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Kanno A, Aizawa T, Mori Y, Aizawa T. Different types of hip fragility fractures have different values of 25-hydroxyvitamin D and parathyroid hormone. J Orthop Sci 2024; 29:256-261. [PMID: 36435724 DOI: 10.1016/j.jos.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vitamin D insufficiency/deficiency is related to fragility fracture. In most previous studies, there was no assessment of vitamin D deficiency status separately for hip fracture types. The first aim is to evaluate vitamin D and parathyroid hormone (PTH) status in patients with hip fracture. The second objective is to determine whether there are differences in vitamin D and PTH between the femoral neck fracture and the femoral metaphyseal fracture group. METHODS 62 men and 248 women with fragility hip fractures were enrolled. 25-hydroxyviamin D [25(OH)D] and intact PTH (iPTH) values were evaluated, and femoral neck bone mineral density (BMD) was measured on the uninjured side. Vertebral fractures (VFs) were assessed using radiographs of the thoracic and lumbar spine. We examined the relationships of 25(OH)D value with the number of prevalent VFs, T-score of femoral neck, and iPTH level. These analyses were also performed, neck fracture and trochanteric fracture separately. RESULTS Mean age was 85 years. The mean 25(OH)D was 11.2 (range, 4.0-26.1) ng/ml, whereas the mean iPTH value was 48.9 pg/ml (range, 9-429 pg/ml). The mean number of VFs was 1.5 (range, 0-11), and the mean T-score was -3.3 (range, -5.2 to -0.5). There was a weak correlation between the 25(OH)D value and the number of VFs. There was a weak but significant correlation between 25(OH)D and iPTH values. In the patients with trochanteric fractures, 25(OH)D value was significantly lower and iPTH value was significantly higher than those with neck fractures. There was a significant correlation between the 25(OH)D value and number of the VFs, 25(OH)D, and iPTH values only in trochanteric fractures. CONCLUSIONS Vitamin D deficiency was severe and PTH levels were higher in the trochanteric fractures. Both vitamin D deficiency and high PTH levels were suggested to have association with bone fragility.
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Affiliation(s)
- Atsuko Kanno
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Sendai South Hospital, Japan; Department of Orthopaedic Surgery, Iwaki City Medical Center, Japan.
| | - Toshitake Aizawa
- Department of Orthopaedic Surgery, Iwaki City Medical Center, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Japan
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Howlett DC, Drinkwater KJ, Mahmood N, Salman L, Griffin J, Javaid MK, Retnasingam G, Marzoug A, Greenhalgh R. Radiology reporting of incidental osteoporotic vertebral fragility fractures present on CT studies: results of UK national re-audit. Clin Radiol 2023; 78:e1041-e1047. [PMID: 37838545 DOI: 10.1016/j.crad.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/16/2023]
Abstract
AIM To describe a UK-wide re-audit of the 2019 Royal College of Radiologists (RCR) audit evaluating patient-related data and organisational infrastructure in the radiological reporting of vertebral fragility fractures (VFFs) on computed tomography (CT) studies and to assess the impact of a series of RCR interventions, initiated to raise VFF awareness, on reporting practice and outcomes. MATERIALS AND METHODS Patient specific and organisational questionnaires largely replicated those utilised in 2019. The patient questionnaire involved retrospective analysis of between 50 and 100 consecutive, non-traumatic CT studies which included the thoracolumbar spine. All RCR radiology audit leads were invited to participate. Data collection commenced from 1 April 2022. RESULTS Data were supplied by 129/194 (67%) departments. One thousand five hundred and eighty-six of 7,316 patients (21.7%) had a VFF on auditor review. Overall improvements were demonstrated in key initial/provisional reporting results; comment on spine/bone (93.2%, 14.4% improvement, p<0.0002); fracture severity assessment (34.7%, 8.5% improvement, p=0.0007); use of recommended terminology (67.8%, 7.5% improvement, p=0.0034); recommendations for further management (11.7%, 9.1% improvement, p<0.0002). CONCLUSIONS The 2022 national re-audit confirms improvements in diagnostic performance and practice in VFF reporting. Continuing work is required to build on this improvement and to further embed best practice.
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Affiliation(s)
- D C Howlett
- Department of Radiology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - K J Drinkwater
- Directorate of Education and Professional Practice, Royal College of Radiologists, London, UK.
