JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, November 27, 2007)
JAMA NEWS RELEASES
FACTORS IDENTIFIED TO HELP PREDICT RISK OF HIP FRACTURE IN POSTMENOPAUSAL WOMEN
HIGH-TRAUMA FRACTURES IN OLDER ADULTS ASSOCIATED WITH OSTEOPOROSIS, INCREASED RISK OF ANOTHER FRACTURE
CERTAIN INFUSION THERAPY AFTER HEART ATTACK DOES NOT APPEAR TO BE BENEFICIAL, MAY CAUSE HARM
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
RESEARCHERS DEVISE COMPUTER PROGRAM TO PREDICT WOMEN’S FIVE-YEAR RISK OF HIP FRACTURE
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, November 27, 2007
Media Advisory: To contact John Robbins, M.D., call Charles Casey at 916-734-9048.
FACTORS IDENTIFIED TO HELP PREDICT RISK OF HIP FRACTURE IN POSTMENOPAUSAL WOMEN
CHICAGO—A clinical model that includes 11 factors has been developed to help predict the 5-year risk of hip fracture in postmenopausal women, according to a study in the November 28 issue of JAMA.
The estimated 329,000 hip fractures that occur annually in the United States are associated with a high rate of illness and death and high cost. Prevention of hip fracture is a high priority for patients, physicians, and public health, according to background information in the article.
John Robbins, M.D., of the University of California at Davis School of Medicine, Sacramento, and colleagues evaluated clinical risk factors for hip fracture in postmenopausal women to create a predictive model for the 5-year risk of hip fracture. The study included data on a total of 93,676 women who participated in the observational component of the Women’s Health Initiative (WHI), a multiethnic study. Factors were identified that were predictors of hip fracture, which were then validated using data on 68,132 women who participated in the clinical trial. The model also was tested in a subset of 10,750 women who had undergone dual-energy x-ray absorptiometry scans (DXA; an imaging technique) for bone mass density assessment, which is used to predict risk of hip fracture.
During an average follow-up of 7.6 years, 1,132 hip fractures were identified among women participating in the observational study (annualized rate, 0.16 percent), while during an average follow-up of 8.0 years, 791 hip fractures occurred among women participating in the clinical trial (annualized rate, 0.14 percent).
Eleven factors were identified that were predictive of hip fracture within 5 years. These factors were age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use and treated diabetes. Incorporating these factors into a clinical algorithm was useful to predict the 5 year risk of hip fracture among postmenopausal women of various ethnic backgrounds.
“Further studies are needed to define the clinical implications of this algorithm and to confirm treatment benefits for those delineated by the WHI risk classification to be an increased risk for hip fracture. Ultimately, the decision of whom to further screen for osteoporosis and whom to treat will need to be based on available resources and major social and political judgments.”
“Knowing the 5-year risk of fracture will permit patients and physicians to make informed choices when balancing making lifestyle changes against undergoing medical interventions. Publication of these results, along with the user-friendly tool for their application, will permit others to rapidly test their utility. However, we believe 11 readily available clinical variables offer a simple means of stratifying the 5-year risk of hip fracture in postmenopausal women,” the researchers conclude.
(JAMA. 2007;298(20):2389-2398. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, November 27, 2007
Media Advisory: To contact Dawn C. Mackey, M.Sc., call Kevin McCormack at 415-600-2984. To contact editorial author Sundeep Khosla, M.D., call John Murphy at 507-284-5005.
HIGH-TRAUMA FRACTURES IN OLDER ADULTS ASSOCIATED WITH OSTEOPOROSIS, INCREASED RISK OF ANOTHER FRACTURE
CHICAGO—Contrary to a widely held assumption, high-trauma nonspine fractures in older women and men, such as from a car crash, are associated with low bone mineral density and an increased risk of a subsequent fracture, according to a study in the November 28 issue of JAMA. These findings suggest that older adults who experience these fractures should be evaluated for osteoporosis.
“...it is widely believed, without supporting evidence, that high-trauma fractures [those resulting from motor vehicle crashes or falls from greater than standing height] are not related to low bone mineral density (BMD) or subsequent fracture risk and therefore are presumed not to be manifestations of osteoporosis,” the authors write. They add that these beliefs have several consequences, including the clinical opinions that an older adult who has a high-trauma fracture does not require evaluation for osteoporosis, and that high-trauma fractures cannot be prevented by osteoporosis treatments that increase BMD and bone strength.
Dawn C. Mackey, M.Sc., of the San Francisco Coordinating Center, San Francisco, and colleagues examined the association between BMD in older adults and risk of high-trauma fracture and the association between this type of fracture and risk of a subsequent fracture. The researchers analyzed data from two U.S. studies of adults 65 years or older from geographically diverse areas. The Study of Osteoporotic Fractures followed-up 8,022 women for 9.1 years (1988-2006), and the Osteoporotic Fractures in Men Study followed-up 5,995 men for 5.1 years (2000-2007).
