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Heyde CE, Roth A, Putzier M. [Osteoporotic vertebral body fractures]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:808-817. [PMID: 37656202 DOI: 10.1007/s00132-023-04433-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
The number of osteoporotic fractures of the spine is increasing. These fractures are associated with elevated morbidity and mortality. This article provides an overview of the special features of these fractures, the diagnostic procedure, their classification, and the conservative and surgical treatment options. For the mostly elderly patients, it is important to treat the underlying disease and to address associated problems such as frailty and sarcopenia. To meet this growing medical and socio-economic challenge, a holistic interdisciplinary and interprofessional treatment approach is required.
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Affiliation(s)
- Christoph-E Heyde
- Klinik u. Poliklinik für Orthopädie, Unfallchirurgie u. Plastische Chirurgie, Bereich Wirbelsäulenchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Andreas Roth
- Klinik u. Poliklinik für Orthopädie, Unfallchirurgie u. Plastische Chirurgie, Bereich Wirbelsäulenchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Michael Putzier
- Centrum für muskuloskelettale Chirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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2
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Hu K, Cassimatis M, Nguyen M, Girgis CM. Ethnic determinants of skeletal health in female patients with fragility fracture in a culturally diverse population. Bone Rep 2023; 18:101677. [PMID: 37101568 PMCID: PMC10123337 DOI: 10.1016/j.bonr.2023.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
Background Low bone density leads to fragility fracture, with significant impact on morbidity and mortality. While ethnic differences in bone density have been observed in healthy subjects, this has not yet been explored in fragility fracture patients. Aims To assess if ethnicity is associated with bone mineral density and serum markers of bone health in female patients who experience fragility fractures. Methods 219 female patients presenting with at least one fragility fracture at a major tertiary hospital in Western Sydney Australia were studied. Western Sydney is a region with great cultural diversity, comprising people from over 170 ethnicities. Within this cohort, the three largest broad ethnic groups were Caucasians (62.1 %), Asians (22.8 %), and Middle Eastern patients (15.1 %). Location and nature of the presenting fracture and other relevant past medical history were obtained. Bone mineral density, measured by dual-energy X-ray absorptiometry, and bone-related serum markers were compared between ethnicities. Covariates (age, height, weight, diabetes, smoking, and at-risk drinking) were adjusted in multiple linear regression model. Results Although Asian ethnicity was associated with lower bone mineral density at the lumbar spine in fragility fracture patients, this association was no longer significant after adjustment for weight. Ethnicity (Asian or Middle Eastern) was not a determinant of bone mineral density at any other skeletal site. Caucasians had lower estimated glomerular filtration rate compared to Asian and Middle Eastern subjects. Serum parathyroid hormone concentrations were significantly lower in Asians compared to other ethnicities. Conclusion Asian ethnicity and Middle Eastern ethnicity were not major determinants of bone mineral density at the lumbar spine, femoral neck, or total hip.
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Affiliation(s)
- Katherine Hu
- Sydney Medical School, University of Sydney, Sydney, Australia
- Corresponding author.
| | - Maree Cassimatis
- Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Minh Nguyen
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia
| | - Christian M. Girgis
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Devries MC, Giangregorio L. Using the specificity and overload principles to prevent sarcopenia, falls and fractures with exercise. Bone 2023; 166:116573. [PMID: 36208722 DOI: 10.1016/j.bone.2022.116573] [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: 05/16/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022]
Abstract
The aim of this narrative review is to discuss the evidence on exercise for fall, fracture and sarcopenia prevention, including evidence that aligns with the specificity and progressive overload principles used in exercise physiology, implementation strategies and future research priorities. We also provide a brief discussion of the influence of protein intake and creatine supplementation as potential effect modifiers. We prioritized evidence from randomized controlled trials and systematic reviews. Resistance training can improve muscle mass, muscle strength and a variety of physical performance measures in older adults. Resistance training may also prevent bone loss or increase bone mass, although whether it needs to be done in combination with impact exercise to be effective is less clear, because many studies use multicomponent interventions. Exercise programs prevent falls, and subgroup and network meta-analyses suggest an emphasis on balance and functional training, or specifically, anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility, to maximize efficacy. Resistance training for major muscle groups at a 6-12 repetitions maximum intensity, and challenging balance exercises should be performed at least twice weekly. Choose resistance training exercises aligned with patient goals or movements done during daily activities (task specificity), alongside balance exercises tailored to ability and aspects of balance that need improvement. Progress the volume, level of difficulty or other aspects to see continuous improvement (progressive overload). A critical future priority will be to address implementation barriers and facilitators to enhance uptake and adherence.
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Affiliation(s)
- M C Devries
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - L Giangregorio
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada.
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Surís X, Vela E, Clèries M, Llargués E, Camins J, Larrosa M. Effects of COVID-19 confinement on the incidence and mortality of major osteoporotic fractures: an observational study in Catalonia, Spain. Arch Osteoporos 2022; 17:150. [PMID: 36441292 PMCID: PMC9702769 DOI: 10.1007/s11657-022-01193-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
There is little information on how the COVID-19 lockdown influenced the epidemiology of major osteoporotic fractures (MOF). We analyzed the incidence and mortality of MOF in 2020 compared with 2018-2019 in Catalonia, Spain. The incidence of MOF decreased steeply, and post-fracture mortality increased during the lockdown and throughout 2020. PURPOSE To analyze the effect of the COVID-19 pandemic and lockdown on major osteoporotic fracture (MOF) incidence and mortality in Catalonia in 2020 and describe how age, sex, and the prior comorbidity burden influenced the epidemiology of MOF types. METHODS In this retrospective observational study, data on age and sex in people aged ≥ 50 years with a new diagnosis of MOF in 2018, 2019, and 2020 were collected. Average daily rates (ADR) were estimated overall and for five MOF: hip, distal forearm, proximal humerus, vertebrae, and pelvis. Morbidity was assessed using Adjusted Morbidity Groups. ADR in 2020 and the previous years were compared for overall and site-specific MOF in four consecutive time periods: pre-confinement, lockdown, deconfinement, and post-confinement. Thirty-day post-fracture mortality was assessed. COVID-19-related mortality was obtained from the Catalan COVID-19 register. RESULTS From 2018 to 2020, there were 86,412 MOF. The ADR of MOF initially increased in 2020 before the pandemic, decreased steeply during lockdown, and remained lower in the rest of the year. The decrease was steeper in vertebral, pelvic and arm fractures, and lower in hip fractures. Differences were more pronounced in younger age groups and people with fewer comorbidities. Mortality increased throughout 2020, reaching a 2.5-fold increase during lockdown. Excess mortality was directly associated with COVID-19. CONCLUSIONS Mobility restrictions due to COVID-19 were associated with a reduction in MOF incidence in Catalonia, especially in younger people and in non-hip fractures. Post-fracture mortality was higher than in previous years due to the high COVID-19 mortality in the elderly.
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Affiliation(s)
- Xavier Surís
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain.
- Rheumatology Department, Hospital General de Granollers, C/ Francesc Ribas SN 08400, Granollers, Barcelona, Spain.
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
- Catalan Health Service, Barcelona, Spain.
| | - Emili Vela
- Knowledge and Information Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System, Barcelona, Spain
| | - Montserrat Clèries
- Knowledge and Information Unit, Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System, Barcelona, Spain
| | - Esteve Llargués
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Internal Medicine Department, Hospital General de Granollers, Granollers, Spain
| | - Jordi Camins
- Rheumatology Department, Hospital General de Granollers, C/ Francesc Ribas SN 08400, Granollers, Barcelona, Spain
| | - Marta Larrosa
- Department of Health, Master Plan of Musculoskeletal Diseases, Barcelona, Spain
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Carey JJ, Chih-Hsing Wu P, Bergin D. Risk assessment tools for osteoporosis and fractures in 2022. Best Pract Res Clin Rheumatol 2022; 36:101775. [PMID: 36050210 DOI: 10.1016/j.berh.2022.101775] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoporosis is one of the frequently encountered non-communicable diseases in the world today. Several hundred million people have osteoporosis, with many more at risk. The clinical feature is a fragility fracture (FF), which results in major reductions in the quality and quantity of life, coupled with a huge financial burden. In recognition of the growing importance, the World Health Organisation established a working group 30 years ago tasked with providing a comprehensive report to understand and assess the risk of osteoporosis in postmenopausal women. Dual-energy X-ray absorptiometry (DXA) is the most widely endorsed technology for assessing the risk of fracture or diagnosing osteoporosis before a fracture occurs, but others are available. In clinical practice, important distinctions are essential to optimise the use of risk assessments. Traditional tools lack specificity and were designed for populations to identify groups at higher risk using a 'one-size-fits-all' approach. Much has changed, though the purpose of risk assessment tools remains the same. In 2022, many tools are available to aid the identification of those most at risk, either likely to have osteoporosis or suffer the clinical consequence. Modern technology, enhanced imaging, proteomics, machine learning, artificial intelligence, and big data science will greatly advance a more personalised risk assessment into the future. Clinicians today need to understand not only which tool is most effective and efficient for use in their practice, but also which tool to use for which patient and for what purpose. A greater understanding of the process of risk assessment, deciding who should be screened, and how to assess fracture risk and prognosis in older men and women more comprehensively will greatly reduce the burden of osteoporosis for patients, society, and healthcare systems worldwide. In this paper, we review the current status of risk assessment, screening and best practice for osteoporosis, summarise areas of uncertainty, and make some suggestions for future developments, including a more personalised approach for individuals.