| | - N Mahmood
- Department of Radiology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - L Salman
- Department of Radiology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - J Griffin
- The Royal Osteoporosis Society, Bath, UK
| | - M K Javaid
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - G Retnasingam
- Department of Radiology St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - A Marzoug
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - R Greenhalgh
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK
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Kim SH, Jang SY, Nam K, Cha Y. Analysis of Long-Term Medical Expenses in Vertebral Fracture Patients. Clin Orthop Surg 2023; 15:989-999. [PMID: 38045582 PMCID: PMC10689215 DOI: 10.4055/cios23203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background The objective of this study was to analyze the direct medical expenses of a vertebral fracture cohort (VC) and a matched cohort (MC) over 5 years preceding and following the fracture, analyze the duration of the rise in medical expenses due to the fracture, and examine whether the expenses vary with age group, utilizing a national claims database. Methods Subjects with vertebral fractures and matched subjects were chosen from the National Health Insurance Service Sample cohort (NHIS-Sample) of South Korea. Patients with vertebral fractures were either primarily admitted to acute care hospitals (index admissions) or those who received kyphoplasty or vertebroplasty during the follow-up period (2002-2015). A risk-set matching was performed using 1 : 5 random sampling to simulate a real-world situation. Individual-level direct medical expenses per quarter were calculated for 5 years prior and subsequent to the vertebral fracture. In this analysis using a comparative interrupted time series design, we examined the direct medical expenses of a VC and an MC. Results A total of 3,923 incident vertebral fracture patients and 19,615 matched subjects were included in this study. The mean age was 75.5 ± 7.4 years, and 69.5% were women. The mean difference in medical expenses between the two groups increased steadily before the fracture. The medical expenses of the VC peaked in the first quarter following the fracture. The cost changes were 1.82 times higher for the VC than for the MC (95% confidence interval, 1.62-2.04; p < 0.001) in the first year. Subsequently, there were no differential changes in medical expenses between the two groups (p > 0.05). In the < 70-year subgroup, there were no differential changes in medical expenses between the two groups (p > 0.05). However, in the ≥ 80-year subgroup, the cost changes for the VC were higher than those for the MC up to 5 years after time zero. Conclusions Based on our study results, we suggest that health and medical policies for vertebral fractures should be designed to last up to approximately 1 year after the fracture. Health policies should be differentiated according to age group.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Kyeongdong Nam
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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Talevski J, Beauchamp A, Bird S, Daly RM. Integrating post-fracture care into the primary care setting (interFRACT): Protocol for a mixed-methods study to co-design a care program to improve rates of osteoporosis and fracture treatment. BMJ Open 2023; 13:e067560. [PMID: 37076158 PMCID: PMC10124312 DOI: 10.1136/bmjopen-2022-067560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Despite evidence showing that timely diagnosis and appropriate pharmacological treatment of osteoporosis reduces subsequent fracture rates, osteoporosis remains significantly underdiagnosed and undertreated. The large and ongoing treatment gap for osteoporosis and associated fragility fractures could be addressed by considering systematic approaches for post-fracture care in the primary care setting. This study will develop the Integrating Post-Fracture Care into Primary Care (interFRACT) care program that aims to enhance diagnosis and treatment of osteoporosis and improve initiation and adherence to fracture prevention strategies for older adults in the primary care setting. METHODS AND ANALYSIS This mixed-methods study will follow an established co-design approach that involves six steps; the first three aim to gain an understanding of the consumer experience and needs, while the latter three focus on how to improve that experience through design and action. This will include: development of a Stakeholder Advisory Committee to provide guidance on all aspects of study design, including implementation, evaluation and dissemination; interviews with primary care physicians to explore beliefs and attitudes towards osteoporosis and fracture treatment; interviews with consumers (older adults with a diagnosis of osteoporosis and/or fragility fracture) to identify current needs for osteoporosis treatment and fracture prevention; a series of co-design workshops to develop the components of the interFRACT care program based on published guidance and findings from interviews; and a feasibility study with primary care physicians to determine the usability and acceptability of the interFRACT care program. ETHICS AND DISSEMINATION Ethical approval was obtained from Deakin University Human Research Ethics Committee (approval number: HEAG-H 56_2022). Study results will be published in peer-reviewed journals, presented at national and international conferences, and collated in reports for participating primary care practices.
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Affiliation(s)
- Jason Talevski
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- The Australian Institute of Musculoskeletal Sciences (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- School of Rural Health, Monash University, Warragul, Victoria, Australia
| | - Alison Beauchamp
- School of Rural Health, Monash University, Warragul, Victoria, Australia
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Stefanie Bird
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Caffarelli C, Mondanelli N, Crainz E, Giannotti S, Frediani B, Gonnelli S. The Phenotype of Bone Turnover in Patients with Fragility Hip Fracture: Experience in a Fracture Liaison Service Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127362. [PMID: 35742610 PMCID: PMC9223564 DOI: 10.3390/ijerph19127362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023]
Abstract
Background: Hip fragility fractures are becoming one of the main health care problems in countries with an aging population. This study aimed to evaluate the clinical characteristics and the usefulness of bone turnover markers in patients with a hip fracture. Methods: In a cohort of 363 patients (84.1 ± 9.2 years) with hip fractures we measured 25-hydroxyvitamin D (25OHD), bone alkaline phosphatase, type I collagen β carboxy telopeptide (βCTX), and parathyroid hormone (PTH). We recorded patients’ Charlson Comorbidity Index (CCI) and previous history of fragility fractures. Results: Vitamin D and PTH levels were inversely correlated (r = −024; p < 0.001). The prevalence of 25OHD deficiency was 57.8%, the PTH levels greater than 65 pg/mL was in 47.0 %, and in those who had βCTX values the upper limit was 61.8%. Moreover, 62% of patients with a fragility hip fracture had a history of a previous fracture. The 25OHD serum levels were inversely associated with CCI and a previous fragility fracture. On the contrary, PTH and βCTX serum levels showed a positive significant correlation with CCI and previous fragility fractures. Conclusion: This study confirmed the usefulness of a bone turnover markers assessment, along with the comorbidities and history of previous fragility fractures in order to better identify the risk of hip fracture.
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Affiliation(s)
- Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, Section of Internal Medicine, University of Siena, 53100 Siena, Italy;
| | - Nicola Mondanelli
- Department of Medicine, Surgery and Neurosciences, Section of Orthopedics and Traumatology, University of Siena, 53100 Siena, Italy; (N.M.); (S.G.)
| | - Eduardo Crainz
- Department of Orthopaedics and Traumatology, Section of Orthopedics and Traumatology, University Hospital of Siena, 53100 Siena, Italy;
| | - Stefano Giannotti
- Department of Medicine, Surgery and Neurosciences, Section of Orthopedics and Traumatology, University of Siena, 53100 Siena, Italy; (N.M.); (S.G.)
