WorldWideScience

Sample records for osteoporotic bone fractures

  1. The challenge of fracture management in osteoporotic bones

    African Journals Online (AJOL)

    Conclusion: Osteoporotic fractures are a challenge to orthopaedic and trauma ... operative management careful planning as team work and use of newer .... function and quality of life in these elderly patients. .... on the balance of the above risks and benefits for each ... cement meant to reinforce bone seems optimal solution.

  2. Practical use of bone scan in patients with an osteoporotic vertebral compression fracture.

    Science.gov (United States)

    Jun, Deuk Soo; An, Byoung Keun; Yu, Chang Hun; Hwang, Kyung Hoon; Paik, Je Won

    2015-02-01

    Rib fractures are one of main causes of chest or flank pain when related to an osteoporotic vertebral compression fracture (OVCF). The authors investigated the incidence and risk factors of rib fracture in 284 patients with OVCF using bone scans and evaluated the feasibility as to whether bone scans could be utilized as a useful screening tool. Hot uptake lesions on ribs were found in 122 cases (43.0%). The factors analyzed were age, sex, number and locations of fractured vertebrae, BMD, and compression rates as determined using initial radiography. However, no statistical significances were found. In 16 cases (5.6%), there were concurrent multiple fractures of both the thoracic and lumbar spines not detected by single site MRI. Sixty cases (21.1%) of OVCF with the a compression rate of less than 15% could not be identified definitely by initial plain radiography, but were confirmed by bone scans. It is concluded that a bone scan has outstanding ability for the screening of rib fractures associated with OVCF. Non-adjacent multiple fractures in both thoracic and lumbar spines and fractures not identified definitely by plain radiography were detected on bone scans, which provided a means for determining management strategies and predicting prognosis.

  3. Polymorphisms of muscle genes are associated with bone mass and incident osteoporotic fractures in Caucasians

    DEFF Research Database (Denmark)

    Harsløf, Torben; Frost, M; Nielsen, T L

    2013-01-01

    The interaction between muscle and bone is complex. The aim of this study was to investigate if variations in the muscle genes myostatin (MSTN), its receptor (ACVR2B), myogenin (MYOG), and myoD1 (MYOD1) were associated with fracture risk, bone mineral density (BMD), bone mineral content (BMC......), and lean body mass. We analyzed two independent cohorts: the Danish Osteoporosis Prevention Study (DOPS), comprising 2,016 perimenopausal women treated with hormone therapy or not and followed for 10 years, and the Odense Androgen Study (OAS), a cross-sectional, population-based study on 783 men aged 20......-29 years. Nine tag SNPs in the four genes were investigated. In the DOPS, individuals homozygous for the variant allele of the MSTN SNP rs7570532 had an increased risk of any osteoporotic fracture, with an HR of 1.82 (95 % CI 1.15-2.90, p = 0.01), and of nonvertebral osteoporotic fracture, with an HR of 2...

  4. Usefulness of the Trabecular Bone Score for assessing the risk of osteoporotic fracture.

    Science.gov (United States)

    Redondo, L; Puigoriol, E; Rodríguez, J R; Peris, P; Kanterewicz, E

    2018-04-01

    The trabecular bone score (TBS) is an imaging technique that assesses the condition of the trabecular microarchitecture. Preliminary results suggest that TBS, along with the bone mineral density assessment, could improve the calculation of the osteoporotic fracture risk. The aim of this study was to analyse TBS values and their relationship with the clinical characteristics, bone mineral density and history of fractures of a cohort of posmenopausal women. We analysed 2,257 posmenopausal women from the FRODOS cohort, which was created to determine the risk factors for osteoporotic fracture through a clinical survey and bone densitometry with vertebral morphometry. TBS was applied to the densitometry images. TBS values ≤1230 were considered indicative of degraded microarchitecture. We performed a simple and multiple linear regression to determine the factors associated with this index. The mean TBS value in L1-L4 was 1.203±0.121. Some 55.3% of the women showed values indicating degraded microarchitecture. In the multiple linear regression analysis, the factors associated with low TBS values were age, weight, height, spinal T-score, glucocorticoid treatment, presence of type 2 diabetes and a history of fractures due to frailty. TBS showed microarchitecture degradation values in the participants of the FRODOS cohort and was associated with anthropometric factors, low bone mineral density values, the presence of fractures, a history of type 2 diabetes mellitus and the use of glucocorticoids. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  5. Rehabilitation in osteoporotic vertebral fractures

    OpenAIRE

    Pratelli, Elisa; Cinotti, Irene; Pasquetti, Pietro

    2010-01-01

    Vertebral fractures occur particularly in osteoporotic patients due to an increased bone fragility. Vertebral fractures influence the quality of life, mobility and mortality. Preventive training exercises and proprioception reeducation can be utilised for improving posture, balance and level of daily function and for decreasing pain. Quality of life is improved even beyond the active training period. This mini review provides information based on the literature for the rehabilitation of osteo...

  6. Predicting Hip Fracture Type With Cortical Bone Mapping (CBM) in the Osteoporotic Fractures in Men (MrOS) Study.

    Science.gov (United States)

    Treece, Graham M; Gee, Andrew H; Tonkin, Carol; Ewing, Susan K; Cawthon, Peggy M; Black, Dennis M; Poole, Kenneth E S

    2015-11-01

    Hip fracture risk is known to be related to material properties of the proximal femur, but fracture prediction studies adding richer quantitative computed tomography (QCT) measures to dual-energy X-ray (DXA)-based methods have shown limited improvement. Fracture types have distinct relationships to predictors, but few studies have subdivided fracture into types, because this necessitates regional measurements and more fracture cases. This work makes use of cortical bone mapping (CBM) to accurately assess, with no prior anatomical presumptions, the distribution of properties related to fracture type. CBM uses QCT data to measure the cortical and trabecular properties, accurate even for thin cortices below the imaging resolution. The Osteoporotic Fractures in Men (MrOS) study is a predictive case-cohort study of men over 65 years old: we analyze 99 fracture cases (44 trochanteric and 55 femoral neck) compared to a cohort of 308, randomly selected from 5994. To our knowledge, this is the largest QCT-based predictive hip fracture study to date, and the first to incorporate CBM analysis into fracture prediction. We show that both cortical mass surface density and endocortical trabecular BMD are significantly different in fracture cases versus cohort, in regions appropriate to fracture type. We incorporate these regions into predictive models using Cox proportional hazards regression to estimate hazard ratios, and logistic regression to estimate area under the receiver operating characteristic curve (AUC). Adding CBM to DXA-based BMD leads to a small but significant (p fracture, with AUC increasing from 0.78 to 0.79, assessed using leave-one-out cross-validation. For specific fracture types, the improvement is more significant (p trochanteric fractures and 0.76 to 0.82 for femoral neck fractures. In contrast, adding DXA-based BMD to a CBM-based predictive model does not result in any significant improvement. © 2015 The Authors. Journal of Bone and Mineral Research

  7. [Effect of different bone cement dispersion types in the treatment of osteoporotic vertebral compression fracture].

    Science.gov (United States)

    Zhao, Yong-Sheng; Li, Qiang; Li, Qiang; Zheng, Yan-Ping

    2017-05-25

    To observe different bone cement dispersion types of PVP, PKP and manipulative reduction PVP and their effects in the treatment of senile osteoporotic vertebral compression fractures and the bone cement leakage rate. The clinical data of patients with osteoporotic vertebral compression fractures who underwent unilateral vertebroplasty from January 2012 to January 2015 was retrospectively analyzed. Of them, 56 cases including 22 males and 34 females aged from 60 to 78 years old were treated by PVP operation; Fouty-eight cases including 17 males and 31 females aged from 61 to 79 years old were treated by PKP operation; Forty-three cases including 15 males and 28 females aged from 60 to 76 years old were treated by manipulative reduction PVP operation. AP and lateral DR films were taken after the operation; the vertebral bone cement diffusion district area and mass district area were calculated with AutoCAD graphics processing software by AP and lateral DR picture, then ratio(K) of average diffusion area and mass area were calculated, defining K100% as diffusion type. Different bone cement dispersion types of PVP, PKP and manipulative reduction PVP operation were analyzed. According to bone cement dispersion types, patients were divided into diffusion type, mixed type and mass type groups.Visual analogue scale (VAS), vertebral body compression rate, JOA score and bone cement leakage rate were observed. All patients were followed up for 12-24 months with an average of 17.2 months. There was significant difference in bone cement dispersion type among three groups ( P <0.05). The constituent ratio of diffusion type, mixed type and mass type in PVP operation was 46.43%, 35.71%, 17.86%, in PKP was 16.67%, 37.50% , 45.83%, and in manipulative reduction PVP was 37.21%, 44.19% and 18.60%, respectively. PVP operation and manipulative reduction PVP were mainly composed of diffusion type and mixed type, while PKP was mainly composed of mass type and mixed type. There was no

  8. Osteoporotic fractures in older adults

    OpenAIRE

    Colón-Emeric, Cathleen S.; Saag, Kenneth G.

    2006-01-01

    Osteoporotic fractures are emerging as a major public health problem in the aging population. Fractures result in increased morbidity, mortality and health expenditures. This article reviews current evidence for the management of common issues following osteoporotic fractures in older adults including: (1) thromboembolism prevention; (2) delirium prevention; (3) pain management; (4) rehabilitation; (5) assessing the cause of fracture; and (6) prevention of subsequent fractures. Areas for prac...

  9. A comparison of bone mineral density in osteoporotic fracture of the proximal femur using dual energy X-ray absorptiometry

    International Nuclear Information System (INIS)

    Lee, Jong Seok; Yoo, Beong Gyu; Kim, Keung Sik

    2000-01-01

    There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and February in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry (DEXA). The result was compared using age matched paired T test. The results were as follows: The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. The bone density of neck, Ward's triangle, trochanter (P<0.05) and lumbar spine (P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. The bone density of neck, Ward's triangle, trochanter (P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. The bone density of neck, Ward's triangle, trochanter and lumbar spine (P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities (BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine

  10. A comparison of bone mineral density in osteoporotic fracture of the proximal femur using dual energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Seok; Yoo, Beong Gyu [Wonkwang Health Science College, Iksan (Korea, Republic of); Kim, Keung Sik [Yonsei University Yong Dong Severance Hospital, Seoul (Korea, Republic of)

    2000-04-15

    There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and February in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry (DEXA). The result was compared using age matched paired T test. The results were as follows: The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. The bone density of neck, Ward's triangle, trochanter (P<0.05) and lumbar spine (P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. The bone density of neck, Ward's triangle, trochanter (P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. The bone density of neck, Ward's triangle, trochanter and lumbar spine (P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities (BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine.

  11. Intrinsic material property differences in bone tissue from patients suffering low-trauma osteoporotic fractures, compared to matched non-fracturing women.

    Science.gov (United States)

    Vennin, S; Desyatova, A; Turner, J A; Watson, P A; Lappe, J M; Recker, R R; Akhter, M P

    2017-04-01

    Osteoporotic (low-trauma) fractures are a significant public health problem. Over 50% of women over 50yrs. of age will suffer an osteoporotic fracture in their remaining lifetimes. While current therapies reduce skeletal fracture risk by maintaining or increasing bone density, additional information is needed that includes the intrinsic material strength properties of bone tissue to help develop better treatments, since measurements of bone density account for no more than ~50% of fracture risk. The hypothesis tested here is that postmenopausal women who have sustained osteoporotic fractures have reduced bone quality, as indicated with measures of intrinsic material properties compared to those who have not fractured. Transiliac biopsies (N=120) were collected from fracturing (N=60, Cases) and non-fracturing postmenopausal women (N=60, age- and BMD-matched Controls) to measure intrinsic material properties using the nano-indentation technique. Each biopsy specimen was embedded in epoxy resin and then ground, polished and used for the nano-indentation testing. After calibration, multiple indentations were made using quasi-static (hardness, modulus) and dynamic (storage and loss moduli) testing protocols. Multiple indentations allowed the median and variance to be computed for each type of measurement for each specimen. Cases were found to have significantly lower median values for cortical hardness and indentation modulus. In addition, cases showed significantly less within-specimen variability in cortical modulus, cortical hardness, cortical storage modulus and trabecular hardness, and more within-specimen variability in trabecular loss modulus. Multivariate modeling indicated the presence of significant independent mechanical effects of cortical loss modulus, along with variability of cortical storage modulus, cortical loss modulus, and trabecular hardness. These results suggest mechanical heterogeneity of bone tissue may contribute to fracture resistance

  12. Evaluation of locked plate in the osteosynthesis of fractures in osteoporotic bones.

    Science.gov (United States)

    Oboirien, Muhammad; Agbo, Stephen Patrick; Ajiboye, Lukman Olalekan

    2017-01-01

    The use of conventional dynamic compression plates (DCPs) in osteoporotic bones is associated with higher chances of implant failure. The advent and use of locking combi-plates have ensured a stable construct during osteosynthesis of fractures in osteoporotic bones. The study aims to assess the outcome of use of locking combi-plates in the management of fractures in osteoporotic bones in our environment. Cases of patients with nonunion and localized osteoporosis from January 2014 to December 2014 that were managed with locked combi-plates were reviewed. Outcome was assessed by time to healing, stability of implant construct after 6 and 12 months. There were 10 patients with mean age of 47.4 ± 12.63 years. There were 9 males and 1 female, and road traffic crashes were the mechanism of injury in 90% (n = 9) and gunshot injuries in 10% (n = 1). Atrophic nonunion was the most common indication for osteosynthesis with 80%, followed by fibrous nonunion with 10.0%. The humerus was the most common long bone involved with 50%. Locked broad DCP was used in 62.5%, and the duration between initial injury and surgery was 6 and 48 months, with an average of 17.5 months. The outcome was such that 90% healed after 12 months on follow-up while one case had the implant backing out and delay union at 6 months. The use of locked plate in the management of nonunion in the presence of osteoporosis ensures stable fixation construct and healing. Contexte: L'utilisation de plaques de compression dynamiques conventionnelles dans les os ostéoporotiques est associée à des chances plus élevées de défaillance de l'implant. L'avènement et l'utilisation de combi-plaques de verrouillage ont assuré une construction stable lors de l'ostéosyntheis de fractures dans les os ostéoporotiques. Objectifs: L'étude vise à évaluer le résultat de l'utilisation de combi-plaques de verrouillage dans la gestion des fractures dans les os ostéoporotiques dans notre environnement. Méthodologie: Les

  13. Management of osteoporotic vertebral fractures

    OpenAIRE

    Dionyssiotis, Yannis

    2010-01-01

    Yannis DionyssiotisRhodes General Hospital, Rhodes, GreeceAbstract: Osteoporotic vertebral fractures are associated with considerable reduction of quality of life, morbidity, and mortality. The management of patients with vertebral fractures should include treatment for osteoporosis and measures to reduce pain and improve mobility. This article provides information for management and rehabilitation of vertebral fractures based on clinical experience and literature.Keywords: vertebral fracture...

  14. Osteoporotic Hip and Spine Fractures

    OpenAIRE

    Cannada, Lisa K.; Hill, Brian W.

    2014-01-01

    Hip and spine fractures represent just a portion of the burden of osteoporosis; however, these fractures require treatment and often represent a major change in lifestyle for the patient and their family. The orthopedic surgeon plays a crucial role, not only in the treatment of these injuries but also providing guidance in prevention of future osteoporotic fractures. This review provides a brief epidemiology of the fractures, details the surgical techniques, and outlines the current treatment...

  15. Ankle fractures have features of an osteoporotic fracture.

    Science.gov (United States)

    Lee, K M; Chung, C Y; Kwon, S S; Won, S H; Lee, S Y; Chung, M K; Park, M S

    2013-11-01

    We report the bone attenuation of ankle joint measured on computed tomography (CT) and the cause of injury in patients with ankle fractures. The results showed age- and gender-dependent low bone attenuation and low-energy trauma in elderly females, which suggest the osteoporotic features of ankle fractures. This study was performed to investigate the osteoporotic features of ankle fracture in terms of bone attenuation and cause of injury. One hundred ninety-four patients (mean age 51.0 years, standard deviation 15.8 years; 98 males and 96 females) with ankle fracture were included. All patients underwent CT examination, and causes of injury (high/low-energy trauma) were recorded. Mean bone attenuations of the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis were measured on CT images. Patients were divided into younger age (fractures than the younger age group. With increasing age, bone attenuations tended to decrease and the difference of bone attenuation between the genders tended to increase in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis. Ankle fracture had features of osteoporotic fracture that is characterized by age- and gender-dependent low bone attenuation. Ankle fracture should not be excluded from the clinical and research interest as well as from the benefit of osteoporosis management.

  16. Orthobiologics in the augmentation of osteoporotic fractures.

    Science.gov (United States)

    Watson, J Tracy; Nicolaou, Daemeon A

    2015-02-01

    Many orthobiologic adjuvants are available and widely utilized for general skeletal restoration. Their use for the specific task of osteoporotic fracture augmentation is less well recognized. Common conductive materials are reviewed for their value in this patient population including the large group of allograft adjuvants categorically known as the demineralized bone matrices (DBMs). Another large group of alloplastic materials is also examined-the calcium phosphate and sulfate ceramics. Both of these materials, when used for the proper indications, demonstrate efficacy for these patients. The inductive properties of bone morphogenic proteins (BMPs) and platelet concentrates show no clear advantages for this group of patients. Systemic agents including bisphosphonates, receptor activator of nuclear factor κβ ligand (RANKL) inhibitors, and parathyroid hormone augmentation all demonstrate positive effects with this fracture cohort. Newer modalities, such as trace ion bioceramic augmentation, are also reviewed for their positive effects on osteoporotic fracture healing.

  17. Mechanical stimulation enhanced estrogen receptor expression and callus formation in diaphyseal long bone fracture healing in ovariectomy-induced osteoporotic rats.

    Science.gov (United States)

    Chow, S K H; Leung, K S; Qin, J; Guo, A; Sun, M; Qin, L; Cheung, W H

    2016-10-01

    Estrogen receptor (ER) in ovariectomy-induced osteoporotic fracture was reported to exhibit delayed expression. Mechanical stimulation enhanced ER-α expression in osteoporotic fracture callus at the tissue level. ER was also found to be required for the effectiveness of vibrational mechanical stimulation treatment in osteoporotic fracture healing. Estrogen receptor(ER) is involved in mechanical signal transduction in bone metabolism. Its expression was reported to be delayed in osteoporotic fracture healing. The purpose of this study was to investigate the roles played by ER during osteoporotic fracture healing enhanced with mechanical stimulation. Ovariectomy-induced osteoporotic SD rats that received closed femoral fractures were divided into five groups, (i) SHAM, (ii) SHAM-VT, (iii) OVX, (iv) OVX-VT, and (v) OVX-VT-ICI, where VT stands for whole-body vibration treatment and ICI for ER antagonization by ICI 182,780. Callus formation and gene expression were assessed at 2, 4, and 8 weeks postfracture. In vitro osteoblastic differentiation, mineralization, and ER-α expression were assessed. The delayed ER expression was found to be enhanced by vibration treatment. Callus formation enhancement was shown by callus morphometry and micro-CT analysis. Enhancement effects by vibration were partially abolished when ER was modulated by ICI 182,780, in terms of callus formation capacity at 2-4 weeks and ER gene and protein expression at all time points. In vitro, ER expression in osteoblasts was not enhanced by VT treatment, but osteoblastic differentiation and mineralization were enhanced under estrogen-deprived condition. When osteoblastic cells were modulated by ICI 182,780, enhancement effects of VT were eliminated. Vibration was able to enhance ER expression in ovariectomy-induced osteoporotic fracture healing. ER was essential in mechanical signal transduction and enhancement in callus formation effects during osteoporotic fracture healing enhanced by vibration

  18. Three-year experience with combined treatment with alendronate and alfacalcidol in Japanese patients with severe bone loss and osteoporotic fracture

    Directory of Open Access Journals (Sweden)

    Iwamoto J

    2011-06-01

    Full Text Available Jun Iwamoto1, Yoshihiro Sato2, Mitsuyoshi Uzawa3, Tsuyoshi Takeda1, Hideo Matsumoto11Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan; 2Department of Neurology, Mitate Hospital, Fukuoka, Japan; 3Department of Orthopaedic Surgery, Keiyu Orthopaedic Hospital, Gunma, JapanPurpose: Combined treatment with alendronate and alfacalcidol is more useful to increase bone mineral density (BMD than alendronate or alfacalcidol alone. A retrospective study was conducted to investigate the 3-year outcome of combined treatment with alendronate and alfacalcidol in patients with severe bone loss (BMD ≤ 50% of the young adult mean and osteoporotic fracture.Methods: Thirty-four patients (six men and 28 postmenopausal women with primary or secondary osteoporosis who had been treated with alendronate and alfacalcidol for more than 3 years were analyzed. The lumbar spine or total hip BMD and bone turnover markers were monitored, and the incidence of osteoporotic fractures was assessed.Results: The urinary level of cross-linked N-terminal telopeptides of type I collagen and serum level of alkaline phosphatase significantly decreased (-42.5% at 3 months and -18.9% at 3 years, and the lumbar spine BMD, but not the total hip BMD, significantly increased (14.8% at 3 years, compared with the baseline values. However, the incidence of vertebral and nonvertebral fractures was 26.5% and 2.9%, respectively, suggesting a high incidence of vertebral fractures.Conclusion: The results of the present study suggest that combined treatment with alendronate and alfacalcidol may be useful to reduce bone turnover and increase the lumbar spine BMD in patients with severe bone loss and osteoporotic fracture. However, its efficacy against vertebral fractures appears not to be sufficient. Thus, anabolic agents such as teriparatide should be taken into consideration as first-line drugs in patients with severe osteoporosis.Keywords: osteoporosis

  19. Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links

    Directory of Open Access Journals (Sweden)

    Fisher A

    2013-02-01

    Full Text Available A Fisher,1,3 W Srikusalanukul,1 M Davis,1,3 P Smith2,31Departments of Geriatric Medicine, 2Orthopaedic Surgery, The Canberra Hospital, 3Australian National University Medical School, Canberra, ACT, AustraliaBackground: Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs and osteoporotic fractures.Aims and methods: To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH, 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured.Results: CVDs were diagnosed in 472 (63.3% patients. Vitamin D deficiency was similarly prevalent in patients with (78.0% and without (82.1% CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001, a higher prevalence of secondary hyperparathyroidism (SPTH (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001, and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/µmol, 87.9% vs 74.8%, P < 0.001. In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007 and high DPD/Cr (OR 2.8, P = 0.016 were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004 in subjects with SHPT and 9.7 (P < 0.001 in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007 and excess DPD/Cr (OR 2.5, P = 0.031. CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death.Conclusion: SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations

  20. Preliminary Results for the Treatment of a Pain-Causing Osteoporotic Vertebral Compression Fracture with a Sky Bone Expander

    International Nuclear Information System (INIS)

    Liu, Jin Bo; Tang, Xue Ming; Xu, Nan Wei; Bao, Hong Tao

    2008-01-01

    Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander. Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation. Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 ± 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 ± 5.0 mL) was injected per vertebra. The average anterior height was 18.4 ± 5.1 mm preoperatively and 20.5 ± 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 ± 5.2 mm preoperatively and 18.9 ± 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 ± 8.2 degrees preoperatively to 9.2 ± 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 ± 1.8 points preoperatively to 3.1 ± 2.0, 2.9 ± 1.7, 2.6 ± 1.5 and 2.9 ± 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms. As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally

  1. Once-yearly zoledronic acid in the prevention of osteoporotic bone fractures in postmenopausal women

    Directory of Open Access Journals (Sweden)

    Irene Lambrinoudaki

    2008-09-01

    Full Text Available Irene Lambrinoudaki, Sophia Vlachou, Fotini Galapi, Dimitra Papadimitriou, K Papadias2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, GreeceAbstract: Zoledronic acid is a nitrogen-containing, third-generation bisphosphonate that has recently been approved for the treatment of postmenopausal osteoporosis as an annual intravenous infusion. Zoledronic acid is an antiresorptive agent which has a high affinity for mineralized bone and especially for sites of high bone turnover. Zoledronic acid is excreted by the kidney without further metabolism. Zoledronic acid administered as a 5 mg intravenous infusion annually increases bone mineral density in the lumbar spine and femoral neck by 6.7% and 5.1% respectively and reduces the incidence of new vertebral and hip fractures by 70% and 41% respectively in postmenopausal women with osteoporosis. Most common side effects are post-dose fever, flu-like symptoms, myalgia, arthralgia, and headache which usually occur in the first 3 days after infusion and are self-limited. Rare adverse effects include renal dysfunction, hypocalcemia, atrial fibrillation, and osteonecrosis of the jaw.Keywords: zoledronic acid, postmenopausal osteoporosis, bisphosphonate

  2. Pathogenesis of osteoporotic hip fractures.

    Science.gov (United States)

    McClung, Michael R

    2003-01-01

    Osteoporosis is characterized late in the course of the disease by an increased risk of fracture, particularly in the elderly. It occurs in both sexes, affecting approximately 8 million women and 2 million men aged > or = 50 years (1). While low bone density is a predictor of fractures, it is not the only determinant of fracture risk. Other factors include advanced age, altered bone quality, a personal or family history of falls, frailty, poor eyesight, debilitating diseases, and high bone turnover. A diet with sufficient calcium and vitamin D is important to minimize bone loss and, along with regular exercise, to maintain muscle strength. Bisphosphonates have been shown to reduce the risk of hip fracture. For elderly patients, the use of hip protectors may be used as a treatment of last resort. Regardless of the age of the patient, individual patient risk factors must be considered to target appropriate treatment and prevent fracture.

  3. Genetic analysis identifies DDR2 as a novel gene affecting bone mineral density and osteoporotic fractures in Chinese population.

    Directory of Open Access Journals (Sweden)

    Yan Guo

    Full Text Available DDR2 gene, playing an essential role in regulating osteoblast differentiation and chondrocyte maturation, may influence bone mineral density (BMD and osteoporosis, but the genetic variations actually leading to the association remain to be elucidated. Therefore, the aim of this study was to investigate whether the genetic variants in DDR2 are associated with BMD and fracture risk. This study was performed in three samples from two ethnicities, including 1,300 Chinese Han subjects, 700 Chinese Han subjects (350 with osteoporotic hip fractures and 350 healthy controls and 2,286 US white subjects. Twenty-eight SNPs in DDR2 were genotyped and tested for associations with hip BMD and fractures. We identified 3 SNPs in DDR2 significantly associated with hip BMD in the Chinese population after multiple testing adjustments, which were rs7521233 (P = 1.06×10-4, β: -0.018 for allele C, rs7553831 (P = 1.30×10-4, β: -0.018 for allele T, and rs6697469 (P = 1.59×10-3, β: -0.015 for allele C, separately. These three SNPs were in high linkage disequilibrium. Haplotype analyses detected two significantly associated haplotypes, including one haplotype in block 2 (P = 9.54×10-4, β: -0.016 where these three SNPs located. SNP rs6697469 was also associated with hip fractures (P = 0.043, OR: 1.42 in the Chinese population. The effect on fracture risk was consistent with its association with lower BMD. However, in the white population, we didn't observe significant associations with hip BMD. eQTL analyses revealed that SNPs associated with BMD also affected DDR2 mRNA expression levels in Chinese. Our findings, together with the prior biological evidence, suggest that DDR2 could be a new candidate for osteoporosis in Chinese population. Our results also reveal an ethnic difference, which highlights the need for further genetic studies in each ethnic group.

  4. Atomic force microscopy on human trabecular bone from an old woman with osteoporotic fractures

    DEFF Research Database (Denmark)

    Hassenkam, Tue; Jørgensen, Henrik L; Pedersen, Morten

    2005-01-01

    AFM images were taken of the exterior surface of a single trabecula, extracted from a human femoral head removed during surgery for a hip fracture in an old women with former fractures. The images showed a dense structure of bundled collagen fibrils banded with 67 nm periodicity. Bundles were see...

  5. Fibroblast Growth Factor-23, Sclerostin, and Bone Microarchitecture in Patients With Osteoporotic Fractures of the Proximal Femur: A Cross-sectional Study.

    Science.gov (United States)

    Herlyn, Philipp K E; Cornelius, Norina; Haffner, Dieter; Zaage, Franziska; Kasch, Cornelius; Schober, Hans-Christof; Mittlmeier, Thomas; Fischer, Dagmar-C

    2016-01-01

    This cross-sectional observational cohort study was designed to simultaneously investigate bone microarchitecture and serum markers of bone metabolism in elderly osteoporotic patients experiencing a trochanteric or femoral neck fracture. Special emphasis was put on renal function, sclerostin and fibroblast growth factor-23 (FGF-23). Eighty-two patients (median age: 84 years; 49 trochanteric fractures) scheduled for emergency surgery due to an osteoporotic fracture participated. Bone specimens for ex vivo microcomputed X-ray tomography were sampled during surgery. Blood samples for laboratory workup were collected before surgery (t0) and 1 day afterward (t1). Fifty-eight patients consented to dual-energy X-ray absorptiometry scanning of the lumbar spine and/or contralateral femoral neck after recovery during the in-patient stay. Samples were grouped according to the site of fracture. Regression coefficients were controlled for age and/or estimated glomerular filtration rate (eGFR), if appropriate. Patients experiencing a femoral neck fracture presented with better preserved renal function (eGFR) and lower C-terminal fragment of fibroblast growth factor-23 (cFGF-23) concentrations compared to those with trochanteric fractures. By contrast, serum sclerostin was similar at both time points and did not differ between groups. Age-adjusted correlation analysis revealed negative associations between eGFR and cFGF-23 determined at t1 (R=-0.34; ptrochanteric and femoral neck fractures, respectively. Our study provides evidence that not only an age-related decline of renal function but also the type of skeletal injury may contribute to the circulating concentrations of cFGF-23. Copyright © 2016 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  6. Methodology for identifying patients at high risk for osteoporotic fracture.

    Science.gov (United States)

    Westfall, G; Littlefield, R; Heaton, A; Martin, S

    2001-09-01

    Osteoporotic fractures are associated with significant morbidity, mortality, and health care costs. The purpose of this paper is to present and validate a mathematical model that managed care organizations can apply to administrative claims data to help locate members at risk for osteoporotic fracture and estimate future fracture rates. Using known risk factors from previous clinical studies, 92,000 members of a large Midwest health plan were placed in 1 of 4 risk categories based on historical claims markers: demographic/lifestyle (age, sex, smoking, alcoholism); steroid use; medical history (previous osteoporotic fracture, ordinary bone fracture, osteoporosis diagnosis, bone mineral density test); or steroid use with medical history. Logistic regression was used to assign a probability of fracture for the 4 groups over the next 2 years. These predictions were compared with actual fracture rates, and refined models were produced. The models were then validated by applying them to current data and comparing the predicted fracture rate for each group to known results. The model predicted that 1.26% of the study members would experience osteoporotic fracture over the next 2 years; the actual result was 1.27%. Within the 4 risk groups, the predicted fracture rates were lower than the actual rates for the demographic risk group (0.87% predicted vs 0.97% actual) and higher than the actual rates for the steroid use (1.78% predicted vs 1.58% actual), medical history (5.90% predicted vs 4.94% actual), and the steroid use with medical history groups (7.80% predicted vs 6.42% actual). The application of this risk model to an administrative claims database successfully identified plan members at risk for osteoporotic fracture.

  7. Chance Fracture Secondary to a Healed Kyphotic Compression Osteoporotic Fracture

    Directory of Open Access Journals (Sweden)

    Teh KK

    2009-11-01

    Full Text Available Chance fracture is an unstable vertebral fracture, which usually results from a high velocity injury. An elderly lady with a previously healed osteoporotic fracture of the T12 and L1 vertebra which resulted in a severe kyphotic deformity subsequently sustained a Chance fracture of the adjacent L2 vertebrae after a minor fall. The previously fracture left her with a deformity which resulted in significant sagittal imbalance therefore predisposing her to this fracture. This case highlights the importance of aggressive treatment of osteoporotic fractures in order to prevent significant sagittal imbalance from resultant (i.e. kyphotic deformity.

  8. Association of stressful life events with accelerated bone loss in older men: the Osteoporotic Fractures in Men (MrOS) Study

    Science.gov (United States)

    Fink, Howard A.; Kuskowski, Michael A.; Cauley, Jane A.; Taylor, Brent C.; Schousboe, John T.; Cawthon, Peggy M.; Ensrud, Kristine E.

    2015-01-01

    Purpose/Introduction Prior studies suggest that stressful life events may increase adverse health outcomes, including falls and possibly fractures. The current study builds on these findings and examines whether stressful life events are associated with increased bone loss. Methods 4388 men aged ≥65 years in the Osteoporotic Fractures in Men study completed total hip bone mineral density (BMD) measures at baseline and visit 2, approximately 4.6 years later, and self-reported stressful life events data mid-way between baseline and visit 2, and at visit 2. We used linear regression to model the association of stressful life events with concurrent annualized total hip BMD loss, and log binomial regression or Poisson regression to model risk of concurrent accelerated BMD loss (>1 SD more than mean annualized change). Results 75.3% of men reported ≥1 type of stressful life event, including 43.3% with ≥2 types of stressful life events. Mean annualized BMD loss was −0.36% (SD 0.88) and 13.9% of men were categorized with accelerated BMD loss (about 5.7% or more total loss). Rate of annualized BMD loss increased with the number of types of stressful life events after adjustment for age (pstressful life events (RR, 1.10 [95% CI, 1.04–1.16]) per increase of 1 type of stressful life event). Fracture risk was not significantly different between stressful life event-accelerated bone loss subgroups (p=0.08). Conclusions In these older men, stressful life events were associated with a small, dose-related increase in risk of concurrent accelerated hip bone loss. Low frequency of fractures limited assessment of whether rapid bone loss mediates any association of stressful life events with incident fractures. Future studies are needed to confirm these findings and to investigate the mechanism that may underlie this association. PMID:25169421

  9. Association between polymorphisms of apolipoprotein E, bone mineral density of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in postmenopausal women with hip or lower forearm fracture

    DEFF Research Database (Denmark)

    Sennels, Henriette Pia; Sand, J C; Madsen, B

    2003-01-01

    surgery and age-matched controls from the population register. The APOE genotypes of 327 women were studied: 73 with lower forearm fractures, 43 with hip fractures and 211 age-matched controls. The participants were not receiving antiosteoporotic treatment. Polymerase chain reaction restriction fragment...... are contradictory. The aim of this study was to examine the association between polymorphisms of APOE, BMD of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in a population of postmenopausal women with hip or lower forearm fractures admitted to a department of orthopaedic....... In conclusion, this study showed no association between bone mass parameters (BMD, speed of sound (SOS), broadband ultrasound attenuation (BUA)), hip or lower forearm fracture and APOE genotypes in a population of postmenopausal women and age-matched controls....

  10. Association between polymorphisms of apolipoprotein E, bone mineral density of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in postmenopausal women with hip or lower forearm fracture

    DEFF Research Database (Denmark)

    Sennels, Henriette Pia; Sand, J C; Madsen, B

    2003-01-01

    are contradictory. The aim of this study was to examine the association between polymorphisms of APOE, BMD of the lower forearm, quantitative ultrasound of the calcaneus and osteoporotic fractures in a population of postmenopausal women with hip or lower forearm fractures admitted to a department of orthopaedic...... surgery and age-matched controls from the population register. The APOE genotypes of 327 women were studied: 73 with lower forearm fractures, 43 with hip fractures and 211 age-matched controls. The participants were not receiving antiosteoporotic treatment. Polymerase chain reaction restriction fragment...... length polymorphism (PCR-RFLP) was used to detect the APOE genotypes. Quantitative ultrasound was measured at the calcaneus. Bone mineral density (BMD) of the lower forearm was measured with dual-energy X-ray absorptiometry. The distributions of genotype frequencies in this study were: E2/E2: 0.3%; E2/E3...

  11. Kyphoplasty for severe osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Bao Zhaohua; Wang Genlin; Yang Huilin; Meng Bin; Chen Kangwu; Jiang Weimin

    2010-01-01

    Objective: To evaluate the clininal efficacy of kyphoplasty for severe osteoporotic vertebral compression fractures. Methods: Forty-five patients with severe osteoporotic compressive fractures were treated by kyphoplasty from Jan 2005 to Jan 2009. The compressive rate of the fractured vertebral bodies was more than 75%. According to the morphology of the vertebral compression fracture bodies the unilateral or bilateral balloon kyphoplasty were selected. The anterior vertebral height was measured on a standing lateral radiograph at pre-operative, post-operative (one day after operation) and final follow-up time. A visual analog scale(VAS) and the Oswestry disability index (ODI) were chosen to evaluate pain status and functional activity. Results: The mean follow-up was for 21.7 months (in range from 18 to 48 months). The anterior vertebral body height of fracture vertebra was restored from preoperative (18.7 ± 3.1)% to postoperative (51.4 ± 2.3)%, the follow-up period (50.2 ± 2.7)%. There was a significant improvement between preoperative and postoperative values (P 0.05). The VAS was 8.1 ± 1.4 at preoperative, 2.6 ± 0.9 at postoperative, 2.1 ± 0.5 at final follow-up time; and the ODI was preoperative 91.1 ± 2.3, postoperative 30.7 ± 7.1, follow-up period 26.1 ± 5.1. There was statistically significant improvement in the VAS and ODI in the post-operative assessment compared with the pre-operative assessment (P 0.05). Asymptomatic cement leakage occurred in three cases. New vertebral fracture occurred in one case. Conclusion: The study suggests that balloon kyphoplasty is a safe and effective procedure in the treatment of severe osteoporotic vertebral compression fractures. (authors)

  12. Heavy metals accumulation affects bone microarchitecture in osteoporotic patients.

    Science.gov (United States)

    Scimeca, Manuel; Feola, Maurizio; Romano, Lorenzo; Rao, Cecilia; Gasbarra, Elena; Bonanno, Elena; Brandi, Maria Luisa; Tarantino, Umberto

    2017-04-01

    Bone metabolism is affected by mechanical, genetic, and environmental factors and plays a major role in osteoporosis. Nevertheless, the influence of environmental pollution on the occurrence of osteoporosis is still unclear and controversial. In this context, heavy metals are the most important pollutants capable to affect bone mass. The aim of this study was to investigate whether heavy metals accumulation in bone tissues could be related to the altered bone metabolism and architecture of osteoporotic patients. To this end, we analyzed 25 bone head biopsies osteoporotic patients and 25 bone head biopsies of osteoarthritic patients. Moreover we enrolled 15 patients underwent hip arthroplasty for high-energy hip fracture or osteonecrosis of the femoral head as a control group. Bone head biopsies were studied by BioQuant-osteo software, scanning electron microscopy and Energy Dispersive X-ray microanalysis. We found a prevalence of lead, cadmium and chromium accumulation in osteoporotic patients. Noteworthy, high levels of sclerostin, detected by immunohistochemistry, correlate with the accumulation of heavy metal found in the bone of osteoporotic patients, suggesting a molecular link between heavy metal accumulation and bone metabolism impairment. In conclusion, the presence of heavy metals into bone shed new light on the comprehension of the pathogenesis of osteoporosis since these elements could play a non redundant role in the development of osteoporosis at cellular/molecular and epigenetic level. Nevertheless, in vivo and in vitro studies need to better elucidate the molecular mechanism in which heavy metals can participate to osteoporosis. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1333-1342, 2017. © 2016 Wiley Periodicals, Inc.

  13. Osteoporotic fracture of the sacrum: sacroplasty and physical medecine.

    Science.gov (United States)

    Thomas, E N; Cyteval, C; Herisson, C; Leonard, L; Blotman, F

    2009-06-01

    Traditional treatment of sacrum osteoporotic fractures is mainly based on antalgics and rest in bed. But complications are frequent, cutaneous, respiratory, thrombotic or digestive and mortality at 1 year significant. We wanted to define the interest of sacroplasty when treating osteoporotic fracture of sacrum. We reviewed literature while studying a clinical case in an elderly patient. Sacroplasty was efficient at short and mean delay to control the pain due to osteoporotic sacrum fracture. Rate of complications is low in the centers mastering the procedure. Sacroplasty is of evident interest for elderly patients suffering of an osteoporotic fracture of sacrum. It reduces decubitus complications, secondary effects of antalgics and allows an early reeducation.

  14. Periapical multilocular osteoporotic bone marrow defect

    International Nuclear Information System (INIS)

    Jung, Yun Hoa; Cho, Bong Hae; Nah, Kyung Soo

    2005-01-01

    A case of osteoporotic bone marrow defect, which appeared as a well-defined multilocular radiolucency overlapping the roots of mandibular right second molar, was reported. On periapical radiograph, a daughter cyst-like radiolucency was seen at the anterior margin of the lesion making it difficult to rule out odontogenic keratocyst.

  15. Periapical multilocular osteoporotic bone marrow defect

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Yun Hoa; Cho, Bong Hae; Nah, Kyung Soo [Pusan National University College of Medicine, Busan (Korea, Republic of)

    2005-12-15

    A case of osteoporotic bone marrow defect, which appeared as a well-defined multilocular radiolucency overlapping the roots of mandibular right second molar, was reported. On periapical radiograph, a daughter cyst-like radiolucency was seen at the anterior margin of the lesion making it difficult to rule out odontogenic keratocyst.

  16. Comparison of bone densitometry methods in healthy and osteoporotic women

    International Nuclear Information System (INIS)

    Reinbold, W.D.; Dinkel, E.; Genant, H.K.

    1988-01-01

    To compare methods of noninvasive measurement of bone mineral content, 40 healthy early postmenopausal women and 68 postmenopausal women with osteoporosis were studied. The methods included mono- and dual-energy quantitative computed tomography (QCT) and dual-photon absorptiometry (DPA) of the lumbar spine, single-photon absorptiometry (SPA) of the distal third of the radius, and combined cortical thickness (CCT) of the second metacarpal shaft. Lateral thoracolumbar radiographic studies were performed and the spinal fracture index calculated. There was good correlation between QCT and DPA methods in early postmenopausal women and moderate correlation in postmenopausal osteoporotic women. Correlations between spinal measurements (QCT or DPA) and appendicular cortical measurements (SPA or CCT) were moderate in healthy women and poor in osteoporotic women. Measurements resulting from one method were not predictive of measurements obtained by another method for individual patients. The strongest correlation with severity of vertebral fracture was provided by QCT and the weakest by SPA. There was good correlation between single- and dual-energy QCT results. Osteoporotic women and younger healthy women can be distinguished by the measurement of spinal trabecular bone density using QCT, and this method is more sensitive than the measurement of spinal integral bone by DPA or of appendicular cortical bone by SPA or CCT. (orig.) [de

  17. Kyphoplasty for osteoporotic fractures with spinal canal compromise

    International Nuclear Information System (INIS)

    Gan Minfeng; Yang Huilin; Zou Jun; Wang Genlin; Mei Xin; Zhou Feng; Chen Liang; Jiang Weimin

    2010-01-01

    Objective: To explore the feasibility and clinical outcome of kyphoplasty in the treatment of osteoporotic fractures with canal compromise. Methods: A total of 16 patients with osteoporotic fractures with canal compromise without neurological deficit were attempted to be treated by kyphoplasty. During kyphoplasty, modified techniques including staged bone cement injection and dynamic fluoroscopic monitoring were used. Pain was measured using the self-reporting Visual Analogue pain Scale (VAS) preoperatively, postoperatively and in the final follow-up. Disability was measured using the Oswestry Disability questionnaire (ODI) preoperatively, postoperatively and in the final follow-up. The height of the compromised vertebral body, the kyphotic angle and the spinal canal compromise were measured preoperatively, postoperatively and in the final follow-up. Results: Operations were completed smoothly, with the exception of one patient with less cement leakage but without clinical symptom occurred. Relief of pain was achieved after kyphoplasty. The mean VAS score of these patients decreased from 8.1 ± 1.2 pre-operatively to 2.7 ± 0.6 post-operatively (P 0.05). In the final follow-up, the spinal canal compromise was (14.4 ± 3.1)%. Conclusion: Kyphoplasty is a relatively safe and effective method for the treatment of osteoporotic fractures with canal compromise without neurological deficit. (authors)

  18. [Correlation analysis of cement leakage with volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence in percutaneous vertebroplasty for osteoporotic vertebral compression fractures].

    Science.gov (United States)

    Liang, De; Ye, Linqiang; Jiang, Xiaobing; Huang, Weiquan; Yao, Zhensong; Tang, Yongchao; Zhang, Shuncong; Jin, Daxiang

    2014-11-01

    To investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Between March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the clinical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was -3.8 (range, -6.7- -2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. All procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P

  19. Review of radiological scoring methods of osteoporotic vertebral fractures for clinical and research settings

    Energy Technology Data Exchange (ETDEWEB)

    Oei, Ling [Erasmus Medical Center, Department of Internal Medicine, Rotterdam (Netherlands); Erasmus Medical Center, Department of Epidemiology, P.O. Box 2040 Ee21-75, CA, Rotterdam (Netherlands); Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Rotterdam (Netherlands); Erasmus Medical Center, Departments of Internal Medicine and Epidemiology, P.O. Box 2040 Ee21-83, CA, Rotterdam (Netherlands); Rivadeneira, Fernando [Erasmus Medical Center, Department of Internal Medicine, Rotterdam (Netherlands); Erasmus Medical Center, Department of Epidemiology, P.O. Box 2040 Ee21-75, CA, Rotterdam (Netherlands); Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Rotterdam (Netherlands); Erasmus Medical Center, Departments of Internal Medicine and Epidemiology, P.O. Box 2040 Ee5-79, CA, Rotterdam (Netherlands); Ly, Felisia; Breda, Stephan J. [Erasmus Medical Center, Department of Internal Medicine, Rotterdam (Netherlands); Erasmus Medical Center, Department of Epidemiology, P.O. Box 2040 Ee21-75, CA, Rotterdam (Netherlands); Erasmus Medical Center, Departments of Internal Medicine and Epidemiology, P.O. Box 2040 Ee21-83, CA, Rotterdam (Netherlands); Zillikens, M.C. [Erasmus Medical Center, Department of Internal Medicine, Rotterdam (Netherlands); Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Rotterdam (Netherlands); Erasmus Medical Center, Department of Internal Medicine, ' s Gravendijkwal 230, CE, Rotterdam (Netherlands); Hofman, Albert [Erasmus Medical Center, Department of Epidemiology, P.O. Box 2040 Ee21-75, CA, Rotterdam (Netherlands); Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Rotterdam (Netherlands); Uitterlinden, Andre G. [Erasmus Medical Center, Department of Internal Medicine, Rotterdam (Netherlands); Erasmus Medical Center, Department of Epidemiology, P.O. Box 2040 Ee21-75, CA, Rotterdam (Netherlands); Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Rotterdam (Netherlands); Erasmus Medical Center, Departments of Internal Medicine and Epidemiology, P.O. Box 2040 Ee5-75B, CA, Rotterdam (Netherlands); Krestin, Gabriel P.; Oei, Edwin H.G. [Erasmus Medical Center, Department of Radiology, ' s Gravendijkwal 230, CE, Rotterdam (Netherlands)

    2013-02-15

    Osteoporosis is the most common metabolic bone disease; vertebral fractures are the most common osteoporotic fractures. Several radiological scoring methods using different criteria for osteoporotic vertebral fractures exist. Quantitative morphometry (QM) uses ratios derived from direct vertebral body height measurements to define fractures. Semi-quantitative (SQ) visual grading is performed according to height and area reduction. The algorithm-based qualitative (ABQ) method introduced a scheme to systematically rule out non-fracture deformities and diagnoses osteoporotic vertebral fractures based on endplate depression. The concordance across methods is currently a matter of debate. This article reviews the most commonly applied standardised radiographic scoring methods for osteoporotic vertebral fractures, attaining an impartial perspective of benefits and limitations. It provides image examples and discusses aspects that facilitate large-scale application, such as automated image analysis software and different imaging investigations. It also reviews the implications of different fracture definitions for scientific research and clinical practice. Accurate standardised scoring methods for assessing osteoporotic vertebral fractures are crucial, considering that differences in definition will have implications for patient care and scientific research. Evaluation of the feasibility and concordance among methods will allow establishing their benefits and limitations, and most importantly, optimise their effectiveness for widespread application. (orig.)

  20. Review of radiological scoring methods of osteoporotic vertebral fractures for clinical and research settings

    International Nuclear Information System (INIS)

    Oei, Ling; Rivadeneira, Fernando; Ly, Felisia; Breda, Stephan J.; Zillikens, M.C.; Hofman, Albert; Uitterlinden, Andre G.; Krestin, Gabriel P.; Oei, Edwin H.G.

    2013-01-01

    Osteoporosis is the most common metabolic bone disease; vertebral fractures are the most common osteoporotic fractures. Several radiological scoring methods using different criteria for osteoporotic vertebral fractures exist. Quantitative morphometry (QM) uses ratios derived from direct vertebral body height measurements to define fractures. Semi-quantitative (SQ) visual grading is performed according to height and area reduction. The algorithm-based qualitative (ABQ) method introduced a scheme to systematically rule out non-fracture deformities and diagnoses osteoporotic vertebral fractures based on endplate depression. The concordance across methods is currently a matter of debate. This article reviews the most commonly applied standardised radiographic scoring methods for osteoporotic vertebral fractures, attaining an impartial perspective of benefits and limitations. It provides image examples and discusses aspects that facilitate large-scale application, such as automated image analysis software and different imaging investigations. It also reviews the implications of different fracture definitions for scientific research and clinical practice. Accurate standardised scoring methods for assessing osteoporotic vertebral fractures are crucial, considering that differences in definition will have implications for patient care and scientific research. Evaluation of the feasibility and concordance among methods will allow establishing their benefits and limitations, and most importantly, optimise their effectiveness for widespread application. (orig.)

  1. Low-energy extracorporeal shockwave therapy (ESWT improves metaphyseal fracture healing in an osteoporotic rat model.

    Directory of Open Access Journals (Sweden)

    Gina A Mackert

    Full Text Available As result of the current demographic changes, osteoporosis and osteoporotic fractures are becoming an increasing social and economic burden. In this experimental study, extracorporeal shock wave therapy (ESWT, was evaluated as a treatment option for the improvement of osteoporotic fracture healing.A well-established fracture model in the metaphyseal tibia in the osteoporotic rat was used. 132 animals were divided into 11 groups, with 12 animals each, consisting of one sham-operated group and 10 ovariectomized (osteoporotic groups, of which 9 received ESWT treatment. Different energy flux intensities (0.15 mJ/mm2, 0.35 mJ/mm2, or 0.55 mJ/mm2 as well as different numbers of ESWT applications (once, three times, or five times throughout the 35-day healing period were applied to the osteoporotic fractures. Fracture healing was investigated quantitatively and qualitatively using micro-CT imaging, quantitative real-time polymerase chain reaction (qRT-PCR analysis, histomorphometric analysis and biomechanical analysis.The results of this study show a qualitative and quantitative improvement in the osteoporotic fracture healing under low-energy (energy flux intensity: 0,15 mJ/mm2 ESWT and with fewer treatment applications per healing period.In conclusion, low-energy ESWT seems to exhibit a beneficial effect on the healing of osteoporotic fractures, leading to improved biomechanical properties, enhanced callus-quantity and -quality, and an increase in the expression of bone specific transcription factors. The results suggest that low-energy ESWT, as main treatment or as adjunctive treatment in addition to a surgical intervention, may prove to be an effective, simple to use, and cost-efficient option for the qualitative and quantitative improvement of osteoporotic fracture healing.

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

    Science.gov (United States)

    Lin, JiSheng; Yang, Yong; Fei, Qi; Zhang, XiaoDong; Ma, Zhao; Wang, Qi; Li, JinJun; Li, Dong; Meng, Qian; Wang, BingQiang

    2016-01-01

    This cross-sectional study compared three tools for predicting painful new osteoporotic vertebral fractures (PNOVFs) in older Chinese men: bone mineral density (BMD), the Osteoporosis Self-Assessment Tool for Asians (OSTA), and the World Health Organization fracture risk assessment tool (FRAX) (without BMD). Men aged ≥50 years were apportioned to a group for men with fractures who had undergone percutaneous vertebroplasty (n=111), or a control group of healthy men (n=385). Fractures were verified on X-ray and magnetic resonance imaging. BMD T-scores were determined by dual energy X-ray absorptiometry. Diagnosis of osteoporosis was determined by a BMD T-score of ≤2.5 standard deviations below the average for a young adult at peak bone density at the femoral neck, total hip, or L1-L4. Demographic and clinical risk factor data were self-reported through a questionnaire. BMD, OSTA, and FRAX scores were assessed for identifying PNOVFs via receiver-operating characteristic (ROC) curves. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. Between the men with fractures and the control group, there were significant differences in BMD T-scores (at femoral neck, total hip, and L1-L4), and OSTA and FRAX scores. In those with fractures, only 53.15% satisfied the criteria for osteoporosis. Compared to BMD or OSTA, the FRAX score had the best predictive value for PNOVFs: the AUC of the FRAX score (cutoff =2.9%) was 0.738, and the sensitivity and specificity were 82% and 62%, respectively. FRAX may be a valuable tool for identifying PNOVFs in older Chinese men.

  3. Epidemiology of Osteoporosis and Osteoporotic Fractures in South Korea

    Directory of Open Access Journals (Sweden)

    Young-Kyun Lee

    2013-06-01

    Full Text Available Several epidemiologic studies suggested that osteoporosis and osteoporotic fractures are not uncommon in South Korea. However, these previous cohort studies had limitations that may have influenced their results and the generalizability of the study conclusions, including small sample sizes, inclusion of only women, enrollment of participants from specific areas, and nonrandom selection of participants. Recently, epidemiologic studies using a nationwide claim register have been performed to overcome these limitations through collaboration between the Korean Society of Bone and Mineral Research and Health Insurance Review Assessments. Our review of the Korean Nationwide-database Osteoporosis Study could be helpful to obtain accurate incidence and prevalence estimations of osteoporosis and osteoporosis-related fractures in Korea.

  4. The Relationship Between Osteoporotic Risk Factors and Bone Mineral Density

    Directory of Open Access Journals (Sweden)

    Şule Şahin Onat

    2013-12-01

    Full Text Available Objective: Since osteoporosis is a preventable disease to some extent, risk factor determination and if possible modification is very important. The aim of this study is to identify the relationship between ostoporotic risk factors and bone mineral density results and emphasize the importance of risk factors. Materials and Methods: The study comprised 103 postmenopausal osteoporotic women. Demographic characteristics, osteoporortic risk factors, lumbar vertebrae and femur neck T scores were recorded. Relationships between lumbar vertebra and femur neck T scores and risk factors were statistically studied. Results: Advanced age, low physical activity status, inadequte dietary calcium intake and vertebral compression fractures were found to be associated with low bone mineral density results in postmenopausal osteoporotic women whereas marital status, occupation, education level and familial fracture history were not. Furthermore early menopause was found to be associated with low femoral T scores and smoking with low lumbar T scores. Tendency to fall and number of chronic diseases were irrelevant to bone mineral density. Conclusions: Risk factor assesment is still important for osteoporosis prevention. (Turkish Journal of Osteoporosis 2013;19:74-80

  5. The influence of fat infiltration of back extensor muscles on osteoporotic vertebral fractures.

    Science.gov (United States)

    So, Kwang-Young; Kim, Dae-Hee; Choi, Dong-Hyuk; Kim, Choong-Young; Kim, Jeong-Seok; Choi, Yong-Soo

    2013-12-01

    Retrospective study. To investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture. In persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial. Two hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors. A negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%±14.5% and 64.2%±9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015). Fat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.

  6. Load-adaptive bone remodeling simulations reveal osteoporotic microstructural and mechanical changes in whole human vertebrae.

    Science.gov (United States)

    Badilatti, Sandro D; Christen, Patrik; Parkinson, Ian; Müller, Ralph

    2016-12-08

    Osteoporosis is a major medical burden and its impact is expected to increase in our aging society. It is associated with low bone density and microstructural deterioration. Treatments are available, but the critical factor is to define individuals at risk from osteoporotic fractures. Computational simulations investigating not only changes in net bone tissue volume, but also changes in its microstructure where osteoporotic deterioration occur might help to better predict the risk of fractures. In this study, bone remodeling simulations with a mechanical feedback loop were used to predict microstructural changes due to osteoporosis and their impact on bone fragility from 50 to 80 years of age. Starting from homeostatic bone remodeling of a group of seven, mixed sex whole vertebrae, five mechanostat models mimicking different biological alterations associated with osteoporosis were developed, leading to imbalanced bone formation and resorption with a total net loss of bone tissue. A model with reduced bone formation rate and cell sensitivity led to the best match of morphometric indices compared to literature data and was chosen to predict postmenopausal osteoporotic bone loss in the whole group. Thirty years of osteoporotic bone loss were predicted with changes in morphometric indices in agreement with experimental measurements, and only showing major deviations in trabecular number and trabecular separation. In particular, although being optimized to match to the morphometric indices alone, the predicted bone loss revealed realistic changes on the organ level and on biomechanical competence. While the osteoporotic bone was able to maintain the mechanical stability to a great extent, higher fragility towards error loads was found for the osteoporotic bones. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Two to three years of hormone replacement treatment in healthy women have long-term preventive effects on bone mass and osteoporotic fractures: the PERF study

    DEFF Research Database (Denmark)

    Bagger, Yu Z; Tankó, László B; Alexandersen, Peter

    2004-01-01

    density (BMD) at the spine (L1-L4) and bone mineral content (BMC) in the forearm were measured at baseline, the end of the trials, and follow-up. At follow-up, we assessed the radiological presence of vertebral fracture and collected information on the new incidence of nonvertebral fractures. Compared...

  8. Under-reporting of osteoporotic vertebral fractures on computed tomography

    International Nuclear Information System (INIS)

    Williams, Alexandra L.; Al-Busaidi, Aisha; Sparrow, Patrick J.; Adams, Judith E.; Whitehouse, Richard W.

    2009-01-01

    Purpose: Osteoporotic vertebral fractures are frequently asymptomatic. They are often not diagnosed clinically or radiologically. Despite this, prevalent osteoporotic vertebral fractures predict future osteoporotic fractures and are associated with increased mortality and morbidity. Appropriate management of osteoporosis can reduce future fracture risk. Fractures on lateral chest radiographs taken for other conditions are frequently overlooked by radiologists. Our aim was to assess the value of computed tomography (CT) in the diagnosis of vertebral fracture and identify the frequency with which significant fractures are missed. Materials and methods: The thoracic CT scans of 100 consecutive male and 100 consecutive female patients over 55 years were reviewed. CT images were acquired on General Electric Lightspeed multi-detector (MD) CT scanners (16 or 32 row) using 1.25 mm slice thickness. Midline sagittal images were reconstructed from the 3D volume images. The presence of moderate (25-40% height loss) or severe (>40% height loss) vertebral fractures between T1 and L1 was determined using an established semi-quantitative method and confirmed by morphological measurement. Results were compared with the formal CT report. Results: Scans of 192 patients were analysed (95 female; 97 male); mean age 70.1 years. Thirty-eight (19.8%) patients had one or more moderate to severe vertebral fractures. Only 5 (13%) were correctly reported as having osteoporotic fractures in the official report. The sensitivity of axial CT images to vertebral fracture was 0.35. Conclusion: Incidental osteoporotic vertebral fractures are under-reported on CT. The sensitivity of axial images in detecting these fractures is poor. Sagittal reformations are strongly recommended to improve the detection rate

  9. Podoplanin immunopositive lymphatic vessels at the implant interface in a rat model of osteoporotic fractures.

    Directory of Open Access Journals (Sweden)

    Katrin Susanne Lips

    Full Text Available Insertion of bone substitution materials accelerates healing of osteoporotic fractures. Biodegradable materials are preferred for application in osteoporotic patients to avoid a second surgery for implant replacement. Degraded implant fragments are often absorbed by macrophages that are removed from the fracture side via passage through veins or lymphatic vessels. We investigated if lymphatic vessels occur in osteoporotic bone defects and whether they are regulated by the use of different materials. To address this issue osteoporosis was induced in rats using the classical method of bilateral ovariectomy and additional calcium and vitamin deficient diet. In addition, wedge-shaped defects of 3, 4, or 5 mm were generated in the distal metaphyseal area of femur via osteotomy. The 4 mm defects were subsequently used for implantation studies where bone substitution materials of calcium phosphate cement, composites of collagen and silica, and iron foams with interconnecting pores were inserted. Different materials were partly additionally functionalized by strontium or bisphosphonate whose positive effects in osteoporosis treatment are well known. The lymphatic vessels were identified by immunohistochemistry using an antibody against podoplanin. Podoplanin immunopositive lymphatic vessels were detected in the granulation tissue filling the fracture gap, surrounding the implant and growing into the iron foam through its interconnected pores. Significant more lymphatic capillaries were counted at the implant interface of composite, strontium and bisphosphonate functionalized iron foam. A significant increase was also observed in the number of lymphatics situated in the pores of strontium coated iron foam. In conclusion, our results indicate the occurrence of lymphatic vessels in osteoporotic bone. Our results show that lymphatic vessels are localized at the implant interface and in the fracture gap where they might be involved in the removal of

  10. Podoplanin Immunopositive Lymphatic Vessels at the Implant Interface in a Rat Model of Osteoporotic Fractures

    Science.gov (United States)

    Lips, Katrin Susanne; Kauschke, Vivien; Hartmann, Sonja; Thormann, Ulrich; Ray, Seemun; Kampschulte, Marian; Langheinrich, Alexander; Schumacher, Matthias; Gelinsky, Michael; Heinemann, Sascha; Hanke, Thomas; Kautz, Armin R.; Schnabelrauch, Matthias; Schnettler, Reinhard; Heiss, Christian; Alt, Volker; Kilian, Olaf

    2013-01-01

    Insertion of bone substitution materials accelerates healing of osteoporotic fractures. Biodegradable materials are preferred for application in osteoporotic patients to avoid a second surgery for implant replacement. Degraded implant fragments are often absorbed by macrophages that are removed from the fracture side via passage through veins or lymphatic vessels. We investigated if lymphatic vessels occur in osteoporotic bone defects and whether they are regulated by the use of different materials. To address this issue osteoporosis was induced in rats using the classical method of bilateral ovariectomy and additional calcium and vitamin deficient diet. In addition, wedge-shaped defects of 3, 4, or 5 mm were generated in the distal metaphyseal area of femur via osteotomy. The 4 mm defects were subsequently used for implantation studies where bone substitution materials of calcium phosphate cement, composites of collagen and silica, and iron foams with interconnecting pores were inserted. Different materials were partly additionally functionalized by strontium or bisphosphonate whose positive effects in osteoporosis treatment are well known. The lymphatic vessels were identified by immunohistochemistry using an antibody against podoplanin. Podoplanin immunopositive lymphatic vessels were detected in the granulation tissue filling the fracture gap, surrounding the implant and growing into the iron foam through its interconnected pores. Significant more lymphatic capillaries were counted at the implant interface of composite, strontium and bisphosphonate functionalized iron foam. A significant increase was also observed in the number of lymphatics situated in the pores of strontium coated iron foam. In conclusion, our results indicate the occurrence of lymphatic vessels in osteoporotic bone. Our results show that lymphatic vessels are localized at the implant interface and in the fracture gap where they might be involved in the removal of lymphocytes, macrophages

  11. An animal model of co-existing sarcopenia and osteoporotic fracture in senescence accelerated mouse prone 8 (SAMP8).

    Science.gov (United States)

    Zhang, Ning; Chow, Simon Kwoon Ho; Leung, Kwok Sui; Lee, Ho Hin; Cheung, Wing Hoi

    2017-10-15

    Sarcopenia and osteoporotic fracture are common aging-related musculoskeletal problems. Recent evidences report that osteoporotic fracture patients showed high prevalence of sarcopenia; however, current clinical practice basically does not consider sarcopenia in the treatment or rehabilitation of osteoporotic fracture. There is almost no report studying the relationship of the co-existing of sarcopenia and osteoporotic fracture healing. In this study, we validated aged senescence accelerated mouse prone 8 (SAMP8) and senescence accelerated mouse resistant 1 (SAMR1) as animal models of senile osteoporosis with/without sarcopenia. Bone mineral density (BMD) at the 5th lumbar and muscle testing of the two animal strains were measured to confirm the status of osteoporosis and sarcopenia, respectively. Closed fracture was created on the right femur of 8-month-old animals. Radiographs were taken weekly post-fracture. MicroCT and histology of the fractured femur were performed at week 2, 4 and 6 post-fracture, while mechanical test of both femora at week 4 and 6 post-fracture. Results showed that the callus of SAMR1 was significantly larger at week 2 but smaller at week 6 post-fracture than SAMP8. Mechanical properties were significantly better at week 4 post-fracture in SAMR1 than SAMP8, indicating osteoporotic fracture healing was delayed in sarcopenic SAMP8. This study validated an animal model of co-existing sarcopenia and osteoporotic fracture, where a delayed fracture healing might be resulted in the presence of sarcopenia. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Epidemiology of rib fractures in older men: Osteoporotic Fractures in Men (MrOS) prospective cohort study.

    Science.gov (United States)

    Barrett-Connor, Elizabeth; Nielson, Carrie M; Orwoll, Eric; Bauer, Douglas C; Cauley, Jane A

    2010-03-15

    To study the causes and consequences of radiologically confirmed rib fractures (seldom considered in the context of osteoporosis) in community dwelling older men. Prospective cohort study (Osteoporotic Fractures in Men (MrOS) Study). 5995 men aged 65 or over recruited in 2000-2 from six US sites; 99% answered mailed questionnaires about falls and fractures every four months for a mean 6.2 (SD 1.3) year follow-up. New fractures validated by radiology reports; multivariate Cox proportional hazard ratios were used to evaluate factors independently associated with time to incident rib fracture; associations between baseline rib fracture and incident hip and wrist fracture were also evaluated. The incidence of rib fracture was 3.5/1000 person years, and 24% (126/522) of all incident non-spine fractures were rib fractures. Nearly half of new rib fractures (48%; n=61) followed falling from standing height or lower. Independent risk factors for an incident rib fracture were age 80 or above, low bone density, difficulty with instrumental activities of daily living, and a baseline history of rib/chest fracture. Men with a history of rib/chest fracture had at least a twofold increased risk of an incident rib fracture (adjusted hazard ratio 2.71, 95% confidence interval 1.86 to 3.95), hip fracture (2.05, 1.33 to 3.15), and wrist fracture (2.06, 1.14 to 3.70). Only 14/82 of men reported being treated with bone specific drugs after their incident rib fracture. Rib fracture, the most common incident clinical fracture in men, was associated with classic risk markers for osteoporosis, including old age, low hip bone mineral density, and history of fracture. A history of rib fracture predicted a more than twofold increased risk of future fracture of the rib, hip, or wrist, independent of bone density and other covariates. Rib fractures should be considered to be osteoporotic fractures in the evaluation of older men for treatment to prevent future fracture.

  13. Rate of bone loss in postmenopausal and osteoporotic women

    International Nuclear Information System (INIS)

    Aloia, J.F.; Ross, P.; Vaswani, A.; Zanzi, I.; Cohn, S.H.

    1982-01-01

    Regional and total bone mass were determined in three groups of women by photon absorptiometry of the distal radius [bone mineral content (BMC)] and total neutron activation analysis [total body calcium (TBCa)], respectively. There were three groups of patients: group A, osteoporotic women treated with a variety of pharmacologic agents; group B, osteoporotic women (controls) taking only calcium supplements; and group C, normal postmenopausal women. The mean TBCa and BMC were considerably higher in the postmenopausal women than in the osteoporotic women. The rate of change of bone mass in group C was -0.45%/yr and -0.9%/yr for the total skeleton and radius, respectively. Group B had no significant rate of loss, whereas group A demonstrated a significant increase in TBCa of 0.75%/yr with no change in the BMC of the radius. There were no significant between-subject correlations for the slopes (rates of change) of the two bone mineral measurements

  14. Dynamic locking screw improves fixation strength in osteoporotic bone: an in vitro study on an artificial bone model.

