Humeral fractures due to low-energy trauma: an epidemiological survey in patients referred to a large emergency department in Northern Italy.

UNLABELLED: This survey describes the epidemiology of approximately 1800 low-energy humeral fractures seen in a large emergency department in Northern Italy over 7 years (2007-2013), highlighting the differences from previous Italian studies. PURPOSE: The purpose of this study was to determine the incidence of humeral fractures due to low-energy trauma in patients 40 years of age or older referred to a large Emergency Department (Parma, Northern Italy) in a 7-year period (2007-2013). METHODS: All humeral fractures referred to the emergency department of the Academic Hospital of Parma (the main hospital in the province with a catchment area of approximately 345,000) were retrieved from the hospital database using both ICD-9CM codes and text strings. The diagnosis of humeral fracture due to low-energy trauma was confirmed by medical records and X-ray reports, after exclusion of injuries due to a clear-cut high-energy trauma or cancer. RESULTS: The query identified 1843 humeral fractures (1809 first fractures), with a clear predominance in women (78 %). Fractures of the proximal humerus represented the large majority of humeral fractures (more than 85 %), with an incidence progressively increasing with age (more than 60-fold in women and 20-fold in men). Simultaneous fractures (hip in particular) were frequent especially after 85 years of age (1 out of 8 cases). When compared to other Italian studies, the incidence of humeral fractures was significantly lower than that derived from discharge data corrected for hospitalization rate (standardized rate ratio 0.74; p < 0.001), while the pattern of age-related changes was significantly different from that computed by applying the ratio between hip and humeral fractures observed in Malmö, Sweden, to the Italian hip fracture rates. CONCLUSIONS: This study gives an up-to-date description of the epidemiology of low-energy humeral fractures in Italy. Our results partly differ from previous Italian studies based on indirect estimations.

Hospital admission rates for distal forearm fractures: an epidemiological survey in patients referred to a large emergency department in Northern Italy.

UNLABELLED: In this survey, the proportion of patients with distal forearm fractures admitted to the Parma University Hospital during 2012 (13 %) was relatively low and generally lower than that reported in other studies. In our region, the main orthopedic approach remains conservative. PURPOSE: The purpose of this study was to define the ratio between hospitalized and non-hospitalized fragility fractures of the distal forearm in our province (Parma, Northern Italy). METHODS: All forearm fractures referred during 2012 to the emergency department of the Parma University Hospital (the main hospital in the province with a catchment area of approximately 345,000) were retrieved from the hospital database using both ICD-9-CM codes and text strings. The diagnosis of distal forearm fracture due to low-energy trauma and the need for hospitalization were individually confirmed by medical records and X-ray reports. The analysis was limited to subjects aged 40 years and over. RESULTS: In both sexes combined, 66 subjects out of 505 were hospitalized (13.1 %; confidence interval (CI) 95 % 10.4-16.3 %), 47 immediately (8.1 %) and 25 (5 %) after a few days. The percentage of cases hospitalized was 12 % in women (CI 95 % 9.2-15.6 %) and 17 % in men (CI 95 % 11.1-25 %; p = 0.16). CONCLUSIONS: The percentage of fragility distal forearm fractures hospitalized in our area is relatively low and generally lower than that reported in other studies.

Longitudinal changes of trabecular bone score after estrogen deprivation: effect of menopause and aromatase inhibition.

PURPOSE: To examine the effects of the menopausal transition and treatment with aromatase inhibitors (AI) on trabecular bone score (TBS, a newly proposed index of bone architecture derived from DXA vertebral scans) and vertebral bone mineral density (BMD). METHODS: Retrospective cohort study on 29 women who became postmenopausal during a mean follow-up of 2.9 years (MP group) and 34 women treated with AI during a mean follow-up of 2.1 years (AI group). BMD was measured by DXA and TBS with a specific software. RESULTS: TBS decreased after menopause, but the change was significantly lower than that of the lumbar BMD (-4.6 vs. -6.8 %; mean difference: 2.2 %; p = 0.016). An even larger difference was observed in the AI group (-2.1 vs. -5.9 %; mean difference: 3.8 %; p = 0.002). CONCLUSIONS: The decrease of TBS induced by menopause or treatment with AI is significantly lower than that of lumbar BMD.