Risk of developing diabetes in children with overweight or obesity differs from that of adults
Teenage girls with reproductive health condition are more likely to have high blood pressure
Osteoporosis and Fracture Risk among Older US Asian Adults
This review summarizes the current knowledge regarding osteoporosis and fracture among older US Asian adults. Asian adults have lower (areal) bone density than non-Hispanic White adults and thus are more likely to be diagnosed and treated for osteoporosis, despite their…
Prevalence of Elevated Alanine Aminotransferase in Adolescents in the United States 2011-2018
The objective of this study is to characterize suspected nonalcoholic fatty liver disease (NAFLD) using elevated alanine aminotransferase (ALT) in a diverse and nationally representative cohort of adolescents and to characterize higher ALT elevation in adolescents with obesity. Data from…
Collaboration on Studies Examining Health Conditions in Pediatric and Adult Populations Focused on Asians and Asian Subgroups
The ethnic diversity of younger and older US populations is continuing to increase. This research program supported by the Stanford Center for Asian Health Research and Education will support the continuation of existing studies within our team examining cardiometabolic and…
Hip Fracture Risk and Outcomes in Older Black Women
This study examines hip fracture risk and outcome in older Black women using data from Kaiser Permanente Northern California. The study will examine the predictors of hip fracture, fracture risk prediction, and morbidity and mortality following hip fracture.
Sex- and ethnic-specific patterns in the incidence of hip fracture among older US Asian and non-Hispanic White adults
Asian and Pacific Islander (Asian/PI) adults have lower hip fracture incidence than non-Hispanic White (NHW) adults, but data regarding Asian/PI subgroups are limited. We compared hip fracture incidence among older US Asian/PI and NHW populations, including ethnic subgroup differences. Using…
Racial and ethnic differences seen in marker of early diabetic kidney disease
A prospective study of lifestyle factors and bone health in breast cancer patients who received aromatase inhibitors in an integrated healthcare setting
Fracture and osteoporosis are known side effects of aromatase inhibitors (AIs) for postmenopausal hormone receptor positive (HR+) breast cancer (BC) patients. How modifiable lifestyle factors impact fracture risk in these patients is relatively unknown. We conducted a prospective cohort study…
Cardiovascular Disease Risk Factors Among Middle-Aged and Older Adult Vietnamese American Members of a Northern California Health Plan
There is increasing recognition that cardiovascular disease (CVD) risk factors vary by Asian subgroups. We examined CVD risk factor prevalence among Vietnamese adults in a northern California health plan. We used electronic health record data to examine smoking, overweight/obesity (body…
Prevalence of sleep-related problems and risks in a community-dwelling older adult population: a cross-sectional survey-based study
Despite evidence of adverse health consequences of inadequate restorative sleep for older adults, assessment of sleep quantity, quality, and use of sleep aids is not routinely done. We aimed to characterize sleep problems, sleep risks, and advice received about sleep…
Calculator for Length of Use of Bisphosphonates (CLUB)
Despite the wide availability of bisphosphonate drugs that reduce fracture risk, treatment rates have fallen, attributable to concerns for atypical femoral fractures and osteonecrosis of the jaw. While risk/benefit ratios of bisphosphonate treatment for osteoporosis remain highly favorable in the…
Prevalence of prediabetes and diabetes vary by ethnicity among U.S. Asian adults at healthy weight, overweight, and obesity ranges: an electronic health record study
Asian adults develop Type 2 diabetes at a lower body mass index (BMI) compared to other racial/ethnic groups. We examined the variation in prevalence of prediabetes and diabetes among Asian ethnic groups within weight strata by comparing middle-aged Chinese, Filipino,…
Identifying modifiable obesogenic behaviors among Latino adolescents in primary pediatric care.
Latino adolescents engage in more obesogenic behaviors, including sedentary behaviors and sugary drink consumption, than White adolescents. However, it is unclear whether engagement in obesogenic behaviors differs within the Latino population. Cross-sectional data were examined from Latino adolescents ages 13-17…
Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults
Inability to adhere to nutritional recommendations is common and linked to worse outcomes in patients with nutrition-sensitive conditions. The purpose of this study is to evaluate whether medically tailored meals (MTMs) improve outcomes in recently discharged adults with nutrition-sensitive conditions…
Ethnic diversity and burden of polycystic ovary syndrome among US adolescent females
Polycystic Ovary Syndrome (PCOS) is a common female endocrine disorder presenting as early as adolescence. Recent data suggest that Asians may be at increased risk. This study examines PCOS prevalence by race/ethnicity in a large, diverse population of adolescent females.…
The Prevalence of Elevated Alanine Aminotransferase Levels Meeting Clinical Action Thresholds in Children with Obesity in Primary Care Practice
Using a clinically actionable threshold for alanine aminotransferase to define suspected nonalcoholic fatty liver disease in US children with obesity, the risk of suspected nonalcoholic fatty liver disease was highest for Asian and Hispanic race/ethnicity, male sex, and severe obesity.