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, 53100 Siena, Italy;
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Section of Internal Medicine, University of Siena, 53100 Siena, Italy;
- Correspondence: ; Tel.: +39-0577-585468
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Gregson CL, Compston JE. New national osteoporosis guidance-implications for geriatricians. Age Ageing 2022; 51:6565793. [PMID: 35403198 PMCID: PMC9760060 DOI: 10.1093/ageing/afac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 02/05/2023] Open
Abstract
Fragility fractures are painful, debilitating, often life-changing and accounted for an estimated 2.4% of pre-pandemic health care spending in the UK. Those who are older, frail and multimorbid have the highest fracture risk and therefore the most to gain from anti-osteoporosis treatments to reduce this risk. Currently, an unacceptable treatment gap exists between those eligible for and those who receive treatment. This commentary discusses the major changes to the new, National Institute for Health and Care Excellence accredited, UK National Osteoporosis Guideline Group (NOGG) guidance (published March 2022) most relevant to the management of older people's bone health. Changes include intervention thresholds; using fracture probabilities from FRAX; for patients too frail to undergo DXA; greater emphasis on vertebral fracture detection and the use of intravenous zoledronate as a first-line anti-osteoporosis therapy; the new concept of 'very high fracture risk' which should prompt consideration of use of parenteral anti-osteoporosis therapy; new guidance regarding anabolic treatment options; concerns regarding denosumab cessation; and the urgent need to get patients with a fragility fracture onto treatment to reduce re-fracture risk with follow-up to check tolerance and ensure adherence.
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Affiliation(s)
- Celia L Gregson
- Address correspondence to: Celia L. Gregson, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK. Tel: +44 (0)117 4147842.
| | - Juliet E Compston
- Cambridge Biomedical Campus, University of Cambridge, Cambridge, CB2 0AH, UK
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Schoeneberg C, Pass B, Oberkircher L, Rascher K, Knobe M, Neuerburg C, Lendemans S, Aigner R. Impact of concomitant injuries in geriatric patients with proximal femur fracture : an analysis of the Registry for Geriatric Trauma. Bone Joint J 2021; 103-B:1526-1533. [PMID: 34465160 DOI: 10.1302/0301-620x.103b9.bjj-2021-0358.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The impact of concomitant injuries in patients with proximal femoral fractures has rarely been studied. To date, the few studies published have been mostly single-centre research focusing on the influence of upper limb fractures. A retrospective cohort analysis was, therefore, conducted to identify the impact and distribution of concomitant injuries in patients with proximal femoral fractures. METHODS A retrospective, multicentre registry-based study was undertaken. Between 1 January 2016 and 31 December 2019, data for 24,919 patients from 100 hospitals were collected in the Registry for Geriatric Trauma. This information was queried and patient groups with and without concomitant injury were compared using linear and logistic regression models. In addition, we analyzed the influence of the different types of additional injuries. RESULTS A total of 22,602 patients met the inclusion criteria. The overall prevalence of a concomitant injury was 8.2% with a predominance of female patients (8.7% vs 6.9%; p < 0.001). Most common were fractures of the ipsilateral upper limb. Concomitant injuries resulted in prolonged time-to-surgery (by 3.4 hours (95 confidence interval (CI) 2.14 to 4.69)) and extended length of stay in hospital by 2.2 days (95% CI 1.74 to 2.61). Mortality during the admission was significantly higher in the concomitant injury group (7.4% vs 5.3%; p < 0.001). Additionally, walking ability and quality of life were reduced in these patients at discharge. More patients were discharged to a nursing home instead of their own home compared to patients without additional injuries (25.8% vs 30.3%; p < 0.001). CONCLUSION With a prevalence of 8.2%, the appearance of a concomitant injury is common in elderly patients with hip fracture. These patients are at a greater risk for death during the admission, longer hospital stays, and delayed surgery. This knowledge is clinically important for all who are involved in the treatment of proximal femur fractures. Cite this article: Bone Joint J 2021;103-B(9):1526-1533.
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Affiliation(s)
- Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Klinikum Essen, Essen, Germany
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Klinikum Essen, Essen, Germany
| | - Ludwig Oberkircher
- Center for Orthopaedic and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | | | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Carl Neuerburg
- Department of General, Trauma and Reconstructive Surgery, Ludwigs-Maximilians-University, Munich, Germany
| | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Klinikum Essen, Essen, Germany
| | - Rene Aigner
- Center for Orthopaedic and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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A Bibliometric Analysis of Fragility Fractures: Top 50. ACTA ACUST UNITED AC 2021; 57:medicina57060639. [PMID: 34205638 PMCID: PMC8233744 DOI: 10.3390/medicina57060639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
Background and Objectives: The population is aging and fragility fractures are a research topic of steadily growing importance. Therefore, a systematic bibliometric review was performed to identify the 50 most cited articles in the field of fragility fractures analyzing their qualities and characteristics. Materials and Methods: From the Core Collection database in the Thomson Reuters Web of Knowledge, the most influential original articles with reference to fragility fractures were identified in February 2021 using a multistep approach. Year of publication, total number of citations, average number of citations per year since year of publication, affiliation of first and senior author, geographic origin of study population, keywords, and level of evidence were of interest. Results: Articles were published in 26 different journals between 1997 and 2020. The number of total citations per article ranged from 12 to 129 citations. In the majority of publications, orthopedic surgeons and traumatologists (66%) accounted for the first authorship, articles mostly originated from Europe (58%) and the keyword mostly used was “hip fracture”. In total, 38% of the articles were therapeutic studies level III followed by prognostic studies level I. Only two therapeutic studies with level I could be identified. Conclusions: This bibliometric review shows the growing interest in fragility fractures and raises awareness that more high quality and interdisciplinary studies are needed.