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Affiliation(s)
- John J Carey
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland.
| | - Paulo Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Director, Obesity/Osteoporosis Special Clinic, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Diane Bergin
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland; Galway University Hospitals, Ireland
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Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe. Eur J Trauma Emerg Surg 2022; 48:4385-4402. [PMID: 35523966 PMCID: PMC9075714 DOI: 10.1007/s00068-022-01978-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/16/2022] [Indexed: 12/13/2022]
Abstract
Purpose This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies to resume the clinical activities were also discussed. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. All the comparative studies reporting data on the impact of Covid-19 in the field of orthopaedic and trauma surgery in Europe were accessed. Only comparative clinical studies which investigated the year 2020 versus 2019 were eligible. Results 57 clinical investigations were included in the present study. Eight studies reported a reduction of the orthopaedic consultations, which decreased between 20.9 and 90.1%. Seven studies reported the number of emergency and trauma consultations, which were decreased between 37.7 and 74.2%. Fifteen studies reported information with regard to the reasons for orthopaedic and trauma admissions. The number of polytraumas decreased between 5.6 and 77.1%, fractures between 3.9 and 63.1%. Traffic accidents admissions dropped by up to 88.9%, and sports-related injuries dropped in a range of 59.3% to 100%. The overall reduction of the surgical interventions ranged from 5.4 to 88.8%. Conclusion The overall trend of consultations, surgeries, and rate of traumas and fragility fractures appear to decrease during the 2020 European COVID pandemic compared to the pre-pandemic era. Given the heterogeneities in the clinical evidence, results from the present study should be considered carefully. Level of evidence Level IV, systematic review.
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Abstract
This is a review of evidence and practical tips on exercise for individuals with osteoporosis, including individuals with hip and vertebral fractures. Balance and functional training, with or without strength training, can prevent falls. Several types of exercise can improve outcomes that are important to patients, such as physical functioning or quality of life. Individuals with osteoporosis should prioritize balance, functional and resistance training ≥ twice weekly, where exercises, volume, intensity, and progression are aligned with the patient's goals and abilities. Patients who want to participate in other activities (e.g., walking, impact exercise, yoga, Pilates) can do them in addition to, but not instead of, balance and functional or strength training, if they can be done safely or modified. Avoid generic advice like "Don't bend or twist", which is difficult or impossible to operationalize, and may create fear and activity avoidance. Instead, be specific about the types of activities to avoid or modify, and provide tips on how to make daily activities safer, or signpost to resources from national osteoporosis societies. For example, not all bending or twisting is bad; it is activities that involve rapid, repetitive, sustained, weighted, or end range of motion twisting or flexion of the spine that may need to be modified, especially in individuals at high risk of fracture.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2K 2N1, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2K 2N1, Canada
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Paccou J, Lenne X, Ficheur G, Theis D, Cortet B, Bruandet A. Analysis of Hip Fractures in France During the First COVID-19 Lockdown in Spring 2020. JAMA Netw Open 2021; 4:e2134972. [PMID: 34787657 PMCID: PMC8600388 DOI: 10.1001/jamanetworkopen.2021.34972] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has posed a number of unprecedented challenges to the health care system in France, where hip fractures in the elderly population are a major public health concern. OBJECTIVE To explore the association of the first nationwide COVID-19 lockdown in France with the absolute number of hip fractures among patients 50 years or older. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the French national hospitals database to identify patients 50 years or older who were hospitalized for hip fracture in France from January to July 2019 and January to July 2020. EXPOSURES The first nationwide COVID-19 lockdown in France from March 16 to May 10, 2020. MAIN OUTCOMES AND MEASURES The main outcome was the number of hospitalizations for hip fracture from January to July 2020 (study period) compared with the number of hospitalizations for hip fracture during the same period in 2019 (control period). Hospitalization rate ratios (HRRs) comparing the study period with the control period were calculated for 3 intervals (before lockdown [January 1 to March 15], during lockdown [March 16 to May 10], and after lockdown [May 11 to July 31]) and were stratified by gender, age and hospital type. RESULTS The study included 46 393 patients hospitalized for hip fracture during January to July 2019 (34 589 [74.4%] women; mean [SD] age, 82.8 [10.5] years) and 44 767 patients hospitalized for hip fracture from January to July 2020 (33 160 [74.1%] women; mean [SD] age, 82.9 [10.5] years). During the lockdown in 2020, 10 429 patients (23.30%) were hospitalized for hip fracture compared with 11 782 patients (25.40%) during the same period in 2019 (HRR, 0.89; 95% CI, 0.86-0.91; P < .001). The lockdown period was associated with a decrease in the number of hip fractures of 11% among women (from 8756 in 2019 to 7788 in 2020) and 13% among men (from 3026 in 2019 to 2641 in 2020). When the absolute number of hip fractures was stratified by age group, the lockdown period was associated with a decrease in the number of hip fractures in all age groups except in patients older than 89 years (HRR, 0.97; 95% CI, 0.92-1.01; P = .17). In the group of patients aged 80 to 89 years, the number of hip fractures decreased from 4925 to 4370 (HRR, 0.89; 95% CI, 0.85-0.92; P < .001). During the lockdown, hospitalizations decreased by 33% (HRR, 0.67; 95% CI, 0.63-0.71; P < .001) in public university hospitals and by 24% (HRR, 0.76; 95% CI, 0.73-0.79; P < .001) in public general hospitals but increased by 46% (HRR, 1.46; 95% CI,1.38-1.54; P < .001) in private for-profit hospitals. CONCLUSIONS AND RELEVANCE In this cohort study, hospitalizations for hip fractures in France decreased by 11% during the first nationwide COVID-19 lockdown. Further studies are needed to investigate the long-lasting consequences of the COVID-19 pandemic on the incidence of osteoporotic fractures.
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Affiliation(s)
- Julien Paccou
- Department of Rheumatology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Xavier Lenne
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Grégoire Ficheur
- Évaluation des Technologies de Santé et des Pratiques Médicales, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Didier Theis
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Bernard Cortet
- Department of Rheumatology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Amélie Bruandet
- Department of Medical Information, Lille University Hospital, Lille, France
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Carey JJ, Yang L, Erjiang E, Wang T, Gorham K, Egan R, Brennan A, Dempsey M, Armstrong C, Heaney F, McCabe E, Yu M. Vertebral Fractures in Ireland: A Sub-analysis of the DXA HIP Project. Calcif Tissue Int 2021; 109:534-543. [PMID: 34085087 PMCID: PMC8484104 DOI: 10.1007/s00223-021-00868-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Osteoporosis is an important global health problem resulting in fragility fractures. The vertebrae are the commonest site of fracture resulting in extreme illness burden, and having the highest associated mortality. International studies show that vertebral fractures (VF) increase in prevalence with age, similarly in men and women, but differ across different regions of the world. Ireland has one of the highest rates of hip fracture in the world but data on vertebral fractures are limited. In this study we examined the prevalence of VF and associated major risk factors, using a sample of subjects who underwent vertebral fracture assessment (VFA) performed on 2 dual-energy X-ray absorptiometry (DXA) machines. A total of 1296 subjects aged 40 years and older had a valid VFA report and DXA information available, including 254 men and 1042 women. Subjects had a mean age of 70 years, 805 (62%) had prior fractures, mean spine T-score was - 1.4 and mean total hip T-scores was - 1.2, while mean FRAX scores were 15.4% and 4.8% for major osteoporotic fracture and hip fracture, respectively. Although 95 (7%) had a known VF prior to scanning, 283 (22%) patients had at least 1 VF on their scan: 161 had 1, 61 had 2, and 61 had 3 or more. The prevalence of VF increased with age from 11.5% in those aged 40-49 years to > 33% among those aged ≥ 80 years. Both men and women with VF had significantly lower BMD at each measured site, and significantly higher FRAX scores, P < 0.01. These data suggest VF are common in high risk populations, particularly older men and women with low BMD, previous fractures, and at high risk of fracture. Urgent attention is needed to examine effective ways to identify those at risk and to reduce the burden of VF.
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Affiliation(s)
- John J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
| | - Lan Yang
- School of Engineering, National University of Ireland Galway, Galway, Ireland
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - E Erjiang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kelly Gorham
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Rebecca Egan
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland Galway, Galway, Ireland
| | | | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Eva McCabe
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
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Ogliari G, Ong T, Marshall L, Sahota O. Seasonality of adult fragility fractures and association with weather: 12-year experience of a UK Fracture Liaison Service. Bone 2021; 147:115916. [PMID: 33737194 DOI: 10.1016/j.bone.2021.115916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the monthly and seasonal variation in adult osteoporotic fragility fractures and the association with weather. METHODS 12-year observational study of a UK Fracture Liaison Service (outpatient secondary care setting). Database analyses of the records of adult outpatients aged 50 years and older with fragility fractures. Weather data were obtained from the UK's national Meteorological Office. In the seasonality analyses, we tested for the association between months and seasons (determinants), respectively, and outpatient attendances, by analysis of variance (ANOVA) and Tukey's test. In the meteorological analyses, the determinants were mean temperature, mean daily maximum and minimum temperature, number of days of rain, total rainfall and number of days of frost, per month, respectively. We explored the association of each meteorological variable with outpatient attendances, by regression models. RESULTS The Fracture Liaison Service recorded 25,454 fragility fractures. We found significant monthly and seasonal variation in attendances for fractures of the: radius or ulna; humerus; ankle, foot, tibia or fibula (ANOVA, all p-values <0.05). Fractures of the radius or ulna and humerus peaked in December and winter. Fractures of the ankle, foot, tibia or fibula peaked in July, August and summer. U-shaped associations were showed between each temperature parameter and fractures. Days of frost were directly associated with fractures of the radius or ulna (p-value <0.001) and humerus (p-value 0.002). CONCLUSION Different types of fragility fractures present different seasonal patterns. Weather may modulate their seasonality and consequent healthcare utilisation.
