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Qi W, Wang D, Hong Y, Yao J, Wang H, Zhu L, Pan H. Investigating the causal relationship between thyroid dysfunction diseases and osteoporosis: a two-sample Mendelian randomization analysis. Sci Rep 2024; 14:12784. [PMID: 38834708 DOI: 10.1038/s41598-024-62854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
The prevalence of thyroid dysfunction diseases (TDFDs) and osteoporosis (OP) is high. Previous studies have indicated a potential association between TDFDs and OP, yet the causal direction remains unclear. This study aimed to investigate the potential causal relationship between TDFDs and the risk of developing OP and related fractures. We obtained pooled data from genome-wide association studies (GWASs) conducted on TDFDs and OP in European populations and identified single-nucleotide polymorphisms (SNPs) with genome-wide significance levels associated with exposure to TDFDs as instrumental variables. Inverse variance weighted (IVW) was employed as the primary method for Mendelian randomization (MR) analysis, supplemented by MR‒Egger, weighted median, simple mode and weighted mode methods. Sensitivity analyses were conducted to evaluate the robustness of the findings. The IVW method demonstrated an increased risk of OP in patients with TDFDs, including hyperthyroidism and hypothyroidism (TDFDs: OR = 1.11; 95% CI 1.09, 1.13; hypothyroidism: OR = 1.14; 95% CI 1.10, 1.17; hyperthyroidism: OR = 1.09; 95% CI 1.06, 1.12). These findings were supported by supplementary analysis, which revealed a positive correlation between TDFDs and the risk of OP. Multiple sensitivity analyses confirmed the absence of horizontal pleiotropy in the study, thus indicating the robustness of our results. The causal relationship between TDFDs and increased risk of OP implies the need for early bone mineral density (BMD) screening and proactive prevention and treatment strategies for individuals with TDFDs.
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Affiliation(s)
- Weihui Qi
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China
| | - Dong Wang
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China
| | - Yihu Hong
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China
| | - Jun Yao
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China
| | - Huang Wang
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China
| | - Li Zhu
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China.
| | - Hao Pan
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China.
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Clark D, Brazina S, Miclau T, Park S, Hsieh CL, Nakamura M, Marcucio R. Age-related changes to macrophage subpopulations and TREM2 dysregulation characterize attenuated fracture healing in old mice. Aging Cell 2024:e14212. [PMID: 38825965 DOI: 10.1111/acel.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/11/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024] Open
Abstract
Fracture healing complications increase with age, with higher rates of delayed unions and nonunions and an associated increase in morbidity and mortality in older adults. Macrophages have a dynamic role in fracture healing, and we have previously demonstrated that age-related changes in macrophages are associated with attenuated fracture repair in old mice. Here, we provide a single cell characterization of the immune cells involved in the early phase of fracture healing. We show that there were multiple transcriptionally distinct macrophage subpopulations present simultaneously within the healing tissue. Fracture healing was attenuated in old mice compared to young, and macrophages from the fracture callus of old mice demonstrated a pro-inflammatory phenotype compared to young. Interestingly, Trem2 expression was decreased in old macrophages compared to young. Young mice lacking Trem2 demonstrated attenuated fracture healing and inflammatory dysregulation similar to old mice. Trem2 dysregulation has previously been implicated in other age-related diseases, but its role in fracture healing is unknown. This work provides a robust characterization of the macrophage subpopulations involved in fracture healing, and further reveals the important role of Trem2 in fracture healing and may be a potential driver of age-related inflammatory dysregulation. Future work may further examine macrophages and Trem2 as potential therapeutic targets for management of fracture repair in older adults.
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Affiliation(s)
- Daniel Clark
- Center for Craniofacial Regeneration, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Sloane Brazina
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, California, USA
| | - Ted Miclau
- Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, School of Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Sangmin Park
- Center for Craniofacial Regeneration, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Christine L Hsieh
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco VA Health Care System, San Francisco, California, USA
| | - Mary Nakamura
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco VA Health Care System, San Francisco, California, USA
| | - Ralph Marcucio
- Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, School of Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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3
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Rule AD, Grossardt BR, Weston AD, Garner HW, Kline TL, Chamberlain AM, Allen AM, Erickson BJ, Rocca WA, St Sauver JL. Older Tissue Age Derived From Abdominal Computed Tomography Biomarkers of Muscle, Fat, and Bone Is Associated With Chronic Conditions and Higher Mortality. Mayo Clin Proc 2024; 99:878-890. [PMID: 38310501 PMCID: PMC11153040 DOI: 10.1016/j.mayocp.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To determine whether body composition derived from medical imaging may be useful for assessing biologic age at the tissue level because people of the same chronologic age may vary with respect to their biologic age. METHODS We identified an age- and sex-stratified cohort of 4900 persons with an abdominal computed tomography scan from January 1, 2010, to December 31, 2020, who were 20 to 89 years old and representative of the general population in Southeast Minnesota and West Central Wisconsin. We constructed a model for estimating tissue age that included 6 body composition biomarkers calculated from abdominal computed tomography using a previously validated deep learning model. RESULTS Older tissue age associated with intermediate subcutaneous fat area, higher visceral fat area, lower muscle area, lower muscle density, higher bone area, and lower bone density. A tissue age older than chronologic age was associated with chronic conditions that result in reduced physical fitness (including chronic obstructive pulmonary disease, arthritis, cardiovascular disease, and behavioral disorders). Furthermore, a tissue age older than chronologic age was associated with an increased risk of death (hazard ratio, 1.56; 95% CI, 1.33 to 1.84) that was independent of demographic characteristics, county of residency, education, body mass index, and baseline chronic conditions. CONCLUSION Imaging-based body composition measures may be useful in understanding the biologic processes underlying accelerated aging.
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Affiliation(s)
- Andrew D Rule
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension.
| | - Brandon R Grossardt
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Alexander D Weston
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Hillary W Garner
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic, Jacksonville, FL
| | | | - Alanna M Chamberlain
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Bradley J Erickson
- Artificial Intelligence Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN
| | - Walter A Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Ruckle DE, Dahan A, Jesurajan J, Nayak R, Rice RC, Wongworawat MD, Johnson JP, Rajfer R. A Look Into How the "Blue Zone" Lifestyle May Affect Patients' Lives Before and After Hip Fracture: A Propensity-Matched Cohort Study. J Am Acad Orthop Surg 2024:00124635-990000000-01011. [PMID: 38833726 DOI: 10.5435/jaaos-d-23-00723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Hip fractures are life-changing injuries with associated one-year mortality up to 30%. Five locations in the world have been termed "blue zones," where the longevity of the population is markedly higher than that of surrounding areas and there are 10 times more centenarians. The United States has one blue zone (Loma Linda, California), which is believed to be because of the lifestyle of the Seventh-day Adventist population living there. We hypothesized that patients from the blue zone experience low-energy, frailty-driven, osteoporotic hip fractures later in life and an increased postinjury longevity relative to non-blue zone control subjects. METHODS A review of patients treated for hip fracture between January 2010 and August 2020 from a single institution was conducted. Demographic data were collected, and the end point of mortality was assessed using death registry information, queried in April 2024. Groups were divided into blue zone and non-blue zone. Statistical analysis was conducted with P < 0.05 considered significant. RESULTS Complete data were available for 1,032 patients. The blue zone cohort sustained low-energy hip fractures 12 years later in life (83.2 versus 71.1, P < 0.01). Propensity score matching was used to account for this difference. After propensity score matching, age, body mass index, American Society of Anesthesiologists score, surgery performed, sex, mechanism, ethnicity, diabetes, chronic obstructive pulmonary disease, CHF, chronic kidney disease grade, dementia, surgical time, and drug/tobacco/marijuana use were similar between groups. Blue zone patients had lower mortality at both 1 and 2 years postoperatively (12% versus 24%, P = 0.03 and 20% versus 33%, P = 0.03, respectively), had more hypertension (76% versus 62%, P = 0.03), reported lower alcohol use (7% versus 20%, P < 0.01), and included more Seventh-day Adventists (64% versus 15%, P < 0.01). CONCLUSION The blue zone lifestyle affected the onset of frailty and delayed osteoporotic hip fracture by 12 years in this propensity-matched cohort study. Postoperative mortality was also markedly lower in the blue zone cohort.
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Affiliation(s)
- David E Ruckle
- From the Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, CA (Ruckle, Jesurajan, Nayak, Rice, Wongworawat, and Rajfer), the Department of Anesthesiology, University of California San Diego, San Diego, CA (Dahan), Department of Orthopedic Surgery, University of Alabama Birmingham Medicine, Birmingham, Alabama (Johnson)
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Yıldız Potter İ, Yeritsyan D, Mahar S, Kheir N, Vaziri A, Putman M, Rodriguez EK, Wu J, Nazarian A, Vaziri A. Proximal femur fracture detection on plain radiography via feature pyramid networks. Sci Rep 2024; 14:12046. [PMID: 38802519 PMCID: PMC11130146 DOI: 10.1038/s41598-024-63001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
Hip fractures exceed 250,000 cases annually in the United States, with the worldwide incidence projected to increase by 240-310% by 2050. Hip fractures are predominantly diagnosed by radiologist review of radiographs. In this study, we developed a deep learning model by extending the VarifocalNet Feature Pyramid Network (FPN) for detection and localization of proximal femur fractures from plain radiography with clinically relevant metrics. We used a dataset of 823 hip radiographs of 150 subjects with proximal femur fractures and 362 controls to develop and evaluate the deep learning model. Our model attained 0.94 specificity and 0.95 sensitivity in fracture detection over the diverse imaging dataset. We compared the performance of our model against five benchmark FPN models, demonstrating 6-14% sensitivity and 1-9% accuracy improvement. In addition, we demonstrated that our model outperforms a state-of-the-art transformer model based on DINO network by 17% sensitivity and 5% accuracy, while taking half the time on average to process a radiograph. The developed model can aid radiologists and support on-premise integration with hospital cloud services to enable automatic, opportunistic screening for hip fractures.
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Affiliation(s)
| | - Diana Yeritsyan
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue RN123, Boston, MA, 02215, USA
| | - Sarah Mahar
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue RN123, Boston, MA, 02215, USA
| | - Nadim Kheir
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue RN123, Boston, MA, 02215, USA
| | - Aidin Vaziri
- BioSensics, LLC, 57 Chapel Street, Newton, MA, 02458, USA
| | - Melissa Putman
- Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Edward K Rodriguez
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue RN123, Boston, MA, 02215, USA
| | - Jim Wu
- Department of Radiology, Massachusetts General Brigham (MGB) and Harvard Medical School, 75 Francis Street, Boston, MA, 02215, USA
| | - Ara Nazarian
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue RN123, Boston, MA, 02215, USA
- Department of Orthopaedic Surgery, Yerevan State University, Yerevan, Armenia
| | - Ashkan Vaziri
- BioSensics, LLC, 57 Chapel Street, Newton, MA, 02458, USA
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Associated factors of stress, urgency, and mixed urinary incontinence in a geriatric outpatient assessment of older women with hip fracture. Eur Geriatr Med 2024:10.1007/s41999-024-00997-w. [PMID: 38802641 DOI: 10.1007/s41999-024-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Urinary incontinence (UI) is known to be common among older female hip fracture patients. Little is known about different subtypes of UI among these patients. Our aim was to identify factors associated with subtypes of UI in a cross-sectional design. METHODS 1,675 female patients aged ≥ 65 and treated for their first hip fracture in Seinäjoki Central Hospital, Finland, during 2007-2019, were included in a prospective cohort study. Of these, 1,106 underwent comprehensive geriatric assessment (CGA), including questions on continence, at our geriatric outpatient clinic 6 month post-fracture. A multivariable-adjusted multinomial logistic regression model was used to examine factors associated with UI subtypes. RESULTS Of the 779 patients included, 360 (46%) were continent and 419 (54%) had UI 6-month post-fracture. Of the women with UI, 117 (28%) had stress UI, 183 (44%) had urgency UI and 119 (28%) had mixed UI, respectively. Mean age of the patients was 82 ± 6,91. In multivariable analysis, depressive mood and poor mobility and functional ability were independently associated with stress UI. Fecal incontinence (FI) and Body Mass Index (BMI) over 28 were independently associated with urgency UI. Mixed UI shared the aforementioned factors with stress and urgency UI and was independently associated with constipation. CONCLUSIONS Mixed UI was associated with most factors, of which depressive mood and impaired mobility and poor functional ability were shared with stress UI, and FI and higher BMI with urgency UI. CGA is key in assessing UI in older hip fracture patients, regardless of subtype.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Kashanian K, Bourget-Murray J, Horton I, Morris J, Papp SR, Grammatopoulos G. National Institute of Health and Care Excellence (NICE) Guidelines for Displaced Intracapsular Hip Fractures: Examining Satisfaction with the Guidelines and Effects on Outcomes. J Arthroplasty 2024:S0883-5403(24)00481-9. [PMID: 38763481 DOI: 10.1016/j.arth.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024] Open
Abstract
INTRODUCTION The objectives of the study were to: 1) evaluate satisfaction with the new 2023 National Institute of Health and Care Excellence (NICE) criteria for selecting total hip arthroplasty (THA) over hemiarthroplasty (HA) and surgical recommendations for treatment of displaced intra-capsular hip fractures; 2) describe why THA is performed when NICE criteria are not met; and 3) determine whether satisfaction with these guidelines is associated with improved outcomes. METHODS A retrospective chart review of patients who had a displaced intra-capsular hip fracture treated with THA at a single tertiary academic center between 2010 and 2022 was performed. Pre-operative patient characteristics were reviewed to determine if the indication for THA met NICE criteria. Operative details, peri-operative complications, re-operation, and revision arthroplasty within 12 months of surgery were recorded. RESULTS Data from 196 patients (63% women; age 67 ± 10 years) were used. There were 161 THAs (82.1%) that satisfied NICE criteria. The two most common reasons for performing a THA when NICE criteria were not met (n = 35) included pre-operative radiographic osteoarthritis (Tönnis grade ≥ 2; 48.6%) and decreased patient age (< 65 years; 31.5%). Satisfaction with the NICE criteria was associated with fewer peri-operative complications (0.6 versus 37.1%; P < 0.001), re-operations (0.6 versus 31.4%; P < 0.001), and revisions (0.6 versus 28.6%; P < 0.001). The most common reason for revision was periprosthetic fracture, possibly secondary to the use of uncemented femoral stems (171 of 196, 87.2%). DISCUSSION Satisfaction with the new NICE criteria is associated with improved perioperative outcomes. Further studies are necessary to determine if pre-existing hip osteoarthritis and younger age merit consideration in patient selection.