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The Variation Characteristics and Influencing Factors of Base Flow of the Hexi Inland Rivers. ATMOSPHERE 2021. [DOI: 10.3390/atmos12030356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The climate is becoming warmer and more humid in the inland area of northwestern China. In addition, human activities have changed the underlying surface of the river basin, and the instability of the runoff changes has intensified. As a component of river runoff, the base flow reflects the impacts of climate change and human activities. Therefore, it is necessary to carry out research on the change in the base flow and its influencing factors in the context of climate change and human activities. In this study, a base flow method suitable for the inland rivers in northwestern China was assessed, and the variation rules and influencing factors of the base flow were analyzed. The results reveal that since the 1980s, the base flow of the Hexi inland rivers has exhibited an increasing trend, and the growth rate has exhibited the following order: western > central > eastern. The Base Flow Index (the proportion of the base flow to the total runoff in a period) values are in the range of 0.45–0.65. Overall, the change in the base flow of the Hexi inland rivers is the result of the coupling of climate factors and land-use change. The influence of land-use change on the base flow of the Hexi inland rivers gradually weakens from east to west, except for the Xiying River, while the influence of climate change gradually increases. The contribution rates of land-use change to the base flow in the eastern, central, and western regions were 75%, 55%, and 27%. Temperature and precipitation are the main climate factors affecting the change in the base flow in the western and central regions, respectively.
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Yang J, Cosman F, Stone PW, Li M, Nieves JW. Vertebral fracture assessment (VFA) for osteoporosis screening in US postmenopausal women: is it cost-effective? Osteoporos Int 2020; 31:2321-2335. [PMID: 32778935 DOI: 10.1007/s00198-020-05588-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/04/2020] [Indexed: 01/03/2023]
Abstract
UNLABELLED Vertebral fracture assessment (VFA) is cost-effective when it was incorporated in the routine screening for osteoporosis in community-dwelling women aged ≥ 65 years, which support guidelines, such as the National Osteoporosis Foundation (NOF) for the diagnostic use of VFA as an important addition to fracture risk assessment. INTRODUCTION To evaluate the cost-effectiveness of VFA as a screening tool to reduce future fracture risk in US community-dwelling women aged ≥ 65 years. METHODS An individual-level state-transition cost-effectiveness model from a healthcare perspective was constructed using derived data from published literature. The time horizon was lifetime. Five screening strategies were compared, including no screening at all, central dual-energy X-ray absorptiometry (DXA) only, VFA only, central DXA followed by VFA if the femoral neck T-score (FN-T) ≤ - 1.5, or if the FN-T ≤ - 1.0. Various initiation ages and rescreening intervals were evaluated. Oral bisphosphonate treatment for 5-year periods was assumed. Incremental cost-effectiveness ratios (2017 US dollars per quality-adjusted life-year (QALY) gained) were used as the outcome measure. RESULTS The incorporation of VFA slightly increased life expectancy by 0.1 years and reduced the number of subsequent osteoporotic fractures by 3.7% and 7.7% compared with using DXA alone and no screening, respectively, leading to approximately 30 billion dollars saved. Regardless of initiation ages and rescreening intervals, central DXA followed by VFA if the FN-T ≤ - 1.0 was most cost-effective ($40,792 per QALY when the screening is initiated at age 65 years and with rescreening every 5 years). Results were robust to change in VF incidence and medication costs. CONCLUSION In women aged ≥ 65 years, VFA is cost-effective when it was incorporated in routine screening for osteoporosis. Our findings support the National Osteoporosis Foundation (NOF) guidelines for the diagnostic use of VFA as an important addition to fracture risk assessment.
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Affiliation(s)
- J Yang
- Institute for Social and Economic Research and Policy (ISERP), Columbia University, New York, NY, 10027, USA
| | - F Cosman
- Department of Medicine, Columbia University, New York, NY, 10032, USA
| | - P W Stone
- School of Nursing, Columbia University, New York, NY, USA
| | - M Li
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - J W Nieves
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
- Hospital for Special Surgery, New York, NY, 10021, USA.
- Department of Epidemiology and Institute of Human Nutrition, Columbia University, 630 West 168th Street, IHN PH 1512, New York, NY, 10032, USA.
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11
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Howlett D, Drinkwater K, Griffin J, Javaid K. Improving outcomes for patients with osteoporotic vertebral fragility fractures: the role of the radiologist. Clin Radiol 2020; 75:811-812. [DOI: 10.1016/j.crad.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022]
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12
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Yang J, Mao Y, Nieves JW. Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: A systematic review and meta-analysis. Bone 2020; 136:115358. [PMID: 32268210 DOI: 10.1016/j.bone.2020.115358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/20/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vertebral fracture (VF) is the most common osteoporotic fracture in postmenopausal women, although most VFs are subclinical. Prevalent VFs are a significant predictor of subsequent fracture and therefore, identification of VF improves the identification of those with high fracture risk. The aim of present study was to systematically review the literature that assessed the prevalence of VF in asymptomatic postmenopausal women, using Vertebral Fracture Assessment (VFA) by dual-energy X-ray absorptiometry. METHOD Medline, Web of Science and Cochrane databases were searched between Jan 1st, 2000 and Jan 31st, 2018, for publications in English that reported the prevalence of VFA-detected VF in asymptomatic postmenopausal women. We also searched for reports, conference papers and grey literature. Reviewers screened studies for eligibility and extracted data for included studies. Random effects meta-analyses were performed to calculate the prevalence of VF. The presence of publication bias was assessed using funnel plots by precision and Egger's Test of the Intercept. RESULTS A total of 1777 articles were identified, 94 studies were fully reviewed and 28 studies (n = 25,418) met the inclusion criteria and were analyzed. More than two thirds of the studies were cross-sectional and the sample size varied widely across the studies (from 63 to 5156). The mean age ranged from 59.5 to 86.2 years old. The prevalence of osteoporosis and osteopenia varied between 6-57.0% and 25.1-58.9%, respectively. However, among women who had prevalent VFs, up to 43% had osteopenia and as many as 32% had normal bone density. The weighted pooled prevalence of VFA-detected VF in asymptomatic women was 28% (95% CI: 23%-32%). CONCLUSION VFA is able to identify prevalent VF in asymptomatic postmenopausal women. The use of VFA identified an average of 28% of asymptomatic women with VFs, many of whom did not have a diagnosis of osteoporosis. Implementation of VFA as a routine screening tool may detect high risk women. Detection of VF might lead to pharmacological treatment in individuals who may not otherwise be treated.
