Identifying predictive factors for vertebral collapse fractures in multiple myeloma patients.

BACKGROUND CONTEXT: Vertebral compression fractures (VCFs) are a common complication for patients with multiple myeloma. These fractures are associated with significant morbidity and mortality due to severe back pain, spinal instability, increased risk of new fractures, neurologic dysfunction, and other physical symptoms. PURPOSE: To identify risk factors associated with the development of VCFs which may help to predict them in future patients. STUDY DESIGN: A retrospective multicenter cohort study. PATIENT SAMPLE: Patients with multiple myeloma diagnosed between 2012 and 2018 and appropriate baseline- and follow-up imaging studies (>6 months after diagnosis) were included. OUTCOME MEASURES: Individual odds ratios for each of the fifteen potential risk factors including patient factors and radiographical characteristics. METHODS: Relevant clinical baseline data were extracted from the patient charts. Computed tomography (CT) scans were used to score all radiographic variables. VCFs were graded following the Genant grading system. General Linear Mixed Models were used to analyze risk factors associated with vertebral fractures. RESULTS: A total of 143 patients with 1,605 eligible vertebrae were included in the study with a mean follow-up time of 25 months. Mean age at diagnosis was 65 years and 39% were female. Among 1,605 vertebrae, there were 192 (12%) VCFs (Genant grade 1 or higher) at the time of diagnosis and 111 (7%) occurred during follow-up. In a General Linear Mixed Model, significant predictors were gender (odds ratio [OR]=1.5), International Staging System stage 2 and 3 (OR=3.6 and OR=4.1 respectively), and back pain (OR=2.7). Furthermore, lower Hounsfield Unit score, lytic lesions and abnormal alignment were risk factors for (the development of) VCFs. CONCLUSIONS: This study investigated both patient characteristics and vertebra-specific risk factors for VFCs in multiple myeloma patients. The factors found in this study might be useful for identifying patients at higher risk of VFCs to help clinical management to prevent vertebral collapse and the development of spinal deformities.

Patterns of orodental injury and mouthguard use in Dutch field hockey.

BACKGROUND: Orodental injuries in field hockey are a growing cause of concern that requires attention. OBJECTIVE: The objective of this cross-sectional study was to investigate the patterns of orodental injury, and the use of mouthguards in Dutch national field hockey. MATERIALS AND METHODS: In the period from 1 May to 31 July 2014, a 33-item questionnaire about orodental injury and mouthguard use was sent to 7 field hockey clubs in the Netherlands. Data were analysed using 2 multivariable logistic (non-)linear regression per outcome measurement: (1) orodental injury and (2) type of mouthguard. RESULTS: Out of 6585 players, 1299 (20%) responded sufficiently and were eligible for the study. In total, 214 hockey players (16%) experienced at least 1 orodental injury in their career. The injuries were less severe in athletes who wore a mouthguard during an accident than in those who did not, OR=2.1 to 3.3, p≤0.05. Players without mouthguard sustained broken and knocked out teeth more frequently, while players with a mouthguard had more lip cuts (p≤0.05). Players complained less about custom-made than about mouth-moulded mouthguards (p≤0.05). Also, males were more at risk for an orodental injury, OR=1.4 (95% CI 1.0 to 1.9), and were less likely to have a custom-made mouthguard, OR=0.7 (95% CI 0.6 to 0.9), than females. CONCLUSIONS: A substantial number of field hockey players suffers from orodental injury. Mouthguards should be included in prevention strategies as they are associated with less severe injuries and patterns of injury are to be taken into account when targeting specific groups.

Dentofacial trauma and players' attitude towards mouthguard use in field hockey: a systematic review and meta-analysis.

BACKGROUND: Dentofacial injuries are a risk while playing field hockey. Wearing mouthguards is recommended. OBJECTIVE: To synthesise findings on the prevalence and characteristics of dentofacial injuries sustained by field hockey players. We also investigated the prevalence of regular mouthguard use and players' attitude towards use of mouthguard. MATERIAL AND METHODS: A literature search was performed using PubMed, EMBASE, OvidSP, Web of Science, Cochrane and Cinahl databases. Eligible studies were identified based on the title, abstract and full text of articles. If applicable, a random effects model was used to calculate the overall effect size; otherwise, pooled prevalence was reported. RESULTS: 11 studies were eligible for the analysis. The average proportion of field hockey players who had sustained at least one dentofacial injury varied from 12.7% (95% CI 8.5% to 17.0%) among junior and senior players to 45.2% (95% CI 39.3% to 51.0%) among elite players. We did not observe any significant differences with respect to gender. In the 2000s, a significantly higher proportion of players regularly wore a mouthguard, 84.5% (95% CI 69.3% to 99.7%) as compared with players 20 years ago, 31.4% (95% CI 22.7% to 40.1%). The most common complaints about the mouthguard were that it was unnecessary and uncomfortable. CONCLUSION: Dentofacial injuries pose a serious problem in field hockey and a substantial number of players do not regularly wear a mouthguard. Greater use of mouthguards would be expected to reduce dentofacial injuries in field hockey.