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Affiliation(s)
- Koorosh Kashanian
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario
| | - Jonathan Bourget-Murray
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario; Department of Surgery, Division of Orthopaedic Surgery, The Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Isabel Horton
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario
| | - Jared Morris
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario
| | - Steven Ray Papp
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario
| | - George Grammatopoulos
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario.
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Costa V, Rojo A, López-López S, Pareja-Galeano H, Velásquez A, Perea L, Raya R. Evaluating the Usability and Safety of Virtual Reality Application Combined with the SWalker for Functional Gait Rehabilitation. Games Health J 2024. [PMID: 38757664 DOI: 10.1089/g4h.2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Objective: This research evaluates from a usability point of view the combination of a developed fully immersive virtual reality (VR) solution with the SWalker robotic device. It aims to contribute to research in the exploration of immersive experiences overground with a functional gait recovery device. Materials and Methods: We evaluated the system in a pilot study with 20 healthy participants aged 85.1 (SD: 6.29). Participants used the SWalker-VR platform while testing one VR application focused on walking and the other on balance practice. Afterward, the participants answered three usability questionnaires. Results: The platform was validated in terms of safety using the Simulator Sickness Questionnaire, obtaining less than 20 points for all subscales: nausea (4.29 ± 14.47), oculomotor (0.38 ± 14.18), and disorientation (1.39 ± 14.52). For usability evaluation, the System Usability Scale provided an overall score of 70.63 ± 11.64, and the Post-Study System Usability Questionnaire (PSSUQ) rated 1.61 ± 0.54. The usability scores reported by both questionnaires were moderate and good, respectively. These results were similar in overall scores for both groups: participants with low cognitive level and participants with high cognitive level. Finally, the possible causes for the "no answered" responses on the PSSUQ were discussed. Conclusion: It is concluded that the SWalker-VR platform is reported to have adequate usability and high security by older adults. The potential interest of studying the effects of the long-term use of this platform by older adults with gait impairment is expressed. Clinical Trials reference: NCT06025981.
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Affiliation(s)
- Vanina Costa
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Ana Rojo
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Sergio López-López
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
| | - Helios Pareja-Galeano
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Rafael Raya
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
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Yu M, Qin K, Fan J, Zhao G, Zhao P, Zeng W, Chen C, Wang A, Wang Y, Zhong J, Zhu Y, Wagstaff W, Haydon RC, Luu HH, Ho S, Lee MJ, Strelzow J, Reid RR, He TC. The evolving roles of Wnt signaling in stem cell proliferation and differentiation, the development of human diseases, and therapeutic opportunities. Genes Dis 2024; 11:101026. [PMID: 38292186 PMCID: PMC10825312 DOI: 10.1016/j.gendis.2023.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/18/2023] [Accepted: 04/12/2023] [Indexed: 02/01/2024] Open
Abstract
The evolutionarily conserved Wnt signaling pathway plays a central role in development and adult tissue homeostasis across species. Wnt proteins are secreted, lipid-modified signaling molecules that activate the canonical (β-catenin dependent) and non-canonical (β-catenin independent) Wnt signaling pathways. Cellular behaviors such as proliferation, differentiation, maturation, and proper body-axis specification are carried out by the canonical pathway, which is the best characterized of the known Wnt signaling paths. Wnt signaling has emerged as an important factor in stem cell biology and is known to affect the self-renewal of stem cells in various tissues. This includes but is not limited to embryonic, hematopoietic, mesenchymal, gut, neural, and epidermal stem cells. Wnt signaling has also been implicated in tumor cells that exhibit stem cell-like properties. Wnt signaling is crucial for bone formation and presents a potential target for the development of therapeutics for bone disorders. Not surprisingly, aberrant Wnt signaling is also associated with a wide variety of diseases, including cancer. Mutations of Wnt pathway members in cancer can lead to unchecked cell proliferation, epithelial-mesenchymal transition, and metastasis. Altogether, advances in the understanding of dysregulated Wnt signaling in disease have paved the way for the development of novel therapeutics that target components of the Wnt pathway. Beginning with a brief overview of the mechanisms of canonical and non-canonical Wnt, this review aims to summarize the current knowledge of Wnt signaling in stem cells, aberrations to the Wnt pathway associated with diseases, and novel therapeutics targeting the Wnt pathway in preclinical and clinical studies.
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Affiliation(s)
- Michael Yu
- School of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Kevin Qin
- School of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Jiaming Fan
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, The School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Guozhi Zhao
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Piao Zhao
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Zeng
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Neurology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong 523475, China
| | - Connie Chen
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Annie Wang
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Yonghui Wang
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Clinical Laboratory Medicine, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Jiamin Zhong
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, The School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yi Zhu
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Orthopaedic Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - William Wagstaff
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Rex C. Haydon
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Hue H. Luu
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Sherwin Ho
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Michael J. Lee
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Jason Strelzow
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Russell R. Reid
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Laboratory of Craniofacial Suture Biology and Development, Department of Surgery Section of Plastic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Tong-Chuan He
- Molecular Oncology Laboratory, Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Laboratory of Craniofacial Suture Biology and Development, Department of Surgery Section of Plastic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
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10
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Boukebous B, Biau D, Gao F. AtoG: A simple score to predict complications and death after hip fractures, in line with the comprehensive geriatric assessment. Orthop Traumatol Surg Res 2024; 110:103827. [PMID: 38280714 DOI: 10.1016/j.otsr.2024.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/07/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Proximal Femur Fractures (PFFs) are a significant public health issue and occur in the context of global frailty and aging. Recent literature identifies new patient-related prognostic factors that focus on socioeconomic environment, patient well-being, or nutrition status. Specific scores have been developed, but in most cases, they fail to be in line with the comprehensive geriatric assessment, or do not assess the newly identified prognostic factors, contain multitude collinearities, or are too complex to be used in the daily practice. Hypothesis A comprehensive score with equal representation of the patient's dimensions does at least as good as the Charlson score (CCI), to predict complications and mortality. OBJECTIVE To develop a new comprehensive prognostic score, predicting inpatient complications and mortality up to 5-year after PFF. MATERIAL AND METHODS The patients treated surgically for PFF on a native hip, between 2005 and 2017 were selected from a French national database. The variables were the gender, age, the type of treatment (osteosynthesis or arthroplasty), and the CCI. The outcomes were the medical and surgical complications as inpatient and the mortality (up to 5-year). Variables were grouped into dimensions with similar clinical significance, using a Principal Component Analysis, for instance, bedsores and malnutrition. The dimensions were tested for 90-day mortality and complications, in regressions models. Two scores were derived from the coefficients: SCOREpond (strict ponderation), and SCORE (with loose ponderation: 1 point/risk factors, -1 point/protective factors). Calibration, discrimination (ROC curves with Area Under Curves AUC), and cross-validation were assessed for SCOREpond, SCORE, and CCI. RESULTS Analyses were performed on 7756 fractures. The factorial analysis identified seven dimensions: age; brain-related conditions (including dementia): 1738/7756; severe chronic conditions (for instance, organ failures) 914/7756; undernutrition: 764/7756; environment, including social issues or housing difficulties: 659/7756; associated trauma: 814/7756; and gender. The seven dimensions were selected for the prognostic score named AtoG (ABCDEFG, standing for Age, Brain, Comorbidities, unDernutrition, Environment, other Fractures, Gender). The median survival rate was 50.8 months 95% CI [49-53]. Anaemia and urologic complications were the most prevalent medical complications (1674/7756, 21%, and 1109/7756, 14.2%). A total of 149/7756 patients (1.9%) developed a mechanical inpatient complication (fractures or dislocations), with a slightly higher risk for arthroplasties. The AUCs were 0.69, 0.68, and 0.67 for AtoGpond, AtoG, and CCI, respectively, for 90-day mortality, and 0.64, 0.63, and 0.56 for complications. Compared to patients with AtoG=0, Hazard Ratios for 90-day mortality were 2.3 95% CI [1.7-2.9], 4.2 95% CI [3.1-5.4], 6 95% CI [4.5-8.1], 8.3 95% CI [6.5-12.9], and 13.7 95% CI [8-24], from AtoG=1 to AtoG≥5, respectively (p<10-4); the 90-day survival decreased by 5%/point, roughly. The sur-risk of mortality associated with AtoG was up to 5-year: HR=1.51 (95% CI [1.46-1.55], p<10-4). Compared to AtoG=0, from AtoG=1 to AtoG≥5, the pooled Odd Ratios were 1.14 95% CI [1.06-1.2], 1.53 95% CI [1.4-1.7], 2.17 95% CI [1.9-2.4], 2.9 95% CI [2.4-3.4], and 4.9 95% CI [3.3-7.4] for any complication (p<10-4). CONCLUSION AtoG is a multidimensional score in line with the concept of comprehensive geriatric assessment. It had good discrimination and performance in predicting 90-day mortality and complications. Performances were as good as CCI for 90-day mortality, and better than it for the complications. LEVEL OF PROOF IV; retrospective cohort study.
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Affiliation(s)
- Baptiste Boukebous
- Université Paris Cité, équipe ECAMO, Centre of Research in Epidemiology and Statistics (CRESS), Inserm, UMR 1153, Paris, France; Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, université Paris Cité, AP-HP, Paris, France.
| | - David Biau
- Université Paris Cité, équipe ECAMO, Centre of Research in Epidemiology and Statistics (CRESS), Inserm, UMR 1153, Paris, France; Service de chirurgie orthopédique et traumatologique, Cochin, université Paris Cité, AP-HP, Paris, France
| | - Fei Gao
- Recherche sur les Services et management en santé (RSMS) - U1309, université de Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, 35000 Rennes, France
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11
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Popa M, Cursaru A, Cretu B, Iordache S, Iacobescu GL, Spiridonica R, Serban B, Cirstoiu C. Enhancing Osteoporosis Management: A Thorough Examination of Surgical Techniques and Their Effects on Patient Outcomes. Cureus 2024; 16:e59681. [PMID: 38836146 PMCID: PMC11149898 DOI: 10.7759/cureus.59681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/06/2024] Open
Abstract
Managing osteoporotic fractures in older individuals is a difficult task in orthopedic surgery. It requires a careful approach that combines advanced diagnostic methods, customized surgical treatments, and comprehensive rehabilitation strategies. This article presents the results of an analysis carried out at the University Emergency Hospital, Bucharest. The analysis specifically examines the treatment of osteoporotic fractures using different osteosynthesis techniques. Although diagnostic tools like dual-energy X-ray absorptiometry (DXA) and Fracture Risk Assessment Tool (FRAX) have improved, a considerable number of fractures still happen in people who do not have obvious osteoporosis. This emphasizes the importance of using additional diagnostic measures such as high-resolution peripheral quantitative computed tomography (HR-pQCT) and quantitative computed tomography (QCT) to improve the accuracy of predictions. The study demonstrates the intricate nature of surgical decision-making and the significance of adjusting techniques to meet the specific needs of each patient. An instance of osteosynthesis failure resulting from the inappropriate choice of method highlighted the crucial significance of a thorough preoperative assessment. The discussion highlights the importance of early mobilization and rehabilitation in reducing the risks associated with prolonged immobilization and improving patient recovery. This paper strongly supports the use of evidence-based and patient-centered methods in the management of osteoporotic fractures. It emphasizes the importance of utilizing the most recent advancements in diagnostic and surgical technologies. Promising advancements in orthopedic medicine lie in the future, particularly in the integration of interdisciplinary research and personalized medicine. These advancements have the potential to enhance patient outcomes in this population that is at high risk.
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Affiliation(s)
- Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Georgian L Iacobescu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopaedics and Trauma, University of Medicine and Pharmacy Carol Davila, Bucharest, ROU
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
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12
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Blay R, Flores LE, Kupzyk K, Waltman N, Lappe J, Mack L, Bilek L. Twelve-month resistance and impact exercise program or risedronate provides a relative benefit to hip bone structure in postmenopausal women: results from a randomized controlled trial. Osteoporos Int 2024; 35:877-891. [PMID: 38368307 DOI: 10.1007/s00198-023-07008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/19/2023] [Indexed: 02/19/2024]
Abstract
Bone strength estimates are important for fracture prevention. This study compared bone strength changes in postmenopausal women with low bone mass who were assigned to 12 months of exercise, a bone medication, or control. Exercise and bone medications benefited structure at the hip. Structure should be considered in fracture prevention research. PURPOSE Exercise and bisphosphonates reduce fracture risk, but their impact on estimates of bone strength remains uncertain. This study compared changes in tibial bone strength using peripheral quantitative computed tomography (pQCT) and hip structure analysis (HSA) outcomes from dual-energy X-ray absorptiometry (DXA) scans in postmenopausal women with low bone mass assigned to 12 months of exercise, risedronate, or control. METHODS In this RCT, 276 postmenopausal women within 6 years of menopause were randomly assigned to three groups: exercise (92), risedronate (91), or control (93). Exercise included weighted jogging and progressive resistance exercises; risedronate treatment was 150 mg monthly; all groups received calcium and vitamin D. pQCT and DXA images were obtained at baseline and 6 and 12 months and compared between groups over time. RESULTS Participants had a mean (± SD) age of 54.5 (± 3.2) years with an average of 36.7 (± 40.7) months postmenopause. No significant differences were found between groups for the change in pQCT outcomes (volumetric bone mineral density, area, and strength estimates). At 12 months, mean percent differences (95% CI) in HSA measures between exercise and controls were as follows: intertrochanteric, cross-sectional area 2.25% (0.28, 4.12) (p = .03), cross-sectional moment of inertia (CSMI) 5.67% (1.47, 9.87) (p < .01), and section modulus (SM) 4.38% (1.02, 7.74) (p = .01), and narrow neck, average cortical thickness 2.37% (-0.08, 4.83) (p = .031). Mean percent differences (95% CI) in HSA measures between risedronate and control were as follows: intertrochanteric, CSMI 4.28% (-0.24, 8.81) (p = .03) and SM 3.35% (-0.21, 6.91) (p = .03), and shaft, subperiosteal width 0.82% (0.05, 1.58) (p = .047), CSMI 2.53% (0.88, 4.18) (p = .004), and SM 1.57% (0.34, 2.8) (p = .008). Exercise maintained neck-shaft angle compared to both control 1.27% (0.13, 2.41) (p = .04) and risedronate 1.31% (0.23, 2.39) (p = .03). All other differences for changes in HSA outcomes over time were not significantly different between the exercise and risedronate groups. CONCLUSION Exercise and bisphosphonates may influence structural and strength estimates at the hip, but not at peripheral sites (tibia). Neither exercise nor bisphosphonates were found to be superior in improving estimates of hip bone strength.
