Effects of postoperative osteoporosis treatment on subsequent fracture and the 5-year survival rates after hemiarthroplasty for hip fracture

Prevalence and Risk Factors of Osteoporosis: A Cross-Sectional Study in a Tertiary Center

Background and Objectives: Osteoporosis is a common disease of the skeletal system that increases the risk of fracture. The prevalence of osteoporosis has been increasing as the aging population increases, affecting more than 200 million people worldwide. This study aimed to shed light on the clinical impact of osteoporosis on women's health and quality of life by evaluating the prevalence and risk factors for this disease among postmenopausal women, using a 10-year dataset from a tertiary center. Materials and Methods: This retrospective cohort study was conducted at Dokuz Eylül University, Department of Obstetrics and Gynecology, between 2010 and 2022. A total of 3289 postmenopausal women aged 50-60 years who were undergoing routine gynecological checkups were included in the study. Patients with a prior diagnosis, a history of medical conditions, or who were taking medications affecting bone mineral density (BMD) were excluded. Data on demographics, smoking status, diabetes status, body mass index (BMI), parity, and fracture history were collected. BMD scores were classified as normal, osteopenia, or osteoporosis. Results: The prevalence of osteoporosis was 10.4%. The median age of the patients was 56.0 years. Smoking, diabetes, and a history of bone fractures were found to significantly increase the risk of osteoporosis. BMI was found to have a protective effect against osteoporosis. According to multivariate analysis, the risk of osteoporosis increased by 2.46 times in patients who smoke, 3.78 times in patients with diabetes, and 6.23 times in patients with a history of fractures. Conclusions: Awareness of modifiable risk factors such as smoking is crucial for preventing osteoporosis-related complications. Diabetes, even when it is not complicated, increases the risk of osteoporosis. Physical exercise, calcium, and vitamin D intake are important, especially during young adulthood, as they are the primary contributors to peak bone mass. Because neck fractures are more common in patients with osteopenia, early diagnosis and routine screening can mitigate future complications.

Secondary osteoporosis prevention: three-year outcomes from a Fracture Liaison Service in elderly hip fracture patients

BACKGROUND

Hip fractures are the most serious fragility fractures due to their associated disability, higher hospitalization costs and high mortality rates. Fracture Liaison Service (FLS) programs have enhanced the management of osteoporosis-related fractures and have shown their clinical effectiveness.

AIMS

To analyze the effect of the implementation of a FLS model of care over the survival and mortality rates following a hip fracture.

METHODS

We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture before and after the implementation of the FLS in our center (between January 2016 and December 2019). Patients were followed for three years after the index date. Mortality, complications and refracture rates were compared between the two groups using a Multivariate Cox proportional hazard model.

RESULTS

A total of 1366 patients were included in this study (353 before FLS implementation and 1013 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (79.3% vs 12.5%; p < 0.01) and there was an increase in adherence to treatment (51.7% vs 30.2%; p < 0.01). A total of 413 (40.8%) patients after FLS implementation and 141 (39.9%) individuals before (p = 0.47) died during the three-years follow-up period. A second fracture occurred in 101 (10.0%) patients after FLS implementation and 37 (10.5%) individuals before (p = 0.78). Patients after the implementation of the FLS protocol had a lower all cause one-year mortality [adjusted Hazard Ratio (HR) 0.74 (0.57-0.94)] and a decreased risk of suffering a second osteoporotic fracture [adjusted HR 0.54 (0.39-0.75) in males and adjusted HR 0.46 (0.30-0.71) in females].

CONCLUSIONS

The implementation of a FLS protocol was associated with a lower all-cause one-year mortality rate and a higher survivorship in elderly hip fracture patients. However, no three-year mortality rate differences were observed between the two groups. We also found a reduction in the complication and second-fracture rates.

The Efficiency of Antiosteoporosis Medicine after Intertrochanteric Fracture Surgery: A Retrospective Study of Refracture Rate, Function Recovery, Complications, and Mortality in the Chinese Elderly Population

