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Sample records for fracture risk rate

  1. 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...

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

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    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

  3. 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.

  4. The impact of lifestyle risk factors on the rate of infection after surgery for a fracture of the ankle

    DEFF Research Database (Denmark)

    Olsen, L L; Møller, A M; Brorson, S

    2017-01-01

    risk factors for the development of infection following surgery for a fracture of the ankle. This large study brings new evidence concerning these common risk factors; although prospective studies are needed to confirm causality. Cite this article: Bone Joint J 2017;99-B:225-30.......AIMS: Lifestyle risk factors are thought to increase the risk of infection after acute orthopaedic surgery but the evidence is scarce. We aimed to investigate whether smoking, obesity and alcohol overuse are risk factors for the development of infections after surgery for a fracture of the ankle....... PATIENTS AND METHODS: We retrospectively reviewed all patients who underwent internal fixation of a fracture of the ankle between 2008 and 2013. The primary outcome was the rate of deep infection and the secondary outcome was any surgical site infection (SSI). Associations with the risk factors...

  5. Association of Increased Urinary Albumin With Risk of Incident Clinical Fracture and Rate of Hip Bone Loss: the Osteoporotic Fractures in Men Study.

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    Fink, Howard A; Vo, Tien N; Langsetmo, Lisa; Barzilay, Joshua I; Cauley, Jane A; Schousboe, John T; Orwoll, Eric S; Canales, Muna T; Ishani, Areef; Lane, Nancy E; Ensrud, Kristine E

    2017-05-01

    Prior studies suggest that increased urine albumin is associated with a heightened fracture risk in women, but results in men are unclear. We used data from Osteoporotic Fractures in Men (MrOS), a prospective cohort study of community-dwelling men aged ≥65 years, to evaluate the association of increased urine albumin with subsequent fractures and annualized rate of hip bone loss. We calculated albumin/creatinine ratio (ACR) from urine collected at the 2003-2005 visit. Subsequent clinical fractures were ascertained from triannual questionnaires and centrally adjudicated by review of radiographic reports. Total hip BMD was measured by DXA at the 2003-2005 visit and again an average of 3.5 years later. We estimated risk of incident clinical fracture using Cox proportional hazards models, and annualized BMD change using ANCOVA. Of 2982 men with calculable ACR, 9.4% had ACR ≥30 mg/g (albuminuria) and 1.0% had ACR ≥300 mg/g (macroalbuminuria). During a mean of 8.7 years of follow-up, 20.0% of men had an incident clinical fracture. In multivariate-adjusted models, neither higher ACR quintile (p for trend 0.75) nor albuminuria (HR versus no albuminuria, 0.89; 95% CI, 0.65 to 1.20) was associated with increased risk of incident clinical fracture. Increased urine albumin had a borderline significant, multivariate-adjusted, positive association with rate of total hip bone loss when modeled in ACR quintiles (p = 0.06), but not when modeled as albuminuria versus no albuminuria. Macroalbuminuria was associated with a higher rate of annualized hip bone loss compared to no albuminuria (-1.8% more annualized loss than in men with ACR fracture associations. In these community-dwelling older men, we found no association between urine albumin levels and risk of incident clinical fracture, but found a borderline significant, positive association with rate of hip bone loss. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and

  6. Fracture Rates and Fracture Sites in Patients With Osteogenesis Imperfecta

    DEFF Research Database (Denmark)

    Folkestad, Lars; Hald, Jannie Dahl; Ersbøll, Annette Kjaer;

    2016-01-01

    , with a peak during the toddler and adolescent years (incidence rate [IR] 233.9 per 1000 person years), fewer fractures during adulthood (IR 84.5 per 1000 person years), and increased fracture rates in older women (IR 111.9 per 1000 person years). This is the largest register-based nationwide study...... years. In comparison, 709 persons in the reference population experienced a total of 1018 fractures during follow-up. Both male and female patients with OI had an increased fracture rate throughout their life. The fracture rate ratio for participants aged 0 to 19 years was 10.7, for participants aged 20...... to 54 years 17.2, and for participants aged 55 years and over 4.1 when compared to the reference population. The highest fracture rate was seen in males with OI aged 0 to 19 years (257 fractures per 1000 person-years). The fractures appear to follow the same pattern as in the general population...

  7. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial

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    Vittinghoff, E.; Kado, D. M.; Lane, N. E.; Ensrud, K. E.; Shipp, K.

    2016-01-01

    Summary Biomechanical analyses support the theory that thoracic spine hyperkyphosis may increase risk of new vertebral fractures. While greater kyphosis was associated with an increased rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture. Introduction Biomechanical analyses suggest hyperkyphosis may increase risk of incident vertebral fracture by increasing the load on vertebral bodies during daily activities. We propose to assess the association of kyphosis with incident radiographic vertebral fracture. Methods We used data from the Fracture Intervention Trial among 3038 women 55–81 years of age with low bone mineral density (BMD). Baseline kyphosis angle was measured using a Debrunner kyphometer. Vertebral fractures were assessed at baseline and follow-up from lateral radiographs of the thoracic and lumbar spine. We used Poisson models to estimate the independent association of kyphosis with incident fracture, controlling for age and femoral neck BMD. Results Mean baseline kyphosis was 48° (SD = 12) (range 7–83). At baseline, 962 (32 %) participants had a prevalent fracture. There were 221 incident fractures over a median of 4 years. At baseline, prevalent fracture was associated with 3.7° greater average kyphosis (95 % CI 2.8–4.6, p < 0.0005), adjusting for age and femoral neck BMD. Before adjusting for prevalent fracture, each 10° greater kyphosis was associated with 22 % increase (95 % CI 8–38 %, p = 0.001) in annualized rate of new radiographic vertebral fracture, adjusting for age and femoral neck BMD. After additional adjustment for prevalent fracture, estimated increased annualized rate was attenuated and no longer significant, 8 % per 10° kyphosis (95 % CI −4 to 22 %, p = 0.18). Conclusions While greater kyphosis increased the rate of

  8. Lithium use and the risk of fractures

    NARCIS (Netherlands)

    Wilting, Ingeborg; de Vries, Frank; Thio, Brahm M. K. S.; Cooper, Cyrus; Heerdink, Eibert R.; Leutkens, Hubert G. M.; Nolen, Willem A.; Egberts, Antoine C. G.; van Staa, Tjeerd P.

    A recent study reported a decreased risk of fractures among lithium users. We conducted a case-control study within the UK General Practice Research Database, comparing never, ever, current, recent and past lithium use in 231,778 fracture cases to matched controls. In addition, the risk of fractures

  9. 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

  10. Pressure ulcer risk in hip fracture patients

    NARCIS (Netherlands)

    Houwing, R. H.; Rozendaal, M; Wouters-Wesseling, W; Buskens, E.; Keller, P; Haalboom, JRE

    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

  11. Postmenopausal osteoporosis: fracture risk and prevention.

    Science.gov (United States)

    Kaunitz, Andrew M; McClung, Michael R; Feldman, Robert G; Wysocki, Susan

    2009-11-01

    In the estrogen-regulated RANK ligand (RANKL)/RANK/osteoprotegerin (OPG) pathway, estrogen deficiency favors osteoclast maturation, leading to increased bone resorption compared with bone formation. Treatment of low bone mineral density (BMD) should be based on fracture risk, assessed using the WHO Fracture Risk Algorithm (FRAX(R)). Criteria for treatment are 10-year overall fracture risk ≥ 20% or 10-year hip fracture risk ≥ 3%. Vitamin D supplementation at levels higher than those traditionally recommended may be appropriate for healthy menopausal women. Multiple strategies are needed to effectively manage osteoporosis in postmenopausal women.

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

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    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

  13. 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

  14. 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

  15. Risk factors associated with facial fractures

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    Anne Margareth Batista

    2012-04-01

    Full Text Available The aim of the present study was to identify risk factors for facial fractures in patients treated in the emergency department of a hospital. The medical charts of 1121 patients treated in an emergency ward over a three-year period were analyzed. The independent variables were gender, age, place of residence (urban or rural area and type of accident. The dependent variables were fractured mandible, zygoma, maxilla, nasal bone and more than one fractured facial bone. Statistical analysis was performed using the chi-square test (a < 0.05, univariate and multivariate Poisson distributions and the logistic regression analysis (p < 0.20. Maxillofacial trauma was recorded in 790 charts (70.5%, with 393 (35.1% charts reporting facial fractures. Motorcycle accidents were found to be the main risk factor for mandibular fractures (PR = 1.576, CI = 1.402-1.772 and simultaneous fractures of more than one facial bone (OR = 4.625, CI = 1.888-11.329 as well as the only risk factor for maxillary bone fractures (OR = 11.032, CI = 5.294-22.989. Fractures of the zygomatic and nasal bones were mainly associated with accidents involving animals (PR = 1.206, CI = 1.104-1.317 and sports (OR = 8.710, CI = 4.006-18.936, respectively. The determinant for the majority of facial fractures was motorcycle accidents, followed by accidents involving animals and sports.

  16. Women with cardiovascular disease have increased risk of osteoporotic fracture.

    Science.gov (United States)

    Chen, Jian Sheng; Hogan, Chris; Lyubomirsky, Greg; Sambrook, Philip N

    2011-01-01

    This study investigated whether women with cardiovascular disease (CVD) would have an increased risk of fractures as osteoporosis and CVD share many common risk factors. From February 2006 to January 2007, 17,033 women aged ≥50 years (mean 71.8, range 50-106) were recruited by 1,248 primary care practitioners and interviewed by trained nurses. For each woman, 10-year probability of a future major osteoporotic fracture was estimated using the World Health Organization Fracture Risk Assessment Tool (FRAX). The study showed that the 10-year probability of a major osteoporotic fracture was higher for 6,219 CVD women compared to 10,814 non-CVD women after adjustment for age, BMI, current smoking, and alcohol use (adjusted geometric means 14.3 and 13.8%, respectively; P < 0.001). With regard to high risk of fracture (i.e., 10-year probability ≥ 20%), the adjusted odds ratio for CVD was 1.23 (95% CI 1.13-1.35, P < 0.001). However, compared to non-CVD women, CVD women were more likely to report a previous fracture, to have a secondary osteoporosis, and to use glucocorticoids. Among the 4,678 women who were classified as having a high fracture risk, current use rate of bone-related medications (i.e., any one of bisphosphonates, raloxifene, PTH, vitamin D, calcium, or hormone therapy) was 50.2% in the CVD group and 56.9% in the non-CVD group. Women with CVD were at increased risk of fracture partly due to bone-specific risk factors such as history of previous fracture, use of glucocorticoids, and secondary osteoporosis. This risk is not being treated appropriately by primary health physicians.

  17. New insights in professional horse racing; "in-race" heart rate data, elevated fracture risk, hydration, nutritional and lifestyle analysis of elite professional jockeys.

    Science.gov (United States)

    O'Reilly, John; Cheng, Hoi Lun; Poon, Eric Tsz-Chun

    2017-03-01

    Weight-making practices have been shown to impair musculoskeletal and physiological function of jockeys. This study investigated the "in-race" heart rate (HR) responses and hydration status during competitive racing, as well as selected physiological and lifestyle parameters of professional jockeys based in Hong Kong. "In-race" HR responses and early morning hydration status of 20 male jockeys were examined in hot and moderate climactic occasions. Additionally, bone mineral density (BMD), dietary intake and lifestyle choices were assessed. Osteopenia was observed in the calcanei of jockeys (left: 0.51 ± 0.06; right: 0.46 ± 0.12 g · cm(-2)). Energy and protein intake were significantly lower on a race day compared to a non-race day (P race" HRmax values were similar to those from VO2max laboratory tests (186 ± 14 vs. 185 ± 8 bpm). Hypohydration was observed on both racing days. (USG: 1.0247 ± 0.006 and 1.0256 ± 0.0258 mg · L(-1) for hot and moderate conditions, respectively). Sauna usage (25.5%) and food restriction (20.4%) were the most common weight-making practices. Current lifestyle choices of jockeys result in suboptimal bone health, hydration status and nutritional intake, which can significantly enhance the fracture risk. Further research should develop exercise and nutrition guidelines for optimising their skeletal health.

  18. Fragility fracture: recent developments in risk assessment.

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    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.

  19. Gout and the Risk of Non-vertebral Fracture.

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    Kim, Seoyoung C; Paik, Julie M; Liu, Jun; Curhan, Gary C; Solomon, Daniel H

    2017-02-01

    Prior studies suggest an association between osteoporosis, systemic inflammation, and pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Conflicting findings exist on the association between hyperuricemia and osteoporosis. Furthermore, it remains unknown whether gout, a common inflammatory arthritis, affects fracture risk. Using data from a US commercial health plan (2004-2013), we evaluated the risk of non-vertebral fracture (ie, forearm, wrist, hip, and pelvis) in patients with gout versus those without. Gout patients were identified with ≥2 diagnosis codes and ≥1 dispensing for a gout-related drug. Non-gout patients, identified with ≥2 visits coded for any diagnosis and ≥1 dispensing for any prescription drugs, were free of gout diagnosis and received no gout-related drugs. Hip fracture was the secondary outcome. Fractures were identified with a combination of diagnosis and procedure codes. Cox proportional hazards models compared the risk of non-vertebral fracture in gout patients versus non-gout, adjusting for more than 40 risk factors for osteoporotic fracture. Among gout patients with baseline serum uric acid (sUA) measurements available, we assessed the risk of non-vertebral fracture associated with sUA. We identified 73,202 gout and 219,606 non-gout patients, matched on age, sex, and the date of study entry. The mean age was 60 years and 82% were men. Over the mean 2-year follow-up, the incidence rate of non-vertebral fracture per 1,000 person-years was 2.92 in gout and 2.66 in non-gout. The adjusted hazard ratio (HR) was 0.98 (95% confidence interval [CI] 0.85-1.12) for non-vertebral fracture and 0.83 (95% CI 0.65-1.07) for hip fracture in gout versus non-gout. Subgroup analysis (n = 15,079) showed no association between baseline sUA and non-vertebral fracture (HR = 1.03, 95% CI 0.93-1.15), adjusted for age, sex, comorbidity score, and number of any prescription drugs. Gout was not associated with a risk of non

  20. Clopidogrel and the risk of osteoporotic fractures

    DEFF Research Database (Denmark)

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

    2012-01-01

    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...... of osteoporotic fractures, especially in subjects with a treatment duration of more than 1 year. However, individuals with low exposure to clopidogrel (...

  1. 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

  2. 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

    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

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

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    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.

  4. Risk factors for surgical site infection of pilon fractures

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    Tingting Ren

    2015-06-01

    Full Text Available OBJECTIVES: Pilon fracture is a complex injury that is often associated with severe soft tissue damage and high rates of surgical site infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among patients undergoing surgical fixation of a pilon fracture. METHODS: The medical records of all pilon fracture patients who underwent surgical fixation from January 2010 to October 2012 were reviewed to identify those who developed a surgical site infection. Then, we constructed univariate and multivariate logistic regressions to evaluate the independent associations of potential risk factors with surgical site infection in patients undergoing surgical fixation of a pilon fracture. RESULTS: A total of 519 patients were enrolled in the study from January 2010 to October 2012. A total of 12 of the 519 patients developed a surgical site infection, for an incidence of 2.3%. These patients were followed for 12 to 29 months, with an average follow-up period of 19.1 months. In the final regression model, open fracture, elevated postoperative glucose levels (≥125 mg/dL, and a surgery duration of more than 150 minutes were significant risk factors for surgical site infection following surgical fixation of a pilon fracture. CONCLUSIONS: Open fractures, elevated postoperative glucose levels (≥125 mg/dL, and a surgery duration of more than 150 minutes were related to an increased risk for surgical site infection following surgical fixation of a pilon fracture. Patients exhibiting the risk factors identified in this study should be counseled regarding the possible surgical site infection that may develop after surgical fixation.

  5. A comparison of hip fracture incidence rates among elderly in Sweden by latitude and sunlight exposure.

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    Nilson, Finn; Moniruzzaman, Syed; Andersson, Ragnar

    2014-03-01

    Research has shown that hip fracture risk increases with latitude; hypothetically due to reduced sunlight exposure and its effect on bone quality. Sweden, with large differences in latitude and UV radiation, is ideal to study in order to analyse the association between latitude and UV radiation on age- and sex-specific hip fracture rates among elderly. Aggregated (2006-2008) age- and sex-specific hip fracture data was obtained for each Swedish municipality as well as the municipality's latitudinal coordinates and aggregated (2006-2008) UV radiation levels. Pearson correlations were calculated between hip fracture incidence rates, latitude and UV radiation. Independent t tests were calculated on tertile-categorized latitudinal data in order to investigate the difference in hip fracture risk between these categories. Statistically significant correlations were seen in all groups between hip fracture incidence rates and latitude as well as UV radiation. The independent t tests showed that this correlation was mainly due to high incidence rates in high latitude municipalities. Statistically significant correlations are seen between hip fracture incidence rates and latitude as well as UV radiation in Sweden and the northern parts of Sweden have an increased risk of hip fractures compared to the middle and southern parts. To our knowledge this is the first study using a national discharge register that shows this relationship and provides a starting point for further research to investigate why populations in northern Sweden have a higher risk of hip fractures compared to other Swedish regions.

  6. 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.

  7. Modeling climate effects on hip fracture rate by the multivariate GARCH model in Montreal region, Canada

    Science.gov (United States)

    Modarres, Reza; Ouarda, Taha B. M. J.; Vanasse, Alain; Orzanco, Maria Gabriela; Gosselin, Pierre

    2014-07-01

    Changes in extreme meteorological variables and the demographic shift towards an older population have made it important to investigate the association of climate variables and hip fracture by advanced methods in order to determine the climate variables that most affect hip fracture incidence. The nonlinear autoregressive moving average with exogenous variable-generalized autoregressive conditional heteroscedasticity (ARMA X-GARCH) and multivariate GARCH (MGARCH) time series approaches were applied to investigate the nonlinear association between hip fracture rate in female and male patients aged 40-74 and 75+ years and climate variables in the period of 1993-2004, in Montreal, Canada. The models describe 50-56 % of daily variation in hip fracture rate and identify snow depth, air temperature, day length and air pressure as the influencing variables on the time-varying mean and variance of the hip fracture rate. The conditional covariance between climate variables and hip fracture rate is increasing exponentially, showing that the effect of climate variables on hip fracture rate is most acute when rates are high and climate conditions are at their worst. In Montreal, climate variables, particularly snow depth and air temperature, appear to be important predictors of hip fracture incidence. The association of climate variables and hip fracture does not seem to change linearly with time, but increases exponentially under harsh climate conditions. The results of this study can be used to provide an adaptive climate-related public health program and ti guide allocation of services for avoiding hip fracture risk.

  8. Risk-factors for surgical delay following hip fracture.

    Science.gov (United States)

    Sanz-Reig, J; Salvador Marín, J; Ferrández Martínez, J; Orozco Beltrán, D; Martínez López, J F

    To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay. The mean age of the patients was 83.7 years. The mean Charlson Index was 2.8. The pre-fracture baseline co-morbidities were equal or greater than 2 in 70% of cases. Mean timing of surgery was 3.1 days. At the time of admission, 122 (67.7%) patients were fit for surgery, of which 80 (44.4%) underwent surgery within 2 days. A Charlson index greater than 2, anticoagulant therapy, and admission on Thursday to Saturday, were independently associated with a surgical delay greater than 2 days. The rate of hip fracture patients undergoing surgery within 2 days is low. Risk factors associated to surgical delay are non-modifiable. However, their knowledge should allow the development of protocols that can reduce surgical delay in this group of patients. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Potential Impact of Benzodiazepine Use on the Rate of Hip Fractures in Five Large European Countries and the United States

    OpenAIRE

    2012-01-01

    Benzodiazepine use increases the risk of falls and has been associated with an increased risk of hip fractures. Our aim was to estimate the possible population impact of the use of benzodiazepines on the rate of hip fracture in France, Germany, Italy, Spain, the United Kingdom, and the United States. We conducted a literature review to estimate the pooled relative risk (RR) for hip fractures and use of benzodiazepines. Prevalence rates of benzodiazepine use in 2009 were calculated for each co...

  10. [Fall risk and fracture. Aging and fall/fracture].

    Science.gov (United States)

    Kozaki, Koichi

    2013-05-01

    Fall deteriorates QOL and ADL of elderly people, especially when they suffer from hip and vertebral fractures. It is not easy to identify the cause of falling, because falling usually result from multiple factors. Among various potential causes, osteoporosis, osteoarthritis, medication of hypnotic drugs, and environmental factors are important, because they are frequent and can be modifiable. When evaluating fall risks, grasping power, one-leg standing time, timed up&go test, are useful. On the other hand, fall risk index, 22-item self-assessment test, is easy and even better in predicting future falls. In the Cochrane systematic review article 2009, exercise such as Tai-Chi, withdrawal of hypnotic drugs, and vitamin D supplementation are shown to prevent falls in community-dwelling elderly.

  11. Low-trauma fractures indicate increased risk of hip fracture in frail older people.

    Science.gov (United States)

    Chen, Jian Sheng; Cameron, Ian D; Simpson, Judy M; Seibel, Markus J; March, Lyn M; Cumming, Robert G; Lord, Stephen R; Sambrook, Philip N

    2011-02-01

    This study aims to investigate the risk of subsequent fractures after low-trauma fracture in frail older people. A total of 1412 elderly residents (mean age 86.2 years, SD 7.0 years, female 77%) were recruited from aged care facilities in Australia. Residents were assessed and then followed for any fracture for 2 years and hip fractures for at least 5 years. Residents with and without a newly acquired fracture in the first 2 years were compared for risk of subsequent hip fracture. Residents with a nonhip fracture in the first 2 years had an increased risk of subsequent hip fracture for about 2.5 years, whereas those with a hip fracture had a similar risk over the whole period compared with those with no fracture. During these 2.5 years, 60, 28, and 6 subsequent hip fractures occurred in the nonfracture group (n = 953), the nonhip fracture group (n = 194), and the hip fracture group (n = 101), respectively, resulting in the probability of subsequent hip fracture of 8.0%, 19.9%, and 10.4%, respectively. Compared with the nonfracture group, the hazard ratio (HR) was 2.82 [95% confidence interval (CI) 1.73-4.59; p < .001] for the nonhip fracture group and 1.48 (95% CI 0.63-3.49, p = .37) for the hip fracture group after adjusting for age, sex, residence type, calcaneal broadband ultrasound attenuation, fracture history, weight, lower leg length, immobility, cognitive function, and medications. Frail institutionalized older people with newly acquired fractures are at increased risk of subsequent hip fracture for the next few years. Accordingly, despite their advanced age, they are a high-priority target group to investigate interventions that might reduce the risk of hip fracture.

  12. Fracture Rates and Fracture Sites in Patients With Osteogenesis Imperfecta

    DEFF Research Database (Denmark)

    Folkestad, Lars; Hald, Jannie Dahl; Ersbøll, Annette Kjær;

    2017-01-01

    Osteogenesis imperfecta (OI) is a hereditary, clinically heterogeneous, connective tissue disorder. The population prevalence of OI in Denmark is 10.6 in 100,000. A hallmark of the disease is frequent fractures that are often precipitated by minimal trauma. The aim of the current study...

  13. Low evaluation rate for osteoporosis among patients presenting with a rib fracture.

    Science.gov (United States)

    Kim, Whang; Gong, Hyun Sik; Lee, Seung Hoo; Park, Jin Woo; Kim, Kahyun; Baek, Goo Hyun

    2017-12-01

    This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. Increased emphasis or education for osteoporosis evaluation may be necessary in case of rib fractures. Rib fractures from a low-energy trauma are common in the elderly, and a history of rib fracture has been reported to increase the risk for a subsequent osteoporotic fracture. The purpose of this study was to evaluate how many of the patients presenting with an isolated rib fracture were being evaluated for osteoporosis and the risk for a subsequent fracture. We retrospectively reviewed all patients aged 50 years or older who were diagnosed with a rib fracture between January 2011 and April 2016 at a regional tertiary care university hospital near Seoul, South Korea. We excluded those who had been treated for osteoporosis or those with other concomitant fractures or fractures from a motor vehicle accident or cancer. We evaluated the frequency of dual energy X-ray absorptiometry (DXA) scan examinations in these patients. There were 231 patients with isolated rib fractures (132 men and 99 women). The mean age was 65 years. Rib fractures were most commonly diagnosed at the emergency department and most of the patients were referred to the department of thoracic surgery for follow-up evaluations. Of these 231 patients, 29 (12%) had DXA examinations after the injury, and only 9 (4%) of them did so within 6 months. Physicians specializing in orthopedic surgery, family medicine, internal medicine, rehabilitation medicine, and emergency medicine were ordering the examination. This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. This study suggests that increased emphasis or education for osteoporosis evaluation may be necessary for physicians who are often referred to for care of rib fractures.

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

    Science.gov (United States)

    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

    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 available in 398,610 women with an average age of 63 (range, 20-105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30 kg/m(2) ) was present in 22%. A majority of osteoporotic fractures (81%) and hip fractures (87%) arose in non-obese women. Compared to a BMI of 25 kg/m(2) , the hazard ratio (HR) for osteoporotic fracture at a BMI of 35 kg/m(2) was 0.87 (95% confidence interval [CI], 0.85-0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic fracture was increased (HR, 1.16; 95% CI, 1.09-1.23). Low BMI is a risk factor for hip and all osteoporotic fracture, but is a protective factor for lower leg fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) fracture. When adjusted for BMD, low BMI remained a risk factor for hip fracture but was protective for osteoporotic fracture, tibia and fibula fracture, distal forearm fracture, and upper arm fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm fracture but was also a risk factor for all osteoporotic fractures. The association between BMI and fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility fracture. The contribution of increasing population rates of obesity to apparent decreases in fracture rates should be explored.

  15. 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.

  16. [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.

  17. The risk factors that effect the prognosis in fractures of the hip

    OpenAIRE

    Ozturk, Irfan

    2004-01-01

    There is still some controversy and problems about the treatment of hip fractures in elderly people. In addition to success of surgical technique, low postoperative morbidity and mortality rates also have to be the aim of the therapy. In elderly people whose hips are fractured, there is a high rate of postoperative mortality and medical problems. For this reason preoperative evaluation of hip fractured patients must be well recognized. There are so many "risk evaluation schedules" present in ...

  18. The risk factors that effect the prognosis in fractures of the hip

    OpenAIRE

    Ozturk, Irfan

    2004-01-01

    There is still some controversy and problems about the treatment of hip fractures in elderly people. In addition to success of surgical technique, low postoperative morbidity and mortality rates also have to be the aim of the therapy. In elderly people whose hips are fractured, there is a high rate of postoperative mortality and medical problems. For this reason preoperative evaluation of hip fractured patients must be well recognized. There are so many "risk evaluation schedules" p...

  19. Epidemiology of Pelvic Fractures in Germany: Considerably High Incidence Rates among Older People.

    Science.gov (United States)

    Andrich, Silke; Haastert, Burkhard; Neuhaus, Elke; Neidert, Kathrin; Arend, Werner; Ohmann, Christian; Grebe, Jürgen; Vogt, Andreas; Jungbluth, Pascal; Rösler, Grit; Windolf, Joachim; Icks, Andrea

    2015-01-01

    Epidemiological data about pelvic fractures are limited. Until today, most studies only analyzed inpatient data. The purpose of this study was to estimate incidence rates of pelvic fractures in the German population aged 60 years or older, based on outpatient and inpatient data. We conducted a retrospective population-based observational study based on routine data from a large health insurance company in Germany. Age and sex-specific incidence rates of first fractures between 2008 and 2011 were calculated. We also standardized incidence rates with respect to age and sex in the German population. Multiple Poisson regression models were used to evaluate the association between the risk of first pelvic fracture as outcome and sex, age, calendar year and region as independent variables. The total number of patients with a first pelvic fracture corresponded to 8,041 and during the study period 5,978 insured persons needed inpatient treatment. Overall, the standardized incidence rate of all first pelvic fractures was 22.4 [95% CI 22.0-22.9] per 10,000 person-years, and the standardized incidence rate of inpatient treated fractures 16.5 [16.1-16.9]. Our adjusted regression analysis confirmed a significant sex (RR 2.38 [2.23-2.55], p year (higher risk in later years compared to 2008, p = 0.0162) and first fracture risk and a further significant association with region (RR 0.92 [0.87-0.98], p = 0.006, Westfalen-Lippe as reference). The observed incidences are considerably higher than incidences described in the international literature, even if only inpatient treated pelvic fractures are regarded. Besides which, non-inclusion of outpatient data means that a relevant proportion of pelvic fractures are not taken into account. Prevention of low energy trauma among older people remains an important issue.

  20. 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....

  1. 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.

  2. Fracture risk in hepatitis C virus infected persons

    DEFF Research Database (Denmark)

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

    2014-01-01

    -energy fracture was 1.20 (95% CI: 0.99-1.44). CONCLUSIONS: HCV-exposed patients had increased risk of all fracture types. In contrast, overall risk of fracture did not differ between patients with chronic vs. cleared HCV-infection, although chronic HCV-infection might be associated with a small excess risk of low......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...

  3. Risk Factors for Hip Fracture in Older Men: The Osteoporotic Fractures in Men Study (MrOS).

    Science.gov (United States)

    Cauley, Jane A; Cawthon, Peggy M; Peters, Katherine E; Cummings, Steven R; Ensrud, Kristine E; Bauer, Douglas C; Taylor, Brent C; Shikany, James M; Hoffman, Andrew R; Lane, Nancy E; Kado, Deborah M; Stefanick, Marcia L; Orwoll, Eric S

    2016-10-01

    Almost 30% of hip fractures occur in men; the mortality, morbidity, and loss of independence after hip fractures are greater in men than in women. To comprehensively evaluate risk factors for hip fracture in older men, we performed a prospective study of 5994 men, primarily white, age 65+ years recruited at six US clinical centers. During a mean of 8.6 years of 97% complete follow-up, 178 men experienced incident hip fractures. Information on risk factors including femoral neck bone mineral density (FNBMD) was obtained at the baseline visit. Cox proportional hazards models were used to calculate the hazard ratio (HR) with 95% confidence intervals; Fine and Gray models adjusted for competing mortality risk. Older age (≥75 years), low FNBMD, currently smoking, greater height and height loss since age 25 years, history of fracture, use of tricyclic antidepressants, history of myocardial infarction or angina, hyperthyroidism or Parkinson's disease, lower protein intake, and lower executive function were all associated with an increased hip fracture risk. Further adjustment for competing mortality attenuated HR for smoking, hyperthyroidism, and Parkinson's disease. The incidence rate of hip fracture per 1000 person-years (PY) was greatest in men with FNBMD T-scores hip fracture at rates of 14.52 versus 0.88 per 1000 PY in men age hip fracture. Many of these assessments can easily be incorporated into routine clinical practice and may lead to improved risk stratification. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and Mineral Research.

  4. 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.

  5. Cement-based composites: Strain rate effects on fracture

    Energy Technology Data Exchange (ETDEWEB)

    Mindess, S.; Shah, S.P.

    1986-01-01

    This book contains over 20 selections. Some of the titles are: Continuum damage mechanics studies on the dynamic fracture of concrete; Dynamic compressive strength of cementitious materials; Rate-sensitivity of mode I and mode II fracture concrete; and An impact damage model of concrete.

  6. Inflammatory Markers and the Risk of Hip and Vertebral Fractures in Men: the Osteoporotic Fractures in Men (MrOS).

    Science.gov (United States)

    Cauley, Jane A; Barbour, Kamil E; Harrison, Stephanie L; Cloonan, Yona K; Danielson, Michelle E; Ensrud, Kristine E; Fink, Howard A; Orwoll, Eric S; Boudreau, Robert

    2016-12-01

    Cytokines play major roles in regulating bone remodeling, but their relationship to incident fractures in older men is uncertain. We tested the hypothesis that men with higher concentrations of pro-inflammatory markers have a higher risk of fracture. We used a case-cohort design and measured inflammatory markers in a random sample of 961 men and in men with incident fractures including 120 clinical vertebral, 117 hip, and 577 non-spine fractures; average follow-up 6.13 years (7.88 years for vertebral fractures). We measured interleukin (IL)-6, C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), soluble receptors (SR) of IL-6 (IL-6SR) and TNF (TNFαSR1 and TNFαSR2), and IL-10. The risk of non-spine, hip, and clinical vertebral fracture was compared across quartiles (Q) of inflammatory markers using Cox proportional hazard models with tests for linear trend. In multivariable-adjusted models, men with the highest (Q4) TNFa cytokine concentrations and their receptors had a 2.0-4.2-fold higher risk of hip and clinical vertebral fracture than men with the lowest (Q1). Results were similar for all non-spine fractures, but associations were smaller. There was no association between CRP and IL-6SR and fracture. Men in the highest Q of IL-10 had a 49% lower risk of vertebral fracture compared with men in Q1. Among men with ≥3 inflammatory markers in the highest Q, the hazard ratio (HR) for hip fractures was 2.03 (95% confidence interval [CI] 1.11-3.71) and for vertebral fracture 3.06 (1.66-5.63). The HRs for hip fracture were attenuated by 27%, 27%, and 15%, respectively, after adjusting for appendicular lean mass (ALM), disability, and bone density, suggesting mediating roles. ALM also attenuated the HR for vertebral fractures by 10%. There was no association between inflammation and rate of hip BMD loss. We conclude that inflammation may play an important role in the etiology of fractures in older men. © 2016 American Society for Bone and Mineral Research.

  7. Potential impact of benzodiazepine use on the rate of hip fractures in Denmark (DK), the Netherlands (NL) and Norway (NO)

    NARCIS (Netherlands)

    Khong, Phuong T.; De Vries, Frank; Goldenberg, Jennifer S.B.; Klungel, Olaf H.; Petri, Hans

    2011-01-01

    Background: Benzodiazepines can increase the risk of falls and have therefore often been associated with an increased risk of hip fractures. However, estimations of the potential impact of benzodiazepine use on the population rate of hip fractures are missing. Objectives: To estimate the possible po

  8. Validity of bone mineral density and WHO fracture risk assessment thresholds in hip fractures.

    Science.gov (United States)

    Shahla, Ahmad

    2011-09-01

    Hip fractures are common and serious consequence of osteoporosis. Bone mineral density (BMD) measurement and the World Health Organization (WHO) fracture risk assessment tool are considered to predict the hip osteoporotic fractures. In this study, their sensitivities in hip fracture cases are evaluated. BMD and WHO probability of fracture risk were determined in 71 hip fractures ≥ 50 years of old. Totally, 65% of patients had ≤-2.5 BMD T score. 81% of patients had above the upper interventional threshold of WHO fracture risk probability model. Sensitivities were low in 50-59 year age group with progression in older age groups. Results of BMD T score and fracture risk probabilities were not significant between men and women. There were 23% and 49% sensitivities of less than or equal to -2.5 T score in the 50-59 and 60-69 year age groups with a 31% sensitivity of greater than 3% probability of hip fracture risk in the 50-59 year age group, both of which were not valid for predicting hip fracture risk.

  9. 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.

  10. 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...

  11. Fracture risk following bariatric surgery: a population-based study.

    Science.gov (United States)

    Nakamura, K M; Haglind, E G C; Clowes, J A; Achenbach, S J; Atkinson, E J; Melton, L J; Kennel, K A

    2014-01-01

    The effects of bariatric surgery on skeletal health are poorly understood. We found that bariatric surgery patients are more prone to fracture when compared to the general population. While further studies of fracture risk in this population are needed, bone health should be discussed in bariatric surgery clinics. Bariatric surgery is an increasingly common treatment for medically complicated obesity. Adverse skeletal changes after bariatric surgery have been reported, but their clinical importance remains unknown. We hypothesized that bariatric surgery patients are at increased risk of fracture. We conducted a historical cohort study of fracture incidence among 258 Olmsted County, Minnesota, residents who underwent a first bariatric surgery in 1985-2004. Relative fracture risk was expressed as standardized incidence ratios (SIRs), while potential risk factors were evaluated by hazard ratios (HR) obtained from a time-to-fracture regression model. The mean (±SD) body mass index at bariatric surgery was 49.0 ± 8.4 kg/m(2), with an average age of 44 ± 10 years and 82% (212) females. Gastric bypass surgery was performed in 94% of cases. Median follow-up was 7.7 years (range, 6 days to 25 years), during which 79 subjects experienced 132 fractures. Relative risk for any fracture was increased 2.3-fold (95% confidence interval (CI), 1.8-2.8) and was elevated for a first fracture at the hip, spine, wrist, or humerus (SIR, 1.9; 95% CI, 1.1-2.9), as well as for a first fracture at any other site (SIR, 2.5; 95% CI, 2.0-3.2). Better preoperative activity status was associated with a lower age-adjusted risk (HR, 0.4; 95% CI, 0.2-0.8) while prior fracture history was not associated with postoperative fracture risk. Bariatric surgery, which is accompanied by substantial biochemical, hormonal, and mechanical changes, is associated with an increased risk of fracture.

  12. Genetic profiling and individualized assessment of fracture risk.

    Science.gov (United States)

    Nguyen, Tuan V; Eisman, John A

    2013-03-01

    Osteoporosis and its consequence of fragility fracture impose a considerable demand on health-care services because fracture is associated with a series of adverse events, including re-fracture and mortality. One of the major priorities in osteoporosis care is the development of predictive models to identify individuals at high risk of fracture for early intervention and management. Existing predictive models include clinical factors and anthropometric characteristics but have not considered genetic variants in the prediction. Genome-wide association studies conducted in the past decade have identified several genetic variants relevant to fracture risk. These genetic variants are common in frequency but have very modest effect sizes. A remaining challenge is to use these genetic data to individualize fracture risk assessment on the basis of an individual's genetic risk profile. Empirical and simulation studies have shown that the usefulness of a single genetic variant for fracture risk assessment is very limited, but a profile of 50 genetic variants, each with odds ratio ranging from 1.02 to 1.15, could improve the accuracy of fracture prediction beyond that obtained by use of existing clinical risk factors. Thus, genetic profiling when integrated with existing risk assessment models could inform a more accurate prediction of fracture risk in an individual.

  13. 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...

  14. Prenatal exposure to vitamin D from fortified margarine and risk of fractures in late childhood

    DEFF Research Database (Denmark)

    Händel, Mina Nicole; Frederiksen, Peder; Osmond, Clive

    2017-01-01

    availability in relation to fracture risk. The study did not provide evidence that prenatal exposure to extra vitamin D from a mandatory fortification programme of 1·25 µg vitamin D/100 g margarine was sufficient to influence the risk of fractures in late childhood, regardless of season of birth. Replication......Prenatal low vitamin D may have consequences for bone health. By means of a nationwide mandatory vitamin D fortification programme, we examined the risk of fractures among 10-18-year-old children from proximate birth cohorts born around the date of the termination of the programme. For all subjects...... in fracture rates across birth cohorts was analysed by fitting an age-cohort model to the data. We addressed the potential modification of the effect of vitamin D availability by season of birth. The risk of fractures was increased among both girls and boys who were born before the vitamin D fortification...

  15. Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009

    Directory of Open Access Journals (Sweden)

    Ray Marks

    2009-12-01

    Full Text Available Ray MarksCity University of New York and Columbia University, New York, NY, USAAbstract: Hip fractures – which commonly lead to premature death, high rates of morbidity, or reduced life quality – have been the target of a voluminous amount of research for many years. But has the lifetime risk of incurring a hip fracture decreased sufficiently over the last decade or are high numbers of incident cases continuing to prevail, despite a large body of knowledge and a variety of contemporary preventive and refined surgical approaches? This review examines the extensive hip fracture literature published in the English language between 1980 and 2009 concerning hip fracture prevalence trends, and injury mechanisms. It also highlights the contemporary data concerning the personal and economic impact of the injury, plus potentially remediable risk factors underpinning the injury and ensuing disability. The goal was to examine if there is a continuing need to elucidate upon intervention points that might minimize the risk of incurring a hip fracture and its attendant consequences. Based on this information, it appears hip fractures remain a serious global health issue, despite some declines in the incidence rate of hip fractures among some women. Research also shows widespread regional, ethnic and diagnostic variations in hip fracture incidence trends. Key determinants of hip fractures include age, osteoporosis, and falls, but some determinants such as socioeconomic status, have not been well explored. It is concluded that while more research is needed, well-designed primary, secondary, and tertiary preventive efforts applied in both affluent as well as developing countries are desirable to reduce the present and future burden associated with hip fracture injuries. In this context, and in recognition of the considerable variation in manifestation and distribution, as well as risk factors underpinning hip fractures, well-crafted comprehensive, rather

  16. Vertebral fracture risk (VFR) score for fracture prediction in postmenopausal Women

    DEFF Research Database (Denmark)

    Lillholm, Martin; Ghosh, A.; Pettersen, P. C.

    2011-01-01

    Early prognosis of osteoporosis risk is not only important to individual patients but is also a key factor when screening for osteoporosis drug trial populations. We present an osteoporosis fracture risk score based on vertebral heights. The score separated individuals who sustained fractures (by...

  17. 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.

  18. High hip fracture risk in men with severe aortic calcification: MrOS study.

    Science.gov (United States)

    Szulc, Pawel; Blackwell, Terri; Schousboe, John T; Bauer, Douglas C; Cawthon, Peggy; Lane, Nancy E; Cummings, Steven R; Orwoll, Eric S; Black, Dennis M; Ensrud, Kristine E

    2014-04-01

    A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data for men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of nonspine fracture in 5994 men aged ≥ 65 years. AAC was assessed on 5400 baseline lateral thoracolumbar radiographs using a validated visual semiquantitative score. Total hip bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Incident nonspine fractures were centrally adjudicated. After adjustment for age, body mass index (BMI), total hip BMD, fall history, prior fracture, smoking status, comorbidities, race, and clinical center, the risk of nonspine fracture (n=805) was increased among men with higher AAC (hazard ratio [HR] quartile 4 [Q4] [AAC score ≥ 9] versus quartile 1 [Q1] [0-1], 1.36; 96% confidence interval [CI], 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 versus Q1, 2.33; 95% CI, 1.41-3.87). By contrast, the association between AAC and the risk of nonspine, nonhip fracture was weaker and not significant (HR Q4 versus Q1, 1.22; 95% CI, 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index, or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other nonspine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.

  19. High hip fracture risk in men with severe aortic calcification - MrOS study

    Science.gov (United States)

    Szulc, Pawel; Blackwell, Terri; Schousboe, John T.; Bauer, Douglas C.; Cawthon, Peggy; Lane, Nancy E.; Cummings, Steven R.; Orwoll, Eric S.; Black, Dennis M.; Ensrud, Kristine E.

    2013-01-01

    A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data in men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of non-spine fracture in 5994 men aged ≥65 years. AAC wasassessed on 5400 baseline lateral thoraco-lumbar radiographs using a validated visual semi-quantitative score. Total hip bone mineral density (BMD) was measured using dual energy X-ray absorptiometry. Incident non-spine fractures were centrally adjudicated. After adjustment for age, BMI, total hip BMD, fall history, prior fracture, smoking status, co-morbidities, race and clinical center, the risk of non-spine fracture (n=805) was increased among men with higher AAC (HR Q4 (AAC score ≥9) vs Q1 (0-1): 1.36, 96%CI: 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 vs Q1: 2.33, 95%CI: 1.41-3.87). By contrast, the association between AAC and the risk of non-spine-non-hip fracture was weaker and not significant (HR Q4 vs Q1: 1.22, 95%CI: 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other non-spine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture. PMID:23983224

  20. 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.

  1. Reprint of: The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide.

    Science.gov (United States)

    Curtis, Elizabeth M; Moon, Rebecca J; Harvey, Nicholas C; Cooper, Cyrus

    2017-08-01

    Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus. Substantial geographic variation has been noted in the incidence of osteoporotic fractures worldwide, with Western populations (North America, Europe and Oceania), reporting increases in hip fracture throughout the second half of the 20th century, with a stabilisation or decline in the last two decades. In developing populations however, particularly in Asia, the rates of osteoporotic fracture appears to be increasing. The massive global burden consequent to osteoporosis means that fracture risk assessment should be a high priority amongst health measures considered by policy makers. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above threshold for osteoporosis diagnosis. A number of web-based tools to enable the inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms have been developed to improve the identification of individuals at high fracture risk, the most commonly used globally being FRAX(®). Access to DXA, osteoporosis risk assessment, case finding and treatment varies worldwide, but despite such advances studies indicate that a minority of men and women at high fracture risk receive treatment. Importantly, research is ongoing to demonstrate the clinical efficacy and cost-effectiveness of osteoporosis case finding and risk assessment strategies worldwide. The huge burden caused by osteoporosis related fractures to individuals, healthcare systems and societies should provide a clear impetus for the progression of such

  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. Gout increases risk of fracture: A nationwide population-based cohort study.

    Science.gov (United States)

    Tzeng, Huey-En; Lin, Che-Chen; Wang, I-Kuan; Huang, Po-Hao; Tsai, Chun-Hao

    2016-08-01

    There is still debate on whether high uric acid increases bone mineral density (BMD) against osteoporotic fracture or bone resorption caused by gout inflammation. This study aimed to evaluate whether gout offers a protective effect on bone health or not. We conducted a nationwide population-based retrospective cohort study to evaluate the association between gout history and risk factors of fracture.A retrospective cohort study was designed using the claim data from Longitudinal Health Insurance Database (LHID). A total of 43,647 subjects with gout and a cohort of 87,294 comparison subjects without gout were matched in terms of age and sex between 2001 and 2009, and the data were followed until December 31, 2011. The primary outcome of the study was the fracture incidence, and the impacts of gout on fracture risks were analyzed using the Cox proportional hazards model.After an 11-year follow-up period, 6992 and 11,412 incidents of fracture were reported in gout and comparison cohorts, respectively. The overall incidence rate of fracture in individuals with gout was nearly 23%, which was higher than that in individuals without gout (252 vs 205 per 10,000 person-years) at an adjusted hazard ratio of 1.17 (95% confidence interval = 1.14-1.21). Age, sex, and fracture-associated comorbidities were adjusted accordingly. As for fracture locations, patients with gout were found at significant higher fracture risks for upper/lower limbs and spine fractures. In gout patient, the user of allopurinol or benzbromarone has significantly lower risk of facture than nonusers.Gout history is considered as a risk factor for fractures, particularly in female individuals and fracture sites located at the spine or upper/lower limbs.

  4. Constant rate solutions for a fractured well with an asymmetric fracture

    Energy Technology Data Exchange (ETDEWEB)

    Berumen, S.; Rodriguez, F. [PEMEX E and P and UNAM, Ciudad Universitaria, Postal 70-256, 04510 Coyoacan (Mexico); Tiab, D. [School of Petroleum and Geological Engineering, The University of Oklahoma, 100 East Boyd Street, T301 SEC Norman, OK (United States)

    2000-01-01

    This paper presents solutions for the pressure response on hydraulically fractured wells flowing at constant flow rate through an asymmetric vertical fracture. The pressure behavior of wells intercepting asymmetric fractures of both infinite and finite conductivity was investigated by solving numerically and analytically the mathematical model. The new solutions developed for the dimensionless wellbore pressure under production at constant flow rate are presented in terms of an asymmetry factor {xi}. New curves for these systems were generated and the deviation from the classical solution was readily detected. Some qualitative criteria to interpret the intensity of this effect are provided. Results of our investigation indicated that at early times for fractures of moderate conductivity (C{sub D}<5) the characteristic slope of one fourth is present, except for cases of strong asymmetry (0.85<{xi}{<=}1) where no evidence of straight line having one fourth slope was observed. However, it was also detected that at intermediate fracture conductivities (5fracture characterization of fractured wells.

  5. Reduced fracture risk in users of thiazide diuretics.

    Science.gov (United States)

    Rejnmark, L; Vestergaard, P; Mosekilde, L

    2005-03-01

    Thiazide diuretics (TD) reduce renal calcium excretion and may increase bone mineral density. A reduced fracture risk has been reported in some but not all studies. The aim of this study was to assess fracture risk in users of TD. The study design was nationwide population-based pharmacoepidemiological case-control study with fracture in year 2000 as outcome and use of TD during the previous 5 years as the exposure variable. Individual use of TD was derived from the Danish National Pharmacological Database and related to fracture data from the National Hospital Discharge Register. These data were combined with information on use of other drugs, social status, working status, income, educational status, contacts with general practitioners and practicing specialists, and comorbidity. A total of 64,699 patients (age = 40 years) who sustained a fracture during the year 2000 were compared to 194,111 age- and gender-matched controls. After adjustment for potential confounders, current use of TD was associated with a 10% (95% confidence interval [CI], 7% to 12%) reduced risk of any fracture and a 17% (95% CI 11% to 23%) reduced risk of forearm fractures. In former TD users, the risk reduction was slightly less pronounced. Similar results were found in men and women, and in subjects younger or > or = 65 years of age. Dose-effect analysis revealed a decreased risk of any fracture and fractures at the forearm and hip with an increased number of redeemed defined daily dosages (DDDs) of TD. Therefore, use of more than 2000 DDD was associated with a 19% (95% CI 10% to 27%) decreased hip fracture risk. We conclude that use of TD is associated with a significantly reduced fracture risk.

  6. Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael

    2006-01-01

    Society of Anaesthesiologists score, New Mobility Score, time to surgery and type of implant, surgery by unsupervised junior registrars was still a significant independent risk factor for re-operation in technically demanding proximal femoral fractures. CONCLUSION: Unsupervised junior registrars should......OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal...... rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding. RESULTS: Unsupervised junior...

  7. Infection Rates in Open Fractures of the Tibia: Is the 6-Hour Rule Fact or Fiction?

    Directory of Open Access Journals (Sweden)

    Ameya S. Kamat

    2011-01-01

    Full Text Available Aims. Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. The timing of operative debridement can be debated. We review open fractures of the tibia and compare infection rates in those that were operated on within and after 6-hours. Method. 103 consecutive open fractures of the tibia were reviewed. The data was analysed retrospectively with regard to severity of fracture and incidence of infection. Infection rates over a three-month period were compared between the two groups. Results. 12 (11.6% patients developed an infection within the first 3 months of injury. 7 of which were taken to theatre within 6-hours, and 5 after 6-hours. No significant differences were found between these two groups. Conclusion. There is no significant difference in timing of surgery. Initial basic interventions may play more of a role in limiting the risk of infection.

