Clinical inertia in thyrotropin suppressive therapy for low-risk differentiated thyroid cancer: A real-world experience at an endocrine center in Bangkok.

The management of low-risk differentiated thyroid cancer (DTC) has evolved over time toward treatment de-escalation. However, overtreatment with supraphysiological dose of levothyroxine (LT4) continues to be observed despite current clinical guideline. This study aimed to assess the actual thyrotropin suppressive therapy for low-risk DTC patients at an endocrine center in Bangkok. This retrospective study included patients with low-risk DTC who were regularly follow-up for at least 18 months at Theptarin Hospital between 2016 and 2022. The serum thyroid stimulating hormone (TSH) levels were stratified as TSH < 0.1 mIU/L; TSH 0.1 to 0.5 mIU/L; TSH 0.5 to 2.0 mIU/L; and TSH > 2.0 mIU/L. The initial risk stratification (IRS) and dynamic risk stratification were determined at 12 months of follow-up after completing the initial treatment and at the last visit. The clinical factors associated with overtreatment with LT4 were analyzed. A total of 102 patients (83.3% female, age at diagnosis 41.8 ±â€…13.6 years, mean tumor size 1.6 ±â€…1.0 cm) were evaluated with a mean follow-up of 5.9 years. The IRS classified 92.2% of patients after the initial treatment and 93.1% of patients at the last follow-up visit into the excellent response category. The mean LT4 daily dosage at the last follow-up was 121.3 ±â€…44.8 µg/day. Serum TSH levels were in an appropriate target range according to IRS in only 8.8% (9/102) of the patients and then improved to 19.6% (20/102) at the last follow-up visit. Further analysis showed that treating physicians with ≥10 years of practice was associated with severe TSH suppression therapy (TSH < 0.1 mIU/L). Despite the current clinical guideline recommendations and scientific evidences, less than one-fifth of low-risk DTC patients achieved the appropriate serum TSH target. While the proportion of an optimum LT4 suppressive had improved during the study period, further efforts are needed to overcome this clinical inertia.

Profile of Levothyroxine Replacement Therapy in Graves' Disease Patients with Hypothyroidism Post-Radioactive Iodine Ablation: Focus on Different Weight-Based Regimens.

Objective: To evaluate the status of euthyroidism achieved among Thai patients with post-ablative hypothyroidism and to examine the difference between various weight-based daily levothyroxine (LT4) replacement regimens in these patients. Methodology: We conducted a retrospective review of Thai patients with Graves' disease (GD) who developed hypothyroidism following radioactive iodine treatment from 2016 to 2020 at Theptarin hospital. Daily LT4 dose was calculated based on actual body weight (ABW), ideal body weight (IBW), and estimated lean body mass (LBM). Results: We reviewed a total of 271 patient records. Of these, 81.2% were females with a mean age of 40.8±11.7 years, LT4 intake duration of 27.1±14.6 months, and LT4 dose/kg ABW of 1.4±0.5 µg/kg/day. At the final follow-up, 62.4% of patients achieved thyroid-stimulating hormone (TSH) levels within the reference interval, 15.5% had TSH levels over, and 22.1% had TSH levels under the reference range. Obese patients required a lower daily LT4 dose relative to ABW and higher daily LT4 dose relative to IBW to attain euthyroidism (ABW 1.1±0.4 µg/kg/day and IBW 2.0±0.8 µg/kg/day). Estimated daily LT4 dose based on LBM showed a constant dosage of 2.0 µg/kg/day in all BMI categories. Conclusions: Suboptimum LT4 replacement therapy was found in almost half of hypothyroid patients with GD treated with radioactive iodine. Estimated LBM was a better indicator for dosing calculation in these patients compared with ABW and IBW.

Recurrence Factors and Characteristic Trends of Papillary Thyroid Cancer over Three Decades.