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Affiliation(s)
- Giulia Ogliari
- Department of Health Care for Older People, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom.
| | - Terence Ong
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Lindsey Marshall
- Department of Trauma & Orthopaedics, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom.
| | - Opinder Sahota
- Department of Health Care for Older People, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom; Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Derby Road, Nottingham NG7 2UH, United Kingdom; National Institute for Health Research (NIHR, Nottingham Biomedical Research Centre (BRC), Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, United Kingdom.
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11
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Naranjo A, Ojeda S, Negrín MÁ. Impact of confinement during the SARS-CoV-2 pandemic on the incidence of fragility fracture. MEDICINA CLÍNICA (ENGLISH EDITION) 2021; 156:464-465. [PMID: 33778160 PMCID: PMC7980208 DOI: 10.1016/j.medcle.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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[Impact of confinement during the SARS-CoV-2 pandemic on the incidence of fragility fracture]. Med Clin (Barc) 2021; 156:464-465. [PMID: 33593635 PMCID: PMC7846244 DOI: 10.1016/j.medcli.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022]
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Bouvard B, Annweiler C, Legrand E. Osteoporosis in older adults. Joint Bone Spine 2021; 88:105135. [PMID: 33486108 DOI: 10.1016/j.jbspin.2021.105135] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022]
Abstract
The incidence of fragility fractures increases progressively with advance in age after 50 years, and the phenomenon of population ageing will lead to an increased proportion of the world population having osteoporosis and fractures. The consequences of fractures are more serious in older adults: all low-trauma fractures were associated with increased mortality risk and the risk of a second major osteoporotic fracture after a first one also increased with advance in age. Along with the decrease in bone mineral density, falls play an essential role in the occurrence of fragility fractures in older adults, and the assessment of the risk of falling is part of the fracture risk assessment. Despite advances in the diagnosis of osteoporosis, the assessment of fracture risk, and a wide range of effective anti-osteoporosis medications, with parenteral route which can improve observance, many data indicate that the therapeutic care gap is particularly wide in the elderly in whom the importance and impact of a treatment are high and even more in those living in institutions.
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Affiliation(s)
- Béatrice Bouvard
- Service de Rhumatologie, CHU Angers, 4, rue Larrey, 49933 Angers, France; Groupe d'étude sur le remodelage osseux et les biomatériaux, CHU Angers, 4, rue Larrey, 49933 Angers, France; Faculté de Santé, Université d'Angers, Angers, France.
| | - Cédric Annweiler
- Faculté de Santé, Université d'Angers, Angers, France; Département de gériatrie et Centre mémoire ressources recherche, Centre de recherche sur l'autonomie et la longévité, Centre Hospitalier Universitaire, UPRES EA 4638, Université d'Angers, UNAM, Angers, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, ON, Canada
| | - Erick Legrand
- Service de Rhumatologie, CHU Angers, 4, rue Larrey, 49933 Angers, France; Groupe d'étude sur le remodelage osseux et les biomatériaux, CHU Angers, 4, rue Larrey, 49933 Angers, France; Faculté de Santé, Université d'Angers, Angers, France
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14
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Rigamonti L, Kahle P, Peters H, Wolfarth B, Thouet T, Bonaventura K, Back DA. Instructing Ultrasound-guided Examination Techniques Using a Social Media Smartphone App. Int J Sports Med 2020; 42:365-370. [PMID: 33075835 DOI: 10.1055/a-1268-8837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Social media applications on smartphones allow for new avenues of instruction in sports medicine and exercise sciences. This study tested the feasibility of instructing health care personnel through videos of ultrasound vascular measurements distributed by a social media messenger application. After two training sessions with an ultrasound device, voluntary physicians (n=10) and nurses (n=10) received a video for the performance of an ultrasound-guided determination of intima-media-thickness and diameter of the femoral arteries via a social media messenger application. All participants examined the same healthy human subject. There was no significant difference between the groups regarding overall time of performance, measurements of the femoral arteries, or a specifically designed "assessment of mobile imparted arterial ultrasound determination" score. The physicians group achieved significantly higher scores in the established "objective structured assessment of ultrasound skills" score (p=0.019). Approval of the setting was high in both groups. Transmission of videos via social media applications can be used for instructions on the performance of ultrasound-guided vascular examinations in sports medicine, even if investigators' performances differ depending on their grade of ultrasound experience. In the future, the chosen approach should be tested in practical scientific examination settings.
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Affiliation(s)
- Lia Rigamonti
- University Outpatient Clinic, Sports Medicine & Orthopaedics, University of Potsdam, Potsdam
| | - Patrick Kahle
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim
| | - Harm Peters
- Dieter Scheffner Center for Medical Teaching and Educational Research, Charité Universitätsmedizin Berlin, Berlin
| | - Bernd Wolfarth
- Department of Sport Medicine Humboldt University and Charité University School of Medicine, Berlin
| | - Thomas Thouet
- Department of Sport Medicine Humboldt University and Charité University School of Medicine, Berlin
| | - Klaus Bonaventura
- University Outpatient Clinic, Sports Medicine & Orthopaedics, University of Potsdam, Potsdam.,Clinic for Cardiology and Angiology, Ernst von Bergmann Hospital, Potsdam
| | - David Alexander Back
- Dieter Scheffner Center for Medical Teaching and Educational Research, Charité Universitätsmedizin Berlin, Berlin.,Clinic of Traumatology and Orthopedics, Berlin, Bundeswehr Hospital Berlin
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15
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Ogliari G, Lunt E, Ong T, Marshall L, Sahota O. The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: an observational study. Arch Osteoporos 2020; 15:156. [PMID: 33026586 PMCID: PMC7539555 DOI: 10.1007/s11657-020-00825-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
We investigated whether osteoporotic fractures declined during lockdown, among adults aged 50 years and older. We showed that fewer outpatients attended the Fracture Clinic, for non-hip fractures, during lockdown; in contrast, no change in admissions for hip fractures was observed. This could be due to fewer outdoors falls, during lockdown. PURPOSE Many countries implemented a lockdown to control the spread of the COVID-19 pandemic. We explored whether outpatient attendances to the Fracture Clinic for non-hip fragility fracture and inpatient admissions for hip fracture declined during lockdown, among adults aged 50 years and older, in a large secondary care hospital. METHODS In our observational study, we analysed the records of 6681 outpatients attending the Fracture Clinic, for non-hip fragility fractures, and those of 1752 inpatients, admitted for hip fracture, during the time frames of interest. These were weeks 1st to 12th in 2020 ("prior to lockdown"), weeks 13th to 19th in 2020 ("lockdown") and corresponding periods over 2015 to 2019. We tested for differences in mean numbers (standard deviation (SD)) of outpatients and inpatients, respectively, per week, during the time frames of interest, across the years. RESULTS Prior to lockdown, in 2020, 63.1 (SD 12.6) outpatients per week attended the Fracture Clinic, similar to previous years (p value 0.338). During lockdown, 26.0 (SD 7.3) outpatients per week attended the Fracture Clinic, fewer than previous years (p value < 0.001); similar findings were observed in both sexes and age groups (all p values < 0.001). During lockdown, 16.1 (SD 5.6) inpatients per week were admitted for hip fracture, similar to previous years (p value 0.776). CONCLUSION During lockdown, fewer outpatients attended the Fracture Clinic, for non-hip fragility fractures, while no change in inpatient admissions for hip fracture was observed. This could reflect fewer non-hip fractures and may inform allocation of resources during pandemic.
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Affiliation(s)
- Giulia Ogliari
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK.
| | - Eleanor Lunt
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
| | - Terence Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lindsey Marshall
- Department of Trauma & Orthopaedics, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Opinder Sahota
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
- University of Nottingham , Nottingham, UK
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16
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Gomez-Vaquero C, Valencia L, Nolla JM, Boquet D, Martínez Pardo S, Mihaylov Grigorov M, Lafont A, Segalés N, Roig Vilaseca D, Cerdà D, Casado E, Oncins X, Sallés M, Mínguez S, García Mira Y, Holgado S, López Louzao A, Pitarch C, Castellanos Moreira R, Florez H, Tebé C. The incidence of clinical fractures in adults aged 50 years and older in Spain. Rheumatol Adv Pract 2020. [DOI: 10.1093/rap/rkaa050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The aim of this study was to quantify the incidence of all clinical fractures, including traumatic and fragility fractures, in patients aged 50 years and older, and to describe their distribution by fracture location, sex and age.
Methods
The incidence of clinical fractures at 10 hospitals in Catalonia, with a reference population of 3 155 000 inhabitants, was studied. For 1 week, from 30 May to 5 June 2016, we reviewed the discharge reports of the Traumatology section of the Emergency Department to identify all fractures diagnosed in patients ≥50 years of age. As a validation technique, data collection was carried out for 1 year at one of the centres, from 1 December 2015 to 30 November 2016. The fracture incidence, including the 95% CI, was estimated for the entire sample and grouped by fracture type, location, sex and age.
