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Sample records for absolute fracture risk

  1. External Validation of the Garvan Nomograms for Predicting Absolute Fracture Risk: The Tromsø Study

    OpenAIRE

    Ahmed, Luai A; Nguyen, Nguyen D; Åshild Bjørnerem; Joakimsen, Ragnar M; Lone Jørgensen; Jan Størmer; Dana Bliuc; Center, Jacqueline R; Eisman, John A.; Nguyen, Tuan V; Nina Emaus

    2014-01-01

    BACKGROUND: Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort. METHODS: The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were dete...

  2. Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Vestergaard, Peter; Rud, Bo;

    2006-01-01

    In the non-HRT arms of the DOPS study, 10-year fracture risk was higher at each level of T score than predicted by the Kanis algorithm. Under-reporting of fractures in registers and inclusion of HRT users are probable explanations for inappropriately low fracture risk estimates for younger women....... We validated the 2001 Kanis risk algorithm using incident fractures observed in untreated women in the first 10 years of the Danish Osteoporosis Prevention Study (DOPS). Comparisons were also made with the relative risks derived from a recent meta-analysis of 12 cohort studies. MATERIALS AND METHODS...... score and by 1.30 (95% CI, 1.06; 1.58) for each unit decrease in lumbar spine T score at baseline. Absolute fracture risk was higher than expected from the Kanis algorithm at all T score levels. The difference was greatest for participants in the higher range of T scores. At T = -1, the observed risk...

  3. External validation of the Garvan nomograms for predicting absolute fracture risk: the Tromso study.

    Directory of Open Access Journals (Sweden)

    Luai A Ahmed

    Full Text Available BACKGROUND: Absolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort. METHODS: The analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed. Reclassification analysis was used to compare the models performance. RESULTS: The incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women to 3.1 times (men higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008 in women and 17.2% (p = 0.001 in men for osteoporotic fractures, and 13.3% (p = 0.07 in women and 17.5% (p = 0.09 in men for hip fracture. CONCLUSIONS: The Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction.

  4. Prediction of absolute risk of fragility fracture at 10 years in a Spanish population: validation of the WHO FRAX ™ tool in Spain

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    Solà Sílvia

    2011-01-01

    Full Text Available Abstract Background Age-related bone loss is asymptomatic, and the morbidity of osteoporosis is secondary to the fractures that occur. Common sites of fracture include the spine, hip, forearm and proximal humerus. Fractures at the hip incur the greatest morbidity and mortality and give rise to the highest direct costs for health services. Their incidence increases exponentially with age. Independently changes in population demography, the age - and sex- specific incidence of osteoporotic fractures appears to be increasing in developing and developed countries. This could mean more than double the expected burden of osteoporotic fractures in the next 50 years. Methods/Design To assess the predictive power of the WHO FRAX™ tool to identify the subjects with the highest absolute risk of fragility fracture at 10 years in a Spanish population, a predictive validation study of the tool will be carried out. For this purpose, the participants recruited by 1999 will be assessed. These were referred to scan-DXA Department from primary healthcare centres, non hospital and hospital consultations. Study population: Patients attended in the national health services integrated into a FRIDEX cohort with at least one Dual-energy X-ray absorptiometry (DXA measurement and one extensive questionnaire related to fracture risk factors. Measurements: At baseline bone mineral density measurement using DXA, clinical fracture risk factors questionnaire, dietary calcium intake assessment, history of previous fractures, and related drugs. Follow up by telephone interview to know fragility fractures in the 10 years with verification in electronic medical records and also to know the number of falls in the last year. The absolute risk of fracture will be estimated using the FRAX™ tool from the official web site. Discussion Since more than 10 years ago numerous publications have recognised the importance of other risk factors for new osteoporotic fractures in addition to

  5. [Absolute risk fracture prediction by risk factors validation and survey of osteoporosis in a Brussels cohort followed during 10 years (FRISBEE study)].

    Science.gov (United States)

    Body, J J; Moreau, M; Bergmann, P; Paesmans, M; Dekelver, C; Lemaire, M L

    2008-09-01

    Osteoporosis is a major public health problem. For the time being, the diagnosis of osteoporosis relies on densitometry (T-score 3 months), tabagism and excessive alcohol consumption. A WHO taskforce has combined these different factors in order to integrate them in a 10-years predictive risk model of fracture (FRAX**). This model should still be validated in different populations, especially in populations not included in its development, which is the case for Belgium. We are evaluating these different risk factors for fracture in a Brussels population of 5000 women (60-80 years) who will be followed each year during 10 years. We also assess the predictive value of other risk factors for fracture not included in the WHO model (tendency to fall, use of sleeping pills, early non substituted menopause, sedentarity, ...). In an interim analysis of the first 452 women included and with data yet available at the time of this writing, we could find a significant (P 70 years, a personal history of fracture after 50 years and a BMI < 20. PMID:18949979

  6. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: w.j.pontefract@sheffield.ac.uk; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)

    2009-09-15

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  7. Cumulative Alendronate Dose and the Long-Term Absolute Risk of Subtrochanteric and Diaphyseal Femur Fractures: A Register-Based National Cohort Analysis

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia Agnete; Eastell, Richard

    2010-01-01

    = 2.62-6.05). The HR for hip fracture was 1.37 (95% CI = 1.30-1.46)) in women and 2.47 (95% CI = 2.07-2.95) in men. Risks of subtrochanteric/diaphyseal fracture were similar in patients who had received 9 yr of treatment (highest quartile) and patients who had stopped therapy after the equivalent of 3...

  8. Variance computations for functional of absolute risk estimates

    OpenAIRE

    Pfeiffer, R. M.; E. Petracci

    2011-01-01

    We present a simple influence function based approach to compute the variances of estimates of absolute risk and functions of absolute risk. We apply this approach to criteria that assess the impact of changes in the risk factor distribution on absolute risk for an individual and at the population level. As an illustration we use an absolute risk prediction model for breast cancer that includes modifiable risk factors in addition to standard breast cancer risk factors. Influence function base...

  9. Variance computations for functional of absolute risk estimates.

    Science.gov (United States)

    Pfeiffer, R M; Petracci, E

    2011-07-01

    We present a simple influence function based approach to compute the variances of estimates of absolute risk and functions of absolute risk. We apply this approach to criteria that assess the impact of changes in the risk factor distribution on absolute risk for an individual and at the population level. As an illustration we use an absolute risk prediction model for breast cancer that includes modifiable risk factors in addition to standard breast cancer risk factors. Influence function based variance estimates for absolute risk and the criteria are compared to bootstrap variance estimates.

  10. Relative and absolute risk in epidemiology and health physics

    International Nuclear Information System (INIS)

    The health risk from ionizing radiation commonly is expressed in two forms: (1) the relative risk, which is the percentage increase in natural disease rate and (2) the absolute or attributable risk which represents the difference between the natural rate and the rate associated with the agent in question. Relative risk estimates for ionizing radiation generally are higher than those expressed as the absolute risk. This raises the question of which risk estimator is the most appropriate under different conditions. The absolute risk has generally been used for radiation risk assessment, although mathematical combinations such as the arithmetic or geometric mean of both the absolute and relative risks, have also been used. Combinations of the two risk estimators are not valid because the absolute and relative risk are not independent variables. Both human epidemiologic studies and animal experimental data can be found to illustrate the functional relationship between the natural cancer risk and the risk associated with radiation. This implies that the radiation risk estimate derived from one population may not be appropriate for predictions in another population, unless it is adjusted for the difference in the natural disease incidence between the two populations

  11. Identifying individuals at risk for fracture in Guatemala.

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    Keaton M Nasser

    Full Text Available INTRODUCTION: The FRAX calculator combines a set of clinical risk factors with country-specific incidence rates to determine the ten-year absolute risk of major osteoporotic fracture. However, regional or country-specific databases from Central American countries are not available. We compared the use of various FRAX databases and the Pluijm algorithm in determining risk of fracture. METHODS: We collected clinical risk factor data needed for the FRAX calculator and Pluijm algorithm of Hispanic women in Guatemala and calculated the FRAX absolute risk measures of major osteoporotic fracture and hip fracture. Subjects were postmenopausal women greater than age 40 with no history of using medication that affect bone. A random sample of 204 women in 34 different regions women in Guatemala City was visited in their homes to complete the surveys. The Pluijm risk score and FRAX risk score using the US Hispanic, Spain, and Mexican databases were calculated. RESULTS: We used the US NOF guidelines for treatment which suggest a treatment threshold for patients with a 10-year hip fracture probability ≥ 3% or a 10-year major osteoporotic fracture risk ≥ 20%. The number of patients meeting the suggested threshold limits for treatment using the Spain and Mexico calculators were identical. There was 100% conformity in threshold limits for both hip and major osteoporotic fracture risk. The mean conformity for any fracture risk between US Hispanic and the other two databases was 97.5%. Conformity was 99.0% based on major osteoporotic fracture and 97.5% based on risk of hip fracture. The Pluijm evaluation shows conformity of 87.2% and 83.3%, respectively, when compared to the US Hispanic and Spain/Mexico FRAX thresholds for risk of fracture. DISCUSSION: Although the different FRAX databases provide variations in the absolute risk of fracture, the overall conformity to treatment thresholds amongst the US Hispanic, Spain, and Mexico databases show the database

  12. Fracture risk assessed by Fracture Risk Assessment Tool (FRAX) compared with fracture risk derived from population fracture rates

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Abrahamsen, Bo; Hermann, Anne Pernille;

    2011-01-01

    Purpose: To evaluate the performance of the Swedish version of Fracture Risk Assessment Tool (FRAX)) without bone mass density (BMD) in a Danish population to examine the possibility of applying this version to Danish women. METHODS: From the Danish National Register of social security numbers, we...... randomly selected 5000 women living in the region of Southern Denmark aged 40-90 years to receive a mailed questionnaire concerning risk factors for osteoporosis based on FRAX. The predicted 10-year probability of hip fractures was calculated for each woman returning a complete questionnaire using...... the Swedish version of FRAX. The observed 10-year hip fracture risk was also calculated for each woman using age-specific hip fracture rates from the National Hospital Discharge Register and National survival tables. RESULTS: A total of 4194 (84%) women responded to the questionnaire and 3636 (73%) gave...

  13. Pressure ulcer risk in hip fracture patients

    NARCIS (Netherlands)

    Houwing, RH; Rozendaal, M; Wouters-Wesseling, W; Buskens, E; Keller, P; Haalboom, JRE

    2004-01-01

    Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU wer

  14. Vitamin D supplementation and fracture risk

    Science.gov (United States)

    This letter is written in response to an editorial by Gray and Bolland stating incorrectly that vitamin D does not reduce fracture risk and that safety of vitamin D has not been demonstrated. We and others have demonstrated that vitamin D is effective in lowering risk of fractures when given in adeq...

  15. The risk of fracture in patients with multiple sclerosis: The UK general practice research database

    DEFF Research Database (Denmark)

    Bazelier, Marloes T; van Staa, Tjeerd; Uitdehaag, Bernard Mj;

    2011-01-01

    threefold increased risk of hip fracture [HR = 2.79,95% confidence interval (CI) 1.83-4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR = 1.35,95% CI 1.13-1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR = 1.85, 95% CI 1.......14-2.98) or antidepressants (HR = 1.79, 95% CI 1.37-2.35) in the previous 6 months. Absolute fracture risks were low in younger MS patients but became substantial when patients were older than 60 years of age. It is concluded that MS is associated with an increased risk of fracture. Fracture risk assessment may be indicated......Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We...

  16. Soluble CD14 and fracture risk

    OpenAIRE

    Bethel, M; Bůžková, P; Fink, HA; Robbins, JA; Cauley, JA; Lee, J.; Barzilay, JI; Jalal, DI; Carbone, LD

    2016-01-01

    © 2015 International Osteoporosis Foundation and National Osteoporosis Foundation Summary: Soluble CD14 (sCD14) is an inflammatory marker associated with osteoclasts. Using Cox proportional hazards models, we found a positive association between plasma levels of sCD14 and risk of incident fracture among participants in the Cardiovascular Health Study. sCD14 may be useful in identifying those at risk for fracture. Introduction: Soluble CD14, a proinflammatory cytokine, is primarily derived fro...

  17. Fragility fracture: recent developments in risk assessment.

    Science.gov (United States)

    Aspray, Terry J

    2015-02-01

    More than half of older women who sustain a fragility fracture do not have osteoporosis by World Health Organization (WHO) bone mineral density (BMD) criteria; and, while BMD has been used to assess fracture risk for over 30 years, a range of other skeletal and nonskeletal clinical risk factors (CRFs) for fracture have been recognized. More than 30 assessment tools using CRFs have been developed, some predicting fracture risk and others low BMD alone. Recent systematic reviews have reported that many tools have not been validated against fracture incidence, and that the complexity of tools and the number of CRFs included do not ensure best performance with poor assessment of (internal or comparative) validity. Internationally, FRAX® is the most commonly recommended tool, in addition to QFracture in the UK, The Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool in Canada and Garvan in Australia. All tools estimate standard 10-year risk of major osteoporotic and 10-year risk of hip fracture: FRAX® is able to estimate fracture risk either with or without BMD, but CAROC and Garvan both require BMD and QFracture does not. The best evidence for the utility of these tools is in case finding but there may be future prospects for the use of 10-year fracture risk as a common currency with reference to the benefits of treatment, whether pharmacological or lifestyle. The use of this metric is important in supporting health economic analyses. However, further calibration studies will be needed to prove that the tools are robust and that their estimates can be used in supporting treatment decisions, independent of BMD.

  18. Communication of fracture risk and treatment benefit in terms of ‘bone health age’ using FRAX or Qfracture

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Rubin, Katrine Hass; Hansen, Carrinna;

    2013-01-01

    the same time increase agreement between risk algorithms. Results: The algorithms differed less in estimated bone health age than in percent risk. A 60 years old woman with a maternal history of hip fracture has a predicted major osteoporotic fracture risk equivalent to that of a 71 years (FRAX) or 68......Introduction: Communication of absolute and relative risks is challenging despite the development of tools to quickly derive absolute fracture risk estimates from risk factors with or without BMD. We speculated that back-transformation of risks to a risk age could make for a clearer message and at...... years-old woman (Qfracture). Treatment with 40% risk reduction is equivalent to a reduction in risk age by 10 years in both algorithms, reducing risk age to 62 (FRAX) or 60 years (Qfracture). Table 1 Assuming no treatment Assuming treatment with 40% risk reduction FRAX ‘Age’/ 10 years risk Qfracture...

  19. General practitioners’ use of absolute risk versus individual risk factors in cardiovascular disease prevention: an experimental study

    OpenAIRE

    Jansen, Jesse; Bonner, Carissa; McKinn, Shannon; Irwig, Les; Glasziou, Paul ,; Doust, Jenny; Teixeira-Pinto, Armando; Hayen, Andrew; Turner, Robin; McCaffery, Kirsten

    2014-01-01

    Objective To understand general practitioners’ (GPs) use of individual risk factors (blood pressure and cholesterol levels) versus absolute risk in cardiovascular disease (CVD) risk management decision-making. Design Randomised experiment. Absolute risk, systolic blood pressure (SBP), cholesterol ratio (total cholesterol/high-density lipoprotein (TC/HDL)) and age were systematically varied in hypothetical cases. High absolute risk was defined as 5-year risk of a cardiovascular event >15%, hig...

  20. Multiple Sclerosis Increases Fracture Risk: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Guixian Dong

    2015-01-01

    Full Text Available Purpose. The association between multiple sclerosis (MS and fracture risk has been reported, but results of previous studies remain controversial and ambiguous. To assess the association between MS and fracture risk, a meta-analysis was performed. Method. Based on comprehensive searches of the PubMed, Embase, and Web of Science, we identified outcome data from all articles estimating the association between MS and fracture risk. The pooled risk ratios (RRs with 95% confidence intervals (CIs were calculated. Results. A significant association between MS and fracture risk was found. This result remained statistically significant when the adjusted RRs were combined. Subgroup analysis stratified by the site of fracture suggested significant associations between MS and tibia fracture risk, femur fracture risk, hip fracture risk, pelvis fracture risk, vertebrae fracture risk, and humerus fracture risk. In the subgroup analysis by gender, female MS patients had increased fracture risk. When stratified by history of drug use, use of antidepressants, hypnotics/anxiolytics, anticonvulsants, and glucocorticoids increased the risk of fracture risk in MS patients. Conclusions. This meta-analysis demonstrated that MS was significantly associated with fracture risk.

  1. Binomial Distribution Sample Confidence Intervals Estimation 7. Absolute Risk Reduction and ARR-like Expressions

    Directory of Open Access Journals (Sweden)

    Andrei ACHIMAŞ CADARIU

    2004-08-01

    Full Text Available Assessments of a controlled clinical trial suppose to interpret some key parameters as the controlled event rate, experimental event date, relative risk, absolute risk reduction, relative risk reduction, number needed to treat when the effect of the treatment are dichotomous variables. Defined as the difference in the event rate between treatment and control groups, the absolute risk reduction is the parameter that allowed computing the number needed to treat. The absolute risk reduction is compute when the experimental treatment reduces the risk for an undesirable outcome/event. In medical literature when the absolute risk reduction is report with its confidence intervals, the method used is the asymptotic one, even if it is well know that may be inadequate. The aim of this paper is to introduce and assess nine methods of computing confidence intervals for absolute risk reduction and absolute risk reduction – like function.Computer implementations of the methods use the PHP language. Methods comparison uses the experimental errors, the standard deviations, and the deviation relative to the imposed significance level for specified sample sizes. Six methods of computing confidence intervals for absolute risk reduction and absolute risk reduction-like functions were assessed using random binomial variables and random sample sizes.The experiments shows that the ADAC, and ADAC1 methods obtains the best overall performance of computing confidence intervals for absolute risk reduction.

  2. Clopidogrel and the risk of osteoporotic fractures

    DEFF Research Database (Denmark)

    Jørgensen, Niklas Rye; Grove, E L; Schwarz, Peter;

    2012-01-01

    intervention. The mode of action of clopidogrel involves pathways that are important to the metabolic activity in bone cells, although to our knowledge whether P2Y(12) receptors are involved in the regulation of bone metabolism has not yet been investigated. Therefore the objective of the present study...... was to investigate the association between clopidogrel use and risk of fractures. Methods:  We investigated the association between clopidogrel use and fracture incidence in a nationwide cohort study within the Danish population of approximately 5.3 million individuals. All patients who were prescribed clopidogrel...... during the years 1996-2008 were included in the study (n=77,503) and three non-users were randomly selected, matched for age and gender (n=232,510), for each clopidogrel-treated subject. Results:  Treatment with clopidogrel was associated with both increased overall fracture risk and increased risk...

  3. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome

    NARCIS (Netherlands)

    Mahmoodi, Bakhtawar K.; ten Kate, Min Ki; Waanders, Femke; Veeger, Nic J. G. M.; Brouwer, Jan-Leendert P.; Vogt, Liffert; Navis, Gerjan; van der Meer, Jan

    2008-01-01

    Background-No data are available on the absolute risk of either venous thromboembolism (VTE) or arterial thromboembolism (ATE) in patients with nephrotic syndrome. Reported risks are based on multiple case reports and small studies with mostly short-term follow-up. We assessed the absolute risk of V

  4. Contribution of Individual Risk Factor Changes to Reductions in Population Absolute Cardiovascular Risk

    Directory of Open Access Journals (Sweden)

    Thomas Cochrane

    2014-01-01

    Full Text Available Background. Few studies have investigated individual risk factor contributions to absolute cardiovascular disease (CVD risk. Even fewer have examined changes in individual risk factors as components of overall modifiable risk change following a CVD prevention intervention. Design. Longitudinal study of population CVD risk factor changes following a health screening and enhanced support programme. Methods. The contribution of individual risk factors to the estimated absolute CVD risk in a population of high risk patients identified from general practice records was evaluated. Further, the proportion of the modifiable risk attributable to each factor that was removed following one year of enhanced support was estimated. Results. Mean age of patients (533 males, 68 females was 63.7 (6.4 years. High cholesterol (57% was most prevalent, followed by smoking (53% and high blood pressure (26%. Smoking (57% made the greatest contribution to the modifiable population CVD risk, followed by raised blood pressure (26% and raised cholesterol (17%. After one year of enhanced support, the modifiable population risk attributed to smoking (56%, high blood pressure (68%, and high cholesterol (53% was removed. Conclusion. Approximately 59% of the modifiable risk attributable to the combination of high blood pressure, high cholesterol, and current smoking was removed after intervention.

  5. High-Risk and Low-Risk Human Papillomavirus and the Absolute Risk of Cervical Intraepithelial Neoplasia or Cancer

    DEFF Research Database (Denmark)

    Thomsen, Louise T; Frederiksen, Kirsten; Munk, Christian;

    2014-01-01

    OBJECTIVE: To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test. METHODS: In this prospective cohort study, consecutive liquid-based cer...

  6. Adequacy of relative and absolute risk models for lifetime risk estimate of radiation-induced cancer

    International Nuclear Information System (INIS)

    This report examines the applicability of the relative (multiplicative) and absolute (additive) models in predicting lifetime risk of radiation-induced cancer. A review of the epidemiologic literature, and a discussion of the mathematical models of carcinogenesis and their relationship to these models of lifetime risk, are included. Based on the available data, the relative risk model for the estimation of lifetime risk is preferred for non-sex-specific epithelial tumours. However, because of lack of knowledge concerning other determinants of radiation risk and of background incidence rates, considerable uncertainty in modelling lifetime risk still exists. Therefore, it is essential that follow-up of exposed cohorts be continued so that population-based estimates of lifetime risk are available

  7. [Hip Fracture--Epidemiology, Management and Liaison Service. Risk factor for hip fracture].

    Science.gov (United States)

    Fujiwara, Saeko

    2015-04-01

    Many risk factors have been identified for hip fracture, including female, advanced age, osteoporosis, previous fractures, low body weight or low body mass index, alcohol drinking, smoking, family history of fractures, use of glucocorticoid, factors related to falls, and bone strength. The factors related to falls are number of fall, frail, post stroke, paralysis, muscle weakness, anti-anxiety drugs, anti-depression drugs, and sedatives. Dementia and respiratory disease and others have been reported to be risk factors for secondary hip fracture.

  8. Management of High Blood Pressure in Those without Overt Cardiovascular Disease Utilising Absolute Risk Scores

    Directory of Open Access Journals (Sweden)

    Mark R. Nelson

    2011-01-01

    Full Text Available Increasing blood pressure has a continuum of adverse risk for cardiovascular events. Traditionally this single measure was used to determine who to treat and how vigorously. However, estimating absolute risk rather than measurement of a single risk factor such as blood pressure is a superior method to identify who is most at risk of having an adverse cardiovascular event such as stroke or myocardial infarction, and therefore who would most likely benefit from therapeutic intervention. Cardiovascular disease (CVD risk calculators must be used to estimate absolute risk in those without overt CVD as physician estimation is unreliable. Incorporation into usual practice and limitations of the strategy are discussed.

  9. Fracture risk and zoledronic acid therapy in men with osteoporosis

    DEFF Research Database (Denmark)

    Boonen, Steven; Reginster, Jean-Yves; Kaufman, Jean-Marc;

    2012-01-01

    Fractures in men are a major health issue, and data on the antifracture efficacy of therapies for osteoporosis in men are limited. We studied the effect of zoledronic acid on fracture risk among men with osteoporosis.......Fractures in men are a major health issue, and data on the antifracture efficacy of therapies for osteoporosis in men are limited. We studied the effect of zoledronic acid on fracture risk among men with osteoporosis....

  10. Fracture as an Independent Risk Factor of Dementia

    OpenAIRE

    Tsai, Chun-Hao; Chuang, Chieh-Sen; Hung, Chih-Hung; Lin, Cheng-Li; Sung, Fung-Chang; Tang, Chih-Hsin; Hsu, Horng-Chang; Chung, Chi-Jung

    2014-01-01

    Abstract Dementia is among various diseases affecting the elderly, who is also at a high risk for fractures. This study aimed to evaluate the association between fracture history and sequential risk of dementia in Taiwan. A retrospective cohort study was designed using the claims data of the entire insured residents covered by Taiwan's universal health insurance from 1998 to 2010. A total of 66,797 patients with fractures and 133,594 control subjects without fractures were matched in terms of...

  11. Communicating risk using absolute risk reduction or prolongation of life formats

    DEFF Research Database (Denmark)

    Harmsen, Charlotte Gry; Kristiansen, Ivar Sønbø; Larsen, Pia Veldt;

    2014-01-01

    patients. AIM: To compare the impact of using Prolongation Of Life (POL) and Absolute Risk Reduction (ARR) information formats to express effectiveness of cholesterol-lowering therapy on patients' redemptions of statin prescriptions, and on patients' confidence in their decision and satisfaction......BACKGROUND: It is important that patients are well-informed about risks and benefits of therapies to help them decide whether to accept medical therapy. Different numerical formats can be used in risk communication but It remains unclear how the different formats affect decisions made by real-life....... The COMRADE questionnaire was used to measure patients' confidence in their decision and satisfaction with the risk communication. RESULTS: Of the 240 patients included for analyses, 112 were allocated to POL information and 128 to ARR. Patients redeeming a statin prescription totalled six (5.4%) when...

  12. Different effects of age, adiposity and physical activity on the risk of ankle, wrist and hip fractures in postmenopausal women.

    Science.gov (United States)

    Armstrong, Miranda E G; Cairns, Benjamin J; Banks, Emily; Green, Jane; Reeves, Gillian K; Beral, Valerie

    2012-06-01

    While increasing age, decreasing body mass index (BMI), and physical inactivity are known to increase hip fracture risk, whether these factors have similar effects on other common fractures is not well established. We used prospectively-collected data from a large cohort to examine the role of these factors on the risk of incident ankle, wrist and hip fractures in postmenopausal women. 1,155,304 postmenopausal participants in the Million Women Study with a mean age of 56.0 (SD 4.8) years, provided information about lifestyle, anthropometric, and reproductive factors at recruitment in 1996-2001. All participants were linked to National Health Service cause-specific hospital records for day-case or overnight admissions. During follow-up for an average of 8.3 years per woman, 6807 women had an incident ankle fracture, 9733 an incident wrist fracture, and 5267 an incident hip fracture. Adjusted absolute and relative risks (RRs) for incident ankle, wrist, and hip fractures were calculated using Cox regression models. Age-specific rates for wrist and hip fractures increased sharply with age, whereas rates for ankle fracture did not. Cumulative absolute risks from ages 50 to 84 years per 100 women were 2.5 (95%CI 2.2-2.8) for ankle fracture, 5.0 (95%CI 4.4-5.5) for wrist fracture, and 6.2 (95%CI 5.5-7.0) for hip fracture. Compared with lean women (BMI<20 kg/m(2)), obese women (BMI≥30 kg/m(2)) had a three-fold increased risk of ankle fracture (RR=3.07; 95%CI 2.53-3.74), but a substantially reduced risk of wrist fracture and especially of hip fracture (RR=0.57; 0.51-0.64 and 0.23; 0.21-0.27, respectively). Physical activity was associated with a reduced risk of hip fracture but was not associated with ankle or wrist fracture risk. Ankle, wrist and hip fractures are extremely common in postmenopausal women, but the associations with age, adiposity, and physical activity differ substantially between the three fracture sites. PMID:22465850

  13. Pain-relief medication and risk of fractures.

    Science.gov (United States)

    Vestergaard, Peter

    2008-09-01

    Medications to treat pain are in widespread use and any change in the risk of fracture may consequently have a significant impact at a population level. Strong analgesics of the opiate and opiate-like group are associated with an increased risk of fractures probably from an increased risk of falls resulting from the dizziness induced by these drugs. However, not all strong analgesics are associated with an increased risk of fractures. The differences are not readily explained from variations in pharmacokinetic properties. Weak analgesics mainly interact with the prostaglandin system; these drugs include non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid and acetaminophen. Acetaminophen is associated with an increased risk of fractures while acetylsalicylic acid is not. Some but not all NSAIDs are associated with an increased fracture risk, and the differences are not explained by variations in pharmacokinetic properties. More research is needed to determine if some analgesics are safer than others with respect to fracture risk. PMID:18691002

  14. Risk of fracture in patients with muscular dystrophies

    NARCIS (Netherlands)

    Pouwels, S.; Boer, A. de; Leufkens, H.G.M.; Weber, W.E.; Cooper, C.; Onzenoort, H.A.W. van; Vries, F de

    2014-01-01

    The aim of the study was to determine fracture risk in incident muscular dystrophy (MD) patients. Patients with MD are at a 1.4-fold increased risk of fracture as compared with population-based control patients. Risk further increased among elderly and female patients and among patients exposed to o

  15. Risk of fracture in patients with muscular dystrophies

    NARCIS (Netherlands)

    Pouwels, S; de Boer, A; Leufkens, H G M; Weber, W E J; Cooper, C; van Onzenoort, H A W; de Vries, F

    2014-01-01

    UNLABELLED: The aim of the study was to determine fracture risk in incident muscular dystrophy (MD) patients. Patients with MD are at a 1.4-fold increased risk of fracture as compared with population-based control patients. Risk further increased among elderly and female patients and among patients

  16. Risk of solid cancer, cardiovascular disease, anaphylaxis, osteoporosis and fractures in patients with systemic mastocytosis

    DEFF Research Database (Denmark)

    Broesby-Olsen, Sigurd; Farkas, Dóra Körmendiné; Vestergaard, Hanne;

    2016-01-01

    In patients with systemic mastocytosis (SM), several aspects of morbidity remain poorly understood. We assessed the risk of solid cancers, cardiovascular disease, anaphylaxis, osteoporosis, and fractures in SM patients. Using Danish medical registries, we conducted a nationwide population.......2 (95% CI 0.9-1.6) and the 10-year AR was 5.9% (95% CI 3.9-8.4). SM patients are at increased risk of solid cancers - especially melanoma and NMSC-and cardiovascular disease. The risk of anaphylaxis and osteoporosis is clearly increased in SM, though absolute risk was low in this population-based study...

  17. Proximal Femoral Geometry as Fracture Risk Factor in Female Patients with Osteoporotic Hip Fracture

    Science.gov (United States)

    Han, Jun

    2016-01-01

    Background Proximal femoral geometry may be a risk factor of osteoporotic hip fractures. However, there existed great differences among studies depending on race, sex and age of subjects. The purpose of the present study is to analyze proximal femoral geometry and bone mineral density (BMD) in the osteoporotic hip fracture patients. Furthermore, we investigated proximal femoral geometric parameters affecting fractures, and whether the geometric parameters could be an independent risk factor of fractures regardless of BMD. Methods This study was conducted on 197 women aged 65 years or more who were hospitalized with osteoporotic hip fracture (femur neck fractures ; 84, intertrochanteric fractures; 113). Control group included 551 women who visited to check osteoporosis. Femur BMD and proximal femoral geometry for all subjects were measured using dual energy X-ray absorptiometry (DXA), and compared between the control and fracture groups. Besides, proximal femoral geometric parameters associated with fractures were statistically analyzed. Results There were statistically significant differences in the age and weight, cross-sectional area (CSA)/length/width of the femoral neck and BMD of the proximal femur between fracture group and control group. BMD of the proximal femur in the control group was higher than in the fracture group. For the femoral neck fractures group, the odds ratio (OR) for fractures decrease in the CSA and neck length (NL) of the femur increased by 1.97 times and 1.73 times respectively, regardless of BMD. The OR for fractures increase in the femoral neck width increased by 1.53 times. In the intertrochanteric fracture group, the OR for fractures increase in the femoral neck width increased by 1.45 times regardless of BMD. Conclusions We found that an increase of the femoral neck width could be a proximal femoral geometric parameter which plays important roles as a risk factor for fracture independently of BMD.

  18. Caffeine and the risk of hip fracture: the Framingham Study.

    Science.gov (United States)

    Kiel, D P; Felson, D T; Hannan, M T; Anderson, J J; Wilson, P W

    1990-10-01

    Caffeine increases urinary calcium output and has been implicated as a risk factor for osteoporosis. The authors examined the effect of caffeine on hip fracture risk in 3,170 individuals attending the 12th (1971-1973) Framingham Study examination. Coffee and tea consumption, age, Framingham examination number, weight, smoking, alcohol consumption, and estrogen use were used to evaluate hip fracture risk according to caffeine intake. Hip fractures occurred in 135 subjects during 12 years of follow-up. Fracture risk over each 2-year period increased with increasing caffeine intake (one cup of coffee = one unit of caffeine, one cup of tea = 1/2 unit of caffeine). For intake of 1.5-2.0 units per day, the adjusted relative risk (RR) of fracture was not significantly elevated compared with intake of one or less units per day. Consumption of greater than or equal to 2.5 units per day significantly increased the risk of fracture. Overall, intake of greater than two cups of coffee per day (four cups of tea) increased the risk of fracture. In summary, hip fracture risk was modestly increased with heavy caffeine use, but not for intake equivalent to one cup of coffee per day. Since caffeine use may be associated with other behaviors that are, themselves, risk factors for fracture, the association may be indirect. Further studies should be performed to confirm these findings.

  19. Risk of hip fracture after osteoporosis fractures. 451 women with fracture of lumbar spine, olecranon, knee or ankle

    DEFF Research Database (Denmark)

    Lauritzen, J B; Lund, B

    1993-01-01

    In a follow-up study during 1976-1984, the risk of a subsequent hip fracture was investigated in women aged 60-99 years, hospitalized for the following fractures: lumbar spine (n 70), olecranon (n 52), knee (n 129) and ankle (n 200). Follow-up ranged from 0 to 9 years. Observation time of the 4...... different fractures were 241, 180, 469, and 779, person-years, respectively. In women aged 60-79 years with one of the following fractures the relative risk of a subsequent hip fracture was increased by 4.8 (lumbar spine), 4.1 (olecranon), 3.5 (knee) and 1.5 (ankle). The relative risk of hip fracture showed...

  20. Fracture risk in hepatitis C virus infected persons

    DEFF Research Database (Denmark)

    Hansen, Ann-Brit Eg; Omland, Lars Haukali; Krarup, Henrik;

    2014-01-01

    BACKGROUND & AIMS: The association between Hepatitis C virus (HCV)-infection and fracture risk is not well characterized. We compared fracture risk between HCV-seropositive (HCV-exposed) patients and the general population and between patients with cleared and chronic HCV-infection. METHODS......: Outcome measures were time to first fracture at any site, time to first low-energy and first non-low-energy (other) fracture in 12,013 HCV-exposed patients from the DANVIR cohort compared with a general population control cohort (n=60,065) matched by sex and age. Within DANVIR, 4500 patients with chronic...... HCV-infection and 2656 patients with cleared HCV-infection were studied. RESULTS: Compared with population controls, HCV-exposed patients had increased overall risk of fracture [adjusted incidence rate ratio (aIRR) 2.15, 95% Confidence Interval (CI) 2.03-2.28], increased risk of low-energy fracture (a...

  1. Measuring, and identifying predictors of, women's perceptions of three types of breast cancer risk: population risk, absolute risk and comparative risk

    OpenAIRE

    Apicella, C.; Peacock, S.J.; Andrews, L.; Tucker, K.; Daly, M B; Hopper, J L

    2009-01-01

    Although a key function of cancer genetics services is to provide risk information, to date there has been little consistency in the way in which breast cancer risk perception has been measured. The aims of the study were to measure estimates of (i) population risk, (ii) absolute risk and (iii) comparative risk of developing breast cancer for Ashkenazi Jewish women, and to determine predictors of breast cancer risk perception. Of 152 women, 107 (70%) completed all questions. The mean (s.d.) e...

  2. Subclinical Thyroid Dysfunction and Fracture Risk

    DEFF Research Database (Denmark)

    Blum, Manuel R; Bauer, Douglas C; Collet, Tinh-Hai;

    2015-01-01

    IMPORTANCE: Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE: To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION: The databases of MEDLI...

  3. Analysis on the risk factors of second fracture in osteoporosis-

    Directory of Open Access Journals (Sweden)

    RUAN Wen-dong

    2011-04-01

    Full Text Available 【Abstract】 Objective: To explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions. Methods: From January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group. Therefore, 273 patients, 225 first-fracture cases, aged (67.7± 8.5 years, and 48 refracture cases, aged (72.7±9.5 years, were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density (BMD T-scores tested by dual-energy X-rays absorptiometry (DEXA, Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods. Results: Females accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the followup. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age (>75 years, HR=1.23, 95%CI 1.18-1.29; >85 years, HR=1.68, 95% CI 1.60-1.76, female sex (HR=1.36, 95%CI 1.32-1.40, prior vertebral fractures (HR=1.62, 95%CI 1.01-2.07, prior hip fractures (HR=1.27, 95%CI 0.89-2.42, BMD T-score<-3.5 (HR=1.38, 95%CI 1.17-1.72 and weakened motor skills (HR=1.27, 95%CI 1.09-1.40. Conclusions: The risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the

  4. Analysis on the risk factors of second fracture in osteoporosis-related fractures

    Institute of Scientific and Technical Information of China (English)

    RUAN Wen-dong; WANG Pei; MA Xin-long; GE Rui-ping; ZHOU Xian-hu

    2011-01-01

    Objective: To explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions.Methods: From January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group.Therefore, 273 patients, 225 first-fracture cases, aged (67.7±8.5) years, and 48 refracture cases, aged (72.7-9.5) years,were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density (BMD) T-scores tested by dual-energy X-rays absorptiometry (DEXA), Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods.Results: Females accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the followup. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age (>75years, HR=1.23, 95%CI 1.18-1.29; >85 years, HR=1.68, 95%CI 1.60-1.76), female sex (HR=1.36, 95%CI 1.32-1.40), prior vertebral fractures (HR=1.62, 95%CI 1.01-2.07), prior hip fractures (HR=1.27, 95%CI 0.89-2.42), BMD T-score<-3.5(HR=1.38, 95%CI 1.17-1.72) and weakened motor skills (HR=1.27,95%CI 1.09-1.40).Conclusions: The risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for

  5. Risk of fracture in adults on renal replacement therapy

    DEFF Research Database (Denmark)

    Hansen, Ditte; Olesen, Jonas B; Gislason, Gunnar H;

    2016-01-01

    BACKGROUND: Patients on dialysis treatment or living with a transplanted kidney have several risk factors for bone fracture, especially disturbances in mineral metabolism and immunosuppressive therapy. We describe the incidence of fracture in this retrospective national Danish cohort study...... and explore the influence of age, gender, comorbidity and prescribed medication. METHODS: By individual-level linkage between nationwide administrative registries, the risk of fracture was compared between the group of patients receiving chronic dialysis treatment and patients receiving their first renal...... transplanted group: 1.82 (95% CI: 1.62-2.06)]. Prescribed diuretics, lipid-modifying agents and proton pump inhibitors also modulated the fracture risk. CONCLUSIONS: Patients on dialysis or living with a transplanted kidney have a significantly higher risk of fracture than the Danish background population...

  6. Zolpidem Use and Risk of Fracture in Elderly Insomnia Patients

    OpenAIRE

    Kang, Dong-Yoon; Park, Soyoung; Rhee, Chul-Woo; Kim, Ye-Jee; Choi, Nam-Kyong; Lee, Joongyub; Park, Byung-Joo

    2012-01-01

    Objectives To evaluate the risk of fractures related with zolpidem in elderly insomnia patients. Methods Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same leng...

  7. Hyponatremia, a risk factor for osteoporosis and fractures in women

    DEFF Research Database (Denmark)

    Holm, J P; Amar, A O S; Hyldstrup, L;

    2016-01-01

    Hyponatremia has been linked to an increased risk of osteoporosis and fractures. We found an increased hazard ratio of major osteoporotic fractures adjusted for potential confounders, including osteoporosis and medication. A reduced BMD was not sufficiently explaining the association. Our data...... indicate that hyponatremia should be considered a risk factor for osteoporosis and fractures. INTRODUCTION: Hyponatremia is the most common electrolyte disorder in clinical practice and could be a risk factor for both osteoporosis and fractures. Mild hyponatremia has traditionally been regarded as a benign...... and asymptomatic condition; however, data from large population and animal studies have led to a reappraisal of this view. The purpose of this study was to evaluate the association of hyponatremia with osteoporosis and major osteoporotic fractures (MOF) in women. METHODS: This is a historical cohort study...

  8. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study

    Science.gov (United States)

    Rousseau, Catherine; Jean, Sonia; Gamache, Philippe; Lebel, Stéfane; Mac-Way, Fabrice; Biertho, Laurent; Michou, Laëtitia

    2016-01-01

    Objective To investigate whether bariatric surgery increases the risk of fracture. Design Retrospective nested case-control study. Setting Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. Participants 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls. Main outcome measures Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. Results Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for

  9. Major osteoporotic fragility fractures: Risk factor updates and societal impact.

    Science.gov (United States)

    Pisani, Paola; Renna, Maria Daniela; Conversano, Francesco; Casciaro, Ernesto; Di Paola, Marco; Quarta, Eugenio; Muratore, Maurizio; Casciaro, Sergio

    2016-03-18

    Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders (for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence. PMID:27004165

  10. Risk factors for recurrent stress fractures in athletes.

    Science.gov (United States)

    Korpelainen, R; Orava, S; Karpakka, J; Siira, P; Hulkko, A

    2001-01-01

    Our aim was to identify factors predisposing athletes to multiple stress fractures, with the emphasis on biomechanical factors. Our hypothesis was that certain anatomic factors of the ankle are associated with risk of multiple stress fractures of the lower extremities in athletes. Thirty-one athletes (19 men and 12 women) with at least three separate stress fractures each, and a control group of 15 athletes without fractures completed a questionnaire focusing on putative risk factors for stress fractures, such as nutrition, training history, and hormonal history in women. Bone mineral density was measured by dual-energy x-ray absorptiometry in the lumbar spine and proximal femur. Biomechanical features such as foot structure, pronation and supination of the ankle, dorsiflexion of the ankle, forefoot varus and valgus, leg-length inequality, range of hip rotation, simple and choice reaction times, and balance in standing were measured. There was an average of 3.7 (range, 3 to 6) fractures in each athlete, totaling 114 fractures. The fracture site was the tibia or fibula in 70% of the fractures in men and the foot and ankle in 50% of the fractures in women. Most of the patients were runners (61%); the mean weekly running mileage was 117 km. Biomechanical factors associated with multiple stress fractures were high longitudinal arch of the foot, leg-length inequality, and excessive forefoot varus. Nearly half of the female patients (40%) reported menstrual irregularities. Runners with high weekly training mileage were found to be at risk of recurrent stress fractures of the lower extremities. PMID:11394600

  11. The Effects of Age, Adiposity, and Physical Activity on the Risk of Seven Site-Specific Fractures in Postmenopausal Women.

    Science.gov (United States)

    Lacombe, Jason; Cairns, Benjamin J; Green, Jane; Reeves, Gillian K; Beral, Valerie; Armstrong, Miranda Eg

    2016-08-01

    Risk factors for fracture of the neck of the femur are relatively well established, but those for fracture at other sites are little studied. In this large population study we explore the role of age, body mass index (BMI), and physical activity on the risk of fracture at seven sites in postmenopausal women. As part of the Million Women Study, 1,154,821 postmenopausal UK women with a mean age of 56.0 (SD 4.8) years provided health and lifestyle data at recruitment in 1996 to 2001. All participants were linked to National Health Service (NHS) hospital records for day-case or overnight admissions with a mean follow-up of 11 years per woman. Adjusted absolute and relative risks for seven site-specific incident fractures were calculated using Cox regression models. During follow-up, 4931 women had a fracture of the humerus; 2926 of the forearm; 15,883 of the wrist; 9887 of the neck of the femur; 1166 of the femur (not neck); 3199 a lower leg fracture; and 10,092 an ankle fracture. Age-specific incidence rates increased gradually with age for fractures of forearm, lower leg, ankle, and femur (not neck), and steeply with age for fractures of neck of femur, wrist, and humerus. When compared to women with desirable BMI (20.0 to 24.9 kg/m(2) ), higher BMI was associated with a reduced risk of fracture of the neck of femur, forearm, and wrist, but an increased risk of humerus, femur (not neck), lower leg, and ankle fractures (p Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR). PMID:26950269

  12. Exercise and risk factors of osteoporotic fractures in elderly women

    OpenAIRE

    Korpelainen, R.

    2005-01-01

    Abstract The aim of this study was to examine lifestyle risk factors for low bone mass, falls and fractures, and to determine the effect of 30-month exercise trial on bone mass, balance, muscle strength and gait in elderly women. Reliability of an inclinometric method for assessing postural sway was evaluated. Data on risk factors, falls and fractures were collected by questionnaires, and calcaneus and radius bone mass were measured from 1,222 women. Lifetime physical activity, low occ...

  13. Indices of risk assessment of fracture of the proximal humerus

    Science.gov (United States)

    Giannotti, Stefano; Bottai, Vanna; Dell’osso, Giacomo; Donati, Daniela; Bugelli, Giulia; De Paola, Gaia; Guido, Giulio

    2012-01-01

    Summary Osteoporotic fractures are now a social problem for incidence and costs. Fractures of the proximal humerus events are frequent and constantly increasing. It is estimated that they are 20% of all osteoporotic fractures. Bone densitometry in most cases underestimates the real humeral bone density. There is little information about osteoporotic changes in the proximal humerus and their association with the cortical thickness of the humeral shaft. The ratio between the thickness of the cortical and the total diameter of the humeral diaphysis is the cortical index. Fracture risk limit value is 0.231. Convinced of the need to quantify in a reproducible way the real local humerus bone density, we performed a comparative evaluation of bone density of the humerus and femur in patients admitted to our clinic for fractures of the humerus and femur. We evaluated 28 women treated surgically for a fragility fracture of the proximal humerus or femur neck in 2010. All cortical index obtained were lower than the limit for fracture risk set at 0.231, so the IC was more predictive of neck medial fractures of the femur than had DEXA and the U.S. The information about the cortical index may provide a simple way of determining the bone quality of the proximal humerus and of facilitating decision-making in the surgical treatment of patients with fractures of the humerus. So we want to emphasize the importance of therapy for osteoporosis even in patients with fractures of the proximal humerus, which often have not critical densitometric values of femur or column, but they are at risk of new fractures. PMID:22783334

  14. Greater absolute risk for all subtypes of breast cancer in the US than Malaysia.

    Science.gov (United States)

    Horne, Hisani N; Beena Devi, C R; Sung, Hyuna; Tang, Tieng Swee; Rosenberg, Philip S; Hewitt, Stephen M; Sherman, Mark E; Anderson, William F; Yang, Xiaohong R

    2015-01-01

    Hormone receptor (HR) negative breast cancers are relatively more common in low-risk than high-risk countries and/or populations. However, the absolute variations between these different populations are not well established given the limited number of cancer registries with incidence rate data by breast cancer subtype. We, therefore, used two unique population-based resources with molecular data to compare incidence rates for the 'intrinsic' breast cancer subtypes between a low-risk Asian population in Malaysia and high-risk non-Hispanic white population in the National Cancer Institute's surveillance, epidemiology, and end results 18 registries database (SEER 18). The intrinsic breast cancer subtypes were recapitulated with the joint expression of the HRs (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor-2 (HER2). Invasive breast cancer incidence rates overall were fivefold greater in SEER 18 than in Malaysia. The majority of breast cancers were HR-positive in SEER 18 and HR-negative in Malaysia. Notwithstanding the greater relative distribution for HR-negative cancers in Malaysia, there was a greater absolute risk for all subtypes in SEER 18; incidence rates were nearly 7-fold higher for HR-positive and 2-fold higher for HR-negative cancers in SEER 18. Despite the well-established relative breast cancer differences between low-risk and high-risk countries and/or populations, there was a greater absolute risk for HR-positive and HR-negative subtypes in the US than Malaysia. Additional analytical studies are sorely needed to determine the factors responsible for the elevated risk of all subtypes of breast cancer in high-risk countries like the United States.

  15. FRAX fracture risk in women with a recent fracture of the distal forearm

    DEFF Research Database (Denmark)

    Egsmose, Emilie Lund; Birkvig, Mette; Buhl, Thora;

    2015-01-01

    assessments were analysed by the Bland-Altman method. Agreement on the individual level was expressed as 95 % limits of agreement (LoA) and on the group level as the mean (or median) of intra-individual differences (the bias). The femoral neck T-score was -1.69 ± 0.87 (hip with lowest BMD value). The risk of...... a major fracture and a hip fracture based on the lowest femoral neck BMD value was 23.8 ± 21.4 % and 7.6 ± 8.3 %, respectively. For major fracture risk assessed without versus with the lowest BMD value, lower and upper LoA were -12.3 and 21.1 percentage points (pp) (bias 4.4 pp, p < 0.0001). The...... corresponding LoA for hip fracture risk were -11.6 and18.6 pp (bias 3.5 pp, p < 0.0001). LoA for major fracture risk assessed with the lowest versus the highest BMD value were 0.0 and 9.5 pp (bias 2.0, p < 0.0001), and correspondingly for hip fracture risk 0.0 and 9.5 pp (bias 1.0 pp, p < 0.0001). Intra...

  16. Schizophrenia, antipsychotics and risk of hip fracture

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Jensen, Signe O W; Nielsen, Jimmi

    2013-01-01

    In a nationwide study using linkage of Danish hospital registers we examined predictors of hip fracture (ICD-10: S72) in 15,431 patients with schizophrenia (ICD-10: F20 or ICD-8: 295) and 3,807,597 population controls. Shorter education, disability pension, lifetime alcohol abuse, somatic co-morb....... Preventive strategies should focus attention to severely ill patients with high likelihood of a receiving complex psychopharmacologic treatment and high doses of antipsychotics....... (matched to 1:3 to schizophrenia controls without hip fracture), antipsychotic polypharmacy predicted hip fracture. Analyses among antipsychotic monotherapy patients showed no differential effect of individual antipsychotics. A dose-response relationship of hip fracture and lifetime antipsychotics...

  17. Fracture risk is decreased in women with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Glintborg, Dorte; Nybo, Mads;

    2016-01-01

    Hyperandrogenism, obesity, and hyperinsulinemia may protect against osteoporosis, whereas amenorrhea, increased cortisol, and low growth hormone may be associated with higher fracture risk in polycystic ovary syndrome (PCOS). OBJECTIVE: To investigate fracture risk in PCOS. MATERIAL/METHODS: PCOS...... Denmark: Women with PCOS and/or hirsutism were identified in the Danish National Patient Register (1995-2012). Each patient was assigned three age-matched controls on the index date of PCOS diagnosis. Individuals with a previous endocrine diagnosis were excluded. Within PCOS Denmark, we embedded a well......-characterized subcohort of patients, PCOS OUH, diagnosed with PCOS at Odense University Hospital (n = 1,217). We identified incident fractures by ICD-10 codes and used conditional Cox regression analysis to compare fracture risk. RESULTS: PCOS Denmark: 19,199 women with PCOS and 57,483 controls were included, mean age 30...

  18. Impact and risk factors of post-stroke bone fracture.

    Science.gov (United States)

    Huo, Kang; Hashim, Syed I; Yong, Kimberley L Y; Su, Hua; Qu, Qiu-Min

    2016-02-20

    Bone fracture occurs in stroke patients at different times during the recovery phase, prolonging recovery time and increasing medical costs. In this review, we discuss the potential risk factors for post-stroke bone fracture and preventive methods. Most post-stroke bone fractures occur in the lower extremities, indicating fragile bones are a risk factor. Motor changes, including posture, mobility, and balance post-stroke contribute to bone loss and thus increase risk of bone fracture. Bone mineral density is a useful indicator for bone resorption, useful to identify patients at risk of post-stroke bone fracture. Calcium supplementation was previously regarded as a useful treatment during physical rehabilitation. However, recent data suggests calcium supplementation has a negative impact on atherosclerotic conditions. Vitamin D intake may prevent osteoporosis and fractures in patients with stroke. Although drugs such as teriparatide show some benefits in preventing osteoporosis, additional clinical trials are needed to determine the most effective conditions for post-stroke applications. PMID:26929915

  19. An absolute risk model to identify individuals at elevated risk for pancreatic cancer in the general population.

    Directory of Open Access Journals (Sweden)

    Alison P Klein

    Full Text Available PURPOSE: We developed an absolute risk model to identify individuals in the general population at elevated risk of pancreatic cancer. PATIENTS AND METHODS: Using data on 3,349 cases and 3,654 controls from the PanScan Consortium, we developed a relative risk model for men and women of European ancestry based on non-genetic and genetic risk factors for pancreatic cancer. We estimated absolute risks based on these relative risks and population incidence rates. RESULTS: Our risk model included current smoking (multivariable adjusted odds ratio (OR and 95% confidence interval: 2.20 [1.84-2.62], heavy alcohol use (>3 drinks/day (OR: 1.45 [1.19-1.76], obesity (body mass index >30 kg/m(2 (OR: 1.26 [1.09-1.45], diabetes >3 years (nested case-control OR: 1.57 [1.13-2.18], case-control OR: 1.80 [1.40-2.32], family history of pancreatic cancer (OR: 1.60 [1.20-2.12], non-O ABO genotype (AO vs. OO genotype (OR: 1.23 [1.10-1.37] to (BB vs. OO genotype (OR 1.58 [0.97-2.59], rs3790844(chr1q32.1 (OR: 1.29 [1.19-1.40], rs401681(5p15.33 (OR: 1.18 [1.10-1.26] and rs9543325(13q22.1 (OR: 1.27 [1.18-1.36]. The areas under the ROC curve for risk models including only non-genetic factors, only genetic factors, and both non-genetic and genetic factors were 58%, 57% and 61%, respectively. We estimate that fewer than 3/1,000 U.S. non-Hispanic whites have more than a 5% predicted lifetime absolute risk. CONCLUSION: Although absolute risk modeling using established risk factors may help to identify a group of individuals at higher than average risk of pancreatic cancer, the immediate clinical utility of our model is limited. However, a risk model can increase awareness of the various risk factors for pancreatic cancer, including modifiable behaviors.

  20. Risk Factors for Hip Fracture in Japanese Older Adults

    Directory of Open Access Journals (Sweden)

    Takashi Yamashita

    2012-09-01

    Full Text Available Risk factors for hip fracture in Japanese older populations are understudied compared with Western countries arguably due to the relatively lower prevalence rates in Japan. Nationally representative data from the Nihon University Japanese Longitudinal Study of Aging were analyzed using logistic regression to examine possible risk factors of hip fractures, separately for older women (n = 2,859 and older men (n = 2,108. Results showed that older Japanese women with difficulty bending their knees (OR = 1.9, with diabetes (OR = 1.7 times, and/or with more activity of daily living limitations (OR = 1.1 had higher risks of hip fracture. Older Japanese men with difficulty bending their knees (OR = 2.6, who use more external prescription drugs (OR = 1.9, and with cancer (OR = 2.0 times had higher risks of hip fracture. Further considerations of gender- and culture-specific factors along with the identified risk factors may provide insights into future intervention programs for hip fracture in Japanese older populations.

  1. Cardiovascular Risk Factor Analysis in Patients with a Recent Clinical Fracture at the Fracture Liaison Service

    Directory of Open Access Journals (Sweden)

    Caroline E. Wyers

    2014-01-01

    Full Text Available Patients with a low bone mineral density have an increased risk of cardiovascular diseases (CVD and venous thromboembolic events (VTE. The aim of our retrospective chart review was to investigate the prevalence of CVD, VTE, hypertension (HT, and diabetes mellitus type 2 (DM2 in patients with a recent clinical fracture visiting the Fracture Liaison Service (FLS. Out of 3057 patients aged 50–90 years, 1359 consecutive patients, who agreed and were able to visit the FLS for fracture risk evaluation, were included (71.7% women; mean age 65.2 yrs. Based on medical history, 29.9% had a history of CVD (13.7%, VTE (1.7%, HT (14.9%, and DM2 (7.1% or a combination. Their prevalence increased with age (21% in patients aged 50–59 years to 48% in patients aged >80 years and was higher in men than in women (36% versus 27%, but independent of bone mineral density and fracture type. Careful evaluation of medical history with respect to these risk factors should be performed in patients with a recent clinical fracture before starting treatment with medications that increase the risk of VTE or cardiovascular events, such as raloxifene, strontium ranelate, or NSAIDs.

  2. One idea of portfolio risk control for absolute return strategy risk adjustments by signals from correlation behavior

    Science.gov (United States)

    Nishiyama, N.

    2001-12-01

    Absolute return strategy provided from fund of funds (FOFs) investment schemes is the focus in Japanese Financial Community. FOFs investment mainly consists of hedge fund investment and it has two major characteristics which are low correlation against benchmark index and little impact from various external changes in the environment given maximizing return. According to the historical track record of survival hedge funds in this business world, they maintain a stable high return and low risk. However, one must keep in mind that low risk would not be equal to risk free. The failure of Long-term capital management (LTCM) that took place in the summer of 1998 was a symbolized phenomenon. The summer of 1998 exhibited a certain limitation of traditional value at risk (VaR) and some possibility that traditional VaR could be ineffectual to the nonlinear type of fluctuation in the market. In this paper, I try to bring self-organized criticality (SOC) into portfolio risk control. SOC would be well known as a model of decay in the natural world. I analyzed nonlinear type of fluctuation in the market as SOC and applied SOC to capture complicated market movement using threshold point of SOC and risk adjustments by scenario correlation as implicit signals. Threshold becomes the control parameter of risk exposure to set downside floor and forecast extreme nonlinear type of fluctuation under a certain probability. Simulation results would show synergy effect of portfolio risk control between SOC and absolute return strategy.

  3. Patients with eating disorders. A high-risk group for fractures

    DEFF Research Database (Denmark)

    Vestergaard, Peter; Emborg, Charlotte; Støving, René K;

    2003-01-01

    PURPOSE: To analyze fracture risk and bone mineral density in patients with eating disorders (anorexia nervosa, bulimia nervosa, and other eating disorders). DESIGN: Clinical overview. FINDINGS: Bone mineral density is decreased and fracture risk increased in patients with anorexia nervosa....... In patients with bulimia nervosa, bone mineral is only marginally decreased and fracture risk marginally increased. In patients with other eating disorders (eating disorders not otherwise specified), bone mineral density is decreased and fracture risk increased. CONCLUSIONS: Fracture risk is increased...... in patients with eating disorders. An eating disorder should be suspected in severely underweight young individuals (primarily girls) presenting with fractures, especially low-energy fractures....

  4. A general practice-based study examining the absolute risk of cardiovascular disease in treated hypertensive patients.

    OpenAIRE

    Fahey, T P; Peters, T J

    1996-01-01

    BACKGROUND: When managing hypertension, the assessment of the absolute risk of a cardiovascular' event is now advocated as the most accurate way in which the risks and benefits of anti-hypertensive therapy should be judged. Most studies that have examined control of hypertension have relied solely on the blood pressure level attained after treatment, with no measurement of the likely absolute risk in individual patients. AIM: To assess control of hypertension by quantifying the 10-year absolu...

  5. Risk of falling in patients with a recent fracture

    Directory of Open Access Journals (Sweden)

    Willems Gittie

    2007-06-01

    Full Text Available Abstract Background Patients with a history of a fracture have an increased risk for future fractures, even in short term. The aim of this study was to assess the number of patients with falls and to identify fall risk factors that predict the risk of falling in the first three months after a clinical fracture. Methods Prospective observational study with 3 months of follow-up in a large European academic and regional hospital. In 277 consenting women and men aged ≥ 50 years and with no dementia and not receiving treatment for osteoporosis who presented to hospital with a clinical fracture, fall risk factors were assessed according to the guidelines on fall prevention in the Netherlands. Follow-up information on falls and fractures was collected by monthly telephone interview. Incidence of falls and odds ratio's (OR, with 95% confidence intervals were calculated. Results 512 consecutive patients with a fracture were regarded for analysis, 87 were not eligible for inclusion and 137 patients were excluded. No follow-up data were available for 11 patients. Therefore full analysis was possible in 277 patients. A new fall incident was reported by 42 patients (15%, of whom five had a fracture. Of the 42 fallers, 32 had one new fall and 10 had two or more. Multivariate analysis in the total group with sex, age, ADL difficulties, urine incontinence and polypharmacy showed that sex and ADL were significant fall risk factors. Women had an OR of 3.02 (95% CI 1.13–8.06 and patients with ADL-difficulties had an OR of 2.50 (95% CI 1.27–4.93. Multivariate analysis in the female group with age, ADL difficulties, polypharmacy and presence of orthostatic hypotension indicated that polypharmacy was the predominant risk factor (OR 2.51; 95% CI: 1.19 – 5.28. The incidence of falls was 35% in women with low ADL score and polypharmacy compared to 15% in women without these risk factors (OR 3.56: CI 1.47 – 8.67. Conclusion 15% of patients reported a new fall

  6. Fracture risk in perimenopausal women treated with beta-blockers

    DEFF Research Database (Denmark)

    Rejnmark, Lars; Vestergaard, Peter; Kassem, Moustapha;

    2004-01-01

    beta2-Adrenergic receptors have been identified on human osteoblastic and osteoclastic cells, raising the question of a sympathetic regulation of bone metabolism. We investigated effects of treatment with beta-adrenergic receptor antagonists (beta-blockers) on bone turnover, bone mineral density...... (BMD), and fracture risk. Within the Danish Osteoporosis Prevention Study (DOPS) a population based, comprehensive cohort study of 2016 perimenopausal women, associations between treatment with beta-blockers and bone turnover and BMD were assessed in a cross-sectional design at the start of study....... Moreover, in a nested case-control design, fracture risk during the subsequent 5 years was assessed in relation to treatment with beta-blockers at baseline. Multiple regression- and logistic regression-analyses were performed. Treatment with beta-blockers was associated with a threefold increased fracture...

  7. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture

    OpenAIRE

    Tzermiadianos, Michael N.; Renner, Susan M.; Phillips, Frank M.; Hadjipavlou, Alexander G.; Zindrick, Michael R.; Havey, Robert M.; Voronov, Michael; Patwardhan, Avinash G.

    2008-01-01

    This study investigated the effect of endplate deformity after an osteoporotic vertebral fracture in increasing the risk for adjacent vertebral fractures. Eight human lower thoracic or thoracolumbar specimens, each consisting of five vertebrae were used. To selectively fracture one of the endplates of the middle VB of each specimen a void was created under the target endplate and the specimen was flexed and compressed until failure. The fractured vertebra was subjected to spinal extension und...

  8. Fracture Risk Analysis in Postmenopausal Women with the Current Methods

    Directory of Open Access Journals (Sweden)

    Salih Gultekin

    2014-03-01

    Full Text Available Aim: This study was conducted to assess the risk of fracture in postmenopausal women using dual x-ray absorptiometry bone mineral density (DEXA-BMD as a reference method and FRAX as a new clinical risk assessment tool. Material and Method: 168 postmenopausal women (> 50 years evaluating with DEXA-BMD and FRAX methods were included in the study. Femoral BMD (F-BMD, femoral T-score (F-Ts, lumbar spine BMD (L-BMD and lumbar spine T-score (L-Ts values of the patients were calculated. Fracture risk assessments were carried out using T-score values and FRAX 10-year hip fracture (HF and major osteoporotic fracture (MOF risk ratios. Data were analyzed statistically. Results: According to the results of F-Ts and L-Ts, 44/168 (26.2% and 65/168 (38.7% of patients had osteoporosis as compatible with high fracture risk. In osteoporotic patients, mean values for F-Ts L-Ts, F-BMD and L-BMD were -2.8 ± 0.4, -3.2 ± 0.5, 0.530 ± 0.049 and 0.682 ± 0.066, respectively. There were found to be high MOF risk in 16/168 (9.5% and high HF risk in 51/168 (30.4% of patients according to FRAX. Positive correlations were determined between F-Ts and L-Ts (moderate; rho = 0.424, p <0.05 and between HF and MOF (strong; rho = 0.958, p <0001. There were strong negative correlations among HF and MOF with F-Ts (respectively, rho = -0.897 and rho = -0.844, p <0.001 and moderate negative correlations among HF and MOF with L-Ts (respectively, rho = -0.535 and rho = - 0.567, p <0.05. Discussion: In postmenopausal women with osteoporosis, risk assessment by the FRAX besides the DXA-BMD measurements can be useful for not to be missed of patients with high risk of fracture.

  9. Monoclonal gammopathy of undetermined significance and risk of skeletal fractures: a population-based study

    OpenAIRE

    Kristinsson, Sigurdur Y.; Tang, Min; Pfeiffer, Ruth M.; Björkholm, Magnus; Blimark, Cecilie; Mellqvist, Ulf-Henrik; Wahlin, Anders; Turesson, Ingemar; Landgren, Ola

    2010-01-01

    Patients with multiple myeloma (MM) have an increased risk of fractures. On the basis of small numbers, patients with monoclonal gammopathy of undetermined significance (MGUS) have been reported to have an increased fracture risk. Using population-based data from Sweden, we assessed the risks of fractures in 5326 MGUS patients diagnosed from 1958 to 2006, compared with 20 161 matched controls. MGUS patients had an increased risk of any fracture at 5 (hazard ratio [HR] = 1.74; 95% confidence i...