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Affiliation(s)
- Jingyan Yang
- Institute for Social and Economic Research and Policy (ISERP), Columbia University, New York, NY, USA; Patient Health and Impact, Pfizer Inc., New York, NY, USA
| | - Yushan Mao
- Department of Endocrinology, The Affiliated Hospital of Medical School, Ningbo University, Zhejiang, China
| | - Jeri W Nieves
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Hospital for Special Surgery, New York, NY, USA.
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13
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Hiding in plain sight-unreported osteoporotic vertebral fractures. Eur Radiol 2020; 30:4711-4712. [PMID: 32462443 DOI: 10.1007/s00330-020-06944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
KEY POINTS • Reporting of vertebral fractures has important clinical consequences and can be improved by routinely performing sagittal reformating and by the use of a standard nomenclature and classification.
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14
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Radiology reporting of osteoporotic vertebral fragility fractures on computed tomography studies: results of a UK national audit. Eur Radiol 2020; 30:4713-4723. [DOI: 10.1007/s00330-020-06845-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/05/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022]
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Di Monaco M, Castiglioni C, Bardesono F, Milano E, Massazza G. Sarcopenia, osteoporosis and the burden of prevalent vertebral fractures: a cross-sectional study of 350 women with hip fracture. Eur J Phys Rehabil Med 2020; 56:184-190. [PMID: 32052946 DOI: 10.23736/s1973-9087.20.05991-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The concurrent presence of sarcopenia and osteoporosis may enhance fracture risk. AIM The aim of this study was to evaluate the association between sarcopenia, osteoporosis, or the concurrent presence of both the conditions (osteosarcopenia) and the burden (number and severity) of vertebral fractures in women with hip fracture. DESIGN Cross-sectional study. SETTING Division of Physical and Rehabilitation Medicine. POPULATION We studied 350 women with subacute hip fracture. METHODS Lateral radiographs of the spine were taken 18.2±4.5 days after fracture occurrence and the Spine Deformity Index (SDI) was calculated. Body composition was assessed by dual-energy X-ray absorptiometry. Low muscle mass was identified with appendicular lean mass <15.02 kg and low bone mineral density with a femoral T-Score <-2.5. RESULTS The presence of sarcopenia (P=0.033) and osteoporosis (P=0.032) was associated with the SDI scores independently of each other and independently of age, percentage of body fat and hip-fracture type. The 350 women were categorized into 3 groups according to the absence of both osteoporosis and sarcopenia (N.=25), presence of either osteoporosis or sarcopenia (N.=95) or presence of osteosarcopenia (N.=230). We found a significant difference in SDI scores across the 3 groups: χ2 (2, N.=350) = 15.29; P<0.001. The categorization of the 350 women into the 3 groups was associated with the SDI scores (P=0.001) independently of age, percentage of body fat and hip-fracture type. CONCLUSIONS Both osteoporosis and sarcopenia were independently associated with the burden of prevalent vertebral fractures in women with hip fracture. The concurrent presence of sarcopenia and osteoporosis was associated with a higher SDI Score than the presence of only one of the 2 conditions. CLINICAL REHABILITATION IMPACT Subjects with both low bone mass and low muscle mass should be considered at particularly high risk for vertebral fractures. Interventions targeting both the components of the muscle-bone unit, including exercise, nutrition, and possibly new medications, should be investigated to optimize fracture prevention.
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Affiliation(s)
- Marco Di Monaco
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Opera San Camillo Foundation, Turin, Italy -
| | - Carlotta Castiglioni
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Opera San Camillo Foundation, Turin, Italy
| | - Francesca Bardesono
- Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Edoardo Milano
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Opera San Camillo Foundation, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University of Turin, Turin, Italy
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Abstract
BACKGROUND Osteoporosis results in fragility fractures that are associated with a high morbidity and mortality as well as an increased risk for subsequent fragility fractures. Thus, the first fragility fracture should be the last. To achieve this goal patients need treatment of osteoporosis according to the prevailing clinical guidelines. OBJECTIVE This article presents the current clinical care situation of patients with a manifest osteoporosis in Germany and the accompanying risks. As a possible solution the concept of a fracture liaison service (FLS) as a new intersectoral care concept is presented and options for the establishment of FLS in Germany are provided. MATERIAL AND METHODS A literature search (PubMed) was conducted using key terms. The practical experiences of the authors in the context of establishing an FLS were also considered. RESULTS Compared to other countries, in Germany only a minority of patients receive treatment for osteoporosis after fragility fractures. To improve the care situation an intersectoral FLS provides a coordinated referral of patients with fragility fractures from inpatient care in hospitals to specialists in private practice. This enables the strict identification and treatment of high-risk patients according to the prevailing clinical guidelines. In Germany, different options exist to structure an FLS under consideration of the local circumstances. CONCLUSION In Germany, FLS should be established nationwide and according to uniform standards. This would significantly improve the quality of clinical care of patients with manifest osteoporosis.
