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Osteoporotic fracture is the most major complication of osteoporosis. It is a significant global public health problem which continues to bring serious family and social burden. In order to improve the prevention and treatment of osteoporotic fractures， many countries have carried out new ways of fracture prevention and management， and achieved some results. Prevention mainly aims at those at high risk of fracture， and includes new health education on fracture and the promotion of fall prevention measures. For management， the "Fracture liaison services" mode is mainly applied to the fracture patients， with refined patient management to deal with the fractures that have occurred. This article summarizes the global prevalence of osteoporotic fractures， risk factors， and the current research progress in fracture prevention and management in China and the West.
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Postmenopausal osteoporosis is a kind of degenerative disease, also described as "invisible killer." Estrogen is generally considered as the key hormone for women to maintain bone mineral content during their lives. Iron accumulation refers to a state of human serum ferritin that is higher than the normal value but less than 1000 μg/L. It has been found that iron accumulation and osteoporosis could occur simultaneously with the decrease in estrogen level after menopause. In recent years, many studies indicated that iron accumulation plays a vital role in postmenopausal osteoporosis, and a significant correlation has been found between iron accumulation and fragility fractures. In this review, we summarize and analyze the relevant literature including randomized controlled trials, systematic reviews, and meta-analyses between January 1996 and July 2022. We investigate the mechanism of the effect of iron accumulation on bone metabolism and discuss the relationship of iron accumulation, osteoporosis, and postmenopausal fragility fractures, as well as the main clinical treatment strategies. We conclude that it is necessary to pay attention to the phenomenon of iron accumulation in postmenopausal women with osteoporosis and explore the in-depth mechanism of abnormal bone metabolism caused by iron accumulation, in order to facilitate the discovery of effective therapeutic targets for postmenopausal osteoporosis.
Subject(s)
Humans , Female , Osteoporotic Fractures , Osteoporosis, Postmenopausal/drug therapy , Postmenopause , Osteoporosis , Bone Density , Estrogens , Iron/therapeutic useABSTRACT
ABSTRACT Objective: To evaluate whether patients older than 60 years admitted for fracture treatment had a history of previous fracture, a diagnosis of osteoporosis, or were under treatment for bone fragility. Methods: Retrospective study including 100 patients older than 60 years with fracture. Fracture location, bone densitometry within the past two years, previous diagnosis and osteoporosis treatment, and previous fracture within the past five years were assessed. Using Fisher's test, it was evaluated whether there was an association between previous fracture and osteoporosis treatment. Results: The most prevalent fracture was in the proximal femur (48%). Of the patients, 18% had fracture in the last five years, with 22% of them diagnosed with osteoporosis, and 22% under treatment. Previous fracture in the last five years was not associated with having a diagnosis of osteoporosis, having had bone densitometry, or being under treatment for osteoporosis. Conclusion: Among patients with previous fracture, only 22% were aware of their diagnosis of osteoporosis, and less than 25% of them were under bone fragility treatment. Previous fracture in the past five years had no association with having a diagnosis of osteoporosis, having had bone densitometry, or being on osteoporosis treatment. Level of Evidence III, Retrospective Study.
RESUMO Objetivo: Avaliar se os pacientes com mais de 60 anos internados para tratamento de fraturas têm história de fratura prévia, diagnóstico de osteoporose ou se estão em tratamento para fragilidade óssea. Métodos: Estudo retrospectivo que inclui 100 pacientes maiores de 60 anos com fratura. Avaliamos a localização da fratura, a densitometria óssea nos últimos dois anos, o diagnóstico e os tratamentos anteriores de osteoporose, assim como a presença de fratura prévia nos últimos cinco anos. Através de testes de Fisher avaliamos se houve associação entre fratura prévia e tratamento de osteoporose. Resultados: A fratura mais prevalente foi na extremidade proximal do fêmur (48%). Do total de pacientes, 18% tiveram fratura nos últimos cinco anos, sendo que 22% deles tinham diagnóstico de osteoporose e 22% estavam em tratamento. Fratura prévia nos últimos cinco anos não teve associação com diagnóstico de osteoporose, realização de densitometria óssea ou tratamento para osteoporose. Conclusão: Entre os pacientes com fratura prévia, apenas 22% estavam cientes do diagnóstico de osteoporose, e menos de 25% deles estavam em tratamento para fragilidade óssea. Não houve associação de fratura prévia nos últimos cinco anos com diagnóstico de osteoporose, realização de densitometria óssea ou tratamento para osteoporose. Nível de Evidência III, Estudo Retrospectivo.