    Science.gov (United States)

    Pohlemann, Tim; Gueorguiev, Boyko; Agarwal, Yash; Wahl, Dieter; Sprecher, Christoph; Schwieger, Karsten; Lenz, Mark

    2015-04-01

    The novel dynamic locking screw (DLS) was developed to improve bone healing with locked-plate osteosynthesis by equalising construct stiffness at both cortices. Due to a theoretical damping effect, this modulated stiffness could be beneficial for fracture fixation in osteoporotic bone. Therefore, the mechanical behaviour of the DLS at the screw-bone interface was investigated in an artificial osteoporotic bone model and compared with conventional locking screws (LHS). Osteoporotic surrogate bones were plated with either a DLS or a LHS construct consisting of two screws and cyclically axially loaded (8,500 cycles, amplitude 420 N, increase 2 mN/cycle). Construct stiffness, relative movement, axial screw migration, proximal (P) and distal (D) screw pullout force and loosening at the bone interface were determined and statistically evaluated. DLS constructs exhibited a higher screw pullout force of P 85 N [standard deviation (SD) 21] and D 93 N (SD 12) compared with LHS (P 62 N, SD 28, p = 0.1; D 57 N, SD 25, p LHS (p = 0.01). DLS constructs showed significantly lower axial construct stiffness (403 N/mm, SD 21, p LHS (529 N/mm, SD 27; 0.8 mm, SD 0.04). Based on the model data, the DLS principle might also improve in vivo plate fixation in osteoporotic bone, providing enhanced residual holding strength and reducing screw cutout. The influence of pin-sleeve abutment still needs to be investigated.

  15. Osteoporotic Animal Models of Bone Healing: Advantages and Pitfalls.

    Science.gov (United States)

    Calciolari, Elena; Donos, Nikolaos; Mardas, Nikos

    2017-10-01

    The aim of this review was to summarize the advantages and pitfalls of the available osteoporotic animal models of bone healing. A thorough literature search was performed in MEDLINE via OVID and EMBASE to identify animal studies investigating the effect of experimental osteoporosis on bone healing and bone regeneration. The osteotomy model in the proximal tibia is the most popular osseous defect model to study the bone healing process in osteoporotic-like conditions, although other well-characterized models, such as the post-extraction model, might be taken into consideration by future studies. The regenerative potential of osteoporotic bone and its response to biomaterials/regenerative techniques has not been clarified yet, and the critical size defect model might be an appropriate tool to serve this purpose. Since an ideal animal model for simulating osteoporosis does not exist, the type of bone remodeling, the animal lifespan, the age of peak bone mass, and the economic and ethical implications should be considered in our selection process. Furthermore, the influence of animal species, sex, age, and strain on the outcome measurement should be taken into account. In order to make future studies meaningful, standardized international guidelines for osteoporotic animal models of bone healing need to be set up.

  16. Osteoporotic rat models for evaluation of osseointegration of bone implants

    NARCIS (Netherlands)

    Alghamdi, H.S.A.; Beucken, J.J.J.P van den; Jansen, J.A.

    2014-01-01

    Osseointegration of dental and orthopedic bone implants is the important process that leads to mechanical fixation of implants and warrants implant functionality. In view of increasing numbers of osteoporotic patients, bone implant surface optimization strategies with instructive and drug-loading

  17. Cement Leakage in Percutaneous Vertebral Augmentation for Osteoporotic Vertebral Compression Fractures: Analysis of Risk Factors.

    Science.gov (United States)

    Xie, Weixing; Jin, Daxiang; Ma, Hui; Ding, Jinyong; Xu, Jixi; Zhang, Shuncong; Liang, De

    2016-05-01

    The risk factors for cement leakage were retrospectively reviewed in 192 patients who underwent percutaneous vertebral augmentation (PVA). To discuss the factors related to the cement leakage in PVA procedure for the treatment of osteoporotic vertebral compression fractures. PVA is widely applied for the treatment of osteoporotic vertebral fractures. Cement leakage is a major complication of this procedure. The risk factors for cement leakage were controversial. A retrospective review of 192 patients who underwent PVA was conducted. The following data were recorded: age, sex, bone density, number of fractured vertebrae before surgery, number of treated vertebrae, severity of the treated vertebrae, operative approach, volume of injected bone cement, preoperative vertebral compression ratio, preoperative local kyphosis angle, intraosseous clefts, preoperative vertebral cortical bone defect, and ratio and type of cement leakage. To study the correlation between each factor and cement leakage ratio, bivariate regression analysis was employed to perform univariate analysis, whereas multivariate linear regression analysis was employed to perform multivariate analysis. The study included 192 patients (282 treated vertebrae), and cement leakage occurred in 100 vertebrae (35.46%). The vertebrae with preoperative cortical bone defects generally exhibited higher cement leakage ratio, and the leakage is typically type C. Vertebrae with intact cortical bones before the procedure tend to experience type S leakage. Univariate analysis showed that patient age, bone density, number of fractured vertebrae before surgery, and vertebral cortical bone were associated with cement leakage ratio (Pcement leakage are bone density and vertebral cortical bone defect, with standardized partial regression coefficients of -0.085 and 0.144, respectively. High bone density and vertebral cortical bone defect are independent risk factors associated with bone cement leakage.

  18. MRI evaluation and treatment of osteoporotic vertebral compression fracture

    International Nuclear Information System (INIS)

    Yamaguchi, Ken; Otani, Koji

    2003-01-01

    The purpose of this study was to investigate the relation between Gd-DTPA enhanced MRI findings and the prognosis of the fractured vertebral body in the patients with fresh osteoporotic compression vertebral fractures. Subjects were 8 cases, 11 vertebrae. All of the cases were treated with no bed rest and no corset. MRI and radiographs were taken within 1 week after injury. MRI signal intensity of the fractured vertebral body altered low on T1WI at acute phase. When the fractured vertebrae were enhanced at whole area with Gd-DTPA at acute phase, the vertebrae showed no progression of wedge deformity by follow up radiographs. On the other hand, when the fractured vertebrae were not enhanced at whole area, the vertebrae showed progression of wedge deformity. These findings suggests that vertebral fractures in osteoporosis should be taken MRI including GD-DTPA in acute phase after injury. When the fractured vertebrae are enhanced with Gd-DTPA in whole body at acute phase, the fracture may need no special treatment. In conclusion, Gd-DTPA enhanced MRI may be useful to determine the prognosis of the osteoporotic compression fracture. (author)

  19. High serum total cholesterol is a long-term cause of osteoporotic fracture.

    Science.gov (United States)

    Trimpou, P; Odén, A; Simonsson, T; Wilhelmsen, L; Landin-Wilhelmsen, K

    2011-05-01

    Risk factors for osteoporotic fractures were evaluated in 1,396 men and women for a period of 20 years. Serum total cholesterol was found to be an independent osteoporotic fracture risk factor whose predictive power improves with time. The purpose of this study was to evaluate long-term risk factors for osteoporotic fracture. A population random sample of men and women aged 25-64 years (the Gothenburg WHO MONICA project, N = 1,396, 53% women) was studied prospectively. The 1985 baseline examination recorded physical activity at work and during leisure time, psychological stress, smoking habits, coffee consumption, BMI, waist/hip ratio, blood pressure, total, HDL and LDL cholesterol, triglycerides, and fibrinogen. Osteoporotic fractures over a period of 20 years were retrieved from the Gothenburg hospital registers. Poisson regression was used to analyze the predictive power for osteoporotic fracture of each risk factor. A total number of 258 osteoporotic fractures occurred in 143 participants (10.2%). As expected, we found that previous fracture, smoking, coffee consumption, and lower BMI each increase the risk for osteoporotic fracture independently of age and sex. More unexpectedly, we found that the gradient of risk of serum total cholesterol to predict osteoporotic fracture significantly increases over time (p = 0.0377). Serum total cholesterol is an independent osteoporotic fracture risk factor whose predictive power improves with time. High serum total cholesterol is a long-term cause of osteoporotic fracture.

  20. Alkaline biodegradable implants for osteoporotic bone defects--importance of microenvironment pH.

    Science.gov (United States)

    Liu, W; Wang, T; Yang, C; Darvell, B W; Wu, J; Lin, K; Chang, J; Pan, H; Lu, W W

    2016-01-01

    Change of microenvironment pH by biodegradable implants may ameliorate unbalanced osteoporotic bone remodeling. The present work demonstrated that a weak alkaline condition stimulated osteoblasts differentiation while suppressed osteoclast generation. In vivo, implants with an alkaline microenvironment pH (monitored by a pH microelectrode) exhibited a promising healing effect for the repair of osteoporotic bone defects. Under osteoporotic conditions, the response of the bone microenvironment to an endosseous implant is significantly impaired, and this substantially increases the risk of fracture, non-union and aseptic implant loosening. Acid-base equilibrium is an important factor influencing bone cell behaviour. The present purpose was to study the effect of a series of alkaline biodegradable implant materials on regeneration of osteoporotic bone defect, monitoring the microenvironment pH (μe-pH) over time. The proliferation and differentiation potential of osteoporotic rat bone marrow stromal cells and RAW 264.7 cells were examined under various pH conditions. Ovariectomized rat bone defects were filled with specific biodegradable materials, and μe-pH was measured by pH microelectrode. New osteoid and tartrate-resistant acid phosphatase-positive osteoclast-like cells were examined by Goldner's trichrome and TRAP staining, respectively. The intermediate layer between implants and new bone were studied using energy-dispersive X-ray spectroscopy (EDX) linear scanning. In vitro, weak alkaline conditions stimulated osteoporotic rat bone marrow stromal cells (oBMSC) differentiation, while inhibiting the formation of osteoclasts. In vivo, μe-pH differs from that of the homogeneous peripheral blood and exhibits variations over time particular to each material. Higher initial μe-pH was associated with more new bone formation, late response of TRAP-positive osteoclast-like cells and the development of an intermediate 'apatitic' layer in vivo. EDX suggested that

  1. Percutaneous vertebroplasty for multi-level osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Wang Gefang; Cheng Yongde; Wu Chungen; Zhang Ji; Gu Yifeng; Li Minghua

    2008-01-01

    Objective: To prospectively evaluate the clinical efficiency and safety of patients receiving percutaneous vertebroplasty due to multi-level osteoporotic vertebral compression fractures. Methods: A retrospective study was conducted to review eighty-six osteoporotic vertebral compression fracture patients including 23 with three and more levels of vertebroplasty. The outcome was considered carefully by pre and postoperatively the Visual Analogue Scale (VAS)for pain relief, the Oswestry Disability Index (ODI)for the improvement activity of daily life and also the accompanied imaging information. Results: All procedures were performed successfully. Three patients had a transient high blood pressure and dyspnea, and recovered after sublingual nitroglycerin. The VAS and ODI improved from a mean preoperative score of 8.58±1.12 and 81.43 ±12.54 to a mean postoperative score of 3.03±0.98 and 31.04±11.11 one day afterward. Asymptomatic cement leakage rate was 17.8% with no major complications occurred during operation or post-operation. Five patients had new symptomatic vertebral fracture (s) during follow-up in one year. Conclusions: Vertebroplasty with cement to treat multi-level osteoporotic vertebral compression fractures in the elderly is safe and effective, providing immediate and long-term pain relief with improvement in quality of life. Due to the risk of fat embolism, the limitation of three per session must be kept strictly. (authors)

  2. Differences in Site-Specific Fracture Risk Among Older Women with Discordant Results for Osteoporosis at Hip and Spine: the Study of Osteoporotic Fractures

    Science.gov (United States)

    Fink, Howard A.; Harrison, Stephanie L.; Taylor, Brent C.; Cummings, Steven R.; Schousboe, John T.; Kuskowski, Michael A.; Stone, Katie L.; Ensrud, Kristine E.

    2009-01-01

    To examine the fracture pattern in older women whose bone mineral density (BMD) T-score criteria for osteoporosis at hip and spine disagree, hip and spine BMD were measured in Study of Osteoporotic Fractures participants using dual energy x-ray absorptiometry (DXA). Hip osteoporosis was defined as T-score ≤-2.5 at femoral neck or total hip, and spine osteoporosis as T-score ≤-2.5 at lumbar spine. Incident clinical fractures were self-reported and centrally adjudicated. Incident radiographic spine fractures were defined morphometrically. Compared to women with osteoporosis at neither hip nor spine, those osteoporotic only at hip had a 3.0-fold age and weight-adjusted increased risk for hip fracture (95%CI 2.4-3.6), and smaller increases in risk of nonhip nonspine (HR=1.6), clinical spine (OR=2.2), and radiographic spine fractures (OR=1.5). Women osteoporotic only at spine had a 2.8-fold increased odds of radiographic spine fracture (95%CI 2.1-3.8), and smaller increases in risk of clinical spine (OR=1.4), nonhip nonspine (HR=1.6), and hip fractures (HR=1.2). Discordant BMD results predict different fracture patterns. DXA fracture risk estimation in these patients should be site-specific. Women osteoporotic only at spine would not have been identified from hip BMD measurement alone, and may have a sufficiently high fracture risk to warrant preventive treatment. PMID:18296090

  3. Medical Cost Analysis of the Osteoporotic Hip Fractures

    Directory of Open Access Journals (Sweden)

    Savaş Çamur

    2015-12-01

    Full Text Available Objective: Osteoporotic hip fractures decrease the life expectancy for 20% about 20-50% of the patients become permanently dependent in terms of walking for the rest of their life. Life expectancy is increasing in Turkey in the last 20 years. We investigated the impact of osteoporotic hip fractures which increase the morbidity and mortality on the national economy. Materials and Methods: A total of 81 patients admitted to our emergency department with the diagnosis of femur intertrochanteric fracture and femoral neck fracture between 2008 and 2012 were included in this study. We retrospectively evaluated the medical records and the medical costs of these patients from hospital information management system. Results: Of the 81 patients 32 (39.6% males and 49 (60.4% females meeting the inclusion criteria were included in this study. The mean age was 80.1 years (range, 61-103. Twenty-three (27.5% patients had femoral neck fracture and 58 (72.5% patients had intertrochanteric femur fracture. The mean length of hospital stay was 13.4 days in intertrochanteric femur fracture and 15.5 days in femoral neck fracture; average of the total days of hospitalization of all patients was 13.9 days. The average treatment cost per patient was 5,912.36 TL for intertrochanteric fractures, 5,753.00 TL for neck fractures, and 5,863.09 TL for the whole patient population. Conclusion: Hip fracture is a substantial cause of morbidity and mortality in elderly. Taking preventive measures before the fracture occurs may help to prevent this problem which has a high cost treatment and which is a substantial burden for the national economy.

  4. 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.

  5. Clinical application of percutaneous vertebroplasty in the treatment of chronic symptomatic osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Wang Tao; Wu Chungen; Cheng Yongde; Gu Yifeng; Zhu Xue'e; Wang Jue; Wang Wu

    2009-01-01

    Objective: To evaluate percutaneous vertebroplasty (PVP) in treating patients suffering from osteoporotic vertebral compression fractures for three months or more. Methods: During the period of May 2006-May 2008, PVP was performed in 22 patients with chronic symptomatic osteoporotic vertebral compression fractures. Based on the MRI findings, the patients were divided into Group I (n=13) with bone marrow edema and Group II (n=9) without bone marrow edema. Visual analogue score (VAS) was estimated before and after the surgery. The VAS at different fracture time were compared and statistically analyzed. The complications and the patient's subjective satisfaction degree were recorded. Results: The average follow-up period was 12.2 months. The preoperative VAS of Group I and Group II was 7.77 ± 0.73 and 7.44 ± 0.88 respectively,with a general score of 7.63 ± 0.79. One day after the surgery, VAS of Group I and Group II was 3.61 ± 0.51 and 3.88 ± 0.60 respectively, with a general score of 3.72 ± 0.55. The follow-up VAS of Group I and Group II was 3.46 ± 1.05 and 3.56 ± 0.73 respectively, with a general score of 3.50 ± 0.91. No complications, such as nerve compression due to bone cement leakage, occurred in all patients. Subjective satisfaction degree of patients was good (about 90.9%). Conclusion: For patients with chronic osteoporotic vertebral compressive fracture, PVP is a safe and effective treatment. MRI is very useful and important in making preoperative assessment of the patient's condition. PVP is more effective for the patients with bone marrow edema. (authors)

  6. Bone mineral content in early-postmenopausal and postmenopausal osteoporotic women: comparison of measurement methods

    International Nuclear Information System (INIS)

    Reinbold, W.D.; Genant, H.K.; Reiser, U.J.; Harris, S.T.; Ettinger, B.

    1986-01-01

    To investigate associations among methods for noninvasive measurement of skeletal bone mass, we studied 40 healthy early postmenopausal women and 68 older postmenopausal women with osteoporosis. Methods included single- and dual-energy quantitative computed tomography (QCT) and dual-photon absorptiometry (DPA) of the lumbar spine, single-photon absorptiometry (SPA) of the distal third of the radius, and combined cortical thickness (CCT) of the second metacarpal shaft. Lateral thoracolumbar radiography was performed, and a spinal fracture index was calculated. There was good correlation between QCT and DPA methods in early postmenopausal women and modest correlation in postmenopausal osteoporotic women. Correlations between spinal measurements (QCT or DPA) and appendicular cortical measurements (SPA or CCT) were modest in healthy women and poor in osteoporotic women. Measurements resulting from one method are not predictive of those by another method for the individual patient. The strongest correlation with severity of vertebral fracture is provided by QCT; the weakest, by SPA. There was a high correlation between single- and dual-energy QCT results, indicating that errors due to vertebral fat are not substantial in these postmenopausal women. Single-energy QCT may be adequate and perhaps preferable for assessing postmenopausal women. The measurement of spinal trabecular bone density by QCT discriminates between osteoporotic women and younger healthy women with more sensitivity than measurements of spinal integral bone by DPA or of appendicular cortical bone by SPA or CCT

  7. Relationship between vitamin D, osteoporotic fracture and falls.

    Science.gov (United States)

    Candel Romero, Carmen; Forner Cordero, Ángeles; Sánchez Santos, José Cristóbal; Pereiró Berenguer, Inmaculada

    2017-11-22

    Link low levels of vitamin D, osteoporotic fracture and falls. Transversal observational study with the study variables of age, levels of vitamin D, osteoporotic fracture and falls. The study population was patients evaluated by the Rehabilitation Department, Hospital of Sagunto, from January 2013 to December 2014. Of the 242 patients who underwent vitamin D analysis, 70.6% showed levels under 30ng/ml. Forty-eight percent of the patients with below normal levels of vitamin D suffered a fracture, opposed to 32.4% patients with normal levels. Thus, controlling by age, patients with low levels of vitamin D are 4.8 times more likely to suffer a fracture than those with normal levels. Regarding falls, controlling by age, there is a higher risk of falling (adjusted OR 2.68) in those patients with low levels of vitamin D. Patients with low vitamin D levels are more likely to suffer falls and fractures. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  8. Balloon kyphoplasty for aged osteoporotic vertebral compressive fractures using domestic instruments

    International Nuclear Information System (INIS)

    Sun Gang; Jin Peng; Yi Yuhai; Xie Zhiyong; Zhang Xuping; Zhang Kangli

    2006-01-01

    Objective: To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful osteoporosis vertebral compressive fractures using instruments made in China. Methods: 10 cases of painful osteoporotic vertebral compressive fractures, involved 11 vertebrae. Under X-ray fluoroscopy monitoring, the inflatable balloon were inserted into the fractured vertebral body via transpedicular route bilaterally. The balloon was inflated with injected contrast agent to restore vertebral height and form a cavity within vertebral body. The cavity was then filled with bone cement in toothpaste state period. The postoperative symptoms and the radiographic findings of vertebral height recovery were observed. Results: Balloon kyphoplasty was successful in all 10 cases with dramatic pain relief within 48 hours after the procedure without clinical complications. The height restoration of vertebral body was satisfactory with correction of kyphosis up to 6 degree-24 degree. Leakage of a small quantity of bone cement occurred at only the anterior border of the vertebral body. Conclusions: Kyphoplasty using domestic instruments for painful osteoporotic vertebral compressive fractures was effective and safe. (authors)

  9. Nonsurgical Corrective Union of Osteoporotic Vertebral Fracture with Once-Weekly Teriparatide

    Directory of Open Access Journals (Sweden)

    Naohisa Miyakoshi

    2015-01-01

    Full Text Available Osteoporotic vertebral fractures usually heal with kyphotic deformities with subsidence of the vertebral body when treated conservatively. Corrective vertebral union using only antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously. An 81-year-old female with osteoporosis presented with symptomatic fresh L1 vertebral fracture with intravertebral cleft. Segmental vertebral kyphosis angle (VKA at L1 was 20° at diagnosis. Once-weekly teriparatide administration, hospitalized rest, and application of a thoracolumbosacral orthosis alleviated symptoms within 2 months. Corrective union of the affected vertebra was obtained with these treatments. VKA at 2 months after injury was 8° (correction, 12° and was maintained as of the latest follow-up at 7 months. Teriparatide has potent bone-forming effects and has thus been expected to enhance fracture healing. Based on the clinical experience of this case, teriparatide may have the potential to allow correction of unstable vertebral fractures without surgical intervention.

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

    DEFF Research Database (Denmark)

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

    2006-01-01

    affecting DXR bone mineral density (BMD) in this cohort. The study is based on data from a subgroup of women participating in the third Copenhagen City Heart Study and additional data from a questionnaire obtained in 1999. The mean follow-up time was 6.1 years. During the observation period, 245 women...... later osteoporotic fracture and seems to provide meaningful information on bone mass in epidemiological studies, where DXA measurements are not available....

  11. Low-magnitude high-frequency vibration enhances gene expression related to callus formation, mineralization and remodeling during osteoporotic fracture healing in rats.

    Science.gov (United States)

    Chung, Shu-Lu; Leung, Kwok-Sui; Cheung, Wing-Hoi

    2014-12-01

    Low magnitude high frequency vibration (LMHFV) has been shown to improve anabolic and osteogenic responses in osteoporotic intact bones and during osteoporotic fracture healing; however, the molecular response of LMHFV during osteoporotic fracture healing has not been investigated. It was hypothesized that LMHFV could enhance osteoporotic fracture healing by regulating the expression of genes related to chondrogenesis (Col-2), osteogenesis (Col-1) and remodeling (receptor activator for nuclear factor- κ B ligand (RANKL) and osteoproteger (OPG)). In this study, the effects of LMHFV on both osteoporotic and normal bone fracture healing were assessed by endpoint gene expressions, weekly radiographs, and histomorphometry at weeks 2, 4 and 8 post-treatment. LMHFV enhanced osteoporotic fracture healing by up-regulating the expression of chondrogenesis-, osteogenesis- and remodeling-related genes (Col-2 at week 4 (p=0.008), Col-1 at week 2 and 8 (p<0.001 and p=0.008) and RANKL/OPG at week 8 (p=0.045)). Osteoporotic bone had a higher response to LMHFV than normal bone and showed significantly better results as reflected by increased expression of Col-2 and Col-1 at week 2 (p<0.001 for all), larger callus width at week 2 (p=0.001), callus area at week 1 and 5(p<0.05 for all) and greater relative area of osseous tissue (p=0.002) at week 8. This study helps to understand how LMHFV regulates gene expression of callus formation, mineralization and remodeling during osteoporotic fracture healing. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  12. The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research.

    Science.gov (United States)

    Moayyeri, Alireza

    2008-11-01

    Physical activity helps maintain mobility, physical functioning, bone mineral density (BMD), muscle strength, balance and, therefore, may help prevent falls and fractures among the elderly. Meanwhile, it is theoretically possible that physical activity increases risk of fractures as it may increase risk of falls and has only a modest effect on BMD. This review aims to assess the potential causal association between physical activity and osteoporotic fractures from an epidemiological viewpoint. As the medical literature lacks direct evidence from randomized controlled trials (RCTs) with fracture end points, a meta-analysis of 13 prospective cohort studies with hip fracture end point is presented. The current evidence base regarding the link between exercise and fracture risk determinants (namely, falls, BMD, and bone quality) are also summarized. Moderate-to-vigorous physical activity is associated with a hip fracture risk reduction of 45% (95% CI, 31-56%) and 38% (95% CI, 31-44%), respectively, among men and women. Risk of falling is suggested to be generally reduced among physically active people with a potential increased risk in the most active and inactive people. Positive effects of physical activity on BMD and bone quality are of a questionable magnitude for reduction of fracture risk. The complexity of relationship between physical activity and osteoporotic fractures points out to the need for RCTs to be conducted with fractures as the primary end point.

  13. Hydroxyapatite particles maintain peri-implant bone mantle during osseointegration in osteoporotic bone

    NARCIS (Netherlands)

    Tami, A.E.; Leitner, M.M.; Baucke, M.G.; Mueller, T.L.; Lenthe, van G.H.; Müller, R.; Ito, K.

    2009-01-01

    In osteoporotic bones, resorption exceeds formation during the remodelling phase of bone turnover. As a consequence, decreased bone volume and bone contact result in the peri-implant region. This may subsequently lead to loss of fixation. In this study we investigated whether the presence of

  14. Locally delivered ethyl-2,5-dihydroxybenzoate using 3D printed bone implant for promotion of bone regeneration in a osteoporotic animal model

    Directory of Open Access Journals (Sweden)

    B-J Kwon

    2018-01-01

    Full Text Available Osteoporosis is a disease characterized by low bone mass, most commonly caused by an increase in bone resorption that is not matched by sufficient bone formation. The most common complications of postmenopausal osteoporosis are bone-related defects and fractures. Fracture healing is a multifactorial bone regeneration process, influenced by both biological and mechanical factors related to age, osteoporosis and stability of the osteosynthesis. During the treatment of bone defects in osteoporotic conditions, imbalanced bone remodeling is the leading cause for implant failure. To overcome these problems, ethyl-2,5-dihydroxybenzoate (E-2,5-DHB, a drug that promotes bone formation and inhibits bone resorption, was used. E-2,5-DHB-incorporating titanium (Ti implants using poly(lactic-co-glycolic acid (PLGA coating for local delivery of E-2,5-DHB were developed and the effects on bone healing of femoral defects were evaluated in an osteoporotic model. The release of E-2,5-DHB resulted in decreased bone resorption and increased bone formation around the implant. Thus, it was confirmed that, in the osteoporotic model, bone healing was increased and implant fixation was enhanced. These results suggested that E-2,5-DHB-coated Ti implants have great potential as an ultimate local drug delivery system for bone tissue scaffolds.

  15. The importance of zinc on osteoporotic bones

    Energy Technology Data Exchange (ETDEWEB)

    Lima, I.; Lopes, R.T. [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE). Programa de Engenharia Nuclear]. E-mail: ricardo@lin.ufrj.br; inaya@lin.ufrj.br; Anjos, M.J. [Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ (Brazil). Inst. de Fisica]. E-mail: marcelin@lin.ufrj.br; Farias, M.L.F. [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). Hospital Universitario. Servico de Endocrinologia]. E-mail: fleiuss@hucff.ufrj.br; Rosenthal, D. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Inst. de Biofisica Carlos Chagas Filho. Lab. de Fisiologia Endocrina]. E-mail: doris@biof.ufrj.br

    2007-07-01

    Zinc is an essential element that can be found in bones, such as calcium and phosphorus. It seems to have effects on growth, bone turnover and mineralization making its relationship with bones still opening. The goal of this study is, by XRF analysis, characterized bone samples, with and without pathology, in the trabecular region. For that purpose, it was used an XRF beam line at the Synchrotron Light National Laboratory (Campinas, Brazil). The results show that the profile of the zinc distribution and its concentration on femoral heads are strongly related to the associated pathology. (author)

  16. The importance of zinc on osteoporotic bones

    International Nuclear Information System (INIS)

    Lima, I.; Lopes, R.T.; Anjos, M.J.; Farias, M.L.F.; Rosenthal, D.

    2007-01-01

    Zinc is an essential element that can be found in bones, such as calcium and phosphorus. It seems to have effects on growth, bone turnover and mineralization making its relationship with bones still opening. The goal of this study is, by XRF analysis, characterized bone samples, with and without pathology, in the trabecular region. For that purpose, it was used an XRF beam line at the Synchrotron Light National Laboratory (Campinas, Brazil). The results show that the profile of the zinc distribution and its concentration on femoral heads are strongly related to the associated pathology. (author)

  17. 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

  18. Comparison of surgical complications of intertrochanteric hip fractures between non-osteoporotic and osteoporotic patients

    International Nuclear Information System (INIS)

    Azhar, M.S.; Nasab, M.H.K.; Saravi, M.S.

    2013-01-01

    Objective: To determine the role of bone quality in post-treatment complications among patients of intertrochanteric fracture. Methods: The cross-sectional descriptive study was done on 61 patients who presented with intertrochanteric hip fractures to two affiliated hospitals of Mazandaran University of Medical Science, Sari, Iran between February 2009 and December 2010. All the patients went through open reduction and internal fixation using 4-hole dynamic hip screw. The patients were followed up from 2 to 60 months. Data was analysed using SPSS 18. Results: The final rate of malunion, nail protrusion and mortality was 8.3% (n=3), 5.6% (n=2) and 8.4% (n=3) respectively. There was no significant difference between osteoporatic (n=36; 59%) and non-osteoporatic (n=25; 41%) groups regarding the surgical complications of intertrochanteric hip fracture. Conclusion: The quality of bone made no significant difference among patients who were treated for intertrochanteric fracture. (author)

  19. The clinical significance of adjacent rib involvement on MRI in patients with acute osteoporotic compression fractures of the thoracic spine

    International Nuclear Information System (INIS)

    Kim, Hyun Joo; Kim, Jae Hyun; Kwon, Kui Hyang; Choi, Deuk Lin; Goo, Dong Erk; Suh, You Sung; Bae, Won Kyung

    2012-01-01

    The purpose of this study was to evaluate the significance of the presence of adjacent rib involvement in osteoporotic compression fractures. All the patients with acute osteoporotic compression fractures of the thoracic spine on thoracic spine MRI that presented to our clinic between September 2003 and January 2010 were retrospectively reviewed. All the vertebrae were divided into two groups: those that showed signal intensity change in the rib adjacent to the compression fracture and those that did not. We compared the results between the two groups to determine if there were differences in the degree of osteoporosis, the compression fracture level and the age of patients between the two groups. We calculated the degree of correlation between the MRI and the bone scan images of these patients. We also reviewed whether percutaneous vertebroplasty relieved symptoms or not. Signal intensity changes were found in the adjacent rib(s) in 12 of the 60 patients and in 14 of the 94 levels (the total number of levels). The MRI and bone scan showed significant correlation (p < 0.001). There was a statistically significant difference in the incidence of pain at the one month outpatient follow up between the two groups (p = 0.0215). The radiologist should comment on the presence or absence of adjacent rib involvement when reporting on the thoracic spine MRI of patients suffering from osteoporotic compression fractures in order to more accurately determine prognosis

  20. The clinical significance of adjacent rib involvement on MRI in patients with acute osteoporotic compression fractures of the thoracic spine

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Joo; Kim, Jae Hyun; Kwon, Kui Hyang; Choi, Deuk Lin; Goo, Dong Erk; Suh, You Sung [Soonchunhyang Univ. Seoul Hospital/Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of); Bae, Won Kyung [Soonchunhyang Univ. Cheonan Hospital/Soonchunhyang Univ. College of Medicine, Cheonan (Korea, Republic of)

    2012-05-15

    The purpose of this study was to evaluate the significance of the presence of adjacent rib involvement in osteoporotic compression fractures. All the patients with acute osteoporotic compression fractures of the thoracic spine on thoracic spine MRI that presented to our clinic between September 2003 and January 2010 were retrospectively reviewed. All the vertebrae were divided into two groups: those that showed signal intensity change in the rib adjacent to the compression fracture and those that did not. We compared the results between the two groups to determine if there were differences in the degree of osteoporosis, the compression fracture level and the age of patients between the two groups. We calculated the degree of correlation between the MRI and the bone scan images of these patients. We also reviewed whether percutaneous vertebroplasty relieved symptoms or not. Signal intensity changes were found in the adjacent rib(s) in 12 of the 60 patients and in 14 of the 94 levels (the total number of levels). The MRI and bone scan showed significant correlation (p < 0.001). There was a statistically significant difference in the incidence of pain at the one month outpatient follow up between the two groups (p = 0.0215). The radiologist should comment on the presence or absence of adjacent rib involvement when reporting on the thoracic spine MRI of patients suffering from osteoporotic compression fractures in order to more accurately determine prognosis.

  1. Osteoporosis influences the middle and late periods of fracture healing in a rat osteoporotic model

    Institute of Scientific and Technical Information of China (English)

    WANG Jian-wei; LI Wei; XU Shao-wen; YANG Di-sheng; WANG Yun; LIN Min; ZHAO Guang-feng

    2005-01-01

    Objective: To evaluate the influence of osteoporosis on the middle and late periods of fracture healing process through observing the histomorphological changes, bone mineral density and biomechanical properties in ovariectomized rats. Methods: Eighty-four female SD rats of 4 months old were randomly divided into osteoporosis group and sham operation group, 42 in each. Rats in osteoporosis group were performed ovariectomy operation while those in sham operation group were given sham operation. A midshaft tibia fracture model was established 10 weeks after ovariectomy. Tibias were harvested 2, 4, 6, 12, 18 weeks after fracture for bone mineral density, histomorphological and biomechanical evaluation. Results: Compared with the sham operation group, callus bone mineral density was 12.8%, 18.0%, 17.0% lower in osteoporosis group 6, 12, 18 weeks after fracture, respectively (P<0.05); callus failure load was 24.3%, 31.5%, 26.6%, 28.8% lower in osteoporosis group, and callus failure stress was 23.9%, 33.6%, 19.1%, 24.9% lower in osteoporosis group 4, 6, 12, 18 weeks after fracture, respectively (P<0.05). In osteoporosis group, endochondral bone formation was delayed, more osteoclast cells could be seen around the trabecula, and the new bone trabecula arranged loosely and irregularly. Conclusions: Osteoporosis influences the middle and late periods of fracture healing in the rat osteoporotic model. The impairment is considered to be the result of combined effects of prolonged endochondral calcification, high activated osteoclast cell and the deceleration of the increase in bone mineral density.

  2. Osteoporotic compression fracture of the thoracolumbar spine and sacral insufficiency fracture: incidence and analysis of the relationship according to the clinical factors

    International Nuclear Information System (INIS)

    Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam

    2006-01-01

    To evaluate the incidence of sacral insufficiency fracture in osteoporotic patient with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference (ρ = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference (ρ = 0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. About 10% of the patients with osteoporotic compression fracture in the T/L spine also had pelvic sacral

  3. Effect of Wearing Style on Vitamin D and Bone Mineral Density in Postmenopausal Osteoporotic Women

    Directory of Open Access Journals (Sweden)

    Yeşim Gökçe Kutsal

    2011-12-01

    Full Text Available Aim: Vitamin D deficiency is one of the most important public health problems as a result of osteomalacia, osteoporosis, muscle pain disease, muscle weakness and increased risk of falls and fracture. Outfitting style effects the synthesis and blood levels of vitamin D. The aim of our study is to investigate the effect of outfitting style on blood vitamin D and bone mineral density in postmenopausal osteoporotic women. Materials and Methods: Fifty-five female patients who were diagnosed with osteoporosis were included in our study. These women were divided into two groups according to their clothing habits as veiled and unveiled. Data of all patients about menopause, exposure to sun light, dual energy x-ray absorptiometry results, blood calcium, phosphate, parathyroid hormone, 25-hydroxyvitamin D levels and osteoporosis treatment were recorded. Results: We found 25-hydroxyvitamin D level was significantly low in women with veiled dressing style (17,0±7,9 ng/ml in veiled and 33.9±22.0 ng/ml in unveiled patients, p<0.001. There was statistically significant correlations between 25-hydroxyvitamin D level and femur neck Z-scores, femur total bone mineral density, femur total T-score L1-L4 bone mineral density, femur neck bone mineral density for different seasons (p<0.05. Conclusion: Postmenopausal osteoporotic veiled women are more prone to vitamin D deficiency than unveiled women. Low concentration of 25-hydroxyvitamin D is accompanying further decrease in bone mineral density. Despite low concentration of 25-hydroxyvitamin D in veiled postmenopausal osteoporotic women, there is not direct correlation between wearing style and bone mineral density. (Turkish Journal of Osteoporosis 2011;17:85-8

  4. Differences in bone mineral density between mildly and definitively osteoporotic women

    International Nuclear Information System (INIS)

    Heuck, A.F.; Steiger, P.; Block, J.E.; Glueer, C.C.; Steiger, S.; Genant, H.K.

    1988-01-01

    The authors studied 68 postmenopausal women to determine the ability of three bone densitometry techniques (QCT and DPA of the spine and SPA of the radius) for discriminating patients with mild wedge deformities (20%-25% wedge) from definitive compression fractures (≥25% wedge or crush fracture). Decrements of bone density between mildly osteoporotic women and osteoporotic women were -20% (P<.001) for QCT, -11% (P<.01) for DPA, and -5.5% (not significant) for SPA. Z-scores were -0.7 (P<.001) for QCT, -0.6 (P<.01) for DPA, and -0.4 (not significant) for SPA. The group was divided into quartiles of bone density with odds ratios calculated and the highest quartile acting as the reference group (risk=1). Odds ratios for the lower quartiles were 2.3, 5.3, and 10.7 for QCT; 0.4, 2.9, and 3.7 for DPA; and 0.7, 0.7, and 2.7 for SPA, respectively. Only the odds ratio for the lowest quartile of QCT (10.7) was found to be significant (P<.01). Receiver operating characteristic curves were calculated for each modality, with QCT showing the greatest area under the curve (0.70), followed by DPA (0.67) and SPA (0.60). The authors' results show that QCT and DPA are sensitive in discriminating mild from advanced forms of osteoporosis, whereas SPA has limited discriminatory capability

  5. The epidemiology of wrist fractures in older men: the Osteoporotic Fractures in Men (MrOS) study.

    Science.gov (United States)

    Wright, N C; Hooker, E R; Nielson, C M; Ensrud, K E; Harrison, S L; Orwoll, E S; Barrett-Connor, E

    2018-04-01

    There is limited wrist fracture information on men. Our goal was to calculate frequency and identify risk factors for wrist fracture in the Osteoporotic Fractures in Men (MrOS) study. We confirmed that fracture history and certain medications are predictors, and identified novel predictors including markers of kidney function and physical performance. To calculate the incidence of wrist fractures and their risk factors in older community-dwelling men from the US Osteoporotic Fractures in Men (MrOS) study. Using triannual postcards, we identified incident wrist fractures (centrally confirmed by radiology) in men aged ≥ 65. Potential risk factors included the following: demographics, lifestyle, bone mineral density (BMD), selected medications, biomarkers, and physical function and performance measures. Both baseline and time-varying models were adjusted for age, race/ethnicity, MrOS geographic location, and competing mortality risks. We observed 97 incident wrist fractures among 5875 men followed for an average of 10.8 years. The incidence of wrist fracture was 1.6 per 1000 person-years overall and ranged from 1.0 among men aged 65-69 to 2.4 among men age ≥ 80. Significant predictors included the following: fracture history after age 50 [hazard ratio (95% CI): 2.48 (1.65, 3.73)], high serum phosphate [1.25 (1.02, 1.53)], use of selective serotonin receptor inhibitor (SSRI) [3.60 (1.96, 6.63), decreased right arm BMD [0.49 (0.37, 0.65) per SD increase], and inability to perform the grip strength test [3.38 (1.24, 9.25)]. We did not find associations with factors commonly associated with wrist and other osteoporosis fractures like falls, diabetes, calcium and vitamin D intake, and alcohol intake. Among these older, community-dwelling men, we confirmed that fracture history is a strong predictor of wrist fractures in men. Medications such as SSRIs and corticosteroids also play a role in wrist fracture risk. We identified novel risk factors including kidney

  6. AN EPIDEMIOLOGICAL SURVEY OF OSTEOPOROTIC FRACTURES IN OLDER RESIDENTS FROM THE MIDDLE URALS

    Directory of Open Access Journals (Sweden)

    E. N. Gladkova

    2014-01-01

    Full Text Available The epidemiological characteristics of osteoporotic fractures in Russia have been inadequately studied.Objective: to estimate the incidence rate of osteoporotic fractures in the old age groups of an urban population in the Middle Urals.Subjects and methods. The survey was performed in Pervouralsk, a typical industrial town in the Middle Urals, with a total of 160,860 people, including 54,189 dwellers over 50 years of age (20,746 men and 33,443 women, which amounted to 33.7% of the general population of the town. The survey covered its residents aged 50 years and over who had fractures of the proximal hip (FPH, distal forearm (FDF, distal shin, ribs, or surgical neck of the humerusbetween 1 January 2008 and 31 December 2009. Statistical analysis was made applying the programs Biostatistics, Microsoft Excell 2007, and MedCalc (demo-version. The findings were processed using parametric and nonparametric statistical methods.Results. During two years, 1371 fractures, including FPH, FDF, fractures of the humerus, distal shin, and ribs, were registered in the examined sample of persons aged 50 years and over from Pervouralsk. 383 (27.9% of these fractures occurred in men and 988 (72.1% in women. The incidence rate of all fractures was 1265.0 per 100,000 inhabitants aged 50 years and over (1,477.1 for women and 923.1 for men. FDF were more common in women, the incidence was 787.9 cases per 100,000 population; costal fractures – in men (386.7 per 100,000. The investigation has shown that certain types of fractures are predominant in the oldest age groups. Thus, the incidence rate of FDF and fractures of the distal shin decreases while that of FPH and fractures of the humerus increaseswith age, which is likely to be due to several causes: an age-related decline in bone mass; an increase in the frequency of falls with age; muscle weakness and movement discoordination, which alter the mechanism of fall and increase the risk of femoral and

  7. Physical activity and osteoporotic fractures in postmenopausal women with osteoporosis in Serbia

    Directory of Open Access Journals (Sweden)

    Karadzov-Nikolic Aleksandra

    2012-03-01

    Full Text Available Introduction: Physical activity in postmenopausal women can slow bone loss and reduce the risk of osteoporotic fractures. Purpose: Analysis of the incidence of fractures in postmenopausal women with osteoporosis in relation to physical activity. Methods: This paper represents a retrospective multicenter study of postmenopausal women with newly found osteoporosis from August 2008 until November 2011. All data concerning the patients were taken from the National Register for Osteoporosis. Patients were divided into two groups: in the first group were physically active and in the second, physically inactive patients. Physical activity included dancing, active or recreational sports, fast walking, running, jumping and lifting. Results: The study included 363 respondents, mean age 64.4 ± 8.6 years, of whom 155 (42.7% were physically active, and 208 (57.3% physically inactive. 86 (23.7% patients had spontaneous single fractures, 23 (14.8% in the physically active group and 63 (30.3% in the physically inactive group, which was statistically significant difference in frequency (p = 0.001. Respondents with multiple spontaneous fractures were separated in a special group and were not included in the above analysis. 21 patients had spontaneous multiple fractures, of whom 4 (2.5% physically active and 17 (7.55% physically inactive, which was statistically significant difference in frequency (p = 0.032. Conclusion: Spontaneous single and multiple fractures are significantly more frequent with physically inactive subjects.

  8. Serum bone alkaline phosphatase and calcaneus bone density predict fractures: a prospective study.

    Science.gov (United States)

    Ross, P D; Kress, B C; Parson, R E; Wasnich, R D; Armour, K A; Mizrahi, I A

    2000-01-01

    The aim of this study was to assess the ability of serum bone-specific alkaline phosphatase (bone ALP), creatinine-corrected urinary collagen crosslinks (CTx) and calcaneus bone mineral density (BMD) to identify postmenopausal women who have an increased risk of osteoporotic fractures. Calcaneus BMD and biochemical markers of bone turnover (serum bone ALP and urinary CTx) were measured in 512 community-dwelling postmenopausal women (mean age at baseline 69 years) participating in the Hawaii Osteoporosis Study. New spine and nonspine fractures subsequent to the BMD and biochemical bone markers measurements were recorded over an average of 2.7 years. Lateral spinal radiographs were used to identify spine fractures. Nonspine fractures were identified by self-report at the time of each examination. During the 2.7-year follow-up, at least one osteoporotic fracture occurred in 55 (10.7%) of the 512 women. Mean baseline serum bone ALP and urinary CTx were significantly higher among women who experienced an osteoporotic fracture compared with those women who did not fracture. In separate age-adjusted logistic regression models, serum bone ALP, urinary CTx and calcaneus BMD were each significantly associated with new fractures (odds ratios of 1.53, 1.54 and 1.61 per SD, respectively). Multiple variable logistic regression analysis identified BMD and serum bone ALP as significant predictors of fracture (p = 0.002 and 0.017, respectively). The results from this investigation indicate that increased bone turnover is significantly associated with an increased risk of osteoporotic fracture in postmenopausal women. This association is similar in magnitude and independent of that observed for BMD.

  9. Fractures (Broken Bones): First Aid

    Science.gov (United States)

    First aid Fractures (broken bones) Fractures (broken bones): First aid By Mayo Clinic Staff A fracture is a ... 10, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-fractures/basics/ART-20056641 . Mayo Clinic ...

  10. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures.

    Science.gov (United States)

    Sabo, Alex; Hatgis, Jesse; Granville, Michelle; Jacobson, Robert E

    2017-12-19

    Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6 o to 50 o . It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the

  11. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation

    Directory of Open Access Journals (Sweden)

    Yoshihiro Onada

    2016-01-01

    Full Text Available Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP, and typically present with ipsilateral acromioclavicular joint (ACJ dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia.

  12. [Osteoporosis in all young daughters of a mother with multiple osteoporotic fractures. A case of familial osteoporosis].

    Science.gov (United States)

    Parisi, M S; Díaz, A G; Oliveri, M B; Di Gregorio, S; Mautalen, C A

    2001-01-01

    We herein describe a family whose female members are all osteoporotic: a postmenopausal mother and her three premenopausal daughters. The mother aged 60 presented axial and peripheral fractures, and very low bone mineral density (BMD). She reported that her grandmother had suffered a hip fracture. The eldest daughter aged 30 suffered multiple vertebral fractures during pregnancy and lactation associated with very low BMD. In view of these observations, the other two daughters aged 29 and 27 years respectively were evaluated. BMD was found to be severely diminished according to densitometric values for osteoporosis established by WHO, but they had no history of bone fractures. Probably the strong genetic component in bone mass is responsible for the severely diminished BMD observed in all the women in this family, as well as the occurrence of bone fractures in two of them. To our knowledge, there are no similar reports in the literature. Our results evidence the importance of evaluating bone mass in the offspring of an individual presenting severe osteoporosis, in order to detect family members with low bone mass and at high risk of developing bone fractures.

  13. Study on bone mineral density and bone structure of lumbar vertebrae in osteoporotic elderly women with multi-slice CT

    International Nuclear Information System (INIS)

    Wu Shengyong; Qi Ji; Wang Bin; Wen Lianqing

    2005-01-01

    Objective: To evaluate the ability of volumetric bone mineral density (BMD) parameters of lumbar vertebrae in differentiating osteoporotic fractured from nonfractured elderly women with vQCT technique, and to compare the bony structural conditions of osteoporotic elderly women with healthy elderly women. Methods: Multi-slice CT spinal scans of L1 and L2 were acquired in 26 osteoporotic vertebral fractured elderly women (group one) and 30 nonfractured osteoporotic subjects (group two). All the retro-reconstructed images of L1 and L2 were sent to the workstation and processed by volume rendering (VR) technique to measure volumetric BMD (3D-INTGL, 3D-CORT, 3D-TRAB) and trabecular and integral BMD (2D-TRAB, 2D-INTGL) by conventional QCT technique. BMD indexes in DXA were AP-SPINE and bone mineral apparent density (BMAD) in anteroposterior position. The seven parameters between the two group s were compared. Ten healthy elderly women were selected as normal group to reformate 3D-VR images from MSCT images to analyze the bony structure and calculate the ratio of bone volume to total volume (BV/TV) in the center of L1 vertebrae, and to compare the index between the normal group and tenpatients randomly selected from the 56 osteoporotic women. Results: DXA measurements in group one: AP-SPINE and BMAD were (0.796±0.170)g/cm 2 and (272.7±27.7) mg/cm 3 , respectively, showing no statistically significant differences comparing with (0.817±0.140) g/cm 2 and (249.5 ± 26.5) mg/cm 3 in group two. Volumetric BMD in group one included 2D-TRAB (70.4 ± 22.2) mg/cm 3 , 2D-INTGL (138.3±35.1) mg/cm 3 , 3D-INTGL (139.4±34.9 ) mg/cm 3 , 3D-CORT (133.8±26.9) mg/cm 3 , and 3D-TRAB (69.9 ±18.6) mg/cm 3 , respectively, showing statistically differences with (89.1±21.8) mg/cm 3 , (170.6±34.5) mg/cm 3 , (180.5±28.2) mg/cm 3 , (163.2±27.5) mg/cm 3 , and (83.8 ± 17.1) mg/cm 3 in group two (the decrements 18%-23%). The mean value of BV/TV of L1 vertebrae was (8.12 ± 1.96)% in

  14. Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

    Directory of Open Access Journals (Sweden)

    Ioannis D. Papanastassiou

    2014-01-01

    Full Text Available Kyphoplasty (KP and vertebroplasty (VP have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures, cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration, and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV will provide the missing link.

  15. Correlation between preprocedural MRI findings and the clinical effects of percutaneous vertebroplasty in osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Shi Li'na; Wu Chungen; Li Wenbin; Mao Aiwu; Gu Yifeng; Zhang Peilei; Wang Jue; Cheng Yongde

    2011-01-01

    Objective: to analyze the signal characteristics of preprocedural MRI, to compare the pre-and-post procedural clinical outcomes and to discuss the relationship between preprocedural MRI findings and postprocedural clinical effect of percutaneous vertebroplasty (PVP) therapy in patients with osteoporotic vertebral compression fractures. Methods: PVP procedures were carried out in a total of 52 consecutive patients with 116 compression fractures. The clinical data and the imaging materials were retrospective analyzed. According to the degree and extent of marrow edema demonstrated on sagittal MRI, the patients were divided into three groups: group A, having partial bone marrow edema; group B, showing complete bone marrow edema;and group C having no bone marrow edema. By using independent-samples t-test and paired-samples t-test, the preprocedural and postprocedural pain degree and movement dysfunction severity, which were assessed by means of visual analog scale (VAS) and Oswestry disability index(ODI) respectively, were compared between three groups. The occurrence of complications was observed. Results: After PVP, all patients showed significant relief of pain and obvious improvement of daily activity function (P 0.05). Conclusion: PVP is an effective treatment for osteoporotic vertebral compression fractures with or without bone marrow edema. MRI signal characteristics can predict the therapeutic effect of PVP to a certain degree. And the more extensive the bone marrow edema pattern is, the greater pain relief will be expected. (authors)

  16. Long-term outcomes of vertebroplasty for osteoporotic compression fractures

    International Nuclear Information System (INIS)

    Thillainadesan, G.; Schlaphoff, G.; Gibson, K.A.; Hassett, G.M.; McNeil, H.P.

    2010-01-01

    This study aimed to determine outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fractures (VCFs). Prospective assessment of short-term (≤6 weeks), medium-term (6 months) and long-term (29 months) outcomes of vertebroplasty, followed by a retrospective long-term follow-up of patients treated with vertebroplasty compared with conservative therapy. Outcomes measured were visual analogue scale pain scores, analgesic use, disability scores using the Roland Morris Disability questionnaire and a number of new VCFs. In 27 patients with acute VCFs followed prospectively, vertebroplasty resulted in significant reductions in pain levels (56-mm reduction on a 100-mm scale) and disability scores (11.8-point reduction on a 24-point scale) at all follow-up points up to a mean of 29 months compared with pre-vertebroplasty levels (P < 0.001). Analgesic use was significantly less intense in the short and medium term after vertebroplasty (P < 0.005). In 25 patients who had vertebroplasty for VCF, a sustained reduction in all outcomes was demonstrated at a mean follow-up of 30 months, with less pain, significantly lower disability scores (P < 0.05) and less analgesic use (P < 0.05) compared with nine conservatively treated subjects. During the follow-up period, six new VCFs occurred in 4/25 vertebroplasty patients compared with four new VCFs in 2/9 control subjects. Vertebroplasty provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term. Compared with conservative therapy, vertebroplasty provides significantly greater functional improvement and reduction in analgesic use. The procedure is relatively safe with no clearly increased risk of new vertebral fractures.

  17. Percutaneous Stabilization System Osseofix® for Treatment of Osteoporotic Vertebral Compression Fractures - Clinical and Radiological Results after 12 Months.

    Directory of Open Access Journals (Sweden)

    Stephan Albrecht Ender

    Full Text Available A prospective consecutive cohort study (follow-up study.Our study investigated whether implantation of an expandable titanium mesh cage (Osseofix® is a successful and safe minimally invasive therapy for osteoporotic vertebral compression fractures (VCF. Our experiences, clinical and radiological findings after 12 months follow-up are presented. Kypho- and vertebroplasty are well-established minimally invasive procedures for the treatment of osteoporotic VCF. The main complications associated with both procedures are uncontrolled bone cement leakage. Therefore a suitable alternative has been investigated.During June 2010 to May 2011 24 patients were included with 32 osteoporotic VCF (T6 to L4. All of them were stabilized with the Osseofix® system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA. Clinical and radiological results were evaluated preop., postop. and after 12 months postop. based on the Oswestry Disability Index (ODI and the Visual Analogue Scale (VAS, X-ray (Beck Index, Cobb-angle and CT.There was a significant improvement in the mean ODI (70,6% to 30,1% as well as a significant reduction in pain intensity (VAS (7,7 to 1,4 after 12 month. The mean kyphotic angle according to Cobb showed significant improvements (11,7° to 10,4° after 12 months. Postinterventional imaging showed only one case of loss of height in a stabilized vertebral body (3.1%. We saw no changes in posterior vertebral wall or adjacent fractures. Except for one pronounced postoperative hematoma we saw no surgical complications including no cement leakage.Stabilization of symptomatic osteoporotic VCF with Osseofix® system is a safe and effective procedure, even in fractures with posterior wall involvement. The clinical mid-term results are good at a very low complication rate. The Osseofix® system is an interesting alternative to the established procedures of cement augmentation.

  18. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

    Science.gov (United States)

    Gupta, Rakesh Kumar; Gupta, Vinay; Gupta, Navdeep

    2012-01-01

    Background: Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA) has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients) with an average age of 72 years (60 – 94 years) of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31), good (score 24 – 31), fair (score 16 – 23), and poor (score < 16). Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 – 16 weeks). At an average followup of 18 months (range 12 – 24 months), no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN) or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears to be an

  19. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Gupta

    2012-01-01

    Full Text Available Background: Dynamic hip screw (DHS has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients with an average age of 72 years (60 − 94 years of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31, good (score 24 − 31, fair (score 16 − 23, and poor (score < 16. Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 − 16 weeks. At an average followup of 18 months (range 12 − 24 months, no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears

  20. Cemented Hemiarthroplasty in Elderly Osteoporotic Unstable Trochanteric Fractures using Fracture Window

    Directory of Open Access Journals (Sweden)

    Thakur A

    2016-03-01

    Full Text Available Introduction: We would like to analyze the role of cemented hemiarthroplasty in elderly osteoporotic unstable intertrochanteric fractures through trochanteric fracture window. Materials and Methods: The study was conducted from July 2011 to July 2014. From a total of 265 consecutive patients with intertrochanteric fractures of 42 patients were selected according to inclusion criteria and results were analyzed prospectively. All patients were operated at tertiary care institute. Patients which matched the inclusion criteria were selected. 42 patients entered the study and all completed the study. Primary cemented hemiarthroplasty was done in all patients. Modified Harris Hip Score was used to assess all the patients. Results: 42 patients were included in the study with an average age of 80.7 years. Only AO/OTA type 31-A2.2 and 31-A2.3 were included, average HHS at final follow up of three years was 86.2. No revision or reoperation was done. Conclusion: In a selected cohort of patients primary prosthetic replacement in elderly osteoporotic unstable intertrochanteric fractures is good option and the surgical technique allowed us to perform it more easily.

  1. Cost of osteoporotic hip fracture in Spain per Autonomous Region.

    Science.gov (United States)

    Bartra, A; Caeiro, J-R; Mesa-Ramos, M; Etxebarría-Foronda, I; Montejo, J; Carpintero, P; Sorio-Vilela, F; Gatell, S; Canals, L

    2018-05-21

    We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Association of osteoporotic fracture with smoking, alcohol consumption, tea consumption and exercise among Chinese nonagenarians/centenarians.

    Science.gov (United States)

    Du, F; Birong, D; Changquan, H; Hongmei, W; Yanling, Z; Wen, Z; Li, L

    2011-05-01

    To observe the association of osteoporotic fracture with habits of smoking, alcohol consumption, tea consumption and exercise among very old people. A cross-sectional study conducted in Dujiangyan Sichuan China. 703 unrelated Chinese nonagenarians and centenarians (67.76% women, mean age 93.48 years) resident in Dujiangyan. Medical history of osteoporosis and the statement of fracture and habits (current and former) of smoking, alcohol consumption, tea consumption and exercise were collected. In women, subjects with current or former habit of alcohol consumption had significantly higher prevalence osteoporotic fracture than those without this habit; but subjects with former habit of exercise had significantly lower prevalence osteoporotic fracture than those without this habit. However, in men, there was no significant difference in prevalence of these habits between subjects with and without osteoporotic fracture. After adjust for age, gender, sleep habits educational levels, religion habits and temperament, we found that former habit of alcohol consumption had a significant odds ratio (OR=2.473 95% CI (1.074, 5.526)) for osteoporotic fracture. In summary, among nonagenarians and centenarians, among habits (current and former) of smoking, alcohol consumption, tea consumption and exercise, there seems to be significant association of osteoporotic fracture only with current or former habits of alcohol consumption, former habit of exercise. The habit of alcohol consumption might be associated with a greater risk of osteoporotic fracture, but the former habit of exercise might be associated with a lower risk of osteoporotic fracture.

  3. Massive Intrapelvic Hematoma after a Pubic Ramus Fracture in an Osteoporotic Patient

    Energy Technology Data Exchange (ETDEWEB)

    Haruki, Funao, E-mail: hfunao@yahoo.co.jp; Takahiro, Koyanagi [Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013 (Japan)

    2016-03-24

    An 88-year-old female presented with a left thigh pain and dysuria. She visited our hospital 2 week after she noticed her symptoms. She stated that she might have a low-energy fall, but she could not identify the exact onset. Her radiograph of the pelvis (Figure 1) showed displaced left pubic ramus fracture. Her computed tomographic scanning of the pelvis (Figure 2) showed massive intrapelvic hematoma (axial size, 11 cm by 5 cm) around the fracture site, although she did not use any anticoagulants. Because her bone mineral density was 0.357 g/cm{sup 2}, and T score was -4.8 SD, she started a bisphosphonate therapy. She received a bed-rest physical therapy for 6 weeks, and the hematoma regressed spontaneously. She started full weight bearing after 6 weeks, and walked by a walker after 8 weeks. Although it is extremely rare to develop massive chronic intra-pelvic hematoma after a lowenergy pubic ramus fracture without any use of anticoagulants, it may occur in elderly and severely osteoporotic patient.

  4. Thiazides and Osteoporotic Spinal Fractures: A Suspected Linkage Investigated by Means of a Two-Center, Case-Control Study.

    Science.gov (United States)

    De Vecchis, Renato; Ariano, Carmelina; Di Biase, Giuseppina; Noutsias, Michel

    2017-11-01

    An alleged association of chronic use of thiazide diuretics with an increased risk of bone fragility fractures has been highlighted by a relatively recent prospective cohort study. However, the concept that thiazides exert a beneficial effect on osteoporosis is still a predominant view. This effect would be mediated by the decrease in renal clearance of calcium ions, a pharmacological feature recognized for a long time now to this class of drugs, as opposed to the increase in calcium urinary excretion attributed instead to loop diuretics, i.e. furosemide and similar drugs. The purpose of this retrospective study was to attempt to clarify whether regular use of thiazide diuretics as antihypertensive therapeutics is associated with a significantly increased risk of osteoporotic fractures in female patients aged 65 or over. In this two-center retrospective study, we followed up a cohort of female patients with (n = 80) and without (n = 158) thiazide-induced hyponatremia. A total of 48 osteoporotic fractures were recorded during a median follow-up period of 57.5 months. By means of univariate regression analysis, an association was found between thiazide-induced hyponatremia and increased risk of vertebral fractures (odds ratio (OR): 7.6; 95% confidence interval (CI): 3.755 - 15.39; P fractures. No association of a history of thiazide-induced hyponatremia and risk of fracture was noticeable in the final model. Because thiazide-induced hyponatremia was associated with spinal fractures in univariate but not multivariate analysis, a possible explanation is that hyponatremia may be a confounder of the relation between body mass and spinal fractures. Indeed, reduced body mass especially among elderly women with small body build may confer heightened risk of thiazide-induced hyponatremia because of decreased bone sodium available for exchange with the serum sodium. Thus, occurrence of hyponatremia could only serve as an indirect surrogate marker for osteoporosis risk.

  5. [Analysis of correlation between trabecular microstructure and clinical imaging parameters in fracture region of osteoporotic hip].

    Science.gov (United States)

    Peng, Jing; Zhou, Yong; Min, Li; Zhang, Wenli; Luo, Yi; Zhang, Xuelei; Zou, Chang; Shi, Rui; Tu, Chongqi

    2014-05-01

    To analyze the correlation between the trabecular microstructure and the clinical imaging parameters in the fracture region of osteoporotic hip so as to provide a simple method to evaluate the trabecular microstructure by a non-invasive way. Between June 2012 and January 2013, 16 elderly patients with femoral neck fracture underwent hip arthroplasty were selected as the trial group; 5 young patients with pelvic fracture were selected as the control group. The hip CT examination was done, and cancellous bone volume/marrow cavity volume (CV/MV) was analyzed with Mimics 10.01 software in the control group. The CT scan and bone mineral density (BMD) measurement were performed on normal hips of the trial group, and cuboid specimens were gained from the femoral necks at the place of the tensional trabeculae to evaluate the trabecular microstructure parameters by Micro-CT, including bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular spacing (Tb.Sp), trabecular thickness (Tb.Th), connect density (Conn.D), and structure model index (SMI). The correlation between imaging parameters and microstructure parameters was analyzed. In the trial group, the BMD value was 0.491-0.698 g/cm2 (mean, 0.601 g/cm2); according to World Health Organization (WHO) standard, 10 cases were diagnosed as having osteoporosis, and 6 cases as having osteopenia. The CV/MV of the trial group (0.670 1 +/- 0.102 0) was significantly lower than that of the control group (0.885 0 +/- 0.089 1) (t = -4.567, P = 0.000). In the trial group, CV/MV had correlation with BV/TV, Tb.Th, and SMI (P 0.05). BV/TV had correlation with Tb.Th, Tb.N, Tb.Sp, and SMI (P microstructure parameters (P > 0.05). CV/MV obviously decreases in the osteoporotic hip, and there is a correlation between CV/MV and the microstructure parameters of BV/TV, Tb.Th, and SMI, to some extent, which can reflect the variety of the microstructure of the trabeculae. There is no correlation between BMD of femoral neck and

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

    International Nuclear Information System (INIS)

    Lentle, B.C.; Brown, J.P.; Khan, A.

    2007-01-01

    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 fractures

  7. Correlation between Parameters of Calcaneal Quantitative Ultrasound and Hip Structural Analysis in Osteoporotic Fracture Patients.

    Directory of Open Access Journals (Sweden)

    Licheng Zhang

    Full Text Available Calcaneal quantitative ultrasound (QUS, which is used in the evaluation of osteoporosis, is believed to be intimately associated with the characteristics of the proximal femur. However, the specific associations of calcaneal QUS with characteristics of the hip sub-regions remain unclear.A cross-sectional assessment of 53 osteoporotic patients was performed for the skeletal status of the heel and hip.We prospectively enrolled 53 female osteoporotic patients with femoral fractures. Calcaneal QUS, dual energy X-ray absorptiometry (DXA, and hip structural analysis (HSA were performed for each patient. Femoral heads were obtained during the surgery, and principal compressive trabeculae (PCT were extracted by a three-dimensional printing technique-assisted method. Pearson's correlation between QUS measurement with DXA, HSA-derived parameters and Young's modulus were calculated in order to evaluate the specific association of QUS with the parameters for the hip sub-regions, including the femoral neck, trochanteric and Ward's areas, and the femoral shaft, respectively.Significant correlations were found between estimated BMD (Est.BMD and BMD of different sub-regions of proximal femur. However, the correlation coefficient of trochanteric area (r = 0.356, p = 0.009 was higher than that of the neck area (r = 0.297, p = 0.031 and total proximal femur (r = 0.291, p = 0.034. Furthermore, the quantitative ultrasound index (QUI was significantly correlated with the HSA-derived parameters of the trochanteric area (r value: 0.315-0.356, all p<0.05 as well as with the Young's modulus of PCT from the femoral head (r = 0.589, p<0.001.The calcaneal bone had an intimate association with the trochanteric cancellous bone. To a certain extent, the parameters of the calcaneal QUS can reflect the characteristics of the trochanteric area of the proximal hip, although not specifically reflective of those of the femoral neck or shaft.

  8. Injuries of the trochanteric region: can analysis of radiographic indices help in prediction of recurrent osteoporotic hip fractures?

    Science.gov (United States)

    Pellegrini, Andrea; Tacci, Fabrizio; Leigheb, Massimiliano; Costantino, Cosimo; Pedrazzini, Alessio; Pedrazzi, Giuseppe; Vaienti, Enrico; Ceccarelli, Francesco; Pogliacomi, Francesco

    2017-10-18

    In a context of bone fragility, primitive and subsequent fractures are a growing problem in the industrialized countries where the mean age of the population is constantly increasing. Among the various factors that favor a fragility fracture, the most important is osteoporosis, a pathology that can be prevented through diagnostic screenings and treated by pharmacological and rehabilitative therapies. The aim of this study is to identify the subjects who are likely to have a higher risk of subsequent fractures of the trochanteric region through a retrospective radiographic evaluation of patients affected by low-energy trochanteric fractures and operated by intramedullary fixation between June 2013 and June 2015, so they can be targeted for prevention interventions. Three hundred and sixty-one patients yet alive were analyzed 2 years after surgery. Fifty-one (group 1), characterized by another contralateral trochanteric femoral fracture, were included. All subjects were retrospectively examined with the analysis of contralateral femur X-ray performed at the time of initial trauma in order to detect a condition of bone fragility and a predisposition to fractures by evaluating three radiographic indices (Singh index, Dorr's classification and Cortical Thickness Index). Patients of group 1 were compared to the other 310 patients (group 2) affected by isolated trochanteric fracture. Group 1 had all radiographic indices worse than group 2. The results observed suggest that orthopedists can use radiographic indices, in particular Cortical Thickness Index, as a valuable, simple and inexpensive screening tool for prevention of recurrent osteoporotic fractures.

  9. Internal Medicine Hospitalists' Perceived Barriers and Recommendations for Optimizing Secondary Prevention of Osteoporotic Hip Fractures.

    Science.gov (United States)

    Tan, Eng Keong; Loh, Kah Poh; Goff, Sarah L

    2017-12-01

    Osteoporosis is a major public health concern affecting an estimated 10 million people in the United States. To the best of our knowledge, no qualitative study has explored barriers perceived by medicine hospitalists to secondary prevention of osteoporotic hip fractures. We aimed to describe these perceived barriers and recommendations regarding how to optimize secondary prevention of osteoporotic hip fracture. In-depth, semistructured interviews were performed with 15 internal medicine hospitalists in a tertiary-care referral medical center. The interviews were analyzed with directed content analysis. Internal medicine hospitalists consider secondary osteoporotic hip fracture prevention as the responsibility of outpatient physicians. Identified barriers were stratified based on themes including physicians' perception, patients' characteristics, risks and benefits of osteoporosis treatment, healthcare delivery system, and patient care transition from the inpatient to the outpatient setting. Some of the recommendations include building an integrated system that involves a multidisciplinary team such as the fracture liaison service, initiating a change to the hospital policy to facilitate inpatient care and management of osteoporosis, and creating a smooth patient care transition to the outpatient setting. Our study highlighted how internal medicine hospitalists perceive their role in the secondary prevention of osteoporotic hip fractures and what they perceive as barriers to initiating preventive measures in the hospital. Inconsistency in patient care transition and the fragmented nature of the existing healthcare system were identified as major barriers. A fracture liaison service could remove some of these barriers.