BACKGROUND: The prevalence of thyroid cancer is rising worldwide. Although thyroid cancer has a favorable prognosis, up to 20% of patients experienced recurrent disease during the follow-up period. The present study aimed to examine the trend of incidence and factors associated with recurrence and outcomes of papillary thyroid cancer (PTC) in Thai patients over the last 30 years. METHODS: We reviewed the clinical data of all patients with PTC who were treated between 1987 and 2019 at Theptarin Hospital. Clinical characteristics, epidemic trend, factors associated with the persistence/recurrence of the disease, overall disease-specific survival rate, and overall disease-free survival rate were analysed. RESULTS: A total of 235 patients with PTC who were registered between 1987 and 2019 were reviewed. The mean age was 42.5 ± 14.3 years, with a mean follow-up of 9.5 years. Papillary thyroid microcarcinoma (PTMC) was consistently increased and accounted for 21.4% (50/235) of total cases. The American Thyroid Association (ATA) risk stratification was high in 24% of all PTMCs in the last decade, and 16.0% of these patients experienced local recurrence during the follow-up period. Coexistence with Hashimoto's thyroiditis (HT) was found in one-fifth of the patients with PTC and was correlated with a low recurrence rate (HR: 0.16, P=0.013). Only age ≥55 years associated with the persistence/recurrence of the disease. The overall disease-free survival and disease-specific survival rates were 77.4% and 98.3%, respectively. CONCLUSIONS: The prognosis of PTC is generally considered favorable. However, approximately one-fourth of patients with PTMC demonstrated more aggressive clinical behavior, particularly in the last decade of the study. Coexistence of HT contributed to a better prognosis.

Impacts of the American Joint Committee on Cancer (AJCC) 8th edition tumor, node, metastasis (TNM) staging system on outcomes of differentiated thyroid cancer in Thai patients.

BACKGROUND: In 2018, the American Joint Committee on Cancer (AJCC) 8th edition (AJCC8) was introduced to replace the previous version (AJCC7) due to superiority of AJCC8 over AJCC7 for better prediction of survival from thyroid cancer. AIM: To compare AJCC staging systems with the American Thyroid Association (ATA) risk classification for the prediction of 5-year disease-free survival (DFS), and 5-year disease-specific survival (DSS) in Thai patients. METHODS: We retrospectively reviewed all patients with histopathologic diagnosis of DTC who were treated at Theptarin Hospital, Bangkok, Thailand from 1987 to 2019. RESULTS: The study cohort included 262 differentiated thyroid cancer (DTC) patients (papillary thyroid cancer 89.7% with a median time of follow-up 7.8 years). The number (%) of patients within each stage group by AJCC7 and AJCC8 respectively are as follows: Stage I: 173 (66.0%) vs. 232 (88.5%), Stage II: 33 (12.6%) vs. 24 (9.2%), Stage III: 36 (13.7%) vs. 2 (0.8%), Stage IV: 20 (7.7%) vs. 4 (1.5%). The ATA high risk group was found in 24.3% of AJCC7 Stage I compared with 23.7% of AJCC8 Stage I. The 5-year DFS rates in patients classified as stages I, II, III, and IV by AJCC8 were 87.9%, 45.8%, 0% and 25%, respectively. The 5-year DSS rates in patients classified as stages I, II, III and IV by AJCC8 were 98.7%, 100%, 100% and 0%, respectively. AJCC8 was more predictive of DFS rate than AJCC7. CONCLUSIONS: Our study is in accord with previous studies that AJCC8 downstage a significant percentage of patients with DTC and correlated with better prognostic validity. However, even a person at low risk for mortality can be at high risk for recurrence.

Practice patterns and outcomes in the management of Thai patients with Graves' disease.