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Objective:To investigate the correlation between TNFAIP3 gene polymorphism and osteoporotic fractures in the elderly and bone metabolism indexes.Methods:A total of 115 patients with senile osteoporotic fractures admitted to Peace Hospital Affiliated to Shanxi Changzhi Medical College from Jan. 2019 to Jun. 2021 were enrolled as the observation group, and 120 patients with senile osteoporotic fractures matched with gender, age and body mass index of the observation group were selected as the control group. The levels of blood calcium, blood phosphorus, alkaline phosphatase, 25-hydroxyvitamin D and other bone metabolism indexes of all subjects were recorded. The genotypes of rs10499194 and rs13207033 in TNFAIP3 gene were analyzed by capillary electrophoresis and fragment analysis (SNaPshot) . The mRNA relative expression level of TNFAIP3 gene in peripheral blood of all subjects was determined by quantitative real-time fluorescence quantitative polymerase chain reaction.Results:There were statistically significant differences in genotype distribution and gene frequency of RS10499194 and RS13207033 between the observation group and the control group ( P<0.05) . For rs10499194, CT genotype carriers had a significantly higher risk of fracture than wild-type CC genotype carriers [OR=3.253 (1.223-8.652) , P=0.014]. The dominant model was also statistically significant ( P=0.003) . For rs13207033, GA carriers had a significantly higher risk of fracture than wild-type GG carriers [OR=3.775 (1.192-11.952) , P= 0.016]. The dominant model was statistically significant ( P=0.009) . The blood calcium level in AA+GA group was significantly higher than that in GG group at rs13207033 site ( P=0.006) . The mRNA expression level of TNFAIP3 gene in the observation group was 1.41±0.09, which was significantly lower than that in the observation group (2.07±0.12, t=6.69, P<0.001) . TNFAIP3 mRNA expression level of rs10499194 site TT+CT group was 1.35±0.11, significantly lower than CC group 1.43±0.13 ( t=2.82, P=0.007) . Conclusion:The polymorphism of TN-FAIP3 gene is related to the occurrence of osteoporotic fractures and bone metabolism, and may affect the gene expression level.
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ABSTRACT Objective: To assess whether residents (R1, R2, or R3 - according to the year of residency) of a tertiary orthopedic service investigate, treat and/or refer the patient with osteoporotic fracture for osteoporosis (OP) treatment and whether this learning is improved over the years of residency. Methods: Residents answered diagnostic and therapeutic questions related to a clinical case of osteoporotic fracture (OF) in 4 settings, which were initial care in the emergency room, at discharge, during outpatient follow-up at 3 and 6 months. Responses were compared between years of residency. Results: Twenty R1, 21 R2, and 19 R3 raised the questions. One resident treated osteoporosis in R1, two in R2, and four in R3. Seventy-five percent of R1, 90.5% of R2, and 68% of R3 referred patients for OP treatment. Over the years, there has been improved prescribing lab tests for osteoporosis (p = 0.028), with 52.6% of third-year residents prescribing adequate lab tests. In the same period, 100% of R3 correctly prescribed prophylaxis for deep vein thrombosis (p = 0.001). Conclusion: There is learning, but not enough, for secondary prevention of FO. Level of Evidence I; Prospective Comparative Study.
RESUMO Objetivo: Avaliar se residentes (R1, R2 ou R3 - de acordo com o ano de residência) de um serviço ortopédico terciário, investigam, tratam e/ou encaminham o paciente com fratura osteoporótica para tratamento de osteoporose (OP) e se esse aprendizado é melhorado ao longo dos anos de residência. Métodos: Os residentes responderam a questões diagnósticas e terapêuticas relacionadas a um caso clínico de fratura osteoporótica (OF) em 4 cenários, que foram o atendimento inicial no pronto-socorro, no momento da alta hospitalar, durante o acompanhamento ambulatorial em 3 e 6 meses. As respostas foram comparadas entre os anos de residência. Resultado: Vinte R1, 21 R2 e 19 R3 levantaram as questões. Um residente tratou osteoporose em R1, dois em R2 e quatro em R3. Setenta e cinco por cento de R1, 90,5% de R2 e 68% de R3 encaminharam pacientes para tratamento com OP. Há melhora na prescrição de exames laboratoriais para investigação de osteoporose ao longo dos anos (p = 0,028) com 52,6% dos residentes do terceiro ano que prescrevem exames laboratoriais adequados. No mesmo período, 100% de R3 prescreveram corretamente a profilaxia para trombose venosa profunda (p = 0,001). Conclusão: Há aprendizado, porém insuficiente, para a prevenção secundária da FO. Nível de Evidência I; Estudo Prospectivo Comparativo.