  10. Cost-effectiveness of Pharmaceutical Interventions to Prevent Osteoporotic Fractures in Postmenopausal Women with Osteopenia

    OpenAIRE

    Kwon, Jin-Won; Park, Hae-Young; Kim, Ye Jee; Moon, Seong-Hwan; Kang, Hye-Young

    2016-01-01

    Background To assess the cost-effectiveness of drug therapy to prevent osteoporotic fractures in postmenopausal women with osteopenia in Korea. Methods A Markov cohort simulation was conducted for lifetime with a hypothetical cohort of postmenopausal women with osteopenia and without prior fractures. They were assumed to receive calcium/vitamin D supplements only or drug therapy (i.e., raloxifene or risedronate) along with calcium/vitamin D for 5 years. The Markov model includes fracture-spec...

  11. Current concepts of percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: Evidence-based review

    Directory of Open Access Journals (Sweden)

    Ming-Kai Hsieh

    2013-08-01

    Full Text Available Vertebral compression fractures constitute a major health care problem, not only because of their high incidence but also due to both direct and indirect consequences on health-related quality of life and health care expenditures. The mainstay of management for symptomatic vertebral compression fractures is targeted medical therapy, including analgesics, bed rest, external fixation, and rehabilitation. However, anti-inflammatory drugs and certain types of analgesics can be poorly tolerated by elderly patients, and surgical fixation often fails due to the poor quality of osteoporotic bone. Balloon kyphoplasty and vertebroplasty are two minimally invasive percutaneous surgical approaches that have recently been developed for the management of symptomatic vertebral compression fractures. The purpose of this study was to perform a comprehensive review of the literature and conduct a meta-analysis to compare clinical outcomes of pain relief and function, radiographic outcomes of the restoration of anterior vertebral height and kyphotic angles, and subsequent complications associated with these two techniques.

  12. A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures.

    Science.gov (United States)

    Jenkins, Paul J; Ramaesh, Rishikesan; Pankaj, Pankaj; Patton, James T; Howie, Colin R; Goffin, Jérôme M; Merwe, Andrew van der; Wallace, Robert J; Porter, Daniel E; Simpson, A Hamish

    2013-10-01

    The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head. 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head. The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head. The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.

  13. The Photodynamic Bone Stabilization System: a minimally invasive, percutaneous intramedullary polymeric osteosynthesis for simple and complex long bone fractures

    Directory of Open Access Journals (Sweden)

    Vegt P

    2014-12-01

    Full Text Available Paul Vegt,1 Jeffrey M Muir,2 Jon E Block2 1Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands; 2The Jon Block Group, San Francisco, CA, USA Abstract: The treatment of osteoporotic long bone fractures is difficult due to diminished bone density and compromised biomechanical integrity. The majority of osteoporotic long bone fractures occur in the metaphyseal region, which poses additional problems for surgical repair due to increased intramedullary volume. Treatment with internal fixation using intramedullary nails or plating is associated with poor clinical outcomes in this patient population. Subsequent fractures and complications such as screw pull-out necessitate additional interventions, prolonging recovery and increasing health care costs. The Photodynamic Bone Stabilization System (PBSS is a minimally invasive surgical technique that allows clinicians to repair bone fractures using a light-curable polymer contained within an inflatable balloon catheter, offering a new treatment option for osteoporotic long bone fractures. The unique polymer compound and catheter application provides a customizable solution for long bone fractures that produces internal stability while maintaining bone length, rotational alignment, and postsurgical mobility. The PBSS has been utilized in a case series of 41 fractures in 33 patients suffering osteoporotic long bone fractures. The initial results indicate that the use of the light-cured polymeric rod for this patient population provides excellent fixation and stability in compromised bone, with a superior complication profile. This paper describes the clinical uses, procedural details, indications for use, and the initial clinical findings of the PBSS. Keywords: osteoporosis, long bone fracture, bone density, polymeric rod, orthopaedics, surgery

  14. Lithium chloride enhances bone regeneration and implant osseointegration in osteoporotic conditions.

    Science.gov (United States)

    Jin, Yifan; Xu, Lihua; Hu, Xiaohui; Liao, Shixian; Pathak, Janak L; Liu, Jinsong

    2016-10-06

    Osteoporotic patients have a high risk of dental and orthopedic implant failure. Lithium chloride (LiCl) has been reported to enhance bone formation. However, the role of LiCl in the success rate of dental and orthopedic implants in osteoporotic conditions is still unknown. We investigated whether LiCl enhances implant osseointegration, implant fixation, and bone formation in osteoporotic conditions. Sprague-Dawley female rats (n = 18) were ovariectomized (OVX) to induce osteoporosis, and another nine rats underwent sham surgery. Three months after surgery, titanium implants were implanted in the tibia of the OVX and sham group rats. After implantation, the OVX rats were gavaged with 150 mg/kg/2 days of LiCl (OVX + LiCl group) or saline (OVX group), and sham group rats were gavaged with saline for 3 months. Implant osseointegration and bone formation were analyzed using histology, biomechanical testing, and micro computed tomography (micro-CT). More bone loss was observed in the OVX group compared to the control, and LiCl treatment enhanced bone formation and implant fixation in osteoporotic rats. In the OVX group, bone-implant contact (BIC) was decreased by 81.2 % compared to the sham group. Interestingly, the OVX + LiCl group showed 4.4-fold higher BIC compared to the OVX group. Micro-CT data of tibia from the OVX + LiCl group showed higher bone volume, trabecular thickness, trabecular number, and osseointegration compared to the OVX group. Maximum push-out force and implant-bone interface shear strength were 2.9-fold stronger in the OVX + LiCl group compared to the OVX group. In conclusion, LiCl enhanced implant osseointegration, implant fixation, and bone formation in osteoporotic conditions, suggesting LiCl as a promising therapeutic agent to prevent implant failure and bone loss in osteoporotic conditions.

  15. Residual lifetime and 10 year absolute risks of osteoporotic fractures in Chinese men and women.

    Science.gov (United States)

    Si, Lei; Winzenberg, Tania M; Chen, Mingsheng; Jiang, Qicheng; Palmer, Andrew J

    2015-06-01

    To determine the residual lifetime and 10 year absolute risks of osteoporotic fractures in Chinese men and women. A validated state-transition microsimulation model was used. Microsimulation and probabilistic sensitivity analyses were performed to address the uncertainties in the model. All parameters including fracture incidence rates and mortality rates were retrieved from published literature. Simulated subjects were run through the model until they died to estimate the residual lifetime fracture risks. A 10 year time horizon was used to determine the 10 year fracture risks. We estimated the risk of only the first osteoporotic fracture during the simulation time horizon. The residual lifetime and 10 year risks of having the first osteoporotic (hip, clinical vertebral or wrist) fracture for Chinese women aged 50 years were 40.9% (95% CI: 38.3-44.0%) and 8.2% (95% CI: 6.8-9.3%) respectively. For men, the residual lifetime and 10 year fracture risks were 8.7% (95% CI: 7.5-9.8%) and 1.2% (95% CI: 0.8-1.7%) respectively. The residual lifetime fracture risks declined with age, whilst the 10 year fracture risks increased with age until the short-term mortality risks outstripped the fracture risks. Residual lifetime and 10 year clinical vertebral fracture risks were higher than those of hip and wrist fractures in both sexes. More than one third of the Chinese women and approximately one tenth of the Chinese men aged 50 years are expected to sustain a major osteoporotic fracture in their remaining lifetimes. Due to increased fracture risks and a rapidly ageing population, osteoporosis will present a great challenge to the Chinese healthcare system. While national data was used wherever possible, regional Chinese hip and clinical vertebral fracture incidence rates were used, wrist fracture rates were taken from a Norwegian study and calibrated to the Chinese population. Other fracture sites like tibia, humerus, ribs and pelvis were not included in the analysis, thus these

  16. Percutaneous Vertebroplasty for Osteoporotic Compression Fracture: Multivariate Study of Predictors of New Vertebral Body Fracture

    International Nuclear Information System (INIS)

    Komemushi, Atsushi; Tanigawa, Noboru; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Komemushi, Sadao; Sawada, Satoshi

    2006-01-01

    Purpose. To investigate the risk factors and relative risk of new compression fractures following vertebroplasty. Methods. Initially, we enrolled 104 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 83 of the 104 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. Logistic regression analysis of the data obtained from these 83 patients was used to determine relative risks of recurrent compression fractures, using 13 different factors. Results. We identified 59 new fractures in 30 of the 83 patients: 41 new fractures in vertebrae adjacent to treated vertebrae; and 18 new fractures in vertebrae not adjacent to treated vertebrae. New fractures occurred in vertebrae adjacent to treated vertebrae significantly more frequently than in vertebrae not adjacent to treated vertebrae. Only cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty (odds ratio = 4.633). None of the following covariates were associated with increased risk of new fracture: age, gender, bone mineral density, the number of vertebroplasty procedures, the number of vertebrae treated per procedure, the cumulative number of vertebrae treated, the presence of a single untreated vertebra between treated vertebrae, the presence of multiple untreated vertebrae between treated vertebrae, the amount of bone cement injected per procedure, the cumulative amount of bone cement injected, cement leakage into the soft tissue around the vertebra, and cement leakage into the vein

  17. Ultrasound measurements for the prediction of osteoporotic fractures in elderly people

    NARCIS (Netherlands)

    Pluijm, S.M.F.; Graafmans, W.C.; Bouter, L.M.; Lips, P.T.A.M.

    1999-01-01

    In this prospective study we investigated the predictive value of quantitative ultrasound (QUS) measurements and other potential predictors of osteoporotic fractures in the elderly. During a I-year period, 710 participants (132 men and 578 women), aged 70 years and older (mean age ± SD: 82.8 ± 5.9),

  18. Magnetic Resonance Enhancement Patterns at the Different Ages of Symptomatic Osteoporotic Vertebral Compression Fractures

    Energy Technology Data Exchange (ETDEWEB)

    You, Ja Yeon; Lee, Joon Woo; Kim, Jung Eun; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2013-06-15

    To investigate the magnetic resonance (MR) enhancement patterns of symptomatic osteoporotic vertebral compression fracture (VCF) according to the fracture age, based on the successful single-level percutaneous vertebroplasty (PVP) cases. The study included 135 patients who underwent contrast-enhanced MR imaging and successful PVP from 2005 to 2010 due to a single- level osteoporotic VCF. Two radiologists blinded to the fracture age evaluated the MR enhancement patterns in consensus. The MR enhancement patterns were classified according to the enhancing proportion to the vertebral height and the presence or extent of a non-enhancing cleft within the enhancing area on sagittal plane. The Fisher' exact test, Kruskal-Wallis test and Mann-Whitney U test were performed to assess the differences in the MR enhancement patterns according to the fracture age. Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. A diffuse enhancing area can be seen in not only the hyperacute and acute VCFs but also the chronic symptomatic VCFs. Symptomatic VCFs having a segmental enhancing area were all included in the hyperacute or acute stage. Most symptomatic osteoporotic VCFs had a non-enhancing cleft in the enhanced vertebral body (128/135, 94.8%). There was no statistical difference of the enhancement pattern according to the fracture age. Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. The most common pattern is a non-enhancing cleft within a diffuse enhanced vertebra.

  19. Magnetic Resonance Enhancement Patterns at the Different Ages of Symptomatic Osteoporotic Vertebral Compression Fractures

    International Nuclear Information System (INIS)

    You, Ja Yeon; Lee, Joon Woo; Kim, Jung Eun; Kang, Heung Sik

    2013-01-01

    To investigate the magnetic resonance (MR) enhancement patterns of symptomatic osteoporotic vertebral compression fracture (VCF) according to the fracture age, based on the successful single-level percutaneous vertebroplasty (PVP) cases. The study included 135 patients who underwent contrast-enhanced MR imaging and successful PVP from 2005 to 2010 due to a single- level osteoporotic VCF. Two radiologists blinded to the fracture age evaluated the MR enhancement patterns in consensus. The MR enhancement patterns were classified according to the enhancing proportion to the vertebral height and the presence or extent of a non-enhancing cleft within the enhancing area on sagittal plane. The Fisher' exact test, Kruskal-Wallis test and Mann-Whitney U test were performed to assess the differences in the MR enhancement patterns according to the fracture age. Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. A diffuse enhancing area can be seen in not only the hyperacute and acute VCFs but also the chronic symptomatic VCFs. Symptomatic VCFs having a segmental enhancing area were all included in the hyperacute or acute stage. Most symptomatic osteoporotic VCFs had a non-enhancing cleft in the enhanced vertebral body (128/135, 94.8%). There was no statistical difference of the enhancement pattern according to the fracture age. Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. The most common pattern is a non-enhancing cleft within a diffuse enhanced vertebra.

  20. NELL-1 Injection Maintains Long-Bone Quantity and Quality in an Ovariectomy-Induced Osteoporotic Senile Rat Model

    Science.gov (United States)

    Kwak, Jinny; Zara, Janette N.; Chiang, Michael; Ngo, Richard; Shen, Jia; James, Aaron W.; Le, Khoi M.; Moon, Crystal; Zhang, Xinli; Gou, Zhongru; Ting, Kang

    2013-01-01

    Over 10 million Americans have osteoporosis, and is the predominant cause of fractures in the elderly. Treatment of fractures in the setting of osteoporosis is complicated by a suboptimal bone regenerative response due to a decline in the number of osteoblasts, their function, and survival. Consequently, an osteogenic therapeutic to prevent and treat fractures in patients with osteoporosis is needed. Nel-like molecule-1 (NELL-1), a novel osteoinductive growth factor, has been shown to promote bone regeneration. In this study, we aim to demonstrate the capacity of recombinant NELL-1 to prevent ovariectomy (OVX)-induced osteoporosis in a senile rat model. Ten-month-old female Sprague-Dawley rats underwent either sham surgery or OVX. Subsequently, 50 μL of 600 μg/mL NELL-1 lyophilized onto a 0–50-μm tricalcium phosphate (TCP) carrier was injected into the femoral bone marrow cavity while phosphate-buffered saline (PBS) control was injected into the contralateral femur. Our microcomputed tomography results showed that OVX+PBS/TCP control femurs showed a continuous decrease in the bone volume (BV) and bone mineral density (BMD) from 2 to 8 weeks post-OVX. In contrast, OVX+NELL-1/TCP femurs showed resistance to OVX-induced bone resorption showing BV and BMD levels similar to that of SHAM femurs at 8 weeks post-OVX. Histology showed increased endosteal-woven bone, as well as decreased adipocytes in the bone marrow of NELL-1-treated femurs compared to control. NELL-1-treated femurs also showed increased immunostaining for bone differentiation markers osteopontin and osteocalcin. These findings were validated in vitro, in which addition of NELL-1 in OVX bone marrow stem cells resulted in increased osteogenic differentiation. Thus, NELL-1 effectively enhances in situ osteogenesis in the bone marrow, making it potentially useful in the prevention and treatment of osteoporotic fractures. PMID:23083222

  1. Association Between Dabigatran vs Warfarin and Risk of Osteoporotic Fractures Among Patients With Nonvalvular Atrial Fibrillation.

    Science.gov (United States)

    Lau, Wallis C Y; Chan, Esther W; Cheung, Ching-Lung; Sing, Chor Wing; Man, Kenneth K C; Lip, Gregory Y H; Siu, Chung-Wah; Lam, Joanne K Y; Lee, Alan C H; Wong, Ian C K

    2017-03-21

    The risk of osteoporotic fracture with dabigatran use in patients with nonvalvular atrial fibrillation (NVAF) is unknown. To investigate the risk of osteoporotic fracture with dabigatran vs warfarin in patients with NVAF. Retrospective cohort study using a population-wide database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with NVAF from 2010 through 2014 and prescribed dabigatran or warfarin were matched by propensity score at a 1:2 ratio with follow-up until July 31, 2016. Dabigatran or warfarin use during the study period. Risk of osteoporotic hip fracture and vertebral fracture was compared between dabigatran and warfarin users using Poisson regression. The corresponding incidence rate ratio (IRR) and absolute risk difference (ARD) with 95% CIs were calculated. Among 51 496 patients newly diagnosed with NVAF, 8152 new users of dabigatran (n = 3268) and warfarin (n = 4884) were matched by propensity score (50% women; mean [SD] age, 74 [11] years). Osteoporotic fracture developed in 104 (1.3%) patients during follow-up (32 dabigatran users [1.0%]; 72 warfarin users [1.5%]). Results of Poisson regression analysis showed that dabigatran use was associated with a significantly lower risk of osteoporotic fracture compared with warfarin (0.7 vs 1.1 per 100 person-years; ARD per 100 person-years, -0.68 [95% CI, -0.38 to -0.86]; IRR, 0.38 [95% CI, 0.22 to 0.66]). The association with lower risk was statistically significant in patients with a history of falls, fractures, or both (dabigatran vs warfarin, 1.6 vs 3.6 per 100 person-years; ARD per 100 person-years, -3.15 [95% CI, -2.40 to -3.45]; IRR, 0.12 [95% CI, 0.04 to 0.33]), but not in those without a history (0.6 vs 0.7 per 100 person-years; ARD per 100 person-years, -0.04 [95% CI, 0.67 to -0.39]; IRR, 0.95 [95% CI, 0.45 to 1.96]) (P value for interaction, <.001). Among adults with NVAF receiving anticoagulation, the use of dabigatran compared with warfarin was associated with a

  2. Spectacular improvement in vitamin D status in elderly osteoporotic women: 8-year analysis of an osteoporotic population treated in a dedicated fracture liaison service.

    Science.gov (United States)

    Amouzougan, A; Deygat, A; Trombert, B; Constant, E; Denarié, D; Marotte, H; Thomas, T

    2015-12-01

    In a population of postmenopausal women with a fragility fracture, we found a drastic reduction in the proportion of women with severe (D, especially from 2009 onwards. These results show that supplementation has been very widely integrated into current practice. Vitamin D (25(OH)D) is essential for bone health. In institutionalised osteoporotic women, it reduces the risk of fragility fractures. Numerous articles suggesting the possibility of extraosseous effects have generated a growing number of publications and recommendations on more widespread administration, to limit the risks of moderate or severe hypovitaminosis D. We assessed the impact on clinical practice of these recommendations concerning 25(OH)D supplementation in elderly at-risk populations. A total of 1486 postmenopausal osteoporotic women were seen in the context of a fracture liaison service (i.e. a rheumatology consultation following a peripheral fragility fracture), between May 2005 and December 2012. Of these, 1107 had a 25(OH)D assay (femur, n = 520; humerus, n = 207; wrist, n = 380). The average age of the total population was 76.7 ± 9.9 years, while for women with an available 25(OH)D assay, the average age was 75.1 ± 11.8 years. The average 25(OH)D (nmol/L) level was similar for the three fracture sites: femur, 30 ± 36.2; humerus, 27.5 ± 24; and wrist, 31 ± 26. A drastic reduction in the proportion of women with severe (D was observed, especially from 2009 onwards, with a mean prevalence of 69 and 30 % respectively before that year and 35 and 52 % thereafter. Conversely, the proportion of women with 25(OH)D at the threshold value of 75 nmol/L increased from 1.2 to 24 %. Overall, mean serum 25(OH)D levels were significantly higher when comparing the two periods 2005-2008 and 2009-1012 (17.6 ± 14.6 and 48.4 ± 39.2 nmol/L, respectively; p elderly.

  3. Differentiation of benign osteoporotic and neoplastic vertebral compression fractures with a diffusion-weighted, steady-state free precession sequence

    International Nuclear Information System (INIS)

    Baur, A.; Huber, A.; Nikolaou, K.; Staebler, A.; Reiser, M.; Duerr, H.R.

    2002-01-01

    Purpose: To evaluate the diagnosic accuracy of a diffusion-weigthed, steady-state free precession (SSFP) sequence for the differentiation of acute benign osteoporotic and neoplastic vertebral compression fractures. Methods: 85 patients with 102 vertebral compression fractures were examined with MR imaging using a spine array surface coil (Siemens, Vision, 1.5 Tesla). The following sequences were performed in sagittal orientation: T 1 -weighted spin echo (SE), short-tau inversion recovery (STIR) and a diffusion-weighted SSFP sequence (TR=25 msec, diffusion pulse length δ=3 msec). The SSFP images were evaluated qualitatively on a 5-grade scale from strongly hypointense to strongly hyperintense. Quantitative analysis was performed with region of interest measurements (ROI) and calculation of a bone marrow ratio. Results: 60 fractures were due to osteoporosis and 42 fractures were caused by malignancy. 'Hyperintensity' in a vertebral fracture on a SSFP sequence provided a sensitivity of 100% and a specificity of 93%. The positive predictive value was 91%, the negative predictive value was 100%. Quantitative analysis of the bone marrow ratio showed a statistically significant difference between the osteoporosis and the tumor group (p [de

  4. Bone mineral measurements of subchondral and trabecular bone in healthy and osteoporotic rabbits

    International Nuclear Information System (INIS)

    Castaneda, S; Largo, R.; Marcos, M.E.; Herrero-Beaumont, G.; Calvo, E.; Rodriguez-Salvanes, F.; Diaz-Curiel, M.

    2006-01-01

    Experimental models of osteoporosis in rabbits are useful to investigate anabolic agents because this animal has a fast bone turnover with predominant remodelling over the modelling processes. For that purpose, it is necessary to characterize the densitometric values of each type of bony tissue. To determine areal bone mass measurement in the spine and in trabecular, cortical and subchondral bone of the knee in healthy and osteoporotic rabbits. Bone mineral content and bone mineral density were measured in lumbar spine, global knee, and subchondral and cortical bone of the knee with dual energy X-ray absorptiometry using a Hologic QDR-1000/W densitometer in 29 skeletally mature female healthy New Zealand rabbits. Ten rabbits underwent triplicate scans for evaluation of the effect of repositioning. Osteoporosis was experimentally induced in 15 rabbits by bilateral ovariectomy and postoperative corticosteroid treatment for 4 weeks. Identical dual energy X-ray absorptiometry (DXA) studies were performed thereafter. Mean values of bone mineral content at the lumbar spine, global knee, subchondral bone and cortical tibial metaphysis were: 1934±217 mg, 878±83 mg, 149±14 mg and 29±7.0 mg, respectively. The mean values of bone mineral density at the same regions were: 298±24 mg/cm 2 , 455±32 mg/cm 2 , 617±60 mg/cm 2 and 678±163 mg/cm 2 , respectively. (orig.)

  5. Minimal invasive stabilization of osteoporotic vertebral compression fractures. Methods and preinterventional diagnostics

    International Nuclear Information System (INIS)

    Grohs, J.G.; Krepler, P.

    2004-01-01

    Minimal invasive stabilizations represent a new alternative for the treatment of osteoporotic compression fractures. Vertebroplasty and balloon kyphoplasty are two methods to enhance the strength of osteoporotic vertebral bodies by the means of cement application. Vertebroplasty is the older and technically easier method. The balloon kyphoplasty is the newer and more expensive method which does not only improve pain but also restores the sagittal profile of the spine. By balloon kyphoplasty the height of 101 fractured vertebral bodies could be increased up to 90% and the wedge decreased from 12 to 7 degrees. Pain was reduced from 7,2 to 2,5 points. The Oswestry disability index decreased from 60 to 26 points. This effects persisted over a period of two years. Cement leakage occurred in only 2% of vertebral bodies. Fractures of adjacent vertebral bodies were found in 11%. Good preinterventional diagnostics and intraoperative imaging are necessary to make the balloon kyphoplasty a successful application. (orig.) [de

  6. 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

    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...... 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...

  7. A painful, never ending story: older women's experiences of living with an osteoporotic vertebral compression fracture.

    Science.gov (United States)

    Svensson, H K; Olofsson, E H; Karlsson, J; Hansson, T; Olsson, L-E

    2016-05-01

    Vertebral compression fractures (VCF) cause pain and decreased physical ability, with no known well-established treatment. The aim of this study was to illuminate the experience of living with a VCF. The results show that fear and concerns are a major part of daily life. The women's initial contact with health-care providers should focus on making them feel acknowledged by offering person-centered and tailored support. In the past decade, osteoporotic-related fractures have become an increasingly common and costly public health problem worldwide. Vertebral compression fracture (VCF) is the second most common osteoporotic fracture, and patients with VCF describe an abrupt descent into disability, with a subsequent desire to regain independence in everyday life; however, little is known of their situation. The aim of this study was to illuminate the lived experience of women with an osteoporotic VCF. Ten women were interviewed during 2012-2013, starting with an open-ended question: could you tell me what it is like to live with a vertebral compression fracture? The verbatim transcribed interviews were analyzed using a phenomenological hermeneutical approach. The narrative provided descriptions of living in turmoil and chaos, unable to find stability in their life with little improvement regarding pain and physical function. Shifts from periods of constant pain to periods of fear of constant pain created a loss of confidence and an increased sense of confinement. The structural analysis revealed fear and concerns as the most prominent experience building on five themes: struggling to understand a deceiving body, breakthrough pain fueling fear, fearing a trajectory into isolation, concerns of dependency, and fearing an uncertain future. Until researchers find a successful prevention or medical/surgical treatment for osteoporotic VCFs, health-care providers and society abandon these women to remain in a painful and never ending story.

  8. Percutaneous kyphoplasty combined with zoledronic acid infusion in the treatment of osteoporotic thoracolumbar fractures in the elderly

    OpenAIRE

    Shi,Chen; Zhang,Mi; Cheng,An-Yuan; Huang,Zi-Feng

    2018-01-01

    Chen Shi,1,* Mi Zhang,2,* An-Yuan Cheng,1 Zi-Feng Huang1 1Department of Trauma Surgery, Wuhan No 1 Hospital, Wuhan, China; 2Department of Orthopedics, Wuhan No 5 Hospital, Wuhan, China *These authors contributed equally to this work Objective: We studied the efficacy of zoledronic acid (ZOL) infusion on radiographic and clinical outcomes after percutaneous kyphoplasty (PKP) for elderly patients with osteoporotic thoracolumbar fractures (osteoporotic vertebral compression fractures...

  9. Percutaneous kyphoplasty combined with zoledronic acid infusion in the treatment of osteoporotic thoracolumbar fractures in the elderly

    OpenAIRE

    Shi C; Zhang M; Cheng AY; Huang ZF

    2018-01-01

    Chen Shi,1,* Mi Zhang,2,* An-Yuan Cheng,1 Zi-Feng Huang1 1Department of Trauma Surgery, Wuhan No 1 Hospital, Wuhan, China; 2Department of Orthopedics, Wuhan No 5 Hospital, Wuhan, China *These authors contributed equally to this work Objective: We studied the efficacy of zoledronic acid (ZOL) infusion on radiographic and clinical outcomes after percutaneous kyphoplasty (PKP) for elderly patients with osteoporotic thoracolumbar fractures (osteoporotic vertebral compression fractures [OV...

  10. 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

    was not associated with an increased risk of hip fracture (HR 0.90; 95% CI, 0.80 to 1.02) or major osteoporotic fractures (HR 0.97; 95% CI, 0.90 to 1.05), nor was subsequent thyroxine prescription predictive of increased risk of fractures. The number of subsequent 6-month periods with low TSH-suggesting excessive...

  11. Multiple Atraumatic Osteoporotic Vertebral Fractures in an Adolescent with Suprasellar Germinoma: A Case Report

    Directory of Open Access Journals (Sweden)

    CC Wong

    2012-07-01

    Full Text Available We present the case of a patient with multiple atraumatic osteoporotic vertebral fractures in an adolescent with suprasellar germinoma and also review of relevant literature. The patient suffered from a rare adolescent brain tumour with common complications which are often overlooked and give rise to significant morbidity. Suprasellar germinoma is an intracranial neoplasm, that in addition to its rarity, has variable clinical presentation. Despite appropriate treatment and good outcome, tumour related morbidity is still of concern for these patients.

  12. Automatic detection of osteoporotic vertebral fractures in routine thoracic and abdominal MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Baum, Thomas; Dobritz, Martin; Rummeny, Ernst J.; Noel, Peter B. [Technische Universitaet Muenchen, Institut fuer Radiologie, Klinikum rechts der Isar, Muenchen (Germany); Bauer, Jan S. [Technische Universitaet Muenchen, Abteilung fuer Neuroradiologie, Klinikum rechts der Isar, Muenchen (Germany); Klinder, Tobias; Lorenz, Cristian [Philips Research Laboratories, Hamburg (Germany)

    2014-04-15

    To develop a prototype algorithm for automatic spine segmentation in MDCT images and use it to automatically detect osteoporotic vertebral fractures. Cross-sectional routine thoracic and abdominal MDCT images of 71 patients including 8 males and 9 females with 25 osteoporotic vertebral fractures and longitudinal MDCT images of 9 patients with 18 incidental fractures in the follow-up MDCT were retrospectively selected. The spine segmentation algorithm localised and identified the vertebrae T5-L5. Each vertebra was automatically segmented by using corresponding vertebra surface shape models that were adapted to the original images. Anterior, middle, and posterior height of each vertebra was automatically determined; the anterior-posterior ratio (APR) and middle-posterior ratio (MPR) were computed. As the gold standard, radiologists graded vertebral fractures from T5 to L5 according to the Genant classification in consensus. Using ROC analysis to differentiate vertebrae without versus with prevalent fracture, AUC values of 0.84 and 0.83 were obtained for APR and MPR, respectively (p < 0.001). Longitudinal changes in APR and MPR were significantly different between vertebrae without versus with incidental fracture (ΔAPR: -8.5 % ± 8.6 % versus -1.6 % ± 4.2 %, p = 0.002; ΔMPR: -11.4 % ± 7.7 % versus -1.2 % ± 1.6 %, p < 0.001). This prototype algorithm may support radiologists in reporting currently underdiagnosed osteoporotic vertebral fractures so that appropriate therapy can be initiated. circle This spine segmentation algorithm automatically localised, identified, and segmented the vertebrae in MDCT images. (orig.)

  13. Worldwide prevalence and incidence of osteoporotic vertebral fractures.

    Science.gov (United States)

    Ballane, G; Cauley, J A; Luckey, M M; El-Hajj Fuleihan, G

    2017-05-01

    We investigated the prevalence and incidence of vertebral fractures worldwide. We used a systematic Medline search current to 2015 and updated as per authors' libraries. A total of 62 articles of fair to good quality and comparable methods for vertebral fracture identification were considered. The prevalence of morphometric vertebral fractures in European women is highest in Scandinavia (26%) and lowest in Eastern Europe (18%). Prevalence rates in North America (NA) for White women ≥50 are 20-24%, with a White/Black ratio of 1.6. Rates in women ≥50 years in Latin America are overall lower than Europe and NA (11-19%). In Asia, rates in women above ≥65 are highest in Japan (24%), lowest in Indonesia (9%), and in the Middle East, Lebanon, rates are 20%. The highest-lowest ratio between countries, within and across continents, varied from 1.4-2.6. Incidence data is less abundant and more heterogeneous. Age-standardized rates in studies combining hospitalized and ambulatory vertebral fractures are highest in South Korea, USA, and Hong Kong and lowest in the UK. Neither a North-South gradient nor a relation to urbanization is evident. Conversely, the incidence of hospitalized vertebral fractures in European patients ≥50 shows a North-South gradient with 3-3.7-fold variability. In the USA, rates in Whites are approximately 4-fold higher than in Blacks. Vertebral fractures variation worldwide is lower than observed with hip fractures, and some of highest rates are unexpectedly from Asia. Better quality representative studies are needed. We investigate the occurrence of vertebral fractures, worldwide, using published data current until the present. Worldwide, the variation in vertebral fractures is lower than observed for hip fractures. Some of the highest rates are from North America and unexpectedly Asia. The highest-lowest ratio between countries, within and across continents, varied from 1.4-2.6. Better quality representative data is needed.

  14. Combined diffusion-weighted and dynamic contrast-enhanced imaging of patients with acute osteoporotic vertebral fractures

    International Nuclear Information System (INIS)

    Biffar, Andreas; Sourbron, Steven; Dietrich, Olaf; Schmidt, Gerwin; Ingrisch, Michael; Reiser, Maximilian F.; Baur-Melnyk, Andrea

    2010-01-01

    Objectives: To evaluate the potential and to analyze parameter correlations of combined quantitative diffusion-weighted MRI (DWI) and high-temporal-resolution dynamic contrast-enhanced MRI (DCE-MRI) in vertebral bone marrow (vBM) of patients with osteoporosis and acute vertebral compression fractures, providing additional information for a better understanding of the physiological background of parameter changes. Materials and methods: 20 patients with acute osteoporotic fractures were examined with DWI and DCE-MRI at 1.5 T. DCE-MRI was performed with a 2D saturation-recovery turbo-FLASH sequence, acquiring 300 dynamics with a temporal resolution of 1 s. For DWI measurements, a DW HASTE sequence with b-values from 100 to 600 s/mm 2 was applied. In each patient, ROIs were drawn manually in the fractures and in normal appearing vertebrae. For DCE-MRI, the concentration-time curves of these ROIs were analyzed using a two-compartment tracer-kinetic model in the lesions, providing separate estimates of perfusion and permeability, and a one-compartment model in normal vBM, providing only a mixed representation of perfusion and permeability in terms of a mixed flow parameter K trans and the extracellular volume (ECV). In the case of DWI, attenuation curves were fitted to a monoexponential decay model to determine the apparent diffusion coefficient (ADC). Results: Mean perfusion parameters and ADCs were significantly (p trans : 7.81 mL/100 mL/min vs. 14.61 mL/100 mL/min, ECV: 52.84 mL/100 mL vs. 4.61 mL/100 mL, ADC: 1.71 x 10 -3 mm 2 /s vs. 0.57 x 10 -3 mm 2 /s). ADCs showed a significant correlation with the ECV. Conclusion: The quantitative analysis of DWI and DCE-MRI could distinguish osteoporotic fractures from normal appearing vertebrae. A significant correlation found between ECV and ADCs might be able to explain the cause for the increased diffusivity in osteoporotic fractures. Since the other perfusion parameters do not correlate with the ADC, they provide

  15. Implants delivering bisphosphonate locally increase periprosthetic bone density in an osteoporotic sheep model. A pilot study

    Directory of Open Access Journals (Sweden)

    GVA Stadelmann

    2008-07-01

    Full Text Available It is a clinical challenge to obtain a sufficient orthopaedic implant fixation in weak osteoporotic bone. When the primary implant fixation is poor, micromotions occur at the bone-implant interface, activating osteoclasts, which leads to implant loosening. Bisphosphonate can be used to prevent the osteoclastic response, but when administered systemically its bioavailability is low and the time it takes for the drug to reach the periprosthetic bone may be a limiting factor. Recent data has shown that delivering bisphosphonate locally from the implant surface could be an interesting solution. Local bisphosphonate delivery increased periprosthetic bone density, which leads to a stronger implant fixation, as demonstrated in rats by the increased implant pullout force. The aim of the present study was to verify the positive effect on periprosthetic bone remodelling of local bisphosphonate delivery in an osteoporotic sheep model. Four implants coated with zoledronate and two control implants were inserted in the femoral condyle of ovariectomized sheep for 4 weeks. The bone at the implant surface was 50% higher in the zoledronate-group compared to control group. This effect was significant up to a distance of 400µm from the implant surface. The presented results are similar to what was observed in the osteoporotic rat model, which suggest that the concept of releasing zoledronate locally from the implant to increase the implant fixation is not species specific. The results of this trial study support the claim that local zoledronate could increase the fixation of an implant in weak bone.

  16. Spine-hip T-score difference predicts major osteoporotic fracture risk independent of FRAX(®): a population-based report from CAMOS.

    Science.gov (United States)

    Leslie, William D; Kovacs, Christopher S; Olszynski, Wojciech P; Towheed, Tanveer; Kaiser, Stephanie M; Prior, Jerilynn C; Josse, Robert G; Jamal, Sophie A; Kreiger, Nancy; Goltzman, David

    2011-01-01

    The WHO fracture risk assessment tool (FRAX(®)) estimates an individual's 10-yr major osteoporotic and hip fracture probabilities. When bone mineral density (BMD) is included in the FRAX calculation, only the femoral neck measurement can be used. Recently, a procedure was reported for adjusting major osteoporotic fracture probability from FRAX with femoral neck BMD based on the difference (offset) between the lumbar spine and the femoral neck T-score values. The objective of the current analysis was to independently evaluate this algorithm in a population-based cohort of 4575 women and 1813 men aged 50 yr and older from the Canadian Multicentre Osteoporosis Study. For women and men combined, there was a 15% (95% confidence interval 7-24%) increase in major osteoporotic fracture risk for each offset T-score after adjusting for FRAX probability calculated with femoral neck BMD. The effect was stronger in women than men, but a significant sex interaction was not detected. Among the full cohort, 5.5% had their risk category reclassified after using the offset adjustment. Sex- and age-dependent offsets (equivalent to an offset based on Z-scores) showed improved risk classification among individuals designated to be at moderate risk with the conventional FRAX probability measurement. In summary, the T-score difference between the lumbar spine and femoral neck is an independent risk factor for major osteoporotic fractures that is independent of the FRAX probability calculated with femoral neck BMD. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  17. Axial compressive strength of human vertebrae trabecular bones classified as normal, osteopenic and osteoporotic by quantitative ultrasonometry of calcaneus

    Directory of Open Access Journals (Sweden)

    Reinaldo Cesar

    2017-06-01

    Full Text Available Abstract Introduction Biomechanical assessment of trabecular bone microarchitecture contributes to the evaluation of fractures risk associated with osteoporosis and plays a crucial role in planning preventive strategies. One of the most widely clinical technics used for osteoporosis diagnosis by health professionals is bone dual-energy X-ray absorptiometry (DEXA. However, doubts about its accuracy motivate the introduction of congruent technical analysis such as calcaneal ultrasonometry (Quantitative Ultrasonometry - QUS. Methods Correlations between Bone Quality Index (BQI, determined by calcaneal ultrasonometry of thirty (30 individuals classified as normal, osteopenic and osteoporotic, and elastic modulus (E and ultimate compressive strength (UCS from axial compression tests of ninety (90 proof bodies from human vertebrae trabecular bone, which were extracted from cadavers in the twelfth thoracic region (T12, first and fourth lumbar (L1 and L4. Results Analysis of variance (ANOVA showed significant differences for E (p = 0.001, for UCS (p = 0.0001 and BQI. Spearman’s rank correlation coefficient (rho between BQI and E (r = 0.499 and BQI and UCS (r = 0.508 were moderate. Discussion Calcaneal ultrasonometry technique allowed a moderate estimate of bone mechanical strength and fracture risk associated with osteoporosis in human vertebrae.

  18. Numerical analysis of standard and modified osteosynthesis in long bone fractures treatment.

    Science.gov (United States)

    Sisljagić, Vladimir; Jovanović, Savo; Mrcela, Tomislav; Radić, Radivoje; Selthofer, Robert; Mrcela, Milanka

    2010-03-01

    The fundamental problem in osteoporotic fracture treatment is significant decrease in bone mass and bone tissue density resulting in decreased firmness and elasticity of osteoporotic bone. Application of standard implants and standard surgical techniques in osteoporotic bone fracture treatment makes it almost impossible to achieve stable osteosynthesis sufficient for early mobility, verticalization and load. Taking into account the form and the size of the contact surface as well as distribution of forces between the osteosynthetic materials and the bone tissue numerical analysis showed advantages of modified osteosynthesis with bone cement filling in the screw bed. The applied numerical model consisted of three sub-models: 3D model from solid elements, 3D cross section of the contact between the plate and the bone and the part of 3D cross section of the screw head and body. We have reached the conclusion that modified osteosynthesis with bone cement resulted in weaker strain in the part of the plate above the fracture fissure, more even strain on the screws, plate and bone, more even strain distribution along all the screws' bodies, significantly greater strain in the part of the screw head opposite to the fracture fissure, firm connection of the screw head and neck and the plate hole with the whole plate and more even bone strain around the screw.

  19. Poverty is a risk factor for osteoporotic fractures.

    Science.gov (United States)

    Navarro, M C; Sosa, M; Saavedra, P; Lainez, P; Marrero, M; Torres, M; Medina, C D

    2009-03-01

    This study assesses the possible association between poverty and osteoporosis and/or fragility fractures in a population of postmenopausal women. We found that postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Some lifestyles are related to the presence of osteoporosis and/or fragility fractures, whereas poverty is related to some lifestyles. Because of this, we studied the possible association of poverty with osteoporosis and fractures. This was an observational, cross-sectional study performed in the Canary Islands, Spain. Participants consisted of a total of 1,139 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis and who were enrolled in some epidemiological studies. The prevalence of fractures (vertebral and non-vertebral) and the prevalence of osteoporosis (T-score poverty (annual family income lower than 6,346.80 Euros, in a one-member family, n = 474), were older and heavier and had lower height, lower prevalence of tobacco and alcohol consumption, lower use of HRT and higher use of thiazides. After correcting for age and body mass index (BMI), women in poverty had lower spine BMD values than women with a medium and high socioeconomic status (0.840 g/cm(2) vs. 0.867 g/cm(2), p = 0.005), but there were no statistical differences in femoral neck BMD between groups. The prevalence of osteoporosis was also higher in women in poverty [40.6% vs. 35.6%, (OR 1.35, CI 95%: 1.03; 1.76)] after adjusting by age and BMI. Moreover, 37.8% of women in poverty had a history of at least one fragility fracture compared to 27.7% of women not in poverty (OR: 1.45, CI 95%: 1.11; 1.90). The prevalence of vertebral fractures was also higher in women in poverty 24.7% vs. 13.4%, (OR 2.01, CI 95%: 1.44; 2.81). Postmenopausal women with low socioeconomic status had lower values of BMD at

  20. Stress fractures and bone pain

    International Nuclear Information System (INIS)

    Groshar, D.; Even-Sapir, E.; Lam, M.; Israel, O.; Front, D.

    1984-01-01

    Stress fractures result from an unusual repetitive physical activity causing absorption of bone in excess of repair and bone formation. This leads to the weakening of the bone and subsequently to a fracture. It is a benign condition that if recognized in time does not need any treatment besides rest. However, if diagnosis is not made and physical activity continues it may result in severe injury to the bone and a frank fracture may result. Pain is the typical clinical feature and bone scintigraphy, being more sensitive than radiography, is done to establish early diagnosis. The presence of asymptomatic sites of abnormal bone uptake typical of stress fracture in which pain appeared only about 2 weeks after scintigraphy, drew the authors' attention to the question of how close is the relationship between stress fractures and bone pain. Sixty-four military recruits diagnosed as suffering from stress fracture were investigated in order to correlate sites with abnormal uptake of Tc-99m MDP on bone scintigraphy with sites of local pain. In 37 (58%) subjects multiple sites of abnormal uptake were recognised. Of 123 sites of abnormal uptake, 31 (25%) were asymptomatic. In three patients bone pain appeared at the site of the abnormal uptake two weeks after scintigraphy. Bone scintigraphy appears to be more sensitive than bone pain in the diagnosis of stress fractures. The osteoblastic activity which manifests itself by abnormal uptake appears in some cases earlier than the pain caused by the fracture. Present findings may suggest that under certain circumstances, in a population prone to stress fracture, bone scan should be considered as a screening method

  1. Influence of intravertebral cleft on percutaneous vertebroplasty outcome of osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Zhu Xuee; Wu Chungen; Zhang Ji; Cheng Yongde; Gu Yifeng; Li Minghua; Hu Xiaohui

    2008-01-01

    Objective: To evaluate the influence of intravertebral cleft on percutaneous vertebroplasty (PVP)outcome and the efficacy in the treatment of osteoporotic compression fracture and compare to those without intravertebral cleft. Methods: A retrospective study was conducted to review 95 consecutive PVP procedures for 176 compression fractures. Patients were excluded with more than a single vertebral body involvement neoplasm history, lack of complete imaging materials and follow-up of incoordinated patients. Group A consisted of 18 patients with intravertebral cleft, while group B comprised 25 patients without intravertebral cleft. PMMA leakages were classified as intradiscal, perivertebral soft tissue, perivertebral venous and epidural types. The frequencies of leakage were compared between two groups using χ 2 and Fisher exact tests. Visual analogue scale (VAS)and Owestry disability index (ODI)scores were recorded before hand. Results: After PVP, all patients showed significant pain relief and improvement of daily activity function(P 0.05)between the two groups. PMMA leakage occurred in 11 (61.1%)of 18 fractures with intravertebral clefts and 15 (60%)of 25 fractures without intravertebral clefts, revealing no significant difference, but existing between the most frequent seen types in both groups (P < 0.05). Conclusions: PVP is an effective treatment for osteoporotic compression fractures with and without intravertebral cleft. There was no influence of intravertebral clefts on pain relief, improvement of daily activity function and incidence of PMMA leakage besides the PMMA leakage types. (authors)

  2. Percutaneous vertebroplasty and conservative management for the treatment of osteoporotic vertebral fractures: a comparative study

    International Nuclear Information System (INIS)

    Liu Wengui; Lu Jinyu; Sun Jianhua; Liang Ding; Li Zhiwei; Wang Hesheng; Guo Shanfeng

    2011-01-01

    Objective: To investigate the better therapeutic measures for painful osteoporotic vertebral compression fractures (OVCF) through comparing the efficacy of percutaneous vertebroplasty (PVP) with that of conservative management. Methods: Forty-three consecutive patients, encountered from December 2009 to December 2010 in authors' hospital, were enrolled in this study. The patients were divided into PVP group (n=22) and conservative group (n=21). Visual analog score (VAS) for pain and Oswestry disability index (ODI) questionnaire scores were assessed before and 1 week, 1, 3, 6, 12 months after the treatment. Patients' activity levels and other information, including complications and new fractures after treatment, were also evaluated. Results: Before the treatment both the VAS and ODI scores showed no statistically significant difference between the two groups. Significant reduction of both VAS and ODI was observed in PVP group at 1 week and at 1 and 3 months after treatment when compared with those in conservative group (P<0.05). Patients' activity levels in PVP group were significantly improved than that in conservative group (P<0.01). One new fracture was observed in the conservative group, while no new fracture was seen in the PVP group. Conclusion: Immediate pain relief and improvement of daily activities after PVP can be achieved in all patients. PVP should be considered as the treatment of first choice for symptomatic osteoporotic vertebral fractures. (authors)

  3. The hospital resource utilization associated with osteoporotic hip fractures in Kermanshah, Iran.

    Science.gov (United States)

    Saeb, Morteza; Beyranvand, Mandana; Basiri, Zahra; Haghparast-Bidgoli, Hassan

    2014-01-01

    Hip fracture is the most serious complication of osteoporosis and imposes a significant financial burden on countries' economy. This study aimed to assess the hospitalization costs and length of stay associated with osteoporosis hip fractures and identify the major cost components in a referral hospital in Kermanshah city, Iran. In a prospective study, from May 21 2007 to May 21 2008, all patients with osteoporotic hip fracture admitted to a referral hospital for operation were recruited as the study sample. For each patient, information such as age, gender, length of stay (LOS) in hospital and intensive care unit (ICU), medical and diagnostic procedures and cost of surgery and implant were collected both through interview with the patient or a family member and the patients' hospital records. A total of 103 patients (56 men and 47 women) were studied. The average hospital length of stay (LOS) for the patients was 9.7 days, ranging from 5 to 38 days. The average total hospitalization costs was 7,208,588 IRR (US$774). The main components of the costs were ward stay (16.3%), operative (54.6%), implant (26%) and medical and diagnostic procedures (3.1%). The results of this study demonstrate that the hospital resource burden associated with osteoporotic hip fractures in Iran is substantial and expected to rise with the projected increase of life expectancy and the number of elderly in Iran. Estimating the economic burden of osteoporotic hip fractures provide information that can be of importance in the planning and design of preventive strategies. © 2014 KUMS, All rights reserved.

  4. The hospital resource utilization associated with osteoporotic hip fractures in Kermanshah, Iran

    Directory of Open Access Journals (Sweden)

    Morteza Saeb

    2014-01-01

    Full Text Available Abstract: Background: Hip fracture is the most serious complication of osteoporosis and imposes a significant financial burden on countries' economy. This study aimed to assess the hospitalization costs and length of stay associated with osteoporosis hip fractures and identify the major cost components in a referral hospital in Kermanshah city, Iran. Methods: In a prospective study, from May 21 2007 to May 21 2008, all patients with osteoporotic hip fracture admitted to a referral hospital for operation were recruited as the study sample. For each patient, information such as age, gender, length of stay (LOS in hospital and intensive care unit (ICU, medical and diagnostic procedures and cost of surgery and implant were collected both through interview with the patient or a family member and the patients’ hospital records. Results: A total of 103 patients (56 men and 47 women were studied. The average hospital length of stay (LOS for the patients was 9.7 days, ranging from 5 to 38 days. The average total hospitalization costs was 7,208,588 IRR (US$774. The main components of the costs were ward stay (16.3%, operative (54.6%, implant (26% and medical and diagnostic procedures (3.1%. Conclusions: The results of this study demonstrate that the hospital resource burden associated with osteoporotic hip fractures in Iran is substantial and expected to rise with the projected increase of life expectancy and the number of elderly in Iran. Estimating the economic burden of osteoporotic hip fractures provide information that can be of importance in the planning and design of preventive strategies.

  5. Systemic Administration of Allogeneic Mesenchymal Stem Cells Does Not Halt Osteoporotic Bone Loss in Ovariectomized Rats.

    Directory of Open Access Journals (Sweden)

    Shuo Huang

    Full Text Available Mesenchymal stem cells (MSCs have innate ability to self-renew and immunosuppressive functions, and differentiate into various cell types. They have become a promising cell source for treating many diseases, particular for bone regeneration. Osteoporosis is a common metabolic bone disorder with elevated systemic inflammation which in turn triggers enhanced bone loss. We hypothesize that systemic infusion of MSCs may suppress the elevated inflammation in the osteoporotic subjects and slow down bone loss. The current project was to address the following two questions: (1 Will a single dose systemic administration of allogenic MSCs have any effect on osteoporotic bone loss? (2 Will multiple administration of allogenic MSCs from single or multiple donors have similar effect on osteoporotic bone loss? 18 ovariectomized (OVX rats were assigned into 3 groups: the PBS control group, MSCs group 1 (receiving 2x106 GFP-MSCs at Day 10, 46, 91 from the same donor following OVX and MSCs group 2 (receiving 2x106 GFP-MSCs from three different donors at Day 10, 46, 91. Examinations included Micro-CT, serum analysis, mechanical testing, immunofluorescence staining and bone histomorphometry analysis. Results showed that BV/TV at Day 90, 135, BMD of TV and trabecular number at Day 135 in the PBS group were significantly higher than those in the MSCs group 2, whereas trabecular spacing at Day 90, 135 was significantly smaller than that in MSCs group 2. Mechanical testing data didn't show significant difference among the three groups. In addition, the ELISA assay showed that level of Rantes in serum in MSCs group 2 was significantly higher than that of the PBS group, whereas IL-6 and IL-10 were significantly lower than those of the PBS group. Bone histomorphometry analysis showed that Oc.S/BS and Oc.N/BS in the PBS group were significant lower than those in MSCs group 2; Ob.S/BS and Ob.N/BS did not show significant difference among the three groups. The current study

  6. Wearing an active spinal orthosis improves back extensor strength in women with osteoporotic vertebral fractures

    DEFF Research Database (Denmark)

    Valentin, Gitte Hoff; Pedersen, Louise Nymann; Maribo, Thomas

    2014-01-01

    .Study design:Experimental follow-up.Methods:The women used the active spinal orthosis for 3 months. Outcomes were changes in isometric back extensor strength, changes in back pain and changes in physical functioning.Results:A total of 13 women were included in the trial. Wearing the orthosis during a 3-month......Background:Vertebral fractures are the most common clinical manifestations of osteoporosis. Vertebral fractures and reduced back extensor strength can result in hyperkyphosis. Hyperkyphosis is associated with diminished daily functioning and an increased risk of falling. Improvements in back...... extensor strength can result in decreased kyphosis and thus a decreased risk of falls and fractures.Objectives:The aim was to examine the effects of an active spinal orthosis - Spinomed III - on back extensor strength, back pain and physical functioning in women with osteoporotic vertebral fractures...

  7. Extra virgin olive oil consumption reduces the risk of osteoporotic fractures in the PREDIMED trial.

    Science.gov (United States)

    García-Gavilán, J F; Bulló, M; Canudas, S; Martínez-González, M A; Estruch, R; Giardina, S; Fitó, M; Corella, D; Ros, E; Salas-Salvadó, J

    2018-02-01

    The incidence of osteoporotic fractures is lower in countries in the Mediterranean basin. Virgin olive oil, a key component of the Mediterranean Diet (MDiet), with recognised beneficial effects on metabolism and cardiovascular health, may decrease the risk of osteoporotic fractures. The aim to this study was to explore the effect of chronic consumption of total olive oil and its varieties on the risk of osteoporosis-related fractures in a middle-aged and elderly Mediterranean population. We included all participants (n = 870) recruited in the Reus (Spain) centre of the PREvención con DIeta MEDiterránea (PREDIMED) trial. Individuals, aged 55-80 years at high cardiovascular risk, were randomized to a MedDiet supplemented with extra-virgin olive oil, a MedDiet supplemented with nuts, or a low-fat diet. The present analysis was an observational cohort study nested in the trial. A validated food frequency questionnaire was used to assess dietary habits and olive oil consumption. Information on total osteoporotic fractures was obtained from a systematic review of medical records. The association between yearly repeated measurements of olive oil consumption and fracture risk was assessed by multivariate Cox proportional hazards. We documented 114 incident cases of osteoporosis-related fractures during a median follow-up of 8.9 years. Treatment allocation had no effect on fracture risk. Participants in the highest tertile of extra-virgin olive oil consumption had a 51% lower risk of fractures (HR:0.49; 95% CI:0.29-0.81. P for trend = 0.004) compared to those in the lowest tertile after adjusting for potential confounders. Total and common olive oil consumption was not associated with fracture risk. Higher consumption of extra-virgin olive oil is associated with a lower risk of osteoporosis-related fractures in middle-aged and elderly Mediterranean population at high cardiovascular risk. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and

  8. Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997-2006

    DEFF Research Database (Denmark)

    Abrahamsen, B; Vestergaard, P

    2009-01-01

    .7% in women. CONCLUSIONS: The decrease in hip fractures is much too large to be explained by the extent of anti-osteoporotic medication. Interestingly, the decrease in fracture rates also applied to men, despite much lower treatment rates. Potential explanations include smoking habits, obesity, national home...

  9. Biologic disease-modifying anti-rheumatic drugs and the risk of non-vertebral osteoporotic fractures in patients with rheumatoid arthritis aged 50 years and over.

    Science.gov (United States)

    Roussy, J-P; Bessette, L; Bernatsky, S; Rahme, E; Lachaine, J

    2013-09-01

    Prevention of bone mineral density loss in rheumatoid arthritis (RA) has been associated with use of biologic disease-modifying anti-rheumatic drugs (DMARDs). However, in this study, we could not demonstrate a reduction in the risk of non-vertebral fractures. Additional research is required to clarify the impact of biologic DMARDs on fracture risk in RA. Small studies have suggested biologic DMARDs preserve bone mineral density at 6-12 months. Our objective was to determine the association between biologic DMARD use and the risk of non-vertebral osteoporotic fractures in RA subjects aged ≥50 years. A nested case-control study was conducted using Quebec physician billing and hospital discharge data. RA subjects were identified from International Classification of Disease-9/10 codes in billing and hospitalisation data and followed from cohort entry until the earliest of non-vertebral osteoporotic fracture, death, or end of study period. Controls were matched to cases (4:1 ratio) on age, sex, and date of cohort entry. Biologic DMARD exposure was defined as being on treatment for ≥180 days pre-fracture (index). Conditional logistic regression was used, adjusting for indicators of RA severity, comorbidity, drugs influencing fracture risk, and measures of health care utilisation. Over the study period, 1,515 cases were identified (6,023 controls). The most frequent fracture site was hip/femur (42.3%). In total, 172 subjects (49 cases and 123 controls) were exposed to biologic DMARDs. The median duration of exposure was 735 (interquartile range (IQR), 564) and 645 (IQR, 903) days in cases and controls, respectively. We were unable to demonstrate an association between biologic DMARDs and fracture risk (odds ratio, 1.03; 95% confidence interval, 0.42-2.53). RA duration significantly increased the fracture risk. Despite the positive impact of biologic DMARDs on bone remodelling observed in small studies, we were unable to demonstrate a reduction in the risk of non

  10. Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture

    NARCIS (Netherlands)

    H.-F. Zheng (Hou-Feng); V. Forgetta (Vincenzo); Y.-H. Hsu (Yi-Hsiang); K. Estrada Gil (Karol); A. Rosello-Diez (Alberto); P.J. Leo (Paul); C.L. Dahia (Chitra L.); K.H. Park-Min (Kyung Hyun); J.H. Tobias (Jon); C. Kooperberg (Charles); A. Kleinman (Aaron); U. Styrkarsdottir (Unnur); C.-T. Liu (Ching-Ti); C. Uggla (Charlotta); D.S. Evans (Daniel); C. Nielson (Carrie); K. Walter (Klaudia); U. Pettersson-Kymmer (Ulrika); S. McCarthy (Shane); J. Eriksson (Joel); T. Kwan (Tony); M. Jhamai (Mila); K. Trajanoska (Katerina); Y. Memari (Yasin); J.L. Min (Josine L.); J. Huang (Jie); P. Danecek (Petr); B. Wilmot (Beth); R. Li (Rui); W.-C. Chou (Wen-Chi); L.E. Mokry (Lauren E.); A. Moayyeri (Alireza); M. Claussnitzer (Melina); C.-H. Cheng (Chia-Ho); W. Cheung (Warren); M.C. Medina-Gomez (Carolina); B. Ge (Bing); S.-H. Chen (Shu-Huang); K. Choi (Kunho); L. Oei (Ling); J. Fraser (James); R. Kraaij (Robert); M.A. Hibbs (Matthew A.); C.L. Gregson (Celia L.); D. Paquette (Denis); A. Hofman (Albert); C. Wibom (Carl); G.J. Tranah (Gregory); M. Marshall (Mhairi); B.B. Gardiner (Brooke B.); K. Cremin (Katie); P. Auer (Paul); L. Hsu (Li); S. Ring (Susan); J.Y. Tung (Joyce Y.); G. Thorleifsson (Gudmar); A.W. Enneman (Anke); N.M. van Schoor (Natasja); L.C.P.G.M. de Groot (Lisette); N. van der Velde (Nathalie); B. Melin (Beatrice); J.P. Kemp (John); C. Christiansen; I. Sayers (Ian); Y. Zhou (Yanhua); S. Calderari (Sophie); J. Van Rooij (Jeroen); C. Carlson (Chris); U. Peters (Ulrike); S. Berlivet (Soizik); J. Dostie (Josée); A.G. Uitterlinden (André); S.R. Williams (Stephen R.); C. Farber (Charles); D. Grinberg (Daniel); A.Z. LaCroix (Andrea); J. Haessler (Jeff); D.I. Chasman (Daniel); F. Giulianini (Franco); L.M. Rose (Lynda M.); P.M. Ridker (Paul); J.A. Eisman (John); T.V. Nguyen (Tuan); J.R. Center (Jacqueline); X. Nogues (Xavier); N. Garcia-Giralt (Natàlia); L.J. Launer (Lenore); V. Gudnason (Vilmunder); D. Mellström (Dan); L. Vandenput (Liesbeth); N. Amin (Najaf); C.M. van Duijn (Cornelia); M. Karlsson (Magnus); O. Ljunggren (Östen); O. Svensson (Olle); G. Hallmans (Göran); M.F. Rousseau (Francois); S. Giroux (Sylvie); J. Bussière (Johanne); P.P. Arp (Pascal); F. Koromani (Fjorda); R.L. Prince (Richard L.); J.R. Lewis (Joshua); B.L. Langdahl (Bente); A.P. Hermann (A. Pernille); J.-E.B. Jensen (Jens-Erik B.); S. Kaptoge (Stephen); K.T. Khaw; J. Reeve (Jonathan); M.M. Formosa (Melissa M.); A. Xuereb-Anastasi (Angela); K. Åkesson (Kristina); F.E. McGuigan; G. Garg (Gaurav); D. Olmos (David); M.T. Zarrabeitia (María); J.A. Riancho (José); S.H. Ralston (Stuart); N. Alonso (Nerea); X. Jiang (Xi); D. Goltzman (David); T. Pastinen (Tomi); E. Grundberg (Elin); D. Gauguier (Dominique); E.S. Orwoll (Eric); D. Karasik (David); G.D. Smith; G.D. Smith; K. Siggeirsdottir (Kristin); T.B. Harris (Tamara); M.C. Zillikens (Carola); J.B.J. van Meurs (Joyce); U. Thorsteinsdottir (Unnur); M.T. Maurano (Matthew T.); N.J. Timpson (Nicholas); N. Soranzo (Nicole); R. Durbin (Richard); S.G. Wilson (Scott); E.E. Ntzani (Evangelia); M.A. Brown (Matthew); J-A. Zwart (John-Anker); D.A. Hinds (David A.); T.D. Spector (Timothy); L.A. Cupples (Adrienne); C. Ohlsson (Claes); C.M.T. Greenwood (Celia); R.D. Jackson (Rebecca); D.W. Rowe (David W.); C.A. Loomis (Cynthia A.); D.M. Evans (David M.); C.L. Ackert-Bicknell (Cheryl); A.L. Joyner (Alexandra L.); E.L. Duncan (Emma); D.P. Kiel (Douglas P.); F. Rivadeneira Ramirez (Fernando); J.B. Richards (Brent)

    2015-01-01

    textabstractThe extent to which low-frequency (minor allele frequency (MAF) between 1-5%) and rare (MAF ≤ 1%) variants contribute to complex traits and disease in the general population is mainly unknown. Bone mineral density (BMD) is highly heritable, a major predictor of osteoporotic fractures,

  11. Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture

    NARCIS (Netherlands)

    Zheng, Hou-Feng; Forgetta, Vincenzo; Hsu, Yi-Hsiang; Estrada, Karol; Rosello-Diez, Alberto; Leo, Paul J.; Dahia, Chitra L.; Park-Min, Kyung Hyun; Tobias, Jonathan H.; Kooperberg, Charles; Kleinman, Aaron; Styrkarsdottir, Unnur; Liu, Ching-Ti; Uggla, Charlotta; Evans, Daniel S.; Nielson, Carrie M.; Walter, Klaudia; Pettersson-Kymmer, Ulrika; Mccarthy, Shane; Eriksson, Joel; Kwan, Tony; Jhamai, Mila; Trajanoska, Katerina; Memari, Yasin; Min, Josine; Huang, Jie; Danecek, Petr; Wilmot, Beth; Li, Rui; Chou, Wen-Chi; Mokry, Lauren E.; Moayyeri, Alireza; Claussnitzer, Melina; Cheng, Chia-Ho; Cheung, Warren; Medina-Gómez, Carolina; Ge, Bing; Chen, Shu-Huang; Choi, Kwangbom; Oei, Ling; Fraser, James; Kraaij, Robert; Hibbs, Matthew A.; Gregson, Celia L.; Paquette, Denis; Hofman, Albert; Wibom, Carl; Tranah, Gregory J.; Marshall, Mhairi; Gardiner, Brooke B.; Cremin, Katie; Auer, Paul; Hsu, Li; Ring, Sue; Tung, Joyce Y.; Thorleifsson, Gudmar; Enneman, Anke W.; van Schoor, Natasja M.; de Groot, Lisette C. P. G. M.; van der Velde, Nathalie; Melin, Beatrice; Kemp, John P.; Christiansen, Claus; Sayers, Adrian; Zhou, Yanhua; Calderari, Sophie; van Rooij, Jeroen; Carlson, Chris; Peters, Ulrike; Berlivet, Soizik; Dostie, Josée; Uitterlinden, Andre G.; Williams, Stephen R.; Farber, Charles; Grinberg, Daniel; LaCroix, Andrea Z.; Haessler, Jeff; Chasman, Daniel I.; Giulianini, Franco; Rose, Lynda M.; Ridker, Paul M.; Eisman, John A.; Nguyen, Tuan V.; Center, Jacqueline R.; Nogues, Xavier; Garcia-Giralt, Natalia; Launer, Lenore L.; Gudnason, Vilmunder; Mellström, Dan; Vandenput, Liesbeth; Amin, Najaf; van Duijn, Cornelia M.; Karlsson, Magnus K.; Ljunggren, Östen; Svensson, Olle; Hallmans, Göran; Rousseau, François; Giroux, Sylvie; Bussière, Johanne; Arp, Pascal P.; Koromani, Fjorda; Prince, Richard L.; Lewis, Joshua R.; Langdahl, Bente L.; Hermann, A. Pernille; Jensen, Jens-Erik B.; Kaptoge, Stephen; Khaw, Kay-Tee; Reeve, Jonathan; Formosa, Melissa M.; Xuereb-Anastasi, Angela; Åkesson, Kristina; McGuigan, Fiona E.; Garg, Gaurav; Olmos, Jose M.; Zarrabeitia, Maria T.; Riancho, Jose A.; Ralston, Stuart H.; Alonso, Nerea; Jiang, Xi; Goltzman, David; Pastinen, Tomi; Grundberg, Elin; Gauguier, Dominique; Orwoll, Eric S.; Karasik, David; Davey-Smith, George; Smith, Albert V.; Siggeirsdottir, Kristin; Harris, Tamara B.; Zillikens, M. Carola; van Meurs, Joyce B. J.; Thorsteinsdottir, Unnur; Maurano, Matthew T.; Timpson, Nicholas J.; Soranzo, Nicole; Durbin, Richard; Wilson, Scott G.; Ntzani, Evangelia E.; Brown, Matthew A.; Stefansson, Kari; Hinds, David A.; Spector, Tim; Cupples, L. Adrienne; Ohlsson, Claes; Greenwood, Celia M. T.; Jackson, Rebecca D.; Rowe, David W.; Loomis, Cynthia A.; Evans, David M.; Ackert-Bicknell, Cheryl L.; Joyner, Alexandra L.; Duncan, Emma L.; Kiel, Douglas P.; Rivadeneira, Fernando; Richards, J. Brent

    2015-01-01

    The extent to which low-frequency (minor allele frequency (MAF) between 1-5%) and rare (MAF <= 1%) variants contribute to complex traits and disease in the general population is mainly unknown. Bone mineral density (BMD) is highly heritable, a major predictor of osteoporotic fractures, and has been

  12. 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...... (new allopurinol users) and 86,039 age, sex and propensity score matched controls (not exposed to allopurinol or with a gout diagnosis), with no diagnosis of malignancy in the year prior. RESULTS: We found a modest adjusted effect of allopurinol prescription on major osteoporotic fractures (hazard...... 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...

  13. Kyphoplasty via unilateral extrapedicular approach for the treatment of osteoporotic thoracic compression fractures

    International Nuclear Information System (INIS)

    Zhou Feng; Yang Huilin; Gan Minfeng; Zou Jun; Jiang Weimin; Chen Liang; Tang Tiansi

    2010-01-01

    Objective: To explore the feasibility and safety of kyphoplasty via unilateral extrapedicular approach for the treatment of osteoporotic thoracic compression fractures. Methods: A total of 16 patients with painful osteoporotic thoracci fractures were treated by kyphoplasty via unilateral extrapedicular approach. Pain was measured using the self-reporting visual analogue scale (VAS) preoperatively, postoperatively and in the final follow-up. Disability was measured using the Oswestry disability index (ODI) preoperatively, postoperatively and in the final follow-up. The height of the compromised vertebral body, the kyphotic angle were measured preoperatively, postoperatively and in the final follow-up. Results: Operations were completed smoothly, with the exception of 1 patients with less cement leakage but there was no clinical symptom occurred. The other one had intercostal neuralgia. Relief of pain was achieved in 24 hours post-operation. The mean operation time was 31minutes and the mean fluoroscopic time was 19.1. And the mean VAS score of these patients decreased from 8.2 ± 1.1 pre-operatively to 2.6 ± 0.8 post-operatively (P<0.05), and it improved further to 2.8 ± 1.1 in the final follow-up. The ODI score varied from 69.2 ± 1.2 pre-operatively to 32.2 ± 1.1 post-operatively (P<0.05). Improvement was maintained in the final follow-up. Comparing the height of anterior vertebrae (Ha), the height of midline vertebrae (Hm) and the kyphotic angle between pre-and post-operation there was no statistical significant difference. Conclusion: Kyphoplasty via unilateral extrapedicular approach for the treatment of osteoporotic thoracic compression fractures is effective. It can help reducing the radiation exposure. (authors)

  14. Influence of bone mineral density measurement on fracture risk assessment tool® scores in postmenopausal Indian women.