Results
A total of 283 fractures were identified. Seventy per cent were in women, with a mean age of 72 years. The overall fracture incidence was 11.28 per 1000 person-years (95% CI: 11.10, 11.46), with an incidence of traumatic and fragility fractures of 4.15 (95% CI: 4.04, 4.26) and 7.13 per 1000 person-years (95% CI: 6.99, 7.28), respectively. The incidence of fractures observed in the validation sample coincided with that estimated for the whole of Catalonia. The most common fragility fractures were of the hip, forearm, humerus and vertebrae.
Conclusion
The results of this study are the first to estimate the incidence of clinical fragility fractures in Spain, grouped by location, age and sex.
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Affiliation(s)
- Carmen Gomez-Vaquero
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Lidia Valencia
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Joan M Nolla
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Dolors Boquet
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Arnau de Vilanova, Lleida
| | - Silvia Martínez Pardo
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Mútua Terrassa, Terrassa
| | - Mihail Mihaylov Grigorov
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Mútua Terrassa, Terrassa
| | - Anna Lafont
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Mataró, Mataró
| | - Nuria Segalés
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Mataró, Mataró
| | - Daniel Roig Vilaseca
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí
| | - Dacia Cerdà
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí
| | - Enrique Casado
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology and Orthopedics Departments, Parc Taulí Hospital Universitari, Sabadell
| | - Xavier Oncins
- Rheumatology and Orthopedics Departments, Parc Taulí Hospital Universitari, Sabadell
| | - Meritxell Sallés
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Sant Joan de Déu de Manresa, Manresa
| | - Sonia Mínguez
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Sant Joan de Déu de Manresa, Manresa
| | - Yaiza García Mira
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Susana Holgado
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Ana López Louzao
- Rheumatology and Orthopedics Departments, Hospital de l’Esperit Sant, Santa Coloma de Gramenet
| | - Conxita Pitarch
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology and Orthopedics Departments, Hospital de l’Esperit Sant, Santa Coloma de Gramenet
| | - Raúl Castellanos Moreira
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Clínic de Barcelona, Barcelona
| | - Helena Florez
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Clínic de Barcelona, Barcelona
| | - Cristian Tebé
- Statistical Advisory Service, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Spain
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17
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McCabe E, Ibrahim A, Singh R, Kelly M, Armstrong C, Heaney F, Bergin D, McCabe JP, Carey JJ. A systematic review of the Irish osteoporotic vertebral fracture literature. Arch Osteoporos 2020; 15:34. [PMID: 32124074 DOI: 10.1007/s11657-020-0704-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Vertebral fractures (VF) are the most common osteoporotic fracture. They are associated with significant morbidity and mortality and are an important predictor of future fractures. The epidemiology of VF in Ireland is limited and a greater understanding of their scale and impact is needed. Therefore, we conducted a systematic review of publications on osteoporotic VF in Ireland. METHODS Systematic searches were conducted using PubMed, Medline, Embase, Scopus and Cochrane electronic databases to identify eligible publications from Ireland addressing osteoporotic VF. RESULTS Twenty studies met the inclusion criteria out of 1558 citations. All studies were published since 2000. Data was obtained on 182,771 patients with fractures. Nine studies included more than 100 subjects and three included more than 1000. Females accounted for 70% with an overall mean age of 65.2 years (30-94). There was significant heterogeneity in study design, methods and outcome measures including the following: use of administrative claims data on public hospital admissions, surgical and medical interventions, the impact of a fracture liaison service and the osteoporosis economic burden. The prevalence of VF was difficult to ascertain due to definitions used and differences in the study populations. Only two studies systematically reviewed spine imaging using blinded assessors and validated diagnostic criteria to assess the prevalence of fractures in patient cohorts. CONCLUSIONS Several studies show that VF are common when addressed systematically and the prevalence may be rising. However, there is a deficit of large studies systematically addressing the epidemiology and their importance in Ireland.
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Affiliation(s)
- Eva McCabe
- School of Medicine, National University of Ireland, Galway, Ireland. .,Department of Rheumatology, Galway University Hospital, Galway, Ireland.
| | - Ammar Ibrahim
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Rajneet Singh
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Michael Kelly
- Department of Trauma and Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Catherine Armstrong
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Fiona Heaney
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Diane Bergin
- Department of Radiology, Galway University Hospital, Galway, Ireland
| | - John P McCabe
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Trauma and Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
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18
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García Bossi J, Kumar K, Barberini ML, Domínguez GD, Rondón Guerrero YDC, Marino-Buslje C, Obertello M, Muschietti JP, Estevez JM. The role of P-type IIA and P-type IIB Ca2+-ATPases in plant development and growth. JOURNAL OF EXPERIMENTAL BOTANY 2020; 71:1239-1248. [PMID: 31740935 DOI: 10.1093/jxb/erz521] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/16/2019] [Indexed: 06/10/2023]
Abstract
As sessile organisms, plants have evolved mechanisms to adapt to variable and rapidly fluctuating environmental conditions. Calcium (Ca2+) in plant cells is a versatile intracellular second messenger that is essential for stimulating short- and long-term responses to environmental stresses through changes in its concentration in the cytosol ([Ca2+]cyt). Increases in [Ca2+]cyt direct the strength and length of these stimuli. In order to terminate them, the cells must then remove the cytosolic Ca2+ against a concentration gradient, either taking it away from the cell or storing it in organelles such as the endoplasmic reticulum (ER) and/or vacuoles. Here, we review current knowledge about the biological roles of plant P-type Ca2+-ATPases as potential actors in the regulation of this cytosolic Ca2+ efflux, with a focus the IIA ER-type Ca2+-ATPases (ECAs) and the IIB autoinhibited Ca2+-ATPases (ACAs). While ECAs are analogous proteins to animal sarcoplasmic-endoplasmic reticulum Ca2+-ATPases (SERCAs), ACAs are equivalent to animal plasma membrane-type ATPases (PMCAs). We examine their expression patterns in cells exhibiting polar growth and consider their appearance during the evolution of the plant lineage. Full details of the functions and coordination of ECAs and ACAs during plant growth and development have not yet been elucidated. Our current understanding of the regulation of fluctuations in Ca2+ gradients in the cytoplasm and organelles during growth is in its infancy, but recent technological advances in Ca2+ imaging are expected to shed light on this subject.
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Affiliation(s)
- Julián García Bossi
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, Dr. Héctor Torres (INGEBI-CONICET), Buenos Aires, Argentina
| | - Krishna Kumar
- Fundación Instituto Leloir and Instituto de Investigaciones Bioquímicas de Buenos Aires (IIBBA-CONICET), Buenos Aires, Argentina
- Molecular Plant Biology and Biotechnology Laboratory, CSIR-Central Institute of Medicinal and Aromatic Plants Research Centre, GKVK Post, Bengaluru, India
| | - María Laura Barberini
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, Dr. Héctor Torres (INGEBI-CONICET), Buenos Aires, Argentina
| | - Gabriela Díaz Domínguez
- Fundación Instituto Leloir and Instituto de Investigaciones Bioquímicas de Buenos Aires (IIBBA-CONICET), Buenos Aires, Argentina
| | | | - Cristina Marino-Buslje
- Fundación Instituto Leloir and Instituto de Investigaciones Bioquímicas de Buenos Aires (IIBBA-CONICET), Buenos Aires, Argentina
| | - Mariana Obertello
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, Dr. Héctor Torres (INGEBI-CONICET), Buenos Aires, Argentina
| | - Jorge P Muschietti
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, Dr. Héctor Torres (INGEBI-CONICET), Buenos Aires, Argentina
- Departamento de Biodiversidad y Biología Experimental, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Int. Güiraldes, Ciudad Universitaria, Pabellón II, Buenos Aires, Argentina
| | - José M Estevez
- Fundación Instituto Leloir and Instituto de Investigaciones Bioquímicas de Buenos Aires (IIBBA-CONICET), Buenos Aires, Argentina
- Centro de Biotecnología Vegetal (CBV), Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
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19
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Cauley JA, Giangregorio L. Physical activity and skeletal health in adults. Lancet Diabetes Endocrinol 2020; 8:150-162. [PMID: 31759956 DOI: 10.1016/s2213-8587(19)30351-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
Abstract
The purpose of this Review is to examine the associations between physical activity and skeletal health, with an emphasis on observational studies with fracture outcomes and randomised controlled trials (RCTs) of physical activity interventions in adults older than 40 years. In general, increased physical activity-primarily leisure time activity or moderate or vigorous physical activity-is associated with a 1-40% lower risk of hip and all fractures. The primary limitation of these studies relates to health status; healthy people are more likely to exercise and less likely to fracture. Although there is no sufficiently powered RCT of exercise with a fracture outcome, there is evidence that some types of exercise prevent falls and bone loss, and meta-analyses support the anti-fracture effectiveness of exercise. RCTs and meta-analyses suggest that programmes combining impact exercise with moderate or high-intensity progressive resistance exercise might maintain or improve bone mass and prevent fractures, and that functional strength and balance training prevents falls.