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BACKGROUND: Percutaneous curved vertebroplasty is a modified surgical method of percutaneous vertebroplasty; the most prominent feature of which is that it can make the bone cement distributed symmetrically and balance the strength on both sides of the vertebral body. In theory, it can ensure the distribution of bone cement in the vertebral body, and solve the problem that the uneven distribution of bone cement in the traditional percutaneous vertebroplasty and single injection leads to poor pain relief effect in the fracture area. OBJECTIVE: To compare the clinical efficacy of percutaneous curved vertebroplasty and percutaneous vertebroplasty bone cement injection in the treatment of osteoporotic vertebral compression fractures, and to discuss the value of percutaneous curved vertebroplasty in clinical application. METHODS: Seventy patients with single vertebral osteoporotic vertebral compression fractures from the Third Affiliated Hospital of AnHui Medical University between 2017 and 2018 were selected. The patients were randomly divided into two groups. Percutaneous curved vertebroplasty group (n=35) received treatment with percutaneous curved vertebroplasty. Percutaneous vertebroplasty group (n=35) received treatment with percutaneous vertebroplasty. Distribution and leakage of bone cement were observed in the two groups. Visual analogue scale score and Oswestry disability index were assessed preoperatively and 1 day postoperatively. Postoperative follow-up was conducted for 1 year to observe the recovery of the height of the anterior edge of the injured vertebra and the occurrence of adjacent vertebral fractures. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) Compared with the percutaneous vertebroplasty group, the distribution of bone cement was more uniform and satisfactory (P0.05). (4) There was no significant difference in the incidence of adjacent vertebral fractures between the two groups (P>0.05). (5) The results showed that compared with the treatment of percutaneous vertebroplasty, the treatment of osteoporotic vertebral body compression fractures by percutaneous curved vertebroplasty can reduce the rate of bone cement leakage and improve the quality of life of patients.
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BACKGROUND: With the aging of population, brittle fracture diseases have attracted more and more attention from clinicians. Bone mineral density detection cannot meet the risk assessment of brittle fracture. As one of the new directions and methods to evaluate the risk of brittle fracture, cortical thickness has been studied and discussed by more and more scholars. OBJECTIVE: To explore the correlation of bone cortical thickness values and X-ray gray values in different planes of proximal femur with hip brittle fracture in women aged over 50 years old under X-ray DR photography, so as to evaluate the most appropriate measurement plane for predicting the risk of hip brittle fracture in women among different planes of proximal femur. METHODS: According to the inclusion criteria, relevant clinical data of 100 female patients aged over 50 years old who underwent X-ray DR pelvic radiograph examination at Department of Radiology of the Ninth Affiliated Hospital of Guangxi Medical University from July 2018 to June 2019 were collected. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The measurement planes of cortical thickness of the proximal femur were designed to be the middle part of femoral neck, within 1 cm above the lesser trochanter, and within 1 cm below the lesser trochanter, with a total of three groups of measurement planes. The gray value of X-ray was measured by taking the line between the middle point of the great rotor and the small rotor as the rectangular diagonal line to take the rectangular area for measurement. RESULTS AND CONCLUSION: (1) Women aged 50-64 years were as group A (n=50) and those aged 65 years and older were as group B (n=50). (2) The cortical thickness and X-ray gray value within 1 cm below the lesser trochanter, and within 1 cm above the lesser trochanter in the group B were significantly lower than those in the group A; fracture rate was higher in group A than in group B (P 0.05). (3) On the whole, cortical thickness values were highest in the within 1 cm below the lesser trochanter, followed by within 1 cm above the lesser trochanter and lowest in the middle part of the femoral neck (P 0.05). (5) The difference of cortical thickness within 1 cm below the lesser trochanter and within 1 cm above the lesser trochanter between fracture and non-fracture groups in the group A was significant (P 0.05). At the age above 50 years, the difference of cortical thickness and X-ray gray value in each measured plane between fracture and the non-fracture groups was significant (P < 0.05). (6) To conclude, the cortical thickness becomes thinner and the gray value of X-ray becomes smaller, and the possibility of brittle fracture of hip becomes higher. When assessing the risk of hip fracture in women aged over 50 years using cortical thickness of the proximal femur, measurement within 1 cm below the lesser trochanter is recommended.