    Science.gov (United States)

    Daswani, Bhavna; Desai, Meena; Mitra, Sumegha; Gavali, Shubhangi; Patil, Anushree; Kukreja, Subhash; Khatkhatay, M Ikram

    2016-03-01

    Fracture risk assessment tool® calculations can be performed with or without addition of bone mineral density; however, the impact of this addition on fracture risk assessment tool® scores has not been studied in Indian women. Given the limited availability and high cost of bone mineral density testing in India, it is important to know the influence of bone mineral density on fracture risk assessment tool® scores in Indian women. Therefore, our aim was to assess the contribution of bone mineral density in fracture risk assessment tool® outcome in Indian women. Apparently healthy postmenopausal Indian women (n = 506), aged 40-72 years, without clinical risk factors for bone disease, were retrospectively selected, and their fracture risk assessment tool® scores calculated with and without bone mineral density were compared. Based on WHO criteria, 30% women were osteoporotic, 42.9% were osteopenic and 27.1% had normal bone mineral density. Fracture risk assessment tool® scores for risk of both major osteoporotic fracture and hip fracture significantly increased on including bone mineral density (P women eligible without bone mineral density was 0 and with bone mineral density was 1, P > 0.05, whereas, for hip fracture risk number of women eligible without bone mineral density was 2 and with bone mineral density was 17, P Indian women. © The Author(s) 2016.

  15. Community osteoporosis screening services for the prevention of osteoporotic fractures in population health: a literature review.

    Science.gov (United States)

    Nguyen, Vu H

    2017-06-01

    To determine the implications of the reviewed literature in population health improvement. A review of the literature was conducted with the search of four databases: PubMed, PsycINFO, ERIC, and Google Scholar. Search terms entered into these databases were 'osteoporosis community'. After a thorough review of all search results, 11 studies were found to be community osteoporosis screening services, and descriptions of each study's participants and location, details and descriptions of each study's community osteoporosis screening service, and effectiveness on outcome measure(s) for each study's objective were reviewed and examined to determine their implications on population health. Nine of the 11 studies on community osteoporosis screening services were conducted at community pharmacy settings, and all studies included participants that were all or mostly older women, with only three studies that included men as participants. In addition to osteoporosis screening, all studies included osteoporosis education and/or counseling with the exception of one study. Various outcome measures were assessed in these studies, and with the exception of osteoporosis treatment adherence, weight-bearing exercise and osteoporosis-specified quality of life, community osteoporosis screening services showed positive outcomes in increasing osteoporosis awareness, osteoporosis knowledge, osteoporosis risk identification, calcium intake, service satisfaction, primary care physician perspective, and financial sustainability. In particular, community osteoporosis screening services are helpful in identifying those with osteoporosis or are at moderate risk to high risk, and they are effective in increasing outcomes that help prevent osteoporotic fractures, such as osteoporosis medication prescription and calcium intake. Furthermore, participants feel satisfied in partaking in community osteoporosis screening services, primary care physicians do believe that they are useful, and they are

  16. Fragility fractures and bone remodeling in type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Tatiana O. Yalochkina

    2017-11-01

    Full Text Available Fracture risk is significantly increased in both type 1 and type 2 diabetes and individuals with diabetes experience worse fracture outcomes compared to normoglycemic individuals. Patients with T1DM have decreased bone mineral density (BMD, whereas patients with T2DM demonstrate increased BMD compared to healthy control. The latest studies show increased incidence of low-traumatic fractures in patients with T2DM instead of high bone mineral density (BMD. The risk of osteoporotic fractures in patients with T2DM can be explained by disease complications and increased risk of falls and consequent trauma. However, the most important cause of bone fragility in T2DM is the deterioration in bone microarchitecture, the mechanism of which is not completely understood. High BMD in patients with T2DM does not allow us to use dual-energy X-ray-absorptiometry as a “gold standard” test for diagnosticsof osteoporosis. Consequently,new risk factors and diagnostic algorithm as well as treatment strategy should be developed for patients with T2DM. In addition to this, some researchers considered that the group of T2DM is geterogenous and physicians might face patients with osteoporosis and mild diabetes that add very little to bone fragility; patients with osteoporosis and moderate or severe diabetes which also affects bone tissue –diabetoosteoporosis; and patients without osteoporosis but severe diabetes which cause bone tissue deterioration with the development of diabetic bone disease. New diagnostic tools and algorithm and new experimental research are needed for better understanding bone deterioration in patients with T2DM. This review summarizes our current knowledge on fracture rate, risk factors for fractures and causes of bone deterioration in subjects with T2DM.

  17. Piper sarmentosum enhances fracture healing in ovariectomized osteoporotic rats: a radiological study

    Directory of Open Access Journals (Sweden)

    Mohamed Abdalla Estai

    2011-01-01

    Full Text Available INTRODUCTION: Osteoporotic fractures are common during osteoporotic states. Piper sarmentosum extract is known to possess antioxidant and anti-inflammatory properties. OBJECTIVES: To observe the radiological changes in fracture calluses following administration of a Piper sarmentosum extract during an estrogen-deficient state. METHODS: A total of 24 female Sprague-Dawley rats (200-250 g were randomly divided into 4 groups: (i the sham-operated group; (ii the ovariectomized-control group; (iii the ovariectomized + estrogen-replacement therapy (ovariectomized-control + estrogen replacement therapy group, which was supplemented with estrogen (100 μg/kg/day; and (iv the ovariectomized + Piper sarmentosum (ovariectomized + Piper sarmentosum group, which was supplemented with a water-based Piper sarmentosum extract (125 mg/kg. Six weeks after an ovariectomy, the right femora were fractured at the mid-diaphysis, and a K-wire was inserted. Each group of rats received their respective treatment for 6 weeks. Following sacrifice, the right femora were subjected to radiological assessment. RESULTS: The mean axial callus volume was significantly higher in the ovariectomized-control group (68.2 + 11.74 mm³ than in the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups (20.4 + 4.05, 22.4 + 4.14 and 17.5 + 3.68 mm³, respectively. The median callus scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups had median (range, minimum - maximum value as 1.0 (0 - 2, 1.0 (1 - 2 and 1.0 (1 - 2, respectively, which were significantly lower than the ovariectomized-control group score of 2.0 (2 - 3. The median fracture scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups were 3.0 (3 - 4, 3.0 (2 - 3 and 3.0 (2 - 3, respectively, which were significantly higher than the ovariectomized-control group score of 2.0 (1 - 2 (p<0.05. CONCLUSION: The Piper sarmentosum extract improved

  18. Measuring health-related quality of life in men with osteoporosis or osteoporotic fracture

    Directory of Open Access Journals (Sweden)

    Solà Silvia

    2011-10-01

    Full Text Available Abstract Background Osteoporosis is a serious health problem that worsens the quality of life and the survival rate of individuals with this disease on account the osteoporotic fractures. Studies have long focused on women, and its presence in men has been underestimated. While many studies conducted in different countries mainly assess health-related quality of life and identify fracture risks factors in women, few data are available on a Spanish male population. Methods/Design Observational study. Study population Men ≥ 40 years of age with/without diagnosed osteoporosis and with/without osteoporotic fracture included by their family doctor. Measurements The relationship between customary clinical risk factors for osteoporotic fracture and health-related quality of life in a Spanish male population. A telephone questionnaire on health-related quality of life is made. Statistical analysis The association between qualitative variables will be assessed by the Chi-square test. The distribution of quantitative variables by Student's t-test. If the conditions for using this test are not met, the non-parametric Mann-Whitney's U test will be used. The validation of the results obtained by the FRAX™ tool will be performed by way of the Hosmer-Lemeshow test and by calculating the area under the Receiver Operating Characteristic (ROC curve (AUC. All tests will be performed with a confidence intervals set at 95%. Discussion The applicability and usefulness of Health-related quality of life (HRQOL studies are well documented in many countries. These studies allow implementing cost-effective measures in cases of a given disease and reducing the costly consequences derived therefrom. This study attempts to provide objective data on how quality of life is affected by the clinical aspects involved in osteoporosis in a Spanish male population and can be useful as well in cost utility analyses conducted by health authorities. The sample selected is not based

  19. Piper sarmentosum enhances fracture healing in ovariectomized osteoporotic rats: a radiological study.

    Science.gov (United States)

    Estai, Mohamed Abdalla; Suhaimi, Farihah Haji; Das, Srijit; Fadzilah, Fazalina Mohd; Alhabshi, Sharifah Majedah Idrus; Shuid, Ahmad Nazrun; Soelaiman, Ima-Nirwana

    2011-01-01

    Osteoporotic fractures are common during osteoporotic states. Piper sarmentosum extract is known to possess antioxidant and anti-inflammatory properties. To observe the radiological changes in fracture calluses following administration of a Piper sarmentosum extract during an estrogen-deficient state. A total of 24 female Sprague-Dawley rats (200-250 g) were randomly divided into 4 groups: (i) the sham-operated group; (ii) the ovariectomized-control group; (iii) the ovariectomized + estrogen-replacement therapy (ovariectomized-control + estrogen replacement therapy) group, which was supplemented with estrogen (100 μg/kg/day); and (iv) the ovariectomized + Piper sarmentosum (ovariectomized + Piper sarmentosum) group, which was supplemented with a water-based Piper sarmentosum extract (125 mg/kg). Six weeks after an ovariectomy, the right femora were fractured at the mid-diaphysis, and a K-wire was inserted. Each group of rats received their respective treatment for 6 weeks. Following sacrifice, the right femora were subjected to radiological assessment. The mean axial callus volume was significantly higher in the ovariectomized-control group (68.2 ± 11.74 mm³) than in the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups (20.4 ± 4.05, 22.4 ± 4.14 and 17.5 ± 3.68 mm³, respectively). The median callus scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups had median (range, minimum - maximum value) as 1.0 (0 - 2), 1.0 (1 - 2) and 1.0 (1 - 2), respectively, which were significantly lower than the ovariectomized-control group score of 2.0 (2 - 3). The median fracture scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups were 3.0 (3 - 4), 3.0 (2 - 3) and 3.0 (2 - 3), respectively, which were significantly higher than the ovariectomized-control group score of 2.0 (1 - 2) (pPiper sarmentosum extract improved fracture healing, as assessed by the reduced callus volumes and

  20. The association between osteoporotic hip fractures and actinic lesions as a biomarker for cumulative sun exposure in older people-a retrospective case-control study in Argentina.

    Science.gov (United States)

    Perroud, H A; Dagatti, M S; Amigot, B; Levit, G P; Tomat, M F; Morosano, M E; Masoni, A M; Pezzotto, S M

    2017-05-01

    The aim of this study was to analyze the association between the presence of actinic lesions (solar keratosis and non-melanoma skin cancer) and osteoporotic hip fractures in older patients. Both pathologies are common conditions in this age group. Since cumulative sun exposure is difficult to quantify, the presence of actinic lesions can be used to indirectly analyze the association between ultraviolet radiation and osteoporotic hip fractures. This was an observational case-control study. We reviewed the centralized medical records of patients with hip fracture (cases, n = 51) and patients with other diseases hospitalized in the same institution and period (controls, n = 59). The mean age of the patients was 80 ± 8.3 years (range 50-103 years). Differences in maternal hip fracture history were found between cases and controls (14.8 and 8 %, respectively; p = 0.047). Falls history in the past year was higher in cases than in controls (p < 0.0001). Actinic lesions were observed in 32.7 % of patients (prevalence rate 23.5 % in cases, 40.7 % in controls; p = 0.04). When considering patients with actinic lesions, controls have a higher FRAX score compared with cases. Although sun exposure is recommended for bone health, it represents a risk factor for actinic lesions. The presence of actinic lesions may indicate a lower osteoporotic hip fracture risk. A balance between adequate lifetime sun exposure and protection against its adverse effects is required for each patient, in the context of geographic location.

  1. Association of stressful life events with incident falls and fractures in older men: the Osteoporotic Fractures in Men (MrOS) Study

    Science.gov (United States)

    Fink, Howard A.; Kuskowski, Michael A.; Marshall, Lynn M.

    2014-01-01

    Background: small, retrospective studies suggest that major life events and/or sudden emotional stress may increase fall and fracture risk. The current study examines these associations prospectively. Methods: a total of 5,152 men aged ≥65 years in the Osteoporotic Fractures in Men study self-reported data on stressful life events for 1 year prior to study Visit 2. Incident falls and fractures were ascertained for 1 year after Visit 2. Fractures were centrally confirmed. Results: a total of 2,932 (56.9%) men reported ≥1 type of stressful life event. In men with complete stressful life event, fall and covariate data (n = 3,949), any stressful life event was associated with a 33% increased risk of incident fall [relative risk (RR) 1.33, 95% confidence interval (CI) 1.19–1.49] and 68% increased risk of multiple falls (RR = 1.68, 95% CI = 1.40–2.01) in the year following Visit 2 after adjustment for age, education, Parkinson's disease, diabetes, stroke, instrumental activities of daily living (IADL) impairment, chair stand time, walk speed, multiple past falls, depressive symptoms and antidepressant use. Risk increased with the number of types of stressful life events. Though any stressful life event was associated with a 58% increased age-adjusted risk for incident fracture, this association was attenuated and no longer statistically significant after additional adjustment for total hip bone mineral density, fracture after age 50, Parkinson's disease, stroke and IADL impairment. Conclusions: in this cohort of older men, stressful life events significantly increased risk of incident falls independent of other explanatory variables, but did not independently increase incident fracture risk. PMID:24002237

  2. Image diagnosis of nasal bone fracture

    International Nuclear Information System (INIS)

    Hirota, Yoshiharu; Shimizu, Yayoi; Iinuma, Toshitaka.

    1988-01-01

    Twenty cases of nasal bone fractures were evaluated as to the types of fractures based upon HRCT findings. Conventional X-Ray films for nasal bones were analyzed and compared with HRCT findings. Nasal bone fractures were classified into lateral and frontal fractures. HRCT images were evaluated in three planes including upper, middle and lower portions of the nasal bone. Fractures favored males of teens. Lateral fracture gave rise to the fractures of the nasal bone opposite to the external force, loosening of the ipsilateral nasomaxillary sutures and fractures of the frontal process of the maxilla. Conventional X-Ray films were reevaluated after HRCT evaluation and indications of nasal bone fractures were determined. In addition to the discontinuity of the nasal dorsum, fracture lines parallel to and beneath the nasal dorsum and indistinct fracture lines along the nasomaxillary sutures are the indication of nasal bone fractures by conventional X-Ray films. (author)

  3. Cement augmentation of implants--no general cure in osteoporotic fracture treatment. A biomechanical study on non-displaced femoral neck fractures.

    Science.gov (United States)

    Hofmann-Fliri, Ladina; Nicolino, Tomas I; Barla, Jorge; Gueorguiev, Boyko; Richards, R Geoff; Blauth, Michael; Windolf, Markus

    2016-02-01

    Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non-displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut-out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non-augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load-cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non-augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non-displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  4. Ballistic fractures: indirect fracture to bone.

    Science.gov (United States)

    Dougherty, Paul J; Sherman, Don; Dau, Nathan; Bir, Cynthia

    2011-11-01

    Two mechanisms of injury, the temporary cavity and the sonic wave, have been proposed to produce indirect fractures as a projectile passes nearby in tissue. The purpose of this study is to evaluate the temporal relationship of pressure waves using strain gauge technology and high-speed video to elucidate whether the sonic wave, the temporary cavity, or both are responsible for the formation of indirect fractures. Twenty-eight fresh frozen cadaveric diaphyseal tibia (2) and femurs (26) were implanted into ordnance gelatin blocks. Shots were fired using 9- and 5.56-mm bullets traversing through the gelatin only, passing close to the edge of the bone, but not touching, to produce an indirect fracture. High-speed video of the impact event was collected at 20,000 frames/s. Acquisition of the strain data were synchronized with the video at 20,000 Hz. The exact time of fracture was determined by analyzing and comparing the strain gauge output and video. Twenty-eight shots were fired, 2 with 9-mm bullets and 26 with 5.56-mm bullets. Eight indirect fractures that occurred were of a simple (oblique or wedge) pattern. Comparison of the average distance of the projectile from the bone was 9.68 mm (range, 3-20 mm) for fractured specimens and 15.15 mm (range, 7-28 mm) for nonfractured specimens (Student's t test, p = 0.036). In this study, indirect fractures were produced after passage of the projectile. Thus, the temporary cavity, not the sonic wave, was responsible for the indirect fractures.

  5. Assessment of osteoporotic vertebral fractures using specialized workflow software for 6-point morphometry

    International Nuclear Information System (INIS)

    Guglielmi, Giuseppe; Palmieri, Francesco; Placentino, Maria Grazia; D'Errico, Francesco; Stoppino, Luca Pio

    2009-01-01

    Purpose: To evaluate the time required, the accuracy and the precision of a model-based image analysis software tool for the diagnosis of osteoporotic fractures using a 6-point morphometry protocol. Materials and methods: Lateral dorsal and lumbar radiographs were performed on 92 elderly women (mean age 69.2 ± 5.7 years). Institutional review board approval and patient informed consent were obtained for all subjects. The semi-automated and the manual correct annotations of 6-point placement were compared to calculate the time consumed and the accuracy of the software. Twenty test images were randomly selected and the data obtained by multiple perturbed initialisation points on the same image were compared to assess the precision of the system. Results: The time requirement data of the semi-automated system (420 ± 67 s) were statistically different (p < 0.05) from that of manual placement (900 ± 77 s). In the accuracy test, the mean reproducibility error for semi-automatic 6-point placement was 2.50 ± 0.72% [95% CI] for the anterior-posterior reference and 2.16 ± 0.5% [95% CI] for the superior-inferior reference. In the precision test the mean error resulted averaged over all vertebrae was 2.6 ± 1.3% in terms of vertebral width. Conclusions: The technique is time effective, accurate and precise and can, therefore, be recommended in large epidemiological studies and pharmaceutical trials for reporting of osteoporotic vertebral fractures.

  6. Serial MRI findings of osteoporotic vertebral fractures in the thoracic and lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Yoshitaka; Henmi, Tatsuhiko; Sakamoto, Rintaro; Hiasa, Masahiko [Health Insurance Naruto Hospital, Tokushima (Japan)

    1998-12-01

    The prognosis of osteoporotic vertebral fractures in the thoracic and lumbar spine was studied by serial MRI findings. This study covered 80 vertebrae in 69 patients treated conservatively and followed-up for more than six months (23 males and 46 females, average age 70 yrs). Group A, characterized by poor diagnostic imaging, consisted of patients who had both severely collapsed vertebra which was progressive in the lateral roentgenogram and delayed improvement in MRI signal intensities. Group B, consisting of poor clinical prognosis, comprised patients with persistent back pain. The predictive factors for Group A were found to be T{sub 1}-low finding over the entire vertebra within one month after injury and fractures of Th{sub 12} or L{sub 1} vertebra. Areas of T{sub 1}-low and T{sub 2}-low intensity adjacent to the vertebral disc presented no improvement in signal intensity and often caused persistent back pain. (author)

  7. Serial MRI findings of osteoporotic vertebral fractures in the thoracic and lumbar spine

    International Nuclear Information System (INIS)

    Hamada, Yoshitaka; Henmi, Tatsuhiko; Sakamoto, Rintaro; Hiasa, Masahiko

    1998-01-01

    The prognosis of osteoporotic vertebral fractures in the thoracic and lumbar spine was studied by serial MRI findings. This study covered 80 vertebrae in 69 patients treated conservatively and followed-up for more than six months (23 males and 46 females, average age 70 yrs). Group A, characterized by poor diagnostic imaging, consisted of patients who had both severely collapsed vertebra which was progressive in the lateral roentgenogram and delayed improvement in MRI signal intensities. Group B, consisting of poor clinical prognosis, comprised patients with persistent back pain. The predictive factors for Group A were found to be T 1 -low finding over the entire vertebra within one month after injury and fractures of Th 12 or L 1 vertebra. Areas of T 1 -low and T 2 -low intensity adjacent to the vertebral disc presented no improvement in signal intensity and often caused persistent back pain. (author)

  8. [Epidemiology of the osteoporotic fracture of the hip in the province of Palencia].

    Science.gov (United States)

    Arboleya, L R; Castro, M A; Bartolomé, E; Gervás, L; Vega, R

    1997-09-01

    Hip fracture is the most severe consequence of osteoporosis. The aim of the present study was to know the incidence of osteoporotic hip fracture in the Palencia province, its direct economical consequences and characteristics associated with the origin episode. All patients aged over 49 years who had a nontraumatic hip fracture during the second semester of 1994 and the first semester of 1995 were included in the study. An analysis of costs was performed and each patient received a questionnaire to know the circumstances associated with the episode. During the study period the overall incidence of hip fracture was 83/100,000 inhabitants/year, which corresponds to an adjusted incidence of 240.9/100,000 inhabitants older than 49 years (336.8 women and 120.7 men). There was an exponential growth, with peak values starting at 80 years. The female/male ratio was 2.8 and the mean age 80.8 years. Twenty-four percent of fractures occurred in institutionalized persons, with an adjusted incidence of 1,107/100,000 inhabitants/year, which corresponds to a relative risk of 13.57 (95% CI: 10.06-18.28). No significant differences were observed between trochanteric and neck fractures. Ninety-seven percent of fractures occurred after a fall, usually in the morning or afternoon (86%), with lateral direction and impact on the greater trochanter (89%). The mortality rate during admission was 5.9%. The mean cost of care during admission was 1,170,000 pesetas. The incidence of hip fracture in Palencia is slightly higher than the national mean, probably due to populational ageing. The risk of fracture reaches alarming proportions in the institutionalized population. The implementation of efficient preventive measures, particularly among the exposed populations, is necessary.

  9. Characteristics of patients who suffer major osteoporotic fractures despite adhering to alendronate treatment

    DEFF Research Database (Denmark)

    Abrahamsen, B; Rubin, K H; Eiken, Pia Agnete

    2013-01-01

    .03-1.06, for each drug). Dementia (HR 1.81, 95 % CI 1.18-2.78), prior fracture (one: HR 1.17, 95 % CI 1.02-1.34; multiple: HR 1.34, 95 % CI 1.08-1.67), and ulcer disease (HR 1.45, 95 % CI 1.04-2.03) also increased the risk. Diabetes did not influence fracture risk, nor did rheumatic disorders. The risk was lower...... and associations may not be causal, it may be prudent to include dementia, ulcer disease, and Parkinson's disease to capture the risk of fractures on treatment. Lower risk in patients treated with glucocorticoids and in men probably reflects a lower treatment threshold related to guidelines.......Antiresorptive treatment reduces the risk of fractures, but most patients remain at elevated risk. We used health registers to identify predictors of new major osteoporotic fractures in patients adhering to alendronate. Risk factors showed a different pattern than in the general population...

  10. The healing of fractured bones

    Energy Technology Data Exchange (ETDEWEB)

    Bacon, G E [Central Electricity Generating Board, Cheltenham (United Kingdom)

    1997-04-01

    A method utilising neutron beams of width 1 mm, used on D1B (2.4 A) and D20 (1.3 A) to study the healing of fractured bones is presented. It is found that the callus bone uniting the fractured tibia of a sheep, whose healing had been encouraged by daily mechanical vibration over a period of three months, showed no trace of the large preferential vertical orientation of the apatite crystals which is characteristic of the normal bone. Nevertheless the bone had regained about 60% of its mechanical strength and the callus bone, although not oriented, was well crystallized. It is considered that the new monochromator for D20, expected to give increased intensity at 2.5 A, will be of considerable advantage. (author). 2 refs.

  11. Bone shortening of clavicular fractures

    DEFF Research Database (Denmark)

    Thorsmark, A H; Muhareb Udby, P; Ban, I

    2017-01-01

    BACKGROUND: The indication for operative treatment of clavicular fractures with bone shortening over 2 cm is much debated. Correct measurement of clavicular length is essential, and reliable measures of clavicular length are therefore highly requested by clinical decision-makers. The aim of this ......BACKGROUND: The indication for operative treatment of clavicular fractures with bone shortening over 2 cm is much debated. Correct measurement of clavicular length is essential, and reliable measures of clavicular length are therefore highly requested by clinical decision-makers. The aim......-fracture bone lengthening that indicated methodological problems. The Hill et al. and Silva et al. methods had high minimal detectable change, making their use unreliable. CONCLUSION: As all three measurement methods had either reliability or methodological issues, we found it likely that differences...

  12. Factors related to mortality after osteoporotic hip fracture treatment at Chiang Mai University Hospital, Thailand, during 2006 and 2007.

    Science.gov (United States)

    Chaysri, Rathasart; Leerapun, Taninnit; Klunklin, Kasisin; Chiewchantanakit, Siripong; Luevitoonvechkij, Sirichai; Rojanasthien, Sattaya

    2015-01-01

    To investigate the one-year mortality rate after osteoporotic hip fracture and to identify factors associated with that mortality rate. A retrospective review of 275 osteoporotic patients who sustained a low-trauma hip fracture and were admitted in Chiang Mai University Hospital during January 1, 2006 to December 31, 2007 was accomplished. Eligibility criteria were defined as age over 50 years, fracture caused by a simple fall and not apathologicalfracture caused by cancer or infection. Results of this one-year mortality rate study were compared to studies of hip fracture patient mortality in 1997 and the period 1998-2003. The average one-year mortality rate in 2006-2007 was 21.1%. Factors correlated with higher mortality were non-operative treatment, delayed surgical treatment, and absence of medical treatment for osteoporosis. The 2006-2007 mortality rate was slightly higher than for the 1997 and 1998-2003 periods. The one-year mortality rate after osteoporotic hip fracture of 21.1% was approximately 9.3 times the mortality rate for the same age group in the general population, indicating that treatment of osteoporosis as a means of helping prevent hip fracture is very important for the individual, the family, and society as a whole.

  13. Local Application of Growth Hormone to Enhance Osseointegration in Osteoporotic Bones: A Morphometric and Densitometric Study.

    Science.gov (United States)

    Martin-Monge, Elena; Tresguerres, Isabel F; Clemente, Celia; Tresguerres, Jesús Af

    The aim of this study was to assess the effect of local application of growth hormone on osseointegration of dental implants inserted in osteoporotic bones. Twenty female New Zealand rabbits were used in this study. Ten were ovariectomized and fed a low-calcium diet for 6 weeks, and the others remained intact. A titanium implant was inserted into each tibia, in both groups. In half of the rabbits, 2 IU of growth hormone was placed into the ostectomy prior to the implant insertion. Two weeks after implant surgery, all animals were sacrificed. Tibiae were dissected from soft tissues, and included in methacrylate to be studied under light microscopy. Bone-to-implant contact (BIC) and bone mineral density (BMD) were measured by morphometric and densitometric analysis, respectively. Multifactorial analysis of variance (ANOVA) was used for statistical evaluation. P growth hormone was able to increase the BIC in the ovariectomized group, with statistically significant differences with respect to the control group (P growth hormone at the moment of titanium implant insertion in rabbit tibiae significantly enhanced the BIC around titanium implants 15 days after the implantation in this experimental osteoporotic animal model, without affecting the BMD.

  14. 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......Med, Embase and Cochrane databases for papers and evaluated these with respect to methodological quality using the QUADAS checklist. A total of 48 tools were identified, 20 had been externally validated, however only 6 tools had been tested more than once in a population-based setting with acceptable...

  15. Synergistic effects of bisphosphonate and calcium phosphate nanoparticles on peri-implant bone responses in osteoporotic rats.

    Science.gov (United States)

    Alghamdi, Hamdan S; Bosco, Ruggero; Both, Sanne K; Iafisco, Michele; Leeuwenburgh, Sander C G; Jansen, John A; van den Beucken, Jeroen J J P

    2014-07-01

    The prevalence of osteoporosis will increase within the next decades due to the aging world population, which can affect the bone healing response to dental and orthopedic implants. Consequently, local drug targeting of peri-implant bone has been proposed as a strategy for the enhancement of bone-implant integration in osteoporotic conditions. In the present study, an established in-vivo femoral condyle implantation model in osteoporotic and healthy bone is used to analyze the osteogenic capacity of titanium implants coated with bisphosphonate (BP)-loaded calcium phosphate nanoparticles (nCaP) under compromised medical conditions. After 4 weeks of implantation, peri-implant bone volume (%BV; by μCT) and bone area (%BA; by histomorphometry) were significantly increased within a distance of 500 μm from implant surfaces functionalized with BP compared to control implants in osteoporotic and healthy conditions. Interestingly, the deposition of nCaP/BP coatings onto implant surfaces increased both peri-implant bone contact (%BIC) and volume (%BV) compared to the deposition of nCaP or BP coatings individually, in osteoporotic and healthy conditions. The results of real-time PCR revealed similar osteogenic gene expression levels to all implant surfaces at 4-weeks post-implantation. In conclusion, simultaneous targeting of bone formation (by nCaP) and bone resorption (by BP) using nCaP/BP surface coatings represents an effective strategy for synergistically improvement of bone-implant integration, especially in osteoporotic conditions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. 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.

  17. Evaluation of osteoporotic bone structure through synchrotron radiation X-ray microfluorescence images

    Energy Technology Data Exchange (ETDEWEB)

    Lima, I. [Nuclear Engineering Program/COPPE/UFRJ, P.O. Box 68509, Av. Horacio Macedo 2030, Sala I-133, Cidade Universitaria, 21941-914 Rio de Janeiro, RJ (Brazil)], E-mail: inaya@lin.ufrj.br; Anjos, M.J. [Nuclear Engineering Program/COPPE/UFRJ, P.O. Box 68509, Av. Horacio Macedo 2030, Sala I-133, Cidade Universitaria, 21941-914 Rio de Janeiro, RJ (Brazil); Physics Institute, UERJ (Brazil); Farias, M.L.F. [University Hospital, UFRJ (Brazil); Pantaleao, T.U.; Correa da Costa, V.M. [Biophysics Institute, UFRJ (Brazil); Lopes, R.T. [Nuclear Engineering Program/COPPE/UFRJ, P.O. Box 68509, Av. Horacio Macedo 2030, Sala I-133, Cidade Universitaria, 21941-914 Rio de Janeiro, RJ (Brazil)

    2008-12-15

    The abnormal accumulation or deficiency of trace elements may theoretically impair the formation of bone and contribute to osteoporosis. In this context, the knowledge of major and trace elements is very important in order to clarify many issues regarding diseases of the bone, such as osteoporosis, that remain unresolved. Several kinds of imaging techniques can be useful to access morphology and the minerals present in osteoporotic bones. In this work, synchrotron radiation X-ray microfluorescence was used as an X-ray imaging technique to investigate bone structures. Therefore, this research aims to improve the knowledge about some aspects of bone quality. The measurements were carried out at the Brazilian Synchrotron Laboratory Light Laboratory, in Brazil. A white beam with an energy range of 4-23 keV, a 45 deg./45 deg. geometry and a capillary optics were used. It was demonstrated that bone quality can and must be evaluated not only by considering the architecture of bones but also by taking into account the concentration and the distribution of minerals. Our results showed that the elemental distributions in bone zones on a micron scale were very helpful to understand functions in those structures.

  18. Functional outcome following tibio-talar-calcaneal nailing for unstable osteoporotic ankle fractures.

    Science.gov (United States)

    Jonas, S C; Young, A F; Curwen, C H; McCann, P A

    2013-07-01

    Fragility fractures of the ankle are increasing in incidence. Such fractures typically occur from low-energy injuries but lead to disproportionately high levels of morbidity. Ankle fractures in this age group are managed conservatively in plaster or by open reduction and internal fixation. Both modalities have shown high rates of failure in terms of delayed union or mal-union together with perioperative complications such as implant failure and wound breakdown. The optimal treatment of these patients remains controversial. We aimed to review the functional outcome of patients with ankle fragility fractures primarily managed using a tibio-talar-calcaneal nail (TTC). We retrospectively reviewed 31 consecutive patients primarily managed with a TCC nail for osteoporotic fragility fractures about the ankle. Data were collected via case notes, radiographic reviews and by clinical reviews at the outpatient clinic or a telephone follow-up. Information regarding patient characteristics, indication for operation, Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture classification, operative and postoperative complications, time to radiographic union and current clinical state including Olerud and Molander scores were recorded (as a measure of ankle function). Nine of 31 patients had died by the time of follow-up. Mean preoperative and postoperative Olerud and Molander scores were 56 and 45, respectively. There were no postoperative wound complications. Twenty-nine of 31 patients returned to the same level of mobility as pre-injury. There were three peri-prosthetic fractures managed successfully with nail removal and replacement or plaster cast. There were two nail failures, both in patients who mobilised using only a stick, which were managed by nail removal. Ten of 31 patients were not followed up radiographically due to either infirmity or death. Thirteen of 21 followed up radiographically had evidence of union and 8/21 had none. None, however, had clinical evidence

  19. Percutaneous vertebroplasty in the therapy of osteoporotic vertebral compression fractures: a critical review

    International Nuclear Information System (INIS)

    Hochmuth, K.; Proschek, D.; Schwarz, W.; Mack, M.; Vogl, T.J.; Kurth, A.A.

    2006-01-01

    Percutaneous vertebroplasty has become an efficient technique for the treatment of painful vertebral fractures. Osteoporotic vertebral compression fractures are characterized by severe back pain and immobilization causing other complications like thrombosis or pneumonia. Vertebral cement augmentation provides increased strength of the vertebral body and an obvious pain relief. Between 1989 and 2004, 30 studies and a total of 2,086 treated patients have been published in literature. A review of these studies has been performed. The number and age of the patients, number of treated vertebrae, pre- and postoperative outcome of pain and complications of the different studies were assessed and analyzed. Percutaneous vertebroplasty is an efficient technique with low complication rates and a significant reduction in pain. It rapidly improves the mobility and quality of life of patients with vertebral compression fractures. With an increasing number of treated patients, experience with this interventional technique has become excellent. But still there are no randomized controlled trials available, showing that percutaneous vertebroplasty has a significantly better outcome than other treatment options, especially after a long-term follow-up. (orig.)

  20. Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013

    Directory of Open Access Journals (Sweden)

    Zhao Xie

    2015-01-01

    Full Text Available Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123 who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%, followed by vertebral fracture (34.2%. The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients’ ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture.

  1. Effects of focal vibration on bone mineral density and motor performance of postmenopausal osteoporotic women.

    Science.gov (United States)

    Brunetti, O; Botti, F M; Brunetti, A; Biscarini, A; Scarponi, A M; Filippi, G M; Pettorossi, V E

    2015-01-01

    This randomized double blind controlled study is aimed at determining the effect of repeated vibratory stimuli focally applied to the contracted quadriceps muscles (repeated muscle vibration=rMV) on bone mineral density, leg power and balance of postmenopausal osteoporotic women. The study has been conducted on 40 voluntary postmenopausal osteoporotic women, randomised at 2 groups for rMV treatment and for control. The treatment group underwent rMV (100Hz, 300-500 μm; three applications per day, each lasting 10-minutes, for 3 consecutive days) applied to voluntary contracted quadriceps (VC=vibrated and contracted group). The control group, received a sham stimulation on contracted quadriceps (NV=non vibrated group). Bone mineral density T-score of proximal femur of the participants, was evaluated in two weeks before and 360 days after intervention; body balance and explosive leg power were measured 1 day before, 30 days and 360 days after treatment. VC group T-score at one year didn't change significantly relative to baseline values (pretreatment: -2.61±0.11, post-treatment -2.62±0.13); conversely in NV subjects T-score decreased significantly from -2.64 ± 0.15 SD down to -2.99 ± 0.28 SD. A significant improvement of balance and explosive leg power was observed only in VC group at 30 and 360 days after the intervention. We conclude that rMV is a safe, short-lasting and non-invasive treatment that can significantly and persistently improve muscle performance and can effectively counteract progressive demineralisation in postmenopausal and osteoporotic women.

  2. A Rare Nasal Bone Fracture: Anterior Nasal Spine Fracture

    Directory of Open Access Journals (Sweden)

    Egemen Kucuk

    2014-04-01

    Full Text Available Anterior nasal spine fractures are a quite rare type of nasal bone fractures. Associated cervical spine injuries are more dangerous than the nasal bone fracture. A case of the anterior nasal spine fracture, in a 18-year-old male was presented. Fracture of the anterior nasal spine, should be considered in the differential diagnosis of the midface injuries and also accompanying cervical spine injury should not be ignored.

  3. Transplantation of osteoporotic bone marrow stromal cells rejuvenated by the overexpression of SATB2 prevents alveolar bone loss in ovariectomized rats.

    Science.gov (United States)

    Xu, Rongyao; Fu, Zongyun; Liu, Xue; Xiao, Tao; Zhang, Ping; Du, Yifei; Yuan, Hua; Cheng, Jie; Jiang, Hongbing

    2016-11-01

    Estrogen-deficient osteoporosis is an aging-related disease with high morbidity that not only significantly increases a woman's risk of fragility fracture but is also associated with tooth and bone loss in the supporting alveolar bone of the jaw. Emerging evidence suggests that the aging of bone marrow stromal cells (BMSCs) contributes to the development of osteoporosis. In this study, we aimed to investigate the role of the special AT-rich sequence-binding protein 2 (SATB2), a stemness and senescence regulator of craniofacial BMSCs, in rat ovariectomy-induced alveolar osteoporosis. We also sought to determine whether transplantation of SATB2-modified BMSCs could ameliorate estrogen deficient alveolar bone loss. Our data revealed that BMSCs from ovariectomy-induced alveolar bone exhibited typical senescence phenotypes such as diminished stemness and osteogenic capacity, increased expression of senescence or osteoclastic markers and enhanced adipogenic potential. These phenotypic changes are a result of SATB2-mediated senescence dysregulation as evidenced by nuclear γH2AX foci formation. Moreover, overexpression of SATB2 significantly alleviated the senescence of osteoporotic BMSCs in vitro. Importantly, transplantation of SATB2-modified BMSCs significantly attenuated ovariectomy-induced alveolar bone loss in vivo. Together, our results revealed that SATB2 is a critical regulator of alveolar BMSC senescence, and its overexpression decreases these senescent changes both in vitro and in vivo. SATB2-modified BMSC delivery could be a viable and promising therapeutic strategy for alveolar bone loss induced by estrogen-deficient osteoporosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Selective effect of hydroxyapatite nanoparticles on osteoporotic and healthy bone formation correlates with intracellular calcium homeostasis regulation.

    Science.gov (United States)

    Zhao, Rui; Xie, Pengfei; Zhang, Kun; Tang, Zhurong; Chen, Xuening; Zhu, Xiangdong; Fan, Yujiang; Yang, Xiao; Zhang, Xingdong

    2017-09-01

    Adequate bone substitutes osseointegration has been difficult to achieve in osteoporosis. Hydroxyapatite of the osteoporotic bone, secreted by pathologic osteoblasts, had a smaller crystal size and lower crystallinity than that of the normal. To date, little is known regarding the interaction of synthetic hydroxyapatite nanoparticles (HANPs) with osteoblasts born in bone rarefaction. The present study investigated the biological effects of HANPs on osteoblastic cells derived from osteoporotic rat bone (OVX-OB), in comparison with the healthy ones (SHM-OB). A selective effect of different concentrations of HANPs on the two cell lines was observed that the osteoporotic osteoblasts had a higher tolerance. Reductions in cell proliferation, ALP activity, collagen secretion and osteoblastic gene expressions were found in the SHM-OB when administered with HANPs concentration higher than 25µg/ml. In contrast, those of the OVX-OB suffered no depression but benefited from 25 to 250µg/ml HANPs in a dose-dependent manner. We demonstrated that the different effects of HANPs on osteoblasts were associated with the intracellular calcium influx into the endoplasmic reticulum. The in vivo bone defect model further confirmed that, with a critical HANPs concentration administration, the osteoporotic rats had more and mechanically matured new bone formation than the non-treated ones, whilst the sham rats healed no better than the natural healing control. Collectively, the observed epigenetic regulation of osteoblastic cell function by HANPs has significant implication on defining design parameters for a potential therapeutic use of nanomaterials. In this study, we investigated the biological effects of hydroxyapatite nanoparticles (HANPs) on osteoporotic rat bone and the derived osteoblast. Our findings revealed a previously unrecognized phenomenon that the osteoporotic individuals could benefit from higher concentrations of HANPs, as compared with the healthy individuals. The in

  5. Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE): study protocol for a randomised controlled trial

    Science.gov (United States)

    2014-01-01

    Background Osteoporosis and vertebral fracture can have a considerable impact on an individual’s quality of life. There is increasing evidence that physiotherapy including manual techniques and exercise interventions may have an important treatment role. This pragmatic randomised controlled trial will investigate the clinical and cost-effectiveness of two different physiotherapy approaches for people with osteoporosis and vertebral fracture, in comparison to usual care. Methods/Design Six hundred people with osteoporosis and a clinically diagnosed vertebral fracture will be recruited and randomly allocated to one of three management strategies, usual care (control - A), an exercise-based physiotherapy intervention (B) or a manual therapy-based physiotherapy intervention (C). Those in the usual care arm will receive a single session of education and advice, those in the active treatment arms (B + C) will be offered seven individual physiotherapy sessions over 12 weeks. The trial is designed as a prospective, adaptive single-blinded randomised controlled trial. An interim analysis will be completed and if one intervention is clearly superior the trial will be adapted at this point to continue with just one intervention and the control. The primary outcomes are quality of life measured by the disease specific QUALLEFO 41 and the Timed Loaded Standing test measured at 1 year. Discussion There are a variety of different physiotherapy packages used to treat patients with osteoporotic vertebral fracture. At present, the indication for each different therapy is not well defined, and the effectiveness of different modalities is unknown. Trial registration Reference number ISRCTN49117867. PMID:24422876

  6. Percutaneous vertebroplasty for osteoporotic vertebral compression fractures with intraosseous cystic cavity phenomena

    International Nuclear Information System (INIS)

    He Shicheng; Teng Gaojun; Deng Gang; Fang Wen; Guo Jinhe; Zhu Guangyu; Li Guozao; Shen Zhiping; Ding Huijuan

    2005-01-01

    Objective: To evaluate the key technique, short term clinical efficacy and degree of changes in vertebral body height for percutaneous vertebroplasty in treating patients with osteoporotic vertebral compression fractures containing intraosseous cystic cavity phenomena. Methods: Thirty two vertebrae of painful compression fractures with intraosseous vacuum sign occurring in 27 patients were identified from 326 percutaneous vertebroplasties performed in 207 patients during 4 years. PVP was performed under C-arm fluoroscopy guidance only with local anesthesia. Intaosseous venography was performed on each vertebra by hand injection with non-ionic contrast agent, with CT monitoring after PMMA injection for the PMMA distribution in the vertebrae and looking for leakage. The heights of 32 vertebral bodies were measured before and after the vertebroplasty. The efficacy of PVP was evaluated during the follow-up. Results: The successful rate of PVP was 100%. Main appearance of vertebral venography showed cystic cavity-like, stasis of contrast medium within the marrow space of the fractured vertebra. 6.8 ml of PMMA in average was injected into each vertebra. CR, PR and NR were obtained respectively 66.7%, 18.5%, 14.8% mm centrally and 0.06 mm posteriorly. The heights restoration of vertebrae anteriorly and centrally were significantly different (P 0.05). No serious complications related to the technique occurred, except 3 cases with asymptomatic PMMA leakage around vertebrae demonstrated by CT. Conclusions: Significant pain relief and vertebral height restoration by PVP in the treatment of patients with painful vertebral compression fractures accompanied by intraosseous cysticavitary change, are promising with low-rate of PMMA leakage. The basic successful mechanism lies on the proper complete PMMA filling predicting through venography. (authors)

  7. Percutaneous vertebroplasty in patients with intractable pain from osteoporotic or metastatic fractures: a prospective study using quality-of-life assessment

    International Nuclear Information System (INIS)

    Cheung, G.; Chow, E.; Holden, L.; Vidmar, M.; Danjoux, C.; Yee, A.J.M.; Connolly, R.; Finkelstein, J.

    2006-01-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive outpatient procedure whereby vertebral compression fractures are stabilized by the injection of bone cement, or polymethyl methacrylate (PMMA). Rapid partial or complete pain relief can usually be achieved through this procedure. We prospectively evaluate the efficacy of PVP in the relief of pain and improvement in quality of life of patients with intractable pain from osteoporotic and metastatic fractures. Patients with intractable pain from vertebral metastases (many resistant to palliative radiation therapy) and patients with intractable painful osteoporotic fractures were treated with parapedicular or transpedicular injection of PMMA. Plane X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI) scan were performed on all patients. With a reflex hammer, percussion pain was correlated to the imaging abnormalities. The preplanning CT scan was used to calculate the exact entry point and angle of the bone-biopsy needle. All patients were assessed before and after the procedure for quality of life and amount of pain. The following measures were used: 1) the Edmonton Symptom Assessment System (ESAS), for global pain, nausea, tiredness, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath; 2) a site-specific pain score (SSPS); 3) the amount of analgesic intake in morphine equivalents in the last 24 hours; and 4) the Townsend Functional Assessment Scale (TFAS), ascertaining mobility. A postprocedural CT scan was performed the same day on all patients. Follow-up assessment consisted of a phone call at Days 1, 2, and 4 and Weeks 1, 2, 4, 8, and 12. Patients with recurrent back pain or complications were followed in the bone metastases clinic. Thirty patients (19 women, 11 men) were evaluated. Their median age was 68 years (range 31 to 87 years). Thirty procedures (n=30) at 45 vertebral levels were performed; 13 were for pathologic fractures, and 17 were for

  8. Prior ankle fractures in postmenopausal women are associated with low areal bone mineral density and bone microstructure alterations.

    Science.gov (United States)

    Biver, E; Durosier, C; Chevalley, T; Herrmann, F R; Ferrari, S; Rizzoli, R

    2015-08-01

    In a cross-sectional analysis in postmenopausal women, prior ankle fractures were associated with lower areal bone mineral density (BMD) and trabecular bone alterations compared to no fracture history. Compared to women with forearm fractures, microstructure alterations were of lower magnitude. These data suggest that ankle fractures are another manifestation of bone fragility. Whether ankle fractures represent fragility fractures associated with low areal bone mineral density (aBMD) and volumetric bone mineral density (vBMD) and/or bone microstructure alterations remains unclear, in contrast to the well-recognised association between forearm fractures and osteoporosis. The objective of this study was to investigate aBMD, vBMD and bone microstructure in postmenopausal women with prior ankle fracture in adulthood, compared with women without prior fracture or with women with prior forearm fractures, considered as typically of osteoporotic origin. In a cross-sectional analysis in the Geneva Retirees Cohort study, 63 women with ankle fracture and 59 with forearm fracture were compared to 433 women without fracture (mean age, 65 ± 1 years). aBMD was measured by dual-energy X-ray absorptiometry; distal radius and tibia vBMD and bone microstructure were measured by high-resolution peripheral quantitative computed tomography. Compared with women without fracture, those with ankle fractures had lower aBMD, radius vBMD (-7.9%), trabecular density (-10.7%), number (-7.3%) and thickness (-4.6%) and higher trabecular spacing (+14.5%) (P ankle fractures were 2.2 and 1.6, respectively, vs 2.2 and 2.7 for forearm fracture, respectively (P ≤ 0.001 for all). Compared to women with forearm fractures, those with ankle fractures had similar spine and hip aBMD, but microstructure alterations of lower magnitude. Women with ankle fractures have lower aBMD and vBMD and trabecular bone alterations, suggesting that ankle fractures are another manifestation of bone fragility.

  9. Association of Obesity with Forearm Fractures, Bone Mineral Density and Fracture Risk (FRAX® During Postmenopausal Period

    Directory of Open Access Journals (Sweden)

    Erkan Mesci

    2016-08-01

    Full Text Available Objective: The aim of this study was to investigate the association among obesity with bone mineral density (BMD and subsequent fracture risk among postmenopausal women with a previous forearm fracture. Materials and Methods: The study enrolled obese (n=40 and normal-weight (n=40 postmenopausal women who had a previous forearm fracture. BMD measurements were obtained using a GE-LUNAR DPX dual energy X-ray absorptiometry scan for all subjects. FRAX® fracture risk scores were calculated taking into account former fractures and current risk factors of the subjects. Both groups were compared with respect to their BMD values, T scores, FRAX® risk scores and frequency of previous fractures. Results: No difference was observed between groups with regard to mean age, mean age of menopause onset and mean serum calcium, phosphorus and alkaline phosphatase levels (p>0.05 for all. Statistically, obese patients showed highly significantly greater mean BMD values at lumbar spine (L1-L4 and femoral neck in comparison to subjects with normal body weight (p=0.000 for all. Obese patients had a lower 10-year probability of a major osteoporotic fracture on average as determined by FRAX® fracture risk score compared to that in normal-weight subjects (p<0.05. Also, obese group had a lower 10-year probability of a hip fracture versus normal-weight subjects (p<0.01. Both groups were found to have a similar frequency of previous fractures. Conclusion: Although obese patients in this study had greater BMD values and lower FRAX® risk scores, the probability of subsequent fractures predicted for the obese group was not lower when compared to that predicted for normal-weight group. It should be kept in mind that obesity may not necessarily be protective against fractures and treatment algorithms based solely on BMD might be inadequate to predict future fracture risk.

  10. Characteristics of bone turnover in the long bone metaphysis fractured patients with normal or low Bone Mineral Density (BMD.

    Directory of Open Access Journals (Sweden)

    Christoph Wölfl

    Full Text Available The incidence of osteoporotic fractures increases as our population ages. Until now, the exact biochemical processes that occur during the healing of metaphyseal fractures remain unclear. Diagnostic instruments that allow a dynamic insight into the fracture healing process are as yet unavailable. In the present matched pair analysis, we study the time course of the osteoanabolic markers bone specific alkaline phosphatase (BAP and transforming growth factor β1 (TGFβ1, as well as the osteocatabolic markers crosslinked C-telopeptide of type-I-collagen (β-CTX and serum band 5 tartrate-resistant acid phosphatase (TRAP5b, during the healing of fractures that have a low level of bone mineral density (BMD compared with fractures that have a normal BMD. Between March 2007 and February 2009, 30 patients aged older than 50 years who suffered a metaphyseal fracture were included in our study. BMDs were verified by dual energy Xray absorptiometry (DXEA scans. The levels of BTMs were examined over an 8-week period. Osteoanabolic BAP levels in those with low levels of BMD were significantly different from the BAP levels in those with normal BMD. BAP levels in the former group increased constantly, whereas the latter group showed an initial strong decrease in BAP followed by slowly rising values. Osteocatabolic β-CTX increased in the bone of the normal BMD group constantly, whereas these levels decreased significantly in the bone of the group with low BMD from the first week. TRAP5b was significantly reduced in the low level BMD group. With this work, we conduct first insights into the molecular biology of the fracture healing process in patients with low levels of BMD that explains the mechanism of its fracture healing. The results may be one reason for the reduced healing qualities in bones with low BMD.

  11. Custom-Made Titanium 3-Dimensional Printed Interbody Cages for Treatment of Osteoporotic Fracture-Related Spinal Deformity.

    Science.gov (United States)

    Siu, Timothy L; Rogers, Jeffrey M; Lin, Kainu; Thompson, Robert; Owbridge, Mark

    2018-03-01

    Advances in minimally invasive interbody fusion have greatly enhanced surgeons' capability to correct adult spinal deformity with reduced morbidity. However, the feasibility of such approaches is limited in patients with previous osteoporotic fractures as the resultant vertebral deformity renders the end plate geometry incongruous with conventional interbody implants. Current 3-dimensional (3D) printing technology offers a novel solution by fabricating custom-made implants tailored to individual anatomy. We present the results of a patient with osteoporotic lumbar fractures treated by such technology. A 74-year-old woman, with previous osteoporotic fractures at L2 and L3 resulting in concave deformity of the end plates, presented with intractable radiculopathy secondary to lateral recess and foraminal stenosis (L2-3 and L3-4). A minimally invasive lateral lumbar interbody fusion at L2-3 and L3-4 was considered favorable, but due to the associated vertebral collapse, off-the-shelf implants were not compatible with patient anatomy. In silico simulation based on preoperative computed tomography (CT) imaging was thus conducted to design customized cages to cater for the depressed recipient end plates and vertebral loss. The design was converted to implantable titanium cages through 3D additive manufacturing. At surgery, a tight fit between the implants and the targeted disk space was achieved. Postoperative CT scan confirmed excellent implant-end plate matching and restoration of lost disk space. The patient began to ambulate from postoperative day 1 and at 6-month follow-up resolution of radicular symptoms and CT evidence of interbody fusion were recorded. 3D-printed custom-made interbody cages can help overcome the difficulties in deformity correction secondary to osteoporotic fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. [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 riskX-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.

  13. Percutaneous vertebroplasty for osteoporotic painful vertebral compression fractures: a quality of life assesment

    International Nuclear Information System (INIS)

    Ma Yonghong; He Shicheng; Teng Gaojun; Deng Gang; Fang Wen; Guo Jinhe; Zhu Guangyu; Li Guozhuo

    2007-01-01

    Objective: To evaluate long term quality of life of percutaneous vertebroplasty in treating vertebral compression fractures in patients with osteoporosis. Methods: PVP was performed in 183 patients with osteoporotic painful vertebral compression fractures. Twenty five consecutive patients were successfully interviewed. The outcome was measured by pre and postoperatively utilizing the Visual Analogue Scale for pain, the activity of daily life and the Oswestry Disability Index for mobility and quality of life. Results: The mean follow-up was 36.5 months. The Visual Analogue Scale score improved from a mean preoperative score of 8.96 ± 1.11 to a mean postoperative score of 4.58 ± 2.56 (post-24 hours) 3.16 ± 2.28 (post-3 months) 2.11 ± 0.27(post-6 months) and 1.63 ± 0.21 at the last follow-up. The mean Barthel Index significantly improved from 54.3 ± 13.2 to 84.28 ± 18.30 (P<0.05), showing a 55% improvement while the Oswestry Disability Index preoperatively was 25.64 ± 13.84 which decreased to 17.52 ± 10.71 postoperatively (P<0.05), showing a 32% improvement. No serious complications related to the technique occurred, except 5 cases with asymptomatic cement leakage around the vertebrae demonstrated by CT during follow-up period. Conclusion: Percutaneous vertebroplasty is an effective and safe procedure for treating vertebral compression fractures in patients with osteoporosis that provides immediate and long-term pain relief and maintains long-term improvement in quality of life. Asymptomatic cement leakages around vertebrae have no influence on long-term quality of life. (authors)

  14. Osteoporosis and Prevalent Fractures among Adult Filipino Men Screened for Bone Mineral Density in a Tertiary Hospital

    Directory of Open Access Journals (Sweden)

    Erick S. Mendoza

    2016-09-01

    Full Text Available BackgroundOsteoporosis in men is markedly underdiagnosed and undertreated despite higher morbidity and mortality associated with fractures. This study aimed to characterize adult Filipino men with osteopenia, osteoporosis and prevalent fractures.MethodsA cross-sectional study of 184 Filipino men ≥50 years screened for bone mineral density was performed. Age, weight, body mass index (BMI, Osteoporosis Self-Assessment Tool for Asians (OSTA score, smoking status, family history of fracture, diabetes mellitus, physical inactivity, and T-score were considered.ResultsOf the 184 patients, 40.2% and 29.9% have osteopenia and osteoporosis. Sixteen (21.6% and 18 (32.1% osteopenic and osteoporotic men have fragility hip, spine, or forearm fractures. Men aged 50 to 69 years have the same risk of osteoporosis and fractures as those ≥70 years. While hip fractures are higher in osteoporotic men, vertebral fractures are increased in both osteopenic and osteoporotic men. Mere osteopenia predicts the presence of prevalent fractures. A high risk OSTA score can predict fracture. A BMI <21 kg/m2 (P<0.05 and current smoking are associated with osteoporosis.ConclusionA significant fraction of Filipino men with osteopenia and osteoporosis have prevalent fractures. Our data suggest that fractures occur in men <70 years even before osteoporosis sets in. Low BMI, high OSTA score, and smoking are significant risk factors of osteoporosis.

  15. The variability of vertebral body volume and pain associated with osteoporotic vertebral fractures: conservative treatment versus percutaneous transpedicular vertebroplasty.

    Science.gov (United States)

    Andrei, Diana; Popa, Iulian; Brad, Silviu; Iancu, Aida; Oprea, Manuel; Vasilian, Cristina; Poenaru, Dan V

    2017-05-01

    Osteoporotic vertebral fractures (OVF) can lead to late collapse which often causes kyphotic spinal deformity, persistent back pain, decreased lung capacity, increased fracture risk and increased mortality. The purpose of our study is to compare the efficacy and safety of vertebroplasty against conservative management of osteoporotic vertebral fractures without neurologic symptoms. A total of 66 patients with recent OVF on MRI examination were included in the study. All patients were admitted from September 2009 to September 2012. The cohort was divided into two groups. The first study group consisted of 33 prospectively followed consecutive patients who suffered 40 vertebral osteoporotic fractures treated by percutaneous vertebroplasty (group 1), and the control group consisted of 33 patients who suffered 41 vertebral osteoporotic fractures treated conservatively because they refused vertebroplasty (group 2). The data collection has been conducted in a prospective registration manner. The inclusion criteria consisted of painful OVF matched with imagistic findings. We assessed the results of pain relief and minimal sagittal area of the vertebral body on the axial CT scan at presentation, after the intervention, at six and 12 months after initial presentation. Vertebroplasty with poly(methyl methacrylate) (PMMA) was performed in 30 patients on 39 VBs, including four thoracic vertebras, 27 vertebras of the thoracolumbar jonction and eight lumbar vertebras. Group 2 included 30 patients with 39 OVFs (four thoracic vertebras, 23 vertebras of the thoracolumbar junction and 11 lumbar vertebras). There was no significant difference in VAS scores before treatment (p = 0.229). The mean VAS was 5.90 in Group 1 and 6.28 in Group 2 before the treatment. Mean VAS after vertebroplasty was 0.85 in Group 1. The mean VAS at six months was 0.92 in Group 1 and 3.00 in Group 2 (p pain and avoid VB collapse, vertebroplasty is the recommended treatment in OCFs. Considering the

  16. Assessment of patient's pain-related behavior at physical examination may allow diagnosis of recent osteoporotic vertebral fracture.

    Science.gov (United States)

    Postacchini, Roberto; Paolino, Michela; Faraglia, Silvia; Cinotti, Gianluca; Postacchini, Franco

    2013-09-01

    Although innumerable studies have analyzed the multiple aspects of osteoporotic vertebral fractures, no study has focused on the clinical features related to spine pain in patients with recent osteoporotic vertebral compression fractures (VCFs). To determine whether the assessment of pain-related behavior (P-RB) of patients with osteoporotic VCFs of recent onset may allow the fracture to be strongly suspected, or even diagnosed, at physical examination. Pain-related behavior of elderly patients attending an outpatient spine clinic was evaluated on the basis of six consecutive movements made on the examining table. Fifty-six patients complaining only of lumbar or thoracic pain. The fractured patients (FPs), representing the fracture group (FG), were the 19 who had a recent VCF, whereas the control group (CG) consisted of the remaining 37 patients. Assessment of P-RB was based on six parameters: grimacing, sighing, clenching or blocking eyelids, gaping or strongly tightening the lips, need for help to take positions, and extreme difficulty to turn in the prone position. A score of 1 or a decimal was assigned to each parameter, the final score to each patient being 0 to 6. Three types of injury, acute (I), subacute (II), or chronic (III), were identified on the basis of the time elapsed from the probable occurrence of the fracture. The diagnosis of recent fracture was based on magnetic resonance images. Patients were videotaped during their movements. An examiner, unaware of the clinical history and diagnosis, gave a P-RB score to all patients and indicated whether they had to be placed in FG or CG, and also their presumable type of fracture. Subsequently, a DVD with the videotapes of all patients was given to three independent examiners, not specifically expert of spine conditions, who were asked to make the same evaluations as the first examiner. The mean scores for P-RB given by the first examiner were 4.6 to FG and 0.7 to CG (pPain-related behavior evaluation of

  17. Multiple fractures and impaired bone metabolism in Wolfram syndrome: a case report.

    Science.gov (United States)

    Catalano, Antonino; Bellone, Federica; Cicala, Giuseppe; Giandalia, Annalisa; Morabito, Nunziata; Cucinotta, Domenico; Russo, Giuseppina Tiziana

    2017-01-01

    Wolfram Syndrome (WS) is a rare and lethal disease characterized by optic atrophy, diabetes mellitus, diabetes insipidus, and hearing loss. To date, osteoporotic related fractures have not been reported in affected patients. Here, we describe the case of a man affected by WS complicated by several bone fragility fractures. A 50-year-old Caucasian man was hospitalized because of tibia and fibula fractures. His clinical features included diabetes mellitus, diabetes insipidus, optic atrophy and deafness that were consistent with an unrecognized WS diagnosis, which was confirmed by the identification of a specific mutation in gene WFS1 encoding wolframin. Bone mineral density by phalangeal quantitative ultrasound demonstrated severe osteoporosis, with high serum levels of surrogate markers of bone turn-over. Previously unidentified rib fractures were also detected. To the best of our knowledge, this is the first report of osteoporotic related fractures in a patient affected by WS. Although no effective treatments are currently available to delay the progression of the disease, this case report suggests to evaluate fracture risk in the diagnostic work-up of WS.

  18. Total body calcium by neutron activation analysis in normals and osteoporotic populations: a discriminator of significant bone mass loss

    International Nuclear Information System (INIS)

    Ott, S.M.; Murano, R.; Lewellen, T.K.; Nelp, W.B.; Chesnut, C.M.

    1983-01-01

    Measurements of total body calcium by neutron activation (TBC) in 94 normal individuals and 86 osteoporotic patients are reported. The ability of TBC to discriminate normal from osteoporotic females was evaluated with decision analysis. Bone mineral content (BMC) by single-photon absorptiometry was also measured. TBC was higher in males (range 826 to 1363 gm vs 537 to 1054 in females) and correlated with height in all normals. In females over age 55 there was a negative correlation with age. Thus, for normals an algorithm was derived to allow comparison between measured TBC and that predicted by sex, age, and height (TBCp). In the 28 normal females over age 55, the TBC was 764 +/- 115 gm vs. 616 +/- 90 in the osteoporotics. In 63 of the osteoporotic females an estimated height, from tibial length, was used to predict TBC. In normals the TBC/TBCp ratio was 1.00 +/- 0.12, whereas in osteoporotic females it was 0.80 +/- 0.12. A receiver operating characteristic curve showed better discrimination of osteoporosis with TBC/TBCp than with wrist BMC. By using Bayes' theorem, with a 25% prevalence of osteoporosis (estimate for postmenopausal women), the posttest probability of disease was 90% when the TBC/TBCp ratio was less than 0.84. The authors conclude that a low TBC/TBCp ratio is very helpful in determining osteoporosis

  19. Static and dynamic balance performance in patients with osteoporotic vertebral compression fracture.

    Science.gov (United States)

    Wang, Ling-Yi; Liaw, Mei-Yun; Huang, Yu-Chi; Lau, Yiu-Chung; Leong, Chau-Peng; Pong, Ya-Ping; Chen, Chia-Lin

    2013-01-01

    Patients with osteoporotic vertebral compression fracture (OVCF) have postural changes and increased risk of falling. The aim of this study is to compare balance characteristics between patients with OVCF and healthy control subjects. Patients with severe OVCF and control subjects underwent computerised dynamic posturography (CDP) in this case-control study. Forty-seven OVCF patients and 45 controls were recruited. Compared with the control group, the OVCF group had significantly decreased average stability; maximal stability under the `eye open with swayed support surface' (CDP subtest 4) and 'eye closed with swayed support surface' conditions (subtest 5); and decreased ankle strategy during subtests 4 and 5 and under the `swayed vision with swayed support surface' condition (subtest 6). The OVCF group fell more frequently during subtests 5 and 6 and had longer overall reaction time and longer reaction time when moving backward during the directional control test. OVCF patients had poorer static and dynamic balance performance compared with normal control. They had decreased postural stability and ankle strategy with increased fall frequency on a swayed surface; they also had longer reaction times overall and in the backward direction. Therefore, we suggest balance rehabilitation for patients with OVCF to prevent fall.

  20. Petrous bone fracture: a virtual trauma analysis.

    Science.gov (United States)

    Montava, Marion; Deveze, Arnaud; Arnoux, Pierre-Jean; Bidal, Samuel; Brunet, Christian; Lavieille, Jean-Pierre

    2012-06-01

    The temporal bone shields sensorineural, nervous, and vascular structures explaining the potential severity and complications of trauma related to road and sport accidents. So far, no clear data are available on the exact mechanisms involved for fracture processes. Modelization of structures helps to answer these concerns. Our objective was to design a finite element model of the petrous bone structure to modelize temporal bone fracture propagation in a scenario of lateral impact. A finite element model of the petrous bone structure was designed based on computed tomography data. A 7-m/s lateral impact was simulated to reproduce a typical lateral trauma. Results of model analysis was based on force recorded, stress level on bone structure up to induce a solution of continuity of the bony structure. Model simulation showed that bone fractures follow the main axes of the petrous bone and occurred in a 2-step process: first, a crush, and second, a massive fissuration of the petrous bone. The lines of fracture obtained by simulation of a lateral impact converge toward the middle ear region. This longitudinal fracture is located at the mastoid-petrous pyramid junction. Using this model, it was possible to map petrous bone fractures including fracture chronology and areas of fusion of the middle ear region. This technique may represent a first step to investigate the pathophysiology of the petrous bone fractures, aiming to define prognostic criteria for patients' care.

  1. Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women Factores de riesgo para fractura por osteoporosis y baja densidad ósea en mujeres en la pre y post menopausia Fatores de risco para fratura por osteoporose e baixa densidade óssea em mulheres na pré e pós-menopausa

    Directory of Open Access Journals (Sweden)

    Marcelo M Pinheiro

    2010-06-01

    Full Text Available OBJECTIVE: To estimate the prevalence and analyze risk factors associated to osteoporosis and low-trauma fracture in women. METHODS: Cross-sectional study including a total of 4,332 women older than 40 attending primary care services in the Greater São Paulo, Southeastern Brazil, between 2004 and 2007. Anthropometrical and gynecological data and information about lifestyle habits, previous fracture, medical history, food intake and physical activity were obtained through individual quantitative interviews. Low-trauma fracture was defined as that resulting from a fall from standing height or less in individuals 50 years or older. Multiple logistic regression models were designed having osteoporotic fracture and bone mineral density (BMD as the dependent variables and all other parameters as the independent ones. The significance level was set at pOBJETIVO: Estimar la prevalencia y analizar los factores de riesgo asociados con osteoporosis y fractura por bajo impacto entre mujeres. MÉTODOS: Estudio transversal realizado con 4.332 mujeres encima de 40 años de edad provenientes de atención primaria de salud en el área metropolitana de la gran Sao Paulo, SP, entre 2004 2007. Datos antropométricos y ginecológico y relativos a hábitos de vida, fractura previa, antecedentes personales, ingestión alimentaria y actividad física fueron evaluados por medio de entrevista individual y cuantitativa. Fractura por bajo impacto fue definida como decurrente de caída de la propia altura o menos en individuos con más de 50 años de edad. Modelos de regresión multivariada y logística analizaron, respectivamente, la densidad ósea y la fractura por osteoporosis, como variables dependientes y todas las otras como independientes. El nivel de significancia estadística establecido fue pOBJETIVO: Estimar a prevalência e analisar os fatores de risco associados com osteoporose e fratura por baixo impacto entre mulheres. MÉTODOS: Estudo transversal realizado

  2. Low-level laser therapy with helium-neon laser improved viability of osteoporotic bone marrow-derived mesenchymal stem cells from ovariectomy-induced osteoporotic rats

    Science.gov (United States)

    Fallahnezhad, Somaye; Piryaei, Abbas; Tabeie, Faraj; Nazarian, Hamid; Darbandi, Hasan; Amini, Abdoldllah; Mostafavinia, Ataroalsadat; Ghorishi, Seyed Kamran; Jalalifirouzkouhi, Ali; Bayat, Mohammad

    2016-09-01

    The purpose of this study was to evaluate the influences of helium-neon (He-Ne) and infrared (IR) lasers on the viability and proliferation rate of healthy and ovariectomy-induced osteoporotic (OVX) bone marrow mesenchymal stem cells (BMMSCs) in vitro. MSCs harvested from the BM of healthy and OVX rats were culture expanded. He-Ne and IR lasers were applied three times at energy densities of 0.6, 1.2, and 2.4 J/cm2 for BMMSCs. BMMSCs viability and proliferation rate were evaluated by MTT assay on days 2, 4, 6, 14, and 21. The results showed that healthy BMMSCs responded optimally to 0.6 J/cm2 using an IR laser after three times of laser radiation. Moreover, it was found that OVX-BMMSCs responded optimally to 0.6 J/cm2 with He-Ne laser and one-time laser radiation. It is concluded that the low-level laser therapy (LLLT) effect depends on the physiological state of the BMMSCs, type of the laser, wavelength, and number of laser sessions. The biostimulation efficiency of LLLT also depends on the delivered energy density. LLLT can enhance the viability and proliferation rate of healthy and especially osteoporotic autologous BMMSCs, which could be very useful in regenerative medicine.