Spinal fractures in breast cancer survivors often tied to bone metastases
Skeletal Health Outcomes among US Asian Women
The burden of osteoporosis has increased as the US population over age 65 years has increased. Ethnic diversity in the U.S. has also increased. This is the first large scale US study of fracture outcomes among Asians and ethnic subgroups…
Progression of atypical femur stress fracture after discontinuation of bisphosphonate therapy
Atypical femur fracture (AFF) is an uncommon complication of long-term bisphosphonate use, but the risk declines substantially after treatment cessation. We report a case of a 70-year-old woman with osteopenia treated with alendronate for 9 years who presented with right…
Ten-year Thyroid Cancer Incidence in an Integrated Healthcare Delivery System
The incidence of papillary thyroid cancer (PTC) has increased in recent decades, but data from community-based settings are limited. This study characterizes PTC trends in a large, integrated healthcare system over 10 years. The annual incidence of PTC (2006-2015) was…
Variation in fracture risk estimation among East Asian women
Bone mineral density (BMD) testing and fracture risk calculation help clinicians assess fracture risk and counsel patients. However, predicted fracture risks and outcomes for US East Asian individuals remain understudied. Retrospective cohort study. Using standardized clinical profiles for East Asian…
Risk of complete atypical femur fracture with Oral bisphosphonate exposure beyond three years
Bisphosphonate (BP) therapy has been associated with atypical femur fracture (AFF). However, the threshold of treatment duration leading to increased AFF risk is unclear. In a retrospective cohort of older women initiating BP, we compared the AFF risk associated with…
Bisphosphonate Treatment Beyond 5 Years and Hip Fracture Risk in Older Women
Clinical trials have demonstrated the antifracture efficacy of bisphosphonate drugs for the first 3 to 5 years of therapy. However, the efficacy of continuing bisphosphonate for as long as 10 years is uncertain. To examine the association of discontinuing bisphosphonate…
Bone Mineral Density in Older U.S. Filipino, Chinese, Japanese, and White Women
Bone mineral density (BMD) reference data exist for U.S. White, Black, and Hispanic (Mexican American) populations but not for U.S. Asians. Few studies have compared BMD findings among different U.S. Asian ethnicities. Retrospective observational study. Large northern California healthcare system.…
The effect of frequent hemodialysis on matrix metalloproteinases, their tissue inhibitors, and FGF23: Implications for blood pressure and left ventricular mass modification in the Frequent Hemodialysis Network trials
Frequent hemodialysis modifies serum phosphorus, blood pressure, and left ventricular mass (LVM). We ascertained whether frequent hemodialysis is associated with specific changes in biomarker profile among patients enrolled in the frequent hemodialysis network (FHN) trials. This was a post hoc…
The Epidemiology of Metatarsal Fractures Among Older Females With Bisphosphonate Exposure
Bisphosphonates (BP) are used to treat osteoporosis, although rare atypical femur fractures have occurred with long-term exposure, especially among Asians. Metatarsal fractures have also been reported with atypical femur fracture. We examined the epidemiology of metatarsal fractures among 48,390 females…
Cardiac valvular abnormalities associated with use and cumulative exposure of cabergoline for hyperprolactinemia: the CATCH study
Whether lower dose cabergoline therapy for hyperprolactinemia increases risk of valvular dysfunction remains controversial. We examined valvular abnormalities among asymptomatic adults with hyperprolactinemia treated with dopamine agonists. This cross-sectional study was conducted among adults receiving cabergoline or bromocriptine for > 12 months…
Statin Therapy and Risk of Incident Diabetes Mellitus in Adults With Cardiovascular Risk Factors
The association between statins and diabetes mellitus (DM) remains controversial. The Kaiser Permanente CHAMP Study identified adults without DM who had cardiovascular (CV) risk factors and no previous lipid lowering therapy (LLT) between 2008 and 2010. The CV risk factors…
No Association Between Bone Mineral Density and Breast Arterial Calcification Among Postmenopausal Women
The association between bone mineral density (BMD) and breast arterial calcification (BAC) remains poorly understood and controversial. The objective of this article is to examine the association between BMD and BAC in a large cohort of postmenopausal women undergoing routine…
Determinants of Oral Bisphosphonate Use Beyond 5 Years
Few studies have examined factors that determine bisphosphonate (BP) continuation beyond 5 years in clinical practice. To investigate factors associated with BP continuation among women who completed 5 years of BP therapy. Women who received 5 consecutive years of oral…
Longitudinal Evolution of Markers of Mineral Metabolism in Patients With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study
The pathogenesis of disordered mineral metabolism in chronic kidney disease (CKD) is largely informed by cross-sectional studies of humans and longitudinal animal studies. We sought to characterize the longitudinal evolution of disordered mineral metabolism during the course of CKD. Retrospective…
Serum bone markers and risk of osteoporosis and fragility fractures in women who received endocrine therapy for breast cancer: a prospective study
Osteoporosis and fragility fracture are major bone toxicities of aromatase inhibitors (AIs) for postmenopausal hormone receptor-positive breast cancer. Except for a few small studies on bone turnover markers and reduced bone mineral density after AI treatment, data on the associations…
