Forearm bone mineral density and incidence of hip fractures in Swedish urban and rural men 1987-2002

Background: It is not known whether the recently described break in the trend in hip fracture incidence in many settings applies in both women and men, depends on changes in bone mineral density (BMD) or changes in other risk factors, or whether it is apparent in both urban and rural settings. Methods: We evaluated changes in annual hip fracture incidence from 1987 to 2002 in Swedish men aged ≥60 years in one urban (n=25,491) and one rural population (n=16,432) and also secular differences in BMD, measured by single-photon absorptiometry at the distal radius and multiple other risk factors for hip fracture in a population-based sub-sample of the urban and the rural men aged 60–80 years in 1988/89 (n=202 vs. 121) and in 1998/99 (n=79 vs. 69). Results: No statistically significant changes in the annual age-adjusted hip fracture incidence per 10,000 were apparent from 1987 to 2002 in urban (0.38 per year, 95% CI-0.12 to 0.88) or rural men (-0.05 per year, 95% CI -0.63 to 0.53). BMD was similar in 1988/89 and 1998/99 when examining both urban (-19.6 mg/cm², 95% CI -42.6 to 3.5) and rural (-23.0 mg/cm², 95% CI -52.1 to 6.1) men. Conclusions: Since no secular change in age-adjusted hip fracture incidence was found during the study period, a levelling off in hip fracture incidence is present also in Swedish men. Because BMD on a group level was similar in 1988/89 and 1998/99, changes in other risk factors ought to be either of minor importance or counteracted by changes in different risk factors.

Osteo-cise : Strong bones for life': protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures

Background : Osteoporosis affects over 220 million people worldwide, and currently there is no 'cure' for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition.

Methods : The 'Osteo-cise: Strong Bones for Life' study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function, and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged 60 years or above will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month 'research to practise' translational phase. Participants will be randomly assigned to either the 'Osteo-cise' intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test). Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back maximal muscle strength, balance and function (four square step test, functional reach test, timed up-and-go test and 30-second sit-to-stand), falls incidence and health-related quality of life. Cost-effectiveness will also be assessed.

Discussion : The findings from the Osteo-cise: Strong Bones for Life study will provide new information on the efficacy of a targeted multi-modal community-based exercise program incorporating high velocity resistance training, together with an osteoporosis education and behavioural change program for improving multiple risk factors for falls and fracture in older adults at risk of fragility fracture. Trial Registration: Australian New Zealand Clinical Trials Registry reference ACTRN12609000100291

Vitamin D and the musculoskeletal health of older adults

The scientific literature related to vitamin D and bone health in older adults is extensive.

This article aims to summarise key practice points regarding vitamin D and bone health in older adults, relevant to general practitioners, and to provide an overview of the background literature to enable GPs to appreciate the extent of the supporting evidence.

Vitamin D supplementation can prevent falls, particularly in the vitamin D deficient elderly. However, adequate vitamin D levels and dietary calcium intake are needed for effective primary fracture prevention with greatest benefits occurring in the elderly with vitamin D deficiency and/or low dietary calcium intakes. For secondary fracture prevention, ie. preventing further fractures in the elderly who have already sustained a fragility fracture, specific anti-osteoporosis treatment is necessary. However, to maximise the benefits of these medications, vitamin D deficiency should be corrected and adequate dietary calcium consumed.

Musculoskeletal deterioration in men accompanies increases in body fat

Objective
To examine body fat and musculoskeletal changes in men over 5 years.

Methods
Body composition was evaluated for men in the Geelong Osteoporosis Study using whole body dual energy X-ray absorptiometry (DXA) during two time-periods. DXA was performed for 1329 men (25-96 years) during 2001-2006 and for 900 men (25-98 years), 2006-2011. The masses of fat, lean, and bone were expressed relative to the square of height (kg/m2). Each compartment was also expressed as a percentage relative to body weight (%fat, %lean, %bone).

Results
Mean BMI increased from 26.9 kg/m2 in 2001-2006, to 27.2 kg/m2 in 2006-2011 (P = 0.04). Mean fat mass increased by 9.0% from 6.98 kg/m2 (95%CI 6.84-7.11) in 2001-2006, to 7.60 kg/m2 (7.44-7.77) in 2006-2011 (P < 0.001); mean lean mass decreased by 0.9%, from 18.92 kg/m2 (18.83-19.01) to 18.75 kg/m2 (18.64-18.86) (P = 0.02), and mean bone mass decreased 1.6% from 1.041 kg/m2 (1.034-1.047), to 1.024 kg/m2 (1.016-1.032). Mean %fat increased from 23.4% to 25.2%, mean %lean decreased from 72.6% to 70.9% and mean %bone decreased from 4.0% to 3.9% (all P < 0.05).

Conclusions
An increase in BMI, which reflects a substantial increase in body fat mass and declines in both lean and bone mass was reported. This may have implications for future development of bone fragility, sarcopenia, and sarcopenic obesity.