  3. Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures.

    Science.gov (United States)

    Obermayer-Pietsch, Barbara M; Bonelli, Christine M; Walter, Daniela E; Kuhn, Regina J; Fahrleitner-Pammer, Astrid; Berghold, Andrea; Goessler, Walter; Stepan, Vinzenz; Dobnig, Harald; Leb, Georg; Renner, Wilfried

    2004-01-01

    Evidence that genetic disposition for adult lactose intolerance significantly affects calcium intake, bone density, and fractures in postmenopausal women is presented. PCR-based genotyping of lactase gene polymorphisms may complement diagnostic procedures to identify persons at risk for both lactose malabsorption and osteoporosis. Lactase deficiency is a common autosomal recessive condition resulting in decreased intestinal lactose degradation. A -13910 T/C dimorphism (LCT) near the lactase phlorizin hydrolase gene, reported to be strongly associated with adult lactase nonpersistence, may have an impact on calcium supply, bone density, and osteoporotic fractures in the elderly. We determined LCT genotypes TT, TC, and CC in 258 postmenopausal women using a polymerase chain reaction-based assay. Genotypes were related to milk intolerance, nutritional calcium intake, intestinal calcium absorption, bone mineral density (BMD), and nonvertebral fractures. Twenty-four percent of all women were found to have CC genotypes and genetic lactase deficiency. Age-adjusted BMD at the hip in CC genotypes and at the spine in CC and TC genotypes was reduced by -7% to -11% depending on the site measured (p = 0.04). LCT(T/C-13910) polymorphisms alone accounted for 2-4% of BMD in a multiple regression model. Bone fracture incidence was significantly associated with CC genotypes (p = 0.001). Milk calcium intake was significantly lower (-55%, p = 0.004) and aversion to milk consumption was significantly higher (+166%, p = 0.01) in women with the CC genotype, but there were no differences in overall dietary calcium intake or in intestinal calcium absorption test values. The LCT(T/C-13910) polymorphism is associated with subjective milk intolerance, reduced milk calcium intake, and reduced BMD at the hip and the lumbar spine and may predispose to bone fractures. Genetic testing for lactase deficiency may complement indirect methods in the detection of individuals at risk for both lactose

  4. Trunk muscle activity is modified in osteoporotic vertebral fracture and thoracic kyphosis with potential consequences for vertebral health.

    Directory of Open Access Journals (Sweden)

    Alison M Greig

    Full Text Available This study explored inter-relationships between vertebral fracture, thoracic kyphosis and trunk muscle control in elderly people with osteoporosis. Osteoporotic vertebral fractures are associated with increased risk of further vertebral fractures; but underlying mechanisms remain unclear. Several factors may explain this association, including changes in postural alignment (thoracic kyphosis and altered trunk muscle contraction patterns. Both factors may increase risk of further fracture because of increased vertebral loading and impaired balance, which may increase falls risk. This study compared postural adjustments in 24 individuals with osteoporosis with and without vertebral fracture and with varying degrees of thoracic kyphosis. Trunk muscle electromyographic activity (EMG associated with voluntary arm movements was recorded and compared between individuals with and without vertebral fracture, and between those with low and high thoracic kyphosis. Overall, elderly participants in the study demonstrated co-contraction of the trunk flexor and extensor muscles during forwards arm movements, but those with vertebral fractures demonstrated a more pronounced co-contraction than those without fracture. Individuals with high thoracic kyphosis demonstrated more pronounced alternating flexor and extensor EMG bursts than those with less kyphosis. Co-contraction of trunk flexor and extensor muscles in older individuals contrasts the alternating bursts of antagonist muscle activity in previous studies of young individuals. This may have several consequences, including altered balance efficacy and the potential for increased compressive loads through the spine. Both of these outcomes may have consequences in a population with fragile vertebrae who are susceptible to fracture.

  5. Drinking water fluoridation: bone mineral density and hip fracture incidence.

    Science.gov (United States)

    Lehmann, R; Wapniarz, M; Hofmann, B; Pieper, B; Haubitz, I; Allolio, B

    1998-03-01

    The role of drinking water fluoride content for prevention of osteoporosis remains controversial. Therefore, we analyzed the influence of drinking water fluoridation on the incidence of osteoporotic hip fractures and bone mineral density (BMD) in two different communities in eastern Germany: in Chemnitz, drinking water was fluoridated (1 mg/L) over a period of 30 years; in Halle, the water was not fluoridated. BMD was measured in healthy hospital employees aged 20-60 years (Halle: 214 women, 98 men; Chemnitz: 201 women, 43 men, respectively) using dual-energy X-ray absorptiometry. Hip fractures in patients > or = 35 years admitted to the local hospitals in the years 1987-1989 were collected from the clinic registers. There was no difference in age, anthropometric, hormonal, or lifestyle variables between the two groups. Mean fluoride exposure in Chemnitz was 25.2 +/- 7.3 years. No correlation was found between fluoride exposure and age-adjusted BMD. We found no significant difference in spinal or femoral BMD between subjects living in Halle and Chemnitz [lumbar spine: 0.997 +/- 0.129 (g/cm2) vs. 1.045 + 0.171 (g/cm2), p = 0.08, for men; 1.055 +/- 0.112 (g/cm2) vs. 1.046 +/- 0.117 (g/cm2), p = 0.47, for women]. The fracture incidence showed an exponential increase with aging in men and women with an incidence about 3.5 times higher for women. In Chemnitz, we calculated an age-adjusted annual incidence of 142.2 per 100,000 for women and 72.5 per 100,000 for men, respectively. In Halle, the incidences were 178.5 per 100,000 for women and 89.2 per 100,000 for men. There was a lower hip fracture incidence after the age of 85 in women in Chemnitz (1391 per 100,000 in Chemnitz vs. 1957 per 100,000) in Halle, p = 0.006). Using the age-adjusted incidences, significantly fewer hip fractures occurred in Chemnitz in both men and women. In conclusion, our study suggests that optimal drinking water fluoridation (1 mg/L), which is advocated for prevention of dental caries, does

  6. The osteoporotic vertebral structure is well adapted to the loads of daily life, but not to infrequent "error" loads

    NARCIS (Netherlands)

    Homminga, J.J.; Rietbergen, van B.; Lochmüller, E.M.; Weinans, H.; Eckstein, F.; Huiskes, R.

    2004-01-01

    Osteoporotic vertebral fractures typically have a gradual onset, frequently remain clinically undetected, and do not seem to be related to traumatic events. The osteoporotic vertebrae may therefore be expected to display a less "optimal" bone architecture, leading to an uneven load distribution over

  7. Three-dimensional microarchitecture of human osteoporotic, osteoarthrotic and rheumatoid arthritic cancellous bones

    DEFF Research Database (Denmark)

    Ding, Ming; Overgaard, Søren

    , OP often leads to skeletal fractures, and OA and RA result in severe joint disability. Over the last a few decades, much significant research on the properties has been carried out on these diseases, however, a detailed comparison of the microarchitecture of cancellous bones of these diseases...... is not available. In this study, we investigated three-dimensional (3-D) microarchitectural properties of OP, OA and RA cancellous bone. We hypothesized that there were significant differences in microarchitecture among OP, OA and RA bone tissues that might lead to different bone quality. Materials and Method...... Twenty OP, fifty OA, and twelve RA femur heads were harvested from patients undergone total hip replacement surgery. Cubic cancellous bone samples (8*8*8 mm3) were prepared and scanned with a high resolution microtomographic system (vivaCT 40, Scanco Medical AG., Brüttisellen, Switzerland). Then micro...

  8. MDCT after balloon kyphoplasty: analysis of vertebral body architecture one year after treatment of osteoporotic fractures

    International Nuclear Information System (INIS)

    Roehrl, B.; Dueber, C.; Sadick, M.; Brocker, K.; Voggenreiter, G.; Obertacke, U.; Brade, J.

    2006-01-01

    Purpose: to evaluate the value of MDCT in the monitoring of vertebral body architecture after balloon kyphoplasty and observe morphological changes of the vertebral body. Material and methods: during a period of 26 months, 66 osteoporotic fractures of the vertebral bodies were treated with percutanous balloon kyphoplasty. The height of the vertebral body, width of spinal space, sagittal indices, kyphosis und COBB angle, and cement leakage were evaluated by computed tomography before and after treatment and in a long-term follow up. Statistical analysis was performed by calculating quantitative constant parameters of descriptive key data. In addition, parametric and distribution-free procedures were performed for all questions. Results: after kyphoplasty, the treated vertebral bodies showed a significant gain in the height of the leading edge (0.15 cm; p < 0.0001) and in the central part of the vertebral body (0.17 cm; p < 0.0001). The height of the trailing edge did not change significantly. A corresponding gain in the sagittal index was found. The index remained stable during follow-up. Treated vertebral bodies as well as untreated references showed a comparable loss of height over the period of one year. The shape of the vertebral bodies remained stable. In comparison to these findings, treated vertebral bodies showed a reduced loss of height. A significant change in kyphosis und the COBB angle was noted. In total, pallacos leakage was detected in 71% of cases. Conclusion: MDCT is an accurate method for evaluating vertebral body architecture after treatment with balloon kyphoplasty. (orig.)

  9. Temporal trends in obesity, osteoporosis treatment, bone mineral density, and fracture rates: a population-based historical cohort study.

    Science.gov (United States)

    Leslie, William D; Lix, Lisa M; Yogendran, Marina S; Morin, Suzanne N; Metge, Colleen J; Majumdar, Sumit R

    2014-04-01

    Diverging international trends in fracture rates have been observed, with most reports showing that fracture rates have stabilized or decreased in North American and many European populations. We studied two complementary population-based historical cohorts from the Province of Manitoba, Canada (1996-2006) to determine whether declining osteoporotic fracture rates in Canada are attributable to trends in obesity, osteoporosis treatment, or bone mineral density (BMD). The Population Fracture Registry included women aged 50 years and older with major osteoporotic fractures, and was used to assess impact of changes in osteoporosis treatment. The BMD Registry included all women aged 50 years and older undergoing BMD tests, and was used to assess impact of changes in obesity and BMD. Model-based estimates of temporal changes in fracture rates (Fracture Registry) were calculated. Temporal changes in obesity and BMD and their association with fracture rates (BMD Registry) were estimated. In the Fracture Registry (n=27,341), fracture rates declined 1.6% per year (95% confidence interval [CI], 1.3% to 2.0%). Although osteoporosis treatment increased from 5.6% to 17.4%, the decline in fractures was independent of osteoporosis treatment. In the BMD Registry (n=36,587), obesity increased from 12.7% to 27.4%. Femoral neck BMD increased 0.52% per year and lumbar spine BMD increased 0.32% per year after covariate adjustment (pobesity or osteoporosis treatment. © 2014 American Society for Bone and Mineral Research.

  10. Phalangeal bone mineral density predicts incident fractures

    DEFF Research Database (Denmark)

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

    2012-01-01

    This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures...

  11. Is there a role for exercise in the prevention of osteoporotic fractures?

    Science.gov (United States)

    Rutherford, O M

    1999-12-01

    To examine whether there is a role for exercise in improving bone mineral density (BMD), particularly in postmenopausal women. The effects of different types of exercise are examined together with their effects at selected skeletal sites. The role of activity in reducing falls and hip fractures will also be considered as well as the potentially negative effects of excessive exercise. A literature search over the past 20 years was conducted and landmark papers selected. Certain types of exercise have been found to exert moderate benefits on BMD of the wrist, spine, and hip. Most studies do not detect a difference between the effects of endurance activities and strength training for BMD of the spine. It has been more difficult to isolate the optimal type of activity for effecting an osteogenic response at the hip, but recent evidence suggests that high impact work such as stepping and jumping may be effective at this site. The combination of hormone replacement therapy and exercise would appear to be more effective than either intervention on its own. Certain types of exercises have additional benefits, such as muscle strengthening, which could reduce the incidence of falls. Excessive exercise can lead to menstrual disturbances in female athletes and this in turn can cause bone loss, particularly from the spine. Exercise across the life span should be encouraged in order to maximise peak bone mass, reduce age related bone loss, and maintain muscle strength and balance. Although the effects of exercise on BMD later in life are small, epidemiological evidence suggests that being active can nearly halve the incidence of hip fractures in the older population. This effect is most probably multifactorial through the positive effects on bone, muscle strength, balance, and joint flexibility. Younger women should be aware of the dangers to the skeleton of menstrual disorders.

  12. Kyphoplasty for vertebral augmentation in the elderly with osteoporotic vertebral compression fractures: scenarios and review of recent studies.

    Science.gov (United States)

    Bednar, Timothy; Heyde, Christoph E; Bednar, Grace; Nguyen, David; Volpi, Elena; Przkora, Rene

    2013-11-01

    Vertebral compression fractures caused by osteoporosis are among the most common fractures in the elderly. The treatment focuses on pain control, maintenance of independence, and management of the osteoporosis. Elderly patients often encounter adverse effects to pain medications, do not tolerate bed rest, and are not ideal candidates for invasive spinal reconstructive surgery. Percutaneous vertebral augmentation (vertebroplasty or kyphoplasty) has become popular as a less-invasive alternative. However, studies have questioned the effectiveness of these procedures. The authors conducted a MEDLINE search using relevant search terms including osteoporosis, osteoporotic vertebral compression fracture, elderly, kyphoplasty and vertebroplasty. Two elderly patients presented with a fracture of their third and first lumbar vertebral body, respectively. One patient progressed well with conservative treatment, whereas the other patient was hospitalized secondary to pain after conservative measures failed to offer improvement. The hospitalized patient subsequently opted for a kyphoplasty and was able to resume his normal daily activities after the procedure. Selecting patients on an individual case-by-case basis can optimize the effectiveness and outcomes of a vertebral augmentation. This process includes the documentation of an osteoporotic vertebral compression fracture with the aide of imaging studies, including the acuity of the fracture as well as the correlation with the physical examination findings. Patients who are functional and improving under a conservative regimen are not candidates for kyphoplasty. However, if the conservative management is not successful after 4 to 6 weeks and the patient is at risk to become bedridden, an augmentation should be considered. A kyphoplasty procedure may be preferred over vertebroplasty, given the lower risk profile and better outcomes regarding spinal alignment. Published by Elsevier HS Journals, Inc.

  13. A STUDY OF PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY OF HIP IN ELDERLY PATIENTS WITH OSTEOPOROTIC, UNSTABLE INTERTROCHANTERIC FRACTURE

    Directory of Open Access Journals (Sweden)

    Maheshwar

    2015-08-01

    Full Text Available BACKGROUND: Intertrochanteric fractures are a major cause of morbidity and mortality in geriatric population. Osteoporosis contributes significantly to the comminution and instability in such fractures. Internal fixations in unstable intertrochanteric fractures are a ssociated with high rates of implant failures and gross restriction of hip movements. This study was undertaken to evaluate the efficacy of cemented bipolar hemiart h roplasty in elderly patients with osteoporotic, unstable intertrochanteric fractures. PATIE NTS AND METHODS: 52 patients aged above 60 years with unstable, comminuted intertrochanteric fractures with Singh’s index < 4 were operated with primary cemented bipolar hemireplacement arthroplasty. All the patients were mobilized early with full weight b earing in the post - operative period as permitted. 50 patients were evaluated for the functional outcome with Harris Hip score. RESULTS: The average age of patients was 65 years with female predominance (64%. Left side (56% was commonly involved and the c ommonest mode of injury was due to a trivial fall at home. Hypertension (30% was the commonest co - morbid condition. Limb shortening was the commonest complication (8%. The mean ± S.D. of the Harris Hip score was 85.6 ± 10.59 with a range from 56 to 96. Resul ts were excellent in 62%, good in 22%, fair in 12% and poor in 4% of cases. CONCLUSION: Elderly osteoporotic patients with comminuted, unstable intertrochanteric fractures have an increased prevalence of unsatisfactory functional results with conventional internal fixation devices. Primary cemented bipolar hemiarthroplasty with anatomical reconstruction of the trochanters allows early mobilization, improved functional outcome with relatively low incidence of associated complications.

  14. Assessment of jawbone trabecular bone structure amongst osteoporotic women by cone-beam computed tomography: the OSTEOSYR project.

    Science.gov (United States)

    Barngkgei, Imad; Al Haffar, Iyad; Shaarani, Eyad; Khattab, Razan; Mashlah, Ammar

    2016-11-01

    To assess the trabecular bone structure of jawbones and the dens (the odontoid process of the second cervical vertebra) amongst osteoporotic and nonosteoporotic women using cone-beam computed tomography (CBCT). Analysis of the dens trabecular bone structure aimed to test the validity of CBCT in such analysis. Thirty-eight women who went under dual-energy X-ray absorptiometry (DXA) examination were scanned by CBCT. Cuboids from different areas of jawbones and the dens were extracted from each scan. Trabecular thickness (Tb.Th), trabecular separation (Tb.S), bone volume fraction (BV/TV), specific bone surface (BS/TV) and connectivity density were calculated. Student's t-test, Pearson correlation, and logistic regression analysis were used to explore differences in these measures between groups. Jawbone-derived measures showed insignificant differences (P > 0.05) between osteoporotic and non-osteoporotic groups, and weak correlations with femoral neck and lumbar vertebrae T-scores (r ≤ 0.4). Dens-derived measures, however, resulted in the opposite (r = 0.34-0.38 [P value = 0.02-0.036] and r = 0.48-0.61 [P value ≤ 0.003]) and the highest accuracy of osteoporosis prediction: 84.2% and 78.9% respectively. Trabecular bone structure of the mandible and maxilla is not affected in osteoporosis as assessed by CBCT. Dens trabecular bone analysis revealed the opposite, so some trabecular bone measures may be assessed by CBCT, which may aid in predicting osteoporosis. © 2015 Wiley Publishing Asia Pty Ltd.

  15. Lack of Association between Body Weight, Bone Mineral Density and Vitamin D Receptor Gene Polymorphism in Normal and Osteoporotic Women

    Directory of Open Access Journals (Sweden)

    Massimo Poggi

    1999-01-01

    Full Text Available In an ethnically homogeneous population of women living in Tuscany, Italy, the relationships between age, body weight, bone mineral density and the vitamin D receptor (VDR gene polymorphism were studied, with the objective of recognizing patients at risk for osteoporosis. In 275 women bone mineral density was measured by Dual Energy X-rays Absorptiometry (DEXA. In 50 of them the individual genetic pattern for VDR was evaluated by DNA extraction followed by PCR amplification of the VDR gene, and digestion with the restriction enzyme BsmI. Age and bone mineral density were inversely related (R2 = 0.298. Body weight was associated with bone mineral density (R2 = 0.059, but not with age. In osteoporotic women, mean (± SD body weight was 59.9 ± 6.5 Kg, lower than that recorded in non osteoporotic women (64.2 ± 9.4 Kg, even though not significantly different (p = 0.18. No association was found between VDR gene polymorphism, bone density or body weight. The performance of anthropometric and genetic components appear to be poor, and, at least for the time being, bone mineral density measurement by means of MOC-DEXA represents the optimal method to detect women at risk for postmenopausal osteoporosis.

  16. Preliminary clinical research of vertebral body stenting combined with absorbable bone cements for osteoporotic vertebral compression fractures%椎体支架联合可吸收骨水泥治疗骨质疏松性椎体压缩骨折的临床疗效

    Institute of Scientific and Technical Information of China (English)

    贾崇哲; 贾璞; 陈浩; 包利; 冯飞; 刘青山; 杨阳; 唐海

    2016-01-01

    目的 分析经皮椎体后凸成形术(PKP)中运用椎体支架联合可吸收骨水泥治疗骨质疏松性椎体压缩骨折(OVCF)的临床效果. 方法 前瞻性研究2014年1月-2016年1月应用椎体支架联合可吸收骨水泥治疗OVCF患者.比较术前、术后3d、3、6个月视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎体高度恢复情况、椎体后凸Cobb角的变化及其并发症.结果 共纳入15例患者,其中男8例,女7例;年龄51~83岁,平均68.6岁,均完成6个月随访.所有患者均顺利完成手术,无术中、术后并发症发生.VAS评分由术前(7.67±0.62)分改善至术后3d的(2.60 ±0.63)分,术后3个月的(2.00 ±0.65)分,术后6个月的(1.26±0.80)分;ODI由术前(55.62±6.14)%改善至术后3d的(30.84±2.70)%,术后3个月的(21.88±2.42)%,术后6个月的(17.07±2.82)%.术后3d、3个月、6个月与术前比较,VAS评分和ODI显著降低(P均<0.05).椎体前缘高度由术前(2.50 ±0.48) cm恢复为术后3d的(2.59 ±0.49)cm,术后6个月的(2.60±0.50)cm.椎体中部高度由术前(2.27 ±0.38)cm恢复为术后3d的(2.33±0.38) cm,术后6个月的(2.35±0.38) cm.椎体后缘高度由术前(3.09±0.48)cm恢复为术后3d的(3.14±0.46)cm,术后6个月的(3.18±0.50) cm.术后椎体前缘、中部高度较术前均有所恢复(P<0.05),且高度在3d、6个月时丢失不明显(P>0.05);术后椎体后缘高度较术前恢复不明显(P>0.05).Cobb角术前为(8.93±6.58).,恢复为术后3d的(8.03±6.02)°,术后3个月的(8.06±6.08).,术后6个月的(7.93±6.09).,术后Cobb角较术前有所改善(P均<0.05),且随访期间Cobb角变化不明显(P>0.05). 结论 PKP术中椎体支架联合可吸收骨水泥治疗OVCF可改善和维持椎体前缘、中部高度及Cobb角,早期随访效果满意.%Objective To observe the clinical effect and safety of using vertebral body stenting combined with absorbable bone cements during percutaneous kyphoplasty (PKP) for osteoporotic

  17. Intraspinal Leakage of Cement During Vertebroplasty for an Elderly Woman with Osteoporotic Burst Fracture: A Case Report and Short Review of Prevention and Management

    Directory of Open Access Journals (Sweden)

    Yuk-Chuen Siu

    2015-12-01

    Full Text Available Osteoporotic spine fracture is very common nowadays due to the aging population. It may result in prolonged immobilization due to significant back pain. Cement vertebroplasty helps to relieve pain, provides immediate stability and allows early mobilization. Intraspinal leakage of cement is a rare complication but it may lead to catastrophic neurological injuries. Evidence-based management guidelines for this complication are lacking. This is a case report about intraspinal leakage of cement during vertebroplasty for an 85-year-old woman with osteoporotic burst fractures over the lumbar spine. Urgent exploration and decompression was performed. No neurological injury was found after the operation and the patient recovered from osteoporotic back pain uneventfully.

  18. Micro-CT evaluation and histological analysis of screw-bone interface of expansive pedicle screw in osteoporotic sheep.

    Science.gov (United States)

    Wan, Shi-yong; Lei, Wei; Wu, Zi-xiang; Lv, Rong; Wang, Jun; Fu, Suo-chao; Li, Bo; Zhan, Ce

    2008-04-01

    To investigate the properties of screw-bone interface of expansive pedicle screw (EPS) in osteoporotic sheep by micro-CT and histological observation. Six female sheep with bilateral ovariectomy-induced osteoporosis were employed in this experiment. After EPS insertion in each femoral condyle, the sheep were randomly divided into two groups: 3 sheep were bred for 3 months (Group A), while the other 3 were bred for 6 months (Group B). After the animals being killed, the femoral condyles with EPS were obtained, which were three-dimensionally-imaged and reconstructed by micro-CT. Histological evaluation was made thereafter. The trabecular microstructure was denser at the screw-bone interface than in the distant parts in expansive section, especially within the spiral marking. In the non-expansive section, however, there was no significant difference between the interface and the distant parts. The regions of interest (ROI) adjacent to EPS were reconstructed and analyzed by micro-CT with the same thresholds. The three-dimensional (3-D) parameters, including tissue mineral density (TMD), bone volume fraction (BVF, BV/TV), bone surface/bone volume (BS/BV) ratio, trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp), were significantly better in expansive sections than non-expansive sections (P less than 0.05). Histologically, newly-formed bony trabeculae crawled along the expansive fissures and into the center of EPS. The newly-formed bones, as well as the bones at the bone-screw interface, closely contacted with the EPS and constructed four compartments. The findings of the current study, based on micro-CT and histological evaluation, suggest that EPS can significantly provide stabilization in osteoporotic cancellous bones.

  19. Expected lifetime numbers, risks, and burden of osteoporotic fractures for 50-year old Chinese women: a discrete event simulation incorporating FRAX.

    Science.gov (United States)

    Jiang, Yawen; Ni, Weiyi

    2016-11-01

    This work was undertaken to provide an estimation of expected lifetime numbers, risks, and burden of fractures for 50-year-old Chinese women. A discrete event simulation model was developed to simulate the lifetime fractures of 50-year-old Chinese women at average risk of osteoporotic fracture. Main events in the model included hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture. Fracture risks were calculated using the FRAX ® tool. Simulations of 50-year-old Chinese women without fracture risks were also carried out as a comparison to determine the burden of fractures. A 50-year-old Chinese woman at average risk of fracture is expected to experience 0.135 (95 % CI: 0.134-0.137) hip fractures, 0.120 (95 % CI: 0.119-0.122) clinical vertebral fractures, 0.095 (95 % CI: 0.094-0.096) wrist fractures, 0.079 (95 % CI: 0.078-0.080) humerus fractures, and 0.407 (95 % CI: 0.404-0.410) other fractures over the remainder of her life. The residual lifetime risk of any fracture, hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture for a 50-year-old Chinese woman is 37.36, 11.77, 10.47, 8.61, 7.30, and 27.80 %, respectively. The fracture-attributable excess quality-adjusted life year (QALY) loss and lifetime costs are estimated at 0.11 QALYs (95 % CI: 0.00-0.22 QALYs) and US $714.61 (95 % CI: US $709.20-720.02), totaling a net monetary benefit loss of US $1,104.43 (95 % CI: US $904.09-1,304.78). Chinese women 50 years of age are at high risk of osteoporotic fracture, and the expected economic and quality-of-life burden attributable to osteoporotic fractures among Chinese women is substantial.

  20. Common and rare variants in the exons and regulatory regions of osteoporosis-related genes improve osteoporotic fracture risk prediction.

    Science.gov (United States)

    Lee, Seung Hun; Kang, Moo Il; Ahn, Seong Hee; Lim, Kyeong-Hye; Lee, Gun Eui; Shin, Eun-Soon; Lee, Jong-Eun; Kim, Beom-Jun; Cho, Eun-Hee; Kim, Sang-Wook; Kim, Tae-Ho; Kim, Hyun-Ju; Yoon, Kun-Ho; Lee, Won Chul; Kim, Ghi Su; Koh, Jung-Min; Kim, Shin-Yoon

    2014-11-01

    Osteoporotic fracture risk is highly heritable, but genome-wide association studies have explained only a small proportion of the heritability to date. Genetic data may improve prediction of fracture risk in osteopenic subjects and assist early intervention and management. To detect common and rare variants in coding and regulatory regions related to osteoporosis-related traits, and to investigate whether genetic profiling improves the prediction of fracture risk. This cross-sectional study was conducted in three clinical units in Korea. Postmenopausal women with extreme phenotypes (n = 982) were used for the discovery set, and 3895 participants were used for the replication set. We performed targeted resequencing of 198 genes. Genetic risk scores from common variants (GRS-C) and from common and rare variants (GRS-T) were calculated. Nineteen common variants in 17 genes (of the discovered 34 functional variants in 26 genes) and 31 rare variants in five genes (of the discovered 87 functional variants in 15 genes) were associated with one or more osteoporosis-related traits. Accuracy of fracture risk classification was improved in the osteopenic patients by adding GRS-C to fracture risk assessment models (6.8%; P risk in an osteopenic individual.

  1. 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, Bo

    2009-01-01

    initiation within 1 year was highest after spine fracture: 39.6% of women began therapy in 2004 compared with 19.5% in 1997. In men, 16.5% began therapy in 2004 vs. 8.0% in 1997. Following hip fracture, 9.2% of women and 4.1% of men began therapy in 2004 vs. 3.4% and 0.7% in 1997, respectively. Median...... or weekly alendronate obtaining treatment durations equalling those of the licensing trials. INTRODUCTION: Reducing the societal fracture burden remains challenging due to failure to treat fragility fractures and non-compliance with treatment. METHODS: We used national registers to identify patients born...... persistence (years) was 2.8 for daily alendronate, 3.8 for weekly alendronate, 2.5 for etidronate and 4.7 for raloxifene. The risk of discontinuing or changing therapy increased with age. CONCLUSIONS: Prescription rates for anti-osteoporotic medication are very low, especially in hip fracture and in men...

  2. Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model.

    Science.gov (United States)

    Kiyak, Gorkem; Balikci, Tevfik; Heydar, Ahmed Majid; Bezer, Murat

    2018-02-01

    Mechanical study. To compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model. Adequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone-screw interface. Polyurethane blocks were used to mimic human osteoporotic cancellous bone, and six different screw designs were tested. Five standard and expandable screws without augmentation, eight expandable screws with polymethylmethacrylate (PMMA) or calcium phosphate augmentation, and distal cannulated screws with PMMA and calcium phosphate augmentation were tested. Mechanical tests were performed on 10 unused new screws of each group. Screws with or without augmentation were inserted in a block that was held in a fixture frame, and a longitudinal extraction force was applied to the screw head at a loading rate of 5 mm/min. Maximum load was recorded in a load displacement curve. The peak pullout force of all tested screws with or without augmentation was significantly greater than that of the standard pedicle screw. The greatest pullout force was observed with 40-mm expandable pedicle screws with four fins and PMMA augmentation. Augmented distal cannulated screws did not have a greater peak pullout force than nonaugmented expandable screws. PMMA augmentation provided a greater peak pullout force than calcium phosphate augmentation. Expandable pedicle screws had greater peak pullout forces than standard pedicle screws and had the advantage of augmentation with either PMMA or calcium phosphate cement. Although calcium phosphate cement is biodegradable, osteoconductive, and nonexothermic, PMMA provided a significantly greater peak pullout force. PMMA-augmented expandable 40-mm four-fin pedicle screws had the greatest peak pullout force.

  3. Osteoporotic vertebral fractures during pregnancy: be aware of a potential underlying genetic cause.

    Science.gov (United States)

    Campos-Obando, Natalia; Oei, Ling; Hoefsloot, Lies H; Kiewiet, Rosalie M; Klaver, Caroline C W; Simon, Marleen E H; Zillikens, M Carola

    2014-04-01

    Although the baby growing in its mother's womb needs calcium for skeletal development, osteoporosis and fractures very rarely occur during pregnancy. A 27-year-old woman in the seventh month of her first pregnancy contracted midthoracic back pain after lifting an object. The pain was attributed to her pregnancy, but it remained postpartum. Her past medical history was uneventful, except for severely reduced vision of her left eye since birth. Family history revealed that her maternal grandmother had postmenopausal osteoporosis and her half-brother had three fractures during childhood after minor trauma. Her height was 1.58 m; she had no blue sclerae or joint hyperlaxity. Laboratory examination including serum calcium, phosphate, alkaline phosphatase, creatinine, β-carboxyterminal cross-linking telopeptide of type I collagen, 25-hydroxyvitamin D, and TSH was normal. Multiple thoracic vertebral fractures were diagnosed on x-ray examination, and dual-energy x-ray absorptiometry scanning showed severe osteoporosis (Z-scores: L2-L4, -5.6 SD; femur neck, -3.9 SD). DNA analyses revealed two compound heterozygous missense mutations in LRP5. The patient's mother carried one of the LRP5 mutations and was diagnosed with osteoporosis. Her half-brother, treated with cabergoline for a microprolactinoma, also had osteoporosis of the lumbar spine on dual-energy x-ray absorptiometry and carried the same LRP5 mutation. The patient was treated with risedronate for 2.5 years. Bone mineral density and back pain improved. She stopped bisphosphonate use 6 months before planning a second pregnancy. Our patient was diagnosed with osteoporosis pseudoglioma syndrome/familial exudative vitreoretinopathy. Potential underlying genetic causes should be considered in pregnancy-associated osteoporosis with implications for patients and relatives. More studies regarding osteoporosis treatment preceding conception are desirable.

  4. Whole body vibration versus magnetic therapy on bone mineral density in elderly osteoporotic individuals.

    Science.gov (United States)

    Shanb, Alsayed Abdelhameed; Youssef, Enas Fawzy; Muaidi, Qassim Ibrahim; Alothman, Abdullah Ahmed

    2017-08-03

    Osteoporosis usually develops gradually and progresses without significant signs and symptoms. It is one of the most common musculoskeletal conditions associated with aging. To evaluate the effects of whole body vibration (WBV) or magnetic therapy in addition to standard pharmacological treatment on bone mineral density (BMD) in elderly individuals being treated for osteoporosis. Eighty-five participants, 60-75 years of age, were randomly divided into three groups. All three groups received the same standard pharmacological treatment comprised of vitamin D, calcium, and alendronate sodium. In Group I, thirty participants were also exposed to WBV for 25 minutes in each session with two sessions per week for 4 months. In Group II, thirty participants were exposed to magnetic therapy for 50 minutes in each session with two sessions per week for 4 months. In Group III, twenty-five participants received only pharmacological treatment. Dual-energy X-ray absorptiometry was used to measure BMD of the lumbar spine and femoral heads before and after interventions. Venus blood sample was drawn for analysis of calcium and vitamin D. An ANOVA test detected significant (pmagnetic therapy. Statistical t-tests detected significant (pmagnetic therapy in combination with pharmacological treatment, but no significant increase after pharmacological treatment alone. Addition of either WBV or magnetic therapy to standard pharmacological treatment for osteoporosis significantly increased BMD in elderly subjects. No significant difference in effectiveness was detected between these two alternative therapy modalities. Consequently, either WBV or magnetic therapy could be effectively applied in conjunction with pharmacological treatment to increase BMD in elderly osteoporotic patients.

  5. Osteoporotic fractures of proximal femur: clinical and epidemiological features in a population of the city of São Paulo

    Directory of Open Access Journals (Sweden)

    Ana Claudia Ramalho

    Full Text Available CONTEXT: It is believed that about 25% of menopausal women in the USA will exhibit some kind of fracture as a consequence of osteoporosis. Fractures of the proximal femur are associated with a greater number of deaths and disabilities and higher medical expenses than all the other osteoporotic fractures together. OBJECTIVE: To study the clinical and epidemiological features of patients with proximal femur fracture in hospitals in São Paulo. DESIGN: Transversal and retrospective study. LOCAL: Hospital São Paulo and Hospital Servidor Público Estadual "Francisco Morato Oliveira". PARTICIPANTS: Patients aged sixty-five years or more hospitalized because of proximal femur fracture, from March to November 1996 (N = 73. This group was compared to patients of the same age without fracture of the proximal femur. INTERVENTION: Evaluation of weight, height, body mass index; lifestyle habits (physical activity at home, ingestion of dairy calcium, drinking of coffee, smoking habit, gynecological history (ages at menarche and menopause, number of pregnancies and lactations, previous morbidity, use of medications, history of previous fractures, family history of osteoporosis. MEASUREMENT: The comparison of the different data regarding lifestyle habits between the two groups was made using the chi-squared test. Other data were analyzed using the Mann -- Whitney test. P £ 0.05 was considered significant. RESULTS: We noted a predominance of proximal femur fracture among females in relation to males (a female/male ratio of 3.3:1 with a progressive increase in the frequency of proximal femur fracture with age in both sexes. The group with proximal femur fracture, in comparison with the control group, showed a lower body mass index, less physical activity, and a greater number of pregnancies and lactations. Other data were not different. CONCLUSION: In accordance with the literature, we found a predomination of proximal femur fracture in women in relation to men

  6. Statins and physical activity in older men: the osteoporotic fractures in men study.

    Science.gov (United States)

    Lee, David S H; Markwardt, Sheila; Goeres, Leah; Lee, Christine G; Eckstrom, Elizabeth; Williams, Craig; Fu, Rongwei; Orwoll, Eric; Cawthon, Peggy M; Stefanick, Marcia L; Mackey, Dawn; Bauer, Douglas C; Nielson, Carrie M

    2014-08-01

    Muscle pain, fatigue, and weakness are common adverse effects of statin medications and may decrease physical activity in older men. To determine whether statin use is associated with physical activity, longitudinally and cross-sectionally. Men participating in the Osteoporotic Fractures in Men Study (N = 5994), a multicenter prospective cohort study of community-living men 65 years and older, enrolled between March 2000 and April 2002. Follow-up was conducted through 2009. Statin use as determined by an inventory of medications (taken within the last 30 days). In cross-sectional analyses (n = 4137), statin use categories were users and nonusers. In longitudinal analyses (n = 3039), categories were prevalent users (baseline use and throughout the study), new users (initiated use during the study), and nonusers (never used). Self-reported physical activity at baseline and 2 follow-up visits using the Physical Activity Scale for the Elderly (PASE). At the third visit, an accelerometer measured metabolic equivalents (METs [kilocalories per kilogram per hour]) and minutes of moderate activity (METs ≥3.0), vigorous activity (METs ≥6.0), and sedentary behavior (METs ≤1.5). At baseline, 989 men (24%) were users and 3148 (76%) were nonusers. The adjusted difference in baseline PASE between users and nonusers was -5.8 points (95% CI, -10.9 to -0.7 points). A total of 3039 men met the inclusion criteria for longitudinal analysis: 727 (24%) prevalent users, 845 (28%) new users, and 1467 (48%) nonusers. PASE score declined by a mean (95% CI) of 2.5 (2.0 to 3.0) points per year for nonusers and 2.8 (2.1 to 3.5) points per year for prevalent users, a nonstatistical difference (0.3 [-0.5 to 1.0] points). For new users, annual PASE score declined at a faster rate than nonusers (difference of 0.9 [95% CI, 0.1 to 1.7] points). A total of 3071 men had adequate accelerometry data, 1542 (50%) were statin users. Statin users expended less METs (0.03 [95% CI, 0.02-0.04] METs less

  7. “Burden of osteoporotic fractures in primary health care in Catalonia (Spain: a population-based study”

    Directory of Open Access Journals (Sweden)

    Pagès-Castellà Aina

    2012-05-01

    Full Text Available Abstract Background Knowledge on the epidemiology of non-hip fractures in Spain is limited and somewhat outdated. Using computerized primary care records from the SIDIAP database, we derived age and sex-specific fracture incidence rates for the region of Catalonia during the year 2009. Methods The SIDIAP database contains quality-checked clinical information from computerized medical records of a representative sample of >5,800,000 patients (80% of the population of Catalonia. We conducted a retrospective cohort study including all patients aged ≥50 years, and followed them from January 1 to December 31, 2009. Major osteoporotic fractures registered in SIDIAP were ascertained using ICD-10 codes and validated by comparing data to hospital admission and patient-reported fractures records. Incidence rates and 95% confidence intervals were calculated. Results In total, 2,011,430 subjects were studied (54.6% women. Overall fracture rates were 10.91/1,000 person-years (py [95%CI 10.89–10.92]: 15.18/1,000 py [15.15–15.21] in women and 5.78/1,000 py [5.76–5.79] in men. The most common fracture among women was wrist/forearm (3.86/1,000 py [3.74–3.98], while among men it was clinical spine (1.25/1,000 py [1.18–1.33]. All fracture rates increased with age, but varying patterns were observed: while most of the fractures (hip, proximal humerus, clinical spine and pelvis increased continuously with age, wrist and multiple rib fractures peaked at age 75–80 and then reached a plateau. Conclusions Our study provides local estimates of age, sex and site-specific fracture burden in primary health care, which will be helpful for health-care planning and delivery. A proportion of fractures are not reported in primary care records, leading to underestimation of fracture incidence rates in these data.

  8. Navicular bone fracture in the pelvic limb in two horses

    International Nuclear Information System (INIS)

    Kaser-Hotz, B.; Ueltschi, G.; Hess, N.

    1991-01-01

    The case history, radiographic and scintigraphic findings of two horses with pelvic limb navicular bone fractures are presented. In both cases the fractures were of traumatic origin. One horse had a bilateral fracture of the navicular bone, distal border, the other horse had a fracture of the proximal articular border in one pelvic limb navicular bone

  9. Foal Fractures: Osteochondral Fragmentation, Proximal Sesamoid Bone Fractures/Sesamoiditis, and Distal Phalanx Fractures.

    Science.gov (United States)

    Reesink, Heidi L

    2017-08-01

    Foals are susceptible to many of the same types of fractures as adult horses, often secondary to external sources of trauma. In addition, some types of fractures are specific to foals and occur routinely in horses under 1 year of age. These foal-specific fractures may be due to the unique musculoskeletal properties of the developing animal and may present with distinct clinical signs. Treatment plans and prognoses are tailored specifically to young animals. Common fractures not affecting the long bones in foals are discussed in this article, including osteochondral fragmentation, proximal sesamoid bone fractures/sesamoiditis, and distal phalanx fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Differentiation of osteoporotic and neoplastic vertebral fractures by chemical shift {in-phase and out-of phase} MR imaging

    International Nuclear Information System (INIS)

    Ragab, Yasser; Emad, Yasser; Gheita, Tamer; Mansour, Maged; Abou-Zeid, A.; Ferrari, Serge; Rasker, Johannes J.

    2009-01-01

    Objective: The objective of this study was to establish the cut-off value of the signal intensity drop on chemical shift magnetic resonance imaging (MRI) with appropriate sensitivity and specificity to differentiate osteoporotic from neoplastic wedging of the spine. Patients and methods: All patients with wedging of vertebral bodies were included consecutively between February 2006 and January 2007. A chemical shift MRI was performed and signal intensity after (in-phase and out-phase) images were obtained. A DXA was performed in all. Results: A total of 40 patients were included, 20 with osteoporotic wedging (group 1) and 20 neoplastic (group 2). They were 21 males and 19 females. Acute vertebral collapse was observed in 15 patients in group 1 and subacute collapse in another 5 patients, while in group 2, 11 patients showed acute collapse and 9 patients (45%) showed subacute vertebral collapse. On the chemical shift MRI a substantial reduction in signal intensity was found in all lesions in both groups. The proportional changes observed in signal intensity of bone marrow lesions on in-phase compared with out-of-phase images showed significant differences in both groups (P < 0.05). At a cut-off value of 35%, the observed sensitivity of out-of-phase images was 95%, specificity was 100%, positive predictive value was 100% and negative predictive value was 95.2%. Conclusion: A chemical shift MRI is useful in order to differentiate patients with vertebral collapse due to underlying osteoporosis or neoplastic process.

  11. The micro-architecture of human cancellous bone from fracture neck of femur patients in relation to the structural integrity and fracture toughness of the tissue

    Directory of Open Access Journals (Sweden)

    C. Greenwood

    2015-12-01

    Full Text Available Osteoporosis is clinically assessed from bone mineral density measurements using dual energy X-ray absorption (DXA. However, these measurements do not always provide an accurate fracture prediction, arguably because DXA does not grapple with ‘bone quality’, which is a combined result of microarchitecture, texture, bone tissue properties, past loading history, material chemistry and bone physiology in reaction to disease. Studies addressing bone quality are comparatively few if one considers the potential importance of this factor. They suffer due to low number of human osteoporotic specimens, use of animal proxies and/or the lack of differentiation between confounding parameters such as gender and state of diseased bone. The present study considers bone samples donated from patients (n = 37 who suffered a femoral neck fracture and in this very well defined cohort we have produced in previous work fracture toughness measurements (FT which quantify its ability to resist crack growth which reflects directly the structural integrity of the cancellous bone tissue. We investigated correlations between BV/TV and other microarchitectural parameters; we examined effects that may suggest differences in bone remodelling between males and females and compared the relationships with the FT properties. The data crucially has shown that TbTh, TbSp, SMI and TbN may provide a proxy or surrogate for BV/TV. Correlations between FT critical stress intensity values and microarchitecture parameters (BV/TV, BS/TV, TbN, BS/BV and SMI for osteoporotic cancellous tissue were observed and are for the first time reported in this study. Overall, this study has not only highlighted that the fracture model based upon BMD could potentially be improved with inclusion of other microarchitecture parameters, but has also given us clear clues as to which of them are more influential in this role.

  12. Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study1234

    Science.gov (United States)

    Orchard, Tonya S; Larson, Joseph C; Alghothani, Nora; Bout-Tabaku, Sharon; Cauley, Jane A; Chen, Zhao; LaCroix, Andrea Z; Wactawski-Wende, Jean; Jackson, Rebecca D

    2014-01-01

    Background: Magnesium is a necessary component of bone, but its relation to osteoporotic fractures is unclear. Objective: We examined magnesium intake as a risk factor for osteoporotic fractures and altered bone mineral density (BMD). Design: This prospective cohort study included 73,684 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Total daily magnesium intake was estimated from baseline food-frequency questionnaires plus supplements. Hip fractures were confirmed by a medical record review; other fractures were identified by self-report. A baseline BMD analysis was performed in 4778 participants. Results: Baseline hip BMD was 3% higher (P 422.5 compared with magnesium. In contrast, risk of lower-arm or wrist fractures increased with higher magnesium intake [multivariate-adjusted HRs of 1.15 (95% CI: 1.01, 1.32) and 1.23 (95% CI: 1.07, 1.42) for quintiles 4 and 5, respectively, compared with quintile 1; P-trend = 0.002]. In addition, women with the highest magnesium intakes were more physically active and at increased risk of falls [HR for quintile 4: 1.11 (95% CI: 1.06, 1.16); HR for quintile 5: 1.15 (95% CI: 1.10, 1.20); P-trend magnesium intake is associated with lower BMD of the hip and whole body, but this result does not translate into increased risk of fractures. A magnesium consumption slightly greater than the Recommended Dietary Allowance is associated with increased lower-arm and wrist fractures that are possibly related to more physical activity and falls. This trial was registered at clinicaltrials.gov as NCT00000611. PMID:24500155

  13. Biomechanical analysis of range of motion and failure characteristics of osteoporotic spinal compression fractures in human cadaver

    Directory of Open Access Journals (Sweden)

    Robert F Heary

    2017-01-01

    Full Text Available Background: Vertebroplasty is a treatment for osteoporotic vertebral compression fractures. The optimal location of needle placement for cement injection remains a topic of debate. As such, the authors assessed the effects of location of two types of cement instillations. In addition, the motion and failure modes at the index and adjacent segments were measured. Materials and Methods: Seven human osteoporotic cadaver spines (T1-L4, cut into four consecutive vertebral segments, were utilized. Of these, following the exclusion of four specimens not suitable to utilize for analysis, a total of 24 specimens were evaluable. Segments were randomly assigned into four treatment groups: unipedicular and bipedicular injections into the superior quartile or the anatomic center of the vertebra using confidence (Confidence Spinal Cement System®, DePuy Spine, Raynham, MA, USA or polymethyl methacrylate. The specimens were subjected to nondestructive pure moments of 5 Nm, in 2.5 Nm increments, using pulleys and weights to simulate six degrees of physiological motion. A follower preload of 200 N was applied in flexion extension. Testing sequence: range of motion (ROM of intact specimen, fracture creation, cement injection, ROM after cement, and compression testing until failure. Nonconstrained motion was measured at the index and adjacent levels. Results: At the index level, no significant differences were observed in ROM in all treatment groups (P > 0.05. There was a significant increase in adjacent level motion only for the treatment group that received a unipedicular cement injection at the anatomic center. Conclusion: The location of the needle (superior or central and treatment type (unipedicular or bipedicular had no significant effect on the ROM at the index site. At the adjacent levels, a significant increase occurred with therapy through a unipedicular approach into the centrum of the vertebra at the treated segment.

  14. Ulnar nerve paralysis after forearm bone fracture

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2016-08-01

    Full Text Available ABSTRACT Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

  15. New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures.

    Science.gov (United States)

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Sakai, Ryo; Sawada, Koshiro; Mikami, Yasuo; Toyama, Syogo; Ozaki, Etsuko; Kuriyama, Nagato; Kurokawa, Masao; Kubo, Toshikazu

    2017-01-01

    Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm 3 ), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius. There might be

  16. Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women.

    Science.gov (United States)

    Tanaka, S; Kuroda, T; Saito, M; Shiraki, M

    2013-01-01

    This cohort study of 1,614 postmenopausal Japanese women followed for 6.7 years showed that overweight/obesity and underweight are both risk factors for fractures at different sites. Fracture risk assessment may be improved if fracture sites are taken into account and BMI is categorized. The effect of body mass index (BMI) on fracture at a given level of bone mineral density (BMD) is controversial, since varying associations between BMI and fracture sites have been reported. A total of 1,614 postmenopausal Japanese women were followed for 6.7 years in a hospital-based cohort study. Endpoints included incident vertebral, femoral neck, and long-bone fractures. Rate ratios were estimated by Poisson regression models adjusted for age, diabetes mellitus, BMD, prior fracture, back pain, and treatment by estrogen. Over a mean follow-up period of 6.7 years, a total of 254 clinical and 335 morphometric vertebral fractures, 48 femoral neck fractures, and 159 long-bone fractures were observed. Incidence rates of vertebral fracture in underweight and normal weight women were significantly lower than overweight or obese women by 0.45 (95 % confidence interval: 0.32 to 0.63) and 0.61 (0.50 to 0.74), respectively, if BMD and other risk factors were adjusted, and by 0.66 (0.48 to 0.90) and 0.70 (0.58 to 0.84) if only BMD was not adjusted. Incidence rates of femoral neck and long-bone fractures in the underweight group were higher than the overweight/obese group by 2.15 (0.73 to 6.34) and 1.51 (0.82 to 2.77) and were similar between normal weight and overweight/obesity. Overweight/obesity and underweight are both risk factors for fractures at different sites. Fracture risk assessment may be improved if fracture sites are taken into account and BMI is categorized.

  17. Percutaneous Vertebroplasty Compared to Conservative Treatment in Patients With Painful Acute or Subacute Osteoporotic Vertebral Fractures: Three-Months Follow-up in a Clinical Randomized Study

    DEFF Research Database (Denmark)

    Rousing, Rikke; Andersen, Mikkel Østerheden; Jespersen, Stig M.

    2009-01-01

    STUDY DESIGN: Clinical randomized study. OBJECTIVE: The aim of this study is to compare percutaneous vertebroplasty (PVP) to conservative treatment of patients with osteoporotic vertebral fractures in a clinical randomized study with respect to pain, physical and mental outcome, and to asses...... patients (41 females) were included from January 2001 until January 2008. Patients with acute (treatment. Pain was assessed with a visual analogue scale and physical and mental...... within both groups and between the groups after 3 months with a few exceptions. We observed 2 adjacent fractures in the PVP group and non in the conservative group. CONCLUSION: The majority of patients with acute or subacute painful osteoporotic compression fractures in the spine will recover after a few...

  18. Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures.Three months follow up in a clinical randomised study

    DEFF Research Database (Denmark)

    Rousing, Rikke

    2008-01-01

    with a few exceptions. We observed 2 adjacent fractures in the PVP group and non in the conservative group. Conclusion. The majority of patients with acute or subacute painful osteoporotic compression fractures in the spine will recover after a few months of conservative treatment. The risk of adjacent......Abstract Study design. Clinical randomised study.    Objective. The aim of this study is to compare PVP to conservative treatment of patients with osteoporotic vertebral fractures in a clinical randomised study with respect to pain, physical and mental outcome, and to asses the risk of adjacent......) were included from January 2001 until January 2008. Patients with acute (treatment. Pain was assessed with a visual analogue scale and physical and mental outcome were...

  19. Pedicle screws with a thin hydroxyapatite coating for improving fixation at the bone-implant interface in the osteoporotic spine: experimental study in a porcine model.

    Science.gov (United States)

    Ohe, Makoto; Moridaira, Hiroshi; Inami, Satoshi; Takeuchi, Daisaku; Nohara, Yutaka; Taneichi, Hiroshi

    2018-03-30

    OBJECTIVE Instrumentation failure caused by the loosening of pedicle screws (PSs) in patients with osteoporosis is a serious problem after spinal surgery. The addition of a thin hydroxyapatite (HA) surface coating applied by using a sputtering process was reported recently to be a promising method for providing bone conduction around an implant without a significant risk of coating-layer breakage. In this study, the authors evaluated the biomechanical and histological features of the bone-implant interface (BII) of PSs with a thin HA coating in an in vivo porcine osteoporotic spine model. METHODS Three types of PSs (untreated/standard [STPS], sandblasted [BLPS], and HA-coated [HAPS] PSs) were implanted into the thoracic and lumbar spine (T9-L6) of 8 mature Clawn miniature pigs (6 ovariectomized [osteoporosis group] and 2 sham-operated [control group] pigs). The spines were harvested from the osteoporosis group at 0, 2, 4, 8, 12, or 24 weeks after PS placement and from the control group at 0 or 24 weeks. Their bone mineral density (BMD) was measured by peripheral quantitative CT. Histological evaluation of the BIIs was conducted by performing bone volume/tissue volume and bone surface/implant surface measurements. The strength of the BII was evaluated with extraction torque testing. RESULTS The BMD decreased significantly in the osteoporosis group (p < 0.01). HAPSs exhibited the greatest mean extraction peak torque at 8 weeks, and HAPSs and BLPSs exhibited significantly greater mean torque than the STPSs at 12 weeks (p < 0.05). The bone surface/implant surface ratio was significantly higher for HAPSs than for STPSs after 2 weeks (p < 0.05), and bonding between bone and the implant surface was maintained until 24 weeks with no detachment of the coating layer. In contrast, the bone volume/tissue volume ratio was significantly higher for HAPSs than for BLPSs or STPSs only at 4 weeks. CONCLUSIONS Using PSs with a thin HA coating applied using a sputtering process

  20. The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)--quality of life during the first 4 months after fracture.

    Science.gov (United States)

    Borgström, F; Lekander, I; Ivergård, M; Ström, O; Svedbom, A; Alekna, V; Bianchi, M L; Clark, P; Curiel, M D; Dimai, H P; Jürisson, M; Kallikorm, R; Lesnyak, O; McCloskey, E; Nassonov, E; Sanders, K M; Silverman, S; Tamulaitiene, M; Thomas, T; Tosteson, A N A; Jönsson, B; Kanis, J A

    2013-03-01

    The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss. The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS. ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire. The total sample for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not. The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries.

  1. Polymethylmethacrylate distribution is associated with recompression after vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures: A retrospective study

    Science.gov (United States)

    Yao, Qi; Zhang, Genai; Ding, Lixiang; Huang, Hui

    2018-01-01

    Background Osteoporotic vertebral compression fracture, always accompanied with pain and height loss of vertebral body, has a significant negative impact on life quality of patients. Vertebroplasty or kyphoplasty is minimal invasive techniques to reconstruct the vertebral height and prevent further collapse of the fractured vertebrae by injecting polymethylmethacrylate into vertebral body. However, recompression of polymethylmethacrylate augmented vertebrae with significant vertebral height loss and aggressive local kyphotic was observed frequently after VP or KP. The purpose of this study was to investigate the effect of polymethylmethacrylate distribution on recompression of the vertebral body after vertebroplasty or kyphoplasty surgery for osteoporotic vertebral compression fracture. Methods A total of 281 patients who were diagnosed with vertebral compression fracture (T5-L5) from June 2014 to June 2016 and underwent vertebroplasty or kyphoplasty by polymethylmethacrylate were retrospectively analyzed. The X-ray films at 1 day and 12 months after surgery were compared to evaluate the recompression of operated vertebral body. Patients were divided into those without recompression (non-recompression group) and those with recompression (recompression group). Polymethylmethacrylate distribution pattern, including location and relationship to endplates, was compared between the two groups by lateral X-ray film. Multivariate logistic regression analysis was performed to assess the potential risk factors associated with polymethylmethacrylate distribution for recompression. Results One hundred and six (37.7%) patients experienced recompression after surgery during the follow-up period. The polymethylmethacrylate distributed in the middle of vertebral body showed significant differences between two groups. In non-recompression group, the polymethylmethacrylate in the middle portion of vertebral body were closer to endplates than that in the recompression group (upper

  2. Fracture, aging and disease in bone

    Energy Technology Data Exchange (ETDEWEB)

    Ager, J.W.; Balooch, G.; Ritchie, R.O.

    2006-02-01

    From a public health perspective, developing a detailed mechanistic understanding of the well-known increase in fracture risk of human bone with age is essential. This also represents a challenge from materials science and fracture mechanics viewpoints. Bone has a complex, hierarchical structure with characteristic features ranging from nanometer to macroscopic dimensions; it is therefore significantly more complex than most engineering materials. Nevertheless, by examining the micro-/nano-structural changes accompanying the process of aging using appropriate multiscale experimental methods and relating them to fracture mechanics data, it is possible to obtain a quantitative picture of how bone resists fracture. As human cortical bone exhibits rising ex vivo crack-growth resistance with crack extension, its fracture toughness must be evaluated in terms of resistance-curve (R-curve) behavior. While the crack initiation toughness declines with age, the more striking finding is that the crack-growth toughness declines even more significantly and is essentially absent in bone from donors exceeding 85 years in age. To explain such an age-induced deterioration in the toughness of bone, we evaluate its fracture properties at multiple length scales, specifically at the molecular and nanodimensions using pico-force atomic-force microscopy, nanoindentation and vibrational spectroscopies, at the microscale using electron microscopy and hard/soft x-ray computed tomography, and at the macroscale using R-curve measurements. We show that the reduction in crack-growth toughness is associated primarily with a degradation in the degree of extrinsic toughening, in particular involving crack bridging, and that this occurs at relatively coarse size-scales in the range of tens to hundreds of micrometers. Finally, we briefly describe how specific clinical treatments, e.g., with steroid hormones to treat various inflammatory conditions, can prematurely damage bone, thereby reducing its

  3. Bone fracture repair - series (image)

    Science.gov (United States)

    ... by the following methods: a) one or more screws inserted across the break to hold it. b) a steel plate held by screws drilled into the bone. c) a long fluted metal pin with holes in it, is driven down the shaft of the bone ...

  4. Evaluation of laser photobiomodulation on bone defect in the femur of osteoporotic rats: a Raman spectral study

    Science.gov (United States)

    Soares, Luiz Guilherme P.; Aciole, Jouber Mateus d. S.; Neves, Bruno Luiz R. C.; Silveira, Landulfo; Pinheiro, Antônio L. B.

    2015-03-01

    Phototherapies have shown positive effects on the bone repair process, increasing the blood supply to the injured area. The aim of this study was to assess through Raman spectroscopy, the efficacy of laser phototherapy (λ = 780 nm, P = 70 mW, CW, 20.4 J/cm2 per session, 163.2 J/cm2 per treatment) on the bone repair process of osteoporotic rats. The osteoporosis induction was achieved by ovariectomy surgery. Thirty Wistar rats were divided into 4 groups (Basal; OVX, OVX + Clot and OVX + Clot + Laser), then subdivided into 2 subgroups according to the experimental time (15 and 30 days). After the osteoporosis induction time (60 days), a bone defect with 2 mm was created with a trephine drill in the right femur in the animals of groups OVX, Clot and Clot + Laser. After surgery, the irradiation protocol was applied in the same groups on repeated sessions every 48 hours during 15 days. The samples were analyzed by Raman Spectroscopy to assess the inorganic content of phosphate and carbonated hydroxyapatite (~960 and 1070 cm-1, respectively) and organic lipids and proteins (~1454 cm-1). Statistical analysis (ANOVA, Student-T test) showed significant difference between groups Basal, OVX + Clot, and OVX + Clot + Laser for the inorganic content peaks at ~960 (p≤0.001), and ~1070 cm-1 (p≤0.001) in both periods of 15 and 30 days, however on peak at ~1450 cm-1 no differences were detected. It was concluded that the Laser phototherapy increased deposition of HA on bone repair process of osteoporotic rats.

  5. Impact sports and bone fractures among adolescents.

    Science.gov (United States)

    Lynch, Kyle R; Kemper, Han C G; Turi-Lynch, Bruna; Agostinete, Ricardo R; Ito, Igor H; Luiz-De-Marco, Rafael; Rodrigues-Junior, Mario A; Fernandes, Rômulo A

    2017-12-01

    The objective of the present study was to investigate the effects of different sports on stress fractures among adolescents during a 9-month follow-up period. The sample was composed of 184 adolescents divided into three groups (impact sports [n = 102]; swimming [n = 35]; non-sports [n = 47]). The occurrence of stress fracture was reported by participants and coaches. As potential confounders we considered age, sex, resistance training, body composition variables and age at peak of height velocity. There were 13 adolescents who reported fractures during the 9-month period. Bone mineral density values were higher in adolescents engaged in impact sports (P-value = 0.002). Independently of confounders, the risk of stress fracture was lower in adolescents engaged in impact sports than in non-active adolescents (hazard ratio [HR] = 0.23 [95% confidence interval (CI) = 0.05 to 0.98]), while swimming practice was not associated to lower risk of fracture (HR = 0.49 [95% CI = 0.09 to 2.55]). In conclusion, the findings from this study indicate the importance of sports participation among adolescents in the reduction of stress fracture risk, especially with impact sports. More importantly, these results could be relevant for recognising adolescents in danger of not reaching their potential for peak bone mass and later an increased risk of fractures.

  6. Depression and risk of fracture and bone loss: an updated meta-analysis of prospective studies.

    Science.gov (United States)

    Wu, Q; Liu, B; Tonmoy, S

    2018-03-12

    This meta-analysis pooled results from 23 qualifying individual cohort studies and found that depression was significantly associated with an increased risk of fractures and bone loss. The association between depression and risk of fracture remains controversial. We conducted a comprehensive meta-analysis to examine the effect of depression on the risk of osteoporotic fractures and bone loss. We searched databases and reviewed citations in relevant articles for eligible cohort studies. Two investigators independently conducted study selection, appraisal, and data abstraction through the use of a standardized protocol. Random effect models were used for meta-analysis. Cochrane Q and I 2 statistics were used to assess heterogeneity. Funnel plots and rank correlation tests were used to evaluate publication bias. Twenty-three studies were included for meta-analysis. In studies that reported hazard ratio (HR) as the outcome (nine studies [n = 309,862]), depression was associated with 26% increase in fracture risk (HR = 1.26, 95% CI, 1.10-1.43, p meta-analysis having modified inclusion criteria and in different subgroup analyses as well. Significant heterogeneity was observed in the meta-analysis; however, no significant publication bias was detected. Depression is associated with a significant increased risk in fracture and bone loss. Effective prevention may decrease such risk.

  7. Delayed Bleeding and Pelvic Haematoma after Low-Energy Osteoporotic Pubic Rami Fracture in a Warfarin Patient: An Unusual Cause of Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Andrea Sandri

    2014-01-01

    Full Text Available Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications.

  8. Rehabilitation after falls and fractures.

    Science.gov (United States)

    Dionyssiotis, Y; Dontas, I A; Economopoulos, D; Lyritis, G P

    2008-01-01

    Falls are one of the most common geriatric problems threatening the independence of older persons. Elderly patients tend to fall more often and have a greater tendency to fracture their bones. Fractures occur particularly in osteoporotic people due to increased bone fragility, resulting in considerable reduction of quality of life, morbidity, and mortality. This article provides information for the rehabilitation of osteoporotic fractures pertaining to the rehabilitation of the fractured patient, based on personal experience and literature. It also outlines a suggested effective and efficient clinical strategy approach for preventing falls in individual patients.

  9. Computed tomography evaluation of petrous bone fractures ...

    African Journals Online (AJOL)

    Background: Petrous bone trauma is the sequel of blunt head injury and can have life threatening complications resulting in immediate mortality. Early detection and good knowledge of the Computed Tomography (CT) findings ensure prompt treatment of both fractures and complications. Objective: To document the ...

  10. Association of collagen type I alpha1 (COLIA1) Sp1 polymorphism with osteoporotic fracture in Caucasian post-menopausal women: a meta-analysis.

    LENUS (Irish Health Repository)

    Ji, G-R

    2012-01-06

    This study was designed to summarize quantitatively the evidence for a relationship between collagen type I alpha1 (COLIA1) Sp1 polymorphism and osteoporotic fracture risk in Caucasian post-menopausal women. This meta-analysis included 16 studies, which analysed 2294 patients with fractures and 10 285 controls. The combined results showed that there was a significant difference in genotype distribution (SS odds ratio [OR] 0.72; Ss OR 1.18; ss OR 1.97) between patients with fractures and controls. When stratifying by the fracture site, it was found that: (i) patients with vertebral fractures had a significantly higher frequency of the Ss genotype and a lower frequency of the SS genotype than controls; and (ii) patients with non-vertebral fractures had a significantly higher frequency of the ss genotype and a lower frequency of the SS genotype than controls. This meta-analysis suggests that the COLIA1 Sp1 polymorphism may be associated with osteoporotic fracture in Caucasian post-menopausal women.

  11. 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

  12. P2Y12 Receptor Antagonist, Clopidogrel, Does Not Contribute to Risk of Osteoporotic Fractures in Stroke Patients

    DEFF Research Database (Denmark)

    Jørgensen, Niklas R; Schwarz, Peter; Iversen, Helle K

    2017-01-01

    Background: Stroke is a leading cause of mortality and morbidity. It is associated with excessive bone loss and risk of fracture in stroke patients is high. The P2Y12R antagonist and platelet inhibitor, clopidogrel, is widely used for secondary prevention after a stroke. However, recent studies...... have shown that clopidogrel has negative effects on bone and that long-term clopidogrel use is associated with increased fracture risk. The purpose of the current study was therefore to investigate the association of clopidogrel treatment with risk of fractures in stroke and TIA patients.......Methods:The study was a cohort study including all subjects who were prescribed clopidogrel between 1996 and 2008 in Denmark (n= 77,503). Age- and gender matched controls (n= 232,510) were randomly selected from the background population. The study end-points were occurrence of stroke or TIA and occurrence...

  13. Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients

    Directory of Open Access Journals (Sweden)

    Kayser Ralph

    2008-01-01

    Full Text Available Abstract Background Kyphoplasty represents an established minimal-invasive method for correction and augmentation of osteoporotic vertebral fractures. Reliable data on perioperative and postoperative complications are lacking in the literature. The present study was designed to evaluate the incidence and patterns of perioperative complications in order to determine the safety of this procedure for patients undergoing kyphoplasty. Patients and Methods We prospectively enrolled 102 consecutive patients (82 women and 20 men; mean age 69 with 135 operatively treated fractured vertebrae who underwent a kyphoplasty between January 2004 to June 2006. Clinical and radiological follow-up was performed for up 6 months after surgery. Results Preoperative pain levels, as determined by the visual analogous scale (VAS were 7.5 +/- 1.3. Postoperative pain levels were significantly reduced at day 1 after surgery (VAS 2.3 +/- 2.2 and at 6-month follow-up (VAS 1.4 +/- 0.9. Fresh vertebral fractures at adjacent levels were detected radiographically in 8 patients within 6 months. Two patients had a loss of reduction with subsequent sintering of the operated vertebrae and secondary spinal stenosis. Accidental cement extravasation was detected in 7 patients in the intraoperative radiographs. One patient developed a postoperative infected spondylitis at the operated level, which was treated by anterior corporectomy and 360 degrees fusion. Another patient developed a superficial wound infection which required surgical revision. Postoperative bleeding resulting in a subcutaneous haematoma evacuation was seen in one patient. Conclusion The data from the present study imply that percutaneous kyphoplasty can be associated with severe intra- and postoperative complications. This minimal-invasive surgical procedure should therefore be performed exclusively by spine surgeons who have the capability of managing perioperative complications.

  14. Primary-care prescribing of anti-osteoporotic-type medications following hospitalisation for fractures.

    LENUS (Irish Health Repository)

    McGowan, Bernie M

    2011-03-01

    We examined the prescribing of antiosteoporotic medications pre- and post hospital admission in patients with fragility fractures as well as factors associated with prescribing of these treatments following admission.

  15. 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

    where the risk of a subsequent fracture following a first fracture is high. Consequently, there is a significant treatment gap between those who would benefit from treatment and those who receive it, which urgently needs to be addressed so that the burden of disease can be reduced. Conclusions......Summary: Osteoporosis represents a significant and increasing healthcare burden in Europe, but most patients at increased risk of fracture do not receive medication, resulting in a large treatment gap. Identification of patients who are at particularly high risk will help clinicians target...... 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...

