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Hire Dr. Zheer Kejlberg A.

Denmark

USD 45 /hr

MD, PhD, postdoc with a focus on pharmacoepidemiology and prediction

Profile Summary

MD from Aarhus University. PhD at Steno Diabetes Center Aarhus in pharmacoepidemiology of bone fractures in diabetes.

Subject Matter Expertise

• ☆ Biostatistics
• ☆ Statistics
• ☆ R
• ☆ Endocrinology
• ☆ Diabetes
• ☆ Epidemiology

Services

• Writing
• Research
• Consulting
• Data & AI

Writing Medical Writing, Technical Writing

Research Fact Checking, Scientific and Technical Research

Consulting Healthcare Consulting, Scientific and Technical Consulting

Data & AI Predictive Modeling, Statistical Analysis, Data Visualization, Big Data Analytics, Data Cleaning, Data Processing, Data Insights

Work Experience

Aarhus University

- Present

Resident Physician

Aarhus University Hospital

August 2022 - Present

PhD Student

Aarhus University

May 2019 - July 2022

House Officer

Aarhus University Hospital

November 2018 - April 2019

House Officer

Aarhus University Hospital

February 2018 - October 2018

Education

PhD Epidemiology

Aarhus University & Steno Diabetes Center Aarhus

May 2019 - August 2022

MD

Aarhus University

February 2012 - January 2018

Certifications

• Certification details not provided.

Publications

JOURNAL ARTICLE

Zheer Kejlberg Al-Mashhadi, Rikke Viggers, Rasmus Fuglsang-Nielsen, Peter Vestergaard, Søren Gregersen, Jakob Starup-Linde(2022). The risk of major osteoporotic fractures with GLP-1 receptor agonists when compared to DPP-4 inhibitors: A Danish nationwide cohort study . Frontiers in Endocrinology. 13. Frontiers Media {SA}

The risk of major osteoporotic fractures with GLP-1 receptor agonists when compared to DPP-4 inhibitors @article{74edcdd1f897436d993bd055c4a028ce, title = "The risk of major osteoporotic fractures with GLP-1 receptor agonists when compared to DPP-4 inhibitors: A Danish nationwide cohort study", abstract = "BACKGROUND: Type 2 diabetes mellitus (T2D) is associated with an increased fracture risk. There is little evidence for the effects of glucagon-like peptide 1 receptor agonists (GLP-1RA) on fracture risk in T2D. We aimed to investigate the risk of major osteoporotic fractures (MOF) for treatment with GLP-1RA compared to dipeptidyl peptidase 4 inhibitors (DPP-4i) as add-on therapies to metformin.METHODS: We conducted a population-based cohort study using Danish national health registries. Diagnoses were obtained from discharge diagnosis codes (ICD-10 and ICD-8-system) from the Danish National Patient Registry, and all redeemed drug prescriptions were obtained from the Danish National Prescription Registry (ATC classification system). Subjects treated with metformin in combination with either GLP-1RA or DPP-4i were enrolled from 2007 to 2018. Subjects were propensity-score matched 1:1 based on age, sex, and index date. MOF were defined as hip, vertebral, humerus, or forearm fractures. A Cox proportional hazards model was utilized to estimate hazard rate ratios (HR) for MOF, and survival curves were plotted using the Kaplan-Meier estimator. In addition, Aalen's Additive Hazards model was applied to examine additive rather than relative hazard effects while allowing time-varying effects.RESULTS: In total, 42,816 individuals treated with either combination were identified and included. After matching, 32,266 individuals were included in the main analysis (16,133 in each group). Median follow-up times were 642 days and 529 days in the GLP-1RA and DPP-4i group, respectively. We found a crude HR of 0.89 [0.76-1.05] for MOF with GLP-1RA compared to DPP-4i. In the fully adjusted model, we obtained an unaltered HR of 0.86 [0.73-1.03]. For the case of hip fracture, we found a crude HR of 0.68 [0.49-0.96] and a similar adjusted HR. Fracture risk was lower in the GLP-1RA group when examining higher daily doses of the medications, when allowing follow-up to continue after medication change, and when examining hip fractures, specifically. Additional subgroup- and sensitivity analyses yielded results similar to the main analysis.CONCLUSION: In our primary analysis, we did not observe a significantly different risk of MOF between treatment with GLP-1RA and DPP-4i. We conclude that GLP-1RA are safe in terms of fracture.", keywords = "Humans, Dipeptidyl-Peptidase IV Inhibitors/therapeutic use, Glucagon-Like Peptide-1 Receptor/agonists, Diabetes Mellitus, Type 2/complications, Osteoporotic Fractures/epidemiology, Cohort Studies, Metformin/therapeutic use, Denmark/epidemiology, Glucagon-Like Peptide 1/therapeutic use", author = "Al-Mashhadi, {Zheer Kejlberg} and Rikke Viggers and Rasmus Fuglsang-Nielsen and Peter Vestergaard and S{\o}ren Gregersen and Jakob Starup-Linde", year = "2022", month = oct, doi = "10.3389/fendo.2022.882998", language = "English", volume = "13", journal = "Frontiers in Endocrinology", issn = "1664-2392", publisher = "Frontiers Media S.A", } . Frontiers in Endocrinology.

