Comorbidities only account for a small proportion of excess mortality after fracture: A record linkage study of individual fracture types

Background: Non-hip non-vertebral fractures (NHNV) constitute the majority of osteoporotic fractures but few studies have examined the association between these fractures, co-morbidity and mortality. Objective: To examine the relationship between individual non-hip non-vertebral fractures, co-morbidities and mortality. Methods: Prospective population-based cohort of 267,043 subjects (45 and Up Study, Australia) had baseline questionnaires linked to hospital administrative and all-cause mortality data from 2006 - 2013. Associations between fracture and mortality examined using multivariate, time dependent Cox models, adjusted for age, prior fracture, body mass index, smoking and co-morbidities (cardiovascular disease, diabetes, stroke, thrombosis and cancer) and survival function curves. Population attributable fraction calculated for each level of risk exposure. Results: During 1,490,651 person-years, women and men experienced 7,571 and 4,571 fractures and 7,064 deaths and 11,078 deaths, respectively. In addition to hip and vertebral fractures, pelvis, humerus, clavicle, rib, proximal tibia/fibula, elbow and distal forearm fractures in both sexes, and ankle fractures in men, were associated with increased multivariable adjusted mortality hazard ratios ranging from 1.3 to 3.4. Co-morbidity independently added to mortality such that a woman with a humeral fracture and one co-morbidity had a similarly reduced 5 year survival to that of a woman with a hip fracture and no co-morbidities. Population mortality attributable to any fracture without co-morbidity was 9.2% in women and 5.3% in men. Conclusion: All proximal non-hip, non-vertebral fractures in women and men were associated with increased mortality risk. Co-existent co-morbidities independently further increased mortality. Population attributable risk for mortality for fracture was similar to cardiovascular disease and diabetes, highlighting their importance and potential benefit for early intervention and treatment

New Technologies, New Identities, and the Growth of Mass Opposition in the Arab Spring

The recent revolutions known as the Arab Spring have been characterized as the products of social media. However, there is an alternative view that revolution takes place on the street or the battlefield and that the role of social media has been overstated. We argue that some new technologies can serve to facilitate rapid social change when they provide ways to overcome restrictions on the freedoms of expression and association. In doing so, communication technologies enable the formation of new social identities that can challenge existing social orders by promoting the growth of a social movement that is positioned as loyal to the nation and its people but opposed to the government. Our analyses focus on the role of social media in spreading video images of dissent and the links between this video material, satellite television, and mobile telephones in Tunisia and Egypt

Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation in a fracture liaison service setting: A prospective cohort study

Objective: Osteoporotic fragility fractures, that are common in men and women, signal increased risk of future fractures and of premature mortality. Less than one-third of postmenopausal women and fewer men are prescribed active treatments to reduce fracture risk. Therefore, in this study the association of oral bisphosphonate recommendation with subsequent fracture and mortality over eight years in a fracture liaison service setting was analysed. Materials and methods: In this prospective cohort study, 5011 men and women aged \u3e50 years, who sustained a clinical fracture, accepted the invitation to attend the fracture liaison service of the West Glasgow health service between 1999 and 2007. These patients were fully assessed and all were recommended calcium and vitamin D. Based on pre-defined fracture risk criteria, 2534 (50.7%) patients were additionally also recommended oral bisphosphonates. Mortality and subsequent fracture risk were the pre-defined outcomes analysed using Cox proportional hazard models. Results: Those recommended bisphosphonates were more often female (82.9 vs. 72.4%), were older (73.4 vs. 64.4 years), had lower bone mineral density T-score (-3.1 vs. -1.5) and more had sustained hip fractures (21.7 vs. 6.2%; p \u3c 0.001). After adjustments, patients recommended bisphosphonates had lower subsequent fracture risk (Hazard Ratio (HR): 0.60; 95% confidence interval (CI): 0.49±0.73) and lower mortality risk (HR: 0.79, 95%CI: 0.64±0.97). Conclusion: Of the patients, who are fully assessed after a fracture at the fracture liaison service, those with higher fracture risk and a recommendation for bisphosphonates had worse baseline characteristics. However, after adjusting for these differences, those recommended bisphosphonate treatment had a substantially lower risk for subsequent fragility fracture and lower risk for mortality. These community-based data indicate the adverse public health outcomes and mortality impacts of the current low treatment levels post fracture could be improved by bisphosphonate recommendation for both subsequent fracture and mortality