  16. Anti-osteoporotic activity of harpagide by regulation of bone formation in osteoblast cell culture and ovariectomy-induced bone loss mouse models.

    Science.gov (United States)

    Chung, Hwa-Jin; Kyung Kim, Won; Joo Park, Hyen; Cho, Lan; Kim, Me-Riong; Kim, Min Jeong; Shin, Joon-Shik; Ho Lee, Jin; Ha, In-Hyuk; Kook Lee, Sang

    2016-02-17

    Harpagide, an iridoid glucoside, is a constituent of the root of Harpagophytum procumbens var. sublobatum (Engl.) Stapf, Devil's claw which has been used in patients with osteoarthritis (OA). In the present study, we investigated the anti-osteoporotic potential of harpagide and its underlying mechanism of action in in vitro cell culture and in vivo bone loss animal models. Harpagide was obtained from the alkalic hydrolysis of harpagoside, a major constituent of H. procumbens var. sublobatum Analysis of biomarkers for bone formation in osteoblastic MC3T3-E1 cells and bone resorption in osteoclast cells derived from mouse bone marrow cells was performed to evaluate the mechanism of action. The protective activity of harpagide against bone loss was also evaluated in ovariectomized (OVX) mouse model. Harpagide improved bone properties by stimulating the process of differentiation and maturation of osteoblast cells and suppressing the process of RANKL-induced differentiation of osteoclast cells. In OVX-induced bone loss mouse model, oral administration of harpagide significantly improved recovery of bone mineral density, trabecular bone volume, and trabecular number in the femur. Harpagide also prevented increase of trabecular separation and structure model index induced by OVX. Harpagide effectively inhibited the serum levels of biochemical markers of bone loss, including alkaline phosphatase, osteocalcin, C-terminal telopeptide, and tartrate-resistant acid phosphatase. Taken together, the present study demonstrates that harpagide has a potential for prevention of bone loss in OVX mice by regulating the stimulation of osteoblast differentiation and the suppression of osteoclast formation. Therefore, these findings suggest that harpagide might serve as a bioactive compound derived from H. procumbens var. sublobatum for improvement of age-dependent bone destruction disease. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Greater intake of fruit and vegetables is associated with a lower risk of osteoporotic hip fractures in elderly Chinese: a 1:1 matched case-control study.

    Science.gov (United States)

    Xie, H-L; Wu, B-H; Xue, W-Q; He, M-G; Fan, F; Ouyang, W-F; Tu, S-L; Zhu, H-L; Chen, Y-M

    2013-11-01

    In this case-control study, we examined the relationship between the consumption of fruit and vegetables and risk of hip fractures in 646 pairs of incident cases and controls in elderly Chinese. We found that greater consumption of both fruit and vegetables in men and vegetables in women was associated with a lower risk of osteoporotic hip fractures in elderly Chinese. The association between fruit and vegetable consumption and the risk of osteoporotic fractures remains controversial due to limited published evidence. The purpose of this study was to determine whether consuming fruits and vegetables has a protective effect against hip fractures. Between January 2008 and December 2012, 646 (162 males, 484 females) incident cases (70.9 ± 6.8 years) of hip fractures were enrolled from five hospitals, with 646 sex- and age-matched (±3 years) controls (70.7 ± 6.8 years) from hospitals or the community. Face-to-face interviews were conducted to assess habitual dietary intakes using a 79-item food frequency questionnaire and various covariates by structured questionnaires. Multivariate conditional logistic regression analyses showed dose-dependent inverse correlations between the intake of total fruit (p-trend = 0.014), total vegetables (p-trend fruits and vegetables combined (p-trend fruits, vegetables and the combination of fruits and vegetables were 0.53 (0.32-0.87), 0.37 (0.23-0.60) and 0.25 (0.15-0.41), respectively. Stratified analyses showed that the benefits remained significant in males (p = 0.001) but not in females (p = 0.210) (p-interaction 0.045). Among the subcategories of fruits and vegetables, similar associations were observed for all subgroups except light-coloured fruits. Our findings suggest that greater consumption of both fruits and vegetables in men and vegetables in women may decrease the risk of osteoporotic hip fractures in elderly Chinese.

  18. The prediction of cyclic proximal humerus fracture fixation failure by various bone density measures.

    Science.gov (United States)

    Varga, Peter; Grünwald, Leonard; Windolf, Markus

    2018-02-22

    Fixation of osteoporotic proximal humerus fractures has remained challenging, but may be improved by careful pre-operative planning. The aim of this study was to investigate how well the failure of locking plate fixation of osteoporotic proximal humerus fractures can be predicted by bone density measures assessed with currently available clinical imaging (realistic case) and a higher resolution and quality modality (theoretical best-case). Various density measures were correlated to experimentally assessed number of cycles to construct failure of plated unstable low-density proximal humerus fractures (N = 18). The influence of density evaluation technique was investigated by comparing local (peri-implant) versus global evaluation regions; HR-pQCT-based versus clinical QCT-based image data; ipsilateral versus contralateral side; and bone mineral content (BMC) versus bone mineral density (BMD). All investigated density measures were significantly correlated with the experimental cycles to failure. The best performing clinically feasible parameter was the QCT-based BMC of the contralateral articular cap region, providing significantly better correlation (R 2  = 0.53) compared to a previously proposed clinical density measure (R 2  = 0.30). BMC had consistently, but not significantly stronger correlations with failure than BMD. The overall best results were obtained with the ipsilateral HR-pQCT-based local BMC (R 2  = 0.74) that may be used for implant optimization. Strong correlations were found between the corresponding density measures of the two CT image sources, as well as between the two sides. Future studies should investigate if BMC of the contralateral articular cap region could provide improved prediction of clinical fixation failure compared to previously proposed measures. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  19. Clinical Definitions of Sarcopenia and Risk of Hospitalization in Community-Dwelling Older Men: The Osteoporotic Fractures in Men Study.

    Science.gov (United States)

    Cawthon, Peggy M; Lui, Li-Yung; Taylor, Brent C; McCulloch, Charles E; Cauley, Jane A; Lapidus, Jodi; Orwoll, Eric; Ensrud, Kristine E

    2017-10-01

    The association between various definitions of sarcopenia and hospitalization has not been evaluated in community-dwelling older men. We used data from 1,516 participants at Visit 3 of the Osteoporotic Fractures in Men (MrOS) study who also had linked Medicare Fee-For-Service Claims data available. We examined the association between several sarcopenia definitions (International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman) and hospitalization, using two-part ("hurdle") models, adjusted for age, clinical center, functional limitations, self-reported health, comorbidity, and cognitive function. Predictors included sarcopenia status (the summary definitions and the components of slowness, weakness, and/or lean mass); outcomes included hospitalization and cumulative inpatient days/year in the 3 years following the Visit 3 exam. After accounting for confounding factors, none of the summary definitions or the definition components (slowness, weakness, or low lean mass) were associated with likelihood of hospitalization, the rate ratio of inpatient days among those hospitalized, or the mean rate of inpatient days amongst all participants. Sarcopenia was not associated hospitalization in community-dwelling older men. These results provide further evidence that current sarcopenia definitions are unlikely to identify those who are most likely to have greater hospitalization. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures.

    Science.gov (United States)

    Gao, Chang; Zong, Min; Wang, Wen-Tao; Xu, Lei; Cao, Da; Zou, Yue-Fen

    2018-05-01

    Background Percutaneous kyphoplasty (PKP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). Pre- and postoperative identification of risk factors for cement leakage and follow-up complications would therefore be helpful but has not been systematically investigated. Purpose To evaluate pre- and postoperative risk factors for the occurrence of short-term cement leakages and long-term complications after PKP for OVCFs. Material and Methods A total of 283 vertebrae with PKP in 239 patients were investigated. Possible risk factors causing cement leakage and complications during follow-up periods were retrospectively assessed using multivariate analysis. Cement leakage in general, three fundamental leakage types, and complications during follow-up period were directly identified through postoperative computed tomography (CT). Results Generally, the presence of cortical disruption ( P = 0.001), large volume of cement ( P = 0.012), and low bone mineral density (BMD) ( P = 0.002) were three strong predictors for cement leakage. While the presence of intravertebral cleft and Schmorl nodes ( P = 0.045 and 0.025, respectively) were respectively identified as additional risk factors for paravertebral and intradiscal subtype of cortical (C-type) leakages. In terms of follow-up complications, occurrence of cortical leakage was a strong risk factor both for new VCFs ( P = 0.043) and for recompression ( P = 0.004). Conclusion The presence of cortical disruption, large volume of cement, and low BMD of treated level are general but strong predictors for cement leakage. The presence of intravertebral cleft and Schmorl nodes are additional risk factors for cortical leakage. During follow-up, the occurrence of C-type leakage is a strong risk factor, for both new VCFs and recompression.

  1. Frailty Change and Major Osteoporotic Fracture in the Elderly: Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton Cohort.

    Science.gov (United States)

    Li, Guowei; Papaioannou, Alexandra; Thabane, Lehana; Cheng, Ji; Adachi, Jonathan D

    2016-04-01

    Investigating the cumulative rate of deficits and the change of a frailty index (FI) chronologically is helpful in clinical and research settings in the elderly. However, limited evidence for the change of frailty before and after some nonfatal adverse health event such as a major osteoporotic fracture (MOF) is available. Data from the Global Longitudinal Study of Osteoporosis in Women 3-Year Hamilton cohort were used in this study. The changes of FI before and after onset of MOF were compared between the women with and without incident MOF. We also evaluated the relationship between risk of MOF, falls, and death and the change of FI and the absolute FI measures. There were 3985 women included in this study (mean age 69.4 years). The change of FI was significantly larger in the women with MOF than those without MOF at year 1 (0.085 versus 0.067, p = 0.036) and year 2 (0.080 versus 0.052, p = 0.042) post-baseline. The FI change was not significantly related with risk of MOF independently of age. However, the absolute FI measures were significantly associated with increased risk of MOF, falls, and death independently of age. In summary, the increase of the FI is significantly larger in the elderly women experiencing a MOF than their peer controls, indicating their worsening frailty and greater deficit accumulation after a MOF. Measures of the FI change may aid in the understanding of cumulative aging nature in the elderly and serve as an instrument for intervention planning and assessment. © 2015 American Society for Bone and Mineral Research.

  2. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents

    DEFF Research Database (Denmark)

    Larsen, Erik Roj; Mosekilde, Leif; Foldspang, Anders

    2004-01-01

    , vertebral column, pelvis, cervical femur, and intertrochanteric femur. Results: Active participation was 50.3% in the Calcium and Vitamin D Program and 46.4% in the Environmental and Health Program. We observed a 16% reduction in fracture incidence rate (relative risk [RR], 0.84; CI, 0.72-0.98; p

  3. Fracture of nasal bones: an epidemiologic analysis

    Directory of Open Access Journals (Sweden)

    Fornazieri, Marco Aurélio

    2008-12-01

    Full Text Available Introduction: One of the most common diseases in the otorhinolaryngology emergency room is the nasal bones fracture. The peak of incidence is between 15 and 25 years of age. Generally men are more affected. Objective: To analyze the age, gender and the most frequent causes of nasal fractures evaluated in the otorhinolaryngology service of a tertiary hospital. Method: Retrospective study of records of the patients with nasal fracture diagnosis treated between July 1st, 2003 and July 1st, 2007. Results: 167 patients with nasal bones fracture were included in the study, including 134 men and 33 women. Violence was the most frequent cause, with 55 cases (32.9%, followed by fall from their own height, with 33 cases (19.7%, and motorcycle accident, 14 cases (8.4%. The most common age was between 21 and 39 years (46.1%. Conclusion: Male, age between 21 and 39 years and violence are the most common characteristics found in our service. Motorcycle accidents also play an important role in this affection.

  4. Shape-based assessment of vertebral fracture risk in postmenopausal women using discriminative shape alignment

    DEFF Research Database (Denmark)

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

    2012-01-01

    RATIONALE AND OBJECTIVES: Risk assessment of future osteoporotic vertebral fractures is currently based mainly on risk factors, such as bone mineral density, age, prior fragility fractures, and smoking. It can be argued that an osteoporotic vertebral fracture is not exclusively an abrupt event...... independently performed manual annotations of the vertebrae, and fracture prediction using shape features extracted from the baseline annotations was performed. This was implemented using posterior probabilities from a standard linear classifier. RESULTS: The classifier tested on the study population quantified...

  5. Early Onset of Laying and Bumblefoot Favor Keel Bone Fractures

    Science.gov (United States)

    Gebhardt-Henrich, Sabine G.; Fröhlich, Ernst K. F.

    2015-01-01

    Simple Summary Numerous studies have documented a high prevalence of keel bone fractures in laying hens. In this longitudinal study, 80 white and brown laying hens were regularly checked for keel bone deviations and fractures while egg production was individually monitored. About 62% of the hens had broken keel bones at depopulation. More new fractures occurred during the time when laying rates were highest. Hens with broken keel bones at depopulation had laid their first egg earlier than hens with intact keel bones. All birds with bumblefoot on both feet had a fracture at depopulation. Abstract Numerous studies have demonstrated influences of hybrid, feed, and housing on prevalence of keel bone fractures, but influences of behavior and production on an individual level are less known. In this longitudinal study, 80 white and brown laying hens were regularly checked for keel bone deviations and fractures while egg production was individually monitored using Radio Frequency Identification (RFID) from production until depopulation at 65 weeks of age. These focal birds were kept in eight pens with 20 hens per pen in total. About 62% of the hens had broken keel bones at depopulation. The occurrence of new fractures was temporally linked to egg laying: more new fractures occurred during the time when laying rates were highest. Hens with fractured keel bones at depopulation had laid their first egg earlier than hens with intact keel bones. However, the total number of eggs was neither correlated with the onset of egg laying nor with keel bone fractures. All birds with bumblefoot on both feet had a fracture at depopulation. Hens stayed in the nest for a longer time during egg laying during the ten days after the fracture than during the ten days before the fracture. In conclusion, a relationship between laying rates and keel bone fractures seems likely. PMID:26633520

  6. Left in limbo – Experiences and needs among postmenopausal women newly diagnosed with osteoporosis without preceding osteoporotic fractures

    DEFF Research Database (Denmark)

    Jakobsen, Pernille Ravn; Hermann, Anne Pernille; Søndergaard, Jens

    2018-01-01

    to participate in treatment decision-making and (3) needs of being able to take care of bone health. Conclusion and implications In general the women experienced as been left ‘in limbo’, and they requested targeted and tailored information about osteoporosis. In particular, they want information about dual...... more attention on the benefits of detecting early stage osteoporosis. The study highlights the call for new approaches to postmenopausal women newly diagnosed with osteoporosis without preceding fractures....

  7. Osteoporotic cytokines and bone metabolism on rats with induced hyperthyroidism; changes as a result of reversal to euthyroidism.

    Science.gov (United States)

    Simsek, Gönül; Karter, Yesari; Aydin, Seval; Uzun, Hafize

    2003-12-31

    Hyperthyroidism is characterized by increased bone turnover and resorptive activity. Raised levels of serum osteoporotic cytokines, such as interleukin (IL) -1beta, IL-6 and tumor necrosis factor (TNF)-alpha have been demonstrated previously in hyperthyroidism. These elevations are controversial and it is difficult to differentiate the contribution of thyroid hormones to the elevation of cytokines from that of the autoimmune inflammation in Graves' disease (GD) and follicular cell damage in thyroiditis. Therefore, we investigated the effect of thyroid hormones on serum IL-1beta, IL-6, TNF-alpha levels and bone metabolism on L-thyroxine induced hyperthyroid rats and changes in cytokine levels and bone metabolism on the same rats after reversal to euthyroidism. Rats were treated with L-thyroxine for 5 weeks (0.4 mg/ 100 g food). Plasma T3, T4, TSH and serum IL-1beta, IL-6, TNFalpha, Calcium (Ca), phosphorous (P), parathyroid hormone (PTH), alkaline phosphatase (ALP), bone alkaline phosphatase (B-ALP) levels were measured and differential leucocyte counts were made initially, at the 5th week of the experiment (hyperthyroid state) and 5 weeks after quitting the administration of L-thyroxine (euthyroid state). Significant rises in serum IL-1beta, IL-6 and TNFalpha were noted in hyperthyroidism (P hyperthyroid state while there was no correlation in euthyroid states. Ca and P levels did not differ significantly while PTH levels declined significantly in the hyperthyroid state (P hyperthyroidism (P hyperthyroid state (P metabolism in hyperthyroidism might be mediated by cytokines and the increased bone turnover in hyperthyroidism failed to decrease despite euthyroidism.

  8. Pharmacotherapy of cardiovascular comorbidities in osteoporotic postmenopausal women

    Directory of Open Access Journals (Sweden)

    Nadezhda V. Izmozherova

    2017-05-01

    Full Text Available Aim: to assess tolerability and efficacy of cardiovascular comorbidities pharmacotherapy in osteoporotic postmenopausal women. Methods: cross-sectional study included 112 osteoporotic postmenopausal women aged from 49 to 85. Results: 95 persons (84.8% had indications for angiotensine-convertising enzyme inhibitors (ACEI prescription. Cough was associated with significantly higher odds of coronary heart disease, congestive heart failure and a trend to multiple bone fractures. Valsartan was initiated in 32 coughing patients. Target blood pressure level was reached in 15 women. In 15 cases blood pressure levels decreased by 30% of baseline level. Conclusion: efficacy of cardiovascular diseases in osteoporotic postmenopausal women treatment needs to be assessed in specially designed clinical trials.

  9. Chronic Osteoporotic Pain in Mice: Cutaneous and Deep Musculoskeletal Pain Are Partially Independent of Bone Resorption and Differentially Sensitive to Pharmacological Interventions

    Directory of Open Access Journals (Sweden)

    Miyako Suzuki

    2017-01-01

    Full Text Available Although the pathological changes in osteoporotic bones are well established, the characterization of the osteoporotic pain and its appropriate treatment are not fully elucidated. We investigated the behavioral signs of cutaneous and deep musculoskeletal pain and physical function; time-dependent changes in bone mineral density (BMD and the emergence of the behavioral phenotype; and the effects of pharmacological interventions having different mechanisms of action (chronic intraperitoneal administration of pamidronate [0.25 mg/kg, 5x/week for 5 weeks] versus acute treatment with intraperitoneal morphine [10 mg/kg] and pregabalin [100 mg/kg] in a mouse model of ovariectomized or sham-operated mice 6 months following surgery. We observed reduced BMD associated with weight gain, referred cutaneous hypersensitivity, and deep musculoskeletal pain that persisted for 6 months. Chronic bisphosphonate treatment, 6 months after ovariectomy, reversed bone loss and hypersensitivity to cold, but other behavioral indices of osteoporotic pain were unchanged. While the efficacy of acute morphine on cutaneous pain was weak, pregabalin was highly effective; deep musculoskeletal pain was intractable. In conclusion, the reversal of bone loss alone is insufficient to manage pain in chronic osteoporosis. Additional treatments, both pharmacological and nonpharmacological, should be implemented to improve quality of life for osteoporosis patients.

  10. Biochemical Predictors of Low Bone Mineral Density and Fracture Susceptibility in Maltese Postmenopausal Women.

    Science.gov (United States)

    Formosa, Melissa M; Xuereb-Anastasi, Angela

    2016-01-01

    Osteoporosis and fractures are complex conditions influenced by an interplay of genetic and environmental factors. The aim of the study was to investigate three biochemical parameters including total serum calcium, total serum alkaline phosphatase (sALP) and albumin in relation to bone mineral density (BMD) at the lumbar spine and femoral neck (FN), and with all-type of low-trauma fractures in Maltese postmenopausal women. Levels were also correlated with age and physical activity. A case-control study of 1045 women was performed. Women who suffered a fracture were classified as cases whereas women without a fracture history were included as controls subdivided into normal, osteopenic, or osteoporotic according to their BMD measurements. Blood specimens were collected following good standard practice and testing was performed by spectrophotometry. Calcium and sALP levels were weakly correlated with FN BMD levels (calcium: r = -0.111, p = 0.002; sALP: r = 0.089, p = 0.013). Fracture cases had the lowest serum levels of calcium, sALP and albumin relative to all other control groups, which decreased with increasing age, possibly increasing fracture risk. Biochemical levels were lowest in women who sustained a hip fracture and more than one fracture. Biochemical parameters decreased with reduced physical activity; however, this was most evident for fracture cases. Reduced physical activity was associated with lower BMD levels at the hip, and to a lower extent at the spine. In conclusion, results suggest that levels of serum calcium and albumin could be indicative of fracture risk, whereas calcium levels and to lower extent sALP levels could be indicators of hip BMD.

  11. Evaluation on vertebral endplate injury and adjacent intervertebral disk injury of patients with osteoporotic vertebral compression fractures by MRI and its clinical significance

    International Nuclear Information System (INIS)

    Shen Yu; Shen Huiliang; Fang Xiutong; Zhang Wenbo

    2012-01-01

    Objective: To investigate the relationship between vertebral endplate injury and adjacent intervertebral disk injury of patients with acute or sub-acute osteoporotic vertebral compression fractures (OVC-F) by MRI, and to provide basis for diagnosis of OVCF. Methods: The clinical data of a total of 66 patients with OVCF underwent vertebroplasty (76 fracture of vertebral bodies) were selected. The vertebral endplate injury and adjacent intervertebral disk injury of OVCF patients were detected by MRI. Results: There were 57 vertebral endplate injury in 76 fracture vertebral bodies (75% ). There were only 27 vertebral bodies with vertebral endplate injury in 57 fracture vertebral bodies with endplate injury (47% ), and 22 vertebral with superior and inferior vertebral endplate injury (39% ), and 8 vertebral bodies with inferior vertebral endplate injury (14% ). There were 48 vertebral bodies with intervertebral disc injury in 76 fracture vertebral bodies (63% ). There were 22 intervertebral disc injury located above the fracture of the lumbar spine in 48 vertebral bodies with intervertebral disc injury (45% ), and 19 fracture vertebral bodies with upper and lower intervertebral disc injury (40% ), and 7 intervertebral injuries located below the fracture of the lumbar spine (15% ). Conclusion: Vertebral endplate injury is frequently associated with the adjacent intervertebral disk injury. The clinical diagnosis and treatment should be emphasized in the fracture vertebral endplate damage and adjacent intervertebral disc injury. (authors)

  12. Short-Term Effects of Kefir-Fermented Milk Consumption on Bone Mineral Density and Bone Metabolism in a Randomized Clinical Trial of Osteoporotic Patients.

    Science.gov (United States)

    Tu, Min-Yu; Chen, Hsiao-Ling; Tung, Yu-Tang; Kao, Chao-Chih; Hu, Fu-Chang; Chen, Chuan-Mu

    2015-01-01

    Milk products are good sources of calcium that may reduce bone resorption and help prevent bone loss as well as promote bone remodeling and increase bone formation. Kefir is a product made by kefir grains that degrade milk proteins into various peptides with health-promoting effects, including antithrombotic, antimicrobial and calcium-absorption enhancing bioactivities. In a controlled, parallel, double-blind intervention study over 6 months, we investigated the effects of kefir-fermented milk (1,600 mg) supplemented with calcium bicarbonate (CaCO3, 1,500 mg) and bone metabolism in 40 osteoporosis patients, and compared them with CaCO3 alone without kefir supplements. Bone turnover markers were measured in fasting blood samples collected before therapy and at 1, 3, and 6 months. Bone mineral density (BMD) values at the spine, total hip, and hip femoral neck were assessed by dual-energy x-ray absorptiometry (DXA) at baseline and at 6 months. Among patients treated with kefir-fermented milk, the relationships between baseline turnover and 6 months changes in DXA-determined BMD were significantly improved. The serum β C-terminal telopeptide of type I collagen (β-CTX) in those with T-scores > -1 patients significantly decreased after three months treatment. The formation marker serum osteocalcin (OC) turned from negative to positive after 6 months, representing the effect of kefir treatment. Serum parathyroid hormone (PTH) increased significantly after treatment with kefir, but decreased significantly in the control group. PTH may promote bone remodeling after treatment with kefir for 6 months. In this pilot study, we concluded that kefir-fermented milk therapy was associated with short-term changes in turnover and greater 6-month increases in hip BMD among osteoporotic patients. ClinicalTrials.gov NCT02361372.

  13. Short-Term Effects of Kefir-Fermented Milk Consumption on Bone Mineral Density and Bone Metabolism in a Randomized Clinical Trial of Osteoporotic Patients.

    Directory of Open Access Journals (Sweden)

    Min-Yu Tu

    Full Text Available Milk products are good sources of calcium that may reduce bone resorption and help prevent bone loss as well as promote bone remodeling and increase bone formation. Kefir is a product made by kefir grains that degrade milk proteins into various peptides with health-promoting effects, including antithrombotic, antimicrobial and calcium-absorption enhancing bioactivities. In a controlled, parallel, double-blind intervention study over 6 months, we investigated the effects of kefir-fermented milk (1,600 mg supplemented with calcium bicarbonate (CaCO3, 1,500 mg and bone metabolism in 40 osteoporosis patients, and compared them with CaCO3 alone without kefir supplements. Bone turnover markers were measured in fasting blood samples collected before therapy and at 1, 3, and 6 months. Bone mineral density (BMD values at the spine, total hip, and hip femoral neck were assessed by dual-energy x-ray absorptiometry (DXA at baseline and at 6 months. Among patients treated with kefir-fermented milk, the relationships between baseline turnover and 6 months changes in DXA-determined BMD were significantly improved. The serum β C-terminal telopeptide of type I collagen (β-CTX in those with T-scores > -1 patients significantly decreased after three months treatment. The formation marker serum osteocalcin (OC turned from negative to positive after 6 months, representing the effect of kefir treatment. Serum parathyroid hormone (PTH increased significantly after treatment with kefir, but decreased significantly in the control group. PTH may promote bone remodeling after treatment with kefir for 6 months. In this pilot study, we concluded that kefir-fermented milk therapy was associated with short-term changes in turnover and greater 6-month increases in hip BMD among osteoporotic patients.ClinicalTrials.gov NCT02361372.

  14. Methods and Reliability of Radiographic Vertebral Fracture Detection in Older Men: The Osteoporotic Fractures in Men Study

    Science.gov (United States)

    Cawthon, Peggy M.; Haslam, Jane; Fullman, Robin; Peters, Katherine W.; Black, Dennis; Ensrud, Kristine E.; Cummings, Steven R.; Orwoll, Eric S.; Barrett-Connor, Elizabeth; Marshall, Lynn; Steiger, Peter; Schousboe, John T.

    2014-01-01

    We describe the methods and reliability of radiographic vertebral fracture assessment in MrOS, a cohort of community dwelling men aged ≥65 yrs. Lateral spine radiographs were obtained at Visit 1 (2000-2) and 4.6 years later (Visit 2). Using a workflow tool (SpineAnalyzer™, Optasia Medical), a physician reader completed semi-quantitative (SQ) scoring. Prior to SQ scoring, technicians performed “triage” to reduce physician reader workload, whereby clearly normal spine images were eliminated from SQ scoring with all levels assumed to be SQ=0 (no fracture, “triage negative”); spine images with any possible fracture or abnormality were passed to the physician reader as “triage positive” images. Using a quality assurance sample of images (n=20 participants; 8 with baseline only and 12 with baseline and follow-up images) read multiple times, we calculated intra-reader kappa statistics and percent agreement for SQ scores. A subset of 494 participants' images were read regardless of triage classification to calculate the specificity and sensitivity of triage. Technically adequate images were available for 5958 of 5994 participants at Visit 1, and 4399 of 4423 participants at Visit 2. Triage identified 3215 (53.9%) participants with radiographs that required further evaluation by the physician reader. For prevalent fractures at Visit 1 (SQ≥1), intra-reader kappa statistics ranged from 0.79-0.92; percent agreement ranged from 96.9%-98.9%; sensitivity of the triage was 96.8% and specificity of triage was 46.3%. In conclusion, SQ scoring had excellent intra-rater reliability in our study. The triage process reduces expert reader workload without hindering the ability to identify vertebral fractures. PMID:25003811

  15. OUTCOME OF UNCEMENTED UNIPOLAR HEMIARTHROPLASTY IN FRACTURE NECK OF FEMUR, IN GERIATRIC PATIENTS IN RELATION TO BONE QUALITY

    Directory of Open Access Journals (Sweden)

    Mehraj Din

    2015-09-01

    Full Text Available BACKGROUND: Osteoporosis plays an important role in pathogenesis of fracture neck of femur in mobile elderly. Hemiarthroplasty is most common mode of management of femoral neck fractures in elderly in developing world. We report the outcome of uncemented hemiarthropl asty in elderly patients with a femoral neck fracture in relation to bone quality of patient as estimated by Dual energy x ray absorptiometry (DEXA scan. MATERIALS AND METHODS: 75 uncemented hemiarthroplasties for femoral neck fractures were performed in elderly patients more than 70 years of age between August 2008 and April 2012. The clinical, radiological results and bone mineral density of 65 hips in 65 patients who could be followed up were analyzed. For all cases Austin Moore prosthesis was implanted . RESULTS: The mean age of the patients was 79.96±7.21 years ( 7 1 to 96 years. 44 patients were women and 21 were men. Average duration of follow - up was 18.59±11.53 months ( R ange 4 to 44 months. The mean Harris Hip Score in patients with osteopenia was 80 .29±13.29 and in patients with osteoporosis it was 79.96 ± 11.67 at the time of the last follow - up. There was no significant difference in mean Harris hi p score in osteoporotic and non - osteoporotic patient’s p value 0.923. Out of 65 patients whose results were assessed in our study 48 patients (73.8% had osteoporosis and 17 patients (26.1% had Osteopenia. None of the patients in our study had a normal bone density. The mean T Score as measured on DEXA scan was - 3.74±1.57. CONCLUSION: Uncemented hemiarthro plasty for elderly patients more than 70 years of age with a femoral neck fracture showed satisfactory short - term results with no relationship to the bone quality

  16. 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.

  17. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures: a systematic review and cost-effectiveness analysis.

    Science.gov (United States)

    Stevenson, Matt; Gomersall, Tim; Lloyd Jones, Myfanwy; Rawdin, Andrew; Hernández, Monica; Dias, Sofia; Wilson, David; Rees, Angie

    2014-03-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive surgical procedure in which bone cement is injected into a fractured vertebra. Percutaneous balloon kyphoplasty (BKP) is a variation of this approach, in which an inflatable balloon tamp is placed in the collapsed vertebra prior to cement injection. To systematically evaluate and appraise the clinical effectiveness and cost-effectiveness of PVP and percutaneous BKP in reducing pain and disability in people with osteoporotic vertebral compression fractures (VCFs) in England and Wales. A systematic review was carried out. Ten databases including MEDLINE and CINAHL were searched from inception to November 2011, and supplemented by hand-searching relevant articles and contact with an expert. Studies met the inclusion criteria if they were randomised controlled trials (RCTs) including people with painful osteoporotic VCFs with a group receiving PVP or BKP. In addition, lead authors of identified RCTs were contacted for unpublished data. Primary outcomes were health-related quality of life; back-specific functional status/mobility; pain/analgesic use; vertebral body height and angular deformity; incidence of new vertebral fractures and progression of treated fracture. A manufacturer provided academic-in-confidence observational data indicating that vertebral augmentation may be associated with a beneficial mortality effect, and that, potentially, BKP was more efficacious than PVP. These data were formally critiqued. A mathematical model was constructed to explore the cost-effectiveness of BKP, PVP and operative placebo with local anaesthesia (OPLA) compared with optimal pain management (OPM). Six scenario analyses were conducted that assessed combinations of assumptions on mortality (differential beneficial effects for BKP and PVP; equal beneficial effects for BKP and PVP; and no effect assumed) and derivation of utility data (either mapped from visual analogue scale pain score data produced by a network meta

  18. Androgens, Bilateral Oophorectomy, and Cardiovascular Disease Mortality in Postmenopausal Women With and Without Diabetes: The Study of Osteoporotic Fractures.

    Science.gov (United States)

    Appiah, Duke; Winters, Stephen J; Muldoon, Susan B; Hornung, Carlton A; Cauley, Jane A

    2015-12-01

    Diabetes elevates cardiovascular disease (CVD) risk more markedly in women than in men. Because the high risk of CVD among women with type 2 diabetes (DM2) may be partly due to increased ovarian androgen production, we investigated whether a history of bilateral salpingo oophorectomy (BSO) is inversely associated with CVD mortality among women with DM2. Data were obtained from 7,977 women (a random subset of 564 had measurements of sex-steroid hormones) enrolled in the Study of Osteoporotic Fractures (SOF), a community-based, multicenter study that monitored women aged ≥65 years for a mean of 15.1 years. Adjusted hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression. The average age at baseline was 71.5 years, with 6.3% and 18% of participants reporting a history of diabetes or BSO, respectively. In the subset of the SOF cohort with sex-steroid hormone measurements, those with DM2 had 43.6% significantly higher levels of free testosterone that were partly explained by age and adiposity, whereas total and free testosterone levels were lower in women with BSO than in those with intact ovaries. CVD mortality was elevated in women with DM2 without BSO (HR 1.95, 95% CI 1.62-2.35) as well as in women with DM2 and BSO (HR 2.56, 95% CI 1.79-3.65; P = 0.190 for interaction). Overall, BSO was not associated with CVD mortality (HR 1.05, 95% CI 0.89-1.23). The association of diabetes with CVD was not reduced by BSO, suggesting that ovarian hyperandrogenemia may not be a primary mechanism to explain the high risk for CVD among women with DM2. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  19. Height gain of vertebral bodies and stabilization of vertebral geometry over one year after vertebroplasty of osteoporotic vertebral fractures

    International Nuclear Information System (INIS)

    Pitton, Michael B.; Morgen, Nadine; Herber, Sascha; Dueber, Christoph; Drees, Philipp; Boehm, Bertram

    2008-01-01

    The height gain of vertebral bodies after vertebroplasty and geometrical stability was evaluated over a one-year period. Osteoporotic fractures were treated with vertebroplasty. The vertebral geometry and disc spaces were analysed using reformatted computed tomography (CT) images: heights of the anterior, posterior, and lateral vertebral walls, disc spaces, endplate angles, and minimal endplate distances. Vertebrae were assigned to group I [severe compression (anterior height/posterior height) 0.75). A total of 102 vertebral bodies in 40 patients (12 men, 28 women, age 70.3 ± 9.5) were treated with vertebroplasty and prospectively followed for 12 months. Group I showed a greater benefit compared with group II with respect to anterior height gain (+2.1 ± 1.9 vs +0.7 ± 1.6 mm, P < 0.001), reduction of endplate angle (-3.6 ± 4.2 vs -0.8 ± 2.3 , P < 0.001), and compression index (+0.09 ± 0.11 vs +0.01 ± 0.06, P < 0.001). At one-year follow-up, group I demonstrated preserved anterior height gain (+1.5 ± 2.8 mm, P < 0.015) and improved endplate angle (-3.4 ± 4.9 , P < 0.001). In group II, the vertebral heights returned to and were fixed at the pre-interventional levels. Vertebroplasty provided vertebral height gain over one year, particularly in cases with severe compression. Vertebrae with moderate compression were fixed and stabilized at the pre-treatment level over one year. (orig.)

  20. Characterizing the course of back pain after osteoporotic vertebral fracture: a hierarchical cluster analysis of a prospective cohort study.

    Science.gov (United States)

    Toyoda, Hiromitsu; Takahashi, Shinji; Hoshino, Masatoshi; Takayama, Kazushi; Iseki, Kazumichi; Sasaoka, Ryuichi; Tsujio, Tadao; Yasuda, Hiroyuki; Sasaki, Takeharu; Kanematsu, Fumiaki; Kono, Hiroshi; Nakamura, Hiroaki

    2017-09-23

    This study demonstrated four distinct patterns in the course of back pain after osteoporotic vertebral fracture (OVF). Greater angular instability in the first 6 months after the baseline was one factor affecting back pain after OVF. Understanding the natural course of symptomatic acute OVF is important in deciding the optimal treatment strategy. We used latent class analysis to classify the course of back pain after OVF and identify the risk factors associated with persistent pain. This multicenter cohort study included 218 consecutive patients with ≤ 2-week-old OVFs who were enrolled at 11 institutions. Dynamic x-rays and back pain assessment with a visual analog scale (VAS) were obtained at enrollment and at 1-, 3-, and 6-month follow-ups. The VAS scores were used to characterize patient groups, using hierarchical cluster analysis. VAS for 128 patients was used for hierarchical cluster analysis. Analysis yielded four clusters representing different patterns of back pain progression. Cluster 1 patients (50.8%) had stable, mild pain. Cluster 2 patients (21.1%) started with moderate pain and progressed quickly to very low pain. Patients in cluster 3 (10.9%) had moderate pain that initially improved but worsened after 3 months. Cluster 4 patients (17.2%) had persistent severe pain. Patients in cluster 4 showed significant high baseline pain intensity, higher degree of angular instability, and higher number of previous OVFs, and tended to lack regular exercise. In contrast, patients in cluster 2 had significantly lower baseline VAS and less angular instability. We identified four distinct groups of OVF patients with different patterns of back pain progression. Understanding the course of back pain after OVF may help in its management and contribute to future treatment trials.

  1. Lifestyle changes after osteoporotic fractures in elderly women Mudanças dos hábitos de vida após fratura por osteoporose em mulheres idosas

    Directory of Open Access Journals (Sweden)

    Marcelo Medeiros Pinheiro

    2003-10-01

    Full Text Available OBJECTIVE: health promotion and disease prevention activities directed to osteoporosis might help to reduce the rate of osteoporotic fractures among elderly people. METHODS: in order to check whether osteoporotic women modify their habits after the fracture, 518 postmenopausal white Brazilian elderly women were recruited from the outpatient clinic of the Rheumatology Division (122 of them with fracture and were followed for one year. Questionnaire of evaluation was based on the European Vertebral Osteoporosis Study (EVOS and inquiries about topics related to falls, bone mass and fracture. Lateral thoracic and lumbar radiographs were taken according to a standard protocol in order to verify vertebral fracture. Bone mineral density was measured using a bone densitometer (Lunar DPX, Madison, WI. Women's behavior was analyzed before and after the fracture. RESULTS: before the fracture, 34% of them had poor health perception, 40.2% walked at least half an hour per day, 14.7% used canes, 56.6% complained of dizziness, 59.6% scattered rugs, 78.9% used public transportation, 21.1% used car, and 36.8% wore leather instead of rubber sole. After the fracture, 66.4% of those women had worse health perception; 69.7% became more sedentary, 27.9% used more canes, 63.4% complained of more dizziness, 38.3% removed rugs, 68.1% changed from public to private car transportation, and 55.7% modified their shoes from leather to rubber sole. Risk factors related to bone mass did not change before and after the fractures. CONCLUSIONS: these findings suggested that women modify only lifestyle habits related to falls but not those related to bone mass after osteoporotic fracture. Further research is needed in order to check which intervention strategies may lead to better results in preventing osteoporotic fractures.OBJETIVO: atividades de promoção de saúde e prevenção direcionadas para osteoporose podem ajudar a reduzir a taxa de fraturas osteoporóticas na popula

  2. [Petrous bone fracture. Our experience: 1999-2004].

    Science.gov (United States)

    Ramírez Sabio, J B; de Paula Vernetta, C; García Sanchís, J M; Callejo García, F J; Cortés Andrés, O; Quilis Quesada, V; Dualde Beltrán, D; Marco Algarra, J

    2006-12-01

    To review the petrous bone fractures during the last five years (1999-2004) in our hospital, its manage, control, and analysis onf the associated factors. To analyse the managing protocoles and current bibliography. We review 266 temporal bone fractures, 74 with petrous bone association. We analyse these fractures by sex distribution, injurie severity, otorhinolaryngological clinical findings, production mechanism and radiological findings. The cases are discussed and compared with current bibliography. Petrous bone fractures must be always suspected in patients with head trauma, specially if it associates severity and otorrhagia. It is necessary a deep colaboration between neurosurgeons, radiologists and otorhinolaryngologists to obtain a good management, control and follow up of the patients.

  3. Osteoporotic-like effects of cadmium on bone mineral density and content in aged ovariectomized beagles

    International Nuclear Information System (INIS)

    Sacco-Gibson, N.; Abrams, J.; Chaudhry, S.; Hurst, D.; Peterson, D.; Bhattacharyya, M.

    1992-01-01

    Our purpose was to evaluate the effects of ovariectomy in conjunction with cadmium (Cd) exposure on bone. Aged female beagles with 45 Ca-labeled skeletons ovariectomized and exposed to Cd. Successive vertebral scans by dual photon absorptiometry monitored changes in bone mineral density (BMD) in each dog with time. Results showed that ovariectomy or Cd exposure alone caused significant decreases in BMD; ovariectomy with Cd exposure caused the greatest decrease. Ovariectomy alone did not decrease BMD in the distal end or mid-shaft of the tibia while BMD of the distal tibia decreased significantly due to Cd exposure alone. Combination treatment resulted in significant decreases in BMD of both tibial regions. At necropsy, tibiae, humeri, lumbar vertebrae and ribs were obtained for biochemical analysis. No group-to-group differences in bone weights (wet, dry, ash), in ash/dry ratios, or in long bone and vertebral Ca/dry or Ca/ash ratios were observed. Significantly higher total 45 Ca content and 45 Ca/dry and 45 Ca/ash ratios were observed in long bones and vertebrae of OV- and OV+ groups. In contrast, intact ribs showed significantly decreased Ca/dry and Ca/ash ratios compared to the SO-group. Quartered ribs demonstrated regional responses to specific treatment; decreases in total Ca content were greatest in the mid-rib region (-36 to -46%). Results suggest that in the aged female beagle, bone mineral loss associated with estrogen depletion is not only related to bone type (trabecular versus cortical) but also to bone Ca pools. Our results also suggest that a regional heterogeneity of bone plays a role in responsiveness to ovariectomy and Cd exposure. These aspects suggest that Cd is an exogenous factor affecting bone mineral loss independently of estrogen depletion. However, estrogen depletion primes bone for responsiveness to Cd-induced bone mineral loss

  4. Osteoporotic-like effects of cadmium on bone mineral density and content in aged ovariectomized beagles

    Energy Technology Data Exchange (ETDEWEB)

    Sacco-Gibson, N.; Abrams, J.; Chaudhry, S.; Hurst, D.; Peterson, D.; Bhattacharyya, M.

    1992-12-31

    Our purpose was to evaluate the effects of ovariectomy in conjunction with cadmium (Cd) exposure on bone. Aged female beagles with {sup 45}Ca-labeled skeletons ovariectomized and exposed to Cd. Successive vertebral scans by dual photon absorptiometry monitored changes in bone mineral density (BMD) in each dog with time. Results showed that ovariectomy or Cd exposure alone caused significant decreases in BMD; ovariectomy with Cd exposure caused the greatest decrease. Ovariectomy alone did not decrease BMD in the distal end or mid-shaft of the tibia while BMD of the distal tibia decreased significantly due to Cd exposure alone. Combination treatment resulted in significant decreases in BMD of both tibial regions. At necropsy, tibiae, humeri, lumbar vertebrae and ribs were obtained for biochemical analysis. No group-to-group differences in bone weights (wet, dry, ash), in ash/dry ratios, or in long bone and vertebral Ca/dry or Ca/ash ratios were observed. Significantly higher total {sup 45}Ca content and {sup 45}Ca/dry and {sup 45}Ca/ash ratios were observed in long bones and vertebrae of OV- and OV+ groups. In contrast, intact ribs showed significantly decreased Ca/dry and Ca/ash ratios compared to the SO-group. Quartered ribs demonstrated regional responses to specific treatment; decreases in total Ca content were greatest in the mid-rib region ({minus}36 to {minus}46%). Results suggest that in the aged female beagle, bone mineral loss associated with estrogen depletion is not only related to bone type (trabecular versus cortical) but also to bone Ca pools. Our results also suggest that a regional heterogeneity of bone plays a role in responsiveness to ovariectomy and Cd exposure. These aspects suggest that Cd is an exogenous factor affecting bone mineral loss independently of estrogen depletion. However, estrogen depletion primes bone for responsiveness to Cd-induced bone mineral loss.

  5. Loss of Hip BMD in Older Men: The Osteoporotic Fractures in Men (MrOS) Study

    OpenAIRE

    Cawthon, Peggy M.; Ewing, Susan K.; McCulloch, Charles E.; Ensrud, Kristine E.; Cauley, Jane A.; Cummings, Steven R.; Orwoll, Eric S.

    2009-01-01

    Previous studies in older men have not evaluated whether loss of BMD or BMC accelerates nonlinearly with age. This study aimed to describe hip bone loss (both in BMC and BMD) in older men and to test whether BMD loss accelerates with age in an exponential manner in a cohort of 4720 community-dwelling men ≥65 yr of age. Men had two to three measures of femoral neck (FN) BMD (by DXA) over an average follow-up of 4.6 yr. Change in BMD during follow-up was estimated from mixed effects regression ...

  6. Location of Vertebral Fractures is Associated with Bone Mineral Density and History of Traumatic Injury.

    Science.gov (United States)

    Watt, Jennifer; Crilly, Richard

    2017-04-01

    The upper and lower thoracolumbar spine have been associated with different biomechanical outcomes. This concept, as it applies to osteoporotic fracture risk, has not been well documented. This was a case-control study of 120 patients seen in an osteoporosis clinic. Vertebral fractures were identified from lateral radiographs using Genant's semi-quantitative assessment method. An association between bone mineral density (BMD) T-scores and vertebral fracture location was assessed. In an additional analysis, the association between a history of any traumatic injury and possible predictor variables was also explored. The median age of patients was 75 (IQR 67-80), and 84.2% of patients were female. A history of trauma was reported by 46.7% of patients. A vertebral fracture in the lower thoracolumbar spine (T11-L4) was associated with significantly higher femoral neck (p trochanteric (p = 0.002), intertrochanteric (p fractures in the lower thoracolumbar spine. A fracture in the upper thoracolumbar spine (T4-T10) decreased the odds of having a history of traumatic injury (OR 0.32, 95% CI 0.14-0.76, p = 0.01), while a non-vertebral fracture increased the odds of such an injury (OR 2.41, 95% CI 1.10-5.32, p = 0.03). Vertebral fractures in the lower thoracolumbar spine are associated with higher BMD T-scores. This should be studied further to understand possible correlations with patients' future fracture risk.

  7. A method for assessment of the shape of the proximal femur and its relationship to osteoporotic hip fracture.

    Science.gov (United States)

    Gregory, J S; Testi, D; Stewart, A; Undrill, P E; Reid, D M; Aspden, R M

    2004-01-01

    The shape of the proximal femur has been demonstrated to be important in the occurrence of fractures of the femoral neck. Unfortunately, multiple geometric measurements frequently used to describe this shape are highly correlated. A new method, active shape modeling (ASM) has been developed to quantify the morphology of the femur. This describes the shape in terms of orthogonal modes of variation that, consequently, are all independent. To test this method, digitized standard pelvic radiographs were obtained from 26 women who had suffered a hip fracture and compared with images from 24 age-matched controls with no fracture. All subjects also had their bone mineral density (BMD) measured at five sites using dual-energy X-ray absorptiometry. An ASM was developed and principal components analysis used to identify the modes which best described the shape. Discriminant analysis was used to determine which variable, or combination of variables, was best able to discriminate between the groups. ASM alone correctly identified 74% of the individuals and placed them in the appropriate group. Only one of the BMD values (Ward's triangle) achieved a higher value (82%). A combination of Ward's triangle BMD and ASM improved the accuracy to 90%. Geometric variables used in this study were weaker, correctly classifying less than 60% of the study group. Logistic regression showed that after adjustment for age, body mass index, and BMD, the ASM data was still independently associated with hip fracture (odds ratio (OR)=1.83, 95% confidence interval 1.08 to 3.11). The odds ratio was calculated relative to a 10% increase in the probability of belonging to the fracture group. Though these initial results were obtained from a limited data set, this study shows that ASM may be a powerful method to help identify individuals at risk of a hip fracture in the future.

  8. High fluoride and low calcium levels in drinking water is associated with low bone mass, reduced bone quality and fragility fractures in sheep.

    Science.gov (United States)

    Simon, M J K; Beil, F T; Rüther, W; Busse, B; Koehne, T; Steiner, M; Pogoda, P; Ignatius, A; Amling, M; Oheim, R

    2014-07-01

    Chronic environmental fluoride exposure under calcium stress causes fragility fractures due to osteoporosis and bone quality deterioration, at least in sheep. Proof of skeletal fluorosis, presenting without increased bone density, calls for a review of fracture incidence in areas with fluoridated groundwater, including an analysis of patients with low bone mass. Understanding the skeletal effects of environmental fluoride exposure especially under calcium stress remains an unmet need of critical importance. Therefore, we studied the skeletal phenotype of sheep chronically exposed to highly fluoridated water in the Kalahari Desert, where livestock is known to present with fragility fractures. Dorper ewes from two flocks in Namibia were studied. Chemical analyses of water, blood and urine were executed for both cohorts. Skeletal phenotyping comprised micro-computer tomography (μCT), histological, histomorphometric, biomechanical, quantitative backscattered electron imaging (qBEI) and energy-dispersive X-ray (EDX) analysis. Analysis was performed in direct comparison with undecalcified human iliac crest bone biopsies of patients with fluoride-induced osteopathy. The fluoride content of water, blood and urine was significantly elevated in the Kalahari group compared to the control. Surprisingly, a significant decrease in both cortical and trabecular bones was found in sheep chronically exposed to fluoride. Furthermore, osteoid parameters and the degree and heterogeneity of mineralization were increased. The latter findings are reminiscent of those found in osteoporotic patients with treatment-induced fluorosis. Mechanical testing revealed a significant decrease in the bending strength, concurrent with the clinical observation of fragility fractures in sheep within an area of environmental fluoride exposure. Our data suggest that fluoride exposure with concomitant calcium deficit (i) may aggravate bone loss via reductions in mineralized trabecular and cortical bone

  9. Areal and volumetric Bone Mineral Density and risk of multiple types of fracture in older men

    Science.gov (United States)

    Chalhoub, Didier; Orwoll, Eric S.; Cawthon, Peggy M.; Ensrud, Kristine E.; Boudreau, Robert; Greenspan, Susan; Newman, Anne B.; Zmuda, Joseph; Bauer, Douglas; Cummings, Steven; Cauley, Jane A.

    2016-01-01

    Although many studies have examined the association between low bone mineral density (BMD) and fracture risk in older men, none have simultaneously studied the relationship between multiple BMD sites and risk of different types of fractures. Using data from the Osteoporotic Fractures in Men study, we evaluated the association between areal BMD (aBMD) by dual-energy X-ray absorptiometry (DXA) and volumetric BMD (vBMD) by quantitative computed tomography (QCT) measurements, and different types of fractures during an average of 9.7 years of follow up. Men answered questionnaires about fractures every 4 months (>97% completions). Fractures were confirmed by centralized review of radiographic reports; pathological fractures were excluded. Risk of fractures was assessed at the hip, spine, wrist, shoulder, rib/chest/sternum, ankle/foot/toe, arm, hand/finger, leg, pelvis/coccyx, skull/face and any non-spine fracture. Age and race adjusted Cox proportional-hazards modeling was used to assess the risk of fracture in 3301 older men with both aBMD (at the femoral neck (FN) and lumbar spine) and vBMD (at the trabecular spine and FN, and cortical FN) measurements, with hazard ratios (HRs) expressed per standard deviation (SD) decrease. Lower FN and spine aBMD were associated with an increased risk of fracture at the hip, spine, wrist, shoulder, rib/chest/sternum, arm, and any non-spine fracture (statistically significant HRs per SD decrease ranged from 1.24 - 3.57). Lower trabecular spine and FN vBMD were associated with increased risk of most fractures with statistically significant HRs ranging between 1.27 and 3.69. There was a statistically significant association between FN cortical vBMD and fracture risk at the hip (HR=1.55) and spine sites (HR=1.26), but no association at other fracture sites. In summary, both lower aBMD and vBMD were associated with increased fracture risk. The stronger associations observed for trabecular vBMD than cortical vBMD may reflect the greater

  10. Probabilistic Risk Assessment for Bone Fracture - Bone Fracture Risk Module (BFxRM)

    Science.gov (United States)

    Licata, Angelo; Myers, Jerry G.; Lewandowski, Beth

    2013-01-01

    This presentation summarizes the concepts, development, and application of NASA's Bone Fracture Risk Module (BFxRM). The overview includes an assessmnet of strenghts and limitations of the BFxRM and proposes a numebr of discussion questions to the panel regarding future development avenues for this simulation system.

  11. Central tarsal bone fracture in the border collie.

    Science.gov (United States)

    Guilliard, M

    2007-07-01

    Fracture of the plantar process of the central tarsal bone together with a dorsomedial displacement of the body of the bone was seen in six border collies. All injuries occurred during free exercise, with no extrinsic trauma. Three dogs had concomitant tarsal fractures. Primary treatment was by lag screwing the central tarsal bone to the fourth tarsal bone. All cases eventually made an excellent recovery. The superficial radiographic appearance was of a luxation of the bone as reported in a previous series, but appraisal of the radiographs showed evidence of fracture in all cases. A cadaver study to assess the mechanism of luxation showed that it is unlikely to occur naturally.

  12. Osteoporosis in clinical practice – bone densitometry and fracture risk

    African Journals Online (AJOL)

    Osteoporosis is a condition of decreased bone mass and bone density associated with an increase in fracture risk. Bone mineral density (BMD) of the lumbar spine and femur can be reliably measured by double-beam X-ray absorptiometry (DEXA), which provides a measure of bone strength. Reduction in BMD is a ...

  13. Stress fracture development classified by bone scintigraphy

    International Nuclear Information System (INIS)

    Zwas, S.T.; Elkanovich, R.; Frank, G.; Aharonson, Z.

    1985-01-01

    There is no consensus on classifying stress fractures (SF) appearing on bone scans. The authors present a system of classification based on grading the severity and development of bone lesions by visual inspection, according to three main scintigraphic criteria: focality and size, intensity of uptake compare to adjacent bone, and local medular extension. Four grades of development (I-IV) were ranked, ranging from ill defined slightly increased cortical uptake to well defined regions with markedly increased uptake extending transversely bicortically. 310 male subjects aged 19-2, suffering several weeks from leg pains occurring during intensive physical training underwent bone scans of the pelvis and lower extremities using Tc-99-m-MDP. 76% of the scans were positive with 354 lesions, of which 88% were in th4e mild (I-II) grades and 12% in the moderate (III) and severe (IV) grades. Post-treatment scans were obtained in 65 cases having 78 lesions during 1- to 6-month intervals. Complete resolution was found after 1-2 months in 36% of the mild lesions but in only 12% of the moderate and severe ones, and after 3-6 months in 55% of the mild lesions and 15% of the severe ones. 75% of the moderate and severe lesions showed residual uptake in various stages throughout the follow-up period. Early recognition and treatment of mild SF lesions in this study prevented protracted disability and progression of the lesions and facilitated complete healing

  14. The Effect of Polymethyl Methacrylate Augmentation on the Primary Stability of Cannulated Bone Screws in an Anterolateral Plate in Osteoporotic Vertebrae: A Human Cadaver Study.

    Science.gov (United States)

    Rüger, Matthias; Sellei, Richard M; Stoffel, Marcus; von Rüden, Christian

    2016-02-01

    Study Design Cohort study. Objective Expandable anterolateral plates facilitate the reduction of posttraumatic deformities of thoracolumbar spine injuries and are commonly used in cases of unstable injuries or compromised bone quality. In this in vitro study, the craniocaudal yield load of the osseous fixation of an anterior angular stable plate fixation system and the effect of polymethyl methacrylate (PMMA) screw augmentation on the primary stability of the screw-bone interface during kyphosis reduction was evaluated in 12 osteoporotic human thoracolumbar vertebrae. Methods The anterolateral stabilization device used for this study is comprised of two swiveling flanges and an expandable midsection. It facilitates the controlled reduction of kyphotic deformities in situ with a geared distractor. Single flanges were attached to 12 thoracolumbar vertebrae. Six specimens were augmented with PMMA by means of cannulated bone screws. The constructs were subjected to static, displacement-controlled craniocaudal loading to failure in a servohydraulic testing machine. Results The uncemented screws cut out at a mean 393 ± 66 N, whereas the cemented screws showed significantly higher yield load of 966 ± 166 N (p augmentation is an effective method to increase two- to threefold the primary stability of the screw-bone interface of an anterolateral spine stabilization system in osteoporotic bone. We recommend it in cases of severely compromised bone quality to reduce the risk of screw loosening during initial kyphosis correction and to increase long-term construct stability.

  15. Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the Osteoporotic Fractures in Men (MrOs) Study.

    Science.gov (United States)

    Yu, Ruby; Leung, Jason; Woo, Jean

    2014-08-01

    We examined whether sarcopenia is predictive of incident fractures among older men, whether the inclusion of sarcopenia in models adds any incremental value to bone mineral density (BMD), and whether sarcopenia is associated with a higher risk of fractures in elderly with osteoporosis. A cohort of 2000 community-dwelling men aged ≥65 years were examined for which detailed information regarding demographics, socioeconomic, medical history, clinical, and lifestyle factors were documented. Body composition and BMD were measured using dual energy X-ray absorptiometry. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013, and related to sarcopenia and its component measures using Cox proportional hazard regressions. The contribution of sarcopenia for predicting fracture risk was evaluated by receiver operating characteristic analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During an average of 11.3 years of follow-up, 226 (11.3%) men sustained at least 1 incident fracture, making the incidence of fractures 1200.6/100,000 person-years. After multivariate adjustments, sarcopenia was associated with increased fracture risk (hazard ratio [HR], 1.87, 95% confidence interval [CI], 1.26-2.79) independent of BMD and other clinical risk factors. The addition of sarcopenia did not significantly increase area under curve or IDI but significantly improved the predictive ability on fracture risk over BMD and other clinical risk factors by 5.12% (P sarcopenia (sarco-osteoporosis) resulted in a significantly increased risk of fractures (HR, 3.49, 95% CI, 1.76-6.90) compared with those with normal BMD and without sarcopenia. This study confirms that sarcopenia is a predictor of fracture risk in this elderly men cohort, establishes that sarcopenia provides incremental predictive value for fractures over the

  16. Properties of Turkish Osteoporotic Women According to Risk Factor Assesment: A Multicenter Study

    Directory of Open Access Journals (Sweden)

    M. Eryavuz

    2002-03-01

    Full Text Available Osteoporosis is a metabolic bone disease characterized by a decreased bone mass and a deterioration in bone microarchitecture which causes an enhanced fragility of the skeleton and creates a greater susceptibility to fractures. With increases in life expectancy and in the number of elderly people bone loss and fractures are becoming more common in the all over the world. The purpose of this study is to determine chracteristics and risk factors of Turkish osteoporotic women and to assess the effect of different geographic areas on risk factors. Nine hundred and five osteoporotic women who have lived 6 different geographic areas were included in this study. The study was completed in 26 different centers and its duration was 6 months. The mean age of patients were 62±9 years. Although sixty percent of those patients belived that they knew consequences of osteoporosis 35% did not know. The most known symptoms of osteoporosis were fractures (33%, kyphosis and low back pain (23%. Most of the physicians who diagnosed opteoporosis for the first time were physiatrists (86%. Being a physiatrist, we have a great deal of responsibilities in osteoporosis. Finally, we suggest that to determine the characteristics of Turkish osteoporotic women which depend on many factors such as differences of geographic factors, only will be possible by evaluation of great number of osteoporotic women.

  17. Petrous bone fractures violating otic capsule.

    Science.gov (United States)

    Magliulo, Giuseppe; Ciniglio Appiani, Mario; Iannella, Giannicola; Artico, Marco

    2012-12-01

    This study presents our experience with a series of patients suffering from petrous bone fractures violating the otic capsule who underwent subtotal petrosectomy combined with eustachian tube, middle ear, and mastoid obliteration, with the goal of preventing cerebrospinal fluid (CSF) leak and meningitis. This study enrolled 26 patients between 1997 and 2011. The clinical symptoms, otoscopy, and preoperative and postoperative audiometry and facial function, as well as CSF leak or meningitis, were evaluated in each patient. The entire group underwent a subtotal petrosectomy using the technique described in detail by Fisch. In addition, each patient was interviewed using a questionnaire to evaluate the impact on quality of life. Intraoperatively, we found significant CSF leaks in 14 patients (42.5%). No patient reported other episodes of CSF leak or meningitis after the surgery. The patients' responses of facial nerve function were slightly worse than the House-Brackmann evaluation (50% versus 42.3%; p < 0.05). The vast majority (88.5%) of the patients experienced no social impact. Our findings suggest the importance of not underestimating the risk for CSF leak in the petrous bone fractures violating the otic capsule. Preoperative counseling regarding the various troublesome complications must adequately motivate candidates to undergo surgery by pointing out the positive impact of the proposed treatment.

  18. Analyzing the cellular contribution of bone marrow to fracture healing using bone marrow transplantation in mice

    International Nuclear Information System (INIS)

    Colnot, C.; Huang, S.; Helms, J.

    2006-01-01

    The bone marrow is believed to play important roles during fracture healing such as providing progenitor cells for inflammation, matrix remodeling, and cartilage and bone formation. Given the complex nature of bone repair, it remains difficult to distinguish the contributions of various cell types. Here we describe a mouse model based on bone marrow transplantation and genetic labeling to track cells originating from bone marrow during fracture healing. Following lethal irradiation and engraftment of bone marrow expressing the LacZ transgene constitutively, wild type mice underwent tibial fracture. Donor bone marrow-derived cells, which originated from the hematopoietic compartment, did not participate in the chondrogenic and osteogenic lineages during fracture healing. Instead, the donor bone marrow contributed to inflammatory and bone resorbing cells. This model can be exploited in the future to investigate the role of inflammation and matrix remodeling during bone repair, independent from osteogenesis and chondrogenesis

  19. Usefulness of MR imaging in pathologic fracture of long bone

    International Nuclear Information System (INIS)

    Lim, Hyo Soon; Park, Jin Gyoon; Song, Jae Min; Chung, Tae Woong; Yoon, Woong; Kang, Heoung Kyun

    2002-01-01

    The purpose of this study was to evaluate the usefulness of MR imaging of pathologic fractures of the long bones. In 18 patients aged between four and 75 (mean, 25.8) years with histologically confirmed pathologic fractures of the long bones, plain radiographs and MR images were retrospectively analyzed. The former were examined with regard to location and type of fracture, and the presence or absence of underlying disease causing fracture; and the latter in terms of underlying disease, extraosseous mass formation, and soft tissue change. The long bones involved were the femur in nine patients, the humerus in six, and the tibia in three. Underlying diseases were metastatic tumor (n=6), benign bone tumor (n=5), primary malignant bone tumor (n=4), osteomyelitis (n=2), and eosinophilic granuloma (n=1). Plain radiographs showed the fracture site as the metaphysis in ten cases, the disphysis in five, and the metadisphysis in one. Fractures were either transverse (n=10), oblique (n=3), spiral (n=1), vertical (n=1), or telescopic (n=1). In two cases, the fracture line was not visible. MR images revealed underlying diseases in all cases. Two benign bone tumors took the form of a cystic mass, hematoma was seen in three cases. Where pathologic fracture of a long bone had occurred, or a pathologic fracture in which the findings of plain radiography were equivocal, MR imaging was useful for evaluating the pattern and extent of an underlying lesion

  20. Comparison of prescribing and adherence patterns of anti-osteoporotic medications post-admission for fragility type fracture in an urban teaching hospital and a rural teaching hospital in Ireland between 2005 and 2008.

    LENUS (Irish Health Repository)

    McGowan, B

    2013-03-13

    INTRODUCTION: Poor adherence reduces the potential benefits of osteoporosis therapy, lowering gains in bone mineral density resulting in increased risk of fractures. AIM: To compare prescribing and adherence patterns of anti-osteoporotic medications in patients admitted to an urban teaching hospital in Ireland with a fragility type fracture to patients admitted to a rural hospital in the North Western region. METHODOLOGY: We identified all patients >55 years admitted to Sligo General Hospital between 2005 and 2008 with a fragility fracture (N = 744) using the hospital in-patient enquiry system (HIPE). The medical card number of those patients eligible for the primary care reimbursement services scheme (PCRS) facilitated the linkage of the HSE-PCRS scheme database to the HIPE database which enabled a study to identify persistence rates of patients prescribed osteoporosis therapy after discharge. The results were compared to the findings of a similar study carried out in St. James\\'s Hospital, Dublin. RESULTS: The 12 months post-fracture prescribing increased from 11.0 % (95 % CI 9.6, 12.4) in 2005 to 47 % (95 % CI 43.6, 50.3) in 2008 in the urban setting and from 25 % (95 % CI 21.5, 28.9) to 39 % (95 % CI 34.5, 42.7) in the rural setting. Adherence levels to osteoporosis medications at 12 months post-initiation of therapy was <50 % in both study groups. Patients on less frequent dosing regimes were better adherers. CONCLUSION: The proportion of patients being discharged on anti-osteoporosis medications post-fragility fracture increased between 2005 and 2008 in both patient groups. Sub-optimal adherence levels to osteoporosis medications continue to be a major concern.

  1. Implant failure in osteosynthesis of fractures of long bones ...

    African Journals Online (AJOL)

    Patients who had open operative treatment of fractures of long bones were reviewed retrospectively to identify the incidence of and risk factors for implant failure. One hundred and five patients had open reduction and internal fixation of 117 fractures of long bones, out of which four patients suffered implant failure.

  2. FRACTURE OF THE CENTRAL TARSAL BONE IN NONRACEHORSES: FOUR CASES.

    Science.gov (United States)

    Knuchell, Jeannie A; Spriet, Mathieu; Galuppo, Larry D; Katzman, Scott A

    2016-07-01

    Fractures of the central tarsal bone are a rarely recognized cause of acute severe hind limb lameness in nonracehorses. Diagnosis of these fractures can be challenging and little is known about their configuration or outcome. The objectives of this retrospective case series study were to describe the clinical features, imaging findings, and outcomes of fractures of the central tarsal bone in a sample of nonracehorses. Medical records from 2001 to 2014 were searched for cases of central tarsal bone fractures in nonracehorses. All available imaging findings including radiography, ultrasound, computed tomography (CT), and/or nuclear scintigraphy were reviewed. History, clinical presentation, and outcome were collected from the records. Four horses met the inclusion criteria. All had a similar configuration as a simple nondisplaced slab fracture in a dorsomedial to plantarolateral orientation. Initial radiographs failed to reveal the fracture in three of four cases. When additional plantarolateral-dorsomedial oblique radiographic views were obtained, the fracture could be identified in all cases. Fractures of the central tarsal bone seemed to occur in a consistent dorsomedial to plantarolateral orientation in this sample of nonracehorses, which is different from the configuration previously reported in racehorses. While CT can be used for detection and assessment of these fractures, authors propose that radiography can also identify these fractures with the appropriate view. Authors recommend the use of several plantarolateral to dorsomedial radiographic projections at varying degrees of obliquity for horses with a suspected central tarsal bone fracture. © 2016 American College of Veterinary Radiology.

  3. Solitary, spontaneous cervical and large bone fractures in aluminium osteodystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Sundaram, M.; Dessner, D. (Saint Louis Univ. Medical Center, MI (USA). Dept. of Radiology); Ballal, S. (Saint Louis Univ. Medical Center, MI (USA). Div. of Nephrology)

    1991-02-01

    Aluminum-induced bone disease in uremic patients receiving dialysis was first described a little more than 10 years ago. The epidemic form of the disease was seen in centers where there was a high aluminum content in the water dialysate. Although this problem has been corrected, sporadic forms of the disease continue to be noted in dialyzed and nondialyzed patients. Multiple fractures are a radiological feature of aluminum-related bone disease. We present four patients whose nontraumatic fractures involved large bones, without evidence of multiple fractures. Healing was not seen in any of the fractures. In patients receiving dialysis the presence of spontaneous fractures of large bones or cervical vertebrae, which may be clinically silent or vaguely symptomatic, should raise the possibility of aluminum-induced osteomalacia even if these fractures are solitary. (orig./GDG).