  8. Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael

    2006-01-01

    Society of Anaesthesiologists score, New Mobility Score, time to surgery and type of implant, surgery by unsupervised junior registrars was still a significant independent risk factor for re-operation in technically demanding proximal femoral fractures. CONCLUSION: Unsupervised junior registrars should......OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal...... rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding. RESULTS: Unsupervised junior...

  9. Fast rate fracture of aluminum using high intensity lasers

    Science.gov (United States)

    Dalton, Douglas Allen

    Laser induced shock experiments were performed to study the dynamics of various solid state material processes, including shock-induced melt, fast rate fracture, and elastic to plastic response. Fast rate fracture and dynamic yielding are greatly influenced by microstructural features such as grain boundaries, impurity particles and alloying atoms. Fast fracture experiments using lasers are aimed at studying how material microstructure affects the tensile fracture characteristics at strain rates above 106 s-1. We used the Z-Beamlet Laser at Sandia National Laboratories to drive shocks via ablation and we measured the maximum tensile stress of aluminum targets with various microstructures. Using a velocity interferometer and sample recovery, we are able to measure the maximum tensile stress and determine the source of fracture initiation in these targets. We have explored the role that grain size, impurity particles and alloying in aluminum play in dynamic yielding and spall fracture at tensile strain rates of ˜3x106 s-1. Preliminary results and analysis indicated that material grain size plays a vital role in the fracture morphology and spall strength results. In a study with single crystal aluminum specimens, velocity measurements and fracture analysis revealed that a smaller amplitude tensile stress was initiated by impurity particles; however, these particles served no purpose in dynamic yielding. An aluminum-magnesium alloy with various grain sizes presented the lowest spall strength, but the greatest dynamic yield strength. Fracture mode in this alloy was initiated by both grain boundaries and impurity particles. With respect to dynamic yielding, alloying elements such as magnesium serve to decrease the onset of plastic response. The fracture stress and yield stress showed no evidence of grain size dependence. Hydrodynamic simulations with material strength models are used to compare with our experiments. In order to study the strain rate dependence of spall

  10. Neonatal clavicle fracture in cesarean delivery: incidence and risk factors.

    Science.gov (United States)

    Choi, Hyun Ah; Lee, Yeon Kyung; Ko, Sun Young; Shin, Son Moon

    2017-07-01

    Neonatal clavicle fracture in cesarean delivery is rare and has not been extensively studied. We performed a retrospective review of cesarean deliveries with neonatal clavicle fracture during a 12-year period. Maternal and neonatal factors as well as surgical factors related to cesarean delivery for the fracture were determined and compared to the control group to analyze their significance. Among a total 89 367 deliveries during the study period, 36 286 babies were born via cesarean section. Nineteen cases of clavicle fractures in cesarean section were identified (0.05% of total live births via cesarean section). In the analysis of maternal and neonatal risk factors, birthweight, birthweight ≥ 4000  g and maternal age were significantly associated with clavicle fracture in cesarean section. However, clavicle fractures were not correlated with the selected surgical factors such as indication for cesarean section, skin incision to delivery time and incision type of skin and uterus. Logistic regression analysis showed that birthweight was the major risk factor for clavicle fracture. Clavicle fractures complicated 0.05% of cesarean deliveries. The main risk factor related to a clavicle fracture in cesarean section was the birthweight of an infant. As reported in previous studies associated with vaginal delivery, clavicle fracture is considered to be an unavoidable event and may not be eliminated, even in cesarean delivery.

  11. Delivery by Cesarean Section is not Associated With Decreased at-Birth Fracture Rates in Osteogenesis Imperfecta

    Science.gov (United States)

    Bellur, S; Jain, M; Cuthbertson, D; Krakow, D; Shapiro, JR; Steiner, RD; Smith, PA; Bober, MB; Hart, T; Krischer, J; Mullins, M; Byers, PH; Pepin, M; Durigova, M; Glorieux, FH; Rauch, F; Sutton, VR; Lee, B; Nagamani, SC

    2015-01-01

    Purpose Osteogenesis imperfecta (OI) predisposes to recurrent fractures. The moderate-to-severe forms of OI present with antenatal fractures and the mode of delivery that would be safest for the fetus is not known. Methods We conducted systematic analyses on the largest cohort of individuals (n=540) with OI enrolled to-date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared in individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates including method of delivery on fracture-related outcomes. Results When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean section (CS). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CS for delivery. Conclusion Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI shows that delivery by CS is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CS should be performed only for other maternal or fetal indications, but not for the sole purpose of fracture prevention in OI. PMID:26426884

  12. 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...

  13. Evaluating and mitigating fracture risk in established rheumatoid arthritis.

    Science.gov (United States)

    Mullen, Matthew B; Saag, Kenneth G

    2015-01-01

    Patients with rheumatoid arthritis are predisposed to systemic bone loss, and they are at an increased risk of fractures. Although there are similarities in the patient demographics between rheumatoid arthritis patients and the general population of osteoporosis patients, there are factors, particularly the use of glucocorticoids, which are specific to rheumatoid arthritis. These factors can lead to an increased risk of bone loss and fracture. Given that fractures are often very debilitating, especially in elderly patients, it is of paramount importance for the practicing rheumatologist to be aware of ways to reduce the risk of fracture in patients with rheumatoid arthritis. This review discusses currently available modalities for fracture risk assessment as well as pharmacologic and lifestyle interventions available to treat and prevent bone loss in rheumatoid arthritis patients.

  14. Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009

    Science.gov (United States)

    Marks, Ray

    2010-01-01

    Hip fractures – which commonly lead to premature death, high rates of morbidity, or reduced life quality – have been the target of a voluminous amount of research for many years. But has the lifetime risk of incurring a hip fracture decreased sufficiently over the last decade or are high numbers of incident cases continuing to prevail, despite a large body of knowledge and a variety of contemporary preventive and refined surgical approaches? This review examines the extensive hip fracture literature published in the English language between 1980 and 2009 concerning hip fracture prevalence trends, and injury mechanisms. It also highlights the contemporary data concerning the personal and economic impact of the injury, plus potentially remediable risk factors underpinning the injury and ensuing disability. The goal was to examine if there is a continuing need to elucidate upon intervention points that might minimize the risk of incurring a hip fracture and its attendant consequences. Based on this information, it appears hip fractures remain a serious global health issue, despite some declines in the incidence rate of hip fractures among some women. Research also shows widespread regional, ethnic and diagnostic variations in hip fracture incidence trends. Key determinants of hip fractures include age, osteoporosis, and falls, but some determinants such as socioeconomic status, have not been well explored. It is concluded that while more research is needed, well-designed primary, secondary, and tertiary preventive efforts applied in both affluent as well as developing countries are desirable to reduce the present and future burden associated with hip fracture injuries. In this context, and in recognition of the considerable variation in manifestation and distribution, as well as risk factors underpinning hip fractures, well-crafted comprehensive, rather than single solutions, are strongly indicated in early rather than late adulthood. PMID:20463818

  15. Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Lentle, B.C. [Univ. of British Columbia, Dept. of Radiology, Vancouver, British Columbia (Canada); Brown, J.P. [Laval Univ., Dept. of Medicine, Sainte-Foy, Quebec (Canada); Khan, A. [McMaster Univ., Dept. of Medicine, Hamilton, Ontario (Canada)]. E-mail: blentle@shaw.ca (and others)

    2007-02-15

    Given the increasing evidence that vertebral fractures are underdiagnosed and not acted on, Osteoporosis Canada and the Canadian Association of Radiologists initiated a project to develop and publish a set of recommendations to promote and facilitate the diagnosis and reporting of vertebral fractures. The identification of spinal fractures is not uniform. More than 65% of vertebral fractures cause no symptoms. It is also apparent that vertebral fractures are inadequately recognized when the opportunity for diagnosis arises fortuitously. It is to patients' benefit that radiologists report vertebral fractures evident on a chest or other radiograph, no matter how incidental to the immediate clinical indication for the examination. The present recommendations can help to close the gap in care in recognizing and treating vertebral fractures, to prevent future fractures and thus reduce the burden of osteoporosis-related morbidity and mortality, as well as fracture-related costs to the health care system. Several studies indicate that a gap exists in regard to the diagnosis of vertebral fractures and the clinical response following such diagnosis. All recommendations presented here are based on consensus. These recommendations were developed by a multidisciplinary working group under the auspices of the Scientific Advisory Council of Osteoporosis Canada and the Canadian Association of Radiologists. Prevalent vertebral fractures have important clinical implications in terms of future fracture risk. Recognizing and reporting fractures incidental to radiologic examinations done for other reasons has the potential to reduce health care costs by initiating further steps in osteoporosis diagnosis and appropriate therapy. Physicians should be aware of the importance of vertebral fracture diagnosis in assessing future osteoporotic fracture risk. Vertebral fractures incidental to radiologic examinations done for other reasons should be identified and reported. Vertebral

  16. Potential population impact of antidepressant use on hip fractures rate in Denmark (DK), Norway (NO) and the Netherlands (NL)

    NARCIS (Netherlands)

    Goldenberg, Jennifer S.B.; Petri, Hans; Khong, Phuong T.; Klungel, Olaf H.; De Vries, Frank

    2011-01-01

    Background: The use of antidepressants has been associated with an increased hip fracture risk in observational studies. However, the potential impact of antidepressant consumption on the population rate of hip fractures has not been estimated. Objectives: To evaluate the population impact of antide

  17. 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...

  18. Risk of nonvertebral fractures among elderly postmenopausal women using antidepressants.

    Science.gov (United States)

    Rabenda, Véronique; Bruyère, Olivier; Reginster, Jean-Yves

    2012-10-01

    To examine the association between antidepressants, including TCAs, SSRIs, and miscellaneous antidepressants and the risk of nonvertebral fractures among women with osteoporosis. This study was a post-hoc analysis of pooled data from two international, phase III, randomized, placebo-controlled, double-blind studies (the Spinal Osteoporosis Therapeutic Intervention [SOTI] and TReatment Of Peripheral OSteoporosis [TROPOS]). A nested case-control study was performed in the placebo treated population. Adjusted logistic regression models were used to estimate the risk of nonvertebral fracture associated with the use of antidepressants. After 3 years of follow-up, 391 nonvertebral fractures cases were identified and matched to 1955 controls. Compared with non-users of antidepressants, antidepressants use was associated with an increased risk of nonvertebral fractures (adjusted OR=1.64; 95%CI, 1.03-2.62]). Particularly, there was a 2-fold risk increase (95%CI, 1.07-3.79) of nonvertebral fracture for current users of SSRIs and a 2.1-fold risk increase for subjects who were current users of TCAs (95%CI, 1.02-4.30). Among patients categorized as recent or past users, none of the classes of antidepressants were statistically associated with increased risk of nonvertebral fracture. Our findings confirm that both SSRIs and TCAs increase the risk of nonvertebral fracture in current users. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Prevalent vertebral fractures on chest CT: higher risk for future hip fracture.

    Science.gov (United States)

    Buckens, Constantinus F; de Jong, Pim A; Mali, Willem P; Verhaar, Harald J; van der Graaf, Yolanda; Verkooijen, Helena M

    2014-02-01

    Subclinical or undiagnosed vertebral fractures on routine chest computed tomography (CT) may be useful for detecting patients at increased risk of future hip fractures who might benefit from preventive interventions. We investigated whether prevalent vertebral fractures on routine chest CT are associated with future hip fractures. From a source population of 5679 patients ≥40 years old undergoing chest CT in one of three Dutch hospitals between 2002 and 2005, patients hospitalized for hip fractures (n = 149) during a median follow-up of 4.4 years were identified. Following a case-cohort design, a random sample of 576 patients was drawn from the source population and added to the cases. In this group, the presence and severity of vertebral fractures was determined using semiquantitative vertebral fracture assessment and multivariate case-cohort appropriate Cox modeling. We found that cases were older (69 versus 63 years) and more often female (48% versus 38%) than the source population. Compared with those with no fracture, patients with any vertebral fracture had triple the risk of future hip fracture (age- and gender-adjusted hazard ratio [HR] = 3.1, 95% confidence interval [CI] 2.1-4.7). This HR rose to 3.8 (CI 2.6-5.6) if mild fractures were discounted. Future fracture risk increased significantly with increasing severity of vertebral fracture status: from mild (HR = 2.4, CI 1.5-3.7) and moderate (HR = 4.8, CI 2.5-9.2) to severe (HR = 6.7, CI 2.9-15.5). The same was true for having higher cumulative fracture grades: 1 to 3 (HR = 2.7, CI 1.8-4.1), 4 to 6 (HR = 4.8, CI 2.2-10.5), or ≥7 (HR = 11.2, CI 3.7-34.6). In conclusion, prevalent vertebral fractures on routine clinical chest CT are associated with future hip fracture risk. © 2014 American Society for Bone and Mineral Research.

  20. 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...

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

    Directory of Open Access Journals (Sweden)

    Bo eAbrahamsen

    2012-01-01

    Full Text Available Vitamin D status in pregnant women has been linked to childhood bone mineral density in their offspring but it is unclear if effects extend to fracture risk in adulthood or even old age. As vitamin D levels in the population show pronounced seasonal variation in Denmark, we performed 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 nine-year period between 1997-2005 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, but this was only statistically significant in the two oldest age groups (age 85-89 and 90-95. These findings suggest that vitamin D availability in the first and second trimester of intrauterine life could have a small but lasting impact on bone health and the risk of osteoporotic fractures

  2. Is warfarin usage a risk factor for osteoporotic fractures? A cohort study in the emergency department

    Directory of Open Access Journals (Sweden)

    Genady Drozdinsky

    2017-04-01

    Full Text Available Background Several studies have examined the association between warfarin sodium use and risk of osteoporotic fractures with conflicting results. Our study addresses this question, for the first time regarding patients attending emergency department (ED. Aims The aim of this study was to retrospectively detect whether there is higher rate of usage of warfarin sodium in patients with osteoporotic fractures attending an ED. Methods This is a retrospective study from patients' computerized charts. All individuals >65 years old who had an osteoporotic fracture and attended an ED in a tertiary hospital were compared with a similar group of elderly individuals >65 years old without an osteoporotic fracture who attended the ED for a cause other than an osteoporotic fracture. Results This study included 328 patients who were evaluated in the years 2005–2016. Overall, 164 individuals with a typical osteoporotic fracture (hip -66 patients (40 per cent, spine- 92 patients (56 per cent, humerus -4 patients (2 per cent, radius -13 patients (8 per cent were identified and compared with a matched group of elderly individuals who were evaluated in the ED for other complaints. Warfarin sodium was used in 61 individuals (19 per cent in the entire cohort, 34 in the fracture group and 27 in the non-fracture group (p=0.324. Conclusion In elderly patients, attending an ED, warfarin sodium use does not seem to be a risk factor for an osteoporotic fracture

  3. Surgical menopause and nonvertebral fracture risk among older US women.

    Science.gov (United States)

    Vesco, Kimberly K; Marshall, Lynn M; Nelson, Heidi D; Humphrey, Linda; Rizzo, Joanne; Pedula, Kathryn L; Cauley, Jane A; Ensrud, Kristine E; Hochberg, Marc C; Antoniucci, Diana; Hillier, Teresa A

    2012-05-01

    The aim of this study was to determine whether older postmenopausal women with a history of bilateral oophorectomy before natural menopause (surgical menopause) have a higher risk of nonvertebral postmenopausal fracture than women with natural menopause. We used 21 years of prospectively collected incident fracture data from the ongoing Study of Osteoporotic Fractures, a cohort study of community-dwelling women without previous bilateral hip fracture who were 65 years or older at enrollment, to determine the risk of hip, wrist, and any nonvertebral fracture. χ(2) and t tests were used to compare the two groups on important characteristics. Multivariable Cox proportional hazards regression models stratified by baseline oral estrogen use status were used to estimate the risk of fracture. Baseline characteristics differed significantly among the 6,616 women within the Study of Osteoporotic Fractures who underwent either surgical (1,157) or natural (5,459) menopause, including mean age at menopause (44.3 ± 7.4 vs 48.9 ± 4.9 y, P menopause, even among women who had never used oral estrogen (hip fracture: hazard ratio [HR], 0.87; 95% CI, 0.63-1.21; wrist fracture: HR, 1.10; 95% CI, 0.78-1.57; any nonvertebral fracture: HR, 1.11; 95% CI, 0.93-1.32). These data provide some reassurance that the long-term risk of nonvertebral fracture is not substantially increased for postmenopausal women who experienced premenopausal bilateral oophorectomy, compared with postmenopausal women with intact ovaries, even in the absence of postmenopausal estrogen therapy.

  4. Identification of risk factors for neurological deficits in patients with pelvic fractures

    DEFF Research Database (Denmark)

    Schmal, Hagen; Hauschild, Oliver; Culemann, Ulf

    2010-01-01

    , pelvic injury configuration, and treatment.In 223 patients (6.5%), neurological lesions were diagnosed on the day of discharge from the hospital. The degree of instability of the pelvic fracture correlated with occurrence of nerve lesions. Rate of neurological dysfunction increased from 1.5% in type...... A fractures to 14.4% in type C fractures (Pfractures, the roots L5 (18.3%) and S1 (15.6%) and isolated peripheral nerves (19.2%) were identified. Patients sustaining complex pelvic trauma (7.85%) suffered from significantly more neurological...... dysfunctions (33.5%) compared to patients without peripelvic organ or soft tissue injuries (Ptype A3 sacral fractures were not associated with a different risk to develop neurological deficits (3.8%), unstable sacral fractures with the need for operative fixation showed an increased rate...

  5. BONE MASS, RATES OF OSTEOPOROTIC FRACTURES, AND PREVENTION OF FRACTURES: ARE THERE DIFFERENCES BETWEEN CHINA AND WESTERN COUNTRIES?

    Institute of Scientific and Technical Information of China (English)

    葛秦生; StevenRCummings; 涂苓; 陈孝署; 赵熙和; 俞卫

    1994-01-01

    Fractures are one of the most common causes of disability in older women.The quantity and density of bone decrease with age.Most types of fractures increase as bone density declines.But most of the knowledge about causes and prevention of fractures comes from studies performed in Western countries.Asian women appear to have similar or slightly lower bone density that may be a result of their smaller size.The appear to have a lower risk of hip fracture than Whites.which may be a result of their shorter hip axis.The risks of other types of fractures in Chinese women is less well defined and reasons for differences in the rates of osteoporotic fractures between China and Western countries remain to be expolored.A study is underway in Beijing to describe the risks and potential causes of fractures among older women in urban China.Randomized trials in Western countries have demonstrated that calcium and vitamin D,estrogen,calcitonin,or bisphosphonates can reduce the rate of fractures.Increased intake of calcium and vitamin D may be the most effective approach to preventing fractures in China,but this should be tested be tested in a randomized trial.

  6. Oral bisphosphonates and risk of subtrochanteric or diaphyseal femur fractures in a population-based cohort.

    Science.gov (United States)

    Kim, Seo Young; Schneeweiss, Sebastian; Katz, Jeffrey N; Levin, Raisa; Solomon, Daniel H

    2011-05-01

    Bisphosphonates are the primary therapy for postmenopausal and glucocorticoid-induced osteoporosis. Case series suggest a potential link between prolonged use of bisphosphonates and low-energy fracture of subtrochanteric or diaphyseal femur as a consequence of oversuppression of bone resorption. Using health care utilization data, we conducted a propensity score-matched cohort study to examine the incidence rates (IRs) and risk of subtrochanteric or diaphyseal femur fractures among oral bisphosphonate users compared with raloxifene or calcitonin users. A Cox proportional hazards model evaluated the risk of these fractures associated with duration of osteoporosis treatment. A total of 104 subtrochanteric or diaphyseal femur fractures were observed among 33,815 patients. The estimated IR of subtrochanteric or diaphyseal femur fractures per 1000 person-years was 1.46 [95% confidence interval (CI) 1.11-1.88] among the bisphosphonate users and 1.43 (95% CI 1.06-1.89) among raloxifene/calcitonin users. No significant association between bisphosphonate use and subtrochanteric or diaphyseal femur fractures was found [hazard ratio (HR) = 1.03, 95% CI 0.70-1.52] compared with raloxifene/calcitonin. Even with this large study size, we had little precision in estimating the risk of subtrochanteric or diaphyseal femur fractures in patients treated with bisphosphonates for longer than 5 years (HR = 2.02, 95% CI 0.41-10.00). The occurrence of subtrochanteric or diaphyseal femur fracture was rare. There was no evidence of an increased risk of subtrochanteric or diaphyseal femur fractures in bisphosphonate users compared with raloxifene/calcitonin users. However, this study cannot exclude the possibility that long-term bisphosphonate use may increase the risk of these fractures.

  7. A comprehensive hip fracture program reduces complication rates and mortality

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Moltke, Finn Borgbjerg; Schousboe, B.

    2008-01-01

    OBJECTIVES: To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive Multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). DESIGN: Retrospective chart review...... with historical control. SETTING: Orthopedic ward (110 beds) at a university hospital (700 beds). PARTICIPANTS: Five hundred thirty-five consecutive patients aged 40 and older (94% >= 60) hospitalized for hip fracture between January 1, 2003, and March 3 1, 2004. Three hundred and thirty-six patients (70.3%) were...... tract infection (P mortality was 23% in the control group versus 12% in the intervention...

  8. The effect of loading rate on ductile fracture toughness and fracture surface roughness

    DEFF Research Database (Denmark)

    Osovski, S.; Srivastava, Akhilesh Kumar; Ponson, L.

    2015-01-01

    The variation of ductile crack growth resistance and fracture surface roughness with loading rate is modeled under mode I plane strain, small scale yielding conditions. Three-dimensional calculations are carried out using an elastic-viscoplastic constitutive relation for a progressively cavitatin...

  9. Management of interest rate risk

    Directory of Open Access Journals (Sweden)

    Šabović Šerif

    2014-01-01

    Full Text Available Interest rate risk is one of the biggest and most dangerous risks that a bank is exposed to. When a change of interest rates occurs, the incomes of a bank based on credits and securities endure significant changes. Banks resources also endure some changes. The change of interest rates changes the value of the assets and liabilities of the bank and it's net and investment worth . The change of interest rates also affects bank's balance sheet, income sheet statement and bank's share capital.

  10. Patients at increased fracture risk: identification and pharmacological treatment

    NARCIS (Netherlands)

    Klop, C.

    2016-01-01

    Fragility fractures are common and are associated with a substantial burden for patients and the healthcare system. Hip fractures in particular are associated with increased morbidity, institutionalisation, and even mortality with a mortality rate between 20-30% in the first year. This burden is inc

  11. 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.

  12. Risk factors for vertebral and nonvertebral fracture over 10 years: a population-based study in women.

    Science.gov (United States)

    Finigan, Judith; Greenfield, Diana M; Blumsohn, Aubrey; Hannon, Rosemary A; Peel, Nicola F; Jiang, Guirong; Eastell, Richard

    2008-01-01

    Risk factors may vary for different types of fracture, in particular for vertebral fractures. We followed 367 women >50 yr of age from a population-based cohort for up to 10 yr. Factors that predicted vertebral rather than nonvertebral fractures related to physical weakness, poor health, and weight loss. Similar factors were also associated with greater bone loss at the hip. Many risk factors predict fractures overall, but it is less clear whether certain factors relate to vertebral fractures in particular. The aim of this study was to compare the risk factors for vertebral and nonvertebral fractures. We carried out a 10-yr prospective population-based study of 375 women who were 50-85 yr of age initially. At baseline, we measured BMD, blood and urine biochemistry, and anthropometric measurements. Medical and lifestyle data were obtained by questionnaire. Incident vertebral fractures were determined for 311 subjects from spinal radiographs at 0, 2, 5, 7, and 10 yr using an algorithm-based qualitative method, and nonvertebral fractures were confirmed radiographically. Relative risks were calculated by Cox regression analysis. During follow-up, 70 subjects sustained one or more nonvertebral fractures and 29 sustained one or more vertebral fractures. Risk factors that predicted both types of fracture included increasing age, decreasing BMD at all sites, prevalent vertebral fracture, and shorter estrogen exposure. For nonvertebral fractures only, the risk factors included low urinary creatinine and less frequent use of stairs. The factors for vertebral fractures included lighter weight, reduced body fat, heavy smoking, lower serum calcium, albumin, and thyroid T(3), weak grip strength, and poor physical capability. In a multivariate model, weight, fat mass, serum calcium and T(3), prevalent vertebral fracture, and physical capability remained significant. Furthermore, grip strength, serum albumin, weight loss, and physical capability were associated with rate of bone

  13. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study.

    Science.gov (United States)

    Lu, Chia-Wen; Chang, Yu-Kang; Chang, Hao-Hsiang; Kuo, Chia-Sheng; Huang, Chi-Ting; Hsu, Chih-Cheng; Huang, Kuo-Chin

    2015-12-01

    Bariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02-1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01-2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99-2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse effects of bariatric

  14. 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.

  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

    The Fracture Risk Assessment Tool (FRAX) has been developed by the World Health Organization to evaluate the 10-year risk of a hip fracture and a major osteoporotic fracture. We examined the agreement between fracture risk calculated with and without femoral neck bone mineral density (BMD......) in individual patients and the impact of BMD measurement side. Bilateral femoral neck BMD results obtained by dual-energy X-ray absorptiometry and clinical risk factor data from 140 women (age 66 ± 8 years) with a recent distal forearm fracture were used for FRAX analyses. Discrepancies between pairs of risk...... 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...

  16. Effects of Canagliflozin on Fracture Risk in Patients With Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Watts, Nelson B; Bilezikian, John P; Usiskin, Keith; Edwards, Robert; Desai, Mehul; Law, Gordon; Meininger, Gary

    2016-01-01

    Canagliflozin is a sodium glucose cotransporter 2 inhibitor developed to treat type 2 diabetes mellitus (T2DM). The purpose of this study was to describe the effects of canagliflozin on bone fracture risk. This was a randomized phase 3 study in patients with T2DM. Canagliflozin doses of 100 and 300 mg were evaluated in the overall population of patients from 9 placebo- and active-controlled studies (N = 10 194), as well as in separate analyses of a single trial enriched with patients with a prior history/risk of cardiovascular disease (ie, the CANagliflozin cardioVascular Assessment Study [CANVAS]; N = 4327) and a pooled population of 8 non-CANVAS studies (N = 5867). The incidence of adjudicated fracture adverse events (AEs), fall-related AEs, and volume depletion-related AEs was assessed. The incidence of fractures was similar with canagliflozin (1.7%) and noncanagliflozin (1.5%) in the pooled non-CANVAS studies. In CANVAS, a significant increase in fractures was seen with canagliflozin (4.0%) vs placebo (2.6%) that was balanced between the upper and lower limbs. The incidence of fractures was higher with canagliflozin (2.7%) vs noncanagliflozin (1.9%) in the overall population, which was driven by the increase of fractures in CANVAS. The incidence of reported fall-related AEs was low, but significantly higher with canagliflozin in CANVAS, potentially related to volume depletion-related AEs, but not significantly different in the pooled non-CANVAS studies and the overall population. Fracture risk was increased with canagliflozin treatment, driven by CANVAS patients, who were older, with a prior history/risk of cardiovascular disease, and with lower baseline estimated glomerular filtration rate and higher baseline diuretic use. The increase in fractures may be mediated by falls; however, the cause of increased fracture risk with canagliflozin is unknown.

  17. Clinical fracture risk evaluated by hierarchical agglomerative clustering

    DEFF Research Database (Denmark)

    Kruse, Christian; Eiken, P; Vestergaard, P

    2017-01-01

    profiles. INTRODUCTION: The purposes of this study were to establish and quantify patient clusters of high, average and low fracture risk using an unsupervised machine learning algorithm. METHODS: Regional and national Danish patient data on dual-energy X-ray absorptiometry (DXA) scans, medication...... containing less than 250 subjects. Clusters were identified as high, average or low fracture risk based on bone mineral density (BMD) characteristics. Cluster-based descriptive statistics and relative Z-scores for variable means were computed. RESULTS: Ten thousand seven hundred seventy-five women were...... as low fracture risk with high to very high BMD. A mean age of 60 years was the earliest that allowed for separation of high-risk clusters. DXA scan results could identify high-risk subjects with different antiresorptive treatment compliance levels based on similarities and differences in lumbar spine...

  18. 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...

  19. The effect of loading rate on ductile fracture toughness and fracture surface roughness

    Science.gov (United States)

    Osovski, S.; Srivastava, A.; Ponson, L.; Bouchaud, E.; Tvergaard, V.; Ravi-Chandar, K.; Needleman, A.

    2015-03-01

    The variation of ductile crack growth resistance and fracture surface roughness with loading rate is modeled under mode I plane strain, small scale yielding conditions. Three-dimensional calculations are carried out using an elastic-viscoplastic constitutive relation for a progressively cavitating solid with two populations of void nucleating second phase particles. Larger inclusions that result in void nucleation at an early stage are modeled as discrete void nucleation sites while smaller particles that require large strains to nucleate voids are homogeneously distributed. The calculations are carried out for two values of density of the larger inclusions, 3.6% and 7.1%, and for prescribed loading rates K˙˙I ranging from 1 ×105 MPa√{ m }s-1 to 5 ×107 MPa√{ m }s-1. The ductile fracture mode is found to undergo a transition from one that can be regarded as growth of a dominant main crack at the lower loading rates to one dominated by damage nucleation and micro-cracking ahead of the main crack at the higher loading rates. The values of JIC, the tearing modulus, TR, the total plastic dissipation and the plastic dissipation in the fracture process region are all found to increase with increasing loading rate. However, the ratio of plastic dissipation in the fracture process region to total plastic dissipation decreases with increasing prescribed loading rate. The fracture surfaces are found to display two self-affine regimes, with a Hurst exponent β ≈ 0.60 at small length scales and with β ≈ 0.45 at larger length scales. The multi-fractal spectra indicate multi-affine behavior in most cases but a range of loading rates and length scales exhibiting mono-affine behavior is also found. Parameters characterizing the fracture surface statistics, including the length scale at which a transition from a power law tail to an exponential tail occurs, are related to the mode of crack growth/damage accumulation. A linear relation is found between the values of JIC

  20. Contralateral hip fractures and other osteoporosis-related fractures in hip fracture patients: Incidence and risk factors. An observational cohort study of 1,229 patients

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); B.L. Borger van der Burg (Boudewijn); M.L. Röling (Maarten); D.H.-J. van Leeuwen (Diederik); P. van den Berg (Peter); A.H.P. Niggebrugge (Arthur); M.R. de Vries (Mark); W.E. Tuinebreijer (Wim); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)

    2012-01-01

    textabstractPurpose: To report risk factors, 1-year and overall risk for a contralateral hip and other osteoporosis-related fractures in a hip fracture population. Methods: An observational study on 1,229 consecutive patients of 50 years and older, who sustained a hip fracture between January 2005

  1. Relating structural loading rate to tensing rate for fracture mechanics specimens

    NARCIS (Netherlands)

    Walters, C.L.; Przydatek, J.

    2014-01-01

    It is vely well-known that fracture toughness depends on loading rate. Higher strain rates can shift the ductile to brittle transition curve to higher temperatures, resulting in a more brittle structure at the same temperature. However, there is little effort to relate the testing rate to the

  2. Numerical Modeling of Variable Fluid Injection-Rate Modes on Fracturing Network Evolution in Naturally Fractured Formations

    Directory of Open Access Journals (Sweden)

    Yu Wang

    2016-05-01

    Full Text Available In this study, variable injection-rate technology was numerically investigated in a pre-existing discrete fracture network (DFN formation, the Tarim Basin in China. A flow-stress-damage (FSD coupling model has been used in an initial attempt towards how reservoir response to variable injection-rates at different hydraulic fracturing stages. The established numerical model simultaneously considered the macroscopic and microscopic heterogeneity characteristics. Eight numerical cases were studied. Four cases were used to study the variable injection-rate technology, and the other four cases were applied for a constant injection-rate in order to compare with the variable injection-rate technology. The simulation results show that the variable injection-rate technology is a potentially good method to a form complex fracturing networks. The hydraulic fracturing effectiveness when increasing the injection-rate at each stage is the best, also, the total injected fluid is at a minimum. At the initial stage, many under-fracturing points appear around the wellbore with a relatively low injection-rate; the sudden increase of injection rate drives the dynamic propagation of hydraulic fractures along many branching fracturing points. However, the case with decreasing injection rate is the worst. By comparing with constant injection-rate cases, the hydraulic fracturing effectiveness with variable flow rate technology is generally better than those with constant injection-rate technology. This work strongly links the production technology and hydraulic fracturing effectiveness evaluation and aids in the understanding and optimization of hydraulic fracturing simulations in naturally fractured reservoirs.

  3. Androgen deprivation therapy and fracture risk in Chinese patients with prostate carcinoma

    Science.gov (United States)

    Lee, Chi-Ho; Huang, Gang; Chan, Pak-Hei; Hai, Jojo; Yeung, Chun-Yip; Fong, Carol Ho-Yi; Woo, Yu-Cho; Ho, Kwan Lun; Yiu, Ming-Kwong; Leung, Frankie; Lau, Tak-Wing; Tse, Hung-Fat; Lam, Karen Siu-Ling; Siu, Chung-Wah

    2017-01-01

    Objective Androgen deprivation therapy (ADT) increases fracture risk in men with carcinoma of the prostate, but little is known about the fracture risk for different types of ADT. We studied the fracture risk amongst Chinese patients with carcinoma of the prostate prescribed different ADT regimens. Subjects and methods This was a single-centered observational study that involved 741 patients with carcinoma of the prostate from January 2001 to December 2011. Results After a median follow-up of 5 years, 71.7% of the study cohort received ADT and the incidence rate of fracture was 8.1%. Multivariable Cox regression analysis revealed that use of ADT was significantly associated with risk of incident fracture (Hazard Ratio [HR] 3.60; 95% Confidence Interval [95% CI] 1.41–9.23; p = 0.008), together with aged >75 years and type 2 diabetes. Compared with no ADT, all three types of ADT were independently associated with the risk of incident fracture: anti-androgen monotherapy (HR 4.47; 95% CI 1.47–13.7; p = 0.009), bilateral orchiectomy ± anti-androgens (HR 4.01; 95% CI 1.46–11.1; p = 0.007) and luteinizing hormone-releasing hormone agonists ± anti-androgens (HR 3.16; 95% CI 1.18–8.43; p = 0.022). However, there was no significant difference in the relative risks among the three types of ADT. Conclusions Fracture risk increases among all types of ADT. Clinicians should take into account the risk-benefit ratio when prescribing ADT, especially in elderly patients with type 2 diabetes. PMID:28158241

  4. 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.

  5. 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 (BMIfracture (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. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. 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.

  7. Risk Factors for Hip Fracture in Older Home Care Clients

    Science.gov (United States)

    Poss, Jeff; Cook, Richard J.; Byrne, Kerry; Hirdes, John P.

    2009-01-01

    Background Little information is available on hip fracture risks among community-dwelling persons receiving home care. Our aim was to identify risk factors for hip fracture from health information routinely collected for older home care clients. Methods This was a cohort study involving secondary analysis of data on 40,279 long-stay (>60 days) home care clients aged 65 and older in Ontario, Canada; occurrence of hip fracture as well as potential risk factor information were measured using the Resident Assessment Instrument (RAI)/Minimum Data Set–Home Care assessment instrument. Results In all, 1,003 clients (2.5%) had hip fracture on follow-up assessment. Older (85+ vs 65–74, relative risk [95% confidence interval]: 0.52 [0.43–0.64]) clients are at increased risk; males are at reduced risk [0.60 (0.51–0.70)]. Other risk factors include osteoporosis (1.19 [1.03–1.36]), falls (1.31 [1.15–1.49]), unsteady gait (1.18 [1.03–1.36]), use of ambulation aide (1.39 [1.21–1.59]), tobacco use (1.42, [1.13–1.80]), severe malnutrition (2.61 [1.67–4.08]), and cognitive impairment (1.30 [1.12–1.51]). Arthritis (0.86 [0.76–0.98]) and morbid obesity (0.34 [0.16–0.72]) were associated with reduced risk. Males and females demonstrated different risk profiles. Conclusions Important risk factors for hip fracture can be identified from routinely collected data; these could be used to identify at-risk clients for further investigation and prevention strategies [22]. PMID:19196903

  8. 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...

  9. 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....

  10. Schizophrenia, antipsychotics and risk of hip fracture

    DEFF Research Database (Denmark)

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

    2013-01-01

    -morbidity, antipsychotics (IRR=1.19; 95% CI 1.15-1.24), antidepressant (IRR=1.18; 95% CI 1.16-1.20), anticholinergics (IRR=1.29; 95% CI 1.22-1.36), benzodiazepines (IRR=1.06; 95% CI 1.04-1.08) and corticosteroids (IRR=1.44; 95% CI 1.36-1.53) were significant predictors. In 556 persons with schizophrenia and hip fracture...

  11. Does Biolox Delta ceramic reduce the rate of component fractures in total hip replacement?

    Science.gov (United States)

    Massin, P; Lopes, R; Masson, B; Mainard, D

    2014-10-01

    Biolox Delta ceramic has been optimized with nano-sized, yttria-stabilized tetragonal zirconium and strontium oxide to help limit cracking propagation. Although its mechanical properties are better than those of earlier generation ceramics, existing data on this material are limited, thus the goals of this study were to determine: 1) the remaining rate of implant fracture; 2) the ideal combination of head diameter and component position. Hypothesis. We hypothesized that the use of the ceramic composite Biolox Delta had reduced the risk of implant fracture. Materials and methods. The bibliographic search (in Pubmed database with the key words «ceramic fracture» and «total hip prosthesis ») identified 46 articles on fractures in third or fourth generation ceramic components, including 5 involving Biolox Delta. Manufacturer's data and ANSM (Agence nationale de sécurité du médicament et des produits de santé) (National Agency for Safety of Drugs and Medical Products) reports were compared with the few clinical cases published in the literature. Results. According to the manufacturer (CeramTec GmbH, Plochingen, Germany), the use of Biolox Delta ceramic has reduced the rate of femoral head fractures to 0.003% compared to 0.021% with alumina ceramic. The fracture rate of liners has remained stable, at approximately 0.03%. The number of ANSM reports confirmed these tendencies. The rate of head component fractures decreases as the head diameter increases. The quality of impaction on the morse taper (cleanliness of the taper, insertion along the axis) plays an important role. Although it is generally only available for cup sizes above 50mm, a 36-mm head diameter seems to be optimal because it prevents impingement between the cup rim and the neck of the stem, without increasing micro-separation with larger diameters. Conclusion. Although Biolox Delta ceramic is more resistant to fractures than alumina ceramic, it can be fractured under suboptimal implantation

  12. 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...... be greater in women who have not yet reached peak bone mass. Reduced participation in sports activities was probably not the reason for the reduced risk of fractures. This article is protected by copyright. All rights reserved....... 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...

  13. Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States.

    Science.gov (United States)

    Khong, T P; de Vries, F; Goldenberg, J S B; Klungel, O H; Robinson, N J; Ibáñez, Luisa; Petri, H

    2012-07-01

    Benzodiazepine use increases the risk of falls and has been associated with an increased risk of hip fractures. Our aim was to estimate the possible population impact of the use of benzodiazepines on the rate of hip fracture in France, Germany, Italy, Spain, the United Kingdom, and the United States. We conducted a literature review to estimate the pooled relative risk (RR) for hip fractures and use of benzodiazepines. Prevalence rates of benzodiazepine use in 2009 were calculated for each country using the IMS MIDAS database and three public databases in Denmark, the Netherlands, and Norway. Both the RR and prevalence rates were used for calculation of population attributable risks (PARs) of hip fractures associated with benzodiazepine use. The literature review showed an increased risk of hip fractures in benzodiazepine users (RR = 1.4, 95 % CI 1.2-1.6). Rate of benzodiazepine use showed considerable differences between countries, ranging from 4.7 % to 22.3 % of population ever in a 1-year period. These are reflected in results for the PARs; estimated attributions of benzodiazepines to the rate of hip fractures were 1.8 %, 95 % CI 1.1-2.6 (Germany); 2.0 %, 95 % CI 1.2-2.8 (United Kingdom); 5.2 %, 95 % CI 3.2-7.3 (Italy); 7.4 %, 95 % CI 4.5-10.0 (France); 8.0 %, 95 % CI 4.9-11.0 (United States); and 8.2 %, 95 % CI 5.1-12.0 (Spain). PAR estimates suggest that the potential attribution of benzodiazepine use on the population rate of hip fractures in the five specified European countries and the United States varies between 1.8 % and 8.2 %. During the next phase of the IMI-PROTECT study, a comparison with individual patient data will show whether this approach is valid.

  14. Multivariate injury risk criteria and injury probability scores for fractures to the distal radius.

    Science.gov (United States)

    Burkhart, Timothy A; Andrews, David M; Dunning, Cynthia E

    2013-03-15

    The purpose of this study was to develop a multivariate distal radius injury risk prediction model that incorporates dynamic loading variables in multiple directions, and interpret the distal radius failure data in order to establish injury probability thresholds. Repeated impacts with increasing intensity were applied to the distal third of eight human cadaveric radius specimens (mean (SD) age=61.9 (9.7)) until injury occurred. Crack (non-propagating damage) and fracture (specimen separated into at least two fragments) injury events were recorded. Best subsets analysis was performed to find the best multivariate injury risk model. Force-only risk models were also determined for comparison. Cumulative distribution functions were developed from the parameters of a Weibull analysis and the forces and risk scores (i.e., values calculated from the injury risk models) from 10% to 90% probability were calculated. According to the adjusted R(2), variance inflation factor and p-values, the model that best predicted the crack event included medial/lateral impulse, Fz load rate, impact velocity and the natural logarithm of Fz (Adj. R(2)=0.698), while the best predictive model of the fracture event included medial/lateral impulse, impact velocity and peak Fz (Adj. R(2)=0.845). The multivariate models predicted injury risk better than both the Fz-only crack (Adj. R(2)=0.551) and fracture (Adj. R(2)=0.293) models. Risk scores of 0.5 and 0.6 corresponded to 10% failure probability for the crack and fracture events, respectively. The inclusion of medial/lateral impulse and impact velocity in both crack and fracture models, and Fz load rate in the crack model, underscores the dynamic nature of these events. This study presents a method capable of developing a set of distal radius fracture prediction models that can be used in the assessment and development of distal radius injury prevention interventions.

  15. 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

  16. Risk Assessment in Fractured Clayey Tills - Which Modeling Tools?

    DEFF Research Database (Denmark)

    Chambon, Julie Claire Claudia; Bjerg, Poul Løgstrup; Binning, Philip John

    2012-01-01

    assessment is challenging and the inclusion of the relevant processes is difficult. Furthermore the lack of long-term monitoring data prevents from verifying the accuracy of the different conceptual models. Further investigations based on long-term data and numerical modeling are needed to accurately......The article presents different tools available for risk assessment in fractured clayey tills and their advantages and limitations are discussed. Because of the complex processes occurring during contaminant transport through fractured media, the development of simple practical tools for risk...

  17. 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

    . 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...

  18. 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...

  19. Inflammation, bone loss and fracture risk in spondyloarthritis

    Science.gov (United States)

    Briot, Karine; Roux, Christian

    2015-01-01

    Osteoporosis (ie, low bone mineral density) is common in ankylosing spondylitis, related to both systemic inflammation and decreased mobility. Vertebral fracture risk is increased; acute back pain in these patients is not always a flare-up of the disease, as it can be related to bone complications. Intervertebral disc fractures in the ankylosed spine are associated with severe neurological complications. As expected from pathophysiology, treatments effective against inflammation have a positive effect on bone, and prospective open studies have shown that tumour-necrosis-factor blockers can improve bone mineral density at the spine and the hip. There is so far no evidence of a decreased risk of fractures with such treatment. PMID:26509065

  20. Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia; Prieto-Alhambra, Daniel;

    2016-01-01

    and women aged 50-94 at the start of treatment, who had not previously taken alendronate, 1996-2007. INTERVENTIONS: Treatment with alendronate. MAIN OUTCOME MEASURES: Incident fracture of the subtrochanteric femur or femoral shaft (ST/FS) or the hip. Non-fracture controls from the cohort were matched...... to fracture cases by sex, year of birth, and year of initiation of alendronate treatment. Conditional logistic regression models were fitted to calculate odds ratios with and without adjustment for comorbidity and comedications. Sensitivity analyses investigated subsequent treatment with other drugs...... for osteoporosis. RESULTS: 1428 participants sustained a ST/FS (incidence rate 3.4/1000 person years, 95% confidence interval 3.2 to 3.6), and 6784 sustained a hip fracture (16.2/1000 person years, 15.8 to 16.6). The risk of ST/FS was lower with high adherence to treatment with alendronate (medication possession...

  1. Fracture Risk and Areal Bone Mineral Density in Adolescent Females with Anorexia Nervosa

    Science.gov (United States)

    Faje, Alexander T.; Fazeli, Pouneh K.; Miller, Karen K.; Katzman, Debra K.; Ebrahimi, Seda; Lee, Hang; Mendes, Nara; Snelgrove, Deirdre; Meenaghan, Erinne; Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Objective To (i) compare fracture prevalence in adolescent females with anorexia nervosa (AN) vs. normal-weight controls and (ii) examine whether reductions in areal bone mineral density (aBMD) predict fracture risk in females with AN. Methods 418 females (310 with active AN and 108 normal-weight controls) 12–22 years old were studied cross-sectionally. Lifetime fracture history was recorded by a physician during participant interviews. Body composition and aBMD measurements of the whole body, whole body less head, lumbar spine, and hip were assessed by dual-energy x-ray absorptiometry (DXA), and bone mineral apparent density (BMAD) was calculated for the lumbar spine. Results Participants with AN and normal-weight controls did not differ for chronological age, sexual maturity, or height. The lifetime prevalence of prior fracture was 59.8% higher in those with AN compared to controls (31.0 % versus 19.4 %, p = 0.02), and the fracture incidence rate peaked in our cohort after the diagnosis of AN. Lower aBMD and lumbar BMAD were not associated with a higher prevalence of fracture in the AN or control group on univariate or multivariate analyses. Compared to controls, fracture prevalence was significantly higher in the subgroup of girls with AN who had normal aBMD or only modest reductions of aBMD (Z-scores > −1 or −1.5). Discussion This is the first study to show that the risk of fracture during childhood and adolescence is significantly higher in patients with AN than in normal-weight controls. Fracture prevalence is increased in this cohort of subjects with AN even without significant reductions in aBMD. PMID:24430890

  2. Multi-hazard risk assessment applied to hydraulic fracturing operations

    Science.gov (United States)

    Garcia-Aristizabal, Alexander; Gasparini, Paolo; Russo, Raffaella; Capuano, Paolo

    2017-04-01

    Without exception, the exploitation of any energy resource produces impacts and intrinsically bears risks. Therefore, to make sound decisions about future energy resource exploitation, it is important to clearly understand the potential environmental impacts in the full life-cycle of an energy development project, distinguishing between the specific impacts intrinsically related to exploiting a given energy resource and those shared with the exploitation of other energy resources. Technological advances as directional drilling and hydraulic fracturing have led to a rapid expansion of unconventional resources (UR) exploration and exploitation; as a consequence, both public health and environmental concerns have risen. The main objective of a multi-hazard risk assessment applied to the development of UR is to assess the rate (or the likelihood) of occurrence of incidents and the relative potential impacts on surrounding environment, considering different hazards and their interactions. Such analyses have to be performed considering the different stages of development of a project; however, the discussion in this paper is mainly focused on the analysis applied to the hydraulic fracturing stage of a UR development project. The multi-hazard risk assessment applied to the development of UR poses a number of challenges, making of this one a particularly complex problem. First, a number of external hazards might be considered as potential triggering mechanisms. Such hazards can be either of natural origin or anthropogenic events caused by the same industrial activities. Second, failures might propagate through the industrial elements, leading to complex scenarios according to the layout of the industrial site. Third, there is a number of potential risk receptors, ranging from environmental elements (as the air, soil, surface water, or groundwater) to local communities and ecosystems. The multi-hazard risk approach for this problem is set by considering multiple hazards

  3. Sensitivity Analysis of the Bone Fracture Risk Model

    Science.gov (United States)

    Lewandowski, Beth; Myers, Jerry; Sibonga, Jean Diane

    2017-01-01

    Introduction: The probability of bone fracture during and after spaceflight is quantified to aid in mission planning, to determine required astronaut fitness standards and training requirements and to inform countermeasure research and design. Probability is quantified with a probabilistic modeling approach where distributions of model parameter values, instead of single deterministic values, capture the parameter variability within the astronaut population and fracture predictions are probability distributions with a mean value and an associated uncertainty. Because of this uncertainty, the model in its current state cannot discern an effect of countermeasures on fracture probability, for example between use and non-use of bisphosphonates or between spaceflight exercise performed with the Advanced Resistive Exercise Device (ARED) or on devices prior to installation of ARED on the International Space Station. This is thought to be due to the inability to measure key contributors to bone strength, for example, geometry and volumetric distributions of bone mass, with areal bone mineral density (BMD) measurement techniques. To further the applicability of model, we performed a parameter sensitivity study aimed at identifying those parameter uncertainties that most effect the model forecasts in order to determine what areas of the model needed enhancements for reducing uncertainty. Methods: The bone fracture risk model (BFxRM), originally published in (Nelson et al) is a probabilistic model that can assess the risk of astronaut bone fracture. This is accomplished by utilizing biomechanical models to assess the applied loads; utilizing models of spaceflight BMD loss in at-risk skeletal locations; quantifying bone strength through a relationship between areal BMD and bone failure load; and relating fracture risk index (FRI), the ratio of applied load to bone strength, to fracture probability. There are many factors associated with these calculations including

  4. The fracture risk assessment tool (FRAX® score in subclinical hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Polovina Snežana

    2015-01-01

    Full Text Available Background/Aim. The Fracture Risk Assessment Tool (FRAX® score is the 10-year estimated risk calculation tool for bone fracture that includes clinical data and hip bone mineral density measured by dual-energy x-ray absorptiometry (DXA. The aim of this cross-sectional study was to elucidate the ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and post-menopausal women with subclinical hyperthyroidism. Methods. The bone mineral density (by DXA, thyroid stimulating hormone (TSH level, free thyroxine (fT4 level, thyroid peroxidase antibodies (TPOAb titre, osteocalcin and beta-cross-laps were measured in 27 pre- and post-menopausal women with newly discovered subclinical hyperthyroidism [age 58.85 ± 7.83 years, body mass index (BMI 27.89 ± 3.46 kg/m2, menopause onset in 46.88 ± 10.21 years] and 51 matched euthyroid controls (age 59.69 ± 5.72 years, BMI 27.68 ± 4.66 kg/m2, menopause onset in 48.53 ± 4.58 years. The etiology of subclinical hyperthyroisims was autoimmune thyroid disease or toxic goiter. FRAX® score calculation was performed in both groups. Results. In the group with subclinical hyperthyroidism the main FRAX® score was significantly higher than in the controls (6.50 ± 1.58 vs 4.35 ± 1.56 respectively; p = 0.015. The FRAX® score for hip was also higher in the evaluated group than in the controls (1.33 ± 3.92 vs 0.50 ± 0.46 respectively; p = 0.022. There was no correlations between low TSH and fracture risk (p > 0.05. The ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and postmenopausal female subjects (p < 0.001 is presented by the area under the curve (AUC plotted via ROC analysis. The determined FRAX score cut-off value by this analysis was 6%, with estimated sensitivity and specificity of 95% and 75.9%, respectively. Conclusion. Pre- and postmenopausal women with subclinical hyperthyroidism have higher FRAX® scores and thus

  5. Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients.