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BACKGROUND: Percutaneous kyphoplasty (PKP) has become an effective method for the treatment of osteoporotic vertebral compression fractures, but the distribution of bone cement in the vertebral body can cause certain differences in postoperative clinical symptoms. OBJECTIVE: To investigate the clinical effect of bone cement distribution on the treatment of vertebral compression fractures in different sites after percutaneous kyphoplasty. METHODS: A retrospective analysis of eligible 339 patients with vertebral compression fractures at different sites who received treatment at the Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University from January 2017 to January 2019 were included in this study. These patients were aged 60-85 years. They were divided into a thoracic fracture group (n=144) and a lumbar fracture group (n=195). All patients received bone cement injection after percutaneous kyphoplasty. After surgery, the diffusion distribution of bone cement in the vertebral body was divided into I-V types in each group. Visual Analogue Scale score and Oswestry Disability Index were evaluated before surgery, and 3 days and 6 months after surgery. This study was approved by the Medical Ethics Committee, Affiliated Zhongshan Hospital of Dalian University, China. RESULTS AND CONCLUSION: (1) At 3 days and 6 months after surgery, Visual Analogue Scale score and Oswestry Disability Index were significantly decreased compared with before surgery (P 0.05). (3) At 6 months after surgery, there was no significant difference in Oswestry Disability Index between different distribution types of bone cement in the thoracic fracture group (P > 0.05). At 6 months after surgery, Visual Analogue Scale score in patients with types I, II and III bone cement distribution was significantly lower than in those with types IV and V bone cement distribution (P 0.05). At 6 months after surgery, Visual Analogue Scale score in patients with types I, II and III bone cement distribution was significantly lower than in that in patients undergoing types IV and V bone cement distribution (P < 0.05). (5) These results suggest that after percutaneous kyphoplasty, bone cement distributed in types I-III can lead to better pain relief than that distributed in other types.
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OBJECTIVE@#To investigate the influencing factors of hidden blood loss (HBL) during the treatment of percutaneous vertebroplasty (PVP).@*METHODS@#The clinical data of 125 patients with osteoporotic vertebral compression fractures (OVCFs) treated with percutaneous vertebroplasty from March 2016 to December 2017 were retrospectively analyzed. All patients underwent X rays of the AP and lateral lumbar spine, double oblique, and dynamic positions. Lumbar spine CT, MRI, and dual energy X ray bone densitometer (DXA) were used to confirm the diagnosis. There were 55 males and 70 females, 10 cases of thoracic vertebrae, 89 cases of thoracolumbar vertebrae, 26 cases of lumbar vertebrae, 87 cases with single segment, 29 cases with double segment,and 9 cases with 3 segments. The vertebral compression height ratios of 67 patients were less than 1 / 3, and the ratios for 41 patients were from 1 / 3 to 2 / 3,for 17 patients were more than 2 / 3. Blood routine examination were performed before and 3 days after surgery to analyze hidden blood loss and to explore its risk factors.@*RESULTS@#The average hidden blood loss was (317±156) ml in 125 patients. Multiple linear regression analysis revealed a history of diabetes(=0.011),surgical segments(=0.036),number of segments (<0.001),vertebral height loss rate (=0.002),vertebral height recovery rate (<0.001) and bone cement leakage rate (=0.003) were positively correlated with hidden blood loss. Moreover,it was found that the blood loss was higher in those with higher vertebral height loss rate than in those with lower vertebral height loss rate, and the blood loss was higher in those with good vertebral height recovery than those with poor vertebral height recovery. Additionally,the cement leakage was also an important factor in increasing hidden blood loss. However,there was no significant correlation between bone mineral density(=0.814) or history of hypertension(=0.055) and hidden blood loss.@*CONCLUSION@#Patients with OVCFs have a large amount of hidden blood loss after PVP treatment, which needs attention. At the same time, the history of diabetes, surgical segments, number of segments, bone cement leakage rate, vertebral height loss rate and vertebral height recovery rate are the risk factors for hidden blood loss.
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Female , Humans , Male , Bone Cements , Fractures, Compression , Osteoporotic Fractures , Retrospective Studies , Risk Factors , Spinal Fractures , Treatment Outcome , VertebroplastyABSTRACT
Distal femur fractures in elderly patients with osteoporosis are complicated because poor bone quality makes screw purchase and fixation less secure, presenting many clinical challenges to the orthopedic surgeon. Minimally invasive locked plating using an angularly stable locking compression plate has become an integral tool for achieving secure fixation in osteoporotic distal femur fractures with improved biomechanical performance. On the other hand, complications, such as implant failure and periplate fracture, have still occurred. This paper describes the principles of internal fixation in minimally invasive lateral locked plating in elderly patients with osteoporotic distal femur fractures as well as how to avoid complications.