  10. Risk of fracture in patients with Guillain-Barré syndrome

    NARCIS (Netherlands)

    Pouwels, S; de Boer, A; Leufkens, H G M; Weber, W E J; Cooper, C; van Staa, T P; de Vries, F

    2014-01-01

    UNLABELLED: The aim of this study was to evaluate fracture risk in patients with Guillain-Barré syndrome (GBS). No association with risk of fracture was observed for GBS patients compared with controls. Only GBS patients using pain treatment had a doubled risk of fracture. INTRODUCTION: Symptoms of

  11. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture.

    Science.gov (United States)

    Tzermiadianos, Michael N; Renner, Susan M; Phillips, Frank M; Hadjipavlou, Alexander G; Zindrick, Michael R; Havey, Robert M; Voronov, Michael; Patwardhan, Avinash G

    2008-11-01

    This study investigated the effect of endplate deformity after an osteoporotic vertebral fracture in increasing the risk for adjacent vertebral fractures. Eight human lower thoracic or thoracolumbar specimens, each consisting of five vertebrae were used. To selectively fracture one of the endplates of the middle VB of each specimen a void was created under the target endplate and the specimen was flexed and compressed until failure. The fractured vertebra was subjected to spinal extension under 150 N preload that restored the anterior wall height and vertebral kyphosis, while the fractured endplate remained significantly depressed. The VB was filled with cement to stabilize the fracture, after complete evacuation of its trabecular content to ensure similar cement distribution under both the endplates. Specimens were tested in flexion-extension under 400 N preload while pressure in the discs and strain at the anterior wall of the adjacent vertebrae were recorded. Disc pressure in the intact specimens increased during flexion by 26 +/- 14%. After cementation, disc pressure increased during flexion by 15 +/- 11% in the discs with un-fractured endplates, while decreased by 19 +/- 26.7% in the discs with the fractured endplates. During flexion, the compressive strain at the anterior wall of the vertebra next to the fractured endplate increased by 94 +/- 23% compared to intact status (p 0.05). Subsequent flexion with compression to failure resulted in adjacent fracture close to the fractured endplate in six specimens and in a non-adjacent fracture in one specimen, while one specimen had no adjacent fractures. Depression of the fractured endplate alters the pressure profile of the damaged disc resulting in increased compressive loading of the anterior wall of adjacent vertebra that predisposes it to wedge fracture. This data suggests that correction of endplate deformity may play a role in reducing the risk of adjacent fractures. PMID:18795344

  12. Changing incidence and residual lifetime risk of common osteoporosis-related fractures

    DEFF Research Database (Denmark)

    Lauritzen, J B; Schwarz, Peter; Lund, B;

    1993-01-01

    Changes in incidence and lifetime risk of fractures are of major importance in the epidemiology of osteoporosis. We focused on hip fractures in women and men and on radial and humeral fractures in women. The study subjects comprised 4500 women and men 20 years old or more with fractures. In women...

  13. EXTERNAL FIXATION OF INTERTROCHANTERIC FRACTURES AS AN OPTION IN HIGH RISK GERIATRIC PATIENTS

    OpenAIRE

    Badoo; Naveed,; Syed Baasit Shafi; Mohammad,, K

    2015-01-01

    OBJECTIVE: The purpose of this study is to evaluate the usefulness of external fixation of intertrochanteric fractures in high risk geriatric patients. DESIGN: Prospective clinical study. SETTINGS: Level - 1 trauma C entre. PATIENTS: Fifty high risk geriatric patients with intertrochanteric fractures. INTERVENTION: Close reduction and external fixation using AO external fixator. OUTCOME MEASURED: fracture union, time to union, pin tract in...

  14. A risk assessment tool for contaminated sites in low-permeability fractured media

    DEFF Research Database (Denmark)

    In Denmark, many contaminated sites are located in areas with low permeability or fractured geologies such as glacial moraine clays. Fractures increase the risk of fast transport of contaminants to underlying groundwater systems. It is therefore important to consider fracture transport when...... evaluating the risk of contaminated sites to drinking water resources....

  15. Mapping the prescriptiome to fractures in men--a national analysis of prescription history and fracture risk

    DEFF Research Database (Denmark)

    Abrahamsen, B; Brixen, K

    2009-01-01

    . INTRODUCTION: Osteoporosis in men is frequently related to alcohol abuse, hypogonadism, hypercalciuria, or the use of glucocorticoids. Very limited information is available on the impact of other medications on fracture risk in men. METHODS: We conducted a nationwide population-based case-control study...... identified 3.2 million redemptions of prescriptions for 1,073 different drugs. The analysis confirmed associations between fracture risk and use of sedatives, anti-epileptics, anti-psychotics, anxiolytics, SSRI, opioids and other analgesics, loop diuretics, and glucorticoids. New associations were also found....... We observed an odds ratio (OR [95% CI] for any fracture) for fracture in users of dopaminergic agents (1.6 [1.3-1.9]) and iron compounds (1.2 [1.1-1.5]). The largest impact on fracture risk at population level was exerted by loop diuretics and analgesics. CONCLUSIONS: An array of drugs is associated...

  16. Risk assessment tools to identify women with increased risk of osteoporotic fracture. Complexity or simplicity?

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Friis-Holmberg, Teresa; Hermann, Anne Pernille;

    2013-01-01

    of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance each tool was sufficient for practical use and lastly to examine whether the complexity of the tools influenced their discriminative power. We searched Pub...... fracture outcomes. High quality studies in randomized design with population-based cohorts with different case mixes are needed. © 2013 American Society for Bone and Mineral Research....

  17. Self-perceived facture risk

    DEFF Research Database (Denmark)

    Rothmann, M J; Ammentorp, J; Bech, M;

    2015-01-01

    SUMMARY: This Danish cross-sectional study (n=20,905) showed that women aged 65-81 years generally underestimated fracture risk compared to absolute risk estimated by the FRAX® algorithm. Significant association was found between risk factors (e.g., previous fracture, parental hip fracture......, and self-rated heath) and self-perceived fracture risk. Although women recognized the importance of some fracture risk factors, a number of significant risk factors appeared to be less well known. INTRODUCTION: The aim of this study is to investigate women's self-perceived fracture risk and potential...... factors associated with this and to compare self-perceived risk with absolute fracture risk estimated by FRAX® in women aged 65-80 years. METHODS: Data from 20,905 questionnaires from the ROSE study were analyzed. The questionnaire included 25 items on osteoporosis, risk factors for fractures, and self...

  18. Development of a Korean Fracture Risk Score (KFRS for Predicting Osteoporotic Fracture Risk: Analysis of Data from the Korean National Health Insurance Service.

    Directory of Open Access Journals (Sweden)

    Ha Young Kim

    Full Text Available Asian-specific prediction models for estimating individual risk of osteoporotic fractures are rare. We developed a Korean fracture risk prediction model using clinical risk factors and assessed validity of the final model.A total of 718,306 Korean men and women aged 50-90 years were followed for 7 years in a national system-based cohort study. In total, 50% of the subjects were assigned randomly to the development dataset and 50% were assigned to the validation dataset. Clinical risk factors for osteoporotic fracture were assessed at the biennial health check. Data on osteoporotic fractures during the follow-up period were identified by ICD-10 codes and the nationwide database of the National Health Insurance Service (NHIS.During the follow-up period, 19,840 osteoporotic fractures were reported (4,889 in men and 14,951 in women in the development dataset. The assessment tool called the Korean Fracture Risk Score (KFRS is comprised of a set of nine variables, including age, body mass index, recent fragility fracture, current smoking, high alcohol intake, lack of regular exercise, recent use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis. The KFRS predicted osteoporotic fractures over the 7 years. This score was validated using an independent dataset. A close relationship with overall fracture rate was observed when we compared the mean predicted scores after applying the KFRS with the observed risks after 7 years within each 10th of predicted risk.We developed a Korean specific prediction model for osteoporotic fractures. The KFRS was able to predict risk of fracture in the primary population without bone mineral density testing and is therefore suitable for use in both clinical setting and self-assessment. The website is available at http://www.nhis.or.kr.

  19. Fracture Risk Assessment in Chronic Kidney Disease, Prospective Testing Under Real World Environments (FRACTURE: a prospective study

    Directory of Open Access Journals (Sweden)

    West Sarah L

    2010-08-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is associated with an increased risk of fracture. Decreased bone mass and disruption of microarchitecture occur early in the course of CKD and worsens with the progressive decline in renal function so that at the time of initiation of dialysis at least 50% of patients have had a fracture. Despite the excess fracture risk, and the associated increases in morbidity and mortality, little is known about the factors that are associated with an increase in fracture risk. Our study aims to identify prognostic factors for bone loss and fractures in patients with stages 3 to 5 CKD. Methods This prospective study aims to enroll two hundred and sixty men and women with stages 3 to 5 CKD. Subjects will be followed for 24 months and we will examine the ability of: 1 bone mineral density by dual x-ray absorptiometry at the spine, hip, and radius; 2 volumetric bone density by high resolution peripheral quantitated computed tomography at the radius and tibia; 3 serum markers of bone turnover; 4 bone formation rate by bone biopsy; and 5 muscle strength and balance to predict spine and non-spine fractures, identified by self-report and/or vertebral morphometry. All measurements will be obtained at baseline, at 12 and at 24 months with the exception of bone biopsy, which will be measured once at 12 months. Subjects will be contacted every 4 months to determine if there have been incident fractures or falls. Discussion This study is one of the first that aims to identify risk factors for fracture in early stage CKD patients. Ultimately, by identifying risk factors for fracture and targeting treatments in this group-before the initiation of renal replacement therapy - we will reduce the burden of disease due to fractures among patients with CKD.

  20. Study of Hip Fracture Risk using Tree Structured Survival Analysis

    Directory of Open Access Journals (Sweden)

    Lu Y

    2003-01-01

    Full Text Available In dieser Studie wird das Hüftfraktur-Risiko bei postmenopausalen Frauen untersucht, indem die Frauen in verschiedene Subgruppen hinsichtlich dieses Risikos klassifiziert werden. Frauen in einer gemeinsamen Subgruppe haben ein ähnliches Risiko, hingegen in verschiedenen Subgruppen ein unterschiedliches Hüftfraktur-Risiko. Die Subgruppen wurden mittels der Tree Structured Survival Analysis (TSSA aus den Daten von 7.665 Frauen der SOF (Study of Osteoporosis Fracture ermittelt. Bei allen Studienteilnehmerinnen wurde die Knochenmineraldichte (BMD von Unterarm, Oberschenkelhals, Hüfte und Wirbelsäule gemessen. Die Zeit von der BMD-Messung bis zur Hüftfraktur wurde als Endpunkt notiert. Eine Stichprobe von 75% der Teilnehmerinnen wurde verwendet, um die prognostischen Subgruppen zu bilden (Trainings-Datensatz, während die anderen 25% als Bestätigung der Ergebnisse diente (Validierungs-Datensatz. Aufgrund des Trainings-Datensatzes konnten mittels TSSA 4 Subgruppen identifiziert werden, deren Hüftfraktur-Risiko bei einem Follow-up von im Mittel 6,5 Jahren bei 19%, 9%, 4% und 1% lag. Die Einteilung in die Subgruppen erfolgte aufgrund der Bewertung der BMD des Ward'schen Dreiecks sowie des Oberschenkelhalses und nach dem Alter. Diese Ergebnisse konnten mittels des Validierungs-Datensatzes reproduziert werden, was die Sinnhaftigkeit der Klassifizierungregeln in einem klinischen Setting bestätigte. Mittels TSSA war eine sinnvolle, aussagekräftige und reproduzierbare Identifikation von prognostischen Subgruppen, die auf dem Alter und den BMD-Werten beruhen, möglich. In this paper we studied the risk of hip fracture for post-menopausal women by classifying women into different subgroups based on their risk of hip fracture. The subgroups were generated such that all the women in a particular subgroup had relatively similar risk while women belonging to two different subgroups had rather different risks of hip fracture. We used the Tree Structured

  1. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study.

    NARCIS (Netherlands)

    Mahmoodi, B.K.; Kate, M.K. ten; Waanders, F.; Veeger, N.J.; Brouwer, J.L.; Vogt, L.; Navis, G.; Meer, J.W.M. van der

    2008-01-01

    BACKGROUND: No data are available on the absolute risk of either venous thromboembolism (VTE) or arterial thromboembolism (ATE) in patients with nephrotic syndrome. Reported risks are based on multiple case reports and small studies with mostly short-term follow-up. We assessed the absolute risk of

  2. Mapping return levels of absolute NDVI variations for the assessment of drought risk in Ethiopia

    Science.gov (United States)

    Tonini, F.; Hochmair, H. H.; Jona Lasinio, G.

    2012-12-01

    The analysis and forecasting of extreme climatic events has become increasingly relevant to planning effective financial and food-related interventions in third-world countries. Natural disasters and climate change, both large and small scale, have a great impact on non-industrialized populations who rely exclusively on activities such as crop production, fishing, and similar livelihood activities. It is important to identify the extent of the areas prone to severe drought conditions in order to study the possible consequences of the drought on annual crop production. In this paper, we aim to identify such areas within the South Tigray zone, Ethiopia, using a transformation of the Normalized Difference Vegetation Index (NDVI) called Absolute Difference NDVI (ADVI). Negative NDVI shifts from the historical average can generally be linked to a reduction in the vigor of local vegetation. Drought is more likely to increase in areas where negative shifts occur more frequently and with high magnitude, making it possible to spot critical situations. We propose a new methodology for the assessment of drought risk in areas where crop production represents a primary source of livelihood for its inhabitants. We estimate ADVI return levels pixel per pixel by fitting extreme value models to independent monthly minima. The study is conducted using SPOT-Vegetation (VGT) ten-day composite (S10) images from April 1998 to March 2009. In all short-term and long-term predictions, we found that central and southern areas of the South Tigray zone are prone to a higher drought risk compared to other areas.; Temporal autocorrelation among monthly minima within the Alamata woreda. (a) ACF-Boxplot and (b) PACF-Boxplot. ; ADVI return level estimates. (a) 10-Month return levels. (b) 100-Month return levels. (c) 1000-Month return levels.

  3. Fracture risk and bone mineral density in Turner syndrome.

    Science.gov (United States)

    Bakalov, Vladimir K; Bondy, Carolyn A

    2008-06-01

    Bone health is a major lifelong concern in caring for women and girls with Turner syndrome (TS). There is an approximately 25% increase in fracture risk most of which is related to medium or high impact trauma. The long bones, especially of the forearm are predominantly affected. This fact may be due to a selective cortical bone deficiency in TS which is unrelated to hypogonadism. In addition, lack of adequate estrogen replacement can lead to trabecular bone deficiency and increase in vertebral compression fractures after age 45. Evaluation of bone density by dual X-ray absorptiometry (DEXA) is important, however, it should be used judiciously in TS in view of its inherent tendency to underestimate the bone density of people with short stature. Bone size-independent methods, such as QCT or volumetric transformation of DEXA data should be used in individuals shorter than 150 cm. Achieving optimal bone density is of critical importance for fracture prevention in TS, and should be pursued by timely introduction of hormone replacement therapy, adequate dose of estrogens during the young adult life, optimal calcium and vitamin D intake and regular physical exercise. In addition, other measures to prevent fall and trauma should be considered, including optimizing hearing and vision, avoiding contact sports and exercise to improve coordination. PMID:18415020

  4. Relationship of Height to Site-Specific Fracture Risk in Postmenopausal Women.

    Science.gov (United States)

    Armstrong, Miranda Eg; Kirichek, Oksana; Cairns, Benjamin J; Green, Jane; Reeves, Gillian K

    2016-04-01

    Height has been associated with increased risk of fracture of the neck of femur. However, information on the association of height with fractures at other sites is limited and conflicting. A total of 796,081 postmenopausal women, who reported on health and lifestyle factors including a history of previous fractures and osteoporosis, were followed for 8 years for incident fracture at various sites by record linkage to National Health Service hospital admission data. Adjusted relative risks of fracture at different sites per 10-cm increase in height were estimated using Cox regression. Numbers with site-specific fractures were: humerus (3036 cases), radius and/or ulna (1775), wrist (9684), neck of femur (5734), femur (not neck) (713), patella (649), tibia and/or fibula (1811), ankle (5523), and clavicle/spine/rib (2174). The risk of fracture of the neck of femur increased with increasing height (relative risk [RR] = 1.48 per 10-cm increase, 99% confidence interval [CI] 1.39-1.57) and the proportional increase in risk was significantly greater than for all other fracture sites (pheterogeneity < 0.001). For the other sites, fracture risk also increased with height (RR = 1.15 per 10 cm, CI 1.12-1.18), but there was only very weak evidence of a possible difference in risk between the sites (pheterogeneity = 0.03). In conclusion, taller women are at increased risk of fracture, especially of the neck of femur. PMID:26572496

  5. Population-based studies on risk of fracture in patients with neurological disorders

    NARCIS (Netherlands)

    Pouwels, S.

    2014-01-01

    Introduction Patients with neurological disorders may be at an increased risk of fracture via multiple causal pathways, including increases in the risk of falls, changes in bone mineral density and quality of bone microarchitecture. Risk of fracture may be increased by the disease itself, by comorbi

  6. The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom : 2000-2010

    NARCIS (Netherlands)

    Gibson-Smith, D; Klop, C; Elders, P J M; Welsing, P M J; van Schoor, N; Leufkens, H G M; Harvey, N C; van Staa, T P; de Vries, F

    2014-01-01

    UNLABELLED: The risk of a subsequent major or any fracture after a hip fracture and secular trends herein were examined. Within 1 year, 2.7 and 8.4% of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5% after 5 years. Subsequent fracture rates increased during th

  7. A risk assessment tool for contaminated sites in low-permeability fractured media

    DEFF Research Database (Denmark)

    Chambon, Julie Claire Claudia; Binning, Philip John; Jørgensen, Peter R.;

    2011-01-01

    A risk assessment tool for contaminated sites in low-permeability fractured media is developed, based on simple transient and steady-state analytical solutions. The discrete fracture (DF) tool, which explicitly accounts for the transport along fractures, covers different source geometries...

  8. Model linear absolute and relative risk estimates for cancer induced by ionizing radiation in Mexican cohort of occupationally exposed

    International Nuclear Information System (INIS)

    From the rate of natural mortality ms cancer (t) for every 100 thousand habitants, modeled by a fourth-degree polynomial function of the age data of the Mexican population (2008), and assuming: a) a relationship 1: 5 of cancer induced radiation respect to presented spontaneously, b) a size of initial cohort No = 100 k SOPs, c) a speed of HE = (2 ± 1) mSv / received by the SOPs from 18 to 65 years, d) a latency of 8 years for cancer induction after irradiation, e) a time tracking cohort to 75 years, f) and taking the coefficients absolute and relative risk BEIRs induction of cancer models II and VII (excluding leukemia); It determined: BEIR II for a total of 125 and 400 deaths from cancer for absolute and relative linear models respectively. For BEIR VII has a number of fatal cases of 345 and 927 deaths respectively for absolute and relative linear model cancer.

  9. Easy Absolute Values? Absolutely

    Science.gov (United States)

    Taylor, Sharon E.; Mittag, Kathleen Cage

    2015-01-01

    The authors teach a problem-solving course for preservice middle-grades education majors that includes concepts dealing with absolute-value computations, equations, and inequalities. Many of these students like mathematics and plan to teach it, so they are adept at symbolic manipulations. Getting them to think differently about a concept that they…

  10. Shape-based Assessment of Vertebral Fracture Risk in Postmenopausal Women Using Discriminative Shape Alignment

    DEFF Research Database (Denmark)

    Crimi, Alessandro; Loog, Marco; de Bruijne, Marleen;

    2012-01-01

    RATIONALE AND OBJECTIVES: Risk assessment of future osteoporotic vertebral fractures is currently based mainly on risk factors, such as bone mineral density, age, prior fragility fractures, and smoking. It can be argued that an osteoporotic vertebral fracture is not exclusively an abrupt event but...... the result of a decaying process. To evaluate fracture risk, a shape-based classifier, identifying possible small prefracture deformities, may be constructed. MATERIALS AND METHODS: During a longitudinal case-control study, a large population of postmenopausal women, fracture free at baseline, were...... followed. The 22 women who sustained at least one lumbar fracture on follow-up represented the case group. The control group comprised 91 women who maintained skeletal integrity and matched the case group according to the standard osteoporosis risk factors. On radiographs, a radiologist and two technicians...

  11. A Biomechanical Approach to Assessing Hip Fracture Risk

    Science.gov (United States)

    Ellman, Rachel

    2009-01-01

    Bone loss in microgravity is well documented, but it is difficult to quantify how declines in bone mineral density (BMD) contribute to an astronaut's overall risk of fracture upon return. This study uses a biomechanical approach to assessing hip fracture risk, or Factor of Risk (Phi), which is defined as the ratio of applied load to bone strength. All long-duration NASA astronauts from Expeditions 1-18 were included in this study (n=25), while crewmembers who flew twice (n=2) were treated as separate subjects. Bone strength was estimated based on an empirical relationship between areal BMD at the hip, as measured by DXA, and failure load, as determined by mechanical testing of cadaver femora. Fall load during a sideways fall was calculated from a previously developed biomechanical model, which takes into account body weight, height, gender, and soft tissue thickness overlying the lateral aspect of the hip that serves to attenuate the impact force. While no statistical analyses have been performed yet, preliminary results show that males in this population have a higher FOR than females, with a post- flight Phi of 0.87 and 0.36, respectively. FOR increases 5.1% from preflight to postflight, while only one subject crossed the fracture "threshold" of Phi = 1, for a total of 2 subjects with a postflight Phi > 1. These results suggest that men may be at greater risk for hip fracture due largely in part to their relatively thin soft tissue padding as compared to women, since soft tissue thickness has the highest correlation (R(exp 2)= .53) with FOR of all subject-specific parameters. Future work will investigate changes in FOR during recovery to see if baseline risk levels are restored upon return to 1-g activity. While dual x-ray absorptiometry (DXA) is the most commonly used clinical measure of bone health, it fails to provide compartment-specific information that is useful in assessing changes to bone quality as a result of microgravity exposure. Peripheral

  12. Fracture risk in Danish men with prostate cancer: a nationwide register study

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Nielsen, Morten F; Eskildsen, Peter;

    2007-01-01

    fracture risk became apparent early after diagnosis and remained pronounced even in long-term survivors. Androgen deprivation therapy (ADT) with an odds ratio of 1.7 (1.2-2.5; P < 0.01) and orchidectomy, at 1.7 (1.2-2.4; P < 0.01) added to the overall fracture risk. In all, 3.1% of hip fractures in Danish...... excess mortality in patients with advanced prostate cancer...

  13. Dementia and Hip Fractures: Development of a Pathogenic Framework for Understanding and Studying Risk

    OpenAIRE

    Friedman, Susan M.; Menzies, Isaura B.; Bukata, Susan V.; Mendelson, Daniel A.; Stephen L Kates

    2010-01-01

    Dementia and hip fractures are 2 conditions that are seen primarily in older adults, and both are associated with substantial morbidity and mortality. An individual with dementia is up to 3 times more likely than a cognitively intact older adult to sustain a hip fracture. This may occur via several mechanisms, including (1) risk factors that are common to both outcomes; (2) the presence of dementia increasing hip fracture incidence via intermediate risk factors, such as falls, osteoporosis, a...

  14. Treating postmenopausal osteoporosis in women at increased risk of fracture - critical appraisal of bazedoxifene: a review

    DEFF Research Database (Denmark)

    Thomsen, Súsanna v.; Vestergaard, Peter

    2010-01-01

    for gastrointestinal side effects, and especially in women in whom osteoporosis is frequent, several options for treatment are needed. The objectives of this review were to critically appraise the effects of bazedoxifene on risk of fractures especially in women at high risk of fractures. A systematic literature search...

  15. A meta-analysis of the association of fracture risk and body mass index in women

    NARCIS (Netherlands)

    Johansson, Helena; Kanis, John A; Odén, Anders; McCloskey, Eugene; Chapurlat, Roland D; Christiansen, Claus; Cummings, Steve R; Diez-Perez, Adolfo; Eisman, John A; Fujiwara, Saeko; Glüer, Claus-C; Goltzman, David; Hans, Didier; Khaw, Kay-Tee; Krieg, Marc-Antoine; Kröger, Heikki; LaCroix, Andrea Z; Lau, Edith; Leslie, William D; Mellström, Dan; Melton, L Joseph; O'Neill, Terence W; Pasco, Julie A; Prior, Jerilynn C; Reid, David M; Rivadeneira, Fernando; van Staa, Tjerd; Yoshimura, Noriko; Zillikens, M Carola; van Staa, Tjeerd

    2014-01-01

    Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were av

  16. Value of routine blood tests for prediction of mortality risk in hip fracture patients

    DEFF Research Database (Denmark)

    Mosfeldt, Mathias; Pedersen, Ole B; Riis, Troels;

    2012-01-01

    There is a 5- to 8-fold increased risk of mortality during the first 3 months after a hip fracture. Several risk factors are known. We studied the predictive value (for mortality) of routine blood tests taken on admission....

  17. Older Male Physicians Have Lower Risk of Trochanteric but Not Cervical Hip Fractures

    Directory of Open Access Journals (Sweden)

    Hsiu-Nien Shen

    2015-02-01

    Full Text Available Background: Osteoporosis is pathophysiologically related to trochanteric fractures, and this condition is more preventable by lifestyle modifications than cervical fractures. We investigated whether older physicians, who are health-conscious people, are at a lower risk of hip fractures because of fewer trochanteric fractures. Methods: Data regarding older (≥65 years physicians (n = 4303 and matched non-medical persons (control were retrieved from Taiwan’s National Health Insurance claims. All of the subjects were obtained from NHIRD with index dates from 1 January 2000 to 31 December 2008. Cox proportional hazard and competing risk regression models were established to estimate the hazard ratio (HR of hip fracture associated with older physicians. Results: The incidence rates of trochanteric fractures were lower in older physicians than in controls (1.73 and 3.07 per 1000 person-years, respectively, whereas the rates of cervical fractures were similar between the two groups (2.45 and 2.12 per 1000 person-years, respectively. Older physicians yielded 46% lower hazard of trochanteric fractures than controls (adjusted HR 0.54, 95% confidence interval 0.37–0.79; by contrast, hazards of cervical fractures were comparable between the two groups. The HRs estimated from the competing risk models remained unchanged. Conclusions: Our findings indicated that health risk awareness may pose a significant preventive effect on trochanteric hip fractures.

  18. Season of birth and the risk of hip fracture in Danish men and women aged 65+

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Heitmann, Berit Lilienthal; Eiken, Pia Agnete

    2012-01-01

    an epidemiological analysis of hip fracture rates as a function of season of birth, age, and sex. We retrieved information on all hip fractures in the 9-year period between 1997 and 2005 in all men and women aged 65-95, excluded hip fractures that occurred in current and recent prednisolone users, and subsequently...... calculated fracture rates and relative risks. The analysis covered 541,109 men and 691,522 women. In women, we observed a small but statistically significant difference between fracture rates by season of birth for all age intervals expect the youngest (age 65-69). A similar pattern was seen in men...

  19. The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis

    DEFF Research Database (Denmark)

    Bang, Ulrich Christian; Benfield, Thomas; Bendtsen, Flemming;

    2014-01-01

    with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption. RESULTS: During the study period, bone fractures......BACKGROUND & AIMS: Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat...

  20. The risk of fractures associated with thiazolidinediones: a self-controlled case-series study.

    Directory of Open Access Journals (Sweden)

    Ian J Douglas

    2009-09-01

    Full Text Available BACKGROUND: The results of clinical trials have suggested that the thiazolidinedione antidiabetic agents rosiglitazone and pioglitazone are associated with an increased risk of fractures, but such studies had limited power. The increased risk in these trials appeared to be limited to women and mainly involved fractures of the arm, wrist, hand, or foot: risk patterns that could not be readily explained. Our objective was to further investigate the risk of fracture associated with thiazolidinedione use. METHODS AND FINDINGS: The self-controlled case-series design was used to compare rates of fracture during thiazolidinedione exposed and unexposed periods and thus estimate within-person rate ratios. We used anonymised primary care data from the United Kingdom General Practice Research Database (GPRD. All patients aged 40 y or older with a recorded fracture and at least one prescription for a thiazolidinedione were included (n = 1,819. We found a within-person rate ratio of 1.43 (95% confidence interval [CI] 1.25-1.62 for fracture at any site comparing exposed with unexposed periods among patients prescribed any thiazolidinedione. This association was similar in men and women and in patients treated with either rosiglitazone or pioglitazone. The increased risk was also evident at a range of fracture sites, including hip, spine, arm, foot, wrist, or hand. The risk increased with increasing duration of thiazolidinedione exposure: rate ratio 2.00 (95% CI 1.48-2.70 for 4 y or more of exposure. CONCLUSION: Within individuals who experience a fracture, fracture risk is increased during periods of exposure to thiazolidinediones (both rosiglitazone and pioglitazone compared with unexposed periods. The increased risk is observed in both men and women and at a range of fracture sites. The risk also increases with longer duration of use.

  1. Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study

    Directory of Open Access Journals (Sweden)

    Thulesius Hans

    2010-03-01

    Full Text Available Abstract Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality Index combined the clinical risk factors age ≥80 years, weight Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%. These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

  2. Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures

    Directory of Open Access Journals (Sweden)

    Halvorson Jason J

    2012-02-01

    Full Text Available Abstract Background One potential complication of retrograde femoral nailing in the treatment of femur fractures is the risk of septic knee. This risk theoretically increases in open fractures as a contaminated fracture site has the potential to seed the instrumentation being passed in and out of the sterile intraarticular starting point. There are few studies examining this potential complication in a relatively commonly practiced technique. Methods All patients who received a retrograde femoral nail for femur fracture between September 1996 and November 2006 at a Level 1 trauma center were retrospectively reviewed. This yielded 143 closed fractures, 38 open fractures and 4 closed fractures with an ipsilateral traumatic knee arthrotomy. Patient follow-up records were reviewed for documentation of septic knee via operative notes, wound culture or knee aspirate data, or the administration of antibiotics for suspected septic knee. Results No evidence of septic knee was found in the 185 fractures examined in the dataset. Utilizing the Wilson confidence interval, the rate of septic knee based on our population was no greater than 2%, with that of the open fracture group alone being 9%. Conclusions Based on these results and review of the literature, the risk of septic knee in retrograde femoral nailing of both open and closed femoral shaft fractures appears low but potentially not insignificant. Funding There was no outside source of funding from either industry or other organization for this study.

  3. Risk of fracture in celiac disease: Gender, dietary compliance, or both?

    Institute of Scientific and Technical Information of China (English)

    María Inés Pinto Sánchez; Edgardo Smecuol; Adriana Crivelli; Juan Andrés de Paula; Juan C Gómez; Silvia Pedreira; Eduardo Mauri(n)o; Julio César Bai; Adriana Mohaidle; Andrea Baistrocchi; Dolores Matoso; Horacio Vázquez; Andrea González; Roberto Mazure; Evangelina Maffei; Guillermina Ferrari

    2011-01-01

    AIM: To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture risk. METHODS: We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age- and sex-matched controls who had been diagnosed with functional gastrointestinal disorders. Data were collected through in-person interviews with an investigator. The overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis). RESULTS: Compared with the control group, the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR): 1.78, 95% CI: 1.23-2.56, P < 0.002] and in men (HR: 2.67, 95% CI: 1.37-5.22, P < 0.004). Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003). In the time period after diagnosis, the risk of fractures was comparable between the CD cohort and controls in both sexes (HR: 1.08, 95% CI: 0.55-2.10 for women; HR: 1.57, 95% CI: 0.57-4.26 for men). CONCLUSION: CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis. This is associated with male sex and classic clinical presentation. The fracture risk was reduced after the treatment.

  4. Pronounced Risk of Fractures among Elderly Men Affected by Granulomatosis with Polyangiitis

    DEFF Research Database (Denmark)

    Faurschou, Mikkel; Baslund, Bo; Obel, Niels

    2015-01-01

    OBJECTIVE: It is unknown whether patients affected by granulomatosis with polyangiitis (GPA) are at increased risk of fractures, and whether the fracture risk in GPA varies with age and sex. The aim of the present study was to compare the fracture risk among patients with GPA with that among age......- and sex-matched population controls. METHODS: We established a monocentric cohort of patients treated for GPA at a Danish tertiary care center from 1995 to 2010 (n = 159) and a register-derived GPA cohort identified from the Danish National Hospital Register (n = 402). Each patient was matched with 7...... population controls. The occurrence of fractures among patients was compared with that among controls by calculation of incidence rate ratios (IRR). RESULTS: In the monocentric cohort, an increased fracture risk was observed among men aged ≥ 55 years at the time of first hospitalization for GPA (IRR 3.5, 95...

  5. Important risk factors and attributable risk of vertebral fractures in the population-based Tromsø study

    Directory of Open Access Journals (Sweden)

    Waterloo Svanhild

    2012-08-01

    Full Text Available Abstract Background Vertebral fractures, the most common type of osteoporotic fractures, are associated with increased risk of subsequent fracture, morbidity, and mortality. The aim of this study was to examine the contribution of important risk factors to the variability in vertebral fracture risk. Methods Vertebral fracture was ascertained by VFA method (DXA, GE Lunar Prodigy in 2887 men and women, aged between 38 and 87 years, in the population-based Tromsø Study 2007/2008. Bone mineral density (BMD; g/cm2 at the hip was measured by DXA. Lifestyle information was collected by questionnaires. Multivariable logistic regression model, with anthropometric and lifestyle factors included, was used to assess the association between each or combined risk factors and vertebral fracture risk. Population attributable risk was estimated for combined risk factors in the final multivariable model. Results In both sexes, age (odds ratio [OR] per 5 year increase: 1.32; 95% CI 1.19-1.45 in women and 1.21; 95% CI 1.10-1.33 in men and BMD (OR per SD decrease: 1.60; 95% CI 1.34-1.90 in women and1.40; 95% CI 1.18-1.67 in men were independent risk factors for vertebral fracture. At BMD levels higher than 0.85 g/cm2, men had a greater risk of fracture than women (OR 1.52; 95% CI 1.14-2.04, after adjusting for age. In women and men, respectively, approximately 46% and 33% of vertebral fracture risk was attributable to advancing age (more than 70 years and low BMD (less than 0.85 g/cm2, with the latter having a greater effect than the former. Conclusions These data confirm that age and BMD are major risk factors for vertebral fracture risk. However, in both sexes the two factors accounted for less than half of fracture risk. The identification of individuals with vertebral fracture is still a challenge.

  6. Beyond mobility assessment: Timed up and go test and its relationship to osteoporosis and fracture risk

    OpenAIRE

    Shereen M. Mousa, MD; Doha Rasheedy, MD; Khalid E. El-Sorady, MSc; Ahmed K. Mortagy, MD

    2016-01-01

    Background: Fracture determinants are falls, bone fragility, imbalance, and decreased lower limb strength. The timed up and go (TUG) test assesses most of the fracture determinants. Aim: To assess the relationship between mobility status using TUG test, bone mineral density (BMD), and different fracture risks predicted by different tools. Methods: A case (TUG time > 20 seconds)–control (TUG ≤ 20 seconds) study comprised 66 patients and 72 controls. Participants were assessed for falls, ...

  7. Physical inactivity is an independent risk factor for hip fracture in the elderly.

    OpenAIRE

    Coupland, C; Wood, D.; Cooper, C.

    1993-01-01

    STUDY OBJECTIVE--To test the hypothesis that physical inactivity is an independent risk factor for hip fracture in the elderly. DESIGN--Population based, case-control study. SETTING--Metropolitan borough of Newcastle upon Tyne. PARTICIPANT--A total of 197 patients aged 50 years and over, resident in Newcastle, and admitted consecutively with a hip fracture, and 382 community controls, matched by age and sex, who had not suffered a hip fracture. MEASUREMENTS AND MAIN RESULTS--Validated methods...

  8. Higher relative, but lower absolute risks of myocardial infarction in women than in men

    DEFF Research Database (Denmark)

    Reuterwall, C; Hallqvist, J; Ahlbom, A;

    1999-01-01

    Middle-aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the SHEEP study was to compare the effects of different MI risk factors in women and men....

  9. Absolute risk of suicide after first hospital contact in mental disorder

    DEFF Research Database (Denmark)

    Nordentoft, Merete; Mortensen, Preben Bo; Pedersen, Carsten Bøcker

    2011-01-01

    Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up.......Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up....

  10. Predict of fracture risk rate according to morphological measuring of proximal femoral part using dual energy x-ray absorptiometry

    International Nuclear Information System (INIS)

    The femoral fracture is the most serious problem of old ages having osteoporotic fractures. First of all, prevention to reduce the incidence of hip fracture and to identify the risk factor is essential subject. The purpose of this study is to investigate which geometric parameters of proximal femur are related to the hip fracture risk in old ages. Author analyzed the bone density and bone content of over 60 years old women who had suffered hip fracture (n = 60) and non fracture groups (n = 60). Author concluded that geometric measurements of proximal femoral part made on dual energy x-ray absorptiometry can predict hip fracture independently of bone mineral density

  11. Exposure to antiepileptic drugs and the risk of hip fracture: a case-control study

    DEFF Research Database (Denmark)

    Tsiropoulos, Ioannis; Andersen, Morten; Nymark, Tine;

    2008-01-01

    PURPOSE: To investigate whether the use of antiepileptic drugs (AEDs) increases the risk of hip fracture. METHODS: We performed a case-control study using data from the Funen County (population 2004: 475,000) hip fracture register. Cases (n = 7,557) were all patients admitted to county hospitals ...

  12. The role of sarcopenia in the risk of osteoporotic hip fracture.

    Science.gov (United States)

    Oliveira, A; Vaz, C

    2015-10-01

    Several common age-related mechanisms and factors influence muscle and bone, affecting functionality of both tissues. Sarcopenia is closely linked with osteoporosis, and their combined effect may exacerbate negative health outcomes. Fall-related fractures are some of the most serious consequences of these two systemic pathologies, with hip fracture being a major complication affecting osteoporotic and sarcopenic elderly. This work aims to review the literature on the current state of knowledge about the relations between sarcopenia and osteoporosis and to present the association between sarcopenia and osteoporosis and the risk of hip fracture. A literature search was performed in PubMed and Scopus databases for articles with the predefined terms "sarcopenia," "muscular atrophy," "femoral fractures," "hip fractures," "osteoporosis," and "bone density." There is a growing and significant interest being directed to sarcopenia and associated risk for osteoporotic hip fracture, but there still is a notorious heterogeneity in the methodology and cohort size of the available studies. Collectively, most of the studies herein analyzed indicate that sarcopenia could be a predictor of risk for hip fracture. The simultaneous evaluation of sarcopenia and osteoporosis may be of importance in identifying those patients in higher risk of suffering an osteoporotic hip fracture and who could benefit from preventive or therapeutic interventions, or both.

  13. Subclinical thyroid dysfunction and fracture risk a meta-analysis

    NARCIS (Netherlands)

    M.R. Blum (Manuel); D.C. Bauer (Douglas C.); T.-H. Collet (Tinh-Hai); H.A. Fink (Howard A.); A.R. Cappola (Anne); F.L. Da Costa (F. Leal); C.D. Wirth (Christina); R.P. Peeters (Robin); B.O. Asvold (Bjorn O.); W.P.J. den Elzen (Wendy); R.N. Luben (Robert); M. Imaizumi (Misa); A.P. Bremner (Alexandra P.); A. Gogakos (Apostolos); R. Eastell (Richard); P.M. Kearney (Patricia M.); E.S. Strotmeyer (Elsa S.); E.R. Wallace (Erin R.); M. Hoff (Mari); G. Ceresini (Graziano); F. Rivadeneira Ramirez (Fernando); A.G. Uitterlinden (André); D.J. Stott (David. J.); R.G.J. Westendorp (Rudi); K.T. Khaw; A. Langhammer (Arnuf); L. Ferrucci (Luigi); J. Gussekloo (Jacobijn); G. Williams (Graham); J.P. Walsh (John); P. Jùni (Peter); D. Aujesky (Drahomir); N. Rodondi (Nicolas)

    2015-01-01

    textabstractIMPORTANCE Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION The databases of

  14. Fracture risk and adjuvant therapies in young breast cancer patients: a population-based study.

    Directory of Open Access Journals (Sweden)

    Chun-Hung Chang

    Full Text Available Breast cancer survivors have an increased risk of bone fracture. But the risk among young patients with adjuvant therapies remains unknown. This population-based study is aimed to assess the incidence and risk of fracture among young (age of 20 to 39 years breast cancer patients who received adjuvant therapies.From January 2001 to December 2007, 5,146 newly diagnosed breast cancer patients were enrolled from the National Health Insurance Research Database (NHIRD in Taiwan. Patients were observed for a maximum of 6 years to determine the incidence of newly onset fracture. Kaplan Meier and Cox regression analyses were used to evaluate the risk of fracture in young breast cancer patients who received adjuvant treatments.Of the total 5,146 young (age of 20 to 39 years breast cancer patients, the Cox multivariate proportional hazards analysis showed that AIs, radiotherapy, and monoclonal antibodies were significantly associated with a high risk of fracture. Moreover, patients who received AIs for more than 180 days had a high hazard ratio (HR of 1.77 (95% CI = 0.68-4.57, and patients who received more than four radiotherapy visits had a high HR of 2.54 (95% CI = 1.07-6.06. Under the site-specific analysis, young breast cancer patients who received AIs had the highest risk of hip fracture (HR = 8.520, 95% CI = 1.711-42.432, p < 0.04, whereas patients who received radiotherapy had the highest risk of vertebral fracture (HR = 5.512, 95% CI = 1.847-16.451, p < 0.01.Young breast cancer patients who are receiving AIs, radiotherapy or monoclonal antibody need to be more careful for preventing fracture events. Breast cancer treatment plans are suggested to incorporate fracture prevention interventions.

  15. Increased fracture rate in women with breast cancer: a review of the hidden risk

    Directory of Open Access Journals (Sweden)

    Body Jean-Jacques

    2011-08-01

    Full Text Available Abstract Background Women with breast cancer, particularly individuals diagnosed at a relatively early age, have an increased incidence of fractures. Fractures can have serious clinical consequences including the need for major surgery, increased morbidity and mortality, increased cost of disease management, and reduced quality of life for patients. The primary cause of the increased fracture risk appears to be an accelerated decrease in bone mineral density (BMD resulting from the loss of estrogenic signaling that occurs with most treatments for breast cancer, including aromatase inhibitors. However, factors other than BMD levels alone may influence treatment decisions to reduce fracture risk in this setting. Our purpose is to review current evidence for BMD loss and fracture risk during treatment for breast cancer and discuss pharmacologic means to reduce this risk. Results Fracture risk during treatment for breast cancer may be influenced by the rate of BMD loss and the consequent rapid alterations in bone microarchitecture, in addition to the established fracture risk factors in postmenopausal osteoporosis. The rapid decrease in BMD during adjuvant chemoendocrine therapy for breast cancer may necessitate more aggressive pharmacotherapy than is indicated for healthy postmenopausal women who develop osteoporosis. Over the last few years, clinical trials have established the effectiveness of bisphosphonates and other antiresorptive agents to preserve BMD during adjuvant therapy for early breast cancer. In addition, some bisphosphonates (eg, zoledronic acid may also delay disease recurrence in women with hormone-responsive tumors, thereby providing an adjuvant benefit in addition to preserving BMD and potentially preventing fractures. Conclusions It is likely that a combined fracture risk assessment (eg, as in the WHO FRAX algorithm will more accurately identify both women with postmenopausal osteoporosis and women with breast cancer who require

  16. A fracture risk assessment model of the femur in children with osteogenesis imperfecta (OI) during gait.

    Science.gov (United States)

    Fritz, Jessica M; Guan, Yabo; Wang, Mei; Smith, Peter A; Harris, Gerald F

    2009-11-01

    Osteogenesis imperfecta (OI) is a heritable bone fragility disorder characterized by skeletal deformities and increased bone fragility. There is currently no established clinical method for quantifying fracture risk in OI patients. This study begins the development of a patient-specific model for femur fracture risk assessment and prediction based on individuals' gait analysis data, bone geometry from imaging and material properties from nanoindentation (Young's modulus=19 GPa, Poisson's ratio=0.3). Finite element models of the femur were developed to assess fracture risk of the femur in a pediatric patient with OI type I. Kinetic data from clinical gait analysis was used to prescribe loading conditions on the femoral head and condyles along with muscle forces on the bone's surface. von Mises stresses were analyzed against a fracture strength of 115 MPa. The patient with OI whose femur was modeled showed no risk of femoral fracture during normal gait. The highest stress levels occurred during the mid-stance and loading responses phases of gait. The location of high stress migrated throughout the femoral diaphysis across the gait cycle. Maximum femoral stress levels occurred during the gait cycle phases associated with the highest loading. The fracture risk (fracture strength/von Mises stress), however, was low. This study provides a relevant method for combining functional activity, material property and analytical methods to improve patient monitoring.

  17. Type 1 Diabetes and Risk for Fracture: Meta-analysis and Review of the Literature

    Science.gov (United States)

    Shah, Viral N; Shah, Chirag S.; Snell-Bergeon, Janet K

    2016-01-01

    Background Fracture risk in men and women with type 1 diabetes (type 1 DM) has not been studied in a large prospective well designed cohort. Objective A systematic review and meta-analysis of observational studies were conducted to assess the association between type 1 DM and fractures. Data source Data were selected from Medline and Embase and abstract from annual scientific meeting of various diabetes and bone and mineral societies. Study selection Published studies reporting fracture risk in subjects with type 1 DM in comparison with subjects without diabetes between 1990 and July, 2014 and abstracts from various annual meeting (2005 onwards) were included for this meta-analysis. Data extraction Data were extracted from text of included publication or abstract of conferences. Data synthesis Fourteen studies that met inclusion criteria reported 2,066 fracture events among 27,300 subjects with type 1 DM (7.6%) and 136,579 fracture events among 4,364,125 subjects without diabetes (3.1%). The pooled relative risk (RR) of any fracture in subjects with type 1 DM was 3.16 (95% CI 1.51–6.63, p=0.002). Women and men with type 1 DM had four and two times higher risk for any fractures, respectively, compared to subjects without diabetes. The pooled RR of hip fractures and spinal fractures were 3.78 (95%CI; 2.05–6.98, p<0.001) and 2.88 (1.71–4.82, p<0.001), respectively, among subjects with type 1 DM. Conclusion Our meta-analysis suggests that both men and women with type 1 DM might have an increased risk for any fractures. A large prospective epidemiological study is needed to confirm our findings. PMID:26096918

  18. Fracture Risk Prediction Using Phalangeal Bone Mineral Density or FRAX(®)?

    DEFF Research Database (Denmark)

    Friis-Holmberg, Teresa; Rubin, Katrine Hass; Brixen, Kim;

    2014-01-01

    In this prospective study, we investigated the ability of Fracture Risk Assessment Tool (FRAX), phalangeal bone mineral density (BMD), and age alone to predict fractures using data from a Danish cohort study, Danish Health Examination Survey 2007-2008, including men (n = 5206) and women (n = 7552......) aged 40-90 yr. Data were collected using a self-administered questionnaire and by phalangeal BMD measurement. Information on incident and prevalent fractures, rheumatoid arthritis, and secondary osteoporosis was retrieved from the Danish National Patient Registry. Survival analyses were used to examine...... the association between low, intermediate, and high risk by phalangeal T-score or FRAX and incident fractures, and receiver operating characteristic curves were obtained. Mean follow-up time was 4.3 yr, and a total of 395 persons (3.1%) experienced a fracture during follow-up. The highest rate of major...

  19. Coffee consumption and risk of fracture in the Cohort of Swedish Men (COSM.

    Directory of Open Access Journals (Sweden)

    Helena Hallström

    Full Text Available BACKGROUND: Recent research in a large cohort of women showed that coffee consumption is not associated with increased risk of fracture. Whether this is the case also among men is less clear. METHODS: In the Cohort of Swedish Men (COSM study, 42,978 men aged 45-79 years old at baseline in 1997 answered a self-administered food frequency questionnaire covering coffee consumption and a medical and lifestyle questionnaire covering potential confounders. Our main outcomes first fracture at any site and first hip fracture were collected from the National Patient Registry in Sweden. The association between coffee consumption and fracture risk was investigated using Cox's proportional hazards regression. RESULTS: During a mean follow-up of 11.2 years, 5,066 men had a first fracture at any site and of these, 1,186 (23% were hip fractures. There was no association between increasing coffee consumption (per 200 ml and rate of any fracture (hazard ratio [HR] 1.00; 95% confidence interval [CI] 0.99-1.02 or hip fracture (HR 1.02; 95% CI 0.99-1.06 after adjustment for potential confounders. For men consuming ≥ 4 cups of coffee/day compared to those consuming <1 cup of coffee/day, HR for any type of fracture was 0.91 (95% CI 0.80-1.02 and for hip fracture: 0.89 (95% CI 0.70-1.14. CONCLUSIONS: High coffee consumption was not associated with an increased risk of fractures in this large cohort of Swedish men.

  20. Risk of fracture with thiazolidinediones: an individual patient data meta-analysis

    Directory of Open Access Journals (Sweden)

    Marloes T Bazelier

    2013-02-01

    Full Text Available Background: The use of thiazolidinediones (TZDs has been associated with increased fracture risks. Our aim was to estimate the risk of fracture with TZDs in three different healthcare registries, using exactly the same study design, and to perform an individual patient data meta-analysis of these three studies. Methods: Population-based cohort studies were performed utilizing the British General Practice Research Database (GPRD, the Dutch PHARMO Record Linkage System, and the Danish National Health Registers. In all three databases, the exposed cohort consisted of all patients (aged 18+ with at least one prescription of antidiabetic (AD medication. Cox proportional hazards models were used to estimate hazard ratios (HRs of fracture. The total period of follow-up for each patient was divided into periods of current exposure and past exposure, with patients moving between current and past use.Results: In all three registries, the risk of fracture was increased for women who were exposed to TZDs: HR 1.48 [1.37-1.60] in GPRD, HR 1.35 [1.15-1.58] in PHARMO and HR 1.22 [1.03-1.44] in Denmark. Combining the data in an individual patient data meta-analysis resulted, for women, in a 1.4-fold increased risk of any fracture for current TZD users versus other AD drug users (adj. HR 1.44 [1.35-1.53]. For men, there was no increased fracture risk (adj. HR 1.05 [0.96-1.14]. Risks were increased for fractures of the radius/ulna, humerus, tibia/fibula, ankle and foot, but not for hip/femur or vertebral fractures. Current TZD users with more than 25 TZD presciptions ever before had a 1.6-fold increased risk of fracture compared with other AD drug users (HR 1.59 [1.46-1.74].Conclusion: In this study, we consistently found a 1.2- to 1.5-fold increased risk of fractures for women using TZDs, but not for men, across three different healthcare registries. TZD users had an increased risk for fractures of the extremities, and risks further increased for prolonged users

  1. Fractures of the Sacrum After Chemoradiation for Rectal Carcinoma: Incidence, Risk Factors, and Radiographic Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Han Jo [Department of Orthopedic Surgery, Washington University, St. Louis, Missouri (United States); Boland, Patrick J. [Department of Surgery, Orthopaedic Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Meredith, Dennis S. [Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York (United States); Lis, Eric [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zhang Zhigang; Shi Weiji [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yamada, Yoshiya J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Goodman, Karyn A., E-mail: goodmank@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2012-11-01

    Purpose: Sacral insufficiency fractures after adjuvant radiation for rectal carcinoma can present similarly to recurrent disease. As a complication associated with pelvic radiation, it is important to be aware of the incidence and risk factors associated with sacral fractures in the clinical assessment of these patients. Methods and Materials: Between 1998 and 2007, a total of 582 patients with locally advanced rectal carcinoma received adjuvant chemoradiation and surgical excision. Of these, 492 patients had imaging studies available for review. Hospital records and imaging studies from all 492 patients were retrospectively evaluated to identify risk factors associated with developing a sacral insufficiency fracture. Results: With a median follow-up time of 3.5 years, the incidence of sacral fractures was 7.1% (35/492). The 4-year sacral fracture free rate was 0.91. Univariate analysis showed that increasing age ({>=}60 vs. <60 years), female sex, and history of osteoporosis were significantly associated with shorter time to sacral fracture (P=.01, P=.004, P=.001, respectively). There was no significant difference in the time to sacral fracture for patients based on stage, radiotherapy dose, or chemotherapy regimen. Multivariate analysis showed increasing age ({>=}60 vs. <60 years, hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.22-5.13, P=.01), female sex (HR = 2.64, CI = 1.29-5.38, P=.008), and history of osteoporosis (HR = 3.23, CI = 1.23-8.50, P=.02) were independent risk factors associated with sacral fracture. Conclusions: Sacral insufficiency fractures after pelvic radiation for rectal carcinoma occur more commonly than previously described. Independent risk factors associated with fracture were osteoporosis, female sex, and age greater than 60 years.

  2. Fractures of the Sacrum After Chemoradiation for Rectal Carcinoma: Incidence, Risk Factors, and Radiographic Evaluation

    International Nuclear Information System (INIS)

    Purpose: Sacral insufficiency fractures after adjuvant radiation for rectal carcinoma can present similarly to recurrent disease. As a complication associated with pelvic radiation, it is important to be aware of the incidence and risk factors associated with sacral fractures in the clinical assessment of these patients. Methods and Materials: Between 1998 and 2007, a total of 582 patients with locally advanced rectal carcinoma received adjuvant chemoradiation and surgical excision. Of these, 492 patients had imaging studies available for review. Hospital records and imaging studies from all 492 patients were retrospectively evaluated to identify risk factors associated with developing a sacral insufficiency fracture. Results: With a median follow-up time of 3.5 years, the incidence of sacral fractures was 7.1% (35/492). The 4-year sacral fracture free rate was 0.91. Univariate analysis showed that increasing age (≥60 vs. <60 years), female sex, and history of osteoporosis were significantly associated with shorter time to sacral fracture (P=.01, P=.004, P=.001, respectively). There was no significant difference in the time to sacral fracture for patients based on stage, radiotherapy dose, or chemotherapy regimen. Multivariate analysis showed increasing age (≥60 vs. <60 years, hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.22-5.13, P=.01), female sex (HR = 2.64, CI = 1.29-5.38, P=.008), and history of osteoporosis (HR = 3.23, CI = 1.23-8.50, P=.02) were independent risk factors associated with sacral fracture. Conclusions: Sacral insufficiency fractures after pelvic radiation for rectal carcinoma occur more commonly than previously described. Independent risk factors associated with fracture were osteoporosis, female sex, and age greater than 60 years.

  3. Psychotropic drugs and the risk of fractures in old age: a prospective population-based study

    Directory of Open Access Journals (Sweden)

    Piirtola Maarit

    2010-07-01

    Full Text Available Abstract Background There is evidence that the use of any psychotropic and the concomitant use of two or more benzodiazepines are related to an increased risk of fractures in old age. However, also controversial results exist. The aim was to describe associations between the use of a psychotropic drug, or the concomitant use of two or more of these drugs and the risk of fractures in a population aged 65 years or over. Methods This study was a part of a prospective longitudinal population-based study carried out in the municipality of Lieto, South-Western Finland. The objective was to describe gender-specific associations between the use of one psychotropic drug [benzodiazepine (BZD, antipsychotic (AP or antidepressant (AD] or the concomitant use of two or more psychotropic drugs and the risk of fractures in a population 65 years or over. Subjects were participants in the first wave of the Lieto study in 1990-1991, and they were followed up until the end of 1996. Information about fractures confirmed with radiology reports in 1,177 subjects (482 men and 695 women during the follow-up was collected from medical records. Two follow-up periods (three and six years were used, and previously found risk factors of fractures were adjusted as confounding factors separately for men and women. The Poisson regression model was used in the analyses. Results The concomitant use of two or more BZDs and the concomitant use of two or more APs were related to an increased risk of fractures during both follow-up periods after adjusting for confounding factors in men. No similar associations were found in women. Conclusions The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men. Our findings show only risk relations. We cannot draw the conclusion that these drug combinations are causes of fractures.

  4. Tobacco smoking and risk of hip fracture in men and women

    DEFF Research Database (Denmark)

    Høidrup, S; Prescott, E; Sørensen, T I;

    2000-01-01

    BACKGROUND: Previous findings suggest that tobacco smoking increases the risk of hip fracture in women. A similar adverse effect of smoking is suspected to be present in men, but bone mineral density studies have raised the concern that men may be more sensitive to the deleterious effect of smoking...... on bone than women. In this study we prospectively determined the influence of current, previous, and cumulative smoking history on risk of hip fracture in men and women and addressed the issue of possible gender difference in the susceptibility to tobacco smoking. METHODS: Pooled data from three...... population studies conducted in Copenhagen with detailed information on smoking habit. A total of 13,393 women and 17,379 men, initially examined between 1964 and 1992, were followed until 1997 for first admission due to hip fracture. The relative risks (RR) of hip fracture associated with smoking were...

  5. Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study.

    Science.gov (United States)

    Johnell, O; Gullberg, B; Kanis, J A; Allander, E; Elffors, L; Dequeker, J; Dilsen, G; Gennari, C; Lopes Vaz, A; Lyritis, G

    1995-11-01

    The aims of this study were to determine common international risk factors for hip fracture in women aged 50 years or more. We studied women aged 50 years or more who sustained a hip fracture in 14 centers from Portugal, Spain, France, Italy, Greece, and Turkey over a 1-year period. Women aged 50 years or more selected from the neighborhood or population registers served as controls. Cases and controls were interviewed using a structured questionnaire on work, physical activity, exposure to sunlight, reproductive, history and gynecologic status, height, weight, mental score, and consumption of tobacco, alcohol, calcium, coffee, and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), short fertile period, low physical activity. lack of sunlight exposure, low milk consumption, no consumption of tea, and a poor mental score. No significant adverse effects of coffee or smoking were observed. Moderate intake of spirits was a protective factor in young adulthood, but otherwise no significant effect of alcohol intake was observed. For some risks, a threshold effect was observed. A low BMI and milk consumption were significant risks only in the lowest 50% and 10% of the population, respectively. A late menarche, poor mental score, low BMI and physical activity, low exposure to sunlight, and a low consumption of calcium and tea remained independent risk factors after multivariate analysis, accounting for 70% of hip fractures. Excluding mental score and age at menarche (not potentially reversible), the attributable risk was 56%. Thus, about half of the hip fractures could be explained on the basis of the potentially reversible risk factors sought. In contrast, the use of risk factors to "predict" hip fractures had moderate sensitivity and specificity. We conclude that variations in lifestyle factors are associated with significant differences in the risk of hip fracture, account for a large component of the total risk, and may

  6. The association between compliance and persistence with bisphosphonate therapy and fracture risk: A review

    Directory of Open Access Journals (Sweden)

    Middelhoven Hans

    2007-09-01

    Full Text Available Abstract Background Sub optimal levels of compliance and persistence with bisphosphonates are potentially compromising the reduction of post menopausal osteoporotic (PMO fracture risk. Methods A structured literature search (1990–2006 was performed to identify primary research studies evaluating the relationship between compliance and persistence with bisphosphonates and post menopausal osteoporotic (PMO fracture risk in clinical practice. Search criteria were: bisphosphonates; osteoporosis/osteopenia in postmenopausal women; all types of fractures; compliance and persistence. Results Only two retrospective studies using prescription databases have specifically evaluated bisphosphonates. A cohort study tracking 35,537 women reported that in those with a Medication Possession Ratio (MPR of ≥80% over 24 months the risk of fracture was lower than in those with an MPR of A nested case control study reported that 12 months persistence (refill gap Four other studies, not specific to bisphosphonates, reported that compliance ≥12 months decreased fracture risk by ~25%. Conclusion Sub optimal compliance and persistence with bisphosphonates is not providing the best possible protection against the risk of PMO fracture, however, more research is needed to delineate this relationship in clinical practice.

  7. Risk Assessment of Bone Fracture During Space Exploration Missions to the Moon and Mars

    Science.gov (United States)

    Lewandowski, Beth E.; Myers, Jerry G.; Nelson, Emily S.; Griffin, Devon

    2008-01-01

    The possibility of a traumatic bone fracture in space is a concern due to the observed decrease in astronaut bone mineral density (BMD) during spaceflight and because of the physical demands of the mission. The Bone Fracture Risk Module (BFxRM) was developed to quantify the probability of fracture at the femoral neck and lumbar spine during space exploration missions. The BFxRM is scenario-based, providing predictions for specific activities or events during a particular space mission. The key elements of the BFxRM are the mission parameters, the biomechanical loading models, the bone loss and fracture models and the incidence rate of the activity or event. Uncertainties in the model parameters arise due to variations within the population and unknowns associated with the effects of the space environment. Consequently, parameter distributions were used in Monte Carlo simulations to obtain an estimate of fracture probability under real mission scenarios. The model predicts an increase in the probability of fracture as the mission length increases and fracture is more likely in the higher gravitational field of Mars than on the moon. The resulting probability predictions and sensitivity analyses of the BFxRM can be used as an engineering tool for mission operation and resource planning in order to mitigate the risk of bone fracture in space.

  8. Pilot case-control investigation of risk factors for hip fractures in the urban Indian population

    Directory of Open Access Journals (Sweden)

    Malhotra Nidhi

    2010-03-01

    Full Text Available Abstract Background Despite the reported high prevalence of osteoporosis in India, there have been no previous studies examining the risk factors for hip fracture in the Indian population. Methods We carried out a case control investigation comprising 100 case subjects (57 women and 43 men admitted with a first hip fracture into one of three hospitals across New Delhi. The 100 controls were age and sex matched subjects who were either healthy visitors not related to the case patients or hospital staff. Information from all subjects was obtained through a questionnaire based interview. Results There was a significant increase in the number of cases of hip fracture with increasing age. There were significantly more women (57% than men (43%. Univariate analysis identified protective effects for increased activity, exercise, calcium and vitamin supplements, almonds, fish, paneer (cottage cheese, curd (plain yogurt, and milk. However, tea and other caffeinated beverages were significant risk factors. In women, hormone/estrogen therapy appeared to have a marginal protective effect. For all cases, decreased agility, visual impairment, long term medications, chronic illnesses increased the risk of hip fracture. The multivariate analysis confirmed a protective effect of increased activity and also showed a decrease in hip fracture risk with increasing body mass index (odds ratio (OR 0.024, 95% confidence interval (CI 0.006-0.10 & OR 0.81, 95% CI 0.68-0.97 respectively. Individuals who take calcium supplements have a decreased risk of hip fracture (OR 0.076; CI 0.017-0.340, as do individuals who eat fish (OR 0.094; CI 0.020-0.431, and those who eat paneer (OR 0.152; 0.031-0.741. Tea drinkers have a higher risk of hip fracture (OR 22.8; 95% CI 3.73-139.43. Difficulty in getting up from a chair also appears to be an important risk factor for hip fractures (OR 14.53; 95% CI 3.86-54.23. Conclusions In the urban Indian population, dietary calcium, vitamin D

  9. Hip fracture risk and different gene polymorphisms in the turkish population

    Directory of Open Access Journals (Sweden)

    Ercan Dinçel

    2008-01-01

    Full Text Available BACKGROUND: We aimed to discuss the risk assessments for both patients with hip fractures due to fall-related, low energy traumas and non-fractured control patients by examining bone mineral density and genetic data, two features associated with femoral strength and hip fracture risk. METHODS: Twenty-one osteoporotic patients with proximal femur fractures and non-fractured, osteoporotic, age- and gender-matched controls were included in the study. Bone mineral density measurements were performed with a Lunar DXA. The COL1A1, ESR, VDR, IL-6, and OPG genes were amplified, and labeling of specific gene sequences was performed in a multiplex polymerase chain reaction using the osteo/check PCR kit from the whole blood of all subjects. RESULTS: The bone mineral density (trochanteric and total bone mineral density values of the fracture group was significantly decreased relative to the control group. We were not able to conduct statistical tests for the polymorphisms of the COL1A1, ESR, and VDR genes because our results were expressed in terms of frequency. Although they were not significant, we did examine differences in the IL-6 and OPG genes polymorphisms between the two groups. We concluded that increasing the number of cases will allow us to evaluate racial differences in femoral hip fracture risk by genotypes.

  10. Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study.