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Affiliation(s)
- R Blay
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - L E Flores
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - K Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - N Waltman
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - J Lappe
- Creighton Osteoporosis Research Center, Omaha, NE, USA
| | - L Mack
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - L Bilek
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
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13
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Koole C, Bleeser T, Hoogma DF, Coppens S, Teunkens A, Rex S. Haemodynamic effects of continuous spinal anaesthesia versus single-shot spinal anaesthesia or general anaesthesia for hip fracture surgery: a systematic review and meta-analysis. Br J Anaesth 2024; 132:1160-1162. [PMID: 38242801 DOI: 10.1016/j.bja.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Charlotte Koole
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Tom Bleeser
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Danny F Hoogma
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Steve Coppens
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - An Teunkens
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
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14
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Wang C, Hou M, Zhang C, Ma T, Li Z, Lin H, Zhang K, Huang Q. Biomechanical evaluation of a modified intramedullary nail for the treatment of unstable femoral trochanteric fractures. Heliyon 2024; 10:e29671. [PMID: 38660243 PMCID: PMC11040111 DOI: 10.1016/j.heliyon.2024.e29671] [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: 01/03/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Background The Proximal Femoral Nail Antirotation (PFNA) device is the most commonly used implant to fix unstable femoral trochanteric fractures (UFTFs), but it has a relatively high incidence of complications. Due to this factor, the modified intramedullary nail (MIN) was created to treat patients with UFTFs. The aim was to exhibit the MIN and make a comparison with PFNA and InterTAN using biomechanical methods. Methods An adult UFTF model was developed using Mimics software. The PFNA, InterTAN nail, and MIN models were drawn referring to the corresponding parameters and installed in the fracture models. Vertical, anteroposterior (AP) bending, and torsion loads of the femoral head were set in advance and loaded onto the fracture models. The value of maximal displacement and von Mises stress was evaluated via finite element analysis (FEA). Results The MIN model had smaller values for maximal displacement than that of the PFNA model, and the increase in displacement was less pronounced for the MIN compared to PFNA under increasing vertical loads. For the indicator of von Mises stress, the MIN model showed lower stress compared with the PFNA model in vertical loads ranging from 300 N to 2100 N. Except for the maximal stress at implants under AP bending loads, the MIN demonstrated the most superior biomechanical properties under AP bending and torsional loads. Conclusion The MIN offered obvious advantages in terms of mechanical stability and stress distribution among the three studied implants, providing a promising implant option for patients with UFTFs.
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Affiliation(s)
- ChaoFeng Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - MingMing Hou
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - CongMing Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Hua Lin
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Kun Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
| | - Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China
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15
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Rostagno C, Mannarino GM, Cartei A, Rubbieri G, Ceccofiglio A, Gori AM, Civinini R, Marcucci R. Preoperative Drug Monitoring in Management of Patients with Hip Fracture on Treatment with Direct Oral Anticoagulants. Clin Interv Aging 2024; 19:655-664. [PMID: 38706637 PMCID: PMC11067930 DOI: 10.2147/cia.s444902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Aim of the present study was to evaluate whether monitoring direct oral anticoagulant (DOAC) levels may improve management of anticoagulated patients who need surgery for hip fracture. Patients and Methods A total of 147 out of 2231 (7.7%) patients with hip fracture admitted to a tertiary teaching hospital were on DOACs (group A), whereas 206 patients matched for age, sex, and type of fracture not on anticoagulant or P2Y12 platelet inhibitors were considered as control group (group B). Patients on DOACs were divided into two subgroups: A1 in which intervention was scheduled in relation to the last drug intake according to current guidelines, and A2 included patients in whom time of surgery (TTS) was defined according to DOAC levels. Neuraxial anesthesia was considered with DOAC levels <30 ng/mL, general anesthesia for levels in the range 30-50 ng/mL. Results and conclusions TTS was significantly lower in controls than in DOAC patients: surgery within 48 hours was performed in 80.6% of group B versus 51% in group A (p<0.0001). In A2, 41 patients underwent surgery within 48 hours (56%) in comparison to 32 A1 patients (45.1%; p=0.03). TTS and length of hospitalization were on average 1 day lower in patients with assay of DOAC levels. Finally, 35/39 (89%) patients with DOAC levels <50 ng/mL had surgery within 48 hours (26 under neuraxial anesthesia, without any neurological complication, and 13 in general anesthesia). Conclusion DOAC assay in patients with hip fracture may be useful for correct definition of time to surgery, particularly in patients who are candidates for neuraxial anesthesia. Two-thirds of patients with DOAC levels <50 ng/mL at 48 hours from last drug intake underwent uneventful neuraxial anesthesia, saving at least 24 hours in comparison to guidelines.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
| | | | | | - Gaia Rubbieri
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
| | | | - Anna Maria Gori
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
- Traumatologia e Ortopedia, AOU Careggi, Firenze, Italy
- Malattie aterotrombotiche, AOU Careggi, Firenze, Italy
| | | | - Rossella Marcucci
- Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy
- Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy
- Traumatologia e Ortopedia, AOU Careggi, Firenze, Italy
- Malattie aterotrombotiche, AOU Careggi, Firenze, Italy
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Hu JS, Jin YP, Wu JK, Ni JG. Skeletal muscle index based on CT at the 12th thoracic spine level can predict osteoporosis and fracture risk: a propensity score-matched cohort study. Front Med (Lausanne) 2024; 11:1387807. [PMID: 38725469 PMCID: PMC11079204 DOI: 10.3389/fmed.2024.1387807] [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: 02/18/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
Background Multiple studies have shown that skeletal muscle index (SMI) measured on abdominal computed tomography (CT) is strongly associated with bone mineral density (BMD) and fracture risk as estimated by the fracture risk assessment tool (FRAX). Although some studies have reported that SMI at the level of the 12th thoracic vertebra (T12) measured on chest CT images can be used to diagnose sarcopenia, it is regrettable that no studies have investigated the relationship between SMI at T12 level and BMD or fracture risk. Therefore, we further investigated the relationship between SMI at T12 level and FRAX-estimated BMD and fracture risk in this study. Methods A total of 349 subjects were included in this study. After 1∶1 propensity score matching (PSM) on height, weight, hypertension, diabetes, hyperlipidemia, hyperuricemia, body mass index (BMI), age, and gender, 162 subjects were finally included. The SMI, BMD, and FRAX score of the 162 participants were obtained. The correlation between SMI and BMD, as well as SMI and FRAX, was assessed using Spearman rank correlation. Additionally, the effectiveness of each index in predicting osteoporosis was evaluated through the receiver operating characteristic (ROC) curve analysis. Results The BMD of the lumbar spine (L1-4) demonstrated a strong correlation with SMI (r = 0.416, p < 0.001), while the BMD of the femoral neck (FN) also exhibited a correlation with SMI (r = 0.307, p < 0.001). SMI was significantly correlated with FRAX, both without and with BMD at the FN, for major osteoporotic fractures (r = -0.416, p < 0.001, and r = -0.431, p < 0.001, respectively) and hip fractures (r = -0.357, p < 0.001, and r = -0.311, p < 0.001, respectively). Moreover, the SMI of the non-osteoporosis group was significantly higher than that of the osteoporosis group (p < 0.001). SMI effectively predicts osteoporosis, with an area under the curve of 0.834 (95% confidence interval 0.771-0.897, p < 0.001). Conclusion SMI based on CT images of the 12th thoracic vertebrae can effectively diagnose osteoporosis and predict fracture risk. Therefore, SMI can make secondary use of chest CT to screen people who are prone to osteoporosis and fracture, and carry out timely medical intervention.
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Affiliation(s)
| | | | | | - Jian-guang Ni
- Department of Orthopedics, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, China
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17
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Wang M, Seibel MJ. Secondary fracture prevention in primary care: a narrative review. Osteoporos Int 2024:10.1007/s00198-024-07036-1. [PMID: 38652313 DOI: 10.1007/s00198-024-07036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/28/2024] [Indexed: 04/25/2024]
Abstract
The global burden of osteoporosis continues to rise with an ageing population. Untreated osteoporotic fractures not only heighten the risk of subsequent fractures but are associated with excess mortality. Although primary care guidelines consistently stress the importance of secondary fracture prevention, fewer than 20% of patients are appropriately treated for osteoporosis following an initial osteoporotic fracture. This worldwide phenomenon is known as the osteoporosis care gap. This literature review examines the barriers to secondary fracture prevention in primary care and evaluates the effectiveness of targeted primary care interventions. Common themes emerged from the majority of qualitative studies, including a need for improved communication between the hospital team and primary care, better defined responsibilities and osteoporosis-directed education for the primary care physicians. Quantitative studies demonstrated that most targeted, intensive interventions aimed at educating patients and their primary care physician about osteoporosis treatment significantly increased rates of investigation and treatment. Greater uptake of models of secondary fracture prevention in primary care is urgently needed to address the osteoporosis care gap.
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Affiliation(s)
- Mawson Wang
- Bone Research Program, ANZAC Research Institute, The University of Sydney at Concord Campus, Hospital Rd, Gate 3, Concord, NSW, Australia.
- Department of Endocrinology and Metabolism, Concord Hospital, Sydney Local Health District, Concord, NSW, Australia.
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, The University of Sydney at Concord Campus, Hospital Rd, Gate 3, Concord, NSW, Australia
- Department of Endocrinology and Metabolism, Concord Hospital, Sydney Local Health District, Concord, NSW, Australia
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18
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Zhong Z, Hu Z, Zhou W, Qin X, Tan S. The bone marrow lipidomics of mice reveal sex-related differences. Biomed Chromatogr 2024:e5875. [PMID: 38643980 DOI: 10.1002/bmc.5875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/25/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024]
Abstract
Osteoporosis is a common skeletal disorder characterized by an imbalance between bone resorption and formation, exhibiting a higher prevalence in women compared with men. While previous studies have primarily focused on genomics and genetics in osteoporosis susceptibility, there is a lack of systematic exploration of sex-specific differences in lipid levels in mouse bone marrow. Multiple reaction monitoring-based liquid chromatography-trandem mass spectrometry (LC-MS/MS) was used to quantify lipidomic profiles in bone marrow samples from three female mice and three male mice. The LC-MS/MS technique based on the multiple reaction monitoring method identified and quantified 184 lipids from 15 lipid classes. The contents of most lipids in the bone marrow cells of female mice were higher than those in male mice, including four polyunsaturated fatty acids, three phospholipids and four sphingolipids. Among all the lipid molecules, lactosylceramide (d18:0/16:0) showed the highest fold change in female mice, while its precursor lipid, glucosylceramide, was the most up-regulated in male mice. This study, focusing on bone marrow lipidomics, elucidates significant sexual dimorphism in lipid levels within bone marrow cells. It provides novel evidence supporting the higher prevalence of osteoporosis in women and enhances our understanding of the connection between sex-specific lipid levels and the risk of osteoporosis.
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Affiliation(s)
- Ziqing Zhong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zuojian Hu
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Wei Zhou
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xue Qin
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shaolin Tan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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Chiu CT, Lee JI, Lu CC, Huang SP, Chen SC, Geng JH. The association between body mass index and osteoporosis in a Taiwanese population: a cross-sectional and longitudinal study. Sci Rep 2024; 14:8509. [PMID: 38605101 PMCID: PMC11009266 DOI: 10.1038/s41598-024-59159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024] Open
Abstract
This study investigates the correlation between body mass index (BMI) and osteoporosis utilizing data from the Taiwan Biobank. Initially, a comprehensive analysis of 119,009 participants enrolled from 2008 to 2019 was conducted to assess the association between BMI and osteoporosis prevalence. Subsequently, a longitudinal cohort of 24,507 participants, initially free from osteoporosis, underwent regular follow-ups every 2-4 years to analyze the risk of osteoporosis development, which was a subset of the main cohort. Participants were categorized into four BMI groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 27 kg/m2), and obese groups (BMI ≥ 27 kg/m2). A T-score ≤ - 2.5 standard deviations below that of a young adult was defined as osteoporosis. Overall, 556 (14.1%), 5332 (9.1%), 2600 (8.1%) and 1620 (6.7%) of the participants in the underweight, normal weight, overweight and obese groups, respectively, had osteoporosis. A higher prevalence of osteoporosis was noted in the underweight group compared with the normal weight group (odds ratio [OR], 2.20; 95% confidence interval [95% CI], 1.99 to 2.43; p value < 0.001) in multivariable binary logistic regression analysis. Furthermore, in the longitudinal cohort during a mean follow-up of 47 months, incident osteoporosis was found in 61 (9%), 881 (7.2%), 401 (5.8%) and 213 (4.6%) participants in the underweight, normal weight, overweight and obese groups, respectively. Multivariable Cox proportional hazards analysis revealed that the risk of incident osteoporosis was higher in the underweight group than in the normal weight group (hazard ratio [HR], 1.63; 95% CI 1.26 to 2.12; p value < 0.001). Our results suggest that BMI is associated with both the prevalence and the incidence of osteoporosis. In addition, underweight is an independent risk factor for developing osteoporosis. These findings highlight the importance of maintaining normal weight for optimal bone health.