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Dretakis K, Igoumenou VG. The role of parathyroid hormone (PTH) and vitamin D in falls and hip fracture type. Aging Clin Exp Res 2019; 31:1501-1507. [PMID: 30701437 DOI: 10.1007/s40520-019-01132-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fragility fractures of the hip are associated with high morbidity and mortality, and represent a rather devastating consequence of osteoporosis. Hip fractures are traditionally investigated as a whole, although it has been recently implied that distinct pathogenic mechanisms may lead either to trochanteric or subcapital fractures. AIMS To investigate whether differences exist by hip fracture type with respect to serum 25(OH)D (vitamin D) and parathyroid hormone (PTH) levels, in addition to epidemiological and demographic data, including history of falls. METHODS The inclusion criteria were met by 116 patients [48 men and 68 women; mean age 80.8 ± 8.5 (range 62-94) years]. Patients were analyzed according to hip fracture type, history of falls, and vitamin D and PTH status. RESULTS Older age, recurrent falls, serum levels of PTH > 65 pg/ml, and severe vitamin D deficiency were found to be associated with trochanteric fractures. Additionally, older age, female gender, PTH > 65 pg/ml, and severe vitamin D deficiency were related to recurrent falls. Meanwhile, patients with absence of PTH response to low vitamin D levels, were not repeated fallers and suffered mostly from subcapital fractures. DISCUSSION AND CONCLUSION Elevated PTH levels predispose both to falls and trochanteric fractures, while vitamin D-deficient patients with normal PTH levels are mostly related to subcapital fractures. It is thereby indicated that different pathophysiological processes lie behind subcapital and trochanteric fractures. A better understanding of these mechanisms may assist in the development of prevention strategies for individuals recognized at risk for falls and either type of hip fracture.
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Affiliation(s)
| | - Vasilios G Igoumenou
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Turk AC, Sahın F, Kucukler FK, Devecı H. Analysis of kyphosis, vertebral fracture and bone mineral density measurement in women living in nursing homes. Saudi Med J 2018; 39:711-718. [PMID: 29968895 PMCID: PMC6146251 DOI: 10.15537/smj.2018.7.22580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To analyze the relationship between vertebral fracture, degree of kyphosis, and BMD in women living in nursing homes. METHODS This cross-sectional study was carried out in the Department of Physical Medicine and Rehabilitation, Hitit University Hospital, Corum, Turkey, betweenJanuary 2014 and January 2015. Of the 126 female patients who participated in the study, 48 lived in nursing homes (nursing-home-group [NHG]), 78 lived in non-nursing home settings (control-group [CG]). Vertebral fractures were evaluated via the semi-quantitative Genant method. Cases in which a Cobb angle measured 40 degrees or more resulted in a diagnosis of kyphosis. RESULTS The mean age of participants in the NHG was 77.2±7.6 years and 76.8±6.2 years in the CG (p greater than 0.05). The kyphosis rate in the NHG was found to be higher at 52.1% compared to 27.7% for the CG (p less than 0.001). In the NHG, 68.7% had osteoporosis, 31.3% had osteopenia; in the CG, 55.2% had osteoporosis, 32% had osteopenia, 12.8% had normal values (p less than 0.05).The vertebral fracture rate was 37.5% in the NHG and 24.3% in the CG (p greater than 0.05). The Cobb angle had correlation with the number of fractures in both groups (p less than 0.05). CONCLUSIONS The osteoporosis and kyphosis rates of women living in NHG were higher than those of women living in CG. As kyphosis and the number of fractures are correlated, it is important to analyze kyphosis in women residing in NHG.
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Affiliation(s)
- Ayla C Turk
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hitit University, Corum, Turkey. E-mail.
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19
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High prevalence of simultaneous rib and vertebral fractures in patients with hip fracture. Injury 2017; 48:447-453. [PMID: 28063675 DOI: 10.1016/j.injury.2016.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/17/2016] [Accepted: 12/28/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose was to evaluate the prevalence and location of simultaneous fracture using bone scans in patients with hip fracture and to determine the risk factors associated with simultaneous fracture. PATIENTS AND METHODS One hundred eighty two patients with hip fracture were reviewed for this study. Clinical parameters and bone mineral density (BMD) of the lumbar vertebra and femoral neck were investigated. To identify acute simultaneous fracture, a bone scan was performed at 15.4±4.1days after hip fracture. The prevalence and location of simultaneous fracture were evaluated, and multivariate logistic regression analysis was performed to determine the risk factors. RESULTS Simultaneous fracture was observed in 102 of 182 patients, a prevalence of 56.0%. Rib fracture was the most common type of simultaneous fracture followed by rib with vertebral fracture. The BMD of the lumbar vertebra was significantly lower in patients with simultaneous fracture (p=0.044) and was identified as an independent risk factor (odds ratio: OR 0.05, 95% confidence interval: CI 0.01-0.57). CONCLUSIONS The prevalence of simultaneous fracture was relatively high among patients with hip fracture, and BMD was significantly lower in patients with simultaneous fracture than in patients without it. Surgeons should be aware of the possibility of simultaneous fracture in patients with hip fracture.