Breaking down the language of racism:a computerised linguistic analysis of racist groups’ self-defining online statements

The Internet represents a powerful tool for racist groups to build a sense of group consciousness and promote their cause. In the current study, we examined the language used by racist (n = 87), anti-racist (n = 50), and nonactivist (n = 1379) groups when describing their self-defining beliefs online. We used computerized linguistic analysis software to measure psychological indicators and antecedents of group consciousness and to examine the persuasive techniques used in online group communication. Racist and anti-racist groups were similar on some linguistic indicators of group consciousness (e.g., use of words reflecting perceived injustice), but differed on others (e.g., use of words reflecting group identification). Linguistic indicators of antecedents of group consciousness (moral foundations and focus on religion) differed across groups, with racist groups focused more on purity, respect for authority, and religion, and less on fairness than anti-racist groups. Racist groups also used less cognitively complex language than nonactivist groups (but similar levels to anti-racist groups). Our results contribute to understanding how racist groups promote their self-defining beliefs online, and identify several key factors that should be considered when designing policies to reduce racist groups' growth and impact

External validation of the Garvan nomograms for predicting absolute fracture risk: The Tromso study

Background: Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort. Methods: The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed.Reclassification analysis was used to compare the models performance. Results: The incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture. Conclusions: The Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction

Challenges in assessing the nature of effective collaboration in blended university courses

The ability to collaborate effectively face-to-face and online represents a critical skill for university graduates. However, there are still challenges regarding how to accurately assess this skill through traditional student learning measures. To better understand the nature of effective collaboration of university students in blended courses, the current study drew on the student approaches to learning framework and social network analysis techniques. We examined how student approaches to inquiry, approaches to online learning technologies, perceptions of the blended learning environment, different learning outcomes and configurations of collaboration are related. The methodologies commonly used in student approaches to learning research identified deep and surface approaches to inquiry and technologies, positive and negative perceptions of the integration of the learning environment, and of online workload, which also showed logical alignment with relatively better and poorer academic achievement in the course. Based on approaches, perceptions, and learning outcomes, students were divided into groups orientated towards understanding versus reproducing learning. The social network analysis techniques revealed features of different configurations of collaborations by different groups of students and their choices as to whether and with whom to collaborate during the learning process. Nuanced differences were found amongst different configurations of collaborations. © 2021 Articles published in the Australasian Journal of Educational Technology (AJET). All Rights Reserved

Contralateral hip fractures and other osteoporosis-related fractures in hip fracture patients: Incidence and risk factors. An observational cohort study of 1,229 patients

Purpose: To report risk factors, 1-year and overall risk for a contralateral hip and other osteoporosis-related fractures in a hip fracture population. Methods: An observational study on 1,229 consecutive patients of 50 years and older, who sustained a hip fracture between January 2005 and June 2009. Fractures were scored retrospectively for 2005-2008 and prospectively for 2008-2009. Rates of a contralateral hip and other osteoporosis- related fractures were compared between patients with and without a history of a fracture. Previous fractures, gender, age and ASA classification were analysed as possible risk factors. Results: The absolute risk for a contralateral hip fracture was 13.8 %, for one or more osteoporosis-related fracture( s) 28.6 %. First-, second- and third-year risk for a second hip fracture was 2, 1 and 0 %. Median (IQR) interval between both hip fractures was 18.5 (26.6) months. One-year incidence of other fractures was 6 %. Only age was a risk factor for a contralateral hip fracture, hazard ratio (HR) 1.02 (1.006-1.042, p = 0.008). Patients with a history of a fracture (33.1 %) did not have a higher incidence of fractures during follow-up (16.7 %) than patients without fractures in their history (14 %). HR for a contralateral hip fracture for the fracture versus the non-fracture group was 1.29 (0.75-2.23, p = 0.360). Conclusion: The absolute risk of a contralateral hip fracture after a hip fracture is 13.8 %, the 1-year risk was 2 %, with a short interval between the 2 hip fractures. Age was a risk factor for sustaining a contralateral hip fracture; a fracture in history was not

Associations of Type 2 Diabetes, Body Composition, and Insulin Resistance with Bone Parameters: The Dubbo Osteoporosis Epidemiology Study.