Don’t Fall for That: A Residency Curricular Innovation about Fall Prevention
Amid a growing geriatric population and rise in frailty-related morbidity, fall prevention represents an opportunity to improve patient outcomes and reduce health care costs. Traditional lectures on geriatric content have had limited impact on physician behaviors; however, use of multimodal…
Atypical femur fracture incidence in women increases with duration of bisphosphonate exposure
In a northern California population of older women who were treated with oral bisphosphonate drugs, the incidence of atypical femur fracture, a rare complication of treatment, increased with longer duration of bisphosphonate exposure. These findings align with those previously reported…
Chronic disease prevalence varies by Asian subgroup, Kaiser Permanente research finds
Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: an electronic health record based cohort study
Few large cohort studies have examined the prevalence of diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), obesity, and smoking among middle-aged and older adults in the major Asian-American ethnic groups and Native Hawaiian/Pacific Islanders (PIs). The aim of…
Depot Medroxyprogesterone Acetate, Oral Contraceptive, Intrauterine Device Use, and Fracture Risk
To assess fracture risk among women with depot medroxyprogesterone acetate (DMPA), oral contraceptive pill (OCP), and intrauterine device (IUD) use. A retrospective cohort study of 308,876 women age 12-45 years who initiated DMPA, combined or progestin-only OCPs, and copper and…
Association Between Progression of Retinopathy and Concurrent Progression of Kidney Disease: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
Associations between retinopathy and kidney disease have been previously described. The association between the progression of retinopathy and concurrent progression of chronic kidney disease is unknown. To assess the association between progression of retinopathy and concurrent progression of chronic kidney…
Using Pharmacy Data and Adherence to Define Long-Term Bisphosphonate Exposure in Women
Assigning drug exposure is a necessary first step in examining bisphosphonate (BP) treatment in observational studies using pharmacy data. To determine whether the choice of adherence level using the proportion of days covered (PDC) affected BP exposure assignment. 10,381 female…
Serum Sex Hormones and the Risk of Fracture across the Menopausal Transition: Study of Women’s Health Across the Nation
Sex steroid hormones have been linked to fractures in older women. To test the hypothesis that hormones measured over the menopausal transition predict fractures. Seven US clinical centers. Two thousand nine hundred sixty women (average age, 46.4 ± 2.7 years)…
Urinary N-Telopeptide as Predictor of Onset of Menopause-Related Bone Loss in Pre- and Perimenopausal Women
The menopause transition (MT) is a period of rapid bone loss and has been proposed to be a time-limited window for early intervention to prevent permanent microarchitectural damage and reduce the risk of subsequent fracture. To intervene early, however, we…
The Association of Polycystic Ovary Syndrome and Gestational Hypertensive Disorders in a Diverse Community-Based Cohort
To examine the association of polycystic ovary syndrome (PCOS) and pregnancy-induced hypertension (PIH) within a large population of pregnant women in an integrated healthcare system. This retrospective study utilized a source cohort of 1023 women with PCOS and 1023 women…
Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals
We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all-cause mortality as a secondary outcome, after hospitalization for ACS among HIV-infected and HIV-uninfected individuals. We conducted a retrospective cohort study within Kaiser…
The Association Between Change in Serum Bicarbonate and Change in Thyroid Hormone Levels in Patients Receiving Conventional or More Frequent Maintenance Hemodialysis
Correction of metabolic acidosis in patients with chronic kidney disease has been associated with improvement in thyroid function. We examined whether changes in bicarbonate were associated with changes in thyroid function in patients with end-stage renal disease receiving conventional or…
Understanding functional and social risk characteristics of frail older adults: a cross-sectional survey study
Frailty is a condition of increasing importance, given the aging adult population. With an anticipated shortage of geriatricians, primary care physicians will increasingly need to manage care for frail adults with complex functional risks and social-economic circumstances. We used cross-sectional…
Changes in bone mineral density in women with breast cancer receiving aromatase inhibitor therapy
We assessed bone mineral density (BMD) change with aromatase inhibitor (AI) treatment in a contemporary cohort of women with breast cancer treated in Kaiser Permanente Northern California. Percent and estimated annual percent changes in BMD at the total hip and…
Changes in Biomarker Profile and Left Ventricular Hypertrophy Regression: Results from the Frequent Hemodialysis Network Trials
Regression of left ventricular hypertrophy (LVH) is feasible with more frequent hemodialysis (HD). We aimed to ascertain pathways associated with regression of left ventricular mass (LVM) in patients enrolled in the Frequent HD Network (FHN) trials. This was a post…
Trends in bisphosphonate initiation within an integrated healthcare delivery system