Hip and spine BMD were assessed by dual-energy x-ray absorptiometry (an imaging technique). New nonspine fractures were confirmed by x-ray. Fractures were classified as high trauma or as low trauma (due to falls from standing height and less severe trauma). Overall, 264 women and 94 men sustained an initial high-trauma fracture and 3,211 women and 346 men sustained an initial low-trauma fracture.
The researchers found that low BMD was associated with an increased risk of high- and low-trauma fracture. After adjusting for age, each 1-standard deviation (SD) decrease in total hip BMD was associated with a 45 percent increased risk of high-trauma fracture in women and a 54 percent increased risk in men. Similarly, after adjusting for age, a 1-SD decrease in total hip BMD was associated with a 49 percent greater risk of low-trauma fracture in women and a 69 percent greater risk in men.
After adjusting for age and total hip BMD, women who sustained a high-trauma fracture had a 34 percent greater risk of a subsequent fracture than women who had not experienced a high-trauma fracture. Similarly, women who sustained a low-trauma fracture had a 31 percent greater risk of a subsequent fracture than women who had not experienced a low-trauma fracture.
“In conclusion, BMD was strongly associated with high-trauma nonspine fractures in older women and men, and high-trauma nonspine fractures predicted subsequent fractures to the same extent as low-trauma nonspine fractures in women. Therefore, we concluded that high-trauma nonspine fractures should be considered potential osteoporotic fractures and should receive similar clinical management as low-trauma nonspine fractures,” the authors write.
(JAMA. 2007;298(20):2381-2388. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: HIGH-TRAUMA FRACTURES AND BONE MINERAL DENSITY
In an accompanying editorial, Sundeep Khosla, M.D., of Mayo Clinic, Rochester, Minn., comments on the study in this week’s JAMA on high-trauma fractures.
“The study by Mackey et al clearly demonstrates that the current definition of high-trauma fracture is not particularly useful. Until a better definition of fractures unrelated to BMD is developed, older patients sustaining high-trauma fractures cannot be ignored in terms of their skeletal status, and they should be evaluated more thoroughly for underlying osteoporosis. In addition, these fractures should be included as end points in clinical trials involving prevention or treatment of osteoporosis.”
(JAMA. 2007;298(20):2418-2419. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, November 27, 2007
Media Advisory: To contact corresponding author Abhinav Goyal, M.D., M.H.S., call Ashante Dobbs at 404-727-5692.
CERTAIN INFUSION THERAPY AFTER HEART ATTACK DOES NOT APPEAR TO BE BENEFICIAL, MAY CAUSE HARM
CHICAGO—Infusion of a combination therapy consisting of glucose, insulin, and potassium, which was thought could be a beneficial treatment immediately following a heart attack, may increase the risk of heart failure and death in the first 3 days for patients with ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack), according to a study in the November 28 issue of JAMA.
Small studies have supported the use of glucose-insulin-potassium (GIK) infusion in the treatment of STEMI, while a larger study indicated a neutral effect of GIK infusion on the risk of death at 30 days after a heart attack, according to background information in the article.
Rafael Díaz, M.D., of the Etudios Cardiologica Latin America, Rosario, Argentina, and Abhinav Goyal, M.D., M.H.S., from the Emory School of Medicine, Atlanta, and colleagues conducted a study to determine the association between GIK infusion therapy and 30-day and 6-month outcomes in patients with STEMI, and whether GIK infusion may cause harm in the early post-infusion period. The study included analysis of the outcomes of the OASIS-6 GIK randomized controlled trial of 2,748 patients with acute STEMI, and the prespecified analyses of the combined trial data from the OASIS-6 GIK and CREATE-ECLA GIK trial populations of 22,943 patients with acute STEMI.
The researchers found that in the OASIS-6 trial, there were no differences between the GIK infusion and control groups in the 30-day outcomes of death, heart failure, or the composite of death or heart failure. There also were no differences in six-month clinical event rates
In the combined OASIS-6 and CREATE-ECLA GIK trial results, there were no differences between the GIK infusion and control groups in the 30-day rate of death, heart failure, or the composite of death or heart failure. In the analyses from days 0 to 3, the risks of death and the composite of death or heart failure were higher in the GIK group compared with the control group, with 712 deaths (6.2 percent) in the GIK group and 632 deaths (5.5 percent) in the control group; and 1,509 death or heart failure events in GIK group (15.8 percent) and 1,388 events in the control group (14.5 percent). The difference in the death rate disappeared by 30 days, with 1,108 deaths (9.7 percent) in the GIK group and 1,068 (9.3 percent) in the control group.
“GIK therapy increased levels of glucose, potassium, and net fluid gain post-infusion, all three of which predicted death after adjusting for multiple confounders. Adjusting for glucose, potassium, and net fluid gain eliminated the apparent increase in mortality at 3 days observed with GIK infusion, suggesting a direct association with these factors. Administration of GIK infusion within 4 hours of symptom onset yielded no benefit compared with later initiation,” the authors write.
