Evaluación de los factores relacionados con la aparición de nuevas fracturas por fragilidad: un estudio de casos y controles / Evaluation of factors related to the occurrence of new fragility fractures: A case–control study

Introducción: Las fracturas por fragilidad (FF) son frecuentes en pacientes osteoporóticos. Existen una serie de factores de riesgo y variables clínicas, que podrían predecir su aparición. Material y método: Se realizó un estudio observacional retrospectivo de casos y controles. Los casos estuvieron definidos por la presencia de una FF (326 participantes) y los controles por pacientes de similares características sin FF (629 participantes). Resultados: Ciertos factores aumentan el riesgo de FF, como un diagnóstico previo de DM tipo 2 (OR: 2,001), las elevaciones de 1ng/mL del CTX (OR: 1,88), tener antecedentes parentales de fractura de cadera (OR: 1,667), el aumento en 5 años en la edad (OR: 1,39) y los incrementos de 1kg/m2 del IMC (OR: 1,041). Por el contrario, otros factores evaluados disminuyen ese riesgo, como mantener unos niveles de 25(OH)D≥30ng/mL (OR: 0,686) y una T-score≥−2,5 (OR: 0,642). Conclusiones: Niveles de 25(OH)D≥30ng/mL y una T-score en el cuello femoral≥−2,5 son factores protectores de las FF, mientras que el diagnóstico previo de DM tipo 2, un CTX elevado, el antecedente parental de fractura de cadera, un incremento de 1kg/m2 del IMC y el aumento de la edad en 5 años serían predisponentes a padecer FF.(AU)

Introduction: Fragility fractures (FF) are frequent in osteoporotic patients. There are a series of risk factors and clinical variables that could predict their appearance. Material and method: A retrospective observational study of cases and controls was carried out. Cases were defined by the presence of FF (326 participants) and controls by patients with similar characteristics without FF (629 participants). Results: Certain factors increase the risk of FF, such as a previous diagnosis of type 2 DM (OR: 2.001), 1ng/mL elevations of CTX (OR: 1.88), having a parental history of hip fracture (OR: 1.667), 5-year increase in age (OR: 1.39), and 1kg/m2 increases in BMI (OR: 1.041). In contrast, other factors evaluated decreased this risk, such as maintaining 25(OH)D levels≥30ng/mL (OR: 0.686) and a T-score≥−2.5 (OR: 0.642). Conclusions: Levels of 25(OH)D≥30ng/mL and a T-score at the femoral neck≥−2.5 are protective factors for FF, while a previous diagnosis of type 2 DM, an elevated CTX, a parental history of hip fracture, an increase of 1kg/m2 in BMI and an increase in age by 5 years would be predisposing to FF.(AU)

[Translated article] Evaluation of factors related to the occurrence of new fragility fractures: A case–control study / Evaluación de los factores relacionados con la aparición de nuevas fracturas por fragilidad: un estudio de casos y controles

Introduction: Fragility fractures (FF) are frequent in osteoporotic patients. There are a series of risk factors and clinical variables that could predict their appearance. Material and method: A retrospective observational study of cases and controls was carried out. Cases were defined by the presence of FF (326 participants) and controls by patients with similar characteristics without FF (629 participants). Results: Certain factors increase the risk of FF, such as a previous diagnosis of type 2 DM (OR: 2.001), 1ng/mL elevations of CTX (OR: 1.88), having a parental history of hip fracture (OR: 1.667), 5-year increase in age (OR: 1.39), and 1kg/m2 increases in BMI (OR: 1.041). In contrast, other factors evaluated decreased this risk, such as maintaining 25(OH)D levels≥30ng/mL (OR: 0.686) and a T-score≥−2.5 (OR: 0.642). Conclusions: Levels of 25(OH)D≥30ng/mL and a T-score at the femoral neck≥−2.5 are protective factors for FF, while a previous diagnosis of type 2 DM, an elevated CTX, a parental history of hip fracture, an increase of 1kg/m2 in BMI and an increase in age by 5 years would be predisposing to FF.(AU)