BACKGROUND: The treatment of hyperthyroid Graves' disease (GD) varies considerably among geographic areas. In this study, we aimed to evaluate practice patterns and treatment outcomes in Thai patients with hyperthyroid GD. METHODS: A retrospective cohort study over 35 years (1985-2019) in patients with hyperthyroid GD was conducted. The trends of treatment options were compared periodically during the study period and the overall remission rate from each option was determined. RESULTS: A total of 2736 hyperthyroid GD patients were treated and followed-up for at least 3 months over the study period (female 82.0%, mean age at diagnosis 36.3 ± 12.0 years, median duration of follow-up 74.5 months). Anti-thyroid drug (ATD) was the most commonly used treatment (78.0%), followed by RAI (21.0%), and surgery (1.0%). There was a significant downward trend for surgery, from 12.3% in the 1980s to only 0.2% in last phase of the study period. The preference for RAI therapy has also decreased in the last 5 years. Among ATD-treated patients, the remission rate was achieved only in 30.7 and 16.0% of all ATD-treated patients were eventually treated with RAI. Spontaneous hypothyroidism developed in 2.7% of the ATD-treated patients during a follow-up period. Almost all RAI-treated patients (97.1%) developed hypothyroidism. CONCLUSIONS: Our present study highlighted the changing landscape of primary treatments for hyperthyroid GD toward ATD and the sharp downward trend in the surgical option. Even though ATD was associated with a low remission rate, it was preferred by many patients and physicians. The use of RAI as the primary treatment decreased in the last decade. However, RAI was a very effective treatment for Graves' hyperthyroidism but will inevitably induce hypothyroidism and a requirement for life-long replacement therapy.

Serum T3 Level and Duration of Minimum Maintenance Dose Therapy Predict Relapse n Methimazole-Treated Graves Disease.

BACKGROUND: Methimazole (MMI) has been advocated as a preferred option for most Graves disease (GD) patients. However, long-term remission after a course of MMI treatment is achieved in only 20% to 40% of patients, depending on the duration of follow-up. OBJECTIVE: To evaluate clinical factors for predicting relapse of GD in Thai patients after MMI treatment. METHODS: A retrospective analysis was performed of newly diagnosed patients with GD who achieved remission of hyperthyroid GD after at least 12 months of MMI treatment. Long-term outcomes were assessed and predictive factors of early and late relapse were evaluated. RESULTS: A total of 443 patients with newly diagnosed GD who were treated with MMI for at least 12 months from 1985 to 2019, and were able to discontinue medication, were studied. The mean age at diagnosis was 37.0 ±â€…11.4 years and 81.7% were female. Of the 320 patients (72.2%) who achieved initial remission after MMI treatment for 23 months, 106 patients (33.1%) experienced late relapse during the mean follow-up duration of 9.7 years after MMI withdrawal. The remission rates decreased from 36.4% at the first year after stopping MMI to only 20.7% at 10 years. High initial serum triiodothyronine (T3) level and duration of minimum maintenance dose therapy (MMDT) of <6 months were associated with late disease relapse after remission. CONCLUSION: The long-term remission rate of Graves hyperthyroidism was achieved in one-fifth of MMI-treated Thai patients. Predictive markers for late relapse included high initial serum T3 level and a duration of MMDT of <6 months.

Impact of first-line treatment choice on long-term outcomes of hyperthyroid Graves' disease patients with thyrotoxic periodic paralysis.

BACKGROUND: Thyrotoxic periodic paralysis (TPP) is a unique manifestation of Graves' disease. While it is uncommon in Asian, it is extremely rare in Caucasian patients (0.1-0.2%). Previous studies suggested that TPP indicate more severity of Graves' disease and definitive treatments should be used to prevent relapses. AIM: To describe clinical features and impact of first-line treatment on long-term outcomes of TPP patients. METHOD: A retrospective cohort study over 35 years (1985-2019) of TPP from Graves' disease patients was conducted. All cases were analyzed and their clinical courses were compared between those who received anti-thyroid drugs (ATD) versus radioactive iodine (RAI) as a primary treatment. None of them underwent surgery. RESULTS: A total of 2964 hyperthyroid Graves' disease patients were treated and followed-up at least 3 months over the study period. TPP was identified in 63 cases (2.1%) of all patients. There were 60 males and only 3 females with age at presentation of 35.0 ± 8.2 years. TPP was the first presentation of hyperthyroid Graves' disease in 82.5% of them. During the acute attack of TPP, all patients presented with bilateral lower limb flaccid weaknesses with median serum potassium of 2.1 mmol/L. No fatal TPP cases were found. RAI was selected as primary treatment in 27 patients (42.9%). Nearly all RAI-treated patients rendered hypothyroidism with the median RAI dose at 15 mCi. No patients who were in remission after RAI treatment developed recurrent attack of TPP. In the remaining 36 ATD-treated patients with mean follow-up time at 9.1 years, relapse was found in 10 patients (27.8%) after the drug discontinuation and 6 patients suffered recurrent TPP. Only 8 ATD-treated TPP patients (22.2%) went into remission. CONCLUSIONS: TPP is a rare complication of hyperthyroid Graves' disease. Definitive treatment with RAI or thyroidectomy should be employed to prevent relapse and further attacks of TPP.