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Invernizzi M, Noale M, Iolascon G, Letizia Mauro G, Falaschi P, Arioli G, Maggi S, Cisari C. Vertebral fractures, function and cognitive status in osteoporotic hip fractured women: The FOCUS study. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Crilly RG, Kloseck M, Mequanint S. Hip Fracture Types in Canadian Men and Women Change Differently with Age: A Population-Level Analysis. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:75-9. [PMID: 27158225 PMCID: PMC4856061 DOI: 10.4137/cmamd.s38531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND We have previously reported a gender difference in the occurrence of hip fracture type with age in our local population. In the current report, we have explored this phenomenon in a Canadian population using five years of data from a national administrative database. We have compared community-dwelling and institutionalized individuals to determine if frailty is important and has a differential effect on the type of hip fracture experienced. METHODS Hospitalization records from 2005 to 2009, in which the most responsible diagnosis, that is the diagnosis causing the admission to hospital, was a hip fracture, were obtained from the Discharge Abstract Database of the Canadian Institute for Health Information. Hip fracture type was identified using the Canadian Classification of Health Interventions and the International Classification of Diseases 10th Revision, Canada (ICD-10-CA). Hip fracture proportions were calculated for the study period and stratified by age group and sex. RESULTS The relative proportion of intertrochanteric fractures in women rose from 35% in the youngest group (55-59 years) to 51% in the oldest group (84+ years; P < 0.0001). In men, the proportions remain relatively stable (47% and 44%, respectively). Community and institutionalized patients showed the same pattern. CONCLUSIONS The change in the proportion of the two hip fracture types that occur in women but not men may point to differences in the etiology and consequently the approaches to prevention for the two fracture types. Level of frailty did not seem to be important.
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Affiliation(s)
- Richard G. Crilly
- Division of Geriatric Medicine, Schulich School of Medicine, The University of Western Ontario, London, ON, Canada
| | - Marita Kloseck
- School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada
| | - Selam Mequanint
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Gonnelli S, Caffarelli C, Rossi S, Siviero P, Maggi S, Crepaldi G, Nuti R. The Trochanteric Localization is a Mediator of Slower Short-Term Functional Recovery in Overweight and Obese Elderly Women with Recent Hip Fracture: The BREAK Study. Calcif Tissue Int 2015; 97:560-7. [PMID: 26254556 DOI: 10.1007/s00223-015-0049-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 08/03/2015] [Indexed: 01/06/2023]
Abstract
The hypothesis tested in this study, carried out on elderly Italian women with recent hip fracture, was to assess the extent to which the effect of a condition of being overweight/obese on short-term functional recovery as evaluated by the "time to permitted load" could be explained by a mediator variable (type of hip fracture). We studied 727 women aged 60 years or over with a recent low trauma surgically treated hip fracture and for whom an information on post-surgery complications and on the time to permitted load was available. To assess for mediation, the statistical analyses were carried out following the procedure described by Baron and Kenny. In this study, 46 % of women with hip fracture presented a time to permitted load of ≥ 10 days. The women with a post-surgery time to permitted load of ≥ 10 days showed a significantly higher proportion of trochanteric fracture localization (72.1 vs 42 %), of total overweight/obesity (46.5 vs 36.8 %) and of post-surgery complications (38.8 vs 18.8 %). The mediating effect of hip fracture localization on the association between overweight/obesity and the time of permitted load was demonstrated and confirmed in a multivariate logistic regression model. This study, carried out using a "mediator" statistical analysis, suggests that in elderly women with hip fracture being overweight/obese is associated with a slower short-term functional recovery as evaluated by the time to permitted load and that this association is mediated by the trochanteric localization of hip fracture.
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Affiliation(s)
- Stefano Gonnelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Stefania Rossi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Paola Siviero
- CNR Aging Branch, Institute of Neuroscience, Padua, Italy
| | - Stefania Maggi
- CNR Aging Branch, Institute of Neuroscience, Padua, Italy
| | | | - Ranuccio Nuti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
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Di Monaco M, Castiglioni C, Di Monaco R, Tappero R. Prevalence and burden of vertebral fractures in older men and women with hip fracture: A cross-sectional study. Geriatr Gerontol Int 2015; 16:352-7. [DOI: 10.1111/ggi.12479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Marco Di Monaco
- Osteoporosis Research Center; Division of Physical and Rehabilitation Medicine; Presidio Sanitario San Camillo; Fondazione Opera San Camillo; Torino Italy
| | - Carlotta Castiglioni
- Osteoporosis Research Center; Division of Physical and Rehabilitation Medicine; Presidio Sanitario San Camillo; Fondazione Opera San Camillo; Torino Italy
| | - Roberto Di Monaco
- Department of Culture, Politics, and Society; University; Torino Italy
| | - Rosa Tappero
- Osteoporosis Research Center; Division of Physical and Rehabilitation Medicine; Presidio Sanitario San Camillo; Fondazione Opera San Camillo; Torino Italy
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Watt J, Cox L, Crilly RG. Distribution of vertebral fractures varies among patients according to hip fracture type. Osteoporos Int 2015; 26:885-90. [PMID: 25236878 DOI: 10.1007/s00198-014-2887-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED This study explored the distribution of vertebral fractures in hip fracture patients. Unlike patients with intertrochanteric fractures, those with subcapital fractures were less likely to have vertebral fractures in the T4-T10 region of the spine. The dissimilar distribution of vertebral fractures among patients with intertrochanteric and subcapital fractures may indicate different underlying etiologies. INTRODUCTION There are two main types of hip fractures: intertrochanteric and subcapital. Both types can have associated vertebral fractures. In this study, we explored the distribution of vertebral fractures in the two hip fracture populations. METHODS This was a retrospective analysis of a convenience sample of 120 patients: 40 with subcapital fractures and vertebral fractures, 40 with intertrochanteric fractures and vertebral fractures, and 40 with vertebral fractures only. Based on Genant's semiquantitative assessment method of radiographic images, the distribution and severity of each patient's vertebral fractures were explored [1]. RESULTS Patients with subcapital fractures had significantly fewer total vertebral fractures (93 vs. 144, p = 0.005; 93 vs. 127, p = 0.019), vertebral fractures from T4 to T10 (41 vs. 81, p = 0.005; 41 vs. 64, p = 0.042), and vertebral fractures at the T7-T8 peak (11 vs. 31, p = 0.002; 11 vs. 30, p = 0.003) than patients with intertrochanteric fractures and those with vertebral fractures alone, respectively, and they were more likely to have only one vertebral fracture (15 vs. 3, p < 0.001; 15 vs. 2, p < 0.001). The number of vertebral fractures from T11 to L4 and at the T12-L1 peak did not differ among the groups. The numbers of fractures at each vertebral level was significantly correlated only between those with intertrochanteric fractures and those with vertebral fractures alone (r = 0.65, p = 0.009). CONCLUSION The distribution of vertebral fractures among patients with subcapital fractures differed from the other fracture groups, which may indicate that subcapital fractures and some lumbar fractures have a different underlying etiology than intertrochanteric fractures and thoracic (T4-T10) fractures.