Introducción: Las fracturas por fragilidad (FF) son frecuentes en pacientes osteoporóticos. Existen una serie de factores de riesgo y variables clínicas, que podrían predecir su aparición. Material y método: Se realizó un estudio observacional retrospectivo de casos y controles. Los casos estuvieron definidos por la presencia de una FF (326 participantes) y los controles por pacientes de similares características sin FF (629 participantes). Resultados: Ciertos factores aumentan el riesgo de FF, como un diagnóstico previo de DM tipo 2 (OR: 2,001), las elevaciones de 1ng/mL del CTX (OR: 1,88), tener antecedentes parentales de fractura de cadera (OR: 1,667), el aumento en 5 años en la edad (OR: 1,39) y los incrementos de 1kg/m2 del IMC (OR: 1,041). Por el contrario, otros factores evaluados disminuyen ese riesgo, como mantener unos niveles de 25(OH)D≥30ng/mL (OR: 0,686) y una T-score≥−2,5 (OR: 0,642). Conclusiones: Niveles de 25(OH)D≥30ng/mL y una T-score en el cuello femoral≥−2,5 son factores protectores de las FF, mientras que el diagnóstico previo de DM tipo 2, un CTX elevado, el antecedente parental de fractura de cadera, un incremento de 1kg/m2 del IMC y el aumento de la edad en 5 años serían predisponentes a padecer FF.(AU)

[Translated article] Evaluation of factors related to the occurrence of new fragility fractures: A case-control study.

INTRODUCTION: Fragility fractures (FF) are frequent in osteoporotic patients. There are a series of risk factors and clinical variables that could predict their appearance. MATERIAL AND METHOD: A retrospective observational study of cases and controls was carried out. Cases were defined by the presence of FF (326 participants) and controls by patients with similar characteristics without FF (629 participants). RESULTS: Certain factors increase the risk of FF, such as a previous diagnosis of type 2 DM (OR: 2.001), 1ng/mL elevations of CTX (OR: 1.88), having a parental history of hip fracture (OR: 1.667), 5-year increase in age (OR: 1.39), and 1kg/m2 increases in BMI (OR: 1.041). In contrast, other factors evaluated decreased this risk, such as maintaining 25(OH)D levels≥30ng/mL (OR: 0.686) and a T-score≥-2.5 (OR: 0.642). CONCLUSIONS: Levels of 25(OH)D≥30ng/mL and a T-score at the femoral neck≥-2.5 are protective factors for FF, while a previous diagnosis of type 2 DM, an elevated CTX, a parental history of hip fracture, an increase of 1kg/m2 in BMI and an increase in age by 5 years would be predisposing to FF.

Evaluation of factors related to the occurrence of new fragility fractures: A case-control study. / Evaluación de los factores relacionados con la aparición de nuevas fracturas por fragilidad: un estudio de casos y controles.

INTRODUCTION: Fragility fractures (FF) are frequent in osteoporotic patients. There are a series of risk factors and clinical variables that could predict their appearance. MATERIAL AND METHOD: A retrospective observational study of cases and controls was carried out. Cases were defined by the presence of FF (326 participants) and controls by patients with similar characteristics without FF (629 participants). RESULTS: Certain factors increase the risk of FF, such as a previous diagnosis of type 2 DM (OR: 2.001), 1ng/mL elevations of CTX (OR: 1.88), having a parental history of hip fracture (OR: 1.667), 5-year increase in age (OR: 1.39), and 1kg/m2 increases in BMI (OR: 1.041). In contrast, other factors evaluated decreased this risk, such as maintaining 25(OH)D levels≥30ng/mL (OR: 0.686) and a T-score≥-2.5 (OR: 0.642). CONCLUSIONS: Levels of 25(OH)D≥30ng/mL and a T-score at the femoral neck≥-2.5 are protective factors for FF, while a previous diagnosis of type 2 DM, an elevated CTX, a parental history of hip fracture, an increase of 1kg/m2 in BMI and an increase in age by 5 years would be predisposing to FF.

Validation of the Munich Swallowing Score (MUCSS) in patients with neurogenic dysphagia: A preliminary study.