In the setting of changing temporal trends in the management of osteoporosis, we examined how select characteristics of new oral bisphosphonate (BP) initiators changed over time among 94,073 women within a large, integrated healthcare organization during the period 2004 to…
Contemporary rates and correlates of statin use and adherence in nondiabetic adults with cardiovascular risk factors: The KP CHAMP study
Statin therapy is highly efficacious in the prevention of fatal and nonfatal atherosclerotic events in persons at increased cardiovascular risk. However, its long-term effectiveness in practice depends on a high level of medication adherence by patients. We identified nondiabetic adults…
Thyroid function in end stage renal disease and effects of frequent hemodialysis
End-stage renal disease (ESRD) is associated with perturbations in thyroid hormone concentrations and an increased prevalence of hypothyroidism. Few studies have examined the effects of hemodialysis dose or frequency on endogenous thyroid function. Within the Frequent Hemodialysis Network (FHN) trials,…
Racial and ethnic differences in hip fracture outcomes in men
To examine temporal trends and racial/ethnic differences in hip fracture incidence and mortality outcome in older men. Retrospective cohort study. We ascertained men 50 years or older with a hip fracture during 2000 to 2010 in a diverse northern California…
Hyperprolactinemia in end-stage renal disease and effects of frequent hemodialysis
End-stage renal disease is associated with elevations in circulating prolactin concentrations, but the association of prolactin concentrations with intermediate health outcomes and the effects of hemodialysis frequency on changes in serum prolactin have not been examined. The FHN Daily and…
Predicting Hypertension Among Children With Incident Elevated Blood Pressure
To develop a model to predict hypertension risk among children with incident elevated blood pressure (BP); to test the external validity of the model. A retrospective cohort study was conducted in 3 organizations: Kaiser Permanente Colorado was the model derivation…
Predicting Adherence and Persistence with Oral Bisphosphonate Therapy in an Integrated Health Care Delivery System
Examining drug exposure is essential to pharmacovigilance, especially for bisphosphonate (BP) therapy. To examine differences in 4 measures of oral BP exposure: treatment discontinuation, adherence, persistence, and nonpersistence. Among women aged ≥ 50 years who initiated oral BP therapy during…
Racial-Ethnic Differences in Fall Prevalence among Older Women: A Cross-Sectional Survey Study
Falls are the leading cause of hip fracture in older women, with important public health implications. Fall risk increases with age and other clinical factors, and varies by race/ethnicity. International studies suggest that fall risk is lower in Asians, although…
Femur Fracture Outcomes Associated with Bisphosphonate Use
In clinical practice, bisphosphonate drugs are considered one of the main therapies for osteoporosis, based on strong clinical evidence of significant reduction in risk of hip, vertebral and non-vertebral fractures during the first 3-5 years of therapy. However, concerns have…
Denosumab Global Safety Methodology and Background Rate Assessment and Global Safety Assessment Among Women with Postmenopausal Osteoporosis Using Multiple Observational Databases
This long term surveillance study has three primary goals: 1) to establish algorithms and identify women with postmenopausal osteoporosis; 2) to establish algorithms and identify the occurrence of adverse events of special interest, including osteonecrosis of the jaw, atypical fracture,…
Risk of Type 2 Diabetes Mellitus following Gestational Diabetes Pregnancy in Women with Polycystic Ovary Syndrome
This study examines gestational diabetes mellitus (GDM) in women with polycystic ovary syndrome (PCOS) and the risk of type 2 diabetes mellitus (DM) following GDM pregnancy. A cohort of 988 pregnant women with PCOS who delivered during 2002-2005 was examined…
Innovative partnerships to advance public health training in community-based academic residency programs
Collaborative partnerships between community-based academic residency training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH)…
Applying ethnic-specific bone mineral density T-scores to Chinese women in the USA
Caucasian reference data are used to classify bone mineral density in US women of all races. However, use of Chinese American reference data yields lower osteoporosis prevalence in Chinese women. The reduction in osteoporosis labeling may be relevant for younger…
Urinary N-Telopeptide and Rate of Bone Loss Over the Menopause Transition and Early Postmenopause
The purpose of this study was to assess the ability of urinary N-telopeptide (U-NTX) to gauge rate of bone loss across and after the menopause transition (MT). U-NTX measurement was measured in early postmenopause in 604 participants from the Study…
Accuracy of the Atherosclerotic Cardiovascular Risk Equation in a Large Contemporary, Multiethnic Population
The accuracy of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation for atherosclerotic cardiovascular disease (ASCVD) events in contemporary and ethnically diverse populations is not well understood. The goal of this study was to evaluate…
The association of race/ethnicity and risk of atypical femur fracture among older women receiving oral bisphosphonate therapy
Several epidemiologic studies suggest that compared to white women, Asians have a greater propensity to suffer an atypical femur fracture (AFF) while taking bisphosphonate therapy. This study examines the relative risk of AFF following bisphosphonate initiation for Asian compared to…
