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Sample records for preventing osteoporotic fractures

  1. Identifying osteoporotic vertebral fracture

    Science.gov (United States)

    2015-01-01

    Osteoporosis per se is not a harmful disease. It is the sequela of osteoporosis and most particularly the occurrence of osteoporotic fracture that makes osteoporosis a serious medical condition. All of the preventative measures, investigations, treatment and research into osteoporosis have one primary goal and that is to prevent the occurrence of osteoporotic fracture. Vertebral fracture is by far and away the most prevalent osteoporotic fracture. The significance and diagnosis of vertebral fracture are discussed in this article. PMID:26435923

  2. The Efficacy of Bisphosphonates for Prevention of Osteoporotic Fracture: An Update Meta-analysis

    Science.gov (United States)

    Byun, Ji-Hye; Jang, Sunmee; Lee, Sumin; Park, Suyeon; Yoon, Hyun Koo

    2017-01-01

    Background The efficacy of bisphosphonates for osteoporotic fracture has been consistently reported in recent randomized controlled trials (RCTs) enrolling hundreds of patients. The objective of this study was to update knowledge on the efficacy of available bisphosphonates in the prevention of vertebral and non-vertebral fractures. Methods An approach “using systematic reviews” on PubMed and Cochrane Library was taken. Twenty-four RCTs investigating the effects of bisphosphonates for the prevention of osteoporotic fracture were included in final analysis. A pairwise meta-analysis was conducted with a random effects model. Subgroup analysis was performed according to the type of bisphosphonate. Results The use of bisphosphonate decrease the risk of overall osteoporotic fracture (odds ratio [OR] 0.62; Posteoporotic fractures but no significance was observed for etidronate (OR 0.34; P=0.127). Conclusions This update meta-analysis re-confirmed that bisphosphonate use can effectively reduce the risk of osteoporotic fracture. However, there is a lack of evidence regarding etidronate for the prevention of osteoporotic fracture. PMID:28326300

  3. 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.

  4. 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...

  5. Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis.

    Science.gov (United States)

    Saito, T; Sterbenz, J M; Malay, S; Zhong, L; MacEachern, M P; Chung, K C

    2017-12-01

    Patients with osteoporotic fractures have an increased risk for secondary fractures. However, a rigorous study that assesses the effectiveness of individual osteoporotic drugs in preventing subsequent fractures is lacking. The purpose of this review was to analyze the effectiveness of anti-osteoporotic drugs in preventing secondary fractures. We searched for randomized controlled trials that showed the incidence of secondary fractures while using anti-osteoporotic drugs (bisphosphonates, selective estrogen receptor modulators, parathyroid hormone (PTH), or calcitonin) in MEDLINE, Embase.com , and Cochrane Central Register databases. We estimated risk ratios (RR) and numbers needed to treat (NNT) to prevent secondary fractures. Twenty-six studies met our eligibility criteria. There was a significant reduction in RR (0.38-0.77) after the use of anti-osteoporotic drugs for secondary vertebral fractures. Bisphosphonates and PTH significantly reduced the risk of a secondary non-vertebral fracture (RR 0.59 and 0.64). PTH needed the fewest number of patients to be treated to prevent a secondary vertebral fracture (NNT: 56). Our study demonstrated the effectiveness of anti-osteoporotic agents included in our systematic review in preventing secondary vertebral fractures. Bisphosphonates and PTH were most effective in preventing non-vertebral fractures. We suggest that clinicians should prescribe these drugs to prevent secondary vertebral/non-vertebral fractures.

  6. Genetics of osteoporotic fracture

    Directory of Open Access Journals (Sweden)

    Chuan Qiu

    2011-03-01

    Full Text Available Chuan Qiu1,2, Christopher J Papasian2, Hong-Wen Deng1,2,3,4, Hui Shen1,21Center for Bioinformatics and Genomics, Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; 2Department of Basic Medical Sciences, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA; 3Center of System Biomedical Sciences, University of Shanghai for Science and Technology, Shanghai, China; 4Molecular and Statistical Genetics Lab, College of Life Sciences, Hunan Normal University, Changsha, ChinaAbstract: Osteoporosis is a major public health problem that results in a massive burden to patients and society through associated low-trauma, osteoporotic fractures. Previous studies have shown that osteoporosis-associated traits, such as low bone mineral density, as well as the probability of actually experiencing an osteoporotic fracture, are under strong genetic control. Susceptibility to osteoporosis and osteoporotic fractures is likely to be controlled by multiple genetic and environmental factors, and by interactions between them. Although numerous genetic studies, mainly candidate gene association studies, have attempted to decipher the genetic basis for osteoporosis and osteoporotic fractures, little success has been achieved. Recent advances in high-throughput genotyping technology and knowledge of common human genetic variants have shifted the approach for studying human complex disorders from candidate gene studies to large-scale genome-wide association studies. In the past three years, more than 10 genome-wide association studies have been carried out for osteoporosis. A number of genes that are associated with osteoporosis-related traits, and/or with the probability of actually experiencing an osteoporotic fracture, have been successfully identified and replicated through these studies. In this article, we review the recent progress in the genetics

  7. [Intervention in lifestyle factors for the prevention of osteoporosis and osteoporotic fractures].

    Science.gov (United States)

    Yoshimura, Noriko

    2005-08-01

    According that osteoporosis is the common condition in an aging society such as in Japan, much progress has been made in understanding the treatment and prevention of osteoporosis. Among potential risk factors, exercise, smoking, and alcohol consumption have been recognised as important lifestyle factors that might influence the risk of osteoporosis and osteoporotic fractures. To assess the relationship between these lifestyle factors and the risk for low bone mass and osteoporosis-related fractures, a systematic literature search over past 13 years was conducted. Accumulating evidence indicates that exercises decrease the risk for hip fractures among middle aged and older men and women. Exercises also help to maintain muscle strength, muscle volume, balance, and joint flexibility, which might prevent falls and fall-related fractures. One randomised controlled trial indicates that high-impact and/or weight-bearing exercise might increase the bone density in the elderly and the peak bone mass among young women. The literature search also address that there is an association between cigarette smoking and the risk of osteoporosis. Smoking cessation is effective to decrease the risk for both osteoporosis and osteoporotic fractures. Future research should be required to evaluate the alcohol consumption and osteoporosis.

  8. [Exercise and physical activities for the prevention of osteoporotic fractures: a review of the evidence].

    Science.gov (United States)

    Yoshimura, Noriko

    2003-09-01

    According that osteoporosis is the common condition in an aging society such as in Japan, much progress has been made in understanding the treatment and prevention of osteoporosis. Among potential risk factors, exercise and physical activities have been recognized as lifestyle factors that might influence the risk of osteoporosis and osteoporotic fractures. To assess the relationship between exercises including physical activities and the risk for low bone mass and osteoporosis-related fractures, a literature search over past 13 years was conducted. Accumulating evidence indicates that exercises decrease the risk for hip fractures among middle aged and older men and women. Exercises also help to maintain muscle strength, muscle volume, balance, and joint flexibility, which might prevent falls and fall-related fractures. One randomized controlled trial showed back-stretching exercise reduced the risk for vertebral fractures. The literature search also indicates that high-impact and/or weight-bearing exercise might increase the bone density in the elderly and the peak bone mass among young women, while there is no association between moderate or lower-impact exercise and bone mineral density. Future research should be required to evaluate the types and quantity of physical activity needed for the prevention of osteoporosis.

  9. 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.