BACKGROUND: The Munich Swallowing Score (MUCSS) is a clinician rated scale for the assessment of the functional level of swallowing saliva/secretions, food and liquids. The MUCSS consists of two eight-point subscales, MUCSS-Saliva and MUCSS-Nutrition. In a previous article, content validity and interrater reliability were described. OBJECTIVE: The aim of the present study was to investigate criterion validity and sensitivity to change of the MUCSS. METHODS: The research was conducted at a tertiary care academic hospital. Data were collected retrospectively in a cohort of 100 acute and subacute neurologic patients. Criterion validity was judged by comparison to the Gugging Swallowing Screen (GUSS), the Barthel Index (BI), Early Rehabilitation Barthel Index (ERI), Extended Barthel Index (EBI) and also by comparison to three physiological scales drawn from FEES videos: The Penetration - Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale (YPR) and the Murray Secretion Scale (MSS). Changes in oral intake and saliva swallowing were followed up for three months. RESULTS: Between MUCSS and scores directly reflecting dysphagic symptoms (GUSS, PAS, YPR, MSS, ERI), strong to moderate correlations were found, weaker but statistically significant associations were seen with global measures of disability (BI isolated, EBI-subscale cognitive functions). MUCSS was sensitive to positive change of saliva swallowing and oral intake during the recovery period. CONCLUSIONS: These preliminary data suggest that the MUCCS is a valid scale and may be appropriate for documenting clinical change in swallowing abilities of patients with neurogenic dysphagia.

[Bilateral superior oblique palsy and botulinum toxin]. / Parálisis bilateral IV par y toxina botulínica.

PURPOSE: To study the effectiveness of botulinum toxin in the treatment of bilateral acquired oblique superior palsy. MATERIAL AND METHOD: Five patients with bilateral asymmetrical acquired superior oblique palsy were treated with periodical injections of botulinum toxin in the inferior oblique and rectus muscles (2.5-5 U). The average age of the sample was 37.4 years. A trauma etiology was present in four cases. Treatment was applied at two months after the beginning of the illness in two cases, at four months in another two cases, and at one year in the other patient. RESULTS: A good result was achieved in three of the cases with botulinum toxin. Two patients required surgery. All of the patients were injected in the inferior obliques, and two cases were also injected in the inferior rectus. The number of injections ranged between four and six applications. It was considered to be a good result when diplopia was corrected in reading and primary position, and torticollis disappeared. Diplopia was not corrected in extreme lateral gazes and supraversion in two cases. CONCLUSIONS: Periodical botulinum toxin injections represent an alternative management to surgery in the treatment of bilateral acquired oblique palsy. In some cases botulinum toxin injections can prevent or decrease the number of surgical interventions

Values and limitations of pharyngolaryngoscopy (transnasal, transoral) in patients with dysphagia.

During the last decade, videoendoscopic evaluation of structures and sensorimotor functions of the pharynx and larynx has been established as a valuable tool in the assessment of dysphagia. This method is feasible at a very early stage and in critically ill patients, is not invasive and frequently repeatable. Several authors described the high sensitivity and specificity of this method in detecting the presence of the most important symptoms of swallowing dysfunction: retention, penetration and aspiration. In our study of 39 patients with neurogenic dysphagia, we found high agreement between the results of videoendoscopic and videofluoroscopic examination regarding the registration of the most critical symptom, i.e. aspiration. Moreover, we observed patients who aspirated only their saliva and whose endoscopically verified aspiration problem remained undetected by radiographic examination, probably due to the lower sensory input of saliva as compared to a contrast medium. Since the detection of aspiration of saliva is of high clinical relevance for pulmonary function, the endoscopic examination turned out to be superior, in this particular respect, to the radiographic examination. However, the method fails to provide sufficient information regarding the cause of the observed symptoms or the amount of aspirated material. Six patients in our study exhibited, in addition to the neurological signs, structural changes (diverticula, pouches) or unexpected functional esophageal disturbances (persistent opening of the upper esophageal sphincter, retrograde peristalsis) which could only be detected by radiographic examination. The two methods should therefore be considered complementary.

Long-term functional outcome in patients with neurogenic dysphagia.