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Affiliation(s)
- Chao-Tse Chiu
- Department of Orthopaedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-In Lee
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Chang Lu
- Department of Orthopaedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Pin Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, 807, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Ph.D. Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Institute of Medical Science and Technology, College of Medicine, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan
| | - Szu-Chia Chen
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospita, l, Kaohsiung Medical University, 812, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, 807, Kaohsiung, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Rd, Xiaogang District, Kaohsiung, 812, Taiwan.
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20
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García-Tercero E, Belenguer-Varea Á, Villalon-Ruibio D, López Gómez J, Trigo-Suarez R, Cunha-Pérez C, Borda MG, Tarazona-Santabalbina FJ. Respiratory Complications Are the Main Predictors of 1-Year Mortality in Patients with Hip Fractures: The Results from the Alzira Retrospective Cohort Study. Geriatrics (Basel) 2024; 9:47. [PMID: 38667514 PMCID: PMC11050287 DOI: 10.3390/geriatrics9020047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction: Hip fractures pose a significant challenge for older individuals given their high incidence and one-year mortality rate. The objective of this study was to identify the primary predictors of one-year mortality in older adults hospitalized for hip fractures. Methods: We conducted a retrospective cohort study involving adults aged 70 years or older who were admitted to the hospital for fragility hip fractures between 1 January 2014 and 31 December 2021. A total of 3229 patients were recruited, with 846 (26.2%) experiencing one-year mortality. Results: Respiratory complications (HR 2.42, 95%CI 1.42-4.14; p = 0.001) were the most significant predictors of one-year mortality, followed by hospital readmission (HR 1.96, 95%CI 1.66-2.32; p < 0.001), the male sex (HR 1.88, 95%CI 1.46-2.32; p < 0.001), cardiac complications (HR 1.88, 95%CI 1.46-2.32; p < 0.001), and a diagnosis of dementia at admission (HR 1.37, 95%CI 1.13-1.66; p = 0.001). The Charlson Index and the American Society of Anesthesiologists physical status classification system also significantly increased the mortality risk. Conversely, higher hemoglobin levels at admission and elevated albumin at discharge significantly reduced the mortality risk. Conclusions: The one-year mortality rate is substantial in older adults with hip fractures who are admitted to an orthogeriatric unit. The appropriate management of anemia, nutritional disorders, and comorbidity at admission and during the follow-up could potentially mitigate long-term mortality after hip fractures.
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Affiliation(s)
- Elisa García-Tercero
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Ángel Belenguer-Varea
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Daniela Villalon-Ruibio
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Jesús López Gómez
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Rodrigo Trigo-Suarez
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Cristina Cunha-Pérez
- School of Doctorate, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, 4068 Stavanger, Norway;
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Francisco Jose Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
- Medical School, Universidad Católica de Valencia Sant Vicent Màrtir, 46001 Valencia, Spain
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21
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Chiang YW, Chang YJ, Huang HJ, Hsieh CP, Lu YH. Does post acute care reduce the mortality of octogenarian and nonagenarian patients undergoing hip fracture surgery? BMC Geriatr 2024; 24:322. [PMID: 38589787 PMCID: PMC11000408 DOI: 10.1186/s12877-024-04936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND With the increasing number of elderly individuals worldwide, a greater number of people aged 80 years and older sustain fragility fracture due to osteopenia and osteoporosis. METHODS This retrospective study included 158 older adults, with a median age of 85 (range: 80-99) years, who sustained hip fragility fracture and who underwent surgery. The patients were divided into two groups, one including patients who joined the post-acute care (PAC) program after surgery and another comprising patients who did not. The mortality, complication, comorbidity, re-fracture, secondary fracture, and readmission rates and functional status (based on the Barthel index score, numerical rating scale score, and Harris Hip Scale score) between the two groups were compared. RESULTS The patients who presented with fragility hip fracture and who joined the PAC rehabilitation program after the surgery had a lower rate of mortality, readmission rate, fracture (re-fracture and secondary fracture), and complications associated with fragility fracture, such as urinary tract infection, cerebrovascular accident, and pneumonia (acute coronary syndrome, out-of-hospital cardiac arrest, or in-hospital cardiac arrest. CONCLUSIONS PAC is associated with a lower rate of mortality and complications such as urinary tract infection, bed sore, and pneumonia in octogenarian and nonagenarian patients with hip fragility fracture.
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Affiliation(s)
- Yu-Wei Chiang
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Yu-Jun Chang
- Big Data Center, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Hui-Jen Huang
- Department of Nursing, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Cheng-Pu Hsieh
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Orthopedics & Sports Medicine Laboratory, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C
| | - Yueh-Hsiu Lu
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C..
- Institute of Biomedical Sciences, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C..
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22
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Chiavarini M, Ricciotti GM, Genga A, Faggi MI, Rinaldi A, Toscano OD, D’Errico MM, Barbadoro P. Malnutrition-Related Health Outcomes in Older Adults with Hip Fractures: A Systematic Review and Meta-Analysis. Nutrients 2024; 16:1069. [PMID: 38613102 PMCID: PMC11013126 DOI: 10.3390/nu16071069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Hip fracture is a common condition in older adults, leading to disability and mortality. Several studies have demonstrated the association between nutritional status and the risk of a negative health outcome after fractures. In this systematic review, we evaluated the association between malnutrition and mortality, changes in mobility/living arrangements, and postoperative complications, such as delirium, in older patients with hip fractures. A literature search on the PubMed, Web of Science, and Scopus databases, up to September 2023, was conducted to identify all studies involving older subjects that reported an association between MNA/GNRI/PNI/CONUT and health outcome after hip fracture. Meta-analysis was performed by a random-effects model using risk values (RR, OR, and HR) extracted from the 14 eligible selected studies. Malnutrition significantly increased the risk of any analyzed adverse outcome by 70% at 1 month, and up to 250% at 1 year. Malnutrition significantly increased delirium risk by 275% (OR = 2.75; 95% CI 1.80-4.18; p ≤ 0.05), mortality risk by 342% (OR = 3.42; 95% CI 2.14-5.48; p ≤ 0.05), mortality hazard risk by 351% (HR = 3.51; 95% CI 1.63-7.55; p ≤ 0.05) at 1 month, and transfer-to-more-supported-living-arrangements risk by 218% (OR = 2.18; 95% CI 1.58-3.01; p ≤ 0.05), and declined mobility risk by 41% (OR = 1.41; 95% CI 1.14-1.75; p ≤ 0.05), mortality risk by 368% (OR = 3.68; 95% CI 3.00-4.52; p ≤ 0.05), and mortality hazard risk by 234% (HR = 2.34; 95% CI 1.91-2.87; p ≤ 0.05) at 1 year. Malnutrition of older patients increases the risk of death and worsens mobility and independence after hip fractures. The results of the present study highlight the importance of nutritional status evaluation of older subjects with hip fractures in order to prevent potential adverse outcomes (Registration No: CRD42023468751).
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Affiliation(s)
| | | | - Anita Genga
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (M.C.); (G.M.R.); (M.I.F.); (A.R.); (O.D.T.); (M.M.D.)
| | | | | | | | | | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (M.C.); (G.M.R.); (M.I.F.); (A.R.); (O.D.T.); (M.M.D.)
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23
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Riaz MH, Riaz J, Mahmood A, Tariq M, Sahar N, Ali RS, Ahmad N, Irshad S, Ahmad MH, Arshad H, Khan TM. Risk Factors of Postoperative Acute Heart Failure in Elderly Patients After Hip Fracture Surgery. Cureus 2024; 16:e58967. [PMID: 38800267 PMCID: PMC11127705 DOI: 10.7759/cureus.58967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background Postoperative acute heart failure (AHF) in elderly patients after hip fracture surgery is a common complication. Therefore, this study aimed to identify the risk factor of AHF after hip fracture surgery among the older population. Methods This retrospective cohort study was performed on 88 admitted patients whose hip fractures were fixed via internal fixation surgery in a tertiary care hospital in Rawalpindi, Pakistan, from January 2022 to March 2023. Recruitment of patients was made through established inclusion and exclusion criteria. Ethical approval and informed consent were also gained before the data collection. A self-designed form was used to collect data. Data analysis was carried out in the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Both descriptive and inferential statistics were applied to compare the attributes of the patients with AHF and patients without AHF. Multivariate logistic regression was used to evaluate the association between the postoperative AHF and its potential risk factors. Results Out of 88 enrolled patients, 12 (13.64%) had developed postoperative AHF. Age ≥ 65 years (OR = 2.606, 95% CI = 1.035~4.160, p = 0.010), anemia (OR = 3.178, 95% CI = 1.847~5.990, p = 0.029), hypertension (OR = 2.019, 95% CI = 1.110~4.034, p = 0.012), diabetes mellitus (OR = 2.003, 95% CI = 1.115~4.012, p = 0.015), hypoalbuminemia (OR = 2.486, 95% CI = 1.218~4.619, p = 0.030), and operation time ≥ 120 minutes (OR = 1.702, 95% CI = 1.099~2.880, p = 0.018), were the risk factors of postoperative AHF in elderly patients after hip fracture surgery. Conclusions In the study population, the incidence of postoperative heart failure was significant and age ≥ 65 years, anemia, hypertension, diabetes mellitus, hypoalbuminemia, and operation time ≥ 120 were significantly involved in the development of it. Preoperative identification and management of AHF risk factors could lead to the prevention of postoperative complications.
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Affiliation(s)
| | - Javaria Riaz
- Medicine, Mohi-ud-Din Islamic Medical College, Mirpur, PAK
| | - Asim Mahmood
- Cardiology, Lahore General Hospital, Lahore, PAK
| | | | - Nabiha Sahar
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Rana Shahzaib Ali
- Orthopedic Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | - Nadeem Ahmad
- Cardiology, Allama Iqbal Medical College, Lahore, PAK
| | - Sumbal Irshad
- Internal Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | | | - Hamid Arshad
- Surgery, Allama Iqbal Medical College, Lahore, PAK
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24
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Li DY, Zhang K, Wang H, Zhuang Y, Zhang BF, Zhang DL. Preoperative Serum Calcium Level Predicts Postoperative Mortality in Older Adult Patients with Hip Fracture: A Prospective Cohort Study of 2333 Patients. J Am Med Dir Assoc 2024; 25:655-660. [PMID: 37660723 DOI: 10.1016/j.jamda.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Hip fractures are a significant cause of mortality among older adults. However, predictive markers for an unfavorable prognosis are still lacking. Serum calcium is an essential element in several biochemical reactions in the body. This study investigated the role of the preoperative serum calcium level as a prognostic parameter for postoperative mortality in older adult patients with hip fractures. DESIGN We conducted a prospective cohort study at the trauma center in our hospital, from January 1, 2015, to September 30, 2019. A total of 2333 older patients with hip fractures were recruited. This prospective cohort study was conducted in accordance with the criteria of STROCSS. SETTING AND PARTICIPANTS Older adult patients with hip fractures were screened between January 2015 and September 2019 at the trauma center of our hospital. METHODS Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative serum calcium level and all-cause mortality. All analyses were performed using EmpowerStats and the R software. RESULTS A total of 2333 older adult patients with hip fractures were included in the study. The mean follow-up was 37.5 months. Overall, 770 patients (33%) died of all causes. The preoperative serum calcium concentrations were 2.18 ± 0.13 mmol/L. Linear multivariate Cox regression models showed that preoperative serum calcium levels were associated with mortality [hazard ratio (HR) 0.37, 95% CI 0.21-0.67; P = .0009] after adjusting for confounders. However, the linear association was unstable, and nonlinearity was identified. A preoperative serum calcium level of 2.3 mmol/L was an inflection point for prediction. When the preoperative serum calcium concentration was below 2.3 mmol/L, serum calcium concentration increased by 1 mmol/L, and mortality risk decreased by 77% (HR 0.23, 95% CI 0.13-0.43, P < .0001). In contrast, when the preoperative serum calcium concentration was more significant than 2.3 mmol/L, the mortality risk increased with serum calcium concentration (HR 6.27, 95% CI 1.65-23.74, P = .0069). CONCLUSIONS AND IMPLICATIONS The preoperative serum calcium level is nonlinearly associated with mortality in older adults with hip fractures, with a U-shaped association, and could be used as a potential predictor of prognosis.
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Affiliation(s)
- Dong-Yang Li
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hu Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yan Zhuang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Dan-Long Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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25
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Huang J, Wu T, Jiang YR, Zheng XQ, Wang H, Liu H, Wang H, Leng HJ, Fan DW, Yuan WQ, Song CL. β-Receptor blocker enhances the anabolic effect of PTH after osteoporotic fracture. Bone Res 2024; 12:18. [PMID: 38514644 PMCID: PMC10958005 DOI: 10.1038/s41413-024-00321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024] Open
Abstract
The autonomic nervous system plays a crucial role in regulating bone metabolism, with sympathetic activation stimulating bone resorption and inhibiting bone formation. We found that fractures lead to increased sympathetic tone, enhanced osteoclast resorption, decreased osteoblast formation, and thus hastened systemic bone loss in ovariectomized (OVX) mice. However, the combined administration of parathyroid hormone (PTH) and the β-receptor blocker propranolol dramatically promoted systemic bone formation and osteoporotic fracture healing in OVX mice. The effect of this treatment is superior to that of treatment with PTH or propranolol alone. In vitro, the sympathetic neurotransmitter norepinephrine (NE) suppressed PTH-induced osteoblast differentiation and mineralization, which was rescued by propranolol. Moreover, NE decreased the PTH-induced expression of Runx2 but enhanced the expression of Rankl and the effect of PTH-stimulated osteoblasts on osteoclastic differentiation, whereas these effects were reversed by propranolol. Furthermore, PTH increased the expression of the circadian clock gene Bmal1, which was inhibited by NE-βAR signaling. Bmal1 knockdown blocked the rescue effect of propranolol on the NE-induced decrease in PTH-stimulated osteoblast differentiation. Taken together, these results suggest that propranolol enhances the anabolic effect of PTH in preventing systemic bone loss following osteoporotic fracture by blocking the negative effects of sympathetic signaling on PTH anabolism.