  10. Fracture healing in osteoporotic bone.

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    Cheung, Wing Hoi; Miclau, Theodore; Chow, Simon Kwoon-Ho; Yang, Frank F; Alt, Volker

    2016-06-01

    As the world population rises, osteoporotic fracture is an emerging global threat to the well-being of elderly patients. The process of fracture healing by intramembranous ossification or/and endochondral ossification involve many well-orchestrated events including the signaling, recruitment and differentiation of mesenchymal stem cells (MSCs) during the early phase; formation of a hard callus and extracellular matrix, angiogenesis and revascularization during the mid-phase; and finally callus remodeling at the late phase of fracture healing. Through clinical and animal research, many of these factors are shown to be impaired in osteoporotic bone. Animal studies related to post-menopausal estrogen deficient osteoporosis (type I) have shown healing to be prolonged with decreased levels of MSCs and decreased levels of angiogenesis. Moreover, the expression of estrogen receptor (ER) was shown to be delayed in ovariectomy-induced osteoporotic fracture. This might be related to the observed difference in mechanical sensitivity between normal and osteoporotic bones, which requires further experiments to elucidate. In mice fracture models related to senile osteoporosis (type II), it was observed that chondrocyte and osteoblast differentiation were impaired; and that transplantation of juvenile bone marrow would result in enhanced callus formation. Other factors related to angiogenesis and vasculogenesis have also been noted to be impaired in aged models, affecting the degradation of cartilaginous matrixes and vascular invasion; the result is changes in matrix composition and growth factors concentrations that ultimately impairs healing during age-related osteoporosis. Most osteoporotic related fractures occur at metaphyseal sites clinically, and reports have indicated that differences exist between diaphyseal and metaphyseal fractures. An animal model that satisfies three main criteria (metaphyseal region, plate fixation, osteoporosis) is suggested for future research for

  11. The effect of teriparatide to alleviate pain and to prevent vertebral collapse after fresh osteoporotic vertebral fracture.

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    Tsuchie, Hiroyuki; Miyakoshi, Naohisa; Kasukawa, Yuji; Nishi, Tomio; Abe, Hidekazu; Segawa, Toyohito; Shimada, Yoichi

    2016-01-01

    Vertebral fracture is often seen in osteoporotic patients. Teriparatide is expected to promote bone union. Therefore, we evaluated the action of vertebral collapse prevention by administering teriparatide to vertebral fracture patients. Thirty-four patients with fresh vertebral fracture (48 vertebrae) participated in this study. They were administered either teriparatide (daily 20 µg/day or weekly 56.5 µg/week) or risedronate (17.5 mg/week): ten patients (20 vertebrae) received teriparatide daily (Daily group), 11 patients (15 vertebrae) received teriparatide weekly (Weekly group), and 13 patients (14 vertebrae) received risedronate (RIS group). We compared some laboratory examination items, visual analogue scale (VAS) of low back pain, vertebral collapse rate and local kyphotic angle, and the cleft frequency. In addition, we evaluated 22 vertebral fracture patients (24 vertebrae) who did not take any osteoporotic medicines (Control group). There was no significant difference in any of the scores at the start of treatment. At 8 and 12 weeks after the initial visit, VAS scores in the Daily and Weekly groups were significantly lower than in the RIS group (p Teriparatide is promising for the prevention of vertebral collapse progression after vertebral fracture.

  12. Percutaneous internal fixation with Y-STRUT® device to prevent both osteoporotic and pathological hip fractures: a prospective pilot study.

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    Cornelis, François H; Tselikas, Lambros; Carteret, Thibault; Lapuyade, Bruno; De Baere, Thierry; Le Huec, Jean Charles; Deschamps, Frédéric

    2017-02-09

    We studied Y-STRUT® (Hyprevention, France), a new percutaneous internal fixation device, in combination with bone cementoplasty to prevent hip fracture. Between February 2013 and February 2015, a total of 16 femoral necks in 4 osteoporotic and 12 oncologic patients have been considered for prophylactic consolidation in this prospective multicentre pilot study involving 4 different hospitals. These consolidations were performed percutaneously under fluoroscopic guidance using Y-STRUT®, a dedicated internal fixation device. For osteoporotic patients, orthopaedic surgeons performed the prophylactic consolidations immediately after surgical treatment of a hip fracture (same anaesthesia) in the opposite side. For oncologic patients, without current hip fracture but considered at risk (Mirels score ≥8), interventional radiologists performed the procedures. We report the preliminary results of feasibility, safety and tolerance of these preventive consolidations using Y-STRUT®. Four patients (mean 83 years old) had prophylactic consolidation because of a severe osteoporosis (mean T-score -3.30) resulting in first hip fractures. Ten patients (mean 61 years old) were treated because of impending pathological fractures (mean Mirels score 9) related to femoral neck osteolytic metastases. All the procedures were performed with success. Wound healing was achieved in all cases with no access site complication. Radiographic exams performed at 3 months follow-up revealed that Y-STRUT® was well integrated in the bone. For the osteoporotic cohort, mean pain was 0.9 ± 0.7 at 3 weeks. For the oncologic cohort, it decreases from 3.6 ± 2.9 at baseline to 2.4 ± 0.9 at 2 months. Preliminary results demonstrate the feasibility and safety of Y-STRUT® implantation as well as the tolerance of the device.

  13. Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients

    International Nuclear Information System (INIS)

    Kobayashi, Kiyokazu; Shimoyama, Keiji; Nakamura, Keiya; Murata, Kiyoshi

    2005-01-01

    To assess the immediate efficacy of percutaneous vertebroplasty (PVP) in relief of pain and improving mobility of patients with vertebral compression fractures (VCF) secondary to osteoporosis, 205 cases (175 patients) underwent 250 percutaneous injections of polymethylmethacrylate (PMMA; unilateral, 247 levels; bilateral, 3 levels) into vertebrae under CT and fluoroscopic guidance for 34 months. Patients were prospectively asked to quantify their pain on a visual analog scale (VAS) before and a day after PVP. The interval to mobilization was recorded in those who were immobilized because of pain and/or bed-rest therapy (115 cases). PVP was technically successful in all patients, with three cases of minimal complications. The mean VAS score available for 196 cases was improved from 7.22±1.89 (range, 3-10) to 2.07±1.19 (range, 0-10) by PVP. Ninety-four of 115 immobilized cases (81.7%) were mobile by 24 h after PVP, and the mean value was 1.9±2.8 days. The incidence of recurrent and new fractures was 15.6% in 4-25 months (mean, 15.3 months). PVP is a safe and effective treatment for relieving the pain associated with osteoporotic VCF and strengthening the vertebrae, avoiding refractures. This therapy leads to early mobilization and avoidance of the dangers of conservative therapy of bed-rest. (orig.)

  14. Local drug delivery for enhancing fracture healing in osteoporotic bone.

    Science.gov (United States)

    Kyllönen, Laura; D'Este, Matteo; Alini, Mauro; Eglin, David

    2015-01-01

    Fragility fractures can cause significant morbidity and mortality in patients with osteoporosis and inflict a considerable medical and socioeconomic burden. Moreover, treatment of an osteoporotic fracture is challenging due to the decreased strength of the surrounding bone and suboptimal healing capacity, predisposing both to fixation failure and non-union. Whereas a systemic osteoporosis treatment acts slowly, local release of osteogenic agents in osteoporotic fracture would act rapidly to increase bone strength and quality, as well as to reduce the bone healing period and prevent development of a problematic non-union. The identification of agents with potential to stimulate bone formation and improve implant fixation strength in osteoporotic bone has raised hope for the fast augmentation of osteoporotic fractures. Stimulation of bone formation by local delivery of growth factors is an approach already in clinical use for the treatment of non-unions, and could be utilized for osteoporotic fractures as well. Small molecules have also gained ground as stable and inexpensive compounds to enhance bone formation and tackle osteoporosis. The aim of this paper is to present the state of the art on local drug delivery in osteoporotic fractures. Advantages, disadvantages and underlying molecular mechanisms of different active species for local bone healing in osteoporotic bone are discussed. This review also identifies promising new candidate molecules and innovative approaches for the local drug delivery in osteoporotic bone. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  15. Osteoporotic Fracture Care: Are We Closer to Gold Standards?