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Affiliation(s)
- Jane A Cauley
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Lora Giangregorio
- BC Matthews Hall and Lyle S Hallman Institute, Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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20
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Clemens KK, Ouedraogo A, Speechley M, Richard L, Thain J, Shariff SZ. Hip Fractures in Older Adults in Ontario, Canada-Monthly Variation, Insights, and Implications. Can Geriatr J 2019; 22:148-164. [PMID: 31565111 PMCID: PMC6715412 DOI: 10.5770/cgj.22.341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background In older adults, hip fractures have been described to peak in cooler months. Seasonal differences in patient vulnerability to fracture and social/behavioural factors might contribute to these trends. Methods Using linked health-care databases in Ontario Canada, we examined monthly variation in hip fracture hospitalizations in those > 65 years (2011–2015). We stratified results by age category (66–79, ≥80 years). We then examined for variation in the demographic and comorbidity profiles of patients across the months, and as an index of contributing social/behavioural factors, noted variation in health-care behaviours. Results There were 47,971 and 52,088 hospitalizations for hip fracture in those 66–79, and ≥80 years, respectively. There was strong seasonality in fractures in both groups. Peaks occurred in October and December when patients appeared most vulnerable. Rates fell in the summer in those 66–79 years, and in the late winter in those ≥80 years (when health-care utilization also declined). A smaller peak in fractures occurred in May in both groups. Conclusions Hip fractures peak in the autumn, early winter, and spring in Canada. A dip in fractures occurs in the late winter in the oldest old. Environmental factors might play a role, but seasonal vulnerability to fracture and winter isolation might also be influential.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology, Western University, London, ON, Canada.,ICES, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Mark Speechley
- Lawson Health Research Institute, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Jenny Thain
- Department of Medicine, Division of Geriatrics, Western University, London, ON, Canada
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21
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Yousfi L, Houam L, Boukrouche A, Lespessailles E, Ros F, Jennane R. Texture Analysis and Genetic Algorithms for Osteoporosis Diagnosis. INT J PATTERN RECOGN 2019. [DOI: 10.1142/s0218001420570025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Early diagnosis of osteoporosis can efficiently predict fracture risk. There is a great demand to prevent this disease. The goal of this study was to distinguish osteoporotic cases from healthy controls on 2D bone radiograph images, using texture analysis and genetic algorithms (GAs). Gray Level Co-occurrence Matrix (GLCM), Run length Matrix (RLM) and Binarized Statistical Image Features (BSIF) were used for texture analysis. Features are numerous and parameter-dependent. The related experts can pick out the useful input features for the classifier. It however remains a difficult task and may be inefficient or even harmful as the data pattern is not clear. In this paper, GAs were used to optimize the two parameters of the co-occurrence matrix (distance parameter or pixel separation, orientation or direction) and the number of gray levels used in the preprocessing quantification step. GAs were also used to select the best combination of features extracted from GLCM and RLM matrices. Experiments were conducted on two populations composed of Osteoporotic Patients and Control Subjects. Results show that GAs combined with GLCM and BSIF features can improve the classification rates (ACC = 87.50%) obtained using GLCM (ACC = 77.8%) alone.
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Affiliation(s)
- Laatra Yousfi
- Laboratory of Inverse Problems, Modeling, Information and Systems (PI:MIS), University 8 Mai 1945 Guelma, Algeria
- Department of Electrical Engineering, University of Tebessa, Tebessa, Algeria
| | - Lotfi Houam
- Department of Electrical Engineering, University of Tebessa, Tebessa, Algeria
| | - Abdelhani Boukrouche
- Laboratory of PI:MIS, Department of Electronic and Telecommunications University of Guelma, BP 401, 24000 Guelma, Algeria
| | - Eric Lespessailles
- Laboratory I3MTO EA 4708, University of Orleans, CHR Orléans, 45032 Orleans, France
| | - Frédéric Ros
- Laboratory PRISME, University of Orleans, 12 rue de Blois, 45067 Orleans, France
| | - Rachid Jennane
- Laboratory I3MTO EA 4708, University of Orleans, CHR Orléans, 45032 Orleans, France
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22
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Recknor CP, Van Dussen D, MacIntyre N, Recknor J. Functional risk for fracture by safe functional motion testing: a short version of the safe functional motion test. Ther Adv Musculoskelet Dis 2019; 11:1759720X19856012. [PMID: 31258630 PMCID: PMC6591662 DOI: 10.1177/1759720x19856012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/18/2019] [Indexed: 01/12/2023] Open
Abstract
Background: ‘Unsafe’ movement strategies used to perform everyday activities were
quantified using scores for tasks included in the Short Form Safe Functional
Motion test series (SSFM). Baseline scores were independently associated
with incident fractures after adjusting for factors known to effect fracture
risk. The purpose of the present study is to determine whether the SSFM, a
series of tests of habitual motion, is associated with incident fragility
fracture at any skeletal sites. Methods: An osteoporosis clinic database was queried for adults with baseline SSFM
scores and corresponding data for prevalent fractures, femoral neck bone
mineral density (fnBMD), osteoporosis medication use, and incident fractures
at 1-year and 3-year follow ups [n = 1700 (118 incident
fractures) and n = 1058 (202 incident fractures),
respectively]. Multiple logistic regressions, adjusted for sex, age, fnBMD,
osteoporosis medication use, and any prevalent fractures at baseline, were
used to determine whether baseline SSFM scores were associated with incident
fragility fractures. Results: An Sfm-3 score was a significant independent predictor of any fracture at 1
year [adjusted odds ratio (95% CI) = 1.118 (1.025, 1.219) for each 10-point
decrease in Sfm-3; p = 0.012], and 3-year follow up
[adjusted odds ratio (95% CI) = 1.183 (1.098, 1.274) for each 10-point
decrease in Sfm-3; p < 0.0001]. Conclusions: Scores on the SSFM predict fracture risk such that for each 10-point drop in
score the odds of fracture are increased by up to 18% independent of risk
associated with age, bone mineral density, use of bone-sparing medications,
and history of a fracture.
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Affiliation(s)
| | - Daniel Van Dussen
- Youngstown State University College of Liberal Arts and Social Sciences, 440 DeBartolo Hall, Youngstown, OH 44555-0002, USA
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23
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Numé AK, Carlson N, Gerds TA, Holm E, Pallisgaard J, Søndergaard KB, Hansen ML, Vinther M, Hansen J, Gislason G, Torp-Pedersen C, Ruwald MH. Risk of post-discharge fall-related injuries among adult patients with syncope: A nationwide cohort study. PLoS One 2018; 13:e0206936. [PMID: 30462687 PMCID: PMC6248940 DOI: 10.1371/journal.pone.0206936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/21/2018] [Indexed: 01/06/2023] Open
Abstract
Background Syncope could be related to high risk of falls and injury in adults, but documentation is sparse. We examined the association between syncope and subsequent fall-related injuries in a nationwide cohort. Methods By cross-linkage of nationwide registers, all residents ≥18 years with a first-time diagnosis of syncope were identified between 1997–2012. Syncope patients were matched 1:1 with individuals from the general population. The absolute one-year risk of fall-related injuries, defined as fractures and traumatic head injuries requiring hospitalization, was calculated using Aalen-Johansen estimator. Ratios of the absolute one-year risk of fall-related injuries (ARR) were assessed by absolute risk regression analysis. Results We identified 125,763 patients with syncope: median age 65 years (interquartile range 46–78). At one year, follow-up was complete for 99.8% where a total of 8394 (6.7%) patients sustained a fall-related injury requiring hospitalization, of which 1606 (19.1%) suffered hip fracture. In the reference group, 4049 (3.2%) persons had a fall-related injury. The one-year ARR of a fall-related injury was 1.79 (95% confidence interval 1.72–1.87, P<0.001) in patients with syncope compared with the reference group; however, increased ARR was not exclusively in older patients. Factors independently associated with increased ARR of fall-related injuries in the syncope population were: injury in past 12 months, 2.39 (2.26–2.53, P<0.001), injury in relation to the syncope episode, 1.62 (1.49–1.77, P<0.001), and depression, 1.37 (1.30–1.45, P<0.001) Conclusion Patients with syncope were at 80% increased risk of severe fall-related injuries within the year following discharge. Notably, increased risk was not exclusively in older patients.
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Affiliation(s)
- Anna-Karin Numé
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
- * E-mail:
| | - Nicolas Carlson
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Thomas A. Gerds
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Holm
- Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Jannik Pallisgaard
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
| | | | - Morten L. Hansen
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
| | - Michael Vinther
- Department of Cardiology, Copenhagen University National Hospital, Copenhagen, Denmark
| | - Jim Hansen
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Departments of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin H. Ruwald
- Department of Cardiology, Copenhagen University Herlev Gentofte Hospital, Hellerup, Denmark
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Miller PD, Bilezikian JP, Lewiecki EM, Watts NB, Carey JJ. Re: A History of Pivotal Advances in Clinical Research Into Bone and Mineral Diseases. J Bone Miner Res 2018; 33:1900-1901. [PMID: 30102788 DOI: 10.1002/jbmr.3566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA
| | - Nelson B Watts
- Mercy Health, Osteoporosis and Bone Health Services, Cincinnati, OH, USA
| | - John J Carey
- National University of Ireland Galway, Medicine, and Merlin Park University Hospital Galway, Rheumatic Diseases, Galway, Ireland
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25
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Bhattacharya P, Altai Z, Qasim M, Viceconti M. A multiscale model to predict current absolute risk of femoral fracture in a postmenopausal population. Biomech Model Mechanobiol 2018; 18:301-318. [PMID: 30276488 PMCID: PMC6418062 DOI: 10.1007/s10237-018-1081-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
Abstract
Osteoporotic hip fractures are a major healthcare problem. Fall severity and bone strength are important risk factors of hip fracture. This study aims to obtain a mechanistic explanation for fracture risk in dependence of these risk factors. A novel modelling approach is developed that combines models at different scales to overcome the challenge of a large space–time domain of interest and considers the variability of impact forces between potential falls in a subject. The multiscale model and its component models are verified with respect to numerical approximations made therein, the propagation of measurement uncertainties of model inputs is quantified, and model predictions are validated against experimental and clinical data. The main results are model predicted absolute risk of current fracture (ARF0) that ranged from 1.93 to 81.6% (median 36.1%) for subjects in a retrospective cohort of 98 postmenopausal British women (49 fracture cases and 49 controls); ARF0 was computed up to a precision of 1.92 percentage points (pp) due to numerical approximations made in the model; ARF0 possessed an uncertainty of 4.00 pp due to uncertainties in measuring model inputs; ARF0 classified observed fracture status in the above cohort with AUC = 0.852 (95% CI 0.753–0.918), 77.6% specificity (95% CI 63.4–86.5%) and 81.6% sensitivity (95% CI 68.3–91.1%). These results demonstrate that ARF0 can be computed using the model with sufficient precision to distinguish between subjects and that the novel mechanism of fracture risk determination based on fall dynamics, hip impact and bone strength can be considered validated.