Change in Weight Status and Development of Hypertension
To examine the association of BMI percentile and change in BMI percentile to change in blood pressure (BP) percentile and development of hypertension (HTN). This retrospective cohort included 101?606 subjects age 3 to 17 years from 3 health systems across…
Obesity Severity, Dietary Behaviors, and Lifestyle Risks Vary by Race/Ethnicity and Age in a Northern California Cohort of Children with Obesity
Identification of modifiable behaviors is important for pediatric weight management and obesity prevention programs. This study examined obesogenic behaviors in children with obesity in a Northern California obesity intervention program using data from a parent/teen-completed intake questionnaire covering dietary and…
Retinopathy and the Risk of Cardiovascular Disease in Patients With Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort Study)
Patients with chronic kidney disease (CKD) experience other diseases such as cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess whether retinopathy predicts future CVD events in a subgroup of the participants of the Chronic Renal…
Comparing US paediatric and adult weight classification at the transition from late teenage to young adulthood
Although paediatric growth charts are recommended for weight assessment prior to age 20, many teenagers transition earlier to adult care where absolute body mass index (BMI) is used. This study examines concordance of weight classification in older teenagers using paediatric…
Gestational Thyrotoxicosis, Antithyroid Drug Use and Neonatal Outcomes within an Integrated Healthcare Delivery System
Increasing attention has focused on the prevalence and outcomes of hyperthyroidism in pregnancy, given concerns for hepatotoxicity and embryopathy associated with antithyroid drugs (ATDs). In an integrated health care delivery system, we examined the prevalence of thyrotoxicosis and gestational ATD…
Serum 25 Hydroxyvitamin D, Bone Mineral Density and Fracture Risk Across the Menopause
Low levels of serum 25 Hydroxyvitamin D [25(OH)D] have been linked to greater fracture risk in older women. This study aimed to determine whether higher 25(OH)D is associated with slower loss of bone mineral density (BMD) and lower fracture risk…
Trends in mortality following hip fracture in older women
To examine contemporary trends in mortality following hip fracture among older postmenopausal women in an integrated healthcare delivery system. Retrospective cohort study of 13,550 women aged ?65 years with hip fracture during 2000 to 2010. Demographic factors, comorbidity index score,…
The Study to Understand the Genetics of the Acute Response to Metformin and Glipizide in Humans (SUGAR-MGH): Design of a pharmacogenetic Resource for Type 2 Diabetes
Genome-wide association studies have uncovered a large number of genetic variants associated with type 2 diabetes or related phenotypes. In many cases the causal gene or polymorphism has not been identified, and its impact on response to anti-hyperglycemic medications is…
Racial/ethnic differences in hip and diaphyseal femur fractures
Contemporary femur fracture rates were examined in northern California women and compared by race/ethnicity. During 2006-2012, hip fracture rates declined, but diaphyseal fracture rates increased, especially in Asians. Women with diaphyseal fracture were younger and more likely to be bisphosphonate-treated.…
Lipid Screening in Children and Adolescents in Community Practice: 2007 to 2010
Integrated guidelines on cardiovascular health and risk reduction in children issued in 2011 newly recommended universal screening for dyslipidemia in children at 9 to 11 years and 17 to 21 years. We determined the frequency and results of lipid testing…
Lactation intensity and fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: The SWIFT cohort
Lactation may influence future progression to type 2 diabetes after gestational diabetes mellitus (GDM). However, biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM. This study investigates…
Retinopathy and Progression of CKD: The Chronic Renal Insufficiency Cohort Study
Retinal abnormalities may be associated with changes in the renal vasculature. This study assessed the association between retinopathy and progression of kidney disease in participants of the Chronic Renal Insufficiency Cohort (CRIC) study. This was a prospective study in which…
Prevalence of obesity and extreme obesity in children aged 3-5 years
Early childhood adiposity may have significant later health effects. This study examines the prevalence and recognition of obesity and severe obesity among preschool-aged children. The electronic medical record was used to examine body mass index (BMI), height, sex and race/ethnicity…
Femur fracture classification in women with a history of breast cancer
Women with breast cancer are at increased risk for femur fracture. Contributing factors include estrogen deficiency, cancer-related therapies, or direct bone involvement. This study examines fracture subtypes in women with prior breast cancer experiencing a femur fracture. Women age ?50…
Increasing Use of Vitamin D Supplementation in the Chronic Renal Insufficiency Cohort Study
This study examined rates and determinants of vitamin D supplementation among Chronic Renal Insufficiency Cohort (CRIC) participants and determined the association between dose and 25-hydroxyvitamin D (25(OH)D) level. The 2010 Institute of Medicine Report noted a significant increase in vitamin…
Bone health history in breast cancer patients on aromatase inhibitors