    Science.gov (United States)

    Marmor, Meir; Alt, Volker; Latta, Loren; Lane, Joseph; Rebolledo, Brian; Egol, Kenneth A; Miclau, Theodore

    2015-12-01

    This review summarizes symposium presentations from the OTA's Basic Science Focus Forum on care for osteoporotic fractures. The limitations of diaphyseal osteoporotic animal bone models are discussed, together with the potential benefits of using metaphyseal models to study osteoporotic fracture fixation constructs. Metaphyseal bone repair models provide better simulation of the most common osteoporotic fractures. Selection of an osteoporotic model for mechanical testing is also challenging. One should always thoroughly define the clinical problem to be addressed. The selected model should then be validated for behavior matched to known clinical behavior with known fixation configurations. The medical management of osteoporosis is directed at enhancing bone mass, improving bone quality, and lowering fracture risk. Medical strategies to achieve these goals are discussed. The medical strategy should include provision of an adequate calcium and vitamin D environment to facilitate well-mineralized bone and improve bone quality, prevent excessive bone resorption, and provide an anabolic stimulus to enhance bone formation. Atypical femur fractures continue to be a serious issue for the orthopaedic community. Risk factors, treatment modalities, and prevention strategies are discussed. A comprehensive strategy for the improved treatment of osteoporotic fractures must address both biological and mechanical issues and includes 4 specific approaches: (1) removal of inhibitors to bone healing; (2) introduction of bone healing stimulants; (3) modification of fracture fixation constructs; and (4) application of bone augmentation or substitutes. There is currently no optimal bone substitute. Substitutes should be chosen based on the most critical need when treating a particular fracture.

  16. Danish, national cross-sectional observational study on the prevalence of prior major osteoporotic fractures in adults presenting with hip fracture—limitations and scope for fracture liaison services in prevention of hip fracture

    DEFF Research Database (Denmark)

    Frederiksen, A.; Abrahamsen, B.; Johansen, P. B.

    2018-01-01

    . Identification of vertebral fractures in particular is lacking. Introduction: The purpose of this study was to examine the prevalence of prior major osteoporotic fractures (MOF) in the prior 10 years preceding hip fracture in order to provide information about the potential for prevention of hip fractures...... if occurring more than 6 months before the present fracture. Results: A total of 28% of hip fracture patients (32% of women and 19% of men) had at least one recognized MOF in the preceding 10 years. Forearm and humerus fractures constituted > 70% of prior MOF. In both genders, vertebral fractures only...... represented a small percentage (2.6%) of previously recognized MOF. Men were less likely than women to have experienced a prior MOF, chiefly due to fewer forearm and humerus fractures. Conclusion: The majority of hip fractures—and in particular hip fractures in men—occur without a previously treated MOF...

  17. Concomitant and previous osteoporotic vertebral fractures.

    Science.gov (United States)

    Lenski, Markus; Büser, Natalie; Scherer, Michael

    2017-04-01

    Background and purpose - Patients with osteoporosis who present with an acute onset of back pain often have multiple fractures on plain radiographs. Differentiation of an acute osteoporotic vertebral fracture (AOVF) from previous fractures is difficult. The aim of this study was to investigate the incidence of concomitant AOVFs and previous OVFs in patients with symptomatic AOVFs, and to identify risk factors for concomitant AOVFs. Patients and methods - This was a prospective epidemiological study based on the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA) with 1,005 patients and 2,874 osteoporotic vertebral fractures, which has been running since February 1, 2006. Concomitant fractures are defined as at least 2 acute short-tau inversion recovery (STIR-) positive vertebral fractures that happen concomitantly. A previous fracture is a STIR-negative fracture at the time of initial diagnostics. Logistic regression was used to examine the influence of various variables on the incidence of concomitant fractures. Results - More than 99% of osteoporotic vertebral fractures occurred in the thoracic and lumbar spine. The incidence of concomitant fractures at the time of first patient contact was 26% and that of previous fractures was 60%. The odds ratio (OR) for concomitant fractures decreased with a higher number of previous fractures (OR =0.86; p = 0.03) and higher dual-energy X-ray absorptiometry T-score (OR =0.72; p = 0.003). Interpretation - Concomitant and previous osteoporotic vertebral fractures are common. Risk factors for concomitant fractures are a low T-score and a low number of previous vertebral fractures in cases of osteoporotic vertebral fracture. An MRI scan of the the complete thoracic and lumbar spine with STIR sequence reduces the risk of under-diagnosis and under-treatment.

  18. Indirect comparison of bazedoxifene vs oral bisphosphonates for the prevention of vertebral fractures in postmenopausal osteoporotic women.

    Science.gov (United States)

    Ellis, Alexandra G; Reginster, Jean-Yves; Luo, Xuemei; Bushmakin, Andrew G; Williams, Robert; Sutradhar, Santosh; Mirkin, Sebastian; Jansen, Jeroen P

    2014-08-01

    Compare the efficacy of bazedoxifene with oral bisphosphonates for reduction of vertebral fracture risk in postmenopausal osteoporotic (PMO) women and in higher-risk patients based on evidence from randomized controlled trials (RCTs). Eight RCTs assessing vertebral fracture risk reduction with oral bisphosphonates (n = 7) or bazedoxifene (n = 1) were identified by a systematic literature review. Individual study results were pooled in a network meta-analysis (NMA) to indirectly compare treatment effects for overall PMO women and a higher-risk subgroup (FRAX ≥ 20%). Three sets of NMA analyses were conducted: aggregate data (AD) from the bisphosphonate RCTs and bazedoxifene RCT for the full population or the FRAX ≥20% subgroup (NMA AD); bisphosphonate AD and bazedoxifene AD from each FRAX subgroup adjusted for baseline risk (NMA AD meta-regression); and bisphosphonate AD and bazedoxifene individual patient data (IPD) adjusted for baseline risk/FRAX (NMA AD/IPD meta-regression). For the overall population, bisphosphonates had lower fracture risks versus bazedoxifene although there is considerable uncertainty in supporting one intervention over another. The relative risk reduction (RRR) for bazedoxifene was -0.23 (95% CrI: -1.11, 0.27) versus ibandronate, -0.17 (-0.76, 0.22) versus alendronate, and -0.06 (-0.62, 0.30) versus risedronate. RESULTS from the meta-regression analyses were similar. For the FRAX ≥20% population, estimated fracture rates with bazedoxifene were lower than with bisphosphonates, but again the uncertainty limits strong interpretation. The RRR for bazedoxifene was 0.51 (-0.31, 0.83) versus ibandronate, 0.53 (-0.18, 0.83) versus alendronate, and 0.57 (-0.07, 0.85) versus risedronate. The meta-regression analyses showed comparable findings. The analyses only considered vertebral fractures for oral bisphosphonates versus bazedoxifene, and IPD was available only for bazedoxifene. In light of this, bazedoxifene is comparable to

  19. Identifying osteoporotic vertebral endplate and cortex fractures.

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    Wáng, Yì Xiáng J; Santiago, Fernando Ruiz; Deng, Min; Nogueira-Barbosa, Marcello H

    2017-10-01

    Osteoporosis is the most common metabolic bone disease, and vertebral fractures (VFs) are the most common osteoporotic fracture. A single atraumatic VF may lead to the diagnosis of osteoporosis. Prevalent VFs increase the risk of future vertebral and non-vertebral osteoporotic fracture independent of bone mineral density (BMD). The accurate and clear reporting of VF is essential to ensure patients with osteoporosis receive appropriate treatment. Radiologist has a vital role in the diagnosis of this disease. Several morphometrical and radiological methods for detecting osteoporotic VF have been proposed, but there is no consensus regarding the definition of osteoporotic VF. A vertebra may fracture yet not ever result in measurable changes in radiographic height or area. To overcome these difficulties, algorithm-based qualitative approach (ABQ) was developed with a focus on the identification of change in the vertebral endplate. Evidence of endplate fracture (rather than variation in vertebral shape) is the primary indicator of osteoporotic fracture according to ABQ criteria. Other changes that may mimic osteoporotic fractures should be systemically excluded. It is also possible that vertebral cortex fracture may not initially occur in endplate. Particularly, vertebral cortex fracture can occur in anterior vertebral cortex without gross vertebral deformity (VD), or fractures deform the anterior vertebral cortex without endplate disruption. This article aims to serve as a teaching material for physicians or researchers to identify vertebral endplate/cortex fracture (ECF). Emphasis is particularly dedicated to identifying ECF which may not be associated apparent vertebral body collapse. We believe a combined approach based on standardized radiologic evaluation by experts and morphometry measurement is the most appropriate approach to detect and classify VFs.