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Affiliation(s)
- Pinaki Bhattacharya
- Department of Mechanical Engineering, University of Sheffield, The Sir Frederick Mappin Building, Mappin Street, Sheffield, S1 3JD, UK. .,INSIGNEO Institute for in Silico Medicine, University of Sheffield, The Pam Liversidge Building, Mappin Street, Sheffield, S1 3JD, UK.
| | - Zainab Altai
- Department of Mechanical Engineering, University of Sheffield, The Sir Frederick Mappin Building, Mappin Street, Sheffield, S1 3JD, UK.,INSIGNEO Institute for in Silico Medicine, University of Sheffield, The Pam Liversidge Building, Mappin Street, Sheffield, S1 3JD, UK
| | - Muhammad Qasim
- Department of Mechanical Engineering, University of Sheffield, The Sir Frederick Mappin Building, Mappin Street, Sheffield, S1 3JD, UK.,INSIGNEO Institute for in Silico Medicine, University of Sheffield, The Pam Liversidge Building, Mappin Street, Sheffield, S1 3JD, UK
| | - Marco Viceconti
- Department of Mechanical Engineering, University of Sheffield, The Sir Frederick Mappin Building, Mappin Street, Sheffield, S1 3JD, UK.,INSIGNEO Institute for in Silico Medicine, University of Sheffield, The Pam Liversidge Building, Mappin Street, Sheffield, S1 3JD, UK
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26
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James MK, Robitsek RJ, Saghir SM, Gentile PA, Ramos M, Perez F. Clinical and non-clinical factors that predict discharge disposition after a fall. Injury 2018; 49:975-982. [PMID: 29463382 DOI: 10.1016/j.injury.2018.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/26/2018] [Accepted: 02/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls can result in injuries that require rehabilitation and long-term care after hospital discharge. Identifying factors that contribute to prediction of discharge disposition is crucial for efficient resource utilization and reducing cost. Several factors may influence discharge location after hospitalization for a fall. The aim of this study was to examine clinical and non-clinical factors that may predict discharge disposition after a fall. We hypothesized that age, injury type, insurance type, and functional status would affect discharge location. METHODS This two-year retrospective study was performed at an urban, adult level-1 trauma center. Fall patients who were discharged home or to a facility after hospital admission were included in the study. Data was obtained from the trauma registry and electronic medical records. Logistic regression modeling was used to assess independent predictors. RESULTS A total of 1,121 fallers were included in the study. 621 (55.4%) were discharged home and 500 (44.6%) to inpatient rehabilitation (IRF)/skilled nursing facility (SNF). The median age was 64 years (IQR: 49-79) and 48.4% (543) were male. The median length of hospital stay was 5 days (IQR: 2.5-8). Increasing age (p < 0.001), length of stay in the ICU (p < 0.001), injury severity (p < 0.001), number of comorbidities (p = 0.038), having Medicare insurance (p = 0.025), having a fracture at any body region (p < 0.001), and ambulation status (p = 0.025) significantly increased the odds of being discharged to IRF/SNF compared to home. The removal of injury severity score and ICU length of stay from the "late/regular discharge" model, to create an "early discharge" model, decreased the accuracy of the prediction rate from 78.5% to 74.9% (p < 0.001). CONCLUSION A combination of demographic, clinical, social, economic, and functional factors can together predict discharge disposition after a fall. The majority of these factors can be assessed early in the hospital stay, which may facilitate a timely discharge plan and shorter stays in the hospital.
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Affiliation(s)
- Melissa K James
- Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, USA.
| | - R Jonathan Robitsek
- Department of Surgery, Jamaica Hospital Medical Center, Jamaica, New York, USA.
| | - Syed M Saghir
- Department of Medicine, University of Nevada, Las Vegas, Nevada, USA.
| | - Patricia A Gentile
- Departement of Occupational Therapy, NYU Steinhardt School of Culture, Education and Human Development, New York, NY, USA.
| | - Marylin Ramos
- Department of Rehabilitation, Jamaica Hospital Medical Center, Jamaica, New York, USA.
| | - Frances Perez
- Department of Case Management, Jamaica Hospital Medical Center, Jamaica, New York, USA.
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27
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Litwic AE, Westbury LD, Robinson DE, Ward KA, Cooper C, Dennison EM. Bone Phenotype Assessed by HRpQCT and Associations with Fracture Risk in the GLOW Study. Calcif Tissue Int 2018; 102:14-22. [PMID: 28913616 PMCID: PMC5760585 DOI: 10.1007/s00223-017-0325-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022]
Abstract
The epidemiology and pathogenesis of fractures in postmenopausal women has previously been investigated in the Global Longitudinal study of Osteoporosis in Women (GLOW). To date, however, relationships between bone imaging outcomes and fracture have not been studied in this cohort. We examined relationships between high-resolution peripheral quantitative computed tomography (HRpQCT) parameters and fracture in the UK arm of GLOW, performing a cluster analysis to assess if our findings were similar to observations reported from older participants of the Hertfordshire Cohort Study (HCS), and extended the analysis to include tibial measurements. We recorded fracture events and performed HRpQCT of the distal radius and tibia and dual-energy X-ray absorptiometry (DXA) of the hip in 321 women, mean age 70.6 (SD 5.4) years, identifying four clusters at each site. We saw differing relationships at the radius and tibia. Two radial clusters (3 and 4) had a significantly lower hip areal bone mineral density (p < 0.001) compared to Cluster 1; only individuals in Cluster 4 had a significantly higher risk of fracture (p = 0.005). At the tibia, clusters 1, 3 and 4 had lower hip areal bone mineral density (p < 0.001) compared to Cluster 2; individuals in Cluster 3 had a significantly higher risk of fracture (p = 0.009). In GLOW our findings at the radius were very similar to those previously reported in the HCS, suggesting that combining variables derived from HRpQCT may give useful information regarding fracture risk in populations where this modality is available. Further data relating to tibial HRpQCT-phenotype and fractures are provided in this paper, and would benefit from validation in other studies. Differences observed may reflect age differences in the two cohorts.
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Affiliation(s)
- A E Litwic
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - D E Robinson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
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28
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Fraenkel M, Yitshak-Sade M, Beacher L, Carmeli M, Mandelboim M, Siris E, Novack V. Is the association between hip fractures and seasonality modified by influenza vaccination? An ecological study. Osteoporos Int 2017; 28:2611-2617. [PMID: 28536736 DOI: 10.1007/s00198-017-4077-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
Abstract
UNLABELLED Osteoporotic hip fractures in 4344 patients were more common during winter. Lower temperatures were associated with higher rates of fracture only in those not vaccinated for influenza. Influenza outbreaks increased the risk of hip fractures. Further studies are needed to assess whether influenza vaccination can prevent hip fractures. INTRODUCTION Winter seasonality of osteoporotic hip fracture incidence has been demonstrated, yet the explanation for the association is lacking. We hypothesize that the seasonality of osteoporotic hip fracture can be explained by an association between hip fractures and seasonal influenza outbreaks. METHODS This retrospective cohort study included all patients admitted to Soroka University Medical Center with a diagnosis of osteoporotic hip fracture (ICD-9 code 820) between the years 2001 and 2013. Patients with malignancies, trauma, and age under 50 were excluded. In a time series analysis, we examined the association between hip fracture incidence and seasonality adjusted for meteorological factors, and population rates of influenza infection and vaccination using Poisson models. RESULTS Four thousand three hundred forty-four patients with a hip fracture were included (69% females, mean age 78). Daily fracture rates were significantly higher in winter (1.1 fractures/day) compared to summer, fall, and spring (0.79, 0.90, and 0.91; p < 0.001). In analysis adjusted for seasons and spline function of time, temperatures were associated with hip fractures risk only in those not vaccinated for influenza (n = 2939, for every decrease of 5 °C, RR 1.08, CI 1.02-1.16; p < 0.05). In subgroup analysis during the years with weekly data on national influenza rates (2010-2013), the risk for hip fracture, adjusted for seasons and temperature, was 1.26 2 weeks following a week with high infection burden (CI 1.05;1.51 p = 0.01), while the temperature was not significantly associated with the fracture risk. CONCLUSIONS Under dry and warm desert climate, winter hip fracture incidence increase might be associated with influenza infection, and this effect can be negated by influenza vaccination.
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Affiliation(s)
- M Fraenkel
- Endocrine Unit, Soroka University Medical Center, Beersheba, Israel.
- Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - M Yitshak-Sade
- Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - L Beacher
- Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - M Carmeli
- Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Ben-Gurion University Medical School, Beersheba, Israel
| | - M Mandelboim
- Central Virology Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Siris
- Division of Endocrinology, Columbia University Medical Center, New York, USA
| | - V Novack
- Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
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29
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Lamb LC, Montgomery SC, Wong Won B, Harder S, Meter J, Feeney JM. A multidisciplinary approach to improve the quality of care for patients with fragility fractures. J Orthop 2017; 14:247-251. [PMID: 28367005 DOI: 10.1016/j.jor.2017.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/12/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Fragility fractures have become a worldwide epidemic associated with significant morbidity and mortality. As the world population ages, the number of patients that experience these fractures is also expected to rise. A multidisciplinary team was assembled that was coordinated by the Acute Inpatient Medical Service and included orthopedic surgeons, geriatricians, anesthesiologists, cardiologists, nurses, trauma surgeons, emergency medicine physicians, physiatrists, and physical therapists. This team was formed with the expectation that geriatric fragility fracture complications, specifically hip fractures, could be reduced by identifying and implementing best practices using guidelines from the American Academy of Orthopedic Surgery and those from the International Geriatric Fracture Society. METHODS We implemented a clinical pathway with a standardized approach with reduction in care variation and followed that by instituting performance improvement measures. The difference in outcome measurements as reported by TQIP for the year prior to implementation and the year following creation of the fragility fracture program was evaluated. RESULTS Benchmarking data demonstrated improved outcomes for patients with fragility fractures. Length of stay was significantly below national average, mortality remained below national average, and complication rates for UTIs and pressure ulcers were both reduced from 2014 to 2015 and below the national average. CONCLUSION The clinical pathway we adopted for the care of patients with fragility fractures has resulted in reduced lengths of stay, below average mortality, and improved discharge disposition.
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Affiliation(s)
- Laura C Lamb
- Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland Street, Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Stephanie C Montgomery
- Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland Street, Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Brian Wong Won
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Siobhan Harder
- Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland Street, Hartford, CT 06103, USA
| | - Jeffrey Meter
- Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland Street, Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - James M Feeney
- Saint Francis Hospital and Medical Center, Department of Surgery, 114 Woodland Street, Hartford, CT 06103, USA; University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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Torstensson M, Leth-Møller K, Andersson C, Torp-Pedersen C, Gislason GH, Holm EA. Danish register-based study on the association between specific antipsychotic drugs and fractures in elderly individuals. Age Ageing 2017; 46:258-264. [PMID: 27932365 DOI: 10.1093/ageing/afw209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Indexed: 01/22/2023] Open
Abstract
Background antipsychotic drugs (APs) have been associated with falls and fractures in elderly individuals but limited knowledge on specific drugs exist. Objective to investigate the association between individual APs and fractures in elderly persons. Design and setting nationwide register-based cohort study. Subjects all Danish individuals aged ≥65 who had not been in treatment with any AP in the year before inclusion. Methods incidence rate ratios (IRRs) of fractures of hip, pelvis or upper extremities during treatment with commonly used APs were assessed in multivariable Poisson models. Exposure was divided into time periods from initiation of treatment: 0-30 days, 31-365 days or >365 days. Results one year prior to inclusion, 1,540,915 individuals ≥65 years had not received APs and of these 93,298 initiated treatment with APs. Mean follow-up was 9.6 years. During follow-up, 246,057 (16%) experienced a fracture. Associations were for all APs highest in the initial treatment period (0-30 days) with IRRs for risperidone 1.97 (95% CI: 1.70-2.28), olanzapine 2.31 (95% CI: 1.96-2.73), quetiapine 2.09 (95% CI: 1.73-2.52), zuclopenthixol 2.19 (95% CI: 1.82-2.63), chlorprothixen 1.62 (95% CI: 1.18-2.24), flupenthixol 1.43 (95% CI: 1.06-1.93), levomepromazine 1.19 (95% CI 0.86-1.66), haloperidol 2.98 (95% CI 2.57-3.45), compared with the background population. Conclusions use of APs is associated with fractures in elderly persons especially in the initial treatment period. If AP use in an elderly person is deemed necessary, individual falls prophylaxis should be considered.
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Affiliation(s)
- Maia Torstensson
- Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Katja Leth-Møller
- Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Christian Torp-Pedersen
- Department of Health, Science and Technology, Aalborg University and Department of Cardiology and Clinical Epidemiology Aalborg University Hospital, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, University Hospital Gentofte, Gentofte, Denmark
- Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Astrid Holm
- Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
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Kemmler W, Bebenek M, Kohl M, von Stengel S. Possible different roles of exercise in preventing vertebral and hip fractures: response to comments by Sugiyama et al. Osteoporos Int 2016; 27:3137-8. [PMID: 27166682 DOI: 10.1007/s00198-016-3629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- W Kemmler
- Institute of Medical Physics, University of Erlangen, Henkestrasse 91, 91052, Erlangen, Germany.
| | - M Bebenek
- Institute of Medical Physics, University of Erlangen, Henkestrasse 91, 91052, Erlangen, Germany
| | - M Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Furtwangen, Germany
| | - S von Stengel
- Institute of Medical Physics, University of Erlangen, Henkestrasse 91, 91052, Erlangen, Germany
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Torstensson M, Hansen AH, Leth-Møller K, Jørgensen TSH, Sahlberg M, Andersson C, Kristensen KE, Ryg J, Weeke P, Torp-Pedersen C, Gislason G, Holm E. Danish register-based study on the association between specific cardiovascular drugs and fragility fractures. BMJ Open 2015; 5:e009522. [PMID: 26715481 PMCID: PMC4710826 DOI: 10.1136/bmjopen-2015-009522] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine whether drugs used in treatment of cardiovascular diseases (CVD-drugs), including hypertension, increase the risk of fragility fractures in individuals above the age of 65 years. DESIGN Retrospective nationwide cohort study. SETTING Danish nationwide national registers. PARTICIPANTS All individuals in Denmark ≥ 65 years who used specified CVD-drugs in the study period between 1999 and 2012. MAIN OUTCOMES MEASURES Time-dependent exposure to CVD-drugs (nitrates, digoxin, thiazides, furosemide, ACE inhibitors, angiotensin receptor antagonists, β-blockers, calcium antagonists and statins) was determined by prescription claims from pharmacies. The association between use of specific CVD-drugs and fragility fractures was assessed using multivariable Poisson regression models, and adjusted incidence rate ratios (IRRs) were calculated. RESULTS Overall, 1,586,554 persons were included, of these 16.1% experienced a fall-related fracture. The multivariable Poisson regression analysis showed positive associations between fracture and treatment with furosemide, thiazide and digoxin. IRRs during the first 14 days of treatment were for furosemide IRR 1.74 (95% CI 1.61 to 1.89) and for thiazides IRR 1.41 (1.28 to 1.55); IRR during the first 30 days of treatment with digoxin was 1.18 (1.02 to 1.37). CONCLUSIONS Use of furosemide, thiazides and digoxin was associated with elevated rates of fragility fractures among elderly individuals. This may warrant consideration when considering diuretic treatment of hypertension in elderly individuals.
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Affiliation(s)
- Maia Torstensson
- Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Katja Leth-Møller
- Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Marie Sahlberg
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Peter Weeke
- Department of Cardiology, Laboratory of Molecular Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark
| | - Ellen Holm
- Department of Geriatric Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
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Saei Ghare Naz M, Ozgoli G, Aghdashi MA, Salmani F. Prevalence and Risk Factors of Osteoporosis in Women Referring to the Bone Densitometry Academic Center in Urmia, Iran. Glob J Health Sci 2015; 8:135-45. [PMID: 26925890 PMCID: PMC4965671 DOI: 10.5539/gjhs.v8n7p135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/18/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Osteoporosis is one of the fastest growing health problems around the world. Several factors can affect this silent disease. The current study aimed to determine the prevalence and risk factors of osteoporosis in women in Urmia, a city in northwestern Iran. METHODS This cross‑sectional study was performed on 360 non-pregnant women over the age of 15 who referred for bone density testing to the Urmia Imam Khomeini Academic Hospital. Data were collected by questionnaire, and bone mineral density of the femoral neck and lumbar spines L1- L4 was evaluated by dual X-ray absorptiometry. RESULTS The total prevalence of osteoporosis in this study was 42.2%; prevalence of osteoporosis among women 45 years old or less was 14.3% and over the age of 45 years was 50.7%. The factors such as level of education, history of bone fracture, disease history (rheumatoid arthritis, diabetes, high blood pressure), gravidity and parity values, duration of lactation (p<0.001), nutrition dimension of lifestyle (p=0.03), and green tea consumption (p=002) showed a statistically significant association with the bone mineral density. According to the regression model, age (OR=1.081), history of bone fracture (OR=2.75), and gravidity (OR=1.14) were identified as significant risk factors for osteoporosis, while the body mass index (OR=0.94) was identified as a protector against osteoporosis. CONCLUSION The prevalence of osteoporosis in this study was high, and findings showed that the advancement of age, lifestyle, and reproductive factors (especially gravidity and duration of lactation) were determining factors for osteoporosis .Appropriate educational programs and interventions could help to increase the women's peak bone mass therefore reducing their risk of developing osteoporosis.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Department of Midwifery, School of Nursing and Midwifery Urmia Medical University , Urmia, Iran.