    Science.gov (United States)

    Vochteloo, Anne J H; van Vliet-Koppert, Sabine T; Maier, Andrea B; Tuinebreijer, Wim E; Röling, Maarten L; de Vries, Mark R; Bloem, Rolf M; Nelissen, Rob G H H; Pilot, Peter

    2012-06-01

    Long-term place of residence after hip fracture is not often described in literature. The goal of this study was to identify risk factors, known at admission, for failure to return to the pre-fracture place of residence of hip fracture patients in the first year after a hip fracture. This is a prospective longitudinal study of 444 consecutive admissions of hip fracture patients aged ≥ 65 years. Place of residence prior to admission, at discharge, after 3 and 12 months was registered. Patients admitted from a nursing home (n = 49) were excluded from statistical analysis. Multivariable logistic regression analysis was performed, using age, gender, presence of a partner, ASA-score, dementia, anaemia at admission, type of fracture, pre-fracture level of mobility and level of activities of daily living (ADL) as possible risk factors. Two hundred eighty-nine patients lived in their own home, 31.8% returned at discharge, 72.9% at 3 months and 72.8% at 12 months. Age, absence of a partner, dementia, and a lower pre-fracture level of ADL or mobility were independent contributors to failure to return to their own home at discharge, 3 or 12 months. 106 patients lived in a residential home; 33.3% returned at discharge, 68.4% at 3 months and 64.4% at 12 months. Age was an independent contributor to failure to return to a residential home. Age, dementia and a lower pre-fracture level of ADL were the main significant risk factors for failure to return to the pre-fracture residence. As the 3- and 12-month return-rates were similar, 3-month follow-up might be used as an endpoint in future research.

  6. Probabilistic pipe fracture evaluations for leak-rate-detection applications

    Energy Technology Data Exchange (ETDEWEB)

    Rahman, S.; Ghadiali, N.; Paul, D.; Wilkowski, G. [Battelle, Columbus, OH (United States)

    1995-04-01

    Regulatory Guide 1.45, {open_quotes}Reactor Coolant Pressure Boundary Leakage Detection Systems,{close_quotes} was published by the U.S. Nuclear Regulatory Commission (NRC) in May 1973, and provides guidance on leak detection methods and system requirements for Light Water Reactors. Additionally, leak detection limits are specified in plant Technical Specifications and are different for Boiling Water Reactors (BWRs) and Pressurized Water Reactors (PWRs). These leak detection limits are also used in leak-before-break evaluations performed in accordance with Draft Standard Review Plan, Section 3.6.3, {open_quotes}Leak Before Break Evaluation Procedures{close_quotes} where a margin of 10 on the leak detection limit is used in determining the crack size considered in subsequent fracture analyses. This study was requested by the NRC to: (1) evaluate the conditional failure probability for BWR and PWR piping for pipes that were leaking at the allowable leak detection limit, and (2) evaluate the margin of 10 to determine if it was unnecessarily large. A probabilistic approach was undertaken to conduct fracture evaluations of circumferentially cracked pipes for leak-rate-detection applications. Sixteen nuclear piping systems in BWR and PWR plants were analyzed to evaluate conditional failure probability and effects of crack-morphology variability on the current margins used in leak rate detection for leak-before-break.

  7. Measurement of fracture properties of concrete at high strain rates

    Science.gov (United States)

    Rey-De-Pedraza, V.; Cendón, D. A.; Sánchez-Gálvez, V.; Gálvez, F.

    2017-01-01

    An analysis of the spalling technique of concrete bars using the modified Hopkinson bar was carried out. A new experimental configuration is proposed adding some variations to previous works. An increased length for concrete specimens was chosen and finite-element analysis was used for designing a conic projectile to obtain a suitable triangular impulse wave. The aim of this initial work is to establish an experimental framework which allows a simple and direct analysis of concrete subjected to high strain rates. The efforts and configuration of these primary tests, as well as the selected geometry and dimensions for the different elements, have been focused to achieve a simple way of identifying the fracture position and so the tensile strength of tested specimens. This dynamic tensile strength can be easily compared with previous values published in literature giving an idea of the accuracy of the method and technique proposed and the possibility to extend it in a near future to obtain other mechanical properties such as the fracture energy. The tests were instrumented with strain gauges, accelerometers and high-speed camera in order to validate the results by different ways. Results of the dynamic tensile strength of the tested concrete are presented. This article is part of the themed issue 'Experimental testing and modelling of brittle materials at high strain rates'.

  8. Measurement of fracture properties of concrete at high strain rates.

    Science.gov (United States)

    Rey-De-Pedraza, V; Cendón, D A; Sánchez-Gálvez, V; Gálvez, F

    2017-01-28

    An analysis of the spalling technique of concrete bars using the modified Hopkinson bar was carried out. A new experimental configuration is proposed adding some variations to previous works. An increased length for concrete specimens was chosen and finite-element analysis was used for designing a conic projectile to obtain a suitable triangular impulse wave. The aim of this initial work is to establish an experimental framework which allows a simple and direct analysis of concrete subjected to high strain rates. The efforts and configuration of these primary tests, as well as the selected geometry and dimensions for the different elements, have been focused to achieve a simple way of identifying the fracture position and so the tensile strength of tested specimens. This dynamic tensile strength can be easily compared with previous values published in literature giving an idea of the accuracy of the method and technique proposed and the possibility to extend it in a near future to obtain other mechanical properties such as the fracture energy. The tests were instrumented with strain gauges, accelerometers and high-speed camera in order to validate the results by different ways. Results of the dynamic tensile strength of the tested concrete are presented.This article is part of the themed issue 'Experimental testing and modelling of brittle materials at high strain rates'.

  9. 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.

  10. BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS).

    Science.gov (United States)

    Nielson, Carrie M; Marshall, Lynn M; Adams, Annette L; LeBlanc, Erin S; Cawthon, Peggy M; Ensrud, Kristine; Stefanick, Marcia L; Barrett-Connor, Elizabeth; Orwoll, Eric S

    2011-03-01

    Low body mass index (BMI) is a risk factor for fracture, but little is known about the association between high BMI and fracture risk. We evaluated the association between BMI and fracture in the Osteoporotic Fractures in Men Study (MrOS), a cohort of 5995 US men 65 years of age and older. Standardized measures included weight, height, and hip bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA); medical history; lifestyle; and physical performance. Only 6 men (0.1%) were underweight (<18.5 kg/m(2)); therefore, men in this category were excluded. Also, 27% of men had normal BMI (18.5 to 24.9 kg/m(2)), 52% were overweight (25 to 29.9 kg/m(2)), 18% were obese I (30 to 34.9 kg/m(2)), and 3% were obese II (35 to 39.9 kg/m(2)). Overall, nonspine fracture incidence was 16.1 per 1000 person-years, and hip fracture incidence was 3.1 per 1000 person-years. In age-, race-, and BMD-adjusted models, compared with normal weight, the hazard ratio (HR) for nonspine fracture was 1.04 [95% confidence interval (CI) 0.87-1.25] for overweight, 1.29 (95% CI 1.00-1.67) for obese I, and 1.94 (95% CI 1.25-3.02) for obese II. Associations were weaker and not statistically significant after adjustment for mobility limitations and walking pace (HR = 1.02, 95% CI 0.84-1.23, for overweight; HR = 1.12, 95% CI 0.86-1.46, for obese I, and HR = 1.44, 95% CI 0.90-2.28, for obese II). Obesity is common among older men, and when BMD is held constant, it is associated with an increased risk of fracture. This association is at least partially explained by worse physical function in obese men.

  11. Inflammatory markers and risk of hip fracture in older white women: the study of osteoporotic fractures.

    Science.gov (United States)

    Barbour, Kamil E; Lui, Li-Yung; Ensrud, Kristine E; Hillier, Teresa A; LeBlanc, Erin S; Ing, Steven W; Hochberg, Marc C; Cauley, Jane A

    2014-09-01

    Hip fractures are the most devastating consequence of osteoporosis and impact 1 in 6 white women leading to a two- to threefold increased mortality risk in the first year. Despite evidence of inflammatory markers in the pathogenesis of osteoporosis, few studies have examined their effect on hip fracture. To determine if high levels of inflammation increase hip fracture risk and to explore mediation pathways, a case-cohort design nested in a cohort of 4709 white women from the Study of Osteoporotic Fractures was used. A random sample of 1171 women was selected as the subcohort (mean age 80.1 ± 4.2 years) plus the first 300 women with incident hip fracture. Inflammatory markers interleukin-6 (IL-6) and soluble receptors (SR) for IL-6 (IL-6 SR) and tumor necrosis factor (TNF SR1 and TNF SR2) were measured, and participants were followed for a median (interquartile range) of 6.3 (3.7, 6.9) years. In multivariable models, the hazard ratio (HR) of hip fracture for women in the highest inflammatory marker level (quartile 4) was 1.64 (95% confidence interval [CI], 1.09-2.48, p trend = 0.03) for IL-6 and 2.05 (95% CI, 1.35-3.12, p trend hip fracture was 1.51 (95% CI, 1.07-2.14) and 1.42 (95% CI, 0.87-2.31) compared with women with zero to one marker(s) in the highest quartile (p trend = 0.03). After individually adjusting for seven potential mediators, cystatin-C (a biomarker of renal function) and bone mineral density (BMD) attenuated HRs among women with the highest inflammatory burden by 64% and 50%, respectively, suggesting a potential mediating role. Older white women with high inflammatory burden are at increased risk of hip fracture in part due to poor renal function and low BMD. © 2014 American Society for Bone and Mineral Research.

  12. 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

  13. Predicting fractures in an international cohort using risk factor algorithms without BMD.

    Science.gov (United States)

    Sambrook, Philip N; Flahive, Julie; Hooven, Fred H; Boonen, Steven; Chapurlat, Roland; Lindsay, Robert; Nguyen, Tuan V; Díez-Perez, Adolfo; Pfeilschifter, Johannes; Greenspan, Susan L; Hosmer, David; Netelenbos, J Coen; Adachi, Jonathan D; Watts, Nelson B; Cooper, Cyrus; Roux, Christian; Rossini, Maurizio; Siris, Ethel S; Silverman, Stuart; Saag, Kenneth G; Compston, Juliet E; LaCroix, Andrea; Gehlbach, Stephen

    2011-11-01

    Clinical risk factors are associated with increased probability of fracture in postmenopausal women. We sought to compare prediction models using self-reported clinical risk factors, excluding BMD, to predict incident fracture among postmenopausal women. The GLOW study enrolled women aged 55 years or older from 723 primary-care practices in 10 countries. The population comprised 19,586 women aged 60 years or older who were not receiving antiosteoporosis medication and were followed annually for 2 years. Self-administered questionnaires were used to collect data on characteristics, fracture risk factors, previous fractures, and health status. The main outcome measure compares the C index for models using the WHO Fracture Risk (FRAX), the Garvan Fracture Risk Calculator (FRC), and a simple model using age and prior fracture. Over 2 years, 880 women reported incident fractures including 69 hip fractures, 468 "major fractures" (as defined by FRAX), and 583 "osteoporotic fractures" (as defined by FRC). Using baseline clinical risk factors, both FRAX and FRC showed a moderate ability to correctly order hip fracture times (C index for hip fracture 0.78 and 0.76, respectively). C indices for "major" and "osteoporotic" fractures showed lower values, at 0.61 and 0.64. Neither algorithm was better than the model based on age + fracture history alone (C index for hip fracture 0.78). In conclusion, estimation of fracture risk in an international primary-care population of postmenopausal women can be made using clinical risk factors alone without BMD. However, more sophisticated models incorporating multiple clinical risk factors including falls were not superior to more parsimonious models in predicting future fracture in this population.

  14. Quantitative NDI integration with probabilistic fracture mechanics for the assessment of fracture risk in pipelines

    Energy Technology Data Exchange (ETDEWEB)

    Kurz, Jochen H.; Cioclov, Dragos; Dobmann, Gerd; Boiler, Christian [Fraunhofer Inst. fuer Zerstoerungsfreie Pruefverfahren (IZFP), Saarbruecken (Germany)

    2009-07-01

    In the context of probabilistic paradigm of fracture risk assessment in structural components a computer simulation rationale is presented which has at the base the integration of Quantitative Non-destructive Inspection and Probabilistic Fracture Mechanics. In this study the static failure under static loading is assessed in the format known as Failure Assessment Diagram (FAD). The key concept in the analysis is the stress intensity factor (SIF) which accounts on the geometry of the component and the size of a pre-existent defect of a crack nature. FAD assessments can be made in deterministic sense, which yields the end result in dual terms of fail/not-fail. The fracture risk is evaluated in probabilistic terms. The superposed probabilistic pattern over the deterministic one (in mean sense) is implemented via Monte-Carlo sampling. The probabilistic fracture simulation yields a more informative analysis in terms of probability of failure. An important feature of the PVrisk software is the ability to simulate the influence of the quality and reliability of non-destructive inspection (NDI). It is achieved by integrating, algorithmically. probabilistic FAD analysis and the Probability of Detection (POD). The POD information can only be applied in a probabilistic analysis and leads to a refinement of the assessment. By this means, it can be ascertained the decrease of probability of failure (increase of reliability) when POD-characterized NDI is applied. Therefore, this procedure can be used as a tool for inspection based life time conceptions. In this paper results of sensitivity analyses of the fracture toughness are presented with the aim to outline, in terms of non-failure probabilities, the benefits of applying NDI, in various qualities, in comparison with the situation when NDI is lacking. (orig.)

  15. Distribution of Risks for Major Osteoporotic Fracture Based on Fracture Risk Assessment Tool in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

    Directory of Open Access Journals (Sweden)

    Nik Fatin Farhana Binti Mohd Rahhim

    2015-09-01

    Full Text Available Background: Osteoporosis has become a growing public health problem in Indonesia. A definite estimation of osteoporosis prevalence in Indonesia is not available due to the limited access of dual energy X ray absorptiometry (DXA facilities. In 2008, the World Health Organization has developed a tool called Fracture Risk Assessment Tool to identify fracture risk based on the clinical risk factors. The study aimed to identify the risk factors of osteoporotic fracture using Fracture Risk Assessment Tool in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Methods: This descriptive study was conducted from June–December 2013 in Orthopedic & Traumatology, Internal Medicine, Geriatric and Surgery polyclinics Dr. Hasan Sadikin General Hospital, Bandung to 77 respondents, aged 40–90 years, using the random sampling method. Fracture risks were calculated online, and the data obtained were analyzed and presented using frequency distribution in tables. Results: Most of the respondents had low risk for osteoporotic fracture, and only 5.19% of them had moderate risk. The main risk factors were rheumatoid arthritis (57.14%, followed by current smoking (27.27% and prolonged glucocorticoids consumption (25.98%. The moderate risk group was females, above 60 years old and with normal BMI or underweight with risks of previous fracture, parent’s previous hip fracture, rheumatoid arthritis and prolonged glucocorticoids exposure. Conclusions: Majority of the respondents have low risk for osteoporotic fracture. It must be taken into consideration that increasing age, rheumatoid arthritis, current smoking, prolonged glucocorticoids consumption, previous fracture and parent’s previous hip fracture can cause increased risk.

  16. Can we predict postoperative complications in elderly Chinese patients with hip fractures using the surgical risk calculator?

    Directory of Open Access Journals (Sweden)

    Wang X

    2017-09-01

    Full Text Available Xiao Wang, Bin Jiang Zhao, Yue Su Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China Purpose: Hip fractures are associated with poor prognosis in elderly patients partly due to the high rate of postoperative complications. This study was aimed to investigate whether the surgical risk calculator is suitable for predicting postoperative complications in elderly Chinese patients with hip fractures.Methods: The incidence of postoperative complications among 410 elderly patients with hip fractures was predicted by the surgical risk calculator and then compared with the actual value. The risk calculator model was evaluated using the following three metrics: Hosmer–Lemeshow test for the goodness-of-fit of the model, receiver operating characteristic curve (ROC (also referred as C-statistic for the predictive specificity and sensitivity, and the Brier’s score test for predictive accuracy.Results: Preoperative risk factors including gender, age, preoperative functional status, American Society of Anesthesiologists grade, hypertension, dyspnea, dialysis, previous cardiovascular history, and cerebrovascular disease were positively correlated with the incidence of postoperative complications in elderly patients with hip fractures. The predicted complication incidence rate was well matched with the actual complication rate by Hosmer–Lemeshow test. The model had high sensitivity and specificity for predicting the mortality rate of these patients with a C-statistic index of 0.931 (95% CI [0.883, 0.980]. The surgical calculator model had an accuracy of 90% for predicting the reoperation rate (Brier’s score <0.01.Conclusions: The surgical risk calculator could be useful for predicting mortality and reoperation in elderly patients with hip fracture. Patients and surgeons may use this simple calculator to better manage the preoperative risks. Keywords: hip fracture, femoral head fracture, elder age, surgical

  17. Risk of Hip Fracture Associated with Hepatitis C Virus Infection and Hepatitis C/HIV Coinfection

    Science.gov (United States)

    Re, Vincent Lo; Volk, Jessica; Newcomb, Craig W.; Yang, Yu-Xiao; Freeman, Cristin P.; Hennessy, Sean; Kostman, Jay R.; Tebas, Pablo; Leonard, Mary B.; Localio, A. Russell

    2012-01-01

    Hepatitis C virus (HCV) infection has been associated with reduced bone mineral density, but its association with fracture rates is unknown, particularly in the setting of human immunodeficiency virus (HIV) coinfection. Our objectives were to determine whether persons with HCV infection alone are at increased risk for hip fracture compared to uninfected individuals and to examine if the risk of hip fracture is higher among HCV/HIV-coinfected persons compared to those with HCV alone, those with HIV alone, and those uninfected with either virus. We conducted a cohort study in 36,950 HCV/HIV-coinfected, 276,901HCV-monoinfected, 95,827 HIV-monoinfected, and 3,110,904 HCV/HIV-uninfected persons within the U.S. Medicaid populations of California, Florida, New York, Ohio, and Pennsylvania (1999–2005). Incidence rates of hip fracture were lowest among uninfected persons (1.29 events/1000 person-years), increased with the presence of either HIV infection (1.95 events/1000 person-years) or HCV infection (2.69 events/1000 person-years), and were highest among HCV/HIV-coinfected individuals (3.06 events/1000 person-years). HCV/HIV coinfection was associated with an increased relative hazard (adjusted hazard ratio [95% confidence interval]) of hip fracture compared to HCV-monoinfected (1.38 [1.25–1.53]), HIV-monoinfected (females: 1.76 [1.44–2.16]; males: 1.36 [1.20–1.55]), and uninfected persons (females: 2.65 [2.21–3.17]; males: 2.20 [1.97–2.47]). HCV monoinfection was associated with an increased risk of hip fracture compared to uninfected individuals, and the relative increase was highest in the youngest age groups (females, 18–39 years: 3.56 [2.93–4.32]; males, 18–39 years: 2.40 [2.02–2.84]). Conclusion Among Medicaid enrollees, HCV/HIV coinfection was associated with increased rates of hip fracture compared to HCV-monoinfected, HIV-monoinfected, and HCV/HIV-uninfected persons. HCV-monoinfected patients had an increased risk of hip fracture compared to

  18. 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.

  19. Association of fracture risk with benzodiazepine among adults in South Korea.

    Science.gov (United States)

    Hwang, Jin Seub; Oh, Sung-Hee; Oh, Kang Seob; Lee, Kyoung-Uk; Woo, Jong-Min; Lee, Boung-Chul; Park, EunJeong; Kwak, Su Jin; Kwon, Jin-Won

    2015-02-01

    This study examined the association between fracture and benzodiazepine (BZD) prescription in Korean adults using case-crossover (CCO) and self-controlled case-series (SCCS) designs, which have the advantage to control confounding bias, such as individual characteristics. Patients with fracture were defined as patients who visited the emergency room and orthopedics department with the ICD-10 diagnosis code for fracture. Fractures due to motor vehicle accidents and stroke were excluded. Whereas the CCO design presented odds ratio (OR) using a conditional logistic regression model, SCCS design showed incidence rate ratio (IRR) using a conditional Poisson regression model. The concomitant drugs that can affect the fracture were adjusted. Sensitivity analysis and subgroup analysis by age (elderly vs. nonelderly), action mechanism (short-acting vs. long-acting), and prescription duration (short-term user vs. long-term user) were conducted. The adjusted OR (AOR) for control period I (prior to 90 days from case) was 1.39 (95% CI=1.25-1.54) for all BZD prescriptions. The adjusted ORs for other control periods showed similar trends. The adjusted IRRs (AIRR) during the first 4 weeks, 4-8 weeks, 8-12 weeks, and 12-16 weeks from new BZD use were 1.46 (95% CI=1.28-1.66), 1.23 (95% CI=1.01-1.49), 1.09 (95% CI=0.86-1.37), and 1.38 (95% CI=1.07-1.77), respectively. Regardless of age group, action mechanism, or prescription duration, fracture risk was higher during case period than control. The risk for fracture was higher in both elderly and non-elderly people with BZD prescription than in those without BZD prescription. Careful monitoring for people who start BZD treatment and further research in the non-elderly is required.

  20. 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

    on the medical assumption that 50% of additional hip fractures may be prevented with compliant and persistent use of alendronate in five years following the initial fracture. RESULTS: In the no treatment arm, the average cost was EUR 16,233 and 0.32 hip fractures per woman, and in the alendronate treatment arm...... 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...... the first month after fracture and does not normalise until 15 years later. Fracture prevention programs have focused on identifying patients at risk of secondary low energy trauma fractures. The secondary prevention programs for fractures begin immediately after the first fracture, through identification...

  1. 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....

  2. Strain rates of opening-mode fractures in deep basinal settings

    Science.gov (United States)

    Eichhubl, Peter; Hooker John, N.; Andras, Fall; Laubach Stephen, E.

    2010-05-01

    Long-term strain rates for geologic processes are characteristically in the range of 10-13 to 10-17 s-1 as measured by a variety of techniques, including geodetic techniques, radiometric dating of tectonic and structural processes, and through stratigraphic correlations. Here, we present strain rates for populations of opening-mode fractures in sandstone in deep basinal settings. Fracture strain is obtained by collecting aperture-frequency data for microfractures along scanlines in weakly deformed sandstone. Opening durations of individual macrofractures in the same population are then obtained through detailed microthermometry of fluid inclusions in crack-seal fracture cement, combined with textural reconstructions of the fracture opening history. Temperature data are then correlated with known burial history models to obtain the duration of fracture opening and the fracture opening strain rate. Individual fractures in deeply buried sandstone of the East Texas basin, a passive margin setting, opened over 48 m.y. with a strain rate of 2x10-18 s-1to 5x10-19 s-1. Similar strain rates are obtained for fractures in the Piceance intermontane basin of Colorado. These ultraslow strain rates compare well to longterm intraplate seismic strain rates suggesting that rates of fracture opening are controlled by intraplate tectonic deformation processes.

  3. Percent body fat, fractures and risk of osteoporosis in women.

    Science.gov (United States)

    Wyshak, G

    2010-06-01

    Globally, in an aging population, osteoporosis and fractures are emerging as major public health problems; accessible and affordable recognition, prevention and treatment strategies are needed. Percent body fat is known to be associated with bone mineral density and fractures. This paper uses an innovative, virtually cost-free method to estimate percent body fat from age, height and weight, and assesses its validity by examining the association between percent body fat and fractures among women 39 and older. An epidemiologic study. 3940 college alumnae, median age 53.6, participated by responding to a mailed questionnaire covering medical history, behavioral factors, birth date, weight and height. T-tests, chi-square and multivariable logistic regression. Percent body fat estimated from age, weight, height and gender. Associations of fractures with percent body fat are expressed as odds ratios: for osteoporotic (wrist, hip and/or x-ray confirmed vertebral), the adjusted OR = 2.41, 95% CI (1.65, 3.54), P age, height and weight may be a valid, cost-saving, and cost-effective alternative tool for screening and assessing risk of osteoporosis in settings where Dual x-ray absorptiometry (DXA) or other radiological techniques are too costly or unavailable.

  4. 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.

  5. Risk of femoral shaft and subtrochanteric fractures among users of bisphosphonates and raloxifene

    DEFF Research Database (Denmark)

    Vestergaard, P; Schwartz, F; Rejnmark, L;

    2010-01-01

    Prior studies have suggested an association between bisphosphonate use and subtrochanteric fractures. This cohort study showed an increased risk of subtrochanteric and femoral shaft fractures both before and after the start of drugs against osteoporosis including bisphosphonates. This may suggest...

  6. Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study

    Directory of Open Access Journals (Sweden)

    Rinkens Paula ELM

    2006-10-01

    Full Text Available Abstract Background Many risk factors for fractures have been documented, including low bone-mineral density (BMD and a history of fractures. However, little is known about the short-term absolute risk (AR of fractures and the timing of clinical fractures. Therefore, we assessed the risk and timing of incident clinical fractures, expressed as 5-year AR, in postmenopausal women. Methods In total, 10 general practice centres participated in this population-based prospective study. Five years after a baseline assessment, which included clinical risk factor evaluation and BMD measurement, 759 postmenopausal women aged between 50 and 80 years, were re-examined, including undergoing an evaluation of clinical fractures after menopause. Risk factors for incident fractures at baseline that were significant in univariate analyses were included in a multivariate Cox survival regression analysis. The significant determinants were used to construct algorithms. Results In the total group, 12.5% (95% confidence interval (CI 10.1–14.9 of the women experienced a new clinical fracture. A previous clinical fracture after menopause and a low BMD (T-score Conclusion In postmenopausal women, clinical fractures cluster in time. One in two women with a recent clinical fracture had a new clinical fracture within 5 years, regardless of BMD. The 5-year AR for a first clinical fracture was much lower and depended on BMD.

  7. Risk Factors for Hip Fractures in Elderly Patients

    Directory of Open Access Journals (Sweden)

    Erhan Bayram

    2014-09-01

    Full Text Available Aim: In this study, we aimed to determine the risk factors for hip fractures in elderly patients in order to contribute to efforts to reduce the incidence of hip fractures. Methods: We evaluated 54 patients aged 79.12±8.83 (range: 55-95 years, who presented to our emergency department due to hip fractures (Group 1 and 52 hospitalized patients aged 69.04±7.66 (range: 60-83 years, without a hip fracture (Group 2. We compare the groups in terms of neuropathy symptom score (NSS, neurological impairment score (NIS, accompanying diseases, foot deformities, dermal and nail problems, body mass index (BMI, osteoporosis, and use of walking aid devices. Results: The mean BMI score was 24.81±3.67 and 27.67±4.86 in Group 1 and in Group 2, respectively. The difference was statistically significant (p=0.001. The mean NSS and NIS in Group 1 was 2.87±2.89 and 2.06±1.17, respectively, while the mean NSS was 1.83±2.84 and NIS was 0.6±0.82 in group 2. The two scores were higher in group 1 than in Group 2, however, the difference in NISs between the groups was statistically significant (p<0.001. In Group 1, the number of patients smoking or drinking alcohol was higher than in Group 2, but the difference was not significant (p=0.37, p=0.324. There were no significant relationship between foot deformities and hip fractures. The number of patients with osteoporosis and those using walking aid devices was significantly higher in Group 1 than in Group 2 (p=0.007, p<0.001. Conclusion: In this study including a limited number of patients, we determined that a low BMI score, osteoporosis, and use of walking aid device are the risk factors for hip fractures. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 187-90

  8. Serum Phosphate Is Associated With Fracture Risk: The Rotterdam Study and MrOS.

    Science.gov (United States)

    Campos-Obando, Natalia; Koek, W Nadia H; Hooker, Elizabeth R; van der Eerden, Bram Cj; Pols, Huibert A; Hofman, Albert; van Leeuwen, Johannes Ptm; Uitterlinden, Andre G; Nielson, Carrie M; Zillikens, M Carola

    2017-02-08

    Extreme phosphate levels (P) have been associated with mineralization defects and increased fracture risk. Whether P within normal range is related to bone health in the general population is not well understood. To investigate the association of P with bone mineral density (BMD) and fracture risk, we assessed two population-based cohorts: the Dutch Rotterdam Study (RS-I, RS-II, RS-III; n = 6791) and the US Osteoporotic Fractures in Men (MrOS; n = 5425) study. The relationship of P with lumbar spine (LS) and femoral neck (FN) BMD was tested in all cohorts via linear models; fracture risk was tested in RS-I, RS-II, and MrOS through Cox models, after follow-up of 8.6, 6.6, and 10.9 years, respectively. Adjustments were made for age, body mass index, smoking, serum levels of calcium, potassium, 25-hydroxyvitamin D, estimated glomerular filtration rate (eGFR), FN-BMD, prevalent diabetes, and cardiovascular disease. Additional adjustments were made for phosphate intake, parathyroid hormone, and fibroblast growth factor 23 levels in MrOS. We further stratified by eGFR. Results were pooled through study-level meta-analyses. Hazard ratios (HR) and betas (β) (from meta-analyses) are expressed per 1 mg/dL P increase. P was positively associated with fracture risk in men and women from RS, and findings were replicated in MrOS (pooled HR all [95% CI]: 1.47 [1.31-1.65]). P was associated with fracture risk in subjects without chronic kidney disease (CKD): all (1.44 [1.26-1.63]) and in men with CKD (1.93 [1.42-2.62]). P was inversely related to LS-BMD in men (β: -0.06 [-0.11 to -0.02]) and not to FN-BMD in either sex. In summary, serum P was positively related to fracture risk independently from BMD and phosphate intake after adjustments for potential confounders. P and LS-BMD were negatively related in men. Our findings suggest that increased P levels even within normal range might be deleterious for bone health in the normal population. © 2017 American Society for

  9. 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

  10. 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.

  11. Tensile fracture and shear localization under high loading rate in tungsten alloys

    OpenAIRE

    Couque, H.; Lankford, J.; Bose, A

    1992-01-01

    The influence of loading rate and microstructure on the tensile and compressive failure properties of three microstructurally dissimilar tungsten alloys has been investigated. Dynamic tensile fracture properties were characterized through fracture toughness tests performed at a stress intensity loading rate of 106 MPa $\\sqrt{{\\rm m}}$ s-1, and by tensile testing at a strain rate of 103 s-1. Shear banding phenomena were investigated by means of compression tests performed at strain rates of 5 ...

  12. Lower extremity soft tissue reconstruction and amputation rates in patients with open tibial fractures in Sweden during 1998–2010

    Science.gov (United States)

    2014-01-01

    Background The rates of soft tissue reconstruction and amputation after open tibial fractures have not been studied on a national perspective. We aimed to determine the frequency of soft tissue coverage after open tibial fracture as well as primary and secondary amputation rates. Methods Data on all patients (> = 15 years) admitted to hospital with open tibial fractures were extracted from the Swedish National Patient Register (1998–2010). All surgical procedures, re-admissions, and mechanisms of injury were analysed accordingly. The risk of amputation was calculated using logistic regression (adjusted for age, sex, mechanism of injury, reconstructive surgery and fixation method). The mean follow-up time was 6 (SD 3.8) years. Results Of 3,777 patients, 342 patients underwent soft tissue reconstructive surgery. In total, there were 125 amputations. Among patients with no reconstructive surgery, 2% (n = 68 patients) underwent amputation. In an adjusted analysis, patients older than 70 years (OR = 2.7, 95%, CI = 1.1-6) and those who underwent reconstructive surgery (OR = 3.1, 95% CI = 1.6-5.8) showed higher risk for amputation. Fixations other than intramedullary nailing (plate, external fixation, closed reduction and combination) as the only method were associated with a significant higher risk for amputation (OR 5.1-14.4). Reconstruction within 72 hours (3 days) showed better results than reconstruction between 4–90 days (p = 0.04). Conclusions The rate of amputations after open tibial fractures is low (3.6%). There is a higher risk for amputations with age above 70 (in contrast: male sex and tissue reconstruction are rather indicators for more severe soft tissue injuries). Only a small proportion of open tibial fractures need soft tissue reconstructive surgery. Reconstruction with free or pedicled flap should be performed within 72 hours whenever possible. PMID:25323662

  13. 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

  14. 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

    1735 fractures of the distal radius, 747 fractures of the proximal humerus, 878 cervical and 635 trochanteric hip fractures were included. In men 273 cervical and 232 trochanteric hip fractures were included. The fractures were registered during the period 1976 to 1984 and changes in age......-specific incidence were calculated (chi-squared test for linear trend; p-values less than 0.05 were considered significant). On the basis of life tables and population background data, the lifetime risk was estimated. The incidence of cervical hip fractures in women aged 60-89 years decreased significantly (p ....05) during the observation period, while no significant decrease was found in the incidence of trochanteric fractures. No significant changes in incidence were observed in women with radial or humeral fractures, or in men with hip fractures. A women 60 years old with a life expectancy of 81 years had...

  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

    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...... were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5- and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost...

  16. Increased rates of wound complications with locking plates in distal fibular fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); E.M.M. van Lieshout (Esther); M.R.D. Vries; M. van der Elst (Maarten)

    2011-01-01

    textabstractIntroduction: There is a growing use of locking compression plates in fracture surgery. The current study was undertaken to investigate the wound complication rates of locking versus non-locking plates in distal fibular fractures. Patients and methods: During a 6-year study period all co

  17. 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.

  18. Hydrogen Embrittlement - Loading Rate Effects in Fracture Mechanics Testing

    NARCIS (Netherlands)

    Koers, R.W.J.; Krom, A.H.M.; Bakker, A.

    2001-01-01

    The fitness for purpose methodology is more and more used in the oil and gas industry to evaluate the significance of pre-existing flaws and material deficiencies with regard to the suitability of continued operation of equipment. In this methodology, traditional fracture mechanics is integrated wit

  19. INFLUENCE OF LOADING RATE ON DYNAMIC FRACTURE BEHAVIOR OF FIBER-REINFORCED COMPOSITES

    Institute of Scientific and Technical Information of China (English)

    Kezhuang Gong; Zheng Li; Weizhong Qin

    2008-01-01

    The effect of loading rate on the dynamic fracture properties and the failure mechanisms of glass fiber-reinforced composite materials under mode I fracture is studied.Dynamic reflective caustic experiments are carried out for two loading rates.By measuring the characteristic dimensions of the shadow spots during the caustic experiments,the dynamic SIFs are calculated for different loading rates.The experimental results indicate that the dynamic fracture toughness KId increases remarkably with increasing loading rate,and the crack grows faster under the high-velocity impact.Moreover,by examining the crack growth routes and the fracture surfaces,it is shown that the loading rate also greatly affects the failure mechanisms at micro-scale.

  20. Influence of mechanical rock properties and fracture healing rate on crustal fluid flow dynamics

    Science.gov (United States)

    Sachau, Till; Bons, Paul; Gomez-Rivas, Enrique; Koehn, Daniel; de Riese, Tamara

    2016-04-01

    Fluid flow in the Earth's crust is very slow over extended periods of time, during which it occurs within the connected pore space of rocks. If the fluid production rate exceeds a certain threshold, matrix permeability alone is insufficient to drain the fluid volume and fluid pressure builds up, thereby reducing the effective stress supported by the rock matrix. Hydraulic fractures form once the effective pressure exceeds the tensile strength of the rock matrix and act subsequently as highly effective fluid conduits. Once local fluid pressure is sufficiently low again, flow ceases and fractures begin to heal. Since fluid flow is controlled by the alternation of fracture permeability and matrix permeability, the flow rate in the system is strongly discontinuous and occurs in intermittent pulses. Resulting hydraulic fracture networks are largely self-organized: opening and subsequent healing of hydraulic fractures depends on the local fluid pressure and on the time-span between fluid pulses. We simulate this process with a computer model and describe the resulting dynamics statistically. Special interest is given to a) the spatially and temporally discontinuous formation and closure of fractures and fracture networks and b) the total flow rate over time. The computer model consists of a crustal-scale dual-porosity setup. Control parameters are the pressure- and time-dependent fracture healing rate, and the strength and the permeability of the intact rock. Statistical analysis involves determination of the multifractal properties and of the power spectral density of the temporal development of the total drainage rate and hydraulic fractures. References Bons, P. D. (2001). The formation of large quartz veins by rapid ascent of fluids in mobile hydrofractures. Tectonophysics, 336, 1-17. Miller, S. a., & Nur, A. (2000). Permeability as a toggle switch in fluid-controlled crustal processes. Earth and Planetary Science Letters, 183(1-2), 133-146. Sachau, T., Bons, P. D

  1. 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.

  2. Hip fracture risk estimation based on principal component analysis of QCT atlas: a preliminary study

    Science.gov (United States)

    Li, Wenjun; Kornak, John; Harris, Tamara; Lu, Ying; Cheng, Xiaoguang; Lang, Thomas

    2009-02-01

    We aim to capture and apply 3-dimensional bone fragility features for fracture risk estimation. Using inter-subject image registration, we constructed a hip QCT atlas comprising 37 patients with hip fractures and 38 age-matched controls. In the hip atlas space, we performed principal component analysis to identify the principal components (eigen images) that showed association with hip fracture. To develop and test a hip fracture risk model based on the principal components, we randomly divided the 75 QCT scans into two groups, one serving as the training set and the other as the test set. We applied this model to estimate a fracture risk index for each test subject, and used the fracture risk indices to discriminate the fracture patients and controls. To evaluate the fracture discrimination efficacy, we performed ROC analysis and calculated the AUC (area under curve). When using the first group as the training group and the second as the test group, the AUC was 0.880, compared to conventional fracture risk estimation methods based on bone densitometry, which had AUC values ranging between 0.782 and 0.871. When using the second group as the training group, the AUC was 0.839, compared to densitometric methods with AUC values ranging between 0.767 and 0.807. Our results demonstrate that principal components derived from hip QCT atlas are associated with hip fracture. Use of such features may provide new quantitative measures of interest to osteoporosis.

  3. Analytical modeling of gas production rate in tight channel sand formation and optimization of artificial fracture.

    Science.gov (United States)

    Wang, Ruifei; Song, Hongqing; Tang, Hewei; Wang, Yuhe; Killough, John; Huang, Gang

    2016-01-01

    Permeability variation in tight channel sand formation makes an important role in gas production. Based on the features of channel sand formation, a mathematical model has been established considering anisotropy of permeability. The analytical solutions were derived for productivity of both vertical wells and vertically fractured wells. Simulation results show that, gas production rate of anisotropic channel sand formation is less than that of isotropic formation. For vertically fractured well, artificial fracture direction, drainage radius, permeability ratio and fracture half-length have considerable influence on production rate. The optimum fracture direction should be deviated less than π/8 from the maximum permeability direction (or the channel direction). In addition, the analytical model was verified by in situ measured data. The research provides theoretical basis for the development of tight channel sand gas reservoirs.

  4. Randomised trial assessing the impact of framing of fracture risk and osteoporosis treatment benefits in patients undergoing bone densitometry

    Science.gov (United States)

    Kalluru, Rama; Petrie, Keith J; Grey, Andrew; Nisa, Zaynah; Horne, Anne M; Gamble, Greg D; Bolland, Mark J

    2017-01-01

    Objectives The accuracy of patients' perception of risk is important for decisions about treatment in many diseases. We framed the risk of fracture and benefits of treatment in different ways and assessed the impact on patients' perception of fracture risk and intentions to take medication. Design Randomised trial of 4 different presentations of fracture risk and likely benefits from osteoporosis treatment. Setting Academic centre. Participants 200 patients undergoing bone densitometry. Intervention Presentation that framed the patient's absolute fracture risk either as the chance of having or not having an event, with their likely benefits from osteoporosis treatment in natural frequencies or numbers needed to treat. Outcomes Participants' views about their fracture risk and the need for osteoporosis treatment. Results The median 5-year fracture risk threshold participants regarded as high enough to consider preventative medication was 50–60%, and did not change substantially after the presentation. The median (Q1, Q3) 5-year risk initially estimated by participants was 20% (10, 50) for any fracture and 19% (10, 40) for hip fracture. 61% considered their fracture risk was low or very low, and 59–67% considered their fracture risk was lower than average. These participant estimates were 2–3 times higher than Garvan calculator estimates for any fracture, and 10–20 times higher for hip fracture. Participant estimates of fracture risk halved after the presentation, but remained higher than the Garvan estimates (1.5–2 times for any fracture, 5–10 times for hip fracture). There was no difference in these outcomes between the randomised groups. Participants' intentions about taking medication to prevent fractures were not substantially affected by receiving information about fracture risk and treatment benefits. Conclusions Altering the framing of estimated fracture risks and treatment benefits had little effect on participants' perception of the need to take

  5. Increased risk of hip fractures in patients with dementia: a nationwide population-based study

    OpenAIRE

    Wang, Hao-Kuang; Hung, Chao-Ming; Lin, Sheng-Hsiang; Tai, Yi-Cheng; Lu, Kang; Liliang, Po-Chou; Lin, Chi-Wei; Lee, Yi-Che; Fang, Pei-Hsuan; Chang, Li-Ching; Li, Ying-Chun

    2014-01-01

    Background Dementia has been associated with an increased risk of hip fracture. However, little research has been conducted on the impact of dementia on wrist or vertebral fracture development. The aim of this study was to investigate whether dementia is a risk factor for different types of fracture in Taiwan. Methods The study sample was drawn from Taiwan’s National Health Insurance Research Database of reimbursement claims, and comprised 1408 patients who visited ambulatory care centers or ...

  6. 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

  7. 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

  8. False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures

    Directory of Open Access Journals (Sweden)

    Kwang-Soon Song

    2013-01-01

    Full Text Available Background: To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER stage IV (Lauge-Hansen ankle fractures. Materials and Methods: We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59% patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia. Results: All 14 fractures showed different degrees of tibiofibular clear space (TFCS and tibiofibular overlapping (TFO on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.

  9. [Is Mapuche ethnicity a risk factor for hip fracture in aged?].

    Science.gov (United States)

    Sapunar, Jorge; Bravo, Paulina; Schneider, Hermann; Jiménez, Marcela

    2003-10-01

    Ethnic factors are involved in the risk for osteoporosis and hip fracture. To assess the effect of Mapuche ethnicity on the risk of hip fracture. A case control study. Cases were subjects over 55 years of age admitted, during one year, for hip fracture not associated to major trauma or tumors. Controls were randomly chosen from other hospital services and paired for age with cases. The magnitude of the association between ethnicity and hip fracture was expressed as odds ratio in a logistic regression model. In the study period, 156 cases with hip fracture were admitted. The proportion of subjects with Mapuche origin was significantly lower among cases than controls (11.8 and 26.5% respectively, p Mapuche ethnicity was associated with hip fracture with an odds radio of 0.14 (p = 0.03, 95% CI 0.03-0.8). In this sample, Mapuche ethnicity is a protective factor for hip fracture.

  10. 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...

  11. 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

  12. 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

    was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracture risk was higher at each level of BMD T score than expected from the model...... by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause....

  13. 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

    was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracture risk was higher at each level of BMD T score than expected from the model...... by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause....

  14. 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.

  15. [Hip fracture as risk factor for mortality in patients over 65 years of age. Case-control study].

    Science.gov (United States)

    Negrete-Corona, J; Alvarado-Soriano, J C; Reyes-Santiago, L A

    2014-01-01

    association between hip fracture and increased mortality was found, with a significant p value of 0.001. The main cause of death among hip fracture patients in our study was sepsis in 7 (35%), while among the control group it was myocardial infarction in 3 (15%). Time wise, mortality was found to be higher within the first six months, with 10 deaths (50%), and within the first year, with six deaths (30%). Hip fracture is in fact a risk factor associated with mortality among patients over 65 years of age. Females are the group most prone to sustaining a hip fracture and, therefore, to increased mortality rates. The major cause of death among our patient population was sepsis, apparently caused by mismanagement of soft tissues, a poor aseptic technique during the surgical procedure, a long hospital stay or a poor family support network, and dementia, which is related to poor surgical wound care. The highest mortality rates were found in ages over 90 years, and they were associated with preexisting chronic-degenerative conditions. The age group at highest risk of hip fracture was 80-89 years. Patients with hip fracture should always be managed together with the internist and the geriatrician and they should be considered as orthopedic emergencies, as a long hospital stay and delayed surgical treatment are associated with major complications and increased mortality rates.

  16. Comparing self-perceived and estimated fracture risk by FRAX® of women with osteoporosis.

    Science.gov (United States)

    Baji, Petra; Gulácsi, László; Horváth, Csaba; Brodszky, Valentin; Rencz, Fanni; Péntek, Márta

    2017-12-01

    In this study, we compared subjective fracture risks of Hungarian women with osteoporosis to FRAX®-based estimates. Patients with a previous fracture, parental hip fracture, low femoral T-score, higher age, and higher BMI were more likely to underestimate their risks. Patients also failed to associate risk factors with an increased risk of fractures. The main objectives were to explore associations between self-perceived 10-year fracture risks of women with osteoporosis (OP) and their risks calculated by the FRAX® algorithm and to identify determinants of the underestimation of risk. We carried out a cross-sectional study in 11 OP centers in Hungary and collected data on the risk factors considered by the FRAX® calculator. Patients estimated their subjective 10-year probability of any major osteoporotic and hip fracture numerically, in percentages and also on a visual analog scale (VAS). We compared subjective and FRAX® estimates and applied logistic regression to analyze the determinants of the underestimation of risk. Associations between risk factors and subjective risk were explored using linear probability models. Nine hundred seventy-two OP patients were included in the analysis. Major OP and hip fracture risk by FRAX® were on average 20.1 and 10.5%, while subjective estimates were significantly higher, 30.0 and 24.7%, respectively. Correlations between FRAX® and subjective measures were very weak (r = 0.12-0.16). Underestimation of major OP fracture risk was associated with having had a single previous fracture (OR = 2.0), parental hip fracture (OR = 3.4), femoral T-score ≤-2.5 (OR = 4.2), higher age, body mass index, and better general health state. We did not find significant associations between subjective risk estimates and most of the risk factors except for previous fractures. Hungarian OP patients fail to recognize most of the risk factors of fractures. Thus, education of patients about these risk factors would be beneficial especially

  17. Prevalence of Fracture in Healthy Iranian Children Aged 9–18 Years and Associated Risk Factors; A Population Based Study

    Directory of Open Access Journals (Sweden)

    Marjan Jeddi

    2017-01-01

    Full Text Available Objective: To determine the prevalence of fractures and associated risk factors in healthy Iranian children and adolescents. Methods: In this cross sectional population based study, 478 healthy Iranian children and adolescents aged 9–18 years old participated. Baseline data and bone mineral content and density have been determined. One questionnaire was completed for all individuals including previous history of fracture, its location, and level of trauma. Albumin, calcium, phosphorus, alkaline phosphatase, and vitamin D levels were measured. Results: We found a prevalence of 12.9% for fracture. (34.5% for girls and 65.5% for boys; about 71% suffered long bone fracture with distal forearm as the most common site. Totally 58% of the boys and 54% of the girls had fracture with low-energy trauma. The fracture group had lower bone mineral apparent density in the lumbar spine (0.19±0.04 vs. 0.20±0.03, p=0.04, lower serum albumin (4.6±0.5 vs 4.8±0.4, p=0.02, and higher serum alkaline phosphatase level (446±174 vs. 361±188, p=0.02 compared with non-fracture subjects. By logistic regression analysis, we found a significant association for sex, and bone mineral content of the lumbar spine with fracture (p=0.003, p=0.039. Conclusion: Compared to other studies, our subjects had lower rate of fracture. We found an association between low bone density and fracture in children and adolescents. This finding has important implications for public health. Further research may contribute to recognition of preventive measures.

  18. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia.

    Science.gov (United States)

    Seeman, Ego; Devogelaer, Jean-Pierre; Lorenc, Roman; Spector, Timothy; Brixen, Kim; Balogh, Adam; Stucki, Gerold; Reginster, Jean-Yves

    2008-03-01

    Many fractures occur in women with moderate fracture risk caused by osteopenia. Strontium ranelate was studied in 1431 postmenopausal women with osteopenia. Vertebral fracture risk reduction of 41-59% was shown depending on the site and fracture status at baseline. This is the first report of antivertebral fracture efficacy in women with vertebral osteopenia. Women with osteoporosis are at high risk for fracture. However, more than one half of all fractures in the community originate from the larger population at more moderate risk of fracture caused by osteopenia. Despite this, evidence for antifracture efficacy in these persons is limited. The aim of this study was to determine whether strontium ranelate, a new drug that reduces fracture risk in women with osteoporosis, is also effective in women with osteopenia. Data from the Spinal Osteoporosis Therapeutic Intervention study (SOTI; n = 1649) and the TReatment Of Peripheral OSteoporosis (TROPOS; n = 5091) were pooled to evaluate the antivertebral fracture efficacy of strontium ranelate in women with lumbar spine (LS) osteopenia with any BMD value at the femoral neck (FN; N = 1166) and in 265 women with osteopenia at both sites (intention-to-treat analysis). The women were randomized to strontium ranelate 2 g/d orally or placebo for 3 yr. No group differences were present in baseline characteristics that may influence fracture outcome independent of therapy. In women with LS osteopenia, treatment reduced the risk of vertebral fracture by 41% (RR = 0.59; 95% CI, 0.43-0.82), by 59% (RR = 0.41; 95% CI, 0.17-0.99) in the 447 patients with no prevalent fractures, and by 38% (RR = 0.62; 95% CI, 0.44-0.88) in the 719 patients with prevalent fractures. In women with osteopenia at both sites, treatment reduced the risk of fracture by 52% (RR = 0.48; 95% CI, 0.24-0.96). Strontium ranelate safely reduces the risk of vertebral fractures in women with osteopenia with or without a prevalent fracture.