SGLT2 inhibitor treatment is not associated with an increased risk of osteoporotic fractures when compared to GLP-1 receptor agonists @article{7279d51b28264989bd45fa7d7984b6e0, title = "SGLT2 inhibitor treatment is not associated with an increased risk of osteoporotic fractures when compared to GLP-1 receptor agonists: A nationwide cohort study", abstract = "Background: Type 2 diabetes mellitus (T2D) is associated with an increased fracture risk. It is debated whether sodium-glucose cotransporter 2 (SGLT2) inhibitors influence fracture risk in T2D. We aimed to investigate the risk of major osteoporotic fractures (MOF) with SGLT2 inhibitors compared to glucagon-like peptide 1 (GLP-1) receptor agonists when used as add-on therapies to metformin.Methods: We conducted a population-based cohort study using Danish national health registries. Diagnoses were obtained from discharge diagnosis codes (ICD-10 and ICD-8-system) from the Danish National Patient Registry, and all redeemed drug prescriptions were obtained from the Danish National Prescription Registry (ATC classification system). Subjects treated with metformin in combination with either SGLT2 inhibitors or GLP-1 receptor agonists were identified and enrolled from 2012 to 2018. Subjects were then propensity-score matched 1:1 based on age, sex, and index date. Major osteoporotic fractures (MOF) were defined as hip, vertebral, humerus, or forearm fractures. A Cox proportional hazards model was utilized to estimate hazard rate ratios (HR) for MOF, and survival curves were plotted using the Kaplan-Meier estimator.Results: In total, 27,543 individuals treated with either combination were identified and included. After matching, 18,390 individuals were included in the main analysis (9,190 in each group). Median follow-up times were 355 [interquartile range (IQR) 126-780] and 372 [IQR 136-766] days in the SGLT2 inhibitor and GLP-1 receptor agonist group, respectively. We found a crude HR of 0.77 [95% CI 0.56-1.04] for MOF with SGLT2 inhibitors compared to GLP-1 receptor agonists. In the fully adjusted model, we obtained an unaltered HR of 0.77 [95% CI 0.56-1.05]. Results were similar across subgroup- and sensitivity analyses.Conclusion: These results suggest that SGLT2 inhibitors have no effect on fracture risk when compared to GLP-1 receptor agonists. This is in line with results from previous studies.", keywords = "Cohort Studies, Diabetes Mellitus, Type 2/complications, Glucagon-Like Peptide-1 Receptor, Humans, Metformin/therapeutic use, Osteoporotic Fractures/chemically induced, Sodium-Glucose Transporter 2 Inhibitors/adverse effects", author = "Al-Mashhadi, {Zheer Kejlberg} and Rikke Viggers and Jakob Starup-Linde and Peter Vestergaard and S{\o}ren Gregersen", note = "Copyright {\textcopyright} 2022 Al-Mashhadi, Viggers, Starup-Linde, Vestergaard and Gregersen.", year = "2022", month = aug, doi = "10.3389/fendo.2022.861422", language = "English", volume = "13", journal = "Frontiers in Endocrinology", issn = "1664-2392", publisher = "Frontiers Media S.A", } . Frontiers in Endocrinology.