    Science.gov (United States)

    Kanis, J; Johnell, O; Gullberg, B; Allander, E; Elffors, L; Ranstam, J; Dequeker, J; Dilsen, G; Gennari, C; Vaz, A L; Lyritis, G; Mazzuoli, G; Miravet, L; Passeri, M; Perez Cano, R; Rapado, A; Ribot, C

    1999-01-01

    The aims of this study were to identify risk factors for hip fracture in men aged 50 years or more. We identified 730 men with hip fracture from 14 centers from Portugal, Spain, France, Italy, Greece and Turkey during the course of a prospective study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers. The questionnaire examined aspects of work, physical activity past and present, diseases and drugs, height, weight, indices of co-morbidity and consumption of tobacco, alcohol, calcium, coffee and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), low sunlight exposure, a low degree of recreational physical activity, low consumption of milk and cheese, and a poor mental score. Co-morbidity including sleep disturbances, loss of weight, impaired mental status and poor appetite were also significant risk factors. Previous stroke with hemiplegia, prior fragility fractures, senile dementia, alcoholism and gastrectomy were associated with significant risk, whereas osteoarthrosis, nephrolithiasis and myocardial infarction were associated with lower risks. Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of anti-epileptic agents. Of the potentially 'reversible' risk factors, BMI, leisure exercise, exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis, accounting for 54% of hip fractures. Excluding BMI, 46% of fractures could be explained on the basis of the risk factors sought. Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks (14% and 9% respectively). The use of risk factors to predict hip fractures had relatively low sensitivity and specificity (59.6% and 61

  11. Anticholinergic Medication Use and Risk of Fracture in Elderly Adults with Depression.

    Science.gov (United States)

    Chatterjee, Satabdi; Bali, Vishal; Carnahan, Ryan M; Chen, Hua; Johnson, Michael L; Aparasu, Rajender R

    2016-07-01

    Limited research exists regarding the effect of anticholinergics on falls and fractures in elderly nursing home residents in the United States. This study examined the risk of fractures associated with anticholinergic medication use in elderly nursing home residents with depression. A nested case-control design involving a cohort of elderly adults with depression from the 2007 to 2010 Minimum Data Set (MDS)-linked Medicare data was used to evaluate the risk of fractures. The study sample included Medicare beneficiaries aged 65 and older diagnosed with depression having at least one nursing home stay during 2007 to 2010 and no history of falls or fractures in 2007 (base period). Cases were individuals with incident fractures after the baseline period. For each case, four age- and sex-matched controls were selected using incidence density sampling. Anticholinergic exposure was defined using the Anticholinergic Drug Scale (ADS). Prescription of Level 2 or 3 anticholinergic medications within 30 days before the event date was the primary exposure. The primary outcome was an inpatient or outpatient claim for a fracture between January 1, 2008, and December 31, 2010. A conditional logistic regression model stratified on matched case-control sets was used to evaluate association between anticholinergic use and fractures, controlling for other risk factors of the outcome. The study sample consisted of 40,452 individuals with fractures and 161,808 matched controls. After adjusting for other risk factors, high-level anticholinergic use was associated with 14% greater fracture risk than nonuse (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.11-1.17). The high risk of fractures remained consistent across levels of anticholinergic potency (Level 2, OR = 1.15, 95% CI = 1.11-1.19; Level 3, OR = 1.10, 95% CI = 1.07-1.15). The study findings remained consistent in multiple sensitivity analyses. Overall, use of high-level anticholinergic medications was associated with

  12. Potential explanatory factors for higher incident hip fracture risk in older diabetic adults.

    Science.gov (United States)

    Strotmeyer, Elsa S; Kamineni, Aruna; Cauley, Jane A; Robbins, John A; Fried, Linda F; Siscovick, David S; Harris, Tamara B; Newman, Anne B

    2011-01-01

    Type 2 diabetes is associated with higher fracture risk. Diabetes-related conditions may account for this risk. Cardiovascular Health Study participants (N = 5641; 42.0% men; 15.5% black; 72.8±5.6 years) were followed 10.9 ± 4.6 years. Diabetes was defined as hypoglycemic medication use or fasting glucose (FG) ≥126 mg/dL. Peripheral artery disease (PAD) was defined as ankle-arm index <0.9. Incident hip fractures were from medical records. Crude hip fracture rates (/1000 person-years) were higher for diabetic vs. non-diabetic participants with BMI <25 (13.6, 95% CI: 8.9-20.2 versus 11.4, 95% CI: 10.1-12.9) and BMI ≥25 to <30 (8.3, 95% CI: 5.7-11.9 versus 6.6, 95% CI: 5.6-7.7), but similar for BMI ≥30. Adjusting for BMI, sex, race, and age, diabetes was related to fractures (HR = 1.34; 95% CI: 1.01-1.78). PAD (HR = 1.25 (95% CI: 0.92-1.57)) and longer walk time (HR = 1.07 (95% CI: 1.04-1.10)) modified the fracture risk in diabetes (HR = 1.17 (95% CI: 0.87-1.57)). Diabetes was associated with higher hip fracture risk after adjusting for BMI though this association was modified by diabetes-related conditions. PMID:21837239

  13. Risk Factors and Clinical Evaluation of Superficial Femoral Artery Stent Fracture: Prote'ge'GPS Stent

    International Nuclear Information System (INIS)

    To evaluate the occurrence of superficial femoral artery stent fractures, the risk factors of stent fracture, and the relationship between fractures and clinical findings. Of the 38 patients who underwent treatment with Prote'ge'GPS stenting due to arterial occlusions on the superficial femoral artery, 17 also underwent a clinical analysis. Forty-three stents were inserted in the 17 superficial femoral arteries, ranging between 15 and 50 cm in length, with a mean treated length of 26.4 cm (15-50 cm). A fracture was evaluated by taking a PA and lateral simple radiography, as well as a follow-up evaluation accompanied with a CT angiography, DSA, and a color Doppler sonography. The examination involved the assessment of the difference between bone fractures due to length, placement, and frequency. Fractures occurred in 13 of 43 stents (30.2%). A total of 10 (71.4%) occurred in the upper third, compared to 4 (28.6%) in the lower third of the superficial femoral artery. In addition, 10 stents (71.4%) had a single strut fracture, whereas 4 (28.6%) had multiple strut fractures. A stent fracture occurred more frequently when the stents and lesions were longer (p=0.021, 0.012) and the stents were inserted near the joint. However, there was no significant relationship between stent numbers and the fractures (p=0.126). When the stents were inserted along the popliteal artery, a stent fracture occurred more frequently in the lower third of the artery. The stent fractures did not significantly influence the patency rate of the stented artery (p=0.44) Prote'ge'GPS stents in the superficial femoral artery revealed a considerable number of fractures and the fracture frequency showed a significant relationship with the length of stents and lesions. The closer stent insertion was to the joints, the more frequently fractures occurred. There were no evident significant relationships between the presence of stent fractures and the patency of the stented arteries

  14. Habitual physical inertia and other factors in relation to risk of fracture of the proximal femur.

    Science.gov (United States)

    Boyce, W J; Vessey, M P

    1988-09-01

    Physical inactivity is associated with low bone mass in adults, and might therefore be a risk factor for proximal femoral fracture in old age. This hypothesis was tested in a case-control study of 139 selected patients with confirmed proximal femoral fracture and 139 age- and sex-matched community controls, using an interviewer-administered questionnaire. Patients had been significantly less physically active in middle age than had controls, a difference that was greater in the younger subjects. It is suggested that the progressive decrease during the present century in the amount of physical activity associated with everyday life has resulted in increased numbers of elderly people being at risk of femoral fracture and may be the cause of the rises in age-specific incidence rates now being observed. If this explanation is correct, a planned increase in leisure-time physical activity in middle age and beyond may be the most effective method of preventing these fractures. PMID:3232586

  15. Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention

    DEFF Research Database (Denmark)

    Lauritzen, J B

    1997-01-01

    have a high risk of hip fracture (annual rate of 5-6%), and the incidence of falls is about 1,500 falls/1,000 persons/year. Most hip fractures are a result of a direct trauma against the hip. The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about......%, corresponding to 9 out of 247 residents saved from sustaining a hip fracture. The review points to the essentials of the development of hip fracture, which constitutes; risk of fall, type of fall, type of impact, energy absorption, and lastly bone strength, which is the ultimate and last permissive factor...

  16. Potential Biases in Estimating Absolute and Relative Case-Fatality Risks during Outbreaks.

    Directory of Open Access Journals (Sweden)

    Marc Lipsitch

    Full Text Available Estimating the case-fatality risk (CFR-the probability that a person dies from an infection given that they are a case-is a high priority in epidemiologic investigation of newly emerging infectious diseases and sometimes in new outbreaks of known infectious diseases. The data available to estimate the overall CFR are often gathered for other purposes (e.g., surveillance in challenging circumstances. We describe two forms of bias that may affect the estimation of the overall CFR-preferential ascertainment of severe cases and bias from reporting delays-and review solutions that have been proposed and implemented in past epidemics. Also of interest is the estimation of the causal impact of specific interventions (e.g., hospitalization, or hospitalization at a particular hospital on survival, which can be estimated as a relative CFR for two or more groups. When observational data are used for this purpose, three more sources of bias may arise: confounding, survivorship bias, and selection due to preferential inclusion in surveillance datasets of those who are hospitalized and/or die. We illustrate these biases and caution against causal interpretation of differential CFR among those receiving different interventions in observational datasets. Again, we discuss ways to reduce these biases, particularly by estimating outcomes in smaller but more systematically defined cohorts ascertained before the onset of symptoms, such as those identified by forward contact tracing. Finally, we discuss the circumstances in which these biases may affect non-causal interpretation of risk factors for death among cases.

  17. Interpreting Risk: Variations and Explanations of Resident Perceptions of Hydraulic Fracturing Impacts

    OpenAIRE

    Uzunian, Adrian B.

    2016-01-01

    Hydraulic fracturing is a novel technological development that has pushed the extraction of energy resources forward. As technology improves and world oil and gas markets shift, more shale formations are being uncovered, and new drilling activities are seen as economically viable. I examine the ways in which residents perceive environmental and health risks of hydraulic fracturing in the Eagle Ford Shale region of Texas, and how these perceptions differ depending on social position and where ...

  18. Patient-related risk factors for fracture-healing complications in the United Kingdom General Practice Research Database

    OpenAIRE

    HERNANDEZ, ROHINI K.; Do, Thy P.; Critchlow, Cathy W; Dent, Ricardo E.; Jick, Susan S

    2012-01-01

    Background and purpose A variety of risk factors have been hypothesized to contribute to the development of fracture-healing complications; however, population-based estimates of the strength of these risk factors are limited. In this case-control study, we evaluated patient-related risk factors for fracture-healing complications. Methods Using the United Kingdom General Practice Research Database, we identified patients with a fracture-healing complication (delayed union, nonunion, or maluni...

  19. Risk factors for failed closed reduction of pediatric supracondylar humerus fractures.

    Science.gov (United States)

    Beck, John D; Riehl, John T; Moore, Blake E; Deegan, John H; Sartorius, Jennifer; Graham, John; Mirenda, William M

    2012-10-01

    The purpose of this retrospective study was to examine pediatric supracondylar humerus fractures at a Level I trauma center. Data were analyzed to identify risk factors associated with closed reduction failure. Closed pediatric supracondylar humerus fractures that were treated at the authors' trauma center between October 1997 and January 2009 were reviewed. The main outcome variable was necessity of open reduction. To determine which factors were independently associated with a failed closed reduction, a multivariate logistic model was fit predicting open reduction status.A total of 174 patients required operative treatment. Of these, 23 underwent open reduction and 151 underwent with closed reduction and percutaneous pinning. For patients who required open reduction, 39.1% had an associated injury compared with 14.6% of patients treated with closed reduction (P=.008). Average time from presentation to surgery was 4.1 hours in the open reduction and 6.3 hours in the closed reduction group (P=.049). Risk factors that significantly predicted failure of closed reduction were the presence of an associated injury, initial fracture displacement, and Gartland type III fracture (P=.008, .03, and .023, respectively).Associated injury, large initial fracture displacement, and Gartland type III factures were statistically significant independent risk factors for closed reduction failure. Increased time from injury to presentation demonstrated a trend toward open reduction. Consideration should be given to the expedient transfer of patients with type III supracondylar humerus fractures with associated injuries when definitive care will be provided at another institution. PMID:23027486

  20. Analysis of the occurrence of dietary and non-dietary factors of fracture risk in relation to bone mineral density in women

    Directory of Open Access Journals (Sweden)

    Kamila Sobaś

    2010-09-01

    Full Text Available Background. This study analysed the correlation between characteristic dietary and non-dietary factors of fracture risk in women and mineral density of bone tissue (BMD. Material and methods. The study involved examination of 172 women, aged between 32 and 59. Calcium intake from a daily diet was determined with the use of the semi-quantitative food consumption frequency method. The physical activity of the women was expressed in MET-minutes/week. BMD was determined by double-energy X-ray absorptiometry (DXA. The frequency of bone fracture and osteoporosis risk factors was determined and a 10-year risk of fracture (RB-10 was individually diagnosed according to the WHO and IOF criteria (2007. A high level of fracture risk (RB-10 > 14% was assumed according to the Johnell’s algorithm [2005]. Results. The most frequent factors of fracture risk in women included: bone pains (76% of the total sample, inadequate calcium intake (43%, smoking (24%, previous fractures (24%, incidence of chronic diseases (22%, menstrual disorders (19%, family history of osteoporosis (17%, low physical activity (15% and the incidence of thyroid disorders (10%. 85% of women had at least one factor of 10-year absolute risk of fracture. None of the examined women consumed a sufficient amount of calcium and the average calcium intake level was low (median of about 400 mg/day. Bone mineral density did not reveal any relationship with current intake of calcium by women, but depended on the consumption of dairy products in the past. Conclusions. Daily consumption of dairy products in childhood and in the school period was conductive to a higher mineral density of bone tissue in women. Advanced age and the occurrence of menstrual disorders were conductive to a lower mineral density of bone tissue in women. Women with low bone mineral density (lower BMD tertile more frequently used supplementation with preparations containing calcium (25% and more often had at least one RB

  1. Absolute advantage

    NARCIS (Netherlands)

    J.G.M. van Marrewijk (Charles)

    2008-01-01

    textabstractA country is said to have an absolute advantage over another country in the production of a good or service if it can produce that good or service using fewer real resources. Equivalently, using the same inputs, the country can produce more output. The concept of absolute advantage can a

  2. What are the Risk Factors for Hardware Removal After Tibia or Fibula Fracture?

    Science.gov (United States)

    Perdue, Paul W; Rosenbaum, Yoseph A; Perfetti, Dean C; Kapadia, Bhaveen H; Boylan, Matthew R; Jauregui, Julio J; Paulino, Carl B

    2015-01-01

    Indications for open reduction and internal fixation (ORIF) of tibia and/or fibula fractures vary; however, some patients require removal of hardware (ROH) due to various complications. Currently, data evaluating the epidemiology of and risk factors for ROH of the tibia/fibula are limited. We examined the associations between tibia/fibula fractures and (1) characteristics of fractures requiring ORIF, (2) indications for ROH, (3) demographic risk factors for ROH; (4) length of stay, and (5) total hospital charges. The Nationwide Inpatient Sample (NIS) was used to identify patients admitted for tibia/fibula ORIF and ROH between 1998 and 2010 in the United States. We used ICD-9 codes to identify fracture locations, comorbidities, and indications for ROH. We identified 1,610,149 ORIF patients, and 56,864 of these patients (3.5%) underwent ROH. Logistic regression analyses and independent sample t-tests were used to assess risk factors and differences. Among fractures requiring ORIF, the most common were for closed fractures of both tibia and fibula. The most common indications for ROH were infection and osteomyelitis. Risk factors for ROH included men and Deyo comorbidity scores of 1 and 2 or more. Age and race were not risk factors for ROH. The length of stay and total charges were significantly higher for ROH compared to those with ORIF only. Hardware removal is a serious complication following ORIF for fractures of the tibia/fibula. The results of the current study suggest that gender, presence of comorbidities, and payer status were all significant factors in predicting hardware removal for the tibia/fibula following ORIF. PMID:26852642

  3. Vertebral Strength and Estimated Fracture Risk Across the BMI Spectrum in Women.

    Science.gov (United States)

    Bachmann, Katherine N; Bruno, Alexander G; Bredella, Miriam A; Schorr, Melanie; Lawson, Elizabeth A; Gill, Corey M; Singhal, Vibha; Meenaghan, Erinne; Gerweck, Anu V; Eddy, Kamryn T; Ebrahimi, Seda; Koman, Stuart L; Greenblatt, James M; Keane, Robert J; Weigel, Thomas; Dechant, Esther; Misra, Madhusmita; Klibanski, Anne; Bouxsein, Mary L; Miller, Karen K

    2016-02-01

    Somewhat paradoxically, fracture risk, which depends on applied loads and bone strength, is elevated in both anorexia nervosa and obesity at certain skeletal sites. Factor-of-risk (Φ), the ratio of applied load to bone strength, is a biomechanically based method to estimate fracture risk; theoretically, higher Φ reflects increased fracture risk. We estimated vertebral strength (linear combination of integral volumetric bone mineral density [Int.vBMD] and cross-sectional area from quantitative computed tomography [QCT]), vertebral compressive loads, and Φ at L4 in 176 women (65 anorexia nervosa, 45 lean controls, and 66 obese). Using biomechanical models, applied loads were estimated for: 1) standing; 2) arms flexed 90°, holding 5 kg in each hand (holding); 3) 45° trunk flexion, 5 kg in each hand (lifting); 4) 20° trunk right lateral bend, 10 kg in right hand (bending). We also investigated associations of Int.vBMD and vertebral strength with lean mass (from dual-energy X-ray absorptiometry [DXA]) and visceral adipose tissue (VAT, from QCT). Women with anorexia nervosa had lower, whereas obese women had similar, Int.vBMD and estimated vertebral strength compared with controls. Vertebral loads were highest in obesity and lowest in anorexia nervosa for standing, holding, and lifting (p estimated vertebral strength were associated positively with lean mass (R = 0.28 to 0.45, p ≤ 0.0001) in all groups combined and negatively with VAT (R = -[0.36 to 0.38], p estimated vertebral fracture risk (Φ) for holding and bending because of inferior vertebral strength. Despite similar vertebral strength as controls, obese women had higher vertebral fracture risk for standing, holding, and lifting because of higher applied loads from higher body weight. Examining the load-to-strength ratio helps explain increased fracture risk in both low-weight and obese women.

  4. EXTERNAL FIXATION OF INTERTROCHANTERIC FRACTURES AS AN OPTION IN HIGH RISK GERIATRIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Badoo

    2015-03-01

    Full Text Available OBJECTIVE: The purpose of this study is to evaluate the usefulness of external fixation of intertrochanteric fractures in high risk geriatric patients. DESIGN: Prospective clinical study. SETTINGS: Level - 1 trauma C entre. PATIENTS: Fifty high risk geriatric patients with intertrochanteric fractures. INTERVENTION: Close reduction and external fixation using AO external fixator. OUTCOME MEASURED: fracture union, time to union, pin tract infect ion rate, shortening, varus collapse and range of motion at knee. RESULTS: Fifty patients with average age of 68.5 years all high anaesthetic/surgical risk were managed by closed reduction and external fixation. Forty were operated under regional and ten u nder local anaesthesia. Eight patients died before fracture union and four were lost in follow up after removal of fixator. Remaining thirty eight were in regular follow up for at least six months. Pin tract inflammation was the most common complication wh ile shortening and varus collapse occurred in ten cases. CONCLUSION: external fixation of intertrochanteric fractures is useful in high risk geriatric patients.

  5. Patient effective dose and radiogenic risks from fluoroscopically assisted surgical reconstruction of femoral fractures

    International Nuclear Information System (INIS)

    The objectives were to assess patient effective radiation dose from fluoroscopically guided surgical reconstruction of femoral fractures and provide normalized data for the estimation of patient effective dose and risks associated with such procedures performed in any laboratory. The fluoroscopic control required during surgical reconstruction of femoral fractures was classified into two types identified by beam orientation, i.e., posterior-anterior (PA) and lateral cross-table (LC) exposures. The duration and the dose area product (DAP) of each exposure were monitored in 24 patients with femoral fractures. Patient dose per DAP unit and per minute of fluoroscopy were measured at 14 radiosensitive organs/tissues using an anthropomorphic phantom and thermoluminescence dosimetry. The typical effective dose to patients with femoral fracture treated surgically in our institution was 11.6-21.7 μSv. This effective dose is estimated to cause an excess of 1.4 fatal cancers per million patients treated, and an excess of 0.4 hereditary disorders per million of births. Induction of deterministic skin injuries to treated patients is highly improbable at the dose levels found in this study. Patient effective dose and associated risks from a typical fluoroscopically guided surgical fixation of femoral fracture are low. However, they may be significantly elevated if treated patients are young individuals and/or the fluoroscopic exposure is prolonged. The present data may be used to determine effective dose to patients undergoing surgical reconstruction of femoral fracture in any institution. (authors)

  6. Discrete Fracture Network Models for Risk Assessment of Carbon Sequestration in Coal

    Energy Technology Data Exchange (ETDEWEB)

    Jack Pashin; Guohai Jin; Chunmiao Zheng; Song Chen; Marcella McIntyre

    2008-07-01

    A software package called DFNModeler has been developed to assess the potential risks associated with carbon sequestration in coal. Natural fractures provide the principal conduits for fluid flow in coal-bearing strata, and these fractures present the most tangible risks for the leakage of injected carbon dioxide. The objectives of this study were to develop discrete fracture network (DFN) modeling tools for risk assessment and to use these tools to assess risks in the Black Warrior Basin of Alabama, where coal-bearing strata have high potential for carbon sequestration and enhanced coalbed methane recovery. DFNModeler provides a user-friendly interface for the construction, visualization, and analysis of DFN models. DFNModeler employs an OpenGL graphics engine that enables real-time manipulation of DFN models. Analytical capabilities in DFNModeler include display of structural and hydrologic parameters, compartmentalization analysis, and fluid pathways analysis. DFN models can be exported to third-party software packages for flow modeling. DFN models were constructed to simulate fracturing in coal-bearing strata of the upper Pottsville Formation in the Black Warrior Basin. Outcrops and wireline cores were used to characterize fracture systems, which include joint systems, cleat systems, and fault-related shear fractures. DFN models were constructed to simulate jointing, cleating, faulting, and hydraulic fracturing. Analysis of DFN models indicates that strata-bound jointing compartmentalizes the Pottsville hydrologic system and helps protect shallow aquifers from injection operations at reservoir depth. Analysis of fault zones, however, suggests that faulting can facilitate cross-formational flow. For this reason, faults should be avoided when siting injection wells. DFN-based flow models constructed in TOUGH2 indicate that fracture aperture and connectivity are critical variables affecting the leakage of injected CO{sub 2} from coal. Highly transmissive joints

  7. Mammographic breast density and breast cancer risk: interactions of percent density, absolute dense, and non-dense areas with breast cancer risk factors.

    Science.gov (United States)

    Yaghjyan, Lusine; Colditz, Graham A; Rosner, Bernard; Tamimi, Rulla M

    2015-02-01

    We investigated if associations of breast density and breast cancer differ according to the level of other known breast cancer risk factors, including body mass index (BMI), age at menarche, parity, age at first child's birth, age at menopause, alcohol consumption, a family history of breast cancer, a history of benign breast disease, and physical activity. This study included 1,044 postmenopausal incident breast cancer cases diagnosed within the Nurses' Health Study cohort and 1,794 matched controls. Percent breast density, absolute dense, and non-dense areas were measured from digitized film images with computerized techniques. Information on breast cancer risk factors was obtained prospectively from biennial questionnaires. Percent breast density was more strongly associated with breast cancer risk in current postmenopausal hormone users (≥50 vs. 10 %: OR 5.34, 95 % CI 3.36-8.49) as compared to women with past (OR 2.69, 95 % CI 1.32-5.49) or no hormone history (OR 2.57, 95 % CI 1.18-5.60, p-interaction = 0.03). Non-dense area was inversely associated with breast cancer risk in parous women, but not in women without children (p-interaction = 0.03). Associations of density with breast cancer risk did not differ by the levels of BMI, age at menarche, parity, age at first child's birth, age at menopause, alcohol consumption, a family history of breast cancer, a history of benign breast disease, and physical activity. Women with dense breasts, who currently use menopausal hormone therapy are at a particularly high risk of breast cancer. Most breast cancer risk factors do not modify the association between mammographic breast density and breast cancer risk.

  8. Does Alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women

    Directory of Open Access Journals (Sweden)

    Papaioannou Alexandra

    2005-07-01

    Full Text Available Abstract Background Alendronate has been found to reduce the risk of fractures in postmenopausal women as demonstrated in multiple randomized controlled trials enrolling thousands of women. Yet there is a paucity of such randomized controlled trials in osteoporotic men. Our objective was to systematically review the anti-fracture efficacy of alendronate in men with low bone mass or with a history of prevalent fracture(s and incorporate prior knowledge of alendronate efficacy in women in the analysis. Methods We examined randomized controlled trials in men comparing the anti-fracture efficacy of alendronate to placebo or calcium or vitamin D, or any combination of these. Studies of men with secondary causes of osteoporosis other than hypogonadism were excluded. We searched the following electronic databases (without language restrictions for potentially relevant citations: Medline, Medline in Process (1966-May 24/2004, and Embase (1996–2004. We also contacted the manufacturer of the drug in search of other relevant trials. Two reviewers independently identified two trials (including 375 men, which met all inclusion criteria. Data were abstracted by one reviewer and checked by another. Results of the male trials were pooled using Bayesian random effects models, incorporating prior information of anti-fracture efficacy from meta-analyses of women. Results The odds ratios of incident fractures in men (with 95% credibility intervals with alendronate (10 mg daily were: vertebral fractures, 0.44 (0.23, 0.83 and non-vertebral fractures, 0.60 (0.29, 1.44. Conclusion In conclusion, alendronate decreases the risk of vertebral fractures in men at risk. There is currently insufficient evidence of a statistically significant reduction of non-vertebral fractures, but the paucity of trials in men limit the statistical power to detect such an effect.

  9. Prediction of absolute risk reduction of cardiovascular events with perindopril for individual patients with stable coronary artery disease - results from EUROPA

    NARCIS (Netherlands)

    van der Leeuw, Joep; Oemrawsingh, Rohit M.; van der Graaf, Yolanda; Brugts, Jasper J.; Deckers, Jaap W.; Bertrand, Michel; Fox, Kim; Ferrari, Roberto; Remme, Willem J.; Simoons, Maarten L.; Boersma, Eric; Visseren, Frank L J

    2015-01-01

    BACKGROUND: Angiotensin-converting-enzyme inhibition reduces the risk of cardiovascular events at a group level. Presumably, the absolute effect of treatment varies between individuals. We sought to develop multivariable prediction scores to estimate individual treatment effect of perindopril in pat

  10. Potential Explanatory Factors for Higher Incident Hip Fracture Risk in Older Diabetic Adults

    Directory of Open Access Journals (Sweden)

    Elsa S. Strotmeyer

    2011-01-01

    Full Text Available Type 2 diabetes is associated with higher fracture risk. Diabetes-related conditions may account for this risk. Cardiovascular Health Study participants (N=5641; 42.0% men; 15.5% black; 72.8±5.6 years were followed 10.9 ± 4.6 years. Diabetes was defined as hypoglycemic medication use or fasting glucose (FG ≥126 mg/dL. Peripheral artery disease (PAD was defined as ankle-arm index <0.9. Incident hip fractures were from medical records. Crude hip fracture rates (/1000 person-years were higher for diabetic vs. non-diabetic participants with BMI <25 (13.6, 95% CI: 8.9–20.2 versus 11.4, 95% CI: 10.1–12.9 and BMI ≥25 to <30 (8.3, 95% CI: 5.7–11.9 versus 6.6, 95% CI: 5.6–7.7, but similar for BMI ≥30. Adjusting for BMI, sex, race, and age, diabetes was related to fractures (HR = 1.34; 95% CI: 1.01–1.78. PAD (HR = 1.25 (95% CI: 0.92–1.57 and longer walk time (HR = 1.07 (95% CI: 1.04–1.10 modified the fracture risk in diabetes (HR = 1.17 (95% CI: 0.87–1.57. Diabetes was associated with higher hip fracture risk after adjusting for BMI though this association was modified by diabetes-related conditions.

  11. Socioeconomic characteristics and lifestyle elements vs. 10-year fracture risk in people aged 65+ from small towns in the north-east of Poland. The SenFood Project

    Directory of Open Access Journals (Sweden)

    Małgorzata Anna Słowińska

    2013-12-01

    Full Text Available Introduction. This study evaluated the correlation between selected socioeconomic and lifestyle characteristics and 10-year risk of fracture in persons aged 65+, living in small towns in the north-east of Poland. Material  and methods. 267 individuals (76 males and 191 females aged 76.9 ±2.5 years, living in small towns in the north-east of Poland in independent households, took part in the study. The basic information on the socioeconomic situation and lifestyle of the subjects was gathered during a face-to-face interview. Dual energy X-ray absorptiometry (DXA was used to determine bone mineral density (BMD in the distal part of the forearm. The absolute 10-year risk of bone fracture was calculated in accordance with the algorithm developed by WHO and IOF. Results. The average value of 10-year fracture risk was significantlyhigher in females than in males (31.4% vs. 14.5%, respectively, as was the probability of fracturing a thigh bone (13.7% vs. 6.1%, respectively, as was the probability of any fracture (23.9% vs. 10.1%, respectively, but BMD was lower (290.6 mg/cm2 vs. 405.2 mg/cm2, respectively. A higher 10-year risk of fracture was observed in people who used dietary supplements (T3 RB-10: OR = 3.23; 95% CI: 1.61-6.47 and a lower risk was observed in people who had a spouse/partner (T3 RB-10: OR = 0.14; 95% CI: 0.07-0.28, lived with someone (T3 RB-10: OR = 0.20; 95% CI: 0.08-0.48 and with a high physical activity (T2 RB-10: OR = 0.68; 95% CI: 0.47-0.99. Conclusions. The 10-year risk of fracture was significantly gender-related. Lower bone mineral density and more than twice higher 10-year fracture risk, probability of fracturing a thigh bone and any fracture was observed in women than in men. The 10-year risk of fracture was higher in single persons, living alone, with a low physical activity and using dietary supplements.

  12. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Jørgensen, Henrik L; Laulund, Anne Sofie;

    2015-01-01

    The long-term relationship between hypothyroidism and fracture risk is challenging to dissect because of the modifying influence of subsequent thyroxine replacement with the potential for excessive replacement doses. We studied changes in serum thyrotropin concentration (TSH) over time and associ......The long-term relationship between hypothyroidism and fracture risk is challenging to dissect because of the modifying influence of subsequent thyroxine replacement with the potential for excessive replacement doses. We studied changes in serum thyrotropin concentration (TSH) over time...... as a predictor of fracture risk in postmenopausal women whereas hypothyroid time predicted increased fracture risk in men below age 75 years. In conclusion, among patients who present with an elevated TSH, the long-term risk of hip and other osteoporotic fractures is strongly related to the cumulative duration...

  13. Predictors of Fracture Risk and Bone Mineral Density in Men with Prostate Cancer on Androgen Deprivation Therapy

    Directory of Open Access Journals (Sweden)

    Katherine Neubecker

    2011-01-01

    Full Text Available Decrease of bone mineral density (BMD and fracture risk is increased in men with prostate cancer receiving androgen deprivation therapy (ADT. We looked at possible predictors of decreased BMD and increased fracture risk in men with prostate cancer; most of whom were on ADT. In a retrospective study, we analyzed serum, BMD, and clinical risk factors used in the Fracture Risk Assessment (FRAX tool and others in 78 men with prostate cancer with reported height loss. The subjects were divided in two groups: 22 men with and 56 without vertebral fractures. 17 of the 22 men with vertebral fractures on spine X-rays did not know they had a vertebral fracture. Of those 17 men, 9 had not previously qualified for treatment based on preradiograph FRAX score calculated with BMD, and 6 based on FRAX calculated without BMD. Performing spine films increased the predictive ability of FRAX for vertebral fracture. Vertebral fracture was better predicted by FRAX for other osteoporotic fractures than FRAX for hip fractures. The inclusion of BMD in FRAX calculations did not affect the predictive ability of FRAX. The PSA level showed a positive correlation with lumbar spine BMD and accounted for about 9% of spine BMD.

  14. Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors

    International Nuclear Information System (INIS)

    As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1–10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients

  15. A review of lifestyle, smoking and other modifiable risk factors for osteoporotic fractures

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Brask-Lindemann, Dorthe; Rubin, Katrine Hass;

    2014-01-01

    could include reduction of excessive alcohol intake, smoking cessation, adequate nutrition, patient education, daily physical activity and a careful review of medications that could increase the risk of falls and fractures. There remains, however, an unmet need for high-quality intervention studies...

  16. Hydraulic fracturing – Integrating public participation with an independent review of the risks and benefits

    International Nuclear Information System (INIS)

    This paper describes a fully independent public participation and review process on the environmental, economic, health, community and social risks and benefits of hydraulic fracturing for the development of unconventional gas and oil resources. We describe the approach taken to maximise public engagement in the process and how that participation informed the work of an independent panel charged with examining the scientific evidence and related legal issues. The major findings from the review are presented, including a risk matrix which summarises the frequency, severity and mitigation measures for 16 potential hazards associated with hydraulic fracturing, as they may pertain to the province of Nova Scotia in Canada. We discuss the complexity of managing public perceptions of novel risks such as hydraulic fracturing and conclude with brief observations on the contribution of the review to public policy. -- Highlights: •We describe a review and public participation process on hydraulic fracturing •We discuss the difficulty of reconciling social and scientific assessments of risk •Processes of societal learning should be further developed •Changes in natural resource governance and democratic process are needed •Where trust is very low governments may still be incapable of action

  17. Recreational football training decreases risk factors for bone fractures in untrained premenopausal women

    DEFF Research Database (Denmark)

    Helge, Eva Wulff; Aagaard, Per; Jakobsen, Markus D.;

    2010-01-01

    The present intervention was designed to investigate whether a 14-week period of regular recreational association football (F) or endurance running (R) has an effect on the risk of falls and bone fractures due to gains in muscle function and volumetric bone mineral density (vBMD). Fifty healthy......BMD. In F, peak jump power increased by 3+/-6% (Pfootball...

  18. Dipeptidyl peptidase-4 inhibitors and fracture risk: an updated meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Fu, Jianying; Zhu, Jianhong; Hao, Yehua; Guo, Chongchong; Zhou, Zhikun

    2016-01-01

    Data on the effects of dipeptidyl peptidase-4 (DPP-4) inhibitors on fracture risk are conflicting. Here, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of DPP-4 inhibitors. Electronic databases were searched for relevant published articles, and unpublished studies presented at ClinicalTrials.gov were searched for relevant clinical data. Eligible studies included prospective randomized trials evaluating DPP-4 inhibitors versus placebo or other anti-diabetic medications in patients with type 2 diabetes. Study quality was determined using Jadad scores. Statistical analyses were performed to calculate the risk ratios (RRs) and 95% confidence intervals (CIs) using fixed-effects models. There were 62 eligible RCTs with 62,206 participants, including 33,452 patients treated with DPP-4 inhibitors. The number of fractures was 364 in the exposed group and 358 in the control group. The overall risk of fracture did not differ between patients exposed to DPP-4 inhibitors and controls (RR, 0.95; 95% CI, 0.83-1.10; P = 0.50). The results were consistent across subgroups defined by type of DPP-4 inhibitor, type of control, and length of follow-up. The study showed that DPP-4 inhibitor use does not modify the risk of bone fracture compared with placebo or other anti-diabetic medications in patients with type 2 diabetes. PMID:27384445

  19. Is allopurinol use associated with an excess risk of osteoporotic fracture?

    DEFF Research Database (Denmark)

    Dennison, Elaine M; Rubin, Katrine Hass; Schwarz, Peter;

    2015-01-01

    UNLABELLED: Using a Danish Register cohort of 86,039 adult new allopurinol users and propensity score matched controls, we found that gout requiring allopurinol prescription was associated with an increased fracture risk. PURPOSE: Gout, an acute inflammatory arthritis, is common and associated wi...

  20. Innovative probabilistic risk assessment applications: barrier impairments and fracture toughness. Panel Discussion

    International Nuclear Information System (INIS)

    Full text of publication follows: New probabilistic risk assessment (PRA) applications promise to improve the overall safety and efficiency of nuclear plant operations. This discussion will explore the use of PRA in evaluating barrier integrity with respect to the consequences of natural phenomena such as tornadoes, floods, and harsh environments. Additionally, the session will explore proposals to improve fracture toughness techniques using PRA. (authors)

  1. Inferior alveolar nerve injuries associated with mandibular fractures at risk: a two-center retrospective study.

    Science.gov (United States)

    Boffano, Paolo; Roccia, Fabio; Gallesio, Cesare; Karagozoglu, K; Forouzanfar, Tymour

    2014-12-01

    The aim of the study was to investigate the incidence of the inferior alveolar nerve (IAN) injury in mandibular fractures. This study is based on two databases that have continuously recorded patients hospitalized with maxillofacial fractures in two departments-Department of Maxillofacial Surgery, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands, and Division of Maxillofacial Surgery, San Giovanni Battista Hospital, Turin, Italy. Demographic, anatomic, and etiology variables were considered for each patient and statistically assessed in relation to the neurosensory IAN impairment. Statistically significant associations were found between IAN injury and fracture displacement (p = 0.03), isolated mandibular fractures (p = 0.01), and angle fractures (p = 0.004). A statistically significant association was also found between IAN injury and assaults (p = 0.03). Displaced isolated mandibular angle fractures could be considered at risk for increased incidence of IAN injury. Assaults seem to be the most important etiological factor that is responsible for IAN lesions. PMID:25383147

  2. Factors associated with an increased risk of vertebral fracture in monoclonal gammopathies of undetermined significance

    International Nuclear Information System (INIS)

    Monoclonal gammopathies of undetermined significance (MGUS) have been shown to be associated with an increased risk of fractures. This study describes prospectively the bone status of MGUS patients and determines the factors associated with vertebral fracture. We included prospectively 201 patients with MGUS, incidentally discovered, and with no known history of osteoporosis: mean age 66.6±12.5 years, 48.3% women, 51.7% immunoglobulin G (IgG), 33.3% IgM and 10.4% IgA. Light chain was kappa in 64.2% patients. All patients had spinal radiographs and bone mineral density measurement in addition to gammopathy assessment. At least one prevalent non-traumatic vertebral fracture was discovered in 18.4% patients and equally distributed between men and women. Fractured patients were older, had a lower bone density and had also more frequently a lambda light chain isotype. Compared with patients with κ light chain, the odds ratio of being fractured for patients with λ light chain was 4.32 (95% confidence interval 1.80–11.16; P=0.002). These results suggest a high prevalence of non-traumatic vertebral fractures in MGUS associated with lambda light chain isotype and not only explained by low bone density

  3. Risk Factors for Fracture in Diabetes: The Canadian Multicentre Osteoporosis Study

    OpenAIRE

    Fraser, Lisa-Ann; Papaioannou, Alexandra; Adachi, Jonathan D.; Ma, Jinhui; Thabane, Lehana

    2013-01-01

    Objective. Individuals with diabetes have been found to be at increased risk of nontraumatic fracture. However, within the diabetic population, how to distinguish who is at the highest risk and warranting therapy has remained elusive. Design. Cross-sectional analysis of a national population-based cohort study. Patients. Men and women over the age of 50 with diabetes from across Canada. Measurements. Logistic regression analysis to identify diabetes specific factors associated with a history ...

  4. Risk estimates for hip fracture from clinical and densitometric variables and impact of database selection in Lebanese subjects.

    Science.gov (United States)

    Badra, Mohammad; Mehio-Sibai, Abla; Zeki Al-Hazzouri, Adina; Abou Naja, Hala; Baliki, Ghassan; Salamoun, Mariana; Afeiche, Nadim; Baddoura, Omar; Bulos, Suhayl; Haidar, Rachid; Lakkis, Suhayl; Musharrafieh, Ramzi; Nsouli, Afif; Taha, Assaad; Tayim, Ahmad; El-Hajj Fuleihan, Ghada

    2009-01-01

    Bone mineral density (BMD) and fracture incidence vary greatly worldwide. The data, if any, on clinical and densitometric characteristics of patients with hip fractures from the Middle East are scarce. The objective of the study was to define risk estimates from clinical and densitometric variables and the impact of database selection on such estimates. Clinical and densitometric information were obtained in 60 hip fracture patients and 90 controls. Hip fracture subjects were 74 yr (9.4) old, were significantly taller, lighter, and more likely to be taking anxiolytics and sleeping pills than controls. National Health and Nutrition Examination Survey (NHANES) database selection resulted in a higher sensitivity and almost equal specificity in identifying patients with a hip fracture compared with the Lebanese database. The odds ratio (OR) and its confidence interval (CI) for hip fracture per standard deviation (SD) decrease in total hip BMD was 2.1 (1.45-3.05) with the NHANES database, and 2.11 (1.36-2.37) when adjusted for age and body mass index (BMI). Risk estimates were higher in male compared with female subjects. In Lebanese subjects, BMD- and BMI-derived hip fracture risk estimates are comparable to western standards. The study validates the universal use of the NHANES database, and the applicability of BMD- and BMI-derived risk fracture estimates in the World Health Organization (WHO) global fracture risk model, to the Lebanese. PMID:19246223

  5. Atypical fractures, a biased perspective.

    Science.gov (United States)

    Aspenberg, Per

    2016-01-01

    When stress fractures started to show up in the femurs of elderly ladies, it was soon evident that bisphosphonate use lay behind, and the absolute risk increase due to bisphosphonate use was reasonably well estimated already in 2008. Thereafter followed a period of confusion: the term atypical fracture was introduced, with a definition so vague that the true stress fractures tended to disappear in a cloud of ambiguity. This cast doubt on the association with bisphosphonates. The association was then re-established by large epidemiological studies based on radiographic adjudication. Atypical fractures are largely caused by bisphosphonates. With a correct indication, bisphosphonates prevent many more fractures than they cause, at least during the first years of use. With an incorrect indication they are likely to cause more harm than good. PMID:26768286

  6. Prevalence of risk factors for fractures and use of DXA scanning in Danish women. A regional population-based study

    DEFF Research Database (Denmark)

    Rubin, K H; Abrahamsen, B; Hermann, A P;

    2011-01-01

    in the region of Southern Denmark to receive a mailed questionnaire concerning risk factors for fractures. Results The respondents rate was 84% and 77% of the invited population were available for analysis. A total of 10.3% of the women without risk factors and only 36% of the women with three or more risk.......5% of those with more than 40 km to the nearest scanner had a history of DXA. Logistic regression analysis showed that distance, fracture risk, oral glucocorticoids, low-energy fracture, conditions associated with secondary osteoporosis, low BMI, history of falls, age 65–79 years, spouse status, and income...

  7. C-reactive protein, established risk factors and social inequalities in cardiovascular disease – the significance of absolute versus relative measures of disease

    Directory of Open Access Journals (Sweden)

    Hedblad Bo

    2008-06-01

    Full Text Available Abstract Background The widespread use of relative scales in socioepidemiological studies has recently been criticized. The criticism is based mainly on the fact that the importance of different risk factors in explaining social inequalities in cardiovascular disease (CVD varies, depending on which scale is used to measure social inequalities. The present study examines the importance of established risk factors, as opposed to low-grade inflammation, in explaining socioeconomic differences in the incidence of CVD, using both relative and absolute scales. Methods We obtained information on socioeconomic position (SEP, established risk factors (smoking, hypertension, and hyperlipidemia, and low-grade inflammation as measured by high-sensitive (hs C-reactive protein (CRP levels, in 4,268 Swedish men and women who participated in the Malmö Diet and Cancer Study (MDCS. Data on first cardiovascular events, i.e., stroke or coronary event (CE, was collected from regional and national registers. Social inequalities were measured in relative terms, i.e., as ratios between incidence rates in groups with lower and higher SEP, and also in absolute terms, i.e., as the absolute difference in incidence rates in groups with lower and higher SEP. Results Those with low SEP had a higher risk of future CVD. Adjustment for risk factors resulted in a rather small reduction in the relative socioeconomic gradient, namely 8% for CRP (≥ 3 mg/L and 21% for established risk factors taken together. However, there was a reduction of 18% in the absolute socioeconomic gradient when looking at subjects with CRP-levels Conclusion C-reactive protein and established risk factors all contribute to socioeconomic differences in CVD. However, conclusions on the importance of "modern" risk factors (here, CRP, as opposed to established risk factors, in the association between SEP and CVD depend on the scale on which social inequalities are measured. The one-sided use of the relative

  8. Prevalence of Fracture Risk Factors in Postmenopausal Women Enrolled in the POSSIBLE US Treatment Cohort

    OpenAIRE

    Nicole Yurgin; Sally Wade; Sacha Satram-Hoang; David Macarios; Marc Hochberg

    2013-01-01

    Subject- and physician-reported data from 4,429 postmenopausal women receiving osteoporosis treatment in the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US) were used to assess the prevalence of risk factors (RFs) and on-study fracture. RFs assessed at study entry were age >70 years; fracture since age 50; minimum T-score (hip/spine) ≤−2.5 at diagnosis; body mass index 70 years were the most common RFs in the osteoporosis group, and age >70 years an...

  9. Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture

    OpenAIRE

    Duo Wai-Chi Wong; Wenxin Niu; Yan Wang; Ming Zhang

    2016-01-01

    Introduction Foot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis. Methods A three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The sim...

  10. Impact of Maternal Diet on Offspring Bone Fracture Risk During Childhood

    DEFF Research Database (Denmark)

    Petersen, Sesilje Elise Bondo

    , including maternal diet and vitamin D status. However, few studies have investigated whether these factors during pregnancy impact offspring bone health in short as well as in the long term. The overall objective of this thesis was to investigate epidemiologically whether maternal vitamin D status...... and dietary patterns in two prospective pregnancy cohorts, were associated with offspring risk of bone fractures in childhood. Overall, our studies provided limited support to the hypothesis that fetal bone health is programmed by the maternal vitamin D status and overall diet during pregnancy. However......, there were some indications of an increased risk for fractures when the mother consumed a Western diet and had high consumption of artificially sweetened soft drinks. Further, our results indicated that mid-pregnancy use of dietary supplements with high doses of vitamin D increased the risk for offspring...

  11. Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture.

    Directory of Open Access Journals (Sweden)

    Duo Wai-Chi Wong

    Full Text Available Foot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis.A three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The simulated impact velocities were from 2.0 to 7.0 m/s with 1.0 m/s interval.At 5.0 m/s impact velocity, the maximum von Mises stress of the trabecular calcaneus and talus were 3.21MPa and 2.41MPa respectively, while that of the Tresca stress were 3.46MPa and 2.55MPa. About 94% and 84% of the trabecular calcaneus and talus exceeded the shear yielding stress, while 21.7% and 18.3% yielded the compressive stress. The peak stresses were distributed around the talocalcaneal articulation and the calcaneal tuberosity inferiorly, which corresponded to the common fracture sites.The prediction in this study showed that axial compressive impact at 5.0 m/s could produce considerable yielding of trabecular bone in both calcaneus and talus, dominantly by shear and compounded with compression that predispose the rearfoot in the risk of fracture. This study suggested the injury pattern and fracture mode of high energy trauma that provides insights in injury prevention and fracture management.

  12. Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County, Minnesota

    OpenAIRE

    Jafri, Mohammed R.; Nordstrom, Charles W.; Murray, Joseph A; Van Dyke, Carol T.; Dierkhising, Ross A.; Zinsmeister, Alan R.; Melton, Lee J.

    2007-01-01

    Celiac disease is associated with decreased bone density, but there are conflicting data regarding fracture risk. We determined the fracture incidence relative to matched controls in a population-based cohort with celiac disease before and after diagnosis. Olmsted County residents with celiac disease (n = 83) diagnosed between 1950 and 2002 were compared with 166 gender and age matched controls. Fracture histories were ascertained from each subject’s medical records. Celiac disease is linked ...

  13. Absolute beginners

    OpenAIRE

    Costa, Carlos Casimiro da; Costa, Jacinta Casimiro da

    2012-01-01

    Tomorrow, I m recovering my Thursday child as an absolute beginner , Transporting you to the essential touch of surface skin and space, Only for you, i do not regret, looking for education in a materia set. My love is your love , my materiality is you making things, The legacy of our ethnography, craftsmen s old and disappear, make me strong hard feelings, Recovering experiences and knowledge sprinkled in powder of stone, wood and metal ( ) reflecting in your dirty face the ...

  14. Airflow limitation as a risk factor for low bone mineral density and hip fracture

    Science.gov (United States)

    Herland, Trine; Apalset, Ellen M; Eide, Geir Egil; Tell, Grethe S; Lehmann, Sverre

    2016-01-01

    Aim To investigate whether airflow limitation is associated with bone mineral density (BMD) and risk of hip fractures. Methods A community sample of 5,100 subjects 47–48 and 71–73 years old and living in Bergen was invited. Participants filled in questionnaires and performed a post-bronchodilator spirometry measuring forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). All attendants were invited to have a BMD measurement of the hip. During 10 years of follow-up, information on death was collected from the Norwegian Cause of Death Registry, and incident hip fractures were registered from regional hospital records of discharge diagnoses and surgical procedure codes. Results The attendance rate was 69% (n=3,506). The prevalence of chronic obstructive pulmonary disease (COPD) (FEV1/FVC<0.7) was 9%. In multiple logistic regression, the lowest quartile of BMD versus the three upper was significantly predicted by FEV1/FVC<0.7 and FEV1% predicted (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.11 to 2.25, and OR per increase of 10%: 0.92, 95% CI: 0.86 to 0.99, respectively). Hip fracture occurred in 126 (4%) participants. In a Cox regression analysis, FEV1% predicted was associated with a lowered risk of hip fracture (hazard ratio per increase of 10%: 0.89, 95% CI: 0.79 to 0.997). Conclusion Airflow limitation is positively associated with low BMD and risk of hip fracture in middle-aged and elderly. PMID:27733234

  15. Risk factors for fracture in elderly men: a population-based prospective study

    DEFF Research Database (Denmark)

    Frost, M; Abrahamsen, B; Masud, Tahir;

    2012-01-01

    Risk factors for fractures were assessed in a random sample of 4,696 elderly men followed for 5.4 years. Results highlighted the importance of assessment of falls and dizziness as well as novel risk factors including frequent urination and erectile dysfunction. INTRODUCTION: Knowledge about risk......-4/year: 2.10; 1.35-3.27, >4/year: 2.46; 1.12-5.41, both compared to no falls), dizziness (2.36; 1.51-3.71), erectile dysfunction (1.41; 1.06-1.87) and frequent urination (2.06; 1.26-3.39). Similarly, falls (2.36; 1.45-3.86), dizziness (2.83; 1.52-5.25), erectile dysfunction (2.01; 1.......30-3.09) and pulmonary illness (1.90; 1.03-3.53) were associated with increased risk of osteoporotic fractures in adjusted models. CONCLUSION: These results underline the importance of assessment of dizziness, falls and those with a family history of hip fracture. Frequent urination and erectile dysfunction were...

  16. Crohn's disease and risk of fracture: does thyroid disease play a role?

    Institute of Scientific and Technical Information of China (English)

    Nakechand Pooran; Pankaj Singh; Simmy Bank

    2003-01-01

    AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's disease. A group of 206 patients without inflammatory bowel disease served as controls. Primary outcome was thyroid disorder. Secondary outcomes included use of steroids, immunosuppressive medications, surgery and incidence of fracture.RESULTS: The prevalence of hyperthyroidism was similar in both groups. However, the prevalence of hypothyroidism was lower in Crohn's patients (3.8 % vs 8.2 %, P=0.05).Within the Crohn's group, the use of immunosuppressive agents (0 % vs11 %), steroid usage (12.5 % vs37 %), small bowel surgery (12.5 % vs 28 %) and large bowel surgery (12.5 % vs27 %) were lower in the hypothyroid subset as compared to the euthyroid subset. Seven (3.4 %) Crohn'spatients suffered fracture, all of whom were euthyroid.CONCLUSION: Thyroid disorder was not found to be associated with Crohn's disease and was not found to increase the risk for fractures. Therefore, screening for thyroid disease is not a necessary component in the management of Crohn's disease.

  17. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

    Science.gov (United States)

    Labronici, Pedro José; Reder, Vitor Rodrigues; de Araujo Marins Filho, Guilherme Ferreira; Pires, Robinson Esteves Santos; Fernandes, Hélio Jorge Alvachian; Mercadante, Marcelo Tomanik

    2016-01-01

    Objective To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. Method 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. Results All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. Conclusion The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk. PMID:27069891

  18. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    2016-04-01

    Full Text Available OBJECTIVE: To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. METHOD: 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. RESULTS: All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2 were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. CONCLUSION: The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk.

  19. Incidence and risk of work-related fracture injuries: experience of a state-managed workers' compensation system.

    Science.gov (United States)

    Islam, S S; Biswas, R S; Nambiar, A M; Syamlal, G; Velilla, A M; Ducatman, A M; Doyle, E J

    2001-02-01

    Incidence rates of occupational fractures at various anatomic sites and associated risk factors have not been well documented. We identified 3490 work-related fractures from a West Virginia Workers Compensation database that occurred between July 1, 1994, and June 30, 1995. The annual incidence rate was 55 per 10,000 workers, which is substantially higher than the work-related fracture rates reported previously. The incidence rate of fracture was highest in the agricultural sector, followed by the mining, construction, and manufacturing sectors (202.0, 165.2, 116.7, and 88.0 per 10,000 workers, respectively). The age-specific gender distribution comparing fracture and non-fracture injuries showed a bimodal distribution, with greater proportions of female employees at the younger and older age groups. Fracture of the phalanges was the most common, followed by fractures of the foot bone and carpal bone (15.8, 9.5, and 7.9 per 10,000 workers, respectively). In a multiple logistic regression analysis, age, gender, occupation, caught in-between objects, fall, struck by or against object, and vehicle collision were significant independent predictors of fracture (all sites combined). We believe work-related fractures to be a bigger problem than previously reported. The association among gender, age, occupation, and causes of fractures identified in this study will be useful in developing gender- and occupation-specific prevention intervention.

  20. Incidence and risk of work-related fracture injuries: experience of a state-managed workers' compensation system.

    Science.gov (United States)

    Islam, S S; Biswas, R S; Nambiar, A M; Syamlal, G; Velilla, A M; Ducatman, A M; Doyle, E J

    2001-02-01

    Incidence rates of occupational fractures at various anatomic sites and associated risk factors have not been well documented. We identified 3490 work-related fractures from a West Virginia Workers Compensation database that occurred between July 1, 1994, and June 30, 1995. The annual incidence rate was 55 per 10,000 workers, which is substantially higher than the work-related fracture rates reported previously. The incidence rate of fracture was highest in the agricultural sector, followed by the mining, construction, and manufacturing sectors (202.0, 165.2, 116.7, and 88.0 per 10,000 workers, respectively). The age-specific gender distribution comparing fracture and non-fracture injuries showed a bimodal distribution, with greater proportions of female employees at the younger and older age groups. Fracture of the phalanges was the most common, followed by fractures of the foot bone and carpal bone (15.8, 9.5, and 7.9 per 10,000 workers, respectively). In a multiple logistic regression analysis, age, gender, occupation, caught in-between objects, fall, struck by or against object, and vehicle collision were significant independent predictors of fracture (all sites combined). We believe work-related fractures to be a bigger problem than previously reported. The association among gender, age, occupation, and causes of fractures identified in this study will be useful in developing gender- and occupation-specific prevention intervention. PMID:11227632

  1. Comparison of additive (absolute) risk projection models and multiplicative (relative) risk projection models in estimating radiation-induced lifetime cancer risk

    International Nuclear Information System (INIS)

    Lifetime cancer risk estimates depend on risk projection models. While the increasing lengths of follow-up observation periods of atomic bomb survivors in Hiroshima and Nagasaki bring about changes in cancer risk estimates, the validity of the two risk projection models, the additive risk projection model (AR) and multiplicative risk projection model (MR), comes into question. This paper compares the lifetime risk or loss of life-expectancy between the two projection models on the basis of BEIR-III report or recently published RERF report. With Japanese cancer statistics the estimates of MR were greater than those of AR, but a reversal of these results was seen when the cancer hazard function for India was used. When we investigated the validity of the two projection models using epidemiological human data and animal data, the results suggested that MR was superior to AR with respect to temporal change, but there was little evidence to support its validity. (author)

  2. Study of sex differences in the association between hip fracture risk and body parameters by DXA-based biomechanical modeling.

    Science.gov (United States)

    Nasiri, Masoud; Luo, Yunhua

    2016-09-01

    There is controversy about whether or not body parameters affect hip fracture in men and women in the same way. In addition, although bone mineral density (BMD) is currently the most important single discriminator of hip fracture, it is unclear if BMD alone is equally effective for men and women. The objective of this study was to quantify and compare the associations of hip fracture risk with BMD and body parameters in men and women using our recently developed two-level biomechanical model that combines a whole-body dynamics model with a proximal-femur finite element model. Sideways fall induced impact force of 130 Chinese clinical cases, including 50 males and 80 females, were determined by subject-specific dynamics modeling. Then, a DXA-based finite element model was used to simulate the femur bone under the fall-induced loading conditions and calculate the hip fracture risk. Body weight, body height, body mass index, trochanteric soft tissue thickness, and hip bone mineral density were determined for each subject and their associations with impact force and hip fracture risk were quantified. Results showed that the association between impact force and hip fracture risk was not strong enough in both men (r=-0.31,p0.05), but it can be considered as a protective factor among women (r=-0.28,p<0.05). In contrast to men, trochanteric soft tissue thickness can be considered as a protective factor against hip fracture in women (r=-0.50,p<0.001). This study suggested that the biomechanical risk/protective factors for hip fracture are sex-specific. Therefore, the effect of body parameters should be considered differently for men and women in hip fracture risk assessment tools. These findings support further exploration of sex-specific preventive and protective measurements to reduce the incidence of hip fractures. PMID:27292653

  3. Calcium plus vitamin D supplementation and risk of fractures: an updated meta analysis from the National Osteoporosis Foundation

    Science.gov (United States)

    Introduction: Calcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized contr...

  4. Logistic regression in estimates of femoral neck fracture by fall

    OpenAIRE

    Jaroslava Wendlová

    2010-01-01

    Jaroslava WendlováDerer’s University Hospital and Policlinic, Osteological Unit, Bratislava, SlovakiaAbstract: The latest methods in estimating the probability (absolute risk) of osteoporotic fractures include several logistic regression models, based on qualitative risk factors plus bone mineral density (BMD), and the probability estimate of fracture in the future. The Slovak logistic regression model, in contrast to other models, is created from quantitative variables o...

  5. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove

    2016-01-01

    AIM: To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify.......3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN. CONCLUSION: Teeth involved in alveolar process fractures appear...

  6. Fracture Risk in Relation to Serum 25-Hydroxyvitamin D and Physical Activity: Results from the EPIC-Norfolk Cohort Study

    Science.gov (United States)

    Julian, Cristina; Lentjes, Marleen A. H.; Huybrechts, Inge; Wareham, Nick; Khaw, Kay-Tee

    2016-01-01

    Vitamin D deficiency and physical inactivity have been associated with bone loss and fractures, but their combined effect has scarcely been studied either in younger or older adults. Therefore, we aimed to assess the associations between physical activity, age and 25-hydroxyvitamin D (25(OH)D) status separately and in combination with the incidence of fracture risk in the EPIC-Norfolk cohort study. Baseline (1993–1998) self-reported physical activity and serum 25(OH)D concentrations at follow-up (1998–2000) were collected in 14,624 men and women (aged 42–82 y between 1998 and 2000). Fracture incidence was ascertained up to March 2015. Cox proportional hazard model was used to determine HRs of fractures by plasma 25(OH)D (90 nmol/L), age (65 y) and physical activity (inactive and active) categories, by follow-up time per 20 nmol/L increase in serum 25(OH)D and to explore age-25(OH)D and physical activity-25(OH)D interactions. The age-, sex-, and month-adjusted HRs (95% CIs) for all fractures (1183 fractures) by increasing vitamin D category were not significantly different. With additional adjustment for body mass index, smoking status, alcohol intake, supplement use and history of fractures, the fracture risk was 29% lower in those participants with 50 to 70 nmol/L compared with those in the lowest quintile (<30 nmol/L). Physical inactivity based on a single baseline assessment was not associated with fracture risk. Vitamin D status appeared inversely related to fractures in middle aged adults. In older adults, the relationship between vitamin D status and fracture risk was observed to be J-shaped. Clinical and public health practice in vitamin D supplementation could partially explain these findings, although definitive conclusions are difficult due to potential changes in exposure status over the long follow up period. PMID:27749911

  7. Cost-effectiveness of quantitative ultrasound as a technique for screening of osteoporotic fracture risk

    OpenAIRE

    Aidelsburger, P.; Hessel, F.; Wasem, J

    2004-01-01

    Aim: On behalf of the German Agency for Health Technology Assessment (DAHTA@DIMDI) a rapid economic HTA was conducted. Aim of the HTA was to evaluate the cost-effectiveness of quantitative ultrasound (QUS) for screening of osteoporotic fracture risk. Study population was formed by postmenopausal women. QUS was compared to the dual X-ray absorptiometry (DXA) as the most frequently used method of measurement. Methods: According to the recommendations for rapid economic HTA a comprehensive liter...

  8. Fusion of clinical and stochastic finite element data for hip fracture risk prediction.

    Science.gov (United States)

    Jiang, Peng; Missoum, Samy; Chen, Zhao

    2015-11-26

    Hip fracture affects more than 250,000 people in the US and 1.6 million worldwide per year. With an aging population, the development of reliable fracture risk models is therefore of prime importance. Due to the complexity of the hip fracture phenomenon, the use of clinical data only, as it is done traditionally, might not be sufficient to ensure an accurate and robust hip fracture prediction model. In order to increase the predictive ability of the risk model, the authors propose to supplement the clinical data with computational data from finite element models. The fusion of the two types of data is performed using deterministic and stochastic computational data. In the latter case, uncertainties in loading and material properties of the femur are accounted for and propagated through the finite element model. The predictive capability of a support vector machine (SVM) risk model constructed by combining clinical and finite element data was assessed using a Women׳s Health Initiative (WHI) dataset. The dataset includes common factors such as age and BMD as well as geometric factors obtained from DXA imaging. The fusion of computational and clinical data systematically leads to an increase in predictive ability of the SVM risk model as measured by the AUC metric. It is concluded that the largest gains in AUC are obtained by the stochastic approach. This gain decreases as the dimensionality of the problem increases: a 5.3% AUC improvement was achieved for a 9 dimensional problem involving geometric factors and weight while a 1.3% increase was obtained for a 20 dimensional case including geometric and conventional factors. PMID:26482733

  9. Case Report: Turner’s Syndrome with Juvenil Osteoporosis and Spontaneous Fracture Risk

    OpenAIRE

    Ayşegül Türkyılmaz; Diclehan Oral; Nafi Sakar; Turgay Budak

    2008-01-01

    In this study, a case report is presented with Turner’s Syndrome with isochromosome carrier, Juvenile Osteoporosis and spontaneous fracture risk. As regards the case, who was referred to Genetic laboratory of Medical Biology Department, Medical Faculty, Dicle University, with pre-diagnosis of growth and development retardation and primary amenore, on average 10 preparats were prepared after performing peripheric blood culture method for chromosomal analysis. The preparats were stained with Gi...

  10. Absolute risk representation in cardiovascular disease prevention: comprehension and preferences of health care consumers and general practitioners involved in a focus group study

    Directory of Open Access Journals (Sweden)

    Ryan Rebecca

    2010-03-01

    Full Text Available Abstract Background Communicating risk is part of primary prevention of coronary heart disease and stroke, collectively referred to as cardiovascular disease (CVD. In Australia, health organisations have promoted an absolute risk approach, thereby raising the question of suitable standardised formats for risk communication. Methods Sixteen formats of risk representation were prepared including statements, icons, graphical formats, alone or in combination, and with variable use of colours. All presented the same risk, i.e., the absolute risk for a 55 year old woman, 16% risk of CVD in five years. Preferences for a five or ten-year timeframe were explored. Australian GPs and consumers were recruited for participation in focus groups, with the data analysed thematically and preferred formats tallied. Results Three focus groups with health consumers and three with GPs were held, involving 19 consumers and 18 GPs. Consumers and GPs had similar views on which formats were more easily comprehended and which conveyed 16% risk as a high risk. A simple summation of preferences resulted in three graphical formats (thermometers, vertical bar chart and one statement format as the top choices. The use of colour to distinguish risk (red, yellow, green and comparative information (age, sex, smoking status were important ingredients. Consumers found formats which combined information helpful, such as colour, effect of changing behaviour on risk, or comparison with a healthy older person. GPs preferred formats that helped them relate the information about risk of CVD to their patients, and could be used to motivate patients to change behaviour. Several formats were reported as confusing, such as a percentage risk with no contextual information, line graphs, and icons, particularly those with larger numbers. Whilst consumers and GPs shared preferences, the use of one format for all situations was not recommended. Overall, people across groups felt that risk

  11. Length of preoperative hospital stay: a risk factor for reducing surgical infection in femoral fracture cases

    Directory of Open Access Journals (Sweden)

    Hoberdan Oliveira Pereira

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To analyze infections of the surgical site among patients undergoing clean-wound surgery for correction of femoral fractures. METHODS: This was a historical cohort study developed in a large-sized hospital in Belo Horizonte. Data covering the period from July 2007 to July 2009 were gathered from the records in electronic medical files, relating to the characteristics of the patients, surgical procedures and surgical infections. The risk factors for infection were identified by means of statistical tests on bilateral hypotheses, taking the significance level to be 5%. Continuous variables were evaluated using Student'sttest. Categorical variables were evaluated using the chi-square test, or Fisher's exact test, when necessary. For each factor under analysis, a point estimate and the 95% confidence interval for the relative risk were obtained. In the final stage of the study, multivariate logistic regression analysis was performed. RESULTS: 432 patients who underwent clean-wound surgery for correcting femoral fractures were included in this study. The rate of incidence of surgical site infections was 4.9% and the risk factors identified were the presence of stroke (odds ratio, OR = 5.0 and length of preoperative hospital stay greater than four days (OR = 3.3. CONCLUSION: To prevent surgical site infections in operations for treating femoral fractures, measures involving assessment of patients' clinical conditions by a multiprofessional team, reduction of the length of preoperative hospital stay and prevention of complications resulting from infections will be necessary.