  19. 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.......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....

  20. Bipolar disorder and the risk of fracture: A nationwide population-based cohort study.

    Science.gov (United States)

    Su, Jian-An; Cheng, Bi-Hua; Huang, Yin-Cheng; Lee, Chuan-Pin; Yang, Yao-Hsu; Lu, Mong-Liang; Hsu, Chung-Yao; Lee, Yena; McIntyre, Roger S; Chin Lin, Tzu; Chin-Hung Chen, Vincent

    2017-08-15

    The co-primary aims are: 1) to compare the risk of fracture between adults with bipolar disorder and those without bipolar disorder; and 2) to assess whether lithium, anticonvulsants and antipsychotics reduce risk of fracture among individuals with bipolar disorder. The analysis herein is a population-based retrospective cohort study, utilizing the National Health Insurance (NHI) medical claims data collected between 1997 and 2013 in Taiwan. We identified 3705 cases with incident diagnoses of bipolar disorder during study period and 37,050 matched controls without bipolar diagnoses. Incident diagnosis of fracture was operationalized as any bone fracture after the diagnosis of bipolar disorder or after the matched index date for controls. Bipolar patients had significantly higher risk of facture when compared to matched controls (17.6% versus 11.7%, respectively pbipolar disorder and a prior history of psychiatric hospitalization were had higher risk for bone fracture than those without prior history of psychiatric hospitalization when compared to match controls. Higher cumulative dose of antipsychotics or mood stabilizers did not increase the risk of fracture. The diagnoses of bipolar disorder were not confirmed with structured clinical interview. Drug adherence, exact exposure dosage, smoking, lifestyle, nutrition and exercise habits were unable to be assessed in our dataset. Bipolar disorder is associated with increased risk of fracture, and higher cumulative dose of mood stabilizers and antipsychotics did not further increase the risk of fracture. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Low Serum DHEAS Predicts Increased Fracture Risk in Older Men: The MrOS Sweden Study.

    Science.gov (United States)

    Ohlsson, Claes; Nethander, Maria; Kindmark, Andreas; Ljunggren, Östen; Lorentzon, Mattias; Rosengren, Björn E; Karlsson, Magnus K; Mellström, Dan; Vandenput, Liesbeth

    2017-03-09

    The adrenal-derived hormones dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are the most abundant circulating hormones and their levels decline substantially with age. DHEAS is considered an inactive precursor, which is converted into androgens and estrogens via local metabolism in peripheral target tissues. The predictive value of serum DHEAS for fracture risk is unknown. The aim of this study was, therefore, to assess the associations between baseline DHEAS levels and incident fractures in a large cohort of older men. Serum DHEAS levels were analyzed with mass spectrometry in the population-based Osteoporotic Fractures in Men study in Sweden (n = 2568, aged 69 to 81 years). Incident X-ray validated fractures (all, n = 594; non-vertebral major osteoporotic, n = 255; hip, n = 175; clinical vertebral, n = 206) were ascertained during a median follow-up of 10.6 years. DHEAS levels were inversely associated with the risk of any fracture (hazard ratio [HR] per SD decrease = 1.14, 95% confidence interval [CI] 1.05-1.24), non-vertebral major osteoporotic fractures (HR = 1.31, 95% CI 1.16-1.48), and hip fractures (HR = 1.18, 95% CI 1.02-1.37) but not clinical vertebral fractures (HR = 1.09, 95% CI 0.95-1.26) in Cox regression models adjusted for age, body mass index (BMI) and prevalent fractures. Further adjustment for traditional risk factors for fracture, bone mineral density (BMD), and/or physical performance variables as well as serum sex steroid levels only slightly attenuated the associations between serum DHEAS and fracture risk. Similarly, the point estimates were only marginally reduced after adjustment for FRAX estimates with BMD. The inverse association between serum DHEAS and all fractures or major osteoporotic fractures was nonlinear, with a substantial increase in fracture risk (all fractures 22%, major osteoporotic fractures 33%) for those participants with serum DHEAS levels below the median (0.60 μg/mL). In

  2. 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.

  3. 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

    A huge number of risk assessment tools have been developed. Far from all have been validated in external studies, more of them have absence of methodological and transparent evidence and few are integrated in national guidelines. Therefore, we performed a systematic review to provide an overview...... 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....

  4. 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......Although many strong risk factors for osteoporosis-such as family history, fracture history and age-are not modifiable, a number of important risk factors are potential targets for intervention. Thus, simple, non-pharmacological intervention in patients at increased risk of osteoporotic fractures...

  5. Use of glucose-lowering drugs and risk of fracture in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Starup-Linde, Jakob; Gregersen, Søren; Frost, Morten;

    2017-01-01

    BACKGROUND: Diabetes mellitus is associated with an increased risk of hip fracture. The aim ofthis cohort study was to investigate whether glucose-lowering drugs influence the risk of hip fracture in patients with incident diabetes. METHODS: A study was performed on a cohort of patients...... was glucose-lowering drugs and the primary endpoint was hip fracture. Unadjusted, adjusted, and propensity score adjusted Cox regressions were performed. RESULTS: 5244 patients with type 2 diabetes with a mean follow up of 5.5years were included in the study. Use of sulphonylureas within the last 90days...... was associated with hip fracture in patients with type 2 diabetes, hazard ratio 1.64 (95% confidence interval: 1.54,1.75), whereas ever use of sulohonylyreas was not associated with an increased risk of fractures. Use of sulphonylureas within the last 90days was also associated with an increased risk...

  6. 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

    than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture. CONCLUSIONS: Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types.......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...... malabsorption on fracture risk among patients with CP. METHODS: We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women...

  7. The influence of strain rate on the interfacial fracture toughness between PVB and laminated glass

    Science.gov (United States)

    Iwasaki, R.; Sato, C.

    2006-08-01

    This paper presents the experimental results of high speed tests using laminated safety glass to determine the interfacial fracture toughness between PVB (polyvinyl butyral) sheets and glass plates. Low-speed tensile test of PVB was carried out firstly. PVB shows a non-linear visco-elastic property. The property was described using a non-linear visco-elastic model. The visco-elastic parameters were calculated to compare the experimentally obtained stress-strain curves and the results of simulation. A simple fracture-mechanical model for PVB laminated glass was conducted to determine the energy release rate G. The fracture toughness Gc of the PVB laminated glass specimens were calculated from both the results of low-speed tensile tests and the equation for the energy release rate. The strain-stress curves of PVB under high strain rates are totally different from those of the low speed tests. The phenomenon can be explained from the phase transition due to the difference of strain rates because the mechanical properties of PVB changes from visco-elastic to glassy behavior. The fracture toughness of PVB laminated glass was calculated from the experimental results of high speed tests. Fracture energy was defined and also compared to the fracture toughness.

  8. Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); S.T. Vliet-Koppert; A.B. Maier (Andrea); W.E. Tuinebreijer (Wim); M.R. de Vries (Mark); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)

    2012-01-01

    textabstractIntroduction: Long-term place of residence after hip fracture is not often described in literature. The goal of this study was to identify risk factors, known at admission, for failure to return to the pre-fracture place of residence of hip fracture patients in the Wrst year after a hip

  9. Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); S.T. Vliet-Koppert; A.B. Maier (Andrea); W.E. Tuinebreijer (Wim); M.R. de Vries (Mark); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)

    2012-01-01

    textabstractIntroduction: Long-term place of residence after hip fracture is not often described in literature. The goal of this study was to identify risk factors, known at admission, for failure to return to the pre-fracture place of residence of hip fracture patients in the Wrst year after a hip

  10. 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.

  11. Chronic non-cholestatic liver disease is not associated with an increased fracture rate in children.

    Science.gov (United States)

    Konstantynowicz, Jerzy; Lebensztejn, Dariusz M; Skiba, Elzbieta; Sobaniec-Lotowska, Maria E; Abramowicz, Pawel; Piotrowska-Jastrzebska, Janina; Kaczmarski, Maciej

    2011-05-01

    Chronic liver disease in adults is a risk factor of osteoporosis, but little is known about risk of fractures in children with non-cholestatic liver disease. The aim of this study was to investigate associations among the severity of liver fibrosis, bone mass and low-energy fractures in children. History of fractures, anthropometry, and bone mass and size were examined in 39 Caucasian children (25 boys, 14 girls) aged 7.1-18 years (mean 11.9 ± 3.1) with chronic hepatitis B and liver fibrosis evidenced by liver biopsy. Severity of liver fibrosis was based on histological classification according to the method of Batts and Ludwig (mild, 1-2 scores; advanced, 3 scores) and Ishak (1-3 and 4-5 scores, respectively). Bone mineral content (BMC), density (BMD) and body composition were determined in the total body and lumbar spine using dual energy X-ray absorptiometry. Seven subjects (4 girls, 3 boys; 18% of the sample) had low BMD in the total body and lumbar spine region (Z-scores below -2.0). No associations were found among BMC, BMD, bone size and the severity of liver fibrosis. Nine boys (36% of all boys) and one girl reported repeated fractures (forearm, wrist, tibia, ankle, humerus), showing trends similar to the prevalence in general population. Fractures were neither associated with lower BMD/BMC nor with scores of liver fibrosis. Deficits in BMD in children with chronic hepatitis B are not associated with the severity of liver fibrosis. This study suggests that non-cholestatic liver disease does not increase the risk of low-energy fractures during growth. From the practical perspective, however, children with chronic liver disease should be screened for history and clinical risk factors for fractures rather than referred to bone density testing.

  12. Coffee, tea, and the risk of hip fracture: a meta-analysis.

    Science.gov (United States)

    Sheng, J; Qu, X; Zhang, X; Zhai, Z; Li, H; Liu, X; Li, H; Liu, G; Zhu, Z; Hao, Y; Qin, A; Dai, K

    2014-01-01

    The present meta-analysis shows no clear association between coffee consumption and the risk of hip fractures. There was a nonlinear association between tea consumption and the risk of hip fracture. Compared to no tea consumption, drinking 1-4 cups of tea daily was associated with a lower risk of hip fracture. Prospective cohort and case-control studies have suggested that coffee and tea consumption may be associated with the risk of hip fracture; the results have, however, been inconsistent. We conducted a meta-analysis to assess the association between coffee and tea consumption and the risk of hip fracture. We performed systematic searches using MEDLINE, EMBASE, and OVID until February 20, 2013, without limits of language or publication year. Relative risks (RRs) with 95% confidence intervals (CI) were derived using random-effects models throughout all analyses. We conducted categorical, dose-response, heterogeneity, publication bias, and subgroup analyses. Our study was based on 195,992 individuals with 9,958 cases of hip fractures from 14 studies, including six cohort and eight case-control studies. The pooled RRs of hip fractures for the highest vs. the lowest categories of coffee and tea consumption were 0.94 (95% CI 0.71-1.17) and 0.84 (95% CI 0.66-1.02), respectively. For the dose-response analysis, we found evidence of a nonlinear association between tea consumption and the risk of hip fracture (p(nonlinearity) risk of hip fracture by 28% (0.72; 95% CI 0.56-0.88 for 1-2 cups/day), 37% (0.63; 95% CI 0.32-0.94 for 2-3 cups/day), and 21% (0.79; 95% CI 0.62-0.96 for 3-4 cups/day). We found no significant association between coffee consumption and the risk of hip fracture. A nonlinear association emerged between tea consumption and the risk of hip fracture; individuals drinking 1-4 cups of tea per day exhibited a lower risk of hip fractures than those who drank no tea. The association between 5 daily cups of tea, or more, and hip fracture risk should be

  13. High fall incidence and fracture rate in elderly dialysis patients

    NARCIS (Netherlands)

    Polinder-Bos, H. A.; Emmelot-Vonk, M. H.; Gansevoort, R. T.; Diepenbroek, A.; Gaillard, C. A. J. M.

    2014-01-01

    Background: Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors f

  14. Benzodiazepines and risk of hip fractures in older people: a review of the evidence.

    Science.gov (United States)

    Cumming, Robert G; Le Couteur, David G

    2003-01-01

    A hip fracture epidemic is occurring in developed countries in association with population aging. The increasing number of people with a hip fracture has major implications for clinicians and health service managers. More importantly, a hip fracture is a devastating event in the life of an older person, as it often leads to loss of independence and death. Identification of risk factors for hip fracture is an essential first step towards prevention. The use of psychotropic medications is an established risk factor for hip fracture. The purpose of this article is to systematically review epidemiological studies of the relationship between use of benzodiazepines and risk of hip fracture and, then, to see how the findings of these studies fit with what is known about the pharmacology of benzodiazepines. Eleven primary epidemiological studies were identified. The results of these studies were not consistent; however, the inconsistency appeared to be almost entirely explained by research design. The studies that did not show an association between increased hip fracture risk and benzodiazepine use were nearly all hospital-based case-control studies, a type of study that often lacks validity because of the difficulty of finding an appropriate control group. After excluding the hospital-based case-control studies, all but one of the remaining seven studies found that use of benzodiazepines was associated with an increased risk of hip fracture that varied between 50% and 110%. The only higher quality study that did not find an association between benzodiazepine use and hip fracture was also the only study conducted entirely in nursing homes. There was no evidence that the risk of hip fracture differed between short- and long-acting benzodiazepines. People using higher doses of benzodiazepines and those who had recently started using benzodiazepines were at the highest risk of hip fracture. In very old people, there was some preliminary evidence that benzodiazepines that

  15. The radiation swelling effect on fracture properties and fracture mechanisms of irradiated austenitic steels. Part II. Fatigue crack growth rate

    Science.gov (United States)

    Margolin, B.; Minkin, A.; Smirnov, V.; Sorokin, A.; Shvetsova, V.; Potapova, V.

    2016-11-01

    The experimental data on the fatigue crack growth rate (FCGR) have been obtained for austenitic steel of 18Cr-10Ni-Ti grade (Russian analog of AISI 321 steel) irradiated up to neutron dose of 150 dpa with various radiation swelling. The performed study of the fracture mechanisms for cracked specimens under cyclic loading has explained why radiation swelling affects weakly FCGR unlike its effect on fracture toughness. Mechanical modeling of fatigue crack growth has been carried out and the dependencies for prediction of FCGR in irradiated austenitic steel with and with no swelling are proposed and verified with the obtained experimental results. As input data for these dependencies, FCGR for unirradiated steel and the tensile mechanical properties for unirradiated and irradiated steels are used.

  16. Fracture risk assessment in Latin America: is Frax an adaptable instrument for the region?

    Science.gov (United States)

    Morales-Torres, Jorge; Clark, Patricia; Delezé-Hinojosa, Margarita; Cons-Molina, Fidencio; Messina, Osvaldo Daniel; Hernández, Jaime; Jaller-Raad, Juan José; Quevedo-Solidoro, Héctor; Radominski, Sebastiao Cezar

    2010-10-01

    Osteoporosis is a generalized disease of bone that increases fracture risk. Multiple factors influence this risk, besides low bone mass. To decrease osteoporotic fractures, those patients who require preventive management should be readily identified. This paper aims to review current information on the use of the fracture risk assessment tool (FRAX) in Latin America. Bone mineral density measurement is currently the method of reference for evaluating the fracture risk and opting for treatment; but, it misses a notable proportion of individuals who have clinical risk factors for osteoporosis and fractures. FRAX was designed to predict the 10-year absolute risk of sustaining a major osteoporotic fracture or a hip fracture. Although data is available for several countries, from Latin America, only Argentina appears in the current version of the tool. Its present use in other Latin American countries is possible with some adaptations based in similarities of epidemiological information of each country with some of the existing databases. The cutoff value beyond which treatment should be initiated needs to be determined, based not only on clinical criteria, but also on economic considerations.

  17. Could whole body vibration exercises influence the risk factors for fractures in women with osteoporosis?

    Directory of Open Access Journals (Sweden)

    Eloá Moreira-Marconi

    2016-12-01

    Conclusions: Although the paucity of research regarding direct effects of WBV in decreasing fractures, WBV could be a feasible and effective way to modify well-recognized risk factors for falls and fractures, improvements in some aspects of neuromuscular function and balance. More studies have to be performed establish protocols with well controlled parameters.

  18. 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 ...

  19. 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.

  20. Education, marital status, and risk of hip fractures in older men and women: the CHANCES project.

    Science.gov (United States)

    Benetou, V; Orfanos, P; Feskanich, D; Michaëlsson, K; Pettersson-Kymmer, U; Ahmed, L A; Peasey, A; Wolk, A; Brenner, H; Bobak, M; Wilsgaard, T; Schöttker, B; Saum, K-U; Bellavia, A; Grodstein, F; Klinaki, E; Valanou, E; Papatesta, E-M; Boffetta, P; Trichopoulou, A

    2015-06-01

    The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk. The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA. A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models. Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72-0.95]. Respective HRs were 0.97 (95 % CI 0.82-1.13) for men and 0.75 (95 % CI 0.65-0.85) for women. Overall, individuals living alone, especially those aged 60-69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02-1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05). The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60-69 years, when compared to those being married/cohabiting.

  1. Currency Risk Management under Floating Rates

    Directory of Open Access Journals (Sweden)

    Nicu Duret

    2016-09-01

    Full Text Available As for the research into this subject, we find, therefore, that one of the most important indicators that quantify the international competitiveness is the exchange rate, together with other fundamental macroeconomic variables such as the size of the potential GDP, the equilibrium real exchange rate, gives a certain insight into the functioning of the fundamental macroeconomic mechanisms and their regulation. Commercial and financial operations imply relationships between partners from different currency countries or areas that involve conversion operations, of replacement of a currency to another. Exchange rate fluctuations of one currency create currency risk, to the extent that it is used to carry out international transactions. These operations are subjected to currency risk as exchange rates change frequently from one period to another and, on the other hand, speculations in the forex market influence the exchange rate by the interventions of those who perform them.

  2. Real-world effectiveness of daily teriparatide in Japanese patients with osteoporosis at high risk for fracture: final results from the 24-month Japan Fracture Observational Study (JFOS).

    Science.gov (United States)

    Soen, Satoshi; Fujiwara, Saeko; Takayanagi, Ryoichi; Kajimoto, Kenta; Tsujimoto, Mika; Kimura, Shuichi; Sato, Masayo; Krege, John H; Enomoto, Hiroyuki

    2017-11-01

    The Japan Fracture Observational Study (JFOS), a prospective observational study, investigated the real-world effectiveness of daily teriparatide to reduce clinical fracture risk in osteoporotic patients. In routine clinical practice, Japanese patients initiated on teriparatide 20 μg/day by subcutaneous injection were enrolled. The primary end-point was the rate of clinical fractures at 6-month intervals over 24 months. Bone mineral density (BMD), procollagen type 1 aminoterminal propeptide (P1NP), back pain, and health-related quality-of-life (HRQoL) information was collected. Of 1,996 patients at baseline, 90.1% were female, and mean age was 76.9 years. Teriparatide persistence at 12 and 24 months was 68.0% and 51.6%, respectively. Compared to the first 6-month treatment interval, the odds ratio of fractures decreased by 56.4% during 6-12 months, 51.6% during 12-18 months, and 58.8% during 18-24 months (all p < .01). After 24 months, BMD increased by 17.2% (lumbar spine) and 7.9% (total hip). After 6 months, P1NP levels increased by 259.3%. A reduction in back pain (100 mm visual analog scale) of 16.1 mm at 3 months was maintained through 24 months. HRQoL (pain, daily living activities, general health) improved by ≥10% at each post-baseline time point. Of 279 (14.6%) patients with ≥1 adverse event (AE), 71 (3.7%) experienced ≥1 drug-related AE (investigator assessed), including nausea (0.7%), dizziness (0.4%), and decreased appetite (0.3%). Osteosarcoma was not reported; there were no new safety signals. JFOS demonstrated effectiveness of teriparatide 20 μg/day to reduce the risk of clinical fractures in Japanese patients in a real-world setting.

  3. 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] (pcluster 5 in women in cluster 1 and 2 (pcluster 2 (pclusters 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. Copyright © 2016. Published by Elsevier Inc.

  4. Incidence rates and trends of hip/femur fractures in five European countries

    DEFF Research Database (Denmark)

    Requena, G; Abbing-Karahagopian, V; Huerta, C

    2014-01-01

    Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003-2009 in five European countries. The study was performed using seven...... electronic health-care records databases (DBs) from Denmark, The Netherlands, Germany, Spain, and the United Kingdom, based on the same protocol. Yearly IRs of hip/femur fractures were calculated for the general population and for those aged ≥50 years. Trends over time were evaluated using linear regression......, P femur fractures varied greatly across European countries. With the exception of Denmark, no decreasing trend was observed over the study period....

  5. 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

  6. Thiazide diuretics and the risk for hip fracture

    NARCIS (Netherlands)

    M. van de Klift (Marjolein); C.E.D. de Laet (Chris); R.M.C. Herings (Ron); Th. Stijnen (Theo); H.A.P. Pols (Huib); B.H.Ch. Stricker (Bruno); M.W.C.J. Schoofs (Marlette); A. Hofman (Albert)

    2003-01-01

    textabstractBACKGROUND: Since most hip fractures are related to osteoporosis, treating accelerated bone loss can be an important strategy to prevent hip fractures. Thiazides have been associated with reduced age-related bone loss by decreasing urinary calcium excretion. OBJECTIVE: To examine the ass

  7. Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly Has a Low Conversion Rate.

    Science.gov (United States)

    Grosso, Matthew J; Danoff, Jonathan R; Murtaugh, Taylor S; Trofa, David P; Sawires, Andrew N; Macaulay, William B

    2017-01-01

    Hemiarthroplasty (HA) has been a mainstay treatment for displaced femoral neck fractures for many years. The purpose of this study was to report the conversion rate of HA to total hip arthroplasty (THA) for displaced femoral neck fractures and compare outcomes between implant constructs (bipolar vs unipolar), fixation options (cemented vs cementless stems), and age groups (fractures at our institution between 1999 and 2013 with a minimum of 2-year follow-up. The overall component revision rate, including conversion to THA, revision HA, revision with open reduction internal fixation, and Girdlestone procedure, was 5.6% (39/686). Seventeen patients (2.5%) were converted from HA to THA at an average of 1.9 years after index procedure. A significantly lower conversion rate of 1.4% (7/499 patients) was found in the older patient cohort (≥75 years old) compared to 5.3% (11/187) in the younger cohort. The most common causes for conversion surgery to THA were acetabular wear (5 patients), aseptic loosening (4 patients), and periprosthetic fracture (3 patients). There was a significantly lower rate of periprosthetic fracture (0.4% vs 2.5%, P value .025) in the cemented implant group compared to the cementless group. We observed a higher rate of dislocations in the bipolar vs unipolar group (3.8% vs 1%, P value .02) and no other significant differences between these groups. We observed a low reoperation rate for this cohort of patients, relatively higher conversion rates for the younger population, fewer periprosthetic fractures with the use of cemented stems, and no advantage of bipolar over unipolar prostheses. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Evaluation of easily measured risk factors in the prediction of osteoporotic fractures

    Directory of Open Access Journals (Sweden)

    Brown Jacques P

    2005-09-01

    Full Text Available Abstract Background Fracture represents the single most important clinical event in patients with osteoporosis, yet remains under-predicted. As few premonitory symptoms for fracture exist, it is of critical importance that physicians effectively and efficiently identify individuals at increased fracture risk. Methods Of 3426 postmenopausal women in CANDOO, 40, 158, 99, and 64 women developed a new hip, vertebral, wrist or rib fracture, respectively. Seven easily measured risk factors predictive of fracture in research trials were examined in clinical practice including: age (, 65–69, 70–74, 75–79, 80+ years, rising from a chair with arms (yes, no, weight (≥ 57kg, maternal history of hip facture (yes, no, prior fracture after age 50 (yes, no, hip T-score (>-1, -1 to >-2.5, ≤-2.5, and current smoking status (yes, no. Multivariable logistic regression analysis was conducted. Results The inability to rise from a chair without the use of arms (3.58; 95% CI: 1.17, 10.93 was the most significant risk factor for new hip fracture. Notable risk factors for predicting new vertebral fractures were: low body weight (1.57; 95% CI: 1.04, 2.37, current smoking (1.95; 95% CI: 1.20, 3.18 and age between 75–79 years (1.96; 95% CI: 1.10, 3.51. New wrist fractures were significantly identified by low body weight (1.71, 95% CI: 1.01, 2.90 and prior fracture after 50 years (1.96; 95% CI: 1.19, 3.22. Predictors of new rib fractures include a maternal history of a hip facture (2.89; 95% CI: 1.04, 8.08 and a prior fracture after 50 years (2.16; 95% CI: 1.20, 3.87. Conclusion This study has shown that there exists a variety of predictors of future fracture, besides BMD, that can be easily assessed by a physician. The significance of each variable depends on the site of incident fracture. Of greatest interest is that an inability to rise from a chair is perhaps the most readily identifiable significant risk factor for hip fracture and can be easily incorporated

  9. Fracture in Westerly granite under AE feedback and constant strain rate loading: Nucleation, quasi-static propagation, and the transition to unstable fracture propagation

    Science.gov (United States)

    Thompson, B.D.; Young, R.P.; Lockner, D.A.

    2006-01-01

    New observations of fracture nucleation are presented from three triaxial compression experiments on intact samples of Westerly granite, using Acoustic Emission (AE) monitoring. By conducting the tests under different loading conditions, the fracture process is demonstrated for quasi-static fracture (under AE Feedback load), a slowly developing unstable fracture (loaded at a 'slow' constant strain rate of 2.5 ?? 10-6/s) and an unstable fracture that develops near instantaneously (loaded at a 'fast' constant strain rate of 5 ?? 10-5/s). By recording a continuous ultrasonic waveform during the critical period of fracture, the entire AE catalogue can be captured and the exact time of fracture defined. Under constant strain loading, three stages are observed: (1) An initial nucleation or stable growth phase at a rate of ??? 1.3 mm/s, (2) a sudden increase to a constant or slowly accelerating propagation speed of ??? 18 mm/s, and (3) unstable, accelerating propagation. In the ??? 100 ms before rupture, the high level of AE activity (as seen on the continuous record) prevented the location of discrete AE events. A lower bound estimate of the average propagation velocity (using the time-to-rupture and the existing fracture length) suggests values of a few m/s. However from a low gain acoustic record, we infer that in the final few ms, the fracture propagation speed increased to 175 m/s. These results demonstrate similarities between fracture nucleation in intact rock and the nucleation of dynamic instabilities in stick slip experiments. It is suggested that the ability to constrain the size of an evolving fracture provides a crucial tool in further understanding the controls on fracture nucleation. ?? Birkha??user Verlag, Basel, 2006.

  10. Polymorphism of the low-density lipoprotein receptor-related protein 5 gene and fracture risk.

    Science.gov (United States)

    Wang, Chao; Zhang, Gang; Gu, Mingyong; Zhou, Zhenyu; Cao, Xuecheng

    2014-01-01

    Several molecular epidemiological studies have been conducted to examine the association between low-density lipoprotein receptor-related proteins (LRP5) Ala1330Val polymorphism and fracture; however, the conclusions remained controversial. We therefore performed an extensive meta-analysis on 10 published studies with 184479 subjects. Electronic databases, including PubMed, Excerpta Medica Database (EMBASE), Cochrane, Elsevier Science Direct and China National Knowledge Infrastructure (CNKI) databases were searched. Summary odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using random-effects models. LRP5 Ala1330Val polymorphism was associated with a significantly increased risk of fracture (OR = 1.10; 95% CI, 1.06-1.14; I(2) = 29%). We also found that this polymorphism increased fracture risk in Caucasians. In the subgroup analysis according to gender, women was significantly associated with risk of fracture. In the subgroup analysis by type of fracture, LRP5 Ala1330Val polymorphism showed increased osteoporotic fracture risk. In conclusion, this meta-analysis suggested that an increased risk of fracture was associated with the LRP5 Ala1330Val polymorphism.

  11. 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.

  12. Risk factors for hip fracture. MEDOS study: results of the Toulouse Centre.

    Science.gov (United States)

    Ribot, C; Tremollieres, F; Pouilles, J M; Albarede, J L; Mansat, M; Utheza, G; Bonneu, M; Bonnissent, P; Ricoeur, C

    1993-01-01

    The development of preventive strategies for hip fractures requires better identification of risk factors. The MEDOS study was designed to study prospectively the incidence of hip fracture in 14 centres from six countries and characterise risk factors. At one centre (Toulouse), data were gathered from questionnaires completed by 386 cases of hip fracture aged over 50 years and 848 age- and sex-matched controls over a 12-month period. Of the 935 variables of the MEDOS questionnaire, 235, grouped into 56 items, were statistically analysed. Odds ratios (and 95% confidence intervals) were estimated for each variable from a multiple stepwise logistic regression model. The population comprised 19.2% men and 80.8% women, with a mean age of 80 +/- 8.8 years; 80% were living in an urban area and 76% with their family. Of the 17 significant variables, moderate excess weight and a high nutritional intake of calcium were associated with a decreased risk of hip fracture. Loss of autonomy, a higher height than normal (> 1SD), and a history of previous fractures significantly increased the risk of fracture. Interestingly, all these variables accounted for only 18% of the risk of hip fracture.

  13. Older men with low serum IGF-1 have an increased risk of incident fractures: the MrOS Sweden study.

    Science.gov (United States)

    Ohlsson, Claes; Mellström, Dan; Carlzon, Daniel; Orwoll, Eric; Ljunggren, Osten; Karlsson, Magnus K; Vandenput, Liesbeth

    2011-04-01

    Osteoporosis-related fractures constitute a major health concern not only in women but also in men. Insulin-like growth factor 1 (IGF-1) is a key determinant of bone mass, but the association between serum IGF-1 and incident fractures in men remains unclear. To determine the predictive value of serum IGF-1 for fracture risk in men, older men (n = 2902, mean age of 75 years) participating in the prospective, population-based Osteoporotic Fractures in Men (MrOS) Sweden study were followed for a mean of 3.3 years. Serum IGF-1 was measured at baseline by radioimmunoassay. Fractures occurring after the baseline visit were validated. In age-adjusted hazards regression analyses, serum IGF-1 associated inversely with risk of all fractures [hazard ratio (HR) per SD decrease = 1.23, 95% confidence interval (CI) 1.07-1.41], hip fractures (HR per SD decrease = 1.45, 95% CI 1.07-1.97), and clinical vertebral fractures (HR per SD decrease = 1.40, 95% CI 1.10-1-78). The predictive role of serum IGF-1 for fracture risk was unaffected by adjustment for height, weight, prevalent fractures, falls, and major prevalent diseases. Further adjustment for bone mineral density (BMD) resulted in an attenuated but still significant association between serum IGF-1 and fracture risk. Serum IGF-1 below but not above the median was inversely related to fracture incidence. The population-attributable risk proportion was 7.5% for all fractures and 22.9% for hip fractures. Taken together, older men with low serum IGF-1 have an increased fracture risk, especially for the two most important fracture types, hip and vertebral fractures. The association between serum IGF-1 and fracture risk is partly mediated via BMD.

  14. Alzheimer's Disease is an Important Risk Factor of Fractures: a Meta-analysis of Cohort Studies.

    Science.gov (United States)

    Liang, Ying; Wang, Lei

    2016-04-12

    The risk of fracture in individuals with Alzheimer's disease had not been fully quantified. A systematic review and meta-analysis of cohort studies was performed to estimate the impact of Alzheimer's disease on risk of fractures. Pubmed and Embase were searched for eligible cohort studies assessing the association between Alzheimer's disease and risk of fractures. The overall relative risks (RRs) with 95% CIs were calculated using a random-effects model to evaluate the association. Six cohort studies with a total of 137,986 participants were included into the meta-analysis. Meta-analysis of a total of six studies showed that Alzheimer's disease was significantly associated with two-fold increased risk of fractures (RR = 2.18, 95 % CI 1.64-2.90, P Alzheimer's disease was significantly associated with 2.5-fold increased risk of hip fracture (RR = 2.52, 95 % CI 2.26-2.81, P Alzheimer's disease is a risk factor of hip fracture.

  15. Financial intermediation and interest rate risk

    OpenAIRE

    Zagonov, Maxim

    2011-01-01

    This thesis analyses the link between interest rate risk faced by financial intermediaries in the G-10 countries, their balance sheet composition and national bank regulation. The regulatory authorities both in the US and in Europe increasingly emphasise the issue of bank interest rate exposure. The importance of this topic is also reasserted by recent developments in the monetary environment. The thesis offers three major contributions to the area. First, it empirically investigates the ...

  16. The effect of osteoporotic treatment on the functional outcome, re-fracture rate, quality of life and mortality in patients with hip fractures: a prospective functional and clinical outcome study on 520 patients.

    Science.gov (United States)

    Makridis, Konstantinos G; Karachalios, Theofilos; Kontogeorgakos, Vasilios A; Badras, Leonidas S; Malizos, Konstantinos N

    2015-02-01

    Numerous high quality studies have shown the positive effects of various osteoporotic medical treatment regimens on bone mass and on the reduction of risk for new spinal, hip and non-spinal fractures in osteoporotic patients. However, the effect of osteoporotic treatment on the functional and clinical outcome of patients who have sustained hip fractures and been treated surgically has not yet been addressed. Five hundred and twenty patients out of 611 who were admitted (2009-2011), operated on due to a hip fracture and completed their follow-up evaluations were included in this study. Data related to functional outcome scores, re-fracture rate, quality of life and mortality rate were prospectively recorded, analysed and correlated to osteoporotic medical treatment. There were 151 (25%) men and 369 (71%) women with a mean age of 80.7 years (range, 60 to 90 years). At a mean follow-up of 27.5 months (range, 24 to 36 months) a mortality rate of 23.6% at 2 years was recorded. Mean values of functional and quality of life scores were found to have progressively improved within two years after surgery. Seventy-eight (15%) patients were taking osteoporotic treatment before their hip fracture and 89 (17.1%) started afterwards. Osteoporotic treatment proved to be an important predictor of functional recovery (all p valuesfracture rate (p=0.028) and quality of life (EQ-5D, all dimensions, p valuesfracture mortality rates. Osteoporotic treatment taken before or initiated after fracture is a strong predictor of functional and clinical outcome in patients with hip fractures treated surgically. Copyright © 2014. Published by Elsevier Ltd.

  17. Complications and re-operation rate after tension-band wiring of olecranon fractures

    DEFF Research Database (Denmark)

    Romero, J M; Miran, A; Jensen, Claus Hjorth

    2000-01-01

    Tension-band wire fixation of olecranon fractures leads to a high re-operation rate because of the need to remove the metalware. This problem has commonly been thought to be related mainly to the backing-out of the Kirschner wires. A retrospective study was carried out in 55 patients with displaced...... olecranon fractures operated on with the tension-band wiring technique, in whom there was an overall 71.7% re-operation rate. Complications were few and minor in most patients. The main reason for the removal of the metalware was a direct complaint from the patient (in 61.3% of all removals). A literature...

  18. Proportion of and risk factors for open fractures of the appendicular skeleton in dogs and cats.

    Science.gov (United States)

    Millard, Ralph P; Weng, Hsin-Yi

    2014-09-15

    To evaluate the proportion of and risk factors for open fractures of the appendicular skeleton in dogs and cats that were a result of acute trauma. Cross-sectional and case-control study. 84,629 dogs and 26,675 cats. Dogs and cats examined at Purdue University Veterinary Teaching Hospital from January 1993 through February 2013 were identified; the proportion of open fractures was estimated from the medical records. Additionally, all incident cases of open (77 dogs and 33 cats) and closed (469 dogs and 80 cats) fractures between January 1993 and February 2013 and a random sample of nonfracture patients (722 dogs and 330 cats) in 2010 were used to assess risk factors for open appendicular fractures. Proportion of open fractures for the 20-year period was 0.09% (95% confidence interval [CI], 0.07% to 0.11%) in dogs and 0.12% (95% CI, 0.09% to 0.17%) in cats. Seventy-seven of 546 (14.1%) and 33 of 113 (29.2%) traumatic fractures were classified as open in dogs and cats, respectively. Comminuted fractures were more likely than other configurations to be open in dogs (OR, 5.9; 95% CI, 2.9 to 12.2) and cats (OR, 3.5; 95% CI, 1.0 to 12.0). Vehicle-related trauma was a significant risk factor for open fractures in dogs (OR, 13.8; 95% CI, 3.1 to 61.8). The proportion of incident open fractures in dogs and cats was low. Age, body weight, affected bone or bone segment, fracture configuration, and method of trauma were associated with an open fracture.

  19. Hip Fracture

    Science.gov (United States)

    Diseases and Conditions Hip fracture By Mayo Clinic Staff A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Older people are at a ...

  20. On the spillover of exchange rate risk into default risk

    Directory of Open Access Journals (Sweden)

    Božović Miloš

    2009-01-01

    Full Text Available In order to reduce the exchange-rate risk, banks in emerging markets are typically denominating their loans in foreign currencies. However, in the event of a substantial depreciation of the local currency, the payment ability of a foreign-currency borrower may be reduced significantly, exposing the lender to additional default risk. This paper analyses how the exchange-rate risk of foreign currency loans spills over into default risk. We show that in an economy where foreign currency loans are a dominant source of financing economic activity, depreciation of the local currency establishes a negative feedback mechanism that leads to higher default probabilities, reduced credit supply, and reduced growth. This finding has some important implications that may be of special interest for regulators and market participants in emerging economies.

  1. Influence of strain rate on fracture behavior of poly(methyl methacrylate)

    Institute of Scientific and Technical Information of China (English)

    赵荣国; 陈朝中

    2008-01-01

    The effect of strain rate on fracture behavior of poly(methyl methacrylate) was investigated.The uniaxial tensile rupture tests for the poly(methyl methacrylate) samples were carried out at different strain rates at ambient temperature.It is found that the elastic modulus of the material increases with increasing strain rate,while the elongation is reversal with strain rate.Simultaneously,there exists a critical strain rate within which the stress-strain curves overlap one another,and beyond which the curves depart from each other.The amount of energy added to the system due to work done by the imposed load was calculated,and the strain energy stored in the material at each strain rate was calculated by the current stress integral with respect to strain.The complementary strain energy,which is the difference between the work and the strain energy,was obtained and was considered to supply the surface energy to create a new crack surface in the polymeric material.It is found that the work done by the imposed load,which is needed for the fracture of poly(methyl methacrylate) sample,decreases with increasing strain rate,and the strain energy decreases with strain rate as well,which demonstrates that the polymeric material at high strain rate is easier to fracture than that at low strain rate.As the strain rate increases,the fracture mode changes from ductile,semi-ductile to brittle mode.The complementary strain energy almost sustains a constant at any strain rate.The density of surface energy,which characterizes the energy per unit area needed for creating crack surface,is a strain rate-independent material constant.

  2. Low incidence of flexion-type supracondylar humerus fractures but high rate of complications.

    Science.gov (United States)

    Kuoppala, Eira; Parviainen, Roope; Pokka, Tytti; Sirviö, Minna; Serlo, Willy; Sinikumpu, Juha-Jaakko

    2016-08-01

    Background and purpose - Supracondylar humerus fractures are the most common type of elbow fracture in children. A small proportion of them are flexion-type fractures. We analyzed their current incidence, injury history, clinical and radiographic findings, treatment, and outcomes. Patients and methods - We performed a population-based study, including all children <16 years of age. Radiographs were re-analyzed to include only flexion-type supracondylar fractures. Medical records were reviewed and outcomes were evaluated at a mean of 9 years after the injury. In addition, we performed a systematic literature review of all papers published on the topic since 1990 and compared the results with the findings of the current study. Results - During the study period, the rate of flexion-type fractures was 1.2% (7 out of 606 supracondylar humeral fractures). The mean annual incidence was 0.8 per 105. 4 fractures were multidirectionally unstable, according to the Gartland-Wilkins classification. All but 1 were operatively treated. Reduced range of motion, changed carrying angle, and ulnar nerve irritation were the most frequent short-term complications. Finally, in the long-term follow-up, mean carrying angle was 50% more in injured elbows (21°) than in uninjured elbows (14°). 4 patients of the 7 achieved a satisfactory long-term outcome according to Flynn's criteria. Interpretation - Supracondylar humeral flexion-type fractures are rare. They are usually severe injuries, often resulting in short-term and long-term complications regardless of the original surgical fixation used.

  3. 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

    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...

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

    DEFF Research Database (Denmark)

    Vestergaard, Peter; Thomsen, Iva Susanna vio Streym

    2010-01-01

    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...... indicate that bazedoxifene may be effective in preventing vertebral fractures in postmenopausal women with osteoporosis....

  5. 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

  6. Height and Risk of Hip Fracture: A Meta-Analysis of Prospective Cohort Studies.

    Science.gov (United States)

    Xiao, Zhihong; Ren, Dong; Feng, Wei; Chen, Yan; Kan, Wusheng; Xing, Danmou

    2016-01-01

    The association between height and risk of hip fracture has been investigated in several studies, but the evidence is inconclusive. We therefore conducted this meta-analysis of prospective cohort studies to explore whether an association exists between height and risk of hip fracture. We searched PubMed and EMBASE, Web of Science, and the Cochrane Library for studies of height and risk of hip fracture up to February 16, 2016. The random-effects model was used to combine results from individual studies. Seven prospective cohort studies, with 7,478 incident hip fracture cases and 907,913 participants, were included for analysis. The pooled relative risk (RR) was 1.65 (95% confidence interval (CI): 1.26-2.16) comparing the highest with the lowest category of height. Result from dose-response analysis suggested a linear association between height and hip fracture risk (P-nonlinearity = 0.0378). The present evidence suggests that height is positively associated with increased risk of hip fracture. Further well-designed cohort studies are needed to confirm the present findings in other ethnicities.

  7. Extremely high fracture rate of a modular acetabular component with a sandwich polyethylene ceramic insertion for THA: a preliminary report.

    Science.gov (United States)

    Kircher, Jörn; Bader, Rainer; Schroeder, Bettina; Mittelmeier, Wolfram

    2009-09-01

    Improvements of ceramic components and design changes have reduced failure rates over the past 30 years in total hip arthroplasty. We present a series of n = 11 cases with ceramic failure out of n = 113 implantations, from which n = 66 were ceramic-on-ceramic (n = 50 with ceramic insert with sandwich in polyethylene and n = 16 with directly fixed ceramic inlay) and n = 47 ceramic on polyethylene bearings, between 1999 and 2001 after introduction of a new implantation system to the market. The overall fracture rate of ceramic for the whole series (n = 113) was 9.7%. For the combination ceramic head with UHMW-PE (n = 47) the fracture rate was 2.1%. For the combination ceramic with ceramic (n = 66) the fracture rate was 15.2%. For the combination ceramic with ceramic sandwich in PE (n = 50) the failure rate was 18%. Only three patients experienced a trauma. Demography of patients (age, gender, body weight and BMI) was not statistically different between patients with failed ceramics and the rest of the patients making patient-specific risk factors unlikely to be an explanation for the failures. Retrospective X-ray analysis of the cup positioning did not show significant difference between failed and non-failed implants in terms of mean cup inclination and version making also operation-specific factors unlikely to be the only reason of this high failure rate. Therefore, manufacturer-specific factors such as design features may have contributed to this high failure rate. Further analysis of the whole series with biomechanical testing of the retrieved material needs to be performed.

  8. 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.

  9. Physical activity in middle-aged women and hip fracture risk: the UFO study.

    Science.gov (United States)

    Englund, U; Nordström, P; Nilsson, J; Bucht, G; Björnstig, U; Hallmans, G; Svensson, O; Pettersson, U

    2011-02-01

    In a population-based case-control study, we demonstrate that middle-aged women who were active with walking or in different physical spare time activities were at lower risk of later sustaining a hip fracture compared to more sedentary women. In middle-aged women participating in the Umeå Fracture and Osteoporosis (UFO) study, we investigated whether physical activity is associated with a subsequent decreased risk of sustaining a hip fracture. The UFO study is a nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures. We identified 81 female hip fracture cases that had reported lifestyle data before they sustained their fracture. Each case was compared with two female controls who were identified from the same cohort and matched for age and week of reporting data, yielding a total cohort of 237 subjects. Mean age at baseline was 57.2 ± 5.0 years, and mean age at fracture was 65.4 ± 6.4 years. Conditional logistic regression analysis with adjustments for height, weight, smoking, and menopausal status showed that subjects who were regularly active with walking or had a moderate or high frequency of physical spare time activities (i.e. berry/mushroom picking and snow shovelling) were at reduced risk of sustaining a hip fracture (OR 0.14; 95% CI; 0.05-0.53 for walking and OR 0.19; 95% CI; 0.08-0.46, OR 0.17, 95% CI; 0.05-0.64 for moderate and high frequency of spare time activities, respectively) compared to more sedentary women. An active lifestyle in middle age seems to reduce the risk of future hip fracture. Possible mechanisms may include improved muscle strength, coordination, and balance resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

  10. A 12-year ecological study of hip fracture rates among older Taiwanese adults.

    Science.gov (United States)

    Chan, Ding-Cheng; Lee, Yow-Shan; Wu, Ya-Ju; Tsou, Hsiao-Hui; Chen, Cheng-Ting; Hwang, Jawl-Shan; Tsai, Keh-Sung; Yang, Rong-Sen

    2013-11-01

    Hip fracture rates in Taiwan are among the highest in the world. The aim of this study was to describe the trends of hip fracture hospitalizations among Taiwanese elderly (aged ≥ 65 years) and the trends of antiosteoporosis medication expenditure from 1999 to 2010. We conducted an ecological study using inpatient health care-utilization data from the Department of Health, and medication expenditure data from the IMS Health, Taiwan. The International Classification of Disease, Clinical Modification, 9th version, code 820 was used to identify hip fracture hospitalizations. Medications included alendronate, calcitonin, ibandronate, raloxifene, strontium ranelate, teriparatide, and zoledronic acid. Year 2010 was assigned as the reference point for age-standardized rates, currency exchange (to the US dollar), and discount rates. Over the 12-year study period, age-standardized hip fracture hospitalizations decreased by 2.7 % annually (p for trend < 0.001) for Taiwanese elders. The decline was more obvious among those aged ≥75 years (6.1 %). However, the number of hip fracture hospitalizations increased from 14,342 to 18,023. Total hospitalization costs increased by US$0.6 ± 0.2 million annually (p for trend = 0.002); however, the per capita costs decreased by US$23.0 ± 8.0 (p for trend = 0.017). The total medication expenditure increased 7.2-fold, from US$8.1 million to US$58.9 million, accounting for an increase in the overall pharmaceutical market by fivefold, from 3.4 to 15.9 ‰ (both p for trend < 0.001). From 1999 to 2010, there was a decline in hip fracture rates among elderly Taiwanese adults with a concomitant increase in antiosteoporosis medication expenditure.

  11. Increased risk of fragility fractures among HIV infected compared to uninfected male veterans.

    Directory of Open Access Journals (Sweden)

    Julie A Womack

    Full Text Available BACKGROUND: HIV infection has been associated with an increased risk of fragility fracture. We explored whether or not this increased risk persisted in HIV infected and uninfected men when controlling for traditional fragility fracture risk factors. METHODOLOGY/PRINCIPAL FINDINGS: Cox regression models were used to assess the association of HIV infection with the risk for incident hip, vertebral, or upper arm fracture in male Veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC. We calculated adjusted hazard ratios comparing HIV status and controlling for demographics and other established risk factors. The sample consisted of 119,318 men, 33% of whom were HIV infected (34% aged 50 years or older at baseline, and 55% black or Hispanic. Median body mass index (BMI was lower in HIV infected compared with uninfected men (25 vs. 28 kg/m²; p<0.0001. Unadjusted risk for fracture was higher among HIV infected compared with uninfected men [HR: 1.32 (95% CI: 1.20, 1.47]. After adjusting for demographics, comorbid disease, smoking and alcohol abuse, HIV infection remained associated with an increased fracture risk [HR: 1.24 (95% CI: 1.11, 1.39]. However, adjusting for BMI attenuated this association [HR: 1.10 (95% CI: 0.97, 1.25]. The only HIV-specific factor associated with fragility fracture was current protease inhibitor use [HR: 1.41 (95% CI: 1.16, 1.70]. CONCLUSIONS/SIGNIFICANCE: HIV infection is associated with fragility fracture risk. This risk is attenuated by BMI.

  12. Validation of FRC, a fracture risk assessment tool, in a cohort of older men: the Osteoporotic Fractures in Men (MrOS) Study.

    Science.gov (United States)

    Ettinger, Bruce; Liu, Hau; Blackwell, Terri; Hoffman, Andrew R; Ensrud, Kristine E; Orwoll, Eric S

    2012-01-01

    We evaluated the performance of the Fracture Risk Calculator (FRC) in 5893 men who participated in the baseline visit (March 2000-April 2002) of the Osteoporotic Fractures in Men Study. FRC estimates for 10-yr hip and major osteoporotic (hip, clinical spine, forearm, and shoulder) fractures were calculated and compared with observed 10-yr fracture probabilities. Possible enhancement of the tool's performance when bone mineral density (BMD) was included was evaluated by comparing areas under receiver operating characteristic curves and by Net Reclassification Improvement (NRI). A total of 5893 men were followed-up for an average of 8.4 yr. For most quintiles of predicted fracture risk, the ratios of observed to predicted probabilities were close to unity. Area under the curves improved when BMD was included (p<0.001; 0.79 vs 0.71 for hip fracture and 0.70 vs 0.66 for major osteoporotic fracture, respectively). Using National Osteoporosis Foundation clinical treatment thresholds, BMD inclusion increased NRI significantly, 8.5% (p<0.01) for hip and 4.0% (p=0.01) for major osteoporotic fracture. We conclude that the FRC calibrates well with hip and major osteoporotic fractures observed among older men. Further, addition of BMD to the fracture risk calculation improves the tool's performance.