“The combined OASIS-6 and CREATE-ECLA trial analysis of almost 23,000 patients with STEMI (the largest global experience with GIK therapy) demonstrates that GIK infusion has no effect on any important clinical end point through 30 days following STEMI. However, contrary to our prespecified hypothesis, we observed a higher rate of death and the composite of death or heart failure at 3 days in patients allocated to GIK therapy compared with control.”
(JAMA. 2007;298(20):2399-2405. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
RESEARCHERS DEVISE COMPUTER PROGRAM TO PREDICT WOMEN’S FIVE-YEAR RISK OF HIP FRACTURE
INTRO:
Each year in the U.S., more than three-hundred-thousand hip fractures occur, mostly in women. These fractures are painful, costly and associated with a high rate of death. So it would be helpful to know your specific risk for having a hip fracture, so you’d know if you should take medication or try other things to prevent it, right? A new study may help. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
NAT SOT UP FULL FOR : 05
Dr. Robbins at computer, talking to Ginger
AUDIO:
“How do you consider your health? Fair, good, or very good?”
“Very good”
“OK”
VIDEO:
B-ROLL
Ginger in office with Dr. Robbins at computer, cutaways of Ginger and the computer
AUDIO:
THE ANSWERS TO SUCH QUESTIONS COULD TELL 64-YEAR OLD GINGER DEGREGORY HER RISK OF HAVING A HIP FRACTURE IN THE NEXT FIVE YEARS.
VIDEO:
SOT/FULL
@ :12
Super: John Robbins, M.D.
University of California Davis
Runs :10
AUDIO:
“We have medications that work very well to prevent hip fracture, but they have side effects, they are expensive, so we don’t want to use them in everybody.”
VIDEO:
B-ROLL
Dr. Robbins and colleague with different woman/patient in exam room
Older women walking outside
Older woman using her hands to lift her leg into her car
GFX/JAMA COVER
AUDIO:
THAT’S WHY DR. JOHN ROBBINS FROM UNIVERSITY OF CALIFORNIA DAVIS AND COLLEAGUES FROM OTHER INSTITUTIONS STUDIED MORE THAN A HUNDRED THOUSAND POSTMENOPAUSAL WOMEN, TO SEE WHAT FACTORS INCREASED THE RISK OF HAVING A HIP FRACTURE. THEIR FINDINGS APPEAR IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
John Robbins, M.D.
University of California Davis
Runs :08
AUDIO:
“Clearly, the major factor is age, and that the older you get the more likely you are to have a fracture.”
VIDEO:
B-ROLL
White woman and Black woman standing together
Woman smoking
Woman exercising
Woman’s legs walking
Back to Dr. Robbins and Ginger at computer
AUDIO:
BUT THERE ARE MANY MORE FACTORS TO CONSIDER SUCH AS RACE… CAUCASIAN WOMEN ARE AT GREATER RISK, AS ARE THINNER WOMEN, TALLER WOMEN, WOMEN WHO SMOKE, WOMEN WHO ARE NOT PHYSICALLY ACTIVE, WHO HAVE DIABETES, WHO TAKE CORTICOSTEROIDS. THESE FACTORS CAN EACH PLAY A ROLE, AS CAN A WOMAN’S PERCEPTION OF HOW GOOD HER HEALTH IS. WHEN ALL THE FACTORS ARE ENTERED, THE PROGRAM ESTIMATES RISK.
VIDEO:
NAT SOT UP FULL FOR :07
Dr. Robbins at computer talking to Ginger
AUDIO:
“So this tells us that your probability of having a hip fracture in the next five years is less than a half of one percent. You are at very low risk of having a hip fracture.”
VIDEO:
B-ROLL
Ginger with Dr. Robbins
Cutaway computer
AUDIO:
GOOD NEWS FOR GINGER, BUT IF IT WEREN’T SHE’D STILL WANT TO KNOW SO SHE COULD TAKE ACTION.
VIDEO:
SOT/FULL
@ 1:21
Super: Ginger DeGregory
Dr. Robbins’ patient
Runs :09
AUDIO:
“It’s your body and you have the responsibility to take care of it. Your doctor can give you the information but you need to act on that information.”
VIDEO:
B-ROLL
Sequence of Dr. Robbins in hallway talking with different patient
AUDIO:
DR. ROBBINS SAYS HE WANTS TO FURTHER TEST THE SET OF RISK FACTORS TO MAKE SURE THEY ACCURATELY PREDICT HIP FRACTURE RISK, BUT HE DOES HAVE THIS ADVICE ABOUT TAKING PREVENTIVE MEDICATIONS.
VIDEO:
SOT/FULL
John Robbins, M.D.
University of California Davis
Runs :16
AUDIO:
“If your risk factor is five percent in the next five years I would think it’s probably worth taking them. If it’s one-half of one percent, I would argue against it. Where you make that cut point in between is a difficult decision that’s faced by women, physicians and society.”
VIDEO:
B-ROLL
Women walking outside
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Talk with your physician about your risk of hip fracture. For more information, visit www.jama.com.