  12. Absolute Summ

    Science.gov (United States)

    Phillips, Alfred, Jr.

    Summ means the entirety of the multiverse. It seems clear, from the inflation theories of A. Guth and others, that the creation of many universes is plausible. We argue that Absolute cosmological ideas, not unlike those of I. Newton, may be consistent with dynamic multiverse creations. As suggested in W. Heisenberg's uncertainty principle, and with the Anthropic Principle defended by S. Hawking, et al., human consciousness, buttressed by findings of neuroscience, may have to be considered in our models. Predictability, as A. Einstein realized with Invariants and General Relativity, may be required for new ideas to be part of physics. We present here a two postulate model geared to an Absolute Summ. The seedbed of this work is part of Akhnaton's philosophy (see S. Freud, Moses and Monotheism). Most important, however, is that the structure of human consciousness, manifest in Kenya's Rift Valley 200,000 years ago as Homo sapiens, who were the culmination of the six million year co-creation process of Hominins and Nature in Africa, allows us to do the physics that we do. .

  13. Increase in Fracture Risk Following Unintentional Weight Loss in Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women.

    Science.gov (United States)

    Compston, Juliet E; Wyman, Allison; FitzGerald, Gordon; Adachi, Jonathan D; Chapurlat, Roland D; Cooper, Cyrus; Díez-Pérez, Adolfo; Gehlbach, Stephen H; Greenspan, Susan L; Hooven, Frederick H; LaCroix, Andrea Z; March, Lyn; Netelenbos, J Coen; Nieves, Jeri W; Pfeilschifter, Johannes; Rossini, Maurizio; Roux, Christian; Saag, Kenneth G; Siris, Ethel S; Silverman, Stuart; Watts, Nelson B; Anderson, Frederick A

    2016-07-01

    Increased fracture risk has been associated with weight loss in postmenopausal women, but the time course over which this occurs has not been established. The aim of this study was to examine the effects of unintentional weight loss of ≥10 lb (4.5 kg) in postmenopausal women on fracture risk at multiple sites up to 5 years after weight loss. Using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW), we analyzed the relationships between self-reported unintentional weight loss of ≥10 lb at baseline, year 2, or year 3 and incident clinical fracture in the years after weight loss. Complete data were available in 40,179 women (mean age ± SD 68 ± 8.3 years). Five-year cumulative fracture rate was estimated using the Kaplan-Meier method, and adjusted hazard ratios for weight loss as a time-varying covariate were calculated from Cox multiple regression models. Unintentional weight loss at baseline was associated with a significantly increased risk of fracture of the clavicle, wrist, spine, rib, hip, and pelvis for up to 5 years after weight loss. Adjusted hazard ratios showed a significant association between unintentional weight loss and fracture of the hip, spine, and clavicle within 1 year of weight loss, and these associations were still present at 5 years. These findings demonstrate increased fracture risk at several sites after unintentional weight loss in postmenopausal women. This increase is found as early as 1 year after weight loss, emphasizing the need for prompt fracture risk assessment and appropriate management to reduce fracture risk in this population. © 2016 American Society for Bone and Mineral Research. PMID:26861139

  14. Increase in Fracture Risk Following Unintentional Weight Loss in Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women†

    Science.gov (United States)

    Compston, Juliet E.; Wyman, A; FitzGerald, Gordon; Adachi, Jonathan D.; Chapurlat, Roland D.; Cooper, Cyrus; Díez-Pérez, Adolfo; Gehlbach, Stephen H; Greenspan, Susan L.; Hooven, Frederick H.; LaCroix, Andrea Z.; March, Lyn; Coen Netelenbos, J.; Nieves, Jeri W.; Pfeilschifter, Johannes; Rossini, Maurizio; Roux, Christian; Saag, Kenneth G.; Siris, Ethel S.; Silverman, Stuart; Watts, Nelson B.; Anderson, Frederick A.

    2016-01-01

    Increased fracture risk has been associated with weight loss in postmenopausal women but the time course over which this occurs has not been established. The aim of this study was to examine the effects of unintentional weight loss of ≥10 lb (4.5 kg) in postmenopausal women on fracture risk at multiple sites up to 5 years following weight loss. Using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) we analyzed the relationships between self-reported unintentional weight loss of ≥10 lb at baseline, year 2, or year 3 and incident clinical fracture in the years following weight loss. Complete data were available in 40,179 women (mean age ± SD 68 ± 8.3 years). Five-year cumulative fracture rate was estimated using the Kaplan-Meier method, and adjusted hazard ratios for weight loss as a time-varying covariate were calculated from Cox multiple regression models. Unintentional weight loss at baseline was associated with a significantly increased risk of fracture of the clavicle, wrist, spine, rib, hip, and pelvis for up to 5 years following weight loss. Adjusted hazard ratios showed a significant association between unintentional weight loss and fracture of the hip, spine, and clavicle within 1 year of weight loss, and these associations were still present at 5 years. These findings demonstrate increased fracture risk at several sites after unintentional weight loss in postmenopausal women. This increase is seen as early as 1 year following weight loss, emphasizing the need for prompt fracture risk assessment and appropriate management to reduce fracture risk in this population. PMID:26861139

  15. Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS)

    Science.gov (United States)

    Bernatsky, S.; Abrahamowicz, M.; Papaioannou, A.; Bessette, L.; Adachi, J.; Goltzman, D.; Prior, J.; Kreiger, N.; Towheed, T.; Leslie, W. D.; Kaiser, S.; Ioannidis, G.; Pickard, L.; Fraser, L.-A.; Rahme, E.

    2016-01-01

    Summary We used data from a large, prospective Canadian cohort to assess the association between selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) and fracture. We found an increased risk of fractures in individuals who used SSRI or SNRI, even after controlling for multiple risk factors. Introduction Previous studies have suggested an association between SSRIs and increasing risk of fragility fractures. However, the majority of these studies were not long-term analyses or were performed using administrative data and, thus, could not fully control for potential confounders. We sought to determine whether the use of SSRIs and SNRIs is associated with increased risk of fragility fracture, in adults aged 50+. Methods We used data from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective randomly selected population-based community cohort; our analyses focused on subjects aged 50+. Time to event methodology was used to assess the association between SSRI/SNRI use, modeled time-dependently, and fragility fracture. Results Among 6,645 subjects, 192 (2.9 %) were using SSRIs or/and SNRIs at baseline. During the 10-year study period, 978 (14.7 %) participants experienced at least one fragility fracture. In our main analysis, SSRI/SNRI use was associated with increased risk of fragility fracture (hazard ratio (HR), 1.88; 95 % confidence intervals (CI), 1.48–2.39). After controlling for multiple risk factors, including Charlson score, previous falls, and bone mineral density hip and lumbar bone density, the adjusted HR for current SSRI/SNRI use remained elevated (HR, 1.68; 95 % CI, 1.32–2.14). Conclusions Our results lend additional support to an association between SSRI/SNRI use and fragility fractures. Given the high prevalence of antidepressants use, and the impact of fractures on health, our findings may have a significant clinical impact. PMID:24566587

  16. Growth and Age-Related Abnormalities in Cortical Structure and Fracture Risk.

    Science.gov (United States)

    Seeman, Ego

    2015-12-01

    Vertebral fractures and trabecular bone loss have dominated thinking and research into the pathogenesis and the structural basis of bone fragility during the last 70 years. However, 80% of all fractures are non-vertebral and occur at regions assembled using large amounts of cortical bone; only 20% of fractures are vertebral. Moreover, ~80% of the skeleton is cortical and ~70% of all bone loss is cortical even though trabecular bone is lost more rapidly than cortical bone. Bone is lost because remodelling becomes unbalanced after midlife. Most cortical bone loss occurs by intracortical, not endocortical remodelling. Each remodelling event removes more bone than deposited enlarging existing canals which eventually coalesce eroding and thinning the cortex from 'within.' Thus, there is a need to study the decay of cortical as well as trabecular bone, and to develop drugs that restore the strength of both types of bone. It is now possible to accurately quantify cortical porosity and trabecular decay in vivo. The challenges still to be met are to determine whether measurement of porosity identifies persons at risk for fracture, whether this approach is compliments information obtained using bone densitometry, and whether changes in cortical porosity and other microstructural traits have the sensitivity to serve as surrogates of treatment success or failure. PMID:26394727

  17. Risks to Water Resources from Shale Gas Development and Hydraulic Fracturing in the United States

    Science.gov (United States)

    Vengosh, Avner; Jackson, Robert B.; Warner, Nathaniel; Darrah, Thomas H.; Kondash, Andrew

    2014-05-01

    The rise of shale gas development through horizontal drilling and high volume hydraulic fracturing has expanded oil and gas exploration in the USA. The rapid rate of shale gas exploration has triggered an intense public debate regarding the potential environmental and human health effects. A review of the updated literature has identified four potential risks for impacts on water resources: (1) stray gas contamination of shallow aquifers near shale gas sites; (2) contamination of surface water and shallow groundwater from spills, leaks, and disposal of inadequately treated wastewater or hydraulic fracturing fluids; (3) accumulation of toxic and radioactive residues in soil or stream sediments near disposal or spill sites; and (4) over-extraction of water resources for drilling and hydraulic fracturing that could induce water shortages and conflicts with other water users, particularly in water-scarce areas. As part of a long-term research on the potential water contamination associated with shale gas development, new geochemical and isotopic techniques have been developed for delineating the origin of gases and contaminants in water resource. In particular, multiple geochemical and isotopic (carbon isotopes in hydrocarbons, noble gas, strontium, boron, radium isotopes) tracers have been utilized to distinguish between naturally occurring dissolved gas and salts in water and contamination directly induced from shale gas drilling and hydraulic fracturing operations.

  18. Treatment of Temporal Bone Fractures.

    Science.gov (United States)

    Diaz, Rodney C; Cervenka, Brian; Brodie, Hilary A

    2016-10-01

    Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid (CSF) leak, and hearing loss. Assessment of facial nerve function as soon as possible following injury greatly facilitates clinical decision making. Use of prophylactic antibiotics in the setting of CSF leak is controversial; however, following critical analysis and interpretation of the existing classic and contemporary literature, we believe its use is absolutely warranted. PMID:27648399

  19. Risk of hip fractures associated with benzodiazepines: Applying common protocol to a multi-database nested case-control study. The protect project

    NARCIS (Netherlands)

    Requena, Gema; Logie, John; González-González, Rocío; Gardarsdottir, Helga; Afonso, Ana; Souverein, Patrick C.; Merino, Elisa Martin; Boudiaf, Nada; Huerta, Consuelo; Bate, Andrew; Alvarez, Yolanda; García-Rodríguez, Luis A.; Reynolds, Robert; Schlienger, Raymond G.; De Groot, Mark C.H.; Klungel, Olaf H.; De Abajo, Francisco J.

    2014-01-01

    Background: The association between benzodiazepines (BZD) and hip fractures has been estimated in several observational studies although diverse methodologies and definitions have hampered comparability. Objectives: To evaluate the discrepancies in the risk estimates of hip/femur fractures associate

  20. Fracture Risk Is Decreased in Women With Polycystic Ovary Syndrome: A Register-Based and Population-Based Cohort Study.

    Science.gov (United States)

    Rubin, Katrine Hass; Glintborg, Dorte; Nybo, Mads; Andersen, Marianne; Abrahamsen, Bo

    2016-04-01

    Hyperandrogenism, obesity, and hyperinsulinemia may protect against osteoporosis, whereas amenorrhea, increased cortisol, and low growth hormone may be associated with higher fracture risk in polycystic ovary syndrome (PCOS). The objective of this study was to investigate fracture risk in PCOS. In the PCOS Denmark study, women with PCOS and/or hirsutism were identified in the Danish National Patient Register (1995-2012). Each patient was assigned three age-matched controls on the index date of PCOS diagnosis. Individuals with a previous endocrine diagnosis were excluded. Within PCOS Denmark, we embedded a well-characterized subcohort of patients, PCOS OUH, diagnosed with PCOS at Odense University Hospital (n = 1217). We identified incident fractures by International Classification of Diseases, 10th Revision (ICD-10) codes and used conditional Cox regression analyses to compare fracture risk. In the PCOS Denmark study, there were 19,199 women with PCOS and 57,483 controls were included, mean age 30.6 years (range, 12-60 years). Fracture rates were decreased in PCOS Denmark (10.3/1000 patient years) versus controls (13.6/1000 patient years). The adjusted ORs were 0.76 (95% CI, 0.71 to 0.80) for all fractures, 0.82 (95% CI, 0.74 to 0.92) for major osteoporotic fractures, and 0.57 (95% CI, 0.47 to 0.70) for fractures of head and face. The risk reduction was more pronounced below the age of 30 years at diagnosis. Women with PCOS had significant more hospital contacts due to strains and sprains. In the PCOS OUH subcohort, the risk reduction of fractures did not differ between PCOS women with elevated versus normal testosterone levels and the risk reduction was nominally smaller in overweight versus normal weight PCOS women. Women with PCOS had reduced risk of fractures, in particular of the appendicular skeleton. The risk reduction was greater in women with younger age at diagnosis suggesting that the skeletal effects of PCOS may be greater in women who have not yet

  1. Estrogen receptor alpha polymorphism and risk of cardiovascular disease, cancer, and hip fracture

    DEFF Research Database (Denmark)

    Kjaergaard, Alisa D; Ellervik, Christina; Tybjaerg-Hansen, Anne;

    2007-01-01

    Background- We hypothesized that the estrogen receptor (ESR1) IVS1-397T/C polymorphism affects high-density lipoprotein cholesterol response to hormone replacement therapy and risk of cardiovascular disease (CVD), cancer of reproductive organs, and hip fracture. Methods and Results- We studied...... cross-sectionally 9244 individuals from the Danish general population and followed them up for 23 to 25 years. End points were CVD (ischemic heart disease, myocardial infarction, angina pectoris, ischemic cerebrovascular disease, ischemic stroke, other ischemic cerebrovascular disease, venous...... thromboembolism, deep vein thrombosis, and pulmonary embolism), cancer of reproductive organs (breasts, ovaries, uterus, and prostate), and hip fracture. We also studied patients with ischemic heart disease (n=2495), ischemic cerebrovascular disease (n=856), and breast cancer (n=1256) versus general population...

  2. Relationship between subjective fall risk assessment and falls and fall-related fractures in frail elderly people

    Directory of Open Access Journals (Sweden)

    Shimada Hiroyuki

    2011-08-01

    Full Text Available Abstract Background Objective measurements can be used to identify people with risks of falls, but many frail elderly adults cannot complete physical performance tests. The study examined the relationship between a subjective risk rating of specific tasks (SRRST to screen for fall risks and falls and fall-related fractures in frail elderly people. Methods The SRRST was investigated in 5,062 individuals aged 65 years or older who were utilized day-care services. The SRRST comprised 7 dichotomous questions to screen for fall risks during movements and behaviours such as walking, transferring, and wandering. The history of falls and fall-related fractures during the previous year was reported by participants or determined from an interview with the participant's family and care staff. Results All SRRST items showed significant differences between the participants with and without falls and fall-related fractures. In multiple logistic regression analysis adjusted for age, sex, diseases, and behavioural variables, the SRRST score was independently associated with history of falls and fractures. Odds ratios for those in the high-risk SRRST group (≥ 5 points compared with the no risk SRRST group (0 point were 6.15 (p Conclusion These results suggest that subjective ratings by care staff can be utilized to determine the risks of falls and fall-related fractures in the frail elderly, however, these preliminary results require confirmation in further prospective research.

  3. Long-term fracture risk in patients with celiac disease: a population-based study in Olmsted County, Minnesota.

    Science.gov (United States)

    Jafri, Mohammed R; Nordstrom, Charles W; Murray, Joseph A; Van Dyke, Carol T; Dierkhising, Ross A; Zinsmeister, Alan R; Melton, Lee J

    2008-04-01

    Celiac disease is associated with decreased bone density, but there are conflicting data regarding fracture risk. We determined the fracture incidence relative to matched controls in a population-based cohort with celiac disease before and after diagnosis. Olmsted County residents with celiac disease (n = 83) diagnosed between 1950 and 2002 were compared with 166 gender and age matched controls. Fracture histories were ascertained from each subject's medical records. Celiac disease is linked to an increased fracture risk before and after diagnosis. Before the index date, cases had a fracture rate twice that of controls (CI: 1.0-3.9, P = 0.045) and 2.5-fold greater after the index date (CI: 1.1-5.6, P = 0.026). Appendicular and axial fractures were 2.5 (CI: 0.9-6.5) and 3.2 times more likely (CI: 1.0-10.5) after the index date. These observations support a rationale for earlier detection of celiac disease, and active management of bone disease before bone effects have occurred, to reduce the persistent risk of fractures.

  4. Long-term fracture risk in patients with celiac disease: a population-based study in Olmsted County, Minnesota.

    Science.gov (United States)

    Jafri, Mohammed R; Nordstrom, Charles W; Murray, Joseph A; Van Dyke, Carol T; Dierkhising, Ross A; Zinsmeister, Alan R; Melton, Lee J

    2008-04-01

    Celiac disease is associated with decreased bone density, but there are conflicting data regarding fracture risk. We determined the fracture incidence relative to matched controls in a population-based cohort with celiac disease before and after diagnosis. Olmsted County residents with celiac disease (n = 83) diagnosed between 1950 and 2002 were compared with 166 gender and age matched controls. Fracture histories were ascertained from each subject's medical records. Celiac disease is linked to an increased fracture risk before and after diagnosis. Before the index date, cases had a fracture rate twice that of controls (CI: 1.0-3.9, P = 0.045) and 2.5-fold greater after the index date (CI: 1.1-5.6, P = 0.026). Appendicular and axial fractures were 2.5 (CI: 0.9-6.5) and 3.2 times more likely (CI: 1.0-10.5) after the index date. These observations support a rationale for earlier detection of celiac disease, and active management of bone disease before bone effects have occurred, to reduce the persistent risk of fractures. PMID:17934823

  5. A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX.

    Science.gov (United States)

    McCloskey, Eugene V; Odén, Anders; Harvey, Nicholas C; Leslie, William D; Hans, Didier; Johansson, Helena; Barkmann, Reinhard; Boutroy, Stephanie; Brown, Jacques; Chapurlat, Roland; Elders, Petra Jm; Fujita, Yuki; Glüer, Claus-C; Goltzman, David; Iki, Masayuki; Karlsson, Magnus; Kindmark, Andreas; Kotowicz, Mark; Kurumatani, Norio; Kwok, Timothy; Lamy, Oliver; Leung, Jason; Lippuner, Kurt; Ljunggren, Östen; Lorentzon, Mattias; Mellström, Dan; Merlijn, Thomas; Oei, Ling; Ohlsson, Claes; Pasco, Julie A; Rivadeneira, Fernando; Rosengren, Björn; Sornay-Rendu, Elisabeth; Szulc, Pawel; Tamaki, Junko; Kanis, John A

    2016-05-01

    Trabecular bone score (TBS) is a gray-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a bone mineral density (BMD)-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual-level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables, and outcomes during follow-up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities, and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1 SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR = 1.32, 95% CI 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65-1.87 versus 1.70, 95% CI 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical

  6. Risk Factors and Clinical Evaluation of Superficial Femoral Artery Stent Fracture: Prote'ge'GPS Stent

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Da Un; Kim, Jae Kyu; Jung, Hye Doo; Huh, Tae Wook; Yim, Nam Yeol; Oh, Hyun jun; Choi, Soo Jin Na [Chonnam National University Hospital, Chonnam National University, Medical School, Gwangju (Korea, Republic of); Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Chonnam National University, Medical School, Hwasun (Korea, Republic of)

    2010-12-15

    To evaluate the occurrence of superficial femoral artery stent fractures, the risk factors of stent fracture, and the relationship between fractures and clinical findings. Of the 38 patients who underwent treatment with Prote'ge'GPS stenting due to arterial occlusions on the superficial femoral artery, 17 also underwent a clinical analysis. Forty-three stents were inserted in the 17 superficial femoral arteries, ranging between 15 and 50 cm in length, with a mean treated length of 26.4 cm (15-50 cm). A fracture was evaluated by taking a PA and lateral simple radiography, as well as a follow-up evaluation accompanied with a CT angiography, DSA, and a color Doppler sonography. The examination involved the assessment of the difference between bone fractures due to length, placement, and frequency. Fractures occurred in 13 of 43 stents (30.2%). A total of 10 (71.4%) occurred in the upper third, compared to 4 (28.6%) in the lower third of the superficial femoral artery. In addition, 10 stents (71.4%) had a single strut fracture, whereas 4 (28.6%) had multiple strut fractures. A stent fracture occurred more frequently when the stents and lesions were longer (p=0.021, 0.012) and the stents were inserted near the joint. However, there was no significant relationship between stent numbers and the fractures (p=0.126). When the stents were inserted along the popliteal artery, a stent fracture occurred more frequently in the lower third of the artery. The stent fractures did not significantly influence the patency rate of the stented artery (p=0.44) Prote'ge'GPS stents in the superficial femoral artery revealed a considerable number of fractures and the fracture frequency showed a significant relationship with the length of stents and lesions. The closer stent insertion was to the joints, the more frequently fractures occurred. There were no evident significant relationships between the presence of stent fractures and the patency of the stented arteries

  7. Rachitic Changes, Demineralization, and Fracture Risk in Healthy Infants and Toddlers with Vitamin D Deficiency

    Science.gov (United States)

    Feldman, Henry A.; Kleinman, Paul K.; Connolly, Susan A.; Fair, Rick A.; Myers, Regina M.; Gordon, Catherine M.

    2012-01-01

    Purpose: To examine radiographic findings in children with vitamin D deficiency in comparison with biochemical marker levels and prevalence of fractures. Materials and Methods: The parents or guardians of all participants provided written informed consent at the time of enrollment. The institutional review board approved the protocol, and HIPAA guidelines were followed. From a prospective sample of children seen for routine clinical care, 40 children with vitamin D deficiency (25-hydroxyvitamin D [25-OHD] level, ≤20 ng/mL) were identified, and high-detail computed radiographs of the wrists and knees were obtained. The children ranged in age from 8 to 24 months. Radiographs were scored by three readers with use of the 10-point Thacher score for rachitic changes and a five-point scale for demineralization. Serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels were determined. Fracture history was obtained for 35 of the 40 patients (88%). Results: All readers identified rachitic changes at both readings in two patients (5%) and demineralization in two patients (5%). Interrater agreement was 65% for rachitic changes (κ = 0.33) and 70% for demineralization (κ = 0.37). When the majority of the raters determined that rachitic changes were absent at both readings, alkaline phosphatase levels were lower than those with other assessments (median, 267 vs 515 U/L [4.4589 vs 8.6005 μkat/L]; P = .01). When most raters determined that demineralization was present at both readings, serum 25-OHD levels were lower than those at other assessments (median, 9.0 vs 17.5 ng/mL [22.464 vs 43.68 nmol/L]; P = .02). No fractures were reported or identified radiographically. Conclusion: In infants and toddlers with vitamin D deficiency, rachitic changes and definite demineralization are uncommon and fracture risk is low. © RSNA, 2011 PMID:22106354

  8. Long-term absolute risk of cervical intraepithelial neoplasia grade 3 or worse following human papillomavirus infection: role of persistence

    DEFF Research Database (Denmark)

    Kjær, Susanne K; Frederiksen, Kirsten; Plum, Christian Edinger Munk;

    2010-01-01

    Infection with high-risk human papillomavirus (HPV) is the main cause of high-grade cervical intraepithelial neoplasia (CIN) and cancer. It has been suggested that information about high-risk HPV type-specific infection might make cervical cancer screening more effective. Persistent HPV infection...

  9. Robotic-Assisted Device in Posterior Spinal Fusion for a High Risk Thoraculombar Fracture in Ankylosing Spondylitis

    OpenAIRE

    Suliman, Ali; Wollstein, Ronit; Bernfeld, Benjamin; Bruskin, Alexander

    2014-01-01

    Fractures in ankylosing spondylitis (AS) are often difficult to treat and surgical treatment may be fraught with complications. We describe the use of a robotic-assisted device in the surgical treatment of an unstable L1 fracture in an elderly patient with chronic lymphocytic leukemia and AS. The postoperative course was uneventful and the patient was discharged after 3 days. The use of a robotic-assisted device in spine surgery is particularly indicated in difficult high risk cases.

  10. β3-adrenergic receptor gene, body mass index, bone mineral density and fracture risk in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES)

    OpenAIRE

    Center Jacqueline R; Eisman John A; Morrison Nigel A; Nguyen Nguyen D; Wang Claire Y; Nguyen Tuan V

    2006-01-01

    Abstract Background Recent studies have suggested that the Arg allele of β3-adrenergic receptor (ADRB3) gene is associated with body mass index (BMI), which is an important predictor of bone mineral density (BMD) and fracture risk. However, whether the ADRB3 gene polymorphism is associated with fracture risk has not been investigated. The aim of study was to examine the inter-relationships between ADRB3 gene polymorphisms, BMI, BMD and fracture risk in elderly Caucasians. Methods Genotypes of...

  11. An approach towards a parameterised model for risk assessment of hydraulic fracturing operations

    Science.gov (United States)

    Gläser, Dennis; Class, Holger; Kissinger, Alexander; Beck, Martin

    2016-04-01

    The main ambition of the recently started research project FracRisk (funded within the EU Horizon 2020 programme) is the development of a comprehensive knowledge base and the formulation of scientific recommendations, which can contribute to efforts aimed at minimising the environmental footprint of shale gas production while addressing scientific and public concerns. Forward numerical modelling linked to a detailed risk and uncertainty assessment is applied for estimating the mechanical, hydromechanical, and geochemical consequences resulting from hydraulic fracturing. To capture a broad range of environmental risks, six exemplary scenarios focussing on different physical processes on different spatial and temporal scales are investigated. An approach regarding sources, pathways and targets is used for the quantification of the environmental impacts. A fundamental understanding of the potential risks is achieved by allowing for mutual feedback between the scenarios, identifying key parameters and processes. The coupling of the scenarios to a Polynomial chaos expansion (PCE) paves the way to an abstracted and parameterised model for risk assessment to be used both by regulators and contractors. This contribution at an early stage of the project will elaborate on the general workflow of implementing focussed scenarios into a PCE-based Monte-Carlo approach to parameter sensitivities, that will eventually be embedded into a FEP-based (features, events, processes) evaluation of risk and counteractive measures.

  12. Treating postmenopausal osteoporosis in women at increased risk of fracture – critical appraisal of bazedoxifene: a review

    Directory of Open Access Journals (Sweden)

    Peter Vestergaard

    2009-08-01

    Full Text Available Peter Vestergaard, Susanna vid Streym ThomsenDepartment of Endocrinology and Metabolism C, Aarhus University Hospital, Aarhus, DenmarkAbstract: Several categories of drugs to treat osteoporosis exist in the form of bisphosphonates, strontium, parathyroid hormone, and selective estrogen receptor modulators (SERM. Advantages and disadvantages exist for each category as some patients may, for example, not tolerate bisphosphonates for gastrointestinal side effects, and especially in women in whom osteoporosis is frequent, several options for treatment are needed. The objectives of this review were to critically appraise the effects of bazedoxifene on risk of fractures especially in women at high risk of fractures. A systematic literature search was conducted for studies, especially randomized controlled trials with fractures as end-points. Bazedoxifene is a new member of the SERM group. The literature search identified one randomized controlled trial with fractures as end-point. This was a 3-year randomized double-blind placebo controlled trial in which 7492 postmenopausal women aged 55 to 85 years were randomly allocated to 1 bazedoxifene (20 [n = 1886] or 40 [n = 1872] mg/day; 2 raloxifene (60 mg/day, n = 1849; or 3 placebo (n = 1885. The risk of vertebral fractures decreased with both 20 (HR 0.58, 95% CI 0.38 to 0.89 and 40 (HR 0.63, 95% CI 0.42 to 0.96 mg of bazedoxifene per day compared to placebo. There was no reduction in non-vertebral fractures. A subgroup of women with a priori high risk of fractures was identified post hoc. In this subgroup there was a reduction in the risk of non-vertebral fractures with the 20 mg dose of bazedoxifene compared to placebo (HR 0.50, 95% CI 0.28 to 0.90. In the 40 mg bazedoxifene group no significant reduction in non-vertebral fractures was seen in this subgroup (HR 0.70, 95% CI 0.40 to 1.20. In general post-hoc defined subgroup analyses should be interpreted with caution. However, the results indicate that

  13. TRPV4 deficiency causes sexual dimorphism in bone metabolism and osteoporotic fracture risk.

    Science.gov (United States)

    van der Eerden, B C J; Oei, L; Roschger, P; Fratzl-Zelman, N; Hoenderop, J G J; van Schoor, N M; Pettersson-Kymmer, U; Schreuders-Koedam, M; Uitterlinden, A G; Hofman, A; Suzuki, M; Klaushofer, K; Ohlsson, C; Lips, P J A; Rivadeneira, F; Bindels, R J M; van Leeuwen, J P T M

    2013-12-01

    We explored the role of transient receptor potential vanilloid 4 (TRPV4) in murine bone metabolism and association of TRPV4 gene variants with fractures in humans. Urinary and histomorphometrical analyses demonstrated reduced osteoclast activity and numbers in male Trpv4(-/-) mice, which was confirmed in bone marrow-derived osteoclast cultures. Osteoblasts and bone formation as shown by serum procollagen type 1 amino-terminal propeptide and histomorphometry, including osteoid surface, osteoblast and osteocyte numbers were not affected in vivo. Nevertheless, osteoblast differentiation was enhanced in Trpv4(-/-) bone marrow cultures. Cortical and trabecular bone mass was 20% increased in male Trpv4(-/-) mice, compared to sex-matched wild type (Trpv4(+/+)) mice. However, at the same time intracortical porosity was increased and bone matrix mineralization was reduced. Together, these lead to a maximum load, stiffness and work to failure of the femoral bone, which were not different compared to Trpv4(+/+) mice, while the bone material was less resistant to stress and less elastic. The differential impacts on these determinants of bone strength were likely responsible for the lack of any changes in whole bone strength in the Trpv4(-/-) mice. None of these skeletal parameters were affected in female Trpv4(-/-) mice. The T-allele of rs1861809 SNP in the TRPV4 locus was associated with a 30% increased risk (95% CI: 1.1-1.6; p=0.013) for non-vertebral fracture risk in men, but not in women, in the Rotterdam Study. Meta-analyses with the population-based LASA study confirmed the association with non-vertebral fractures in men. This was lost when the non-population-based studies Mr. OS and UFO were included. In conclusion, TRPV4 is a male-specific regulator of bone metabolism, a determinant of bone strength, and a potential risk predictor for fractures through regulation of bone matrix mineralization and intra-cortical porosity. This identifies TRPV4 as a unique sexually

  14. TRPV4 deficiency causes sexual dimorphism in bone metabolism and osteoporotic fracture risk.

    Science.gov (United States)

    van der Eerden, B C J; Oei, L; Roschger, P; Fratzl-Zelman, N; Hoenderop, J G J; van Schoor, N M; Pettersson-Kymmer, U; Schreuders-Koedam, M; Uitterlinden, A G; Hofman, A; Suzuki, M; Klaushofer, K; Ohlsson, C; Lips, P J A; Rivadeneira, F; Bindels, R J M; van Leeuwen, J P T M

    2013-12-01

    We explored the role of transient receptor potential vanilloid 4 (TRPV4) in murine bone metabolism and association of TRPV4 gene variants with fractures in humans. Urinary and histomorphometrical analyses demonstrated reduced osteoclast activity and numbers in male Trpv4(-/-) mice, which was confirmed in bone marrow-derived osteoclast cultures. Osteoblasts and bone formation as shown by serum procollagen type 1 amino-terminal propeptide and histomorphometry, including osteoid surface, osteoblast and osteocyte numbers were not affected in vivo. Nevertheless, osteoblast differentiation was enhanced in Trpv4(-/-) bone marrow cultures. Cortical and trabecular bone mass was 20% increased in male Trpv4(-/-) mice, compared to sex-matched wild type (Trpv4(+/+)) mice. However, at the same time intracortical porosity was increased and bone matrix mineralization was reduced. Together, these lead to a maximum load, stiffness and work to failure of the femoral bone, which were not different compared to Trpv4(+/+) mice, while the bone material was less resistant to stress and less elastic. The differential impacts on these determinants of bone strength were likely responsible for the lack of any changes in whole bone strength in the Trpv4(-/-) mice. None of these skeletal parameters were affected in female Trpv4(-/-) mice. The T-allele of rs1861809 SNP in the TRPV4 locus was associated with a 30% increased risk (95% CI: 1.1-1.6; p=0.013) for non-vertebral fracture risk in men, but not in women, in the Rotterdam Study. Meta-analyses with the population-based LASA study confirmed the association with non-vertebral fractures in men. This was lost when the non-population-based studies Mr. OS and UFO were included. In conclusion, TRPV4 is a male-specific regulator of bone metabolism, a determinant of bone strength, and a potential risk predictor for fractures through regulation of bone matrix mineralization and intra-cortical porosity. This identifies TRPV4 as a unique sexually

  15. Combined Microwave Ablation and Cementoplasty in Patients with Painful Bone Metastases at High Risk of Fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com; Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy); Ballicu, Nicola, E-mail: nicolaballicu77@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy)

    2016-01-15

    PurposeTo retrospectively evaluate the effectiveness of computed tomography-guided percutaneous microwave ablation (MWA) and cementoplasty in patients with painful bone metastases at high risk of fracture.Materials and MethodsThirty-five patients with 37 metastatic bone lesions underwent computed tomography-guided MWA combined with cementoplasty (polymethylmethacrylate injection). Vertebrae, femur, and acetabulum were the intervention sites and the primary end point was pain relief. Pain severity was estimated by visual analog scale (VAS) before treatment; 1 week post-treatment; and 1, 6, and 12 months post-treatment. Functional outcome was assessed by improved patient walking ability. Radiological evaluation was performed at baseline and 3 and 12 months post-procedure.ResultsIn all patients, pain reduction occurred from the first week after treatment. The mean reduction in the VAS score was 84, 90, 90 % at week 1, month 1, and month 6, respectively. Improved walking ability occurred in 100 and 98 % of cases at the 1- and 6-month functional outcome evaluations, respectively. At the 1-year evaluation, 25 patients were alive, and 10 patients (28 %) had died because of widespread disease. The mean reduction in the VAS score and improvement in surviving patients’ walking ability were 90 and 100 %, respectively. No patients showed evidence of local tumor recurrence or progression and pathological fracture in the treated sites.ConclusionOur results suggest that MWA combined with osteoplasty is safe and effective when treating painful bone metastases at high risk of fracture. The number of surviving patients at the 1-year evaluation confirms the need for an effective and long-lasting treatment.

  16. Do cadmium, lead, and aluminum in drinking water increase the risk of hip fractures? A NOREPOS study.

    Science.gov (United States)

    Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag; Omsland, Tone Kristin; Holvik, Kristin; Meyer, Haakon E; Aamodt, Geir

    2014-01-01

    The aim of this study was to investigate relations between cadmium, lead, and aluminum in municipality drinking water and the incidence of hip fractures in the Norwegian population. A trace metals survey in 566 waterworks was linked geographically to hip fractures from hospitals throughout the country (1994-2000). In all those supplied from these waterworks, 5,438 men and 13,629 women aged 50-85 years suffered a hip fracture. Poisson regression models were fitted, adjusting for age, region of residence, urbanization, and type of water source as well as other possibly bone-related water quality factors. Effect modification by background variables and interactions between water quality factors were examined (correcting for false discovery rate). Men exposed to a relatively high concentration of cadmium (IRR = 1.10; 95 % CI 1.01, 1.20) had an increased risk of fracture. The association between relatively high lead and hip fracture risk was significant in the oldest age group (66-85 years) for both men (IRR = 1.11; 95 % CI 1.02, 1.21) and women (IRR = 1.10; 95 % CI 1.04, 1.16). Effect modification by degree of urbanization on hip fracture risk in men was also found for all three metals: cadmium, lead, and aluminum. In summary, a relatively high concentration of cadmium, lead, and aluminum measured in drinking water increased the risk of hip fractures, but the associations depended on gender, age, and urbanization degree. This study could help in elucidating the complex effects on bone health by risk factors found in the environment.

  17. A risk-economic approach to nuclear power generation. Beyond the myth of absolute safety and unthinkable events

    International Nuclear Information System (INIS)

    This paper deals with a risk-economic approach to nuclear power generation, a very timely yet rather neglected area in the economics profession. The economic and psychological consequences of Japan's recent catastrophe have been so grave and wide-spread, thus calling for careful reexamination of the economics of risk and uncertainty. It is Daniel Bernoulli, a mathematical genius of the 18th century, who first introduced the expected utility theory into decision making under risk. Although a great deal of applications has been done in many areas since then, it appears that the most recent nuclear meltdown of Japan is casting serious doubt upon the general validity of existing risk theories. It is high time for us to establish a new comprehensive approach by taking account of psychological, sociological, cultural, and historical factors. (author)

  18. Prospective Study of Physical Activity and Risk of Developing a Stress Fracture among Preadolescent and Adolescent Females

    Science.gov (United States)

    Field, Alison E.; Gordon, Catherine M.; Pierce, Laura M.; Ramappa, Arun; Kocher, Mininder S.

    2011-01-01

    Objective To identify predictors of developing a stress fracture among adolescent females during a seven-year period. Design Prospective cohort study Setting Adolescent females living throughout the United States Participants 6831 females, aged 9–15 years at baseline, in the Growing Up Today Study (GUTS), an ongoing prospective cohort study. Main Exposures Exposures were assessed by self-report questionnaires completed by adolescent girls in 1996, 1997, 1998, 1999, 2000, 2001, and 2003. The adolescent girl’s history of stress fracture, including age when fracture occurred and site, were reported by their mothers, who are registered nurses, in 2004. Cox proportional hazards models were used in the analysis. Main Outcome Measure Incident stress fracture that occurred between 1997 and 2004. Results During seven years of follow-up, 267 females (3.9%) developed a stress fracture. Independent of age, age at menarche, family history of fracture, and hours per week of low and moderate impact activity, hours per week of running (relative risk (RR)=1.13, 95% confidence interval (CI) 1.04–1.23), basketball (RR=1.12, 95% CI 1.03–1.22) and cheerleading and gymnastics (RR=1.12, 95% CI 1.02–1.23) were significant predictors of developing a stress fracture. No other type of high impact activity was associated with an increased risk. Conclusions Females who engage in running, basketball, cheerleading, or gymnastics should be encouraged to include varied training in lower impact activities to decrease the cumulative amount of impact in order minimize their risk of stress fractures. PMID:21464375

  19. Validation of a 5-year risk score of hip fracture in postmenopausal women. The Danish Nurse Cohort Study

    DEFF Research Database (Denmark)

    Hundrup, Y A; Jacobsen, R K; Andreasen, A H;

    2010-01-01

    We evaluated the Women's Health Initiative (WHI) hip fracture risk score in 15,648 postmenopausal Danish nurses. The algorithm was well calibrated for Denmark. However, the sensitivity was poor at common decision making thresholds. Obtaining sensitivity better than 80% led to a low specificity...... of 61.4%. INTRODUCTION: A new score based on data from the WHI has been designed to predict 5-year risk of hip fracture in postmenopausal women. The performance of the algorithm has not been validated in populations with different lifestyle characteristics and ethnicity. The aim of this study...... was to test the clinical performance of the algorithm in a large Danish cohort of postmenopausal Caucasian women against hip fracture. METHODS: The Danish Nurse Cohort is a prospective risk factor and hormone therapy (HT) study established in 1993. Participants in the present analysis were 15...

  20. Risk assessment in fractured porous media with particular reference to water catchments

    Science.gov (United States)

    Enzenhoefer, R.; Helmig, R.; Nowak, W.; Binning, P. J.

    2009-04-01

    . As a consequence, the four vulnerability criteria are assessed stochastically. The stochastic approach increases computational costs. As a counter-measure, we approximate the transient contaminant transport process by a higher-order expansion in the temporal moments of breakthrough, which we simulate directly from steady-state moment-generating equations [Harvey and Gorelick, 1995]. The computational time saved by the approximation in transient behaviour is then available for stochastic modelling. For further computational savings, we adopt the reverse formulation of well contamination. With the help of a geostatistical fracture-matrix generator [here: Silberhorn-Hemminger, 2002] we generate artificial fractured-matrix systems, representing the mean characteristic karst properties (e.g. fracture density, etc.) within the study area or any artificial aquifer domain. In a Monte Carlo approach, an ensemble of 1000 fracture-matrix systems are randomly generated, and the flow and transport processes are calculated in DuMuX as a one phase two component model. With an inverse formulation of the steady-state transport problem, the capture zone of the well can be calculated for each realization. The mean arrival time at the well may be calculated directly from the first temporal moment equation. Peak contamination level, peak arrival time, threshold arrival time and exposure time require more information than merely the first temporal moment. In order to reconstruct dispersive contaminant dilution and the shape of the breakthrough curve, the second central temporal moment equation (and higher order moment equations) are applied. Then, by statistical analysis of the ensemble results, all four intrinsic well vulnerability measures can be calculated. The final protection area outlines are given by the maximum acceptable risk level for a water manager towards its water supply from the catchment perspective. To validate our approach for a real case scenario, the whole risk concept

  1. Non-sedentary Lifestyle Can Reduce Hip Fracture Risk among Older Caucasians Adults: The Adventist Health Study-2

    Science.gov (United States)

    Lousuebsakul-Matthews, Vichuda; Thorpe, Donna; Knutsen, Raymond; Beeson, W. Larry; Fraser, Gary E.; Knutsen, Synnove F.

    2016-01-01

    Aims The beneficial effect of physical activity on reducing hip fracture risk has been supported in many previous studies. The present cohort study explores the relationship between total daily physical activity expressed as MET-hour/day and hip fracture risk among men over 50 years of age and postmenopausal women (n=22,836). Methodology Associations between self-reported hip fracture incidence and total daily physical activity and selected lifestyle factors were assessed using Cox proportional hazard regression. Results In gender-specific multivariable models, total activity above average (≥ 51 MET-hours per day for men, ≥ 48 MET-hours per day for women) compared to those with sedentary lifestyle (< 40 MET-hours per day) reduced the risk of hip fracture by 60% among men (HR=0.40, 95%CI: 0.23–0.70) (Ptrend=0.002) and 48% among women (HR=0.52, 95%CI: 0.32–0.84) (Ptrend=0.01). Conclusion Our findings suggest that a moderate level of physical activity and avoiding a sedentary lifestyle can reduce the risk of hip fracture among the elderly.

  2. Fracture risk assessment: improved evaluation of vertebral integrity among metastatic cancer patients to aid in surgical decision-making

    Science.gov (United States)

    Augustine, Kurt E.; Camp, Jon J.; Holmes, David R.; Huddleston, Paul M.; Lu, Lichun; Yaszemski, Michael J.; Robb, Richard A.

    2012-03-01

    Failure of the spine's structural integrity from metastatic disease can lead to both pain and neurologic deficit. Fractures that require treatment occur in over 30% of bony metastases. Our objective is to use computed tomography (CT) in conjunction with analytic techniques that have been previously developed to predict fracture risk in cancer patients with metastatic disease to the spine. Current clinical practice for cancer patients with spine metastasis often requires an empirical decision regarding spinal reconstructive surgery. Early image-based software systems used for CT analysis are time consuming and poorly suited for clinical application. The Biomedical Image Resource (BIR) at Mayo Clinic, Rochester has developed an image analysis computer program that calculates from CT scans, the residual load-bearing capacity in a vertebra with metastatic cancer. The Spine Cancer Assessment (SCA) program is built on a platform designed for clinical practice, with a workflow format that allows for rapid selection of patient CT exams, followed by guided image analysis tasks, resulting in a fracture risk report. The analysis features allow the surgeon to quickly isolate a single vertebra and obtain an immediate pre-surgical multiple parallel section composite beam fracture risk analysis based on algorithms developed at Mayo Clinic. The analysis software is undergoing clinical validation studies. We expect this approach will facilitate patient management and utilization of reliable guidelines for selecting among various treatment option based on fracture risk.

  3. Frontal Lobe Function and Risk of Hip Fracture in Patient With Alzheimer Disease: An Analysis of Linked Data.

    Science.gov (United States)

    Roh, Hyun Woong; Hong, Chang Hyung; Lee, SooJin; Lee, Yunhwan; Lee, Kang Soo; Chang, Ki Jung; Oh, Byoung Hoon; Choi, Seong Hye; Kim, Seong Yoon; Back, Joung Hwan; Chung, Young Ki; Lim, Ki Young; Noh, Jai Sung; Son, Sang Joon

    2015-11-01

    To determine the association between frontal lobe function and risk of hip fracture in patients with Alzheimer disease (AD).Retrospective cohort study using multicenter hospital-based dementia registry and national health insurance claim data was done. Participants who had available data of neuropsychological test, national health insurance claim, and other covariates were included. A total of 1660 patients with AD were included based on Stroop Test results. A total of 1563 patients with AD were included based on the Controlled Oral Word Association Test (COWAT) results. Hip fracture was measured by validated identification criteria using national health insurance claim data. Frontal lobe function was measured by Stroop Test and COWAT at baseline.After adjusting for potential covariates, including cognitive function in other domains (language, verbal and nonverbal memory, and attention), the Cox proportional hazard regression analysis revealed that risk of a hip fracture was decreased with a hazard ratio (HR) of 0.98 per one point of increase in the Stroop Test (adjusted HR = 0.98, 95% confidence interval [CI]: 0.97-1.00) and 0.93 per one point increase in COWAT (adjusted HR = 0.93, 95% CI: 0.88-0.99).The risk of hip fracture in AD patients was associated with baseline frontal lobe function. The result of this research presents evidence of association between frontal lobe function and risk of hip fracture in patients with AD. PMID:26559259

  4. Relationship between subjective fall risk assessment and falls and fall-related fractures in frail elderly people

    OpenAIRE

    Shimada Hiroyuki; Suzukawa Megumi; Ishizaki Tatsuro; Kobayashi Kumiko; Kim Hunkyung; Suzuki Takao

    2011-01-01

    Abstract Background Objective measurements can be used to identify people with risks of falls, but many frail elderly adults cannot complete physical performance tests. The study examined the relationship between a subjective risk rating of specific tasks (SRRST) to screen for fall risks and falls and fall-related fractures in frail elderly people. Methods The SRRST was investigated in 5,062 individuals aged 65 years or older who were utilized day-care services. The SRRST comprised 7 dichotom...

  5. WNT16 influences bone mineral density, cortical bone thickness, bone strength, and osteoporotic fracture risk.

    Directory of Open Access Journals (Sweden)

    Hou-Feng Zheng

    2012-07-01

    Full Text Available We aimed to identify genetic variants associated with cortical bone thickness (CBT and bone mineral density (BMD by performing two separate genome-wide association study (GWAS meta-analyses for CBT in 3 cohorts comprising 5,878 European subjects and for BMD in 5 cohorts comprising 5,672 individuals. We then assessed selected single-nucleotide polymorphisms (SNPs for osteoporotic fracture in 2,023 cases and 3,740 controls. Association with CBT and forearm BMD was tested for ∼2.5 million SNPs in each cohort separately, and results were meta-analyzed using fixed effect meta-analysis. We identified a missense SNP (Thr>Ile; rs2707466 located in the WNT16 gene (7q31, associated with CBT (effect size of -0.11 standard deviations [SD] per C allele, P = 6.2 × 10(-9. This SNP, as well as another nonsynonymous SNP rs2908004 (Gly>Arg, also had genome-wide significant association with forearm BMD (-0.14 SD per C allele, P = 2.3 × 10(-12, and -0.16 SD per G allele, P = 1.2 × 10(-15, respectively. Four genome-wide significant SNPs arising from BMD meta-analysis were tested for association with forearm fracture. SNP rs7776725 in FAM3C, a gene adjacent to WNT16, was associated with a genome-wide significant increased risk of forearm fracture (OR = 1.33, P = 7.3 × 10(-9, with genome-wide suggestive signals from the two missense variants in WNT16 (rs2908004: OR = 1.22, P = 4.9 × 10(-6 and rs2707466: OR = 1.22, P = 7.2 × 10(-6. We next generated a homozygous mouse with targeted disruption of Wnt16. Female Wnt16(-/- mice had 27% (P<0.001 thinner cortical bones at the femur midshaft, and bone strength measures were reduced between 43%-61% (6.5 × 10(-13risk of fracture.

  6. Data Mining Activity for Bone Discipline: Calculating a Factor of Risk for Hip Fracture in Long-Duration Astronauts

    Science.gov (United States)

    Ellman, R.; Sibonga, J. D.; Bouxsein, M. L.

    2010-01-01

    The factor-of-risk (Phi), defined as the ratio of applied load to bone strength, is a biomechanical approach to hip fracture risk assessment that may be used to identify subjects who are at increased risk for fracture. The purpose of this project was to calculate the factor of risk in long duration astronauts after return from a mission on the International Space Station (ISS), which is typically 6 months in duration. The load applied to the hip was calculated for a sideways fall from standing height based on the individual height and weight of the astronauts. The soft tissue thickness overlying the greater trochanter was measured from the DXA whole body scans and used to estimate attenuation of the impact force provided by soft tissues overlying the hip. Femoral strength was estimated from femoral areal bone mineral density (aBMD) measurements by dual-energy x-ray absorptiometry (DXA), which were performed between 5-32 days of landing. All long-duration NASA astronauts from Expedition 1 to 18 were included in this study, where repeat flyers were treated as separate subjects. Male astronauts (n=20) had a significantly higher factor of risk for hip fracture Phi than females (n=5), with preflight values of 0.83+/-0.11 and 0.36+/-0.07, respectively, but there was no significant difference between preflight and postflight Phi (Figure 1). Femoral aBMD measurements were not found to be significantly different between men and women. Three men and no women exceeded the theoretical fracture threshold of Phi=1 immediately postflight, indicating that they would likely suffer a hip fracture if they were to experience a sideways fall with impact to the greater trochanter. These data suggest that male astronauts may be at greater risk for hip fracture than women following spaceflight, primarily due to relatively less soft tissue thickness and subsequently greater impact force.

  7. Hydraulic fracturing in unconventional reservoirs - Identification of hazards and strategies for a quantitative risk assessment

    Science.gov (United States)

    Helmig, R.; Kissinger, A.; Class, H.; Ebigbo, A.

    2012-12-01

    fractured reservoir, fracture propagation, fault zones and their role in regard to fluid migration into shallow aquifers). A quantitative risk assessment which should be the main aim of future work in this field has much higher demands, especially on site specific data, as the estimation of statistical parameter uncertainty requires site specific parameter distributions. There is already ongoing research on risk assessment in related fields like CO2 sequestration. We therefore propose these methodologies to be transferred to risk estimation relating to the use of the hydraulic fracking method, be it for unconventional gas or enhanced geothermal energy production. The overall aim should be to set common and transparent standards for different uses of the subsurface and their involved risks and communicate those to policy makers and stake holders.

  8. Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study

    Directory of Open Access Journals (Sweden)

    Bloch Katia V

    2008-08-01

    Full Text Available Abstract Background Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. Methods A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002–2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. Results Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. Conclusion Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs.

  9. Biomechanical optimization of subject-specific implant positioning for femoral head resurfacing to reduce fracture risk.

    Science.gov (United States)

    Miles, Brad; Kolos, Elizabeth; Appleyard, Richard; Theodore, Willy; Zheng, Keke; Li, Qing; Ruys, Andrew J

    2016-07-01

    Peri-prosthetic femoral neck fracture after femoral head resurfacing can be either patient-related or surgical technique-related. The study aimed to develop a patient-specific finite element modelling technique that can reliably predict an optimal implant position and give minimal strain in the peri-prosthetic bone tissue, thereby reducing the risk of peri-prosthetic femoral neck fracture. The subject-specific finite element modelling was integrated with optimization techniques including design of experiments to best possibly position the implant for achieving minimal strain for femoral head resurfacing. Sample space was defined by varying the floating point to find the extremes at which the cylindrical reaming operation actually cuts into the femoral neck causing a notch during hip resurfacing surgery. The study showed that the location of the maximum strain, for all non-notching positions, was on the superior femoral neck, in the peri-prosthetic bone tissue. It demonstrated that varus positioning resulted in a higher strain, while valgus positioning reduced the strain, and further that neutral version had a lower strain. PMID:27098752

  10. Integrin beta3 Leu33Pro polymorphism and risk of hip fracture: 25 years follow-up of 9233 adults from the general population

    DEFF Research Database (Denmark)

    Tofteng, Charlotte L; Bach-Mortensen, Pernille; Bojesen, Stig E;

    2007-01-01

    integrin beta3 Leu33Pro polymorphism have a two-fold risk of hip fracture, mainly confined to postmenopausal women. Integrin beta3 Leu33Pro homozygosity could prove a useful marker for risk of future hip fracture and may contribute to pharmacogenetic variation in effects of integrin alphavbeta3 antagonists....

  11. Fall and Fracture Risk in Sarcopenia and Dynapenia With and Without Obesity: the Role of Lifestyle Interventions.

    Science.gov (United States)

    Scott, David; Daly, Robin M; Sanders, Kerrie M; Ebeling, Peter R

    2015-08-01

    Due to their differing etiologies and consequences, it has been proposed that the term "sarcopenia" should revert to its original definition of age-related muscle mass declines, with a separate term, "dynapenia", describing muscle strength and function declines. There is increasing interest in the interactions of sarcopenia and dynapenia with obesity. Despite an apparent protective effect of obesity on fracture, increased adiposity may compromise bone health, and the presence of sarcopenia and/or dynapenia ("sarcopenic obesity" and "dynapenic obesity") may exacerbate the risk of falls and fracture in obese older adults. Weight loss interventions are likely to be beneficial for older adults with sarcopenic and dynapenic obesity but may result in further reductions in muscle and bone health. The addition of exercise including progressive resistance training and nutritional strategies, including protein and vitamin D supplementation, may optimise body composition and muscle function outcomes thereby reducing falls and fracture risk in this population. PMID:26040576

  12. Dietary magnesium intake, bone mineral density and risk of fracture: a systematic review and meta-analysis.

    Science.gov (United States)

    Farsinejad-Marj, M; Saneei, P; Esmaillzadeh, A

    2016-04-01

    Dietary magnesium intake has been related to osteoporosis and risk of fractures in earlier studies; however, findings were conflicting. This meta-analysis indicated that high magnesium intake was not associated with increased risk of fracture; however, a positive marginally significant correlation was found between magnesium intake and bone mineral density (BMD) in total hip as well as in femoral neck. Although there is some evidence on the association between magnesium intake, BMD and fractures, no previous study has summarized findings in this regard. We aimed to systematically review the current evidence on this association and to perform a meta-analysis of observational studies. We searched MEDLINE, Scopus, EMBASE and Google Scholar up to January 2015 for studies that examined the relationship between magnesium intake and BMD or fracture. Studies that had reported correlation coefficients between magnesium intake and BMD or those that reported odds ratios (ORs) or relative risks (RRs) for risk of fracture in different sites were included. In total, 12 studies were included in the meta-analysis. We found that high intakes of magnesium were not significantly associated with risk of total hip fracture (summary effect size 1.92; 95 % CI 0.81, 4.55) or total fractures (1.01; 0.94-1.07). Combining four effect sizes, a positive marginally significant correlation was observed between magnesium intake and total BMD (pooled r 0.16; 95 % CI 0.001, 032). Based on nine effect sizes, we found a marginally significant association between magnesium intake and femoral neck BMD (0.14; 0.001, 0.28). However, no significant correlation was found between magnesium intake and BMD in lumbar spine (0.09; -0.01, 0.19). We found that high intakes of magnesium were not associated with increased risk of hip and total fractures. There was a positive marginally significant correlation between magnesium intake and BMD in femoral neck and total hip. No significant correlations were observed

  13. Pelvic Insufficiency Fracture After Pelvic Radiotherapy for Cervical Cancer: Analysis of Risk Factors

    International Nuclear Information System (INIS)

    Purpose: To investigate the incidence, clinical characteristics, and risk factors of pelvic insufficiency fracture (PIF) after pelvic radiotherapy (RT) in cervical cancer. Methods and Materials: Medical records and imaging studies, including bone scintigraphy, CT, and MRI of 557 patients with cervical cancer who received whole-pelvic RT between January 1998 and August 2005 were reviewed. Results: Eighty-three patients were diagnosed as having PIF after pelvic RT. The 5-year cumulative incidence of PIF was 19.7%. The most commonly involved site was the sacroiliac joint. Pelvic pain developed in 48 patients (57.8%) at diagnosis. Eleven patients (13.3%) needed admission or narcotics because of severe pain, and others had good relief of symptoms with conservative management. In univariate analysis, age ≥55 years (p < 0.001), anteroposterior/posteroanterior parallel opposing technique (p = 0.001), curative treatment (p < 0.001), and radiation dose ≥50.4 Gy (p = 0.005) were the predisposing factors for development of PIF. Concurrent chemotherapy (p = 0.78) was not significant. Multivariate analysis showed that age ≥55 years (p < 0.001), body weight <55 kg (p = 0.02), curative treatment (p = 0.03), and radiation dose ≥50.4 Gy (p = 0.04) were significant predisposing factors for development of PIF. Conclusion: The development of PIF is not rare after pelvic RT. The use of multibeam arrangements to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture, especially in elderly women with low body weight

  14. The Water Risks of Hydraulic Fracturing (Fracking): Key Issues from the New California Assessment

    Science.gov (United States)

    Gleick, P. H.

    2015-12-01

    A key component of the Water-Energy Nexus is the effort over the past decade or so to quantify the volumes and form of water required for the energy fuel cycle from extraction to generation to waste disposal. The vast majority of the effort in this area has focused on the water needs of electricity generation, but other fuel-cycle components also entail significant water demands and threats to water quality. Recent work for the State of California (managed by the California Council on Science and Technology - CCST) has produced a new state-of-the-art assessment of a range of potential water risks associated with hydraulic fracturing and related oil and gas extraction, including volumetric water demands, methods of disposal of produced water, and aquifer contamination. For example, this assessment produced new information on the disposal of produced water in surface percolation pits and the potential for contamination of local groundwater (see Figure). Understanding these risks raises questions about current production and future plans to expand production, as well as tools used by state and federal agencies to manage these risks. This talk will summarize the science behind the CCST assessment and related policy recommendations for both water and energy managers.

  15. Use of Acid-Suppressive Drugs and Risk of Fracture: A Meta-analysis of Observational Studies

    OpenAIRE

    Eom, Chun-Sick; Park, Sang Min; Myung, Seung-Kwon; Yun, Jae Moon; Ahn, Jeong-Soo

    2011-01-01

    PURPOSE Previous studies have reported inconsistent findings regarding the association between the use of acid-suppressive drugs such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) and fracture risk. We investigated this association using meta-analysis.

  16. Risk factors for insufficient perioperative oral nutrition after hip fracture surgery within a multi-modal rehabilitation programme

    DEFF Research Database (Denmark)

    Foss, Nicolai B; Jensen, Pia S; Kehlet, Henrik

    2007-01-01

    To examine oral nutritional intake in the perioperative phase in elderly hip fracture patients treated according to a well-defined multi-modal rehabilitation program, including unselected oral nutritional supplementation, and to identify independent risk factors for insufficient nutritional intake....

  17. Dental trauma. Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures

    DEFF Research Database (Denmark)

    Lauridsen, Eva Fejerskov; Hermann, Nuno Vibe; Gerds, Thomas Alexander;

    2012-01-01

    included 469 permanent incisors with concussion from 358 patients (226 male, 132 female). Among these, 292 had a concomitant crown fracture (70 with and 222 without pulp exposure). All teeth were examined and treated according to standardized protocol. Statistical analysis:  The risk of PN was analyzed...

  18. Excess risk of hip fractures attributable to the use of antidepressants in five European countries and the USA

    NARCIS (Netherlands)

    Prieto-Alhambra, D.; Petri, H.; Goldenberg, J. S B; Khong, T. P.; Klungel, O. H.; Robinson, N. J.; De Vries, F.

    2014-01-01

    The association between antidepressant use and hip fracture remains unclear. We conducted a systematic review to estimate Population Attributable Risks (PAR) for France, Germany, Italy, Spain, UK, and the USA. We report a heterogeneous prevalence of antidepressant use and related PARs, both lowest f

  19. Use of proton pump inhibitors and risk of hip/femur fracture: a population-based case-control study

    NARCIS (Netherlands)

    S. Pouwels (Sander); A. Lalmohamed (Arief); P. Souverein (Patrick); C. Cooper (Charles); B.J. Veldt (Bart); H.G.M. Leufkens (Hubert); A. de Boer (Anthonius); T.P. van Staa (Tjeerd); F. de Vries (Frank)

    2010-01-01

    textabstractSummary: Previous studies evaluated the association between proton pump inhibitor (PPI) use and subsequent fracture risk, but they showed ambiguous results. Therefore, the objective was to evaluate this association in a different study population. Our findings show that there is probably

  20. Like Mother, Like Daughter? Dietary and Non-Dietary Bone Fracture Risk Factors in Mothers and Their Daughters

    Directory of Open Access Journals (Sweden)

    Kamila SOBAS

    2015-10-01

    Full Text Available Background: The aim of this study was to demonstrate similarities and differences between mothers and daughters regarding dietary and non-dietary risk factors for bone fractures and osteoporosis.Methods: The study was carried out in 2007-2010 on 712 mothers (29-59 years and daughters (12-21 years family pairs. In the sub-sample (170 family pairs bone mineral density (BMD was measured for the forearm by dual-energy x-ray absorptiometry (DXA. The consumption of dairy products was determined with a semi-quantitative food fre-quency questionnaire (ADOS-Ca and calcium intake from the daily diet was calculated.Results: The presence of risk factors for bone fractures in mothers and daughters was significantly correlated. The Spearman rank coefficient for dietary factors of fracture risk was 0.87 (P<0.05 in whole sub-sample, 0.94 (P<0.05 in bottom tercile of BMD, 0.82 (P<0.05 in middle tercile of BMD, 0.54 (P>0.05 in upper tercile of BMD and for non-dietary factors of fracture risk was 0.83 (P<0.05 in whole sub-sample, 0.86 (P<0.05 in bottom tercile of BMD, 0.93 (P<0.05 in middle tercile of BMD, 0.65 (P<0.05 in upper tercile of BMD.Conclusions: Our results confirm the role of the family environment for bone health and document the stronger ef-fect of negative factors of the family environment as compared to other positive factors on bone fracture risk.

  1. Teaching Absolute Value Meaningfully

    Science.gov (United States)

    Wade, Angela

    2012-01-01

    What is the meaning of absolute value? And why do teachers teach students how to solve absolute value equations? Absolute value is a concept introduced in first-year algebra and then reinforced in later courses. Various authors have suggested instructional methods for teaching absolute value to high school students (Wei 2005; Stallings-Roberts…

  2. Is Zolpidem Associated with Increased Risk of Fractures in the Elderly with Sleep Disorders? A Nationwide Case Cross-Over Study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Yih-Jing Tang

    Full Text Available We conducted a study using a case-crossover design to clarify the risk of acute effects of zolpidem and benzodiazepine on all-sites of fractures in the elderly.Case-crossover design.Elderly enrollees (n = 6010 in Taiwan's National Health Insurance Research Database with zolpidem or benzodiazepine use were analyzed for the risk of developing fractures.After adjusting for medications such as antipsychotics, antidepressants, and diuretics, or comorbidities such as hypertension, osteoarthritis, osteoporosis, rheumatoid arthritis and depression, neither zolpidem nor benzodiazepine was found to be associated with increased risk in all-sites fractures. Subjects without depression were found to have an increased risk of fractures. Diazepam is the only benzodiazepine with increased risk of fractures after adjusting for medications and comorbidities. Hip and spine were particular sites for increased fracture risk, but following adjustment for comorbidities, the associations were found to be insignificant.Neither zolpidem nor benzodiazepine was associated with increased risk of all-site fractures in this case cross-over study after adjusting for medications or comorbidities in elderly individuals with insomnia. Clinicians should balance the benefits and risks for prescribing zolpidem or benzodiazepine in the elderly accordingly.