The Association between Daytime Napping Characteristics and Bone Mineral Density in Elderly Thai Women without Osteoporosis.

Low bone mass is more prevalent with increasing age. Studies have found associations between sleep duration, sleep quality and obstructive sleep apnea and bone mineral density (BMD). However, less is known about the relationship between daytime napping and BMD. We aimed to investigate the association between daytime napping and BMD in elderly Thai women. Demographic data, lifestyle information and sleep characteristics were obtained by interviewing 387 elderly women. Weight and height were measured. Serum 25-hydroxyvitamin D [25(OH)D] was measured by radioimmunoassay. BMD was measured by dual-energy X-ray absorptiometry (DXA). Higher BMI and having type 2 diabetes (T2DM) were correlated with higher lumbar spine 2-4 (L2-4) BMD, while younger age, higher BMI and higher serum 25(OH)D level were correlated with higher femoral neck (FN) and total hip (TH) BMD. After adjusting for age, age at menopause, BMI, 25(OH)D level and T2DM, a higher frequency of weekly daytime napping was associated with lower FN and TH BMD but not at L2-4 BMD. Additionally, longer daytime napping duration was negatively associated with BMD at TH. In summary higher frequency and longer duration of daytime napping are associated with lower femoral BMD in elderly women. Mechanisms underlying these associations should be further explored.

Prevalence of sarcopenia and associated factors among Thai population.

The purpose of this study was to determine the prevalence of sarcopenia using the skeletal muscle index (SMI) criteria in the Thai population. The secondary objective was to demonstrate factors influencing low SMI in this population. Femoral neck bone mass density (BMD) was measured by dual-energy X-ray absorptiometry (GE Lunar, Madison, WI, USA) in 435 urban and 397 rural subjects (334 men and 498 women) between 20 and 84 years of age. Body mass index (BMI) was calculated from weight and height. The respective prevalence of sarcopenia among men and women was 35.33 % (95 % CI, 29.91, 40.41) and 34.74 % (95 % CI, 30.56, 39.10). Factors associated with sarcopenia using multiple logistic regression analyses in both sexes were (a) living in the city, (b) higher BMI, and (c) older age. Living in an urban area was the strongest factor, with an odds ratio (OR) of 17.26 ± 7.12 (95 % CI, 7.68, 38.76) in men and 8.62 ± 2.74 (95 % CI, 4.62, 16.05) in women (p < 0.05). The prevalence rate ratio for persons living in urban compared to rural areas was 2.01 (95 % CI, 1.14, 3.53) in men and 1.69 (95 % CI, 1.31, 2.17) in women (p < 0.05). Sarcopenia, as based on SMI, occurs frequently in the Thai population and increases with age. The prevalence of sarcopenia is particularly high among pre-retirement women (50-59 years of age) whereas the number of men with sarcopenia gradually rises with age. An urban environment is the most predictive factor for sarcopenia, followed by high BMI and age. Given the aging population, early recognition of this condition can be beneficial for prevention of an epidemic of sarcopenia-related disability.

Prevalence of vitamin D insufficiency and low bone mineral density in elderly Thai nursing home residents.

