Increase in Fracture Risk Following Unintentional Weight Loss in Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women†
Identifieur interne : 001C85 ( Main/Exploration ); précédent : 001C84; suivant : 001C86Increase in Fracture Risk Following Unintentional Weight Loss in Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women†
Auteurs : Juliet E. Compston [Royaume-Uni] ; A. Wyman [États-Unis] ; Gordon Fitzgerald [États-Unis] ; Jonathan D. Adachi [Canada] ; Roland D. Chapurlat [France] ; Cyrus Cooper [Royaume-Uni] ; Adolfo Díez-Pérez [Espagne] ; Stephen H. Gehlbach [États-Unis] ; Susan L. Greenspan [États-Unis] ; Frederick H. Hooven [États-Unis] ; Andrea Z. Lacroix [États-Unis] ; Lyn March [Australie] ; J. Coen Netelenbos [Pays-Bas] ; Jeri W. Nieves [États-Unis] ; Johannes Pfeilschifter [Allemagne] ; Maurizio Rossini [Italie] ; Christian Roux [France] ; Kenneth G. Saag [États-Unis] ; Ethel S. Siris [États-Unis] ; Stuart Silverman [États-Unis] ; Nelson B. Watts [États-Unis] ; Frederick A. Anderson [Royaume-Uni]Source :
- Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research [ 0884-0431 ] ; 2016.
Abstract
Increased fracture risk has been associated with weight loss in postmenopausal women but the time course over which this occurs has not been established. The aim of this study was to examine the effects of unintentional weight loss of ≥10 lb (4.5 kg) in postmenopausal women on fracture risk at multiple sites up to 5 years following weight loss. Using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) we analyzed the relationships between self-reported unintentional weight loss of ≥10 lb at baseline, year 2, or year 3 and incident clinical fracture in the years following weight loss. Complete data were available in 40,179 women (mean age ± SD 68 ± 8.3 years). Five-year cumulative fracture rate was estimated using the Kaplan-Meier method, and adjusted hazard ratios for weight loss as a time-varying covariate were calculated from Cox multiple regression models. Unintentional weight loss at baseline was associated with a significantly increased risk of fracture of the clavicle, wrist, spine, rib, hip, and pelvis for up to 5 years following weight loss. Adjusted hazard ratios showed a significant association between unintentional weight loss and fracture of the hip, spine, and clavicle within 1 year of weight loss, and these associations were still present at 5 years. These findings demonstrate increased fracture risk at several sites after unintentional weight loss in postmenopausal women. This increase is seen as early as 1 year following weight loss, emphasizing the need for prompt fracture risk assessment and appropriate management to reduce fracture risk in this population.
Url:
DOI: 10.1002/jbmr.2810
PubMed: 26861139
PubMed Central: 4935593
Affiliations:
- Allemagne, Australie, Canada, Espagne, France, Italie, Pays-Bas, Royaume-Uni, États-Unis
- Angleterre, Auvergne-Rhône-Alpes, Californie, Communauté de Madrid, Hollande-Septentrionale, Massachusetts, Midlands de l'Ouest, Ohio, Ontario, Pennsylvanie, Rhône-Alpes, Washington (État), État de New York, Île-de-France
- Amsterdam, Birmingham, Hamilton (Ontario), Lyon, Madrid, Paris, Pittsburgh
- Université McMaster, Université de Pittsburgh
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Saag</name><affiliation wicri:level="3"><nlm:aff id="A17">Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham</wicri:regionArea><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName></affiliation></author><author><name sortKey="Siris, Ethel S" sort="Siris, Ethel S" uniqKey="Siris E" first="Ethel S." last="Siris">Ethel S. Siris</name><affiliation wicri:level="2"><nlm:aff id="A18">Columbia University Medical Center, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Columbia University Medical Center, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name><affiliation wicri:level="2"><nlm:aff id="A19">Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Watts, Nelson B" sort="Watts, Nelson B" uniqKey="Watts N" first="Nelson B." last="Watts">Nelson B. 