Al-Mashhadi ZK, Viggers R, Starup-Linde J, Vestergaard P, Gregersen S(2022). SGLT2 inhibitor treatment is not associated with an increased risk of osteoporotic fractures when compared to GLP-1 receptor agonists: A nationwide cohort study . Frontiers in endocrinology.

Rikke Viggers and Zheer Al-Mashhadi and Jakob Starup-Linde and Peter Vestergaard(2022). The Efficacy of Alendronate Versus Denosumab on Major Osteoporotic Fracture Risk in Elderly Patients With Diabetes Mellitus: A Danish Retrospective Cohort Study . Frontiers in Endocrinology. 12. Frontiers Media {SA}

The Efficacy of Alendronate Versus Denosumab on Major Osteoporotic Fracture Risk in Elderly Patients With Diabetes Mellitus @article{a87dfcd5d38740adafe56edbf4f47c68, title = "The Efficacy of Alendronate Versus Denosumab on Major Osteoporotic Fracture Risk in Elderly Patients With Diabetes Mellitus: A Danish Retrospective Cohort Study", abstract = "Objective: Patients with diabetes mellitus have an increased risk of fractures; however, the underlying mechanism is largely unknown. We aimed to investigate whether the risk of major osteoporotic fractures in diabetes patients differs between subjects initiated with alendronate and denosumab, respectively. Methods and Research Design: We conducted a retrospective nationwide cohort study through access to all discharge diagnoses (ICD-10 system) from the National Danish Patient Registry along with all redeemed drug prescriptions (ATC classification system) from the Health Service Prescription Registry. We identified all subjects with a diabetes diagnosis between 2000 and 2018 and collected data on the first new prescription of anti-osteoporotic treatment between 2011 and 2018. Exposure was defined as either alendronate or denosumab treatment initiated after diabetes diagnosis. Outcome information was collected by identification of all major osteoporotic fracture (MOF) diagnoses, i.e., hip, spine, forearm, and humerus, from exposure until 2018 or censoring by emigration or death. The risk of fracture was calculated as hazard ratios (HR) using multiply adjusted Cox proportional models with death as a competing risk. Results: We included 8,745 subjects initiated with either alendronate (n = 8,255) or denosumab (n = 490). The cohort consisted of subjects with a mean age of 73.62 (SD ± 9.27) years, primarily females (69%) and suffering mainly from type 2 diabetes (98.22%) with a median diabetes duration at baseline of 5.45 years (IQR 2.41–9.19). Those in the denosumab group were older (mean 75.60 [SD ± 9.72] versus 73.51 [SD ± 9.23] years), had a higher proportion of women (81% versus 68%, RR 1.18 [95% CI 1.13–1.24], and were more comorbid (mean CCI 2.68 [95% CI 2.47–2.88] versus 1.98 [95% CI 1.93–2.02]) compared to alendronate initiators. In addition, denosumab users had a higher prevalence of previous fractures (64% versus 46%, RR 1.38 [95% CI 1.28–1.48]). The adjusted HR for any MOF after treatment initiation with denosumab was 0.89 (95% CI 0.78–1.02) compared to initiation with alendronate. Conclusion: The risk of incident MOF among subjects with diabetes was similar between those initially treated with alendronate and denosumab. These findings indicate that the two treatment strategies are equally effective in preventing osteoporotic fractures in subjects with diabetes.", keywords = "alendronate, bone, denosumab, diabetes, fracture, osteoporosis, POPULATION, TURNOVER, BONE-MINERAL DENSITY, BIOCHEMICAL MARKERS, REPORTED MEDICATION USE, THERAPY, GLUCOSE, COMPLICATIONS, POSTMENOPAUSAL WOMEN, EPIDEMIOLOGY, Humans, Bone Density Conservation Agents/therapeutic use, Female, Retrospective Studies, Osteoporotic Fractures/epidemiology, Denosumab/therapeutic use, Diabetes Mellitus, Type 2/complications, Alendronate/therapeutic use, Denmark/epidemiology, Aged, Cohort Studies", author = "Rikke Viggers and Zheer Al-Mashhadi and Jakob Starup-Linde and Peter Vestergaard", note = "Copyright {\textcopyright} 2022 Viggers, Al-Mashhadi, Starup-Linde and Vestergaard.", year = "2022", month = jan, doi = "10.3389/fendo.2021.826997", language = "English", volume = "12", journal = "Frontiers in Endocrinology", issn = "1664-2392", publisher = "Frontiers Media S.A", } . Frontiers in Endocrinology.