  13. Fibrosis markers, hip fracture risk, and bone density in older adults.

    Science.gov (United States)

    Barzilay, J I; Bůžková, P; Kizer, J R; Djoussé, L; Ix, J H; Fink, H A; Siscovick, D S; Cauley, J A; Mukamal, K J

    2016-02-01

    We examined whether blood levels of two markers of fibrosis (transforming growth factor beta one (TGF-β1) and procollagen type III N-terminal propeptide (PIIINP)) are related to hip fracture risk and to bone mineral density (BMD). TGF-β1 levels were associated with lower hip fracture risk in women and with lower BMD in men. PIIINP levels were not associated with either outcome. TGF-β1 serves several roles in bone formation and resorption. A consequence of TGF-β1 activation is the production of PIIINP, a marker of collagen III deposition. Here, we explore whether these two biomarkers are related to incident hip fracture and bone mineral density (BMD) and whether their associations are modified by systemic inflammation, as measured by C-reactive protein (CRP) levels. Participants were from the Cardiovascular Health Study (mean age 78 years; mean follow-up 8.3 years). We included 1681 persons with measured levels of TGF-β1 (149 hip fractures) and 3226 persons with measured levels of PIIINP (310 hip fractures). Among women, higher TGF-β1 levels were associated with lower hip fracture risk (HR, per doubling, 0.78 [95 % CI 0.61, 0.91]). Among men, TGF-β1 levels were associated with hip fracture risk in a non-linear manner, but among those with elevated CRP levels, doubling was associated with increased risk of fracture (HR 2.22 [1.20, 4.08]) (p = 0.02, interaction between low and high CRP and TGF-β1 on fracture risk). TGF-β1 levels had no significant association with total hip or total body BMD in women but were significantly associated with lower BMD in men. There were no associations of PIIINP levels with hip fracture risk or BMD in men or women. TGF-β1 levels appear to be associated with bone-related phenotypes in a sex-specific manner. The reasons for these differences between men and women regarding TGF-β1 levels and hip fracture risk and bone density require further investigation.

  14. 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

  15. 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.

  16. VaR: Exchange Rate Risk and Jump Risk

    Directory of Open Access Journals (Sweden)

    Fen-Ying Chen

    2010-01-01

    Full Text Available Incorporating the Poisson jumps and exchange rate risk, this paper provides an analytical VaR to manage market risk of international portfolios over the subprime mortgage crisis. There are some properties in the model. First, different from past studies in portfolios valued only in one currency, this model considers portfolios not only with jumps but also with exchange rate risk, that is vital for investors in highly integrated global financial markets. Second, in general, the analytical VaR solution is more accurate than historical simulations in terms of backtesting and Christoffersen's independence test (1998 for small portfolios and large portfolios. In other words, the proposed model is reliable not only for a portfolio on specific stocks but also for a large portfolio. Third, the model can be regarded as the extension of that of Kupiec (1999 and Chen and Liao (2009.

  17. 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

  18. High-sensitivity CRP is an independent risk factor for all fractures and vertebral fractures in elderly men: the MrOS Sweden study.

    Science.gov (United States)

    Eriksson, Anna L; Movérare-Skrtic, Sofia; Ljunggren, Östen; Karlsson, Magnus; Mellström, Dan; Ohlsson, Claes

    2014-02-01

    Epidemiological studies have shown low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) to be associated with fracture risk in women. However, it is still unclear whether hs-CRP is also associated with fracture risk in men. We therefore measured serum levels of hs-CRP in 2910 men, mean age 75 years, included in the prospective population-based MrOS Sweden cohort. Study participants were divided into tertile groups based on hs-CRP level. Fractures occurring after the baseline visit were validated (average follow-up 5.4 years). The incidence for having at least one fracture after baseline was 23.9 per 1000 person-years. In Cox proportional hazard regression analyses adjusted for age, hs-CRP was related to fracture risk. The hazard ratio (HR) of fracture for the highest tertile of hs-CRP, compared with the lowest and the medium tertiles combined, was 1.48 (95% CI, 1.20-1.82). Multivariate adjustment for other risk factors for fractures had no major effect on the associations between hs-CRP and fracture. Results were essentially unchanged after exclusion of subjects with hs-CRP levels greater than 7.5 mg/L, as well as after exclusion of subjects with a first fracture within 3 years of follow-up, supporting that the associations between hs-CRP and fracture risk were not merely a reflection of a poor health status at the time of serum sampling. Femoral neck bone mineral density (BMD) was not associated with hs-CRP, and the predictive role of hs-CRP for fracture risk was essentially unchanged when femoral neck BMD was added to the model (HR, 1.37; 95% CI, 1.09-1.72). Exploratory subanalyses of fracture type demonstrated that hs-CRP was clearly associated with clinical vertebral fractures (HR, 1.61; 95% CI, 1.12-2.29). We demonstrate, using a large prospective population-based study, that elderly men with high hs-CRP have increased risk of fractures, and that these fractures are mainly vertebral. The association between hs-CRP and fractures was

  19. Tramadol and the risk of fracture in an elderly female population: a cost utility assessment with comparison to transdermal buprenorphine.

    Science.gov (United States)

    Hirst, Alexander; Knight, Chris; Hirst, Matt; Dunlop, Will; Akehurst, Ron

    2016-03-01

    Opioid treatment for chronic pain is a known risk factor for falls and/or fractures in elderly patients. The latter cause a significant cost to the National Health Service and the Personal Social Services in the UK. Tramadol has a higher risk of fractures than some other opioid analgesics used to treat moderate-to-severe pain and, in the model described here, we investigate the cost effectiveness of transdermal buprenorphine treatment compared with tramadol in a high-risk population. A model was developed to assess the cost effectiveness of tramadol compared with transdermal buprenorphine over a 1-year time horizon and a patient population of high-risk patients (female patients age 75 or older). To estimate the total cost and quality-adjusted life years (QALYs) of treatment, published odds ratios are used in combination with the published incidence rates of four types of fracture: hip, wrist, humerus and other. The model shows tramadol to be associated with 1,058 more fractures per 100,000 patients per year compared with transdermal buprenorphine, resulting in transdermal buprenorphine being cost-effective with an incremental cost-effectiveness ratio of less than £7,000 compared with tramadol. Sensitivity analysis found this result to be robust. In the UK data, there is uncertainty regarding the transdermal buprenorphine odds ratios for fractures. Odds ratios published in Danish and Swedish studies show similar point estimates but are associated with less uncertainty. Transdermal buprenorphine is cost-effective compared to tramadol at a willingness-to-pay threshold of £20,000 per QALY.

  20. DYNAMIC STRENGTH AND STRAIN RATE EFFECTS ON FRACTURE BEHAVIOR OF TUNGSTEN AND TUNGSTEN ALLOYS

    OpenAIRE

    Zurek, A; G. Gray

    1991-01-01

    An investigation of the stress-strain response as a function of strain rate, spall strength, and dynamic fracture behavior of pure W, W-26Re, W-Ni- Fe and W-Ni-Fe-Co has been performed. Spall strength measurements, obtained in symmetric-impact tests, showed an increase in spall strength from 0.4 GPa for pure tungsten to 3.8 GPa for 90W-7Ni-3Fe. Concurrent with the increase in spall strength was a change in fracture mode from cleavage (for pure W) to a mixture of transgranular and intergranula...

  1. 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.

  2. The area moment of inertia of the tibia: a risk factor for stress fractures.

    Science.gov (United States)

    Milgrom, C; Giladi, M; Simkin, A; Rand, N; Kedem, R; Kashtan, H; Stein, M; Gomori, M

    1989-01-01

    In a prospective study of stress fractures among Israeli infantry recruits, the area moment of inertia of the tibia was found to have a statistically significant correlation with the incidence of tibial, femoral and total stress fractures. Recruits with "low" area moments of inertia of the tibia were found to have higher stress fracture morbidity than those with "high" area moments of inertia. The best correlation was obtained when the area moment of inertia was calculated about the AP axis of bending at a cross-sectional level corresponding to the narrowest tibial width on lateral X-rays, a point which is at the distal quarter of the tibia. This finding indicates that bending forces about the approximate AP axis are an important causal factor for tibial and many other stress fractures. The bone's bending strength, or ability to resist bending moments, as measured by the area moment of inertia, helps determine risk to stress fracture.

  3. 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

  4. Occupational physical demand and risk of hip fracture in older women.

    Science.gov (United States)

    Palumbo, Aimee J; Michael, Yvonne L; Burstyn, Igor; Lee, Brian K; Wallace, Robert

    2015-08-01

    Hip fractures are leading causes of disability, morbidity and mortality among older women. Since physical activity helps maintain physical functioning and bone mineral density, occupational physical demand may influence fracture risk. This study investigates the association of occupational physical demand with hip fracture incidence among women. The Women's Health Initiative Observational Study is a multiethnic cohort of 93,676 postmenopausal women, 50-79 years of age at enrolment, enrolled from 1994 to 1998 at 40 geographically diverse clinical centres throughout the USA. Outcomes including hip fractures were assessed annually and up to 3 jobs held since age 18 years were reported by each woman. Occupational physical demand levels were assigned for each job through linkage of occupational titles with Standard Occupational Codes and the Occupational Information Network. Average, cumulative and peak physical demand scores both before and after menopause and throughout women's work life were estimated. Women were followed through 2010 for an average of 11.5 years; 1834 hip fractures occurred during this time. We did not observe an overall association of occupational physical demand with subsequent risk of hip fracture after adjusting for age, race/ethnicity, birth region and education. Previous research on occupations and hip fracture risk in women is inconclusive. This study was able to take critical risk periods into account and control for confounding factors in a large cohort of older women to show that overall occupational physical demand neither increases nor decreases risk of hip fracture later in life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Crack growth rates and fracture toughness of irradiated austenitic stainless steels in BWR environments.

    Energy Technology Data Exchange (ETDEWEB)

    Chopra, O. K.; Shack, W. J.

    2008-01-21

    In light water reactors, austenitic stainless steels (SSs) are used extensively as structural alloys in reactor core internal components because of their high strength, ductility, and fracture toughness. However, exposure to high levels of neutron irradiation for extended periods degrades the fracture properties of these steels by changing the material microstructure (e.g., radiation hardening) and microchemistry (e.g., radiation-induced segregation). Experimental data are presented on the fracture toughness and crack growth rates (CGRs) of wrought and cast austenitic SSs, including weld heat-affected-zone materials, that were irradiated to fluence levels as high as {approx} 2x 10{sup 21} n/cm{sup 2} (E > 1 MeV) ({approx} 3 dpa) in a light water reactor at 288-300 C. The results are compared with the data available in the literature. The effects of material composition, irradiation dose, and water chemistry on CGRs under cyclic and stress corrosion cracking conditions were determined. A superposition model was used to represent the cyclic CGRs of austenitic SSs. The effects of neutron irradiation on the fracture toughness of these steels, as well as the effects of material and irradiation conditions and test temperature, have been evaluated. A fracture toughness trend curve that bounds the existing data has been defined. The synergistic effects of thermal and radiation embrittlement of cast austenitic SS internal components have also been evaluated.

  6. Change in hip bone mineral density and risk of subsequent fractures in older men.

    Science.gov (United States)

    Cawthon, Peggy M; Ewing, Susan K; Mackey, Dawn C; Fink, Howard A; Cummings, Steven R; Ensrud, Kristine E; Stefanick, Marcia L; Bauer, Doug C; Cauley, Jane A; Orwoll, Eric S

    2012-10-01

    Low bone mineral density (BMD) increases fracture risk; how changes in BMD influence fracture risk in older men is uncertain. BMD was assessed at two to three time points over 4.6 years using dual-energy X-ray absorptiometry (DXA) for 4470 men aged ≥65 years in the Osteoporotic Fractures in Men (MrOS) Study. Change in femoral neck BMD was estimated using mixed effects linear regression models. BMD change was categorized as "accelerated" (≤-0.034 g/cm(2) ), "expected" (between 0 and -0.034 g/cm(2) ), or "maintained" (≥0 g/cm(2) ). Fractures were adjudicated by central medical record review. Multivariate proportional hazards models estimated the risk of hip, nonspine/nonhip, and nonspine fracture over 4.5 years after the final BMD measure, during which time 371 (8.3%) men experienced at least one nonspine fracture, including 78 (1.7%) hip fractures. Men with accelerated femoral neck BMD loss had an increased risk of nonspine (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.4-2.8); nonspine/nonhip (HR = 1.6; 95% CI 1.1-2.3); and hip fracture (HR = 6.3; 95% CI 2.7-14.8) compared with men who maintained BMD over time. No difference in risk was seen for men with expected loss. Adjustment for the initial BMD measure did not alter the results. Adjustment for the final BMD measure attenuated the change in BMD-nonspine fracture and the change in BMD-nonspine/nonhip relationships such that they were no longer significant, whereas the change in the BMD-hip fracture relationship was attenuated (HR = 2.6; 95% CI 1.1-6.4). Total hip BMD change produced similar results. Accelerated decrease in BMD is a strong, independent risk factor for hip and other nonspine fractures in men. Copyright © 2012 American Society for Bone and Mineral Research.

  7. Risk factors for equine fractures in Thoroughbred flat racing in North America.

    Science.gov (United States)

    Georgopoulos, Stamatis Panagiotis; Parkin, Tim D H

    2017-04-01

    The aim of this paper is to identify risk factors associated with equine fractures in flat horse racing of Thoroughbreds in North America. Equine fractures were defined as any fracture sustained by a horse during a race. This was a cohort study that made use of all starts from the racecourses reporting injuries. The analysis was based on 2,201,152 racing starts that represent 91% of all official racing starts in the USA and Canada from 1st January 2009-31st December 2014. Approximately 3,990,000 workout starts made by the 171,523 Thoroughbreds that raced during that period were also included in the analysis. During this period the incidence of equine fractures was 2 per 1000 starts. The final multivariable logistic regression models identified risk factors significantly associated (phorses were found to have a 32% higher chance of sustaining a fracture when racing on a dirt surface compared to a synthetic surface; a 35% higher chance if they had sustained a previous injury during racing and a 47% higher chance was also found for stallions compared to mares and geldings. Furthermore, logistic regression models based on data available only from the period 2009-2013 were used to predict the probability of a Thoroughbred sustaining a fracture for 2014. The 5% of starts that had the highest score in our predictive models for 2014 were found to have 2.4 times (95% CI: 1.9-2.9) higher fracture prevalence than the mean fracture prevalence of 2014. The results of this study can be used to identify horses at higher risk on entering a race and could help inform the design and implementation of preventive measures aimed at minimising the number of Thoroughbreds sustaining fractures during racing in North America. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Calcaneal Fractures in Non-Racing Dogs and Cats: Complications, Outcome, and Associated Risk Factors.

    Science.gov (United States)

    Perry, Karen L; Adams, Robert J; Woods, Samantha; Bruce, Mieghan

    2017-01-01

    To estimate the prevalence of complications and describe the outcome associated with calcaneal fractures in non-racing dogs and in cats. Retrospective multicenter clinical cohort study. Medical records of client-owned dogs and cats (2004-2013). Medical records were searched and 50 animals with calcaneal fractures were included for analysis. Complications were recorded and an outcome score applied to each fracture. Associations between putative risk factors and both major complications, and final outcome scores were explored. Complications occurred in 27/50 fractures (61%) including 23 major and 4 minor complications. At final follow-up, 4 animals (10%) were sound, 27 (64%) had either intermittent or consistent mild weight-bearing lameness, 7 (17%) had moderate weight-bearing lameness, and 1 (2%) had severe weight-bearing lameness. Fractures managed using plates and screws had a lower risk of complications than fractures managed using pin and tension band wire, lag or positional screws or a combination of these techniques (Relative risk 0.16, 95% CI 0.02-1.02, P=.052). Non-sighthounds had reduced odds of a poorer outcome score than sighthounds (Odds ratio 0.11, 95% CI 0.02-0.50, P=.005) and fractures with major complications had 13 times the odds of a poorer outcome score (Odds ratio 13.4, 95% CI 3.6-59.5, Pdogs and in cats, and a poorer outcome score was more likely in animals with complications. A more guarded prognosis should be given to owners of non-racing dogs or cats with calcaneal fractures than previously applied to racing Greyhounds with calcaneal fractures. © 2016 The American College of Veterinary Surgeons.

  9. Bone strength measured by peripheral quantitative computed tomography and the risk of nonvertebral fractures: the osteoporotic fractures in men (MrOS) study.

    Science.gov (United States)

    Sheu, Yahtyng; Zmuda, Joseph M; Boudreau, Robert M; Petit, Moira A; Ensrud, Kristine E; Bauer, Douglas C; Gordon, Christopher L; Orwoll, Eric S; Cauley, Jane A

    2011-01-01

    Many fractures occur in individuals without osteoporosis defined by areal bone mineral density (aBMD). Inclusion of other aspects of skeletal strength may be useful in identifying at-risk subjects. We used surrogate measures of bone strength at the radius and tibia measured by peripheral quantitative computed tomography (pQCT) to evaluate their relationships with nonvertebral fracture risk. Femoral neck (FN) aBMD, measured by dual-energy X-ray absorptiometry (DXA), also was included. The study population consisted of 1143 white men aged 69+ years with pQCT measures at the radius and tibia from the Minneapolis and Pittsburgh centers of the Osteoporotic Fractures in Men (MrOS) study. Principal-components analysis and Cox proportional-hazards modeling were used to identify 21 of 58 pQCT variables with a major contribution to nonvertebral incident fractures. After a mean 2.9 years of follow-up, 39 fractures occurred. Men without incident fractures had significantly greater bone mineral content, cross-sectional area, and indices of bone strength than those with fractures by pQCT. Every SD decrease in the 18 of 21 pQCT parameters was significantly associated with increased fracture risk (hazard ration ranged from 1.4 to 2.2) independent of age, study site, body mass index (BMI), and FN aBMD. Using area under the receiver operation characteristics curve (AUC), the combination of FN aBMD and three radius strength parameters individually increased fracture prediction over FN aBMD alone (AUC increased from 0.73 to 0.80). Peripheral bone strength measures are associated with fracture risk and may improve our ability to identify older men at high risk of fracture.

  10. Neonatal vitamin D status from archived dried blood spots and future risk of fractures in childhood

    DEFF Research Database (Denmark)

    Händel, Mina Nicole; Frederiksen, Peder; Cohen, Arieh

    2017-01-01

    Background: Whether antenatal and neonatal vitamin D status have clinical relevance in fracture prevention has not been examined extensively, although observational studies indicate that fetal life may be a sensitive period in relation to bone growth and mineralization during childhood.......Objective: We examined whether 25-hydroxyvitamin D3 [25(OH)D3] concentrations in stored neonatal dried blood spot (DBS) samples are associated with pediatric fracture risk. We hypothesized that in particular, low neonatal vitamin D status may be a risk factor for fracture incidence among children.......Design: In a register-based case-cohort study design, the case group was composed of 1039 individuals who were randomly selected from a total of 82,154 individuals who were born during 1989-1999 and admitted to a Danish hospital with a fracture of the forearm, wrist, scaphoid bone, clavicle, or ankle at age 6-13 y...

  11. 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

    Of Peripheral OSteoporosis study were evaluated. OUTCOME MEASURES: The outcome measures included BMD at the lumbar spine, femoral neck, and total proximal femur assessed at baseline and after a follow-up of 1 and 3 yr; semiquantitative visual assessment of vertebral fractures; and nonvertebral fractures based...... on written documentation. RESULTS: After 3 yr of strontium ranelate treatment, each percentage point increase in femoral neck and total proximal femur BMD was associated with a 3% (95% adjusted confidence interval, 1-5%) and 2% (1-4%) reduction in risk of a new vertebral fracture, respectively. The 3-yr...

  12. 13 CFR 120.1015 - Risk Rating System.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Risk Rating System. 120.1015 Section 120.1015 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Risk-Based Lender Oversight Supervision § 120.1015 Risk Rating System. (a) Risk Rating. SBA may assign a Risk...

  13. Loading rate effects on the fracture of Ni/Au nano-coated acrylic particles

    Directory of Open Access Journals (Sweden)

    Z. L. Zhang

    2012-03-01

    Full Text Available Mechanical failure of monodisperse Ni/Au coated acrylic particles has been investigated by individual compression tests using nanoindentation-based technique equipped with a flat diamond punch. We have found that both fracture property and morphology of particles depend on the compression loading rate. The breaking strain of the metal coating decreases with increasing loading rate, while the breaking stress increases. Two obvious fracture patterns with cracking in meridian or latitude direction are identified according to the loading rate, and attributed respectively to tension- or bendingdominated deformation of the coating. The findings reported here give a significant guiding to the manufacture design of metal coated polymer particles for Anisotropic Conductive Adhesive (ACA packaging.

  14. 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

    OBJECTIVE: To assess the risk of fracture attributable to prostate cancer, and the impact of exposure to prescribed gonadotrophin-releasing hormone agonists and antiandrogens on this risk in a nationwide, population-based case-control study. PATIENTS AND METHODS: Data from the Danish National...

  15. Protein intake and risk of hip fractures in postmenopausal women and men age 50 and older.

    Science.gov (United States)

    Fung, T T; Meyer, H E; Willett, W C; Feskanich, D

    2017-04-01

    In this study, we followed postmenopausal women and men aged 50 and above for up to 32 years and found no evidence that higher protein intake increased the risk of hip fracture. Protein intake from specific sources was inversely associated with risk, but these associations appeared to differ by gender.

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

    DEFF Research Database (Denmark)

    Petersen, Sesilje Elise Bondo

    , 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...

  17. Ankylosing spondylitis confers substantially increased risk of clinical spine fractures : a nationwide case-control study

    NARCIS (Netherlands)

    Prieto-Alhambra, D; Muñoz-Ortego, J; De Vries, F; Vosse, D; Arden, N K; Bowness, P; Cooper, C; Diez-Perez, A; Vestergaard, P

    2015-01-01

    UNLABELLED: Ankylosing spondylitis (AS) leads to osteopenia/osteoporosis and spine rigidity. We conducted a case-control study and found that AS-affected patients have a 5-fold and 50 % increased risk of clinical spine and all clinical fractures, respectively. Excess risk of both is highest in the f

  18. Coffee consumption and risk of fractures: a systematic review and dose-response meta-analysis.

    Science.gov (United States)

    Lee, Dong Ryul; Lee, Jungun; Rota, Matteo; Lee, Juneyoung; Ahn, Hyeong Sik; Park, Sang Min; Shin, Doosup

    2014-06-01

    The data on the association between coffee consumption and the risk of fractures are inconclusive. We performed a comprehensive literature review and meta-analysis to better quantify this association. We identified all potentially relevant articles by searching MEDLINE, EMBASE, Cochrane Library, Web of Science, SCOPUS, and CINAHL (until February 2013). The keywords "coffee," "caffeine," "drink," and "beverage" were used as the exposure factors, and the keyword "fracture" was used as the outcome factor. We determined the overall relative risk (RR) and confidence interval (CI) for the highest and lowest levels of coffee consumption. A dose-response analysis was performed to assess the risk of fractures based on the level of coffee consumption. We included 253,514 participants with 12,939 fracture cases from 9 cohort and 6 case-control studies. The estimated RR of fractures at the highest level of coffee consumption was 1.14 (95% CI: 1.05-1.24; I(2)=0.0%) in women and 0.76 (95% CI: 0.62-0.94; I(2)=7.3%) in men. In the dose-response analysis, the pooled RRs of fractures in women who consumed 2 and 8 cups of coffee per day were 1.02 (95% CI: 1.01-1.04) and 1.54 (95% CI: 1.19-1.99), respectively. Our meta-analysis suggests that daily consumption of coffee is associated with an increased risk of fractures in women and a contrasting decreased risk in men. However, future well-designed studies should be performed to confirm these findings. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. 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.

  20. 骨质疏松骨折后再骨折的临床风险因素%Analysis on the risk factors of second fracture in fracture related to osteoporosis

    Institute of Scientific and Technical Information of China (English)

    阮文东; 王沛; 雪原; 马信龙; 周先虎

    2011-01-01

    目的 探讨骨质疏松患者初次骨折后发生再骨折的风险及其临床特点.方法 收集2006年1月至2008年1月门诊及住院的年龄50岁以上、临床可确诊的骨质疏松骨折患者273例,根据是否有骨质疏松骨折病史分为再骨折组48例和骨折组225例.分析患者一般资料、骨折类型、股骨颈DXA骨密度测定T值、Charlson合并症指数、骨折时间等临床特征,并行运动协调技能评价.结果 骨折组年龄(67.7±8.5)岁,再骨折组(72.7±9.5)岁;再骨折组女性占77.1%,高于骨折组女性构成比70.2%;再骨折类型以椎体骨折后再次发生股骨颈骨折最多见,其次为股骨颈骨折后再次发生股骨颈骨折.再骨折发生的风险因素包括高龄(>75岁,HR=1.23;>85岁,HR=1.68)、女性(HR=1.36)、曾发生椎体骨折(HR=1.62)、曾发生髋部骨折(HR=1.27),骨密度-T值<-3.5(HR=1.38)及运动协调技能减退(HR=1.27).再骨折平均发生于初次骨折后(3.7±2.5)年.骨折组随访2年内再骨折发生率4.9%(11/225).结论 有初次骨质疏松骨折病史的患者发生再骨折的风险仍然很明显,两次骨折之间有足够的间隔采取措施降低再骨折的风险.特别是对发生椎体、髋部骨折的老年女性应进行干预,进行运动协调技能的康复训练和防跌倒练习.%Objective To explore the clinical characteristics and risk factors of re-fracture in patients suffering from osteoporosis-related fractures as well as effective interventions.Methods From January 2006 to January 2008,a total of 273 patients with osteoporosis-related fracture were entered in the study,including out-patients and in-patients who were over 50 years old.The patients were divided into fracture group(n=225)and re-fracture group(n=48).The re-fracture rate was followed up for 2 years,during which 11 patients developed re-fracture.General data including age and sex,fracture types,femoral neck bone mineral density(BMD)T-scores tested by dual-energy X

  1. 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.

  2. Risk assessment tools to identify women with increased risk of osteoporotic fracture: complexity or simplicity? A systematic review.

    Science.gov (United States)

    Rubin, Katrine Hass; Friis-Holmberg, Teresa; Hermann, Anne Pernille; Abrahamsen, Bo; Brixen, Kim

    2013-08-01

    A huge number of risk assessment tools have been developed. Far from all have been validated in external studies, more of them have absence of methodological and transparent evidence, and few are integrated in national guidelines. Therefore, we performed a systematic review to provide an overview of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance of each tool was sufficient for practical use, and last, to examine whether the complexity of the tools influenced their discriminative power. We searched PubMed, Embase, and Cochrane databases for papers and evaluated these with respect to methodological quality using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist. A total of 48 tools were identified; 20 had been externally validated, however, only six tools had been tested more than once in a population-based setting with acceptable methodological quality. None of the tools performed consistently better than the others and simple tools (i.e., the Osteoporosis Self-assessment Tool [OST], Osteoporosis Risk Assessment Instrument [ORAI], and Garvan Fracture Risk Calculator [Garvan]) often did as well or better than more complex tools (i.e., Simple Calculated Risk Estimation Score [SCORE], WHO Fracture Risk Assessment Tool [FRAX], and Qfracture). No studies determined the effectiveness of tools in selecting patients for therapy and thus improving fracture outcomes. High-quality studies in randomized design with population-based cohorts with different case mixes are needed.

  3. Is the quality of drinking water a risk factor for self-reported forearm fractures? Cohort of Norway.

    Science.gov (United States)

    Dahl, C; Søgaard, A J; Tell, G S; Flaten, T P; Krogh, T; Aamodt, G

    2013-02-01

    Compared to pH ≥7.0 in Norwegian municipal drinking water, pH  0.05) after adjustments for indicators of bacteria and organic matter, which may signify an association between poor drinking water and bone health. The Norwegian population has the highest rate of fractures ever reported. A large variation in fracture rate both between and within countries indicates that an environmental factor, such as the quality of drinking water, could be one of the causes of the disparities. Our aim was to investigate a possible association between pH (an important parameter for water quality) and self-reported forearm fracture and to examine whether other water quality factors could account for this association. Using Geographic Information Systems, information on the quality of drinking water was linked to CONOR (n = 127,272; mean age, 50.2 ± 15.8 years), a database comprising ten regional epidemiological health surveys from across the country in the time period 1994-2003. The highest risk of forearm fracture was found at a pH of around 6.75, with a decreasing risk toward both higher and lower pH values. The increased adjusted odds of forearm fracture in men consuming municipal drinking water with pH water with pH ≥7.0 was odds ratio (OR) = 1.19 (95 % CI, 1.14, 1.25), and the corresponding increased odds in women was OR = 1.14 (95 % CI, 1.08, 1.19). This association was attenuated (p > 0.05) after further adjustments for other water quality factors (color grade, intestinal enterococci, and Clostridium perfringens). Our findings indicate a higher risk of fracture when consuming water of an acidic pH; however, the risk does not only seem to be due to the acidity level per se, but also to other aspects of water quality associated with pH.

  4. Risk factors associated with the occurrence of proximal humerus fractures in patients with rheumatoid arthritis: a custom strategy for preventing proximal humerus fractures.

    Science.gov (United States)

    Ochi, Kensuke; Furuya, Takefumi; Ishibashi, Mina; Watanabe, Makiko; Ikari, Katsunori; Taniguchi, Atsuo; Yamanaka, Hisashi; Momohara, Shigeki

    2016-02-01

    To our knowledge, no prior report focused on the risk factors for proximal humerus fractures in patients with rheumatoid arthritis. The purpose of this study was to evaluate the association between potential risk factors and the occurrence of proximal humerus fractures in patients with rheumatoid arthritis. A total of 11,907 patients with rheumatoid arthritis were enrolled in our observational cohort rheumatoid arthritis study between 2000 and 2012. Self-reported proximal humerus fractures were verified using the patients' medical records. Cox proportional hazard models were used to analyze the independent contribution of risk factors to the occurrence of proximal humerus fractures. During follow-up (mean 5.6 years), 92 proximal humerus fractures were verified in 91 patients. Multivariate Cox regression analyses estimated that the hazard ratios of sustaining a proximal humerus fracture were 1.37 for every 10-year increase in age [95 % confidence interval (CI) 1.10-1.70; P rheumatoid arthritis with a smaller daily prednisolone dose in elderly patients with a history of fractures may be important for preventing proximal humerus fractures.

  5. Bone mineral density and fractures after risk-reducing salpingo-oophorectomy in women at increased risk for breast and ovarian cancer

    NARCIS (Netherlands)

    Fakkert, Ingrid E.; Abma, Elske Marije; Westrik, Iris G.; Lefrandt, Joop D.; Wolffenbuttel, Bruce H. R.; Oosterwijk, Jan C.; Slart, Riemer H. J. A.; van der Veer, Eveline; de Bock, Geertruida H.; Mourits, Marian J. E.

    AIM: Risk-reducing salpingo-oophorectomy (RRSO) reduces ovarian cancer risk in BRCA mutation carriers. RRSO is assumed to decrease bone mineral density (BMD) and increase fracture risk more than natural menopause. We aimed to compare BMD and fracture incidence after premenopausal RRSO to general

  6. Dietary patterns and risk of hip fractures in postmenopausal women and men over 50 years

    Science.gov (United States)

    Fung, Teresa T.; Feskanich, Diane

    2016-01-01

    Purpose We examined the association between predominant dietary patterns and risk of hip fractures in postmenopausal women and men over 50 years. Methods We used data from 74,540 women in the Nurses’ Health Study followed between 1980 and 2010, and 35,451 men from the Health Professionals Follow-up Study followed between 1986 and 2012 for this analysis. Health and lifestyle information was assessed every two years. Diet was assessed approximately every four years with a food frequency questionnaire. Two major dietary patterns were previously derived using principal component analysis. The Prudent pattern is characterized by higher intakes of fruits, vegetables, whole grains, and poultry, and the Western pattern is characterized by higher intakes of red and processed meats, sweets, and refined grains. We computed relative risks (RR) for hip fracture by dietary pattern scores using Cox proportional hazards models, adjusting for potential confounders. Results During follow-up, there were 1891 hip fractures in women and 596 in men. No association was observed between the Prudent or Western pattern and risk of hip fractures in either men or women. We also did not find an association among lean (BMI=25) individuals or among those with higher or lower levels of physical activity. Conclusion Neither the Prudent nor the Western dietary pattern was associated with risk of hip fractures in postmenopausal women or men over 50 years of age. PMID:25731807

  7. Role of endocrine-immune dysregulation in osteoporosis, sarcopenia, frailty and fracture risk.

    Science.gov (United States)

    Joseph, Cherian; Kenny, Anne M; Taxel, Pamela; Lorenzo, Joseph A; Duque, Gustavo; Kuchel, George A

    2005-06-01

    Osteoporosis, a key predictor of hip fractures can be treated using a variety of safe and effective interventions. Nevertheless, optimally effective strategies for the prevention of hip fractures must also incorporate efforts to address a broad range of other potentially reversible factors. Hyperthyroidism, anticonvulsants, caffeine and smoking may decrease bone mass and increase fracture risk at any age. In older individuals it is important to also consider additional risk factors, including long-acting benzodiazepines, poor vision and sarcopenia. The presence of sarcopenia, an age-related decline in muscle bulk and quality enhances the risk of frailty and possibly also hip fracture, particularly if associated with diminished functional mobility, lower quadriceps strength and poor balance or body sway. In this review we examine evidence which indicates the presence of endocrine-immune dysregulation in both osteoporosis and sarcopenia. Post-menopausal declines in serum estrogen and androgen levels contribute to increases in local bone levels of cytoclastic cytokines, followed by increased osteoclastogenesis and bone loss. Similarly, the presence of decreased gonadal hormones and IGF-1, combined with unusually high peripheral levels of cytokines, inflammatory mediators and coagulation markers all enhance the risk of sarcopenia and frailty. We propose that a translational research approach which emphasizes common pathophysiologic mechanisms in osteoporosis and sarcopenia could accelerate the speed of discovery of effective strategies for both frailty and hip fracture prevention.

  8. Risk of acute renal failure and mortality after surgery for a fracture of the hip

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Christiansen, Christian Fynbo; Gammelager, Henrik

    2016-01-01

    AIMS: We examined risk of developing acute renal failure and the associated mortality among patients aged > 65 years undergoing surgery for a fracture of the hip. PATIENTS AND METHODS: We used medical databases to identify patients who underwent surgical treatment for a fracture of the hip...... in Northern Denmark between 2005 and 2011. Acute renal failure was classified as stage 1, 2 and 3 according to the Kidney Disease Improving Global Outcome criteria. We computed the risk of developing acute renal failure within five days after surgery with death as a competing risk, and the short-term (six...... to 30 days post-operatively) and long-term mortality (31 days to 365 days post-operatively). We calculated adjusted hazard ratios (HRs) for death with 95% confidence intervals (CIs). RESULTS: Among 13 529 patients who sustained a fracture of the hip, 1717 (12.7%) developed acute renal failure post...

  9. Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level

    DEFF Research Database (Denmark)

    Thorell, Kristine; Ranstad, Karin; Midlöv, Patrik;

    2014-01-01

    BACKGROUND: Risk factors for hip fracture are well studied because of the negative impact on patients and the community, with mortality in the first year being almost 30% in the elderly. Age, gender and fall risk-increasing drugs, identified by the National Board of Health and Welfare in Sweden...... level and risk of hip fracture in an elderly population. METHODS: Data were from Östergötland County, Sweden, and comprised the total population in the county aged 75 years and older during 2006. The odds ratio (OR) for hip fracture during use of fall risk-increasing drugs was calculated by multivariate......, are well known risk factors for hip fracture, but how multimorbidity level affects the risk of hip fracture during use of fall risk-increasing drugs is to our knowledge not as well studied. This study explored the relationship between use of fall risk-increasing drugs in combination with multimorbidity...

  10. Combined Measures of Dynamic Bone Quality and Postural Balance--A Fracture Risk Assessment Approach in Osteoporosis.

    Science.gov (United States)

    Bhattacharya, Amit; Watts, Nelson B; Dwivedi, Alok; Shukla, Rakesh; Mani, Ashutosh; Diab, Dima

    2016-01-01

    We evaluated functional measures of neuromuscular integrity and bone's resistance to fracture as a combined tool in discriminating osteoporosis patients with and without fractures. Functional aspects of neuromuscular integrity were quantified with a noninvasive measure of static and dynamic functional postural stability (FPS), and fracture resistance was obtained with bone shock absorption in patients with osteoporosis aged 65-85 and compared our measures with dual-energy X-ray absorptiometry and Fracture Risk Assessment Tool (FRAX [World Health Organization Collaborating Center for Metabolic Bone Diseases, Sheffield, UK]) in women with osteoporosis, some with and some without vertebral fractures. Patients with vertebral fracture showed larger static FPS (postural sway excursion) in the mediolateral and anterior-posterior directions, suggesting poorer balance. Most of the variables of dynamic FPS showed significant differences between fracture and no-fracture groups (e.g., the fracture group took significantly longer during turning, implying poorer dynamic balance control). Also, compared with healthy control subjects, all 4 dynamic FPS responses for osteoporosis patients with and without fracture were significantly poorer, suggesting potential risk for falls. In summary, patients with osteoporosis who have vertebral fractures (compared with patients with similarly low bone mineral density and other nonfracture risk fractures) have not only lower bone shock absorption damping (ζ) but also increased postural imbalance.

  11. 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.

  12. Risk of onlay fracture during pre-cementation functional occlusal tapping.

    Science.gov (United States)

    Magne, Pascal; Schlichting, Luis H; Paranhos, Maria P G

    2011-09-01

    To evaluate in vitro the pre-cementation resistance of CAD/CAM onlays subjected to functional occlusal tapping. An extracted tooth model (molar and premolar) with simulated bone and periodontal ligament was used to make a mesio-occlusal onlay preparation (two mesial cusps covered). Immediate dentin sealing was applied to the prepared tooth. The corresponding onlays were fabricated with Cerec either using composite resin (Paradigm MZ100) or ceramic (e.max CAD and Mark II) (n=14). An elevated marginal ridge was designed with the intention of generating hyper-occlusion. Pre-cementation occlusal tapping was simulated using closed-loop servo-hydraulics at 2 Hz, starting with a load of 40 N, followed by 80, 120, 160, 200, 240 and 280 N (10 cycles each). All samples were loaded until fracture or to a maximum of 70 cycles. Groups were compared using the life table survival analysis (p=.016, Bonferroni method). Survival probability was MZ100>e.max CAD>Mark II. The restorations made from e.max CAD and Mark II failed at an average load of 157 N and 123 N, respectively with no specimen withstanding all 70 load cycles (survival 0%); with MZ100 the survival rate was 36%. Material selection has a significant effect on the risk of CAD/CAM onlay fracture during pre-cementation functional occlusal tapping with composite resin onlays showing the minimum risk compared to ceramic ones. Copyright © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  13. Infection Reduces Return-to-duty Rates for Soldiers with Type III Open Tibia Fractures

    Science.gov (United States)

    2014-09-01

    Type III open tibia fracture and tabulated the prevalence of infectious complications.We searched the Physical Evaluation Board database to determine...disability among combat casualties, with an average disability rating of 42% based on the Physical Evaluation Board.8 In addition, it has been...redness, warmth , swelling, or purulence that required operative inter- vention. Osteomyelitis was defined as deep infection with positive bone cultures

  14. Correlation of fracture features with mechanical properties as a function of strain rate in zirconium alloys

    Energy Technology Data Exchange (ETDEWEB)

    Das, Arpan; Chakravartty, Jayanta Kumar [Bhabha Atomic Research Centre (Department of Atomic Energy), Trombay, Mumbai, Maharashtra (India). Mechanical Metallurgy Div.

    2016-02-15

    Two dimensional fracture features (i. e., dimple diameter, extent of tearing ridges etc.) quantified from the tensile fractographs are investigated to predict the nature of variation in mechanical properties with strain rates in zirconium alloys tested under ambient temperature where the initial inclusion or other second phase particle contents were kept unaltered. It has been possible to reasonably estimate the strength and ductility properties of an alloy from a systematic analysis of fractographic features.

  15. Determining the risk of falling in elderly patients undergoing hip fracture surgery.

    Science.gov (United States)

    Seyhan, E; Cavdar, I

    2014-01-01

    PURPOSE OF THE STUDY This study examines the risk of falling in elderly patients who underwent hip fracture surgery in the orthopaedic clinic during the postoperative period. MATERIALS AND METHODS This study was a cross-sectional study. The study sample consisted of 71 elderly patients aged more than 65 years undergoing hip fracture surgery. A questionnaire, the Tinetti balance test and the mini-mental state examination (MMSE) were used. RESULTS The analyses included 71 elderly patients with a mean age of 78.45 years. All patients had been hospitalized for hip fracture due to falling, and 29.6% had a history of falling in the one year prior to hospitalization. The mean MMSE score was 18.37 ± 6.54 and the mean Tinetti score was 11.10 ± 6.66. CONCLUSION We found that as the mean age of the elderly patients increased, the risk of falling also increased and the MMSE scores deteriorate and that the elderly patients living alone were at a greater risk of falling and had worse cognitive function, that those with a history of falling before hospitalization were at a greater risk of falling again and that the risk of falling increased as cognitive function declined. Key words:elderly, falling, hip fracture, risk of falling.

  16. 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

  17. Notch Fracture Toughness of Glasses: Dependence on Rate, Age, and Geometry

    Science.gov (United States)

    Vasoya, Manish; Rycroft, Chris H.; Bouchbinder, Eran

    2016-08-01

    Understanding the fracture toughness (resistance) of glasses is a fundamental problem of prime theoretical and practical importance. Here we theoretically study its dependence on the loading rate, the age (history) of the glass, and the notch radius ρ . Reduced-dimensionality analysis suggests that the notch fracture toughness results from a competition between the initial, age- and history-dependent, plastic relaxation time scale τ0pl and an effective loading time scale τext(K˙ I,ρ ) , where K˙ I is the tensile stress-intensity-factor rate. The toughness is predicted to scale with √{ρ } independently of ξ ≡τext/τ0pl for ξ ≪1 , to scale as T √{ρ }log (ξ ) for ξ ≫1 (related to thermal activation, where T is the temperature), and to feature a nonmonotonic behavior in the crossover region ξ ˜O (1 ) (related to plastic yielding dynamics). These predictions are verified using 2D computations, providing a unified picture of the notch fracture toughness of glasses. The theory highlights the importance of time-scale competition and far-from-steady-state elasto-viscoplastic dynamics for understanding the toughness and shows that the latter varies quite significantly with the glass age (history) and applied loading rate. Experimental support for bulk metallic glasses is presented, and possible implications for applications are discussed.

  18. High-Sensitivity CRP Is an Independent Risk Factor for All Fractures and Vertebral Fractures in Elderly Men: The MrOS Sweden Study

    OpenAIRE

    Eriksson, Anna L; Movérare-Skrtic, Sofia; Ljunggren, Östen; Karlsson, Magnus; Mellström, Dan; Ohlsson, Claes

    2014-01-01

    Epidemiological studies have shown low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) to be associated with fracture risk in women. However, it is still unclear whether hs-CRP is also associated with fracture risk in men. We therefore measured serum levels of hs-CRP in 2910 men, mean age 75 years, included in the prospective population-based MrOS Sweden cohort. Study participants were divided into tertile groups based on hs-CRP level. Fractures occurring after the...

  19. Risk Stratification of Stress Fractures and Prediction of Return-to-Duty

    Science.gov (United States)

    2016-12-01

    Award Number: W81XWH-15-C-0024 TITLE: Risk Stratification of Stress Fractures and Prediction of Return -to-Duty PRINCIPAL INVESTIGATOR: Mary L...SUBTITLE Risk Stratification of Stress Fractures and Prediction of Return -to-Duty 5a. CONTRACT NUMBER W81XWH-15-C-0024 Return -to-Duty 5b. GRANT... RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE December 2016 2. REPORT TYPE Annual 3. DATES COVERED 15 Nov 2015- 14 Nov 2016 4. TITLE AND

  20. Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence

    DEFF Research Database (Denmark)

    Roerholt, C; Eiken, P; Abrahamsen, B

    2009-01-01

    SUMMARY: Initiation and compliance with anti-osteoporotic therapy was assessed in 152,777 fracture patients in a national population-based cohort study. Prescription rates were low, especially following hip fracture. Persistence has improved with almost 2/3 of patients who began raloxifene or wee...

  1. 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

    age, crown fracture type, mobility and response to an electric pulp test (EPT) at the initial examination. Results:  Teeth with immature root development: The risk of PN was increased in teeth with a concomitant enamel fracture (log-rank test: P = 0.002), enamel–dentin fracture (log-rank test: P ...The reported risk of pulp necrosis (PN) is generally low in teeth with subluxation injuries. A concomitant crown fracture may increase the risk of PN in such teeth. Aim:  To analyse the influence of a concomitant trauma-related infraction, enamel-, enamel–dentin- or enamel–dentin–pulp fracture...... on the risk of PN in permanent teeth with subluxation injury. Material and Methods:  The study included 404 permanent incisors with subluxation injury from 289 patients (188 male, 101 female). Of these teeth, 137 had also suffered a concomitant crown fracture. All the teeth were examined and treated according...

  2. A long-term follow-up of 221 hip fracture patients in southeastern Finland: analysis of survival and prior or subsequent fractures.

    Science.gov (United States)

    Lüthje, Peter; Helkamaa, Teemu; Kaukonen, Juha-Pekka; Nurmi-Lüthje, Ilona; Kataja, Matti

    2012-01-01

    To analyze the type and effect of prior and subsequent fractures in a hip fracture cohort. Hip fracture patients (n=221) were followed for a mean of 8 years and all prior and subsequent fractures were studied. Incidence of the first fracture and subsequent fractures according to sex, age group, and time between the first and the index hip fracture were measured. The absolute fracture risk was measured in the study subjects and in the age groups hip fracture patients had sustained previous fractures. In men, these were mostly ankle or hip fractures, and in women, wrist fractures. Of the subjects, 24% suffered a subsequent fracture, which in both sexes was usually a second hip fracture. At the end of the 8-year follow-up, 74% of the patients had died. The observed absolute fracture risk was 7% at one year and 24% at 5 years. In women, excess mortality was lowest during the first 4.8 years after the index hip fracture among patients with one fracture. However, it was highest among women with two fractures. In men, excess mortality was lowest among those with two fractures and highest among those with ≥3 fractures. There were no differences between the genders in sustaining subsequent fractures. The fracture risk subsequent to hip fracture was similar in both genders. Patients with prior hip fractures had the worst survival rate. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  3. The surface-forming energy release rate based fracture criterion for elastic-plastic crack propagation

    Science.gov (United States)

    Xiao, Si; Wang, He-Ling; Liu, Bin; Hwang, Keh-Chih

    2015-11-01

    The J-integral based criterion is widely used in elastic-plastic fracture mechanics. However, it is not rigorously applicable when plastic unloading appears during crack propagation. One difficulty is that the energy density with plastic unloading in the J-integral cannot be defined unambiguously. In this paper, we alternatively start from the analysis on the power balance, and propose a surface-forming energy release rate (ERR), which represents the energy available for separating the crack surfaces during the crack propagation and excludes the loading-mode-dependent plastic dissipation. Therefore the surface-forming ERR based fracture criterion has wider applicability, including elastic-plastic crack propagation problems. Several formulae are derived for calculating the surface-forming ERR. From the most concise formula, it is interesting to note that the surface-forming ERR can be computed using only the stress and deformation of the current moment, and the definition of the energy density or work density is avoided. When an infinitesimal contour is chosen, the expression can be further simplified. For any fracture behaviors, the surface-forming ERR is proven to be path-independent, and the path-independence of its constituent term, so-called Js-integral, is also investigated. The physical meanings and applicability of the proposed surface-forming ERR, traditional ERR, Js-integral and J-integral are compared and discussed. Besides, we give an interpretation of Rice paradox by comparing the cohesive fracture model and the surface-forming ERR based fracture criterion.

  4. Are the High Hip Fracture Rates Among Norwegian Women Explained by Impaired Bone Material Properties?

    Science.gov (United States)

    Duarte Sosa, Daysi; Vilaplana, Laila; Güerri, Roberto; Nogués, Xavier; Wang-Fagerland, Morten; Diez-Perez, Adolfo; F Eriksen, Erik

    2015-10-01

    Hip fracture rates in Norway rank among the highest in the world, more than double that of Spanish women. Previous studies were unable to demonstrate significant differences between the two populations with respect to bone mass or calcium metabolism. In order to test whether the difference in fracture propensity between both populations could be explained by differences in bone material quality we assessed bone material strength using microindentation in 42 Norwegian and 46 Spanish women with normal BMD values, without clinical or morphometric vertebral fractures, no clinical or laboratory signs of secondary osteoporosis, and without use of drugs with known influence on bone metabolism. Bone material properties were assessed by microindentation of the thick cortex of the mid tibia following local anesthesia of the area using the Osteoprobe device (Active Life Scientific, Santa Barbara, CA, USA). Indentation distance was standardized against a calibration phantom of methylmethacrylate and results, as percentage of this reference value, expressed as bone material strength index units (BMSi). We found that the bone material properties reflected in the BMSi value of Norwegian women was significantly inferior when compared to Spanish women (77 ± 7.1 versus 80.7 ± 7.8, p hip BMD was significantly higher in Norwegian women (1.218 g/cm(2) versus 0.938 g/cm(2) , p fracture after such falls. These ethnic differences in bone material properties may partly explain the higher propensity for fracture in Norwegian women. © 2015 American Society for Bone and Mineral Research.

  5. Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies.