Type 2 diabetes (T2D) may be associated with increased risk of fractures, despite preserved bone mineral density (BMD). Obesity and insulin resistance (IR) may have separate effects on bone turnover and bone strength, which contribute to skeletal fragility. We characterized and assessed the relative associations of obesity, body composition, IR, and T2D on bone turnover markers (BTMs), BMD, and advanced hip analysis (AHA). In this cross-sectional analysis of Dubbo Osteoporosis Epidemiology Study, 525 (61.3% women) participants were grouped according to T2D, IR (homeostasis model assessment insulin resistance [HOMA-IR] </≥2.5), and BMI (</≥25 kg/m2): insulin-sensitive lean (IS-L), insulin-sensitive overweight/obese (IS-O), insulin-resistant (IR), and T2D. BMD, AHA, and body composition, including visceral adipose tissue (VAT) (on dual-energy x-ray absorptiometry scan) and fasting BTMs, were assessed. Analyses performed using Bayesian model averaging and principal component analysis. T2D was associated with low BTMs (by 26%-30% [95% confidence interval [CI] 11%-46%] in women, 35% [95% CI 18%-48%] in men compared to IS-L), which persisted after adjustment for VAT. BTMs were similar among IR/IS-O/IS-L. BMD was similar among T2D/IR/IS-O; BMD was low only in IS-L. All groups were similar after adjustment for BMI. Similarly, AHA components were lowest in IS-L (attenuated following adjustment). On multivariate analysis, T2D was independently associated with BTMs. IR was also associated with C-terminal telopeptide of type 1 collagen in men. Age and body size were the strongest independent contributors to BMD and AHA. VAT was inversely associated with section modulus, cross-sectional area, cross-sectional moment of inertia in women, and hip axis length in men. Low bone turnover is associated with T2D and IR (in men), while BMD and hip strength/geometry are predominantly associated with body size. VAT, indicative of dysglycemia, is also associated with impaired bone geometry. Establishing the role of BTMs and AHA fracture risk may improve skeletal assessment in T2D people. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research

Nonstandard lumbar region in predicting fracture risk

Background: Femoral neck BMD is the most commonly used skeletal site to estimate fracture risk. The role of lumbar spine BMD in fracture risk prediction is less clear due to osteophytes that spuriously increase LS BMD, particularly at lower levels. The aim of this study was to compare fracture predictive ability of upper L1-L2 BMD compared to standard L2-L4 BMD and assess whether the addition of either lumbar spine site could improve fracture prediction over FN BMD. Methodology: A prospective cohort of 3016 women and men 60+ years from the Dubbo Osteoporosis Epidemiology Study followed for occurrence of minimal trauma fractures from 1989 to 2014. DXA was used to measure bone mineral density at f L1-L2, L2-L4 and FN at baseline. Fracture risks were estimated using Cox proportional hazards models separately for each site. Predictive performances were compared using ROC curve analyses Results:There were 565 women and 179 men with a minimal trauma fracture during a mean of 11±7 years. L1-L2 BMD T-score was significantly lower than L2-L4 T-score in both genders (p Conclusion: In an elderly population, L1-L2 is as good as but not better than L2-L4 site in predicting fracture risk. The addition of LS BMD to FN BMD provided a modest additional benefit in overall fracture risk. Further studies in individuals with spinal degenerative disease are needed

Environmental framing and left-wing political orientation promote sustainability in a US-based common-pool resource dilemma

Little research has explored whether framing effects differ based on political orientation in a Common-Pool Resource (CPR) dilemma. In this research, American Democrats and Republicans (N = 266 individuals recruited via Prolific Academic) played an online CPR game, FISH, framed either as an Environment Game (environment framing) or a Fishing Game (neutral framing). In groups of four, participants harvested fish from a shared ocean over eight seasons earning $.10 per fish caught. Unbeknownst to the participants, their three groupmates were in fact computerised players (bots). The interaction between political orientation as a dichotomous model (Democrat versus Republican) and framing condition was not significant. However, those playing the Environment Game were significantly more cooperative in the first season of play and across all seasons played than those playing the Fishing Game. Additionally, Democrats cooperated significantly more than Republicans in the first season, but not across all seasons played. Exploratory analyses show that the strength of a participant's political orientation affected cooperation to some degree, with strong Democrats playing the Environment Game cooperating at significantly higher rates than both strong Democrats playing the Fishing Game and strong Republicans in both framing conditions. Moderate Democrats and moderate Republicans cooperated comparably across all framing conditions.</p