The dissociative pattern of biochemical bone markers of bone formation and bone resorption present in diabetes patients is thus not caused by glucose per se but may be modulated by unknown factors associated with diabetes mellitus.

SummaryIn the present study, we used national health care databases to estimate fracture incidence rates (IRs) and compared these IRs based on imputed data. We showed that imputation could lead to both over- and underestimation of IRs, and future research should therefore focus on how to improve those imputations.IntroductionOsteoporosis is a major public health burden through associated (osteoporotic) fractures. In Denmark, the incidence rates (IRs) of hip fracture are widely available. However, there is limited data about other fracture sites. A recent report could only provide imputed IRs, although nationwide data is readily available in electronic healthcare databases. Therefore, our aim was to estimate fracture site-specific IRs for Denmark in 2011 and to compare those to the previously reported imputed data.MethodsData from the Danish National Hospital Discharge Register was used to estimate age- and gender-specific IRs for any fracture as well as for different fracture sites in the Danish population aged 20 years and older in 2011. Hip fracture IRs were stratified to sub-sites, and IRs were determined for all hip fractures which were confirmed by surgery.ResultsThe total number of incident fractures in 2011 was 80,760 (IR 191, 95 % confidence interval (CI) 190–192 (per 10,000 person-years)), of which 35,398 (43.8 %, IR 171, 95 % CI 169–173) occurred in men and 45,362 (56.2 %, IR 211, 95 % CI 209–213) in women. The majority of the fractures occurred in the population aged 50 years and older (n = 50,470, IR 249, 95 % CI 247–251). The numbers of any hip fracture were lower than the previously imputed estimates, whereas the number of forearm fractures was higher.ConclusionWe showed age- and gender-specific fracture rates for any fracture as well as for different fracture sites. The IRs of most fracture sites increased with age. Estimating the number of fractures for Denmark based on imputation of data from other countries led to both over- and underestimation. Future research should therefore focus on how to improve those imputations as not all countries have nationwide registry data.

Long-term treatment of young spontaneously hy-pertensive rats (SHR) with angiotensin-converting enzyme (ACE) inhibitors has a persistent effect on blood pressure when treatment is withdrawn. The aim of the present study was to determine whether this effect could be mediated by the effect of treatment on resistance-artery structure. We determined the dose dependence of ACE-inhibitor therapy on blood pressure and small-artery structure during treatment and on the recovery of blood pressure when treatment was withdrawn. SHR (40 per group) were treated from age 4 to 24 weeks with one of three doses of perindopril (0.4, 0.8, or 1.5 mg/kg per day). Control groups were untreated SHR and Wistar-Kyoto rats. At 24 weeks, treatment was stopped and small arteries were taken from half of the rats from the mesenteric, femoral, cerebral, and coronary vascular beds for morphological and functional measurements. The blood pressure of the other half of the rats was followed until 36 weeks of A lthough modern antihypertensive treatment is in / \ general able to control blood pressure, it is _Z \. almost invariably found that withdrawal of treatment results in blood pressure returning to original hypertensive levels in both essential hypertensive patients 13 and animal models of hypertension. 46 A notable exception to this rule concerns treatment of young spontaneously hypertensive rats (SHR) with angioten-sin-converting enzyme (ACE) inhibitors, in which, after treatment is discontinued, blood pressure remains at a level below that of control SHR. 610 This persistent effect of ACE inhibitor treatment seems to be mediated through the ability of ACE inhibitors to reduce angio-tensin II levels, for similar results are obtained with the angiotensin II receptor inhibitor losartan. 11 There is also evidence that the effect is only seen if the treatment is performed while animals are young. 7 Given the fact that the pathogenesis of hypertension in SHR might have relevance for some forms of human essential hypertension, it is clear that elucidation of the mechanism of the persistent effect could provide an interesting new therapeutic approach. One possible mechanism concerns vascular structure because, on the basis that an increased media-lumen ratio of resistance vessels could be a factor that maintains hyperten-sion, 1213 reduction of the media-lumen ratio could maintain low pressure levels. This possibility has been age. During treatment, perindopril caused a dose-dependent reduction in blood pressure and in the media-lumen ratio and media area of the small arteries, whereas there was a dose-dependent increase in lumen diameter. The effect of treatment on the structure of arteries from the different vascular beds was homogeneous. Compared with values from Wistar-Kyoto rats, blood pressure normalization in SHR was not associated with full normalization of structure. After withdrawal of treatment, there was an inverse relation between perindopril dose and the persistent effect. The results suggest that although treatment of SHR has a unif...

Background: Patients suffering from diabetes mellitus (DM) may experience an increased risk of cancer; however, it is not certain whether this effect is due to diabetes per se.Objective: To examine the association between DM and cancers by a systematic review and meta-analysis according to the PRISMA guidelines.Data Sources: The systematic literature search includes Medline at PubMed, Embase, Cinahl, Bibliotek.dk, Cochrane library, Web of Science and SveMed+ with the search terms: “Diabetes mellitus”, “Neoplasms”, and “Risk of cancer”.Study Eligibility Criteria: The included studies compared the risk of cancer in diabetic patients versus non-diabetic patients. All types of observational study designs were included.Results: Diabetes patients were at a substantially increased risk of liver (RR=2.1), and pancreas (RR=2.2) cancer. Modestly elevated significant risks were also found for ovary (RR=1.2), breast (RR=1.1), cervix (RR=1.3), endometrial (RR=1.4), several digestive tract (RR=1.1-1.5), kidney (RR=1.4), and bladder cancer (RR=1.1). The findings were similar for men and women, and unrelated to study design. Meta-regression analyses showed limited effect modification of body mass index, and possible effect modification of age, gender, with some influence of study characteristics (population source, cancer- and diabetes ascertainment).Limitations: Publication bias seemed to be present. Only published data were used in the analyses.Conclusions: The systematic review and meta-analysis confirm the previous results of increased cancer risk in diabetes and extend this to additional cancer sites. Physicians in contact with patients with diabetes should be aware that diabetes patients are at an increased risk of cancer.

Patients suffering a fracture (and especially a hip fracture) have a high incidence of subsequent fracture. Fractures after the age of 50 may be considered an early warning of increased risk for future fractures in many patients.