  20. Identifying osteoporotic vertebral endplate and cortex fractures

    Science.gov (United States)

    Santiago, Fernando Ruiz; Deng, Min; Nogueira-Barbosa, Marcello H.

    2017-01-01

    Osteoporosis is the most common metabolic bone disease, and vertebral fractures (VFs) are the most common osteoporotic fracture. A single atraumatic VF may lead to the diagnosis of osteoporosis. Prevalent VFs increase the risk of future vertebral and non-vertebral osteoporotic fracture independent of bone mineral density (BMD). The accurate and clear reporting of VF is essential to ensure patients with osteoporosis receive appropriate treatment. Radiologist has a vital role in the diagnosis of this disease. Several morphometrical and radiological methods for detecting osteoporotic VF have been proposed, but there is no consensus regarding the definition of osteoporotic VF. A vertebra may fracture yet not ever result in measurable changes in radiographic height or area. To overcome these difficulties, algorithm-based qualitative approach (ABQ) was developed with a focus on the identification of change in the vertebral endplate. Evidence of endplate fracture (rather than variation in vertebral shape) is the primary indicator of osteoporotic fracture according to ABQ criteria. Other changes that may mimic osteoporotic fractures should be systemically excluded. It is also possible that vertebral cortex fracture may not initially occur in endplate. Particularly, vertebral cortex fracture can occur in anterior vertebral cortex without gross vertebral deformity (VD), or fractures deform the anterior vertebral cortex without endplate disruption. This article aims to serve as a teaching material for physicians or researchers to identify vertebral endplate/cortex fracture (ECF). Emphasis is particularly dedicated to identifying ECF which may not be associated apparent vertebral body collapse. We believe a combined approach based on standardized radiologic evaluation by experts and morphometry measurement is the most appropriate approach to detect and classify VFs. PMID:29184768

  1. Percutaneous cement augmentation for osteoporotic vertebral fractures.

    Science.gov (United States)

    Sebaaly, Amer; Rizkallah, Maroun; Bachour, Falah; Atallah, Firas; Moreau, Pierre Emmanuel; Maalouf, Ghassan

    2017-06-01

    Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people.Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population.Percutaneous fixation by 'vertebroplasty' is a tempting alternative for open surgical management of these fractures.Despite discouraging initial results of early trials for vertebroplasty, cement augmentation proved its superiority for the treatment of symptomatic osteoporotic vertebral fracture when compared with optimal medical treatment.Early intervention is also gaining ground recently.Kyphoplasty has the advantage over vertebroplasty of reducing kyphosis and cement leak.Stentoplasty, a new variant of cement augmentation, is also showing promising outcomes.In this review, we describe the additional techniques of cement augmentation, stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed. Cite this article: EFORT Open Rev 2017;2:293-299. DOI: 10.1302/2058-5241.2.160057.

  2. Vertebral fractures in the elderly may not always be "osteoporotic".

    Science.gov (United States)

    Jiang, G; Luo, J; Pollintine, P; Dolan, P; Adams, M A; Eastell, R

    2010-07-01

    Vertebral fractures in the elderly are often assumed to be "osteoporotic" and require anti-osteoporosis therapy. However, some of these fractures may represent traumatic injuries to vertebrae that have comparatively normal bone mineral density (BMD). We hypothesize that radiographic appearances can be used to differentiate between "osteoporotic" fractures of vertebrae with low BMD and strength, and "traumatic" fractures of vertebrae with normal BMD and strength. 73 cadaveric specimens (each comprising two vertebrae with the intervening intervertebral disc and ligaments) were obtained from donors aged 42 to 91 (mean 74) years. Areal BMD was measured in the lateral projection for each vertebral body, using DXA. Each specimen was secured in metal cups containing dental plaster, and compressed to failure at 3mm/s on a computer-controlled materials testing machine. Mechanical failure was detected by a reduction in the gradient of the load-deformation curve. Compressive deformation for each specimen was limited to 4mm in order to prevent gross destruction of the vertebra. Radiographs, obtained before and after mechanical loading, were assessed by an experienced radiologist (GJ) who was blinded to BMD and mechanical data. The algorithm-based qualitative method (ABQ) was used to assign each specimen to two possible outcomes: no discernible fracture of either vertebra, or fracture. The latter were further classified into specimens with osteoporotic fracture and those with traumatic fracture, by applying additional criteria for differential diagnosis. The relationship of failure load to BMD was tested using correlation. BMD and failure load for the three diagnostic outcomes were compared using one-way analysis of variance (ANOVA). Failure load was proportional to BMD (R=0.63, pOsteoporotic," "traumatic" and "no discernible" fractures were reported in 16, 26 and 31 specimens respectively. "Traumatic" fracture specimens had higher BMD and failed at higher loads than

  3. 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

  4. Low prevalence of osteoporosis treatment in patients with recurrent major osteoporotic fracture.

    Science.gov (United States)

    Flais, J; Coiffier, G; Le Noach, J; Albert, J D; Faccin, M; Perdriger, A; Thomazeau, H; Guggenbuhl, P

    2017-12-01

    The majority of patients do not receive anti-osteoporotic treatment following a major osteoporotic fracture, despite the guidelines and the availability of effective anti-osteoporotic treatments. The fight against factors limiting the diagnosis and treatment of osteoporosis should become a priority to improve secondary prevention after an initial osteoporotic fracture. Despite the availability of effective anti-osteoporotic treatments, osteoporosis management is currently insufficient. The main objective of this study was to assess the prevalence of anti-osteoporotic treatments introduced after an initial prior major osteoporotic fracture during hospitalization for recurring fractures. We conducted an observational, cross-sectional, bicentric study that included all patients aged over 50 years who were hospitalized or seen in consultation for major osteoporotic fracture. One hundred twenty-eight out of two hundred four (62.7%) patients had a past history of major osteoporotic fracture and therefore had an indication of treatment based on guidelines. Among these patients, only 43/128 (33.5%) had received anti-osteoporotic treatment as secondary prevention after the initial fracture. The main causes of non-prescription identified were the attending physicians' ignorance of the indication of treatment (n = 30; 35.3%), ignorance of the fracture (n = 17; 20%), and comorbidities (n = 12; 14.1%). The failure to introduce treatment was associated with the presence of comorbidities with a Charlson Comorbidity Index ≥6 (OR = 0.34 [0.16-0.73], p osteoporotic fracture presenting with a new fracture were not treated. The main reason for lack of treatment seems to stem from the incorrect assessment of the patient's fracture risk. Although major osteoporotic fracture leads to an increased risk of mortality and requires treatment, the significance of patient comorbidities was an independent risk factor leading to non-treatment.

  5. Inhibition of Midkine Augments Osteoporotic Fracture Healing.

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    Melanie Haffner-Luntzer

    Full Text Available The heparin-binding growth and differentiation factor midkine (Mdk is proposed to negatively regulate osteoblast activity and bone formation in the adult skeleton. As Mdk-deficient mice were protected from ovariectomy (OVX-induced bone loss, this factor may also play a role in the pathogenesis of postmenopausal osteoporosis. We have previously demonstrated that Mdk negatively influences bone regeneration during fracture healing. Here, we investigated whether the inhibition of Mdk using an Mdk-antibody (Mdk-Ab improves compromised bone healing in osteoporotic OVX-mice. Using a standardized femur osteotomy model, we demonstrated that Mdk serum levels were significantly enhanced after fracture in both non-OVX and OVX-mice, however, the increase was considerably greater in osteoporotic mice. Systemic treatment with the Mdk-Ab significantly improved bone healing in osteoporotic mice by increasing bone formation in the fracture callus. On the molecular level, we demonstrated that the OVX-induced reduction of the osteoanabolic beta-catenin signaling in the bony callus was abolished by Mdk-Ab treatment. Furthermore, the injection of the Mdk-Ab increased trabecular bone mass in the skeleton of the osteoporotic mice. These results implicate that antagonizing Mdk may be useful for the therapy of osteoporosis and osteoporotic fracture-healing complications.

