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Bone modeling and bone remodeling are two different approaches to the physiological metabolism of the human skeleton; both involve bone formation and bone resorption, but they are very different. Bone modeling includes osteoblasts in formation drifts and osteoclasts in resorption drifts, where osteoblasts and osteoclasts are independent of each other but intrinsically coordinated, contributing to changes in bone morphology and structure ultimately. Bone remodeling is a process in which osteoblasts and osteoclasts are closely coupled, resulting in a dynamic balance or imbalance between bone formation and bone resorption, mostly in the form of normal maintenance or gradual reduction of bone mineral mass. Previous literature has suggested that the osteogenic and osteoclastic activities that cause bone modeling usually cease (or end) when the bone matures, but recent studies have shown that bone modeling can occur throughout life and is not only active during infancy and early childhood. Particularly in the context of osteoporosis, some bone-sparing medication can have a significant effect on the process of bone modeling, suggesting that promoting bone modeling may be another useful way to increase bone mass. Therefore, in the field of osteoporosis prevention and treatment, focuse on the role of bone modeling will be significant for patients with osteoporosis.
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Objective:Iron accumulation is related to the occurrence of postmenopausal osteoporosis. Meanwhile, autophagy abnormality of bone marrow hematopoietic cells is observed in hip osteoporotic fracture. This study is performed to investigate correlation between iron accumulation induced bone loss and hematopoietic autophagy dysfunction to explore the new risk factor of osteoporosis.Methods:Male iron accumulation mice model was established by intraperitoneally injecting ferric ammonium citrate. Serum ferritin and osteogenic indicator P1NP were tested by ELISA. Bone mineral density was measured by micro-CT. Femur and tibia bone marrows were collected for hematopoietic stem and progenitor cells proportion and cell apoptosis analysis. Autolysosome formation was measured by image flow cytometry. We used conditional mouse model Atg7 flox/flox; Vav-Cre(Atg7 -/-) in which Atg7 had been genetically deleted in the hematopoietic system. Bone marrow hematopoietic stem and progenitor cells were collected for RNA sequence. micro-CT scan was conducted for Atg7 -/- femur. Results:Ferritin level of iron accumulation mice was significantly higher than control group( P<0.05). Iron accumulation inhibited P1NP and induced decreased bone mineral density( P<0.05). Iron accumulation bone marrow displayed enhanced hematopoietic stem and progenitor cells proportion( P<0.05), with more cell apoptosis( P<0.05). Hematopoietic autophagy was deteriorated in iron accumulation bone marrow. Transcriptomic profiling showed up-regulation of iron activity in Atg7 -/- mice, with increased iron homeostasis and iron membrane transporter genes, including Lcn2, Tfr2, Slc40a1(Fpn1), Steap3, and Cpox. micro-CT revealed severe bone loss and decreased bone mineral density in Atg7 -/- mice( P<0.05). Conclusion:Iron accumulation induced bone loss is related to inhibition of hematopoietic cells. Hematopoietic autophagy dysfunction is associated with bone loss.
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Objective@#To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures.@*Methods@#A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018, including 130 male and 310 female patients aged 60-98 years [(79.3±6.3)years]. According to the DORSSSP scoring system, the patients were divided into low risk group (Group A, n=208), medium risk group (Group B, n=157) and high risk group without SICU transfer after operation (Group C, n=23) and high risk group with SICU transfer after operation (Group D, n=52). The risk prediction results of each group were recorded and compared with the actual complications and mortality.@*Results@#(1)According to the prediction of DORSSSP, the number of postoperative complications in Groups A, B, C and D were 52, 60, 14 and 31, respectively, while the number of actual complications after operation was 45, 55, 13 and 16. There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P<0.01), which was not found in other three groups (P>0.05). The incidence of postoperative complications in Group D was lower than that in Group C (P<0.05). (2) According to the prediction of DORSSSP, the number of postoperative death in Groups A, B, C and D were 0, three, two and four, respectively, while the number of actual death after operation was 0, one, two and one, respectively. The predicted value and the actual value of death were significantly different in Group D (P<0.05), but were not in other three groups (P>0.05). The incidence of postoperative death in Group D was lower than that in Group C (P>0.05).@*Conclusions@#There is a good correlation between DORSSSP score and postoperative complications and mortality. Based on DORSSSP score for stratified treatment, the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.
