pooled β, -0.06; 95% CI, -0.11 to -0.01; P = .02) vs AHI less than 5. Differences in sleep stages were not associated with cognition. This study found that better sleep consolidation and the absence of OSA were associated with better global cognition over 5 years of follow-up. These findings suggest that the role of interventions to improve sleep for maintaining cognitive function requires investigation.

Advantages and Disadvantages of Random Forest Models for Prediction of Hip Fracture Risk Versus Mortality Risk in the Oldest Old.

Targeted fracture prevention strategies among late-life adults should balance fracture risk versus competing mortality risk. Models have previously been constructed using Fine-Gray subdistribution methods. We used a machine learning method adapted for competing risk survival time to evaluate candidate risk factors and create models for hip fractures and competing mortality among men and women aged 80 years and older using data from three prospective cohorts (Study of Osteoporotic Fractures [SOF], Osteoporotic Fracture in Men study [MrOS], Health Aging and Body Composition study [HABC]). Random forest competing risk models were used to estimate absolute 5-year risk of hip fracture and absolute 5-year risk of competing mortality (excluding post-hip fracture deaths). Models were constructed for both outcomes simultaneously; minimal depth was used to rank and select variables for smaller models. Outcome specific models were constructed; variable importance was used to rank and select variables for inclusion in smaller random forest models. Random forest models were compared to simple Fine-Gray models with six variables selected a priori. Top variables for competing risk random forests were frailty and related components in men while top variables were age, bone mineral density (BMD) (total hip, femoral neck), and frailty components in women. In both men and women, outcome specific rankings strongly favored BMD variables for hip fracture prediction while frailty and components were strongly associated with competing mortality. Model discrimination for random forest models varied from 0.65 for mortality in women to 0.81 for hip fracture in men and depended on model choice and variables included. Random models performed slightly better than simple Fine-Gray model for prediction of competing mortality, but similarly for prediction of hip fractures. Random forests can be used to estimate risk of hip fracture and competing mortality among the oldest old. Modest gains in performance for mortality without hip fracture compared to Fine-Gray models must be weighed against increased complexity. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Comparative study of senile osteoporotic intertrochanteric fractures using Asian proximal femoral nail with and without proximal reaming.

Comparative study of senile osteoporotic intertrochanteric fractures using Asian proximal femoral nail with and without proximal reaming.