  6. Radiographic patterns of osteoporotic proximal humerus fractures.

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    Carbone, Stefano; Mezzoprete, Riccardo; Papalia, Matteo; Arceri, Valerio; Carbone, Andrea; Gumina, Stefano

    2018-03-01

    The objectives of the study were: a) to identify osteoporotic proximal humerus fractures in a large consecutive series of patients; b) to identify radiographic fracture patterns among osteoporotic and non-osteoporotic proximal humerus fractures; and c) to calculate intra- and inter-observer reliability of assessment of osteoporosis and of radiographic fracture patterns. This was a prospective observational study of patients admitted to the emergency department affected by a proximal humerus fracture between June 2014 and June 2016. Three researchers evaluated demographic data and comorbidities, x-rays and CT-scans. A new evaluation method for assessment of osteoporosis was proposed; 7 radiographic fracture patterns were studied. Reliabilities between intra- and inter-tester evaluations, and correlations between the presence of osteoporosis and the 7 radiologic fracture patterns were calculated. Two hundred twenty-five patients with a humeral fracture were recruited. Their mean (26-95, 32) age was 58. Of those, 163 (72.4%) were identified as osteoporotic. Among the three raters, the intra- and inter-observer agreement using the proposed methods were high or excellent. Significant correlations with diagnosis of osteoporosis were found with Codman-Lego type 12(p = 0.041), metaphyseal comminution(p patterns were high. Osteoporosis of the proximal humerus was identified in 72% of patients during a two year period; most of these patients were elderly females sustaining low energy trauma. These fractures showed to have specific radiographic patterns, as comminution of metaphysis and tuberosities, impaction of fragments, and inferior subluxation of the humeral head. These patterns can be assessed with the simple observation of a 2-plan view of a radiograph, without the use of specific software. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. Percutaneous vertebroplasty in osteoporotic vertebral compression fractures

    NARCIS (Netherlands)

    Voormolen, Maurits Hendrik Joannes

    2006-01-01

    Percutaneous vertebroplasty (PV) literary means augmentation of the vertebral body through the skin. The main goal is partial or complete pain relief. Nowadays, the most frequent indication for treatment is a painful invalidating osteoporotic vertebral compression fracture (VCF), not responding to

  8. Unnoticed sacral fractures in osteoporotic patients

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    Roucoules, J.; Laredo, J.D.; Pouchot, J.; Artru, L.; Bard, M.; Kuntz, D.; Ryckewaert, A.

    1987-01-01

    We are reporting 4 cases of unnoticed sacral fractures in osteoporotic women. Their mean age was 73 years. Only in one case the fracture was seen on a standard X-Ray. On the other hand, hyperfixation with isotopes on the sacrum formed a very characteristic H-shaped image. In two of these patients, the sacral fracture was confirmed by tomodensitometry, but this examination was unavailing in the third patient. In the 4th case, hyperfixation of the isotope was not significant. Only a guided bone biopsy and the favourable evolution of the disease enabled the diagnosis of sacral fracture.

  9. Anti-Osteoporotic Therapy After Fragility Fracture Lowers Rate of Subsequent Fracture: Analysis of a Large Population Sample.

    Science.gov (United States)

    Bawa, Harpreet S; Weick, Jack; Dirschl, Douglas R

    2015-10-07

    This investigation assessed the effectiveness of initiating anti-osteoporotic therapy after a fragility fracture in preventing subsequent fractures. The Truven Health MarketScan databases, which contain de-identified, integrated, person-specific claim data, were queried from 2003 to 2012. The study population included individuals fifty years of age or older who sustained a fragility fracture, defined as any fracture of the wrist, proximal part of the humerus, hip, or vertebra, and had three years of continuous enrollment following fracture. Patients were stratified into either an anti-osteoporotic therapy group or a no-treatment group. Subsequent fracture was defined as a fragility fracture occurring more than ninety days following the index fracture. Subjects were followed for three years. Unadjusted and age and sex-adjusted odds ratios for subsequent fracture were calculated for both groups. This investigation included 31,069 subjects, of whom 10.6% were treated with anti-osteoporotic therapy following the index fracture. The anti-osteoporotic therapy group was older and had a greater proportion of female patients compared with the no-treatment group. The three-year subsequent fracture rates were 7.5% in the anti-osteoporotic therapy group and 9.7% in the no-treatment group. Unadjusted odds ratios for subsequent fracture showed that the anti-osteoporotic therapy group experienced a risk reduction of 33% after an index wrist fracture, 48% after an index proximal humeral fracture, 28% after an index hip fracture, 20% after an index vertebral fracture, and 25% after all fractures combined. Age and sex-adjusted odds ratios showed that the anti-osteoporotic therapy group experienced a reduction in risk of 50% after an index wrist fracture, 52% after an index proximal humeral fracture, 34% after an index hip fracture, 43% after an index vertebral fracture, and 40% after all fractures combined. The number needed to treat to prevent a subsequent fragility fracture was

  10. Use of teriparatide in osteoporotic fracture patients.

    Science.gov (United States)

    Collinge, Cory; Favela, Juan

    2016-01-01

    Teriparatide [PTH (1-34)] is a genetically engineered analog of human parathyroid hormone that acts as an anabolic drug by increasing activity in both osteoblasts and osteoclasts. Intermittent (once-daily) doses of teriparatide seem to stimulate osteoblast activity and therefore result in a net increase of bone formation. It is recommended for use in post-menopausal women (PMW), men with hypogonadal osteoporosis, as well as men and women with glucocorticoid-induced osteoporosis. In vivo studies have generated important findings regarding teriparatide's role in the enhancement of fracture healing. The intention of this article is to review the clinical findings of teriparatide to stimulate fracture healing. The drug was shown in a prospective randomized, double blind study to achieve earlier radiographic cortical bridging of three of four cortices (7.4 weeks) compared to patients who were assigned to the placebo group (9.1 weeks). Another study compared mean time for healing and functional outcome in two groups of elderly women who had suffered osteoporotic pelvic fractures: one group received daily 100 μg parathyroid hormone (1-84) injections, while the other group received no treatment. Patients who received the PTH (1-84) injections accelerated radiographic and clinical fracture healing (7.8 weeks) when compared to patients who received no treatment (12.6 weeks, pteriparatide use in patients recovering from fractures. In the following scenarios, teriparatide might be considered in patients with osteoporosis and a fracture: (1) patients with severe osteoporosis with use of bisphosphonates for a number of years with a fracture not expected to predictably unite, e.g. atypical femur fracture or open tibia fracture, (2) in cases where an osteoporotic patient has failed fracture healing and is considering surgical treatment e.g. non-union surgery. It seems prudent to reevaluate these patients frequently and reconsider which drug class of osteoporotic drug is best for

  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. Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications.

    NARCIS (Netherlands)

    Link, T.M.; Guglielmi, G.; Kuijk, C. van; Adams, J.E.

    2005-01-01

    As populations age osteoporosis becomes an increasingly important public health issue. Among osteoporotic fractures vertebral fractures are of particular relevance: they are the most common fractures, frequently are asymptomatic but have an important influence on prognosis and morbidity in the

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

    Science.gov (United States)

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

    2016-03-18

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

  14. 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.

  15. Osteoporotic Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research.

    Science.gov (United States)

    Yoo, Je-Hyun; Moon, Seong-Hwan; Ha, Yong-Chan; Lee, Dong Yeon; Gong, Hyun Sik; Park, Si Young; Yang, Kyu Hyun

    2015-11-01

    Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs worldwide. Prior osteoporotic fracture at any site is one of the strongest risk factors for a new fracture, which occurs very soon after the first fracture. Bone mineral density (BMD) scan, a conventional diagnostic tool for osteoporosis, has clear limitations in diagnosing osteoporotic fractures and identifying the risk of subsequent fractures. Therefore, early and accurate diagnosis of osteoporotic fractures using the clinical definition which is applicable practically and independent of BMD, is essential for preventing subsequent fractures and reducing the socioeconomic burden of these fractures. Fractures caused by low-level trauma equivalent to a fall from a standing height or less at major (hip, spine, distal radius, and proximal humerus) or minor (pelvis, sacrum, ribs, distal femur and humerus, and ankle) sites in adults over age 50, should be first regarded as osteoporotic. In addition, if osteoporotic fractures are strongly suspected on history and physical examination even though there are no positive findings on conventional X-rays, more advanced imaging techniques such as computed tomography, bone scan, and magnetic resonance imaging are necessary as soon as possible.