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Aged , Humans , Femur , Hand , Orthopedics , Osteoporosis , Osteoporotic FracturesABSTRACT
PURPOSE: Studies on the incidence and mortality of refractures after primary osteoporotic fracture are limited by the relatively rare incidence of such refractures and small sample sizes. The objectives of this research were: 1) to determine the incidence of osteoporotic refractures and fracture locations and 2) to assess mortality rates associated with osteoporotic refracture over a median follow up of 3 years using nationwide claim database. MATERIALS AND METHODS: Patients over 50 years of age who had an osteoporotic fracture that was confirmed operationally were enrolled. Refracture was defined as that after 6 months of an untreated period. Mortality rate was calculated using the Charlson comorbidity index and was analyzed using Cox proportional hazards regression analysis. RESULTS: A total of 18956 first-time instances of osteoporotic fracture were reported between 2007 and 2012 after a median follow up of 3.1 years (range, 1 to 7 years). Among 18956 patients, 2941 (15.50%) experienced refracture. After follow up for 1 year, cumulative mortality rates for re-fracture and non-refracture groups were 9.1% and 7.2%, respectively. After adjusting for covriates, mortality rate was 1.2 times greater in patients with re-fracture than in patients without re-fracture over a median follow up of 3 years (hazard ratio: 1.20, 95% confidence interval: 1.08–1.34, p<0.001). CONCLUSION: The incidence of osteoporotic re-fracture in this nationwide study was 15.5%, and the mortality rate of re-fracture patients was 1.2 times higher than that of non-refracture patients over a median follow up of 3 years.
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Humans , Comorbidity , Follow-Up Studies , Incidence , Korea , Mortality , Osteoporotic Fractures , Sample SizeABSTRACT
Objective@#To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015. There were 54 males and 82 females, aged 55 to 83 years old, with an average age of 68.3 years. All the enrolled patients had single segment vertebral compression fractures, whose compression degree was ≥1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies. Among them, 59 patients were treated with simulated optimal reduction combined with PVP (PVP group), and 77 patients were treated with PKP (PKP group). The operation time, intraoperative fluoroscopy time, incidence of bone cement leakage, hospitalization cost and length of stay were compared between the two groups. Postoperative X-ray and CT examination were performed to observe bone cement diffusion. Before surgery and after surgery (1 day, 1 week, 1 month, 6 months, 1 year, 2 years and 3 years), Visual analogue scale (VAS) score, Oswestry disability index (ODI) scores, Cobb's angle, ratio of anterior and middle height of the affected vertebrae, and the incidence of vertebral refractures within 3 years were compared between the two groups.@*Results@#All the patients were followed up for 29-43 months, averaging 36 months. One patient in the PVP group was lost to follow-up after one year. In the PKP group, two patients were lost to follow-up after one year and one patient was lost to follow-up after two years. In the PVP group, single vertebral body operation time [(28.9±5.7)seconds] and intraoperative fluoroscopy time [(54.0±13.4)seconds] were significantly less than those in the PKP group, with statistically significant differences (P<0.01). The incidence of bone cement leakage in the two groups was 8.5% and 7.8%, respectively, with no significant difference (P>0.05). The hospitalization cost in the PVP group [(9.7±3.2)thousand yuan] was lower than that in the PKP group [(22.35±16.2)thousand yuan](P<0.01). The diffusion coefficient in PVP group (2.40±0.27) was higher than that in the PKP group (2.29±0.19) (P<0.01). In both groups, the fractured vertebral anterior height ratio, fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P<0.01), while there were no significant differences between the two groups (P>0.05). In both groups, the VAS and ODI were significant decreased after operation (P<0.01). Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5±0.8)points vs. (2.6±0.9)points, (2.7±0.3) points vs. (2.8±0.5)points, (2.8±0.6) points vs. (2.9±0.7)points] and ODI [(25.3±4.0 vs. 25.5±3.9, 25.8±4.1 vs. 27.5±4.0, 26.0±2.9 vs. 28.6±3.9)] at postoperative 1, 2 and 3 years, and there were no significant difference between the two groups at postoperative 1 day, 1 week, 1 month and 6 months (P>0.05). The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in the PKP group (0 vs. 1.3%)(P<0.01).@*Conclusion@#For OVCF, the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP, but the recovery of height of diseased vertebra and correction of kyphosis are better, with lower re-fracture rate of adjacent vertebra in the later stage.