Alendronate Use and Risk of Type 2 Diabetes @article{fdab7859aa724520b77b9dd29724c3b3, title = "Alendronate Use and Risk of Type 2 Diabetes: A Nationwide Danish Nested Case-Control Study", abstract = "Objective: A link has been proposed between glucose homeostasis and bone metabolism. Bisphosphonates are first-line treatment of osteoporosis, and we aimed to investigate whether the risk of developing type 2 diabetes was associated with prior use of alendronate. Research Design and Methods: We conducted a population-based nested case-control study through access to all discharge diagnoses (ICD-10 system) from the National Danish Patient Registry along with all redeemed drug prescriptions (ATC classification system) from the Health Service Prescription Registry. All cases with a diagnosis of type 2 diabetes between 2008 and 2018 were matched on sex and age with 3 randomly selected controls by incidence-density sampling. Exposure was defined as ever use of alendronate and further grouped as effective and compliant use. ORs were calculated by conditional logistic regression analysis with adjustment for several confounders and test for trend for dose-response relationship. Results: We included 163,588 patients with type 2 diabetes and 490,764 matched control subjects with a mean age of 67 years and 55% male subjects. The odds of developing type 2 diabetes were lower among ever users of alendronate (multiple adjusted OR: 0.64 [95% CI 0.62-0.66]). A test for trend suggested a dose-response relationship between longer effective use of alendronate and lower risk of type 2 diabetes. Conclusion: These results suggest a possible protective effect of alendronate in a dose-dependent manner against development of type 2 diabetes.", keywords = "alendronate, bisphosphonate, bone, diabetes, type 2 diabetes", author = "Rikke Viggers and Zheer Al-Mashhadi and Jakob Starup-Linde and Peter Vestergaard", note = "Publisher Copyright: Copyright {\textcopyright} 2021 Viggers, Al-Mashhadi, Starup-Linde and Vestergaard.", year = "2021", month = nov, doi = "10.3389/fendo.2021.771426", language = "English", volume = "12", journal = "Frontiers in Endocrinology", issn = "1664-2392", publisher = "Frontiers Media S.A", } . Frontiers in Endocrinology.