  3. Estimation of return-to-sports-time for athletes with stress fracture – an approach combining risk level of fracture site with severity based on imaging

    Directory of Open Access Journals (Sweden)

    Dobrindt Oliver

    2012-08-01

    Full Text Available Abstract Background The aim was to compare the return-to-sports-time (RTST following stress fractures on the basis of site and severity of injury. This retrospective study was set up at a single institution. Diagnosis was confirmed by an interdisciplinary adjudication panel and images were rated in a blinded-read setting. Methods 52 athletes (female, n = 30; male, n = 22; mean age, 22.8 years with stress fracture (SFX who had undergone at least one examination, either MRI or bone scintigraphy, were included. Magnetic resonance images (MRI and/or bone scintigraphy (BS of SFX were classified as either low- or high-grade SFX, according to existing grading systems. For MRI, high-grade SFX was defined as visibility of a fracture line or bone marrow edema in T1-, T2-weighted and short tau inversion recovery (STIR sequences, with low-grade SFX showing no fracture line and bone marrow edema only in STIR and/or T2-weighted sequences. In BS images, a mild and poorly defined focal tracer uptake represented a low-grade lesion, whereas an intense and sharply marginated uptake marked a high-grade SFX. In addition, all injuries were categorized by location as high- or low-risk stress fractures. RTST was obtained from the clinical records. All patients were treated according to a non-weight-bearing treatment plan and comprehensive follow-up data was complete until full recovery. Two-sided Wilcoxon’s rank sum test was used for group comparisons. Results High-risk SFX had a mean RTST of 132 days (d [IQR 64d – 132d] compared to 119d [IQR 50d – 110d] for low-risk sites (p = 0.19. RTST was significantly longer (p = 0.01 in high-grade lesions [mean, 143d; IQR 66d – 134d] than in low-grade [mean, 95d; IQR 42d – 94d]. Analysis of high-risk SFX showed no difference in RTST (p = 0.45 between high- and low-grade [mean, 131d; IQR 72d – 123d vs. mean, 135d; IQR 63d – 132d]. In contrast, the difference was significant for low-risk SFX

  4. Educational Inequalities in Post-Hip Fracture Mortality: A NOREPOS Study.

    Science.gov (United States)

    Omsland, Tone K; Eisman, John A; Naess, Øyvind; Center, Jacqueline R; Gjesdal, Clara G; Tell, Grethe S; Emaus, Nina; Meyer, Haakon E; Søgaard, Anne Johanne; Holvik, Kristin; Schei, Berit; Forsmo, Siri; Magnus, Jeanette H

    2015-12-01

    Hip fractures are associated with high excess mortality. Education is an important determinant of health, but little is known about educational inequalities in post-hip fracture mortality. Our objective was to investigate educational inequalities in post-hip fracture mortality and to examine whether comorbidity or family composition could explain any association. We conducted a register-based population study of Norwegians aged 50 years and older from 2002 to 2010. We measured total mortality according to educational attainment in 56,269 hip fracture patients (NORHip) and in the general Norwegian population. Both absolute and relative educational inequalities in mortality in people with and without hip fracture were compared. There was an educational gradient in post-hip fracture mortality in both sexes. Compared with those with primary education only, the age-adjusted relative risk (RR) of mortality in hip fracture patients with tertiary education was 0.82 (95% confidence interval [CI] 0.77-0.87) in men and 0.79 (95% CI 0.75-0.84) in women. Additional adjustments for Charlson comorbidity index, marital status, and number of children did not materially change the estimates. Regardless of educational attainment, the 1-year age-adjusted mortality was three- to fivefold higher in hip fracture patients compared with peers in the general population without fracture. The absolute differences in 1-year mortality according to educational attainment were considerably larger in hip fracture patients than in the population without hip fracture. Absolute educational inequalities in mortality were higher after hip fracture compared with the general population without hip fracture and were not mediated by comorbidity or family composition. Investigation of other possible mediating factors might help to identify new targets for interventions, based on lower educational attainment, to reduce post-hip fracture mortality.

  5. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: A retrospective study.

    Science.gov (United States)

    Zhang, Zhendong; Zhuo, Qi; Chai, Wei; Ni, Ming; Li, Heng; Chen, Jiying

    2016-08-01

    Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case-control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty.The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218-20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138-9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001-1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06-5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007-44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103-59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656-38.966, P = 0.01) were all risk factors.Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take into account Vancouver

  6. Cluster analysis of bone microarchitecture from high resolution peripheral quantitative computed tomography demonstrates two separate phenotypes associated with high fracture risk in men and women.

    Science.gov (United States)

    Edwards, M H; Robinson, D E; Ward, K A; Javaid, M K; Walker-Bone, K; Cooper, C; Dennison, E M

    2016-07-01

    Osteoporosis is a major healthcare problem which is conventionally assessed by dual energy X-ray absorptiometry (DXA). New technologies such as high resolution peripheral quantitative computed tomography (HRpQCT) also predict fracture risk. HRpQCT measures a number of bone characteristics that may inform specific patterns of bone deficits. We used cluster analysis to define different bone phenotypes and their relationships to fracture prevalence and areal bone mineral density (BMD). 177 men and 159 women, in whom fracture history was determined by self-report and vertebral fracture assessment, underwent HRpQCT of the distal radius and femoral neck DXA. Five clusters were derived with two clusters associated with elevated fracture risk. "Cluster 1" contained 26 women (50.0% fractured) and 30 men (50.0% fractured) with a lower mean cortical thickness and cortical volumetric BMD, and in men only, a mean total and trabecular area more than the sex-specific cohort mean. "Cluster 2" contained 20 women (50.0% fractured) and 14 men (35.7% fractured) with a lower mean trabecular density and trabecular number than the sex-specific cohort mean. Logistic regression showed fracture rates in these clusters to be significantly higher than the lowest fracture risk cluster [5] (pfemoral neck areal BMD was significantly lower than cluster 5 in women in cluster 1 and 2 (p<0.001 for both), and in men, in cluster 2 (p<0.001) but not 1 (p=0.220). In conclusion, this study demonstrates two distinct high risk clusters in both men and women which may differ in etiology and response to treatment. As cluster 1 in men does not have low areal BMD, these men may not be identified as high risk by conventional DXA alone. PMID:27130873

  7. Scaling Analysis of Natural Fracture Systems in Support of Fluid Flow Modeling and Seismic Risk Assessment

    Science.gov (United States)

    La Pointe, P. R.

    2001-12-01

    Many significant problems in rock engineering require consideration of fluid flow through natural fractures in rock or the mechanical response of a fractured rock mass. Accurate prediction of flow volumes, rates and mass transport through natural fracture systems, and their mechanical response, is critical for design and licensing of nuclear waste repositories, optimization of recovery from many petroleum reservoirs, and also in solution mining, groundwater resource development and protection, and hardrock civil engineering projects. Many of these projects require a large-scale, 3D numerical model for flow, transport or mechanical simulation or visualization. A fundamental problem in constructing these models is that fracture data from wells, boreholes, geophysical profiles or surface outcrops represents a small portion of the rock volume under consideration. Not only does the data represent a very small proportion of the reservoir or rock mass, it also represents fracturing in very restricted size scales. Thus scaling analysis is critical to accurately constructing a fracture model from the data. This paper describes, through two case examples, how scaling analysis techniques have been used to develop models of natural fracturing to support the design and licensing of a high level nuclear waste repository in Finland, and for optimization of a tertiary recovery project in an aging oil field in the US. A new technique for scaling fracture sizes is presented. Together, these two examples illustrate the importance of the scaling analyses, pitfalls in carrying out the analyses, and new methods to improve the 3D characterization of naturally fractured rock masses.

  8. Atypical subtrochanteric and diaphyseal femoral fractures

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Abrahamsen, Bo;

    2014-01-01

    Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients with no exp....... Lower limb geometry and Asian ethnicity may contribute to the risk of AFFs. There is inconsistent evidence that teriparatide may advance healing of AFFs. © 2014 American Society for Bone and Mineral Research....... associations between AFFs and BP use, although the strength of associations and magnitude of effect vary. Although the relative risk of patients with AFFs taking BPs is high, the absolute risk of AFFs in patients on BPs is low, ranging from 3.2 to 50 cases per 100,000 person-years. However, long-term use may...

  9. A prospective cohort study on the absolute risks of venous thromboembolism and predictive value of screening asymptomatic relatives of patients with hereditary deficiencies of protein S, protein C or antithrombin

    NARCIS (Netherlands)

    Mahmoodi, B. K.; Brouwer, J-L P.; Ten Kate, M. K.; Lijfering, W. M.; Veeger, N. J. G. M.; Mulder, A. B.; Kluin-Nelemans, H. C.; van der Meer, J.

    2010-01-01

    Background: Absolute risks of venous thromboembolism (VTE) in protein S-, protein C-, or antithrombin-deficient subjects are mainly based on retrospective data. Screening asymptomatic relatives of these patients is disputed, though studies addressing this issue have yet to be conducted. Methods: We

  10. A prospective cohort study on the absolute risks of venous thromboembolism and predictive value of screening asymptomatic relatives of patients with hereditary deficiencies of protein S, protein C or antithrombin.

    NARCIS (Netherlands)

    Mahmoodi, B.K.; Brouwer, J.L.P.; Kate, M.K. Ten; Lijfering, W.M.; Veeger, N.J.; Mulder, A.B.; Kluin-Nelemans, H.C.; Meer, J. van der

    2010-01-01

    BACKGROUND: Absolute risks of venous thromboembolism (VTE) in protein S-, protein C-, or antithrombin-deficient subjects are mainly based on retrospective data. Screening asymptomatic relatives of these patients is disputed, though studies addressing this issue have yet to be conducted. METHODS: We

  11. MRI and bone scintigraphy in operated high risk femoral neck fractures

    International Nuclear Information System (INIS)

    Fifteen patients who had been operated on for high risk femoral neck fractures with titanium screws were examined with 1.0 Tesla MRI and scintimetry at 1 and 6 weeks after operation. Radiological and clinical follow-up was performed up to two years after surgery. Three patients underwent a third 1.5 Tesla MRI examination. Six patients had normal radiographic findings. Early redisplacement (R) was found in 5/15 patients and non-union (NU) in 2/15 patients. Two patients developed late segmental collapse (LSC). Scintigraphy correlated well with normal radiographic findings, but seemed less reliable in detecting R, NU and LSC. MRI seemed reliable but revealed pathological changes in 2/6 patients with an uneventful recovery. Three of 5 patients with R had moderate to severe pathological findings on MRI. In 2 cases with NU moderate or severe pathologic changes were seen, and 2 patients with LSC had clear pathological MRI findings. We conclude that MRI seem to be the method of choice to detect osteonecrotic areas early, even with T, weighted images only, if performed more than 6 weeks after the operation. (orig.)

  12. Low Magnitude Mechanical Signals Reduce Risk-Factors for Fracture during 90-Day Bed Rest

    Science.gov (United States)

    Muir, J. W.; Xia, Y.; Holquin, N.; Judex, S.; Qin, Y.; Evans, H.; Lang, T.; Rubin, C.

    2007-01-01

    Long duration spaceflight leads to multiple deleterious changes to the musculoskeletal system, where loss of bone density, an order of magnitude more severe than that which follows the menopause, combined with increased instability, conspire to elevate the risk of bone fracture due to falls on return to gravitational fields. Here, a ground-based analog for spaceflight is used to evaluate the efficacy of a low-magnitude mechanical intervention, VIBE (Vibrational Inhibition of Bone Erosion), as a potential countermeasure to preserve musculoskeletal integrity in the face of disuse. Twenty-six subjects consented to ninety days of six-degree head-down tilt bed-rest. 18 completed the 90d protocol, 8 of which received daily 10-minute exposure to 30 Hz, 0.3g VIBE, applied in the supine position using a vest elastically coupled to the vibrating platform. The shoulder harness induced a load of 60% of the subjects body weight. At baseline and 90d, Qualitative Ultrasound Scans (QUS) of the calcaneus and CT-scans of the hip and spine were performed to measure changes in bone density. Postural control (PC) was assessed through center of pressure (COP) recordings while subjects stood on a force platform for 4 minutes of quiet stance with eyes closed, and again with eyes opened. As compared to control bedrest subjects,

  13. No effect of vitamin K1 intake on bone mineral density and fracture risk in perimenopausal women

    DEFF Research Database (Denmark)

    Rejnmark, L; Vestergaard, P; Charles, P;

    2006-01-01

    INTRODUCTION: Vitamin K functions as a co-factor in the post-translational carboxylation of several bone proteins, including osteocalcin. AIM: The aim of this study was to investigate the relationship between vitamin K(1) intake and bone mineral density (BMD) and fracture risk in a perimenopausal......) intake and BMD were assessed at baseline and after 5-years of follow-up (cross-sectional design). Moreover, associations between vitamin K(1) intake and 5-year and 10-year changes in BMD were studied (follow-up design). Finally, fracture risk was assessed in relation to vitamin K(1) intake (nested case......-control design). RESULTS: In our cohort, dietary vitamin K(1) intake (60 mug/day) was close to the daily intake recommended by the Food and Agriculture Organization (FAO). Cross-sectional and longitudinal analyses showed no associations between intake of vitamin K(1) and BMD of the femoral neck or lumbar spine...

  14. Eosinophil count - absolute

    Science.gov (United States)

    Eosinophils; Absolute eosinophil count ... the white blood cell count to give the absolute eosinophil count. ... than 500 cells per microliter (cells/mcL). Normal value ranges may vary slightly among different laboratories. Talk ...

  15. Inferior alveolar nerve injuries associated with mandibular fractures at risk: a two-center retrospective study

    NARCIS (Netherlands)

    P. Boffano; F. Roccia; C. Galessio; K. Karagozoglu; T. Forouzanfar

    2014-01-01

    The aim of the study was to investigate the incidence of the inferior alveolar nerve (IAN) injury in mandibular fractures. This study is based on two databases that have continuously recorded patients hospitalized with maxillofacial fractures in two departments—Department of Maxillofacial Surgery, V

  16. Protective effects of dietary carotenoids on risk of hip fracture in men: the Singapore Chinese Health Study

    OpenAIRE

    Dai, Zhaoli; Wang, Renwei; Ang, Li-Wei; Low, Yen-Ling; Yuan, Jian-Min; Koh, Woon-Puay

    2014-01-01

    Experimental and epidemiologic data suggest that carotenoids in vegetables and fruits may benefit bone health due to their antioxidant properties. The relationship between dietary total and specific carotenoids, as well as vegetables and fruits, and risk of hip fracture was examined among Chinese in Singapore. We used data from the Singapore Chinese Health Study, a prospective cohort of 63,257 men and women who were of ages 45–74 years between 1993 and 1998. At recruitment, subjects were inte...

  17. The risk of second hip fracture is decreased with compliant and persistent use of bisphosphonates

    DEFF Research Database (Denmark)

    Hansen, Louise; Vestergaard, Peter; Petersen, Karin Dam

    the average cost was EUR 13,395 and 0.17 hip fractures per woman. The incremental cost-effectiveness ratio (ICER) resulted in a cost saving of EUR 18,623 per prevented hip fracture. In the alendronate treatment arm, the average cost and effect was EUR 5,631 and 0.16 hip fractures per man. The no treatment arm...... had an average cost of EUR 9,070 and 0.29 hip fractures per man. Thus the ICER resulted in a cost saving of EUR 26,421.01 per prevented hip fracture. Both results were robust to changes in key parameters, for both deterministic and probabilistic sensitivity analyses. CONCLUSION: Our model shows...

  18. Pace bowlers in cricket with history of lumbar stress fracture have increased risk of lower limb muscle strains, particularly calf strains

    Directory of Open Access Journals (Sweden)

    John Orchard

    2010-09-01

    Full Text Available John Orchard1, Patrick Farhart2, Alex Kountouris3, Trefor James3, Marc Portus31School of Public Health, University of Sydney, Australia; 2Punjab Kings XI team, Indian Premier League, India; 3Cricket Australia, Melbourne, AustraliaObjective: To assess whether a history of lumbar stress fracture in pace bowlers in cricket is a risk factor for lower limb muscle strains.Methods: This was a prospective cohort risk factor study, conducted using injury data from contracted first class pace bowlers in Australia during seasons 1998–1999 to 2008–2009 inclusive. There were 205 pace bowlers, 33 of whom suffered a lumbar stress fracture when playing first class cricket. Risk ratios ([RR] with 95% confidence intervals[CI] were calculated to compare the seasonal incidence of various injuries between bowlers with a prior history of lumbar stress fracture and those with no history of lumbar stress fracture.Results: Risk of calf strain was strongly associated with prior lumbar stress fracture injury history (RR = 4.1; 95% CI: 2.4–7.1. Risks of both hamstring strain (RR = 1.5; 95% CI: 1.03–2.1 and quadriceps strain (RR = 2.0; 95% CI: 1.1–3.5 were somewhat associated with history of lumbar stress fracture. Risk of groin strain was not associated with history of lumbar stress fracture (RR = 0.7; 95% CI: 0.4–1.1. Other injuries showed little association with prior lumbar stress fracture, although knee cartilage injuries were more likely in the non-stress fracture group.Conclusion: Bony hypertrophy associated with lumbar stress fracture healing may lead to subsequent lumbar nerve root impingement, making lower limb muscle strains more likely to occur. Confounders may be responsible for some of the findings. In particular, bowling speed is likely to be independently correlated with risk of lumbar stress fracture and risk of muscle strain. However, as the relationship between lumbar stress fracture history and calf strain was very strong, and that there is a

  19. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Carli, L; Tani, C; Spera, V; Vagelli, R; Vagnani, S; Mazzantini, M; Di Munno, O; Mosca, M

    2016-01-01

    Osteoporosis (OP) and fragility fractures (FFx) are a known comorbidity in patients with systemic lupus erythematosus (SLE). This work aimed at evaluating (1) the prevalence of OP and FFx in a cohort of SLE and (2) the risk factors associated with both OP and FFx. The following data were collected from clinical charts: age, sex, menopausal status (MP), body mass index, smoking habits, disease duration, daily dose and cumulative glucocorticoids (GCs), type of organ involvement, comorbidities and medications. Data on bone metabolism, calcium and vitamin D supplementation and treatment with bisphosphonates, teriparatide or denosumab were collected, together with bone mineral density (BMD) values (measured by dual-energy X-ray absorptiometry (DXA)) and history of FFx (occurred after the onset of SLE and unrelated to trauma). OP and reduced BMD were defined according to the WHO. 186 patients were included (women 175, men 11; mean age 46.4±13 years, mean disease duration 14.9±9 years). At their last visit, 97 patients (52.2%) had a reduced BMD and 52 (27.9%) had OP. 22 patients (11.8%), all women, had at least one FFx; six patients (27.3%) were pre-menopausal. On univariate analysis, age, cumulative dose of GC, MP, therapy with antiepileptics and chronic renal failure (CRF) were correlated with OP (p<0.03); age, total amount of GC, MP, CRF, anticoagulants (AC) and antiepileptic therapy were correlated with FFx (p<0.05). The multivariate logistic model confirmed a direct association of OP and age, MP and antiepileptic therapy (p≤0.01) and of FFx and age, chronic therapy with AC and antiepileptics (p<0.03). In conclusion, low BMD is frequently observed in SLE, and FFx are observed also in premenopausal patients. Together with traditional risk factors (age, MP and GC), CRF and chronic treatments with AC or antiepileptics seem to be associated with a higher risk profile for OP and FFx occurrence.

  20. Comparison of selected methods for fracture risk assessment in postmenopausal women: analysis of the Łódź population in the EPOLOS study

    Directory of Open Access Journals (Sweden)

    Elżbieta Skowrońska‑Jóźwiak

    2010-05-01

    Full Text Available INTRODUCTION: The major challenge when administering osteoporosis treatment is to identify patients with the highest fracture risk. FRAX™ is a new algorithm that integrates clinical risk factors of fracture and the results of densitometry. OBJECTIVES: The aim of the study was to evaluate the use of FRAX™ in identifying patients that should receive osteoporosis treatment and compare it with other methods of fracture risk assessment. PATIENTS AND METHODS: The study involved a random sample of 94 postmenopausal women, aged 55 to 79 years, who had not been previously treated for osteoporosis (a part of the EPOLOS [European Polish Osteoporosis Study] population recruited from the region of Łódź, Poland. Clinical risk factors were evaluated and densitometry of the femoral neck was performed. Patients were eligible for treatment on the basis of previous osteoporotic fractures, densitometry results, semiquantitative tabular method (SQM (according to the Osteoporosis Society of Canada Recommendations for Bone Mineral Density Reporting, and a 10‑year fracture risk (calculated with the British FRAX™ tool, using different thresholds. RESULTS: Using the FRAX™ method, between 5.2% to 52% of the examined women would be eligible for treatment, depending on the threshold applied. If the treatment decision was based on a history of vertebral fractures, 4.2% of women would be eligible for treatment, and if other fractures were considered – 20.2%. If the decision was based on densitometry results, 8.5% of women would be eligible for treatment. We observed a high fracture risk in 7%, moderate risk in 19%, and low risk in 74% of women examined by the SQM. CONCLUSIONS: Proper use of FRAX™ in Poland requires determination of the intervention threshold. Use of FRAX™ changes the demographic profile of women eligible for therapy, increasing their number in older age groups.

  1. Is there an increased risk of hip fracture in multiple sclerosis? Analysis of the Nationwide Inpatient Sample

    Directory of Open Access Journals (Sweden)

    Bhattacharya RK

    2014-02-01

    Full Text Available Rajib K Bhattacharya, Niralee Vaishnav, Richard M Dubinsky Departments of Endocrinology, Metabolism and Genetics and Neurology, University of Kansas Medical Center, Kansas City, KS, USA Background: Impaired ambulation, frequent falls, and prolonged immobilization combined with the high rate of vitamin D deficiency in people with multiple sclerosis (MS could lead to an increased risk of hip fracture. Methods: A retrospective cohort analysis of 20 years of the Nationwide Inpatient Sample (AHRQ.gov, a 20% stratified yearly sample of USA hospital admissions from the year 1988–2007, was performed. Based on International Classification of Diseases Ninth Revision (ICD9 codes, admissions with a primary diagnosis of acute hip fracture (ICD9 code 226.xx and a secondary diagnosis of MS (ICD9 code 340 was identified. Indirect adjustment was used to compare the prevalence of MS in this population with that of the USA. Significance was set a priori at P<0.0001 due to the large number of records and multiple comparisons. Results: A total of 1,066,404 hip fracture admissions were identified and 0.25% had MS. Those with MS were younger, had lower mortality rates (0.25% for people with MS versus 2.97% for those without MS, P<0.0001 and lower rates of discharge to nursing home or rehabilitation (69.25% for people with MS versus 72.17% for those without MS, P<0.0001. When compared with the population prevalence, the predicted prevalence of MS among patients with hip fracture was 2.844 (95% confidence interval [CI] 2.837–2.852 greater than expected when adjusted for age, 2.505 (95% CI 2.499–2.512 when adjusted for sex and age, and 2.175 (95% CI 2.168–2.182 when adjusted for race (white, black. Race was specified for only 65% of the sample. Conclusion: In this nationwide sample of 20 years of hospital admissions in the USA, the prevalence of MS in the population with hip fracture was greater than twice that predicted, and MS patients suffered an acute

  2. Absolute nuclear material assay

    Science.gov (United States)

    Prasad, Manoj K.; Snyderman, Neal J.; Rowland, Mark S.

    2010-07-13

    A method of absolute nuclear material assay of an unknown source comprising counting neutrons from the unknown source and providing an absolute nuclear material assay utilizing a model to optimally compare to the measured count distributions. In one embodiment, the step of providing an absolute nuclear material assay comprises utilizing a random sampling of analytically computed fission chain distributions to generate a continuous time-evolving sequence of event-counts by spreading the fission chain distribution in time.

  3. Continuous and long-term treatment is more important than dosage for the protective effect of thiazide use on bone metabolism and fracture risk

    DEFF Research Database (Denmark)

    Kruse, C; Eiken, P; Vestergaard, P

    2016-01-01

    BACKGROUND: Data from observational studies have suggested that thiazide diuretics protect against fractures. Few studies have investigated time frames from initiation of treatment to fracture occurrence. OBJECTIVE: To evaluate the time to spinal, hip, femur, wrist and upper extremity fracture oc...... of thiazide exposure seems to be important to obtain this protective effect on fracture risk, but we have found in this study that this approach is not always used in clinical practice....... classification system code C03AB) between 1996 and 2011 were matched with nonexposed control subjects by date of birth and gender. Weekly odds ratios (ORs) of fracture occurrence and total incidence rates (IRs) and incidence rate ratios (IRRs) of fracture risk were calculated for the periods before treatment...... initiation, weeks 1-42 and weeks 43-780. RESULTS: A total of 1,602,141 'thiazide exposure periods' (46,8271 individuals) and 1,530,233 'nonexposure periods' (655,399 individuals) were included in the analysis. Thiazide use was associated with factors of increased de novo fracture risk. Weekly adjusted...

  4. Trends in absolute and relative educational inequalities in four modifiable ischaemic heart disease risk factors: repeated cross-sectional surveys from the Nord-Trøndelag Health Study (HUNT 1984–2008

    Directory of Open Access Journals (Sweden)

    Ernstsen Linda

    2012-04-01

    Full Text Available Abstract Background There has been an overall decrease in incident ischaemic heart disease (IHD, but the reduction in IHD risk factors has been greater among those with higher social position. Increased social inequalities in IHD mortality in Scandinavian countries is often referred to as the Scandinavian “public health puzzle”. The objective of this study was to examine trends in absolute and relative educational inequalities in four modifiable ischaemic heart disease risk factors (smoking, diabetes, hypertension and high total cholesterol over the last three decades among Norwegian middle-aged women and men. Methods Population-based, cross-sectional data from The Nord-Trøndelag Health Study (HUNT: HUNT 1 (1984–1986, HUNT 2 (1995–1997 and HUNT 3 (2006–2008, women and men 40–59 years old. Educational inequalities were assessed using the Slope Index of Inequality (SII and The Relative Index of Inequality (RII. Results Smoking prevalence increased for all education groups among women and decreased in men. Relative and absolute educational inequalities in smoking widened in both genders, with significantly higher absolute inequalities among women than men in the two last surveys. Diabetes prevalence increased in all groups. Relative inequalities in diabetes were stable, while absolute inequalities increased both among women (p = 0.05 and among men (p = 0.01. Hypertension prevalence decreased in all groups. Relative inequalities in hypertension widened over time in both genders. However, absolute inequalities in hypertension decreased among women (p = 0.05 and were stable among men (p = 0.33. For high total cholesterol relative and absolute inequalities remained stable in both genders. Conclusion Widening absolute educational inequalities in smoking and diabetes over the last three decades gives rise to concern. The mechanisms behind these results are less clear, and future studies are needed to assess if educational

  5. Risk of Pre-and Post-Operative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients

    Science.gov (United States)

    Freter, Susan; Dunbar, Michael; Koller, Katalin; MacKnight, Chris; Rockwood, Kenneth

    2015-01-01

    Background and Purpose Delirium is common after hip fracture. Previous work has shown that a simple delirium risk factor tool, the Delirium Elderly At Risk instrument (DEAR), has a high inter-rater reliability in this population. Little research has looked at the ability of risk factor screening tools to identify patients at high risk of pre-operative delirium. This study investigates the ability of the DEAR to identify patients at high risk of pre-operative delirium, as well as reporting its performance in a post-operative validation sample. Associations between delirium risk factors and pre-operative delirium are explored. Methods This prospective cohort study took place on an orthopedic in-patient service at a University-affiliated tertiary care hospital. Patients aged 65 and older who were admitted for surgical repair of hip fracture (N = 283) were assessed pre-operatively for 5 delirium risk factors (cognitive impairment, sensory impairment, functional dependence, substance use, age) using the DEAR. Patients were assessed for delirium using the Mini-Mental State Examination and the Confusion Assessment Method pre-operatively and on post-operative days 1, 3 and 5. Characteristics of patients who developed delirium were compared with the characteristics of those who did not. Results Delirium was present in 58% (95% CI = 52–63%) of patients pre-operatively and 42% (95% CI = 36–48%) post-operatively. Individually, sensory impairment (χ2 = 21.7, p = .0001), functional dependence (χ2 = 24.1, p = .0001), cognitive impairment (χ2 = 55.5, p = .0001) and substance use (χ2 = 7.5, p = .007) were significantly associated with pre-operative delirium, as was wait-time for surgery (t = 3.1, p = .003) and length of stay (t = 2.8, p =.03). In multivariate modeling, the strongest association with pre-operative delirium was cognitive impairment. Conclusions The DEAR, a simple, delirium risk factor screening tool, can be used to identify hip fracture patients at risk of

  6. Digital x-ray radiogrammetry identifies women at risk of osteoporotic fracture: results from a prospective study

    DEFF Research Database (Denmark)

    Bach-Mortensen, Pernille; Hyldstrup, Lars; Appleyard, Merete;

    2006-01-01

    Using digital X-ray radiogrammetry (DXR) on hand radiographs from a large population-based study, 1,370 postmenopausal women were evaluated in a prospective fashion; fracture occurrence was compared with DXR measurements of historic radiographs. Further, the aim of the study was to evaluate factors...... suffered a fracture. Odds ratios (ORs) per 1 standard deviation decline in DXR-BMD were statistically significant for fracture in the groups of wrist fractures, proximal humerus fractures, vertebral fractures, and other fractures as well as in the total fracture group. In the hip fracture group, the P...

  7. Considerations on the manner to account for fast fracture risk in the design of PWR vessels

    International Nuclear Information System (INIS)

    The way followed in France for analyzing fast fracture resistance of PWR primary components is the one of a deterministic analysis with safety coefficients imposed in the fracture criteria. The study of margins towards fast fracture of the 900 MWe program vessels undertaken in 1982 includes parametric evaluations of the influence of essential variables. It has stimulated further thoughts on the level of safety to fix in the analysis methodology, on the orientations for the choice of safety factors and on the manner to introduce them in the analysis. A first chapter tries to characterize the French approach in comparison to those of other countries. A second chapter examines the manner according to which safety factors can be introduced in the deterministic analysis. It presents the principle for a logical approach accounting for the interdependency of all factors and variables. It establishes criteria for the selection of defect kind and size for the computation

  8. An Assessment of Risk of Migration of Hydrocarbons or Fracturing Fluids to Fresh Water Aquifers: Wattenberg Field, CO

    Science.gov (United States)

    Eustes, A. W.; Fleckenstein, W. W.; Stone, C.; Howell, P.

    2015-12-01

    The United States National Science Foundation, engaging 29 researchers at nine institutions, has funded a Sustainability Research Network (SRN) focused on natural gas development. The mission of this Sustainability Research Network is to provide a logical, science-based framework for evaluating the environmental, economic, and social trade-offs between development of natural gas resources and protection of water and air resources and to convey the results of these evaluations to the public in a way that improves the development of policies and regulations governing natural gas and oil development. Currently, there are a wide range of estimates of the probability of shallow aquifer contamination. There are a series of independent events that must occur to allow hydrocarbon migration and estimates were made of these probabilities. An analysis of data from drilling in the Wattenberg field, CO was made to quantify the probability of contamination. It has been determined that there are five events that must each independently happen to allow the migration of fracturing fluids, and there are three events that must occur independently for the migration of hydrocarbons. The lower number of independent events, which must arise for hydrocarbon migration to occur, explains the infrequent, but well publicized natural gas migrations in poorly constructed wellbores, and the lack of such publicized events of hydraulic fracturing fluid contamination, which was confirmed by our analysis. The significance of these results is to help quantify the risks associated with natural gas development, as related to the contamination of surface aquifers. These results will help shape the discussion of the risks of natural gas development and will assist in identifying areas of improved well construction and hydraulic fracturing practices to minimize risk.

  9. Clinical value of prognostic instruments to identify patients with an increased risk for osteoporotic fractures: systematic review.

    Directory of Open Access Journals (Sweden)

    Johann Steurer

    Full Text Available BACKGROUND: With the broad availability of effective medications, identifying individuals bearing a higher risk for osteoporotic fractures has become an issue of major concern in modern medicine. In recent years various prognostic instruments have become available showing conflicting results regarding estimated risks for individual patients. OBJECTIVE: To provide an overview of current evidence and of opportunities for further research. METHODOLOGY/PRINCIPAL FINDINGS: Systematic review: We identified studies describing the development of instruments and all subsequent validations in electronic databases and reference lists of included studies. We screened for inclusion, read full papers and extracted data on salient clinical features, performance characteristics and quality in duplicate. Searches retrieved 5,275 records of which full texts of 167 papers were obtained after screening titles and abstract. We included 35 studies enrolling a total of 609,969 patients (median 2546 reporting on 31 derivations and 12 validations after assessing full texts. Median follow-up time was 4.1 years (IQR 3 to 7.7. Only four studies validated an instrument that was developed by another group. None of the existing instruments was validated more than once. The five most frequent included variables in the final model were age, body mass index, bone mass index, past history of falls, and maternal history of fractures. The methodological quality of the studies was moderate. CONCLUSION: There is a plethora of evidence available studying the association of risk profiles and the development of osteoporotic fractures. The small number of out-of-sample validations, the large variety of study characteristics, outcomes and follow-up periods impedes from deriving robust summaries and from conclusions regarding the clinical performance of many tools. First and foremost, future activity in this field should aim at reaching a consensus among clinical experts in respect to the

  10. Acute cognitive dysfunction after hip fracture: frequency and risk factors in an optimized, multimodal, rehabilitation program

    DEFF Research Database (Denmark)

    Bitsch, Martin; Foss, Nicolai Bang; Kristensen, Billy Bjarne;

    2006-01-01

    hip fracture surgery in an optimized, multimodal, peri-operative rehabilitation regimen. METHODS: One hundred unselected hip fracture patients treated in a well-defined, optimized, multimodal, peri-operative rehabilitation regimen were included. Patients were tested upon admission and on the second......, but also the number of peri-operative transfusions. The development of APOCD was also associated with impaired post-operative rehabilitation and an increased length of stay. APOCD was associated with the development of a major medical complication in 35% of all patients. In 65% of patients developing APOCD...

  11. ABSOLUTE NEUTRINO MASSES

    DEFF Research Database (Denmark)

    Schechter, J.; Shahid, M. N.

    2012-01-01

    We discuss the possibility of using experiments timing the propagation of neutrino beams over large distances to help determine the absolute masses of the three neutrinos.......We discuss the possibility of using experiments timing the propagation of neutrino beams over large distances to help determine the absolute masses of the three neutrinos....

  12. Comparison of different screening tools (FRAX®, OST, ORAI, OSIRIS, SCORE and age alone) to identify women with increased risk of fracture. A population-based prospective study

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Abrahamsen, Bo; Friis-Holmberg, Teresa;

    2013-01-01

    PURPOSE: To compare the power of FRAX® without bone mineral density (BMD) and simpler screening tools (OST, ORAI, OSIRIS, SCORE and age alone) in predicting fractures. METHODS: This study was a prospective, population-based study performed in Denmark comprising 3614 women aged 40-90years, who...... returned a questionnaire concerning items on risk factors for osteoporosis. Fracture risk was calculated using the different screening tools (FRAX®, OST, ORAI, OSIRIS and SCORE) for each woman. The women were followed using the Danish National Register registering new major osteoporotic fractures during 3......years, counting only the first fracture per person. Area under the receiver operating characteristic curve (ROC) and statistics and Harrell's index were calculated. Agreement between the tools was calculated by kappa statistics. RESULTS: A total of 4% of the women experienced a new major osteoporotic...

  13. Low-Level Cadmium Exposure Is Associated With Decreased Bone Mineral Density and Increased Risk of Incident Fractures in Elderly Men: The MrOS Sweden Study.

    Science.gov (United States)

    Wallin, Maria; Barregard, Lars; Sallsten, Gerd; Lundh, Thomas; Karlsson, Magnus K; Lorentzon, Mattias; Ohlsson, Claes; Mellström, Dan

    2016-04-01

    One risk factor for osteoporosis that has attracted increasing attention in recent years is exposure to cadmium. The aim of this study was to examine the associations between low-level cadmium exposure, from diet and smoking, and bone mineral density (BMD) and incident fractures in elderly men. The study population consisted of 936 men from the Swedish cohort of the Osteoporotic Fractures in Men (MrOS) study, aged 70 to 81 years at inclusion (years 2002 to 2004), with reliable data on cadmium in urine (U-Cd) analyzed using inductively coupled plasma mass spectrometry in baseline samples. The participants also answered a questionnaire on lifestyle factors and medical history. BMD was measured at baseline using dual-energy X-ray absorptiometry (DXA) in the total body, hip, and lumbar spine. During the follow-up period (until 2013), all new fractures were registered by date and type. Associations between BMD and U-Cd were assessed using multiple linear regression, and associations between incident fractures and baseline U-Cd were analyzed using Cox regression. In both cases, a number of potential confounders and other risk factors (eg, age, smoking, body mass index [BMI], and physical activity) were included in the models. We found significant negative associations between U-Cd and BMD, with lower BMD (4% to 8%) for all sites in the fourth quartile of U-Cd, using the first quartile as the reference. In addition, we found positive associations between U-Cd and incident fractures, especially nonvertebral osteoporosis fractures in the fourth quartile of U-Cd, with hazard ratios of 1.8 to 3.3 in the various models. U-Cd as a continuous variable was significantly associated with nonvertebral osteoporosis fractures (adjusted hazard ratio 1.3 to 1.4 per μg Cd/g creatinine), also in never-smokers, but not with the other fracture groups (all fractures, hip fractures, vertebral fractures, and other fractures). Our results indicate that even relatively low cadmium exposure

  14. Interaction between vitamin D receptor genotype and estrogen receptor alpha genotype influences vertebral fracture risk

    NARCIS (Netherlands)

    E.M. Colin; A.G. Uitterlinden (André); A.P. Bergink (Arjan); M. van de Klift (Marjolein); Y. Fang (Yue); P.P. Arp (Pascal); H.A.P. Pols (Huib); J.P.T.M. van Leeuwen (Hans); J.B.J. van Meurs (Joyce); A. Hofman (Albert)

    2003-01-01

    textabstractIn view of the interactions of vitamin D and the estrogen endocrine system, we studied the combined influence of polymorphisms in the estrogen receptor (ER) alpha gene and the vitamin D receptor (VDR) gene on the susceptibility to osteoporotic vertebral fractures in 634

  15. Relationship between bone mineral density changes and fracture risk reduction in patients treated with strontium ranelate

    DEFF Research Database (Denmark)

    Bruyere, Olivier; Roux, Christian; Detilleux, Johann;

    2007-01-01

    OBJECTIVE: Our objective was to analyze the relationship between bone mineral density (BMD) changes and fracture incidence during 3-yr treatment with strontium ranelate. PATIENTS: Women from the strontium ranelate arm of the Spinal Osteoporosis Therapeutic Intervention study and the TReatment...

  16. TRPV4 deficiency causes sexual dimorphism in bone metabolism and osteoporotic fracture risk

    NARCIS (Netherlands)

    B.C.J. van der Eerden (Bram); L. Oei (Ling); P. Roschger (Paul); N. Fratzl-Zelman (Nadja); J.G. Hoenderop (Joost); N.M. van Schoor (Natasja); U. Pettersson-Kymmer (Ulrika); M. Schreuders-Koedam (M.); A.G. Uitterlinden (André); A. Hofman (Albert); M. Suzuki (Masachika); K. Klaushofer (Klaus); C. Ohlsson (Claes); P.J.A. Lips (P. J A); F. Rivadeneira Ramirez (Fernando); R.J.M. Bindels (René); J.P.T.M. van Leeuwen (Hans)

    2013-01-01

    textabstractWe explored the role of transient receptor potential vanilloid 4 (TRPV4) in murine bone metabolism and association of TRPV4 gene variants with fractures in humans. Urinary and histomorphometrical analyses demonstrated reduced osteoclast activity and numbers in male Trpv4-/- mice, which w

  17. TRPV4 deficiency causes sexual dimorphism in bone metabolism and osteoporotic fracture risk.

    NARCIS (Netherlands)

    Eerden, B.C. van der; Oei, L.; Roschger, P.; Fratzl-Zelman, N.; Hoenderop, J.G.J.; Schoor, N.M. van; Pettersson-Kymmer, U.; Schreuders-Koedam, M.; Uitterlinden, A.G.; Hofman, A.; Suzuki, M.; Klaushofer, K.; Ohlsson, C.; Lips, P.J.; Rivadeneira, F.; Bindels, R.J.M.; Leeuwen, J.P. van

    2013-01-01

    We explored the role of transient receptor potential vanilloid 4 (TRPV4) in murine bone metabolism and association of TRPV4 gene variants with fractures in humans. Urinary and histomorphometrical analyses demonstrated reduced osteoclast activity and numbers in male Trpv4(-/-) mice, which was confirm

  18. Naturally fractured formations model in the dispersion of high risk radioactive wastes

    International Nuclear Information System (INIS)

    The aim of this work is the development of hydrologic models for saturated and non saturated naturally fractured formations. The main objective is to simulate in a computer the transport process of radioactive contaminants in retentive rocks in sites used for nuclear waste repositories. (author)

  19. Abdominal body composition measured by quantitative computed tomography and risk of non-spine fractures

    DEFF Research Database (Denmark)

    Sheu, Y; Marshall, L M; Holton, K F;

    2013-01-01

    The effect of abdominal adiposity and muscle on fracture is unclear in older men; therefore, we examined the association among 749 men aged 65+. Among various adipose tissues and muscle groups, lower psoas muscle volume and higher fatty infiltration of abdominal muscle contribute to higher fractu...

  20. Risk of hip fractures associated with benzodiazepines: Applying common protocol to a multi-database nested case-control study. The protect project

    OpenAIRE

    Requena, Gema; Logie, John; González-González, Rocío; Gardarsdottir, Helga; Afonso, Ana; Souverein, Patrick C.; Merino, Elisa Martin; Boudiaf, Nada; Huerta, Consuelo; Bate, Andrew; Alvarez, Yolanda; García-Rodríguez, Luis A; Reynolds, Robert; Schlienger, Raymond G.; De Groot, Mark C.H.

    2014-01-01

    Background: The association between benzodiazepines (BZD) and hip fractures has been estimated in several observational studies although diverse methodologies and definitions have hampered comparability. Objectives: To evaluate the discrepancies in the risk estimates of hip/femur fractures associated with BDZs across different databases and to assess the impact of different matching strategies. Methods: A case control study nested in a cohort of BZD users, examining their association with the...

  1. Near-fatal infection following an elective ankle-fracture fixation: less risk should not mean less vigilance

    Institute of Scientific and Technical Information of China (English)

    Giada Bianchi; Dingxin Qin; Joseph A.Dearani; Qi Qian

    2011-01-01

    Surgical fixation of closed ankle fracture is traditionally viewed as having low risk for post-operative infection. Only a few cases of surgical-site confined infection have been reported. Because of the low infection risk, the necessity for perioperative prophylaxis has been questioned. We report a case of fulminant methicillin-resistant Staphylococcus aureus endocarditis occurring shortly after an elective ankle fixation surgery in an elderly woman with chronic rheumatoid arthritis. Because systemic infection was unexpected, she had been given antipyretics for postoperative fever until just before rapid clinical deterioration. A nearly fatal hematogenous infection occurred after such a procedure, indicating the necessity for being on high alert and considering the possibility of bloodstream infection.

  2. Imaging of vertebral fractures

    Directory of Open Access Journals (Sweden)

    Ananya Panda

    2014-01-01

    Full Text Available Vertebral fracture is a common clinical problem. Osteoporosis is the leading cause of non-traumatic vertebral fracture. Often, vertebral fractures are not clinically suspected due to nonspecific presentation and are overlooked during routine interpretation of radiologic investigations. Moreover, once detected, many a times the radiologist fails to convey to the clinician in a meaningful way. Hence, vertebral fractures are a constant cause of morbidity and mortality. Presence of vertebral fracture increases the chance of fracture in another vertebra and also increases the risk of subsequent hip fracture. Early detection can lead to immediate therapeutic intervention improving further the quality of life. So, in this review, we wish to present a comprehensive overview of vertebral fracture imaging along with an algorithm of evaluation of vertebral fractures.

  3. NGS Absolute Gravity Data

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The NGS Absolute Gravity data (78 stations) was received in July 1993. Principal gravity parameters include Gravity Value, Uncertainty, and Vertical Gradient. The...

  4. Fracture risk assessment of trunk oil pipeline by corrosion fatigue mechanism of service defects development

    OpenAIRE

    Vasyl Luzhetskyy

    2013-01-01

    Engineering estimations of the corrosion fracture velocity of oil pipelines have been given, which include both mechanical and physical-chemical interaction operation factors of strained material with workspace. Characteristics of cyclic corrosion crack resistance of a pipe metal of the exploited oil-trunk pipeline with the regard for operating production factors have been defined. New data about corrosive and fatigue failure of pipes in dependence on the initial sizes and forms of their dete...

  5. Absolute Pitch on Music

    OpenAIRE

    Çuhadar, C.Hakan

    2008-01-01

    Musicians are debated people in the academic circles with the claim of they have both various characteristics and different cognitive personalities on the analogy those other people. One of these different characteristics is absolute pitch ability. Absolute pitch (AP) is a cognitive ability which can be characterized as to identify any tones (labeling) at a given pitch without using any external references. According to the different studies which were held in different times, the prevalence ...

  6. Absolute polarimetry at RHIC

    OpenAIRE

    Okada, H.; Alekseev, I.; Bravar, A; Bunce, G.; Dhawan, S.; Eyser, K. O.; Gill, R; Haeberli, W.; Huang, H.; Jinnouchi, O.; Makdisi, Y.; Nakagawa, I.; Nass, A.; Saito, N; Stephenson, E.

    2007-01-01

    Precise and absolute beam polarization measurements are critical for the RHIC spin physics program. Because all experimental spin-dependent results are normalized by beam polarization, the normalization uncertainty contributes directly to final physics uncertainties. We aimed to perform the beam polarization measurement to an accuracy of $\\Delta P_{beam}/P_{beam} < 5%$. The absolute polarimeter consists of Polarized Atomic Hydrogen Gas Jet Target and left-right pairs of silicon strip detector...

  7. Fracture risk and the use of a diuretic (indapamide sr ± perindopril: a substudy of the Hypertension in the Very Elderly Trial (HYVET

    Directory of Open Access Journals (Sweden)

    Thijs Lutgarde

    2006-12-01

    Full Text Available Abstract Background The Hypertension in the Very Elderly Trial (HYVET is a placebo controlled double blind trial of treating hypertension with indapamide Slow Release (SR ± perindopril in subjects over the age of 80 years. The primary endpoints are stroke (fatal and non fatal. In view of the fact that thiazide diuretics and indapamide reduce urinary calcium and may increase bone mineral density, a fracture sub study was designed to investigate whether or not the trial anti-hypertensive treatment will reduce the fracture rate in very elderly hypertensive subjects. Methods In the trial considerable care is taken to ascertain any fractures and to identify risk factors for fracture, such as falls, co-morbidity, drug treatment, smoking and drinking habits, levels of activity, biochemical abnormalities, cardiac irregularities, impaired cognitive function and symptoms of orthostatic hypotension. Potential results The trial is expected to provide 10,500 patient years of follow-up. Given a fracture rate of 40/1000 patient years and a 20% difference in fracture rate, the power of the sub study is 58% to detect this difference at the 5% level of significance. The corresponding power for a reduction of 25% is 78%. Conclusion The trial is well under way, expected to complete in 2009, and on target to detect, if present, the above differences in fracture rate.

  8. The progress of osteoporotic fracture risk prediction methods%骨质疏松性骨折风险预测方法的研究进展

    Institute of Scientific and Technical Information of China (English)

    俞海燕; 唐伟; 王尧(审校)

    2015-01-01

    骨质疏松性骨折( Osteoporosis fracture ,OF)是一种随着年龄增加而增加的疾病,其预后不佳。因此,及早进行骨质疏松骨折风险预测显得至关重要。骨质疏松骨折预测方法有以下几种:骨密度检查、FRAX工具、Garvan nomogram 评估法、ORAI、OSTA、定量骨超声、骨代谢标志物等。研究表明,FRAX工具可预测个体10年内发生髋部骨折及任何重要的OF的概率,优于其他方法。%Osteoporosis fracture ( OF) is an age-related disease and its prognosis is poor.Therefore, early osteoporotic fracture risk prediction is crucial.Osteoporotic fracture prediction methods include bone mineral density ( BMD), FRAX ( fracture risk assessment tool) , Garvan nomogram Assessment Act, ORAI, OSTA, quantitative ultrasound ( QUS) , and bone turnover markers. Studies have shown that FRAX tool can evaluate the 10-year probability of hip fractures and a major OF, which is superior to other methods.

  9. Risk reduction of falls and fractures, reduction of back pain and safety in elderly high risk patients receiving combined therapy with alfacalcidol and alendronate: a prospective study.

    Science.gov (United States)

    Schacht, Erich; Ringe, Johann D

    2011-01-01

    Efficacy and safety of a new combination package containing 4 or 12 self-explanatory one-week blisters, each with one tablet of 70 mg alendronate (CAS 260055-05-8) and 7 capsules of 1 microg alfacalcidol (CAS 41294-56-8) (Tevabone) on muscle power, muscle function, balance and back pain was investigated in an open, multi-centered, uncontrolled, prospective study on a cohort of elderly patients with a high risk of falls and fractures. 818 practicing physicians all over Germany recruited 2579 patients for a 3-month observational trial being treated with the above combination package. 92.4% were women [89.7% of the women had postmenopausal osteoporosis (PMO)]. Their average age was 74.1 years and the mean body mass index 26.4 kg/m2. 55.4% had a history of falls. Prevalent vertebral and non-vertebral fractures were documented in 62.9% and 61.4% of the patients, respectively, and a creatinine clearance below 65 ml/min was documented in 65.5%. Main outcome parameters were the Chair Rising Test (CRT), Timed Up and Go Test (TUG), back pain and safety at onset and after 3 months. In addition an evaluation of the package design was done at the end of the study. The percentage of patients able to perform the CRT within 10 sec increased from 26.3% to 42.9% after 3 months (increase 63%, p sec of TUG increased by 54% (p sec (p sec (p sec in the performance of TUG results in a 24% increased risk for non-vertebral fractures. Mean back pain measured by a 0-10 visual analogue scale decreased significantly by 41% from 5.9 to 3.5 (p compliance. This may contribute to the previously shown significant effect on reducing falls and fractures with the same regimen during a controlled long-term trial. The same trend was found in all mentioned efficacy parameters and no different trend in safety in the large subgroup of 2106 women with documented PMO. PMID:21355445

  10. Prediction of risk of fracture in the tibia due to altered bone mineral density distribution resulting from disuse: a finite element study.

    Science.gov (United States)

    Gislason, Magnus K; Coupaud, Sylvie; Sasagawa, Keisuke; Tanabe, Yuji; Purcell, Mariel; Allan, David B; Tanner, K Elizabeth

    2014-02-01

    The disuse-related bone loss that results from immobilisation following injury shares characteristics with osteoporosis in post-menopausal women and the aged, with decreases in bone mineral density leading to weakening of the bone and increased risk of fracture. The aim of this study was to use the finite element method to: (i) calculate the mechanical response of the tibia under mechanical load and (ii) estimate of the risk of fracture; comparing between two groups, an able-bodied group and spinal cord injury patients group suffering from varying degrees of bone loss. The tibiae of eight male subjects with chronic spinal cord injury and those of four able-bodied age-matched controls were scanned using multi-slice peripheral quantitative computed tomography. Images were used to develop full three-dimensional models of the tibiae in Mimics (Materialise) and exported into Abaqus (Simulia) for calculation of stress distribution and fracture risk in response to specified loading conditions - compression, bending and torsion. The percentage of elements that exceeded a calculated value of the ultimate stress provided an estimate of the risk of fracture for each subject, which differed between spinal cord injury subjects and their controls. The differences in bone mineral density distribution along the tibia in different subjects resulted in different regions of the bone being at high risk of fracture under set loading conditions, illustrating the benefit of creating individual material distribution models. A predictive tool can be developed based on these models, to enable clinicians to estimate the amount of loading that can be safely allowed onto the skeletal frame of individual patients who suffer from extensive musculoskeletal degeneration (including spinal cord injury, multiple sclerosis and the ageing population). The ultimate aim is to reduce fracture occurrence in these vulnerable groups. PMID:24503510

  11. β3-adrenergic receptor gene, body mass index, bone mineral density and fracture risk in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES

    Directory of Open Access Journals (Sweden)

    Center Jacqueline R

    2006-07-01

    Full Text Available Abstract Background Recent studies have suggested that the Arg allele of β3-adrenergic receptor (ADRB3 gene is associated with body mass index (BMI, which is an important predictor of bone mineral density (BMD and fracture risk. However, whether the ADRB3 gene polymorphism is associated with fracture risk has not been investigated. The aim of study was to examine the inter-relationships between ADRB3 gene polymorphisms, BMI, BMD and fracture risk in elderly Caucasians. Methods Genotypes of the ADRB3 gene were determined in 265 men and 446 women aged 60+ in 1989 at entry into the study, whose BMD were measured by DXA (GE Lunar, WI USA at baseline. During the follow-up period (between 1989 and 2004, fractures were ascertained by reviewing radiography reports and personal interviews. Results The allelic frequencies of the Trp and the Arg alleles were 0.925 and 0.075 respectively, and the relative frequencies of genotypes Trp/Trp, Trp/Arg and Arg/Arg 0.857, 0.138 and 0.006 respectively. There was no significant association between BMI and ADRB3 genotypes (p = 0.10 in women and p = 0.68 in men. There was also no significant association between ADRB3 genotypes and lumbar spine or femoral neck BMD in either men and women. Furthermore, there were no significant association between ADRB3 genotypes and fracture risk in both women and men, either before or after adjusting for and, BMD and BMI. Conclusion The present data suggested that in Caucasian population the contribution of ADRB3 genotypes to the prediction of BMI, BMD and fracture risk is limited.

  12. Protocol for a randomized controlled trial on risk adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients

    Directory of Open Access Journals (Sweden)

    Rixen Dieter

    2009-08-01

    Full Text Available Abstract Background Fractures of the long bones and femur fractures in particular are common in multiple trauma patients, but the optimal management of femur fractures in these patients is not yet resolved. Although there is a trend towards the concept of "Damage Control Orthopedics" (DCO in the management of multiple trauma patients with long bone fractures as reflected by a significant increase in primary external fixation of femur fractures, current literature is insufficient. Thus, in the era of "evidence-based medicine", there is the need for a more specific, clarifying trial. Methods/Design The trial is designed as a randomized controlled open-label multicenter study. Multiple trauma patients with femur shaft fractures and a calculated probability of death between 20 and 60% will be randomized to either temporary fracture fixation with fixateur externe and defined secondary definitive treatment (DCO or primary reamed nailing (early total care. The primary objective is to reduce the extent of organ failure as measured by the maximum sepsis-related organ failure assessment (SOFA score. Discussion The Damage Control Study is the first to evaluate the risk adapted damage control orthopedic surgery concept of femur shaft fractures in multiple trauma patients in a randomized controlled design. The trial investigates the differences in clinical outcome of two currently accepted different ways of treating multiple trauma patients with femoral shaft fractures. This study will help to answer the question whether the "early total care" or the „damage control” concept is associated with better outcome. Trial registration Current Controlled Trials ISRCTN10321620

  13. Higher fish intake is associated with a lower risk of hip fractures in Chinese men and women: a matched case-control study.

    Directory of Open Access Journals (Sweden)

    Fan Fan

    Full Text Available OBJECTIVES: Fish is rich in nutrients that are favorable to bone health, but limited data are available regarding the relationship between fish intake and hip fractures. Our study examined the association between habitual fish intake and risk of hip fractures. METHODS: A case-control study was performed between June 2009 and June 2012 in Guangdong Province, China. Five hundred and eighty-one hip fracture incident cases, aged 55 to 80 years (mean: 71 years, were enrolled from four hospitals. 1∶1 matched controls by gender and age (±3 years were also recruited from communities and hospitals. Face-to-face interviews were used to obtain habitual dietary intake and information on various covariates. RESULTS: Univariate conditional logistic regression analyses showed significantly dose-dependent inverse correlations between the risk of hip fractures and the intake of fresh-water fish, sea fish, mollusca, shellfish, and total fish in all of the subjects (p-trend: <0.001-0.016. After adjusting for covariates, the associations were slightly attenuated but remained significant for all (p-trend: <0.001-0.017 except for fresh-water fish (p = 0.553. The ORs (95%CI of hip fractures for the highest (vs. lowest quartile were 0.80 (0.48-1.31 for fresh-water fish, 0.31 (0.18-0.52 for sea fish, 0.55 (0.34-0.88 for mollusca and shellfish, and 0.47 (0.28-0.79 for total fish, respectively. Stratified and interaction analyses showed that the association was more significant in males than in females (p-interaction = 0.052. CONCLUSION: Higher intake of seafood is independently associated with lower risk of hip fractures in elderly Chinese. Increasing consumption of sea fish may benefit the prevention of hip fractures in this population.

  14. Research progress on risk assessment of osteoporotic fracture patients%骨质疏松性骨折病人风险评估研究进展

    Institute of Scientific and Technical Information of China (English)

    陆宁; 王玉环

    2011-01-01

    从骨密度、骨折史、年龄和性别、骨转换标志、体质量/体质量指数、跌倒、糖皮质激素、吸烟与饮酒等方面介绍了骨质疏松性骨折风险评估研究进展,以筛检高危人群,预防骨折发生.%It introduced the research progress of risk assessment of osteo-porotic fracture from aspects of the bone density, fracture history, age and gender,bone turnover markers, body mass/body mass index, fall - down, glucocorticoids, smoking and drinking so as to screen the high -risk crowd and prevent occurrence of fracture

  15. Assesment risk of fracture in thin-walled fiber reinforced and regular High Performance Concretes sandwich elements

    DEFF Research Database (Denmark)

    Hodicky, Kamil; Hulin, Thomas; Schmidt, Jacob Wittrup;

    2013-01-01

    High Performance Concrete Sandwich Elements (HPCSE) are an interesting option for future low or plus energy building construction. Recent research and development work, however, indicate that such elements are prone to structural cracking due to the combined effect of shrinkage and high temperature...... load. Due to structural restraints, autogenous shrinkage may lead to high self-induced stresses. Therefore autogenous shrinkage plays important role in design of HPCSE. The present paper assesses risk of fracture due to autogenous shrinkage-induced stresses in three fiber reinforced and regular High...... Performance Concretes (HPC). The research work described in this paper contains a description of experimental setup that allows measurement of effective shrinkage in HPC, which develops on an elastic inhomogeneity embedded in HPC matrix undergoing shrinkage during hydration (autogenous shrinkage). The test...

  16. [Fractures of carpal bones].

    Science.gov (United States)

    Lögters, T; Windolf, J

    2016-10-01

    Fractures of the carpal bones are uncommon. On standard radiographs fractures are often not recognized and a computed tomography (CT) scan is the diagnostic method of choice. The aim of treatment is to restore pain-free and full functioning of the hand. A distinction is made between stable and unstable carpal fractures. Stable non-displaced fractures can be treated conservatively. Unstable and displaced fractures have an increased risk of arthritis and non-union and should be stabilized by screws or k‑wires. If treated adequately, fractures of the carpal bones have a good prognosis. Unstable and dislocated fractures have an increased risk for non-union. The subsequent development of carpal collapse with arthrosis is a severe consequence of non-union, which has a heterogeneous prognosis.

  17. Contribution of Genetic Background and Clinical Risk Factors to Low-Trauma Fractures in Human Immunodeficiency Virus (HIV)-Positive Persons: The Swiss HIV Cohort Study

    Science.gov (United States)

    Junier, Thomas; Rotger, Margalida; Biver, Emmanuel; Ledergerber, Bruno; Barceló, Catalina; Bartha, Istvan; Kovari, Helen; Schmid, Patrick; Fux, Christoph; Bernasconi, Enos; Brun del Re, Claudia; Weber, Rainer; Fellay, Jacques; Tarr, Philip E.

    2016-01-01

    Background. The impact of human genetic background on low-trauma fracture (LTF) risk has not been evaluated in the context of human immunodeficiency virus (HIV) and clinical LTF risk factors. Methods. In the general population, 6 common single-nucleotide polymorphisms (SNPs) associate with LTF through genome-wide association study. Using genome-wide SNP arrays and imputation, we genotyped these SNPs in HIV-positive, white Swiss HIV Cohort Study participants. We included 103 individuals with a first, physician-validated LTF and 206 controls matched on gender, whose duration of observation and whose antiretroviral therapy start dates were similar using incidence density sampling. Analyses of nongenetic LTF risk factors were based on 158 cases and 788 controls. Results. A genetic risk score built from the 6 LTF-associated SNPs did not associate with LTF risk, in both models including and not including parental hip fracture history. The contribution of clinical LTF risk factors was limited in our dataset. Conclusions. Genetic LTF markers with a modest effect size in the general population do not improve fracture prediction in persons with HIV, in whom clinical LTF risk factors are prevalent in both cases and controls.