A cross-sectional study was performed to assess bone health history among aromatase inhibitor (AI) users before breast cancer (BC) diagnosis, which may impact fracture risk after AI therapy and choice of initial hormonal therapy. A total of 2,157 invasive BC…
Severe obesity in children: prevalence, persistence and relation to hypertension
Newer approaches for classifying gradations of pediatric obesity by level of body mass index (BMI) percentage above the 95th percentile have recently been recommended in the management and tracking of obese children. Examining the prevalence and persistence of severe obesity…
Patterns of care and persistence after incident elevated blood pressure
BACKGROUND AND OBJECTIVE: Screening for hypertension in children occurs during routine care. When blood pressure (BP) is elevated in the hypertensive range, a repeat measurement within 1 to 2 weeks is recommended. The objective was to assess patterns of care…
Prehypertension and Hypertension in Community-Based Pediatric Practice
OBJECTIVE: To examine the prevalence of prehypertension and hypertension among children receiving well-child care in community-based practices. METHODS: Children aged 3 to 17 years with measurements of height, weight, and blood pressure (BP) obtained at an initial (index) well-child visit…
Physical performance and frailty in chronic kidney disease
Poor physical performance and frailty are associated with elevated risks of death and disability. Chronic kidney disease (CKD) is also strongly associated with these outcomes. The risks of poor physical performance and frailty among CKD patients, however, are not well…
Clinical characteristics, bone mineral density and non-vertebral osteoporotic fracture outcomes among post-menopausal U.S. South Asian Women
PURPOSE: There is limited data pertaining to osteoporotic fractures among North American women of South Asian (SA) descent. This study examines fracture incidence and risk factors among post-menopausal SA, Chinese and White women undergoing mineral density (BMD) testing within a…
Bone resorption and fracture across the menopausal transition: the Study of Women’s Health Across the Nation
OBJECTIVE: Bone turnover markers (BTMs) predict fracture in older women, whereas data on younger women are lacking. To test the hypothesis that BTMs measured before and after menopause predict fracture risk, we performed a cohort study of 2,305 women. METHODS:…
Ethnic variability in bone geometry as assessed by hip structure analysis: Findings from the hip strength across the menopausal transition study
Racial/ethnic origin plays an important role in fracture risk. Racial/ethnic differences in fracture rates cannot be fully explained by bone mineral density (BMD). Studies examining the influence of bone geometry and strength on fracture risk have focused primarily on older…
Risk of preterm delivery in non-diabetic women with polycystic ovarian syndrome
OBJECTIVE: To examine the risk and etiology of preterm delivery in women with polycystic ovary syndrome (PCOS). STUDY DESIGN: Retrospective cohort study comparing preterm delivery rate among non-diabetic PCOS and non-PCOS women with singleton pregnancy. Multivariable logistic regression was used…
Retinopathy and Chronic Kidney Disease in the Chronic Renal Insufficiency Cohort (CRIC) Study
OBJECTIVE: To investigate the association between retinopathy and chronic kidney disease. METHODS: In this observational, cross-sectional study, 2605 patients of the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter study of chronic kidney disease, were offered participation. Nonmydriatic fundus photographs…
Atypical Femur Fractures Among Breast Cancer and Multiple Myeloma Patients Receiving Intravenous Bisphosphonate Therapy: A Case Series
PURPOSE: Atypical femur fractures represent a potential complication of chronic oral bisphosphonate therapy in women with osteoporosis, but the risk of atypical femur fractures among cancer patients receiving intravenous bisphosphonates at higher cumulative doses remains unclear. We examined femur fractures…
Treatment of vitamin d deficiency within a large integrated health care delivery system
BACKGROUND: In the past decade, increasing attention has focused on identification and treatment of vitamin D deficiency although repletion outcomes of pharmacologic vitamin D therapy have not been examined at a population level. OBJECTIVE: To investigate population trends and outcomes…
Prevalence of cervical insufficiency in polycystic ovarian syndrome
BACKGROUND: Pregnant women with polycystic ovarian syndrome (PCOS) experience a greater rate of adverse obstetrical outcomes compared with non-PCOS women. We examined the prevalence and incidence of cervical insufficiency (CI) in a community cohort of pregnant women with and without…
Bisphosphonate-Related Osteonecrosis of the Jaw in Patients With Oral Bisphosphonate Exposure: Clinical Course and Outcomes
PURPOSE: To characterize the spectrum and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurring with oral bisphosphonate therapy. MATERIALS AND METHODS: We assembled a retrospective cohort of patients who had developed oral BRONJ according to the 2009 American Association…
Association Between Retinopathy and Cardiovascular Disease in Patients With Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort [CRIC] Study)
Patients with chronic kidney disease experience co-morbid illnesses, including cardiovascular disease (CVD) and retinopathy. The purpose of the present study was to assess the association between retinopathy and self-reported CVD in a subgroup of the participants in the Chronic Renal…
Influence of breastfeeding during the postpartum oral glucose tolerance test on plasma glucose and insulin