Development in a fragile pariah state: Myanmar 1990-2010

Myanmar was not only a ‘fragile state’ by most definitions during the 1990s and 2000s, but was concurrently isolated as an international ‘pariah’. The complexity of this paradoxical combination of poverty, fragility, pro-economic growth polity and international isolation created an enigmatic context for international agencies, and one in which existing frameworks for development in ‘fragile states’ do not appear overly relevant. Nonetheless, Myanmar experienced a surprising level of development activity, with equally surprising signs of effectiveness. This paper explores this activity, identifying actors, roles, approaches, and modalities of interaction with structures and authorities found to be most effective. The paper is divided into four sections, offering an overview of the historical context, summarising field observations, considering the effectiveness of interventions, and discussing these observations in the light of fragile state policy.

Development in Kyrgyzstan : Failed State or Failed Statebuilding?

This chapter examines the tensions present in approaches to development in Kyrgyzstan. It argues that development in this small post-Soviet republic has been approached primarily as formal statebuilding (Marquette & Beswick 2011), implying a belief that domestic political institutions and processes are the primary cause of fragility and that the adoption of democratic institutions and free market economic policies will result in development. The consequences of this inherently normative endeavour are explored in terms of the local political economy that has developed since independence and especially in the 2000s. Centrally, it is demonstrated how the competing interests and priorities of donors and local elite have undermined development efforts. On the basis of this analysis, it is suggested that rather than being framed as a failing or failed state, Kyrgyzstan is better understood as a case of failed statebuilding that cannot be remedied by the adoption of the current principles for development in fragile states situations, as adopted by the international community. Instead, the focus needs to be on facilitating the rebuilding of state-society relations both locally and internationally with a view to beginning to check the marketization of the state that has occurred.

Persistence, capital account openness, and financial sector health in exchange rate regime choice

This paper investigates empirically the persistence in exchange rate regimes as well as the role of capital account openness and financial sector health (measured by financial development and financial sector fragility) in exchange rate regime determination for a panel of 143 countries covering the post-Bretton Woods period. The results demonstrate that while low- and high-income countries exhibit highly persistent exchange rate regimes, middle-income countries display relatively lower persistence. For middle-income countries, capital account openness and the level of financial development play important roles in exchange rate regime choice. The fragility of the financial sector does not affect the exchange rate regime determination.

TWEI 2.0 (Type will ease itself 2.0)

TWEI 2.0 (Type will ease itself 2.0) is a newly developed artefact of inquiry that engages the reproductions of memory, meaning and experience. The work offers a new typographic mark-making proposal salvaged from ordinary articles common to routines of the everyday – street and road signage, maps, and GPS coordinates. Our experience of these articles offer familiar patterns of recognition and sites for meaning making. We keep hold of and remember the traces of colour, marks and symbols as a means to retain our experiences of places and sites of meaning. In this work TWEI 2.0 positions a cartographic reproduction of digital histories, which have been repurposed from landscapes in Kuwait and Oman. The digital based work will be projected in a large format so to be physically realized on an architectural scale representative of large maps in the gallery environment. This scenario offers a vision that is as inescapable as the signage from which it comments on and offers a consideration of the gallery wall as both a boundary for experience and the production of a site of meaning. The work in this space physically presents an installation that seeks to be at both overwhelming and intimate. Here the artist pursues direct engagement with the audience as a practice of social meaning and partnership providing a direct correlation to our familiarities with common physical signage and sign posting of our streets, corners and roads. In achieving this TWEI 2.0 proposes to highlight the fragility of meaning and the brittleness of memories.

The epidemiology of incident fracture from cradle to senescence

To reduce the burden of fracture, not only does bone fragility need to be addressed, but also injury prevention. Thus, fracture epidemiology irrespective of degree of trauma is informative. We aimed to determine age-and-sex-specific fracture incidence rates for the Barwon Statistical Division, Australia, 2006-2007. Using radiology reports, incident fractures were identified for 5342 males and 4512 females, with incidence of 210.4 (95 % CI 204.8, 216.2) and 160.0 (155.3, 164.7)/10,000/year, respectively. In females, spine (clinical vertebral), hip (proximal femoral) and distal forearm fractures demonstrated a pattern of stable incidence through early adult life, with an exponential increase beginning in postmenopausal years for fractures of the forearm followed by spine and hip. A similar pattern was observed for the pelvis, humerus, femur and patella. Distal forearm, humerus, other forearm and ankle fractures showed incidence peaks during childhood and adolescence. For males, age-related changes mimicked the female pattern for fractures of the spine, hip, ribs, pelvis and humerus. Incidence at these sites was generally lower for males, particularly among the elderly. A similar childhood-adolescent peak was seen for the distal forearm and humerus. For ankle fractures, there was an increase during childhood and adolescence but this extended into early adult life; in contrast to females, there were no further age-related increases. An adolescent-young adult peak incidence was observed for fractures of the face, clavicle, carpal bones, hand, fingers, foot and toe, without further age-related increases. Examining patterns of fracture provides the evidence base for monitoring temporal changes in fracture burden, and for identifying high-incidence groups to which fracture prevention strategies could be directed.