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Compston</name><affiliation wicri:level="1"><nlm:aff id="A1">Cambridge Biomedical Campus, Cambridge, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Cambridge Biomedical Campus, Cambridge</wicri:regionArea><wicri:noRegion>Cambridge</wicri:noRegion></affiliation></author><author><name sortKey="Wyman, A" sort="Wyman, A" uniqKey="Wyman A" first="A" last="Wyman">A. Wyman</name><affiliation wicri:level="2"><nlm:aff id="A2">Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><affiliation wicri:level="2"><nlm:aff id="A2">Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Adachi, Jonathan D" sort="Adachi, Jonathan D" uniqKey="Adachi J" first="Jonathan D." last="Adachi">Jonathan D. Adachi</name><affiliation wicri:level="4"><nlm:aff id="A3">St Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>St Joseph’s Healthcare, McMaster University, Hamilton, Ontario</wicri:regionArea><orgName type="university">Université McMaster</orgName><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Chapurlat, Roland D" sort="Chapurlat, Roland D" uniqKey="Chapurlat R" first="Roland D." last="Chapurlat">Roland D. Chapurlat</name><affiliation wicri:level="3"><nlm:aff id="A4">Division of Rheumatology, INSERM U1033, Université de Lyon, Hôpital E Herriot, Lyon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Division of Rheumatology, INSERM U1033, Université de Lyon, Hôpital E Herriot, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation wicri:level="1"><nlm:aff id="A5">MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton</wicri:regionArea><wicri:noRegion>Southampton</wicri:noRegion></affiliation></author><author><name sortKey="Diez Perez, Adolfo" sort="Diez Perez, Adolfo" uniqKey="Diez Perez A" first="Adolfo" last="Díez-Pérez">Adolfo Díez-Pérez</name><affiliation><nlm:aff id="A6">Hospital del Mar-IMIM-Autonomous University of Barcelona</nlm:aff></affiliation><affiliation wicri:level="3"><nlm:aff id="A7">RETICEF, Instituto Carlos III, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>RETICEF, Instituto Carlos III, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Gehlbach, Stephen H" sort="Gehlbach, Stephen H" uniqKey="Gehlbach S" first="Stephen H" last="Gehlbach">Stephen H. Gehlbach</name><affiliation wicri:level="2"><nlm:aff id="A2">Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Greenspan, Susan L" sort="Greenspan, Susan L" uniqKey="Greenspan S" first="Susan L." last="Greenspan">Susan L. Greenspan</name><affiliation wicri:level="4"><nlm:aff id="A8">University of Pittsburgh, Pittsburgh, PA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Pittsburgh, Pittsburgh, PA</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Hooven, Frederick H" sort="Hooven, Frederick H" uniqKey="Hooven F" first="Frederick H." last="Hooven">Frederick H. Hooven</name><affiliation wicri:level="2"><nlm:aff id="A9">UMASS Medical School, Worcester, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>UMASS Medical School, Worcester, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Lacroix, Andrea Z" sort="Lacroix, Andrea Z" uniqKey="Lacroix A" first="Andrea Z." last="Lacroix">Andrea Z. Lacroix</name><affiliation wicri:level="2"><nlm:aff id="A10">Fred Hutchinson Cancer Research Center, Seattle, Washington, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Fred Hutchinson Cancer Research Center, Seattle, Washington</wicri:regionArea><placeName><region type="state">Washington (État)</region></placeName></affiliation></author><author><name sortKey="March, Lyn" sort="March, Lyn" uniqKey="March L" first="Lyn" last="March">Lyn March</name><affiliation wicri:level="1"><nlm:aff id="A11">University of Sydney Institute of Bone and Joint Research and Department of Rheumatology, Royal North Shore Hospital, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>University of Sydney Institute of Bone and Joint Research and Department of Rheumatology, Royal North Shore Hospital</wicri:regionArea><wicri:noRegion>Royal North Shore Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Coen Netelenbos, J" sort="Coen Netelenbos, J" uniqKey="Coen Netelenbos J" first="J." last="Coen Netelenbos">J. Coen Netelenbos</name><affiliation wicri:level="3"><nlm:aff id="A12">Department of Endocrinology, VU University Medical Center, Amsterdam, Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Endocrinology, VU University Medical