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Objective To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures.Methods A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018,including 130 male and 310 female patients aged 60-98 years [(79.3 ± 6.3) years].According to the DORSSSP scoring system,the patients were divided into low risk group (Group A,n =208),medium risk group (Group B,n =157) and high risk group without SICU transfer after operation (Group C,n =23) and high risk group with SICU transfer after operation (Group D,n =52).The risk prediction results of each group were recorded and compared with the actual complications and mortality.Results (1)According to the prediction of DORSSSP,the number of postoperative complications in Groups A,B,C and D were 52,60,14 and 31,respectively,while the number of actual complications after operation was 45,55,13 and 16.There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P ＜ 0.01),which was not found in other three groups (P ＞ 0.05).The incidence of postoperative complications in Group D was lower than that in Group C (P ＜0.05).(2) According to the prediction of DORSSSP,the number of postoperative death in Groups A,B,C and D were 0,three,two and four,respectively,while the number of actual death after operation was 0,one,two and one,respectively.The predicted value and the actual value of death were significantly different in Group D (P ＜ 0.05),but were not in other three groups (P ＞ 0.05).The incidence of postoperative death in Group D was lower than that in Group C (P ＞ 0.05).Conclusions There is a good correlation between DORSSSP score and postoperative complications and mortality.Based on DORSSSP score for stratified treatment,the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.
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Most osteoporotic hip fracture occurs in the elderly, with the aging of society, the incidence of such fracture is increasing. The majority of patients are now treated with surgery due to high mortality rate by non-surgical treatment. In the choice of time interval about "fracture-operation", several studies found that elderly with osteoporotic hip fracture had various co-morbidities and their physiological reserve function of the body were obviously reduced, which should be corrected before surgery. However, others believed that the co-morbidities are not aggravated within 2-3 days, using the "window period" to perform surgery could help patients to stand as early as possible after operation, which was beneficial not only to the control of co-morbidities, but also to the prevention of complications such as pneumonia, bedsore and muscular atrophy caused by lying on bed after fracture. Therefore, there are some different opinions on the operation time after fracture in the guidelines and consensus of various countries, including 36 hours, 48 hours, 120 hours and early operation. Among these time points, the idea of "surgery within 48 hours after fracture" has been incorporated into the National Medical Insurance Payment Conditions by the Israeli Ministry of Health, and has been included in the guidelines by the American Association of Orthopaedics, and has been reported in most clinical studies. This article reviewed the studies on different operation time after hip osteoporotic fracture, especially for the reasons, advantages and clinical management process of hip fracture surgery within 48 hours. In addition, these views were analyzed in order to provide reference and inspiration for clinical treatment and hospital management of hip osteoporotic fracture.
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Objective@#To compare the clinical effects of surgery within and over 48 hours for hip fractures in elderly patients.@*Methods@#From May 2017 to April 2018, 47 patients over 75 years old with hip fracture were operated in our hospital and met with inclusion criteria. The patients were divided into two groups: within 48-hour group and over 48-hour group according to study design. In the within 48-hour group, there were 22 patients including 5 males and 17 females, aged from 76 to 97 years, with an average age of 83.6±5.0 years, and there were 10 femoral neck fractures (3 total hip arthroplasty, 7 hemiarthroplasty) and 12 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). There were 25 patients (7 males and 18 females) in the over 48-hour group, aged from 76 to 98 years, with an average age of 83.8±5.8 years, and there were 10 femoral neck fractures (2 total hip arthroplasty, 8 hemiarthroplasty) and 15 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). At the end of the follow-up period, the clinical data of the two groups were compared. The differences in the length of stay, cost of stay (excluding implants), postoperative complications within 1 month, hip function score (Harris score) within 1 month and 3 months, and mortality within 3 months and at the end of follow-up were analyzed.@*Results@#Both groups were followed up for 12 to 24 months, with an average of 17.7 months. The hospitalization time (7.9±3.0 d), hospitalization expenses (16 627.5±6 428.8 yuan), the incidence of early complications after operation (59.1%) and Harris score (80.9±8.6) in the within 48-hour group were significantly better than those in the over 48-hour group (12.3±4.1 d, 23 799.0±9 785.3 yuan, 88.0%, 71.1±9.2, respectively). At 3 months after operation, there was no significant difference in Harris score between the two groups (83.9±7.3 in within 48-hour group and 82.3±8.9 in over 48-hour group; t=0.668, P=0.507). Within 3 months, there was no death inwithin 48-hour group, but 2 in over 48-hour group; and 1 in within 48-hour group at the last follow-up.@*Conclusion@#Elderly patients with hip fracture benefit significantly from surgery within 48 hours after admission.