BACKGROUND: Numerous emerging data from research on osteoporosis among Asians found differences from Caucasians. Therefore, the aim of this study was to determine the prevalence of vitamin D insufficiency and osteoporosis in elderly participants from two nursing homes in Thailand, a country located near the equator. METHODS: The subjects of this cross-sectional study comprised 93 elderly Thai women who were living in institutional long-term nursing homes for the aged. Demographic data, daily food and calcium intake, physical activity, and sunlight exposure were measured. Lumbar spine and femoral neck bone mineral density (BMD) and biochemical levels including serum 25 hydroxyvitamin D [25(OH)D] and bone turnover markers were assessed. Vitamin D insufficiency was defined as 25(OH)D level < 70 nmol/l. RESULTS: The mean age of subjects was 75.2 ± 6.0 (SD) years. Dietary calcium intake was low (322 ± 158 mg/day) The mean 25(OH)D level was 64.3 ± 14.9 nmol/L and the prevalence of vitamin D insufficiency was 38.7% (95% CI: 28.8%, 49.4%). There was no correlation between serum 25(OH)D concentrations and age (r = -.11, p = 0.3). The mean BMD of lumbar spine and femoral neck were 0.92 ± 0.19 and 0.65 ± 0.10 g/cm2, respectively. Nearly a half of the subjects had osteopenia (44.1%, 95% CI: 33.8%, 54.8%) and osteoporosis (47.3%, 95% CI: 36.9%, 57.9%). Circulating C-terminal telopeptide of type I collagen (CTx) level correlated significantly with both lumbar spine (r = -0.26, p = 0.01) and femoral neck BMD (r = -0.25, p = 0.02). CONCLUSIONS: More than one-third of Thai elderly women residing in nursing homes had vitamin D insufficiency. Almost all nursing home residents had osteoporosis and/or osteopenia.

Asymptomatic Paget's bone disease in ethnic Thais: a series of four case reports and a review of the literature.

Paget's bone disease is quite common in some parts of Europe and countries inhabited by European emigrants, but it is rare in Asia. There have been only 13 reported cases in Southeast Asia, including one reported case from Thailand. Half of the previously reported cases had bone symptoms and the other half were asymptomatic, but were incidentally discovered when patients were being investigated for other medical problems. Here are reported cases of four asymptomatic patients who presented elevation of serum alkaline phosphatase during routine annual medical checkups. All patients were of Chinese descent and all cases were proven by biopsy. Based on this experience, we are of the opinion that a substantial number of unrecognized cases of Paget's disease exist among ethnic Thais. We feel that they would be revealed if clinicians were alerted of its presence and if they included it as a possible diagnosis together with metastasis and osteoporosis when examining bone lesions or when results for elevated serum alkaline phosphatase are detected during routine checkups. We also anticipate that a higher prevalence of this disease may occur in future Thai generations due to the addition of offspring from Asian-European intermarriages to offspring of Chinese descent in the ethnic Thai population.

Use of in vivo gene expression of isolated bone marrow mesenchymal stromal cells to study the pathophysiology of osteoporosis in patients with severe thalassemia.

We compared osteoblast differentiation gene expressions in the isolated CD105 mesenchymal stromal cells from bone marrow in 10 patients with severe thalassemia and 12 normal donor controls. The fold expressions of osteoblast differentiation genes of CD105 cells from patients with thalassemia were lower than those of normal donors but increased after being cultured in Dulbecco's modified Eagle's medium with 10% fetal calf serum. Moreover, the fold expressions of these genes of CD105 cells from normal donors when cultured with 10% pooled serum of patients with thalassemia were lower than when cultured with 10% pooled serum of normal donors. We have also presented the evidence of reversible suppressed expression of these genes in CD105cells from patients with thalassemia when cultured in pooled serum of normal donors. Moreover, healthy donor CD105 cells exhibited lower expression of these genes when cultured in pooled serum of patients with thalassemia compared with pooled serum of normal donors indicating the existence of circulating factors in thalassemic serum impairing the differentiation of mesenchymal stromal cells to osteoblasts.

Vitamin D status and bone health in healthy Thai elderly women.