Center, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Nieves, Jeri W" sort="Nieves, Jeri W" uniqKey="Nieves J" first="Jeri W." last="Nieves">Jeri W. Nieves</name><affiliation wicri:level="2"><nlm:aff id="A13">Helen Hayes Hospital and Columbia University, West Haverstraw, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Helen Hayes Hospital and Columbia University, West Haverstraw, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Pfeilschifter, Johannes" sort="Pfeilschifter, Johannes" uniqKey="Pfeilschifter J" first="Johannes" last="Pfeilschifter">Johannes Pfeilschifter</name><affiliation wicri:level="1"><nlm:aff id="A14">Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen</wicri:regionArea><wicri:noRegion>Essen</wicri:noRegion><wicri:noRegion>Essen</wicri:noRegion><wicri:noRegion>Essen</wicri:noRegion></affiliation></author><author><name sortKey="Rossini, Maurizio" sort="Rossini, Maurizio" uniqKey="Rossini M" first="Maurizio" last="Rossini">Maurizio Rossini</name><affiliation wicri:level="1"><nlm:aff id="A15">Rheumatology Section, Department of Medicine, University of Verona, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Rheumatology Section, Department of Medicine, University of Verona</wicri:regionArea><wicri:noRegion>University of Verona</wicri:noRegion></affiliation></author><author><name sortKey="Roux, Christian" sort="Roux, Christian" uniqKey="Roux C" first="Christian" last="Roux">Christian Roux</name><affiliation wicri:level="3"><nlm:aff id="A16">Paris Descartes University, Cochin Hospital, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris Descartes University, Cochin Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Saag, Kenneth G" sort="Saag, Kenneth G" uniqKey="Saag K" first="Kenneth G." last="Saag">Kenneth G. Saag</name><affiliation wicri:level="3"><nlm:aff id="A17">Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham</wicri:regionArea><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName></affiliation></author><author><name sortKey="Siris, Ethel S" sort="Siris, Ethel S" uniqKey="Siris E" first="Ethel S." last="Siris">Ethel S. Siris</name><affiliation wicri:level="2"><nlm:aff id="A18">Columbia University Medical Center, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Columbia University Medical Center, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name><affiliation wicri:level="2"><nlm:aff id="A19">Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Watts, Nelson B" sort="Watts, Nelson B" uniqKey="Watts N" first="Nelson B." last="Watts">Nelson B. Watts</name><affiliation wicri:level="2"><nlm:aff id="A20">Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><affiliation wicri:level="1"><nlm:aff id="A1">Cambridge Biomedical Campus, Cambridge, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Cambridge Biomedical Campus, Cambridge</wicri:regionArea><wicri:noRegion>Cambridge</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research</title><idno type="ISSN">0884-0431</idno><idno type="eISSN">1523-4681</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p id="P1">Increased fracture risk has been associated with weight loss in postmenopausal women but the time course over which this occurs has not been established. The aim of this study was to examine the effects of unintentional weight loss of ≥10 lb (4.5 kg) in postmenopausal women on fracture risk at multiple sites up to 5 years following weight loss. Using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) we analyzed the relationships between self-reported unintentional weight loss of ≥10 lb at baseline, year 2, or year 3 and incident clinical fracture in the years following weight loss. Complete data were available in 40,179 women (mean age ± SD 68 ± 8.3 years). Five-year cumulative fracture rate was estimated using the Kaplan-Meier method, and adjusted hazard ratios for weight loss as a time-varying covariate were calculated from Cox multiple regression models. Unintentional weight loss at baseline was associated with a significantly increased risk of fracture of the clavicle, wrist, spine, rib, hip, and pelvis for up to 5 years following weight loss. Adjusted hazard ratios showed a significant association between unintentional weight loss and fracture of the hip, spine, and clavicle within 1 year of weight loss, and these associations were still present at 5 years. These findings demonstrate increased fracture risk at several sites after unintentional weight loss in postmenopausal women. This increase is seen as early as 1 year following weight loss, emphasizing the need for prompt fracture risk assessment and appropriate management to reduce fracture risk in this population.