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Objective To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF).Methods A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015.There were 54 males and 82 females,aged 55 to 83 years old,with an average age of 68.3 years.All the enrolled patients had single segment vertebral compression fractures,whose compression degree was ≥ 1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies.Among them,59 patients were treated with simulated optimal reduction combined with PVP (PVP group),and 77 patients were treated with PKP (PKP group).The operation time,intraoperative fluoroscopy time,incidence of bone cement leakage,hospitalization cost and length of stay were compared between the two groups.Postoperative X-ray and CT examination were performed to observe bone cement diffusion.Before surgery and after surgery (1 day,1 week,1 month,6 months,1 year,2 years and 3 years),Visual analogue scale (VAS) score,Oswestry disability index (ODI) scores,Cobb's angle,ratio of anterior and middle height of the affected vertebrae,and the incidence of vertebral refractures within 3 years were compared between the two groups.Results All the patients were followed up for 29-43 months,averaging 36 months.One patient in the PVP group was lost to follow-up after one year.In the PKP group,two patients were lost to follow-up after one year and one patient was lost to follow-up after two years.In the PVP group,single vertebral body operation time [(28.9 ± 5.7) seconds] and intraoperative fluoroscopy time [(54.0 ± 13.4)seconds] were significantly less than those in the PKP group,with statistically significant differences (P ＜ 0.01).The incidence of bone cement leakage in the two groups was 8.5％ and 7.8％,respectively,with no significant difference (P ＞ 0.05).The hospitalization cost in the PVP group [(9.7 t3.2) thousand yuan] was lower than that in the PKP group [(22.35 ± 16.2) thousand yuan] (P ＜ 0.01).The diffusion coefficient in PVP group (2.40 ± 0.27) was higher than that in the PKP group (2.29 ± 0.19) (P ＜ 0.01).In both groups,the fractured vertebral anterior height ratio,fractured vertebral middle height ratio and Cobb's angle were significantly improved after operation (P ＜ 0.01),while there were no significant differences between the two groups (P ＞0.05).In both groups,the VAS and ODI were significant decreased after operation (P ＜ 0.01).Better results were obtained in PVP group than the PKP group concerning the VAS [(2.5 ± 0.8) points vs.(2.6 ± 0.9) points,(2.7 ± 0.3) points vs.(2.8 ± 0.5) points,(2.8 ± 0.6) points vs.(2.9 ±0.7)points] and ODI [(25.3 ±4.0 vs.25.5 ±3.9,25.8 ±4.1 vs.27.5 ±4.0,26.0 ±2.9 vs.28.6 ±3.9)] at postoperative 1,2 and 3 years,and there were no significant difference between the two groups at postoperative 1 day,1 week,1 month and 6 months (P ＞ 0.05).The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in thePKP group (0 vs.1.3％) (P ＜ 0.01).Conclusion For OVCF,the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP,but the recovery of height of diseased vertebra and correction of kyphosis are better,with lower re-fracture rate of adjacent vertebra in the later stage.
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STUDY DESIGN: Retrospective and comparative study. PURPOSE: We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level. OVERVIEW OF LITERATURE: OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF. METHODS: Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient’s neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively. RESULTS: Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group. CONCLUSIONS: Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.
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ABSTRACT Objectives: To determine the proportion of traumatologists who investigate osteoporosis in elderly patients with fractures and recommend secondary prevention of osteoporotic fractures. Methods: We distributed questionnaires to 244 physicians attending the 2015 Brazilian Congress of Orthopedic Trauma. We determined the respondents' profiles and assessed how they investigated and treated osteoporosis in elderly patients with fractures. Results: Overall, 32% of the respondents reported that their knowledge level regarding osteoporosis ranged from 0-5 (out of 0-10). In total, 42% of the participants reported that they usually requested DXA for elderly patients with fractures and less than 30% reported prescribing supplemental calcium and/or vitamin D. We considered physicians conducting a complete treatment for the patient as those who in addition to requesting DXA prescribed supplemental calcium, vitamin D, and specific medications for their elderly patients, and recommended non-pharmacological measures. Only 0.8% of the participants fulfilled all these criteria. In addition, 47% of the traumatologists reported that they did not treat osteoporosis directly but instead, referred osteoporotic patients to a qualified physician. Conclusion: Less than 50% of the surveyed traumatologists investigated and performed secondary prevention against osteoporotic fractures after treating an elderly patient with a fracture. Level of evidence III, Economic and Decision Analyses - Developing an Economic or Decisions Model.