Local Pressure Drives Low-Density Lipoprotein Accumulation and Coronary Atherosclerosis in Hypertensive Minipigs @article{a0ede8d9e0d7488fab95998d83afd28e, title = "Local Pressure Drives Low-Density Lipoprotein Accumulation and Coronary Atherosclerosis in Hypertensive Minipigs", abstract = "BACKGROUND: The mechanisms by which hypertension accelerates coronary artery disease are poorly understood. Patients with hypertension often have confounding humoral changes, and to date, no experimental models have allowed analysis of the isolated effect of pressure on atherosclerosis in a setting that recapitulates the dimensions and biomechanics of human coronary arteries.OBJECTIVES: This study sought to analyze the effect of pressure on coronary atherosclerosis and explore the underlying mechanisms.METHODS: Using inflatable suprarenal aortic cuffs, we increased mean arterial pressure by >30 mm Hg in the cephalad body part of wild-type and hypercholesterolemic proprotein convertase subtilisin kexin type 9 (PCSK9)D374Y Yucatan minipigs for >1 year. Caudal pressures remained normal.RESULTS: Under hypercholesterolemic conditions in PCSK9D374Y transgenic minipigs, cephalad hypertension accelerated coronary atherosclerosis to almost 5-fold with consistent development of fibroatheromas that were sufficiently large to cause stenosis on computed tomography angiography. This was caused by local pressure forces, because vascular beds shielded from hypertension, but exposed to the same humoral factors, showed no changes in lesion formation. The same experiment was conducted under normocholesterolemic conditions in wild-type minipigs to examine the underlying mechanisms. Hypertension produced clear changes in the arterial proteome with increased abundance of mechanical strength proteins and reduced levels of infiltrating plasma macromolecules. This was paralleled by increased smooth muscle cells and increased intimal accumulation of low-density lipoproteins in the coronary arteries.CONCLUSIONS: Increased pressure per se facilitates coronary atherosclerosis. Our data indicate that restructuring of the artery to match increased tensile forces in hypertension alters the passage of macromolecules and leads to increased intimal accumulation of low-density lipoproteins.", author = "Al-Mashhadi, {Rozh H} and Al-Mashhadi, {Ahmed L} and Nasr, {Zahra P} and Mortensen, {Martin B{\o}dtker} and Lewis, {Esmeralda A} and Emilio Camafeita and Kristian Ravlo and Zheer Al-Mashhadi and Kj{\ae}r, {Daniel W} and Johan Palmfeldt and Peter Bie and Jensen, {Jesper M} and N{\o}rgaard, {Bjarne L} and Erling Falk and Jes{\'u}s V{\'a}zquez and Bentzon, {Jacob F}", note = "Copyright {\textcopyright} 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.", year = "2021", month = feb, doi = "10.1016/j.jacc.2020.11.059", language = "English", volume = "77", pages = "575--589", journal = "Journal of the American College of Cardiology", issn = "0735-1097", publisher = "Elsevier", number = "5", } . Journal of the American College of Cardiology.

Al-Mashhadi, R.H., Al-Mashhadi, A.L., Nasr, Z.P., Mortensen, M.B., Lewis, E.A., Camafeita, E., Ravlo, K., Al-Mashhadi, Z., Kjær, D.W., Palmfeldt, J., et al.(2021). Local Pressure Drives Low-Density Lipoprotein Accumulation and Coronary Atherosclerosis in Hypertensive Minipigs . Journal of the American College of Cardiology. 77. (5). p. 575-589.

Glucose-Lowering Drugs and Fracture Risk @article{9b69ee23cbcf4d48a466749c7412cfd9, title = "Glucose-Lowering Drugs and Fracture Risk: a Systematic Review", abstract = "Purpose of Review: Diabetes mellitus (DM) is associated with increased fracture risk. The aim of this systematic review was to examine the effects of different classes of glucose-lowering drugs on fracture risk in patients with type 2 DM. The heterogeneity of the included studies did not allow formal statistical analyses. Recent Findings: Sixty studies were included in the review. Metformin, dipeptidylpeptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium–glucose cotransporter 2-inhibitors do not appear to increase fracture risk. Results for insulin and sulphonylureas were more disparate, although there may be an increased fracture risk related to hypoglycemia and falls with these treatments. Glitazones were consistently associated with increased fracture risk in women, although the evidence was sparser in men. Summary: New glucose-lowering drugs are continuously being developed and better understanding of these is leading to changes in prescription patterns. Our findings warrant continued research on the effects of glucose-lowering drugs on fracture risk, elucidating the class-specific effects of these drugs.", keywords = "fracture, glucose-lowering drug, diabetes, antidiabetic", author = "Zheer Al-Mashhadi and Rikke Viggers and Rasmus Fuglsang and {de Vries}, Frank and {van den Bergh}, Joop and Torben Harsl{\o}f and Langdahl, {Bente Lomholt} and S{\o}ren Gregersen and Linde, {Jakob Starup}", year = "2020", month = dec, doi = "10.1007/s11914-020-00638-8", language = "English", volume = "18", pages = "737--758", journal = "Current Osteoporosis Reports", issn = "1544-1873", publisher = "Current Science, Inc.", number = "6", } . Current Osteoporosis Reports.