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Safety of 3-year raloxifene treatment in Japanese postmenopausal women aged 75 years or older with osteoporosis. Menopause 2015; 22:1134-7. [DOI: 10.1097/gme.0000000000000441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mears SC, Kates SL. A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2. Geriatr Orthop Surg Rehabil 2015; 6:58-120. [PMID: 26246957 DOI: 10.1177/2151458515572697] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.
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Cianferotti L, Fossi C, Brandi ML. Hip Protectors: Are They Worth it? Calcif Tissue Int 2015; 97:1-11. [PMID: 25926045 DOI: 10.1007/s00223-015-0002-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/11/2015] [Indexed: 01/04/2023]
Abstract
Hip fractures are one of the most serious conditions in frail elderly subjects, greatly increasing morbidity and mortality, and decreasing healthy life years. Since their first introduction on the market, hip protectors have been revealed to be a potential preventive measure for hip fractures, in addition to other well-known recognized medical interventions and rehabilitation procedures. However, randomized controlled trials have given contradictory results regarding their efficacy. Moreover, little data are available on the cost effectiveness of hip protectors. Adherence is a major problem in assessing the effectiveness of hip protectors in preventing fractures. Indeed, there is a lack of general consensus on a standard definition and quantitative objective estimation of adherence to hip protectors, along with still scarce evidence on specific interventions on how to ameliorate it. From what is known so far, it seems reasonable to advise the use of hip protectors in aged care facilities, since recent pooled analyses have suggested their efficacy in this setting. The introduction of sensors combined with hip protectors will probably address this issue, both for monitoring and optimizing compliance, especially in elderly people. In the meantime, new, well-designed studies following specific guidelines are strongly encouraged and needed. In particular, studies in community-dwelling elderly individuals at high risk of first or further fragility fractures are required. The optimization of the tested devices in a preclinical setting according to international standard biomechanical testing is necessary.
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Affiliation(s)
- Luisella Cianferotti
- Department of Surgery and Translational Medicine, Section of Endocrinology, Unit of Bone and Mineral Metabolism, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy,
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Vegt P, Muir JM, Block JE. The Photodynamic Bone Stabilization System: a minimally invasive, percutaneous intramedullary polymeric osteosynthesis for simple and complex long bone fractures. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:453-61. [PMID: 25540600 PMCID: PMC4270358 DOI: 10.2147/mder.s71790] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The treatment of osteoporotic long bone fractures is difficult due to diminished bone density and compromised biomechanical integrity. The majority of osteoporotic long bone fractures occur in the metaphyseal region, which poses additional problems for surgical repair due to increased intramedullary volume. Treatment with internal fixation using intramedullary nails or plating is associated with poor clinical outcomes in this patient population. Subsequent fractures and complications such as screw pull-out necessitate additional interventions, prolonging recovery and increasing health care costs. The Photodynamic Bone Stabilization System (PBSS) is a minimally invasive surgical technique that allows clinicians to repair bone fractures using a light-curable polymer contained within an inflatable balloon catheter, offering a new treatment option for osteoporotic long bone fractures. The unique polymer compound and catheter application provides a customizable solution for long bone fractures that produces internal stability while maintaining bone length, rotational alignment, and postsurgical mobility. The PBSS has been utilized in a case series of 41 fractures in 33 patients suffering osteoporotic long bone fractures. The initial results indicate that the use of the light-cured polymeric rod for this patient population provides excellent fixation and stability in compromised bone, with a superior complication profile. This paper describes the clinical uses, procedural details, indications for use, and the initial clinical findings of the PBSS.
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Affiliation(s)
- Paul Vegt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Abstract
The WHO clinical definition of osteoporosis, based on a measurement of bone mineral density (BMD) by Dual Energy X-ray Absorptiometry, has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above the osteoporosis threshold. The inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms can improve the identification of individuals at high fracture risk; thus a number of web-based tools have been developed, the most commonly used globally being FRAX(®). In this review, we will discuss the epidemiology of osteoporosis, clinical risk factors for fragility fracture, and how this knowledge is being used to aid risk stratification. Importantly, research is on-going to demonstrate the clinical efficacy and cost-effectiveness of such case-finding strategies.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; Paediatric Endocrinology, Southampton University Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
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Abstract
GLOW is an observational, longitudinal, practice-based cohort study of osteoporosis in 60,393 women aged ≥55 years in 10 countries on three continents. In this Review, we present insights from the first 3 years of the study. Despite cost analyses being frequently based on spine and hip fractures, we found that nonvertebral, nonhip fractures were around five times more common and doubled the use of health-care resources compared with hip and spine fractures combined. Fractures not at the four so-called major sites in FRAX(®) (upper arm, forearm, hip and clinical vertebral fractures) account for >40% of all fractures. The risk of fracture is increased by various comorbidities, such as Parkinson disease, multiple sclerosis and lung and heart disease. Obesity, although thought to be protective against all fractures, substantially increased the risk of fractures in the ankle or lower leg. Simple assessment by age plus fracture history has good predictive value for all fractures, but risk profiles differ for first and subsequent fractures. Fractures diminish quality of life as much or more than diabetes mellitus, arthritis and lung disease, yet women substantially underestimate their own fracture risk. Treatment rates in patients at high risk of fracture are below those recommended but might be too frequent in women at low risk. Comorbidities and the limits of current therapeutic regimens jeopardize the efficacy of drugs; new regimens should be explored for severe cases.
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Affiliation(s)
- Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, 4760 E. Galbraith Road, Suite 212, Cincinnati, OH 45236, USA
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Hubert PA, Lee SG, Lee SK, Chun OK. Dietary Polyphenols, Berries, and Age-Related Bone Loss: A Review Based on Human, Animal, and Cell Studies. Antioxidants (Basel) 2014; 3:144-58. [PMID: 26784669 PMCID: PMC4665444 DOI: 10.3390/antiox3010144] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/23/2014] [Accepted: 02/24/2014] [Indexed: 12/27/2022] Open
Abstract
Bone loss during aging has become an increasing public health concern as average life expectancy has increased. One of the most prevalent forms of age-related bone disease today is osteoporosis in which the body slows down bone formation and existing bone is increasingly being resorbed by the body to maintain the calcium balance. Some causes of this bone loss can be attributed to dysregulation of osteoblast and osteoclast activity mediated by increased oxidative stress through the aging process. Due to certain serious adverse effects of the currently available therapeutic agents that limit their efficacy, complementary and alternative medicine (CAM) has garnered interest as a natural means for the prevention of this debilitating disease. Natural antioxidant supplementation, a type of CAM, has been researched to aid in reducing bone loss caused by oxidative stress. Naturally occurring polyphenols, such as anthocyanins rich in berries, are known to have anti-oxidative properties. Several studies have been reviewed to determine the impact polyphenol intake-particularly that of berries-has on bone health. Studies reveal a positive association of high berry intake and higher bone mass, implicating berries as possible inexpensive alternatives in reducing the risk of age related bone loss.
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Affiliation(s)
- Patrice A Hubert
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269-4017, USA.
| | - Sang Gil Lee
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269-4017, USA.
| | - Sun-Kyeong Lee
- Center on Aging, University of Connecticut Health Center, Farmington, CT 06030-5215, USA.
| | - Ock K Chun
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269-4017, USA.
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Sato M, Vietri J, Flynn JA, Fujiwara S. Bone fractures and feeling at risk for osteoporosis among women in Japan: patient characteristics and outcomes in the National Health and Wellness Survey. Arch Osteoporos 2014; 9:199. [PMID: 25391755 PMCID: PMC4229644 DOI: 10.1007/s11657-014-0199-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/24/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Women aged 50 and older in Japan were compared according to perceived risk for osteoporosis and fracture history. Perceived risk was associated with family history of osteoporosis but few other risk factors. Few felt at risk, and perception was only loosely related to epidemiological risks, indicating a need for patient education. PURPOSE Osteoporosis is prevalent but underdiagnosed and undertreated. This study was conducted to explore characteristics associated with history of fractures and feeling at risk for osteoporosis in women aged 50 and older in Japan. METHODS Data were provided by a large annual survey representative of Japanese aged 18 and older. Women 50 and older without diagnosed osteoporosis were categorized into four mutually exclusive groups based on fracture history since age 50 and feeling at risk for developing osteoporosis. Sociodemographic and health characteristics were compared across groups using bivariate statistics, and health outcomes were compared using generalized linear models. RESULTS A total of 16,801 women aged 50 and older were included in the analyses. Most (n = 12,798; 76.2 %) had no fracture since age 50 and did not feel at risk for osteoporosis, 12.9 % (n = 2170) felt at risk but had no fracture, 8.7 % (n = 1455) did not feel at risk despite having a fracture, and 2.2 % (n = 378) had a fracture and felt at risk for osteoporosis. Feeling at risk was slightly more common among those with than without a fracture since age 50 (20.6 vs. 14.5 %, p < 0.001). Feeling at risk was most associated with family history of osteoporosis, though known risk factors for fracture did not significantly differ across the fracture/perceived-risk group. CONCLUSIONS Approximately 15 % of women in Japan aged 50 and older felt at risk for developing osteoporosis in the future, far fewer than expected by epidemiologists. Risk perception was only loosely related to epidemiological risks for fracture, indicating a need for patient education.
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Affiliation(s)
- Masayo Sato
- Eli Lilly K.K., Lilly Research Laboratories, Kobe, Japan
| | - Jeffrey Vietri
- Kantar Health, Health Outcomes Practice, Via Paleocapa 7, 20121 Milan (MI), Italy
| | | | - Saeko Fujiwara
- Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan
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