RESUMO Objetivo: Avaliar a proporção de traumatologistas que investigam a osteoporose nos pacientes idosos com fraturas e recomendam a prevenção secundária das fraturas osteoporóticas. Métodos: Distribuímos questionários para 244 médicos participantes do Congresso Brasileiro de Traumatología Ortopédica em 2015. Determinamos o perfil dos mesmos e avaliamos como os entrevistados investigam e tratam a osteoporose nos pacientes idosos com fraturas. Resultados: Entre os entrevistados, 32% relataram que seu nível de conhecimento sobre osteoporose seria algo entre 0 e 5 (de 0 a 10). No total, 42% dos participantes relataram que frequentemente solicitam DXA para pacientes idosos com fraturas, mas menos de 30% relataram prescrever suplementação com cálcio e/ou vitamina D. Consideramos como prescritores do tratamento completo para o paciente aqueles médicos que, além de solicitar DXA, prescrevem suplementação de cálcio, vitamina D e medicamentos específicos para seus pacientes idosos, além de recomendar medidas não farmacológicas. Apenas 0,8% dos participantes preencheram todos esses critérios. Além disso, 47% dos traumatologistas relataram que não tratam a osteoporose, mas encaminham seus pacientes com osteoporose para um médico que o faz. Conclusão: Menos de 50% dos traumatologistas pesquisados investigam e realizam prevenção secundária contra fraturas osteoporóticas após tratamento de paciente idoso com fratura. Nível de evidência III, Análises econômicas e de decisão - Desenvolvimento de modelo econômico ou de decisão.
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Owing to the increase in life expectancy, the incidence of osteoporotic fracture of the pelvis and acetabulum is increasing. Fractures in the elderly population is different from those in younger patients. Pelvic ring and acetabular fractures in geriatric patients are more likely the result of low-energy trauma, but the outcomes are generally poorer than those of the younger population. Multiple management options are available, but no intervention has become the standard of care for these fractures in the elderly. A treatment strategy should be established depending on the state of the individual patient. Regardless of whether nonsurgical or surgical treatment is selected, early ambulation should be considered to avoid the complications associated with prolonged immobilization.
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Aged , Humans , Acetabulum , Early Ambulation , Immobilization , Incidence , Life Expectancy , Osteoporotic Fractures , Pelvis , Standard of CareABSTRACT
Objective To investigate the the effects of geraniin on modulating the mRNA expression of corebinding factor α 1 (Cbfα 1). Methods The m RNA expressions of Cbfα 1 were detected by real time fluorescence quantitative PCR. Results As compared with the sham group, the expressions of Cbfα 1 mRNA were markedly suppressed in the model group, 12 and 24 w after OPF (P ＜ 0.05). Compared with the model group, geraniin significantly increased mRNA expressions of Cbfα 1. Conclusion Geraniin can upregulate Cbfα 1 gene expression and improve the treatment for OPF.
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@#Reduced muscle strength and quality of life (QoL) has an impact on adults at risk of osteoporotic fractures. Muscle strength and QoL among Malaysian adults at risk of osteoporotic fractures is not known. The aim of our study was to examine muscle strength and QoL status and its relationship among adults at low and moderate to high risk of osteoporotic fractures. In this cross-sectional study, we recruited 27 men and 78 women with mean age 69.3 ± 8.5 years from Orthopaedic Clinic, Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia. A 10-year probability of major osteoporotic fractures were calculated according to WHO fracture risk assessment tool (FRAX) with femoral neck BMD (cut-point 10%). Participants were categorized as low and moderate to high risk of osteoporotic fractures based on FRAX results. Back extensor muscle strength (BES) and dominant hand grip strength (HGS) was measured using a load cell system and a hand dynamometer respectively. European QoL questionnaire (EQ5Dvas) was used to measure QoL. Multiple linear regression was performed with QoL as a dependent variable and back extensor muscle strength and hand grip strength as the independent variables. Approximate 40% of adults were categorized into moderate to high risk of osteoporotic fractures. The mean values among the low and moderate to high risk of osteoporotic fractures for QoL was 80.5 ± 13.2 and 76.9 ± 16.9 (p = 0.77); hand grip strength was 25.7 ± 17.3 and 20.6 ± 5.5 kg (p < 0.001) and back extensor strength was 25.0 ± 7.0 and 18.9 ± 9.5 Newton (p < 0.01) respectively. Hand grip muscle strength appeared to be a determinant of QoL and accounted for 5.8% of the total variance. Improved muscle strength may lead in better QoL among adults at risk of osteoporotic fractures.