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Affiliation(s)
- J Watt
- Department of Medicine, Western University, 801 Commissioner's Road E., London, ON, N6C5J1, Canada
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25
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Vitamin D depletion in hip fracture women is associated with the occurrence of simultaneous upper limb fractures independently of bone mineral density. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2013.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nassar K, Paternotte S, Kolta S, Fechtenbaum J, Roux C, Briot K. Added value of trabecular bone score over bone mineral density for identification of vertebral fractures in patients with areal bone mineral density in the non-osteoporotic range. Osteoporos Int 2014; 25:243-9. [PMID: 24081509 DOI: 10.1007/s00198-013-2502-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022]
Abstract
UNLABELLED Detection of patients with vertebral fracture is similar for areal bone mineral density (aBMD) and trabecular bone score (TBS) in patients with non-vertebral fracture. In non-osteoporotic patients, TBS adds information to lumbar spine aBMD and is related to an index of spine deterioration. INTRODUCTION Vertebral fractures (VFs) are more predictive of future fracture than aBMD. The number and severity of VFs are related to microarchitecture deterioration. TBS has been shown to be related to microarchitecture. The study aimed at evaluating TBS in the prediction of the presence and severity of VFs. METHODS Patients were selected from a Fracture Liaison Service (FLS): aBMD and vertebral fracture assessment (VFA) were assessed after the fracture, using dual-energy X-ray-absorptiometry (DXA). VFs were classified using Genant's semiquantitative method and severity, using the spinal deformity index (SDI). TBS was obtained after analysis of DXA scans. Performance of TBS and aBMD was assessed using areas under the curves (AUCs). RESULTS A total of 362 patients (77.3% women; mean age 74.3 ± 11.7 years) were analysed. Prevalence of VFs was 36.7%, and 189 patients (52.2%) were osteoporotic. Performance of TBS was similar to lumbar spine (LS) aBMD and hip aBMD for the identification of patients with VFs. In the population with aBMD in the non-osteoporotic range (n = 173), AUC of TBS for the discrimination of VFs was higher than the AUC of LS aBMD (0.670 vs 0.541, p = 0.035) but not of hip aBMD; there was a negative correlation between TBS and SDI (r = -0.31; p < 0.0001). CONCLUSION Detection of patients with vertebral fracture is similar for aBMD and TBS in patients with non-vertebral fracture. In patients with aBMD in the non-osteoporotic range, TBS adds information to lumbar spine aBMD alone and is related to an index of spine deterioration.
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Affiliation(s)
- K Nassar
- Rheumatology Department, Cochin Hospital, Paris Descartes University, Paris, France
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Kuroda T, Tanaka S, Saito M, Shiraki Y, Shiraki M. Plasma level of homocysteine associated with severe vertebral fracture in postmenopausal women. Calcif Tissue Int 2013; 93:269-75. [PMID: 23793599 DOI: 10.1007/s00223-013-9754-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 05/20/2013] [Indexed: 01/22/2023]
Abstract
The aim of this cross-sectional cohort study was to clarify risk factors for severe vertebral fractures in postmenopausal Japanese women. Subjects were ambulatory volunteers age over 50 years who were recruited from a population of outpatients at a primary care institute. At registration, age, body mass index (BMI), bone mineral density (BMD), and present illness were investigated. Biochemical parameters including urinary levels of type I collagen cross-linked N-telopeptides (NTXs), and pentosidine and plasma levels of homocysteine were measured. Values were compared with different fracture grades (grade 0-3). A total of 1,475 postmenopausal women (66.6 ± 9.0 years) were included in the present study. Distributions of vertebral fracture grades were grade 1, 137 cases (9.3 %); grade 2, 124 cases (8.4 %); and grade 3, 162 cases (11.0 %). Age, BMI, BMD, NTX, pentosidine, and homocysteine were significantly associated with vertebral fracture in unadjusted analysis. In addition, a higher prevalence of hypertension was observed in patients with severe fracture. When comparing vertebral fracture grade 0 versus grade 2-3 by multiple regression analysis, pentosidine and homocysteine levels were a significant risk for moderate/severe vertebral fracture (odds ratio [OR] = 1.17, 95 % confidence interval [CI] 1.00-1.38, p = 0.049; OR = 1.22, 95 % CI 1.03-1.46, p = 0.013). Homocysteine levels were also a significant risk when comparing vertebral fracture grade 0 versus grade 3 (OR = 1.27, 95 % CI 1.04-1.58, p = 0.021). Plasma level of homocysteine was an independent risk for severe vertebral fractures.
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Affiliation(s)
- Tatsuhiko Kuroda
- Public Health Research Foundation, 1-1-7 Nishiwaseda, Shinjuku-ku, Tokyo 169-0051, Japan.
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