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Affiliation(s)
- Jie Huang
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
| | - Tong Wu
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
| | - Yi-Rong Jiang
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
| | - Xuan-Qi Zheng
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
| | - Huan Wang
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
| | - Hao Liu
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
| | - Hong Wang
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
- Beijing Key Laboratory of Spinal Disease, 100191, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, 100191, Beijing, China
| | - Hui-Jie Leng
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
- Beijing Key Laboratory of Spinal Disease, 100191, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, 100191, Beijing, China
| | - Dong-Wei Fan
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
- Beijing Key Laboratory of Spinal Disease, 100191, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, 100191, Beijing, China
| | - Wan-Qiong Yuan
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China
- Beijing Key Laboratory of Spinal Disease, 100191, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, 100191, Beijing, China
| | - Chun-Li Song
- Department of Orthopedics, Peking University Third Hospital, 100191, Beijing, China.
- Beijing Key Laboratory of Spinal Disease, 100191, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, 100191, Beijing, China.
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26
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Chuang SH, Kuo YJ, Huang SW, Zhang HW, Peng HC, Chen YP. Association Between Long‑Term Exposure to Air Pollution and the Rate of Mortality After Hip Fracture Surgery in Patients Older Than 60 Years: Nationwide Cohort Study in Taiwan. JMIR Public Health Surveill 2024; 10:e46591. [PMID: 38342504 PMCID: PMC10985614 DOI: 10.2196/46591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/08/2023] [Accepted: 02/08/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND To enhance postoperative patient survival, particularly in older adults, understanding the predictors of mortality following hip fracture becomes paramount. Air pollution, a prominent global environmental issue, has been linked to heightened morbidity and mortality across a spectrum of diseases. Nevertheless, the precise impact of air pollution on hip fracture outcomes remains elusive. OBJECTIVE This retrospective study aims to comprehensively investigate the profound influence of a decade-long exposure to 12 diverse air pollutants on the risk of post-hip fracture mortality among older Taiwanese patients (older than 60 years). We hypothesized that enduring long-term exposure to air pollution would significantly elevate the 1-year mortality rate following hip fracture surgery. METHODS From Taiwan's National Health Insurance Research Database, we obtained the data of patients who underwent hip fracture surgery between July 1, 2003, and December 31, 2013. Using patients' insurance registration data, we estimated their cumulative exposure levels to sulfur dioxide (SO2), carbon dioxide (CO2), carbon monoxide (CO), ozone (O3), particulate matter having a size of <10 μm (PM10), particulate matter having a size of <2.5 μm (PM2.5), nitrogen oxides (NOX), nitrogen monoxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), and methane (CH4). We quantified the dose-response relationship between these air pollutants and the risk of mortality by calculating hazard ratios associated with a 1 SD increase in exposure levels over a decade. RESULTS Long-term exposure to SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 demonstrated significant associations with heightened all-cause mortality risk within 1 year post hip fracture surgery among older adults. For older adults, each 1 SD increment in the average exposure levels of SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 corresponded to a substantial escalation in mortality risk, with increments of 14%, 49%, 18%, 12%, 41%, 33%, 38%, 20%, 9%, and 26%, respectively. We further noted a 35% reduction in the hazard ratio for O3 exposure suggesting a potential protective effect, along with a trend of potentially protective effects of CO2. CONCLUSIONS This comprehensive nationwide retrospective study, grounded in a population-based approach, demonstrated that long-term exposure to specific air pollutants significantly increased the risk of all-cause mortality within 1 year after hip fracture surgery in older Taiwanese adults. A reduction in the levels of SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 may reduce the risk of mortality after hip fracture surgery. This study provides robust evidence and highlights the substantial impact of air pollution on the outcomes of hip fractures.
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Affiliation(s)
- Shu-Han Chuang
- Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Applied Science, National Taitung University, Taitung City, Taitung County, Taiwan
| | - Han-Wei Zhang
- MetaTrial Research Center, Biomedica Corporation, New Taipei, Taiwan
- Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hsiao-Ching Peng
- MetaTrial Research Center, Biomedica Corporation, New Taipei, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Huang K, Rockov ZA, Foster LO, Najdawi J, Robles AS, Marecek GS. Optimizing the Entry Point for Medullary Hip Screws. J Am Acad Orthop Surg 2024; 32:279-285. [PMID: 38181514 DOI: 10.5435/jaaos-d-23-00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/26/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION Medullary hip screws (MHSs) are the most common treatment of intertrochanteric hip fractures because they can be used for varied fracture patterns and resist shortening. Identifying the appropriate MHS entry point can be intellectually and technically challenging. We aimed to quantify the variability in the ideal entry point (IEP) for MHSs. METHODS Standing alignment radiographs of 50 patients were evaluated using TraumaCad (Brainlab). The femoral neck shaft angle and the offset from the tip of the greater trochanter (GT) to the femur's longitudinal axis ('greater trochanter offset') were measured. Five MHS system templates were superimposed on the femur's longitudinal axis, and the distance from the GT tip to MHS's top center was measured. Five independent reviewers each templated 20 images such that all images were measured at least twice. A random sample of five images was selected for all five raters to measure and to calculate an intraclass coefficient Mean IEPs were compared with an independent sample Student t -test. RESULTS The mean GT offset was 13.5 ± 5.6 mm (range 12.9 to 26.7 mm). The mean neck shaft angle was 129.5 ± 4.0 (range 120 to 139). The mean IEP for nail systems ranged from 5.7 to 7.1 mm medial to the GT tip; there was no notable difference in pairwise comparison of nail systems or in aggregate. Intraclass coefficient for all ratings, measurements, and nail types ranged from moderate to good. Both intra-rater and inter-rater reliability were excellent. DISCUSSION AND CONCLUSION In a sample with broad variation in femoral anatomy, there is a specific, roughly 1.5 mm wide interval that is 6.4 mm medial to the GT tip that serves as the IEP for the most common MHS systems. No notable difference seems to exist in the IEP among these MHS systems.
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Affiliation(s)
- Kevin Huang
- From the Cedars-Sinai Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA
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Curtin PB, Molla VG, Conway AE, Swart EF. What interventions add value in lateral compression type 1 fragility pelvis fractures? A retrospective cohort study. SAGE Open Med 2024; 12:20503121241236132. [PMID: 38465240 PMCID: PMC10924554 DOI: 10.1177/20503121241236132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Fragility fractures are a large source of morbidity and mortality in the elderly. Orthopaedic surgeons are regularly the main point of contact in patients with lateral compression type 1 pelvis fractures, despite many of these being treated non-operatively. This study aims to identify risk factors for mortality and elucidate which follow-up visits have the potential to improve care for these patients. Methods and materials In all, 211 patients have been identified with fragility lateral compression type 1 fractures at a level 1 trauma centre over a 5-year period. For all patients, we recorded patient demographics, imaging data, hospital readmissions, medical complications and death dates if applicable. Results Of the 211 patients identified, 56.4% had at least one orthopaedic follow-up, of which no patient had a clinically meaningful medical intervention initiated. 30-day readmission rate was 19%, and 1-year mortality was 24%. Male sex, need for an assist device, higher Charlson Comorbidity Index and increased age were found to be statistically associated with increased risk of mortality. Patients who followed up with their primary care physician were found to have a statistically lower risk of mortality. Computed tomography scans were obtained in 70% of patients and never limited patient weight-bearing status or found any additional injury not already identified on the radiograph. Discussion/Conclusions For patients with lateral compression type 1 type fragility fractures, orthopaedic surgeons did not offer additional clinically meaningful intervention after the time of initial diagnosis in this patient cohort. The rate of clinical follow-up with a primary care physician is relatively low despite high rates of medical comorbidity. Computed tomography scans were utilised frequently but did not change recommendations. The high rate of medical complications and lack of orthopaedic intervention suggest that we should re-evaluate the role of the orthopaedic surgeon versus the primary care physician as the primary point of medical contact for patients with these injuries.
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Affiliation(s)
- Patrick B Curtin
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Vadim G Molla
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Alexandra E Conway
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Eric F Swart
- Department of Orthopaedic Surgery, Lahey Healthcare, Burlington, MA, USA
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Singh A, Kotzur T, Vivancos-Koopman I, Emukah C, Brady C, Martin C. A component-based analysis of metabolic syndrome's impact on 30-day outcomes after hip fracture: reduced mortality in obese patients. OTA Int 2024; 7:e301. [PMID: 38292467 PMCID: PMC10827291 DOI: 10.1097/oi9.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Introduction Hip fractures are a common injury associated with significant morbidity and mortality. In the United States, there has been a rapid increase in the prevalence of metabolic syndrome (MetS), a condition comprised several common comorbidities, including obesity, diabetes mellitus, and hypertension, that may worsen perioperative outcomes. This article assesses the impact of MetS and its components on outcomes after hip fracture surgery. Methods Patients who underwent nonelective operative treatment for traumatic hip fractures were identified in the 2015-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Baseline characteristics between groups were compared, and significant differences were included as covariates. Multivariate regression was performed to assess the impact of characteristics of interest on postoperative outcomes. Patients with MetS, or a single one of its constitutive components-hypertension, diabetes, and obesity-were compared with metabolically healthy cohorts. Results In total 95,338 patients were included. Patients with MetS had increased complications (OR 1.509; P < 0.001), but reduced mortality (OR 0.71; P < 0.001). Obesity alone was also associated with increased complications (OR 1.14; P < 0.001) and reduced mortality (OR 0.736; P < 0.001). Both hypertension and diabetes alone increased complications (P < 0.001) but had no impact on mortality. Patients with MetS did, however, have greater odds of adverse discharge (OR 1.516; P < 0.001), extended hospital stays (OR 1.18; P < 0.001), and reoperation (OR 1.297; P = 0.003), but no significant difference in readmission rate. Conclusion Patients with MetS had increased complications but decreased mortality. Our component-based analysis showed had obesity had a similar effect: increased complications but lower mortality. These results may help surgeons preoperatively counsel patients with hip fracture about their postoperative risks.
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Affiliation(s)
- Aaron Singh
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Travis Kotzur
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | | | - Chimobi Emukah
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Christina Brady
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
| | - Case Martin
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX
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Umehara T, Kaneguchi A, Watanabe K, Katayama N, Teramoto H, Kuwahara D, Kaneyashiki R, Mizuno T, Kito N, Kakehashi M. Improvement of muscle quality assessed using the phase angle is influenced by recovery of knee extension strength in patients with hip fractures. Clin Nutr 2024; 43:773-780. [PMID: 38335802 DOI: 10.1016/j.clnu.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND AIMS Studies reported that knee extension strength on the operated side in patients with hip fractures was not recovered to the level on the non-operated side 6 months after surgery or later. In a cross-sectional study, we revealed that a reduction in isometric knee extension muscle strength on the operated side in patients with hip fractures approximately 6 months after surgery was associated with not only a reduction in skeletal muscle mass but also a reduction in muscle quality, characterized by a reduction in the phase angle (PhA). Furthermore, the mechanisms of knee extension strength improvement can be clarified in more detail using the minimal significant change as the index of recovery. However, no longitudinal studies have examined the factors for knee extension strength improvement based on the minimal significant change in patients with hip fractures 6 months after surgery. This study aimed to longitudinally examine the factors influencing the recovery of knee extension strength based on the minimal significant change in patients with hip fractures between 2 weeks and approximately 6 months after surgery. METHODS In this study, the outcomes used were basic and medical information, PhA, skeletal muscle index (SMI), pain, one-leg standing time, movement control during one-leg standing, and walking speed. For PhA, SMI, pain, one-leg standing time, movement control during one-leg standing, and walking speed, the amount of change was calculated by subtracting the data at 2 weeks from the data at 6 months. Group classification was determined by dividing the patients into two groups using a previous study as a reference: recovery group if the knee extension strength value approximately 6 months after surgery minus that 2 weeks after surgery was ≥3.3 kgf and non-recovery group if the value was <3.3 kgf. Logistic regression analysis was performed to explore the association between the recovery and non-recovery groups. RESULTS The recovery group contained 55 patients, while the non-recovery group comprised 35 patients. The only significant factor associated with knee extension muscle strength in the recovery group was the amount of change in PhA. The odds ratio for the amount of change in PhA was 2.26. The discrimination rate of the model was 62.5%. CONCLUSIONS Our results suggest that recovery of knee extension strength in patients with hip fractures after surgery was mainly because of improvements in muscle quality, not improvements in muscle mass or pain.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Keita Watanabe
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Nobuhisa Katayama
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Hidefumi Teramoto
- Department of Orthopedics Surgery, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Daisuke Kuwahara
- Department of Rehabilitation, Saiseikai Kure Hospital, Sanjo 2-1-13, Kure, Hiroshima, Japan
| | - Ryo Kaneyashiki
- Department of Rehabilitation, Saiseikai Kure Hospital, Sanjo 2-1-13, Kure, Hiroshima, Japan
| | - Toshiyuki Mizuno
- Department of Orthopedics Surgery, Saiseikai Kure Hospital, Sanjo 2-1-13, Kure, Hiroshima, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, Hiroshima, Japan
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Zhao W, Fu M, Wang Z, Hou Z. Risk factors and prognosis of perioperative acute heart failure in elderly patients with hip fracture: case-control studies and cohort study. BMC Musculoskelet Disord 2024; 25:143. [PMID: 38355490 PMCID: PMC10868018 DOI: 10.1186/s12891-024-07255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Elderly patients with hip fracture who develop perioperative acute heart failure (AHF) have a poor prognosis. The aim of the present study is to investigate the potential risks of AHF in elderly hip-fracture patients in the postoperative period and to evaluate the prognostic significance of AHF. METHODS A retrospective analysis was conducted on hip fracture patients at the Third Hospital of Hebei Medical University, who were continuously in hospital from September 2018 to August 2020. To identify independent risk factors for AHF in elderly patients with hip fracture, univariate and multivariate Logistic regression analysis was employed. The Kaplan-Meier survival curve illustrated the relationship between all-cause mortality in the AHF and non-AHF groups. An assessment of the correlation between baseline factors and all-cause mortality was conducted by means of univariable and multivariable Cox proportional hazards analysis. RESULTS We eventually recruited 492 patients,318 of whom were in the AHF group. Statistical significance was found between the two groups for age group, concomitant coronary heart disease, COPD, haemoglobin level below 100 g/L on admission, albumin level below 40 g/L on admission, and increased intraoperative blood loss. Age over 75, concomitant coronary artery disease, hemoglobin level below 100 g/L and albumin level below 40 g/L on admission were independent risk factors for AHF in older hip fracture patients. The AHF group exhibited a higher incidence of perioperative complications, such as anemia, cardiovascular issues, and stress hyperglycemia, as well as all-cause mortality. Based on our COX regression analysis, we have identified that the main risk factors for all-cause mortality in AHF patients are concomitant coronary heart disease, absence of pulmonary infection, absence of diabetes, absence of cancer, and absence of urinary tract infection. CONCLUSION Enhancing hip fracture prevention for AHF is particularly important. It is crucial to make informed decisions to avoid poor prognoses. Patients whose age over 75 years old, concomitant coronary heart disease, hemoglobin < 100 g/L and album< 40 g/L on admission are more likely to develop perioperative AHF. To avert complications and potential fatalities, patients with AHF must receive appropriate care during the perioperative period.