  16. Medical Cost Analysis of the Osteoporotic Hip Fractures

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    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.

  17. PTH analogues and osteoporotic fractures

    NARCIS (Netherlands)

    Verhaar, H.J.; Lems, W.F.

    2010-01-01

    Importance of the field: At present there are two parathyroid hormone (PTH) analogues (PTH 1 34 and PTH 1 84) registered for the treatment of established osteoporosis in postmenopausal women (PTH 1 34 and PTH 1 84) and in men (PTH 1 34 only) who are at increased risk of having a fracture. Areas

  18. Secondary prevention of osteoporosis and osteoporotic fractures in real clinical practice and possibilities of its improvement with strontium ranelate

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    Nataliya Vladimirovna Toroptsova

    2012-01-01

    Full Text Available The main ultimate goal of secondary prevention of osteoporosis (OP is to reduce the risk of fracture in patients with the already existing disease; the effect of pathogenetic agents develops only if they are used regularly and long. Low patient adherence to treatment minimizes all efforts to prevent OP complications. There is low-frequency prescription of pathogenetic antiosteoporotic agents to this category of patients. There is a wide range of pathogenetic antiosteoporotic drugs today. On choosing a medicine, a physician should rely on its proven efficacy and safety, as well as its convenience use for a specific patient. The data of an international clinical trial to prevent fractures during long-term therapy with strontium ranelate are given.

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

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    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.

  20. Change of Bone Mineral Density Measurement among Patients with Osteoporotic Fractures in Korean Population Using National Claim Database.

    Science.gov (United States)

    Park, Chan Ho; Lee, Young-Kyun; Ha, Yong-Chan

    2017-08-01

    Prior osteoporotic fractures are strongly associated with subsequent fractures. To prevent this, the diagnosis of osteoporosis following an osteoporotic fracture is important. The measurement of bone mineral density (BMD) is the first step in the diagnosis and management of osteoporosis. Therefore, this study aimed 1) to evaluate the rate of BMD measurement after osteoporotic fracture in the Korean population, and 2) to determine whether the rate of BMD measurement after osteoporotic fracture changed between 2005 and 2010. Using the database of the Health Insurance Review Assessment Service (HIRA), we identified patients with osteoporotic fractures (hip, spine, humerus, and wrist fractures) in 2005 and 2010. BMD examinations were evaluated by using procedure codes and medicines, exclusively approved for osteoporosis treatment. During the study period, about half of all patients with osteoporotic fractures had BMD measurement. Between 2005 and 2010, the rate of BMD measurement significantly increased from 42.0% (65,556/156,190) to 53.9% (103,785/192,556) ( P osteoporotic fractures had BMD measurement, and that screening for osteoporosis in patients with osteoporotic fractures increased between 2005 and 2010.

  1. Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications

    International Nuclear Information System (INIS)

    Link, Thomas M.; Guglielmi, Giuseppe; Kuijk, Cornelis van; Adams, Judith E.

    2005-01-01

    As populations age osteoporosis becomes an increasingly important public health issue. Among osteoporotic fractures vertebral fractures are of particular relevance: they are the most common fractures, frequently are asymptomatic but have an important influence on prognosis and morbidity in the osteoporotic patient. Previous studies have suggested that these fractures are frequently not diagnosed and that radiologists miss a high percentage of osteoporotic, vertebral fractures present on lateral chest radiographs. The aims of this review are (1) to emphasize the important role that radiologists play in the accurate and clear reporting of vertebral fractures, (2) to provide guidance in assessing these fractures in radiographs, MRI and computed tomography imaging of the vertebral spine and (3) to sensitize the radiologist in diagnosing fractures in chest radiographs. (orig.)

  2. Association between Serum Cholesterol Level and Osteoporotic Fractures.

    Science.gov (United States)

    Wang, Yanmao; Dai, Jiezhi; Zhong, Wanrun; Hu, Chengfang; Lu, Shengdi; Chai, Yimin

    2018-01-01

    Previous epidemiological studies have found an association between serum cholesterol level and bone mineral density. However, epidemiological studies evaluating the association between serum cholesterol level and the incidence of osteoporotic fracture are scant. Therefore, the objective of this study was to investigate whether serum cholesterol levels in Chinese participants aged 55 years or older was associated with an increased risk of osteoporotic fracture. We performed a cross-sectional study, including 1,791 participants (62.1% postmenopausal women and 213 fractures). Standardized self-administered questionnaires, physical examination, laboratory tests, and dual-energy X-ray absorptiometry examination were performed. Multivariate-adjusted logistic regression models were used to evaluate associations between serum cholesterol [total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C)] levels and the osteoporotic fracture risk. After adjusting for potential confounding factors, there were no associations between per SD increase in TC and LDL level and an increased risk of osteoporotic fracture in total participants, and in men and women as individual groups. There was a significant association between per SD increase in HDL-C level and an increased risk of osteoporotic fracture in total participants [odds ratios (OR) 1.20, 95% confidence interval (CI) 1.03, 1.40, P  = 0.023] and in women (OR 1.37, 95% CI 1.12, 1.68, P  = 0.003), whereas no association was observed in men (OR 1.01, 95% CI 0.73, 1.40, P  = 0.951). Additionally, we found a significant association between per SD increase in TG level and an increased risk of osteoporotic fracture in total participants (OR 1.20, 95% CI 1.04, 1.38, P  = 0.015). In women, a nonlinear relationship was observed between per SD increase in TG level and an increased risk of osteoporotic fracture. The risk of osteoporotic fracture in women increased

  3. Osteoporotic vertebral fracture simulating a spinal tumor: a case report

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    Moscote-Salazar Luis Rafael

    2015-06-01

    Full Text Available Vertebral fractures are a frequent entity, mainly in the thoracolumbar and lumbar spine. In some circumstances the differential diagnosis of vertebral injuries can confuse the physician, since the difference between an osteoporotic vertebral fracture and a fracture secondary to a tumor is not clear. We report the case of a patient with osteoporotic vertebral fracture simulating a spinal tumor, handled by our department of neurosurgery as illustrative experience to guide the approach in those cases, in which the definitive diagnosis is crucial for therapeutic decision making

  4. Can anti-osteoporotic therapy reduce adjacent fracture in magnetic resonance imaging-proven acute osteoporotic vertebral fractures?

    Science.gov (United States)

    Chen, Ying-Chou; Lin, Wei-Che

    2016-04-06

    Adjacent fracture of the cemented vertebrae result from crushed fragile trabeculae during follow-up, suggesting impaired bone marrow integrity. This study aimed to determine if anti-osteoporotic therapy can decrease the risk of adjacent fracture in patients after vertebroplasty. This retrospective study reviewed of cases of osteoporotic patients with magnetic resonance imaging (MRI)-proven acute vertebral fractures between 2001 and 2007. Osteoporotic patients were investigated as determined by pre-operative MRI with subsequent adjacent fracture of the cemented vertebrae and for the possibility of anti-osteoporotic therapy decreasing the progression of collapse after a minimum of 6 months follow-up. All associated co-morbidities were recorded, as well as the use of anti-osteoporotic drugs (i.e., bisphosphonate, raloxifen, calcitonin, and teriparatide). Cox regression analysis was also performed. The 192 vertebral fractured patients who underwent vertebroplasty and anti-osteoporotic therapy had a mean age of 74.40 ± 6.41. The basic characteristics of patients with and without adjacent fracture differed in age, body mass index, rheumatoid arthritis, and use of glucocorticoids and anti-osteoporotic drugs (Table 1). Using the Kaplan-Meier curve, anti-osteoporotic therapy after vertebroplasty had a significant effect on adjacent fracture (p = 0.037, by log rank text). After adjusting for potential confounders, patients with anti-osteoporotic therapy still had a lower adjacent fracture rate than patients without anti-osteoporotic therapy (p = 0.006; HR: 2.137, 95 % CI: 1.1238-3.690). The adjacent fracture rate also increased in old age (p = 0.019; HR: 1.049; 95 % CI:1.008-1.039) and among smokers (p = 0.026; HR: 3.891; 95 % CI: 1.175-12.890). In this study, adjacent fracture of cemented vertebrae is inevitable after vertebroplasty but can be mitigated by anti-osteoporotic therapy to increase bone mass.

