Kristine E. Ensrud, MD, MPH

Long-term physical functioning trajectories following distal forearm fracture are unknown. We found that women with versus those without distal forearm fracture were more likely to experience a 5-year decline in physical functioning, independent of initial physical functioning level. This association was most evident among women 80 years and older.IntroductionPhysical functioning trajectory following lower arm or wrist fracture is not well understood.PurposeThis study is to evaluate physical functioning trajectory before vs. after lower arm or wrist fracture, stratified by age.MethodsWe performed a nested case–control study of prospective data from the Women’s Health Initiative Study (n = 2097 cases with lower arm or wrist fracture, 20,970 controls). Self-reported fractures and the physical functioning subscale of the RAND 36-item Short-Form Health Survey were assessed annually. We examined three physical …

Background 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. Methods 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 …

Context Serum 25-hydroxyvitamin D (25(OH)D) is the current marker of vitamin D adequacy, but its relationship with bone health has been inconsistent. The ratio of 24,25-dihydroxyvitamin D3 to 25(OH)D3 (vitamin D metabolite ratio or VMR) is a marker of vitamin D that has been associated with longitudinal changes in bone mineral density (BMD) and fracture risk. Objective High-resolution peripheral quantitative computed tomography (HR-pQCT) provides information on bone health beyond standard dual-energy x-ray absorptiometry, in that it measures volumetric BMD (vBMD) as well bone strength. The relationship of the VMR with vBMD and bone strength remains unknown. Methods We evaluated the associations of the VMR and 25(OH)D3 with vBMD and bone strength in the distal radius and tibia, assessed by HR-pQCT in 545 older men participating …

Introduction Depression is a leading cause of disability in older adults, yet it remains underdiagnosed and undertreated. Establishing common multivariable sleep health profiles may eventually help to identify at-risk older adults and match them with appropriate treatments. However, profiles identified across cohorts often differ because of inconsistent measures and methods, hampering progress towards large-scale initiatives. We aimed to overcome this challenge using harmonized data across six cohorts. Methods We harmonized five self-report sleep health indicators across six epidemiologic cohorts of adults aged >60 from the United States and Netherlands (N=613 - 3,123). We performed latent class analysis in each cohort. Generalizability and comparability of findings were assessed using several indices, including cluster stability and novel distance metrics. Generalized …

Introduction Self-reported sleep measures are widely used in epidemiology research and may be influenced by a variety of factors, potentially introducing measurement error. We examined the one-year test/re-test concordance and validity of survey-assessed sleep duration. Methods The Activity Validation Sub Study (AVSS) included 751 participants of the Cancer Prevention Study-3 study to further investigate rest/activity cycles. Sleep duration was collected using three methods survey, Daysimeter device, and sleep diary. Survey-assessed sleep duration was collected in categorical and continuous formats. Selected participants (n=170) were asked to wear a device for seven consecutive days for two non-consecutive quarters and recorded sleep duration in sleep diaries for each night. Of the 170 study participants assigned a device, participants were …

Background Time awake with advancing age is increasingly spent sedentary and has several negative health consequences. We examined associations between the frequency of daily sedentary and active bouts with all‐cause mortality. Methods Data are from 2816 men in the Osteoporotic Fractures in Men (MrOS) Study (mean age ± SD: 79.1 ± 5.2 years) with free‐living activity monitor (SenseWear® Pro3 Armband) data (5.1 ± 0.3 days worn >90%) at the Year 7 visit (2007–2009). Sedentary bout frequency was defined as the number of sedentary bouts per day lasting 5+ min to activity of any intensity. Active bout frequency was defined as the number of active bouts per day lasting 5+ min to sedentary behavior. Sleep time was excluded from the analysis. Deaths were centrally adjudicated using death certificates. Cox proportional hazard models were used to separately examine associations between …

Background Multimorbidity is common among fracture patients. However, its association with osteoporosis investigation and treatment to prevent future fractures is unclear. This limited knowledge impedes optimal patient care. This study investigated the association between multimorbidity and osteoporosis investigation and treatment in persons at high risk following an osteoporotic fracture. Methods and findings The Sax Institute’s 45 and Up Study is a prospective population-based cohort of 267,153 people in New South Wales, Australia, recruited between 2005 and 2009. This analysis followed up participants until 2017 for a median of 6 years (IQR: 4 to 8). Questionnaire data were linked to hospital admissions (Admitted Patients Data Collection (APDC)), emergency presentations (Emergency Department Data Collection (EDDC)), Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS). Data were linked by the Centre for Health Record Linkage and stored in a secured computing environment. Fractures were identified from APDC and EDDC, Charlson Comorbidity Index (CCI) from APDC, Dual-energy X-ray absorptiometry (DXA) investigation from MBS, and osteoporosis treatment from PBS. Out of 25,280 persons with index fracture, 10,540 were classified as high-risk based on 10-year Garvan Fracture Risk (age, sex, weight, prior fracture and falls) threshold ≥20%. The association of CCI with likelihood of investigation and treatment initiation was determined by logistic regression adjusted for education, socioeconomic and lifestyle factors). The high-risk females and males averaged 77 ± 10 and 86 ± 5 years …

Study Objectives To assess the association between psychotropic medications and sleep microstructure in large community-based cohorts of older people. Methods We analyzed overnight polysomnograms of 381 women from the Study of Osteoporotic Fractures (SOF) and 2,657 men from the Osteoporotic Fractures in Men Sleep Study (MrOS), who either used no psychotropic medication (n = 2,819), only benzodiazepines (n = 112), or only selective serotonin reuptake inhibitors (SSRI) (n = 107). Sleep microstructure (cyclic alternating pattern, CAP) was compared between the no medication group and psychotropic medication groups using the Mann-Whitney U test. Significant differences were investigated using multivariable linear regression adjusted for confounders. Results CAP rate, arousal index, apnea-hypopnea index, and the frequency of slow, low-amplitude electroencephalography activation phases were …