  4. Temporal Bone Fracture Causing Superior Semicircular Canal Dehiscence

    Directory of Open Access Journals (Sweden)

    Kevin A. Peng

    2014-01-01

    Full Text Available Importance. Superior semicircular canal dehiscence (SCD is a third window lesion of the inner ear causing symptoms of vertigo, autophony, tinnitus, and hearing loss. A “two-hit” hypothesis has traditionally been proposed, whereby thinly developed bone overlying the superior canal is disrupted by a sudden change in intracranial pressure. Although the symptoms of SCD may be precipitated by head injury, no previous reports have described a temporal bone fracture directly causing SCD. Observations. Two patients sustained temporal bone fractures after closed head trauma, and developed unilateral otologic symptoms consistent with SCD. In each instance, computed tomography imaging revealed fractures extending through the bony roof of the superior semicircular canal. Conclusions and Relevance. Temporal bone fractures, which are largely treated nonoperatively, have not previously been reported to cause SCD. As it is a potentially treatable entity, SCD resulting from temporal bone fracture must be recognized as a possibility and diagnosed promptly if present.

  5. Bone mineral density changes of lumbar spine and femur in osteoporotic patient treated with bisphosphonates and beta-hydroxy-beta-methylbutyrate (HMB): Case report.

    Science.gov (United States)

    Tatara, Marcin R; Krupski, Witold; Majer-Dziedzic, Barbara

    2017-10-01

    Currently available approaches to osteoporosis treatment include application of antiresorptive and anabolic agents influencing bone tissue metabolism. The aim of the study was to present bone mineral density (BMD) changes of lumbar spine in osteoporotic patient treated with bisphosphonates such as ibandronic acid and pamidronic acid, and beta-hydroxy-beta-methylbutyrate (HMB). BMD and volumetric BMD (vBMD) of lumbar spine were measured during the 6 year observation period with the use of dual-energy X-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). The described case report of osteoporotic patient with family history of severe osteoporosis has shown site-dependent response of bone tissue to antiosteoporotic treatment with bisphosphonates. Twenty-five-month treatment with ibandronic acid improved proximal femur BMD with relatively poor effects on lumbar spine BMD. Over 15-month therapy with pamidronic acid was effective to improve lumbar spine BMD, while in the proximal femur the treatment was not effective. A total of 61-week long oral administration with calcium salt of HMB improved vBMD of lumbar spine in the trabecular and cortical bone compartments when monitored by QCT. Positive effects of nearly 2.5 year HMB treatment on BMD of lumbar spine and femur in the patient were also confirmed using DEXA method. The results obtained indicate that HMB may be applied for the effective treatment of osteoporosis in humans. Further studies on wider human population are recommended to evaluate mechanisms influencing bone tissue metabolism by HMB.

  6. Elastic-plastic fracture mechanics of compact bone

    Science.gov (United States)

    Yan, Jiahau

    Bone is a composite composed mainly of organics, minerals and water. Most studies on the fracture toughness of bone have been conducted at room temperature. Considering that the body temperature of animals is higher than room temperature, and that bone has a high volumetric percentage of organics (generally, 35--50%), the effect of temperature on fracture toughness of bone should be studied. Single-edged V-shaped notched (SEVN) specimens were prepared to measure the fracture toughness of bovine femur and manatee rib in water at 0, 10, 23, 37 and 50°C. The fracture toughness of bovine femur and manatee rib were found to decrease from 7.0 to 4.3 MPa·m1/2 and from 5.5 to 4.1 MPa·m1/2, respectively, over a temperature range of 50°C. The decreases were attributed to inability of the organics to sustain greater stresses at higher temperatures. We studied the effects of water and organics on fracture toughness of bone using water-free and organics-free SEVN specimens at 23°C. Water-free and organics-free specimens were obtained by placing fresh bone specimen in a furnace at different temperatures. Water and organics significantly affected the fracture toughness of bone. Fracture toughness of the water-free specimens was 44.7% (bovine femur) and 32.4% (manatee rib) less than that of fresh-bone specimens. Fracture toughness of the organics-free specimens was 92.7% (bovine femur) and 91.5% (manatee rib) less than that of fresh bone specimens. Linear Elastic Fracture Mechanics (LEFM) is widely used to study bone. However, bone often has small to moderate scale yielding during testing. We used J integral, an elastic-plastic fracture-mechanics parameter, to study the fracture process of bone. The J integral of bovine femur increased from 6.3 KJ/mm2 at 23°C to 6.7 KJ/mm2 at 37°C. Although the fracture toughness of bovine bone decreases as the temperature increases, the J integral results show a contrary trend. The energy spent in advancing the crack beyond the linear

  7. Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture.

    Science.gov (United States)

    Sanz-Salvador, Lucía; García-Pérez, Miguel Ángel; Tarín, Juan J; Cano, Antonio

    2015-02-01

    Changes in bone density and bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow for the needs imposed by the building of the fetal skeleton. The fetus contributes to the process through the output of regulators from the placenta. Understanding of the whole process is limited, but some changes are unambiguous. There is an increase in the circulating levels of vitamin D, but its functional impact is unclear. Fetal parathyroid hormone (PTH) and PTH-related peptide (PTHrp) play an indirect role through support of a calcium gradient that creates hypercalcemia in the fetus. Placental GH, which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the IGF1 production. Other key regulators of bone metabolism, such as estrogens or prolactin, are elevated during pregnancy, but their role is uncertain. An increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL) to osteoprotegerin (OPG) acts as an additional pro-resorbing factor in bone. The increase in bone resorption may lead to osteoporosis and fragility fracture, which have been diagnosed, although rarely. However, the condition is transitory as long-term studies do not link the number of pregnancies with osteoporosis. Prevention is limited by the lack of identifiable risk factors. When fractures are diagnosed, rest, analgesics, or, when indicated, orthopedic intervention have demonstrated efficacy. Systemic treatment with anti-osteoporotic drugs is effective, but the potential harm to the fetus imposes caution in their use. © 2015 European Society of Endocrinology.

  8. Evidence Report: Risk of Bone Fracture due to Spaceflight-Induced Changes to Bone

    Science.gov (United States)

    Sibonga, Jean D.; Evans, Harlan J.; Smith, Scott A.; Spector, Elisabeth R.; Yardley, Greg; Myer, Jerry

    2017-01-01

    Given that spaceflight may induce adverse changes in bone ultimate strength with respect to mechanical loads during and post-mission, there is a possibility a fracture may occur for activities otherwise unlikely to induce fracture prior to initiating spaceflight.

  9. Probabilistic Risk Assessment for Astronaut Post Flight Bone Fracture

    Science.gov (United States)

    Lewandowski, Beth; Myers, Jerry; Licata, Angelo

    2015-01-01

    Introduction: Space flight potentially reduces the loading that bone can resist before fracture. This reduction in bone integrity may result from a combination of factors, the most common reported as reduction in astronaut BMD. Although evaluating the condition of bones continues to be a critical aspect of understanding space flight fracture risk, defining the loading regime, whether on earth, in microgravity, or in reduced gravity on a planetary surface, remains a significant component of estimating the fracture risks to astronauts. This presentation summarizes the concepts, development, and application of NASA's Bone Fracture Risk Module (BFxRM) to understanding pre-, post, and in mission astronaut bone fracture risk. The overview includes an assessment of contributing factors utilized in the BFxRM and illustrates how new information, such as biomechanics of space suit design or better understanding of post flight activities may influence astronaut fracture risk. Opportunities for the bone mineral research community to contribute to future model development are also discussed. Methods: To investigate the conditions in which spaceflight induced changes to bone plays a critical role in post-flight fracture probability, we implement a modified version of the NASA Bone Fracture Risk Model (BFxRM). Modifications included incorporation of variations in physiological characteristics, post-flight recovery rate, and variations in lateral fall conditions within the probabilistic simulation parameter space. The modeled fracture probability estimates for different loading scenarios at preflight and at 0 and 365 days post-flight time periods are compared. Results: For simple lateral side falls, mean post-flight fracture probability is elevated over mean preflight fracture probability due to spaceflight induced BMD loss and is not fully recovered at 365 days post-flight. In the case of more energetic falls, such as from elevated heights or with the addition of lateral movement

  10. Surgical management of proximal splint bone fractures in the horse

    International Nuclear Information System (INIS)

    Peterson, P.R.; Pascoe, J.R.; Wheat, J.D.

    1987-01-01

    Fractures of Metacarpal and Metatarsal II and IV (the splint bones) were treated in 283 horses over an 11 year period. In 21 cases the proximal portion of the fractured bone was stabilized with metallic implants. One or more cortical bone screws were used in 11 horses, and bone plates were applied in 11 horses. One horse received both treatments. Complications of screw fixation included bone failure, implant failure, radiographic lucency around the screws, and proliferative new bone at the ostectomy site. Only two of the horses treated with screw fixation returned to their intended use. Complications of plate fixation included partial fixation failure (backing out of screws), wound drainage, and proliferative bony response around the plate. Six of the 11 horses treated by plate fixation returned to their intended use. The authors recommend consideration of plate fixation techniques for repair of fractures in the proximal third of the splint bone

  11. Characterization of Fatty Acid Composition in Bone Marrow Fluid From Postmenopausal Women: Modification After Hip Fracture.

    Science.gov (United States)

    Miranda, Melissa; Pino, Ana María; Fuenzalida, Karen; Rosen, Clifford J; Seitz, Germán; Rodríguez, J Pablo

    2016-10-01

    Bone marrow adipose tissue (BMAT) is associated with low bone mass, although the functional consequences for skeletal maintenance of increased BMAT are currently unclear. BMAT might have a role in systemic energy metabolism, and could be an energy source as well as an endocrine organ for neighboring bone cells, releasing cytokines, adipokines and free fatty acids into the bone marrow microenvironment. The aim of the present report was to compare the fatty acid composition in the bone marrow supernatant fluid (BMSF) and blood plasma of postmenopausal women women (65-80 years old). BMSF was obtained after spinning the aspirated bone marrow samples; donors were classified as control, osteopenic or osteoporotic after dual-energy X-ray absorptiometry. Total lipids from human bone marrow fluid and plasma were extracted, converted to the corresponding methyl esters, and finally analyzed by a gas chromatographer coupled with a mass spectrometer. Results showed that fatty acid composition in BMSF was dynamic and distinct from blood plasma, implying significance in the locally produced lipids. The fatty acid composition in the BMSF was enriched in saturated fatty acid and decreased in unsaturated fatty acids as compared to blood plasma, but this relationship switched in women who suffered a hip fracture. On the other hand, there was no relationship between BMSF and bone mineral density. In conclusion, lipid composition of BMSF is distinct from the circulatory compartment, most likely reflecting the energy needs of the marrow compartment. J. Cell. Biochem. 117: 2370-2376, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  12. Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study.

    LENUS (Irish Health Repository)

    Ong, J C Y

    2012-06-01

    The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.

  13. Changes of Bone-Related Minerals during Denosumab Administration in Post-Menopausal Osteoporotic Patients.

    Science.gov (United States)

    Suzuki, Takako; Nakamura, Yukio; Kato, Hiroyuki

    2017-08-13

    This retrospective study included 21 patients with primary osteoporosis who were treated with the anti-resorption drug, denosumab. To date, there has been no detailed report on the changes of bone-related minerals after anti-resorption drug therapy. Twenty-one post-menopausal females were retrospectively enrolled. Serum zinc (Zn), magnesium (Mg), iron (Fe), copper (Cu), grip strength, and estimated glomerular filtration rate (eGFR) were examined at one week and 1, 2, 4, 6, 8, 10, and 12 months. Lumbar spine (L1-4) bone mineral density (L-BMD) and bilateral total hip BMD (H-BMD) were examined before and at 4, 8, and 12 months after treatment commencement. Serum Zn tended to decrease at one week and one month, and tended to increase during 10 to 12 months. Serum Cu maintained during zero to eight months, then decreased at 10 and 12 months. Serum Fe gradually increased after four months. Serum Mg sharply increased at one week, then decreased further. Grip strength increased for two months, then slightly decreased and maintained 4 to 12 months. eGFR almost maintained for zero to eight months, then slightly decreased thereafter. L-BMD values significantly increased at eight (5.8%) ( p < 0.01) and 12 months (9.8%) ( p < 0.01). H-BMD increased during the period (at 12 months: 3.7%). These results suggest that at later phases of denosumab therapy, Zn and Fe tended to increase while Mg tended to decrease, all of which are important for bone metabolism. Thus, denosumab might improve Zn and Fe metabolism, and thereby likely increase BMD. Since denosumab may not improve Mg, it is better to obtain Mg supplementation during the therapy.

  14. Metaphyseal impaction fractures in acute lymphoblastic leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Manson, D.; Cockshott, W.P.; Martin, R.F.

    1989-01-01

    Patients with acute lymphatic leukaemia frequently are osteoporotic. A small subset of these develop disabling metaphyseal transverse fractures, usually bilateral and in the lower limb. These impaction fractures have a characteristic appearance and develop in recently laid down bone. They may develop ab initio of during therapy, Magnesium deficiency is found in these patients.

  15. Metaphyseal impaction fractures in acute lymphoblastic leukemia

    International Nuclear Information System (INIS)

    Manson, D.; Cockshott, W.P.; Martin, R.F.

    1989-01-01

    Patients with acute lymphatic leukaemia frequently are osteoporotic. A small subset of these develop disabling metaphyseal transverse fractures, usually bilateral and in the lower limb. These impaction fractures have a characteristic appearance and develop in recently laid down bone. They may develop ab initio of during therapy, Magnesium deficiency is found in these patients. (orig.)

  16. The osteoporotic vertebral structure is well adapted to the loads of daily life, but not to infrequent "error" loads.

    Science.gov (United States)

    Homminga, J; Van-Rietbergen, B; Lochmüller, E M; Weinans, H; Eckstein, F; Huiskes, R

    2004-03-01

    Osteoporotic vertebral fractures typically have a gradual onset, frequently remain clinically undetected, and do not seem to be related to traumatic events. The osteoporotic vertebrae may therefore be expected to display a less "optimal" bone architecture, leading to an uneven load distribution over the bone material. We evaluated the trabecular load distribution in an osteoporotic and a healthy vertebra under normal daily loading by combining three recent innovations: high resolution computed tomography (microCT) of entire bones, microfinite element analyses (microFEA), and parallel supercomputers. Much to our surprise, the number of highly loaded trabeculae was not higher in the osteoporotic vertebra than in the healthy one under normal daily loads (8% and 9%, respectively). The osteoporotic trabeculae were more oriented in the longitudinal direction, compensating for effects of bone loss and ensuring adequate stiffness for normal daily loading. The increased orientation did, however, make the osteoporotic structure less resistant against collateral "error" loads. In this case, the number of overloaded trabeculae in the osteoporotic vertebra was higher than in the healthy one (13% and 4%, respectively). These results strengthen the paradigm of a strong relationship between bone morphology and external loads applied during normal daily life. They also indicate that vertebral fractures result from actions like forward flexion or lifting, loads that may not be "daily" but are normally not traumatic either. If future clinical imaging techniques would enable such high-resolution images to be obtained in vivo, the combination of microCT and microFEA would produce a powerful tool to diagnose osteoporosis.

  17. Long-bone fractures in persons with spinal cord injury.

    Science.gov (United States)

    Frotzler, A; Cheikh-Sarraf, B; Pourtehrani, M; Krebs, J; Lippuner, K

    2015-09-01

    Retrospective data analysis. To document fracture characteristics, management and related complications in individuals with traumatic spinal cord injury (SCI). Rehabilitation centre for SCI individuals. Patients' records were reviewed. Patients with traumatic SCI and extremity fractures that had occurred after SCI were included. Patient characteristics, fractured bone, fracture localisation, severity and management (operative/conservative), and fracture-related complications were extracted. A total of 156 long-bone fractures in 107 SCI patients (34 women and 73 men) were identified. The majority of patients were paraplegics (77.6%) and classified as American Spinal Injury Association Impairment Scale A (86.0%). Only the lower extremities were affected, whereby the femur (60.9% of all fractures) was fractured more frequently than the lower leg (39.1%). A total of 70 patients (65.4%) had one fracture, whereas 37 patients (34.6%) had two or more fractures. Simple or extraarticular fractures were most common (75.0%). Overall, 130 (83.3%) fractures were managed operatively. Approximately half of the femur fractures (48.2%) were treated with locking compression plates. In the lower leg, fractures were mainly managed with external fixation (48.8%). Conservative fracture management was applied in 16.7% of the cases and consisted of braces or a well-padded soft cast. Fracture-associated complications were present in 13.5% of the cases but did not differ significantly between operative (13.1%) and conservative (15.4%) fracture management. SCI was associated with simple or extraarticular fractures of the distal femur and the lower leg. Fractures were mainly managed operatively with a low complication rate.

  18. BONE TURNOVER IN OSTEOPOROTIC WOMEN DURING LONG-TERM ORAL BISPHOSPHONATES TREATMENT: IMPLICATIONS FOR TREATMENT FAILURE AND "DRUG HOLIDAY" IN THE REAL WORLD.

    Science.gov (United States)

    Liel, Yair; Plakht, Ygal; Tailakh, Muhammad Abu

    2017-07-01

    Little data exist to support concerns over bone turnover suppression during prolonged oral bisphosphonate treatment and on consequences of the recommended "drug holiday." This study was performed to assess bone resorption rates in postmenopausal osteoporotic women on prolonged oral bisphosphonate treatment and in response to switching to "drug holiday" intravenous bisphosphonate, or continuation of oral bisphosphonates. The frequency distribution of the bone resorption marker urinary deoxypyridinoline crosslinks (uDPD), was obtained retrospectively from 211 osteoporotic women attended at an academic hospital endocrine clinic, treated for >2 years with oral bisphosphonates. In some patients, uDPD was re-assessed following modification or continuation of treatment. The mean duration of oral bisphosphonates treatment was 7.2 ± 3.1 years. uDPD was within reference range for premenopausal women in 61.6% of the patients, below in 7.6% of the patients, and above upper limit in 30.8%. uDPD decreased significantly following intravenous zoledronic acid, increased significantly during "drug holiday," and slightly decreased in those continued on oral bisphosphonate treatment. In this real-world study, the majority of women on prolonged oral bisphosphonates maintained bone resorption rates within the normal reference range for premenopausal women. The likelihood for inadequate suppression was considerably greater than that of over-suppression. Implementing a "drug holiday" resulted in a marked increase in bone resorption rates. Additional studies should explore the potential role of bone turnover markers in the evaluation of patients on prolonged oral bisphosphonates and during "drug holiday" in different settings and using additional markers. BMD = bone mineral density; IQR = interquartile range; uDPD = urinary deoxypyridinoline crosslinks.

  19. CaMKK2 Inhibition in Enhancing Bone Fracture Healing

    Science.gov (United States)

    2016-05-01

    AWARD NUMBER: W81XWH-13-1-0188 TITLE: CaMKK2 Inhibition in Enhancing Bone Fracture Healing PRINCIPAL INVESTIGATOR: Uma Sankar, Ph.D...Enhancing Bone Fracture Healing 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-13-1-0188 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Uma Sankar 5d...accelerated fracture healing . We generated unilateral mid-shaft fractures using a three-point bending method (first described for use in rats by Bonnarens and

  20. Clinical evaluation of stress fractures using bone scintigraphy

    International Nuclear Information System (INIS)

    Furuta, Atsuhiko; Tanohata, Kazunori; Otake, Toru; Hashizume, Toshiyuki; Kobayashi, Yozi; Nakazima, Hiroyuki.

    1984-01-01

    Clinical evaluation of stress fractures were performed in 58 athletes using bone scintigraphy with sup(99m)Tc-MDP. Stress fractures of the tibia were most often seen in the males with running type sports. They occurred more often in the proximal tibia and on the right side. Stress fractures of the fibula were most often seen in females with jumping type sports, such as volley ball. They occurred more often in the distal fibula and on the right side. Tarsal bone fractures were seen most often rugby players. Metatarsal fractures occurred in the third fourth and fifth metatarsals. No lesion was seen in the first and second metatarsals. We feel that stress fractures of the femur can be differentiated from osteosarcoma by small loculated radionuclide accumulation as well as symptome, course and tomographic and CT finding. Bilateral involvement was seen in two cases in patellae and calcanei. Most of the other fractures were seen on the right side. Negative radiographs were seen in 36% of the patients and occurred most commonly in the tarsal bones excluding calcaneus. Bone scintigrams were positive in all cases and were most useful in fractures of the tarsal bones excluding calcaneus. (author)

  1. Clinical evaluation of stress fractures using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Furuta, Atsuhiko; Tanohata, Kazunori; Otake, Toru; Hashizume, Toshiyuki (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan)); Kobayashi, Yozi; Nakazima, Hiroyuki

    1984-05-01

    Clinical evaluation of stress fractures were performed in 58 athletes using bone scintigraphy with sup(99m)Tc-MDP. Stress fractures of the tibia were most often seen in the males with running type sports. They occurred more often in the proximal tibia and on the right side. Stress fractures of the fibula were most often seen in females with jumping type sports, such as volley ball. They occurred more often in the distal fibula and on the right side. Tarsal bone fractures were seen most often rugby players. Metatarsal fractures occurred in the third fourth and fifth metatarsals. No lesion was seen in the first and second metatarsals. We feel that stress fractures of the femur can be differentiated from osteosarcoma by small loculated radionuclide accumulation as well as symptoms, course and tomographic and CT findings. Bilateral involvement was seen in two cases in patellae and calcanei. Most of the other fractures were seen on the right side. Negative radiographs were seen in 36% of the patients and occurred most commonly in the tarsal bones excluding calcaneus. Bone scintigrams were positive in all cases and were most useful in fractures of the tarsal bones excluding calcaneus.

  2. Identification of fracture zones and its application in automatic bone fracture reduction.

    Science.gov (United States)

    Paulano-Godino, Félix; Jiménez-Delgado, Juan J

    2017-04-01

    The preoperative planning of bone fractures using information from CT scans increases the probability of obtaining satisfactory results, since specialists are provided with additional information before surgery. The reduction of complex bone fractures requires solving a 3D puzzle in order to place each fragment into its correct position. Computer-assisted solutions may aid in this process by identifying the number of fragments and their location, by calculating the fracture zones or even by computing the correct position of each fragment. The main goal of this paper is the development of an automatic method to calculate contact zones between fragments and thus to ease the computation of bone fracture reduction. In this paper, an automatic method to calculate the contact zone between two bone fragments is presented. In a previous step, bone fragments are segmented and labelled from CT images and a point cloud is generated for each bone fragment. The calculated contact zones enable the automatic reduction of complex fractures. To that end, an automatic method to match bone fragments in complex fractures is also presented. The proposed method has been successfully applied in the calculation of the contact zone of 4 different bones from the ankle area. The calculated fracture zones enabled the reduction of all the tested cases using the presented matching algorithm. The performed tests show that the reduction of these fractures using the proposed methods leaded to a small overlapping between fragments. The presented method makes the application of puzzle-solving strategies easier, since it does not obtain the entire fracture zone but the contact area between each pair of fragments. Therefore, it is not necessary to find correspondences between fracture zones and fragments may be aligned two by two. The developed algorithms have been successfully applied in different fracture cases in the ankle area. The small overlapping error obtained in the performed tests

  3. The therapeutic effect on bone mineral formation from biomimetic zinc containing tricalcium phosphate (ZnTCP in zinc-deficient osteoporotic mice.

    Directory of Open Access Journals (Sweden)

    Joshua Chou

    Full Text Available The aim of this study was to evaluate the therapeutic efficacy of biomimetic zinc-containing tricalcium phosphate (ZnTCP produced by hydrothermally converting calcium carbonate exoskeletons from foraminifera, in the treatment of osteoporotic mice. X-Ray powder diffraction showed crystallographic structures matching JCPDS profile for tricalcium phosphate. Mass spectroscopy used to calculate total composition amount showed similar amount of calcium (5×10(4 µg/g and phosphate (4×10(4 ppm after conversion and the presence of zinc (5.18×10(3 µg/g. In vitro zinc release showed no release in PBS buffer and <1% zinc release in 7 days. In vivo evaluation was done in ovariectomized mice by implanting the ZnTCP samples in the soft tissues near the right femur bone for four weeks. Thirty ddY mice (5 weeks old, average weight of 21 g were divided into six experimental groups (normal, sham, OVX, β-TCP, ZnTCP and direct injection of zinc. CT images were taken every two weeks where the bone mineral density (BMD and bone mineral content (BMC were calculated by software based on CT images. The ZnTCP group exhibits cortical and cancellous bone growth of 45% and 20% respectively. While sham, OVX and β-TCP suffered from bone loss. A correlation was made between the significant body weight increase in ZnTCP with the significant increase in plasma zinc level compared with OVX. The presented results indicate that biomimetic ZnTCP were effective in preventing and treating bone loss in osteoporotic mice model.

  4. Temporary brittle bone disease: fractures in medical care.

    Science.gov (United States)

    Paterson, Colin R

    2009-12-01

    Temporary brittle bone disease is the name given to a syndrome first reported in 1990, in which fractures occur in infants in the first year of life. The fractures include rib fractures and metaphyseal fractures which are mostly asymptomatic. The radiological features of this disorder mimic those often ascribed to typical non-accidental injury. The subject has been controversial, some authors suggesting that the disorder does not exist. This study reports five infants with typical features of temporary brittle bone disease in whom all or most of the fractures took place while in hospital. A non-accidental cause can be eliminated with some confidence, and these cases provide evidence in support of the existence of temporary brittle bone disease.

  5. Orthodontic treatment for oral rehabilitation after multiple maxillofacial bone fractures.

    Science.gov (United States)

    Nakamura, Yoshiki; Ogino, Tomoko Kuroiwa; Hirashita, Ayao

    2008-09-01

    We present the orthodontic treatment of a patient with occlusal dysfunction after plastic surgery for multiple maxillofacial bone fractures caused by a traffic accident. The patient had mandibular deviation to the right because of inappropriate repositioning and fixation of the fractured bone and complete avulsion of both mandibular central incisors. The bilateral mandibular incisors, canines, and premolars were also suspected of partial avulsion or alveolar bone fracture. Several tests, including percussion and dental computed tomography, were performed on these teeth to rule out ankylosis and confirm tooth movement. Camouflage orthodontic treatment was carried out with expansion of the maxillary arch, alignment of both arches, and space closure between the mandibular lateral incisors to improve the occlusion. Good occlusion and interdigitation were obtained. Orthodontic treatment is useful for the rehabilitation of occlusal dysfunction caused by multiple maxillofacial bone fractures.

  6. Differentiation of osteoporotic and neoplastic vertebral fractures by chemical shift {l_brace}in-phase and out-of phase{r_brace} MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Ragab, Yasser [Radiology Department, Faculty of Medicine, Cairo University (Egypt); Radiology Department, Dr Erfan and Bagedo General Hospital (Saudi Arabia)], E-mail: yragab61@hotmail.com; Emad, Yasser [Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University (Egypt); Rheumatology and Rehabilitation Department, Dr Erfan and Bagedo General Hospital (Saudi Arabia)], E-mail: yasseremad68@yahoo.com; Gheita, Tamer [Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University (Egypt)], E-mail: gheitamer@yahoo.com; Mansour, Maged [Oncology Department, Faculty of Medicine, Cairo University (Egypt); Oncology Department, Dr Erfan and Bagedo General Hospital (Saudi Arabia)], E-mail: magedmansour@yahoo.com; Abou-Zeid, A. [Public Health Department, Faculty of Medicine, Cairo University, Cairo (Egypt)], E-mail: alaabouzeid@yahoo.com; Ferrari, Serge [Division of Bone Diseases, Department of Rehabilitation and Geriatrics, and WHO, Collaborating Center for Osteoporosis Prevention, Geneva University Hospital (Switzerland)], E-mail: serge.ferrari@medecine.unige.ch; Rasker, Johannes J. [Rheumatologist University of Twente, Enschede (Netherlands)], E-mail: j.j.rasker@utwente.nl

    2009-10-15

    Objective: The objective of this study was to establish the cut-off value of the signal intensity drop on chemical shift magnetic resonance imaging (MRI) with appropriate sensitivity and specificity to differentiate osteoporotic from neoplastic wedging of the spine. Patients and methods: All patients with wedging of vertebral bodies were included consecutively between February 2006 and January 2007. A chemical shift MRI was performed and signal intensity after (in-phase and out-phase) images were obtained. A DXA was performed in all. Results: A total of 40 patients were included, 20 with osteoporotic wedging (group 1) and 20 neoplastic (group 2). They were 21 males and 19 females. Acute vertebral collapse was observed in 15 patients in group 1 and subacute collapse in another 5 patients, while in group 2, 11 patients showed acute collapse and 9 patients (45%) showed subacute vertebral collapse. On the chemical shift MRI a substantial reduction in signal intensity was found in all lesions in both groups. The proportional changes observed in signal intensity of bone marrow lesions on in-phase compared with out-of-phase images showed significant differences in both groups (P < 0.05). At a cut-off value of 35%, the observed sensitivity of out-of-phase images was 95%, specificity was 100%, positive predictive value was 100% and negative predictive value was 95.2%. Conclusion: A chemical shift MRI is useful in order to differentiate patients with vertebral collapse due to underlying osteoporosis or neoplastic process.

  7. Role of bone mineral density in predicting morphometric vertebral fractures in patients with HIV infection.

    Science.gov (United States)

    Porcelli, T; Gotti, D; Cristiano, A; Maffezzoni, F; Mazziotti, G; Focà, E; Castelli, F; Giustina, A; Quiros-Roldan, E

    2014-09-01

    This study investigated the bone of HIV patients both in terms of quantity and quality. It was found that HIV-infected patients did fracture independently of the degree of bone demineralization as in other forms of secondary osteoporosis. We aimed to determine the prevalence of vertebral fractures (VFs) in HIV patients who were screened by bone mineral density (BMD) and to explore possible factors associated with VFs. This is a cross-sectional study that included HIV-infected patients recruited in the Clinic of Infectious and Tropical Diseases and that underwent BMD measurement by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and hip (Lunar Prodigy, GE Healthcare). For the assessment of VFs, anteroposterior and lateral X-ray examinations of the thoracic and lumbar spines were performed and were centrally digitized. Logistic regression models were used in the statistical analysis of factors associated with VFs. One hundred thirty-one consecutive patients with HIV infection (93 M, 38 F, median age 51 years; range, 36-75) underwent BMD measurement: 25.2 % of patients showed normal BMD, while 45 % were osteopenic and 29.7 % osteoporotic. Prevalence of low BMD (osteopenia and osteoporosis) was higher in females as compared to males (90 vs 69 %) with no significant correlation with age and body mass index. VFs occurred more frequently in patients with low BMD as compared to patients with normal BMD (88.5 vs. 11.4 %; p osteoporosis (43 vs. 46 %; p = 0.073). VFs were significantly associated with older age and previous AIDS events. These results suggest a BMD patients at risk of skeletal fragility and, therefore, good candidates for morphometric evaluation of spine X-ray in line with other forms of secondary osteoporosis with impaired bone quality.

  8. Ca/P concentration ratio at different sites of normal and osteoporotic rabbit bones evaluated by Auger and energy dispersive X-ray spectroscopy

    OpenAIRE

    Kourkoumelis, Nikolaos; Balatsoukas, Ioannis; Tzaphlidou, Margaret

    2011-01-01

    Osteoporosis is a systemic skeletal disorder associated with reduced bone mineral density and the consequent high risk of bone fractures. Current practice relates osteoporosis largely with absolute mass loss. The assessment of variations in chemical composition in terms of the main elements comprising the bone mineral and its effect on the bone’s quality is usually neglected. In this study, we evaluate the ratio of the main elements of bone mineral, calcium (Ca), and phosphorus (P), as a suit...

  9. Cost-effectiveness of bone densitometry among Caucasian women and men without a prior fracture according to age and body weight.

    Science.gov (United States)

    Schousboe, J T; Gourlay, M; Fink, H A; Taylor, B C; Orwoll, E S; Barrett-Connor, E; Melton, L J; Cummings, S R; Ensrud, K E

    2013-01-01

    We used a microsimulation model to estimate the threshold body weights at which screening bone densitometry is cost-effective. Among women aged 55-65 years and men aged 55-75 years without a prior fracture, body weight can be used to identify those for whom bone densitometry is cost-effective. Bone densitometry may be more cost-effective for those with lower body weight since the prevalence of osteoporosis is higher for those with low body weight. Our purpose was to estimate weight thresholds below which bone densitometry is cost-effective for women and men without a prior clinical fracture at ages 55, 60, 65, 75, and 80 years. We used a microsimulation model to estimate the costs and health benefits of bone densitometry and 5 years of fracture prevention therapy for those without prior fracture but with femoral neck osteoporosis (T-score ≤ -2.5) and a 10-year hip fracture risk of ≥3%. Threshold pre-test probabilities of low BMD warranting drug therapy at which bone densitometry is cost-effective were calculated. Corresponding body weight thresholds were estimated using data from the Study of Osteoporotic Fractures (SOF), the Osteoporotic Fractures in Men (MrOS) study, and the National Health and Nutrition Examination Survey (NHANES) for 2005-2006. Assuming a willingness to pay of $75,000 per quality adjusted life year (QALY) and drug cost of $500/year, body weight thresholds below which bone densitometry is cost-effective for those without a prior fracture were 74, 90, and 100 kg, respectively, for women aged 55, 65, and 80 years; and were 67, 101, and 108 kg, respectively, for men aged 55, 75, and 80 years. For women aged 55-65 years and men aged 55-75 years without a prior fracture, body weight can be used to select those for whom bone densitometry is cost-effective.

  10. Post traumatic facial nerve palsy without temporal bone fracture

    International Nuclear Information System (INIS)

    Scuotto, A.; Cappabianca, S.; Capasso, R.; Porto, A.; D'Oria, S.; Rotondo, M.

    2016-01-01

    Facial nerve injury following head trauma is a frequent event with or without temporal bone fractures. Computed tomography is the imaging modality of choice for assessing the possible bone disruption of the facial nerve canal. Magnetic resonance is helpful in presence of a facial nerve paralysis, unexplained by computed tomography findings. We present a case of delayed post-traumatic facial nerve palsy without radiological evidence of temporal bone fractures, in which magnetic resonance was crucial for diagnosing the nerve impairment. Radiological findings in accordance both with electrodiagnostic tests and clinical presentation suggested the successful conservative management. - Highlights: • Facial nerve is more prone to damage than any other cranial nerve after trauma. • Facial nerve trauma is usually associated with temporal bone fractures. • MRI is mandatory in case of no evidence of bone disruption at CT.

  11. Quantitative ultrasound technique at the phalanges in discriminating between uremic and osteoporotic patients

    International Nuclear Information System (INIS)

    Guglielmi, G.; De Terlizzi, F.; Aucella, F.; Scillitani, A.

    2006-01-01

    This study was conducted to test the ability of quantitative ultrasound technique (QUS) at the phalanges to discriminate between uremic and osteoporotic patients. Three groups of subjects (38 dialytic women, 16 osteoporotic women with vertebral fractures, 19 non-dialytic and non-fractured women) were recruited at the Department of Radiology at 'Casa Sollievo della Sofferenza' Hospital, San Giovanni Rotondo, Italy. The groups were matched for age and body mass index (BMI). On all subjects the following measurements were performed: spinal BMD by QCT and by DXA, Femoral BMD by DXA, phalangeal QUS. For QUS measurements, the DBM Sonic (IGEA, Carpi, Italy) was applied to the metaphysis of the proximal phalanges of the last four fingers of the hand. Osteoporotic women with vertebral fractures showed significantly lower values of spinal BMD by QCT and DXA and Ward's Triangle BMD with respect to hemodialytic patients (p < 0.005). All QUS values, except for BTT and SoS, showed lower values in osteoporotic women with respect to hemodialytic patients (p < 0.05). Control group showed higher values of AD-SoS, BTT and SoS than hemodialytic patients (p < 0.005) while the two groups did not differ for BMD values measured with both QCT and DXA. UBPI and FWA data showed a similar behaviour to DXA and QCT results, whereas BTT and SoS showed a completely different behaviour. AD-SoS was the only parameter that could effectively discriminate among the three groups (ANOVA, p < 0.0001). We conclude that phalangeal QUS can discriminate between hemodialysed patients and controls with similar bone mineral density, and can also discriminate between hemodialysed and osteoporotic subjects with vertebral fractures. Different characteristics of ultrasound signal can be ascribed to each bone tissue condition, enabling a clear differentiation of bone tissue changes occurring in menopause, osteoporosis and renal osteodystrophy

  12. Quantitative ultrasound technique at the phalanges in discriminating between uremic and osteoporotic patients

    Energy Technology Data Exchange (ETDEWEB)

    Guglielmi, G. [Department of Radiology, Scientific Institute Hospital ' Casa Sollievo della Sofferenza' , Viale Cappuccini 1, 71013 San Giovanni Rotondo (Italy)]. E-mail: guglielmi_g@hotmail.com; De Terlizzi, F. [IGEA srl, Carpi (Italy); Aucella, F. [Division of Nephrology, Scientific Institute Hospital ' Casa Sollievo della Sofferenza' , San Giovanni Rotondo (Italy); Scillitani, A. [Division of Endocrinology, Scientific Institute Hospital ' Casa Sollievo della Sofferenza' , San Giovanni Rotondo (Italy)

    2006-10-15

    This study was conducted to test the ability of quantitative ultrasound technique (QUS) at the phalanges to discriminate between uremic and osteoporotic patients. Three groups of subjects (38 dialytic women, 16 osteoporotic women with vertebral fractures, 19 non-dialytic and non-fractured women) were recruited at the Department of Radiology at 'Casa Sollievo della Sofferenza' Hospital, San Giovanni Rotondo, Italy. The groups were matched for age and body mass index (BMI). On all subjects the following measurements were performed: spinal BMD by QCT and by DXA, Femoral BMD by DXA, phalangeal QUS. For QUS measurements, the DBM Sonic (IGEA, Carpi, Italy) was applied to the metaphysis of the proximal phalanges of the last four fingers of the hand. Osteoporotic women with vertebral fractures showed significantly lower values of spinal BMD by QCT and DXA and Ward's Triangle BMD with respect to hemodialytic patients (p < 0.005). All QUS values, except for BTT and SoS, showed lower values in osteoporotic women with respect to hemodialytic patients (p < 0.05). Control group showed higher values of AD-SoS, BTT and SoS than hemodialytic patients (p < 0.005) while the two groups did not differ for BMD values measured with both QCT and DXA. UBPI and FWA data showed a similar behaviour to DXA and QCT results, whereas BTT and SoS showed a completely different behaviour. AD-SoS was the only parameter that could effectively discriminate among the three groups (ANOVA, p < 0.0001). We conclude that phalangeal QUS can discriminate between hemodialysed patients and controls with similar bone mineral density, and can also discriminate between hemodialysed and osteoporotic subjects with vertebral fractures. Different characteristics of ultrasound signal can be ascribed to each bone tissue condition, enabling a clear differentiation of bone tissue changes occurring in menopause, osteoporosis and renal osteodystrophy.

  13. Fracture of phalanx from simple bone cyst: A rare bone lesion in the hand

    Directory of Open Access Journals (Sweden)

    Emre Inozu

    2016-08-01

    Full Text Available Solitary bone cysts, also known as unicameral bone cysts or simple bone cysts, are benign tumors of the bone full of liquid. While typically seen on proximal humerus and femur bones, they are rarely seen on other bones. Simple bone cysts, diagnosed with X-ray. incidentally or for other reasons, are usually asymptomatic. In this case, a 25-year-old male patient with pathologic fracture of the proximal phalanx from an undiagnosed simple bone cyst was reported and referred to the authors' clinic to be treated with curettage. [Hand Microsurg 2016; 5(2.000: 100-103

  14. Percutaneous vertebroplasty in the management of vertebral osteoporotic fractures. Short-term, mid-term and long-term follow-up of 285 patients

    International Nuclear Information System (INIS)

    Masala, Salvatore; Mammucari, Matteo; Angelopoulos, Georgios; Fiori, Roberto; Massari, Francesco; Simonetti, Giovanni; Faria, Skerdilajd

    2009-01-01

    To evaluate the short-term, mid-term and long-term follow-up of 285 patients who had undergone percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (VCF) in our department from 2003 to 2006, and, particularly, to analyse our data on the safety and the usefulness of PVP for durable pain reduction, mobility improvement and the need for analgesic drugs. Follow-up analysis was made through a questionnaire completed by the patients before and after PVP (1 week, 1 year and 3 years). The results are reported by subdivision of patients into groups (by gender, age and number of treated vertebrae), with special reference to pain management, drug administration and quality of life. All patients (285) were followed up for 1 week, 186 for 12 months, and 68 patients were followed up for 3 years. One week after PVP all patients reported normal ambulation (with or without pain), and more than 95% were able to perform activities of daily living (ADL) either without pain or with mild pain. There was no difference in pain relief between the genders after 1 week's follow up, but after 3 years better analgesia results were observed in women. There was no statistically significant difference in the visual analogue scale (VAS) values before PVP between age groups (P = 0.7) and gender (P = 0.4); Patients younger than 75 years had better outcomes than did older ones (>75 years) at 1 week and 1 year follow up. Patients also reported significant reduction in drug therapy for pain. PVP is a safe and useful procedure for the treatment of vertebral osteoporotic fractures. It produces enduring pain reduction, improves patients' mobility and decreases the need for analgesic drugs. (orig.)

  15. Novel Therapeutic Strategy for the Prevention of Bone Fractures

    Science.gov (United States)

    2014-08-01

    increased risk of falls and fractures. 3 Moreover, muscle paralysis using agents such as botulinum toxin induces bone loss 4 and impairs fracture...caused by botulinum toxin -A local injection impairs fracture healing in the rat femur . J Orthop Res 2012 ; 30 : 574 – 580 . 6 . Elkasrawy MN...Techniques 5 kg load cell. Structural, or extrinsic, properties including ultimate force (Fu; height of curve) and stiffness (S; slope of curve) were

  16. Serum osteoprotegerin (OPG) and the A163G polymorphism in the OPG promoter region are related to peripheral measures of bone mass and fracture odds ratios

    DEFF Research Database (Denmark)

    Jørgensen, Henrik L; Kusk, Philip; Madsen, Bente Elmfelt

    2004-01-01

    66 women with lower forearm fracture, 41 women with hip fracture, and 206 age-matched controls. All had broadband ultrasound attenuation (BUA) and speed of sound (SOS) measured at the heel as well as bone mineral density (BMD) measured by DXA at the distal forearm. S-OPG was measured by ELISA. The A......163G genotypes were determined by PCR-RFLP analysis. S-OPG levels correlated positively with age ( r = 0.45; P heel BUA ( r = -0.23; P heel SOS ( r = -0.22; P ...-OPG to the lowest, the odds ratio for osteoporotic fracture was 2.5 (95% CI, 1.3-4.7; P = 0.006). The G allele of the A163G was associated with significantly lower t-scores of both lower forearm BMD, heel BUA, and heel SOS as well as being significantly more frequent in the fracture patients compared...

  17. Persistent organochlorine pollutants and risk for skeletal fractures and impaired bone mineral density in humans. Results from the ''COMPARE'' project

    Energy Technology Data Exchange (ETDEWEB)

    Hagmar, L.; Wallin, E.; Joensson, B.A. [Department of Occupational and Environmental Medicine, Lund (Sweden)

    2004-09-15

    Persistent organochlorine pollutants (POP) have, in animal studies, impaired normal bone metabolism and resulted in increased bone fragility. Especially considering the dramatical increase in osteoporotic fractures in western societies during the last decades, it is a pertinent question whether a high dietary intake of POP might pose a risk for deteriorated bone quality in humans. This problem has been assessed as a part of the collaborative project ''COMPARE'', funded by European Commission RD Life Science Program. As a study base we have used cohorts of Swedish fishermen's families. We have earlier shown that fishermen living at the east coast of Sweden, have a high consumption of contaminated fatty fish from the Baltic Sea and consequently relatively high exposure levels for various POPs, also compared with fishermen from the Swedish west coast. Such a discrepancy was also found for fishermen's wives. The aim of the project was to assess in epidemiological studies whether a high dietary intake of POP through fatty fish from the Baltic may result in an increased incidence of osteoporotic fractures or decreased bone mineral density (BMD). We give here an overview of the results.

  18. Influence of education, marital status, occupation, and the place of living on skeletal status, fracture prevalence, and the course and effectiveness of osteoporotic therapy in women in the RAC-OST-POL Study.

    Science.gov (United States)

    Pluskiewicz, Wojciech; Adamczyk, Piotr; Czekajło, Aleksandra; Grzeszczak, Władysław; Drozdzowska, Bogna

    2014-01-01

    The RAC-OST-POL population-based, epidemiological study provided data concerning the influence of education, marital status, occupation, and the place of living (residence) on skeletal status, fracture prevalence, and the course and effectiveness of osteoporotic therapy in 625 women older than 55 years, all of them recruited from the District of Raciborz in Poland. Their mean age was 66.4 ± 7.8 years. All the women completed a specially designed questionnaire. The skeletal status was assessed by femoral neck (FN) and total hip (TH) densitometry, using a Lunar DPX system (USA). In univariate analyses, taking into consideration the age differences, bone mineralization was dependent on marital status (Z score for FN and TH was significantly higher in widows than in divorcees; p education was associated with a more frequent use of vitamin D (χ(2) = 8.49, df = 3, p women (30%) and least commonly by divorcees (11.8%) (χ(2) = 11.7, df = 3, p = 0.01). Vitamin D was more often used among women from the urban area of Raciborz than by those from surrounding rural areas (χ(2) = 9.2, df = 1, p Women with sedentary jobs demonstrated the highest frequency of intake for vitamin D (χ(2) = 9.92, df = 3, p education, marital status, place of living, and type of occupation may have impacts on implementation of osteoporosis-preventing health programs.

  19. The fracture properties and toughening mechanisms of bone and dentin

    Science.gov (United States)

    Koester, Kurt John

    The mechanical properties of bone and dentin and in particular their fracture properties, are the subject of intense research. The relevance of these properties is increasing as our population ages and fracture incidence impacts the lives of a greater portion of the population. A robust framework is needed to understand the fracture properties of bone and dentin to guide researchers as they attempt to characterize the effects of aging, disease, and pharmaceutical treatments on the properties of these mineralized tissues. In the present work, this framework is provided and applied to human bone, human dentin, and animal bone. In situ electron microscopy was also used to identify the salient toughening mechanisms in bone and dentin. It was found that bone and dentin are extrinsically toughened materials and consequently their fracture properties are best characterized utilizing a crack-growth resistance approach. A description of the different mechanical measurements commonly employed when using small animal models (rats and mice) to evaluate the influence of drug therapies on bone fragility is provided. A study where these properties were measured for a large population of wild-type rats and mice was also conducted. Given my findings, it was determined that for the most complete understanding of small animal bone it was necessary to measure strength and toughness. Strength measurements probe the flaw distribution and toughness measurements to evaluate the resistance to facture in the presence of a single dominant worst-case flaw.

  20. An evaluation of the usefulness of consensus definitions of sarcopenia in older men: results from the observational Osteoporotic Fractures in Men (MrOS) cohort study

    Science.gov (United States)

    Cawthon, Peggy M; Blackwell, Terri L; Cauley, Jane; Kado, Deborah M; Barrett-Connor, Elizabeth; Lee, Christine G; Hoffman, Andrew R; Nevitt, Michael M; Stefanick, Marcia L; Lane, Nancy E; Ensrud, Kristine E; Cummings, Steven R; Orwoll, Eric S

    2016-01-01

    Background Recently, several consensus definitions for sarcopenia have been developed. Objective To evaluate the associations and discriminative ability of definitions of sarcopenia against clinical outcomes. Design Osteoporotic Fractures in Men study Setting Six clinical centers Participants 5,934 community-dwelling men aged ≥65 yrs Measurements Sarcopenia definitions evaluated were: International Working Group (IWG), European Working Group for Sarcopenia in Older Persons (EWGSOP), Foundation for the NIH (FNIH) Sarcopenia, Baumgartner, and Newman. Recurrent falls were defined as ≥2 self-reported falls in the year after baseline (N=694, 11.9%). Incident hip fractures (N=207, 3.5 %) and deaths (N=2003, 34.1%) were confirmed by central review of medical records over 9.8 years. Self-reported functional limitations were assessed at baseline and again 4.6 years later. Logistic regression or proportional hazards models estimated associations between sarcopenia and falls, hip fractures or death. The discriminative ability of the sarcopenia definitions (compared to referent models) for these outcomes was evaluated with areas under the receiver operator curve (AUCs) or C-statistics. Referent models included age alone for falls, function limitations and mortality, and age and BMD for hip fractures. Results The association between sarcopenia by the various definitions and risk of falls, functional limitations, and hip fractures was variable; all definitions were associated with increased mortality risk. However, none of the definitions materially changed discrimination based on AUC and C-statistic when compared to referent models (change ≤1% in all models). Conclusions Sarcopenia definitions as currently constructed did not consistently improve prediction of clinical outcomes in relatively healthy older men. PMID:26502831

  1. The Epidemiology of Hip and Major Osteoporotic Fractures in a Dutch Population of Community-Dwelling Elderly: Implications for the Dutch FRAX® Algorithm.

    Directory of Open Access Journals (Sweden)

    Corinne Klop

    Full Text Available Incidence rates of non-hip major osteoporotic fractures (MOF remain poorly characterized in the Netherlands. The Dutch FRAX® algorithm, which predicts 10-year probabilities of hip fracture and MOF (first of hip, humerus, forearm, clinical vertebral, therefore incorporates imputed MOF rates. Swedish incidence rate ratios for hip fracture to MOF (Malmo 1987-1996 were used to perform this imputation. However, equality of these ratios between countries is uncertain and recent evidence is scarce. Aims were to estimate incidence rates of hip fracture and MOF and to compare observed MOF rates to those predicted by the imputation method for the Netherlands.Using hospitalisation and general practitioner records from the Dutch PHARMO Database Network (2002-2011 we calculated age-and-sex-specific and age-standardized incidence rates (IRs of hip and other MOFs (humerus, forearm, clinical vertebral and as used in FRAX®. Observed MOF rates were compared to those predicted among community-dwelling individuals ≥50 years by the standardized incidence ratio (SIR; 95% CI.Age-standardized IRs (per 10,000 person-years of MOF among men and women ≥50 years were 25.9 and 77.0, respectively. These numbers were 9.3 and 24.0 for hip fracture. Among women 55-84 years, observed MOF rates were significantly higher than predicted (SIR ranged between 1.12-1.50, depending on age. In men, the imputation method performed reasonable.Observed MOF incidence was higher than predicted for community-dwelling women over a wide age-range, while it agreed reasonable for men. As miscalibration may influence treatment decisions, there is a need for confirmation of results in another data source. Until then, the Dutch FRAX® output should be interpreted with caution.

  2. [Prevalence of osteoporosis, estimation of probability of fracture and bone metabolism study in patients with newly diagnosed prostate cancer in the health area of Lugo].

    Science.gov (United States)

    Miguel-Carrera, Jonatan; García-Porrua, Carlos; de Toro Santos, Francisco Javier; Picallo-Sánchez, Jose Antonio

    2018-03-01

    To study the prevalence of osteoporosis and fracture probability in patients diagnosed with prostate cancer. Observational descriptive transversal study. SITE: Study performed from Primary Care of Lugo in collaboration with Rheumatology and Urology Services of our referral hospital. Patients diagnosed with prostate cancer without bone metastatic disease from January to December 2012. Epidemiologic, clinical, laboratory and densitometric variables involved in osteoporosis were collected. The likelihood of fracture was estimated by FRAX ® Tool. Eighty-three patients met the inclusion criteria. None was excluded. The average age was 67 years. The Body Mass Index was 28.28. Twenty-five patients (30.1%) had previous osteoporotic fractures. Other prevalent risk factors were alcohol (26.5%) and smoking (22.9%). Eighty-two subjects had vitamin D below normal level (98.80%). Femoral Neck densitometry showed that 8.9% had osteoporosis and 54% osteopenia. The average fracture risk in this population, estimated by FRAX ® , was 2.63% for hip fracture and 5.28% for major fracture. Cut level for FRAX ® major fracture value without DXA >5% and ≥7.5% proposed by Azagra et al. showed 24 patients (28.92%) and 8 patients (9.64%) respectively. The prevalence of osteoporosis in this population was very high. The more frequent risk factors associated with osteoporosis were: previous osteoporotic fracture, alcohol consumption, smoking and family history of previous fracture. The probability of fracture using femoral neck FRAX ® tool was low. Vitamin D deficiency was very common (98.8%). Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  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. Experimental fracture healing: evaluation using radionuclide bone imaging: concise communication

    International Nuclear Information System (INIS)

    Gumerman, L.W.; Fogel, S.R.; Goodman, M.A.; Hanley, E.N. Jr.; Kappakas, G.S.; Rutkowski, R.; Levine, G.

    1978-01-01

    Radionuclide bone imaging was performed in a rabbit model to observe the course of fracture healing and to establish criteria for distinguishing nonunion and delayed healing from normal healing. Sequential gamma-camera images (with pinhole collimator) were collected and subjected to computer analysis. Five groups were established: (a) control--immobilization; (b) control--immobilization plus periosteal stripping; (c) simple fracture--osteotomy; (d) delayed union--osteotomy plus periosteal stripping; and (e) nonunion--osteotomy, periosteal stripping and polymethyl methacrylate interposed between fracture fragments. Histographic representation of absolute count rates along rabbit tibias followed a predictable pattern in the simple-fracture and delayed-union groups. They differed only in the time of appearance of phases. The non-union group demonstrated no recognizable sequential pattern. In this experimental model, serial bone scanning the quantitative data analysis has shown potential for indicating the course of healing in fractures and for serving as a guide to treatment

  5. Bone biology in the elderly: clinical importance for fracture treatment

    Directory of Open Access Journals (Sweden)

    Rolvien Tim

    2016-12-01

    Full Text Available Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria, which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.

  6. Bone scintigraphy in the diagnosis of fracture and infection of the temporal bone

    International Nuclear Information System (INIS)

    Djupesland, G.; Nakken, K.F.; Mueller, C.; Skjoerten, F.; Roehrt, T.; Eldevik, P.

    1983-01-01

    The sensivit of Tc99m-MDP-bone-scintiscanning in the diagnosis of temporal bone fracture was found to that of conventional radiography if the patients were examined 10 days after the trauma. Temporal bone osteomyelitis with concomitant moderate osteosclerosis was demonstrated by bone scintigraphy in 5 cases of mastoiditis with atypical symptoms. A case of apicitis was for the first time demonstrated by scintigraphy. A low sensivity of 67 Ga-scintigraphy was demonstrated by positive Tc99m-bone-scintigraphy and negative 67 Ga-scintigraphy in a patient with atypical mastoiditis. Tc99m-scintigraphy was negative in 5 cases of otitis media suppurative and in 3 cases of otitis media chronica cum cholesteatoma, all with slight degree of osteosclerosis in the mastoid. The sensitivity of Tc99m-bone-scintigraphy in fracture and osteomyelitis of the temporal bone seems to be a function of the amount of reactive new bone formed. (Authors)

  7. Bone fractures in children and adolescents

    International Nuclear Information System (INIS)

    Otto, S.; Wiersbitzky, H.; Hosten, N.; Mutze, S.

    2003-01-01

    This article provides an overview of the characteristics of radiologic diagnosis of fractures in the pediatric age group. Following an introduction to skeletal development, radiographic imaging is presented. In addition, more advanced imaging modalities, such as ultrasound, CT and MRI, are discussed. It is illustrated how these methods advance the diagnostic process when projection radiography fails to provide a satisfactory diagnosis. A short description of the anatomical characteristics of the growing skeleton is used to explain the mechanisms causing the typical fractures. Finally, specific fractures are reviewed, with emphasis on the most frequent fractures, especially those involving the elbow. (orig.) [de

  8. Minimal invasive stabilization of osteoporotic vertebral compression fractures. Methods and preinterventional diagnostics; Minimal-invasive Stabilisierung osteoporotischer Wirbelkoerpereinbrueche. Methodik und praeinterventionelle Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Grohs, J.G.; Krepler, P. [Orthopaedische Klinik, Universitaet Wien (Austria)

    2004-03-01

    Minimal invasive stabilizations represent a new alternative for the treatment of osteoporotic compression fractures. Vertebroplasty and balloon kyphoplasty are two methods to enhance the strength of osteoporotic vertebral bodies by the means of cement application. Vertebroplasty is the older and technically easier method. The balloon kyphoplasty is the newer and more expensive method which does not only improve pain but also restores the sagittal profile of the spine. By balloon kyphoplasty the height of 101 fractured vertebral bodies could be increased up to 90% and the wedge decreased from 12 to 7 degrees. Pain was reduced from 7,2 to 2,5 points. The Oswestry disability index decreased from 60 to 26 points. This effects persisted over a period of two years. Cement leakage occurred in only 2% of vertebral bodies. Fractures of adjacent vertebral bodies were found in 11%. Good preinterventional diagnostics and intraoperative imaging are necessary to make the balloon kyphoplasty a successful application. (orig.) [German] Minimal-invasive Stabilisierungen stellen eine Alternative zur bisherigen Behandlung osteoporotischer Wirbelfrakturen dar. Die Vertebroplastie und die Ballonkyphoplastik sind 2 Verfahren, um die Festigkeit der Wirbelkoerper nach osteoporotischen Kompressionsfrakturen durch Einbringen von Knochenzement wieder herzustellen. Die Vertebroplastie ist die aeltere, technisch einfachere und kostenguenstigere Technik, geht allerdings regelmaessig mit Zementaustritt einher. Die Ballonkyphoplastik ist die neuere kostenintensivere Technologie, mit der abgesehen von der Schmerzreduktion auch die Wiederherstellung des sagittalen Profils der Wirbelsaeule angestrebt werden kann. Mit der Ballonkyphoplastik konnten bei 101 frakturierten Wirbelkoerpern die Hoehe auf fast 90% des Sollwertes angehoben und die lokale Kyphose von 12 auf 7 vermindert werden. Die Schmerzen wurden - gemessen anhand einer 10-teiligen Skala - von 7,2 auf 2,5 reduziert. Der Oswestry disability

  9. Maternal vitamin D status and offspring bone fractures

    DEFF Research Database (Denmark)

    Petersen, Sesilje Bondo; Olsen, Sjurdur Frodi; Mølgaard, Christian

    2014-01-01

    BACKGROUND: Studies investigating the association between maternal vitamin D status and offspring bone mass measured by dual-energy X-ray absorptiometry (DXA) during childhood have shown conflicting results. PURPOSE: We used occurrence of bone fractures up to the age of 18 as a measure reflecting...... offspring bone mass and related that to maternal vitamin D status. METHODS: The Danish Fetal Origins 1988 Cohort recruited 965 pregnant women during 1988-89 at their 30th gestation week antenatal midwife visit. A blood sample was drawn and serum was stored, which later was analyzed for the concentration...... percentile) 25(OH)D was 76.2 (23.0-152.1) nmol/l. During follow up 294 children were registered with at least one bone fracture diagnosis. Multivariable Cox regression models using age as the underlying time scale indicated no overall association between maternal vitamin D status and first time bone...

  10. The Impact of Type 2 Diabetes on Bone Fracture Healing

    Directory of Open Access Journals (Sweden)

    Carlos Marin

    2018-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM is a chronic metabolic disease known by the presence of elevated blood glucose levels. Nowadays, it is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Many are the complications caused by this chronic disorder, including a negative impact on the cardiovascular system, kidneys, eyes, muscle, blood vessels, and nervous system. Recently, there has been increasing evidence suggesting that T2DM also adversely affects the skeletal system, causing detrimental bone effects such as bone quality deterioration, loss of bone strength, increased fracture risk, and impaired bone healing. Nevertheless, the precise mechanisms by which T2DM causes detrimental effects on bone tissue are still elusive and remain poorly studied. The aim of this review was to synthesize current knowledge on the different factors influencing the impairment of bone fracture healing under T2DM conditions. Here, we discuss new approaches used in recent studies to unveil the mechanisms and fill the existing gaps in the scientific understanding of the relationship between T2DM, bone tissue, and bone fracture healing.

  11. Mechanical design optimization of bioabsorbable fixation devices for bone fractures.

    Science.gov (United States)

    Lovald, Scott T; Khraishi, Tariq; Wagner, Jon; Baack, Bret

    2009-03-01

    Bioabsorbable bone plates can eliminate the necessity for a permanent implant when used to fixate fractures of the human mandible. They are currently not in widespread use because of the low strength of the materials and the requisite large volume of the resulting bone plate. The aim of the current study was to discover a minimally invasive bioabsorbable bone plate design that can provide the same mechanical stability as a standard titanium bone plate. A finite element model of a mandible with a fracture in the body region is subjected to bite loads that are common to patients postsurgery. The model is used first to determine benchmark stress and strain values for a titanium plate. These values are then set as the limits within which the bioabsorbable bone plate must comply. The model is then modified to consider a bone plate made of the polymer poly-L/DL-lactide 70/30. An optimization routine is run to determine the smallest volume of bioabsorbable bone plate that can perform and a titanium bone plate when fixating fractures of this considered type. Two design parameters are varied for the bone plate design during the optimization analysis. The analysis determined that a strut style poly-L-lactide-co-DL-lactide plate of 690 mm2 can provide as much mechanical stability as a similar titanium design structure of 172 mm2. The model has determined a bioabsorbable bone plate design that is as strong as a titanium plate when fixating fractures of the load-bearing mandible. This is an intriguing outcome, considering that the polymer material has only 6% of the stiffness of titanium.

  12. Challenges of Estimating Fracture Risk with DXA: Changing Concepts About Bone Strength and Bone Density.

    Science.gov (United States)

    Licata, Angelo A

    2015-07-01

    Bone loss due to weightlessness is a significant concern for astronauts' mission safety and health upon return to Earth. This problem is monitored with bone densitometry (DXA), the clinical tool used to assess skeletal strength. DXA has served clinicians well in assessing fracture risk and has been particularly useful in diagnosing osteoporosis in the elderly postmenopausal population for which it was originally developed. Over the past 1-2 decades, however, paradoxical and contradictory findings have emerged when this technology was widely employed in caring for diverse populations unlike those for which it was developed. Although DXA was originally considered the surrogate marker for bone strength, it is now considered one part of a constellation of factors-described collectively as bone quality-that makes bone strong and resists fracturing, independent of bone density. These characteristics are beyond the capability of routine DXA to identify, and as a result, DXA can be a poor prognosticator of bone health in many clinical scenarios. New clinical tools are emerging to make measurement of bone strength more accurate. This article reviews the historical timeline of bone density measurement (dual X-ray absorptiometry), expands upon the clinical observations that modified the relationship of DXA and bone strength, discusses some of the new clinical tools to predict fracture risk, and highlights the challenges DXA poses in the assessment of fracture risk in astronauts.

  13. Bone and fall-related fracture risks in women and men with a recent clinical fracture.

    Science.gov (United States)

    van Helden, Svenhjalmar; van Geel, Antonia C M; Geusens, Piet P; Kessels, Alfons; Nieuwenhuijzen Kruseman, Arie C; Brink, Peter R G

    2008-02-01

    Worldwide fracture rates are increasing as a result of the aging population, and prevention, both primary and secondary, is an important public health goal. Therefore, we systematically analyzed risk factors in subjects with a recent clinical fracture. All men and women over fifty years of age who had been treated in the emergency department of, or hospitalized at, our institution because of a recent fracture during a one-year period were offered the opportunity to undergo an evidence-based bone and fall-related risk-factor assessment and bone densitometry. The women included in this study were also compared with a group of postmenopausal women without a fracture history who had been included in another cohort study. Of the 940 consecutive patients, 797 (85%) were eligible for this study and 568 (60%) agreed to participate. The prevalence of fall-related risk factors (75% [95% confidence interval = 71% to 78%]; n = 425) and the prevalence of bone-related risk factors (53% [95% confidence interval = 49% to 57%]; n = 299) at the time of fracture were higher than the prevalence of osteoporosis (35% [95% confidence interval = 31% to 39%]; n = 201) as defined by a dual x-ray absorptiometry T score of fall and bone-related risk factors were present irrespective of the fracture location, patient age, or gender. An overlap between bone and fall-related risk factors was found in 50% of the patients. After adjusting for age, weight, and height, we found that women with a fracture more frequently had a diagnosis of osteoporosis (odds ratio = 2.9; 95% confidence interval = 2.0 to 4.1) and had a more extensive history of falls (odds ratio = 4.0; 95% confidence interval = 2.7 to 5.9) than did the postmenopausal women without a fracture history. Men and women over fifty years of age who had recently sustained a clinical fracture had, at the time of that fracture, bone and fall-related risk factors that were greater than the risk predicted by the presence of osteoporosis. Risk

  14. Trends in post osteoporotic hip fracture care from 2010 to 2014 in a private hospital in Malaysia

    Directory of Open Access Journals (Sweden)

    Swan Sim Yeap

    2017-06-01

    Conclusions: Following a low-trauma hip fracture, approximately 72% of patients were not started on active antiosteoporosis therapy. Of those who were, the median duration of treatment was 1 month. This represents a missed opportunity for the prevention of future fractures.

  15. SURGICAL TREATMENT OF VERTEBRAL FRACTURES ASSOCIATED WITH LOW MINERAL BONE DENSITY

    Directory of Open Access Journals (Sweden)

    V. V. Rerikh

    2010-01-01

    Full Text Available Surgical treatment of 177 patients with monolocal fractures of thoracic and lumbar vertebral bodies was performed using transpedicular fixation (n=17, transpedicular fixation and osteoplasty (n=101, vertebroplasty (n=48 or kyphoplasty (n=ll. Restoration of support ability of the fractured osteoporotic vertebrae within ventral column by means of plasty particularly in combination with internal fixation allows achievement of better clinical outcomes, improvement of the quality of life in patients in the early and late periods after surgery.

  16. High bone turnover is associated with low bone mass and spinal fracture in postmenopausal women

    DEFF Research Database (Denmark)

    Ravn, Pernille; Rix, M; Andreassen, H

    1997-01-01

    -eight women had a lumbar spine bone mineral density (BMD) above 0.860 g/cm2, and 278 women had a BMD below 0.860 g/cm2. Spinal fracture was diagnosed from lateral spine X-ray studies and defined as at least 20% height reduction (wedge, compression, or endplate fracture) in at least one vertebra (T4-L4). Bone...

  17. Identification tibia and fibula bone fracture location using scanline algorithm

    Science.gov (United States)

    Muchtar, M. A.; Simanjuntak, S. E.; Rahmat, R. F.; Mawengkang, H.; Zarlis, M.; Sitompul, O. S.; Winanto, I. D.; Andayani, U.; Syahputra, M. F.; Siregar, I.; Nasution, T. H.

    2018-03-01

    Fracture is a condition that there is a damage in the continuity of the bone, usually caused by stress, trauma or weak bones. The tibia and fibula are two separated-long bones in the lower leg, closely linked at the knee and ankle. Tibia/fibula fracture often happen when there is too much force applied to the bone that it can withstand. One of the way to identify the location of tibia/fibula fracture is to read X-ray image manually. Visual examination requires more time and allows for errors in identification due to the noise in image. In addition, reading X-ray needs highlighting background to make the objects in X-ray image appear more clearly. Therefore, a method is required to help radiologist to identify the location of tibia/fibula fracture. We propose some image-processing techniques for processing cruris image and Scan line algorithm for the identification of fracture location. The result shows that our proposed method is able to identify it and reach up to 87.5% of accuracy.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    the association between low, intermediate, and high risk by phalangeal T-score or FRAX and incident fractures, and receiver operating characteristic curves were obtained. Mean follow-up time was 4.3 yr, and a total of 395 persons (3.1%) experienced a fracture during follow-up. The highest rate of major...... variables performed overall best in the prediction of major osteoporotic fractures. In predicting hip fractures, there was a tendency of T-score performing worse than the other methods....

  19. Physical activity effects on bone metabolism.

    Science.gov (United States)

    Smith, E L; Gilligan, C

    1991-01-01

    The incidence of osteoporotic fractures rises exponentially with age and is increasing faster than the demographic increase in the aging population. Physical activity has great potential to reduce the risk for osteoporotic fractures. Three independent but interactive factors contribute to the risk of fractures: bone strength, the risk of falling, and the effectiveness of neuromuscular response that protects the skeleton from injury. Exercise can reduce fracture risk not only by preventing bone loss, but by decreasing the risk of falling and the force of impact by improving strength, flexibility, balance, and reaction time. Extreme inactivity causes rapid bone loss of up to 40%, while athletic activity results in bone hypertrophy of up to 40%. Exercise intervention programs have reduced bone loss or increased bone mass in both men and women of various ages and initial bone status. These benefits have been shown for arm bone mineral content, total body calcium, spine, calcium bone index, tibia, and calcaneus. In both middle-aged and elderly women, physical activity intervention reduced bone loss or increased bone mass. The mechanisms for maintenance of skeletal integrity rely on a cellular response to hormonal and mechanical load stimuli. Studies in animal models show that training affects cellular activity. In osteoporotics, cellular erosion is increased and mineral apposition rate (MAR) decreased compared with normal age-matched controls. In contrast to this, sows trained on a treadmill 20 min per day for 20 weeks had greater active periosteal surface, periosteal MAR, and osteonal MAR than untrained sows.