  5. Clinical management of osteoporotic vertebral fracture treated with percutaneous vertebroplasty.

    Science.gov (United States)

    Capozzi, Anna; Scambia, Giovanni; Pedicelli, Alessandro; Evangelista, Maurizio; Sorge, Roberto; Lello, Stefano

    2017-01-01

    Our study demonstrated percutaneous vertebroplasty (PVP) is an effective procedure to rapidly reduce back pain in patients affected by acute osteoporotic vertebral compression fractures (OVCFs) assessed by MRI. We confirmed in our sample, femoral bone density impacts more deeply than vertebral T-score and/or BMD on bone strenght, as it is less affected by any interferences. We interestingly found the presence of previous osteoporotic fragility fractures and chronic glucocorticoids therapy should especially negatively influence bone health of our patients. On the other hand, even if both FRAX scores for major osteoporotic fractures and for femoral fractures seemed to globally define a population at major risk for fragility fractures, our analysis is retrospectively done. We choose and suggest a multidisciplinary medical management of these patients, considering OP is a multifactorial disease and OVCFs usually produce lots of different important consequences on general health.

  6. Evaluating osteoporotic fracture risk with the Fracture Risk Assessment Tool in Chinese patients with rheumatoid arthritis.

    Science.gov (United States)

    Meng, Juan; Li, Yanchun; Yuan, Xiaoxu; Lu, Yuewu

    2017-05-01

    This study aims to evaluate the discriminative and predictive capacity of the Fracture Risk Assessment Tool (FRAX) to determine the 10-year risk of osteoporotic fracture in Chinese rheumatoid arthritis (RA) patients.This study included 168 RA patients and 168 healthy individuals as controls. The Chinese mainland FRAX model was applied to calculate the 10-year risk of osteoporotic fractures, defined as fracture of the spine, forearm, hip, or shoulder.The incidence of osteoporosis was significantly increased in RA patients compared to controls (P osteoporotic fractures in Chinese RA patients. Ten-year osteoporotic fracture risk in Chinese RA patients was higher when BMD was incorporated in FRAX.There was a higher incidence of osteoporosis and reduced BMD in RA patients compared to controls. The FRAX model should integrate femoral neck BMD with other risk factors to evaluate osteoporotic fracture risk in RA patients, making it a valuable screening tool.

  7. 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

  8. 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

    2017-01-01

    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 6o to 50o. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Alexandra L. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom)], E-mail: alexandra.firth@virgin.net; Al-Busaidi, Aisha [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom)], E-mail: albusaidi@doctors.org.uk; Sparrow, Patrick J. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom)], E-mail: patsparrow@doctors.org.uk; Adams, Judith E. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom); Department of Clinical Radiology, Imaging Science and Biomedical Engineering, Stopford Building, , University of Manchester, Oxford Road, Manchester M13 9PT (United Kingdom)], E-mail: judith.adams@manchester.ac.uk; Whitehouse, Richard W. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom)], E-mail: Richard.Whitehouse@cmmc.nhs.uk

    2009-01-15

    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.

  10. A systematic review of current osteoporotic metaphyseal fracture animal models.

    Science.gov (United States)

    Wong, R M Y; Choy, M H V; Li, M C M; Leung, K-S; K-H Chow, S; Cheung, W-H; Cheng, J C Y

    2018-01-01

    The treatment of osteoporotic fractures is a major challenge, and the enhancement of healing is critical as a major goal in modern fracture management. Most osteoporotic fractures occur at the metaphyseal bone region but few models exist and the healing is still poorly understood. A systematic review was conducted to identify and analyse the appropriateness of current osteoporotic metaphyseal fracture animal models. A literature search was performed on the Pubmed, Embase, and Web of Science databases, and relevant articles were selected. A total of 19 studies were included. Information on the animal, induction of osteoporosis, fracture technique, site and fixation, healing results, and utility of the model were extracted. Fracture techniques included drill hole defects (3 of 19), bone defects (3 of 19), partial osteotomy (1 of 19), and complete osteotomies (12 of 19). Drill hole models and incomplete osteotomy models are easy to perform and allow the study of therapeutic agents but do not represent the usual clinical setting. Additionally, biomaterials can be filled into drill hole defects for analysis. Complete osteotomy models are most commonly used and are best suited for the investigation of therapeutic drugs or noninvasive interventions. The metaphyseal defect models allow the study of biomaterials, which are associated with complex and comminuted osteoporotic fractures. For a clinically relevant model, we propose that an animal model should satisfy the following criteria to study osteoporotic fracture healing: 1) induction of osteoporosis, 2) complete osteotomy or defect at the metaphysis unilaterally, and 3) internal fixation. Cite this article : R. M. Y. Wong, M. H. V. Choy, M. C. M. Li, K-S. Leung, S. K-H. Chow, W-H. Cheung, J. C. Y. Cheng. A systematic review of current osteoporotic metaphyseal fracture animal models. Bone Joint Res 2018;7:6-11. DOI: 10.1302/2046-3758.71.BJR-2016-0334.R2. © 2018 Wong et al.

  11. [Stress fractures of the distal fibula in an osteoporotic woman].

    Science.gov (United States)

    Schwartz, Frederik; Heerfordt, Ida Marie

    2014-08-04

    We report a case of an 81-year-old osteoporotic woman, who suffered stress fractures of the distal fibula on both sides within a two-year period. The risk factors for stress fractures are reviewed and the importance of a high index of suspicion for stress fractures is emphasized. When a stress fracture is suspected it should lead to plain radiography and treatment with protected weight-bearing with crutches or a brace.

  12. The challenge of fracture management in osteoporotic bones

    African Journals Online (AJOL)

    like diphosphonates to assist in fracture healing and use of augmentation techniques is worthwhile considering. Kenya Orthopaedic Association (K.O.A) formulate a policy for management of osteoporotic fractures in our local set up. InTRoduCTIon. Osteoporosis is defined as a systemic skeletal disease characterised by low ...

  13. 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.

  14. Evaluating osteoporotic fracture risk with the Fracture Risk Assessment Tool in Chinese patients with rheumatoid arthritis

    OpenAIRE

    Meng, Juan; Li, Yanchun; Yuan, Xiaoxu; Lu, Yuewu

    2017-01-01

    Abstract This study aims to evaluate the discriminative and predictive capacity of the Fracture Risk Assessment Tool (FRAX) to determine the 10-year risk of osteoporotic fracture in Chinese rheumatoid arthritis (RA) patients. This study included 168 RA patients and 168 healthy individuals as controls. The Chinese mainland FRAX model was applied to calculate the 10-year risk of osteoporotic fractures, defined as fracture of the spine, forearm, hip, or shoulder. The incidence of osteoporosis wa...

  15. Occult posterior pelvic ring fractures in elderly patients with osteoporotic pubic rami fractures.

    Science.gov (United States)

    Lau, Tak-wing; Leung, Frankie

    2010-08-01

    To evaluate postoperative walking status of elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. 33 women and 4 men aged 66 to 95 (mean, 85) years presented with osteoporotic pubic rami fractures after a fall. 22 (59%) of the patients had additional posterior pelvic ring fractures (9 had lateral compression type-II fractures involving the ilium and 13 had lateral compression type-I fractures involving the sacroalar region). Seven of the 9 patients with lateral compression type-II fractures underwent open reduction and internal fixation using plates and/ or screws. The remaining 30 patients were treated conservatively. Postoperative walking status was similar in elderly patients with osteoporotic pubic rami fractures with or without posterior pelvic ring fractures. Posterior pelvic ring fractures are easily missed in elderly patients with pubic rami fractures. Routine computed tomography of the pelvis is useful in making the diagnosis.