ABSTRACT
Most osteoporotic hip fracture occurs in the elderly, with the aging of society, the incidence of such fracture is increasing. The majority of patients are now treated with surgery due to high mortality rate by non?surgical treatment. In the choice of time interval about "fracture?operation", several studies found that elderly with osteoporotic hip fracture had various co?morbidi?ties and their physiological reserve function of the body were obviously reduced, which should be corrected before surgery. Howev?er, others believed that the co?morbidities are not aggravated within 2-3 days, using the "window period" to perform surgery could help patients to stand as early as possible after operation, which was beneficial not only to the control of co?morbidities, but also to the prevention of complications such as pneumonia, bedsore and muscular atrophy caused by lying on bed after fracture. There?fore, there are some different opinions on the operation time after fracture in the guidelines and consensus of various countries, in?cluding 36 hours, 48 hours, 120 hours and early operation. Among these time points, the idea of "surgery within 48 hours after frac?ture" has been incorporated into the National Medical Insurance Payment Conditions by the Israeli Ministry of Health, and has been included in the guidelines by the American Association of Orthopaedics, and has been reported in most clinical studies. This article reviewed the studies on different operation time after hip osteoporotic fracture, especially for the reasons, advantages and clinical management process of hip fracture surgery within 48 hours. In addition, these views were analyzed in order to provide ref?erence and inspiration for clinical treatment and hospital management of hip osteoporotic fracture.
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Objective To compare the clinical effects of surgery within and over 48 hours for hip fractures in elderly pa?tients. Methods From May 2017 to April 2018, 47 patients over 75 years old with hip fracture were operated in our hospital and met with inclusion criteria. The patients were divided into two groups: within 48?hour group and over 48?hour group according to study design. In the within 48?hour group, there were 22 patients including 5 males and 17 females, aged from 76 to 97 years, with an average age of 83.6±5.0 years, and there were 10 femoral neck fractures (3 total hip arthroplasty, 7 hemiarthroplasty) and 12 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). There were 25 patients (7 males and 18 females) in the over 48?hour group, aged from 76 to 98 years, with an average age of 83.8±5.8 years, and there were 10 femoral neck frac?tures (2 total hip arthroplasty, 8 hemiarthroplasty) and 15 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). At the end of the follow?up period, the clinical data of the two groups were compared. The differences in the length of stay, cost of stay (excluding implants), postoperative complications within 1 month, hip function score (Harris score) within 1 month and 3 months, and mortality within 3 months and at the end of follow?up were analyzed. Results Both groups were fol?lowed up for 12 to 24 months, with an average of 17.7 months. The hospitalization time (7.9±3.0 d), hospitalization expenses (16 627.5± 6 428.8 yuan), the incidence of early complications after operation (59.1% ) and Harris score (80.9 ± 8.6) in the within 48?hour group were significantly better than those in the over 48?hour group (12.3±4.1 d, 23 799.0±9 785.3 yuan, 88.0%, 71.1±9.2, respec?tively). At 3 months after operation, there was no significant difference in Harris score between the two groups (83.9±7.3 in within 48?hour group and 82.3±8.9 in over 48?hour group; t=0.668, P=0.507). Within 3 months, there was no death inwithin 48?hour group, but 2 in over 48?hour group; and 1 in within 48?hour group at the last follow?up. Conclusion Elderly patients with hip fracture benefit significantly from surgery within 48 hours after admission.