Z. Al-Mashhadi and R. Viggers and R. Fuglsang-Nielsen and F. de Vries and J. P. van den Bergh and T. Harsl{\o}f and B. Langdahl and S. Gregersen and Jakob Starup-Linde(2020). Glucose-Lowering Drugs and Fracture Risk—a Systematic Review . Current Osteoporosis Reports. Springer Science and Business Media {LLC}

(2020). Bone Health in the Elderly with Type 2 Diabetes Mellitus–A Systematic Review . OBM Geriatrics.

Zheer Kejlberg Al-Mashhadi, R Viggers, Fuglsang-Nielsen R., Søren Gregersen, J Starup-Linde(2020). The Impact of Exercise on Bone Health in Type 2 Diabetes Mellitus . Current Osteoporosis Reports. 18. (4). p. 357--370. Current Science, Inc.

(2020). The Impact of Exercise on Bone Health in Type 2 Diabetes Mellitus—a Systematic Review . Current Osteoporosis Reports.

Zheer Kejlberg Al-Mashhadi, Rikke Viggers, Fuglsang-Nielsen R., Bente Lomholt Langdahl, Peter Vestergaard, Søren Gregersen, Jakob Starup Linde(2020). Bone Health in the Elderly with Type 2 Diabetes Mellitus . OBM Geriatrics. 4. (2).

Viggers, R., Al-Mashhadi, Z., Fuglsang-Nielsen, R., Gregersen, S., Starup-Linde, J.(2020). The Impact of Exercise on Bone Health in Type 2 Diabetes Mellitus—a Systematic Review . Current Osteoporosis Reports. 18. (4). p. 357-370.

Al-Mashhadi, Z., Viggers, R., Fuglsang-Nielsen, R., de Vries, F., van den Bergh, J.P., Harsløf, T., Langdahl, B., Gregersen, S., Starup-Linde, J.(2020). Glucose-Lowering Drugs and Fracture Risk—a Systematic Review . Current Osteoporosis Reports. 18. (6). p. 737-758.

(2019). 18Fluorodeoxyglucose Accumulation in Arterial Tissues Determined by PET Signal Analysis . Journal of the American College of Cardiology.

Zheer Kejlberg Al-Mashhadi, Rozh H. Al-Mashhadi, Lars Poulsen Tolbod, Lars Bloch, Martin M. Bjørklund, Zahra P. Nasr, Michael Winterdahl, Jørgen Frøkiær, Erling Falk, Jacob Fog Bentzon(2019). 18Fluorodeoxyglucose Accumulation in Arterial Tissues Determined by PET Signal Analysis . Journal of the American College of Cardiology. 74. (9). p. 1220--1232. Elsevier

Al-Mashhadi, R.H., Tolbod, L.P., Bloch, L.Ø., Bjørklund, M.M., Nasr, Z.P., Al-Mashhadi, Z., Winterdahl, M., Frøkiær, J., Falk, E., Bentzon, J.F.(2019). ¹⁸Fluorodeoxyglucose Accumulation in Arterial Tissues Determined by PET Signal Analysis . Journal of the American College of Cardiology. 74. (9). p. 1220-1232.

CONFERENCE ABSTRACT

Fracture risk in treatment with GLP-1RA compared to DPP-4i @article{22ffa1dfa89b4e04ac27b57b6e805b39, title = "Fracture risk in treatment with GLP-1RA compared to DPP-4i: a Danish nationwide cohort study", author = "Al-Mashhadi, {Z. K.} and R. Viggers and R. Fuglsang-Nielsen and P. Vestergaard and S. Gregersen and J. Starup-Linde", year = "2022", month = sep, language = "English", volume = "65", pages = "S183", journal = "Diabetologia", issn = "0012-186X", publisher = "Springer", number = "SUPPL 1", } . Diabetologia.

Zheer Kejlberg Al-Mashhadi, Rikke Viggers, Jakob Starup Linde, Peter Vestergaard, Søren Gregersen(2022). SGLT2 inhibitor treatment does not increase risk of osteoporotic fractures compared to GLP-1 receptor agonists: . Endocrine Abstracts. 81. BioScientifica Ltd.