OBJECTIVE: To examine the effect of breastfeeding during the postpartum oral glucose tolerance test (OGTT) on maternal blood glucose and insulin among women with recent gestational diabetes mellitus. METHODS: Participants were enrolled in the Study of Women, Infant Feeding, and…
Clinical correlates of atypical femoral fracture
BACKGROUND: Reports of atypical femur fracture in bisphosphonate-exposed women have prompted interest in characterizing the clinical profiles of these patients. METHODS: Among women age >/=60 years with hip or femur fracture during 2007-2008, we identified 79 with low-trauma subtrochanteric or…
The impact of subtrochanteric fracture criteria on hip fracture classification
SUMMARY: Hospital diagnosis codes are useful for assessing hip fracture rates in large populations. However, these codes do not reliably differentiate hip fractures that occur in the subtrochanteric region. Identification of subtrochanteric fractures requires review of radiographic images to distinguish…
Lactation Intensity and Postpartum Maternal Glucose Tolerance and Insulin Resistance in Women With Recent GDM: The SWIFT cohort
OBJECTIVE: To examine the association between breastfeeding intensity in relation to maternal blood glucose and insulin and glucose intolerance based on the postpartum 2-h 75-g oral glucose tolerance test (OGTT) results at 6-9 weeks after a pregnancy with gestational diabetes…
Antipsychotic Medication Use Among Children and Risk of Diabetes Mellitus
OBJECTIVE: To assess whether the risk of incident diabetes was increased with the use of second-generation antipsychotics (SGAs) in a large diverse cohort of children. METHODS: A retrospective study was conducted by using the administrative databases of 3 health plans…
Methods for Assessing Fracture Risk Prediction Models: Experience With FRAX in a Large Integrated Health Care Delivery System
Area under the receiver operating characteristics (AUROC) curve is often used to evaluate risk models. However, reclassification tests provide an alternative assessment of model performance. We performed both evaluations on results from FRAX (World Health Organization Collaborating Centre for Metabolic…
Bone and the perimenopause
Loss of ovarian function has a profound impact on female skeletal health. Bone mineral density findings from the Study of Women's Health Across the Nation demonstrate an accelerated rate of bone loss during the menopausal transition. The greatest reduction occurs…
Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease
CONTEXT: A high level of the phosphate-regulating hormone fibroblast growth factor 23 (FGF-23) is associated with mortality in patients with end-stage renal disease, but little is known about its relationship with adverse outcomes in the much larger population of patients…
Oral health considerations in older women receiving oral bisphosphonate therapy
Recent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased awareness of oral health in patients receiving osteoporosis therapy. This study describes the demographic, oral health, and clinical characteristics of a contemporary population of women aged 50 and older…
Association of vitamin D insufficiency with carotid intima-media thickness in HIV-infected persons
We observed an independent association between vitamin D insufficiency and higher carotid intima-media thickness in a cross-sectional analysis of 139 HIV-infected persons. If confirmed, these findings support a clinical trial of vitamin D supplementation to reduce cardiovascular events in HIV-infected…
Fracture risk tool validation in an integrated healthcare delivery system
OBJECTIVE: To evaluate the utility of the Fracture Risk Calculator (FRC, Foundation for Osteoporosis Research and Education) for predicting 10-year hip fracture risk within a 'real world' population. STUDY DESIGN: Retrospective cohort study. METHODS: We identified female members of Kaiser…
Study of Women, Infant Feeding, and Type 2 diabetes mellitus after GDM pregnancy (SWIFT), a prospective cohort study: methodology and design
BACKGROUND: Women with history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes within 5 years after delivery. Evidence that lactation duration influences incident type 2 diabetes after GDM pregnancy is based on one retrospective…
Radiographic findings in bisphosphonate-treated patients with stage 0 disease in the absence of bone exposure
PURPOSE: Radiographic features in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) are well described, but less is known in bisphosphonate-exposed individuals with stage 0 disease (clinical symptoms without exposed necrotic bone) considered at risk for BRONJ. We sought to…
Prevalence of ocular fundus pathology in patients with chronic kidney disease
BACKGROUND AND OBJECTIVES: The objective of this study was to describe the prevalence of ocular fundus pathology in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, longitudinal study of individuals with varying stages of chronic kidney disease (CKD). DESIGN,…
Association of adolescent obesity and lifetime nulliparity–the Study of Women’s Health Across the Nation (SWAN)
OBJECTIVE: To evaluate whether adolescent obesity is associated with difficulties in becoming pregnant later in life. DESIGN: Cross-sectional analysis of baseline data from a longitudinal cohort. SETTING: Multiethnic, community-based observational study of U.S. women. PATIENT(S): Three thousand one hundred fifty-four…
Characteristics of implant failures in patients with a history of oral bisphosphonate therapy
PURPOSE: This study examines the pattern of implant failures reported in a large cohort of patients who received oral bisphosphonate therapy. MATERIALS AND METHODS: A total of 8,572 individuals who received oral bisphosphonate drugs returned a dental survey that obtained…