OBJECTIVE: The prevalence of hypovitaminosis D varies in different countries. Therefore, the current study was designed to assess vitamin D status and bone health in elderly women in Thailand, which is situated near the equator. METHODS: This cross-sectional study was performed in 446 healthy women aged 60-97 y. RESULTS: Serum 25-hydroxyvitamin D (25(OH)D) was 67.6 ± 15.7 (mean ± SD) nmol/L. Daily calcium intake was 309.5 ± 147.2 mg/d. Serum 25(OH)D levels tended to decline with bone mineral density (BMD) status. Based on functional health-based reference values, plasma-intact parathyroid hormone began to rise below serum 25(OH)D level 70 nmol/L and increase significantly when serum 25(OH)D was ≤ 60 nmol/L. Thirty-two percent of elderly women had 25(OH)D insufficiency (≤ 60 nmol/L). There was no trend toward a decrease in the concentration of serum 25(OH)D with age (r = -0.078, P = 0.10) and no significant inverse relationship with plasma intact parathyroid hormone values (r = -0.079, P = 0.097). However, a positive relationship was observed between serum 25(OH)D level and femoral neck BMD (r = 0.156, P = 0.001) but not lumbar spine L(2)-L(4) BMD (r = 0.093, P = 0.050). In addition, BMD at the femoral neck but not lumbar spine of the vitamin D insufficiency group was significantly lower than that of the vitamin D sufficiency group. CONCLUSION: The optimum level of serum 25(OH) value in Thai elderly women should be higher than 70 nmol/L. Vitamin D insufficiency is observed in one-third of elderly women in Bangkok.

Genetic variant in the aquaporin 9 gene is associated with bone mineral density in postmenopausal women.

This study investigated whether single nucleotide polymorphisms (SNP) in the aquaporin 9 (AQP9) gene is associated with bone mineral density (BMD) in Thai postmenopausal women, after an initial genome-wide screening using high-throughput SNP genotyping in pooled DNA samples. Subjects consisted of 516 postmenopausal women aged 50 or more. High-throughput SNP screening was performed by comparing the estimated allele frequency derived from hybridization signal intensities of pooled DNA samples on the Affymetrix 500 K SNP genotyping chip set. The SNP was then genotyped for each subject individually. Data were expressed as mean ± SEM. Pooled DNA SNP screening revealed the allele frequency of an intronic A/T SNP rs2414539 in the AQP9 gene as being different between subjects with femoral neck BMD in tertiles 1 and 3. Individual genotyping in all subjects revealed that femoral neck BMD in subjects with TT, TA, and AA genotypes were 0.79 ± 0.06 (n = 3), 0.75 ± 0.01 (n = 98), and 0.71 ± 0.01 g/cm(2) (n = 415), respectively. The presence of the T allele in rs2414539 was associated with femoral neck BMD (r = 0.11, P < 0.05) but not with lumbar spine BMD. The relationship was still significant after controlling for body weight and age (P < 0.05). Genetic variation in the AQP9 gene is associated with femoral neck BMD in postmenopausal women, and may represent one of the susceptibility genes for phenotypes related to bone mass.

Discrepant influence of vitamin D status on parathyroid hormone and bone mass after two years of calcium supplementation.