    Science.gov (United States)

    Jia, P; Bao, L; Chen, H; Yuan, J; Liu, W; Feng, F; Li, J; Tang, H

    2017-08-09

    In this meta-analysis, evidence of an association between type 2 diabetes mellitus (T2DM) and low-energy fractures has been evaluated including 12 observational studies. The results suggested that T2DM patients had an enhanced risk of low-energy fractures. Type 1 diabetes mellitus (T1DM) patients have been shown to be at enhanced risk of fracture injury, but less is known about low-energy fractures among patients with T2DM. We performed a meta-analysis of 12 observational studies identified in Medline and EMBASE that included 938,742 participants, including 30,827 low-energy fracture cases. The incidence rate ratios (IRRs) of low-energy fractures were determined using a random-effects model. The IRRs of low-energy fracture for men and women were 1.37 (95% confidence interval [CI], 0.94-2.00; p = 0.096) and 1.22 (95% CI, 1.09-1.35; p = 0.000), respectively, and the overall IRR was 1.23 (95% CI, 1.12-1.35; p = 0.000). The IRRs for hip and vertebral fractures were 1.08 (95% CI, 1.02-1.15; p = 0.007) and 1.21 (95% CI, 0.98-1.48; p = 0.073), respectively. The IRRs of low-energy fracture in case-control, prospective, retrospective, and cross-sectional studies were 1.18 (95% CI, 0.81-1.72; p = 0.380), 1.17 (95% CI, 1.05-1.32, p = 0.006), 1.15 (95% CI, 1.02-1.29; p = 0.020), and 1.60 (95% CI, 1.21-2.12; p = 0.001), respectively. The IRRs of low-energy fracture for less than 5 years, 5 to 10 years, and more than 10 years were 1.30 (95%, CI 1.13-1.50; p = 0.000), 1.05 (95% CI, 1.03-1.08; p = 0.000), and 1.19 (95% CI, 1.00-1.41; p = 0.049), respectively. Patients with T2DM had a greater risk of low-energy fracture especially of the hip, compared with that in non-diabetic subjects. However, since according to our funnel plot a publication bias may be present and due to study heterogeneity as well as the limited number of publications, the finding needs to be interpreted with caution.

  6. A Graph Theoretic Approach for Hydraulic Fracturing and Wellbore Leakage Risk Modeling

    Science.gov (United States)

    Glosser, D.; Rose, K.; Bauer, J. R.; Warner, T.

    2016-12-01

    Recent large scale development of unconventional formations for fossil energy has raised concerns over the potential for fluid leakage between subsurface systems and wellbores. This is particularly true in regions with extensive drilling history, where spatial densities of wellbores are higher, and where significant uncertainties in the location and mechanical integrity of such wellbores exist. The generation of induced fracture networks during hydraulic fracturing may increase subsurface connectivity, and create the potential for unwanted fluid migration between operational and legacy wellbores and subsurface fracture networks. We present a graph theoretic approach for identifying geospatial regions and wellbores at increased risk for subsurface connectivity based on wellbore proximity and local geologic characteristics. The algorithm transforms user inputted geospatial data (geologic and wellbore x,y,z) to graph structure, where wellbores are represented as nodes, and where potential overlapping fracture network zones are represented as edges. The algorithm can be used to complement existing fracture models to better account for the reach of induced fractures, and to identify spatial extents at increased risk for unwanted subsurface connectivity. Additionally, the model can be used to identify regions in need of geophysical detection methods for locating undocumented wells. As a result, the method can be part of a cumulative strategy to reduce uncertainty inherent to combined geologic and engineered systems. The algorithm has been successfully tested against a known leakage scenario in Pennsylvania. In addition to identifying wells associated with the leakage event, the algorithm identified two other higher risk networks in the region. The algorithm output provides valuable information for industry to develop environmentally safe drilling and injection plans; and for regulators to identify specific wellbores at greater risk for leakage, and to develop targeted

  7. [New use of benzodiazepines and the risk of hip fracture: A case-crossover study].

    Science.gov (United States)

    Hoffmann, F; Glaeske, G

    2006-04-01

    Benzodiazepines appear to increase the incidence of hip fractures. Their role as a time-dependent risk factor remains unclear. We therefore conducted a case-crossover study to determine whether the new use of benzodiazepines is associated with a rise in hip fractures. We analysed 49 months of the statutory health insurance Gmünder Ersatzkasse (GEK) and enrolled all first hip fractures. The index date was the day of hospital admission. Exposure to new use of benzodiazepines was compared within the five periods preceding the index date. Out of 1630 subjects, 223 (13.7%) had at least one prescription of benzodiazepines in the preceding 150 days before the index date, 74 (4.5%) of them as a first prescription. The average age of the population was 79.8 years (SD: 7.7). Odds ratio (OR) of hip fracture was highest during the initial 5 days of new use (OR: 3.43; 95% CI 1.15-10.20) and then declined to a non-significant OR of 1.59 (95% CI 0.96-2.63) after 30 days. In conclusion, the start of a new benzodiazepine is associated with an increased risk of hip fractures. However, the population attributable risk (PAR) and, therefore, the percentage of preventable events is small (PAR: 0.55%; 95% CI 0.05-1.06%).

  8. Self-rated health and cancer risk

    DEFF Research Database (Denmark)

    Roelsgaard, Ida Kristiane; Olesen, Anne Marie; Simonsen, Mette Kildevæld

    2016-01-01

    BACKGROUND: Self-rated health (SRH) has been shown to be a strong predictor of mortality from a number of major chronic diseases, however, the association with cancer remains unclear. The aim of this study was to investigate a possible association between change in SRH and cancer incidence....... MATERIALS AND METHODS: SRH and information on lifestyle and other risk factors were obtained for 13-636 women in the Danish Nurse Cohort. Cancers that developed during 12 years of follow-up were identified in the National Patient Registry. An association between SRH and cancer was examined in a Cox...... proportional hazards model with adjustment for age, smoking, alcohol, marital status, physical activity, body mass index and estrogen replacement therapy. RESULTS: No significant association was found between SRH and overall cancer incidence in the age-adjusted Cox proportional hazards model (1.04; 95% CI 0...

  9. 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

  10. 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...... with elevated serum urate, obesity and high alcohol consumption. The mainstay of therapy is the urate-lowering agent, allopurinol. Here, we report the relationship between allopurinol prescription and fracture in a large registry population. METHODS: We established a Danish Register cohort of 86,039 adult cases...... gout diagnosis had been confirmed by at least one hospital contact. Prespecified subanalyses by filled dose of allopurinol (mg/day in first year of prescription) showed increased hip and major fracture risk in women in the highest allopurinol dose grouping only, while a less strong dose effect...

  11. Osteoporosis among Fallers without Concomitant Fracture Identified in an Emergency Department: Frequencies and Risk Factors

    DEFF Research Database (Denmark)

    Glintborg, Bente; Hesse, Ulrik; Houe, Thomas

    2011-01-01

    aged 50-80 years sustaining a low-energy fall without fracture were identified from an ED (n = 199). Patients answered a questionnaire on risk factors and underwent osteodensitometry. Data was compared to a group of patients routinely referred to osteodensitometry from general practice (n = 201......We aimed to determine whether the Emergency Department (ED) is a suitable entrance point for osteoporosis screening among fallers without concomitant fracture compared to referral from general practice. Furthermore, to identify factors associated with osteoporosis among fallers. Methods. Patients......). Results. Among the 199 included fallers, 41 (21%) had osteoporosis. Among these, 35 (85%) reported either previous fracture or reduced body height (>3¿cm). These two risk factors were more frequent among fallers with osteoporosis compared to fallers with normal bone mineral density or osteopenia (previous...

  12. Are Bone Turnover Markers Related with Fracture Risk in Initial Diagnose Postmenopausal Osteoporosis? A Cross-Sectional Clinical Study

    Directory of Open Access Journals (Sweden)

    Şeniz Akçay Yalbuzdağ

    2015-08-01

    Full Text Available Objective: In this study, we investigated the relationships between 10 year fracture risk calculated with FRAX assessment tool and bone turnover markers (BTM in women with diagnosed as postmenopausal osteoporosis for the first time. Materials and Methods: After exclusion of the causes of secondary osteoporosis 61 postmenopausal women diagnosed with osteoporosis for the first time were enrolled. Height and weight measurements, comorbid diseases, menopause age, and laboratory investigations were recorded. Lumbar and femur neck and femur total T scores were measured by dual-energy x-ray absorptiometry (DXA. As BTM, serum osteocalcin (OC and urine deoxypridinoline levels were measured. 10-year fracture risk of hip and major osteoporotic fracture was calculated with FRAX assessment tool. Results: The mean age of patients was 61±39 years. Median value of menopause year was 15.13 years (min: 2, max: 40. The median 10-year hip fracture and major osteoporotic fracture risks were calculated as 1.10% (min: 0, max: 23, 6.9% (min: 3, max: 34 respectively. There was no significant relationship between BTM and fracture risk. Positive significant correlation was found between menopause year and hip fracture risk, and between menopause year and major osteoporotic fracture risks (p=0.031, 0.276; p=0.025, r=0.287. Negative significant correlation was detected between body mass index and hip fracture risk (p=0.002, r=-0.392. Conclusion: In our study, we couldn’t find relationship between BTM and fracture risks assessed by using FRAX tool in patients with initially diagnosed of postmenopausal osteoporosis. Further studies are needed to investigate the relationship between BTM and fracture risk in different patient groups. (Turkish Journal of Osteoporosis 2015;21: 58-62

  13. 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

  14. Dynamic tensile fracture of mortar at ultra-high strain-rates

    Energy Technology Data Exchange (ETDEWEB)

    Erzar, B., E-mail: benjamin.erzar@cea.fr; Buzaud, E.; Chanal, P.-Y. [CEA, DAM, GRAMAT, F-46500 Gramat (France)

    2013-12-28

    During the lifetime of a structure, concrete and mortar may be exposed to highly dynamic loadings, such as impact or explosion. The dynamic fracture at high loading rates needs to be well understood to allow an accurate modeling of this kind of event. In this work, a pulsed-power generator has been employed to conduct spalling tests on mortar samples at strain-rates ranging from 2 × 10{sup 4} to 4 × 10{sup 4} s{sup −1}. The ramp loading allowed identifying the strain-rate anytime during the test. A power law has been proposed to fit properly the rate-sensitivity of tensile strength of this cementitious material over a wide range of strain-rate. Moreover, a specimen has been recovered damaged but unbroken. Micro-computed tomography has been employed to study the characteristics of the damage pattern provoked by the dynamic tensile loading.

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

    Science.gov (United States)

    2013-01-01

    Background 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. Methods 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. Results 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. Conclusions 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. PMID:23391264

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

    Directory of Open Access Journals (Sweden)

    Nambu Atsushi

    2013-02-01

    Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusions 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.

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

    Science.gov (United States)

    Nambu, Atsushi; Onishi, Hiroshi; Aoki, Shinichi; Tominaga, Licht; Kuriyama, Kengo; Araya, Masayuki; Saito, Ryoh; Maehata, Yoshiyasu; Komiyama, Takafumi; Marino, Kan; Koshiishi, Tsuyota; Sawada, Eiichi; Araki, Tsutomu

    2013-02-07

    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.

  18. Fatigue Crack Growth Rate of Ti-6Al-4V Considering the Effects of Fracture Toughness and Crack Closure

    Institute of Scientific and Technical Information of China (English)

    ZHANG Junhong; YANG Shuo; LIN Jiewei

    2015-01-01

    Fatigue fracture is one of the main failure modes of Ti-6Al-4V alloy, fracture toughness and crack closure have strong effects on the fatigue crack growth(FCG) rate of Ti-6Al-4V alloy. The FCG rate of Ti-6Al-4V is investigated by using experimental and analytical methods. The effects of stress ratio, crack closure and fracture toughness on the FCG rate are studied and discussed. A modified prediction model of the FCG rate is proposed, and the relationship between the fracture toughness and the stress intensity factor(SIF) range is redefined by introducing a correcting coefficient. Notched plate fatigue tests (including the fracture toughness test and the FCG rate test) are conducted to investigate the influence of affecting factors on the FCG rate. Comparisons between the predicted results of the proposed model, the Paris model, the Walker model, the Sadananda model, and the experimental data show that the proposed model gives the best agreement with the test data particularly in the near–threshold region and the Paris region, and the corresponding calculated fatigue life is also accurate in the same regions. By considering the effects of fracture toughness and crack closure, the novel FCG rate prediction model not only improves the estimating accuracy, but also extends the adaptability of the FCG rate prediction model in engineering.

  19. Fatigue crack growth rate of Ti-6Al-4V considering the effects of fracture toughness and crack closure

    Science.gov (United States)

    Zhang, Junhong; Yang, Shuo; Lin, Jiewei

    2015-03-01

    Fatigue fracture is one of the main failure modes of Ti-6Al-4V alloy, fracture toughness and crack closure have strong effects on the fatigue crack growth(FCG) rate of Ti-6Al-4V alloy. The FCG rate of Ti-6Al-4V is investigated by using experimental and analytical methods. The effects of stress ratio, crack closure and fracture toughness on the FCG rate are studied and discussed. A modified prediction model of the FCG rate is proposed, and the relationship between the fracture toughness and the stress intensity factor(SIF) range is redefined by introducing a correcting coefficient. Notched plate fatigue tests (including the fracture toughness test and the FCG rate test) are conducted to investigate the influence of affecting factors on the FCG rate. Comparisons between the predicted results of the proposed model, the Paris model, the Walker model, the Sadananda model, and the experimental data show that the proposed model gives the best agreement with the test data particularly in the near-threshold region and the Paris region, and the corresponding calculated fatigue life is also accurate in the same regions. By considering the effects of fracture toughness and crack closure, the novel FCG rate prediction model not only improves the estimating accuracy, but also extends the adaptability of the FCG rate prediction model in engineering.

  20. Risk Factors for Open Malleolar Fractures: An Analysis of the National Trauma Data Bank (2007 to 2011).

    Science.gov (United States)

    Shibuya, Naohiro; Liu, George T; Davis, Matthew L; Grossman, Jordan P; Jupiter, Daniel C

    2016-01-01

    A limited number of studies have described the epidemiology of open fractures, and the epidemiology of open ankle fractures is not an exception. Therefore, the risk factors associated with open ankle fractures have not been extensively evaluated. The frequencies and proportions of open ankle fractures among all the recorded malleolar fractures in the US National Trauma Data Bank data set from January 2007 to December 2011 were analyzed. Clinically relevant variables captured in the data set were also used to evaluate the risk factors associated with open ankle fractures, adjusting for other covariates. The entire cohort was further subdivided into "lower" and "higher" energy trauma groups and the same analysis performed for each group separately. We found that a body mass index of >40 kg/m(2) and farm location were risk factors for open ankle fractures and impaired sensorium was protective against open ankle fractures. In the "lower energy" group, male gender, alcohol use, peripheral vascular disease, other injuries, and injury occurring at a farm location were risk factors for open fractures. In the "higher energy" group, female gender, work-related injury, and injury at a farm or industry location demonstrated statistically significantly associations with open fractures.

  1. Does the presence or position of lower third molars alter the risk of mandibular angle or condylar fractures?

    Science.gov (United States)

    Naghipur, Saba; Shah, Adnan; Elgazzar, Reda Fouad

    2014-09-01

    The purpose of this study was to determine whether a relation exists between the presence of mandibular third molars (M3s) and mandibular angle and condylar fractures and whether the risk of these fractures varies with M3 position. A retrospective cohort study was conducted in patients with mandibular fractures presenting to the oral and maxillofacial surgery service from April 2007 to March 2012. Data sources were patients' hospital charts and panoramic radiographs. Predictor variables were the presence and position of M3s. M3 position was based on the Pell and Gregory classification and angulation was determined by measuring the angle between the long axis of the M3 and the mandibular occlusal plane. Outcome variables were the presence of angle and condylar fractures. Other study variables included age, gender, and fracture etiology. Data were analyzed using the χ(2) test and Student t test. The study sample consisted of 446 patients with 731 mandibular fractures. Results showed that the risk of mandibular angle fracture was significantly higher in patients and mandible sides with impacted M3s (P .05). The presence of impacted M3s increased the risk of angle fracture and simultaneously decreased the risk of condylar fracture. However, no relation appeared to exist between M3 position and fracture pattern. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. 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.

  3. Hip fracture history and risk of nonmelanoma skin cancer: a Danish population-based study

    Directory of Open Access Journals (Sweden)

    Lamberg AL

    2011-11-01

    Full Text Available Anna Lei Lamberg1,2, Anne Braae Olesen1,2, Annette Østergaard Jensen11Department of Clinical Epidemiology, 2Department of Dermatology, Aarhus University Hospital, DenmarkBackground: Vitamin D deficiency is associated with osteoporotic fractures, such as hip fracture. Sun exposure, the natural source of vitamin D, is the main risk factor for basal cell carcinoma (BCC and squamous cell carcinoma (SCC. In this study, we examined the association between a history of hip fracture and risk of BCC and SCC.Methods: We conducted a population-based case-controlled study using data on BCC and SCC cases registered in the Danish Cancer Registry from 1990–2005. For each case, we selected five population controls matched by age and gender. We used conditional logistic regression to compute odds ratios (OR and 95% confidence intervals (CI, while adjusting for chronic diseases and socioeconomic status.Results: A history of hip fracture was associated with a decreased risk of BCC (OR 0.90, 95% CI 0.85–0.94, which was most pronounced in cases of tumors on the trunk, extremities, or at multiple sites. We found no association for SCC (OR 1.07, 95% CI 0.98–1.17.Conclusion: Our study showed an inverse association between history of hip fracture and risk of BCC, but not of SCC. Sun exposure, resulting in vitamin D synthesis, may explain the link between the two diseases.Keywords: hip fracture, vitamin D, sunlight, basal cell carcinoma, squamous cell carcinoma

  4. Low-density lipoprotein cholesterol is associated with fracture risk in diabetes patients - a nested case-control study

    DEFF Research Database (Denmark)

    Starup-Linde, Jakob; Gregersen, Søren; Vestergaard, Peter

    2014-01-01

    available for an analysis of patient characteristics, co-morbidities, biochemical parameters and drug usage. Results: Patient age at the time of diabetes diagnosis, a diagnosis of previous fracture, an alcohol related diagnosis, total cholesterol level, and the usage of antidepressants, antiepileptics...... and insulin all increased the odds of fracture. Low-density lipoprotein cholesterol (LDL) levels decreased the odds of fracture, where the level of 3.04-5.96 mmol/l was optimal with regard to fracture risk. Conclusion: LDL may add to the understanding of fractures in diabetes patients and it may be added...

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

    Science.gov (United States)

    Piot, J M; Royer, M; Schmidt-Tanguy, A; Hoppé, E; Gardembas, M; Bourrée, T; Hunault, M; François, S; Boyer, F; Ifrah, N; Renier, G; Chevailler, A; Audran, M; Chappard, D; Libouban, H; Mabilleau, G; Legrand, E; Bouvard, B

    2015-08-28

    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.

  6. 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...

  7. Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis

    DEFF Research Database (Denmark)

    Reginster, Jean-Yves; Felsenberg, Dieter; Boonen, Steven;

    2008-01-01

    to receive either strontium ranelate at 2 gm/day or placebo for 5 years. The main efficacy criterion was the incidence of nonvertebral fractures. In addition, incidence of hip fractures was assessed, by post hoc analysis, in the subset of 1,128 patients who were at high risk of fractures (age 74 years...... or older with lumbar spine and femoral neck bone mineral density T scores -2.4 or less). The incidence of new vertebral fractures was assessed, using the semiquantitative method described by Genant, in the 3,646 patients in whom spinal radiography (a nonmandatory procedure) was performed during the course...... of the study. Fracture data were analyzed using the Kaplan-Meier survival method. RESULTS: Of the 5,091 patients, 2,714 (53%) completed the study up to 5 years. The risk of nonvertebral fracture was reduced by 15% in the strontium ranelate group compared with the placebo group (relative risk 0.85 [95...

  8. Rib stress fractures among rowers: a systematic review on return to sports, risk factors and prevention.

    Science.gov (United States)

    D'Ailly, Philip N; Sluiter, Judith K; Kuijer, Paul P

    2016-06-01

    Rib stress fractures (RSFs) are injuries frequently sustained by elite rowers with an injury rate of 8-16% over the course of a rowing career, resulting in negative effects on training and performance. For clinical management, the aim of this review was to describe time to return to sports, summarize potentially preventive measures and appraise the evidence on risk factors. A search strategy was performed in PubMed, SportDiscus, Web of Science and Embase till June 1st 2015. All studies were graded on their quality. The search resulted in 124 studies, of which 17 were included: Ten reported on return to sports, 17 reported on risk factors and nine on preventive measures. For return to sports, nine studies mentioned a loss of training of 4-6 weeks. The shortest period was one week and the longest 16 weeks. For risk factors, insufficient or conflicting evidence was found for changes in the training program, incorrect rowing technique, female gender, low bone mineral density, inadequate equipment, and training type. For prevention, gradual changes in the training program, alertness on the part of coaches and clinicians, and supplementation of diet and hormones are suggested as effective measures. However, no effect studies have been found. The main outcome of this review on RSFs is that little evidence is available on return to sports, risk factors and preventive measures. Coaches and clinicians should carefully guide and assist rowers suffering from RSFs in off training and in the subsequent training period to regain their pre-injury level.

  9. 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 u...

  10. Soda consumption and risk of hip fractures in postmenopausal women in the Nurses’ Health Study1234

    OpenAIRE

    2014-01-01

    Background: The frequency of soda consumption remains high in the United States. Soda consumption has been associated with poor bone health in children, but few studies have examined this relation in adults, and to our knowledge, no study has examined the relation of soda consumption with risk of hip fractures.

  11. Inappropriate benzodiazepine use in older adults and the risk of fracture

    NARCIS (Netherlands)

    C.S. van der Hooft (Cornelis); M.W.C.J. Schoofs (Marlette); G. Ziere; A. Hofman (Albert); H.A.P. Pols (Huib); M.C.J.M. Sturkenboom (Miriam); B.H.Ch. Stricker (Bruno)

    2008-01-01

    textabstractAIMS: The Beers criteria for prescribing in elderly are well known and used for many drug utilization studies. We investigated the clinical value of the Beers criteria for benzodiazepine use, notably the association between inappropriate use and risk of fracture. METHODS: We performed a

  12. Opioids contribute to fracture risk: a meta-analysis of 8 cohort studies.

    Science.gov (United States)

    Teng, Zhaowei; Zhu, Yun; Wu, Feihu; Zhu, Yanhong; Zhang, Xiguang; Zhang, Chuanlin; Wang, Shuangneng; Zhang, Lei

    2015-01-01

    To evaluate the association between chronic opioid use for non-cancer pain and fracture risk by conducting a meta-analysis of cohort studies. Cohort studies were identified by searching PubMed and EMBASE from their inception to July 2014. A fracture was considered an endpoint. The information was extracted by two authors independently. When the heterogeneity was significant, a random-effects model was used to calculate the overall pooled risk estimates. Eight cohort studies were included in the final meta-analysis. On the basis of the Newcastle-Ottawa Scale (NOS), six studies were considered to be of high quality. The overall combined relative risk for the use of opioids and fractures was 1.88 (95% confidence interval [CI] 1.51-2.34). A subgroup analysis revealed the sources of heterogeneity. The sensitivity analysis indicated stable results, and no publication bias was observed. This meta-analysis of cohort studies demonstrates that opioids significantly increase the risk of fractures.

  13. Rib stress fractures among rowers: definition, epidemiology, mechanisms, risk factors and effectiveness of injury prevention strategies.

    Science.gov (United States)

    McDonnell, Lisa K; Hume, Patria A; Nolte, Volker

    2011-11-01

    Rib stress fractures (RSFs) can have serious effects on rowing training and performance and accordingly represent an important topic for sports medicine practitioners. Therefore, the aim of this review is to outline the definition, epidemiology, mechanisms, intrinsic and extrinsic risk factors, injury management and injury prevention strategies for RSF in rowers. To this end, nine relevant books, 140 journal articles, the proceedings of five conferences and two unpublished presentations were reviewed after searches of electronic databases using the keywords 'rowing', 'rib', 'stress fracture', 'injury', 'mechanics' and 'kinetics'. The review showed that RSF is an incomplete fracture occurring from an imbalance between the rate of bone resorption and the rate of bone formation. RSF occurs in 8.1-16.4% of elite rowers, 2% of university rowers and 1% of junior elite rowers. Approximately 86% of rowing RSF cases with known locations occur in ribs four to eight, mostly along the anterolateral/lateral rib cage. Elite rowers are more likely to experience RSF than nonelite rowers. Injury occurrence is equal among sweep rowers and scullers, but the regional location of the injury differs. The mechanism of injury is multifactorial with numerous intrinsic and extrinsic risk factors contributing. Posterior-directed resultant forces arising from the forward directed force vector through the arms to the oar handle in combination with the force vector induced by the scapula retractors during mid-drive, or repetitive stress from the external obliques and rectus abdominis in the 'finish' position, may be responsible for RSF. Joint hypomobility, vertebral malalignment or low bone mineral density may be associated with RSF. Case studies have shown increased risk associated with amenorrhoea, low bone density or poor technique, in combination with increases in training volume. Training volume alone may have less effect on injury than other factors. Large differences in seat and handle

  14. 75 FR 13145 - SBA Lender Risk Rating System

    Science.gov (United States)

    2010-03-18

    ... FURTHER INFORMATION CONTACT: Bryan Hooper, Director, Office of Credit Risk Management, U.S. Small Business... of Credit Risk Management. BILLING CODE 8025-01-P ... ADMINISTRATION SBA Lender Risk Rating System AGENCY: Small Business Administration. ACTION: Notice; extension of...

  15. Effects of ball sports on future risk of stress fracture in runners.

    Science.gov (United States)

    Fredericson, Michael; Ngo, Jessica; Cobb, Kristin

    2005-05-01

    To evaluate whether playing ball sports during childhood and adolescence is associated with the risk of stress fractures in runners later in life. Retrospective cohort study. National track and field championships, held at Stanford University. One hundred fifty-six elite female and 118 elite male distance runners, age 18 to 44 years. A 1-page questionnaire was used to collect data regarding ages during which athletes played basketball and soccer, as well as other important covariates and outcomes. Athletes reported the ages when stress fractures occurred. Time to event was defined as the number of years from beginning competitive running to the first stress fracture or to current age, if no fracture had occurred. In both men and women, playing ball sports in youth correlated with reduced stress fracture incidence later in life by almost half, controlling for possible confounders. In men, each additional year of playing ball sports conferred a 13% decreased incidence of stress fracture (adjusted hazard ratio [HR] and 95% confidence interval, 0.87 [0.79-0.95]. Among women with regular menses, the HR for each additional year of playing ball sports was similar: 0.87 (0.75-1.00); however, there was no effect of length of time played among women with irregular menses (HR, 1.03 [0.92-1.16]). In men, younger ages of playing ball sports conferred more protection against stress fractures (HR for each 1-year-older age at first exposure, 1.29 [1.14, 1.45]). Runners who participate during childhood and adolescence in ball sports may develop bone with greater and more symmetrically distributed bone mass, and with enhanced protection from future stress fractures.

  16. Common Polymorphism in the LRP5 Gene May Increase the Risk of Bone Fracture and Osteoporosis

    Directory of Open Access Journals (Sweden)

    Guang-Yue Xu

    2014-01-01

    Full Text Available The low-density lipoprotein receptor-related protein 5 gene (LRP5 was identified to be linked to the variation in bone mineral density and types of bone diseases. The present study was aimed at examining the association of LRP5 rs3736228 C>T gene with bone fracture and osteoporosis by meta-analysis. A systematic electronic search of literature was conducted to identify all published studies in English or Chinese on the association of the LRP5 gene with bone fracture and osteoporosis risks. All analyses were calculated using the Version 12.0 STATA software. Odds ratios (ORs and their corresponding 95% confidence interval (95% CI were calculated. An updated meta-analysis was currently performed, including seven independent case-control studies. Results identified that carriers of rs3736228 C>T variant in the LRP5 gene were associated with an increased risk of developing osteoporosis and fractures under 4 genetic models but not under the dominant model (OR = 1.19, 95% CI = 0.97~1.46, and P=0.103. Ethnicity-subgroup analysis implied that LRP5 rs3736228 C>T mutation was more likely to develop osteoporosis and fractures among Asians and Caucasians in majority of subgroups. These results suggest that there is a modest effect of the LRP5 rs3736228 C>T on the increased susceptibility of bone fracture and osteoporosis.

  17. Hip axis length is a FRAX- and bone density-independent risk factor for hip fracture in women.

    Science.gov (United States)

    Leslie, William D; Lix, Lisa M; Morin, Suzanne N; Johansson, Helena; Odén, Anders; McCloskey, Eugene V; Kanis, John A

    2015-05-01

    Bone mineral density (BMD) measurement from dual-energy X-ray absorptiometry (DXA) is widely used to assess skeletal strength in clinical practice, but DXA instruments can also measure biomechanical parameters related to skeletal shape. The objective of the study was to determine whether DXA-derived hip geometry measures provide information on fracture prediction that is independent of hip fracture probability determined from the fracture risk assessment tool (FRAX) algorithm. This was a retrospective registry study using BMD results for Manitoba, Canada. Women aged 40 years and older with baseline hip DXA, derived hip geometry measures, and FRAX scores (n = 50 420) participated in the study. Hospitalized hip fracture (n = 1020) diagnosed during 319 137 person-years of follow-up (median 6.4 y) was measured. Among the hip geometry measures, hip axis length (HAL) showed a consistent association with hip fracture risk when adjusted for age [hazard ratio (HR) 1.30 per SD increase, 95% confidence interval (CI) 1.22-1.38], and this was unaffected by further adjustment for BMD or FRAX score. Adjusted for FRAX score with BMD, there was a significant effect of increasing HAL quintile on hip fracture risk (linear trend P hip geometry measurements are associated with incident hip fracture risk, but many do not confer significant independent predictive information. HAL was found to predict hip fractures when adjusted for BMD or FRAX score and may be of clinical value in refining hip fracture risk.

  18. Strain rate effects on the mechanical properties and fracture mode of skeletal muscle

    Energy Technology Data Exchange (ETDEWEB)

    Shapiro, Michael; Tovar, Nick; Yoo, Daniel [Biomaterials and Biomimetics, New York University College of Dentistry (United States); Sobieraj, Micheal [Orthopedic Surgery, Hospital for Joint Diseases (United States); Gupta, Nikhil [Mechanical and Aerospace Engineering, NYU-Poly (United States); Branski, Ryan C. [Dept of Otolaryngology, New York University School of Medicine (United States); Coelho, Paulo G., E-mail: pc92@nyu.edu [Biomaterials and Biomimetics, New York University College of Dentistry (United States)

    2014-06-01

    The present study aimed to characterize the mechanical response of beagle sartorius muscle fibers under strain rates that increase logarithmically (0.1 mm/min, 1 mm/min and 10 mm/min), and provide an analysis of the fracture patterns of these tissues via scanning electron microscopy (SEM). Muscle tissue from dogs' sartorius was excised and test specimens were sectioned with a lancet into sections with nominal length, width, and thickness of 7, 2.5 and 0.6 mm, respectively. Trimming of the tissue was done so that the loading would be parallel to the direction of the muscle fiber. Samples were immediately tested following excision and failures were observed under the SEM. No statistically significant difference was observed in strength between the 0.1 mm/min (2.560 ± 0.37 MPa) and the 1 mm/min (2.702 ± 0.55 MPa) groups. However, the 10 mm/min group (1.545 ± 0.50 MPa) had a statistically significant lower strength than both the 1 mm/min group and the 0.1 mm/min group with p < 0.01 in both cases. At the 0.1 mm/min rate the primary fracture mechanism was that of a shear mode failure of the endomysium with a significant relative motion between fibers. At 1 mm/min this continues to be the predominant failure mode. At the 10 mm/min strain rate there is a significant change in the fracture pattern relative to other strain rates, where little to no evidence of endomysial shear failure nor of significant motion between fibers was detected.

  19. Comparison of hip geometry, strength, and estimated fracture risk in women with anorexia nervosa and overweight/obese women.

    Science.gov (United States)

    Bachmann, Katherine Neubecker; Fazeli, Pouneh K; Lawson, Elizabeth A; Russell, Brian M; Riccio, Ariana D; Meenaghan, Erinne; Gerweck, Anu V; Eddy, Kamryn; Holmes, Tara; Goldstein, Mark; Weigel, Thomas; Ebrahimi, Seda; Mickley, Diane; Gleysteen, Suzanne; Bredella, Miriam A; Klibanski, Anne; Miller, Karen K

    2014-12-01

    Data suggest that anorexia nervosa (AN) and obesity are complicated by elevated fracture risk, but skeletal site-specific data are lacking. Traditional bone mineral density (BMD) measurements are unsatisfactory at both weight extremes. Hip structural analysis (HSA) uses dual-energy X-ray absorptiometry data to estimate hip geometry and femoral strength. Factor of risk (φ) is the ratio of force applied to the hip from a fall with respect to femoral strength; higher values indicate higher hip fracture risk. The objective of the study was to investigate hip fracture risk in AN and overweight/obese women. This was a cross-sectional study. The study was conducted at a Clinical Research Center. PATIENTS included 368 women (aged 19-45 y): 246 AN, 53 overweight/obese, and 69 lean controls. HSA-derived femoral geometry, peak factor of risk for hip fracture, and factor of risk for hip fracture attenuated by trochanteric soft tissue (φ(attenuated)) were measured. Most HSA-derived parameters were impaired in AN and superior in obese/overweight women vs controls at the narrow neck, intertrochanteric, and femoral shaft (P ≤ .03). The φ(attenuated) was highest in AN and lowest in overweight/obese women (P fractures. Femoral geometry by HSA, hip BMD, and factor of risk for hip fracture attenuated by soft tissue are impaired in AN and superior in obesity, suggesting higher and lower hip fracture risk, respectively. Only attenuated factor of risk was associated with fragility fracture prevalence, suggesting that variability in soft tissue padding may help explain site-specific fracture risk not captured by BMD.

  20. Active commuting reduces the risk of wrist fractures in middle-aged women-the UFO study.

    Science.gov (United States)

    Englund, U; Nordström, P; Nilsson, J; Hallmans, G; Svensson, O; Bergström, U; Pettersson-Kymmer, U

    2013-02-01

    Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus. Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture. The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years. Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk. This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.

  1. A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2010-10-01

    Full Text Available Abstract Background There is a large quality of care gap for patients with osteoporosis. As a fragility fracture is a strong indicator of underlying osteoporosis, it offers an ideal opportunity to initiate investigation and treatment. However, studies of post-fracture populations document screening and treatment rates below 20% in most settings. This is despite the fact that bone mineral density (BMD scans are effective at identifying patients at high risk of fracture, and effective drug treatments are widely available. Effective interventions are required to remedy this incongruity in current practice. Methods This study reviewed randomised controlled trials (RCT involving fully qualified healthcare professionals caring for patients with a fragility fracture in all healthcare settings. Any intervention designed to modify the behaviour of healthcare professionals or implement a service delivery change was considered. The main outcomes were BMD scanning and osteoporosis treatment with anti-resorptive therapy. The electronic databases Medline and Embase were searched from 1994 to June 2010 to identify relevant articles in English. Post-intervention risk differences (RDs were calculated for the main outcomes and any additional study primary outcomes; the trials were meta-analysed. Results A total of 2814 potentially relevant articles were sifted; 18 were assessed in full text. Nine RCTs evaluating ten interventions met the inclusion criteria for the review. All were from North America. Four studies focused on patients with a hip fracture, three on fractures of the wrist/distal forearm, and two included several fracture sites consistent with a fragility fracture. All studies reported positive effects of the intervention for the main study outcomes of BMD scanning and osteoporosis treatment. For BMD scanning the overall risk ratio (95% CI was 2.8 (2.16 to 3.64; the RD was 36% (21% to 50%. For treatment with anti-resorptive therapy the overall risk

  2. A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis.

    Science.gov (United States)

    Little, Elizabeth A; Eccles, Martin P

    2010-10-22

    There is a large quality of care gap for patients with osteoporosis. As a fragility fracture is a strong indicator of underlying osteoporosis, it offers an ideal opportunity to initiate investigation and treatment. However, studies of post-fracture populations document screening and treatment rates below 20% in most settings. This is despite the fact that bone mineral density (BMD) scans are effective at identifying patients at high risk of fracture, and effective drug treatments are widely available. Effective interventions are required to remedy this incongruity in current practice. This study reviewed randomised controlled trials (RCT) involving fully qualified healthcare professionals caring for patients with a fragility fracture in all healthcare settings. Any intervention designed to modify the behaviour of healthcare professionals or implement a service delivery change was considered. The main outcomes were BMD scanning and osteoporosis treatment with anti-resorptive therapy. The electronic databases Medline and Embase were searched from 1994 to June 2010 to identify relevant articles in English. Post-intervention risk differences (RDs) were calculated for the main outcomes and any additional study primary outcomes; the trials were meta-analysed. A total of 2814 potentially relevant articles were sifted; 18 were assessed in full text. Nine RCTs evaluating ten interventions met the inclusion criteria for the review. All were from North America. Four studies focused on patients with a hip fracture, three on fractures of the wrist/distal forearm, and two included several fracture sites consistent with a fragility fracture. All studies reported positive effects of the intervention for the main study outcomes of BMD scanning and osteoporosis treatment. For BMD scanning the overall risk ratio (95% CI) was 2.8 (2.16 to 3.64); the RD was 36% (21% to 50%). For treatment with anti-resorptive therapy the overall risk ratio (95% CI) was 2.48 (1.92 to 3.2); the RD was 20

  3. Characterization of fractured reservoirs using tracer and flow-rate data

    Science.gov (United States)

    Juliusson, Egill; Horne, Roland N.

    2013-05-01

    This article introduces a robust method for characterizing fractured reservoirs using tracer and flow-rate data. The flow-rate data are used to infer the interwell connectivity matrix, which describes how injected fluids are divided between producers in the reservoir. The tracer data are used to find a function called the tracer kernel for each injector-producer connection. The tracer kernel describes the volume and dispersive properties of the interwell flow path. A combination of parametric and nonparametric regression methods was developed to estimate the tracer kernels in situations where data are collected at variable flow rate or variable-injected concentration conditions. This characterization method was developed to describe enhanced geothermal systems, although it works well in general for characterizing incompressible flow in fractured reservoirs (e.g., geothermal, carbon sequestration, radioactive waste and waterfloods of oil fields) where transverse dispersivity can be considered negligible and production takes place at constant bottomhole pressure conditions. The inferred metrics can be used to sketch informative field maps and predict tracer breakthrough curves at variable flow-rate conditions.

  4. Evaluation of Police General Hospital's Fracture Liaison Service (PGH's FLS: The first study of a Fracture Liaison Service in Thailand

    Directory of Open Access Journals (Sweden)

    Tanawat Amphansap

    2016-12-01

    Conclusions: Patients with recent hip fractures participating in the Fracture Liaison service had a significantly higher post-injury BMD follow up and osteoporotic medication administration rates. This resulted in a lower risk of secondary fracture than those who did not participate in the Fracture Liaison service at a follow up time of one year.

  5. Slow strain rate corrosion and fracture characteristics of X-52 and X-70 pipeline steels

    Energy Technology Data Exchange (ETDEWEB)

    Contreras, A. [Instituto Mexicano del Petroleo, Programa de Investigacion y Desarrollo de Ductos, Eje Central Lazaro Cardenas 152, San Bartolo Atepehuacan, C.P. 07730, Mexico, D.F. (Mexico)]. E-mail: acontrer@imp.mx; Albiter, A. [Instituto Mexicano del Petroleo, Programa de Investigacion y Desarrollo de Ductos, Eje Central Lazaro Cardenas 152, San Bartolo Atepehuacan, C.P. 07730, Mexico, D.F. (Mexico); Salazar, M. [Instituto Mexicano del Petroleo, Programa de Investigacion y Desarrollo de Ductos, Eje Central Lazaro Cardenas 152, San Bartolo Atepehuacan, C.P. 07730, Mexico, D.F. (Mexico); Perez, R. [Instituto Mexicano del Petroleo, Programa de Investigacion y Desarrollo de Ductos, Eje Central Lazaro Cardenas 152, San Bartolo Atepehuacan, C.P. 07730, Mexico, D.F. (Mexico)

    2005-10-25

    The susceptibility to stress corrosion cracking (SCC) in a NACE solution saturated with H{sub 2}S, of the X-52 and X-70 steels was studied using slow strain rate tests (SSRT) and electrochemical evaluations. SCC tests were performed in samples which include the longitudinal weld bead of the pipeline steels and were carried out in the NACE solution at both room temperature and 50 deg. C. After failure, the fracture surfaces were observed in a scanning electron microscope (SEM) and the chemical analysis were obtained using X-rays energy dispersive (EDXs) techniques. The specimens tested in air, exhibited a ductile type of failure, and whereas, those tested in the corrosive solution showed a brittle fracture. Specimens tested in the NACE solution saturated with H{sub 2}S presented high susceptibility to SCC. Corrosion was found to be an important factor in the initiation of some cracks. In addition, the effect of the temperature on the corrosion attack was explored. The susceptibility to SCC was manifested as a decrease in the mechanical properties. Potentiodynamic polarization curves and hydrogen permeation measurements were made. The diffusion of atomic hydrogen was related to this fracture forms. The hydrogen permeation flux increased with the increasing of temperature.

  6. Reduced Bone Material Strength is Associated with Increased Risk and Severity of Osteoporotic Fractures. An Impact Microindentation Study.

    Science.gov (United States)

    Sosa, Daysi Duarte; Eriksen, Erik Fink

    2017-07-01

    The aim of the study was to test, whether bone material strength differs between different subtypes of osteoporotic fracture and assess whether it relates to vertebral fracture severity. Cortical bone material strength index (BMSi) was measured by impact microindentation in 66 women with osteoporotic fracture and 66 age- and sex-matched controls without fracture. Bone mineral density (BMD) and bone turnover markers were also assessed. Vertebral fracture severity was graded by semiquantitative (SQ) grading. Receiver operator characteristic (ROC) curves were used to examine the ability of BMSi to discriminate fractures. Subjects with osteoporotic fractures exhibited lower BMSi than controls (71.5 ± 7.3 vs. 76.4 ± 6.2, p < 0.001). After adjusting for age and hip BMD, a significant negative correlation was seen between BMSi and vertebral fracture severity (r (2) = 0.19, p = 0.007). A decrease of one standard deviation (SD) in BMSi was associated with increased risk of fracture (OR 2.62; 95% CI 1.35, 5.10, p = 0.004). ROC curve areas under the curve (AUC) for BMSi in subjects with vertebral fracture (VF), hip fracture (HF), and non-vertebral non-hip fracture (NVNHFx), (mean; 95% CI) were 0.711 (0.608; 0.813), 0.712 (0.576; 0.843), 0.689 (0.576; 0.775), respectively. Combining BMSi and BMD provided further improvement in the discrimination of fractures with AUC values of 0.777 (0.695; 0.858), 0.789 (0.697; 0.882), and 0.821 (0.727; 0.914) for VFx, HFx, and NVNHFx, respectively. Low BMSi of the tibial cortex is associated with increased risk of all osteoporotic fractures and severity of vertebral fractures.

  7. Infection rate in mandibular angle fractures treated with a 2.0-mm 8-hole curved strut plate.

    Science.gov (United States)

    Bui, Peter; Demian, Nagi; Beetar, Patrick

    2009-04-01

    The aim of this study was to determine the rate of postoperative infection and the efficacy of removing teeth in the line of mandibular angle fractures treated with 2.0-mm 8-hole titanium curved strut plates. Our understanding is that this method of repair is currently being used only in a few centers in the United States. A retrospective review of mandibular angle fractures treated with a 2.0-mm 8-hole strut plate during a 4-year period. Postoperative antibiotics were given for 1 week. Follow-up appointments were 4 weeks or longer. A nonchewing diet was instructed for 6 weeks. Data for all selected patients include the information such as age, gender, etiology of injuries, medical history, concurrent injuries, nerve deficits, pre- and postoperative antibiotic administration, postop infection, a presence or absence of teeth in the line of fractures, and whether these teeth were removed. Four patients (4 of 49 or 8.2%) developed infections. Two of those patients had a tooth in the line of a fracture that was retained (2 of 14 or 14%). The third had a tooth in the line of a fracture that was extracted (1 of 18 or 5.6%). The fourth patient was 1 of the 17 patients who did not have teeth in the line of fracture and developed infection (1 of 17 or 5.9%). None of the patients developed failed hardware, malunion, nonunion, malocclusion, or iatrogenic nerve injury. The use of a 2.0-mm 8-hole strut plate is associated with a low infection rate (8.2%). The infection rate for those mandibular angle fractures with teeth in the line of fracture retained was 14% compared with 5.6% for those fractures with the teeth in the line of fracture extracted.

  8. 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

    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...

  9. Strontium ranelate and risk of vertebral fractures in frail osteoporotic women.

    Science.gov (United States)

    Rolland, Yves; Abellan Van Kan, Gabor; Gillette-Guyonnet, Sophie; Roux, Christian; Boonen, Steven; Vellas, Bruno

    2011-02-01

    Therapies to treat osteoporosis remain underutilized and minimally evaluated in frail elderly patients. Our study determined and compared the risk of vertebral fractures in frail, intermediate and robust older patients being treated with strontium ranelate vs. placebo. Data were obtained from the SOTI (Spinal Osteoporosis Therapeutic Intervention) and TROPOS (Treatment Of Peripheral Osteoporosis) studies which randomized participants to receive either strontium ranelate or placebo over 3 years. Frail, intermediate and robust patients were identified using adapted Fried's criteria. Analyses were performed according to the intention-to-treat principle utilizing 1- and 3-year study follow-up data. 2346 robust, 2472 intermediate and 264 frail women were identified. At 3 years, the risk for vertebral fractures was reduced by 30% (Relative Risk [RR], 0.70; 95% confidence interval [CI], 0.57-0.86) in the robust, by 45% (RR, 0.55; 95%CI, 0.46-0.67) in the intermediate and by 58% (RR, 0.42; 95%CI, 0.24-0.74) in the frail patients compared to those assigned to placebo (p<0.01 for all three groups; p=0.11 for trend). Risk of vertebral fracture was significantly reduced within 1 year in all three groups. Numbers of subjects needed to be treated to prevent one new vertebral fracture over 3 years were 13, 9 and 5 in the robust, intermediate and frail groups, respectively. Adverse event profiles and medication compliance were similar across the 3 groups. The imperative to treat osteoporosis appears to be greatest in frail patients since similar relative risk reductions would avert more fractures in frail than in non-frail elderly patients. Copyright © 2010 Elsevier Inc. All rights reserved.

  10. On interest-rate risk management of postal savings bureau

    Institute of Scientific and Technical Information of China (English)

    DU Chong-dong; LI Su-man

    2007-01-01

    This article analyzes interest-rate risks faced by the postal savings bureau (PSB) based on the complete balance sheet.It presents the extended gap model and the extended duration gap model to measure the interest-rate risk, and discusses the inner balance-sheet strategies and the off-balance-sheet strategies to manage the interest-rate risks.

  11. Country risk rating – importance and methodology

    OpenAIRE

    Liliana Ivănuş

    2004-01-01

    Country risk forecasts are important for individuals holding nearly any position of responsibility in an internationally oriented firm, business managers, banks, insurance companies, and public institutions, credit managers, treasurer's offices, risk management officers, strategic planning, international business officials.

  12. "Occult" rib fractures diagnosed on computed tomography scan only are still a risk factor for solid organ injury.

    Science.gov (United States)

    Bhattacharya, Bishwajit; Fieber, Jennifer; Schuster, Kevin; Davis, Kimberly; Maung, Adrian

    2015-01-01

    Prior to the widespread use of computed tomography (CT) scan imaging, lower rib fractures diagnosed on chest X-rays (CXRs) were considered a risk factor for abdominal solid organ injury (ASOI). However, CXRs miss about 50% of the rib fractures that are detected on CT scans. We hypothesized that these "occult" rib fractures would not be predictive for ASOI. Retrospective review of a level I trauma center's database identified all adult blunt trauma patients (n = 11,170) over a 5-year period. Data were abstracted for demographics, injury severity score, presence of ASOI, extremity, pelvic and spine fractures as well as presence and location of rib fractures. Rib fractures correlated with the presence of ASOI, regardless of whether they were diagnosed by CXR or CT scan alone (P rib fractures, especially, correlated with the presence of ipsilateral ASOI (P rib fractures than CXR, rib fractures remain a marker for increased likelihood of ASOI regardless of the modality by which they are diagnosed. Patients with rib fractures also have a greater incidence of spine and pelvic fractures. As the trauma community debates moving away from routine whole-body CT imaging towards a more selective approach, these results suggest that any clinical suspicion of rib fractures, despite a negative CXR, may warrant further investigation.

  13. Development and validation of a prognostic index for fracture risk in older men undergoing prostate cancer treatment

    Science.gov (United States)

    Graham-Steed, Tisheeka R.; Soulos, Pamela R.; Dearing, Natalie; Concato, John; Tinetti, Mary E.; Gross, Cary P.

    2014-01-01

    Objectives Men treated with androgen deprivation therapy (ADT) or radiation therapy (RT) for prostate cancer have an increased risk for fractures. Given uncertainty as to whether specific clinical factors can identify men at increased risk, we sought to develop a prognostic index for risk of fracture in this population. Materials and methods We used the Surveillance, Epidemiology, and End Results-Medicare database to identify men who received ADT or RT after being diagnosed with localized prostate cancer in 2007-2009. Cox proportional hazards models tested the association of potential risk factors with fracture. In a derivation group, hazard ratios were used to assign points for factors independently related to fracture. The prognostic index was then applied to a validation group. Results The sample of 5,824 men had a median age of 73.0 years; 82.9% were white and 8.6% had a fracture within 2 years of treatment for prostate cancer. The Cox model identified 8 variables (age, race, hormone treatment, Elixhauser score, anxiety, Parkinson's, fall-inducing medications and disability status) independently associated with fracture. In the derivation cohort, 4.3% of the sample experienced a fracture in the low-risk group, 8.9% in the intermediate group, and 19.2% in the high-risk group (C statistic, 0.749). The index was applied to the validation cohort (C statistic, 0.782). Conclusion The prognostic index can help to identify patients at increased risk for fracture. This underscores the importance of identifying risk factors for fracture, given the substantial variation in fracture risk in men treated with ADT or RT. PMID:25240918

  14. Development and validation of a prognostic index for fracture risk in older men undergoing prostate cancer treatment.

