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As illustrated in Table 2 , arthrosis About one in every five adults with osteoporosis suffered from coronary heart disease In line with this, hypertension A separate regression model was fitted for each comorbidity. Eleven out of fifteen comorbidities showed a significant association with osteoporosis.

Of note, for adults with osteoporosis, the odds for arthrosis, chronic low back pain, arthritis, depression and chronic heart failure, respectively, were more than two times greater than for adults without osteoporosis Table 2. Sex-stratified analyses as well as analyses restricted to participants with valid data on all independent variables in regression complete cases showed similar results to the main analysis data not presented. The underlying study provides representative data on prevalence rates and comorbidities of osteoporosis based on the German population aged 50 years and older.

The overall prevalence was estimated to 8. According to multiple regression analysis, osteoporosis was significantly related to age, sex, BMI and alcohol consumption while smoking status and education showed no significant association.

Adults with osteoporosis showed more than twofold increased odds for arthrosis, arthritis, chronic low back pain, chronic heart failure and depression, respectively. However, our results agree well with those of other studies on osteoporosis [ 27 — 32 ]. In comparison to other German studies [ 29 — 32 ], results on prevalence rates vary with regard to the methodology of measuring osteoporosis as well.

Similar to GEDA , DEGS1 provides nationally representative data on the health status of the adult population between 18 and 79 years of age and estimated a lifetime prevalence of osteoporosis self-reported for people aged between 50 and 79 years to 8.

Little differences with regard to socioeconomic status and an association with age for women were reported, too [ 29 ]. On the other hand, considering a study based on routine data of a statutory health insurance, prevalence rates were found to be higher.

Deviating methodical procedures might be responsible for differences in prevalence. Results of studies examining the relationship between smoking and osteoporosis as well as alcohol consumption and osteoporosis including low BMD and fracture risk are inconsistent [ 33 — 37 ].

There was also no clear evidence of a relationship between osteoporosis and smoking in the present study. While the prevalence of osteoporosis was significantly lower for higher educated adults in comparison to adults with a low educational level, results of the present regression analysis revealed no significant effects.

Prevalence rates may be biased as a consequence of misclassification as our results are based on self-reported diagnoses that were not clinically verified. Since osteoporosis is not associated with any symptoms prior to a fracture and information on possible fractures were not available within GEDA, prevalence rates may be underestimated by not taking account of yet undiagnosed adults.

On the other hand, considering arthritis, for example, prevalence rates may be overestimated as it is known that patients with other joint disorders often falsely state to suffer from rheumatoid arthritis [ 20 , 39 ]. Using self-reported information on sociodemographic characteristics such as BMI values may lead to biased estimates as well reporting bias. Moreover, only adults living in private households were contacted, hospitalized adults or adults living in care homes could not be considered.

As all interviews were carried out in German, adults had to speak and understand German, thus marginalized groups such as migrants could not be regarded [ 20 ].

Low-level educated adults agreed less often to participate in the telephone interview than people with a medium or high level of education [ 20 ]. A weighting factor provided by the Robert Koch Institute was used to approach the adult residential population structure in Germany [ 20 ]. Osteoporosis represents a major public health concern and its prevention is crucial to the maintenance of health [ 40 ]. It is a systemic condition characterized by changes in bone microarchitecture and a reduction of bone mass, both of which lead to decreased bone strength and at the same time to increased fracture risks.

As a consequence, treatment at all ages aims at retaining bone mass to prevent any type of fracture e. Fractures with severe complications are serious consequences of osteoporosis that have an influence on morbidity, functional impairment of health, a decrease in quality of life as well as an increase in medical costs [ 40 , 41 ].

Additionally, at the time of a fracture, comorbidities in osteoporosis patients play a key role. Further, drug-drug interactions may affect the progress of the disease. Regarding osteoporosis, especially the consumption of drugs that have an effect on bone metabolism is of interest.

In GEDA however, data on the use of pharmaceuticals were not collected and an evaluation of the use of different drug classes could therefore not be done. In the present study nearly all adults with osteoporosis reported at least one comorbid condition, but the cross-sectional design did not allow for an analysis of cause and effect. In the GEDA study population participants that stated to suffer from osteoporosis were for example more than twice as likely to also suffer from depression.

Drosselmeyer et al. Physical disability following fractures affects the capacity for independent living and complicates social participation. Besides, as physical activity is reduced in depressive patients but important to improve or at least stabilize bone mineral density, it would be important to recognize and treat the disease early. Of interest is also the association between arthrosis and osteoporosis.

In the present study, participants with osteoporosis showed more than three times higher odds of having arthrosis. However, in most cross-sectional studies [ 43 ], arthrosis was negatively connected with osteoporosis in the sense that people with arthrosis showed higher BMD. Despite this negative association, the risk of osteoporotic fractures in patients with arthrosis remains the same [ 43 ].

Generally, arthrosis is associated with stiffness and pain in the affected joints, and this may reduce physical activity, which subsequently leads to instability and higher fracture risks.