  18. Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture

    NARCIS (Netherlands)

    Estrada, Karol; Styrkarsdottir, Unnur; Evangelou, Evangelos; Hsu, Yi-Hsiang; Duncan, Emma L.; Ntzani, Evangelia E.; Oei, Ling; Albagha, Omar M. E.; Amin, Najaf; Kemp, John P.; Koller, Daniel L.; Li, Guo; Liu, Ching-Ti; Minster, Ryan L.; Moayyeri, Alireza; Vandenput, Liesbeth; Willner, Dana; Xiao, Su-Mei; Yerges-Armstrong, Laura M.; Zheng, Hou-Feng; Alonso, Nerea; Eriksson, Joel; Kammerer, Candace M.; Kaptoge, Stephen K.; Leo, Paul J.; Thorleifsson, Gudmar; Wilson, Scott G.; Wilson, James F.; Aalto, Ville; Alen, Markku; Aragaki, Aaron K.; Aspelund, Thor; Center, Jacqueline R.; Dailiana, Zoe; Duggan, David J.; Garcia, Melissa; Garcia-Giralt, Natalia; Giroux, Sylvie; Hallmans, Goran; Hocking, Lynne J.; Husted, Lise Bjerre; Jameson, Karen A.; Khusainova, Rita; Kim, Ghi Su; Kooperberg, Charles; Koromila, Theodora; Kruk, Marcin; Laaksonen, Marika; Lacroix, Andrea Z.; Lee, Seung Hun; Leung, Ping C.; Lewis, Joshua R.; Masi, Laura; Mencej-Bedrac, Simona; Nguyen, Tuan V.; Nogues, Xavier; Patel, Millan S.; Prezelj, Janez; Rose, Lynda M.; Scollen, Serena; Siggeirsdottir, Kristin; Smith, Albert V.; Svensson, Olle; Trompet, Stella; Trummer, Olivia; van Schoor, Natasja M.; Woo, Jean; Zhu, Kun; Balcells, Susana; Brandi, Maria Luisa; Buckley, Brendan M.; Cheng, Sulin; Christiansen, Claus; Cooper, Cyrus; Dedoussis, George; Ford, Ian; Frost, Morten; Goltzman, David; Gonzalez-Macias, Jesus; Kahonen, Mika; Karlsson, Magnus; Khusnutdinova, Elza; Koh, Jung-Min; Kollia, Panagoula; Langdahl, Bente Lomholt; Leslie, William D.; Lips, Paul; Ljunggren, Osten; Lorenc, Roman S.; Marc, Janja; Mellstrom, Dan; Obermayer-Pietsch, Barbara; Olmos, Jose M.; Pettersson-Kymmer, Ulrika; Reid, David M.; Riancho, Jose A.; Ridker, Paul M.; Rousseau, Francois; Slagboom, P. Eline; Tang, Nelson L. S.; Urreizti, Roser; Van Hul, Wim; Viikari, Jorma; Zarrabeitia, Maria T.; Aulchenko, Yurii S.; Castano-Betancourt, Martha; Grundberg, Elin; Herrera, Lizbeth; Ingvarsson, Thorvaldur; Johannsdottir, Hrefna; Kwan, Tony; Li, Rui; Luben, Robert; Medina-Gomez, Carolina; Palsson, Stefan Th; Reppe, Sjur; Rotter, Jerome I.; Sigurdsson, Gunnar; van Meurs, Joyce B. J.; Verlaan, Dominique; Williams, Frances M. K.; Wood, Andrew R.; Zhou, Yanhua; Gautvik, Kaare M.; Pastinen, Tomi; Raychaudhuri, Soumya; Cauley, Jane A.; Chasman, Daniel I.; Clark, Graeme R.; Cummings, Steven R.; Danoy, Patrick; Dennison, Elaine M.; Eastell, Richard; Eisman, John A.; Gudnason, Vilmundur; Hofman, Albert; Jackson, Rebecca D.; Jones, Graeme; Jukema, J. Wouter; Khaw, Kay-Tee; Lehtimaki, Terho; Liu, Yongmei; Lorentzon, Mattias; McCloskey, Eugene; Mitchell, Braxton D.; Nandakumar, Kannabiran; Nicholson, Geoffrey C.; Oostra, Ben A.; Peacock, Munro; Pols, Huibert A. P.; Prince, Richard L.; Raitakari, Olli; Reid, Ian R.; Robbins, John; Sambrook, Philip N.; Sham, Pak Chung; Shuldiner, Alan R.; Tylavsky, Frances A.; van Duijn, Cornelia M.; Wareham, Nick J.; Cupples, L. Adrienne; Econs, Michael J.; Evans, David M.; Harris, Tamara B.; Kung, Annie Wai Chee; Psaty, Bruce M.; Reeve, Jonathan; Spector, Timothy D.; Streeten, Elizabeth A.; Zillikens, M. Carola; Thorsteinsdottir, Unnur; Ohlsson, Claes; Karasik, David; Richards, J. Brent; Brown, Matthew A.; Stefansson, Kari; Uitterlinden, Andre G.; Ralston, Stuart H.; Ioannidis, John P. A.; Kiel, Douglas P.; Rivadeneira, Fernando

    2012-01-01

    Bone mineral density (BMD) is the most widely used predictor of fracture risk. We performed the largest meta-analysis to date on lumbar spine and femoral neck BMD, including 17 genome-wide association studies and 32,961 individuals of European and east Asian ancestry. We tested the top BMD-associate

  19. Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture

    NARCIS (Netherlands)

    K. Estrada Gil (Karol); U. Styrkarsdottir (Unnur); E. Evangelou (Evangelos); Y.-H. Hsu; E.L. Duncan (Emma); E.E. Ntzani (Evangelia); L. Oei; O.M.E. Albagha (Omar M.); N. Amin (Najaf); J.P. Kemp (John); D.L. Koller (Daniel); G. Li (Guo); C.-T. Liu (Ching-Ti); R.L. Minster (Ryan); A. Moayyeri (Alireza); L. Vandenput (Liesbeth); D. Willner (Dana); S.-M. Xiao (Su-Mei); L.M. Yerges-Armstrong (Laura); H.-F. Zheng (Hou-Feng); N. Alonso (Nerea); J. Eriksson (Joel); C.M. Kammerer (Candace); S. Kaptoge (Stephen); P.J. Leo (Paul); G. Thorleifsson (Gudmar); S.G. Wilson (Scott); J.F. Wilson (James); V. Aalto (Ville); T.A. van Alen (Theo); A.K. Aragaki (Aaron); T. Aspelund (Thor); J.R. Center (Jacqueline); Z. Dailiana (Zoe); C. Duggan; M. Garcia (Melissa); N. Garcia-Giralt (Natàlia); S. Giroux (Sylvie); G. Hallmans (Göran); L.J. Hocking (Lynne); L.B. Husted; K. Jameson (Karen); R. Khusainova (Rita); G.S. Kim (Ghi Su); C. Kooperberg (Charles); T. Koromila (Theodora); M. Kruk (Marcin); M. Laaksonen (Marika); A.Z. LaCroix (Andrea); S.U. Lee (Seung); P.C. Leung (Ping); J.R. Lewis (Joshua); L. Masi (Laura); S. Mencej-Bedrac (Simona); T.V. Nguyen (Tuan); X. Nogues (Xavier); M.S. Patel (Millan); J. Prezelj (Janez); L.M. Rose (Lynda); S. Scollen (Serena); K. Siggeirsdottir (Kristin); G.D. Smith; O. Svensson (Olle); S. Trompet (Stella); O. Trummer (Olivia); N.M. van Schoor (Natasja); M.M. Woo (Margaret M.); K. Zhu (Kun); S. Balcells (Susana); M.L. Brandi; B.M. Buckley (Brendan M.); S. Cheng (Sulin); C. Christiansen; C. Cooper (Charles); G.V. Dedoussis (George); I. Ford (Ian); M. Frost (Morten); D. Goltzman (David); J. González-Macías (Jesús); M. Kähönen (Mika); M. Karlsson (Magnus); E.K. Khusnutdinova (Elza); J.-M. Koh (Jung-Min); P. Kollia (Panagoula); B.L. Langdahl (Bente); W.D. Leslie (William); P. Lips (Paul); O.̈. Ljunggren; R. Lorenc (Roman); J. Marc (Janja); D. Mellström (Dan); B. Obermayer-Pietsch (Barbara); D. Olmos (David); U. Pettersson-Kymmer (Ulrika); D.M. Reid (David); J.A. Riancho; P.M. Ridker (Paul); M.F. Rousseau (Francois); P.E.S. Lagboom (P Eline); N.L.S. Tang (Nelson L.); R. Urreizti (Roser); W. Van Hul (Wim); J. Viikari (Jorma); M.T. Zarrabeitia (María); Y.S. Aulchenko (Yurii); M.C. Castaño Betancourt (Martha); E. Grundberg (Elin); L. Herrera (Lizbeth); T. Ingvarsson (Torvaldur); H. Johannsdottir (Hrefna); T. Kwan (Tony); R. Li (Rui); R.N. Luben (Robert); M.C. Medina-Gomez (Carolina); S. Th Palsson (Stefan); S. Reppe (Sjur); J.I. Rotter (Jerome); G. Sigurdsson (Gunnar); J.B.J. van Meurs (Joyce); D.J. Verlaan (Dominique); F.M. Williams (Frances); A.R. Wood (Andrew); Y. Zhou (Yanhua); K.M. Gautvik (Kaare); T. Pastinen (Tomi); S. Raychaudhuri (Soumya); J.A. Cauley (Jane); D.I. Chasman (Daniel); G.R. Clark (Graeme); S. Cummings; P. Danoy (Patrick); E.M. Dennison (Elaine); R. Eastell (Richard); J.A. Eisman (John); V. Gudnason (Vilmundur); A. Hofman (Albert); R.D. Jackson (Rebecca); G. Jones (Graeme); J.W. Jukema (Jan Wouter); K-T. Khaw (Kay-Tee); T. Lehtimäki (Terho); Y. Liu (Yongmei); M. Lorentzon (Mattias); E. McCloskey; B.D. Mitchell (Braxton); K. Nandakumar (Kannabiran); G.C. Nicholson (Geoffrey); B.A. Oostra (Ben); M. Peacock (Munro); H.A.P. Pols (Huib); R.L. Prince (Richard); O. Raitakari (Olli); I.R. Reid (Ian); J. Robbins (John); P.N. Sambrook (Philip); P.C. Sham (Pak); A.R. Shuldiner (Alan); F.A. Tylavsky (Frances); C.M. van Duijn (Cock); N.J. Wareham (Nick); L.A. Cupples (Adrienne); M.J. Econs (Michael); D.M. Evans (David); T.B. Harris (Tamara); A.W.C. Kung (Annie); B.M. Psaty (Bruce); J. Reeve (Jonathan); T.D. Spector (Timothy); E.A. Streeten (Elizabeth); M.C. Zillikens (Carola); U. Thorsteinsdottir (Unnur); C. Ohlsson (Claes); D. Karasik (David); J.B. Richards (Brent); M.A. Brown (Matthew); J-A. Zwart (John-Anker); A.G. Uitterlinden (André); S.H. Ralston (Stuart); J.P.A. Ioannidis (John); D.P. Kiel (Douglas); F. Rivadeneira Ramirez (Fernando)

    2012-01-01

    textabstractBone mineral density (BMD) is the most widely used predictor of fracture risk. We performed the largest meta-analysis to date on lumbar spine and femoral neck BMD, including 17 genome-wide association studies and 32,961 individuals of European and east Asian ancestry. We tested the top B

  20. Reanalysis of two studies with contrasting results on the association between statin use and fracture risk : the General Practice Research Database

    NARCIS (Netherlands)

    de Vries, Frank; de Vries, Corinne; Cooper, Cyrus; Leufkens, Bert; van Staa, Tjeerd-Pieter

    2006-01-01

    BACKGROUND: Two recent case-control studies by Meier et al. and van Staa et al. used the UK General Practice Research Database (GPRD) to examine the association between the use of statins and the risk of fractures, with different results. The objective of the present study was to examine methodologi

  1. Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture

    DEFF Research Database (Denmark)

    Estrada, Karol; Styrkarsdottir, Unnur; Evangelou, Evangelos;

    2012-01-01

    Bone mineral density (BMD) is the most widely used predictor of fracture risk. We performed the largest meta-analysis to date on lumbar spine and femoral neck BMD, including 17 genome-wide association studies and 32,961 individuals of European and east Asian ancestry. We tested the top BMD-associ...

  2. Design for minimizing fracture risk of all-ceramic cantilever dental bridge.

    Science.gov (United States)

    Zhang, Zhongpu; Zhou, Shiwei; Li, Eric; Li, Wei; Swain, Michael V; Li, Qing

    2015-01-01

    Minimization of the peak stresses and fracture incidence induced by mastication function is considered critical in design of all-ceramic dental restorations, especially for cantilever fixed partial dentures (FPDs). The focus of this study is on developing a mechanically-sound optimal design for all-ceramic cantilever dental bridge in a posterior region. The topology optimization procedure in association with Extended Finite Element Method (XFEM) is implemented here to search for the best possible distribution of porcelain and zirconia materials in the bridge structure. The designs with different volume fractions of zirconia are considered. The results show that this new methodology is capable of improving FPD design by minimizing incidence of crack in comparison with the initial design. Potentially, it provides dental technicians with a new design tool to develop mechanically sound cantilever fixed partial dentures for more complicated clinical situation. PMID:26405963

  3. Calibration with Absolute Shrinkage

    DEFF Research Database (Denmark)

    Øjelund, Henrik; Madsen, Henrik; Thyregod, Poul

    2001-01-01

    In this paper, penalized regression using the L-1 norm on the estimated parameters is proposed for chemometric je calibration. The algorithm is of the lasso type, introduced by Tibshirani in 1996 as a linear regression method with bound on the absolute length of the parameters, but a modification...

  4. Radiation-Induced Rib Fractures After Hypofractionated Stereotactic Body Radiation Therapy: Risk Factors and Dose-Volume Relationship

    Energy Technology Data Exchange (ETDEWEB)

    Asai, Kaori [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp [Department of Heavy Particle Therapy and Radiation Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Nakamura, Katsumasa; Sasaki, Tomonari; Ohga, Saiji; Nonoshita, Takeshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Yoshitake, Tadamasa [Department of Heavy Particle Therapy and Radiation Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Ohnishi, Kayoko [Department of Radiology, National Center for Global Health and Medicine, Tokyo (Japan); Terashima, Kotaro; Matsumoto, Keiji [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Hirata, Hideki [Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)

    2012-11-01

    Purpose: The purpose of this study was to clarify the incidence, the clinical risk factors, and the dose-volume relationship of radiation-induced rib fracture (RIRF) after hypofractionated stereotactic body radiation therapy (SBRT). Methods and Materials: One hundred sixteen patients treated with SBRT for primary or metastatic lung cancer at our institution, with at least 6 months of follow-up and no previous overlapping radiation exposure, were included in this study. To determine the clinical risk factors associated with RIRF, correlations between the incidence of RIRF and the variables, including age, sex, diagnosis, gross tumor volume diameter, rib-tumor distance, and use of steroid administration, were analyzed. Dose-volume histogram analysis was also conducted. Regarding the maximum dose, V10, V20, V30, and V40 of the rib, and the incidences of RIRF were compared between the two groups divided by the cutoff value determined by the receiver operating characteristic curves. Results: One hundred sixteen patients and 374 ribs met the inclusion criteria. Among the 116 patients, 28 patients (46 ribs) experienced RIRF. The estimated incidence of rib fracture was 37.7% at 3 years. Limited distance from the rib to the tumor (<2.0 cm) was the only significant risk factor for RIRF (p = 0.0001). Among the dosimetric parameters used for receiver operating characteristic analysis, the maximum dose showed the highest area under the curve. The 3-year estimated risk of RIRF and the determined cutoff value were 45.8% vs. 1.4% (maximum dose, {>=}42.4 Gy or less), 51.6% vs. 2.0% (V40, {>=}0.29 cm{sup 3} or less), 45.8% vs. 2.2% (V30, {>=}1.35 cm{sup 3} or less), 42.0% vs. 8.5% (V20, {>=}3.62 cm{sup 3} or less), or 25.9% vs. 10.5% (V10, {>=}5.03 cm{sup 3} or less). Conclusions: The incidence of RIRF after hypofractionated SBRT is relatively high. The maximum dose and high-dose volume are strongly correlated with RIRF.

  5. Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk--a meta-analysis

    DEFF Research Database (Denmark)

    Vestergaard, P; Jørgensen, Niklas R; Mosekilde, L;

    2007-01-01

    AIM: The effects of parathyroid hormone (PTH) alone or in combination with antiresorptive therapy on changes in bone mineral density (BMD) and fracture risk were studied. MATERIALS AND METHODS: Randomised placebo controlled trials were retrieved from the PubMed, Web of Science or Embase databases....... RESULTS: PTH alone or in combination with antiresorptive drugs reduced vertebral [relative risk (RR)=0.36, 95% confidence interval (CI): 0.28-0.47, 2p

  6. Estimating the avoidable burden of certain modifiable risk factors in osteoporotic hip fracture using Generalized Impact Fraction (GIF) model in Iran

    OpenAIRE

    Shahnazari, Banafsheh; Keshtkar, Abbasali; Soltani, Akbar; Aghamaleki, Aria; Mansour, Asieh; Matin, Bahar; Saghafi, Sharareh; Dini, Mahboubeh; Khashayar, Patricia; Bagher LARIJANI

    2013-01-01

    Backgrounds The number of hip fractures, the most common complication of osteoporosis, has increased rapidly over the past decades. The goal of this study is to estimate the avoidable burden of certain modifiable risk factor of the condition using the Generalized Impact Fraction (GIF) model, which has been suggested and used by epidemiologists to overcome the drawbacks associated with the use of Attributable Fraction index. In addition to preventing a risk factor or the avoidable fraction of ...

  7. Assessment of the risk factors for impending fractures following radiotherapy for long bone metastases using CT scan-based virtual simulation: a retrospective study

    International Nuclear Information System (INIS)

    Radiotherapy for long bone metastases (RTLB) can be complicated by fractures, which considerably increase morbidity and mortality. The aim of this study was to analyze the risk factors for impending fractures following radiotherapy for long bone metastases (RTLB) using CT scan-based virtual simulation. Forty-seven (47) patients were treated with RTLB (18 lung, 11 breast, 10 prostate and 8 other cancers) for a period of 18 months. Two doctors analyzed the CT images prior to radiation therapy. The impending fractures were then monitored and the correlation between bone scan parameters and fracture occurrence was analyzed. The male gender ratio was 0.57 and the mean age 62.8 (33–93) years. The average size of the metastatic lesions was 32 (8–87) x 2 (6–81) x 52 (7–408) mm with cortical involvement (CI) in 66% of cases. The site was in the upper third of the bone in 92% of cases (28 femoral, 17 humeral and two tibial). Ten fractures occurred: two during RTLB, seven after one month and one after 6.6 months. The fractured lesions measured 48 (17–87) x 34 (12–66) x 76 (38–408) mm. The predictive parameters for fracture were osteolytic (39% vs. 10%; p = 0.02) and permeative lesions (42% vs. 0%; p < 0.0005), a Mirels score ≥9 (42% vs. 0%; p < 0.0005), circumferential CI ≥30% (71% vs. 0%, p < 0.00001), CI ≥45 mm in height (67% vs. 0%, p < 0.00001) and CI in thickness =100% (40% vs. 0%; p = 0.0008). In the multivariate analysis, circumferential CI ≥30% was the only predictive parameter for fracture (p = 0.00035; OR = 62; CI 95%: 6.5-595). Overall survival was 91% and 40% at one month and twelve months respectively. Prophylactic primary fixation surgery should always be considered when the circumferential CI ≥30%

  8. Five-year alendronate treatment outcome in older postmenopausal Japanese women with osteoporosis or osteopenia and clinical risk factors for fractures

    Directory of Open Access Journals (Sweden)

    Jun Iwamoto

    2009-09-01

    Full Text Available Jun Iwamoto1, Atsushi Miyata2, Yoshihiro Sato3, Tsuyoshi Takeda1, Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan; 2Department of Internal Medicine, Yahata Clinic, Tokyo, Japan; 3Department of Neurology, Mitate Hospital, Fukuoka, JapanAbstract: A retrospective study was conducted to evaluate the outcome of treatment with alendronate (ALN for 5 years in postmenopausal Japanese women with an increased risk of fractures. Forty postmenopausal Japanese women with osteoporosis or osteopenia and clinical risk factors for fractures (mean age: 75.4 years were analyzed; 33 patients were treated with alendronate and 7 were treated with alfacalcidol (ALF, controls in an outpatient clinic run by general practitioners. The metacarpal bone mineral density (BMD measured using a computed X-ray densitometer, urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX, and serum levels of alkaline phosphatase (ALP were monitored during the 5-year treatment period. The urinary NTX and serum ALP levels decreased significantly in the ALN group, compared with the ALF group. The metacarpal BMD was sustained in the ALN group but decreased significantly in the ALF group; the difference between these two groups was also significant. The present study evaluated the outcome of treatment with ALN for 5 years in postmenopausal Japanese women with osteoporosis or osteopenia and clinical risk factors for fractures. ALN successfully suppressed bone turnover and sustained the metacarpal BMD over the 5-year period of treatment in postmenopausal Japanese women with an increased risk of fractures.Keywords: alendronate, osteoporosis, osteopenia, risk factors for fractures, postmenopausal women

  9. Validation of three tools for identifying painful new osteoporotic vertebral fractures in older Chinese men: bone mineral density, Osteoporosis Self-Assessment Tool for Asians, and fracture risk assessment tool

    Directory of Open Access Journals (Sweden)

    Lin JS

    2016-04-01

    Full Text Available JiSheng Lin,* Yong Yang,* Qi Fei, XiaoDong Zhang, Zhao Ma, Qi Wang, JinJun Li, Dong Li, Qian Meng, BingQiang Wang Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China *These authors contributed equally to this work Objective: This cross-sectional study compared three tools for predicting painful new osteoporotic vertebral fractures (PNOVFs in older Chinese men: bone mineral density (BMD, the Osteoporosis Self-Assessment Tool for Asians (OSTA, and the World Health Organization fracture risk assessment tool (FRAX (without BMD. Methods: Men aged ≥50 years were apportioned to a group for men with fractures who had undergone percutaneous vertebroplasty (n=111, or a control group of healthy men (n=385. Fractures were verified on X-ray and magnetic resonance imaging. BMD T-scores were determined by dual energy X-ray absorptiometry. Diagnosis of osteoporosis was determined by a BMD T-score of ≤2.5 standard deviations below the average for a young adult at peak bone density at the femoral neck, total hip, or L1–L4. Demographic and clinical risk factor data were self-reported through a questionnaire. BMD, OSTA, and FRAX scores were assessed for identifying PNOVFs via receiver-operating characteristic (ROC curves. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs were determined. Results: Between the men with fractures and the control group, there were significant differences in BMD T-scores (at femoral neck, total hip, and L1–L4, and OSTA and FRAX scores. In those with fractures, only 53.15% satisfied the criteria for osteoporosis. Compared to BMD or OSTA, the FRAX score had the best predictive value for PNOVFs: the AUC of the FRAX score (cutoff =2.9% was 0.738, and the sensitivity and specificity were 82% and 62%, respectively. Conclusion: FRAX may be a valuable tool for identifying PNOVFs in older Chinese men. Keywords: osteoporosis, male

  10. Support to the identification of potential risks for the environment and human health arising from hydrocarbons operations involving hydraulic fracturing in Europe

    Energy Technology Data Exchange (ETDEWEB)

    Broomfield, L.; Lelland, A.

    2012-09-15

    The potential risks for the environment and human health arising from shale gas production (hydraulic fracturing) in Europe are assessed. As readily accessible oil and gas reserves are becoming progressively limited, the energy supply industry is turning more to unconventional reserves, which were previously too complex or too expensive to extract, like shale gas. There are significant shale gas reserves in Europe. Permission is being sought in many EU Member States for exploratory works and to bring forward projects for hydraulic fracturing and extraction of shale gas. As with any drilling and extraction process, shale gas extraction brings environmental and health risks which need to be understood and addressed. CE Delft conducted the legal assessment on shale gas related EU legislation. Gaps and uncertainties have been addressed, but no real risks within the legislation have been discovered. A large part of the shale gas related legislation is part of the individual member states legislation and not directly addressed by EU legislation.

  11. Indirect restorations for severe tooth wear: Fracture risk and layer thickness

    NARCIS (Netherlands)

    Hamburger, J.T.; Opdam, N.J.M.; Bronkhorst, E.M.; Huysmans, M.C.D.N.J.M.

    2014-01-01

    OBJECTIVES: This in vitro study investigated static failure risk related to restoration layer thickness for different indirect materials and compare them to direct composites. METHODS: Two ceramics (IPS e-max CAD, EmpressCAD (Ivoclar Vivadent)), two indirect composites (Estenia (Kuraray), Sinfony (3

  12. Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences

    Directory of Open Access Journals (Sweden)

    Fisher Alexander A

    2012-02-01

    Full Text Available Abstract Background Data on clinical characteristics and outcomes in regard to hip fracture (HF type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type. Methods Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 ± 8.8 years; 74.9% women with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH vitamin D, PTH, leptin, adiponectin and resistin were determined. Results The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF. Conclusions Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms.

  13. ABSOLUTE POLARIMETRY AT RHIC.

    Energy Technology Data Exchange (ETDEWEB)

    OKADA; BRAVAR, A.; BUNCE, G.; GILL, R.; HUANG, H.; MAKDISI, Y.; NASS, A.; WOOD, J.; ZELENSKI, Z.; ET AL.

    2007-09-10

    Precise and absolute beam polarization measurements are critical for the RHIC spin physics program. Because all experimental spin-dependent results are normalized by beam polarization, the normalization uncertainty contributes directly to final physics uncertainties. We aimed to perform the beam polarization measurement to an accuracy Of {Delta}P{sub beam}/P{sub beam} < 5%. The absolute polarimeter consists of Polarized Atomic Hydrogen Gas Jet Target and left-right pairs of silicon strip detectors and was installed in the RHIC-ring in 2004. This system features proton-proton elastic scattering in the Coulomb nuclear interference (CNI) region. Precise measurements of the analyzing power A{sub N} of this process has allowed us to achieve {Delta}P{sub beam}/P{sub beam} = 4.2% in 2005 for the first long spin-physics run. In this report, we describe the entire set up and performance of the system. The procedure of beam polarization measurement and analysis results from 2004-2005 are described. Physics topics of AN in the CNI region (four-momentum transfer squared 0.001 < -t < 0.032 (GeV/c){sup 2}) are also discussed. We point out the current issues and expected optimum accuracy in 2006 and the future.

  14. Absolute polarimetry at RHIC

    CERN Document Server

    Okada, H; Bravar, A; Bunce, G; Dhawan, S; Eyser, K O; Gill, R; Haeberli, W; Huang, H; Jinnouchi, O; Makdisi, Y; Nakagawa, I; Nass, A; Saitô, N; Stephenson, E; Sviridia, D; Wise, T; Wood, J; Zelenski, A

    2007-01-01

    Precise and absolute beam polarization measurements are critical for the RHIC spin physics program. Because all experimental spin-dependent results are normalized by beam polarization, the normalization uncertainty contributes directly to final physics uncertainties. We aimed to perform the beam polarization measurement to an accuracy of $\\Delta P_{beam}/P_{beam} < 5%$. The absolute polarimeter consists of Polarized Atomic Hydrogen Gas Jet Target and left-right pairs of silicon strip detectors and was installed in the RHIC-ring in 2004. This system features \\textit{proton-proton} elastic scattering in the Coulomb nuclear interference (CNI) region. Precise measurements of the analyzing power $A_N$ of this process has allowed us to achieve $\\Delta P_{beam}/P_{beam} =4.2%$ in 2005 for the first long spin-physics run. In this report, we describe the entire set up and performance of the system. The procedure of beam polarization measurement and analysis results from 2004-2005 are described. Physics topics of $A...

  15. Hip fracture risk in relation to vitamin D supplementation and serum 25-hydroxyvitamin D levels: a systematic review and meta-analysis of randomised controlled trials and observational studies

    Directory of Open Access Journals (Sweden)

    Roddam Andrew W

    2010-06-01

    Full Text Available Abstract Background Vitamin D supplementation for fracture prevention is widespread despite conflicting interpretation of relevant randomised controlled trial (RCT evidence. This study summarises quantitatively the current evidence from RCTs and observational studies regarding vitamin D, parathyroid hormone (PTH and hip fracture risk. Methods We undertook separate meta-analyses of RCTs examining vitamin D supplementation and hip fracture, and observational studies of serum vitamin D status (25-hydroxyvitamin D (25(OHD level, PTH and hip fracture. Results from RCTs were combined using the reported hazard ratios/relative risks (RR. Results from case-control studies were combined using the ratio of 25(OHD and PTH measurements of hip fracture cases compared with controls. Original published studies of vitamin D, PTH and hip fracture were identified through PubMed and Web of Science databases, searches of reference lists and forward citations of key papers. Results The seven eligible RCTs identified showed no significant difference in hip fracture risk in those randomised to cholecalciferol or ergocalciferol supplementation versus placebo/control (RR = 1.13[95%CI 0.98-1.29]; 801 cases, with no significant difference between trials of 21 (heterogeneity = 51.02, p 216 (heterogeneity = 137.9, p 29 (heterogeneity = 149.68, p Conclusions Neither higher nor lower dose vitamin D supplementation prevented hip fracture. Randomised and observational data on vitamin D and hip fracture appear to differ. The reason for this is unclear; one possible explanation is uncontrolled confounding in observational studies. Post-fracture PTH levels are unrelated to hip fracture risk.

  16. Risks and security measures of oil well fracturing%浅析油井压裂的风险及安全对策

    Institute of Scientific and Technical Information of China (English)

    陈利琴

    2015-01-01

    本文对油井压裂过程中会出现的若干风险进行分析,并列举出安全措施,对人员和企业设备提供安全保障。%Risks in oil well fracturing process are analyzed and safety measures are listed in this paper to provide security for the staff and enterprise equipment.

  17. Cost-effectiveness of quantitative ultrasound as a technique for screening of osteoporotic fracture risk: report on a health technology assessment conducted in 2001

    OpenAIRE

    Wasem, Jürgen; Hessel, Franz; Aidelsburger, Pamela

    2004-01-01

    Aim: On behalf of the German Agency for Health Technology Assessment (DAHTA@DIMDI) a rapid economic HTA was conducted. Aim of the HTA was to evaluate the cost-effectiveness of quantitative ultrasound (QUS) for screening of osteoporotic fracture risk. Study population was formed by postmenopausal women. QUS was compared to the dual X-ray absorptiometry (DXA) as the most frequently used method of measurement. Methods: According to the recommendations for rapid economic HTA a comprehensive liter...

  18. Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study

    OpenAIRE

    Kragh Ekstam, Annika

    2016-01-01

    Annika Kragh Ekstam,1,2 Sölve Elmståhl1 1Division of Geriatric Medicine, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, 2Department of Medicine, Hässleholm Hospital, Hässleholm, Sweden Objective: The aim of this study was to assess the mortality in hip fracture patients with regard to use of fall-risk-increasing drugs (FRIDs), by comparing survival in exposed and nonexposed individua...

  19. Optical tweezers absolute calibration

    CERN Document Server

    Dutra, R S; Neto, P A Maia; Nussenzveig, H M

    2014-01-01

    Optical tweezers are highly versatile laser traps for neutral microparticles, with fundamental applications in physics and in single molecule cell biology. Force measurements are performed by converting the stiffness response to displacement of trapped transparent microspheres, employed as force transducers. Usually, calibration is indirect, by comparison with fluid drag forces. This can lead to discrepancies by sizable factors. Progress achieved in a program aiming at absolute calibration, conducted over the past fifteen years, is briefly reviewed. Here we overcome its last major obstacle, a theoretical overestimation of the peak stiffness, within the most employed range for applications, and we perform experimental validation. The discrepancy is traced to the effect of primary aberrations of the optical system, which are now included in the theory. All required experimental parameters are readily accessible. Astigmatism, the dominant effect, is measured by analyzing reflected images of the focused laser spo...

  20. Risk Factors for Non-:union: Fractures of the Clavicle Mid-shift Following the Use of Non-surgical Treatment on Patients Admitted to Poursina Hospital, 2010 - 2012

    Directory of Open Access Journals (Sweden)

    kamran Asadi

    2015-02-01

    Conclusions: Recognition and predicting the risk factors of non-:::union::: in patients with fractures of the middle third of the clavicle could be a clinical guideline for the selection of surgical or non-surgical treatment.

  1. Factores de riesgo de fracturas por fragilidad en una cohorte de mujeres españolas Risk factors for fragility fractures in a cohort of Spanish women

    Directory of Open Access Journals (Sweden)

    Cristian Tebé

    2011-12-01

    Full Text Available Introducción: Las fracturas por fragilidad constituyen un problema de salud pública. El objetivo fue analizar la asociación de los principales factores de riesgo de osteoporosis con la fracturas por fragilidad en una cohorte de mujeres con indicación de densitometría ósea. Métodos: Cohorte retrospectiva con seguimiento hasta una fractura por fragilidad, de una población de mujeres de 40 a 90 años de edad con una primera visita para realizarse una densitometría entre enero de 1992 y febrero de 2008. Se calcularon la tasa de incidencia de fracturas por 1000 mujeres-año de seguimiento y la hazard ratio (HR de fractura mediante un modelo de regresión de Cox. Resultados: Se estudiaron 49.735 mujeres con una edad media de 57,8 años (desviación estándar: 8,5. De ellas, 3631 mujeres (7,1% declararon al menos una fractura por fragilidad en las visitas posteriores a la basal. Los factores de riesgo con una mayor HR ajustada fueron la edad >75 años respecto a Introduction: Fragility fractures are an important public health issue. The aim of this study was to analyze the association of the main osteoporotic risk factors related to fragility fracture in a cohort of women with an indication of bone densitometry (BD. Methods: A retrospective cohort was followed-up until a fragile fracture occurred, in a population of women aged 40 to 90 years with a first visit for BD between January 1992 and February 2008. We calculated the incidence rate of fracture per 1000 women-years of follow-up, and the hazard ratio (HR of fragile fracture using a Cox regression model. Results: A total of 49,735 women were studied. The average age of participants was 57.8 years (SD: 8.5. Of these, 3631 women (7.1% reported a new fragility fracture in post-baseline visits. Risk factors with higher adjusted HR were age > 75 years compared with age < 55 years (HR: 3.8; 95% CI: 3.3-4.4 and having a BC result evaluated as osteoporosis compared to normal (HR: 2.0; 95% CI: 1

  2. Stress fractures in athletes.

    Science.gov (United States)

    Hulkko, A; Orava, S

    1987-06-01

    During the 14-year period of 1971-1985, 368 stress fractures in 324 athletes were treated. The series contained 268 fractures in males and 100 fractures in females; 32 fractures occurred in children (less than 16 years), 117 in adolescents (16-19 years), and 219 in adults. Forty-six fractures were incurred by athletes at an international level, 274 by athletes at a national or district level and 48 by recreational athletes. Of the total cases, 72% occurred to runners and a further 12% to athletes in other sports after running exercises. The distribution of the stress fractures by site was: tibia 182, metatarsal bones 73, fibula 44, big toe sesamoid bones 15, femoral shaft 14, femoral neck 9, tarsal navicular 9, pelvis 7, olecranon 5 and other bones 10. Of the total fractures, 342 were treated conservatively and 26 fractures required surgical treatment. The operative indication was dislocation in 5 cases and delayed union/nonunion in 21 cases. The sites most often affected by delayed union were: anterior midtibia, sesamoid bones of the big toe, base of the fifth metatarsal, olecranon, and tarsal navicular. The athletes at an international level experienced the greatest risk of multiple separate fractures, protracted healing, or fractures requiring surgery. PMID:3623785

  3. Risk of maltreatment-related injury: a cross-sectional study of children under five years old admitted to hospital with a head or neck injury or fracture.

    Directory of Open Access Journals (Sweden)

    Joseph Jonathan Lee

    Full Text Available OBJECTIVES: To determine the predictive value and sensitivity of demographic features and injuries (indicators for maltreatment-related codes in hospital discharge records of children admitted with a head or neck injury or fracture. METHODS: STUDY DESIGN: Population-based, cross sectional study. SETTING: NHS hospitals in England. SUBJECTS: Children under five years old admitted acutely to hospital with head or neck injury or fracture. DATA SOURCE: Hospital Episodes Statistics, 1997 to 2009. MAIN OUTCOME MEASURE: Maltreatment-related injury admissions, defined by ICD10 codes, were used to calculate for each indicator (demographic feature and/or type of injury: i the predictive value (proportion of injury admissions that were maltreatment-related; ii sensitivity (proportion of all maltreatment-related injury admissions with the indicator. RESULTS: Of 260,294 childhood admissions for fracture or head or neck injury, 3.2% (8,337 were maltreatment-related. With increasing age of the child, the predictive value for maltreatment-related injury declined but sensitivity increased. Half of the maltreatment-related admissions occurred in children older than one year, and 63% occurred in children with head injuries without fractures or intracranial injury. CONCLUSIONS: Highly predictive injuries accounted for very few maltreatment-related admissions. Protocols that focus on high-risk injuries may miss the majority of maltreated children.

  4. Vertebral Fracture Prediction

    DEFF Research Database (Denmark)

    2008-01-01

    Vertebral Fracture Prediction A method of processing data derived from an image of at least part of a spine is provided for estimating the risk of a future fracture in vertebraeof the spine. Position data relating to at least four neighbouring vertebrae of the spine is processed. The curvature...... of the spine at at least two of the neighbouring vertebrae is calculated. The different curvature values are computed to obtain a value representative of the degree of irregularity in curvature of the spine and using the degree of irregularity, an estimate of the risk of a future fracture in vertebrae...

  5. A review on risk assessment techniques for hydraulic fracturing water and produced water management implemented in onshore unconventional oil and gas production.

    Science.gov (United States)

    Torres, Luisa; Yadav, Om Prakash; Khan, Eakalak

    2016-01-01

    The objective of this paper is to review different risk assessment techniques applicable to onshore unconventional oil and gas production to determine the risks to water quantity and quality associated with hydraulic fracturing and produced water management. Water resources could be at risk without proper management of water, chemicals, and produced water. Previous risk assessments in the oil and gas industry were performed from an engineering perspective leaving aside important social factors. Different risk assessment methods and techniques are reviewed and summarized to select the most appropriate one to perform a holistic and integrated analysis of risks at every stage of the water life cycle. Constraints to performing risk assessment are identified including gaps in databases, which require more advanced techniques such as modeling. Discussions on each risk associated with water and produced water management, mitigation strategies, and future research direction are presented. Further research on risks in onshore unconventional oil and gas will benefit not only the U.S. but also other countries with shale oil and gas resources. PMID:26386446

  6. The incidence of fragility fractures in Italy.

    Science.gov (United States)

    Ratti, Chiara; Vulcano, Ettore; La Barbera, Giuseppe; Canton, Gianluca; Murena, Luigi; Cherubino, Paolo

    2013-10-01

    Osteoporosis can significantly impact on the risk of developing a fracture. Thus, fragility fractures represent a challenge for health professionals and decision makers of the twenty-first century. The aim of this work is to review the literature concerning osteoporotic fractures in Italy in terms of incidence, rate of hospitalization, relative risk of a new fragility fracture, and costs for the national health system. It was estimated that the costs of treating proximal femur fragility fractures in 2002 summed up to 1 billion Euros. The number of fragility fractures in Italy was calculated as follows: 91.494 hip fractures, 61.009 clinical vertebral fractures, 57.401 humeral fragility fractures, and 94.045 forearm/wrist fragility fractures. The incidence of fragility fractures in Italy is very high, and osteoporosis is the leading cause of morbidity in the Italian population. PMID:24046040

  7. SACRAL FRACTURES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. To delineate the clinical spectrum and treatment choice of sacral fractures.Methods. In this series, 39 sacral fractures were retrospectively reviewed and classified utilizing Denis′ classification. There were 21 Zone Ⅰ fractures, 6 Zone Ⅱ fractures and 12 Zone Ⅲ fractures. Neurological deficits were present in seven patients. Thirty seven patients were treated conservatively and two underwent surgical management.Results.Thirty eight patients were followed up for three months to 19 years. Thirty three have recovered, four improved, and one remained disabled.Conclusion.The treatment of sacral fractures requires assessment of pelvic stability and existing nerve injury. The patients with pelvic ring instability and neurological deficits should be treated with fracture reduction and stability reconstruction. When the patients with pelvic fracture are complicated with neurological deficits, sacral fracture should be first suspected. Once the diagnosis of sacral fracture is made, fracture reduction should be indicated. Conservative treatment usually permits satisfactory results.

  8. Age-dependent fracture risk in hip revisions with radial impaction grafting technique: a 5-10 year medium-term follow-up study.

    Science.gov (United States)

    Chomrikh, Laila; Gebuhr, Peter; Bierling, Roelf; Lind, Ulla; Zwart, Hendrik J J

    2014-02-01

    Radial impaction grafting (RIG) potentially improves the durability and reliability of cementing the femoral components in revision total hip arthroplasty (THA). In this multicenter, prospective study, 88 revision THAs (87 patients) with RIG technique were performed. The average follow-up time was 7.0 years (range, 5.0-10.2). There were 14 femur fractures: 2 intraoperative, 5 within 3 months after surgery, and 7 later in the postoperative stage (range, 5-84 months). Sixteen patients were lost to follow-up and 20 died without stem re-revision. None of the patients have been re-revised for any reason during follow-up. Age was observed to be a significant factor for determining fracture risk. In conclusion, RIG can be considered a reliable surgical technique, especially for younger patients. PMID:23891061

  9. Atypical fractures on long term bisphosphonates therapy.

    LENUS (Irish Health Repository)

    Hussein, W

    2011-01-01

    Bisphosphonates reduce fractures risk in patients with osteoporosis. A new pattern of fractures is now being noted in patients on prolonged bisphosphonate therapy. We report a case of an atypical femoral fracture with preceding pain and highlight the characteristics of these fractures.

  10. Estimating Absolute Site Effects

    Energy Technology Data Exchange (ETDEWEB)

    Malagnini, L; Mayeda, K M; Akinci, A; Bragato, P L

    2004-07-15

    The authors use previously determined direct-wave attenuation functions as well as stable, coda-derived source excitation spectra to isolate the absolute S-wave site effect for the horizontal and vertical components of weak ground motion. They used selected stations in the seismic network of the eastern Alps, and find the following: (1) all ''hard rock'' sites exhibited deamplification phenomena due to absorption at frequencies ranging between 0.5 and 12 Hz (the available bandwidth), on both the horizontal and vertical components; (2) ''hard rock'' site transfer functions showed large variability at high-frequency; (3) vertical-motion site transfer functions show strong frequency-dependence, and (4) H/V spectral ratios do not reproduce the characteristics of the true horizontal site transfer functions; (5) traditional, relative site terms obtained by using reference ''rock sites'' can be misleading in inferring the behaviors of true site transfer functions, since most rock sites have non-flat responses due to shallow heterogeneities resulting from varying degrees of weathering. They also use their stable source spectra to estimate total radiated seismic energy and compare against previous results. they find that the earthquakes in this region exhibit non-constant dynamic stress drop scaling which gives further support for a fundamental difference in rupture dynamics between small and large earthquakes. To correct the vertical and horizontal S-wave spectra for attenuation, they used detailed regional attenuation functions derived by Malagnini et al. (2002) who determined frequency-dependent geometrical spreading and Q for the region. These corrections account for the gross path effects (i.e., all distance-dependent effects), although the source and site effects are still present in the distance-corrected spectra. The main goal of this study is to isolate the absolute site effect (as a function of frequency

  11. Radiographic bone texture analysis is correlated with 3D microarchitecture in the femoral head, and improves the estimation of the femoral neck fracture risk when combined with bone mineral density

    International Nuclear Information System (INIS)

    Purpose: Femoral neck fracture is a major public health problem in elderly persons, representing the main source of osteoporosis-related mortality and morbidity. In this study, we aimed at comparing radiographic texture analysis with three-dimensional (3D) microarchitecture in human femurs, and at evaluating whether bone texture analysis improved the assessment of the femoral neck fracture risk other than that obtainable by bone mineral density (BMD). Materials and methods: Thirteen osteoporotic femoral heads from patients who fractured their femoral neck and twelve non-fractured femoral heads from osteoarthritic patients were studied using respectively (1) a new high-resolution digital X-ray device (BMA™, D3A Medical Systems) allowing for bone texture analysis with fractal parameter Hmean, and (2) a micro-computed tomograph (CT) for 3D microarchitecture. BMD was measured postoperatively by DXA in all patients in the contralateral femur. Results: In these femoral heads, we found that fractal parameter Hmean was correlated with 3D microarchitecture parameters: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular separation (Tb.Sp) and fractal dimension (FD) respectively (p < 0.05). Then, fractal parameter Hmean was significantly lower in the femoral heads from the fractured group than from the non-fractured group (p < 0.01). Finally, multiple regression analysis showed that combining bone texture analysis and total hip BMD significantly improved the estimation of the femoral neck fracture risk from adjusted r2 = 0.46 to adjusted r2 = 0.67 (p < 0.05). Conclusion: Radiographic bone texture analysis was correlated with 3D microarchitecture parameters in the femoral head, provided accurate discrimination between the femoral heads from the fractured and non-fractured groups, and significantly improved the estimation of the femoral neck fracture risk when combined with BMD

  12. Radiographic bone texture analysis is correlated with 3D microarchitecture in the femoral head, and improves the estimation of the femoral neck fracture risk when combined with bone mineral density

    Energy Technology Data Exchange (ETDEWEB)

    Ollivier, Matthieu [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Le Corroller, Thomas, E-mail: Thomas.LeCorroller@ap-hm.fr [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Radiology Department, 13009 Marseille (France); Blanc, Guillaume [APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Parratte, Sébastien [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Champsaur, Pierre [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Radiology Department, 13009 Marseille (France); Chabrand, Patrick [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); Argenson, Jean-Noël [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France)

    2013-09-15

    Purpose: Femoral neck fracture is a major public health problem in elderly persons, representing the main source of osteoporosis-related mortality and morbidity. In this study, we aimed at comparing radiographic texture analysis with three-dimensional (3D) microarchitecture in human femurs, and at evaluating whether bone texture analysis improved the assessment of the femoral neck fracture risk other than that obtainable by bone mineral density (BMD). Materials and methods: Thirteen osteoporotic femoral heads from patients who fractured their femoral neck and twelve non-fractured femoral heads from osteoarthritic patients were studied using respectively (1) a new high-resolution digital X-ray device (BMA™, D3A Medical Systems) allowing for bone texture analysis with fractal parameter Hmean, and (2) a micro-computed tomograph (CT) for 3D microarchitecture. BMD was measured postoperatively by DXA in all patients in the contralateral femur. Results: In these femoral heads, we found that fractal parameter Hmean was correlated with 3D microarchitecture parameters: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular separation (Tb.Sp) and fractal dimension (FD) respectively (p < 0.05). Then, fractal parameter Hmean was significantly lower in the femoral heads from the fractured group than from the non-fractured group (p < 0.01). Finally, multiple regression analysis showed that combining bone texture analysis and total hip BMD significantly improved the estimation of the femoral neck fracture risk from adjusted r{sup 2} = 0.46 to adjusted r{sup 2} = 0.67 (p < 0.05). Conclusion: Radiographic bone texture analysis was correlated with 3D microarchitecture parameters in the femoral head, provided accurate discrimination between the femoral heads from the fractured and non-fractured groups, and significantly improved the estimation of the femoral neck fracture risk when combined with BMD.

  13. Association between estrogen receptor α gene (ESR1 PvuII (C/T and XbaI (A/G polymorphisms and hip fracture risk: evidence from a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Li Tang

    Full Text Available BACKGROUND AND OBJECTIVE: Genetic factors are important in the pathogenesis of fractures. Notably, estrogen receptor α (ESR1 has been suggested as a possible candidate gene for hip fractures; however, published studies of ESR1 gene polymorphisms have been hampered by small sample sizes and inconclusive or ambiguous results. The aim of this meta-analysis is to investigate the associations between two novel common ESR1 polymorphisms (intron 1 polymorphisms PvuII-rs2234693: C>T and XbaI-rs9340799: A>G and hip fracture. METHODS: Crude odds ratios (ORs with 95% confidence intervals (CIs were used to evaluate the strength of the association. RESULTS: Five case-control and three cohort studies were assessed, including a total of 1,838 hip fracture cases and 14,972 healthy controls. This meta-analysis revealed that the PvuII T allele is a highly significant risk factor for hip fracture susceptibility, with an effect magnitude similar in male and pre-menopausal and post-menopausal female patients. In stratified analysis based on ethnicity, the PvuII T allele remained significantly correlated with increased risk of hip fracture in Caucasian populations; this correlation, however, was not found in Asian populations. Unlike the PvuII polymorphism, we did not find significant differences in the XbaI (A>G polymorphism allele or genotype distributions of hip fracture patients and controls. We also found no obvious association between the XbaI polymorphism and hip fracture in any of the racial or gender subgroups. CONCLUSION: Our findings show that the ESR1 PvuII T allele may increase the risk of hip fracture and that the XbaI polymorphism is not associated with hip fracture.

  14. Be Resolute about Absolute Value

    Science.gov (United States)

    Kidd, Margaret L.

    2007-01-01

    This article explores how conceptualization of absolute value can start long before it is introduced. The manner in which absolute value is introduced to students in middle school has far-reaching consequences for their future mathematical understanding. It begins to lay the foundation for students' understanding of algebra, which can change…

  15. Relative Permeability of Fractured Rock

    Energy Technology Data Exchange (ETDEWEB)

    Mark D. Habana

    2002-06-30

    Contemporary understanding of multiphase flow through fractures is limited. Different studies using synthetic fractures and various fluids have yielded different relative permeability-saturation relations. This study aimed to extend the understanding of multiphase flow by conducting nitrogen-water relative permeability experiments on a naturally-fractured rock from The Geysers geothermal field. The steady-state approach was used. However, steady state was achieved only at the endpoint saturations. Several difficulties were encountered that are attributed to phase interference and changes in fracture aperture and surface roughness, along with fracture propagation/initiation. Absolute permeabilities were determined using nitrogen and water. The permeability values obtained change with the number of load cycles. Determining the absolute permeability of a core is especially important in a fractured rock. The rock may change as asperities are destroyed and fractures propagate or st rain harden as the net stresses vary. Pressure spikes occurred in water a solute permeability experiments. Conceptual models of an elastic fracture network can explain the pressure spike behavior. At the endpoint saturations the water relative permeabilities obtained are much less than the nitrogen gas relative permeabilities. Saturations were determined by weighing and by resistivity calculations. The resistivity-saturation relationship developed for the core gave saturation values that differ by 5% from the value determined by weighing. Further work is required to complete the relative permeability curve. The steady-state experimental approach encountered difficulties due to phase interference and fracture change. Steady state may not be reached until an impractical length of time. Thus, unsteady-state methods should be pursued. In unsteady-state experiments the challenge will be in quantifying rock fracture change in addition to fluid flow changes.

  16. Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study

    OpenAIRE

    Kragh Ekstam A; Elmståhl S

    2016-01-01

    Annika Kragh Ekstam,1,2 Sölve Elmståhl1 1Division of Geriatric Medicine, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, 2Department of Medicine, Hässleholm Hospital, Hässleholm, Sweden Objective: The aim of this study was to assess the mortality in hip fracture patients with regard to use of fall-risk-increasing drugs (FRIDs), by comparing survival in exposed and nonexposed individuals. Design: This was a general p...

  17. SENILE OSTEOPOROSIS AND HIP FRACTURE

    Institute of Scientific and Technical Information of China (English)

    戴力扬

    1995-01-01

    A randomized block design was used to compare the Singh index, the cortical index of the femoral neck and the lateral cortical width of the femur of a group of patients with femoral neck fracture, a group with intertrochanterie fracture, and a normal contrrol group among a total of 102 postmenopausal women. The three irtdiees in fracture grotlp were very significantly (P<0. 01) or significantly (P<0. 05) different from those in the normal control subjects. The importance of osteopomosis in hip fracture of the aged is con-firmed. Radiographic measurement of bone mass was found to have some predictive value for the risk of hip fracture.

  18. Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study

    Directory of Open Access Journals (Sweden)

    Kragh Ekstam A

    2016-04-01

    Full Text Available Annika Kragh Ekstam,1,2 Sölve Elmståhl1 1Division of Geriatric Medicine, Department of Health Sciences, Lund University, Skåne University Hospital, Malmö, 2Department of Medicine, Hässleholm Hospital, Hässleholm, Sweden Objective: The aim of this study was to assess the mortality in hip fracture patients with regard to use of fall-risk-increasing drugs (FRIDs, by comparing survival in exposed and nonexposed individuals. Design: This was a general population-based cohort study. Settings: Data on hip fracture patients were retrieved from three national databases. Participants: All hip fracture patients aged 60 years or older in a Swedish county in 2006 participated in this study. Measurements: We studied the mortality in hip fracture patients by comparing those exposed to FRIDs, combinations of FRIDs, and polypharmacy to nonexposed patients, adjusting for age and sex. For survival estimates in patients using four or more FRIDs, a Cox regression analysis was used, adjusting for age, sex, and use of any four or more drugs. Results: First-year all-cause mortality was 24.6% (N=503 in 2,043 hip fracture patients aged 60 years or older, including 170 males (33.8% and 333 females (66.2%. Patients prescribed four or more FRIDs, five or more drugs (polypharmacy, psychotropic drugs, and cardiovascular drugs showed significantly increased first-year mortality. Exposure to four or more FRIDs (518 patients, 25.4% was associated with an increased mortality at 30 days with odds ratios (ORs 2.01 (95% confidence interval [CI] 1.44–2.79, 90 days with OR 1.56 (95% CI 1.19–2.04, 180 days with OR 1.54 (95% CI 1.20–1.97, and 365 days with OR 1.43 (95% CI 1.13–1.80. Cox regression analyses adjusted for age, sex, and use of any four or more drugs showed a significantly higher mortality in patients treated with four or more FRIDs at 90 days (P=0.015 and 180 days (P=0.012 compared to patients treated with three or less FRIDs. Conclusion: First

  19. Prospective study of ankle and foot fractures in elderly women

    Directory of Open Access Journals (Sweden)

    Yadagiri Surender Rao

    2015-01-01

    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  20. EXPERIMENTAL ANALYSIS OF THE ENVIRONMENTAL BEHAVIOR OF HYDRAULIC FRACTURING FLUID COMPOUNDS PRIORITIZED BY POTENTIAL OF ENVIRONMENTAL OR HEALTH RISK

    Science.gov (United States)

    Given the large number of chemical additives used in hydraulic fracturing fluids, it is not practical to conduct a comprehensive analysis in cases where contamination is suspected. The fate and transport model can identify compounds with high likelihood for transport and pe...

  1. Prediction and clinical significance of Fracture Risk Assessment Toll to type 2 diabetes mellitus patients in hospital with the risk of osteoporotic fracture%骨折风险预测简易工具对住院2型糖尿病患者骨折风险的预测及临床意义

    Institute of Scientific and Technical Information of China (English)

    金浩; 丰磊; 李丹丹; 徐国英; 赵伟平; 刘红琴; 赵岚

    2015-01-01

    目的:探讨骨折风险预测简易工具( FRAX)预测住院低骨量2型糖尿病( T2DM)患者发生骨质疏松性骨折的风险。方法采用随机选择175例住院T2DM患者作为T2DM组,同期门诊非T2DM患者108例作为对照组。受试者均采用双能X线骨密度测量仪( DXA)检测腰椎( L1-4)及左侧股骨(股骨颈、大转子、wards三角)的骨密度(BMD),记录每例患者日常生活中可能影响骨代谢的危险因素,根据体重指数(BMI)和股骨颈BMD,用FRAX计算10年主要骨质疏松性骨折发生概率(临床性脊椎、髋骨、前臂和肱骨骨折)和10年髋部骨折发生概率。结果 T2DM组BMD与对照组相比无明显下降( P>0.05),但发生骨质疏松性骨折的风险却明显增高(P<0.05);根据BMI计算10年全部主要骨质疏松性骨折(BBMO)发生概率和10年髋部骨折(BBHF)发生概率、根据股骨颈骨密度计算10年全部主要骨质疏松性骨折(BMO)发生概率和10年髋部骨折( BHF)发生概率之间呈显著正相关( P<0.001);年龄、绝经年限、 BMI、吸烟、补充钙与维生素D、以往骨折史、骨质疏松病史、父母髋部骨折史、糖尿病病史等与发生骨质疏松性骨折的风险密切相关(均P<0.05)。结论 T2 DM患者较对照组更易发生骨质疏松性骨折,并与多种危险因素密切相关;常规补充适量钙剂和维生素D、进行体育运动、控制血糖等可预防和减少骨质疏松性骨折。%Objective With Fracture Risk Assessment Tool ( FRAX) , to predict the risk of osteoporotic frac-ture in hospitalized low bone mass patients with type 2 diabetes mellitus (T2DM).Methods The 175 patients with T2DM in hospital were simple random sample , and the 108 patients with non-T2DM in outpatient service were selected as the control group at the same time.All patients’bone mineral density (BMD) at lumbar (L1-4), the left femur

  2. Potency of a combined alfacalcidol-alendronate therapy to reduce the risk of falls and fractures in elderly patients with glucocorticoid-induced osteoporosis.

    Science.gov (United States)

    Ringe, Johann D; Schacht, Erich; Dukas, Laurent; Mazor, Ze'ev

    2011-01-01

    This is a preplanned subgroup analysis on 318 patients with glucocorticoid-induced osteoporosis (GIOP) from an open, prospective, multi-centered, uncontrolled study on a large cohort of elderly patients with a high risk of falls and fractures. The entire group of 2579 patients was recruited by 818 practicing physicians and treated for three months with a new combination package containing 4 or 12 self-explanatory one-week blisters, each with one tablet of 70 mg alendronate (CAS 260055-05-8) and 7 capsules of 1 pg alfacalcidol (CAS 41294-56-8) (Tevabone"). The average age of the GIOP patients was 71 years and the mean body mass index 26.7 kg/m2. 58% had a diagnosis of increased risk of falls, prevalent vertebral and non-vertebral fractures were documented in 70% and 65% of the patients, respectively, and a creatinine clearance (CrCl) below 65 ml/min was documented in 55 %. Main outcome parameters were the Chair Rising Test (CRT), Timed Up and Go Test (TUG), back pain and safety at onset and after 3 months. In addition, an evaluation of the package design was done at the end of the study. The percentage of patients able to perform the CRT within 10 sec increased from 21.1% to 39.4% after 3 months (increase 87%, p sec increased by 84% (p sec (p = 0.0025) (difference of 1.9 sec) and for the TUG the mean time decreased from 16.86 sec to 14.64 sec (p = 0.0056) (difference of 2.2 sec). Mean back pain measured by a 0-10 visual analogue scale decreased significantly by 43% from 6.0 to 3.4 (p compliance. This may contribute to the previously shown significant effect on reducing falls and fractures with the same regimen during a controlled long-term trial in primary osteoporosis. PMID:21428245

  3. ROE Absolute Sea Level Changes

    Data.gov (United States)

    U.S. Environmental Protection Agency — This raster dataset represents changes in absolute sea level along U.S. coasts from 1993 to 2014. Data were provided by the University of Colorado at Boulder (2015)...

  4. The Practice of Scottish Urologists in the Assessment and Management of Fracture Risk in the Ageing Male being Treated for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Wee Sing Ngu

    2007-01-01

    Full Text Available The aim of this study was to ascertain the practice of urologists in Scotland in the assessment and prevention of fracture risk in males starting castration-type therapy for prostate cancer. A questionnaire survey was sent to all practicing consultant urologists in Scotland. A majority of urologists, 25 (64.1%, did not consider the state of their patients' bone mineral density (BMD before commencing castration-type therapy. The rest used various methods to assess BMD, including clinical impression alone, plain bone radiographs, and dual-energy X-ray absorptiometry (DEXA. Various methods were used in the prophylaxis and treatment of osteoporosis, including avoidance of castration type therapy and the use of bisphosphonates and bicalutamide along with castration-type therapy. This study has shown that there is no consensus as to the assessment and management of fracture risk in patients with prostate cancer commencing or on established castration-type therapy. The situation needs to be addressed with some consensus guidance.

  5. Evaluating the Risks of Surface Spills Associated with Hydraulic Fracturing Activities to Groundwater Resources: a Modeling Study in the South Platte Alluvial Aquifer

    Science.gov (United States)

    Kanno, C.; McLaughlin, M.; Blotevogel, J.; Benson, D. A.; Borch, T.; McCray, J. E.

    2015-12-01

    Hydraulic fracturing has revolutionized the U.S.'s energy portfolio by making shale reservoirs productive and commercially viable. However, the public is concerned that the chemical constituents in hydraulic fracturing fluid, produced water, or natural gas itself could potentially impact groundwater or adjacent streams. Here, we conduct fate and transport simulations of surface spills, the most likely contamination pathway to occur during oil and gas production operations, to evaluate whether or not these spills pose risks to groundwater quality. We focus on the South Platte Alluvial Aquifer, which is located in the greater Denver metro area and overlaps a zone of high-density oil and gas development. The purpose of this work is to assess the mobility and persistence of chemical contaminants (e.g. biocides, friction reducers, surfactants, hydrocarbons, etc.) —based on sorption to soil, degradation potential, co-contaminant interactions, and spill conditions—and to understand the site characteristics and hydrologic conditions that would make a particular location prone to groundwater quality degradation in the event of an accidental release. We propose a coupled analytical-numerical approach that could be duplicated by environmental consultants. Results suggest that risk of groundwater pollution, based on predicted concentration at the groundwater table, is low in most areas of the South Platte system for the contaminants investigated under common spill conditions. However, substantial risk may exist in certain areas where the groundwater table is shallow. In addition, transport of certain contaminants is influenced by interactions with other constituents in produced or stimulation fluids. By helping to identify locations in the Front Range of Colorado that are at low or high risk for groundwater contamination due to a surface spill, it is our hope that this work will aid in improving prevention, mitigation, and remediation practices so that decision-makers can

  6. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  7. Factores de riesgo para osteoporosis y fracturas de cadera: Análisis multivariado Association between hip fractures and risk factors for osteoporosis: Multivariate analysis

    Directory of Open Access Journals (Sweden)

    Ana Masoni

    2007-10-01

    Full Text Available En este trabajo se analizó la asociación entre factores de riesgo (FR y fracturas de cadera, se evaluó la influencia de FR relacionados con baja masa ósea o con traumatismos, y se exploró la existencia de factores protectores (FP. Se estudiaron datos de 376 pacientes hospitalizados, de los cuales 151 presentaban fracturas de cadera osteoporóticas (casos; el resto fueron controles, a partir de historias clínicas y un cuestionario sobre FR para osteoporosis. La edad promedio fue 80.6 ± 8.1 años, similar en casos y controles; la relación mujer/varón fue de 3:1 en ambos grupos. Las mujeres fracturadas eran mayores que los varones fracturados (82.5 ± 8.1 versus 79.7 ± 7.2 años; p In this observational, case-control study, 376 inpatients were evaluated in order to determine the association of risk factors (RF and hip fracture; 151 patients had osteoporotic hip fracture (cases; the remaining were controls. Data were obtained from medical charts, and through a standardized questionnaire about RF. Mean age of the sample (± SD was 80.6 ± 8.1 years, without statistically significant difference between cases and controls; the female:male ratio was 3:1 in both groups. Fractured women were older than men (82.5 ± 8.1 vs. 79.7 ± 7.2 years, respectively; p < 0.01. Physical activity, intake of alcohol and tobacco, and sun exposure were low in all patients. Falls among cases happened predominantly at home (p < 0.001. Among female cases, time spent in household duties was a RF (p = 0.007, which was absent in males. In multivariate analysis, the following RF were significantly more frequent: Cognitive impairment (p = 0.001, and previous falls (p < 0.0001; whereas the following protective factors were significantly different from controls: Calcium intake during youth (p < 0.0001, current calcium intake (p < 0.0001, and mechanical aid for walking (p < 0.0001. Evaluation of RF and protective factors may contribute to diminish the probability of hip

  8. Epidemiological study on talus fractures

    OpenAIRE

    Marcos Hideyo Sakaki; Guilherme Honda Saito; Rafael Garcia de Oliveira; Rafael Trevisan Ortiz; Jorge dos Santos Silva; Túlio Diniz Fernandes; Alexandre Leme Godoy dos Santos

    2014-01-01

    Objective:To analyze the characteristics of patients with talus fractures and the injuries that they present.Methods:Retrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed.Results:Analysis on 23 cases showed that m...

  9. Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study

    Science.gov (United States)

    Lee, Ping-Hsueh; Chou, Po-Liang; Ku, Ming-Chang; Chen, Yu-Ching

    2016-01-01

    Introduction Osteoporosis is becoming an impending epidemic in the Asia-Pacific region. The association between risk of osteoporotic fracture (OTPF) and chronic obstructive pulmonary disease (COPD) in East Asian patients is yet to be fully examined. We conducted a nationwide population-based retrospective cohort study of 98,700 patients aged ≥50 years with or without COPD using a national administrative claims dataset. Materials and Methods The patients were divided into COPD and comparison groups comprising 19,740 and 78,960 patients, respectively. The groups were 1 to 4 matched for age, gender, index date, diabetes mellitus, pre-existing osteoporosis and chronic kidney disease. Information such as the geographic area where southern part represented more sunshine exposure, smoking-related diagnoses, alcohol use disorder, whether there was regular use of inhaled corticosteroids and oral corticosteroids, vitamin D prescriptions, Charlson-Deyo comorbidity index score, and other relevant medical comorbidities were extracted for analysis. They were followed up until OTPF or the end of the year 2013. The outcome measure was an osteoporotic vertebral fracture and other long-bone fractures. A multivariate Cox model was constructed to derive adjusted hazard ratios (aHR) for OTPF with corresponding 95% confidence intervals (CI) after controlling for age, sex, insurance premium category, vitamin D prescription, osteoporosis, and coronary heart disease (CHD). Kaplan–Meier curves of the probability of OTPF-free survival for each cohort were compared using the log-rank test. Patients with OTPF during the first follow-up year were excluded from the overall risk calculation. Contributing factors to the increased risk of OTPF in COPD patients were examined in a sensitivity analysis. Results After a total follow-up of 68,743 patient-years for the COPD group and 278,051 patient-years for the matched comparison group, the HR for OTPF was 1.24 (95% CI [1.02–1.51]; P = 0

  10. Point-of-Care Phalangeal Bone Mineral Density Measurement Can Reduce the Need of Dual-Energy X-Ray Absorptiometry Scanning in Danish Women at Risk of Fracture

    DEFF Research Database (Denmark)

    Holmberg, Teresa; Bech, Mickael; Gram, Jeppe;

    2016-01-01

    Identifying persons with a high risk of osteoporotic fractures remains a challenge. DXA uptake in women with elevated risk of osteoporosis seems to be depending on distance to scanning facilities. This study aimed to investigate the ability of a small portable scanner in identifying women...... with reduced bone mineral density (BMD), and to define triage thresholds for pre-selection. Total hip and lumbar spine BMD was measured by dual-energy X-ray absorptiometry and phalangeal BMD by radiographic absorptiometry in 121 Danish women with intermediate or high 10-year fracture probability (aged 61...

  11. Opportunistic Identification of Vertebral Fractures.

    Science.gov (United States)

    Adams, Judith E

    2016-01-01

    Vertebral fractures are powerful predictors of future fracture, so, their identification is important to ensure that patients are commenced on appropriate bone protective or bone-enhancing therapy. Risk factors (e.g., low bone mineral density and increasing age) and symptoms (back pain, loss of height) may herald the presence of vertebral fractures, which are usually confirmed by performing spinal radiographs or, increasingly, using vertebral fracture assessment with dual-energy X-ray absorptiometry scanners. However, a large number (30% or more) of vertebral fractures are asymptomatic and do not come to clinical attention. There is, therefore, scope for opportunistic (fortuitous) identification of vertebral fractures from various imaging modalities (radiographs, computed tomography, magnetic resonance imaging, and radionuclide scans) performed for other clinical indications and which include the spine in the field of view, with midline sagittal reformatted images from computed tomography having the greatest potential for such opportunistic detection. Numerous studies confirm this potential for identification but consistently find underreporting of vertebral fractures. So, a valuable opportunity to improve the management of patients at increased risk of future fracture is being squandered. Educational training programs for all clinicians and constant reiteration, stressing the importance of the accurate and clear reporting of vertebral fractures ("you only see what you look for"), can improve the situation, and automated computer-aided diagnostic tools also show promise to solve the problem of this underreporting of vertebral fractures. PMID:26412139

  12. Atypical femoral fractures and current management

    Directory of Open Access Journals (Sweden)

    Nianye Zheng

    2016-10-01

    Full Text Available With the rapid increase in patients receiving bisphosphonates (BPs for treating osteoporosis, one of the clinical complications associated with its long-term use is atypical femoral fractures (AFFs. Although the absolute risk for AFFs is low and it was a consensus that AFFs were acceptable compared with the amount of osteoporotic fractures BPs have prevented, epidemiological studies have proved that BPs had a strong association with AFFs and possibly more people were going to suffer from this adverse effect with wide prescriptions of this drug. In addition, AFFs seemed to have impaired ability to heal. Thus, to understand the mechanism(s behind AFFs is important and desirable for considering preventive measures. This article reviewed the clinical features of AFFs as well as potential underlining pathological characteristics, such as the decreased turnover rate caused by BPs that led to multiple-level alternations, e.g., changes not only at cellular and tissue levels, but also related to changes in bone micro- and macrostructure and organic/inorganic contents, leading to potentially compromised mechanical properties of cortical bone when exposed to prolonged BP therapy. Severely suppressed bone turnover may also be the underlying mechanism for impaired fracture healing in patients with AFFs. The rising concerns about the risk for AFFs in nonosteoporotic patients receiving high-dose BPs to treat cancers were also discussed. Detailed investigation will help develop potential targeted pharmacological treatments such as parathyroid hormone. In addition, potential innovative internal fixation implants were discussed with regard to dynamic and biological fixation for enhancing AFF repair.