    Science.gov (United States)

    Graham-Steed, Tisheeka R; Soulos, Pamela R; Dearing, Natalie; Concato, John; Tinetti, Mary E; Gross, Cary P

    2014-10-01

    Men treated with androgen deprivation therapy (ADT) or radiation therapy (RT) for prostate cancer have an increased risk for fractures. Given uncertainty as to whether specific clinical factors can identify men at increased risk, we sought to develop a prognostic index for risk of fracture in this population. We used the Surveillance, Epidemiology, and End Results-Medicare database to identify men who received ADT or RT after being diagnosed with localized prostate cancer in 2007-2009. Cox proportional hazards models tested the association of potential risk factors with fracture. In a derivation group, hazard ratios were used to assign points for factors independently related to fracture. The prognostic index was then applied to a validation group. The sample of 5824 men had a median age of 73.0 years; 82.9% were white and 8.6% had a fracture within 2 years of treatment for prostate cancer. The Cox model identified 8 variables (age, race, hormone treatment, Elixhauser score, anxiety, Parkinson's, fall-inducing medications and disability status) independently associated with fracture. In the derivation cohort, 4.3% of the sample experienced a fracture in the low-risk group, 8.9% in the intermediate group, and 19.2% in the high-risk group (C statistic, 0.749). The index was applied to the validation cohort (C statistic, 0.782). The prognostic index can help to identify patients at increased risk for fracture. This underscores the importance of identifying risk factors for fracture, given the substantial variation in fracture risk in men treated with ADT or RT. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Elastic modulus of posts and the risk of root fracture.

    Science.gov (United States)

    Meira, Josete B C; Espósito, Camila O M; Quitero, Mayra F Z; Poiate, Isis A V P; Pfeifer, Carmem Silvia C; Tanaka, Carina B; Ballester, Rafael Y

    2009-08-01

    The definition of an optimal elastic modulus for a post is controversial. This work hypothesized that the influence of the posts' elastic modulus on dentin stress concentration is dependent on the load direction. The objective was to evaluate, using finite element analysis, the maximum principal stress (sigma(max)) on the root, using posts with different elastic modulus submitted to different loading directions. Nine 3D models were built, representing the dentin root, gutta-percha, a conical post and the cortical bone. The softwares used were: MSC.PATRAN2005r2 (preprocessing) and MSC.Marc2005r2 (processing). Load of 100 N was applied, varying the directions (0 degrees, 45 degrees and 90 degrees) in relation to the post's long axis. The magnitude and direction of the sigma(max) were recorded. At the 45 degrees and 90 degrees loading, the highest values of sigma(max) were recorded for the lowest modulus posts, on the cervical region, with a direction that suggests debonding of the post. For the 0 degrees loading, the highest values of sigma(max) were recorded for higher modulus posts, on the apical region, and the circumferential direction suggests vertical root fracture. The hypothesis was accepted: the effect of the elastic modulus on the magnitude and direction of the sigma(max) generated on the root was dependent on the loading direction.

  16. Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care.

    Science.gov (United States)

    Bachoura, Abdo; Guitton, Thierry G; Smith, R Malcolm; Vrahas, Mark S; Zurakowski, David; Ring, David

    2011-09-01

    Orthopaedic surgical-site infections prolong hospital stays, double rehospitalization rates, and increase healthcare costs. Additionally, patients with orthopaedic surgical-site infections (SSI) have substantially greater physical limitations and reductions in their health-related quality of life. However, the risk factors for SSI after operative fracture care are unclear. We determined the incidence and quantified modifiable and nonmodifiable risk factors for SSIs in patients with orthopaedic trauma undergoing surgery. We retrospectively indentified, from our prospective trauma database and billing records, 1611 patients who underwent 1783 trauma-related procedures between 2006 and 2008. Medical records were reviewed and demographics, surgery-specific data, and whether the patients had an SSI were recorded. We determined which if any variables predicted SSI. Six factors independently predicted SSI: (1) the use of a drain, OR 2.3, 95% CI (1.3-3.8); (2) number of operations OR 3.4, 95% CI (2.0-6.0); (3) diabetes, OR 2.1, 95% CI (1.2-3.8); (4) congestive heart failure (CHF), OR 2.8, 95% CI (1.3-6.5); (5) site of injury tibial shaft/plateau, OR 2.3, 95% CI (1.3-4.2); and (6) site of injury, elbow, OR 2.2, 95% CI (1.1-4.7). The risk factors for SSIs after skeletal trauma are most strongly determined by nonmodifiable factors: patient infirmity (diabetes and heart failure) and injury complexity (site of injury, number of operations, use of a drain). Level II, prognostic study. See the Guideline for Authors for a complete description of levels of evidence.

  17. A Review of the Effect of Anticonvulsant Medications on Bone Mineral Density and Fracture Risk

    Science.gov (United States)

    Lee, Richard H.; Lyles, Kenneth W.; Colón-Emeric, Cathleen

    2011-01-01

    Background Osteoporosis and seizure disorders are common diagnoses in older adults and often occur concomitantly. Objective The goal of this review was to discuss the current hypothesis for the pathogenesis of anticonvulsant-induced bone density loss and the evidence regarding the risk for osteoporosis and fractures in older individuals. Methods A review of the literature was performed, searching in MEDLINE and CINAHL for articles published between 1990 and October 2009 with the following search terms: anticonvulsant OR antiepileptic; AND osteoporosis OR bone density OR fracture OR absorptiometry, photon. Studies within the pediatric population, cross-sectional studies, and studies whose results were published in a language other than English were excluded. Results A search of the published literature yielded >300 results, of which 24 met the inclusion and exclusion criteria and were included in this review. Hepatic enzyme induction by certain anticonvulsant medications appears to contribute to increased metabolism of 25-hydroxyvitamin D to inactive metabolites, which results in metabolic bone disease. There is increasing evidence that anticonvulsant use is associated with a higher risk of osteoporosis and clinical fractures, especially among older agents such as phenobarbital, carbamazepine, phenytoin, and valproate. Several observational studies suggest a class effect among anticonvulsant agents, associated with clinically significant reductions in bone mineral density and fracture risk. The use of anticonvulsant medications increases the odds of fracture by 1.2 to 2.4 times. However, only 2 large-scale observational studies have specifically examined the risk among those aged >65 years. This review also identified a randomized controlled trial whose results suggest that supplementation with high-dose vitamin D may be associated with increased bone mineral density in patients taking anticonvulsant medications. However, no randomized controlled trials

  18. Effects of cooling rate on the fracture properties of TA15 ELI alloy plates

    Institute of Scientific and Technical Information of China (English)

    LI Shikai; XIONG Baiqing; HUI Songxiao

    2007-01-01

    The effects of cooling rate on the mechanical properties and the fatigue crack growth behavior of TA15 ELI alloy plates with different microstructures were investigated at room temperature. The results indicate that the cooling rate (water quench, air cooling, and furnace cooling) has a pronounced influence on the mechanical properties and on the fatigue crack growth,especially for air cooling and furnace cooling.Optical microstructure observation and scanning electron microscopy of tensile fracture surfaces were performed to gain an insight into the mechanism of properties.The dependence of mechanical properties and fatigue crack growth behavior on the cooling rate can be attributed to the α lamellae width and the α colony size,which induce the change in slip length. The microstructure produced by air cooling shows the best damage tolerance behavior when compared with water quench and furnace cooling.

  19. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study.

    Science.gov (United States)

    Reginster, J Y; Seeman, E; De Vernejoul, M C; Adami, S; Compston, J; Phenekos, C; Devogelaer, J P; Curiel, M Diaz; Sawicki, A; Goemaere, S; Sorensen, O H; Felsenberg, D; Meunier, P J

    2005-05-01

    Strontium ranelate, a new oral drug shown to reduce vertebral fracture risk in postmenopausal women with osteoporosis, was studied in the Treatment of Peripheral Osteoporosis (TROPOS) study to assess its efficacy and safety in preventing nonvertebral fractures also. Strontium ranelate (2 g/d) or placebo were randomly allocated to 5091 postmenopausal women with osteoporosis in a double-blind placebo-controlled 5-yr study with a main statistical analysis over 3 yr of treatment. In the entire sample, relative risk (RR) was reduced by 16% for all nonvertebral fractures (P = 0.04), and by 19% for major fragility fractures (hip, wrist, pelvis and sacrum, ribs and sternum, clavicle, humerus) (P = 0.031) in strontium ranelate-treated patients in comparison with the placebo group. Among women at high risk of hip fracture (age > or = 74 yr and femoral neck bone mineral density T score < or = -3, corresponding to -2.4 according to NHANES reference) (n = 1977), the RR reduction for hip fracture was 36% (P = 0.046). RR of vertebral fractures was reduced by 39% (P < 0.001) in the 3640 patients with spinal x-rays and by 45% in the subgroup without prevalent vertebral fracture. Strontium ranelate increased bone mineral density throughout the study, reaching at 3 yr (P < 0.001): +8.2% (femoral neck) and +9.8% (total hip). Incidence of adverse events (AEs) was similar in both groups. This study shows that strontium ranelate significantly reduces the risk of all nonvertebral and in a high-risk subgroup, hip fractures over a 3-yr period, and is well tolerated. It confirms that strontium ranelate reduces vertebral fractures. Strontium ranelate offers a safe and effective means of reducing the risk of fracture associated with osteoporosis.

  20. Identification and management of patients at increased risk of osteoporotic fracture

    DEFF Research Database (Denmark)

    Kanis, J A; Cooper, C; Rizzoli, R

    2017-01-01

    and notably the costs of treatment and long-term care of patients with fractures were considerably higher than the costs for pharmacological prevention. Despite the availability of effective treatments, the uptake of osteoporosis therapy is low and declining, in particular for secondary fracture prevention...... appropriate treatment more precisely and cost-effectively, and should be the focus of future research. Introduction: The purpose of the study was to review data on the identification and treatment of patients with osteoporosis at increased risk of fracture. Methods: A working group convened by the European...... Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review current data on the epidemiology and burden of osteoporosis and the patterns of medical management throughout Europe. Results: In Europe in 2010, the cost of managing osteoporosis was estimated at €37 billion...

  1. 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...

  2. 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

    by the Kaplan–Meier method and Cox regression. Risk factors included in the analysis: gender, age, stage of root development, type of crown fracture, and response to electric pulp test (EPT) at the initial examination. The level of significance was set at 5%. Results:  The risk of PN was low in teeth......The reported risk of pulp necrosis (PN) is low in teeth with concussion injuries. A concomitant crown fracture may affect the risk of PN. Aim:  To analyze the influence of a crown fracture (with and without pulp exposure) on the risk of PN in teeth with concussion injury. Material:  The study...... 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...

  3. [Medication as a risk factor for falls resulting in severe fractures in the elderly].

    Science.gov (United States)

    Coutinho Ed, Evandro da Silva Freire; Silva, Sidney Dutra da

    2002-01-01

    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 such individuals and their families on how to avoid falls when such medication proves necessary.

  4. Long-term survival and risk factors for failure of the native hip joint after operatively treated displaced acetabular fractures.

    Science.gov (United States)

    Clarke-Jenssen, J; Røise, O; Storeggen, S A Ø; Madsen, J E

    2017-06-01

    Our aim in this study was to describe the long-term survival of the native hip joint after open reduction and internal fixation of a displaced fracture of the acetabulum. We also present long-term clinical outcomes and risk factors associated with a poor outcome. A total of 285 patients underwent surgery for a displaced acetabular fracture between 1993 and 2005. For the survival analysis 253 were included, there were 197 men and 56 women with a mean age of 42 years (12 to 78). The mean follow-up of 11 years (1 to 20) was identified from our pelvic fracture registry. There were 99 elementary and 154 associated fracture types. For the long-term clinical follow-up, 192 patients with complete data were included. Their mean age was 40 years (13 to 78) with a mean follow-up of 12 years (5 to 20). Injury to the femoral head and acetabular impaction were assessed with CT scans and patients with an ipsilateral fracture of the femoral head were excluded. A total of 36 patients underwent total hip arthroplasty (THA). The overall ten-year survival of the hip joint was 86% (95% confidence interval (CI) 81% to 90%) and the 20-year survival was 82% (95% CI 76% to 87%). Injury to the femoral head and acetabular impaction were the strongest predictors of failure, with the long-term survival rate falling towards 50% in these patients. The survival fell to 0% at three years when both these risk factors were present in patients aged > 60 years. The long-term survival of the native hip joint after acetabular fractures was good, but the presence of injury to the femoral head and acetabular impaction proved to be strong predictors of failure, especially in patients aged > 60 years. These patients may be better treated with a combination of open reduction and internal fixation and primary arthroplasty. Cite this article: Bone Joint J 2017;99-B:834-40. ©2017 The British Editorial Society of Bone & Joint Surgery.

  5. 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.

  6. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults.

    Science.gov (United States)

    Shadgan, Babak; Pereira, Gavin; Menon, Matthew; Jafari, Siavash; Darlene Reid, W; O'Brien, Peter J

    2015-09-01

    We sought to examine the occurrence of acute compartment syndrome (ACS) in the cohort of patients with tibial diaphyseal fractures and to detect associated risk factors that could predict this occurrence. A total of 1,125 patients with tibial diaphyseal fractures that were treated in our centre were included into this retrospective cohort study. All patients were treated with surgical fixation. Among them some were complicated by ACS of the leg. Age, gender, year and mechanism of injury, injury severity score (ISS), fracture characteristics and classifications and the type of fixation, as well as ACS characteristics in affected patients were studied. Of the cohort of patients 772 (69 %) were male (mean age 39.60 ± 15.97 years) and the rest were women (mean age 45.08 ± 19.04 years). ACS of the leg occurred in 87 (7.73 %) of all tibial diaphyseal fractures. The mean age of those patients that developed ACS (33.08 ± 12.8) was significantly lower than those who did not develop it (42.01 ± 17.3, P leg associated with tibial diaphyseal fractures in adults. Level IV.

  7. 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 ...

  8. Arthroscopic reduction and fibula nailing in high-risk diabetic ankle fractures: case reviews and technical tip.

    Science.gov (United States)

    Thevendran, Gowreeson; Younger, Alastair

    2012-04-01

    The management of diabetic ankle fractures is difficult given the associated wound and bone healing complications. Even with meticulous soft tissue handling and a stable construct, the fixation sometimes fails because of the poor biological environment. This study reports on 2 cases of Weber type B ankle fractures in patients with diabetes mellitus where the authors elected to treat with arthroscopy-assisted fracture reduction and percutaneous fibula nailing to reduce the risk of wound complications.

  9. DUAL-ENERGY X-RAY ABSORPTIOMETRY AND CALCULATED FRAX RISK SCORES MAY UNDERESTIMATE OSTEOPOROTIC FRACTURE RISK IN VITAMIN D–DEFICIENT VETERANS WITH HIV INFECTION

    Science.gov (United States)

    Stephens, Kelly I.; Rubinsztain, Leon; Payan, John; Rentsch, Chris; Rimland, David; Tangpricha, Vin

    2017-01-01

    Objective We evaluated the utility of the World Health Organization Fracture Risk Assessment Tool (FRAX) in assessing fracture risk in patients with human immunodeficiency virus (HIV) and vitamin D deficiency. Methods This was a retrospective study of HIV-infected patients with co-existing vitamin D deficiency at the Atlanta Veterans Affairs Medical Center. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DEXA), and the 10-year fracture risk was calculated by the WHO FRAX algorithm. Two independent radiologists reviewed lateral chest radiographs for the presence of subclinical vertebral fractures. Results We identified 232 patients with HIV and vitamin D deficiency. Overall, 15.5% of patients met diagnostic criteria for osteoporosis on DEXA, and 58% had low BMD (T-score between −1 and −2.5). The median risk of any major osteoporotic and hip fracture by FRAX score was 1.45 and 0.10%, respectively. Subclinical vertebral fractures were detected in 46.6% of patients. Compared to those without fractures, those with fractures had similar prevalence of osteoporosis (15.3% versus 15.7%; P>.999), low BMD (53.2% versus 59.3%; P = .419), and similar FRAX hip scores (0.10% versus 0.10%; P = .412). While the FRAX major score was lower in the nonfracture group versus fracture group (1.30% versus 1.60%; P = .025), this was not clinically significant. Conclusion We found a high prevalence of subclinical vertebral fractures among vitamin D–deficient HIV patients; however, DEXA and FRAX failed to predict those with fractures. Our results suggest that traditional screening tools for fragility fractures may not be applicable to this high-risk patient population. PMID:26684149

  10. DUAL-ENERGY X-RAY ABSORPTIOMETRY AND CALCULATED FRAX RISK SCORES MAY UNDERESTIMATE OSTEOPOROTIC FRACTURE RISK IN VITAMIN D-DEFICIENT VETERANS WITH HIV INFECTION.

    Science.gov (United States)

    Stephens, Kelly I; Rubinsztain, Leon; Payan, John; Rentsch, Chris; Rimland, David; Tangpricha, Vin

    2016-04-01

    We evaluated the utility of the World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) in assessing fracture risk in patients with human immunodeficiency virus (HIV) and vitamin D deficiency. This was a retrospective study of HIV-infected patients with co-existing vitamin D deficiency at the Atlanta Veterans Affairs Medical Center. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DEXA), and the 10-year fracture risk was calculated by the WHO FRAX algorithm. Two independent radiologists reviewed lateral chest radiographs for the presence of subclinical vertebral fractures. We identified 232 patients with HIV and vitamin D deficiency. Overall, 15.5% of patients met diagnostic criteria for osteoporosis on DEXA, and 58% had low BMD (T-score between -1 and -2.5). The median risk of any major osteoporotic and hip fracture by FRAX score was 1.45 and 0.10%, respectively. Subclinical vertebral fractures were detected in 46.6% of patients. Compared to those without fractures, those with fractures had similar prevalence of osteoporosis (15.3% versus 15.7%; P>.999), low BMD (53.2% versus 59.3%; P = .419), and similar FRAX hip scores (0.10% versus 0.10%; P = .412). While the FRAX major score was lower in the nonfracture group versus fracture group (1.30% versus 1.60%; P = .025), this was not clinically significant. We found a high prevalence of subclinical vertebral fractures among vitamin D-deficient HIV patients; however, DEXA and FRAX failed to predict those with fractures. Our results suggest that traditional screening tools for fragility fractures may not be applicable to this high-risk patient population.

  11. Numerical Investigation of Influence of In-Situ Stress Ratio, Injection Rate and Fluid Viscosity on Hydraulic Fracture Propagation Using a Distinct Element Approach

    Directory of Open Access Journals (Sweden)

    Bo Zhang

    2016-02-01

    Full Text Available Numerical simulation is very useful for understanding the hydraulic fracturing mechanism. In this paper, we simulate the hydraulic fracturing using the distinct element approach, to investigate the effect of some critical parameters on hydraulic fracturing characteristics. The breakdown pressure obtained by the distinct element approach is consistent with the analytical solution. This indicates that the distinct element approach is feasible on modeling the hydraulic fracturing. We independently examine the influence of in-situ stress ratio, injection rate and fluid viscosity on hydraulic fracturing. We further emphasize the relationship between these three factors and their contributions to the hydraulic fracturing. With the increase of stress ratio, the fracture aperture increases almost linearly; with the increase of injection rate and fluid viscosity, the fracture aperture and breakdown pressure increase obviously. A low value of product of injection rate and fluid viscosity (i.e., Qμ will lead to narrow fracture aperture, low breakdown pressure, and complex or dispersional hydraulic fractures. A high value of Qμ would lead wide fracture aperture, high breakdown pressure, and simple hydraulic fractures (e.g., straight or wing shape. With low viscosity fluid, the hydraulic fracture geometry is not sensitive to stress ratio, and thus becomes a complex fracture network.

  12. Evaluating the Risk of a Fifth Metatarsal Stress Fracture by Measuring the Serum 25-Hydroxyvitamin D Levels.

    Science.gov (United States)

    Shimasaki, Yu; Nagao, Masashi; Miyamori, Takayuki; Aoba, Yukihiro; Fukushi, Norifumi; Saita, Yoshitomo; Ikeda, Hiroshi; Kim, Sung-Gon; Nozawa, Masahiko; Kaneko, Kazuo; Yoshimura, Masafumi

    2016-03-01

    The fifth metatarsal bone is a common site of stress fractures in soccer athletes. Although several endocrine risk factors for stress fractures have been proposed, the endocrine risks for fifth metatarsal (5-MT) stress fractures have not been evaluated. To evaluate the endocrine risks of fifth metatarsal stress fractures, we conducted a cumulative case-control study. The present study included 37 athletes, of which 18 had a history of a zone 2 or zone 3 fifth metatarsal stress fracture and 19 controls. We analyzed serum 25-hydroxyvitamin D (25-OHD), serum parathyroid hormone (PTH), as well as biochemical markers of bone turnover by univariate or multivariate analyses. Logistic regression analyses adjusted for multiple confounders revealed that insufficient serum 25-OHD levels less than 30 ng/mL (odds ratio [OR], 23.3), higher serum PTH levels (OR, 1.01), or higher serum bone-specific isoform of alkaline phosphatase levels (OR, 1.10) rather than serum tartrate-resistant acid phosphatase 5b were associated with statistically significantly increased odds of 5-MT stress fractures. A postestimation calculation demonstrated that 25-OHD levels of 10 and 20 ng/mL were associated with 5.1 and 2.9 times greater odds for 5-MT stress fractures, respectively. 25-OHD insufficiency was associated with an increased incidence of 5-MT stress fractures. This insight may be useful for intervening to prevent 5-MT stress fractures. Level III, case-control study. © The Author(s) 2015.

  13. Evaluation of susceptibility of high strength steels to delayed fracture by using cyclic corrosion test and slow strain rate test

    Energy Technology Data Exchange (ETDEWEB)

    Li Songjie [School of Materials Science and Engineering, University of Science and Technology Beijing, No. 30 Xueyuan Road, Hidian Zone, Beijing 100083 (China); Structural Metals Center, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047 (Japan); Zhang Zuogui [Structural Metals Center, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047 (Japan); Akiyama, Eiji [Structural Metals Center, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047 (Japan)], E-mail: AKIYAMA.Eiji@nims.go.jp; Tsuzaki, Kaneaki [Structural Metals Center, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047 (Japan); Zhang Boping [School of Materials Science and Engineering, University of Science and Technology Beijing, No. 30 Xueyuan Road, Hidian Zone, Beijing 100083 (China)

    2010-05-15

    To evaluate susceptibilities of high strength steels to delayed fracture, slow strain rate tests (SSRT) of notched bar specimens of AISI 4135 with tensile strengths of 1300 and 1500 MPa and boron-bearing steel with 1300 MPa have been performed after cyclic corrosion test (CCT). During SSRT the humidity around the specimen was kept high to keep absorbed diffusible hydrogen. The fracture stresses of AISI 4135 steels decreased with increment of diffusible hydrogen content which increased with CCT cycles. Their delayed fracture susceptibilities could be successfully evaluated in consideration of both influence of hydrogen content on mechanical property and hydrogen entry.

  14. The association of concurrent vitamin D and sex hormone deficiency with bone loss and fracture risk in older men: the osteoporotic fractures in men (MrOS) study.

    Science.gov (United States)

    Barrett-Connor, Elizabeth; Laughlin, Gail A; Li, Hong; Nielson, Carrie M; Wang, P Ying; Dam, Tien T; Cauley, Jane A; Ensrud, Kristine E; Stefanick, Marcia L; Lau, Edith; Hoffman, Andrew R; Orwoll, Eric S

    2012-11-01

    Low 25-hydroxyvitamin D (VitD), low sex hormones (SH), and high sex hormone binding globulin (SHBG) levels are common in older men. We tested the hypothesis that combinations of low VitD, low SH, and high SHBG would have a synergistic effect on bone mineral density (BMD), bone loss, and fracture risk in older men. Participants were a random subsample of 1468 men (mean age 74 years) from the Osteoporotic Fractures in Men Study (MrOS) plus 278 MrOS men with incident nonspine fractures studied in a case-cohort design. "Abnormal" was defined as lowest quartile for VitD (59 nM). Overall, 10% had isolated VitD deficiency; 40% had only low SH or high SHBG; 15% had both SH/SHBG and VitD abnormality; and 35% had no abnormality. Compared to men with all normal levels, those with both SH/SHBG and VitD abnormality tended to be older, more obese, and to report less physical activity. Isolated VitD deficiency, and low BioT with or without low VitD, was not significantly related to skeletal measures. The combination of VitD deficiency with low BioE and/or high SHBG was associated with significantly lower baseline BMD and higher annualized rates of hip bone loss than SH abnormalities alone or no abnormality. Compared to men with all normal levels, the multivariate-adjusted hazard ratio (95% confidence interval [CI]) for incident nonspine fracture during 4.6-year median follow-up was 1.2 (0.8-1.8) for low VitD alone; 1.3 (0.9-1.9) for low BioE and/or high SHBG alone; and 1.6 (1.1-2.5) for low BioE/high SHBG plus low VitD. In summary, adverse skeletal effects of low sex steroid levels were more pronounced in older men with low VitD levels. The presence of low VitD in the presence of low BioE/high SHBG may contribute substantially to poor skeletal health.

  15. 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.

  16. 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

    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...... smokers 1.59 (95% CI: 1.04-2.43) relative to never smokers. In both sexes, the RR of hip fracture gradually increased by current and accumulated tobacco consumption. The RR were consistently higher in men than in women, but the test for interaction between sex and tobacco smoking was insignificant. After...... 5 years, male ex-smokers had an adjusted RR of 0.73 (95% CI: 0.55-0.98) relative to current smokers, while no significant decrease in risk was observed in female ex-smokers (RR = 0.91; 95% CI: 0.72-1.17)). Approximately 19% of all hip fractures in the present study population were attributable...

  17. Stress corrosion-controlled rates of mode I fracture propagation in calcareous bedrock

    Science.gov (United States)

    Voigtlaender, Anne; Leith, Kerry; Krautblatter, Michael

    2014-05-01

    Surface bedrock on natural rock slopes is subject to constant and cyclic environmental stresses (wind, water, wave, ice, seismic or gravitational). Studies indicate that these stresses range up to several hundred kPa, generally too low to cause macroscopic changes in intact rock, although clear evidence of fracture generation, crack propagation and weathering of bedrock illustrates the effect of environmental stresses at the Earth's surface. We suggest that material degradation and its extent, is likely to be controlled by the rate of stress corrosion cracking (SCC). Stress corrosion is a fluid-material reaction, where fluids preferentially react with strained atomic bonds at the tip of developing fractures. Stress corrosion in ferrous and siliceous materials is often accepted as the fracture propagation and degradation rate-controlling process where materials are subject to stresses and fluids. Although evidence for chemical weathering in propagating bedrock fractures is clear in natural environments, the physical system and quantification of stress corrosion in natural rocks is yet to be addressed. Here, we present preliminary data on the relationship between stresses at levels commonly present on natural rock slopes, and material damage resulting from stress corrosion under constant or cyclic tensile loading. We undertake single notch three-point bending tests (SNBT) on fresh calcareous bedrock specimens (1100x100x100mm) over a two-month period. Two beams containing an artificial notch are stressed to 75% of their ultimate strength, and a constant supply of weak acid is applied at the notch tip to enhance chemical reactions. A third, unloaded, beam is also exposed to weak acid in order to elucidate the contribution of stress corrosion cracking to the material degradation. Stresses at the tip of propagating cracks affect the kinetics of the chemical reaction in the specimen exposed to both loading and corrosion, leading to an increase in degradation, and greater

  18. Adults With Idiopathic Scoliosis Diagnosed at Youth Experience Similar Physical Activity and Fracture Rate as Controls.

    Science.gov (United States)

    Diarbakerli, Elias; Grauers, Anna; Danielsson, Aina; Gerdhem, Paul

    2017-04-01

    Cross-sectional. To describe physical activity level and fracture rates in adults with idiopathic scoliosis, diagnosed before maturity, and to compare with a control group. A previous study found a lower level of sporting activities in adults treated for idiopathic scoliosis compared with controls. Other studies have shown a lower bone mass in adults with idiopathic scoliosis compared with controls. One thousand two hundred seventy-eight adults (aged 18-71 yr) with idiopathic scoliosis and 214 controls (aged 18-70 yr) were included and answered the International Physical Activity Questionnaire - Short Form (IPAQ-SF) and questions about previous fractures. The three scoliosis treatment groups (untreated n = 360, brace n = 460, and surgically treated n = 458) were compared. Furthermore, a comparison based on onset (juvenile n = 169 or adolescent n = 976) was performed. Achieved weekly moderate activity level and metabolic equivalent task (MET) minutes/week were assessed for patients and controls. Statistical comparisons were made with analysis of covariance with adjustments for age, body mass index, and sex. The proportion achieving weekly moderate activity level was 962 out of 1278 for individuals with idiopathic scoliosis (75%) and 157 out of 214 (73%) for controls (P = 0.40). The scoliosis patients reported 2016 MET-minutes/week (median value) and the controls 2456 (P = 0.06). Fracture rates did not differ (P = 0.72). Fewer surgically treated individuals achieved moderate activity level (P = 0.046) compared with the untreated and the previously braced individuals. No difference was seen regarding MET-minutes/week (P = 0.86). No differences were seen between individuals with a juvenile onset compared with individuals with an adolescent onset (all P ≥ 0.05). Adults with idiopathic scoliosis have similar physical activity level and do not sustain more fractures compared with controls. Adults with surgically treated

  19. 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...

  20. The Juvenile Addiction Risk Rating: Development and Initial Psychometrics

    Science.gov (United States)

    Powell, Michael; Newgent, Rebecca A.

    2016-01-01

    This article describes the development and psychometrics of the Juvenile Addiction Risk Rating. The Juvenile Addiction Risk Rating is a brief screening of addiction potential based on 10 risk factors predictive of youth alcohol and drug-related problems that assists examiners in more accurate treatment planning when self-report information is…

  1. Length-scale and strain rate-dependent mechanism of defect formation and fracture in carbon nanotubes under tensile loading

    Science.gov (United States)

    Javvaji, Brahmanandam; Raha, S.; Mahapatra, D. Roy

    2017-02-01

    Electromagnetic and thermo-mechanical forces play a major role in nanotube-based materials and devices. Under high-energy electron transport or high current densities, carbon nanotubes fail via sequential fracture. The failure sequence is governed by certain length scale and flow of current. We report a unified phenomenological model derived from molecular dynamic simulation data, which successfully captures the important physics of the complex failure process. Length-scale and strain rate-dependent defect nucleation, growth, and fracture in single-walled carbon nanotubes with diameters in the range of 0.47 to 2.03 nm and length which is about 6.17 to 26.45 nm are simulated. Nanotubes with long length and small diameter show brittle fracture, while those with short length and large diameter show transition from ductile to brittle fracture. In short nanotubes with small diameters, we observe several structural transitions like Stone-Wales defect initiation, its propagation to larger void nucleation, formation of multiple chains of atoms, conversion to monatomic chain of atoms, and finally complete fracture of the carbon nanotube. Hybridization state of carbon-carbon bonds near the end cap evolves, leading to the formation of monatomic chain in short nanotubes with small diameter. Transition from ductile to brittle fracture is also observed when strain rate exceeds a critical value. A generalized analytical model of failure is established, which correlates the defect energy during the formation of atomic chain with aspect ratio of the nanotube and strain rate. Variation in the mechanical properties such as elastic modulus, tensile strength, and fracture strain with the size and strain rate shows important implications in mitigating force fields and ways to enhance the life of electronic devices and nanomaterial conversion via fracture in manufacturing.

  2. 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...

  3. Concomitant medication use and its implications on the hazard pattern in pharmacoepidemiological studies : Example of antidepressants, benzodiazepines and fracture risk

    NARCIS (Netherlands)

    Abbing-Karahagopian, V.; Souverein, P. C.; Korevaar, J. C.; Leufkens, H. G M; Egberts, T. C G; Gardarsdottir, H.; De Bruin, Marie L.

    2015-01-01

    Background: Antidepressants and benzodiazepines are often co-prescribed and both associated with an increased fracture risk, albeit with distinctive hazard patterns. Timing of initiation of one with respect to the other and duration of use may influence the combined fracture hazard. The objective of

  4. Simplifying cardiovascular risk estimation using resting heart rate.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2010-09-01

    Elevated resting heart rate (RHR) is a known, independent cardiovascular (CV) risk factor, but is not included in risk estimation systems, including Systematic COronary Risk Evaluation (SCORE). We aimed to derive risk estimation systems including RHR as an extra variable and assess the value of this addition.

  5. 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

  6. Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

    Science.gov (United States)

    Kennedy, C. C.; Ioannidis, G.; Cameron, C.; Croxford, R.; Adachi, J. D.; Mursleen, S.; Jaglal, S.

    2016-01-01

    Summary In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. Introduction This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002–2012. Methods This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). Results Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, −3.49 (95% confidence interval (CI), −3.97, −3.01)) compared with the community (APC, −2.93 (95 % CI, −3.28, −2.57); p< 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p <0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95 % CI, 1.45, 1.67); men, 2.18 (95 % CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95 % CI, 1.22, 1.80)) and humerus (RR, 1.40 (95 % CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95 % CI, 0.71, 0.81)) and spine (RR, 0.52 (95 % CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95 % CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95 % CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. Conclusion Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip

  7. 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

  8. Distribution of bone density in the proximal femur and its association with hip fracture risk in older men: the osteoporotic fractures in men (MrOS) study.

    Science.gov (United States)

    Yang, Lang; Burton, Annabel C; Bradburn, Mike; Nielson, Carrie M; Orwoll, Eric S; Eastell, Richard

    2012-11-01

    This prospective case-cohort study aimed to map the distribution of bone density in the proximal femur and examine its association with hip fracture. We analyzed baseline quantitative computed tomography (QCT) scans in 250 men aged 65 years or older, which comprised a randomly-selected subcohort of 210 men and 40 cases of first hip fracture during a mean follow-up period of 5.5 years. We quantified cortical, trabecular, and integral volumetric bone mineral density (vBMD), and cortical thickness (CtTh) in four quadrants of cross-sections along the length of the femoral neck (FN), intertrochanter (IT), and trochanter (TR). In most quadrants, vBMDs and CtTh were significantly (p hip fracture, we merged the two quadrants in the medial and lateral aspects of the FN, IT, and TR. At most sites, QCT measurements were associated significantly (p hip fracture, the hazard ratio (HR) adjusted for age, body mass index (BMI), and clinical site for a 1-SD decrease ranged between 2.28 (95% confidence interval [CI], 1.44-3.63) to 6.91 (95% CI, 3.11-15.53). After additional adjustment for total hip (TH) areal BMD (aBMD), trabecular vBMDs at the FN, TR, and TH were still associated with hip fracture significantly (p fracture significantly (p > 0.05) better than TH aBMD. With an area under the receiver operating characteristic curve (AUC) of 0.901 (95% CI, 0.852-0.950), the regression model combining TH aBMD, age, and trabecular vBMD predicted hip fracture significantly (p hip fracture risk and highlight trabecular vBMD at the FN and TR as an independent risk factor. Copyright © 2012 American Society for Bone and Mineral Research.

  9. Theoretical relation between water flow rate in a vertical fracture and rock temperature in the surrounding massif

    CERN Document Server

    Maréchal, Jean-Christophe

    2010-01-01

    A steady-state analytical solution is given describing the temperature distribution in a homogeneous massif perturbed by cold water flow through a discrete vertical fracture. A relation is derived to express the flow rate in the fracture as a function of the temperature measured in the surrounding rock. These mathematical results can be useful for tunnel drilling as it approaches a vertical cold water bearing structure that induces a thermal anomaly in the surrounding massif. During the tunnel drilling, by monitoring this anomaly along the tunnel axis one can quantify the flow rate in the discontinuity ahead before intersecting the fracture. The cases of the Simplon, Mont Blanc and Gotthard tunnels (Alps) are handled with this approach which shows very good agreement between observed temperatures and the theoretical trend. The flow rates before drilling of the tunnel predicted with the theoretical solution are similar in the Mont Blanc and Simplon cases, as well as the flow rates observed during the drilling....

  10. 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...

  11. Asthma and Therapeutics: Inhaled Corticosteroids, Corticosteroid Osteoporosis, and the Risk of Fracture in Chronic Asthma

    Directory of Open Access Journals (Sweden)

    Toogood John H

    2005-03-01

    Full Text Available Abstract Current guidelines for the diagnosis and treatment of osteoporosis do not address the risks to bone density and the likelihood of fracture that may be associated with inhaled corticosteroid treatment for asthma. This review outlines an approach to the use of bone densitometry in clinical practice for the diagnosis, prevention, and treatment of osteoporosis in asthmatic patients receiving inhaled corticosteroid therapy.

  12. Risk Stratification of Stress Fractures and Prediction of Return to Duty

    Science.gov (United States)

    2015-12-01

    provision of law, no person shall be subject to any penalty for fai ling to comply with a collection of information if it does not display a currently valid...include IRB and HRPO approvals for all study protocols, hiring and training of staff at MGH, as well as the initiation of subject recruitment and...enrollment. In study Task 1 we aim to determine the sex- and race-ethnicity-specific bone traits that may contribute to stress fracture risk in military

  13. Inappropriate benzodiazepine use in older adults and the risk of fracture

    OpenAIRE

    2008-01-01

    textabstractAIMS: The Beers criteria for prescribing in elderly are well known and used for many drug utilization studies. We investigated the clinical value of the Beers criteria for benzodiazepine use, notably the association between inappropriate use and risk of fracture. METHODS: We performed a nested case-control study within the Rotterdam Study, a population-based cohort study in 7983 elderly. The proportion of 'inappropriate' benzodiazepine use according to the Beers criteria was compa...

  14. Improvement of denitrification rates in confined zones of fractured subsoils under continuous wastewater injection.

    Science.gov (United States)

    Carrieri, Carmelo; Masciopinto, Costantino

    2003-01-01

    An attempt to improve the natural biodegradation rate in a fractured aquifer (Nardò (Le), Southern Italy) subject since '91 to the injection of 12,000 m3/d of treated municipal wastewater, has been carried out through tests on pilot plants. The lab experiments showed that a complete nitrogen removal can be realized after 10 d of infiltration in fractures by adding whey in the influent waste. The lab results have been used in a mathematical model in order to simulate ground water quality changes caused by the addition of whey in the injecting water. The analytical parameters of ground water sampled in monitoring wells located at different distances from the injection site, have been compared with mathematical model results. Moreover for preserving such resource from pollution, the mathematical model allowed two areas, around the injection site to be drawn. These areas, where withdrawals would be prohibited, are required to avoid infections by pathogens and bacteria in ground water due to incomplete biodegradation processes. The experimental results can be useful to identify standardized methodology for artificial ground water recharge which could be required for aquifer clean up (Water Frame Directive 2000/60).

  15. Hepatitis C co-infection and severity of liver disease as risk factors for osteoporotic fractures among HIV-infected patients.

    Science.gov (United States)

    Maalouf, Naim M; Zhang, Song; Drechsler, Henning; Brown, Geri R; Tebas, Pablo; Bedimo, Roger

    2013-12-01

    Osteoporosis is increasingly reported in the aging HIV-positive population, and co-infection with hepatitis C virus (HCV) may further increase the risk of osteoporosis. However, it remains unclear whether HCV-related increased fracture risk is a function of the severity of liver disease. We calculated the time-updated alanine aminotransferase to platelet ratio index (APRI) score (an indirect marker of hepatic fibrosis) in all HIV-infected patients enrolled in the Veterans Affairs' Clinical Case Registry between 1984 and 2009. The association between HCV co-infection and incident osteoporotic fracture (defined as closed wrist, vertebral, or hip fracture) was assessed in univariate and multivariate Cox survival models adjusting for traditional risk factors for osteoporosis and APRI score or the presence of cirrhosis. A total of 772 osteoporotic fractures were identified among 56,660 HIV-infected patients (98.1% male; 31.3% HCV co-infected; median age 44.0 years) contributing 305,237 patient-years of follow-up. Fracture rates were significantly higher among HIV/HCV patients than HIV-only patients (2.57 versus 2.07/1000 patient-years, relative risk = 1.24, p < 0.0001). In a Cox multivariable model including age, race, smoking, drug use, body mass index, and antiretroviral therapy, HCV co-infection remained an independent predictor of osteoporotic fractures after controlling for presence of cirrhosis (hazard ratio [HR] = 1.32; p <0.001) or APRI score (HR = 1.30; p = 0.003). Among HIV/HCV co-infected patients, cirrhosis strongly predicted osteoporotic fractures (HR = 1.65; 95% confidence interval [CI] 1.11-2.44; p = 0.012), but APRI score was a weaker predictor (HR = 1.008; 95% CI 1.002-1.014; p = 0.015). In conclusion, among HIV-infected patients, severity of liver disease partly explains the HCV-associated increased risk of osteoporotic fractures. Other determinants of this increased risk remain to be defined.

  16. Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective

    DEFF Research Database (Denmark)

    Hansen, Louise; Petersen, Karin Dam; Eriksen, Stine Aistrup;

    2015-01-01

    Summary: Fractures after the age of 50 are frequently observed in Denmark, and many of these may be osteoporotic. This study examined the incidence of all and subsequent fractures in a 10-year period from 2001 to 2011. The incidence of subsequent fractures was high, especially following hip fract...

  17. Influence of cooling rate on interlaminar fracture properties of unidirectional commingled CF/PEEK composites

    Science.gov (United States)

    Beehag, Andrew; Ye, Lin

    1995-05-01

    The influence of cooling rates on the mechanical property profile (transverse flexure properties and modes-I and -II interlaminar fracture toughness) has been investigated for unidirectional commingled CF/PEEK composites. A laboratory hot press with a steel mould was used to process the composites at 400°C for 60 min, at an applied pressure of 1 MPa. Cooling rates from fast (quenching in oil) to slow (hot press cooling) were achieved at ambient pressure. The results indicate that different matrix morphology was found at different cooling conditions, although deconsolidation occurred in the CF/PEEK composites during cooling. When the cooling rate was shifted from slow to fast, consolidation quality of the CF/PEEK composites was improved. The resulting effect of the consolidation quality and cooling rates on the mechanical property profile of commingled CF/PEEK composites is presented. It was found that the effect of the cooling rate on the mechanical property profile of the commingled CF/PEEK composites could not be isolated from the consolidation quality.

  18. Simultaneous field estimates of urea hydrolysis rates and ammonium retardation factors in a fractured rock aquifer

    Science.gov (United States)

    Smith, R. W.; Taylor, J. L.; Fujita, Y.

    2005-12-01

    Knowledge of the rates of in situ biogeochemical processes is critical to the design and implementation of active and passive environmental remediation strategies. However, often rate determinations require the collection of samples in the field followed by laboratory studies that may occur days or weeks later. Artificial laboratory conditions as well as sample storage effects can lead to erroneous conclusions regarding kinetic processes in nature. We have been investigating in field and laboratory studies the microbial hydrolysis of urea as a method to facilitate calcium carbonate precipitation and co-precipitation of divalent metal and radionuclide contaminants (such as 90Sr). In conjunction with a single well "push-pull" test conducted in a fractured basalt aquifer near the Idaho National Laboratory, in situ rates of urea hydrolysis were estimated by tracking the disappearance of urea and a conservative tracer and measuring the increase in ammonium concentration. The analysis of rates was complicated by cation exchange reactions of ammonium with the aquifer matrix. However, we were able to derive and parameterize a rate law that explicitly included a retardation factor. With this approach, we are able to characterize in situ ureolysis kinetics without resorting to laboratory studies.

  19. The response of industry stock returns to market, exchange rate and interest rate risks

    OpenAIRE

    Hyde, Stuart J

    2007-01-01

    This study investigates the sensitivity of stock returns at the industry level to market, exchange rate and interest rate shocks in the four major European economies: France, Germany, Italy and the UK. In addition to exposure to the market, significant levels of exposure to both exchange rate risk, in the four countries, and interest rate risk, in France and Germany, are identified. Further, responses to sources of risk are decomposed into components attributable to news about future dividend...

  20. 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

    for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%. RESULTS: Immature: No severe complications (PN.......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......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...

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

    Directory of Open Access Journals (Sweden)

    Ego Seeman

    2015-12-01

    Full Text Available 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.

  2. 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

  3. Low Osteoporosis Treatment Initiation Rate in Women after Distal Forearm or Proximal Humerus Fracture: A Healthcare Database Nested Cohort Study.

    Directory of Open Access Journals (Sweden)

    Marie Viprey

    Full Text Available Treatment initiation rates following fragility fractures have often been reported to be low and in recent years numerous programs have been implemented worldwide to increase them. This study aimed at describing osteoporosis (OP treatment initiation in a representative sample of women who were hospitalized for a distal forearm fracture (DFF or proximal humerus fracture (PHF in 2009-2011 in France. The data source was a nationwide sample of 600,000 individuals, extracted from the French National Insurance Healthcare System database. All women aged 50 years and older who were hospitalized for a DFF or PHF between 2009 and 2011 and who had not received any OP treatment in the preceding 12 months were included in a retrospective cohort study. OP treatments initiated during the year following the fracture were analyzed. From 2009 to 2011, 729 women were hospitalized for a DFF or a PHF and 284 were on OP treatment at the time of the fracture occurrence. Among the 445 women who had no prevalent OP treatment, 131 (29.4% received supplementation treatment only (vitamin D and/or calcium and 42 (9.4% received a pharmacologic OP treatment in the year following their fracture. Pharmacological OP treatments included bisphosphonates (n = 21, strontium ranelate (n = 14, hormone replacement therapy (n = 4, or raloxifene (n = 3. General practitioners prescribed 75% of initial OP treatments. Despite the guidelines published in 2006 and the numerous initiatives to promote post-fracture OP treatment, OP treatment initiation rate in women who were hospitalized for a fragility fracture remained low in 2009-2011 in France.

  4. Proton pump inhibitors in rheumatic diseases: clinical practice, drug interactions, bone fractures and risk of infections

    Directory of Open Access Journals (Sweden)

    E. Gremese

    2011-06-01

    Full Text Available Patients affected by acute coronary syndrome (ACS or by chronic inflammatory musculoskeletal and connective tissue diseases (i.e. systemic sclerosis, often need antiaggregant therapy (ASA or Clopidogrel. The concomitant use of proton pump inhibitors (PPIs is suggested to reduce the risk of haemorrhage. Clopidogrel is a prodrug activated by cytocrome P 450. PPIs too have a CYP P450 metabolism, and a drug interaction has been observed between PPIs and clopidogrel. 25% of nonresponsiveness to clopidogrel is due to this drug interaction (1. Some studies have demonstrated that the use of PPIs is associated with an increased risk of bone fractures and Clostridium difficile infection.

  5. Bifurcation and neck formation as a precursor to ductile fracture during high rate extension

    Energy Technology Data Exchange (ETDEWEB)

    Freund, L.B.; Soerensen, N.J. [Brown Univ., Providence, RI (United States)

    1997-12-31

    A block of ductile material, typically a segment of a plate or shell, being deformed homogeneously in simple plane strain extension commonly undergoes a bifurcation in deformation mode to nonuniform straining in the advanced stages of plastic flow. The focus here is on the influence of material inertia on the bifurcation process, particularly on the formation of diffuse necks as precursors to dynamic ductile fracture. The issue is considered from two points of view, first within the context of the theory of bifurcation of rate-independent, incrementally linear materials and then in terms of the complete numerical solution of a boundary value problem for an elastic-viscoplastic material. It is found that inertia favors the formation of relatively short wavelength necks as observed in shaped charge break-up and dynamic fragmentation.

  6. Interest Rate Risk Management using Duration Gap Methodology

    Directory of Open Access Journals (Sweden)

    Dan Armeanu

    2008-01-01

    Full Text Available The world for financial institutions has changed during the last 20 years, and become riskier and more competitive-driven. After the deregulation of the financial market, banks had to take on extensive risk in order to earn sufficient returns. Interest rate volatility has increased dramatically over the past twenty-five years and for that an efficient management of this interest rate risk is strong required. In the last years banks developed a variety of methods for measuring and managing interest rate risk. From these the most frequently used in real banking life and recommended by Basel Committee are based on: Reprising Model or Funding Gap Model, Maturity Gap Model, Duration Gap Model, Static and Dynamic Simulation. The purpose of this article is to give a good understanding of duration gap model used for managing interest rate risk. The article starts with a overview of interest rate risk and explain how this type of risk should be measured and managed within an asset-liability management. Then the articles takes a short look at methods for measuring interest rate risk and after that explains and demonstrates how can be used Duration Gap Model for managing interest rate risk in banks.The world for financial institutions has changed during the last 20 years, and become riskier and more competitive-driven. After the deregulation of the financial market, banks had to take on extensive risk in order to earn sufficient returns. Interest rate volatility has increased dramatically over the past twenty-five years and for that an efficient management of this interest rate risk is strong required. In the last years banks developed a variety of methods for measuring and managing interest rate risk. From these the most frequently used in real banking life and recommended by Basel Committee are based on: Reprising Model or Funding Gap Model, Maturity Gap Model, Duration Gap Model, Static and Dynamic Simulation. The purpose of this article is to give a

  7. 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

  8. Bone mineral density at diagnosis determines fracture rate in children with acute lymphoblastic leukemia treated according to the DCOG-ALL9 protocol

    NARCIS (Netherlands)

    te Winkel, Mariel L.; Pieters, Rob; Hop, Wim C. J.; Roos, Jan C.; Bokkerink, Jos P. M.; Leeuw, Jan A.; Bruin, Marrie C. A.; Kollen, Wouter J. W.; Veerman, Anjo J. P.; de Groot-Kruseman, Hester A.; van der Sluis, Inge M.; van den Heuvel-Eibrink, Marry M.

    2014-01-01

    Purpose: To elucidate incidence and risk factors of bone mineral density and fracture risk in children with Acute Lymphoblastic Leukemia (ALL). Methods: Prospectively, cumulative fracture incidence, calculated from diagnosis until one year after cessation of treatment, was assessed in 672 patients.