Hence, the relation of osteoporosis and arthrosis appears to be very complex and needs to be analysed further. The disease burden in adults with osteoporosis is of high relevance.

Physicians need to be aware of the high occurrence of multimorbidity in adults with osteoporosis. Health care interventions for affected patients should be expanded by offering early or even preventive care for other diseases that go along with it. The dataset analysed during the present study is available from the Robert Koch Institute for researchers who meet the criteria for access, [doi: EM and MTP devised the basic idea for the manuscript. MTP performed the statistical analysis, with contributions by EM.

MTP and MK drafted the manuscript. All authors read and approved the final manuscript. Ethics approval and participant consent was not necessary as this study involved the use of a previously-published de-identified database secondary data analysis according to national guidelines and recommendations in secondary data analysis [ 22 ].

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Manuela Klaschik, Email: ed. Matthias Schmid, Email: ed. Klaus Weckbecker, Email: ed.

BMC Musculoskelet Disord. Published online May Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Dec 22; Accepted Apr Abstract Background Knowledge on prevalence of osteoporosis stratifying for socioeconomic background is insufficient in Germany.

Results Overall, 8. Conclusions There was no clear evidence of socioeconomic differences regarding osteoporosis for adults in Germany. Background Osteoporosis and its consequences are a major public health concern and amount in high expenses for health care systems [ 1 , 2 ].

Results The total number of participants aged 50 years and older was 10, Paphos, Cyprus, September , bib. ACM Interact. Wearable Ubiquitous Technol. Volume 25, Issue 4, Cairo, Egypt. November 25 – 28, Beijing, China, November 13 – 16, Tampere, Finland, October 10 – 11, Singapore, October 8, Toronto, ON, Canada.

September 23 – 25, Montreal, QC, Canada, April 22, Warsaw, Poland, Munich, Germany, June , Heilbronn, Germany.

May 14 – 15, Montreal, Canada, April 21 – 26, Montreal, QC, Canada, April 21 – 26, Palanque, Andreas Riener, Andrew L. Paper , 7 pages.

Tokyo, Japan, March 7 – 11, ACE Lecture Notes in Computer Science, vol Hogrefe Publishing bib. Cairo, Egypt, November , bib. Mumbai, India, September , Springer International Publishing.

HC], November Brighton, UK, October 17 – 20, Mumbai, India, September 25 – 29, Springer-Verlag, Berlin, Heidelberg. Balkrishan D. Oldenburg, Germany, September , Bastian Pfleging , Andrew L. Vienna, Austria, September , Student Research Competition.

Springer Vieweg, Berlin, Heidelberg bib. Lugano, Switzerland, June , Hilversum, The Netherlands, June , ACM bib.

Amsterdam, The Netherlands. Spinger, Berlin-Heidelberg. Pawel W. Lars Lischke , Pawel W. Rovaniemi, Finland, December , ACM October 23 – 27, , Gothenburg, Sweden. Florence, Italy, September 6 – 9, Weyers, A. Dittmar Eds. Internet Society bib. Daniel Buschek There is more to biometrics than user identification: Making mobile interactions personal, secure and representative It – Information Technology, July bib. Brisbane, Australia, June 4 – 8, Oulu, Finland, June , Oulu, Finland, June 20 – 26, Bari, Italy, June 7 – 10, Sydney, Australia, June 1 – 4, Bastian Pfleging , Drea K.

Fekety, Albrecht Schmidt , Andrew L. Springer, Berlin, Germany, ISBN MVG Verlag. Madeira, Portugal, November 15 – 18, Hanna Schneider Pervasive Health bib. Bamberg, Germany, September , Stuttgart, Germany, September 06 – 09, Nottingham, UK, September , Copenhagen, Denmark, August 24 – 27, Ottawa, Kanada, July 22 – 24, Buy A New One?

Copenhagen, Denmark, August 24th – 27th, Duisburg, Germany, June 23 – 26, Seoul, South Korea, April 18 – 23, Seoul, Republic of Korea, April 18 – April 23, Seoul, Korea, April 18 – April 23, Seoul, Korea, April 18 – 23, Do You? Seoul, Republic of Korea, April 18 – 23, ISBN: bib. Hamburg, Germany, March 2 – 6, AH ‘ Melbourne, Victoria, Australia, November 25 – 28, Aarhus, Denmark November 19 – 22, Tampere, Finland, November 4 – 6, Helsinki, Finland, October , Munich, Germany, August 31 – September 3, Vancouver, Canada, June 14 – 18, A picture book as app.

Linkoeping, Sweden, June No. Linkoeping University Electronic Press. Copenhagen, Denmark, June , Schoenen J: Deficient habituation of evoked cortical potentials in migraine: a link between brain biology, behavior and trigeminovascular activation? Biomed Pharmacother , 50 2 Cephalalgia , 27 12 Cephalalgia , 19 5 Kropp P, Gerber WD: Prediction of migraine attacks using a slow cortical potential, the contingent negative variation.