</p></div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Canada</li><li>Espagne</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Auvergne-Rhône-Alpes</li><li>Californie</li><li>Communauté de Madrid</li><li>Hollande-Septentrionale</li><li>Massachusetts</li><li>Midlands de l'Ouest</li><li>Ohio</li><li>Ontario</li><li>Pennsylvanie</li><li>Rhône-Alpes</li><li>Washington (État)</li><li>État de New York</li><li>Île-de-France</li></region><settlement><li>Amsterdam</li><li>Birmingham</li><li>Hamilton (Ontario)</li><li>Lyon</li><li>Madrid</li><li>Paris</li><li>Pittsburgh</li></settlement><orgName><li>Université McMaster</li><li>Université de Pittsburgh</li></orgName></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Compston, Juliet E" sort="Compston, Juliet E" uniqKey="Compston J" first="Juliet E." last="Compston">Juliet E. Compston</name></noRegion><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name></country><country name="États-Unis"><region name="Massachusetts"><name sortKey="Wyman, A" sort="Wyman, A" uniqKey="Wyman A" first="A" last="Wyman">A. Wyman</name></region><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><name sortKey="Gehlbach, Stephen H" sort="Gehlbach, Stephen H" uniqKey="Gehlbach S" first="Stephen H" last="Gehlbach">Stephen H. Gehlbach</name><name sortKey="Greenspan, Susan L" sort="Greenspan, Susan L" uniqKey="Greenspan S" first="Susan L." last="Greenspan">Susan L. Greenspan</name><name sortKey="Hooven, Frederick H" sort="Hooven, Frederick H" uniqKey="Hooven F" first="Frederick H." last="Hooven">Frederick H. Hooven</name><name sortKey="Lacroix, Andrea Z" sort="Lacroix, Andrea Z" uniqKey="Lacroix A" first="Andrea Z." last="Lacroix">Andrea Z. Lacroix</name><name sortKey="Nieves, Jeri W" sort="Nieves, Jeri W" uniqKey="Nieves J" first="Jeri W." last="Nieves">Jeri W. Nieves</name><name sortKey="Saag, Kenneth G" sort="Saag, Kenneth G" uniqKey="Saag K" first="Kenneth G." last="Saag">Kenneth G. Saag</name><name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name><name sortKey="Siris, Ethel S" sort="Siris, Ethel S" uniqKey="Siris E" first="Ethel S." last="Siris">Ethel S. Siris</name><name sortKey="Watts, Nelson B" sort="Watts, Nelson B" uniqKey="Watts N" first="Nelson B." last="Watts">Nelson B. Watts</name></country><country name="Canada"><region name="Ontario"><name sortKey="Adachi, Jonathan D" sort="Adachi, Jonathan D" uniqKey="Adachi J" first="Jonathan D." last="Adachi">Jonathan D. Adachi</name></region></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Chapurlat, Roland D" sort="Chapurlat, Roland D" uniqKey="Chapurlat R" first="Roland D." last="Chapurlat">Roland D. Chapurlat</name></region><name sortKey="Roux, Christian" sort="Roux, Christian" uniqKey="Roux C" first="Christian" last="Roux">Christian Roux</name></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Diez Perez, Adolfo" sort="Diez Perez, Adolfo" uniqKey="Diez Perez A" first="Adolfo" last="Díez-Pérez">Adolfo Díez-Pérez</name></region></country><country name="Australie"><noRegion><name sortKey="March, Lyn" sort="March, Lyn" uniqKey="March L" first="Lyn" last="March">Lyn March</name></noRegion></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Coen Netelenbos, J" sort="Coen Netelenbos, J" uniqKey="Coen Netelenbos J" first="J." last="Coen Netelenbos">J. Coen Netelenbos</name></region></country><country name="Allemagne"><noRegion><name sortKey="Pfeilschifter, Johannes" sort="Pfeilschifter, Johannes" uniqKey="Pfeilschifter J" first="Johannes" last="Pfeilschifter">Johannes Pfeilschifter</name></noRegion></country><country name="Italie"><noRegion><name sortKey="Rossini, Maurizio" sort="Rossini, Maurizio" uniqKey="Rossini M" first="Maurizio" last="Rossini">Maurizio Rossini</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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