OBJECTIVE: To investigate the influence of vitamin D status on parathyroid hormone and bone mass after a 2-year supplementation of calcium alone. PATIENTS AND METHODS: Randomized, double-blind, placebo-controlled clinical trial, in healthy postmenopausal women without osteoporosis: three hundred and thirty-six subjects aged 60-97 years were studied and randomized to receive elemental calcium 500 mg/day (n = 175) or placebo (n = 161) for 2 years. MEASUREMENTS: Changes in parathyroid hormone (PTH) and bone mineral density (BMD) from baseline and vitamin D status. Values are presented as means +/- SD. RESULTS: After 2 years, subjects with calcium supplementation had significant decrease in plasma PTH level (4.4 +/- 1.7 vs 4.7 +/- 1.9 pmol/l, P < 0.01), improved lumbar BMD (1.031 +/- 0.12 vs 1.004 +/- 0.12 g/cm(2), P < 0.001) and total hip BMD (0.890 +/- 0.10 vs 0.883 +/- 0.10 g/cm(2), P < 0.001) without change in femoral neck BMD. In the placebo group, PTH level significantly increased (4.8 +/- 1.6 vs 4.5 +/- 1.5 pmol/l, P < 0.001), lumbar BMD slightly increased (1.027 +/- 0.14 vs 1.018 +/- 0.14 g/cm(2), P < 0.001), total hip and femoral neck BMD decreased (0.876 +/- 0.11 vs 0.887 +/- 0.11 g/cm(2), P < 0.001 and 0.783 +/- 0.10 vs 0.798 +/- 0.10 g/cm(2), P < 0.001, respectively). When subjects were classified according to baseline 25-hydroxyvitamin D [25(OH)D] levels into those with 25(OH)D in the lower tertile (lowVitD) and those in the middle and upper tertiles combined (normVitD). The degree of PTH suppression after calcium supplementation was significantly higher in the normVitD compared to the lowVitD groups (-5.6 +/- 26.7%vs 1.3 +/- 27.2%, P < 0.05). No effect of vitamin D status on the change in lumbar BMD after calcium supplementation was demonstrated. Despite the higher suppression of PTH, there was a slight decrease in femoral neck BMD after calcium supplementation in the normVitD group while femoral neck BMD was more or less maintained in the lowVitD group (-0.6 +/- 3.2%vs 0.5 +/- 2.9%, P < 0.05). CONCLUSION: Calcium supplementation appears to affect femoral bone mass less in Thai postmenopausal women with adequate vitamin D status, despite higher suppression of PTH.

A comparative study of risk factors of femoral neck and intertrochanteric fracture in Thai men.

OBJECTIVE: The objective of this study was to compare the risk factors related to hip fracture between intertrochanteric fracture and femoral neck fracture in Thai men. MATERIAL AND METHOD: The study was conducted in Bangkok and its vicinity from July 1997 to September 1998. The cases were recruited and matched with the controls by age and sex. Multilogit model was performed for finding the significant factors associated to each type of hip fracture. RESULTS: There were 73 femoral neck fractures, 144 intertrochanteric fractures, and 177 controls. It was found that both types of hip fracture were associated with the physical activity and the cerebrovascular accident. However, the Chinese parent race was significantly related to the femoral neck only (adjusted odds ratio (OR) 2.59, 95% confidence interval (CI): 1.21, 5.54) whereas the walking disability was specifically associated with the intertrochanteric fracture (adjusted OR 3.23, 95% CI: 1.29, 8.08). CONCLUSION: Types of hip fracture should be concerned for strategic prevention in men since they have significant difference of risk factors.

Different risk magnitudes of femoral neck and intertrochanteric fractures in Thai women.

OBJECTIVE: To study the risk factors associated of femoral neck and intertrochanteric fractures in Thai women. MATERIAL AND METHOD: A case,control study was conducted in Bangkok and its vicinity between 1997 and 1998 to compare factors related to each type of hip fracture in Thai women. Cases, aged > or =51 years old, were diagnosed as intertrochanteric or femoral neck fracture and were matched with controls by age and sex. Multinomial logistic regression was performed for significant associated factors. RESULTS: Recent physical activity and steroid-containing traditional medicine were strongly associated with intertrochanteric fractures (adjusted odds ratio (OR) 0.17 (95% CI: 0.07, 0.42) and 6.50 (95% CI: 1.93, 21.82), respectively) when compared to femoral neck fractures. Cerebrovascular accident (CVA) was more related to femoral neck fractures when compared to intertrochanteric fractures (adjusted OR 8.63 (95% CI: 2.28, 32.66), and 4.79 (95% CI: 1.19, 19.29), respectively). CONCLUSION: Intertrochanteric fracture could be minimized more by encouraging physical activities and avoidance of steroid use while the reduction of femoral neck fracture should be achieved more by CVA prevention.