Highly-twisted, continuous nanofibre yarns prepared by a hybrid needle-needleless electrospinning technique

Nanofibres prepared by electrospinning have shown enormous potential for various applications. They are obtained predominantly in the form of nonwoven fibre webs. The 2-dimensional nonwoven feature and fragility have considerably confined their further processing into fabrics through knitting or weaving. Nanofibre yarns, which are nanofibre bundles with continuous length and a twist feature, show improved tensile strength, offering opportunities for making 3-dimensional fibrous materials with precisely controlled fibrous architecture, porous features and fabric dimensions. Despite a few techniques having been developed for electrospinning nanofibre yarns, they are chiefly based on the needle electrospinning technique, which often has low nanofibre productivity. In this study, we for the first time report a nanofibre yarn electrospinning technique which combines both needle and needleless electrospinning. A rotating intermediate ring collector was employed to directly collect freshly-electrospun nanofibres into a fibrous cone, which was further drawn and twisted into a nanofibre yarn. This novel system was able to produce high tenacity yarn (tensile strength 128.9 MPa and max strain 222.1%) at a production rate of 240 m h^-1, with a twist level up to 4700 twists per metre. The effects of various parameters, e.g. position of the electrospinning units, operating conditions and polymer concentration, on nanofibre and yarn production were examined.

Effects of depression and serotonergic antidepressants on bone: mechanisms and implications for the treatment of depression

Osteoporosis is a chronic skeletal disease marked by microarchitectural deterioration of the bone matrix and depletion of bone mineral density (BMD), with a consequent increased risk for fragility fractures. It has been frequently associated with depression, which is also a chronic and debilitating disorder with high prevalence. Selective serotonin reuptake inhibitors (SSRIs), first-line agents in the pharmacological treatment of mood and anxiety disorders, have also been shown to negatively affect bone metabolism. SSRIs are the most prescribed antidepressants worldwide and a large number of persons at risk of developing osteoporosis, including older patients, will receive these antidepressants. Therefore, a proper musculoskeletal evaluation of individuals who are being targeted for or using SSRIs is a priority. The aim of this article is to review the evidence regarding the effects of depression and serotonergic antidepressants on bone and its implications for clinical care.

Patients presenting with fractures are likely to be vitamin D deficient: are we getting enough sun?

BACKGROUND: 25-Hydroxyvitamin D serves a crucial role in bone metabolism through its role on osteoclast and osteoblastic function. To assess the implication of vitamin D and its relationship to bone fracture and fracture force, we have examined vitamin D levels in patients requiring inpatient fracture management. METHODS: We performed serological testing of vitamin D levels, calcium, parathyroid hormone and liver function tests on patients admitted to our rural institution in southeastern Australia for inpatient fracture management. All participants completed a questionnaire designed to screen for potential contributing factors to bony fragility. Demographic data were also obtained including age, gender and body mass index. Fracture location and the type of inpatient management as well as the force of injury were included in our analysis. RESULTS: We recruited 100 patients to the study, with a median age of 72 (range 22-98) of whom 66 were women. Most had low-energy fractures (79%), treated by internal fixation (73%) or arthroplasty (9%) with 18 treated non-operatively. The majority of the patients were at best vitamin D insufficient, <75 nmol/L (77%), and 38% were vitamin D deficient (<50 nmol/L). Only 14 patients had a formal diagnosis of osteoporosis at presentation, with 63 patients claiming daily sun exposure in line with recommendations for vitamin D sufficiency. CONCLUSIONS: Our data suggest that the prevalence of vitamin D insufficiency and deficiency is common in patients presenting with fractures in southeastern Australia and is not confined to elderly patients. All patients with fractures should be assessed for vitamin D levels and treated in accordance with vitamin D deficiency guidelines.

Tenerbrosity scene 1

Tenerbrosity Scene 1, is a large format photographic artwork. The work visually explores memory through the recollection of incidents and the fragility of truth. This is situated within the practice of landscape photography in a post-colonial framework. In Scene 1 of 2, a woodland closed shot is presented for the audience. The scene was shot at night in a forest, and provides a focus on the details of trees and leaves, branches and an emerging blackness that surrounds the scene. The journey has taken a strange turn in Tenerbrosity, with suggestions of the strange and unfamiliar, like a fragment or a moment, attempting to pull everything back together, somehow..somewhere… The size of the work as a large unframed print on canvas, actively seeks a physical engagement with the audience via a centrality of vision. The artwork hangs a metre out from the wall and the work sways in the breeze, to ensure the audience is located at a site for the production of meaning and this captures a mixed reality, between artwork, vision, audience and experience. This is achieved to engage with the multi-sequential narratives surrounding traces of memories and decay visually and theoretically traversed throughout the series. This is part of the ongoing exploration of states of the in-between and forms the 1st in a series of 2 artworks. The work is exhibited in the Yarra Ranges, because the work explores the narratives of the decay of memory experienced in this location. Exhibiting here allows a cyclic dialogue with notions of place, home, longing and loss.