OBJECTIVE: The purpose of this prospective cohort study was: (1) to document and investigate long-term post-treatment outcome focusing on swallowing disability; and (2) to reveal variables predicting successful functional follow-up results in 63 patients with neurogenic dysphagia. All patients were admitted to an inpatient neurologic rehabilitation unit. MAIN OUTCOME MEASUREMENTS: Information was gathered through chart review and questionnaires. Functional outcome was categorized according to the degree of feeding status: (1) total tube feeding; (2) oral and tube feeding combined; (3) oral feeding with compensation; and (4) total oral feeding. 'Improvement' was determined as a positive shift in the type of feeding, 'deterioration' as a negative shift and 'no change' was defined as remaining at the same nutritional level. The safety of feeding was assessed by tracking the occurrence of pneumonia. RESULTS: Seventy percent of the patients achieved an improved immediate outcome after therapy. During long-term follow-up examinations, 43% of all patients showed further improvement, 57% did not show any change in their feeding ability and no deterioration was reported for any patient. Comparisons of the relative frequencies of the feeding modalities before and after therapy revealed a significant reduction in tube feeders and a significant increase in oral feeders with compensation during inpatient-treatment. The outpatient-interval showed a significant shift in total oral feeders without compensations but no significant improvement within the tube feeders and within the partial oral feeders. The improvement in nutritional status was not associated with an increased risk of pneumonia. Additional comparisons of the relative frequencies of the compensatory strategies indicated a significant reduction in all treatment techniques at final follow-up. Using logistic regression, predictors of successful post-discharge outcome involved a decreasing pre-treatment interval and unexpectedly low Barthel-ADL mobility scores. CONCLUSIONS: As a result we advocate regular follow-up controls using videofluoroscopic and/or videoendoscopic examination. This facilitates comparisons of swallowing efficiency with and without compensation in order to reduce compensatory strategies as early as possible. The analysis of predictive variables suggests early use of therapy to enhance the chances of successful long-term outcome.

Swallowing therapy of neurologic patients: correlation of outcome with pretreatment variables and therapeutic methods.

The results of swallowing therapy in 58 patients with neurologic disorders are presented. All patients received tube feeding, either partially or exclusively, at admission, and successful outcomes, defined as exclusively oral feeding, were achieved in 67% of patients over a median treatment interval of 15 weeks. A subset of 11 patients who had experienced disease onset 25 weeks or more prior to admission nonetheless had a similar success rate of 64%. No other pretreatment variable, including age, localization of lesion, type or degree of aspiration, or cognitive status, correlated with successful outcome. Indirect therapy methods such as stimulation techniques and exercises to enhance the swallowing reflex, alter muscle tone, and improve voluntary function of the orofacial, lingual, and laryngeal musculature were utilized in all but 1 patient. Direct methods including compensatory strategies such as head and neck positioning, and techniques such as supraglottic swallowing and the Mendelsohn maneuver were additionally employed in nearly one-half of patients. Swallowing therapy is associated with successful outcome, as defined by exclusively oral feeding, among patients with neurogenic dysphagia, regardless of pretreatment variables including time since disease onset. Indirect treatment methods appear to be effective when used either alone or in combination with direct methods. Achievement of oral feeding is not associated with undue risk of pneumonia. Further rigorous scientific studies are needed.

Swallowing therapy in patients with neurological disorders causing cricopharyngeal dysfunction.

The results of swallowing therapy in 28 patients with neurological disorders causing cricopharyngeal (CP) dysfunction are reported. Variables described include the type of swallowing disorder, type and degree of aspiration, and therapeutic strategies. Patients were monitored by cineradiography before, during, and after therapy. Success of therapy was defined by progress in type, ease and safety of feeding, and range of diet. As an example, a case of an unusually severe disorder of a CP opening subsequent to brainstem meningoencephalitis is described. The bedside clinical evaluation, otolaryngologic findings, and radiographic studies helped determine an individualized program of swallowing therapy. Therapy goals, direct and indirect therapeutic strategies, and the treatment outcome are presented. Ninety percent of patients with CP dysfunction improved with swallowing therapy, 65% by objective and 25% by subjective criteria. We conclude that in neurological patients with CP, dysfunction can effectively be treated with swallowing therapy and that surgical approaches to CP dysfunction should be deferred pending the outcome of conservative management.