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ABSTRACT Objective: To identify the prevalence of osteoporosis and hypovitaminosis D among patients at the Siriraj Metabolic Bone Disease (MBD) Clinic, and to compare initial vitamin D levels in patients with and without a history of fragility fractures. Methods: Medical records of patients who attended our MBD clinic between 2012 and 2015 were retrospectively reviewed. Patient baseline demographic, clinical, bone mineral density (BMD), and laboratory data were collected and analyzed. Osteoporosis was diagnosed when patients had a BMD T-score <-2.5 or presented with fragility fractures. Results: There were 761 patients included in this study. Of these, 627 patients (82.4%) were diagnosed with osteoporosis and 508 patients (66.8%) had fragility fractures. Baseline serum 25-hydroxyvitamin D (25(OH)D) levels were available in 685 patients. Of these, 391 patients (57.1%) were diagnosed with hypovitaminosis D. When evaluated only in patients with fragility fractures, the average initial 25(OH)D level was 28.2±11.6 ng/mL, and the prevalence of hypovitaminosis D was 57.6%. Conclusion: A high prevalence of osteoporosis and hypovitaminosis D was found among patients at our clinic; two-thirds of patients had a history of fragility fractures, and no difference in initial 25(OH)D levels was seen between patients with and without fragility fractures. Level of Evidence III, Retrospective Study .
RESUMO Objetivo: Identificar a prevalência de osteoporose e hipovitaminose D entre os pacientes na Siriraj Metabolic Bone Disease (MBD) Clinic e comparar o nível inicial de vitamina D em pacientes com e sem história de fratura por fragilidade óssea. Métodos: Os prontuários de pacientes atendidos em nossa clínica MBD durante o período de 2012 a 2015 foram analisados retrospectivamente. Os dados demográficos, clínicos, densidade mineral óssea (DMO) e os dados laboratoriais basais foram coletados e analisados. A osteoporose foi diagnosticada quando os pacientes tinham DMO com escore T≤ -2,5 ou fraturas por fragilidade óssea. Resultados: Foram incluídos 761 pacientes dos quais, 627 pacientes (82,4%) foram diagnosticados com osteoporose e 508 (66,8%) tinham fraturas por fragilidade. O nível sérico basal de 25-hidroxivitamina D (25(OH)D) estava disponível para 685 pacientes. Desses, 391 pacientes (57,1%) foram diagnosticados com hipovitaminose D. Quando avaliado apenas em pacientes com fratura por fragilidade óssea, o nível inicial médio de 25(OH)D foi de 28,2 ± 11,6 ng/ml e a prevalência de hipovitaminose D foi de 57,6%. Conclusão: Encontrou-se alta prevalência de osteoporose e hipovitaminose D entre os pacientes de nossa clínica, sendo que dois terços deles tinham história de fratura por fragilidade óssea e nenhuma diferença no nível basal de 25(OH)D entre pacientes com e sem fratura por fragilidade. Nível de Evidência III, Estudo Retrospectivo
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OBJECTIVE: We aimed to analyze the applicability of a fracture risk assessment tool for the prediction of osteoporotic fractures in middle-aged and elderly healthy Chinese adults. METHODS: A standard questionnaire was administered, and bone mineral density was measured in residents visiting the Dongliu Street Community Health Service Center. Paired t-tests were used to compare the FRAX-based probabilities of fractures estimated with and without consideration of bone mineral density. Risk stratification and partial correlation analyses were applied to analyze the associations between FRAX-based probabilities and body mass index or bone mineral density at different sites. RESULTS: A total of 444 subjects were included in this study. Of these subjects, 175 (39.59%) were diagnosed as osteoporotic, and 208 (47.06%) were diagnosed as osteopenic. The Kappa value for the detection of osteoporosis at the L1-L4 lumbar spine and femoral neck was 0.314. The FRAX-based 10-year major osteoporotic fracture probability and hip osteoporotic fracture probability estimated without considering bone mineral density were 4.93% and 1.64%, respectively; when estimated while considering bone mineral density, these probabilities were 4.97% and 1.54%, respectively. A significant positive association was observed between the FRAX-based fracture probabilities estimated with and without consideration of bone mineral density, while significant negative associations between body mass index and the estimated FRAX-based fracture probabilities after adjustment for age and the estimated FRAX-based fracture probabilities and femoral neck bone mineral density were identified. These results remained the same after controlling for lumbar spine bone mineral density. CONCLUSIONS: The Chinese FRAX model could predict osteoporotic fracture risk regardless of whether bone mineral density was considered and was especially appropriate for predicting osteoporotic fractures of the femoral neck.