  20. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

    Directory of Open Access Journals (Sweden)

    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  1. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients.

    Science.gov (United States)

    Ikegami, Shota; Kamimura, Mikio; Nakagawa, Hiroyuki; Takahara, Kenji; Hashidate, Hiroyuki; Uchiyama, Shigeharu; Kato, Hiroyuki

    2009-10-10

    Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  2. Roles of Chondrocytes in Endochondral Bone Formation and Fracture Repair

    Science.gov (United States)

    Hinton, R.J.; Jing, Y.; Jing, J.; Feng, J.Q.

    2016-01-01

    The formation of the mandibular condylar cartilage (MCC) and its subchondral bone is an important but understudied topic in dental research. The current concept regarding endochondral bone formation postulates that most hypertrophic chondrocytes undergo programmed cell death prior to bone formation. Under this paradigm, the MCC and its underlying bone are thought to result from 2 closely linked but separate processes: chondrogenesis and osteogenesis. However, recent investigations using cell lineage tracing techniques have demonstrated that many, perhaps the majority, of bone cells are derived via direct transformation from chondrocytes. In this review, the authors will briefly discuss the history of this idea and describe recent studies that clearly demonstrate that the direct transformation of chondrocytes into bone cells is common in both long bone and mandibular condyle development and during bone fracture repair. The authors will also provide new evidence of a distinct difference in ossification orientation in the condylar ramus (1 ossification center) versus long bone ossification formation (2 ossification centers). Based on our recent findings and those of other laboratories, we propose a new model that contrasts the mode of bone formation in much of the mandibular ramus (chondrocyte-derived) with intramembranous bone formation of the mandibular body (non-chondrocyte-derived). PMID:27664203

  3. Point-of-Care Phalangeal Bone Mineral Density Measurement Can Reduce the Need of Dual-Energy X-Ray Absorptiometry Scanning in Danish Women at Risk of Fracture

    DEFF Research Database (Denmark)

    Holmberg, Teresa; Bech, Mickael; Gram, Jeppe

    2016-01-01

    Identifying persons with a high risk of osteoporotic fractures remains a challenge. DXA uptake in women with elevated risk of osteoporosis seems to be depending on distance to scanning facilities. This study aimed to investigate the ability of a small portable scanner in identifying women...... with reduced bone mineral density (BMD), and to define triage thresholds for pre-selection. Total hip and lumbar spine BMD was measured by dual-energy X-ray absorptiometry and phalangeal BMD by radiographic absorptiometry in 121 Danish women with intermediate or high 10-year fracture probability (aged 61...... and only 6 % of women in the low-risk group would be false negatives....

  4. Bone stress in runners with tibial stress fracture.

    Science.gov (United States)

    Meardon, Stacey A; Willson, John D; Gries, Samantha R; Kernozek, Thomas W; Derrick, Timothy R

    2015-11-01

    Combinations of smaller bone geometry and greater applied loads may contribute to tibial stress fracture. We examined tibial bone stress, accounting for geometry and applied loads, in runners with stress fracture. 23 runners with a history of tibial stress fracture & 23 matched controls ran over a force platform while 3-D kinematic and kinetic data were collected. An elliptical model of the distal 1/3 tibia cross section was used to estimate stress at 4 locations (anterior, posterior, medial and lateral). Inner and outer radii for the model were obtained from 2 planar x-ray images. Bone stress differences were assessed using two-factor ANOVA (α=0.05). Key contributors to observed stress differences between groups were examined using stepwise regression. Runners with tibial stress fracture experienced greater anterior tension and posterior compression at the distal tibia. Location, but not group, differences in shear stress were observed. Stepwise regression revealed that anterior-posterior outer diameter of the tibia and the sagittal plane bending moment explained >80% of the variance in anterior and posterior bone stress. Runners with tibial stress fracture displayed greater stress anteriorly and posteriorly at the distal tibia. Elevated tibial stress was associated with smaller bone geometry and greater bending moments about the medial-lateral axis of the tibia. Future research needs to identify key running mechanics associated with the sagittal plane bending moment at the distal tibia as well as to identify ways to improve bone geometry in runners in order to better guide preventative and rehabilitative efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Defect nonunion of a metatarsal bone fracture in a cow: successful management with bone plating and autogenous cancellous bone graft.

    Science.gov (United States)

    Raghunath, M; Singh, N; Singh, T; Gopinathan, A; Mohindroo, J; Atri, K

    2013-01-01

    A two-and-half-year-old cow was presented with a defect nonunion of the right metatarsal III/IV bone following a severely comminuted open fracture two months previously. The animal underwent open fixation using a 4.5 mm, broad, 10-hole, dynamic compression plate and autogenous cancellous bone graft collected from the contralateral iliac shaft. The animal started partial weight bearing after the third postoperative day and resumed complete weight bearing after the 10th day. Fracture healing was complete and the implants were removed after the 120th postoperative day. Stable fixation by means of a bone plate in conjunction with a cancellous bone graft facilitated complete healing and restoration of the bone column of the defect and the metatarsal fracture. The animal made a complete recovery.

  6. In-vivo assessment of femoral bone strength using Finite Element Analysis (FEA based on routine MDCT imaging: a preliminary study on patients with vertebral fractures.

    Directory of Open Access Journals (Sweden)

    Hans Liebl

    Full Text Available To experimentally validate a non-linear finite element analysis (FEA modeling approach assessing in-vitro fracture risk at the proximal femur and to transfer the method to standard in-vivo multi-detector computed tomography (MDCT data of the hip aiming to predict additional hip fracture risk in subjects with and without osteoporosis associated vertebral fractures using bone mineral density (BMD measurements as gold standard.One fresh-frozen human femur specimen was mechanically tested and fractured simulating stance and clinically relevant fall loading configurations to the hip. After experimental in-vitro validation, the FEA simulation protocol was transferred to standard contrast-enhanced in-vivo MDCT images to calculate individual hip fracture risk each for 4 subjects with and without a history of osteoporotic vertebral fractures matched by age and gender. In addition, FEA based risk factor calculations were compared to manual femoral BMD measurements of all subjects.In-vitro simulations showed good correlation with the experimentally measured strains both in stance (R2 = 0.963 and fall configuration (R2 = 0.976. The simulated maximum stress overestimated the experimental failure load (4743 N by 14.7% (5440 N while the simulated maximum strain overestimated by 4.7% (4968 N. The simulated failed elements coincided precisely with the experimentally determined fracture locations. BMD measurements in subjects with a history of osteoporotic vertebral fractures did not differ significantly from subjects without fragility fractures (femoral head: p = 0.989; femoral neck: p = 0.366, but showed higher FEA based risk factors for additional incident hip fractures (p = 0.028.FEA simulations were successfully validated by elastic and destructive in-vitro experiments. In the subsequent in-vivo analyses, MDCT based FEA based risk factor differences for additional hip fractures were not mirrored by according BMD measurements. Our data suggests, that MDCT

  7. Evaluation of bone surrogates for indirect and direct ballistic fractures.

    Science.gov (United States)

    Bir, Cynthia; Andrecovich, Chris; DeMaio, Marlene; Dougherty, Paul J

    2016-04-01

    The mechanism of injury for fractures to long bones has been studied for both direct ballistic loading as well as indirect. However, the majority of these studies have been conducted on both post-mortem human subjects (PMHS) and animal surrogates which have constraints in terms of storage, preparation and testing. The identification of a validated bone surrogate for use in forensic, medical and engineering testing would provide the ability to investigate ballistic loading without these constraints. Two specific bone surrogates, Sawbones and Synbone, were evaluated in comparison to PMHS for both direct and indirect ballistic loading. For the direct loading, the mean velocity to produce fracture was 121 ± 19 m/s for the PMHS, which was statistically different from the Sawbones (140 ± 7 m/s) and Synbone (146 ± 3 m/s). The average distance to fracture in the indirect loading was .70 cm for the PMHS. The Synbone had a statistically similar average distance to fracture (.61 cm, p=0.54) however the Sawbones average distance to fracture was statistically different (.41 cm, pballistic testing was not identified and future work is warranted. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Recombinant human bone morphogenetic protein-2 in the treatment of bone fractures

    Directory of Open Access Journals (Sweden)

    Neil Ghodadra

    2008-09-01

    Full Text Available Neil Ghodadra, Kern SinghDepartment of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USAAbstract: Over one million fractures occur per year in the US and are associated with impaired healing increasing patient morbidity, stress, and economic costs. Despite improvements in surgical technique, internal fixation, and understanding of biologics, fracture healing is delayed or impaired in up to 4% of all fractures. Complications due to impaired fracture healing present therapeutic challenges to the orthopedic surgeon and often lead to chronic functional and psychological disability for the patient. As a result, it has become clinically desirable to augment mechanical fixation with biologic strategies in order to accelerate osteogenesis and promote successful arthrodesis. The discovery of bone morphogenic protein (BMP has been pivotal in understanding the biology of fracture healing and has been a source of intense clinical research as an adjunct to fracture treatment. Multiple in vitro and in vivo studies in animals have elucidated the complex biologic interactions between BMPs and cellular receptors and have convincingly demonstrated rhBMP-2 to be a safe, effective treatment option to enhance bone healing. Multiple clinical trials in trauma surgery have provided level 1 evidence for the use of rhBMP-2 as a safe and effective treatment of fractures. Human clinical trials have provided further insight into BMP-2 dosage, time course, carriers, and efficacy in fracture healing of tibial defects. These promising results have provided hope that a new biologic field of technology has emerged as a useful adjunct in the treatment of skeletal injuries and conditions.Keywords: bone morphogenic protein-2, bone fracture, bone healing

  9. 99mTc-MDP bone scintigraphy in the diagnosis of stress fracture of the metatarsal bones mimicking oligoarthritis

    Directory of Open Access Journals (Sweden)

    Jauković Ljiljana

    2008-01-01

    Full Text Available Background. Stress fractures are the injuries of soft tissues and bones caused by intensive and repeated stress on a bone. Repeated submaximal stress disturbs the balance between the processes of bone production and resorption that results in fracture. Case report. We presented a case of a patient with stress fracture of metatarsal bone. The patient was diagnosed and treated as having reactive oligoarthritis caused by Chlamydia trachomatis and administered antibiotics. Initial plain radiography was negative for bone fracture. Tc-99m bone scintigraphy suggested stress fracture of the second metatarsal. Plain radiography was became positive three weeks later, showing callus formation in the proximal part of the second metatarsal. Conclusion. Bone scintigraphy is a diagnostic test of choice in early diagnosis of stress fracture, and it is important to apply it timely in order to include the entire therapy and prevent complications, as well as to let a patient return to previous daily activites.

  10. Dietary Protein and Vitamin D Intake and Risk of Falls: A Secondary Analysis of Postmenopausal Women from the Study of Osteoporotic Fractures.

    Science.gov (United States)

    Larocque, Sarah C; Kerstetter, Jane E; Cauley, Jane A; Insogna, Karl L; Ensrud, Kristine; Lui, Li-Yung; Allore, Heather G

    2015-01-01

    More than 90% of hip fractures in older Americans result from a fall. Inadequate intake of dietary protein and vitamin D are common in older adults, and diets in low these could contribute to loss of muscle mass and strength or coordination, in turn increasing the risk of falling. The objective of the study was to evaluate the relationship between protein and vitamin D intake with the occurrence of falls in older women in the Study of Osteoporotic Fracture, a prospective cohort of more than 4000 postmenopausal women participating from January 1997 to September 1998. Incident falls were ascertained for one year. Protein and vitamin D intake was assessed by a food frequency questionnaire; associations with a reported fall were estimated with logistic regression, adjusted for fall-related covariates and energy. Protein and vitamin D were modeled separately because of high correlation (rho = 0.55, P women reported a fall within one year. In separate, unadjusted models dietary protein (per 1 g/kg increase) and vitamin D (per 100 International Unit (IU) increase) significantly increased the odds ratio (OR) of falling (OR 1.35 95% CI 1.15-1.59, OR 1.11 95% CI 1.03-1.19, respectively). Once fall-related covariates were added to each model, dietary protein and vitamin D were noncontributory to falls. While we could find no direct association between vitamin D and protein intake and fall prevention, adequate intake of these two nutrients are critical for musculoskeletal health in older adults.

  11. A comparative study of high-viscosity cement percutaneous vertebroplasty vs. low-viscosity cement percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures.

    Science.gov (United States)

    Sun, Kai; Liu, Yang; Peng, Hao; Tan, Jun-Feng; Zhang, Mi; Zheng, Xian-Nian; Chen, Fang-Zhou; Li, Ming-Hui

    2016-06-01

    The clinical effects of two different methods-high-viscosity cement percutaneous vertebroplasty (PVP) and low-viscosity cement percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs) were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups (P>0.05). Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP (Pviscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.

  12. PERIMENOPAUSAL WRIST FRACTURE - AN OPPORTUNITY FOR ...

    African Journals Online (AJOL)

    Review of Medscheme's administrative databases to study ... management of a wrist fracture between 1995 and 1998, and ... reviewed dual-energy ... from three general practices in the UK. ... and Torgerson6 estimated the total cost of treating osteoporotic .... us adults from fHANES Ill. / Bone Miner Res 1997; U, 1761-1768.

  13. Preexisting lesions associated with complete diaphyseal fractures of the third metacarpal bone in 12 Thoroughbred racehorses.

    Science.gov (United States)

    Gray, Sarah N; Spriet, Mathieu; Garcia, Tanya C; Uzal, Francisco A; Stover, Susan M

    2017-07-01

    We characterized features of complete diaphyseal fractures of third metacarpal bones in Thoroughbred racehorses. Given that stress fractures are known to occur in the third metacarpal bone, an additional aim was to determine if complete fractures are associated with signs of a preexisting incomplete stress fracture. Bilateral metacarpi from 12 Thoroughbred racehorses euthanized because of complete unilateral metacarpal diaphyseal fracture were examined visually and radiographically. Open, comminuted, transverse or short oblique fractures occurred in the middle of the diaphysis or supracondylar region. Periosteal surface discoloration and bone callus formation contiguous with the fracture line were present in fractured bones. All contralateral intact metacarpi had gross anatomic lesions, and 10 had radiographic abnormalities similar to those observed on fractured metacarpi. Catastrophic metacarpal fractures occurred in racehorses with bilateral evidence of preexisting bone injury.

  14. Determinants of change in bone mineral density and fracture risk during bisphosphonate holiday.

    Science.gov (United States)

    Xu, L H R; Adams-Huet, B; Poindexter, J R; Maalouf, N M

    2016-05-01

    In a retrospective analysis of 208 osteoporotic patients followed during a bisphosphonate holiday, lower body weight and risedronate use were associated with a more rapid decline in bone mineral density during the bisphosphonate holiday, while bone mineral density (BMD) trends were similar in patients who sustained vs. did not sustain a fracture. A drug holiday has been suggested for some bisphosphonate-treated patients with osteoporosis to minimize potential side effects from prolonged use. However, there is limited information on the evolution of BMD during a bisphosphonate holiday. Our study analyzed the longitudinal course of BMD following bisphosphonate discontinuation and assessed its determinants. Retrospective single-center cohort study of osteoporosis patients treated with alendronate or risedronate for at least 2 years and then discontinued their bisphosphonate for a drug holiday. Patients were stratified by bisphosphonate type and by fracture occurrence during drug holiday. A total of 208 patients were included in this analysis (87.5 % female). At the time of bisphosphonate cessation, mean ± SD age was 66.9 ± 8.9 years and BMI 24.5 ± 4.4 kg/m(2). Duration of bisphosphonate treatment was 5.2 ± 2.3 years, and follow-up during holiday was 3.3 ± 1.7 years. During the first 2 years of the holiday, BMD remained stable at the lumbar spine and femoral neck, but declined significantly at the total hip. BMD declined significantly at all sites thereafter. Significant predictors of BMD decline during bisphosphonate holiday included lower BMI at the start of the holiday and change in body weight during the holiday. BMD decline was more pronounced in former risedronate compared to former alendronate users. BMD trends were similar in patients who sustained vs. did not sustain a fracture during the holiday. BMD at the total hip declines significantly within 1 year of bisphosphonate discontinuation, particularly in lean patients

  15. The Mechanics of Long Bone Fractures.

    Science.gov (United States)

    1981-01-31

    r = .99) between wet density and ultimate bending strength for 37 specimens of human femoral bone. Evans (1973) studied embalmed human tibial...Work 2 2.2 Methods 6 2.2.1 Torsional Loading 6 2.2.2 The Effects of Combined Loading 10 2.2.3 Cancellous Bone Effects 11 2.3 Results 11 2.3.1...PROPERTIES 21 3.1 Previous Work 22 3.2 Methods 26 3.2.1 Cross Sectional Property Software 26 3.2.2 CT Scanning Procedure 28 3.2.3 Linear Dependency of

  16. Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction.

    Science.gov (United States)

    Kim, Il-Kyu; Cho, Hyun-Young; Pae, Sang-Pill; Jung, Bum-Sang; Cho, Hyun-Woo; Seo, Ji-Hoon

    2013-12-01

    Oral and maxillofacial defects often require bone grafts to restore missing tissues. Well-recognized donor sites include the anterior and posterior iliac crest, rib, and intercalvarial diploic bone. The proximal tibia has also been explored as an alternative donor site. The use of the tibia for bone graft has many benefits, such as procedural ease, adequate volume of cancellous and cortical bone, and minimal complications. Although patients rarely complain of pain, swelling, discomfort, or dysfunction, such as gait disturbance, both patients and surgeons should pay close attention to such after effects due to the possibility of tibial fracture. The purpose of this study is to analyze tibial fractures that occurring after osteotomy for a medioproximal tibial graft. An analysis was intended for patients who underwent medioproximal tibial graft between March 2004 and December 2011 in Inha University Hospital. A total of 105 subjects, 30 females and 75 males, ranged in age from 17 to 78 years. We investigated the age, weight, circumstance, and graft timing in relation to tibial fracture. Tibial fractures occurred in four of 105 patients. There were no significant differences in graft region, shape, or scale between the fractured and non-fractured patients. Patients who undergo tibial grafts must be careful of excessive external force after the operation.

  17. Imaging and treatment of a fracture of the hamate bone

    International Nuclear Information System (INIS)

    Andresen, R.; Radmer, S.; Scheufler, O.; Banzer, D.

    2001-01-01

    The relatively rare fractures of the hamate bone are the most common osseous injuries of the distal carpal row, whereby fractures of both the body and the hook of the hamate occur. We present a hamulus ossis hamati fracture that was caused by direct trauma in a high-level game of underwater rugby. Although this was diagnosed by conventional X-ray, the precise position of the fracture was clearly imaged using thin-layer CT, while additional multiplanar MRT revealed further sequelae of the trauma. A CT follow-up after 10 weeks of conservative therapy did not show any osseous consolidation, which indicated the need for surgical revision with exstirpation of the hamulus. (orig.) [de

  18. Multiple vertebral fractures in an elderly male with macroprolactinoma

    Directory of Open Access Journals (Sweden)

    Saša Magaš

    2016-09-01

    Full Text Available Hyperprolactinemia is associated with increased bone loss both in men and women. We report a case of an elderly patient with multiple osteoporotic vertebral fractures due to long-lasting hypogonadism caused by prolactinoma. The patient was treated with transphenoidal surgery, small doses of dopamine agonists, teriparatide, calcium and vitamin D supplements. Treatment led to increase in bone mineral density and decrease in lumbar pain intensity. This case highlights that clinicians should bear in mind the fact that osteoporotic vertebral fractures in men may be linked with hypogonadism and hyperprolactinemia. These conditions can be effectively treated. Therefore, detailed medical history and appropriate endocrinological evaluation should be performed in all male patients with osteoporotic fractures.

  19. Aging and Fracture of Human Cortical Bone and Tooth Dentin

    Energy Technology Data Exchange (ETDEWEB)

    Ager, Joel; Koester, Kurt J.; Ager III, Joel W.; Ritchie, Robert O.

    2008-05-07

    Mineralized tissues, such as bone and tooth dentin, serve as structural materials in the human body and, as such, have evolved to resist fracture. In assessing their quantitative fracture resistance or toughness, it is important to distinguish between intrinsic toughening mechanisms which function ahead of the crack tip, such as plasticity in metals, and extrinsic mechanisms which function primarily behind the tip, such as crack bridging in ceramics. Bone and dentin derive their resistance to fracture principally from extrinsic toughening mechanisms which have their origins in the hierarchical microstructure of these mineralized tissues. Experimentally, quantification of these toughening mechanisms requires a crack-growth resistance approach, which can be achieved by measuring the crack-driving force, e.g., the stress intensity, as a function of crack extension ("R-curve approach"). Here this methodology is used to study of the effect of aging on the fracture properties of human cortical bone and human dentin in order to discern the microstructural origins of toughness in these materials.

  20. The Proprioceptive System Regulates Morphologic Restoration of Fractured Bones

    Directory of Open Access Journals (Sweden)

    Ronen Blecher

    2017-08-01

    Full Text Available Successful fracture repair requires restoration of bone morphology and mechanical integrity. Recent evidence shows that fractured bones of neonatal mice undergo spontaneous realignment, dubbed “natural reduction.” Here, we show that natural reduction is regulated by the proprioceptive system and improves with age. Comparison among mice of different ages revealed, surprisingly, that 3-month-old mice exhibited more rapid and effective natural reduction than newborns. Fractured bones of null mutants for transcription factor Runx3, lacking functional proprioceptors, failed to realign properly. Blocking Runx3 expression in the peripheral nervous system, but not in limb mesenchyme, recapitulated the null phenotype, as did inactivation of muscles flanking the fracture site. Egr3 knockout mice, which lack muscle spindles but not Golgi tendon organs, displayed a less severe phenotype, suggesting that both receptor types, as well as muscle contraction, are required for this regulatory mechanism. These findings uncover a physiological role for proprioception in non-autonomous regulation of skeletal integrity.

  1. KAST Study: The Kiva System As a Vertebral Augmentation Treatment-A Safety and Effectiveness Trial: A Randomized, Noninferiority Trial Comparing the Kiva System With Balloon Kyphoplasty in Treatment of Osteoporotic Vertebral Compression Fractures.

    Science.gov (United States)

    Tutton, Sean M; Pflugmacher, Robert; Davidian, Mark; Beall, Douglas P; Facchini, Francis R; Garfin, Steven R

    2015-06-15

    The KAST (Kiva Safety and Effectiveness Trial) study was a pivotal, multicenter, randomized control trial for evaluation of safety and effectiveness in the treatment of patients with painful, osteoporotic vertebral compression fractures (VCFs). The objective was to demonstrate noninferiority of the Kiva system to balloon kyphoplasty (BK) with respect to the composite primary endpoint. Annual incidence of osteoporotic VCFs is prevalent. Optimal treatment of VCFs should address pain, function, and deformity. Kiva is a novel implant for vertebral augmentation in the treatment of VCFs. A total of 300 subjects with 1 or 2 painful osteoporotic VCFs were randomized to blindly receive Kiva (n = 153) or BK (n = 147). Subjects were followed through 12 months. The primary endpoint was a composite at 12 months defined as a reduction in fracture pain by at least 15 mm on the visual analogue scale, maintenance or improvement in function on the Oswestry Disability Index, and absence of device-related serious adverse events. Secondary endpoints included cement usage, extravasation, and adjacent level fracture. A mean improvement of 70.8 and 71.8 points in the visual analogue scale score and 38.1 and 42.2 points in the Oswestry Disability Index was noted in Kiva and BK, respectively. No device-related serious adverse events occurred. Despite significant differences in risk factors favoring the control group at baseline, the primary endpoint demonstrated noninferiority of Kiva to BK. Analysis of secondary endpoints revealed superiority with respect to cement use and site-reported extravasation and a positive trend in adjacent level fracture warranting further study. The KAST study successfully established that the Kiva system is noninferior to BK based on a composite primary endpoint assessment incorporating pain-, function-, and device-related serious adverse events for the treatment of VCFs due to osteoporosis. Kiva was shown to be noninferior to BK and revealed a positive trend

  2. Finite element analysis of functionally graded bone plate at femur bone fracture site

    Science.gov (United States)

    Satapathy, Pravat Kumar; Sahoo, Bamadev; Panda, L. N.; Das, S.

    2018-03-01

    This paper focuses on the analysis of fractured Femur bone with functionally graded bone plate. The Femur bone is modeled by using the data from the CT (Computerized Tomography) scan and the material properties are assigned using Mimics software. The fracture fixation plate used here is composed of Functionally Graded Material (FGM). The functionally graded bone plate is considered to be composed of different layers of homogeneous materials. Finite element method approach is adopted for analysis. The volume fraction of the material is calculated by considering its variation along the thickness direction (z) according to a power law and the effective properties of the homogeneous layers are estimated. The model developed is validated by comparing numerical results available in the literature. Static analysis has been performed for the bone plate system by considering both axial compressive load and torsional load. The investigation shows that by introducing FG bone plate instead of titanium, the stress at the fracture site increases by 63 percentage and the deformation decreases by 15 percentage, especially when torsional load is taken into consideration. The present model yields better results in comparison with the commercially available bone plates.

  3. The Optimal Volume Fraction in Percutaneous Vertebroplasty Evaluated by Pain Relief, Cement Dispersion, and Cement Leakage: A Prospective Cohort Study of 130 Patients with Painful Osteoporotic Vertebral Compression Fracture in the Thoracolumbar Vertebra.

    Science.gov (United States)

    Sun, Hai-Bo; Jing, Xiao-Shan; Liu, Yu-Zeng; Qi, Ming; Wang, Xin-Kuan; Hai, Yong

    2018-06-01

    To probe the relationship among cement volume/fraction, imaging features of cement distribution, and pain relief and then to evaluate the optimal volume during percutaneous vertebroplasty. From January 2014 to January 2017, a total of 130 patients eligible for inclusion criteria were enrolled in this prospective cohort study. According to the different degrees of pain relief, cement leakage, and cement distribution, all patients were allocated to 2 groups. Clinical and radiologic characteristics were assessed to identify independent factors influencing pain relief, cement leakage, and cement distribution, including age, sex, fracture age, bone mineral density, operation time, fracture level, fracture type, modified semiquantitative severity grade, intravertebral cleft, cortical disruption in the vertebral wall, endplate disruption, type of nutrient foramen, fractured vertebral body volume, intravertebral cement volume, and volume fraction. A receiver operating characteristic curve was used to analyze the diagnostic value of the cement volume/fraction and then to obtain the optional cut-off value. The preoperative visual analog scale scores in the responders versus nonresponders patient groups were 7.37 ± 0.61 versus 7.87 ± 0.92 and the postoperative VAS scores in the responders versus nonresponders were 2.04 ± 0.61 versus 4.33 ± 0.49 at 1 week. There were no independent factors influencing pain relief. There were 95 (73.08%) patients who experienced cement leakage, and cortical disruption in the vertebral wall and cement fraction percentage were identified as independent risk factors by binary logistic regression analysis (adjusted odds ratio [OR] 2.935, 95% confidence interval [95% CI] 1.214-7.092, P = 0.017); (adjusted OR 1.134, 95% CI 1.026-1.254, P = 0.014). The area under the receiver-operating characteristic curve of volume fraction (VF%) was 0.658 (95% CI 0.549-0.768, P = 0.006 cement leakage was 21.545%, with a sensitivity of 69.50% and a

  4. Low Serum Thyrotropin Level and Duration of Suppression as a Predictor of Major Osteoporotic Fractures-The OPENTHYRO Register Cohort

    DEFF Research Database (Denmark)

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

    2014-01-01

    served all hospitals and General Practice (GP) practices in the region. Persons with raised TSH or a history of thyroid/pituitary disease or use of thyroid medications were excluded. The study population consisted of 222,138 (96%) persons with normal and 9217 (4%) with low TSH (low...... increased exponentially by the length of time during which TSH had remained low. © 2014 American Society for Bone and Mineral Research....

  5. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

    Science.gov (United States)

    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  6. The application of digital tomosynthesis in diagnosis of occult bone fracture

    International Nuclear Information System (INIS)

    Tian Jun; Gong Wuxian; Zhang Dianxing; Tian Ye; Huang Shiting

    2011-01-01

    Objective: To evaluate the digital tomosynthesis in the diagnosis of occult bone fracture. Methods: Both DR and DTS were performed in 135 cases with traumatic-induced pain. All the cases were suspected of bone fractures but with no abnormal findings in DR images. Two radiologists reviewed all the images and diagnosed in consensus. All cases were followed up and the imaging diagnoses were reviewed. Results: Bone fractures or joint dislocations of 61 cases were shown in DTS images but not in DR images, including atlanto-axial fracture and subluxation in 7 cases, articular fracture of limbs in 20 cases, bone fractures of wrist, hand and foot in 11 cases, fractures of cervical, thoracic and lumbar vertebra in 7 cases, fracture of sacrococcyx in 8 cases, fracture of nasal bone in 4 cases, fractures of' Sternum, rib, orbit and mandible in 1 case. Thirty-four cases with bone fractures were determined by using DTS in suspected cases and 17 cases were denied. Both DR and DTS images showed normal findings in 23 cases. Imaging diagnoses of all cases were consistent with the results of follow up. Conclusion: DTS can depict bone fractures especially in the deep and complex bony structures, which may improve the diagnostic accuracy of bone fracture. (authors)

  7. Radiodiagnosis of closed fractures of 2-5 metacarpal bones

    International Nuclear Information System (INIS)

    Fastykovskaya, E.D.; Kopysova, V.A.; Kuzina, I.R.

    1986-01-01

    A unified method of radiodiagnosis of angular deformities in subcapital fractures of 2-5 metacarpal bones was proposed. It was based on the standardization of the wrist laying for roentgenography of the oblique view strictly at the angle of 45 deg. The projection angle of deformity of the metacarpal bone was measured on a radiogram obtained and then a true value of the angular displacement of the bone fragments to the palm was determined on a nomogram (i.e. on a chart of the ratio of values of the true and projection angles). The healthy metacarpal bone heads were inclined to the palm at the angle of 13-33 deg. It was found that in subcapital fractures of 2-5 metacarpal bones certain self-correction (varying from 10 to 15 deg) of angular deformities was possible in children and adolescents only. Owing to such radiodiagnosis and a differentiated choice of therapeutic methods (in 48.8% of the patients indications for reposition were determined) good anatomical and functional results were obtained in most of the patients (96.9%)

  8. Are bi-axial proximal sesamoid bone fractures in the British Thoroughbred racehorse a bone fatigue related fracture? A histological study.

    Science.gov (United States)

    Kristoffersen, M; Hetzel, U; Parkin, T D H; Singer, E R

    2010-01-01

    To investigate whether microfractures and alterations in the trabecular bone area are associated with catastrophic bi-axial proximal sesamoid bone fractures (PSBF). Proximal sesamoid bones (PSB) from 10 racehorses with PSBF and from 10 control racehorses without musculoskeletal injury were examined using the bulk basic fuchsin method. Bone histomorphometric and microfracture analysis was performed, and cases and controls compared using two-sample t-test, paired t-test, and Mann-Whitney U test. There was no significant difference in the microfracture density and the trabecular bone area between bones from case and control horses, and between fractured and non-fractured bones in case horses. Microfracture density was low in the areas of the PSB examined. Microfracture density was not significantly different between groups, indicating that propagation of micro-cracks is an unlikely predisposing pathologic alteration in PSBF in British racehorses. There was no significant difference in the bone surface area between groups, which one would expect if modelling, adaptation and an increase in bone density were associated with PSBF fracture in the case horses. Therefore, PSBF in the British racehorse does not appear to be associated with microfractures of the trabecular bone of the PSB. The PSB fractures might represent an acute monotonic fracture; however, the aetiology of the fractures remains unknown with additional research required.

  9. Midterm Follow-Up of Vertebral Geometry and Remodeling of the Vertebral Bidisk Unit (VDU) After Percutaneous Vertebroplasty of Osteoporotic Vertebral Fractures

    International Nuclear Information System (INIS)

    Pitton, Michael Bernhard; Koch, Ulrike; Drees, Philip; Dueber, Christoph

    2009-01-01

    The purpose of this study was to investigate geometrical stability and preservation of height gain of vertebral bodies after percutaneous vertebroplasty during 2 years' follow-up and to elucidate the geometric remodeling process of the vertebral bidisk unit (VDU) of the affected segment. Patients with osteoporotic vertebral compression fractures with pain resistant to analgetic drugs were treated with polymethylmethacrylate vertebroplasty. Mean ± standard error cement volume was 5.1 ± 2.0 ml. Vertebral geometry was documented by sagittal and coronal reformations from multidetector computed tomography data sets: anterior, posterior, and lateral vertebral heights, end plate angles, and compression index (CI = anterior/posterior height). Additionally, the VDU (vertebral bodies plus both adjacent disk spaces) was calculated from the multidetector computed tomography data sets: anterior, posterior, and both lateral aspects. Patients were assigned to two groups: moderate compression with CI of >0.75 (group 1) and severe compression with CI of o vs. -1.0 ± 2.7 o , P o , P < 0.01) and compression indices (+0.11 ± 0.15, P < 0.01). Thus, posterior height loss of vertebrae and adjacent intervertebral disk spaces contributed to a remodeling of the VDU, resulting in some compensation of the kyphotic malposition of the affected vertebral segment. Vertebroplasty improved vertebral geometry during midterm follow-up. In severe vertebral compression, significant height gain and improvement of end plate angles were achieved. The remodeling of the VDUs contributes to reduction of kyphosis and an overall improvement of the statics of the spine.

  10. Non-invasive markers of bone turnover and plasma cytokines differ in osteoporotic patients with multiple myeloma and monoclonal gammopathies of undetermined significance

    International Nuclear Information System (INIS)

    Diamond, T.; Levy, S.; Smith, A.; Day, P.; Manoharan, A.

    2001-01-01

    Multiple myeloma (MM) is a common malignancy manifest by bone marrow infiltration with malignant plasma cells, the production of a paraprotein and lytic bone lesions. Monoclonal gammopathy of undetermined significance (MGUS) is assumed to be the precursor of clinically apparent myeloma, with one or more additional genetic events being required for progression to MM. Elderly patients presenting with osteoporosis and skeletal fractures are not infrequently found to have elevated serum paraprotein concentrations suggestive of either MM or MGUS. Differentiating between these two clinical disorders may prove challenging, despite bone marrow biopsy evidence of plasmacytosis. The underlying pathogenesis of bone loss in these conditions is complex and may be attributed to cytokine-induced osteoclastogenesis coupled with increased osteoclastic bone resorption. In the present study, various markers of bone turnover and plasma cytokines were measured in order to determine whether they may be of value in differentiating between these two disorders. It is concluded that the urinary deoxypyridinoline excretion rate is a sensitive marker of bone resorption and of underlying bone disease activity. It may also help to differentiate between MM and MGUS

  11. Synergistic effects of bisphosphonate and calcium phosphate nanoparticles on peri-implant bone responses in osteoporotic rats

    NARCIS (Netherlands)

    Alghamdi, H.S.A.; Bosco, R.; Both, S.K.; Iafisco, M.; Leeuwenburgh, S.C.G.; Jansen, J.A.; Beucken, J.J.J.P van den

    2014-01-01

    The prevalence of osteoporosis will increase within the next decades due to the aging world population, which can affect the bone healing response to dental and orthopedic implants. Consequently, local drug targeting of peri-implant bone has been proposed as a strategy for the enhancement of

  12. Effects of salmon calcitonin on fracture healing in ovariectomized rats.

    Science.gov (United States)

    Li, Xiaolin; Luo, Xinle; Yu, Nansheng; Zeng, Bingfang

    2007-01-01

    To explore the effects of salmon calcitonin on the healing process of osteoporotic fractures in ovariectomized rats. We performed this study in The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China, during the period March 2002 to December 2004. We used 120 female adult Wistar rats in this experiment, among which 90 underwent ovariectomy (OVX) and the other 30 had sham-operation. All rats had their left tibias fractured 3 months later. The 90 OVX rats were randomly divided into 3 groups with 30 in each, while the 30 sham-operated rats served as control group. After the fracture the rats had subcutaneous injection of normal saline, salmon calcitonin and estrogen, respectively. X-ray film, histological examination, bone mineral density (BMD) measurement and biomechanics testing were carried out to evaluate the fracture healing. Compared with OVX rats treated with normal saline, the rats with salmon calcitonin had significantly higher BMD values in the left tibia, higher max torque, shear stress of the left tibia 8 weeks after fracture (pnormalization of microstructure of bone trabeculae. Salmon calcitonin can, not only increase BMD in osteoporotic bone, but also enhance the bone biomechanical properties and improve the process of fracture healing in fractured osteoporotic bone.

  13. Novel Therapeutic Strategy for the Prevention of Bone Fractures

    Science.gov (United States)

    2015-02-01

    therapeutic potential for improving muscle function in older adults , perhaps leading to the prevention of falls and fractures. Body Aim 1 (months 1-12...directly to postural instability, which in turn increases the risk for falls , and falls are the main etiolog ical factor inmore than 90% of bone...vitamin D supplementation (Girgis et al., 2013) may improve muscle strength and/or neuromuscular control and proprioception, perhaps reducing fall risk

  14. BIOMATERIAL IMPLANTS IN BONE FRACTURES PRODUCED IN RATS FIBULAS

    OpenAIRE

    Shirane, Henrique Yassuhiro; Oda, Diogo Yochizumi; Pinheiro, Thiago Cerizza; Cunha, Marcelo Rodrigues da

    2010-01-01

    To evaluate the importance of collagen and hydroxyapatite in the regeneration of fractures experimentally induced in the fibulas of rats. Method: 15 rats were used. These were subjected to surgery to remove a fragment from the fibula. This site then received a graft consisting of a silicone tubes filled with hydroxyapatite and collagen. Results: Little bone neoformation occurred inside the tubes filled with the biomaterials. There was more neoformation in the tubes with collagen. Conclusion: ...

  15. Diabetes mellitus and bone health: epidemiology, etiology and implications for fracture risk stratification.

    Science.gov (United States)

    Valderrábano, Rodrigo J; Linares, Maria I

    2018-01-01

    Skeletal fractures can result when there are co-morbid conditions that negatively impact bone strength. Fractures represent an important source of morbidity and mortality, especially in older populations. Diabetes mellitus is a metabolic disorder that has reached worldwide epidemic proportions and is increasingly being recognized as a risk factor for fracture. Type 1 and Type 2 diabetes have different effects on bone mineral density but share common pathways, which lead to bone fragility. In this review, we discuss the available data on diabetes and fractures, bone density and the clinical implications for fracture risk stratification in current practice.

  16. An Unusual Case of a Large Hematorrachis Associated with Multi-Level Osteoporotic Vertebral Compression Fractures; a Case Report

    Directory of Open Access Journals (Sweden)

    T.V. Ravi Kumar

    2015-04-01

    Full Text Available Spinal epidural haemorrhage may present as back pain associated with radicular symptoms and can be a catastrophic clinical scenario with progression to paraplegia or even sudden death. Being a rare entity, it needs a high index ofclinical suspicion to diagnose it. Fractures have been documented as a cause of hematorrachis but such hematomas only extend to one or two vertebral segments. Large epidural hematomas are usually associated with conditions like bleeding diathesis, arterio-venous malformations, plasma cell myeloma, and non-Hodgkin’s lymphoma. Surgical management with immediate evacuation of the hematoma is the usual line of management in patients with neurological deficits. Though rare, monitored and careful conservative management can lead to recovery of neurological symptoms and resolution of the hematoma. We report a case of a very large post traumatic epidural hematorrchis extending to 11 vertebral segments from D3 to L1 vertebral bodies, who had a gradual spontaneous recovery.

  17. Sacral Stress Fracture following the Bone Union of Lumbar Spondylolysis

    Directory of Open Access Journals (Sweden)

    Tatsuro Sasaji

    2016-01-01

    Full Text Available While 22 articles have reported on sacral stress fractures, it is a rare injury and its etiology is not well known. We present the case of a 16-year-old male who presented with low back pain in 2015. He was a high school soccer player with a previous history of a bilateral L5 lumbar spondylolysis in 2014. The patient refrained from soccer and wore a brace for six months. Two months after restarting soccer, he again complained of low back pain. After 1 year, a lumbar spine computed tomography revealed the bone union of the spondylolysis. At his first visit to our hospital, his general and neurological conditions were normal and laboratory data were within the normal range. Sacral coronal magnetic resonance imaging (MRI of the left sacral ala revealed an oblique lineal signal void surrounding bone marrow edema. Based on his symptoms, sports history, and MRI, he was diagnosed with a sacral stress fracture. He again refrained from soccer; his low back pain soon improved, and, after 1 year, the abnormal signal change had disappeared on sacral MRI. Recurrent low back pain case caused by a sacral stress fracture occurring after the bone union of lumbar spondylolysis is uncommon.

  18. In vivo analysis of bone calcium by local neutron activation of the hand. Results osteoporotic and hemodialysed patients

    International Nuclear Information System (INIS)

    Maziere, B.; Kuntz, D.; Comar, D.

    1978-01-01

    Neutron activation analysis can be used to measure the total bone mass or simply the calcium mass or concentration of a bone segment, for example the hand bones or vertebrae. For a number of reason, dosimetric, technological but especially physiophatological we decided to use local activation technique. In generalized demineralising one diseases, particularly osteoporosis, the calcium content variations of one segment are in fast comparable to those of another, and more generally to the mineral content variations of the whole skeleton. It is true that ideally we should measure the mineral content of the lumbar vertebrae where the metabolic activity is especially high, and where damage may occur sooner or in any case is detected earlier in osteoporosis. However neutron irradiation of the vertebrae meets with certain technical problems and may also present difficulties in the interpretation of results. Furthermore in other bone diseases, hyperparathyroidism for instance and especially renal osteodystrophy, bone mineral loss is particularly premature and pronounced in the hand and we therefore decided for the moment to use the hand for the neutron activation analysis of bone calcium. The technique enabled us to measure the calcium concentration of the hand bones in hemodialysed subjects and in patients with primitive osteoporosis

  19. Measurement of the bone mineral density of the os calcis as an indication of vertebral fracture in women with lumbar osteoarthritis

    International Nuclear Information System (INIS)

    Kotzki, P.-O.; Buyck, D.; Leroux, J.-L.; Thomas, E.; Rossi, M.

    1993-01-01

    In women with lumbar osteoarthritis, measurement of the os calcis bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA) as an indication of vertebral fracture was evaluated. The in vivo precision of the method was 1.28%. Age-and sex-matched control curves were evaluated using a control of 193 females. Correlation between spine BMD and os calcis BMD was significant (r = 0.65, p<<0.001). For osteoporotic women without osteoarthritis (34), there was no significant difference in spine and the os calcis Z-score (-1.99SD and -1.83SD respectively). For osteoporotic women with osteoarthritis (30) the spine Z-score was -0.49SD; the os calcis Z-scores was -1.92SD. The difference was significant (p<0.001). Receiver operating characteristic (ROC) curves demonstrate the superiority of the os calcis as a measurement site over the lumbar spine, in correlation with existing crush fractures in the presence of osteoarthritis. (author)

  20. Survival times of patients with a first hip fracture with and without subsequent major long-bone fractures.

    Science.gov (United States)

    Angthong, Chayanin; Angthong, Wirana; Harnroongroj, Thos; Naito, Masatoshi; Harnroongroj, Thossart

    2013-01-01

    Survival rates are poorer after a second hip fracture than after a first hip fracture. Previous survival studies have included in-hospital mortality. Excluding in-hospital deaths from the analysis allows survival times to be evaluated in community-based patients. There is still a lack of data regarding the effects of subsequent fractures on survival times after hospital discharge following an initial hip fracture. This study compared the survival times of community-dwelling patients with hip fracture who had or did not have a subsequent major long-bone fracture. Hazard ratios and risk factors for subsequent fractures and mortality rates with and without subsequent fractures were calculated. Of 844 patients with hip fracture from 2000 through 2008, 71 had a subsequent major long-bone fracture and 773 did not. Patients who died of other causes, such as perioperative complications, during hospitalization were excluded. Such exclusion allowed us to determine the effect of subsequent fracture on the survival of community-dwelling individuals after hospital discharge or after the time of the fracture if they did not need hospitalization. Demographic data, causes of death, and mortality rates were recorded. Differences in mortality rates between the patient groups and hazard ratios were calculated. Mortality rates during the first year and from 1 to 5 years after the most recent fracture were 5.6% and 1.4%, respectively, in patients with subsequent fractures, and 4.7% and 1.4%, respectively, in patients without subsequent fractures. These rates did not differ significantly between the groups. Cox regression analysis and calculation of hazard ratios did not show significant differences between patients with subsequent fractures and those without. On univariate and multivariate analyses, age fracture. This study found that survival times did not differ significantly between patients with and without subsequent major long-bone fractures after hip fracture. Therefore, all

  1. Elastoplasticity analysis of the nails used in long bone fractures

    International Nuclear Information System (INIS)

    Paterson, R; Paterson, A; Miralles, M T; Del Sel, G; Del Sel, N

    2011-01-01

    Elastoplastic endomedullary nail-insertion system in long bone fractures is a method which allows generating forces, moments, frictions and stress states in parts of the bone previously selected. Adding previous knowledge on the distribution of forces and acting moments over the bone fragments to be threaded, as well as on the elastoplastic and mechanical properties of the nails to be inserted (designing a special, specific structure for each case), the results, coming from 26 years of applying this technique, have been promising. It is from this perspective that we call this threading and anchoring procedure 'Selective Tension System' (STS). Physicochemical analyses and mechanical trials on elastoplastic nails used in the osteosynthesis in long bone fractures are presented. The magnitude of the forces produced by flattening the nails and the reacting forces at both ends are measured. It is expected that the evidence provided on the elastic variability of these nails will be useful as guidance on the availability and choice of the elastoplastic combinations that best fit each patient.

  2. Biological methods to enhance bone healing and fracture repair.

    Science.gov (United States)

    Verdonk, René; Goubau, Yannick; Almqvist, Fredrik K; Verdonk, Peter

    2015-04-01

    This article looks into normal physiological fracture healing with special emphasis on the diamond concept. A precise definition of nonunion of long bones is described. Most often inadequate fixation (too rigid or too loose) is the reason for nonunion in long bone fractures. Because a critical bone defect cannot be bridged, it may lead directly or indirectly (lack of fixation) to nonunion. Individual inadequate local biological characteristics are also often found to be the cause; poor soft tissue coverage as well as a lack of periosteum and muscle or fascia or skin defects can lead to compromised vascularity in situ. Systemic factors are now much more recognized, e.g., smoking, diabetes, and cachexia, as well as the limited impact of some medications, e.g., nonsteroidal anti-inflammatory drugs and steroids. Today's mode of treatment for nonunion is approached in this article, and suggestions for appropriate treatment of long bone nonunion is presented. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Smith, F W; Gilday, D L; Ash, J M; Green, M D

    1980-01-01

    Many patterns of injury have been described in the child abuse syndrome. Until recently, all the bone manifestations of this syndrome have been diagnosed radiologically. Four cases of multiple costovertebral fracture diagnosed by bone scan are described and their etiology discussed. The use of bone scanning in identifying fractures which previously would have been missed is advocated.

  4. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome

    International Nuclear Information System (INIS)

    Smith, F.W.; Gilday, D.L.; Ash, J.M.; Green, M.D.

    1980-01-01

    Many patterns of injury have been described in the child abuse syndrome. Until recently, all the bone manifestations of this syndrome have been diagnosed radiologically. Four cases of multiple costovertebral fracture diagnosed by bone scan are described and their etiology discussed. The use of bone scanning in identifying fractures which previously would have been missed is advocated. (orig.) [de

  5. Relationship between body composition, body mass index and bone mineral density in a large population of normal, osteopenic and osteoporotic women.

    Science.gov (United States)

    Andreoli, A; Bazzocchi, A; Celi, M; Lauro, D; Sorge, R; Tarantino, U; Guglielmi, G

    2011-10-01

    The knowledge of factors modulating the behaviour of bone mass is crucial for preventing and treating osteoporotic disease; among these factors, body weight (BW) has been shown to be of primary importance in postmenopausal women. Nevertheless, the relative effects of body composition indices are still being debated. Our aim was to analyze the relationship between body mass index (BMI), fat and lean mass and bone mineral density (BMD) in a large population of women. Moreover, this study represents a first important report on reference standard values for body composition in Italian women. Between 2005 and 2008, weight and height of 6,249 Italian women (aged 30-80 years) were measured and BMI was calculated; furthermore BMD, bone mineral content, fat and lean mass were measured by dual-energy X-ray absorptiometry. Individuals were divided into five groups by decades (group 1, 30.0-39.9; group 2, 40.0-49.9; group 3, 50.0-59.9; group 4, 60.0-69.9; group 5, 70.0-79.9). Differences among decades for all variables were calculated using a one-way analysis of variance (ANOVA) and Bonferroni test by the SPSS programme. Mean BW was 66.8±12.1 kg, mean height 159.1±6.3 cm and mean BMI 26.4±4.7 kg/m(2). According to BW and BMI, there was an increase of obesity with age, especially in women older than 50 years (posteoporosis in the examined population was 43.0% and 16.7%, respectively. Our data show that obesity significantly decreased the risk for osteoporosis but did not decrease the risk for osteopenia. It is strongly recommended that a strong policy regarding prevention of osteopenia and osteoporosis be commenced. An overall examination of our results suggests that both fat and lean body mass can influence bone mass and that their relative effect on bone could be modulated by their absolute amount and ratio to total BW.

  6. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

    International Nuclear Information System (INIS)

    Arendse, Regan; Brink, Paul; Beighton, Peter

    2009-01-01

    A father and daughter both had multiple pathological fractures and nodal osteoarthropathy. The father, aged 50 years, had at least 20 healed fractures of the axial and appendicular skeleton, sustained by minor trauma over his 50-year lifespan, many of which had been surgically fixed prior to his first presentation to us. Fractures of the clavicles, thoracic cage and long bones of the arms and legs, had healed with malalignment and deformity. Healed fractures were complicated by ankylosis of the cervical vertebrae and both elbows. He also had osteoarthritis of the hands, with exuberant osteophytosis, and profound perceptive deafness. His general health was good, his intellect and facies were normal, and his sclerae were white. The daughter, aged 27 years, had sustained at least seven fractures of the axial and appendicular skeleton following trivial injuries, in distribution similar to those of the father. She had also experienced painful swelling of the fingers, which preceded progressive development of nodal osteoarthropathy. Her hearing was normal. In both individuals, biochemical and immunological investigations yielded normal results. It was not possible for molecular studies to be undertaken. Pedigree data were consistent with autosomal dominant transmission, and this disorder appeared to be a previously undocumented heritable skeletal dysplasia. (orig.)

  7. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

    Energy Technology Data Exchange (ETDEWEB)

    Arendse, Regan [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); University of Cape Town, Division of Rheumatology, Groote Schuur Hospital, Cape Town (South Africa); Brink, Paul [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); Beighton, Peter [University of Cape Town, Division of Human Genetics, Faculty of Health Sciences, Cape Town (South Africa)

    2009-12-15

    A father and daughter both had multiple pathological fractures and nodal osteoarthropathy. The father, aged 50 years, had at least 20 healed fractures of the axial and appendicular skeleton, sustained by minor trauma over his 50-year lifespan, many of which had been surgically fixed prior to his first presentation to us. Fractures of the clavicles, thoracic cage and long bones of the arms and legs, had healed with malalignment and deformity. Healed fractures were complicated by ankylosis of the cervical vertebrae and both elbows. He also had osteoarthritis of the hands, with exuberant osteophytosis, and profound perceptive deafness. His general health was good, his intellect and facies were normal, and his sclerae were white. The daughter, aged 27 years, had sustained at least seven fractures of the axial and appendicular skeleton following trivial injuries, in distribution similar to those of the father. She had also experienced painful swelling of the fingers, which preceded progressive development of nodal osteoarthropathy. Her hearing was normal. In both individuals, biochemical and immunological investigations yielded normal results. It was not possible for molecular studies to be undertaken. Pedigree data were consistent with autosomal dominant transmission, and this disorder appeared to be a previously undocumented heritable skeletal dysplasia. (orig.)

  8. Evaluation of percutaneous vertebroplasty in osteoporotic vertebral fractures using a combination of CT fluoroscopy and conventional lateral fluoroscopy; Perkutane Vertebroplastie osteoporosebedingter Wirbelkoerperfrakturen: Erfahrungen mit der CT-Fluoroskopie

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Schneider, J.; Brecher, B.; Herber, S.; Mohr, W.; Thelen, M. [Klinik fuer Radiologie, Universitaetskliniken Mainz (Germany); Drees, P.; Eckardt, A.; Heine, J. [Klinik fuer Orthopaedie, Universitaetskliniken Mainz (Germany)

    2004-07-01

    Purpose: Evaluation of vertebroplasty using a combination of CT-fluoroscopy and conventional lateral fluoroscopy in patients with osteoporotic vertebral fractures. Materials and Methods: Fifty-eight patients (23male, 35 women, age 69.7 {+-} 10.2 years) with painful osteoporotic vertebral fractures were treated with vertebroplasty in conscious sedation and local anesthesia. Spiral-CT with sagittal reconstructions of the respective vertebral bodies was used for classification of the fracture. The cannula was placed under CT-guidance in the ventral third of the respective vertebral bodies and cement instilled under CT fluoroscopy and lateral fluoroscopy. When cement migrated towards the vertebral canal, the injection was immediately stopped for 30-60 seconds. After polymerization in this location, the injection was continued until sufficient filling of the vertebra. Results were documented by spiral CT with sagittal reconstructions. Results: A total of 123 vertebral bodies were treated, comprising 39 thoracic and 84 lumbar vertebral bodies, with a mean of 2.1 {+-} 1.3 (range 1 to 6) vertebral bodies in each patient and a maximum of 3 vertebral bodies per session. All interventions were successfully completed in conscious sedation and local anesthesia. A mean volume of 5.9 {+-} 0.6 ml (range 2 to 14 ml) cement was applied for each vertebra, with 79.7% of procedures performed using a unilateral access. To achieve a sufficient cement deposit, a bilateral access was used in 20.3%. The dorsal wall of the vertebra was included in 23.6% of the fractures. In one case, cement migration into the spinal canal was detected, reducing the diameter of the canal by 30%. In two other cases, cement leakage was seen at the puncture site of the vertebra (one intercostotransversally in the 10{sup th} thoracic vertebra and one dorsolaterally in the 1{sup st} lumbar vertebra) with retrograde cement migration through the neuroforamen into the epidural space. In one of these cases, the

  9. Multi-axial fatigue of trabecular bone with respect to normal walking

    CERN Document Server

    Mostakhdemin, Mohammad; Syahrom, Ardiyansyah

    2016-01-01

    This book focuses on the analysis and treatment of osteoporotic bone based on drug administration, tracking fatigue behavior and taking into consideration the mechanical interaction of implants with trabecular bone. Weak trabeculae are one of the most important clinical features that need to be addressed in order to prevent hip joint fractures.

  10. Effects of salmon calcitonin on fracture healing in ovariectomized rats

    International Nuclear Information System (INIS)

    Li, Xiaolin; Zeng, Bingfang; Luo, Xinle; Yu, Nansheng

    2007-01-01

    Objective was to explore the effects of salmon calcitonin on the healing process of osteoporotic fractures in ovariectomized rats. We performed this study in the First Affiliated Hospital of Guangzhaou Medical College, Guangzhaou, China during the period March 2002 to December 2004. We used 120 female adult Wistar rats in this experiment, among which 90 underwent ovariectomy (OVX) and the other 30 had shamoperation. All rats had their left tibias fractured 3 months later. The 90 OVX rats were randomly divided into 3 groups with 30 in each, while the 30 shamoperated rats served as control group. After the fracture rats had subcutaneous injection of normal saline, salmon calcitonin and estrogen, respectively. X-ray film, histological examination, bone mineral density (BMD) measurement and biomechanics testing were carried out to evaluate the fracture healing. Compared with OVX rats treated normal saline, the rats with salmon calcitonin had significantly higher BMD values in the left tibia, higher max torque, shear stress of the left tibia 8 weeks after fracture (p<0.05), and presented with stronger callus formation, shorter fracture healing time and faster normalization of microstructure of bone trabeculae. Salmon calcitonin can, not only increase in osteoporotic bone biomechanical properties and improve the process of fractured osteoporotic bone. (author)

  11. Propagation of a dorsal cortical fracture of the third metacarpal bone in two horses

    International Nuclear Information System (INIS)

    Spurlock, G.H.

    1988-01-01

    Seemingly, propagation of a dorsal cortical fracture in the third metacarpal bone developed after continued race performance in 2 horses. Historically, both horses had intermittent lameness that had responded to nonsteroidal anti-inflammatory drugs and brief rest periods. However, lameness in both horses had increased in severity. Radiography revealed a dorsal cortical fracture of the third metacarpal bone, with propagation of the fracture plane proximally. Fractures were incomplete and healed with stall rest in both horses

  12. Paget's disease of the bone in Chinese woman

    International Nuclear Information System (INIS)

    H'ng, M.W.C.; Ho, Y.Y.

    2005-01-01

    Paget's disease, otherwise known as osteitis deformans, is an unusual condition in the Oriental population. We report a case of Paget's disease in a Chinese woman, incidentally diagnosed on a bone scan. This was confirmed by clinical history, biochemistry and imaging findings using other modalities. Although bone scans are commonly performed to diagnose traumatic occult fractures and bone metastases, they can also be used to diagnose metabolic bone diseases, such as osteoporotic fractures, and to evaluate Paget's disease. It can also diagnose acute fractures secondary to renal osteodystrophy and osteomalacia Copyright (2005) Blackwell Publishing Asia Pty Ltd

  13. Computed tomography of temporal bone fractures and temporal region anatomy in horses.

    Science.gov (United States)

    Pownder, S; Scrivani, P V; Bezuidenhout, A; Divers, T J; Ducharme, N G

    2010-01-01

    In people, specific classifications of temporal bone fractures are associated with clinical signs and prognosis. In horses, similar classifications have not been evaluated and might be useful establishing prognosis or understanding pathogenesis of certain types of trauma. We hypothesized associations between temporal bone fracture location and orientation in horses detected during computed tomography (CT) and frequency of facial nerve (CN7) deficit, vestibulocochlear nerve (CN8) deficit, or temporohyoid osteoarthropathy (THO). Complex temporal region anatomy may confound fracture identification, and consequently a description of normal anatomy was included. All horses undergoing temporal region CT at our hospital between July 1998 and May 2008. Data were collected retrospectively, examiners were blinded, and relationships were investigated among temporal bone fractures, ipsilateral THO, ipsilateral CN7, or ipsilateral CN8 deficits by Chi-square or Fischer's exact tests. Seventy-nine horses had CT examinations of the temporal region (158 temporal bones). Sixteen temporal bone fractures were detected in 14 horses. Cranial nerve deficits were seen with fractures in all parts of the temporal bone (petrosal, squamous, and temporal) and, temporal bone fractures were associated with CN7 and CN8 deficits and THO. No investigated fracture classification scheme, however, was associated with specific cranial nerve deficits. Without knowledge of the regional anatomy, normal structures may be mistaken for a temporal bone fracture or vice versa. Although no fracture classification scheme was associated with the assessed clinical signs, simple descriptive terminology (location and orientation) is recommended for reporting and facilitating future comparisons.

  14. Comparison of macrostructural and microstructural bone features in Thoroughbred racehorses with and without midbody fracture of the proximal sesamoid bone.

    Science.gov (United States)

    Anthenill, Lucy A; Gardner, Ian A; Pool, Roy R; Garcia, Tanya C; Stover, Susan M

    2010-07-01

    To compare macrostructural and microstructural features of proximal sesamoid bones (PSBs) from horses with and without PSB midbody fracture to gain insight into the pathogenesis of PSB fracture. PSBs from 16 Thoroughbred racehorses (8 with and 8 without a PSB midbody fracture). Parasagittal sections of fractured and contralateral intact PSBs from horses with a PSB fracture and an intact PSB from age- and sex-matched control horses without a PSB fracture were evaluated for visual, radiographic, microradiographic, histologic, and his-tomorphometric differences in bone porosity, vascular channels, heme pigment, trabecular anisotropy, and pathological findings. Fractured PSBs and their contralateral intact PSBs had more compacted trabecular bone than did control PSBs. Focal repair or remodeling was evident in the palmar aspect of many fractured and contralateral intact PSBs. Fracture coincided with microstructural features and propagated from the flexor to the articular surface. Fractured PSBs had adapted to high loading but had focal evidence of excessive remodeling and porosity that likely predisposed the horses to complete fracture and catastrophic injury. Detection of focal injury before complete fracture provides an opportunity for prevention of catastrophic injury. Development of diagnostic imaging methods to assess porosity of PSBs may help to identify at-risk horses and allow for modifications of training and racing schedules to reduce the incidence of PSB fracture in Thoroughbred racehorses.

  15. Experimental study on healing process of rat mandibular bone fracture examined by radiological procedures

    International Nuclear Information System (INIS)

    Iuchi, Yukio; Furumoto, Keiichi

    1994-01-01

    The healing process of rat mandibular fractures was stereoscopically observed daily, using plain roentgenography in the lateral-oblique and tooth axis directions and bone scintigraphy using 99m-Tc-methylene diphosphoric acid (Tc-99m-MDP). The findings were compared with microradiograms of regional polished specimens. X-ray findings included the following. Up to 3 days after bone fracture, the fracture mesiodistally showed distinct radiolucency, with sharp and irregular fracture stump. Radiopacity of the fracture site gradually increased 7 days or later, and bone trabecular formation by callus and stump bridging started to occur at 14 days. Findings similar to those in the control group were observed 49 days or later. The inside was difficult to differentiate, irrespective of the observation time. Bone scans in the mesiodistal and buccolingual planes revealed tracer uptake in the areas of mandibular and soft tissue damage one day after bone fracture. Tracer uptake began to be seen in the fracture site 3 days later, and became marked at 14 days. Then Tc-99m DMP began to be localized and returned to the findings similar to those at 49 days. Bone scanning tended to show wider areas earlier than roentgenography. Microradiographic mesiodistal examination revealed distinct radiopacy of the fracture line for 3 days after bone fracture. Seven days later, bone resorption cavity occurred in the cortical bone around the fracture stump, along with neogenesis of callus. Neogenesis and calcification began to occur gradually, and 14 days later, the fracture osteoremodeling of the internal bone trabeculae was observed. Bone trabecular formation within the bone, however, occurred later. (N.K.)

  16. Pathological fracture in non-ossifying fibroma with histological features simulating aneurysmal bone cyst

    International Nuclear Information System (INIS)

    Hoeffel, C.; Mainard, L.; Hoeffel, J.C.; Panuel, M.; Plenat, F.

    1999-01-01

    A 12-year-old-girl presented with a fracture of an osteolytic lesion of the distal radius. A 7-year-old girl presented with a fracture of an osteolytic lesion of the femoral shaft. In both cases it was a non-ossifying fibroma with fracture misdiagnosed at pathology as aneurysmal bone cyst. Fractures through non-ossifying fibromas may alter the histological pattern of the initial lesion in two ways: firstly, by the presence of blood pigments due to the fracture, and secondly, by formation of new bone. Radiological-pathological correlation is essential to avoid histological errors after pathological fracture in a non-ossifying fibroma. (orig.)

  17. Pathologic fracture through a unicameral bone cyst of the pelvis: CT-guided percutaneous curettage, biopsy, and bone matrix injection.

    Science.gov (United States)

    Tynan, Jennifer R; Schachar, Norman S; Marshall, Geoffrey B; Gray, Robin R

    2005-02-01

    Unicameral bone cysts of the pelvis are extremely rare. A 19-year old man presented with a pathologic fracture through a pelvic unicameral bone cyst. He was treated with computed tomography-guided percutaneous curettage, biopsy, and demineralized bone matrix injection. Treatment has proven successful in short-term follow-up.

  18. Spatial Differences in the Distribution of Bone Between Femoral Neck and Trochanteric Fractures.

    Science.gov (United States)

    Yu, Aihong; Carballido-Gamio, Julio; Wang, Ling; Lang, Thomas F; Su, Yongbin; Wu, Xinbao; Wang, Manyi; Wei, Jie; Yi, Chen; Cheng, Xiaoguang

    2017-08-01

    There is little knowledge about the spatial distribution differences in volumetric bone mineral density and cortical bone structure at the proximal femur between femoral neck fractures and trochanteric fractures. In this case-control study, a total of 93 women with fragility hip fractures, 72 with femoral neck fractures (mean ± SD age: 70.6 ± 12.7 years) and 21 with trochanteric fractures (75.6 ± 9.3 years), and 50 control subjects (63.7 ± 7.0 years) were included for the comparisons. Differences in the spatial distributions of volumetric bone mineral density, cortical bone thickness, cortical volumetric bone mineral density, and volumetric bone mineral density in a layer adjacent to the endosteal surface were investigated using voxel-based morphometry (VBM) and surface-based statistical parametric mapping (SPM). We compared these spatial distributions between controls and both types of fracture, and between the two types of fracture. Using VBM, we found spatially heterogeneous volumetric bone mineral density differences between control subjects and subjects with hip fracture that varied by fracture type. Interestingly, femoral neck fracture subjects, but not subjects with trochanteric fracture, showed significantly lower volumetric bone mineral density in the superior aspect of the femoral neck compared with controls. Using surface-based SPM, we found that compared with controls, both fracture types showed thinner cortices in regions in agreement with the type of fracture. Most outcomes of cortical and endocortical volumetric bone mineral density comparisons were consistent with VBM results. Our results suggest: 1) that the spatial distribution of trabecular volumetric bone mineral density might play a significant role in hip fracture; 2) that focal cortical bone thinning might be more relevant in femoral neck fractures; and 3) that areas of reduced cortical and endocortical volumetric bone mineral density might be more relevant for

  19. Sagittal fractures of the third carpal bone in horses: 12 cases (1977-1985)

    International Nuclear Information System (INIS)

    Fischer, A.T. Jr.; Stover, S.M.

    1987-01-01

    Third carpal sagittal fractures were found to be related to racing injuries in 10 of 12 horses. These fractures occurred most commonly on the medial aspect of the bone. A dorsoproximal-dorsodistal view of the carpus was required to visualize the fracture in all cases. Healing of the fracture required periods of rest of up to one year. Conservative management of these fractures resulted in return to function in 7 of 12 horses

  20. Texture analysis of trabecular bone using conventional radiographs: medical imaging and osteoporosis

    International Nuclear Information System (INIS)

    Karunanithi, R.; Panicker, T.M.R.; Paul Korath, M.; Jagadeesan, K.; Ganesan, S.

    2008-01-01

    Osteoporosis is characterized by reduced bone mass, microstructural deterioration with advancing age, and an increase in fracture risk. The accurate clinical assessment of bone strength and fracture risk is important for management of bone loss diseases such as osteoporosis risk. From a clinical point of view, microarchitecture is an interesting aspect to study and define patterns of bone alterations with aging and pathology. Microarchitecture seems to be a determinant of bone fragility independent of bone density. Moreover, bone microarchitecture seems to be important to understand the mechanisms of bone fragility independent of bone density. Moreover bone microarchitecture seems to be important to understand the mechanisms of bone fragility as well as the action of the drugs used to prevent osteoporotic fractures. In the case of osteoporosis the bone texture of the trabecular network as it appears on the plain radiographs can be quantified by applying image processing tools. Among the factors conditioning bone strength and osteoporotic fractures, bone mineral density is the most important and the best studied. Though, other factors also play a role: macroarchitecture of bones, cortical thickness, quality of bone crystal and of collagen network and trabecular microarchitecture. The microarchitecture plays a major role, and is an aspect of the definition of osteoporosis. Therefore, it would be very helpful if these alterations could be measured in addition to bone mineral density with noninvasive techniques, such as radiographs, and to assess the status of the bone by texture analysis