Neurosci Lett , 2 Siniatchkin M, Kropp P, Gerber WD, Stephani U: Migraine in childhood-are periodically occurring migraine attacks related to dynamic changes of cortical information processing? Neurosci Lett , 1 Kropp P, Gerber WD: Contingent negative variation during migraine attack and interval: evidence for normalization of slow cortical potentials during the attack. Cephalalgia , 15 2 Judit A, Sandor PS, Schoenen J: Habituation of visual and intensity dependence of auditory evoked cortical potentials tends to normalize just before and during the migraine attack.

Cephalalgia , 20 8 Cephalalgia , 29 11 Neurobiol Learn Mem , 92 2 Ozkul Y, Uckardes A: Median nerve somatosensory evoked potentials in migraine. Eur J Neurol , 9 3 Clin Neurophysiol , 8 Neurology , 65 9 Woolf CJ, Wall PD: Relative effectiveness of C primary afferent fibers of different origins in evoking a prolonged facilitation of the flexor reflex in the rat.

J Neurosci , 6 5 A MSI study. Brain Res , 1 Burstein R, Cutrer MF, Yarnitsky D: The development of cutaneous allodynia during a migraine attack clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain , Pt 8 Pain , 47 2 Headache , 48 2 Cephalalgia , 26 7 Neurology , 58 8 Cephalalgia , 26 9 Brain Res Mol Brain Res , Pain , Cephalalgia , 13 3 Neurology , 70 6 Dobson CF, Tohyama Y, Diksic M, Hamel E: Effects of acute or chronic administration of anti-migraine drugs sumatriptan and zolmitriptan on serotonin synthesis in the rat brain.

Cephalalgia , 24 1 Srikiatkhachorn A, Tarasub N, Govitrapong P: Effect of chronic analgesic exposure on the central serotonin system: a possible mechanism of analgesic abuse headache. Headache , 40 5 Krasne F, Edwards D: Modulation of the crayfish escape reflex -physiology and neuroethology.

Integ Comp Biol , Neurology , 57 9 Headache , 48 7 Schoenbaum G, Shaham Y: The role of orbitofrontal cortex in drug addiction: a review of preclinical studies. Biol Psychiatry , 63 3 Cite this article as: Coppola et al. Abnormal cortical responses to somatosensory stimulation in medication-overuse headache Academic research paper on ” Clinical medicine “. CC BY. Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study.

Transcranial Direct Current Stimulation tDCS of the visual cortex: a proof-of-concept study based on interictal electrophysiological abnormalities in migraine. A migraine variant with abdominal colic and Alice in wonderland syndrome: a case report and review. Background Medication-overuse headache MOH is a complication of episodic headaches characterized by more than 15 headache days per month and arising from an excessive intake of analgesics or specific anti-migraine drugs, or both [1].

Bietti Eye Foundation-IRCCS, Dept of Neurophysiology of Vision and Neurophthalmology, Rome, Italy Fulllist of author information is available at the end of the article as well as secondary headaches the most prevalent initial headache type is episodic migraine without aura and most patients return to the episodic pattern after drug withdrawal [1].

Methods Subjects-Among consecutive patients attending our headache clinic, 93 patients gave informed consent to participate in the study Table 1 , which was approved by the local ethics committee. Data acquisition SEPs were elicited by electrical stimulation applied to the right median nerve at the wrist using a constant current square wave pulse 0.

Results Assessable SEP recordings were obtained from all patients and controls participating in the study Figure 1. Discussion The distinct changes we found in cortical responses to low and high numbers of sensory stimuli in patients with MOH suggest that the underlying brain mechanisms are altered and differ from those acting in patients with episodic migraine without aura.

The habituation deficit normalizes during attacks, whereas sensitization disappears between attacks, but in the immediate pre-ictal phase both sensitization and absent habituation may co-exist [].

Studies in animals [21] and humans [22] show that SEP amplitudes increase when transient intense activation of noci-ceptive afferents induces central sensitization, as happens in clinical pain conditions including chronic headache. Upregulated platelet 5-HT transporters [35] and decreased whole blood 5-HT levels [36] tend to normalize after drug withdrawal. Given the similar neural mechanisms underlying sensory and behavioural sensitization [40], the interesting question arises whether the sensory sensitization in patients with MOH parallels behavioural sensitization.

Conclusions Cortical responses to repetitive sensory stimuli are abnormal in patients with MOH. We postulate that the abnormal sensory processing in MOH patients reflects a drug-induced impairment of central serotonin neurotransmission, that the decrease of sero-tonergic activity is more profound after chronic NSAID overconsumption and that the cortical sensory sensitization parallels the behavioural sensitization that accompanies drug overuse and is crucially modulated by the medial orbitofrontal cortex.

Author details 1G. Authors’ contributions GC made substantialcontributions to acquisition of data, analysis and interpretation of data as wellas in drafting the manuscript. Competing interests The authors declare that they have no competing interests. Psychol Rev , 77 5 J Headache Pain , 9 2 Cephalalgia , 13 6 Arch Gen Psychiatry , 29 4

 
 

 

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