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Affiliation(s)
- Wei Zhao
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China
| | - Mingming Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, 050051, Hebei PR, China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, People's Republic of China.
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Liang J, Yi Q, Liu Y, Li J, Yang Z, Sun W, Sun W. Recent advances of m6A methylation in skeletal system disease. J Transl Med 2024; 22:153. [PMID: 38355483 PMCID: PMC10868056 DOI: 10.1186/s12967-024-04944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
Skeletal system disease (SSD) is defined as a class of chronic disorders of skeletal system with poor prognosis and causes heavy economic burden. m6A, methylation at the N6 position of adenosine in RNA, is a reversible and dynamic modification in posttranscriptional mRNA. Evidences suggest that m6A modifications play a crucial role in regulating biological processes of all kinds of diseases, such as malignancy. Recently studies have revealed that as the most abundant epigentic modification, m6A is involved in the progression of SSD. However, the function of m6A modification in SSD is not fully illustrated. Therefore, make clear the relationship between m6A modification and SSD pathogenesis might provide novel sights for prevention and targeted treatment of SSD. This article will summarize the recent advances of m6A regulation in the biological processes of SSD, including osteoporosis, osteosarcoma, rheumatoid arthritis and osteoarthritis, and discuss the potential clinical value, research challenge and future prospect of m6A modification in SSD.
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Affiliation(s)
- Jianhui Liang
- Department of Orthopedics, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China
- Shantou University Medical College, Shantou, 515000, China
| | - Qian Yi
- Department of Physiology, School of Basic Medical Science, Southwest Medical University, Luzhou, 646099, Sichuan, China
| | - Yang Liu
- Department of Orthopedics, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China
| | - Jiachen Li
- Department of Orthopedics, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China
- Shantou University Medical College, Shantou, 515000, China
| | - Zecheng Yang
- Department of Orthopedics, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China
| | - Wei Sun
- Department of Orthopedics, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China.
| | - Weichao Sun
- Department of Orthopedics, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China.
- The Central Laboratory, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China.
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Wesselink EJ, van der Vegt M, Remmelzwaal S, Bossers SM, Franssen EJ, Swart EL, Boer C, de Leeuw MA. The impact of mental state altering medications on preventable falls after total hip or total knee arthroplasty: a systematic review and meta-analysis. Patient Saf Surg 2024; 18:6. [PMID: 38347630 PMCID: PMC10863089 DOI: 10.1186/s13037-023-00387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Joint replacement surgery of the lower extremities are common procedures in elderly persons who are at increased risk of postoperative falls. The use of mental state altering medications, such as opioids, antidepressants or benzodiazepines, can further contribute to impaired balance and risk of falls. The objective of the current systematic review was to evaluate the risk of the use of mental state altering medications on postoperative falls in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS A comprehensive search of Medline, Embase and Cochrane Controlled Trials Register was conducted from 1 October 1975 to 1 September 2021. The search was repeated in may 2023 and conducted from 1 October 1975 to 1 June 2023. Clinical trials that evaluated the risk of medication on postoperative THA and TKA falls were eligible for inclusion. Articles were evaluated independently by two researchers for risk of bias using the Newcastle-Ottawa Scale. A meta-analysis was performed to determine the potential effect of postoperative use of mental state altering medications on the risk of falls. Lastly, a qualitative synthesis was conducted for preoperative mental state altering medications use. RESULTS Seven cohort studies were included, of which five studies focussed on the postoperative use of mental state altering medications and two investigated the preoperative use. Meta-analysis was performed for the postoperative mental state altering medications use. The postoperative use of mental state altering medications was associated with fall incidents (OR: 1.81; 95% CI: 1.04; 3.17) (p < 0.01) after THA and TKA. The preoperative use of opioids > 6 months was associated with a higher risk of fall incidents, whereas a preoperative opioid prescription up to 3 months before a major arthroplasty had a similar risk as opioid-naïve patients. CONCLUSIONS The postoperative use of mental state altering medications increases the risk of postoperative falls after THA and TKA. Prior to surgery, orthopaedic surgeons and anaesthesiologists should be aware of the associated risks in order to prevent postoperative falls and associated injuries.
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Affiliation(s)
- Elsbeth J Wesselink
- Department of Clinical Pharmacy, Zaans Medisch Centrum, Koningin Julianaplein 58, 1502 DV, Zaandam, The Netherlands.
- Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Anesthesiology, Boelelaan, Amsterdam, The Netherlands.
| | | | - Sharon Remmelzwaal
- Epidemiology & Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Boelelaan, Amsterdam, The Netherlands
| | - Sebastiaan M Bossers
- Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Anesthesiology, Boelelaan, Amsterdam, The Netherlands
| | - Eric J Franssen
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Eleonora L Swart
- Pharmacy and Clinical Pharmacology, Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Boelelaan, Amsterdam, The Netherlands
| | - Christa Boer
- Faculty of Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Boelelaan, Amsterdam, The Netherlands
| | - Marcel A de Leeuw
- Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Anesthesiology, Boelelaan, Amsterdam, The Netherlands
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Guyan F, Gianduzzo E, Waltenspül M, Dietrich M, Kabelitz M. Cortical Thickness Index and Canal Calcar Ratio: A Comparison of Proximal Femoral Fractures and Non-Fractured Femora in Octogenarians to Centenarians. J Clin Med 2024; 13:981. [PMID: 38398294 PMCID: PMC10889276 DOI: 10.3390/jcm13040981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The cortical thickness index (CTI) is a measure of bone quality and it correlates with the risk of proximal femoral fractures. The purpose of this study was to investigate the CTI in femoral neck, trochanteric fractures and non-fractured femora in geriatric patients and to determine whether there is a correlation between the CTI and the presence of a fracture. Methods: One hundred and fifty patients (fifty femoral neck- (FNFx), fifty trochanteric fractures (TFx) and fifty non-fractured (NFx)) with a mean age of 91 (range 80-104) years were included. Hip radiographs (antero-posterior (ap), lateral) were evaluated retrospectively. Measurements on the proximal femoral inner and outer cortices, including CTI and Dorr's canal calcar ratio (CCR), were assessed for inter-observer reliability (ICC), differences of each fracture and correlation of parameters. Results: The mean ap CTI on the affected side was 0.43, 0.45 and 0.55 for FNFx, TFx and NFx, respectively. There was a significant difference of the ap CTI and CCR comparing the injured and healthy side for both fracture cohorts (p < 0.001). Patients with FNFx or TFx had significantly lower CTI on both sides compared to the NFx group (p < 0.05). There was no difference for CTI (p = 0.527) or CCR (p = 0.291) when comparing both sides in the NFx group. The mean inter-observer reliability was good to excellent (ICC 0.88). Conclusions: In proximal femoral fractures, the CTI and CCR are reduced compared with those in non-fractured femora. Both parameters are reliable and show a good correlation in geriatric patients. Therefore, especially for geriatric patients, the CTI and CCR may help to predict fracture risk and consult patients in daily practice.
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Affiliation(s)
| | | | | | | | - Method Kabelitz
- Clinic for Orthopaedics, Hand Surgery and Trauma Surgery, Stadtspital Zürich, Tièchestrasse 99, 8037 Zürich, Switzerland; (F.G.); (E.G.)
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? - a 1-year prospective cohort study. BMC Geriatr 2024; 24:100. [PMID: 38273298 PMCID: PMC10811924 DOI: 10.1186/s12877-023-04637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Continence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up. METHODS Study population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007-2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes. RESULTS Of the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41-2.51) and DI (1.99, 95% CI 1.21-3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22-4.75) remained associated with the need for more assisted living arrangements. CONCLUSIONS Both pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Lim C, Roh YH, Park YG, Lee J, Nam KW. Is there a difference between preoperative and postoperative delirium in elderly hip fracture patients?: A retrospective case control study. Medicine (Baltimore) 2024; 103:e36584. [PMID: 38277519 PMCID: PMC10817095 DOI: 10.1097/md.0000000000036584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/20/2023] [Indexed: 01/28/2024] Open
Abstract
Delirium is associated with greater morbidity, higher mortality, and longer periods of hospital day after hip fracture. There are number of studies on postoperative delirium after a hip fracture. However, few studies have made a distinction between preoperative and postoperative delirium. The purpose of this study is to compare risk factors and clinical outcome between preoperative and postoperative delirium in elderly patients with a hip fracture surgery. A total of 382 consecutive patients aged > 65 years who underwent operation for hip fracture were enrolled. Among them, the patients diagnosed with delirium were divided into 2 groups (a preoperative delirium group and a postoperative delirium group) according to the onset time of delirium. To evaluate risk factors for preoperative and postoperative delirium, we analyzed demographic data, preoperative laboratory data, and perioperative data. To compare clinical outcomes between preoperative and postoperative delirium, we analyzed postoperative complications, KOVAL score, regression, readmission, and 2-year survival rate. Delirium was diagnosed in 150 (39.3%) patients during hospitalization. Preoperative and postoperative delirium occurred in 67 (44.6%) and 83 (55.4%) patients, respectively. Independent risk factors of preoperative delirium included age (odds ratio: 1.47, 95% confidential interval [CI]: 1.13-2.23, P = .004), stroke (odds ratio [OR]: 2.70, 95% CI: 1.11-6.01, P = .015), American Society of Anesthesiologist (OR: 1.68, 95% CI: 1.137-2.24, P = .033), and time from admission to operation (OR: 1.08, 95% CI: 1.01-1.16, P = .031). There was no significant difference in preoperative KOVAL score between the 2 groups. However, postoperative KOVAL score (5.1 ± 2.0 vs 4.4 ± 2.1, P = .027) and regression rate (68.7% vs 44.6%, P = .029) were significantly higher in the preoperative delirium group than in the postoperative delirium group. Moreover, the 2-year survival rate was significantly lower in the preoperative delirium group than in the postoperative delirium group (62.7% vs 78.3%, P = .046). Characteristics, risk factors, and prognosis are different for patients with preoperative delirium and postoperative delirium. Preoperative delirium patients showed different risk factors with poorer prognosis and higher mortality. Therefore, hip fracture patients with risk factors for preoperative delirium should be monitored more carefully due to their greater risk of mortality.
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Affiliation(s)
- Chaemoon Lim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Young Ho Roh
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Yong-Geun Park
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Jaeryun Lee
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Kwang Woo Nam
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-si, Gyeonggi-do, Korea
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Zhang BF, Liu L, Xu K, Xu P. Serum cystatin C as a biomarker to predict all-cause mortality in geriatrics hip fracture. Heliyon 2024; 10:e24037. [PMID: 38283240 PMCID: PMC10818208 DOI: 10.1016/j.heliyon.2024.e24037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Background Cystatin C, a low-molecular-weight protein, belongs to cysteine protease inhibitors produced primarily by nucleated cells. Its serum concentration, independent of sex, age, or muscle mass, is a good predictor of renal dysfunction in older adults. This study evaluated the association between all-cause mortality and preoperative cystatin C levels in hip fractures. Materials and methods Data describing the demographic and clinical characteristics of the patients were gathered specifically from older individuals who had suffered hip fractures. The study used linear and non-linear multivariate Cox regression models to investigate the association between preoperative cystatin C levels and mortality. The analyses were conducted using the R and EmpowerStats software. Results In total, two thousand three hundred and ninety-four patients were included in this study. A total of 790 patients (33 %) died of all causes. The mean follow-up was 37.62 months. The preoperative cystatin C was 0.91 ± 0.41 mg/L. Linear multivariate Cox regression analysis revealed a significant association between preoperative cystatin C level and death, with a hazard ratio (HR) of 2.19 (95 % confidence interval [CI]: 1.72-2.79, P < 0.0001). Nevertheless, the correlation between the variables was inconsistent. A cystatin C concentration of 1.62 mg/L marked a significant change in the non-linear relationship. A preoperative cystatin C level below 1.62 mg/L was found to be significantly linked with an increased risk of mortality (HR = 2.60, 95 % CI: 1.92-3.52, P < 0.0001). The mortality reached its highest point when the preoperative cystatin C level was greater than 1.62 mg/L. After that, the mortality risk did not increase further (HR = 1.54, 95 % CI: 0.98-2.42, P = 0.0588). The non-linear relationship remained consistent in the propensity score-matching sensitive analysis. Conclusions The study found a non-linear relationship between preoperative cystatin C levels and mortality in geriatric hip fractures. This suggests that preoperative cystatin C can be used as a predictor of the risk of death. The registration number is ChiCTR2200057323.