  13. Cost-effectiveness of quantitative ultrasound as a technique for screening of osteoporotic fracture risk: report on a health technology assessment conducted in 2001

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2004-03-01

    Full Text Available Aim: On behalf of the German Agency for Health Technology Assessment (DAHTA@DIMDI a rapid economic HTA was conducted. Aim of the HTA was to evaluate the cost-effectiveness of quantitative ultrasound (QUS for screening of osteoporotic fracture risk. Study population was formed by postmenopausal women. QUS was compared to the dual X-ray absorptiometry (DXA as the most frequently used method of measurement. Methods: According to the recommendations for rapid economic HTA a comprehensive literature search was conducted. Data of identified and relevant publications have been extracted in form of a qualitative and quantitative information synthesis. The authors calculated incremental cost-effectiveness ratios for different screening procedures: (1 one-step proceeding comparing QUS with DXA, (2 two-step proceeding starting with QUS followed by DXA in pathologic cases. Results: An additional case diagnosed by DXA in a one-step proceeding rises additional costs of about 1,000 EURO. A two-step proceeding with QUS is cost-effective as long as the costs of one QUS examination are lower than 31%-51% of the costs of one DXA examination. Discussion: All considered studies showed methodological limitations. None of them included long term effects like avoided bone fractures. Considering long-term effects probably would change the results. Due to the weakness of data no concluding judgement about the cost-effectiveness of QUS can be given.

  14. Dietary Protein and Vitamin D Intake and Risk of Falls: A Secondary Analysis of Postmenopausal Women from the Study of Osteoporotic Fractures.

    Science.gov (United States)

    Larocque, Sarah C; Kerstetter, Jane E; Cauley, Jane A; Insogna, Karl L; Ensrud, Kristine; Lui, Li-Yung; Allore, Heather G

    2015-01-01

    More than 90% of hip fractures in older Americans result from a fall. Inadequate intake of dietary protein and vitamin D are common in older adults, and diets in low these could contribute to loss of muscle mass and strength or coordination, in turn increasing the risk of falling. The objective of the study was to evaluate the relationship between protein and vitamin D intake with the occurrence of falls in older women in the Study of Osteoporotic Fracture, a prospective cohort of more than 4000 postmenopausal women participating from January 1997 to September 1998. Incident falls were ascertained for one year. Protein and vitamin D intake was assessed by a food frequency questionnaire; associations with a reported fall were estimated with logistic regression, adjusted for fall-related covariates and energy. Protein and vitamin D were modeled separately because of high correlation (rho = 0.55, P protein (per 1 g/kg increase) and vitamin D (per 100 International Unit (IU) increase) significantly increased the odds ratio (OR) of falling (OR 1.35 95% CI 1.15-1.59, OR 1.11 95% CI 1.03-1.19, respectively). Once fall-related covariates were added to each model, dietary protein and vitamin D were noncontributory to falls. While we could find no direct association between vitamin D and protein intake and fall prevention, adequate intake of these two nutrients are critical for musculoskeletal health in older adults.

  15. Persistent organochlorine pollutants and risk for skeletal fractures and impaired bone mineral density in humans. Results from the ''COMPARE'' project

    Energy Technology Data Exchange (ETDEWEB)

    Hagmar, L.; Wallin, E.; Joensson, B.A. [Department of Occupational and Environmental Medicine, Lund (Sweden)

    2004-09-15

    Persistent organochlorine pollutants (POP) have, in animal studies, impaired normal bone metabolism and resulted in increased bone fragility. Especially considering the dramatical increase in osteoporotic fractures in western societies during the last decades, it is a pertinent question whether a high dietary intake of POP might pose a risk for deteriorated bone quality in humans. This problem has been assessed as a part of the collaborative project ''COMPARE'', funded by European Commission RD Life Science Program. As a study base we have used cohorts of Swedish fishermen's families. We have earlier shown that fishermen living at the east coast of Sweden, have a high consumption of contaminated fatty fish from the Baltic Sea and consequently relatively high exposure levels for various POPs, also compared with fishermen from the Swedish west coast. Such a discrepancy was also found for fishermen's wives. The aim of the project was to assess in epidemiological studies whether a high dietary intake of POP through fatty fish from the Baltic may result in an increased incidence of osteoporotic fractures or decreased bone mineral density (BMD). We give here an overview of the results.

  16. Hip fracture - discharge

    Science.gov (United States)

    Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge

  17. Zoledronic acid and clinical fractures and mortality after hip fracture

    DEFF Research Database (Denmark)

    Lyles, Kenneth W; Colón-Emeric, Cathleen S; Magaziner, Jay S;

    2007-01-01

    BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a dose of 5 mg), and 1062 patients were...... assigned to receive placebo. The infusions were first administered within 90 days after surgical repair of a hip fracture. All patients (mean age, 74.5 years) received supplemental vitamin D and calcium. The median follow-up was 1.9 years. The primary end point was a new clinical fracture. RESULTS: The...... rates of any new clinical fracture were 8.6% in the zoledronic acid group and 13.9% in the placebo group, a 35% risk reduction with zoledronic acid (P=0.001); the respective rates of a new clinical vertebral fracture were 1.7% and 3.8% (P=0.02), and the respective rates of new nonvertebral fractures...

  18. Absolute transition probabilities of phosphorus.

    Science.gov (United States)

    Miller, M. H.; Roig, R. A.; Bengtson, R. D.

    1971-01-01

    Use of a gas-driven shock tube to measure the absolute strengths of 21 P I lines and 126 P II lines (from 3300 to 6900 A). Accuracy for prominent, isolated neutral and ionic lines is estimated to be 28 to 40% and 18 to 30%, respectively. The data and the corresponding theoretical predictions are examined for conformity with the sum rules.-

  19. Absolute luminosity measurements at LHCb

    CERN Document Server

    Hopchev, Plamen

    2011-01-01

    Absolute luminosity measurements are of general interest for colliding-beam experiments at storage rings. These measurements are necessary to determine the absolute cross-sections of reaction processes and are valuable to quantify the performance of the accelerator. LHCb has applied two methods to determine the absolute scale of its luminosity measurements for proton-proton collisions at the LHC running at a centre-of-mass energy of 7 TeV. In addition to the classic ``van der Meer'' scan method a novel technique has been developed which makes use of direct imaging of the individual beams using both proton-gas and proton-proton interactions. The beam imaging method is made possible by the high resolution of the LHCb vertex detector and the close proximity of the detector to the beams, and allows beam parameters such as positions, angles and widths to be determined. We describe both methods and compare the two results. In addition, we present the techniques used to transport the absolute luminosity measurement ...

  20. Dental trauma. Combination injuries 2. The risk of pulp necrosis in permanent teeth with subluxation injuries and concomitant crown fractures

    DEFF Research Database (Denmark)

    Lauridsen, Eva Fejerskov; Hermann, Nuno Vibe; Gerds, Thomas Alexander;

    2012-01-01

    to a standardized protocol. Statistical Analysis:  The risk of PN was analysed separately for teeth with immature and mature root development by the Kaplan–Meier method, the log-rank test and Cox regression analysis. The level of significance was set at 5%. Risk factors included in the analysis were gender, patient...

  1. Subtrochanteric fractures in bisphosphonate-naive patients

    DEFF Research Database (Denmark)

    Adachi, Jonathan D; Lyles, Kenneth; Boonen, Steven;

    2011-01-01

    Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were examined, comparing those who sustained ...

  2. Phalangeal bone mineral density predicts incident fractures

    DEFF Research Database (Denmark)

    Friis-Holmberg, Teresa; Brixen, Kim; Rubin, Katrine Hass;

    2012-01-01

    This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures...

  3. DEMONSTRATION BULLETIN: HYDRAULIC FRACTURING OF CONTAMINATED SOIL

    Science.gov (United States)

    Hydraulic fracturing is a physical process that creates fractures in silty clay soil to enhance its permeability. The technology, developed by the Risk Reduction Engineering Laboratory (RREL) and the University of Cincinnati, creates sand-filled horizontal fractures up to 1 in. i...

  4. Determination and maintenance of DE minimis risk for migration of residual tritium (3H) from the 1969 Project Rulison nuclear test to nearby hydraulically fractured natural gas wells.

    Science.gov (United States)

    Daniels, Jeffrey I; Chapman, Jenny B

    2013-05-01

    The Project Rulison underground nuclear test was a proof-of-concept experiment that was conducted under the Plowshare Program in 1969 in the Williams Fork Formation of the Piceance Basin in west-central Colorado. Today, commercial production of natural gas is possible from low permeability, natural gas bearing formations like that of the Williams Fork Formation using modern hydraulic fracturing techniques. With natural gas exploration and production active in the Project Rulison area, this human health risk assessment was performed in order to add a human health perspective for site stewardship. Tritium (H) is the radionuclide of concern with respect to potential induced migration from the test cavity leading to subsequent exposure during gas-flaring activities. This analysis assumes gas flaring would occur for up to 30 d and produce atmospheric H activity concentrations either as low as 2.2 × 10 Bq m (6 × 10 pCi m) from the minimum detectable activity concentration in produced water or as high as 20.7 Bq m (560 pCi m), which equals the highest atmospheric measurement reported during gas-flaring operations conducted at the time of Project Rulison. The lifetime morbidity (fatal and nonfatal) cancer risks calculated for adults (residents and workers) and children (residents) from inhalation and dermal exposures to such activity concentrations are all below 1 × 10 and considered de minimis. The implications for monitoring production water for conforming health-protective, risk-based action levels also are examined. PMID:23532081

  5. Method of estimating risk of future fracture in vertebrae of spine used in medical field, involves computing different curvature values to obtain value representative of degree of irregularity of curvature of spine

    DEFF Research Database (Denmark)

    2008-01-01

    NOVELTY - The curvature (L1-L4) of spine at two neighboring vertebrae is calculated. The different curvature values are computed to obtain a value representative of the degree of irregularity in curvature of spine. The risk of future fracture in vertebrae of spine is estimated using the degree...

  6. Exercise-induced rib stress fractures: potential risk factors related to thoracic muscle co-contraction and movement pattern

    DEFF Research Database (Denmark)

    Vinther-Knudsen, Archibald; Kanstrup, I-L; Christiansen, E;

    2006-01-01

    The etiology of exercise-induced rib stress fractures (RSFs) in elite rowers is unclear. The purpose of the study was to investigate thoracic muscle activity, movement patterns and muscle strength in elite rowers. Electromyographic (EMG) and 2-D video analysis were performed during ergometer rowing...... and range). Further, RSF had greater co-contraction of m. serratus anterior and m. trapezius in the mid-drive phase (RSF: 47.5+/-3.4, 48.5 (35.8-60.2)% EMG signal overlap vs C: 30.8+/-6.5, 27.0 (11.2-61.6)%P=0.043). In addition, the RSF subjects showed a lower knee-extension to elbow-flexion strength ratio...

  7. Dental trauma. Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure

    DEFF Research Database (Denmark)

    Lauridsen, Eva Fejerskov; Hermann, Nuno Vibe; Gerds, Thomas Alexander;

    2012-01-01

    with lateral luxation from 149 patients (87 male, 62 female). A total of 25 teeth with extrusion and 33 teeth with lateral luxation had suffered a concomitant crown fracture (infraction, enamel fracture or enamel-dentin-fracture). All the teeth were examined and treated according to a standardized protocol...

  8. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  9. Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Leal Alejo

    2006-11-01

    Full Text Available Abstract Background Whole-body vibration (WBV is a new type of exercise that has been increasingly tested for the ability to prevent bone fractures and osteoporosis in frail people. There are two currently marketed vibrating plates: a the whole plate oscillates up and down; b reciprocating vertical displacements on the left and right side of a fulcrum, increasing the lateral accelerations. A few studies have shown recently the effectiveness of the up-and-down plate for increasing Bone Mineral Density (BMD and balance; but the effectiveness of the reciprocating plate technique remains mainly unknown. The aim was to compare the effects of WBV using a reciprocating platform at frequencies lower than 20 Hz and a walking-based exercise programme on BMD and balance in post-menopausal women. Methods Twenty-eight physically untrained post-menopausal women were assigned at random to a WBV group or a Walking group. Both experimental programmes consisted of 3 sessions per week for 8 months. Each vibratory session included 6 bouts of 1 min (12.6 Hz in frequency and 3 cm in amplitude with 60° of knee flexion with 1 min rest between bouts. Each walking session was 55 minutes of walking and 5 minutes of stretching. Hip and lumbar BMD (g·cm-2 were measured using dual-energy X-ray absorptiometry and balance was assessed by the blind flamingo test. ANOVA for repeated measurements was adjusted by baseline data, weight and age. Results After 8 months, BMD at the femoral neck in the WBV group was increased by 4.3% (P = 0.011 compared to the Walking group. In contrast, the BMD at the lumbar spine was unaltered in both groups. Balance was improved in the WBV group (29% but not in the Walking group. Conclusion The 8-month course of vibratory exercise using a reciprocating plate is feasible and is more effective than walking to improve two major determinants of bone fractures: hip BMD and balance.

  10. Computational modelling of long bone fractures fixed with locking plates - How can the risk of implant failure be reduced?

    LENUS (Irish Health Repository)

    Nassiri, M

    2013-03-01

    The Locking Compression Plate (LCP) is part of a new plate generation requiring an adapted surgical technique and new thinking about commonly used concepts of internal fixation using plates. Knowledge of the fixation stability provided by these new plates is very limited and clarification is still necessary to determine how the mechanical stability and the risk of implant failure can best be controlled.

  11. Logistic regression in estimates of femoral neck fracture by fall

    Directory of Open Access Journals (Sweden)

    Jaroslava Wendlová

    2010-04-01

    Full Text Available Jaroslava WendlováDerer’s University Hospital and Policlinic, Osteological Unit, Bratislava, SlovakiaAbstract: The latest methods in estimating the probability (absolute risk of osteoporotic fractures include several logistic regression models, based on qualitative risk factors plus bone mineral density (BMD, and the probability estimate of fracture in the future. The Slovak logistic regression model, in contrast to other models, is created from quantitative variables of the proximal femur (in International System of Units and estimates the probability of fracture by fall.Objectives: The first objective of this study was to order selected independent variables according to the intensity of their influence (statistical significance upon the occurrence of values of the dependent variable: femur strength index (FSI. The second objective was to determine, using logistic regression, whether the odds of FSI acquiring a pathological value (femoral neck fracture by fall increased or declined if the value of the variables (T–score total hip, BMI, alpha angle, theta angle and HAL were raised by one unit.Patients and methods: Bone densitometer measurements using dual energy X–ray absorptiometry (DXA, (Prodigy, Primo, GE, USA of the left proximal femur were obtained from 3 216 East Slovak women with primary or secondary osteoporosis or osteopenia, aged 20–89 years (mean age 58.9; 95% CI: −58.42; 59.38. The following variables were measured: FSI, T-score total hip BMD, body mass index (BMI, as were the geometrical variables of proximal femur alpha angle (α angle, theta angle (θ angle, and hip axis length (HAL.Statistical analysis: Logistic regression was used to measure the influence of the independent variables (T-score total hip, alpha angle, theta angle, HAL, BMI upon the dependent variable (FSI.Results: The order of independent variables according to the intensity of their influence (greatest to least upon the occurrence of values of the

  12. Pre-hospital dietary intake correlates with muscle mass at the time of fracture in older hip fractured patients

    Directory of Open Access Journals (Sweden)

    Riccardo eCalvani

    2014-11-01

    Full Text Available Background. Failure to meet an adequate dietary intake is involved in the pathogenesis of sarcopenia and osteoporosis, which in turn increase the risk for falls and fractures, respectively. Older people with hip fracture are often protein-malnourished at hospitalization. Whether low protein-energy intake is associated with muscle atrophy in hip fractured patients is presently unknown. This information is necessary for the development of novel strategies to manage this especially vulnerable patient population. The aim of this study was therefore to explore the relationship between dietary intake and muscle mass in older hip fractured patients.Methods. Analyses were conducted in hip fractured elderly admitted to an orthopedic and trauma surgery ward (University Hospital. Muscle mass was estimated by bioelectrical impedance analysis within 24 h from admission. Dietary information was collected via 24-h dietary recall and nutrient intakes calculated by a nutrition software.Results. Among 62 hip fractured patients (mean age 84.6±7.6 years, 84% women, the average energy intake was 929.2±170.3 Kcal/day, with higher values reported by men (1.046.8±231.4 Kcal/day relative to women (906.5±148.3 Kcal/day; p=0.01. Absolute and normalized protein intake was 50.0±13.5 g/day and 0.88±0.27 g/kg (body weight/day, respectively, with no gender differences. A positive correlation was determined between total energy intake and muscle mass (r=0.384; p=0.003. Similarly, protein and leucine consumption was positively correlated with muscle mass (r=0.367 and 0.311, respectively; p=0.005 for both.Conclusions. A low intake of calories, protein and leucine is associated with reduced muscle mass in hip fractured elderly. Given the relevance of sarcopenia as a risk factor for adverse outcomes in this patient population, our findings highlight the importance of a comprehensive dietary assessment for the detection of nutritional deficits predisposing to or aggravating

  13. Android Apps for Absolute Beginners

    CERN Document Server

    Jackson, Wallace

    2011-01-01

    Anybody can start building simple apps for the Android platform, and this book will show you how! Android Apps for Absolute Beginners takes you through the process of getting your first Android applications up and running using plain English and practical examples. It cuts through the fog of jargon and mystery that surrounds Android application development, and gives you simple, step-by-step instructions to get you started.* Teaches Android application development in language anyone can understand, giving you the best possible start in Android development * Provides simple, step-by-step exampl

  14. Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial

    Directory of Open Access Journals (Sweden)

    Wayne Peter M

    2012-01-01

    Full Text Available Abstract Background Tai Chi (TC is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly. Few randomized trials have simultaneously evaluated TC's potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women. Methods In a pragmatic randomized trial, 86 post-menopausal osteopenic women, aged 45-70, were recruited from community clinics. Women were assigned to either nine months of TC training plus usual care (UC vs. UC alone. Primary outcomes were changes between baseline and nine months of bone mineral density (BMD of the proximal femur and lumbar spine (dual-energy X-ray absorptiometry and serum markers of bone resorption and formation. Secondary outcomes included quality of life. In a subsample (n = 16, quiet standing fall-predictive sway parameters and clinical balance tests were also assessed. Both intent-to-treat and per-protocol analyses were employed. Results For BMD, no intent-to-treat analyses were statistically significant; however, per protocol analyses (i.e., only including TC participants who completed ≥ 75% training requirements of femoral neck BMD changes were significantly different between TC and UC (+0.04 vs. -0.98%; P = 0.05. Changes in bone formation markers and physical domains of quality of life were also more favorable in per protocol TC vs. UC (P = 0.05. Changes in sway parameters were significantly improved by TC vs. UC (average sway velocity, P = 0.027; anterior-posterior sway range, P = 0.014. Clinical measures of balance and function showed non-significant trends in favor of TC. Conclusions TC training offered through existing community-based programs is a safe, feasible, and promising intervention for reducing multiple fracture risks. Our results affirm the value of a more definitive, longer-term trial of TC for osteopenic women, adequately powered to detect clinically relevant effects of TC on

  15. Fracture Risk Assessment in Older Adults Using a Combination of Selected Quantitative Computed Tomography Bone Measures: A Subanalysis of the Age, Gene/Environment Susceptibility-Reykjavik Study

    Science.gov (United States)

    Rianon, Nahid J.; Lang, Thomas F.; Siggeirsdottir, Kristin; Sigurdsson, Gunnar; Eiriksdottir, Gudny; Sigurdsson, Sigurdur; Jonsson, Brynjolfur Y.; Garcia, Melissa; Yu, Binbing; Kapadia, Asha S.; Taylor, Wendell C.; Selwyn, Beatrice J.; Gudnason, Vilmundur; Launer, Lenore J.; Harris, Tamara B.

    2016-01-01

    Bone mineral density (BMD) and geometric bone measures are individually associated with prevalent osteoporotic fractures. Whether an aggregate of these measures would better associate with fractures has not been examined. We examined relationships between self-reported fractures and selected bone measures acquired by quantitative computerized tomography (QCT), a composite bone score, and QCT-acquired dual-energy X-ray absorptiometry–like total femur BMD in 2110 men and 2682 women in the Age, Gene/Environment Susceptibility-Reykjavik Study. The combined bone score was generated by summing gender-specific Z-scores for 4 QCT measures: vertebral trabecular BMD, femur neck cortical thickness, femur neck trabecular BMD, and femur neck minimal cross-sectional area. Except for the latter measure, lower scores for QCT measures, singly and combined, showed positive (p < 0.05) associations with fractures. Results remained the same in stratified models for participants not taking bone-promoting medication. In women on bone-promoting medication, greater femur neck cortical thickness and trabecular BMD were significantly associated with fracture status. However, the association between fracture and combined bone score was not stronger than the associations between fracture and individual measures or total femur BMD. Thus, the selected measures did not all similarly associate with fracture status and did not appear to have an additive effect on fracture status. PMID:23562129

  16. Patients with rett syndrome sustain low-energy fractures

    DEFF Research Database (Denmark)

    Roende, Gitte; Ravn, Kirstine; Fuglsang, Kathrine;

    2011-01-01

    We present the first case-control study addressing both fracture occurrence and fracture mechanisms in Rett syndrome (RTT). Two previous studies have shown increased fracture risk in RTT. This was also our hypothesis regarding the Danish RTT population. Therefore, we investigated risk factors...

  17. Association of protein intake with the change of lean mass among elderly women: The Osteoporosis Risk Factor and Prevention - Fracture Prevention Study (OSTPRE-FPS).

    Science.gov (United States)

    Isanejad, Masoud; Mursu, Jaakko; Sirola, Joonas; Kröger, Heikki; Rikkonen, Toni; Tuppurainen, Marjo; Erkkilä, Arja T

    2015-01-01

    Low protein intake can lead to declined lean mass (LM) in elderly. We examined the associations of total protein (TP), animal protein (AP) and plant protein (PP) intakes with LM. The association of TP intake with LM change was further evaluated according to weight change status. This cross-sectional and prospective cohort study included 554 women aged 68 (sd 1·9) years from the Osteoporosis Risk Factor and Prevention - Fracture Prevention Study (OSTPRE-FPS). The intervention group (n 270) received daily cholecalciferol (800 IU; 20 μg) and Ca (1000 mg) for 3 years while the control group received neither supplementation nor placebo (n 282). Participants filled out a questionnaire on lifestyle factors and a 3-d food record in 2002 and underwent dual-energy X-ray absorptiometry for body composition measurements at baseline and 3 years. Multiple linear regressions evaluated the association between protein intake and LM, adjusting for relevant covariates. At the baseline TP and AP intakes were positively associated with LM and trunk LM, TP was associated also with appendicular LM (aLM). Follow-up results showed that in the total population and the intervention group, higher TP and AP were associated with increased LM and aLM (P ≤ 0·050). No such associations were observed in the control group. PP intake was also associated with aLM change in the total population. Overall, the associations were independent of fat mass. Further, among weight maintainers, TP intake was positively associated with LM, aLM and trunk LM changes (P ≤ 0·020). In conclusion, dietary TP, especially AP, intake may be a modifiable risk factor for sarcopenia by preserving LM in the elderly.

  18. Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation

    DEFF Research Database (Denmark)

    Lauritzen, J B; Schwarz, Peter; McNair, P;

    1993-01-01

    Hip fractures are common in elderly women, and early risk assessment of future hip fractures is relevant in relation to prevention. We studied the predictive value of radial and humeral fractures in women. The influence of weather conditions on the risk was also studied. Women aged 20-99 years wi...

  19. Cosmology with Negative Absolute Temperatures

    CERN Document Server

    Vieira, J P P; Lewis, Antony

    2016-01-01

    Negative absolute temperatures (NAT) are an exotic thermodynamical consequence of quantum physics which has been known since the 1950's (having been achieved in the lab on a number of occasions). Recently, the work of Braun et al (2013) has rekindled interest in negative temperatures and hinted at a possibility of using NAT systems in the lab as dark energy analogues. This paper goes one step further, looking into the cosmological consequences of the existence of a NAT component in the Universe. NAT-dominated expanding Universes experience a borderline phantom expansion ($w<-1$) with no Big Rip, and their contracting counterparts are forced to bounce after the energy density becomes sufficiently large. Both scenarios might be used to solve horizon and flatness problems analogously to standard inflation and bouncing cosmologies. We discuss the difficulties in obtaining and ending a NAT-dominated epoch, and possible ways of obtaining density perturbations with an acceptable spectrum.

  20. Cosmology with negative absolute temperatures

    Science.gov (United States)

    Vieira, J. P. P.; Byrnes, Christian T.; Lewis, Antony

    2016-08-01

    Negative absolute temperatures (NAT) are an exotic thermodynamical consequence of quantum physics which has been known since the 1950's (having been achieved in the lab on a number of occasions). Recently, the work of Braun et al. [1] has rekindled interest in negative temperatures and hinted at a possibility of using NAT systems in the lab as dark energy analogues. This paper goes one step further, looking into the cosmological consequences of the existence of a NAT component in the Universe. NAT-dominated expanding Universes experience a borderline phantom expansion (w inflation and bouncing cosmologies. We discuss the difficulties in obtaining and ending a NAT-dominated epoch, and possible ways of obtaining density perturbations with an acceptable spectrum.

  1. Epidemiological study on talus fractures

    Directory of Open Access Journals (Sweden)

    Marcos Hideyo Sakaki

    2014-08-01

    Full Text Available Objective:To analyze the characteristics of patients with talus fractures and the injuries that they present.Methods:Retrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed.Results:Analysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications.Conclusion:Talus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days.

  2. Mechanistic fracture criteria for the failure of human cortical bone

    Energy Technology Data Exchange (ETDEWEB)

    Nalla, Ravi K.; Kinney, John H.; Ritchie, Robert O.

    2002-12-13

    A mechanistic understanding of fracture in human bone is critical to predicting fracture risk associated with age and disease. Despite extensive work, a mechanistic framework for describing how the underlying microstructure affects the failure mode in bone is lacking.

  3. FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort

    Directory of Open Access Journals (Sweden)

    Azagra Rafael

    2012-10-01

    Full Text Available Abstract Background The WHO has recently published the FRAX® tool to determine the absolute risk of osteoporotic fracture at 10 years. This tool has not yet been validated in Spain. Methods/design A prospective observational study was undertaken in women in the FRIDEX cohort (Barcelona not receiving bone active drugs at baseline. Baseline measurements: known risk factors including those of FRAX® and a DXA. Follow up data on self-reported incident major fractures (hip, spine, humerus and wrist and verified against patient records. The calculation of absolute risk of major fracture and hip fracture was by FRAX® website. This work follows the guidelines of the STROBE initiative for cohort studies. The discriminative capacity of FRAX® was analyzed by the Area Under Curve (AUC, Receiver Operating Characteristics (ROC and the Hosmer-Lemeshow goodness-of-fit test. The predictive capacity was determined using the ratio of observed fractures/expected fractures by FRAX® (ObsFx/ExpFx. Results The study subjects were 770 women from 40 to 90 years of age in the FRIDEX cohort. The mean age was 56.8 ± 8 years. The fractures were determined by structured telephone questionnaire and subsequent testing in medical records at 10 years. Sixty-five (8.4% women presented major fractures (17 hip fractures. Women with fractures were older, had more previous fractures, more cases of rheumatoid arthritis and also more osteoporosis on the baseline DXA. The AUC ROC of FRAX® for major fracture without bone mineral density (BMD was 0.693 (CI 95%; 0.622-0.763, with T-score of femoral neck (FN 0.716 (CI 95%; 0.646-0.786, being 0.888 (CI 95%; 0.824-0.952 and 0.849 (CI 95%; 0.737-0.962, respectively for hip fracture. In the model with BMD alone was 0.661 (CI 95%; 0.583-0.739 and 0.779 (CI 95%; 0.631-0.929. In the model with age alone was 0.668 (CI 95%; 0.603-0.733 and 0.882 (CI 95%; 0.832-0.936. In both cases there are not significant differences against FRAX® model. The

  4. Galeazzi fracture.

    Science.gov (United States)

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  5. 骨折风险评估工具(FRAX)对中老年2型糖尿病患者骨折风险的预测价值%Predictive value of fracture risk assessment tool for determining fracture probabilities in middle aged and elderly patients with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    陈晓佩; 吴天凤; 郑和昕; 袁放; 文晓林; 谢海宝

    2015-01-01

    Objective To evaluate the predictive value of fracture risk assessment tool (FRAX) for determining fracture probabilities in middle-aged and elderly patients with type 2 diabetes.Methods Retrospective analysis was carried out on 153 type 2 diabetic patients aged over 50 years undergoing dual energy X-ray absorptiometry measurements.Fracture risk factors including age,gender,height,weight,body mass index,history of previous fragility fractures,parental history of hip fracture,history of smoking,excessive drinking,long-term use of steroid hormone,history of rheumatoid arthritis,the history of secondary osteoporosis diseases,and femoral neck T-score of bone mineral density (BMD) were recorded.FRAX scores with BMD (FRAX/BMD) and without BMD (FRAX/-) were calculated.Therapeutic interventions were recommended if the 10-year risk of fractures was more than 3% for hip osteoporotic fractures and more than 20% for other major fractures.Subjects were separated into the identical treatment recommendation group and the different treatment recommendation.Fracture risk factors were compared between groups.Results 133 (6.9 %) patients had identical fracture risk predictions in the FRAX calculation,regardless of whether BMD join in or not.Age,gender and femoral neck T scores had significant differences between the two groups (all P<0.001),while other risk factors had no statistical differences between the two groups (all P>0.05).Conclusions In most middle-aged and elderly patients with type 2 diabetes,the FRAX/-provides the same prediction as FRAX/BMD value for predicting fracture risk,which shows that fracture risks can be predicted without bone density examination.The FRAX/-has higher predictive values on fracture for people who are younger,male,and has higher BMD.%目的 探讨骨折风险评估工具(FRAX)对中老年2型糖尿病患者骨折风险的预测价值. 方法 对153例行骨密度检查的50岁以上2型糖尿病患者进行回顾性分析,根据FRAX指

  6. Rehabilitation in peripheral non femoral fractures: a review

    OpenAIRE

    Mangone, Giuseppe; Postiglione, Marco; Pasquetti, Pietro

    2010-01-01

    This paper is a short review of the available information on peripheral non femoral fractures (PNFF) which are strictly related to osteoporosis. Particular attention is focused on wrist fractures in view of their frequent occurrence as indicated by world wide statistics. Of special interest is the definition of risk groups (old age), risk areas (developed countries) and risk factors. Reference is made to 2008 WHO guidelines for fracture risk assessment. PNFF are a serious concern to health au...

  7. Fracture Blisters

    Directory of Open Access Journals (Sweden)

    Uebbing, Claire M

    2011-02-01

    Full Text Available Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1;131-133.

  8. Fractures in infants and toddlers with rickets

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Teresa; Done, Stephen [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Sugar, Naomi; Feldman, Kenneth [Seattle Children' s Hospital, Children' s Protection Program, Seattle, WA (United States); Marasigan, Joanne; Wambold, Nicolle [University of Washington, College of Arts and Sciences, Seattle, WA (United States)

    2010-07-15

    Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets. A retrospective study of children younger than 24 months was performed. Clinical data and radiographs were reviewed. Radiographs obtained within 1 month of the diagnosis were evaluated for the presence or absence of osteopenia, presence or absence of fraying-cupping, and presence and characterization of fractures. After exclusion criteria were applied, 45 children were included in the study. Children with rickets evident by radiograph were in the age range of 2-24 months. Fractures were present in 17.5% of the study group, exclusively in mobile infants and toddlers. Fracture types included transverse long bone fractures, anterior and anterior-lateral rib fractures, and metaphyseal fractures. All fractures occurred exclusively in patients with severe, overtly evident rickets. Fractures occur in older infants and toddlers with overt rickets and can be seen by radiograph. Fractures do not resemble high-risk non-accidental trauma fractures. (orig.)

  9. Risk factors of pulmonary infection after hip fracture in senile patients%老年髋部骨折后肺部感染危险因素分析

    Institute of Scientific and Technical Information of China (English)

    岳玲; 丁薇; 綦珂; 胡皓璐; 蔡竟蕙; 倪秀石

    2016-01-01

    Objective To explore the risk factors of pulmonary infection after hip fracture in senile patients. Methods A retrospective study was performed to study 78 elderly patients with hip fracture were treated in our hospital between 2011 and 2014.There were 30 pulmonary infection patients and 48 non-pulmonary infection patients.The risk factors were analyzed by Logistic regression analysis.Results Pulmonary disease,diabetes mellitus,nasal feeding, indwelling catheter,osteoporosis treatment and NSAIDs treatment were the risk factors of pulmonary infection after hip fracture in senile patients.Conclusions pulmonary infection after hip fracture in senile patients may be correlated with pulmonary disease,diabetes mellitus,nasal feeding,indwelling catheter,osteoporosis treatment,NSAIDs treatment.%目的:探讨影响老年髋部骨折后肺部感染的相关因素。方法回顾性分析2011-2014年因髋部骨折住院的老年患者共计78例,肺部感染组患者30例,非肺部感染组48例,采用 Logistic 多元化回归分析危险因素。结果肺部基础病史、糖尿病史、鼻饲、留置导尿、骨质疏松治疗、非甾体抗炎药物治疗是老年髋部骨折后肺部感染的危险因素。结论老年患者髋部骨折后肺部感染与肺部基础病史、糖尿病史、鼻饲、留置导尿、骨质疏松治疗、非甾体抗炎药物治疗有关。

  10. Integrin beta3 Leu33Pro polymorphism and risk of hip fracture: 25 years follow-up of 9233 adults from the general population

    DEFF Research Database (Denmark)

    Tofteng, Charlotte L; Bach-Mortensen, Pernille; Bojesen, Stig E;

    2007-01-01

    .02), respectively. Multifactorial adjusted Cox regression revealed a hazard ratio of 2.0 (95% confidence interval: 1.1-3.5) for hip fracture in homozygotes versus noncarriers. After stratification by sex, equivalent hazard ratios were 2.0 (1.0-4.1) in women and 2.0 (0.8-5.0) in men. In the 2193 postmenopausal women......, hazard ratio for hip fracture in homozygotes versus noncarriers after additional adjustment for age at menopause and use of hormone replacement therapy was 2.6 (1.2-5.3). Hazard ratio for hip fracture in heterozygotes versus noncarriers did not differ from 1.0. CONCLUSIONS: Individuals homozygous...

  11. Management of proximal humerus fractures in adults.

    Science.gov (United States)

    Vachtsevanos, Leonidas; Hayden, Lydia; Desai, Aravind S; Dramis, Asterios

    2014-11-18

    The majority of proximal humerus fractures are low-energy osteoporotic injuries in the elderly and their incidence is increasing in the light of an ageing population. The diversity of fracture patterns encountered renders objective classification of prognostic value challenging. Non-operative management has been associated with good functional outcomes in stable, minimally displaced and certain types of displaced fractures. Absolute indications for surgery are infrequent and comprise compound, pathological, multi-fragmentary head-splitting fractures and fracture dislocations, as well as those associated with neurovascular injury. A constantly expanding range of reconstructive and replacement options however has been extending the indications for surgical management of complex proximal humerus fractures. As a result, management decisions are becoming increasingly complicated, in an attempt to provide the best possible treatment for each individual patient, that will successfully address their specific fracture configuration, comorbidities and functional expectations. Our aim was to review the management options available for the full range of proximal humerus fractures in adults, along with their specific advantages, disadvantages and outcomes.

  12. Fracture source

    Directory of Open Access Journals (Sweden)

    2003-07-01

    Full Text Available The fracture properties of many different types of fibers are covered in a timely new book that will prove to be a tremendous source of information and references for researchers in the wide and diverse field of fibers and composites, says Bill Clegg.

  13. Measurement of the absolute speed is possible?

    OpenAIRE

    Sergey V. Shevchenko; Tokarevsky, Vladimir V.

    2016-01-01

    One of popular problems, which  are experimentally studied in physics in a long time, is the testing of the special relativity theory, first of all – measurements of isotropy and constancy of light speed; as well as attempts to determine so called “absolute speed”, i.e. the Earth speed in the absolute spacetime (absolute reference frame), if this spacetime (ARF) exists.  Corresponding experiments aimed at the measuring of proper speed of some reference frame in oth...

  14. Innovative probabilistic risk assessment applications: barrier impairments and fracture toughness. 2. Demolition Debris and Tornado Missile Hazard During Decommissioning

    International Nuclear Information System (INIS)

    impose on decommissioning projects. Unit 1 began operation in 1968. Because of the age of Unit 1's design and the low frequency of tornadoes in California, the original plant design did not provide any protection from tornado hazards. Tornado protection requirements were later imposed as a back-fit; however, the approved license change was based on a probabilistic risk assessment that defined Unit 1's tornado missile damage acceptance limit in terms of reactor core damage frequency. When several Unit 1 buildings have been demolished, construction will begin on an ISFSI for Unit 1's spent fuel. The ISFSI design incorporates tornado missile barrier features into the storage canister and transfer cask. These design provisions will alleviate any need to manage tornado missile hazards. Units 2 and 3 share a design basis for tornado missile protection that closely follows the U.S. Nuclear Regulatory Commission's Standard Review Plan (NUREG 0800), Revision 1. Critical components are identified that are required to be functional following design-basis tornadoes. Missile barriers protect most critical components; however, some critical components are allowed to be exposed to tornado missiles provided the aggregate annual probability of damage to all critical components is -7 per unit. According to the analysis that established this probability, it is directly proportional to the inventory of unrestrained objects within a missile pickup/transport area that includes the entire site. To determine the increased probability of damage due to demolition work, the quantity of loose debris was estimated for several discrete time intervals of the decommissioning process. This intermediate result showed that debris controls would be necessary to protect critical components in Units 2 and 3 during the demolition of Unit 1. Several different methods for controlling debris were evaluated for efficacy, feasibility, and cost-effectiveness. Unit 1 decommissioning work will increase the number of

  15. Pediatric Ankle Fractures: Concepts and Treatment Principles.

    Science.gov (United States)

    Su, Alvin W; Larson, A Noelle

    2015-12-01

    Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management relies on appropriate examination, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, computed tomography. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high-risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity. PMID:26589088

  16. Implementing a Greener Hydraulic Fracturing in Scotland

    OpenAIRE

    Cano, Michele; Matthew, Anietie; Quinn, Brian

    2015-01-01

    International audience Abstract - The drive to implement unconventional gas drilling by means of hydraulic fracturing in United Kingdom (UK) has been a major issue of concern due to the potential environmental and health impacts. This paper is aimed at examining the following: what triggers the need for the unconventional gas; the process of unconventional gas through hydraulic fracturing method; the potential risks of hydraulic fracturing to the environment and to human health; key succes...

  17. Fracture healing and drug therapies in osteoporosis

    OpenAIRE

    Hoang-Kim, Amy; Gelsomini, Letizia; Luciani, Deianira; Moroni, Antonio; Giannini, Sandro

    2009-01-01

    Fracture repair has not been fully optimised and there is opportunity to increase the healing rate and reduce the number of complications using pharmacological means. While most anti-osteoporosis drugs have been widely tested for their ability to decrease the risk of osteoporotic fractures, fragility fractures still occur in patients under medical intervention. The primary purpose of this systematic review is to understand these underlying mechanisms between bone and drug therapies in osteopo...

  18. Risk factors of neurological lesions in low cervical spine fractures and dislocations Fatores de risco de lesão neurológica nas fraturas e luxações da coluna cervical baixa

    Directory of Open Access Journals (Sweden)

    DANILO GONÇALVES COELHO

    2000-12-01

    Full Text Available Eighty-nine patients with lower cervical spine fractures or dislocations were evaluated for risk factors of neurological lesion. The age, sex, level and pattern of fracture and sagittal diameter of the spinal canal were analysed. There were no significant differences on the age, gender, level and Torg's ratio between intact patients and those with nerve root injury, incomplete or complete spinal cord injuries. Bilateral facet dislocations and burst fractures are a significant risk factor of spinal cord injury.O risco de lesão neurológica foi avaliado em 89 pacientes com fraturas ou luxações da coluna cervical baixa. Foram analisados o sexo, a idade, o diâmetro sagital do canal vertebral, o nível e o tipo de fratura ou luxação. Não foram encontradas diferenças significativas para a idade, sexo, nível da fratura ou luxação e razão de Torg entre os pacientes intactos e aqueles com lesão radicular, lesão medular incompleta e lesão medular completa. Luxações bilaterais de facetas articulares e fraturas em explosão são um fator de risco significativo de lesão neurológica.

  19. Multicenter survey on risk factors for surgical site infection following limb fracture surgery%四肢骨折手术部位感染危险因素多中心调查

    Institute of Scientific and Technical Information of China (English)

    芦永华; 黄新玲; 何文英; 先疆燕

    2016-01-01

    目的:探讨四肢骨折术后手术部位感染(SSI)的相关危险因素,为制定合理的预防控制措施提供依据。方法收集2014年1月1日—6月30日16所医院1453例接受四肢骨折手术患者的临床资料,进行单因素及多因素 logistic 回归分析。结果1453例四肢骨折手术患者,发生 SSI 12例,SSI 发生率为0.83%。单因素分析结果显示,术前7 d 是否存在其他部位感染、损伤至手术的时间、手术时机、手术持续时间、开放性骨折、切口类型及麻醉类型是四肢骨折 SSI 的危险因素(均 P <0.05)。多因素 logistic 回归分析结果显示,切口类型、麻醉类型、开放性骨折、损伤至手术的时间及手术持续时间是四肢骨折术后 SSI 的独立危险因素,其 OR 及95% CI 分别为12.47(2.78~15.88)、11.55(2.84~17.02)、10.79(2.72~11.13)、2.35(2.12~6.81)、3.07(1.88~4.13)。结论四肢骨折术后 SSI 是多因素综合作用所致,识别危险因素,加强重点环节管理,是预防和控制手术部位感染的关键。%Objective To evaluate the risk factors for surgical site infection(SSI)following limb fracture surgery, and provide basis for making prevention and control measures.Methods Clinical data of 1 453 patients undergoing limb fracture surgery in 16 hospitals between January 1,2014 and June 30,2014 were collected,risk factors for SSI were analyzed by univariate and multivariate logistic regression analysis.Results Among 1 453 patients undergoing limb fracture surgery,12 developed SSI(0.83%).Univariate analysis showed that risk factors for SSI following limb fracture surgery were infection at the other sites 7 days before operation,time from injury to operation,opera-tion opportunity, duration of operation,open fracture, wound type, and anesthesia type ( all P < 0.05 ). Multivariate logistic regression analysis showed that independent risk

  20. Is Implantation of a Left Ventricular Assist Device in Patients With Critical or Impending Cardiogenic Shock an Absolute Contraindication? Looking Back at Our Past Experience Trying to Identify Contraindicative Risk Factors.

    Science.gov (United States)

    Dell'Aquila, Angelo Maria; Schneider, Stefan R B; Risso, Paolo; Welp, Henryk; Glockner, David G; Alles, Sebastian; Sindermann, Jürgen R; Scherer, Mirela

    2015-12-01

    Poor survival has been demonstrated after ventricular assist device (VAD) implantation for Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 and 2 patients compared with more stable levels. However, risk factors within this high-risk cohort have not been determined so far. The aim of the present study was to identify risk factors associated with this very high mortality rate. Between February 1993 and January 2013, 298 patients underwent VAD implantation in our institution. One hundred nine patients were in INTERMACS level 1 and 49 patients were in INTERMACS level 2 and were therefore defined as hemodynamically critical (overall 158 patients). Assist devices implanted were: HVAD HeartWare n = 18; Incor n = 11; VentrAssist n = 2; DeBakey n = 22; and pulsatile systems n = 105. After cumulative support duration of 815.35 months, Kaplan-Meier analysis revealed a survival of 63.9, 48.8, and 40.3% at 1, 6, and 12 months, respectively. Cox regression analyses identified age > 50 (P = 0.001, odds ratio [OR] 2.48), white blood cell count > 13.000/μL (P = 0.01, OR 2.06), preoperative renal replacement therapy (P = 0.001, OR 2.63), and postcardiotomy failure (P < 0.001, OR 2.79) as independent predictors of mortality. Of note, last generation VADs were not associated with significantly better 6-month survival (P = 0.59). Patients without the aforementioned risk factors could yield a survival of 79.2% at 6 months. This single-center experience shows that VAD implantation in hemodynamically unstable patients generally results in poor early outcome, even in third-generation pumps. However, avoiding the aforementioned risk factors could result in improved outcome.

  1. Scapular fractures and concomitant injuries

    Institute of Scientific and Technical Information of China (English)

    Osaree Akaraborworn; Burapat Sangthong; Komet Thongkhao; Prattana Chiniramol; Khanitta Kaewsaengrueang

    2012-01-01

    Objective: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized.Few studies have investigated this presumed association.In this study,wc investigated the incidence of significant associated injuries with scapular fracture and their outcomes.Methods: A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand.All blunt trauma patients were identified.Patients' demographics,injury mechanism,associated injuries,Injury Severity Score (ISS),and survival outcomes were recorded.The management of associated injuries with scapular fracture was reviewed,and the risk factors for mortality were identified.Results: Among the 7 345 trauma patients admitted,scapular fractures occurred in 84 cases (1.1%).The mean age was (37.98±15.21) years.Motorcycle crash was the most frequent mechanism of injury,occurring in 51 cases (60.7%).Seventy-four patients (88.1%) suffering from scapular fractures had associated injuries:5 (6.0%) had significant chest injuries,but none of them had blunt thoracic aortic injury.Two patients (2.4%) with scapular fractures died.Factors determining the likelihood of mortality were:(1) ISS>25(LR=8.5,P<0.05); (2) significant associated chest injury (AIS>3,LR=5.3,P<0.05) and (3) significant associated abdominal injury (AIS>3,LR=5.3,P<0.05).Conclusion: A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury,extremity injury,head injury,etc.If a scapular fracture is found with a high ISS score,high chest or abdomen AIS score,the patient would have a high risk of mortality.

  2. Inequalities, Absolute Value, and Logical Connectives.

    Science.gov (United States)

    Parish, Charles R.

    1992-01-01

    Presents an approach to the concept of absolute value that alleviates students' problems with the traditional definition and the use of logical connectives in solving related problems. Uses a model that maps numbers from a horizontal number line to a vertical ray originating from the origin. Provides examples solving absolute value equations and…

  3. Absolute Income, Relative Income, and Happiness

    Science.gov (United States)

    Ball, Richard; Chernova, Kateryna

    2008-01-01

    This paper uses data from the World Values Survey to investigate how an individual's self-reported happiness is related to (i) the level of her income in absolute terms, and (ii) the level of her income relative to other people in her country. The main findings are that (i) both absolute and relative income are positively and significantly…

  4. Investigating Absolute Value: A Real World Application

    Science.gov (United States)

    Kidd, Margaret; Pagni, David

    2009-01-01

    Making connections between various representations is important in mathematics. In this article, the authors discuss the numeric, algebraic, and graphical representations of sums of absolute values of linear functions. The initial explanations are accessible to all students who have experience graphing and who understand that absolute value simply…

  5. Monolithically integrated absolute frequency comb laser system

    Energy Technology Data Exchange (ETDEWEB)

    Wanke, Michael C.

    2016-07-12

    Rather than down-convert optical frequencies, a QCL laser system directly generates a THz frequency comb in a compact monolithically integrated chip that can be locked to an absolute frequency without the need of a frequency-comb synthesizer. The monolithic, absolute frequency comb can provide a THz frequency reference and tool for high-resolution broad band spectroscopy.

  6. Representative Consumer's Risk Aversion and Efficient Risk-Sharing Rules

    OpenAIRE

    Hara, Chiaki; Huang, James; Kuzmics, Christoph

    2007-01-01

    We study the representative consumer's risk attitude and efficient risk-sharing rules in a singleperiod, single-good economy in which consumers have homogeneous probabilistic beliefs but heterogeneous risk attitudes. We prove that if all consumers have convex absolute risk tolerance, so must the representative consumer. We also identify a relationship between the curvature of an individual consumer's individual risk sharing rule and his absolute cautiousness, the first derivative of absolute ...

  7. Representative Consumer's Risk Aversion and Efficient Risk-Sharing Rules

    OpenAIRE

    Hara, Chiaki; Kuzmics, Christoph

    2004-01-01

    We study the representative consumer's risk attitude and efficient risk-sharing rules in a single-period, single-good economy in which consumers have homogeneous probabilistic beliefs but heterogeneous risk attitudes. We prove that if all consumers have convex absolute risk tolerance, so must the representative consumer. We also identify a relationship between the curvature of an individual consumer's individual risk sharing rule and his absolute cautiousness, the first derivative of absolute...

  8. AMC及 ALC与侵袭性B细胞淋巴瘤低危患者的预后关系分析%Relationship between absolute monocyte/lymphocyte count and prognosis in low-risk patients with aggressive B cell lymphoma

    Institute of Scientific and Technical Information of China (English)

    徐诣芝; 何代英; 罗治彬; 李静; 王琛

    2015-01-01

    目的:探讨外周血单核细胞绝对计数(AMC)及淋巴细胞绝对计数(ALC)与侵袭性B细胞淋巴瘤低危患者预后的相关性。方法回顾性分析了2003~2013年42例初发侵袭性B细胞淋巴瘤低危患者的AMC、ALC及淋巴细胞/单核细胞比值(LMR)与患者各项临床指标、无进展生存期(PFS)和总生存期(OS)的相关性。结果据ROC曲线划分AMC、ALC、LMR对5年OS影响的界限值分别为475/mm3、1005/mm3和2.1。AMC≥475/mm3、ALC<1005/mm3是 PFS的独立不良因素(RR=4.271、3.023;P=0.01、0.39);AMC≥475/mm3是OS的独立不良因素(RR=4.680;P<0.01)。结论初发时高AMC、低ALC患者预后较差。推测外周血AMC、ALC可能成为侵袭性B细胞淋巴瘤低危患者进一步分层的预后指标。%Objective To investigate the prognostic significance of peripheral blood absolute monocyte/lymphocyte count in low‐risk patients with aggressive B cell lymphoma .Methods Retrospective study was performed in 42 low‐risk patients with ag‐gressive B cell lymphoma approved by histology between 2003 to 2013 .Peripheral blood absolute monocyte count (AMC) ,absolute lymphocyte count (ALC) ,lymphocyte/monocyte(LMR) and the some other clinical characters were estimated .Results The best absolute monocyte/lymphocyte count cut‐offs respectively were 475/mm3 and 1 005/mm3 ,analyzed by receiver operating character‐istic curve .AMC≥475/mm3 and ALC<1 005/mm3 were found to be independent predictors of progress free survival (RR=4 .271 , 3 .023 ;P= 0 .01 ,0 .39);AMC≥475/mm3 was found to be independent predictors of 5‐year overall survival (RR= 4 .680;P<0 .0001) in low‐risk patients with aggressive B cell lymphoma .Conclusion Higher AMC and/or lower ALC are poor prognosis fac‐tors .AMC and ALC may be important prognostic factors of low‐risk patients with aggressive B cell lymphoma .

  9. Risk factors of failure in closed reduction for supracondylar fractures of humerus in children%儿童肱骨髁上骨折闭合复位失败的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    杨杰; 孙辽军; 杜胜虎; 黄祥祥; 陈华; 郭晓山

    2013-01-01

    目的 探讨导致儿童肱骨髁上骨折闭合复位失败的危险因素,从而指导临床治疗.方法 回顾性分析2008年2月至2013年2月于本院治疗的138例肱骨髁上骨折患儿的临床资料,记录其年龄、BMI指数、受伤机制、骨折类型、受伤至手术时间、最大初始移位(对位及旋转).采用均值比较或卡方检验对以上因素进行单因素分析,再采用多因素logistic分析对可能的危险因素进行分析,以明确肱骨髁上骨折闭合复位失败的相关因素.结果 单因素分析显示BMI指数、骨折类型、受伤至手术时间、最大初始移位与儿童肱骨髁上骨折闭合复位失败有显著相关性,多因素Logistic回归分析显示,骨折类型、受伤至手术时间、最大初始移位是儿童肱骨髁上骨折闭合复位失败的独立危险因素.结论 伤后肿胀高峰期、GartlandⅢ型骨折、初始移位大的患儿闭合复位失败机率高,选择复位及固定方式时应仔细考虑这些危险因素.%Objective To investigate the risk factors of failure in closed reduction for supracondylar fracture of humerus in children and to guide clinical treatment.Methods Children with supracon dylar fractures who were treated in our hospital from February 2008 to February 2013 were studied.Age,BMI index,mechanism of injury,fracture type,duration from injury to surgery,the maximum initial displacement (right position and rotation) were analyzed.Mean comparison or chi-square test was used for univariate analysis and multivariate logistic regression analysis was used to identify possible risk factors.Results Univariate analysis showed that BMI index,fracture type,duration from injury to surgery and the maximum initial displacement were significantly correlated with the failure in closed reduction.Multivariate logistic regression analysis showed that the type of fracture,duration from injury to surgery and the maximum initial displacement were independent risk factors

  10. The epidemic of hip fractures: are we on the right track?

    Directory of Open Access Journals (Sweden)

    Klaas A Hartholt

    Full Text Available BACKGROUND: Hip fractures are a public health problem, leading to hospitalization, long-term rehabilitation, reduced quality of life, large healthcare expenses, and a high 1-year mortality. Especially older adults are at greater risk of fractures than the general population, due to the combination of an increased fall risk and osteoporosis. The aim of this study was to determine time trends in numbers and incidence rates of hip fracture-related hospitalizations and admission duration in the older Dutch population. METHODS AND FINDINGS: Secular trend analysis of all hospitalizations in the older Dutch population (≥65 years from 1981 throughout 2008, using the National Hospital Discharge Registry. Numbers, age-specific and age-adjusted incidence rates (per 10,000 persons of hospital admissions and hospital days due to a hip fracture were used as outcome measures in each year of the study. Between 1981 and 2008, the absolute number of hip fractures doubled in the older Dutch population. Incidence rates of hip fracture-related hospital admissions increased with age, and were higher in women than in men. The age-adjusted incidence rate increased from 52.0 to 67.6 per 10,000 older persons. However, since 1994 the incidence rate decreased (percentage annual change -0.5%, 95% CI: -0.7; -0.3, compared with the period 1981-1993 (percentage annual change 2.3%, 95% CI: 2.0; 2.7. The total number of hospital days was reduced by a fifth, due to a reduced admission duration in all age groups. A possible limitation was that data were obtained from a linked administrative database, which did not include information on medication use or co-morbidities. CONCLUSIONS: A trend break in the incidence rates of hip fracture-related hospitalizations was observed in the Netherlands around 1994, possibly as a first result of efforts to prevent falls and fractures. However, the true cause of the observation is unknown.

  11. 老年人跌倒与骨折的风险及其预防%Risk factors and the preventing methods of fracture caused by falls in the elderly

    Institute of Scientific and Technical Information of China (English)

    覃朝晖; 于普林

    2011-01-01

    The incidence of the fracture caused by falls in the olderly is high. The fracture due to falls can cause bad consequences. It was an importent cause of disability and death and threatened health and life of the elderly. In this article,the epidemiological characteristics of the fracture caused by falls in older people were introduced and the risk factors and the corresponding preventing methods were discussed.%老年人跌倒致骨折的发生率高,后果严重,是老年人伤残、失能和死亡的重要原因之一,也是威胁老年人健康和生命的一个重要原因.文章介绍了老年人跌倒致骨折的发生情况、后果,阐述了老年人跌倒致骨折的危险因素,并针对危险因素提出了预防对策.

  12. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

    Directory of Open Access Journals (Sweden)

    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  13. 不同骨质疏松性骨折风险社区老年人健康行为研究%A health behaviors research about the community-dwelling older people with different risk of osteoporotic fractures

    Institute of Scientific and Technical Information of China (English)

    王玉环; 何斌; 张苇; 陆宁

    2012-01-01

    目的 了解不同骨质疏松性骨折风险社区老年人的健康行为.方法 采用骨质疏松性骨折风险预测简易工具(FRAX),以分层抽样方法,对石河子市3个社区450名60岁及以上的老年人进行人户一对一问卷调查.结果 骨折高低风险人群健康行为得分经统计学检验,差异有统计学意义(P<0.01).社区高风险骨质疏松性骨折老年人行为平均得分为(30.59 ±4.67)分,得分率为56.6%;得分33分及以上者86人,及格率仅为37.2%.低风险骨质疏松性骨折老年人健康行为平均得分为(32.01 ±4.49)分,得分率为59.3%;得分33分及以上者102人,及格率为46.6%.单因素分析显示,文化程度是影响低风险骨质疏松性骨折老年人健康行为的主要因素;多元线性逐步回归分析显示,性别及月收入是影响高风险骨质疏松性骨折老年人健康行为的主要因素.结论重点加强高风险骨折群体中低收入者、男性群体及低风险骨折群体中教育程度低的老年人健康行为干预力度.%Objective To find out a health behaviors about the community-dwelling older people with different risk of osteoporotic fractures,and to provide the interventions basis for high risk population.Methods By fracture risk assessment tool(FRAX).Stratified sampling method was used.Data were collected by face-to-face interviews with questionnaires in 450 people aged 60 years and over who come from the three communities.Results By the statistical test,the scores of behavior between high and low risk older people had statistical significance(P<0.01 ).The scores of high risk of osteoporotic fractures behavior in older people were 30.59 ± 4.67,which rate was 56.6%.There were 86 people who scored 33 and over,pass rate was only 37.2% ; The behavior scores of low risk of osteoporotic fractures older people were 32.01 ± 4.49,which rate was 59.3%.There were 102 people who scored 33 and over,pass rate was only 46.6%.The one

  14. The Simplicity Argument and Absolute Morality

    Science.gov (United States)

    Mijuskovic, Ben

    1975-01-01

    In this paper the author has maintained that there is a similarity of thought to be found in the writings of Cudworth, Emerson, and Husserl in his investigation of an absolute system of morality. (Author/RK)

  15. Absolute calibration technique for spontaneous fission sources

    International Nuclear Information System (INIS)

    An absolute calibration technique for a spontaneously fissioning nuclide (which involves no arbitrary parameters) allows unique determination of the detector efficiency for that nuclide, hence of the fission source strength

  16. Absolute distance metrology for space interferometers

    OpenAIRE

    Swinkels, B L; Wendrich, T.J.; Bhattacharya, N; Wielders, A.A.; Braat, J.J.M.

    2004-01-01

    Space interferometers consisting of several free flying telescopes, such as the planned Darwin mission, require a complex metrology system to make all the components operate as a single instrument. Our research focuses on one of its sub-systems that measures the absolute distance between two satellites with high accuracy. For Darwin the required accuracy would be in the order of 10 μm over 250 meter. To measure this absolute distance, we are currently exploring the frequency sweeping interfer...

  17. [FLS - three letters alter secondary fracture prevention].

    Science.gov (United States)

    Suhm, N; Meier, C; Kraenzlin, M; Kungler, E; Savic, B; Mueller, S; Jakob, M; Rikli, D

    2016-01-01

    The increasing importance of preventive measures in the field of orthopedics and trauma surgery becomes apparent because of the demographic changes and the high risk for secondary fractures following osteoporotic fractures. Within the fracture treatment chain, orthopedics and trauma surgery are in the "pole position" to initiate these measures in geriatric patients. In the past orthopedists and trauma surgeons have constantly accused of neglecting secondary fracture prevention in fragility fracture patients. There are several reasons that speak in favor of us undertaking a role in secondary fracture prevention: osteoporosis medication is highly effective in fracture prevention when correctly indicated, the positive effects of osteoporosis therapy on fracture healing and legal issues. Arguments that have been used to justify neglect of secondary fracture prevention are undesired side effects related to osteoporosis medications, such as atypical femoral fractures and osteonecrosis of the jaws, interference of some specific drugs with fracture healing and the working conditions in emergency departments. These run contrary to the consideration of chronic diseases such as osteoporosis, secondary osteoporosis and the underlying disease could be overlooked and the increasing complexity of medicinal osteoporosis therapy. In the first part of the article these arguments are weighed against each other. In the second part the concept of a fracture liaison service (FLS) is discussed. The FLS framework now allows an active role to be taken with respect to secondary fracture prevention despite the busy daily routine schedule. Implementation of an FLS is facilitated by dedicated instruction protocols and programs. Self-financing of an FLS is currently possible only in some specific healthcare systems. In healthcare systems in German-speaking areas a cross-financing must be available and the value of an FLS indirectly presented. Apart from the financial aspects, implementation of

  18. Risk Factors for Posttraumatic Synostosis and Outcomes Following Surgery of Ankle fractures%踝关节骨折术后下胫腓骨性连接风险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈宏峰; 王利民

    2015-01-01

    目的:评估踝关节骨折内固定方法和其他危险因素与术后胫腓骨远端骨性连接发生的关系。方法收集踝关节骨折术后患者资料,评估是否存在下胫腓骨性连接。所有骨折都使用钢板治疗,有需要者辅以下胫腓螺钉。记录和分析患者病史、损伤情况以及内固定方法。同时对并发症进行回顾性分析,功能评分采用FAOS(Foot and Ankle Outcome Score)评分。结果286例踝关节骨折纳入本研究,39例发生完全连接,20例发生不完全骨性桥接。多变量分析显示男性(OR=2.54,P<0.01),下胫腓螺钉置入(OR=2.02,P<0.01)和胫距脱位(OR=1.61,P=0.041)是独立的危险因素。伴有骨性连接的踝关节背伸(P=0.009)、跖屈(P=0.013)和内翻( P<0.001)活动受限,但是随访其功能和非连接者一致。结论下胫腓螺钉、男性和胫距关节脱位是术后胫腓骨远端骨性连接的显著性危险因素,骨性连接会导致踝关节活动受限,但对其功能无显著性影响。%Objective To evaluate the relationship between ankle fracture fixation method and other risk factors in the development of synostosis in posttraumatic operative ankle fractures.Methods All operative ankle fractures were evaluated for the presence of distal tibiofibu-lar synostosis.All fractures were treated in a fracture-specific and ligament-specific fashion with syndesmotic screws if needed.Patient de-mographic and medical history data as well as injury and fixation profile were evaluated.Incidence of complications was also reviewed.Ameri-can orthopaedic foot and ankle society( FAOS) score were compared between the groups.Results Of the 286 ankle fractures included in the study, 39 demonstrated complete synostosis and 20 demonstrated incomplete bony bridging.Multivariate analysis revealed male sex(OR=2.54, P<0.01), syndesmotic screw fixation((OR=2.02, P<0.01), and tibiotalar

  19. Arthrofibrosis After Periarticular Fracture Fixation.

    Science.gov (United States)

    McAlister, Ian; Sems, Stephen Andrew

    2016-04-01

    Arthrofibrosis after periarticular fractures can create clinically significant impairments in both the upper and lower extremities. The shoulder, elbow, and knee are particularly susceptible to the condition. Many risk factors for the development of arthrofibrosis cannot be controlled by the patient or surgeon. Early postoperative motion should be promoted whenever possible. Manipulations under anesthesia are effective for a period of time in certain fracture patterns, and open or arthroscopic surgical debridements should be reserved for the patient for whom nonoperative modalities fail and who has a clinically significant deficit. PMID:26772943

  20. Uso de medicamentos como fator de risco para fratura grave decorrente de queda em idosos Medication as a risk factor for falls resulting in severe fractures in the elderly

    Directory of Open Access Journals (Sweden)

    Evandro da Silva Freire Coutinho

    2002-10-01

    Full Text Available Quedas seguidas de fraturas entre idosos constituem um importante problema de saúde pública. Um estudo caso-controle foi conduzido para avaliar o papel do uso de um conjunto de medicamentos, como fator de risco para esses acidentes entre pessoas com 60 anos ou mais, na cidade do Rio de Janeiro, Brasil. Cento e sessenta e nove casos de internação por fratura conseqüente a queda, e 315 controles hospitalares foram pareados por idade, sexo e hospital. Odds ratios (OR, ajustados por fatores potenciais de confusão, foram obtidos utilizando-se regressão logística condicional. Observou-se um aumento no risco desses acidentes para o uso de drogas bloqueadoras dos canais de cálcio (OR = 1,96, 1,16-3,30 e benzodiazepínicos (OR = 2,09, 1,08-4,05, e uma redução para o uso de diuréticos (OR = 0,40, 0,20-0,80. Antiácidos, digitálicos e laxantes mostraram-se associados a uma redução do risco de fraturas por quedas, cuja significância estatística atingiu níveis limítrofes (0,05 Falls leading to fractures among the elderly are a major public problem. A case-control study was conducted on the use of certain drugs as a risk factor for hospitalization due to fractures after falls among individuals aged 60 years or over in the city of Rio de Janeiro, Brazil. One hundred sixty-nine cases and 315 in-patient controls were matched by age, sex, and hospital. Odds ratios (OR adjusted for potential confounders were calculated using conditional logistic regression. Increased risk of such accidents was found for calcium channel antagonists (OR = 1.96, 1.16-3.30 and benzodiazepines (OR = 2.09, 1.08-4.05, and decreased risk was associated with diuretics (OR = 0.40, 0.20-0.80. Antacids, digitalis, and laxatives were associated with reduced risk of fractures after falls that reached borderline statistical significance (0.05 < p < 0.10. The findings highlight the need to weigh risks and benefits of medication in the elderly. It is also important to advise

  1. The importance of previous fracture site on osteoporosis diagnosis and incident fractures in women.

    Science.gov (United States)

    Morin, Suzanne N; Lix, Lisa M; Leslie, William D

    2014-07-01

    Previous fracture increases the risk of subsequent fractures regardless of the site of the initial fracture. Fracture risk assessment tools have been developed to guide clinical management; however, no discrimination is made as to the site of the prior fracture. Our objective was to determine which sites of previous nontraumatic fractures are most strongly associated with a diagnosis of osteoporosis, defined by a bone mineral density (BMD) T-score of ≤ -2.5 at the femoral neck, and an incident major osteoporotic fracture. Using administrative health databases, we conducted a retrospective historical cohort study of 39,991 women age 45 years and older who had BMD testing with dual-energy X-ray absorptiometry (DXA). Logistic regression and Cox proportional multivariate models were used to test the association of previous fracture site with risk of osteoporosis and incident fractures. Clinical fractures at the following sites were strongly and independently associated with higher risk of an osteoporotic femoral neck T-score after adjustment for age: hip (odds ratio [OR], 3.58; 95% confidence interval [CI], 3.04-4.21), pelvis (OR, 2.23; 95% CI, 1.66-3.0), spine (OR, 2.16; 95% CI, 1.77-2.62), and humerus (OR, 1.74; 95% CI, 1.49-2.02). Cox proportional hazards models, with adjustment for age and femoral neck BMD, showed the greatest increase in risk for a major osteoporotic fracture for women who had sustained previous fractures of the spine (hazard ratio [HR], 2.08; 95% CI, 1.72-2.53), humerus (HR, 1.70; 95% CI, 1.44-2.01), patella (HR, 1.54; 95% CI, 1.10-2.18), and pelvis (HR, 1.45; 95% CI, 1.04-2.02). In summary, our results confirm that nontraumatic fractures in women are associated with osteoporosis at the femoral neck and that the site of previous fracture impacts on future osteoporotic fracture risk, independent of BMD.