Prevalence of osteonecrosis of the jaw in patients with oral bisphosphonate exposure
PURPOSE: Osteonecrosis of the jaw (ONJ) is a serious complication associated with bisphosphonate therapy, but its epidemiology in the setting of oral bisphosphonate therapy is poorly understood. The present study examined the prevalence of ONJ in patients receiving chronic oral…
Intravenous bisphosphonate-related osteonecrosis of the jaw: bone scintigraphy as an early indicator
PURPOSE: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is recognized as a serious complication among patients receiving bisphosphonate therapy. However, methods for early detection and identification of patients at risk for osteonecrosis of the jaw (ONJ) need further investigation. The purpose…
Bone mineral density changes during the menopause transition in a multiethnic cohort of women
CONTEXT: Rates of bone loss across the menopause transition and factors associated with variation in menopausal bone loss are poorly understood. OBJECTIVE: Our objective was to assess rates of bone loss at each stage of the transition and examine major…
GFR, body mass index, and low high-density lipoprotein concentration in adults with and without CKD
BACKGROUND: Low high-density lipoprotein (HDL) cholesterol level is common in patients with chronic kidney disease, but associations between severity of chronic kidney disease, obesity, and HDL level have not been well defined. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: Within…
Plasma leptin levels and coronary artery calcification in older adults
CONTEXT: Leptin is associated with adiposity and insulin resistance and may play a direct role in vascular calcification. It is unclear, however, whether leptin is an independent predictor of atherosclerotic burden. OBJECTIVE: The aim of this study was to examine…
Value of the sagittal abdominal diameter in coronary heart disease risk assessment: cohort study in a large, multiethnic population
Whether visceral obesity predicts coronary heart disease (CHD) risk above and beyond overall fatness remains unsettled. Moreover, whether the association between visceral obesity and CHD risk differs by sex, age, race, and overall fatness is poorly understood. The authors conducted…
Statin therapy and risks for death and hospitalization in chronic heart failure
CONTEXT: Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear. OBJECTIVE: To evaluate the association between initiation of statin therapy and risks for death and hospitalization among adults with chronic heart failure. DESIGN,…
The association of genetic polymorphisms in sex hormone biosynthesis and action with insulin sensitivity and diabetes mellitus in women at midlife
We evaluated associations of insulin sensitivity, metabolic syndrome, and diabetes mellitus with single nucleotide polymorphism (SNP) variants from sex hormone biosynthesis and action in women of 4 races/ethnicities. DNA was extracted from transformed cell samples of 1,538 women in the…
The metabolic syndrome and chronic kidney disease
PURPOSE OF REVIEW: The metabolic syndrome is a constellation of physical and laboratory abnormalities including hypertension, hyperglycemia, hyperlipidemia and abdominal obesity. Over the past decade, the metabolic syndrome has emerged as a critically important risk factor for cardiovascular disease. RECENT…
Epidemiology of non-dialysis-requiring chronic kidney disease and cardiovascular disease
PURPOSE OF REVIEW: To review recent literature about the relationship between non-dialysis-requiring chronic kidney disease and cardiovascular disease as well as possible explanatory factors. RECENT FINDINGS: Reduced estimated glomerular filtration rate below 60 ml/min/1.73 m independently predicts the risk of…
Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome
CONTEXT: Polycystic ovary syndrome (PCOS) is associated with menstrual and reproductive abnormalities, insulin resistance, and obesity. OBJECTIVE: The objective of this study was to determine the prevalence of diagnosed PCOS and its association with cardiovascular risk factors. SETTING: The study…
Persistence with weekly alendronate therapy among postmenopausal women
INTRODUCTION: Although clinical trials indicate that oral bisphosphonates reduce osteoporotic fracture risk, compliance with bisphosphonate therapy in practice is suboptimal, with 1-year discontinuation rates exceeding 50%. METHODS: We conducted a retrospective cohort study among female members of a large integrated…
The relationship between nucleoside analogue treatment duration, insulin resistance, and fasting arterialized lactate level in patients with HIV infection
BACKGROUND: Treatment with nucleoside reverse-transcriptase inhibitors (NRTIs) is associated with hyperlactatemia, presumably as a result of NRTI-induced mitochondrial toxicity. We examined the association of NRTI treatment duration and lactate level in human immunodeficiency virus (HIV)-infected patients and assessed the relationship…
Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults
The metabolic syndrome is a risk factor for the development of diabetes and cardiovascular disease; however, no prospective studies have examined the metabolic syndrome as a risk factor for chronic kidney disease (CKD). A total of 10,096 nondiabetic participants who…
Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease
BACKGROUND: Previous studies have suggested a higher prevalence of thyroid abnormalities in persons with end-stage renal disease. However, little is known regarding the epidemiology of thyroid disorders in persons with less severe kidney dysfunction. METHODS: We used data from the…