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Affiliation(s)
- Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Lin Liu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Ke Xu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Peng Xu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Vlachos C, Ampadiotaki MM, Papagrigorakis E, Galanis A, Patilas C, Sakellariou E, Rodis G, Vasiliadis E, Kontogeorgakos VA, Pneumaticos S, Vlamis J. Is Regional Bone Mineral Density the Differentiating Factor Between Femoral Neck and Femoral Trochanteric Fractures? Cureus 2024; 16:e53003. [PMID: 38406115 PMCID: PMC10894667 DOI: 10.7759/cureus.53003] [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] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Background Osteoporosis is globally recognized as a prevalent bone disease, and proximal femoral fractures constitute a serious complication associated with it. In recent years, the frequency of hip fractures has increased rapidly, with ramifications that extend into the social and economic aspects of both patients' lives and healthcare systems. The primary goal of this study is to discover whether bone mineral density (BMD) in specific regions of the hip could be related to femoral neck or trochanteric fractures. Methodology This prospective cohort study employed dual-energy X-ray absorptiometry (DEXA) measurements on 70 individuals with proximal femoral fractures. The participants sought treatment at the emergency department of our unit for hip fractures and adhered to our predefined eligibility criteria. These criteria primarily included (i) age exceeding 60 years and (ii) a diagnosis of either femoral neck or trochanteric fracture attributed to (iii) a low-energy lateral fall and (iv) a previously established state of complete ambulation before the occurrence of the fracture. In this context, we recorded the BMD of the hip, as well as the BMD values of the upper and lower halves of the neck, trochanteric region, and diaphysis. For the comparison of the categorical variables, Pearson's χ2 criterion was used, whereas Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results No statistical differences were identified when comparing regional BMDs and T-scores with the fracture type. This conclusion was also reconfirmed concerning age, gender, and Tonnis classification. Only a moderate correlation was observed, demonstrating lower values of regional BMDs in women compared to men. Conclusions The inability of our study to establish a direct correlation between BMD measurements across diverse areas of the proximal femur underlines the imperative need for subsequent investigations. These studies should not only integrate more precise techniques for measuring and mapping the BMD of different hip regions but should also encompass a comprehensive examination that would consider both intrinsic and extrinsic characteristics of the proximal femur.
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Affiliation(s)
- Christos Vlachos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | | | - Eftychios Papagrigorakis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | - Athanasios Galanis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | - Christos Patilas
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | - Evangelos Sakellariou
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | | | - Elias Vasiliadis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT Trauma Hospital, Athens, GRC
| | | | - Spiros Pneumaticos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | - John Vlamis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
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Cui S, Zhao L, Zhao W, Ma J, Ma X. Excess Mortality for Femoral Intertrochanteric Fracture Patients Aged 50 Years and Older Treated Surgically and Conservatively in Tianjin, China: A Cohort Study. Orthop Surg 2024; 16:207-215. [PMID: 37975209 PMCID: PMC10782262 DOI: 10.1111/os.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Intertrochanteric fracture is one type of hip fracture, which is the most serious consequence of osteoporosis. Along with the growing elderly population, intertrochanteric fracture is expected to rise increasingly. The aim of this study was to assess excess mortality after intertrochanteric fractures and to identify the predictors of long-term mortality by therapy among patients aged 50 years and older in Tianjin. METHODS This is a retrospective cohort study on mortality for 3029 patients aged 50 years and older in Tianjin experiencing an intertrochanteric fracture between December 26, 2014 and December 31, 2018. Data were from Tianjin Hospital Hip Fracture (THHF) cohort. Follow-up period was until March 31, 2022. Mortality, excess mortality, and comorbidities were analyzed and stratified by therapy and gender. Time dependent Cox models were performed to estimate the effects of the variables. RESULTS Absolute mortality for all the patients was 5.90% at 3 months, 12.55% at 12 months, 19.92% at 24 months and 27.28% at 36 months. Absolute mortality for surgical group was 1.57% at 3 months, 4.77% at 12 months, 8.49% at 24 months and 12.07% at 36 months, significantly lower than conservative group: 10.50% at 3 months, 20.73% at 12 months, 31.96% at 24 months and 43.04% at 36 months. We found a substantially lower mortality (hazard ratio [HR] 0.34, 95% confidence internal, [CI]: 0.23-0.52, p = 0.000) among patients undergoing surgical therapy than those undergoing conservative therapy, even when controlled for gender, age, the length of hospital stay, and all the comorbidities. Female patients (HR 0.68, 95% CI: 0.58-0.79, p = 0.000) were less likely to die than male patients after an intertrochanteric fracture. Patients treated by the two methods were both found to have excess mortality rates compared to the general population, although in different levels. The excess mortality rates for patients in the conservative therapy group were 14.46% in males and 17.93% in females, while in the surgical therapy group, 2.78% in females and 4.37% in males. The comorbidities moderate or severe renal disease (HR 2.19, 95% CI: 1.61-2.98, p = 0.000), metastatic solid tumor (HR 6.35, 95% CI: 1.56-25.85, p = 0.010), hypoproteinemia (HR 1.22, 95% CI: 1.01-1.47, p = 0.034), and older age (HR 1.89, 95% CI: 1.73-2.08, p = 0.000) were also risk factors on mortality. A worse-case analysis for the primary outcome were performed as sensitivity analysis and it was consistent with the original conclusion. CONCLUSION Intertrochanteric factures for people aged 50 years older were found to have excess mortality compared to the general population in Tianjin city, and preventing the fractures in the hip for elderly people was imperative. After controlling tfor comorbidities and age, female gender and surgical therapy were protective factors for the death after fractures, which could provide strong evidence for patients and surgeons to make decisions.
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Affiliation(s)
- Shuang‐shuang Cui
- Tianjin HospitalTianjin UniversityTianjinChina
- Orthopaedics Institute of TianjinTianjin HospitalTianjinChina
| | - Li‐kun Zhao
- Tianjin HospitalTianjin UniversityTianjinChina
- Orthopaedics Institute of TianjinTianjin HospitalTianjinChina
| | - Wen‐jun Zhao
- Tianjin HospitalTianjin UniversityTianjinChina
- Orthopaedics Institute of TianjinTianjin HospitalTianjinChina
| | - Jian‐xiong Ma
- Tianjin HospitalTianjin UniversityTianjinChina
- Orthopaedics Institute of TianjinTianjin HospitalTianjinChina
| | - Xin‐long Ma
- Tianjin HospitalTianjin UniversityTianjinChina
- Orthopaedics Institute of TianjinTianjin HospitalTianjinChina
- Department of OrthopaedicsTianjin HospitalTianjinChina
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Long A, Yang D, Jin L, Zhao F, Wang X, Zhang Y, Liu L. Admission Inflammation Markers Influence Long-term Mortality in Elderly Patients Undergoing Hip Fracture Surgery: A Retrospective Cohort Study. Orthop Surg 2024; 16:38-46. [PMID: 37984859 PMCID: PMC10782247 DOI: 10.1111/os.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/05/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. METHODS We reports on a retrospective study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the study, and their demographic and pre-operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. RESULTS The 30-day, 1-year, 2-year, and 4-year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut-off values of admission NLR, MLR and CAR for 1-year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080-1.864, p = 0.012) were found to be only independent risk factors with 4-year all-cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1-year (HR = 1.700, 95% CI: 1.173-2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107-1.936, p = 0.008), and 4-year (HR = 1.341, 95% CI: 1.057-1.700, p = 0.016) all-cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all-cause mortality. CONCLUSION Admission CAR and NLR may be useful indicators for predicting the long-term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings.
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Affiliation(s)
- Anhua Long
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Dongxiang Yang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Lu Jin
- Evidence‐Based Medicine CenterBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Feifei Zhao
- Evidence‐Based Medicine CenterBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Xuefei Wang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Yakui Zhang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Liang Liu
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
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Liang J, Zhang J, Lou Z, Tang X. Development and validation of a predictive nomogram for subsequent contralateral hip fracture in elderly patients within 2 years after hip fracture surgery. Front Med (Lausanne) 2023; 10:1263930. [PMID: 38179269 PMCID: PMC10764586 DOI: 10.3389/fmed.2023.1263930] [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: 07/25/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Purpose Contralateral hip refracture following initial hip fracture surgery is life-threatening in the elderly with high incidence and mortality. This study investigated the associated independent risk factors and established a nomogram prediction model. Methods Totally 734 elderly patients with hip fractures who underwent surgical treatment (January 2016-December 2020) were enrolled. Following analyses on demographic variables, clinical characteristics, and laboratory examination, independent risk factors of contralateral hip fractures in the elderly were identified through the least absolute shrinkage and selection operator (LASSO) regression, and univariate and multivariate logistic regression. Patients were randomly allocated into training (n = 513) and validation sets (n = 221). A training set-based nomogram prediction model was established and assessed for predictability, discriminatory ability, and clinical applicability using the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) in both sets. Results Contralateral hip refractures occurred in 7.08% (52/734) patients within 2 years after surgery. Age, hemoglobin (Hb), heart disease, neurovascular disease, Parkinson's disease (PD), Alzheimer's disease (AD), chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD) were independent risk factors. The nomogram prediction model had a favorable discriminatory ability, as indicated by the areas under the ROC curves (AUC): 0.906 (95% CI, 0.845-0.967) in the training set and 0.956 (95% CI, 0.927-0.985) in the validation set. The calibration curves demonstrated a good consistency between the actual subsequent contralateral hip fracture incidence and the predicted probability. The DCA of the nomogram demonstrated the model's excellent clinical efficacy. Conclusion The nomogram model enabled accurate individualized prediction for the occurrence of subsequent contralateral hip fracture in the elderly within 2 years after surgical treatment, which might help clinicians with precise references for appropriate perioperative management and rehabilitation education following initial hip surgery for their patients.
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Affiliation(s)
- Jiahui Liang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
| | - Jian Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
| | - Zhiyuan Lou
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, China
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Jing B, Chen D, Dai H, Liu J, Chen C, Dai M, Hu J, Lu Z, Wang J. Association between neutrophil-to-lymphocyte ratio and postoperative fatigue in elderly patients with hip fracture. Heliyon 2023; 9:e22314. [PMID: 38144319 PMCID: PMC10746395 DOI: 10.1016/j.heliyon.2023.e22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/26/2023] Open
Abstract
Background and purpose: Postoperative fatigue (POF) is a common and distressing post-operative symptom. This study aimed to explore the relationship between neutrophil-to-lymphocyte ratio (NLR) and POF in elderly patients with hip fracture. Method Elderly patients (age ≥65 years) with acute hip fracture admitted to the Department of Orthopedics of Anqing Municipal Hospital from June 2018 to June 2020 were included. Fatigue was assessed using the Fatigue Severity Scale at the 3-month follow-up postoperatively. Univariate and multivariate analyses were performed to explore the associations between NLR and POF. The diagnostic performance of NLR was analysed using Receiver Operating Characteristic (ROC) curve analysis and the Delong test. Result A total of 321 elderly patients with hip fractures were included; 120 (37.4 %) of them were diagnosed with POF. Univariate analysis indicated significant differences in NLR, platelet-to-lymphocyte ratio (PLR), education, neutrophil count, lymphocyte count, Hamilton Depression Scale (HAMD) and Insomnia Severity Index (ISI) scores (P < 0.05). Multivariate analysis indicated neutrophil count (odds ratio [OR], 1.46; 95 % confidence interval [CI] 1.27-1.67), lymphocyte count (OR 0.32, 95 % CI 0.19-0.53), NLR (OR1.81, 95 % CI 1.50-2.17) and PLR (OR 1.005, 95 % CI 1.001-1.009) were significantly associated with POF. The areas under the ROC curves (AUCs) of neutrophil count, lymphocyte count, NLR and PLR were 0.712, 0.667, 0.775 and 0.605, respectively. The Delong test indicated that NLR had the best diagnostic performance (p < 0.05). Conclusion NLR independently predicts POF in elderly patients with acute hip fracture.
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Affiliation(s)
- Baosheng Jing
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Dangui Chen
- Department of Hematology, AnQing Municipal Hospitals, Anqing, China
| | - Huming Dai
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Jingrui Liu
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Cheng Chen
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Mingjun Dai
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Jing Hu
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Zhengfeng Lu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianjun Wang
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
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Konda SR, Esper GW, Meltzer-Bruhn AT, Solasz SJ, Ganta A, Leucht P, Tejwani NC, Egol KA. One year later: How outcomes of hip fractures treated during the "first wave" of the COVID-19 pandemic were affected. Musculoskelet Surg 2023; 107:405-412. [PMID: 37020155 PMCID: PMC10075150 DOI: 10.1007/s12306-023-00784-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/26/2023] [Indexed: 04/07/2023]
Abstract
The purpose of this study was to assess the impact of COVID-19 on long-term outcomes in the geriatric hip fracture population. We hypothesize that COVID + geriatric hip fracture patients had worse outcomes at 1-year follow-up. Between February and June 2020, 224 patients > 55 years old treated for a hip fracture were analyzed for demographics, COVID status on admission, hospital quality measures, 30- and 90-day readmission rates, 1-year functional outcomes (as measured by the EuroQol- 5 Dimension [EQ5D-3L] questionnaire), and inpatient, 30-day, and 1-year mortality rates with time to death. Comparative analyses were conducted between COVID + and COVID- patients. Twenty-four patients (11%) were COVID + on admission. No demographic differences were seen between cohorts. COVID + patients experienced a longer length of stay (8.58 ± 6.51 vs. 5.33 ± 3.09, p < 0.01) and higher rates of inpatient (20.83% vs. 1.00%, p < 0.01), 30-day (25.00% vs. 5.00%, p < 0.01), and 1-year mortality (58.33% vs. 18.50%, p < 0.01). There were no differences seen in 30- or 90-day readmission rates, or 1-year functional outcomes. While not significant, COVID + patients had a shorter average time to death post-hospital discharge (56.14 ± 54.31 vs 100.68 ± 62.12, p = 0.171). Pre-vaccine, COVID + geriatric hip fracture patients experienced significantly higher rates of mortality within 1 year post-hospital discharge. However, COVID + patients who did not die experienced a similar return of function by 1-year as the COVID- cohort.