  2. Analysis of the gynecological risk factors of femoral neck fracture with osteoporosis in elderly women%老年女性股骨颈骨折妇科相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈古福; 查前龙; 朱德军

    2015-01-01

    目的:探讨老年女性骨质疏松性股骨颈骨折的危险因素,为早期准确预测其骨质疏松股骨颈骨折提供客观依据。方法采用病例对照研究方法,选择150例年龄>60岁的骨质疏松性股骨颈骨折女性患者作为骨折组,同时在周边地区随机选取150例年龄相当的无股骨颈骨折的老年女性作为对照组。通过问卷调查的方法,调查两组年龄、初潮年龄、绝经年龄、怀孕次数、生产次数、母乳喂养时间、体重指数等妇科相关情况。采用 Logistic 回归分析的方法对影响股骨颈骨折的因素进行分析。结果对照组与骨折组的初潮年龄、绝经年龄、怀孕次数、生产次数、母乳喂养时间、体重指数比较差异均有统计学意义(P <0.05或 P <0.01),其中老年女性骨质疏松性股骨颈骨折的发生与初潮年龄、怀孕次数、生产次数、母乳喂养时间呈正相关(P <0.05或 P<0.01),与绝经年龄、体重指数呈负相关(P <0.01)。结论初潮晚、绝经早、孕产次数多、母乳喂养时间长、体重指数低可能是老年女性骨质疏松性股骨颈骨折的重要危险因素。%Objective To investigate the risk factors for osteoporosis in elderly women with femoral neck fracture for accurately predicting early femoral neck fracture of osteoporotic and providing an objective basis. Methods 150 os-teoporotic femoral neck fracture women older than 60 years were selected as a research group with case-control study. Age-matched 150 cases were randomly selected in the surrounding area without femoral neck fractures as a control group. Through questionnaire survey, including age, menarche age, menopause age, number of pregnancies, number of births, breast feeding time, body mass index and other gynecological relevant circumstances. Logistic regression a-nalysis was used to evaluate the effect. Results The difference of menarche age, menopause age, number of preg

  3. Femur fracture classification in women with a history of breast cancer

    Directory of Open Access Journals (Sweden)

    Stephanie Chau

    2014-05-01

    Conclusion: Most femur fractures in women with prior breast cancer occurred in the hip. Among younger women and those experiencing diaphyseal fractures, a larger proportion were pathologic and some were found to be atypical. Further studies should examine risk factors for femur fracture in women with breast cancer with specific attention to fracture subtype and pharmacologic exposures.

  4. Current medical treatment strategies concerning fracture healing.

    Science.gov (United States)

    Giannotti, Stefano; Bottai, Vanna; Dell'osso, Giacomo; Pini, Erica; De Paola, Gaia; Bugelli, Giulia; Guido, Giulio

    2013-05-01

    The morbidity and socioeconomic costs associated with bone healing are considerable. A number of fractures are complicated by impaired healing. This is prevalent in certain risk groups such as elderly, osteoporotics, post-menopausal women, and in people with malnutrition. The biologic process of fracture healing is complex and impacted by multiple factors. Some of them, such as the nutritional and health conditions, are patient-dependent, while others depend on the trauma experienced and stability of the fracture. Fracture healing disorders negatively affect the patient's quality of life and result in high health-care costs, as a second surgery is required to stabilize the fracture and stimulate bone biology. Future biotechnologies that accelerate fracture healing may be useful tools, which might also prevent the onset of these disorders. We list the characteristics of the drugs used for osteoporosis, but we point out in particular the use of strontium ranelate and teriparatide in our clinical practice in elderly patients, especially females, who reported fractures with risk of nonunion. This medical treatment could impaired fracture healing however, most of the evidence is obtained in animal studies and very few studies have been done in humans. Thus one could hypothesize the possibility of a medical treatment both as a preventive and as support to the synthesis. However, no clinical studies are available so far, and such studies are warranted before any conclusions can be drawn. A positive effect of osteoporosis treatments on bone healing is an interesting possibility and merits further clinical research. PMID:24133528

  5. Lower extremity stress fractures in the military.

    Science.gov (United States)

    Jacobs, Jeremy M; Cameron, Kenneth L; Bojescul, John A

    2014-10-01

    Stress fractures of the lower extremities are common among the military population and, more specifically, military recruits who partake in basic training. Both intrinsic and extrinsic factors play a role in the development of these injuries, and it is important to identify those individuals at risk early in their military careers. Some of these factors are modifiable, so they may become preventable injuries. It is important to reiterate that one stress fracture places the soldier at risk for future stress fractures; but the first injury should not be reason enough for separation from the military, as literature would support no long-term deficits from properly treated stress fractures. Early in the process, radiographic analysis is typically normal; continued pain may warrant advanced imaging, such as scintigraphy or MRI. Most stress fractures that are caught early are amendable to nonoperative management consisting of a period of immobilization and NWB followed by progressive rehabilitation to preinjury levels. Complete or displaced fractures may require operative intervention as do tension-sided FNSF. Improving dietary and preaccession physical fitness levels may play a role in reducing the incidence of stress fractures in the active-duty military population. It is important to keep in mind when evaluating soldiers and athletes who present with activity-related pain that stress fractures are not uncommon and should be given significant consideration.

  6. An absolute scale for measuring the utility of money

    Science.gov (United States)

    Thomas, P. J.

    2010-07-01

    Measurement of the utility of money is essential in the insurance industry, for prioritising public spending schemes and for the evaluation of decisions on protection systems in high-hazard industries. Up to this time, however, there has been no universally agreed measure for the utility of money, with many utility functions being in common use. In this paper, we shall derive a single family of utility functions, which have risk-aversion as the only free parameter. The fact that they return a utility of zero at their low, reference datum, either the utility of no money or of one unit of money, irrespective of the value of risk-aversion used, qualifies them to be regarded as absolute scales for the utility of money. Evidence of validation for the concept will be offered based on inferential measurements of risk-aversion, using diverse measurement data.

  7. A global algorithm for estimating Absolute Salinity

    Directory of Open Access Journals (Sweden)

    T. J. McDougall

    2012-12-01

    Full Text Available The International Thermodynamic Equation of Seawater – 2010 has defined the thermodynamic properties of seawater in terms of a new salinity variable, Absolute Salinity, which takes into account the spatial variation of the composition of seawater. Absolute Salinity more accurately reflects the effects of the dissolved material in seawater on the thermodynamic properties (particularly density than does Practical Salinity.

    When a seawater sample has standard composition (i.e. the ratios of the constituents of sea salt are the same as those of surface water of the North Atlantic, Practical Salinity can be used to accurately evaluate the thermodynamic properties of seawater. When seawater is not of standard composition, Practical Salinity alone is not sufficient and the Absolute Salinity Anomaly needs to be estimated; this anomaly is as large as 0.025 g kg−1 in the northernmost North Pacific. Here we provide an algorithm for estimating Absolute Salinity Anomaly for any location (x, y, p in the world ocean.

    To develop this algorithm, we used the Absolute Salinity Anomaly that is found by comparing the density calculated from Practical Salinity to the density measured in the laboratory. These estimates of Absolute Salinity Anomaly however are limited to the number of available observations (namely 811. In order to provide a practical method that can be used at any location in the world ocean, we take advantage of approximate relationships between Absolute Salinity Anomaly and silicate concentrations (which are available globally.

  8. Open Fractures of the Hand: Review of Pathogenesis and Introduction of a New Classification System.

    Science.gov (United States)

    Tulipan, Jacob E; Ilyas, Asif M

    2016-01-01

    Open fractures of the hand are a common and varied group of injuries. Although at increased risk for infection, open fractures of the hand are more resistant to infection than other open fractures. Numerous unique factors in the hand may play a role in the altered risk of postinjury infection. Current systems for the classification of open fractures fail to address the unique qualities of the hand. This article proposes a novel classification system for open fractures of the hand, taking into account the factors unique to the hand that affect its risk for developing infection after an open fracture.

  9. Open Calcaneus Fractures and Associated Injuries.

    Science.gov (United States)

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  10. Open Calcaneus Fractures and Associated Injuries.

    Science.gov (United States)

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  11. Universal Cosmic Absolute and Modern Science

    Science.gov (United States)

    Kostro, Ludwik

    The official Sciences, especially all natural sciences, respect in their researches the principle of methodic naturalism i.e. they consider all phenomena as entirely natural and therefore in their scientific explanations they do never adduce or cite supernatural entities and forces. The purpose of this paper is to show that Modern Science has its own self-existent, self-acting, and self-sufficient Natural All-in Being or Omni-Being i.e. the entire Nature as a Whole that justifies the scientific methodic naturalism. Since this Natural All-in Being is one and only It should be considered as the own scientifically justified Natural Absolute of Science and should be called, in my opinion, the Universal Cosmic Absolute of Modern Science. It will be also shown that the Universal Cosmic Absolute is ontologically enormously stratified and is in its ultimate i.e. in its most fundamental stratum trans-reistic and trans-personal. It means that in its basic stratum. It is neither a Thing or a Person although It contains in Itself all things and persons with all other sentient and conscious individuals as well, On the turn of the 20th century the Science has begun to look for a theory of everything, for a final theory, for a master theory. In my opinion the natural Universal Cosmic Absolute will constitute in such a theory the radical all penetrating Ultimate Basic Reality and will substitute step by step the traditional supernatural personal Absolute.

  12. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1991-01-01

    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increase...

  13. Design and baseline characteristics of a prospective cohort study for determinants of osteoporotic fracture in community-dwelling elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN Study

    Directory of Open Access Journals (Sweden)

    Moon Jong-Seong

    2009-12-01

    Full Text Available Abstract Background Osteoporosis and osteoporotic fracture in men are significant public health problems in an aging society. However, information on male osteoporosis remains impressively lacking, especially for Asians. We designed the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN study as an ancillary study of a cohort study, the Fujiwara-kyo study, to determine risk factors for osteoporotic fractures in Japanese men. Methods/Design Design: A community-based single-centre prospective cohort study with at least a 5-year follow-up Subjects: All the male participants of the Fujiwara-kyo study who were living in the four cities studied, aged 65 years and older, and able to walk without aid from others. Primary outcome: Incidence of osteoporotic fractures including vertebral and clinical non-vertebral fractures. Additional outcomes: Change in bone mineral density (BMD, change in hip geometry, onset of receiving benefits from Long-term Care Insurance (LCI, health-related quality of life, and mortality. Baseline measurements: BMD at the lumbar spine (LS and hip (TH, hip geometry, vertebral deformity assessment, bone turnover markers, physical and cognitive performance, various medical and lifestyle factors, and geriatric psychosocial measures confirmed by interviews based on self-administrated questionnaires. Outcome surveillance: Annual mail surveys and a follow-up survey at the fifth year comprising similar items to the baseline study will be used to determine the outcomes. Receipt of benefits from LCI and mortality will be obtained from the city governments. Current status: The baseline study was conducted for 2174 eligible men, and 2012 completed the study and were eligible for follow-up. Prevalence rates of osteoporosis (BMD 2.5 SD or more below the young adult mean (YAM and low BMD (BMD 1 SD or more below YAM in at least one of LS and TH were calculated to be 4.4% and 41.8%, respectively. The proportion of men with low BMD only at TH showed a

  14. Multi-Phase Fracture-Matrix Interactions Under Stress Changes

    Energy Technology Data Exchange (ETDEWEB)

    A.S. Grader; D. Elsworth; P.M. Halleck; F. Alvarao; A. Alajmi; Z. Karpyn; N. Mohammed; S. Al-Enezi

    2005-12-07

    fracture, its topology and occupancy on the nature of mass transfer between the matrix and the fracture. Counter-current imbibition next to the fracture was observed and quantified, including the influence of formation layering. A group of Shear fractures were studied, with layers perpendicular and parallel to the main axis of the sample. The structures of the fractures as well as their impact on absolute permeability and on oil displacement by water were evaluated. Shear fractures perpendicular to the layers lead to a wide distribution of pores and to an overall increase in absolute permeability. Shear fractures parallel to the layers lead to an overall increase in absolute permeability, but a decrease in displacement efficiency. This DoE project funded or partially funded three Ph.D. and four M.Sc. students at the Pennsylvania State University. The results from the research have yielded several abstracts, presentations and papers. Much of the work is still in the process of being published.

  15. Excess mortality following hip fracture: a systematic epidemiological review

    DEFF Research Database (Denmark)

    Abrahamsen, B; van Staa, T; Ariely, R;

    2009-01-01

    This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlighting th...

  16. Absolute calibration in vivo measurement systems

    International Nuclear Information System (INIS)

    Lawrence Livermore National Laboratory (LLNL) is currently investigating a new method for obtaining absolute calibration factors for radiation measurement systems used to measure internally deposited radionuclides in vivo. Absolute calibration of in vivo measurement systems will eliminate the need to generate a series of human surrogate structures (i.e., phantoms) for calibrating in vivo measurement systems. The absolute calibration of in vivo measurement systems utilizes magnetic resonance imaging (MRI) to define physiological structure, size, and composition. The MRI image provides a digitized representation of the physiological structure, which allows for any mathematical distribution of radionuclides within the body. Using Monte Carlo transport codes, the emission spectrum from the body is predicted. The in vivo measurement equipment is calibrated using the Monte Carlo code and adjusting for the intrinsic properties of the detection system. The calibration factors are verified using measurements of existing phantoms and previously obtained measurements of human volunteers. 8 refs

  17. Quantum theory allows for absolute maximal contextuality

    Science.gov (United States)

    Amaral, Barbara; Cunha, Marcelo Terra; Cabello, Adán

    2015-12-01

    Contextuality is a fundamental feature of quantum theory and a necessary resource for quantum computation and communication. It is therefore important to investigate how large contextuality can be in quantum theory. Linear contextuality witnesses can be expressed as a sum S of n probabilities, and the independence number α and the Tsirelson-like number ϑ of the corresponding exclusivity graph are, respectively, the maximum of S for noncontextual theories and for the theory under consideration. A theory allows for absolute maximal contextuality if it has scenarios in which ϑ /α approaches n . Here we show that quantum theory allows for absolute maximal contextuality despite what is suggested by the examination of the quantum violations of Bell and noncontextuality inequalities considered in the past. Our proof is not constructive and does not single out explicit scenarios. Nevertheless, we identify scenarios in which quantum theory allows for almost-absolute-maximal contextuality.

  18. Absolute photoacoustic thermometry in deep tissue.

    Science.gov (United States)

    Yao, Junjie; Ke, Haixin; Tai, Stephen; Zhou, Yong; Wang, Lihong V

    2013-12-15

    Photoacoustic thermography is a promising tool for temperature measurement in deep tissue. Here we propose an absolute temperature measurement method based on the dual temperature dependences of the Grüneisen parameter and the speed of sound in tissue. By taking ratiometric measurements at two adjacent temperatures, we can eliminate the factors that are temperature irrelevant but difficult to correct for in deep tissue. To validate our method, absolute temperatures of blood-filled tubes embedded ~9 mm deep in chicken tissue were measured in a biologically relevant range from 28°C to 46°C. The temperature measurement accuracy was ~0.6°C. The results suggest that our method can be potentially used for absolute temperature monitoring in deep tissue during thermotherapy.

  19. Epidemiology of fractures in people with severe and profound developmental disabilities

    Science.gov (United States)

    Glick, N.R.; Fischer, M.H.; Heisey, D.M.; Leverson, G.E.; Mann, D.C.

    2005-01-01

    Fractures are more prevalent among people with severe and profound developmental disabilities than in the general population. In order to characterize the tendency of these people to fracture, and to identify features that may guide the development of preventive strategies, we analyzed fracture epidemiology in people with severe and profound developmental disabilities who lived in a stable environment. Data from a 23-year longitudinal cohort registry of 1434 people with severe and profound developmental disabilities were analyzed to determine the effects of age, gender, mobility, bone fractured, month of fracture, and fracture history upon fracture rates. Eighty-five percent of all fractures involved the extremities. The overall fracture rate increased as mobility increased. In contrast, femoral shaft fracture risk was substantially higher in the least mobile [relative risk (RR), 10.36; 95% confidence interval (CI), 3.29-32.66] compared with the most mobile group. Although the overall fracture rate was not associated with age, the femoral shaft fractures decreased but hand/foot fractures increased with age. Overall fracture risk declined in August and September (RR, 0.70; 95% CI, 0.55-0.89), being especially prominent for tibial/fibular fractures (RR, 0.31; 95% CI, 0.13-0.70). Gender was not a factor in fracture risk. Two primary fracture mechanisms are apparent: one, largely associated with lack of weight-bearing in people with the least mobility, is exemplified by femoral fractures during non-traumatic events as simple as diapering or transfers; the other, probably due to movement- or fall-related trauma, is exemplified by hand/foot fractures in people who ambulate. The fracture experience of people with severe and profound developmental disabilities is unique and, because it differs qualitatively from postmenopausal osteoporosis, may require population-specific methods for assessing risk, for improving bone integrity, and for reduction of falls and accidents

  20. Risk factors and treatment of intraoperative femur fracture in hip replacement%髋关节置换术中股骨骨折的处理与相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    卜延民; 张铁良; 赵秀祥; 于建华; 郑得志

    2010-01-01

    Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.%目的 分析髋关节置换术中股骨骨折的危险因素并探讨其处理方法.方法 对我科2002年11月-2009年11月收治的38例髋关节置换术中发生股骨骨折的患者资料进行回顾性分析.骨折分类按照Amstutz分型或美国骨科医师协会(AAOS)分型,并据此选择治疗方法.25例予术中内固定,包括14例单纯捆绑固定,5例钢板固定和6例大段异体骨结合钢丝捆绑带捆扎固定.有12例更换长柄假体.结果 平均随访4.5年(0.5~7.5年),有36例正常愈合,2例延迟愈合,有1例4年后假体柄松动需要翻修.结论 骨质疏松、术中暴力、髓腔发育异常和假体型号过大是术中股骨骨折的主要原因.按照骨折分型选择适当的治疗方法多能取得满意的临床效果.

  1. Absolute Stability And Hyperstability In Hilbert Space

    Science.gov (United States)

    Wen, John Ting-Yung

    1989-01-01

    Theorems on stabilities of feedback control systems proved. Paper presents recent developments regarding theorems of absolute stability and hyperstability of feedforward-and-feedback control system. Theorems applied in analysis of nonlinear, adaptive, and robust control. Extended to provide sufficient conditions for stability in system including nonlinear feedback subsystem and linear time-invariant (LTI) feedforward subsystem, state space of which is Hilbert space, and input and output spaces having finite numbers of dimensions. (In case of absolute stability, feedback subsystem memoryless and possibly time varying. For hyperstability, feedback system dynamical system.)

  2. Absolute-Magnitude Distributions of Supernovae

    CERN Document Server

    Richardson, Dean; Wright, John; Maddox, Larry

    2014-01-01

    The absolute-magnitude distributions of seven supernova types are presented. The data used here were primarily taken from the Asiago Supernova Catalogue, but were supplemented with additional data. We accounted for both foreground and host-galaxy extinction. A bootstrap method is used to correct the samples for Malmquist bias. Separately, we generate volume-limited samples, restricted to events within 100 Mpc. We find that the superluminous events (M_B -15) make up about 3%. The normal Ia distribution was the brightest with a mean absolute blue magnitude of -19.25. The IIP distribution was the dimmest at -16.75.

  3. Precise Measurement of the Absolute Fluorescence Yield

    Science.gov (United States)

    Ave, M.; Bohacova, M.; Daumiller, K.; Di Carlo, P.; di Giulio, C.; San Luis, P. Facal; Gonzales, D.; Hojvat, C.; Hörandel, J. R.; Hrabovsky, M.; Iarlori, M.; Keilhauer, B.; Klages, H.; Kleifges, M.; Kuehn, F.; Monasor, M.; Nozka, L.; Palatka, M.; Petrera, S.; Privitera, P.; Ridky, J.; Rizi, V.; D'Orfeuil, B. Rouille; Salamida, F.; Schovanek, P.; Smida, R.; Spinka, H.; Ulrich, A.; Verzi, V.; Williams, C.

    2011-09-01

    We present preliminary results of the absolute yield of fluorescence emission in atmospheric gases. Measurements were performed at the Fermilab Test Beam Facility with a variety of beam particles and gases. Absolute calibration of the fluorescence yield to 5% level was achieved by comparison with two known light sources--the Cherenkov light emitted by the beam particles, and a calibrated nitrogen laser. The uncertainty of the energy scale of current Ultra-High Energy Cosmic Rays experiments will be significantly improved by the AIRFLY measurement.

  4. SURGICAL FIXATIION OF TALAR FRACTURES - OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Sreenivasa Reddy

    2015-09-01

    Full Text Available BACKGROUND: Fractures and dislocations of the talus are challenging injuries. The frequent incidence of serious complications, such as osteonecrosis, associated with talus fractures leads to a substantial risk of unsatisfactory results. The results of surgical interv ention in these cases have improved over the years, thanks to the usage newer implants and superior surgical skills. MATERIALS AND METHODS: The present study was undertaken in the department of Orthopedics and Traumatology, Osmania General Hospital, during the period September 12 to September 14, and comprises 30 patients who underwent surgical management of displaced talar fractures . CONCLUSIONS : Most of the fractures of the talus should be treated with reduction and internal fixation to reduce the complic ations. Once the fractures are fixed the joints can be mobilized early so that Post trauamatic stiffness can be prevented. However development of Aseptic necrosis and pain the joint are independent of method of treatment and are dependent on the initial di splacement of the fragments.

  5. 类风湿关节炎合并骨质疏松性骨折的危险因素研究进展%Research progress on risk factors of osteoporotic fractures in patients with rheumatoid arthritis

    Institute of Scientific and Technical Information of China (English)

    刘文; 徐胜前

    2016-01-01

    Rheumatoid arthritis is a autoimmune diseases characterized as joint chronic synovitis, and is accompanied with systemic damage.Osteoporotic fracture is one of the common complications of rheumatoid arthritis, which may decrease quality of life, and even increase the mortality of patients.Variety of factors may be associated with the occurrence of osteoporotic fractures in rheumatoid arthritis patients.In this article, through the literature review we discuss the risk factors of osteoporotic fracture, including vitamin D deficiency, lower limb muscle strength and balance ability in rheumatoid arthritis patients.%类风湿关节炎是一种以关节的慢性滑膜炎为特征、并伴有全身多系统损害的自身免疫性疾病。骨质疏松性骨折是类风湿关节炎常见并发症之一,可降低类风湿关节炎患者的生命质量,甚至增加患者的死亡率。类风湿关节炎合并骨质疏松性骨折与多种因素有关,通过阅读文献,探讨类风湿关节炎合并骨质疏松性骨折与维生素D缺乏、下肢肌力及平衡能力减退及跌倒之间关联性,帮助临床医生了解类风湿关节炎患者发生骨质疏松性骨折的危险因素。

  6. Research progress on risk factors of osteoporotic fractures in patients with rheumatoid arthritis%类风湿关节炎合并骨质疏松性骨折的危险因素研究进展

    Institute of Scientific and Technical Information of China (English)

    刘文; 徐胜前

    2016-01-01

    Rheumatoid arthritis is a autoimmune diseases characterized as joint chronic synovitis, and is accompanied with systemic damage.Osteoporotic fracture is one of the common complications of rheumatoid arthritis, which may decrease quality of life, and even increase the mortality of patients.Variety of factors may be associated with the occurrence of osteoporotic fractures in rheumatoid arthritis patients.In this article, through the literature review we discuss the risk factors of osteoporotic fracture, including vitamin D deficiency, lower limb muscle strength and balance ability in rheumatoid arthritis patients.%类风湿关节炎是一种以关节的慢性滑膜炎为特征、并伴有全身多系统损害的自身免疫性疾病。骨质疏松性骨折是类风湿关节炎常见并发症之一,可降低类风湿关节炎患者的生命质量,甚至增加患者的死亡率。类风湿关节炎合并骨质疏松性骨折与多种因素有关,通过阅读文献,探讨类风湿关节炎合并骨质疏松性骨折与维生素D缺乏、下肢肌力及平衡能力减退及跌倒之间关联性,帮助临床医生了解类风湿关节炎患者发生骨质疏松性骨折的危险因素。

  7. Identifying patient preferences for communicating risk estimates: A descriptive pilot study

    Directory of Open Access Journals (Sweden)

    O'Connor Annette M

    2001-08-01

    Full Text Available Abstract Background Patients increasingly seek more active involvement in health care decisions, but little is known about how to communicate complex risk information to patients. The objective of this study was to elicit patient preferences for the presentation and framing of complex risk information. Method To accomplish this, eight focus group discussions and 15 one-on-one interviews were conducted, where women were presented with risk data in a variety of different graphical formats, metrics, and time horizons. Risk data were based on a hypothetical woman's risk for coronary heart disease, hip fracture, and breast cancer, with and without hormone replacement therapy. Participants' preferences were assessed using likert scales, ranking, and abstractions of focus group discussions. Results Forty peri- and postmenopausal women were recruited through hospital fliers (n = 25 and a community health fair (n = 15. Mean age was 51 years, 50% were non-Caucasian, and all had completed high school. Bar graphs were preferred by 83% of participants over line graphs, thermometer graphs, 100 representative faces, and survival curves. Lifetime risk estimates were preferred over 10 or 20-year horizons, and absolute risks were preferred over relative risks and number needed to treat. Conclusion Although there are many different formats for presenting and framing risk information, simple bar charts depicting absolute lifetime risk were rated and ranked highest overall for patient preferences for format.

  8. Association of P2Y(2) receptor SNPs with bone mineral density and osteoporosis risk in a cohort of Dutch fracture patients

    DEFF Research Database (Denmark)

    Wesselius, Anke; Bours, Martijn J L; Henriksen, Zanne;

    2013-01-01

    The P2Y(2) receptor is a G-protein-coupled receptor with adenosine 5'-triphosphate (and UTP) as natural ligands. It is thought to be involved in bone physiology in an anti-osteogenic manner. As several non-synonymous single nucleotide polymorphisms (SNPs) have been identified within the P2Y(2...... at Maastricht University Medical Centre for standard medical follow-up after a recent fracture, were genotyped for three non-synonymous P2Y(2) receptor gene SNPs. BMD was measured at three locations (total hip, lumbar spine, and femoral neck) using dual-energy X-ray absorptiometry. Differences in BMD between...

  9. No Absolutism Here: Harm Predicts Moral Judgment 30× Better Than Disgust-Commentary on Scott, Inbar, & Rozin (2016).

    Science.gov (United States)

    Gray, Kurt; Schein, Chelsea

    2016-05-01

    Moral absolutism is the idea that people's moral judgments are insensitive to considerations of harm. Scott, Inbar, and Rozin (2016, this issue) claim that most moral opponents to genetically modified organisms are absolutely opposed-motivated by disgust and not harm. Yet there is no evidence for moral absolutism in their data. Perceived risk/harm is the most significant predictor of moral judgments for "absolutists," accounting for 30 times more variance than disgust. Reanalyses suggest that disgust is not even a significant predictor of the moral judgments of absolutists once accounting for perceived harm and anger. Instead of revealing actual moral absolutism, Scott et al. find only empty absolutism: hypothetical, forecasted, self-reported moral absolutism. Strikingly, the moral judgments of so-called absolutists are somewhat more sensitive to consequentialist concerns than those of nonabsolutists. Mediation reanalyses reveal that moral judgments are most proximally predicted by harm and not disgust, consistent with dyadic morality. PMID:27217244

  10. Acetabular fractures--Risk factors for a negative outcome of the surgical management%髋臼骨折--手术治疗效果欠佳的不利因素

    Institute of Scientific and Technical Information of China (English)

    Beate P. Hanson; David L. Helfet; Suthorn Bavonratanavech; Ian Harris; 陈国奋; 顾立强

    2004-01-01

    现有文献中没有确定性的治疗髋臼移位骨折的最佳方法.一般情况下倾向于开放复位内固定.但是,由于缺少不同特定内固定物间的比较,因此难以做出推荐.报道一致认为,导致结果差和一般的潜在不利因素包括老龄、术后复位不良、严重的骨折、股骨头损伤,以及延迟处理.%The optimal method of managing displaced acetabular fractures is not established in the literature.It may be that open reduction and internal fixation in general is universally preferred;however,specific types of hardware have not been compared and therefore recommendations cannot be made. Potential risk factors consistently reported to be associated with poor to fair outcomes include older age, poor post operative reduction, more severe fracture characteristics, femoral head injury, and a delay in treatment.

  11. Det demokratiske argument for absolut ytringsfrihed

    DEFF Research Database (Denmark)

    Lægaard, Sune

    2014-01-01

    Artiklen diskuterer den påstand, at absolut ytringsfrihed er en nødvendig forudsætning for demokratisk legitimitet med udgangspunkt i en rekonstruktion af et argument fremsat af Ronald Dworkin. Spørgsmålet er, hvorfor ytringsfrihed skulle være en forudsætning for demokratisk legitimitet, og hvorf...

  12. Time Function and Absolute Black Hole

    DEFF Research Database (Denmark)

    Javadi, Hossein; Forouzbakhsh, Farshid

    2006-01-01

    Einstein’s theory of gravity is not consistent with quantum mechanics, because general relativity cannot be quantized. [1] But without conversion of force and energy, it is impossible to find a grand unified theory. A very important result of CPH theory is time function that allows we give a new ...... description of absolute black hole and before the big bang....

  13. Teaching Absolute Value Inequalities to Mature Students

    Science.gov (United States)

    Sierpinska, Anna; Bobos, Georgeana; Pruncut, Andreea

    2011-01-01

    This paper gives an account of a teaching experiment on absolute value inequalities, whose aim was to identify characteristics of an approach that would realize the potential of the topic to develop theoretical thinking in students enrolled in prerequisite mathematics courses at a large, urban North American university. The potential is…

  14. ABSOLUTE MEASUREMENT OF THE GANIL BEAM ENERGY

    NARCIS (Netherlands)

    CASANDJIAN, JM; MITTIG, W; BEUNARD, R; GAUDARD, L; LEPINESZILY, A; VILLARI, ACC; AUGER, G; BIANCHI, L; CUNSOLO, A; FOTI, A; LICHTENTHALER, R; PLAGNOL, E; SCHUTZ, Y; SIEMSSEN, RH; WIELECZKO, JP

    1993-01-01

    The energy of the GANIL cyclotron beam was measured on-line during the Pb-208 + Pb-208 elastic scattering experiment ''Search for Color van der Waals Force in the Pb-208 + Pb-208 Mott scattering'' with an absolute precision of 7 x 10(-5) at approximately 1.0 GeV, which represents an improvement of o

  15. Stimulus Probability Effects in Absolute Identification

    Science.gov (United States)

    Kent, Christopher; Lamberts, Koen

    2016-01-01

    This study investigated the effect of stimulus presentation probability on accuracy and response times in an absolute identification task. Three schedules of presentation were used to investigate the interaction between presentation probability and stimulus position within the set. Data from individual participants indicated strong effects of…

  16. Solving Absolute Value Equations Algebraically and Geometrically

    Science.gov (United States)

    Shiyuan, Wei

    2005-01-01

    The way in which students can improve their comprehension by understanding the geometrical meaning of algebraic equations or solving algebraic equation geometrically is described. Students can experiment with the conditions of the absolute value equation presented, for an interesting way to form an overall understanding of the concept.

  17. Absolute-stability results in infinite dimensions

    NARCIS (Netherlands)

    Curtain, RF; Logemann, H; Staffans, O

    2004-01-01

    We derive absolute-stability results of Popov and circle-criterion type for infinite-dimensional systems in an input-output setting. Our results apply to feedback systems in which the linear part is the series interconnection of an input-output stable linear system and an integrator, and the nonline

  18. Magnetoresistive sensor for absolute position detection

    NARCIS (Netherlands)

    Groenland, J.P.J.

    1984-01-01

    A digital measurement principle for absolute position is decscribed. The position data is recorded serially into a single track of a hard-magnetic layer with the help of longitudinal saturation recording. Detection is possible by means of an array of sensor elements which can be made of a substrate.

  19. Thin-film magnetoresistive absolute position detector

    NARCIS (Netherlands)

    Groenland, Johannes Petrus Jacobus

    1990-01-01

    The subject of this thesis is the investigation of a digital absolute posi- tion-detection system, which is based on a position-information carrier (i.e. a magnetic tape) with one single code track on the one hand, and an array of magnetoresistive sensors for the detection of the informatio

  20. Magnetoresistive transducer for absolute position detection

    NARCIS (Netherlands)

    Groenland, J.P.J.

    1984-01-01

    In this paper a new method is presented for the measurement of absolute linear or angular position. The digital position information is recorded serially into one track of a suitable hard-magnetic medium. The stray field of this information layer determines the angular magnetisation distribution in

  1. Fracture Criterion for Fracture Mechanics of Magnets

    Institute of Scientific and Technical Information of China (English)

    潘灏; 杨文涛

    2003-01-01

    The applicability and limitation of some fracture criteria in the fracture mechanics of magnets are studied.It is shown that the magnetic field intensity factor can be used as a fracture criterion when the crack in a magnet is only affected by a magnetic field. For some magnetostrictive materials in which the components of magnetostriction strain do not satisfy the compatibility equation of deformation, the stress intensity factor can no longer be effectively applicable as a fracture criterion when the crack in a magnet is affected by a magnetic field and mechanical loads simultaneously.

  2. Analysis of risk factors of postoperative joint instability in fractures around the knee%膝关节周围骨折术后关节不稳的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈奇; 魏长宝; 徐小峰; 曹学书; 孟晨; 曹兴兵

    2015-01-01

    目的:探讨造成膝关节周围骨折术后关节不稳的危险因素。方法从我科2010年10月至2013年7月住院患者中选取符合纳入标准的膝关节周围骨折病例116例,其中男67例,女49例,平均年龄(47.3±14.4)岁。车祸伤54例,摔伤50例,高处坠落伤6例,机器绞伤3例,殴打伤2例,重物砸伤1例。所有患者均随访12个月。选取年龄、性别、糖尿病史、原发暴力、骨折程度、开放性损伤、韧带损伤、关节囊损伤、术中出血量、手术时间、冠状位胫股角、伸直受限、屈曲受限为初筛因素,先纳入一元Logistic回归模型,再将有关联性的因素纳入多元Logistic回归模型,寻求造成膝关节周围骨折术后关节不稳的危险因素。结果一元Logistic回归分析发现,骨折程度、开放性骨折、韧带损伤、关节囊损伤情况、术中出血量和关节屈曲受限与术后关节不稳有关,差异均有统计学意义(均P<0.05)。多元Logistic回归分析发现,上述关联因素中,关节囊损伤和屈曲受限是造成膝关节周围骨折术后关节不稳的危险因素,差异均有统计学意义(均P<0.05)。结论关节囊损伤和屈曲受限是造成膝关节周围骨折术后关节不稳的主要危险因素。因此,在膝关节周围骨折的外科治疗过程中,积极修复损伤的关节囊,避免术中切开关节囊,术后早期功能锻炼,避免关节屈曲受限,能降低术后关节不稳的发生率,促进关节功能的恢复。%Objective To investigate the risk factors of joint instability after open reduction and internal fixation for the fractures around the knee. Methods 116 cases of fractures around the knee from Oct. 2010 to Jul. 2013 were selected from the Affiliated Hospital of Jiangsu University on inclusion criteria, inclu-ding 67 males and 49 females, with an average age of (47. 3±14. 4) years. There were 54 cases of traffic acci-dent injury, 50 cases

  3. Investigation regarding prevention of insufficiency fractures in children with severe cerebral palsy by Light-Emitting Diode (LED) irradiation

    OpenAIRE

    Asagai, Yoshimi; Yamamoto, Kengo; Ohshiro, Toshio; Ohshiro, Takafumi

    2014-01-01

    Bone metabolism in children with severe fractures was examined, risk factors for fractures were characterized, and effects of LED (light-emitting diode) irradiation on the risk factors for fractures were investigated. Since insufficiency fracture in children with severe cerebral palsy can be caused without obvious external force in daily care, it is sometimes handled as a medical accident and can lead to a lawsuit. It is very important to explain the possibility of an insufficiency fracture t...

  4. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: What is the evidence?

    NARCIS (Netherlands)

    E.M.M. van Lieshout (Esther); V. Alt (Volker)

    2016-01-01

    textabstractDespite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substi

  5. Analysis of the Arthroscopically Diagnosed Soft-Tissue Injuries Associated With the Distal Radius Fractures

    Directory of Open Access Journals (Sweden)

    Katerina Katerina Kasapinova

    2014-06-01

    CONCLUSIONS: The frequency of the associated soft-tissue lesions in distal radius fractures is high. Ulnar styloid fracture was identified as risk factor for associated LT lesion, as well as combined lesion of both scapholunate and luntriquetral ligament.

  6. Metatarsal stress fractures - aftercare

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000553.htm Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  7. Fracture toughness correlations

    International Nuclear Information System (INIS)

    In this study existing fracture parameter correlations are reviewed. Their applicability and reliability are discussed in detail. A new KIC-CVN-correlation, based on a theoretical brittle fracture model, is presented

  8. Hip fracture surgery

    Science.gov (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

  9. An absolute measure for a key currency

    Science.gov (United States)

    Oya, Shunsuke; Aihara, Kazuyuki; Hirata, Yoshito

    It is generally considered that the US dollar and the euro are the key currencies in the world and in Europe, respectively. However, there is no absolute general measure for a key currency. Here, we investigate the 24-hour periodicity of foreign exchange markets using a recurrence plot, and define an absolute measure for a key currency based on the strength of the periodicity. Moreover, we analyze the time evolution of this measure. The results show that the credibility of the US dollar has not decreased significantly since the Lehman shock, when the Lehman Brothers bankrupted and influenced the economic markets, and has increased even relatively better than that of the euro and that of the Japanese yen.

  10. Absolute Parallelism Geometry: Developments, Applications and Problems

    OpenAIRE

    Wanas, M. I.

    2002-01-01

    Absolute parallelism geometry is frequently used for physical applications. It has two main defects, from the point of view of applications. The first is the identical vanishing of its curvature tensor. The second is that its autoparallel paths do not represent physical trajectories. The present work shows how these defects were treated in the course of development of the geometry. The new version of this geometry contains simultaneous non-vanishing torsion and curvatures. Also, the new paths...

  11. Cosmological frames for theories with absolute parallelism

    OpenAIRE

    Ferraro, Rafael; Fiorini, Franco

    2011-01-01

    The vierbein (tetrad) fields for closed and open Friedmann-Robertson-Walker cosmologies are hard to work out in most of the theories featuring absolute parallelism. The difficulty is traced in the fact that these theories are not invariant under local Lorentz transformations of the vierbein. We illustrate this issue in the framework of f(T) theories and Born-Infeld determinantal gravity. In particular, we show that the early Universe as described by the Born-Infeld scheme is singularity free ...

  12. The absolute differential calculus (calculus of tensors)

    CERN Document Server

    Levi-Civita, Tullio

    2013-01-01

    Written by a towering figure of twentieth-century mathematics, this classic examines the mathematical background necessary for a grasp of relativity theory. Tullio Levi-Civita provides a thorough treatment of the introductory theories that form the basis for discussions of fundamental quadratic forms and absolute differential calculus, and he further explores physical applications.Part one opens with considerations of functional determinants and matrices, advancing to systems of total differential equations, linear partial differential equations, algebraic foundations, and a geometrical intro

  13. Absolute clock synchronisation and special relativity paradoxes

    OpenAIRE

    Ciborowski, Jacek; Wlodarczyk, Marta

    2012-01-01

    Solving special relativity paradoxes requires rigorous analysis of event timing, due to relative simultaneity in consequence of the Lorentz transformation. Since clock synchronisation is a convention in special theory of relativity, instead of the Einstein's procedure one may choose such that offers absolute simultaneity. We present in short the corresponding formalism in one spatial dimension. We show that paradoxes do not arise with this choice of synchronisation and descriptions of these i...

  14. Absolute distance metrology for space interferometers

    OpenAIRE

    Swinkels, B L; Bhattacharya, N; Wielders, A.A.; Braat, J.J.M.

    2005-01-01

    Future space missions, among which the Darwin Space Interferometer, will consist of several free flying satellites. A complex metrology system is required to have all the components fly accurately in formation and have it operate as a single instrument. Our work focuses on a possible implementation of the sub-system that measures the absolute distance between two satellites with high accuracy. For Darwin the required accuracy is on the order of 70 micrometer over a distance of 250 meter. We a...

  15. Measurement of absolute gravity acceleration in Firenze

    Directory of Open Access Journals (Sweden)

    M. de Angelis

    2011-01-01

    Full Text Available This paper reports the results from the accurate measurement of the acceleration of gravity g taken at two separate premises in the Polo Scientifico of the University of Firenze (Italy. In these laboratories, two separate experiments aiming at measuring the Newtonian constant and testing the Newtonian law at short distances are in progress. Both experiments require an independent knowledge on the local value of g. The only available datum, pertaining to the italian zero-order gravity network, was taken more than 20 years ago at a distance of more than 60 km from the study site. Gravity measurements were conducted using an FG5 absolute gravimeter, and accompanied by seismic recordings for evaluating the noise condition at the site. The absolute accelerations of gravity at the two laboratories are (980 492 160.6 ± 4.0 μGal and (980 492 048.3 ± 3.0 μGal for the European Laboratory for Non-Linear Spectroscopy (LENS and Dipartimento di Fisica e Astronomia, respectively. Other than for the two referenced experiments, the data here presented will serve as a benchmark for any future study requiring an accurate knowledge of the absolute value of the acceleration of gravity in the study region.

  16. Measurement of absolute gravity acceleration in Firenze

    Science.gov (United States)

    de Angelis, M.; Greco, F.; Pistorio, A.; Poli, N.; Prevedelli, M.; Saccorotti, G.; Sorrentino, F.; Tino, G. M.

    2011-01-01

    This paper reports the results from the accurate measurement of the acceleration of gravity g taken at two separate premises in the Polo Scientifico of the University of Firenze (Italy). In these laboratories, two separate experiments aiming at measuring the Newtonian constant and testing the Newtonian law at short distances are in progress. Both experiments require an independent knowledge on the local value of g. The only available datum, pertaining to the italian zero-order gravity network, was taken more than 20 years ago at a distance of more than 60 km from the study site. Gravity measurements were conducted using an FG5 absolute gravimeter, and accompanied by seismic recordings for evaluating the noise condition at the site. The absolute accelerations of gravity at the two laboratories are (980 492 160.6 ± 4.0) μGal and (980 492 048.3 ± 3.0) μGal for the European Laboratory for Non-Linear Spectroscopy (LENS) and Dipartimento di Fisica e Astronomia, respectively. Other than for the two referenced experiments, the data here presented will serve as a benchmark for any future study requiring an accurate knowledge of the absolute value of the acceleration of gravity in the study region.

  17. Stress fractures of the olecranon in javelin throwers.

    Science.gov (United States)

    Hulkko, A; Orava, S; Nikula, P

    1986-08-01

    Between the years 1977 and 1984, four javelin throwers with a stress fracture of the olecranon were seen and treated. In one patient, acute painful dislocation of the fracture occurred during a competitive throw. Two patients had stress fracture of the tip. The fracture treated conservatively healed in 18 months. The patient treated by excision of the tip was able to throw after 2 months. Two patients had slightly oblique, more distally located stress fractures, which were treated with a tension band and 2 Kirschner wires. The fractures healed in 4 months. One of the patients had a refracture 11 months after the primary operation. It was successfully treated with a compression screw and two bone pegs. Because of the high risk of delayed union and nonunion, stress fractures of the olecranon should be treated operatively in javelin throwers. PMID:3759300

  18. Postpartum Sacral Stress Fracture: An Atypical Case Report

    Directory of Open Access Journals (Sweden)

    Andrea Speziali

    2015-01-01

    Full Text Available Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors during the cesarean section is not a reasonable cause of sacral fracture. Pregnancy and lactation could be risk factors for sacral stress fracture even in atraumatic delivery such as cesarean section. Our patient had no risk factors for osteoporosis except for pregnancy and lactation. Transient or focal osteoporosis is challenging to assess and it cannot be ruled out even if serum test and mineral density are within the normal range.

  19. Absolute age determination of quaternary faults

    Energy Technology Data Exchange (ETDEWEB)

    Cheong, Chang Sik; Lee, Seok Hoon; Choi, Man Sik [Korea Basic Science Institute, Seoul (Korea, Republic of)] (and others)

    2000-03-15

    To constrain the age of neotectonic fault movement, Rb-Sr, K-Ar, U-series disequilibrium, C-14 and Be-10 methods were applied to the fault gouges, fracture infillings and sediments from the Malbang, Ipsil, Wonwonsa faults faults in the Ulsan fault zone, Yangsan fault in the Yeongdeog area and southeastern coastal area. Rb-Sr and K-Ar data imply that the fault movement of the Ulan fault zone initiated at around 30 Ma and preliminary dating result for the Yang san fault is around 70 Ma in the Yeongdeog area. K-Ar and U-series disequilibrium dating results for fracture infillings in the Ipsil fault are consistent with reported ESR ages. Radiocarbon ages of quaternary sediments from the Jeongjari area are discordant with stratigraphic sequence. Carbon isotope data indicate a difference of sedimentry environment for those samples. Be-10 dating results for the Suryum fault area are consistent with reported OSL results.

  20. Classification of fracture and non-fracture groups by analysis of coherent X-ray scatter

    Science.gov (United States)

    Dicken, A. J.; Evans, J. P. O.; Rogers, K. D.; Stone, N.; Greenwood, C.; Godber, S. X.; Clement, J. G.; Lyburn, I. D.; Martin, R. M.; Zioupos, P.

    2016-07-01

    Osteoporotic fractures present a significant social and economic burden, which is set to rise commensurately with the aging population. Greater understanding of the physicochemical differences between osteoporotic and normal conditions will facilitate the development of diagnostic technologies with increased performance and treatments with increased efficacy. Using coherent X-ray scattering we have evaluated a population of 108 ex vivo human bone samples comprised of non-fracture and fracture groups. Principal component fed linear discriminant analysis was used to develop a classification model to discern each condition resulting in a sensitivity and specificity of 93% and 91%, respectively. Evaluating the coherent X-ray scatter differences from each condition supports the hypothesis that a causal physicochemical change has occurred in the fracture group. This work is a critical step along the path towards developing an in vivo diagnostic tool for fracture risk prediction.

  1. Discriminants of Prevalent Fractures in Chronic Kidney Disease

    OpenAIRE

    Nickolas, Thomas L.; Cremers, Serge; Zhang, Amy; Thomas, Valeri; Stein, Emily; Cohen, Adi; Chauncey, Ryan; Nikkel, Lucas; Yin, Michael T.; Liu, Xiaowei S.; Boutroy, Stephanie; Staron, Ronald B.; Leonard, Mary B.; McMahon, Donald J.; Dworakowski, Elzbieta

    2011-01-01

    Patients with chronic kidney disease (CKD) have higher rates of fracture than the general population. Increased bone remodeling, leading to microarchitectural deterioration and increased fragility, may accompany declining kidney function, but there are no reliable methods to identify patients at increased risk for fracture. In this cross-sectional study of 82 patients with predialysis CKD, high-resolution imaging revealed that the 23 patients with current fractures had significantly lower are...

  2. Proximal humerus fractures.

    Science.gov (United States)

    Price, Matthew C; Horn, Pamela L; Latshaw, James C

    2013-01-01

    Proximal humerus fractures are among the most common fractures associated with osteoporosis. With an aging population, incidence of these fractures will only increase. The proximal humerus not only forms the lateral portion of the shoulder articulation but also has significant associations with musculoskeletal and neurovascular structures. As a result, fractures of the proximal humerus can significantly impact not only the function of the shoulder joint, but the health and function of the entire upper extremity as well. Understanding of these fractures, the management options, and associated nursing care, can help reduce morbidity rate and improve functional outcomes.

  3. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures

    Energy Technology Data Exchange (ETDEWEB)

    Nachtrab, O. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Cassar-Pullicino, V.N., E-mail: Victor.Pullicino@rjah.nhs.uk [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Lalam, R.; Tins, B.; Tyrrell, P.N.M.; Singh, J. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom)

    2012-12-15

    MR imaging plays a vital role in the diagnosis and management of hip fractures in all age groups, in a large spectrum of patient groups spanning the elderly and sporting population. It allows a confident exclusion of fracture, differentiation of bony from soft tissue injury and an early confident detection of fractures. There is a spectrum of MR findings which in part is dictated by the type and cause of the fracture which the radiologist needs to be familiar with. Judicious but prompt utilisation of MR in patients with suspected hip fractures has a positive therapeutic impact with healthcare cost benefits as well as social care benefits.

  4. Absolute Quantitation of DNA Methylation of 28 Candidate Genes in Prostate Cancer Using Pyrosequencing

    Directory of Open Access Journals (Sweden)

    Nataڑa Vasiljeviš

    2011-01-01

    Full Text Available Aberrant DNA methylation plays a pivotal role in carcinogenesis and its mapping is likely to provide biomarkers for improved diagnostic and risk assessment in prostate cancer (PCa. We quantified and compared absolute methylation levels among 28 candidate genes in 48 PCa and 29 benign prostate hyperplasia (BPH samples using the pyrosequencing (PSQ method to identify genes with diagnostic and prognostic potential.

  5. Femoral Neck Shaft Angle in Men with Fragility Fractures

    Directory of Open Access Journals (Sweden)

    S. P. Tuck

    2011-01-01

    Full Text Available Introduction. Femoral neck shaft angle (NSA has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric, symptomatic vertebral (91, and distal forearm (67 fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm2: lumbar spine, femoral neck, and total femur measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately, nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P=0.001, but larger in those with distal forearm fractures (129.8° versus 128.5°: P=0.01. Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

  6. Participation of osteoporosis in femoral neck fracture

    International Nuclear Information System (INIS)

    Quantitative computed tomography (QCT) was used to measure bone mineral contents of the proximal femur. First, 62 specimens of cancellous bones of the proximal femur obtained at operation were burnt for mineral determination after preoperative QCT measurement to evaluate the relationship between QCT values and ash weight. The findings indicated that QCT measurement of proximal femur was as useful as that of the lumbar spine. Next, 10 groups of 50 men and 50 women ranging in age from the 5th to the 9th decade were tested to define the control mean and range of QCT mineral content of proximal femur, to compare with 32 cases of femoral neck fracture. In women with femoral neck fracture, QCT values of the femoral neck were less than those of the same normal age group except for cases of medial fracture in the 9th decade. This measurement might provide an index for fracture risk. (author)

  7. The Relationship between Mid-face Fractures and Brain Injuries

    Directory of Open Access Journals (Sweden)

    Khalighi Sigaroudi A.

    2012-03-01

    Full Text Available Statement of Problem: Although advances in technology have led to improvements in man’s life in different aspects, statistics show that the incidence of fractures is increasing in different regions of the body. Recent studies show that midface fractures are strongly associated with patient's death. The exact relationship between different types of facial fractures and brain injuries is still controversial. Purpose: To evaluate individuals with midface fractures from different causes and determine if there is any relationship between various midface fractures and brain injuries. Materials and Methods: In this descriptive cross-sectional retrospective study, we assessed the hospital charts of all the patients with midface fractures at the trauma center of Poursina hospital. The complete medical record of each patient was reviewed. The etiologic and demographic data, the type of midface fracture and brain injury, and Glasgow coma scale (GCS were assessed. The data were analyzed by, the Chi-square, and the Fisher’s exact tests. The statistical package SPSS was used for all the analyses.Results: Of all the patients 47% had brain injury. The Important significant correlations were as follows: Le Fort III with Brain Contusion ( p =0.0001, nasal orbital ethmoid fractures with subdural hematoma ( p =0.0001, frontal fracture with subdural hematoma ( p =0.0001. Zygomatic complex fracture with Brain Contusion ( p =0.009. Nasal fracture correlated with Brain Contusion ( p =0.0001. The zygomatic complex fracture was the most prevalent fracture.Conclusion: Different midface fracture patterns have the risk of brain injury simultaneously. So midface fractures need more attention. According to the results, more attention is needed to be paid to driving rules specially the use of helmet and seat belt.

  8. Risk factors for wound complications after internal fixation of distal tibial fracture%胫骨远端骨折内固定治疗术后切口并发症的风险因素分析

    Institute of Scientific and Technical Information of China (English)

    赵晓伟; 张元民; 王国栋; 孟纯阳

    2014-01-01

    Objective To identify risk factors for wound complications related to internal fixation of distal tibial fracture.Methods A total of 125 patients undergone open reduction and internal fixation of the distal tibial fracture between January 2008 and December 2011 were enrolled.There were 72 men and 53 women with mean age of 41.46 years.Factors contributing to operative wound complications assessed were demographic characteristics (age,gender,and smoking history),types of fracture,operative time,time from injury to operation,and concomitant diseases (diabetes and peripheral vascular disease).Patients with wound complications were defined as those requiring dressing care and oral or intravenous antibiotics or those requiring further surgical treatment.Results At follow-up,wound complications were recorded including 1 patient (0.8%) had surgical debridement and 10 patients (8.0%) had dressing care and oral or intravenous antibiotic therapy.Logistic regression analysis identified risk factors for wound complications were open fracture (OR =23.077,95% CI 2.672-199.342,P <0.01) and age (OR =1.078,95% CI 1.011-1.150,P < 0.05).Otherwise,following factors exhibited no significant correlation with wound complications:age,body mass index,smoking history,types of fracture,multiple injury or not,and operative time.Conclusion Patients with older age or open fracture present an increased risk of wound complications after operation and need special concern.%目的 分析胫骨远端骨折内固定术后切口并发症及其相关的风险因素. 方法 纳入2008年1月-2011年12月行切开复位内固定治疗的125例胫骨远端骨折患者,其中男72例,女53例;平均年龄41.46岁.对患者的人口统计学数据(年龄、性别、吸烟史)、骨折类型、手术时间、受伤至手术时间及伴发疾病(糖尿病、周围血管疾病)等变量进行评估分析.对于需要进行换药处理、口服或静脉滴注抗生素或进一步手术治疗的

  9. Absolute calibration of the Auger fluorescence detectors

    Energy Technology Data Exchange (ETDEWEB)

    Bauleo, P.; Brack, J.; Garrard, L.; Harton, J.; Knapik, R.; Meyhandan, R.; Rovero, A.C.; /Buenos Aires, IAFE; Tamashiro, A.; Warner, D.

    2005-07-01

    Absolute calibration of the Pierre Auger Observatory fluorescence detectors uses a light source at the telescope aperture. The technique accounts for the combined effects of all detector components in a single measurement. The calibrated 2.5 m diameter light source fills the aperture, providing uniform illumination to each pixel. The known flux from the light source and the response of the acquisition system give the required calibration for each pixel. In the lab, light source uniformity is studied using CCD images and the intensity is measured relative to NIST-calibrated photodiodes. Overall uncertainties are presently 12%, and are dominated by systematics.

  10. Musical Activity Tunes Up Absolute Pitch Ability

    DEFF Research Database (Denmark)

    Dohn, Anders; Garza-Villarreal, Eduardo A.; Ribe, Lars Riisgaard;

    2014-01-01

    Absolute pitch (AP) is the ability to identify or produce pitches of musical tones without an external reference. Active AP (i.e., pitch production or pitch adjustment) and passive AP (i.e., pitch identification) are considered to not necessarily coincide, although no study has properly compared...... that APs generally undershoot when adjusting musical pitch, a tendency that decreases when musical activity increases. Finally, APs are less accurate when adjusting the pitch to black key targets than to white key targets. Hence, AP ability may be partly practice-dependent and we speculate that APs may...... benefit from frequent contact with fixed standard chroma to keep in tune....

  11. Absolute Priority for a Vehicle in VANET

    Science.gov (United States)

    Shirani, Rostam; Hendessi, Faramarz; Montazeri, Mohammad Ali; Sheikh Zefreh, Mohammad

    In today's world, traffic jams waste hundreds of hours of our life. This causes many researchers try to resolve the problem with the idea of Intelligent Transportation System. For some applications like a travelling ambulance, it is important to reduce delay even for a second. In this paper, we propose a completely infrastructure-less approach for finding shortest path and controlling traffic light to provide absolute priority for an emergency vehicle. We use the idea of vehicular ad-hoc networking to reduce the imposed travelling time. Then, we simulate our proposed protocol and compare it with a centrally controlled traffic light system.

  12. Development of an absolute neutron dosimeter

    Energy Technology Data Exchange (ETDEWEB)

    Acevedo, C; Birstein, L; Loyola, H [Section de Desarrollos Innovativos, Comision Chilena de EnergIa Nuclear (CCHEN), Casilla 188-D, Santiago (Chile)], E-mail: lbirstei@cchen.cl

    2008-11-01

    An Absolute Neutron Dosimeter was developed to be used as a calibration standard for the Radiation Metrology Laboratory at CCHEN. The main component of the Dosimeter consists of a Proportional Counter of cylindrical shape, with Polyethylene walls and Ethylene gas in its interior. It includes a cage shaped arrangement of graphite bars that operates like the Proportional Counter cathode and a tungsten wire of 25 {mu}m in diameter {mu}m as the anode. Results of a Montecarlo modeling for the Dosimeter operation and results of tests and measurements performed with a radioactive source are presented.

  13. ABSOLUT LOMO绝对创意

    Institute of Scientific and Technical Information of China (English)

    婷婷(整理)

    2007-01-01

    ABSOLUT与创意素来有着不解之缘。由Andy Warhal的ABSOLUT WARHOL至今,已有超过400位不同领域的创意大师为ABSOLUT的当代艺术宝库贡献了自己的得意之作。ABSOLUT的创意仿佛永远不会枯竭,而一系列的作品也让惊喜从未落空。

  14. Femoral neck fracture following groin irradiation

    International Nuclear Information System (INIS)

    Purpose: The incidence and risk factors are evaluated for femoral neck fracture following groin irradiation for gynecologic malignancies. Methods and Materials: The radiation therapy records of 1313 patients with advanced and recurrent cancer of the vagina, vulva, cervix, and endometrium, treated at the Mallinckrodt Institute of Radiology from 1954 to 1992, were reviewed. Median follow-up was 12.7 years. From this group, 207 patients were identified who received irradiation to the pelvis and groins with anterposterior-posterior anterior (AP-PA), 18 MV photons. Data were reviewed regarding irradiation dose to the femoral neck and other presumed risk factors including age, primary site, stage, groin node status, menopausal status, estrogen use, cigarette use, alcohol consumption, and osteoporosis. Results: The per-patient incidence of femoral neck fracture was 4.8% (10 out of 207). Four patients developed bilateral fractures. However, the cumulative actuarial incidence of fracture was 11% at 5 years and 15% at 10 years. Cox multivariate analysis of age, weight, and irradiation dose showed that only irradiation dose may be important to developing fracture. Step-wise logistic regression of presumed prognostic factors revealed that only cigarette use and x-ray evidence of osteoporosis prior to irradiation treatment were predictive of fracture. Conclusion: Femoral head fracture is a common complication of groin irradiation for gynecologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication

  15. Hyponatremia independent of osteoporosis is associated with fracture occurrence.

    LENUS (Irish Health Repository)

    Kinsella, Sinead

    2010-02-01

    Mild hyponatremia has traditionally been considered benign, but it may be associated with gait and attention deficits and an increased risk of falls that may result in fracture. A retrospective study was conducted to quantify the association of hyponatremia with fracture occurrence and to examine whether this relationship is independent of osteoporosis.

  16. Periprosthetic fractures of the femur after total knee arthroplasty

    OpenAIRE

    McGraw, Phil; Kumar, Arun

    2010-01-01

    Periprosthetic fracture following total knee arthroplasty is a potentially serious complication. This injury can involve the distal femur, proximal tibia or the patella. This review article analyzes the prevalence, risk factors, classification and treatment options for periprosthetic fractures of the femur.

  17. Arterial injury and pseudoaneurysm formation after lesser trochanter fracture

    Directory of Open Access Journals (Sweden)

    Susanne Regus

    2015-01-01

    Conclusion: Surgeons should pay attention to any displaced bone fragments close to calcified vessels, especially in the evaluation of routine x-rays following surgical treatment of fractures. This could minimize the potential life-threatening risk of delayed diagnosis, especially because it represents a routine image following surgical fracture treatments.

  18. Factors affecting functional prognosis of patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, M T

    2011-01-01

    Having a hip fracture is considered one of the most fatal fractures for elderly people, resulting in impaired function, and increased morbidity and mortality. This challenges clinicians in identifying patients at risk of worse outcome, in order to optimise and intensify treatment in these patients...

  19. [Fracture endoprosthesis of distal humerus fractures].

    Science.gov (United States)

    Müller, L P; Wegmann, K; Burkhart, K J

    2013-08-01

    The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.

  20. Celiac Disease in Women with Hip Fractures

    Science.gov (United States)

    LeBoff, Meryl S.; Cobb, Haley; Gao, Lisa Y.; Hawkes, William; Yu-Yahiro, Janet; Kolatkar, Nikheel S.; Magaziner, Jay

    2014-01-01

    Objective Celiac disease is associated with decreased bone density, however, the risk of fractures in celiac disease patients is unclear. We compared the prevalence of celiac disease between a group of women with hip fractures and a group of women undergoing elective joint replacement surgery and the association between celiac disease and vitamin D levels. Methods Two hundred eight community dwelling and postmenopausal women were recruited from Boston, MA (n=81) and Baltimore, MD (n=127). We measured tissue transglutaminase IgA by ELISA to diagnose celiac disease and 25-hydroxyvitamin D (25(OH)D) levels by radioimmunoassay in both women with hip fractures (n=157) and the control group (n=51), all of whom were from Boston. Subjects were excluded if they took any medications or had medical conditions that might affect bone. Results Median serum 25(OH)D levels were significantly lower (p< 0.0001) in the hip fracture cohorts compared to the elective joint replacement cohort (14.1 ng/ml vs. 21.3 ng/ml, respectively). There were no differences in the percentage of subjects with a positive tissue transglutaminase in the women with hip fractures versus the control group (1.91% vs. 1.61%, respectively). Conclusion Vitamin D levels are markedly reduced in women with hip fractures, however hip fracture patients did not show a higher percentage of positive tissue transglutaminase levels compared with controls. These data suggest that routine testing for celiac disease among hip fracture patients may not prove useful, although larger prospective studies among hip fracture subjects are needed. PMID:23732553