Objective  This research aimed to discern the effects of antiosteoporosis medication on postoperative functional recovery, refracture incidence, complications, and mortality in geriatric patients with intertrochanteric fractures. Methods  A retrospective study was conducted on 250 patients aged 65 years and above who underwent surgery for intertrochanteric fractures between January 2013 and December 2014. Intertrochanteric fracture is diagnosed with International Classification of Diseases 10th Revision code (S72.101) and classified by the Evans-Jensen system. Collected data encompassed demographic details, pre- and postoperative histories of antiosteoporotic medication, functional outcomes (measured using Harris hip score, Parker Mobility Score, and EuroQol-5 Dimension [EQ-5D] scores), refracture incidences, complications, and survival rates. The antiosteoporotic regimen was categorized into essential (calcium, vitamin D) and advanced medications (bisphosphonate, calcitonin, etc.). Outcomes between patients on antiosteoporosis treatment (AO group) and those without (control group) were compared. Results  The cohort comprised 250 patients, with a gender distribution of 85 males (34%) and 165 females (66%), and a mean age of 79.8 ± 7.0 years. The median follow-up period was 15.82 months (maximum 31.13 months). Postoperatively, 126 (50.4%) patients were administered antiosteoporotic treatment. The refracture incidence in the AO group (2.4%, n  = 3) was notably lower than the control group (8.9%, n  = 11), manifesting a substantial risk reduction (odds ratio 0.251, 95% confidence interval 0.068-0.920, p  = 0.024). While no marked differences in functional outcomes between the AO and control groups were observed (Harris score [96.17 ± 7.77 vs. 97.29 ± 6.74, p  = 0.074), Parker score [8.54 ± 1.26 vs. 8.62 ± 1.18, p  = 0.411], EQ-5D [0.83 ± 0.05 vs. 0.82 ± 0.06, p  = 0.186]), patients administered a combination of essential and advanced drugs showcased significantly improved Harris and EQ-5D scores compared to those on essential drugs alone (Harris score [77.93 ± 2.04 vs. 84.94 ± 2.73, p  = 0.015], EQ-5D [0.65 ± 0.03 vs. 0.75 ± 0.04, p  = 0.015]). Conclusion  Postoperative antiosteoporosis treatment acts as a deterrent against refracture following intertrochanteric fracture surgeries, evidenced by a decline in refracture rates. However, the treatment's impact on functional recovery, quality of life, complications, and mortality remains indistinct. Interestingly, the combined administration of essential and advanced antiosteoporotic drugs seems to foster enhanced functional outcomes, warranting further exploration in future studies.

Distinctive Geometrical Traits of Proximal Femur Fractures-Original Article and Review of Literature

Background and Objectives: The incidence of proximal femoral fractures is escalating rapidly, generating a significant challenge for healthcare systems globally and, carrying serious social and economic implications. The primarily object of this study was to discover potential distinguishing factors between fractures occurring in the femoral neck and trochanteric region. Materials and Methods: We performed a prospective cohort study of the radiographic images of 70 people over 65 years of age who were admitted to the orthopedic department with hip fracture and who fulfilled our eligibility criteria. Neck Length (NL), Offset Lenth (OL), Hip Axis Length (HAL), Neck Shaft Angle (NSA), Wiberg Angle (WA), Acetabular Angle (AA), Femoral Neck Diameter (FND), Femoral Head Diameter (FHD), Femoral Shaft Diameter (FSD), Femoral Canal Diameter (FCD) and Tonnis classification were recorded. For the comparison of the categorical variables, Pearson's χ2 criterion was used, while Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results: There were no statistically significant variances observed while comparing the selected geometric parameters of the proximal femur with the type of fracture. This finding was reaffirmed in relation to age, gender, and Tonnis classification. However, a moderate correlation was noted, revealing comparatively reduced values of HAL, FHD, and FND in women as opposed to men. Conclusions: The inability of our research to establish the differentiative geometric factors between femoral neck and trochanteric fractures underscores the need for further investigations, which would take into consideration the intrinsic characteristics of the proximal femur.

Mapping knowledge structure and global status of sarcopenia in geriatric hip fractures: A bibliometric and visualized study

Background

Sarcopenia in geriatric hip fractures is attracting increased attention in recent years. This study aimed to explore the bibliometric characteristics and current status of sarcopenia research in hip fractures of older patients.

Methods

Publications related to sarcopenia in geriatric hip fracture published between January 2000 and July 2022 were extracted from the Science Citation Index Expanded, and bibliometric and visualized studies were performed by VOSviewer, Citespace, and R.

Results

The 1,223 articles used in our study were written by 6,326 authors from 1,879 organizations in 60 countries, published in 388 journals, and cited 37,198 references from 5,422 journals. The United States contributed the most publications (288 publications). The journal with the largest number of papers was Osteoporosis International (62 publications), and the Journals of Gerontology Series A - Biological Sciences and Medical Sciences had been more cited than any other journals in this field (3,302 citations). The University of Melbourne published the biggest number of papers (72 publications) focusing on sarcopenia in geriatric hip fractures while the California Pacific Medical Center Research Institute had the largest citations (4,239 citations). Cawthon PM was the most productive and influential author in the field. keywords were classified into 6 clusters: Cluster 1 (sarcopenia in aging), Cluster 2 (osteoporosis), Cluster 3 (bone density), Cluster 4 (body composition), Cluster 5 (physical performance), and Cluster 6 (risk factor).

Conclusion

Geriatric hip fracture is one of the most significant health issues in the aging society. In the past 20 years, an increasing number of studies were performed to explore the relationship between sarcopenia and hip fracture in older adults. The United States showed the strongest influence in this field, including publication numbers, citations, institutions, funding agencies, and authorship. Sarcopenia in aging, osteoporosis, bone density, body composition, physical performance, and risk factors may become the future hotspots in this field.

The current situation in the approach to osteoporosis in older adults in Turkey: areas in need of improvement with a model for other populations

PURPOSE

The total number of older adults in Turkey is striking, amounting to around 8 million, and this translates into considerably higher numbers of cases of osteoporosis (OP) and fractures in older adults. In this article, we outlined the current situation of OP in older adults in Turkey and investigated the differences between Turkey and a representative developed European country (Belgium), in terms of the screening, diagnosis, and treatment of OP. Our intention in this regard was to identify areas in need of improvement and subsequently to make a clear call for action to address these issues.