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Affiliation(s)
- Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY, 11418, USA.
| | - Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
| | - Ariana T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
| | - Sara J Solasz
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY, 11418, USA
| | - Philipp Leucht
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Bellevue Hospital, 462 1st Ave, New York, NY, 10016, USA
| | - Nirmal C Tejwani
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Bellevue Hospital, 462 1st Ave, New York, NY, 10016, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E 17Th St, New York, NY, 10010, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Richmond Hill, NY, 11418, USA
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Hsu CL, Wu PC, Yin CH, Chen CH, Lee KT, Lin CL, Shi HY. Clinical Outcomes and Cost-Effectiveness of Osteoporosis Screening With Dual-Energy X-ray Absorptiometry. Korean J Radiol 2023; 24:1249-1259. [PMID: 38016684 DOI: 10.3348/kjr.2023.0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical outcomes and cost-effectiveness of dual-energy X-ray absorptiometry (DXA) for osteoporosis screening. MATERIALS AND METHODS Eligible patients who had and had not undergone DXA screening were identified from among those aged 50 years or older at Kaohsiung Veterans General Hospital, Taiwan. Age, sex, screening year (index year), and Charlson comorbidity index of the DXA and non-DXA groups were matched using inverse probability of treatment weighting (IPTW) for propensity score analysis. For cost-effectiveness analysis, a societal perspective, 1-year cycle length, 20-year time horizon, and discount rate of 2% per year for both effectiveness and costs were adopted in the incremental cost-effectiveness (ICER) model. RESULTS The outcome analysis included 10337 patients (female:male, 63.8%:36.2%) who were screened for osteoporosis in southern Taiwan between January 1, 2012, and December 31, 2021. The DXA group had significantly better outcomes than the non-DXA group in terms of fragility fractures (7.6% vs. 12.5%, P < 0.001) and mortality (0.6% vs. 4.3%, P < 0.001). The DXA screening strategy gained an ICER of US$ -2794 per quality-adjusted life year (QALY) relative to the non-DXA at the willingness-to-pay threshold of US$ 33004 (Taiwan's per capita gross domestic product). The ICER after stratifying by ages of 50-59, 60-69, 70-79, and ≥ 80 years were US$ -17815, US$ -26862, US$ -28981, and US$ -34816 per QALY, respectively. CONCLUSION Using DXA to screen adults aged 50 years or older for osteoporosis resulted in a reduced incidence of fragility fractures, lower mortality rate, and reduced total costs. Screening for osteoporosis is a cost-saving strategy and its effectiveness increases with age. However, caution is needed when generalizing these cost-effectiveness results to all older populations because the study population consisted mainly of women.
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Affiliation(s)
- Chiao-Lin Hsu
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pin-Chieh Wu
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Health Care Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopaedics and Orthopaedic Research Center, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - King-Teh Lee
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Park One International Hospital, Kaohsiung, Taiwan
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Business Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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Ding K, Zhu Y, Li J, Yuwen P, Yang W, Zhang Y, Wang H, Ren C, Chen W, Zhang Q, Zhang Y. Age-related Changes with the Trabecular Bone of Ward's Triangle and Neck-shaft Angle in the Proximal Femur: A Radiographic Study. Orthop Surg 2023; 15:3279-3287. [PMID: 37853985 PMCID: PMC10694024 DOI: 10.1111/os.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE The Ward triangle is an important area used clinically to diagnose and assess osteoporosis and its fracture risk in the proximal femur. The main objective of this study was to investigate the rules of development and maturation of the trabeculae of Ward's triangle to provide a basis for the prevention and treatment proximal femur fracture. METHODS From January 2018 to December 2019, individuals from 4 months to 19 years old who underwent hip growth and development assessments at the Third Hospital of Hebei Medical University were selected retrospectively. The outpatient electronic medical record system was used to collect information such as age, gender, imaging images, and clinical diagnosis. The development score and maturity characteristics of the trabecular bone were analyzed using hip radiograph data. Correlation analysis was performed to identify the relationship among age, neck-shaft angle and development and maturity score of the trabecular bone. RESULTS A total of 941 patients were enrolled in this study, including 539 males and 402 females. Primary compression trabeculae were all present at 1 year of age and matured at 7 years of age and older; primary tension trabeculae were all present at 4 years of age and matured at 18 years of age. Secondary compression trabeculae were present at 4 years of age and matured at 18 years of age. In addition, the neck-shaft angle progressively decreases from 4 months to 14 years of age but barely changes between 15 and 19 years of age. CONCLUSION In short, the development and maturation of the trabeculae in the ward' triangle followed a specific temporal pattern that was related to the neck-shaft angle. Therefore, these findings can help us understand structure and mechanical characteristics of proximal femoral trabeculae, and improve our understanding of the mechanism and treatment of proximal femoral fractures.
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Affiliation(s)
- Kai Ding
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Jiaxing Li
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Peizhi Yuwen
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Weijie Yang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yifan Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Haicheng Wang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Chuan Ren
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Wei Chen
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Qi Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
- Chinese Academy of EngineeringBingjiaokou HutongBejingChina
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Wang M, Seibel MJ. Approach to the Patient With Bone Fracture: Making the First Fracture the Last. J Clin Endocrinol Metab 2023; 108:3345-3352. [PMID: 37290052 PMCID: PMC10655538 DOI: 10.1210/clinem/dgad345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
The global burden of osteoporosis and osteoporotic fractures will increase significantly as we enter a rapidly aging population. Osteoporotic fractures lead to increased morbidity, mortality, and risk of subsequent fractures if left untreated. However, studies have shown that the majority of patients who suffer an osteoporotic fracture are not investigated or treated for osteoporosis, leading to an inexcusable "osteoporosis care gap." Systematic and coordinated models of care in secondary fracture prevention known as fracture liaison services (FLS) have been established to streamline and improve the care of patients with osteoporotic fractures, and employ core principles of identification, investigation, and initiation of treatment. Our approach to the multifaceted care of secondary fracture prevention at a hospital-based FLS is illustrated through several case vignettes.
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Affiliation(s)
- Mawson Wang
- The University of Sydney, Bone Research Program, ANZAC Research Institute, Concord, NSW 2139, Australia
| | - Markus J Seibel
- The University of Sydney, Bone Research Program, ANZAC Research Institute, Concord, NSW 2139, Australia
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Loh B, Jiang L, Timing L, Kong N, Ganesan G, Tan KB, Bee S, Koh JSB, Howe TS, Huei NY. Predictors of 10-year Mortality After Hip Fracture Surgery in a Pre-Pandemic Cohort. Geriatr Orthop Surg Rehabil 2023; 14:21514593231216558. [PMID: 38023062 PMCID: PMC10655639 DOI: 10.1177/21514593231216558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Though hip fractures are associated with significant mortality and morbidity, increasing life expectancy in developed countries necessitates an analysis of mortality trends and factors predicting long term survival. The aim of this study is to identify the predictors of 10-year mortality as well as assess the correlation of Age-adjusted Charlson comorbidity index (ACCI) with 10-year mortality in a surgically treated Asian geriatric hip fracture population. Materials and Methods From January 1, 2007 to December 31, 2009, 766 patients who underwent surgery for hip fracture with a minimum follow up of 10-years were recruited to the study (92% follow-up rate). A review of the patient's electronic hospital records was performed to glean the following data: patient demographics, pre-existing comorbidities, operation duration, length of stay, fracture configuration, as well as mortality data up to 10 years. CCI scores and individual co-morbidities were correlated with inpatient, 30-day, 1-year, 5-year and beyond 10-year mortality. Results Of the 766 patients, the mortality rate for 30-day, 1-year, 5-year and 10-years was 2.9%, 12.0%, 38.9% and 61.6% respectively. The average ACCI was 5.31. The 10-year mortality for patients with ACCI ≤ 3, ACCI 4-5 and ACCI ≥ 6 are 29.4%, 57.4% and 77.5% respectively. End-Stage-Renal Failure (ESRF), liver failure and COPD were dominant predictors of mortality at 10 years, whereas cancer was the predominant predictor at 1 year. Discussion ACCI significantly correlates with the 10-year mortality after surgically treated hip fractures with a shift of the dominant predictors from cancer to ESRF and COPD. This could inform future health policy and resource planning. This data also represents recently available pre-pandemic survival trends after hip fracture surgery and serves as a baseline for post-pandemic outcome surveillance of interventions for fragility fractures. Conclusion This study demonstrates that ACCI correlated with 10-year mortality after surgical treatment of hip fractures.
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Affiliation(s)
- Bryan Loh
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | - Lei Jiang
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | - Liu Timing
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | - Naomi Kong
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | | | | | - Suang Bee
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
- Ministry of Health, Singapore
| | | | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | - Ng Yeong Huei
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
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Yang G, Cui G, Liu Y, Guo J, Yue C. O-POSSUM and P-POSSUM as predictors of morbidity and mortality in older patients after hip fracture surgery: a meta-analysis. Arch Orthop Trauma Surg 2023; 143:6837-6847. [PMID: 37162574 DOI: 10.1007/s00402-023-04897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND The POSSUM model has been widely used to predict morbidity and mortality after general surgery. Modified versions known as O-POSSUM and P-POSSUM have been used extensively in orthopedic surgery, but their accuracy is unclear. This systematic review evaluated the predictive value of these models in older patients with hip fractures. METHODS This study was performed and reported based on the "Preferred reporting items for systematic reviews and meta-analyses" guidelines. PubMed, Cochrane, EMBASE, and Web of Science were comprehensively searched for relevant studies, whose methodological quality was evaluated according to the "Methodological index for non-randomized studies" scale. Revman 5 was used to calculate weighted ratios of observed to expected morbidity or mortality. RESULTS The meta-analysis included 10 studies, of which nine (2549 patients) assessed the ability of O-POSSUM to predict postoperative morbidity, nine (3649 patients) assessed the ability of O-POSSUM to predict postoperative mortality, and four (1794 patients) assessed the ability of P-POSSUM to predict postoperative mortality. The corresponding weighted ratios of observed to expected morbidity or mortality were 0.84 (95% CI 0.70-1.00), 0.68 (95% CI 0.49-0.95), and 0.61 (95% CI 0.16-2.38). CONCLUSIONS While O-POSSUM shows reasonable accuracy in predicting postoperative morbidity in older patients with hip fractures, both P-POSSUM and O-POSSUM substantially overestimate postoperative mortality. The POSSUM model should be optimized further for this patient population.
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Affiliation(s)
- Guangyao Yang
- Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Guofeng Cui
- Department of Orthopedic, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, 471002, Henan Province, People's Republic of China
| | - Youwen Liu
- Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Jiayi Guo
- Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Chen Yue
- Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China.
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Skuladottir SS, Hjaltadottir I, Launer L, Cotch MF, Siggeirsdottir K, Gudnason V, Sigurdsson G, Steingrimsdottir L, Halldorsson T, Ramel A. Milk intake and hip fracture incidence in community-dwelling old Icelandic adults. Osteoporos Int 2023; 34:1951-1959. [PMID: 37558894 DOI: 10.1007/s00198-023-06883-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
Milk and milk products have been known as important for bone health. Can ingestion of milk and milk products lower hip fracture risk for older adults? In this study, older Icelandic adults who were ingesting higher milk had a lower risk of hip fractures. INTRODUCTION This study describes associations between milk intake and hip fracture risk in older Icelanders. The data indicate that no/low milk consumption is related to greater hip fracture risk. Hip fracture can have a severe effect on the life of older adults. Health authorities recommend milk intake for better bone health. However, previous studies addressing this association have been divergent. METHODS This prospective study included 4614 subjects (mean age 76 years) recruited between 2002 and 2006 into the Age, Gene/Environment Susceptibility-Reykjavik (AGES-Reykjavik) study. Information on hip fractures occurring between recruitment and end of follow-up in 2012 was extracted from hospital records. RESULTS A total of 14% of participants reported milk intake < 0.5 times/day (the lowest category) and 22% of the participants consumed at least milk two times/day (highest category). Milk consumption was positively related to the volumetric bone mineral density at baseline with a sex- and age-adjusted difference of 8.95 ± 2.5 mg/cm3 between the highest compared to lowest milk intake categories (P < 0.001). During the follow-up, 7.4% of participants had a hip fracture, and we observed a decreased risk of incident hip fractures in the highest compared to the lowest milk intake category with a hazard ratio of 0.69 (95% CI: 0.47-0.99) in adjusted model. Further analysis indicated a linear relationship between milk intake and fracture risk (P-value for linear trend < 0.001). CONCLUSION Milk intake is associated with a lower risk of incident hip fracture in a linear way in Icelandic community-dwelling older adults.
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Affiliation(s)
- Sigrun S Skuladottir
- The Icelandic Gerontological Research Institute, Reykjavik, Iceland.
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.
- Faculty of Nursing, University of Iceland, Eiríksgata, 101, Reykjavik, Iceland.
| | | | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute On Aging, Baltimore, MD, USA
| | - Mary-Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | - Alfons Ramel
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
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Shah ID, Piple AS, Schlauch AM, Crawford BD, Tamer P, Prentice HA, Grimsrud CD. Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty Performed for Displaced Femoral Neck Fractures. J Orthop Trauma 2023; 37:539-546. [PMID: 37348042 DOI: 10.1097/bot.0000000000002650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and the posterior approach for total hip arthroplasty in geriatric patients with displaced femoral neck fractures (FNFs). DESIGN Retrospective cohort study. SETTING Multicenter Health care Consortium. PATIENTS Seven-hundred and nine patients 60 years or older with acute displaced FNFs between 2009 and 2021. INTERVENTION Total hip arthroplasty using either DAA or posterior approach. MAIN OUTCOME MEASUREMENTS Rates of postoperative complications including dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. Secondary outcome measures included ambulation capacity at discharge, ambulation distance with inpatient physical therapy, discharge disposition, and narcotic prescription quantities (morphine milligram equivalents). RESULTS Through a multivariable regression analysis, DAA was associated with significantly shorter operative time ( B = -6.89 minutes; 95% confidence interval [CI] -12.84 to -0.93; P = 0.024), lower likelihood of blood transfusion during the index hospital stay (adjusted odds ratios = 0.54; 95% CI 0.27 to 0.96; P = 0.045), and decreased average narcotic prescription amounts at 90 days (B = -230.45 morphine milligram equivalents; 95% CI -440.24 to -78.66; P = 0.035) postoperatively. There were no significant differences in medical complications, dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. CONCLUSION When comparing the DAA versus posterior approach for total hip arthroplasty performed for displaced FNF, DAA was associated with shorter operative time, lower likelihood of blood transfusion, and lower 90-day postoperative narcotic prescription amounts. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ishan D Shah
- Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA
| | - Amit S Piple
- The Taylor Collaboration, St. Mary's Medical Center, San Francisco, CA
| | - Adam M Schlauch
- Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA
| | - Benjamin D Crawford
- Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA
| | - Pierre Tamer
- Department of Orthopaedic Surgery, St. Mary's Medical Center, San Francisco, CA
| | - Heather A Prentice
- Medical Device and Surveillance Department, Kaiser Permanente, San Diego, CA; and
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