  9. Bone mineral density at diagnosis determines fracture rate in children with acute lymphoblastic leukemia treated according to the DCOG-ALL9 protocol

    NARCIS (Netherlands)

    Winkel, M.L. te; Pieters, R.; Hop, W.C.J.; Roos, J.C.; Bokkerink, J.P.M.; Leeuw, J.A. de; Bruin, M.C.; Kollen, W.J.; Veerman, A.J.P.; Groot-Kruseman, H.A. de; Sluis, I.M. van der; Heuvel-Eibrink, M.M. van den

    2014-01-01

    PURPOSE: To elucidate incidence and risk factors of bone mineral density and fracture risk in children with Acute Lymphoblastic Leukemia (ALL). METHODS: Prospectively, cumulative fracture incidence, calculated from diagnosis until one year after cessation of treatment, was assessed in 672 patients.

  10. Self-perceived facture risk

    DEFF Research Database (Denmark)

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

    2015-01-01

    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......-perceived risk of fractures and enabled calculation of absolute fracture risk by FRAX®. Data were analyzed using bivariate tests and regression models. RESULTS: Women generally underestimated their fracture risk compared to absolute risk estimated by FRAX®. Women with risk factors for facture estimated......-rated heath, conditions related to secondary osteoporosis, and inability to do housework. CONCLUSIONS: These women aged 65-81 years underestimated their risk of fracture. However, they did seem to have an understanding of the importance of some risk factors such as previous fractures, parental hip fracture...

  11. Characterizing trabecular bone structure for assessing vertebral fracture risk on volumetric quantitative computed tomography

    Science.gov (United States)

    Nagarajan, Mahesh B.; Checefsky, Walter A.; Abidin, Anas Z.; Tsai, Halley; Wang, Xixi; Hobbs, Susan K.; Bauer, Jan S.; Baum, Thomas; Wismüller, Axel

    2015-03-01

    While the proximal femur is preferred for measuring bone mineral density (BMD) in fracture risk estimation, the introduction of volumetric quantitative computed tomography has revealed stronger associations between BMD and spinal fracture status. In this study, we propose to capture properties of trabecular bone structure in spinal vertebrae with advanced second-order statistical features for purposes of fracture risk assessment. For this purpose, axial multi-detector CT (MDCT) images were acquired from 28 spinal vertebrae specimens using a whole-body 256-row CT scanner with a dedicated calibration phantom. A semi-automated method was used to annotate the trabecular compartment in the central vertebral slice with a circular region of interest (ROI) to exclude cortical bone; pixels within were converted to values indicative of BMD. Six second-order statistical features derived from gray-level co-occurrence matrices (GLCM) and the mean BMD within the ROI were then extracted and used in conjunction with a generalized radial basis functions (GRBF) neural network to predict the failure load of the specimens; true failure load was measured through biomechanical testing. Prediction performance was evaluated with a root-mean-square error (RMSE) metric. The best prediction performance was observed with GLCM feature `correlation' (RMSE = 1.02 ± 0.18), which significantly outperformed all other GLCM features (p GLCM feature correlation also significantly outperformed MDCTmeasured mean BMD (RMSE = 1.11 ± 0.17) (pGLCM-derived texture features.

  12. The risk of hydraulic fracturing on public health in the UK and the UK's fracking legislation.

    Science.gov (United States)

    Reap, Elisabeth

    2015-01-01

    Hydraulic fracturing to extract natural gas from shale rock is a new, rapidly expanding industry in the United States (US). However, there is concern that these operations could be having large negative impacts such as groundwater contamination, increased air pollution and seismic events. The United Kingdom (UK) is looking at the potential for emulating the success of 'shale gas' in the US. Differences in population density and geological conditions mean that the public health impacts recorded in the US cannot be directly extrapolated to the UK. There is limited academic literature available but findings suggest that the UK government is not fully recognising the inherent risks of hydraulic fracturing exposed by this literature. Government reports suggest a reliance on engineering solutions and better practice to overcome problems found in the US when evidence suggests that there are inherent risks and impacts that cannot be eliminated. This study applies US results to approximate the impact of one exposure pathway, inhalation of hydrocarbons by the public from operational air emissions over the 30 year lifetime of a well and finds that 7.2 extra cancer cases from exposure to air contamination would be expected in the UK if all test sites, approved test sites and test sites awaiting approval as of January 2015 went on to extract gas. In conclusion, limited assessment of the public health implications of hydraulic fracturing operations is available but the UK government appears to not be applying the precautionary principle to potentially significant legislation.

  13. 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......-based cohort study including 687 adult (≥15 years) SM patients diagnosed during 1997-2012. A comparison cohort of 68,700 subjects from the general Danish population who were alive and without SM at the given SM subject's diagnosis were age- and gender-matched. Outcomes were a new diagnosis of solid cancer...... 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...

  14. [FRAX® thresholds to identify people with high or low risk of osteoporotic fracture in Spanish female population].

    Science.gov (United States)

    Azagra, Rafael; Roca, Genís; Martín-Sánchez, Juan Carlos; Casado, Enrique; Encabo, Gloria; Zwart, Marta; Aguyé, Amada; Díez-Pérez, Adolf

    2015-01-06

    To detect FRAX(®) threshold levels that identify groups of the population that are at high/low risk of osteoporotic fracture in the Spanish female population using a cost-effective assessment. This is a cohort study. Eight hundred and sixteen women 40-90 years old selected from the FRIDEX cohort with densitometry and risk factors for fracture at baseline who received no treatment for osteoporosis during the 10 year follow-up period and were stratified into 3 groups/levels of fracture risk (low20%) according to the real fracture incidence. The thresholds of FRAX(®) baseline for major osteoporotic fracture were: low riskrisk (3.6%; 95% CI 2.2-5.9), intermediate risk (13.7%; 95% CI 7.1-24.2) and high risk (21.4%; 95% CI12.9-33.2). The most cost-effective option was to refer to dual energy X-ray absorptiometry (DXA-scan) for FRAX(®)≥ 5 (Intermediate and high risk) to reclassify by FRAX(®) with DXA-scan at high/low risk. These thresholds select 17.5% of women for DXA-scan and 10% for treatment. With these thresholds of FRAX(®), compared with the strategy of opportunistic case finding isolated risk factors, would improve the predictive parameters and reduce 82.5% the DXA-scan, 35.4% osteoporosis prescriptions and 28.7% cost to detect the same number of women who suffer fractures. The use of FRAX ® thresholds identified as high/low risk of osteoporotic fracture in this calibration (FRIDEX model) improve predictive parameters in Spanish women and in a more cost-effective than the traditional model based on the T-score ≤ -2.5 of DXA scan. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  15. Credit ratings and CEO risk-taking incentives

    NARCIS (Netherlands)

    Kuang, Y.F.; Qin, B.

    2013-01-01

    This study examines the sophistication of rating agencies in incorporating managerial risk-taking incentives into their credit risk evaluation. We measure risk-taking incentives using two proxies: the sensitivity of managerial wealth to stock return volatility (vega) and the sensitivity of

  16. 76 FR 23646 - Financial Management Policies-Interest Rate Risk

    Science.gov (United States)

    2011-04-27

    ... Office of Thrift Supervision Financial Management Policies--Interest Rate Risk AGENCY: Office of Thrift... following information collection. Title of Proposal: Financial Management Policies--Interest Rate Risk. OMB... collection request (ICR) described below has been submitted to the Office of Management and Budget (OMB) for...

  17. 76 FR 9870 - Financial Management Policies-Interest Rate Risk

    Science.gov (United States)

    2011-02-22

    ... Office of Thrift Supervision Financial Management Policies--Interest Rate Risk AGENCY: Office of Thrift... of Proposal: Financial Management Policies--Interest Rate Risk OMB Number: 1550-0094 Form Number: N/A... below to the Office of Management and Budget (OMB) for review, as required by the Paperwork Reduction...

  18. 12 CFR 615.5135 - Management of interest rate risk.

    Science.gov (United States)

    2010-01-01

    ... agricultural credit bank shall develop and implement an interest rate risk management program as set forth in... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Management of interest rate risk. 615.5135 Section 615.5135 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM FUNDING AND...

  19. Interest Rate Risk Management using Duration Gap Methodology

    Directory of Open Access Journals (Sweden)

    Dan Armeanu

    2008-01-01

    should be measured and managed within an asset-liability management. Then the articles takes a short look at methods for measuring interest rate risk and after that explains and demonstrates how can be used Duration Gap Model for managing interest rate risk in banks.

  20. Plasma homocysteine level is a risk factor for osteoporotic fractures in elderly patients

    Directory of Open Access Journals (Sweden)

    Zhu Y

    2016-08-01

    .Conclusion: In this study, we found that the plasma Hcy level in elderly patients with OPF is higher than that of nonosteoporotic patients. It is not correlated with BMD, but positively correlated with bone resorption markers. An increased Hcy level appears to be a risk factor for OPFs in elderly people. Keywords: elderly patient, osteoporosis, fracture, homocysteine, bone mineral density, bone turnover marker

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

    DEFF Research Database (Denmark)

    Kjaergaard, AD; Ellervik, C; Tybjaerg-Hansen, A;

    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...... 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...... 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...

  2. Evolution of the fracture process zone in high-strength concrete under different loading rates

    Directory of Open Access Journals (Sweden)

    Cámara M.

    2010-06-01

    Full Text Available For cementitious materials, the inelastic zone around a crack tip is termed as fracture process zone (FPZ and dominated by complicated mechanism, such as microcracking, crack deflection, bridging, crack face friction, crack tip blunting by voids, crack branching, and so on. Due to the length of the FPZ is related with the characteristic length of the cementitious materials, the size, extent and location of the FPZ has been the object of countless research efforts for several decades. For instance, Cedolin et al. [1] have used an optical method based on the moiré interferometry to determine FPZ in concrete. Castro-Montero et al. [2] have applied the method of holographic interferometry to mortar to study the extension of the FPZ. The advantage of the interferometry method is that the complete FPZ can be directly observed on the surface of the sample. Swartz et al. [3] has adopted the dye penetration technique to illustrate the changing patterns observed as the crack progress from the tensile side to the compression side of the beam. Moreover, acoustic emission (AE is also an experimental technique well suited for monitoring fracture process. Haidar et al. [4] and Maji et al. [5] have studied the relation between acoustic emission characteristics and the properties of the FPZ. Compared with the extensive research on properties of the FPZ under quasi-static loading conditions, much less information is available on its dynamic characterization, especially for high-strength concrete (HSC. This paper presents the very recent results of an experimental program aimed at disclosing the loading rate effect on the size and velocity of the (FPZ in HSC. Eighteen three-point bending specimens were conducted under a wide range of loading rates from from 10-4 mm/s to 103 mm/s using either a servo-hydraulic machine or a self-designed drop-weight impact device. The beam dimensions were 100 mm 100 mm in cross section, and 420 mm in length. The initial notch

  3. Hip fracture risk estimation based on bone mineral density of a biomechanically guided region of interest: a preliminary study

    Science.gov (United States)

    Li, Wenjun; Kornak, John; Li, Caixia; Koyama, Alain; Saeed, Isra; Lu, Ying; Lang, Thomas

    2008-03-01

    We aim to define a biomechanically-guided region of interest inside the proximal femur for improving fracture risk prediction based on bone density measurements. The central hypothesis is that by identifying and focusing on the proximal femoral tissues strongly associated with hip fracture risk, we can provide a better densitometric evaluation of fracture risk compared to current evaluations based on anatomically defined regions of interest using DXA or CT. To achieve this, we have constructed a hip statistical atlas of quantitative computed tomography (QCT) images by applying rigid and non-rigid inter-subject image registration to transform hip QCT scans of 15 fractured patients and 15 controls into a common reference space, and performed voxel-by-voxel t-tests between the two groups to identify bone tissues that showed the strongest relevance to hip fracture. Based on identification of this fracture-relevant tissue volume, we have generated a biomechanically-guided region of interest (B-ROI). We have applied BMD measured from this new region of interest to discriminate the fractured patients and controls, and compared it to BMD measured in the total proximal femur. For the femur ROI approach, the BMD values of the fractured patients and the controls had an overlap of 60 mg/cm 3, and only 1 out of 15 fractured patients had BMD below the overlap region; for the B-ROI approach, a much narrower BMD overlap region of 28 mg/cm 3 was observed, and 11 out of 15 fractured patients had BMDs below the overlap region.

  4. Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study.

    Science.gov (United States)

    Neerland, Bjørn Erik; Krogseth, Maria; Juliebø, Vibeke; Hylen Ranhoff, Anette; Engedal, Knut; Frihagen, Frede; Ræder, Johan; Bruun Wyller, Torgeir; Watne, Leiv Otto

    2017-01-01

    Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia. Prospective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method. Pre-fracture cognitive function was assessed using the Informant Questionnaire of Cognitive Decline in the Elderly and by consensus diagnosis. The presence of new-onset dementia was determined at follow-up evaluation at six or twelve months after surgery. Blood pressure was recorded at admission, perioperatively and postoperatively. Preoperative delirium was present in 149 of 536 (28%) assessable patients, and 124 of 387 (32%) developed delirium postoperatively (incident delirium). The following risk factors for incident delirium in patients without pre-fracture cognitive impairment were identified: low body mass index, low level of functioning, severity of physical illness, and receipt of ≥ 2 blood transfusions. New-onset dementia was diagnosed at follow-up in 26 of 213 (12%) patients, associated with severity of physical illness, delirium, receipt of vasopressor drugs perioperatively and high mean arterial pressure postoperatively. Risk factors for incident delirium seem to differ according to pre-fracture cognitive status. The use of vasopressors during surgery and/or postoperative hypertension is associated with new-onset dementia after hip fracture.

  5. A study on rate sensitivity of elasto-plastic fracture toughness of TRIP steel evaluated by a small punch test

    Directory of Open Access Journals (Sweden)

    Shi L.

    2012-08-01

    Full Text Available TRIP steel indicates an excellent characteristic in energy absorption because of its high ductility and strength by strain-induced martensitic transformation (SIMT. Recently, some shock absorption members are being used for automotive industries. For good fuel consumption of the automobile, it would realize the weight reduction without decaying performance if TRIP steel can be applied to those members. It can be considered that the fracture toughness is an important factor to evaluate the performance. To evaluate fracture toughness locally at any point of a product of those members, small punch testing method is quite effective. In the present study, first, an impact small punch testing apparatus is established. In addition, elasto-plastic fracture toughness of TRIP steel under impact loading and its rate sensitivity tested at various deflection rates are challenged to evaluate.

  6. A study on rate sensitivity of elasto-plastic fracture toughness of TRIP steel evaluated by a small punch test

    Science.gov (United States)

    Iwamoto, T.; Hashimoto, S.-ya; Shi, L.

    2012-08-01

    TRIP steel indicates an excellent characteristic in energy absorption because of its high ductility and strength by strain-induced martensitic transformation (SIMT). Recently, some shock absorption members are being used for automotive industries. For good fuel consumption of the automobile, it would realize the weight reduction without decaying performance if TRIP steel can be applied to those members. It can be considered that the fracture toughness is an important factor to evaluate the performance. To evaluate fracture toughness locally at any point of a product of those members, small punch testing method is quite effective. In the present study, first, an impact small punch testing apparatus is established. In addition, elasto-plastic fracture toughness of TRIP steel under impact loading and its rate sensitivity tested at various deflection rates are challenged to evaluate.

  7. Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures.

    Science.gov (United States)

    McDonough, Christine M; Colla, Carrie H; Carmichael, Donald; Tosteson, Anna N A; Tosteson, Tor D; Bell, John-Erik; Cantu, Robert V; Lurie, Jonathan D; Bynum, Julie P W

    2017-03-01

    Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Observational cohort. Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna ("wrist") fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007-2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population.

  8. Interest Rate Risk Management and the Use of Derivative Securities

    Directory of Open Access Journals (Sweden)

    Ioana-Diana PĂUN

    2013-12-01

    Full Text Available This study aims to demonstrate the utility of derivative financial instruments for the management of interest rate risk that is faced by banks and financial institutions, and to provide an efficient flow of monitoring and control thereof. Banking institutions can now use a combination of balance sheet and off balance sheet measures, i.e. gap method, of interest rate risk management, in order to control exposure of short-term rates and derivatives to control the residual interest rate exposures. The result of the study shows that banks can achieve better diversification and risk management using derivatives.

  9. How vein sealing boosts fracture widening rates - The buckling-enhanced aperture growth mechanism for syn-tectonic veins

    Science.gov (United States)

    Nüchter, Jens-Alexander

    2017-01-01

    The paper introduces the mechanism of buckling-enhanced aperture growth for syn-tectonic veins that formed in simple-shear dominated kinematic frameworks in the middle or lower crust. Apart from the well understood concepts of fracture widening driven by effective tensile stresses, buckling-enhanced fracture aperture growth relates widening to active outward buckling of more viscous incipient cement layers precipitated as hydrothermal minerals for the pore fluid on the walls of juvenile syn-tectonic veins, driven by fracture-parallel compressive creep strain in the host rocks. Thus, the mechanism proposed here follows similar principles as tectonic folding, although important differences exist. Inspired by the structural record of low-aspect ratio veins exposed in HP/LT metamorphic rocks cropping out on south Evia island, Greece, generic numerical models are calculated to study development of buckling instabilities in such incompletely cemented veins and their impact on aperture growth rates. The models indicate (1) that aperture growth rates increase with increasing viscosity contrast between the host rocks and the cement layers, (2) an increase in the thickness of the cement layers cause acceleration of aperture growth, (3) that support of restraining forces at the vein tips offered by the host rocks against buckling of the cement layers cause fully compressive states of stress ahead the fracture tips, and (4) that fracture aperture growth is possible against fully compressive fracture-normal stresses. The buckling-enhanced vein aperture growth mechanism yields important implications for the maintenance and decay of fracture-bound permeability and for the mechanical state of the middle and lower crust in seismically active regions.

  10. INTERNATIONAL FINANCE AND THE RISK OF EXCHANGE RATE

    OpenAIRE

    Garcia Villegas, Emilio; Facultad de Ciencias Contables, Universidad Nacional Mayor de San Marcos

    2014-01-01

    Three major aspects are highlighted in international finance), international risks b) international opportunities and c) market imperfections. International risk-financial risks become relevant and insids them the risk of exchange rate that during the last years due to constant fluctuations of currencies like the U.S. dollar, Japanese yen, pound sterling and the euro have impacted economic and financial situation of enterprises. In recent years has been real important to strengthen the senior...

  11. Cash sub-additive risk measures and interest rate ambiguity

    OpenAIRE

    El Karoui, Nicole; Ravanelli, Claudia

    2009-01-01

    A new class of risk measures called cash sub-additive risk measures is introduced to assess the risk of future financial, non financial and insurance positions. The debated cash additive axiom is relaxed into the cash sub-additive axiom to preserve the original difference between the numeraire of the current reserve amounts and future positions. Consequently, cash sub-additive risk measures can model stochastic and/or ambiguous interest rates or defaultable contingent claims. Practical exampl...

  12. Cash Sub-additive Risk Measures and Interest Rate Ambiguity

    OpenAIRE

    El Karoui, Nicole; Ravanelli, Claudia

    2007-01-01

    A new class of risk measures called cash sub-additive risk measures is introduced to assess the risk of future financial, non financial and insurance positions. The debated cash additive axiom is relaxed into the cash sub-additive axiom to preserve the original difference between the numeraire of the current reserve amounts and future positions. Consequently, cash sub-additive risk measures can model stochastic and/or ambiguous interest rates or defaultable contingent claims. Practical exampl...

  13. Combining chemical and isotopic measurements to estimate pesticide degradation rates in a fractured-rock aquifer

    Science.gov (United States)

    Farlin, Julien; Gallé, Tom; Bayerle, Michael; Pittois, Denis; El-Khabbaz, Hassanya; Schreglmann, Kathrin; Höche, Martina; Elsner, Martin

    2013-04-01

    Encouraged by new regulatory requirements for pesticide registration and authorization, the transport and environmental fate of these compounds in the different environmental compartments has been studied extensively. Degradation rates vary widely depending on hydraulic and chemical characteristics, with the strongest degradation usually occuring in the topsoil. Nonetheless, significant pesticide attenuation may still take place during transport in the aquifer, since residence times are generally much longer than in the soil. Ideally, pesticide transformation in the aquifer needs to be determined under real field conditions. Mass balance calculations however are complicated by the fact that the initial pesticide mass leached from the soil is often not known precisely enough. In this study, isotopic and classical pesticide concentration measurements were combined with groundwater dating techniques to assess the degradation rate of atrazine and its metabolite desethylatrazine in a fractured sandstone. The mass balance problem was solved by introducing the desethylatrazine to atrazine ratio, a relative measure which was used to quantify the advancement of atrazine degradation with increasing transport time in the subsurface. The extent of transformation of the parent compound was finally estimated from the shift in the isotopic signal between soil application and the outlet of the groundwater system.

  14. Community-based risk assessment of water contamination from high-volume horizontal hydraulic fracturing.

    Science.gov (United States)

    Penningroth, Stephen M; Yarrow, Matthew M; Figueroa, Abner X; Bowen, Rebecca J; Delgado, Soraya

    2013-01-01

    The risk of contaminating surface and groundwater as a result of shale gas extraction using high-volume horizontal hydraulic fracturing (fracking) has not been assessed using conventional risk assessment methodologies. Baseline (pre-fracking) data on relevant water quality indicators, needed for meaningful risk assessment, are largely lacking. To fill this gap, the nonprofit Community Science Institute (CSI) partners with community volunteers who perform regular sampling of more than 50 streams in the Marcellus and Utica Shale regions of upstate New York; samples are analyzed for parameters associated with HVHHF. Similar baseline data on regional groundwater comes from CSI's testing of private drinking water wells. Analytic results for groundwater (with permission) and surface water are made publicly available in an interactive, searchable database. Baseline concentrations of potential contaminants from shale gas operations are found to be low, suggesting that early community-based monitoring is an effective foundation for assessing later contamination due to fracking.

  15. 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

    and history (including secondary sources) and can be applied to a wide range of compounds. The tool successfully simulates published data from short duration column and field experiments. The use for risk assessment is illustrated by three typical risk assessment case studies, involving pesticides......, chlorinated solvents, benzene and MTBE. The model is compared with field data and with results from a simpler approach based on an Equivalent Porous Media (EPM). Risk assessment conclusions of the DF and EPM approaches are very different due to the early breakthrough, long term tailing, and lower attenuation...... due to degradation associated with fractured media. While the DF tool simulates the field data, it is difficult to conclude that the DF model is superior to an EPM model because of a lack of long term monitoring data. However, better agreement with existing field data by the DF model using observed...

  16. Combined Lumbar-Sacral Plexus Block in High Surgical Risk Geriatric Patients undergoing Early Hip Fracture Surgery

    Directory of Open Access Journals (Sweden)

    Petchara S

    2015-11-01

    Full Text Available Objective: To evaluate the postoperative outcome after using combined lumbar and sacral plexus block (CLSB, as a sole anesthetic method in hip fracture (HF surgery in highrisk geriatric patients. Materials and Methods: A single-center retrospective study was conducted, between 2010 and 2012, on 70 elderly HF patients with American Society of Anesthesiologists grading III-IV who underwent early surgical intervention with our CLSB protocol. Perioperative data, outcome, and complications were recorded. Results: Forty-eight patients (69% had ongoing anticoagulant medication. Postoperatively, all patients were hemodynamically stable and awake. None of them required general anesthesia conversion. Minor anesthetic-related complications were found in nine patients. One patient (1% died from sepsis due to pneumonia. Patients’ satisfactions were all rated as very good or excellent. Conclusion: CLSB is an interesting anesthetic option in HF surgery, especially in high surgical risk geriatric patients. This method offers an excellent clinical efficiency and high patients’ satisfaction without serious complications.

  17. Comparison of fracture toughness (KIC) and strain energy release rate (G) of selected nuclear graphites

    Science.gov (United States)

    Chi, Se-Hwan

    2016-08-01

    The fracture behaviors of six nuclear graphite grades for a high-temperature gas-cooled reactor (HTGR), which differed in coke particle size and forming method, were characterized based on the ASTM standard graphite fracture toughness test method (ASTM D 7779-11) at room temperature. The G appeared to show good correlation with the fracture surface roughness and the G-Δa curves appeared to describe the fracture process well from crack initiation to failure. Comparison of the local (KIC) and gross (GIC, G-Δa) fracture parameters showed that the resistance to crack initiation and propagation was higher in the extruded or vibration molded medium particle size grades (PCEA, NBG-17, NBG-18: EVM group) than in the iso-molded fine particle size grades (IG-110, IG-430, NBG-25: IMF group). The ASTM may need to provide a guideline for G-Δa curve analysis. The KIC appeared to increase with specimen thickness (size).

  18. 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

    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...... of reproductive organs, or hip fracture between genotypes. In case-control studies, risk of CVD did not differ between genotypes; however, the odds ratio for breast cancer in women with TT versus CC genotypes was 1.4 (95% CI, 1.1 to 1.7). Meta-analysis in men of 6 previous and the present 2 studies, including...

  19. High Complication Rate With Anterior Total Hip Arthroplasties on a Fracture Table

    Science.gov (United States)

    Collis, Dennis K.

    2010-01-01

    Background Recent attention in THA has focused on minimally invasive techniques and their short-term outcomes. Despite much debate over the outcomes and complications of the two-incision and the mini-lateral and mini-posterior approaches, complications arising from use of the anterior THA on a fracture table are not well documented. Questions/purposes We determined the intraoperative and postoperative complications with the anterior approach to THA through an extended single-surgeon patient series. Methods We reviewed 800 primary THAs performed anteriorly with the aid of a fracture table over 5 years and recorded all intraoperative and postoperative complications up to latest followup (average, 1.8 years; range, 0–5 years). Patients with severe acetabular deformity or severe flexion contractures were excluded and those surgeries were performed with a lateral approach during the time period of this study. Results Intraoperative complications included 19 trochanteric fractures, three femoral perforations, one femoral fracture, one acetabular fracture, one bleeding complication, and one case of cardiovascular collapse. There were no ankle fractures. Postoperative complications included seven patients with dislocations; seven with deep infections; one with delayed femur fracture; 37 with wound complications, among which 13 had reoperation for local débridement; 14 with deep venous thrombosis; and two with pulmonary embolism; and 31 other nonfatal medical complications. Conclusions The main intraoperative complications of trochanteric fractures and perforations occurred mostly early in the series, while the main postoperative complications related to wound healing were prevalent throughout the entire series. Despite potential advantages of use of a fracture table, surgeons should be aware of the potential complications of trochanteric fractures, perforations, and wound-healing problems associated with this technique. Level of Evidence Level IV, therapeutic study

  20. Proximal femoral replacement in the management of acute periprosthetic fractures of the hip: a competing risks survival analysis.

    Science.gov (United States)

    Colman, Matthew; Choi, Lisa; Chen, Antonia; Crossett, Lawrence; Tarkin, Ivan; McGough, Richard

    2014-02-01

    To examine the mortality and implant survivorship of proximal femoral replacement (PFR), revision total hip arthroplasty (REV) and open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur, we retrospectively reviewed 97 consecutive acute periprosthetic proximal femoral fractures from 2000 to 2010. Three groups were defined: PFR (n=21), REV (n=19), and ORIF (n=57). Outcome measures were all-cause mortality, implant failure, and reoperation. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no statistical difference between the three groups (P=0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (P=0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 7%, 7%; ORIF 2%, 2%). We conclude that PFR as compared with REV or ORIF may have worse medium-term implant survival, primarily due to instability and dislocation.

  1. 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

  2. Energy Release Rate in hydraulic fracture: can we neglect an impact of the hydraulically induced shear stress?

    CERN Document Server

    Wrobel, Michal; Piccolroaz, Andrea

    2016-01-01

    A novel hydraulic fracture (HF) formulation is introduced which accounts for the hydraulically induced shear stress at the crack faces. It utilizes a general form of the elasticity operator alongside a revised fracture propagation condition based on the critical value of the energy release rate. It is shown that the revised formulation describes the underlying physics of HF in a more accurate way and is in agreement with the asymptotic behaviour of the linear elastic fracture mechanics. A number of numerical simulations by means of the universal HF algorithm previously developed in Wrobel & Mishuris (2015) are performed in order to: i) compare the modified HF formulation with its classic counterpart and ii) investigate the peculiarities of the former. Computational advantages of the revised HF model are demonstrated. Asymptotic estimations of the main solution elements are provided for the cases of small and large toughness. The modified formulation opens new ways to analyse the physical phenomenon of HF ...

  3. Pressure oscillations caused by momentum on shut in of a high rate well in a fractured formation

    Energy Technology Data Exchange (ETDEWEB)

    Bhatnagar, S.

    1989-06-01

    Pressure transient testing techniques are an important part of reservoir and production testing procedures. These techniques are frequently used to determine practical information about underground reservoirs such as the permeability, porosity, liquid content, reservoir and liquid discontinuities and other related data. This information is valuable in helping to analyze, improve and forecast reservoir performance. This report is concerned with developing models for pressure transient well testing in high permeability, high flow rate, naturally fractured reservoirs. In the present work, a study was made of the effects of liquid inertia in the fractures and the wellbore on the pressure response obtained during a well test. The effects of turbulent flow and multi-phase flow effects such as gravitational segregation or anisotropic porous media effects were not considered. The scope of the study was limited to studying inertial effects on the pressure response of a fractured reservoir.

  4. Heart Rate and Heart Rate Variability in Parents at Risk for Child Physical Abuse.

    Science.gov (United States)

    Crouch, Julie L; Hiraoka, Regina; McCanne, Thomas R; Reo, Gim; Wagner, Michael F; Krauss, Alison; Milner, Joel S; Skowronski, John J

    2015-12-10

    The present study examined heart rate and heart rate variability (i.e., respiratory sinus arrhythmia [RSA]) in a sample of 48 general population parents (41.7% fathers), who were either at high risk (n = 24) or low risk (n = 24) for child physical abuse. During baseline assessments of heart rate and RSA, parents sat quietly for 3 min. Afterward, parents were presented with a series of anagrams (either easy or difficult) and were instructed to solve as many anagrams as possible in 3 min. As expected, high-risk (compared with low-risk) parents evinced significantly higher resting heart rate and significantly lower resting RSA. During the anagram task, high-risk parents did not evince significant changes in heart rate or RSA relative to baseline levels. In contrast, low-risk parents evinced significant increases in heart rate and significant decreases in RSA during the anagram task. Contrary to expectations, the anagram task difficulty did not moderate the study findings. Collectively, this pattern of results is consistent with the notion that high-risk parents have chronically higher levels of physiological arousal relative to low-risk parents and exhibit less physiological flexibility in response to environmental demands. High-risk parents may benefit from interventions that include components that reduce physiological arousal and increase the capacity to regulate arousal effectively. © The Author(s) 2015.

  5. Concomitant medication use and its implications on the hazard pattern in pharmacoepidemiological studies: example of antidepressants, benzodiazepines and fracture risk

    OpenAIRE

    2015-01-01

    Background: Antidepressants and benzodiazepines are often co-prescribed and both associated with an increased fracture risk, albeit with distinctive hazard patterns. Timing of initiation of one with respect to the other and duration of use may influence the combined fracture hazard.The objective of our study was to describe patterns of concomitant use of benzodiazepine and antidepressants in terms of timing of initiation and duration and to illustrate the potential impact of various scenarios...

  6. Concomitant medication use and its implications on the hazard pattern in pharmacoepidemiological studies : Example of antidepressants, benzodiazepines and fracture risk

    OpenAIRE

    2015-01-01

    Background: Antidepressants and benzodiazepines are often co-prescribed and both associated with an increased fracture risk, albeit with distinctive hazard patterns. Timing of initiation of one with respect to the other and duration of use may influence the combined fracture hazard. The objective of our study was to describe patterns of concomitant use of benzodiazepine and antidepressants in terms of timing of initiation and duration and to illustrate the potential impact of various scenario...

  7. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study

    OpenAIRE

    2014-01-01

    Purpose Anxiolytics and hypnotics are widely used and may cause injurious falls. We aimed to examine associations between exposure to anxiolytics and hypnotics and the risk of hip fracture among all older people in Norway. Further, we wanted to examine associations between exposure to hypnotics and time of fracture. Methods A nationwide prospective cohort study of people in Norway born before 1945 (n=906,422) was conducted. We obtained information on all prescriptions of anxiolytics and hy...

  8. Multi-rate mass transfer modeling of two-phase flow in highly heterogeneous fractured and porous media

    Science.gov (United States)

    Tecklenburg, Jan; Neuweiler, Insa; Carrera, Jesus; Dentz, Marco

    2016-05-01

    We study modeling of two-phase flow in highly heterogeneous fractured and porous media. The flow behaviour is strongly influenced by mass transfer between a highly permeable (mobile) fracture domain and less permeable (immobile) matrix blocks. We quantify the effective two-phase flow behavior using a multirate rate mass transfer (MRMT) approach. We discuss the range of applicability of the MRMT approach in terms of the pertinent viscous and capillary diffusion time scales. We scrutinize the linearization of capillary diffusion in the immobile regions, which allows for the formulation of MRMT in the form of a non-local single equation model. The global memory function, which encodes mass transfer between the mobile and the immobile regions, is at the center of this method. We propose two methods to estimate the global memory function for a fracture network with given fracture and matrix geometry. Both employ a scaling approach based on the known local memory function for a given immobile region. With the first method, the local memory function is calculated numerically, while the second one employs a parametric memory function in form of truncated power-law. The developed concepts are applied and tested for fracture networks of different complexity. We find that both physically based parameter estimation methods for the global memory function provide predictive MRMT approaches for the description of multiphase flow in highly heterogeneous porous media.

  9. The relationship between dietary protein consumption and risk of fracture: a subgroup and dose-response meta-analysis of prospective cohort studies.

    Science.gov (United States)

    Wu, Ai-Min; Sun, Xiao-Lei; Lv, Qing-Bo; Zhou, Yong; Xia, Dong-Dong; Xu, Hua-Zi; Huang, Qi-Shan; Chi, Yong-Long

    2015-03-16

    It is still debate of the relationship between the dietary protein consumption and risk of fracture. We searched Medline and Embase to assess the effects of dietary protein consumption on risk of fracture. Twelve prospective cohort studies with 407,104 participants were included, higher total protein consumption may be decrease 11% risk of hip fractures, with adj. RR of 0.89 (0.82, 0.97), no significant difference was found for total protein and risk of all fractures and limb fracture; for animal protein consumption and risk of all fractures and hip fracture, with adj.RR of 0.79 (032, 1.96) and 1.04 (0.70, 1.54); for vegetable protein consumption and risk of all fractures, hip fracture and limb fractures with adj.RR of 0.77 (0.52, 1.12), 1.00 (0.53, 1.91), and 0.94 (0.40, 2.22), the subgroup of vegetable protein consumption and risk of all fractures of postmenopausal women with adj.RR of 0.78(0.52,1.16). Dose-response meta-analysis the relationship of total/animal/vegetable protein and hip fracture was consistent to the results of forest plot, the line of total protein and hip fracture was below the Y = 1.0 line. This meta-analysis showed that total dietary protein consumption may be decrease the risk of hip fracture, but not for animal or vegetable protein.

  10. A retrospective cohort study on the influence of UV index and race/ethnicity on risk of stress and lower limb fractures

    OpenAIRE

    Montain, Scott J; McGraw, Susan M.; Ely, Matthew R.; Grier, Tyson L; Knapik, Joseph J.

    2013-01-01

    Background Low vitamin D status increases the risk of stress fractures. As ultraviolet (UV) light is required for vitamin D synthesis, low UV light availability is thought to increase the risk of vitamin D insufficiency and poor bone health. The purpose of this investigation was to determine if individuals with low UV intensity at their home of record (HOR) or those with darker complexions are at increased risk of developing stress fractures and lower limb fractures during U.S. Army Basic Com...

  11. 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

  12. Objectively-Verified Parental Non-Hip Major Osteoporotic Fractures and Offspring Osteoporotic Fracture Risk: A Population-Based Familial Linkage Study.

    Science.gov (United States)

    Yang, Shuman; Leslie, William D; Walld, Randy; Roos, Leslie L; Morin, Suzanne N; Majumdar, Sumit R; Lix, Lisa M

    2017-04-01

    Parental hip fracture (HF) is associated with increased risk of offspring major osteoporotic fractures (MOFs; comprising hip, forearm, clinical spine or humerus fracture). Whether other sites of parental fracture should be used for fracture risk assessment is uncertain. The current study tested the association between objectively-verified parental non-hip MOF and offspring incident MOF. Using population-based administrative healthcare data for the province of Manitoba, Canada, we identified 255,512 offspring with linkage to at least one parent (238,054 mothers and 209,423 fathers). Parental non-hip MOF (1984-2014) and offspring MOF (1997-2014) were ascertained with validated case definitions. Time-dependent multivariable Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). During a median of 12 years of offspring follow-up, we identified 7045 incident MOF among offspring (3.7% and 2.5% for offspring with and without a parental non-hip MOF, p hip MOF (HR 1.27; 95% CI, 1.19 to 1.35), paternal non-hip MOF (HR 1.33; 95% CI, 1.20 to 1.48), and any parental non-hip MOF (HR 1.28; 95% CI, 1.21 to 1.36) were significantly associated with offspring MOF after adjusting for covariates. The risk of MOF was even greater for offspring with both maternal and paternal non-hip MOF (adjusted HR 1.61; 95% CI, 1.27 to 2.02). All HRs were similar for male and female offspring (all pinteraction >0.1). Risks associated with parental HF only (adjusted HR 1.26; 95% CI, 1.13 to 1.40) and non-hip MOF only (adjusted HR 1.26; 95% CI, 1.18 to 1.34) were the same. The strength of association between any parental non-hip MOF and offspring MOF decreased with older parental age at non-hip MOF (ptrend  = 0.028). In summary, parental non-hip MOF confers an increased risk for offspring MOF, but the strength of the relationship decreases with older parental age at fracture. © 2016 American Society for Bone and

  13. Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, X; Yan, S; Liu, C; Xu, Y; Wan, L; Wang, Y; Gao, W; Meng, S; Liu, Y; Liu, R; Xu, D

    2016-04-01

    Previous studies suggested possible bone loss and fracture risk in patients with systemic lupus erythematosus (SLE). The aim of this systematic review and meta-analysis was to assess the strength of the relationship of SLE with fracture risk and the mean difference of bone mineral density (BMD) levels between SLE patients and controls. Literature search was undertaken in multiple indexing databases on September 26, 2015. Studies on the relationship of SLE with fracture risk and the mean difference of BMD levels between SLE patients and controls were included. Data were combined using standard methods of meta-analysis. Twenty-one studies were finally included into the meta-analysis, including 15 studies on the mean difference of BMD levels between SLE patients and controls, and 6 studies were on fracture risk associated with SLE. The meta-analysis showed that SLE patients had significantly lower BMD levels than controls in the whole body (weighted mean difference [WMD] = -0.04; 95 % CI -0.06 to -0.02; P systematic review and meta-analysis provides strong evidence for the relationship of SLE with bone loss and fracture risk.

  14. Prolonged risk of subtrochanteric and diaphyseal femur fractures after discontinuing alendronate treatment: A nationwide nested case-control study in Taiwan

    Directory of Open Access Journals (Sweden)

    Weng-Foung Huang, PhD

    2015-06-01

    Conclusion: Discontinuation of alendronate therapy did not reduce the risk of subtrochanteric femoral fractures until it was discontinued for >5 years. In conclusion, alendronate use significantly increased the risk of subtrochanteric femoral fractures, and the risk may persist for 5 years after discontinuation.

  15. 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

    are currently the subject of a U.S. Food and Drug Administration review. Objective: Our objective was to examine the risk of subtrochanteric/diaphyseal femur fractures in long term users of alendronate. Design: We conducted an age- and gender-matched cohort study using national healthcare data. Patients...... fractures occurred at a rate of 13 per 10,000 patient-years in untreated women and 31 per 10,000 patient-years in women receiving alendronate [adjusted hazard ratio (HR) = 1.88; 95% confidence interval (CI) = 1.62-2.17]. Rates for men were six and 31 per 10,000 patient-years, respectively (HR = 3.98; 95% CI...

  16. Interest Rate Risk Management and the Use of Derivative Securities

    National Research Council Canada - National Science Library

    Ioana-Diana PĂUN; Ramona GOGONCEA

    2013-01-01

    This study aims to demonstrate the utility of derivative financial instruments for the management of interest rate risk that is faced by banks and financial institutions, and to provide an efficient...

  17. Fractal lacunarity of trabecular bone and magnetic resonance imaging: New perspectives for osteoporotic fracture risk assessment.

    Science.gov (United States)

    Zaia, Annamaria

    2015-03-18

    Osteoporosis represents one major health condition for our growing elderly population. It accounts for severe morbidity and increased mortality in postmenopausal women and it is becoming an emerging health concern even in aging men. Screening of the population at risk for bone degeneration and treatment assessment of osteoporotic patients to prevent bone fragility fractures represent useful tools to improve quality of life in the elderly and to lighten the related socio-economic impact. Bone mineral density (BMD) estimate by means of dual-energy X-ray absorptiometry is normally used in clinical practice for osteoporosis diagnosis. Nevertheless, BMD alone does not represent a good predictor of fracture risk. From a clinical point of view, bone microarchitecture seems to be an intriguing aspect to characterize bone alteration patterns in aging and pathology. The widening into clinical practice of medical imaging techniques and the impressive advances in information technologies together with enhanced capacity of power calculation have promoted proliferation of new methods to assess changes of trabecular bone architecture (TBA) during aging and osteoporosis. Magnetic resonance imaging (MRI) has recently arisen as a useful tool to measure bone structure in vivo. In particular, high-resolution MRI techniques have introduced new perspectives for TBA characterization by non-invasive non-ionizing methods. However, texture analysis methods have not found favor with clinicians as they produce quite a few parameters whose interpretation is difficult. The introduction in biomedical field of paradigms, such as theory of complexity, chaos, and fractals, suggests new approaches and provides innovative tools to develop computerized methods that, by producing a limited number of parameters sensitive to pathology onset and progression, would speed up their application into clinical practice. Complexity of living beings and fractality of several physio-anatomic structures suggest

  18. 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

  19. Impact of Competing Risk of Mortality on Association of Weight Loss With Risk of Central Body Fractures in Older Men: A Prospective Cohort Study.

    Science.gov (United States)

    Ensrud, Kristine E; Harrison, Stephanie L; Cauley, Jane A; Langsetmo, Lisa; Schousboe, John T; Kado, Deborah M; Gourlay, Margaret L; Lyons, Jennifer G; Fredman, Lisa; Napoli, Nicolas; Crandall, Carolyn J; Lewis, Cora E; Orwoll, Eric S; Stefanick, Marcia L; Cawthon, Peggy M

    2017-03-01

    To determine the association of weight loss with risk of clinical fractures at the hip, spine, and pelvis (central body fractures [CBFs]) in older men with and without accounting for the competing risk of mortality, we used data from 4523 men (mean age 77.5 years). Weight change between baseline and follow-up (mean 4.5 years between examinations) was categorized as moderate loss (loss ≥10%), mild loss (loss 5% to models with death as a competing risk. During an average of 8 years, 337 men (7.5%) experienced CBF and 1569 (34.7%) died before experiencing this outcome. Among men with moderate weight loss, CBF probability was 6.8% at 5 years and 16.9% at 10 years using Kaplan-Meier versus 5.7% at 5 years and 10.2% at 10 years using a competing risk approach. Men with moderate weight loss compared with those with stable weight had a 1.6-fold higher adjusted risk of CBF (HR 1.59; 95% CI, 1.06 to 2.38) using Cox models that was substantially attenuated in models accounting for competing mortality risk and no longer significant (subdistribution HR 1.16; 95% CI, 0.77 to 1.75). Results were similar in analyses substituting hip fracture for CBF. Older men with weight loss who survive are at increased risk of CBF, including hip fracture. However, ignoring the competing mortality risk among men with weight loss substantially overestimates their long-term fracture probability and relative fracture risk. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and Mineral Research.

  20. Risk rating in the tea planting industry: The employees′ opinion

    Directory of Open Access Journals (Sweden)

    Joseph Bobby

    2010-01-01

    Full Text Available Background: Workers in the tea planting industry are exposed to a variety of occupational health and safety hazards. Whether the workers perceive the risks involved and to what degree is an interesting point in question. Aims: To identify occupational health and safety risks involved in the tea planting sector and to rate these risks from the workers′ perspective. Settings and Design: Permanent workers from four estates belonging to one tea planting company in southern India were enlisted in this descriptive study . Materials and Methods: The sample was randomly and then proportionately selected to give a total number equal to the calculated sample size of 341. Data were collected by reviewing medical records, conducting focus group discussions with field officers and supervisors, worker interviews and key informant interviews with the management in these four estates. Proportions were used to describe occurrence and distribution of work-related injuries. The risks as perceived by the workers were rated on their severity and frequency, using a Risk Rating Matrix. Results and Conclusion: The incidence of injuries was greater among male workers, those working both in the field and factory and those handling multiple tasks. The most common morbidities suffered were "small cuts and abrasions" in about 53%of the workers. Backache and insect bites were assigned the highest risk rating scores. Continued monitoring of the risk assessment by the workers could help in a planned reduction of commonly occurring injuries by agreeing on a specified risk limit.

  1. College Students' Perceived Disease Risk versus Actual Prevalence Rates

    Science.gov (United States)

    Smith, Matthew Lee; Dickerson, Justin B.; Sosa, Erica T.; McKyer, E. Lisako J.; Ory, Marcia G.

    2012-01-01

    Objective: To compare college students' perceived disease risk with disease prevalence rates. Methods: Data were analyzed from 625 college students collected with an Internet-based survey. Paired t-tests were used to separately compare participants' perceived 10-year and lifetime disease risk for 4 diseases: heart disease, cancer, diabetes, and…

  2. Risk premiums in cap rates of investment property

    NARCIS (Netherlands)

    Berkhout, T.M.; Wouwe, van M.; Tansens, P.R.

    2005-01-01

    Our research wants to establish links and patterns over time between the constituent components of the cap rates, and between real interest and risk premium in particular. We developed a statistical model to predict and explain the risk premium asked for by investors buying properties throughout Eur

  3. 75 FR 9257 - SBA Lender Risk Rating System

    Science.gov (United States)

    2010-03-01

    ... to payment trends, business ] financial statements, industry position, business size and age, and... ADMINISTRATION SBA Lender Risk Rating System AGENCY: Small Business Administration. ACTION: Notice of revised... assist SBA in assessing the risk of each active 7(a) Lender's and Certified Development Company's...

  4. 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.

  5. Modeling Atmospheric Emissions and Calculating Mortality Rates Associated with High Volume Hydraulic Fracturing Transportation

    Science.gov (United States)

    Mathews, Alyssa

    Emissions from the combustion of fossil fuels are a growing pollution concern throughout the global community, as they have been linked to numerous health issues. The freight transportation sector is a large source of these emissions and is expected to continue growing as globalization persists. Within the US, the expanding development of the natural gas industry is helping to support many industries and leading to increased transportation. The process of High Volume Hydraulic Fracturing (HVHF) is one of the newer advanced extraction techniques that is increasing natural gas and oil reserves dramatically within the US, however the technique is very resource intensive. HVHF requires large volumes of water and sand per well, which is primarily transported by trucks in rural areas. Trucks are also used to transport waste away from HVHF well sites. This study focused on the emissions generated from the transportation of HVHF materials to remote well sites, dispersion, and subsequent health impacts. The Geospatial Intermodal Freight Transport (GIFT) model was used in this analysis within ArcGIS to identify roadways with high volume traffic and emissions. High traffic road segments were used as emissions sources to determine the atmospheric dispersion of particulate matter using AERMOD, an EPA model that calculates geographic dispersion and concentrations of pollutants. Output from AERMOD was overlaid with census data to determine which communities may be impacted by increased emissions from HVHF transport. The anticipated number of mortalities within the impacted communities was calculated, and mortality rates from these additional emissions were computed to be 1 in 10 million people for a simulated truck fleet meeting stricter 2007 emission standards, representing a best case scenario. Mortality rates due to increased truck emissions from average, in-use vehicles, which represent a mixed age truck fleet, are expected to be higher (1 death per 341,000 people annually).

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

    Directory of Open Access Journals (Sweden)

    Ayşegül Türkyılmaz

    2008-01-01

    Full Text Available 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 Giemsa Banding Techniques , and were studied. As a result of chromosomal analysis of the case, whose X-chromatid was positive, the chromosom constitution was determined to be 46,X,i(X(qter→q10::q10→qter and diagnosed as Turner’s Syndrome. In the assessment of the results obtained from lumbar vertebrae L1, L2, L3 and L4 which were subjected to osteo-densitometric analysis, BMD was found to be 0.592g/cm²and it was concluded that it might be Juvenil Osteoporosis with spontaneous fracture risk due to bone mineral density loss of 31% (Z-score: -27 according to WHO criteria.

  7. 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, Christian; 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...... 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....

  8. Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents

    National Research Council Canada - National Science Library

    Cho, Hong Man; Lee, Kyujung; Min, Woongbae; Choi, Yong Suk; Lee, Hyun Suk; Mun, Hyoung Jin; Shim, Hye Young; Lee, Da Geon; Yoo, Mi Joung

    2016-01-01

    .... Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes...

  9. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C.; Solgaard, Søren

    2017-01-01

    fractures ≤ 90 days postoperatively was 2.1% (n = 150). 70 fractures were detected intraoperatively (46 required osteosynthesis). 51 postoperatively detected fractures occurred without trauma (42 of which were reoperated) and 29 were postoperative fall-related fractures (27 of which were reoperated). 134...

  10. Gaming in risk-adjusted mortality rates: effect of misclassification of risk factors in the benchmarking of cardiac surgery risk-adjusted mortality rates

    NARCIS (Netherlands)

    Siregar, S.; Groenwold, R.H.; Versteegh, M.I.; Noyez, L.; Burg, W.J.P.P. ter; Bots, M.L.; Graaf, Y. van der; Herwerden, L.A. van

    2013-01-01

    OBJECTIVE: Upcoding or undercoding of risk factors could affect the benchmarking of risk-adjusted mortality rates. The aim was to investigate the effect of misclassification of risk factors on the benchmarking of mortality rates after cardiac surgery. METHODS: A prospective cohort was used comprisin

  11. 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.

  12. 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

    2015-01-01

    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). Associations between self-reported hip fracture incidence and total daily physical activity and selected lifestyle factors were assessed using Cox proportional hazard regression. 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