METHODS

Herein, considering the steps related to the OP approach, we made a complete review of the studies conducted in Turkey and compared with the literature recommendations.

RESULTS

There is a need for a national osteoporotic fracture registry; measures should be taken to improve the screening and treatment of OP in older males, such as educational activities; technicians involved in dual-energy X-ray absorptiometry (DXA) scanning should undergo routine periodic training; all DXA centers should identify center-specific least significant change values; all older adults should be considered for routine lateral dorsolumbar X-ray imaging for the screening of vertebral fractures while ordering DXA scans; the inclusion of vertebral fracture assessment (VFA) software in DXA assessments should be considered; screening using a fracture risk assessment tool (FRAX) algorithm that is specific to Turkey should be integrated; the fortification of foods with vitamin D is required; the high fracture risk by country-specific FRAX algorithm and the presence of falls/high fall risk should be integrated in reimbursement terms; and finally, more "fracture liaison services" should be established.

CONCLUSION

We suggest that the practical consideration of our suggestions will provide considerable support to the efforts for combating with the adverse consequences of OP in society. This approach can be subsequently modeled for other populations to improve the management of OP globally.

Adherence to Anti-Osteoporotic Treatment and Clinical Implications after Hip Fracture: A Systematic Review

The role of anti-osteoporotic treatment as part of the secondary prevention after hip fracture in terms of mortality and re-fracture risk has been studied, and the results are promising. Decreased treatment adherence and compliance is a problem that needs to be addressed by healthcare professionals. A systematic review of the literature was performed using the PubMed database with terms that included hip fracture, mortality, second fracture, and specific anti-osteoporotic treatment. We included 28 articles, 21 regarding mortality and 20 re-fracture rates in hip fracture patients. All studies showed lower mortality after hip fracture associated with anti-osteoporotic treatment, mostly bisphosphonate agents. The re-fracture risk is still debatable, since conflicting data were found. Although most of the studies showed notable effects on mortality and re-fracture rates associated with anti-osteoporotic treatment, we still need more data to validate the actual results.

A correlative studies between osteoporosis and blood cell composition: Implications for auxiliary diagnosis of osteoporosis

Osteoporosis is defined as a metabolic skeletal disease characterized by a decrease of the bone mass per unit volume, caused by a variety of reasons. Increasing evidence indicate that the host inflammatory response was correlated with the occurrence and development of osteoporosis, and it has been recognized that T lymphocytes and B lymphocytes play a critical role in pathogenesis of inflammatory bone disease. Between January 2018 and December 2018, retrospective analysis of 487 patients (exclusion of patients with recent infections and hematologic disorders whose leukocyte counts or classifications are markedly abnormal) who underwent bone mineral density (BMD) examinations in Huzhou Central Hospital. The patients were divided into normal bone density group, osteopenia group, and osteoporosis group according to the T score of BMD in the left femoral neck, respectively. Statistics of the lymphocyte ratio and the monocyte ratio in the blood routine examination results during the same period were performed so as to make a comparison of the differences among the groups. The correlation of the lymphocyte ratio and monocyte ratio with the T score of BMD in the left femoral neck was also analyzed. The difference between neutrocyte ratio lymphocyte ratio and the monocyte ratio was statistically significant in both males and females among the normal bone density group, osteopenia group and osteoporosis group (P < .01 or P < .05). Inflammation plays an important role in the progression of osteoporosis. By monitoring these three indicators in blood routine examination, early intervention for osteoporosis may become possible.

Clinical Characteristics of Primary and Secondary Osteoporotic Fractures: Data from Single Referral Center Emergency Department

Background

To investigate the characteristics of patients with osteoporotic fractures (OF) who visited the emergency room, we analyzed the frequency and distribution of primary and secondary OF.

Methods

From March 2015 to April 2017, 406 patients with OF were assigned to wrist (W; n=132), spine (S; n=78), and hip (H; n=196) according to the site. All subjects were classified as having primary fracture or secondary fracture. Age, fracture site, the risk of future fracture using Fracture Risk Assessment Tool (FRAX) were compared.

Results

The mean age at fracture site was significantly different among the 3 groups, groups W (66.57±10.03), S (73.50±9.07), and H (78.50±7.72). The most common site of OF were in the order of wrist, spine, and hip with the increase of age. The FRAX scores significantly increased (P<0.001) in the order of W (8.35±5.67), S (10.74±6.99), and H (13.88±7.98) in total patient, and same in primary fracture group (W, 7.50±4.18; S, 9.76±5.91; H, 11.93±6.61; P<0.001). The main site of prior fractures in secondary fracture was same lesion, which means that the prior fracture of secondary wrist fracture was wrist fracture such as spine for spine, hip for hip.

Conclusions

We determined that as age increasing, the major sites of OF were different and FRAX scores increased. The most common site for secondary fracture was the same one. Hence, the risk of subsequent fracture in same site should be noted after patient suffered OF.