  16. Percutaneous Vertebroplasty in Iranian Patients with Osteoporotic Vertebral Fractures

    Directory of Open Access Journals (Sweden)

    Farzad Omidi Kashani

    2013-09-01

    Full Text Available Background: Osteoporotic compression vertebral fractures are common clinical problems. In those with refractory fractures, percutaneous cement augmentation has been suggested. The aim of this study was to evaluate the functional outcome of percutaneous vertebroplasty in Iranian patients with refractory osteoporotic fractures. Methods: We retrospectively studied 37 osteoporotic fractures in 28 patients (6 men and 22 women, who had been treated with vertebroplasty from August 2009 to June 2012. The mean follow-up period was 12.1±3.6 (range: 6-42 months. The patients’ states were assessed by the visual analogue scale and short form-36 questionnaire. Student t test was used to analyze the pre- and postoperative data. Results: The mean age of the patients was 71.6±6.1 (range: 50 to 91 years and the most common fractured vertebrae were L1 and T12. There were five patients with two levels of vertebral fractures and two with three levels. Vertebroplasty could improve the scores for pain and quality of life from preoperative 7.6 ± 1.4 and 44.8 ± 7.6 to 1.8 ± 0.4 and 74.1 ± 5.3 at four weeks after surgery. At the last follow-up visit, this improvement continued with no significant decline. The most common complication was cement leakage (32.4% per vertebra, wherein all of of the patients were clinically asymptomatic. Adjacent vertebral fracture occurred in six cases. Conclusion: By understanding the risks, we propose vertebroplasty in Iranian patients with refractory osteoporotic vertebral fracture. If correctly performed, this procedure can significantly improve the pain and quality of life in these elderly osteoporotic patients.

  17. Osteoporotic Vertebral Fractures as Part of Systemic Disease.

    Science.gov (United States)

    Oei, Ling; Zillikens, M Carola; Rivadeneira, Fernando; Oei, Edwin H G

    2016-01-01

    Our understanding of the genetic control of skeletogenesis and bone remodeling is expanding, and normally, bone resorption and bone formation are well balanced through regulation by hormones, growth factors, and cytokines. Osteoporosis is considered a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue. Consequent increased bone fragility results in higher fracture risk. The most common osteoporotic fractures are located in the spine, and they form a significant health issue. A large variety of systemic diseases are associated with risk of osteoporotic vertebral fractures, illustrating its multifactorial etiology. Prevalences of these conditions vary from common to extremely rare, and incidence peaks differ according to etiology. This review appreciates different aspects of osteoporotic vertebral fractures as part of systemic disease, including genetic, immunologic, inflammatory, metabolic, and endocrine pathways. It seems impossible to be all-comprehensive on this topic; nevertheless, we hope to provide a reasonably thorough overview. Plenty remains to be elucidated in this field, identifying even more associated diseases and further exposing pathophysiological mechanisms underlying osteoporotic vertebral fractures. Copyright © 2016 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  18. The challenge of fracture management in osteoporotic bones ...

    African Journals Online (AJOL)

    Patients and methods: Consecutive files of traceable patients who were treated for osteoporotic fractures from January 1998 to December 2007. The demographic data, investigations, management methods and functional outcomes of the treatment were determined. The data collected was analysed using SPSS 17.0 ...

  19. Experimental fracture protocols in assessments of potential agents for osteoporotic fracture healing using rodent models.

    Science.gov (United States)

    Ibrahim, Nurul 'Izzah; Mohamad, Sharlina; Mohamed, Norazlina; Shuid, Ahmad Nazrun

    2013-12-01

    Osteoporosis may cause bone fracture even under slight trauma. Osteoporotic fracture has become a major public health problem but until today, the treatments available are not satisfactory. Many pre-clinical testings on animals were done to find new agents that can be sourced from natural products and synthetic drugs for osteoporotic fracture healing. Animal models are more appropriate for fracture healing study than human subject due to several reasons including the ethical issues involved. The bones of rodents are similar to human in term of their morphological change and response to therapy. Small rodents such as rats and mice are suitable animal models for fracture healing studies as they have a similar bone remodeling system to human. To date, there is no specific guideline to carry out fracture healing studies in animal models for the evaluation of new agents. This paper highlights the protocols of various fracture and fixation methods for experimental osteoporotic fracture healing using rodent models.

  20. Epidemiology of falls and osteoporotic fractures: a systematic review

    Science.gov (United States)

    Morrison, Alan; Fan, Tao; Sen, Shuvayu S; Weisenfluh, Lauren

    2013-01-01

    Background and methods Fractures in elderly populations result from the combination of falls and osteoporosis. We report a systematic review of studies indexed in PubMed reporting annual rates of low-trauma falls and associated osteoporotic fractures among older community-dwelling people (age ≥ 50 years). An osteoporotic fracture was defined as either a fracture resulting from a low-impact fall in subjects with clinical osteoporosis, a fall resulting in an investigator-defined osteoporotic fracture, or a fall resulting in a low-trauma fracture. Rates are presented using descriptive statistics. Meta-analysis was conducted for statistically homogeneous data sets. Results The median (range) annual fall prevalence rates (median proportion of people who experienced one or more falls during the past year) for cohorts of women and men (10 determinations), women alone (seven determinations), and men alone (four determinations) were, respectively, 0.334 (0.217–0.625), 0.460 (0.372–0.517), and 0.349 (0.284–0.526). In studies that reported fall prevalence rates for Western men and women separately (four determinations), the pooled risk ratio (95% confidence interval [CI]) for men versus women was 0.805 (95% CI 0.721–0.900). The ranges of fall prevalence rates in East Asian women (two studies) and East Asian men (two studies) were, respectively, 0.163–0.258 and 0.087–0.184. The risk ratio (95% CI) for fall prevalence in East Asian men versus women was 0.634 (0.479–0.838) in studies (two determinations) reporting results for East Asian men and women separately. In cohorts of Western women and men (five determinations), the pooled rate (95% CI) of low-impact falls resulting in fractures was 0.041 (0.031–0.054). The proportion of low-trauma fractures attributable to falls among the Western community-dwelling elderly was within the range of 0.860–0.950 for fractures at all sites or the hip (five determinations). A range of 0.716–0.924 of all fractures were

  1. The impact of osteoporotic fractures compared with other health conditions in older adults living in Virginia, United States.

    Science.gov (United States)

    Cunningham, T D; Martin, B C; DeShields, S C; Romero, C C

    2016-10-01

    This study compared length of stay, hospital costs, 30-day readmission, and mortality for patients admitted primarily for osteoporotic fractures to those admitted for five other common health conditions. The results indicated that osteoporotic fractures were associated with highest hospital charges and the second highest hospital stay after adjusting for confounders. This study aimed to compare the effect of osteoporotic fractures and other common hospitalized conditions in both men and women age 55 years and older on a large in-patient sample. De-identified patient level and readmission and transfer data from the Virginia Health Information (VHI) system for 2008 through 2014 were merged. Logistic regression models were used to assess mortality and 30-day readmission, while generalized linear models were fitted to assess LOS and hospital charges. After adjustment for confounders, osteoporotic fractures had the second longest LOS (6.0 days, 95 % CI = 5.9-6.0) and the highest average total hospital charges ($47,386.0, 95 % CI = $46,707.0-$48,074.0) compared to the other five common health problems. Recognizing risk and susceptibility to osteoporotic fractures is an important motivator for individual behaviors that mitigate this disease. Furthermore, acknowledging the economic impact and disabling burden of osteoporotic fractures on society are compelling reasons to promote bone health as well as to prevent, diagnose, and manage osteoporosis.

  2. 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

  3. Percutaneous Sacroplasty for Non-neoplastic Osteoporotic Sacral Insufficiency Fractures.

    Science.gov (United States)

    Heo, Dong-Hwa; Park, Choon-Keun

    2017-02-01

    Osteoporosis is an important problem in those of advanced age. Osteoporosis can induce sacral insufficiency fractures (SIFs). As average life expectancy increases, the number of patients with osteoporotic SIFs also increases. Osteoporotic SIFs cause severe low back pain and immobilization. Treatment of SIFs varies from analgesia to surgery. To describe our experience and assess the safety and effectiveness of minimally invasive percutaneous sacroplasty in patients with osteoporotic SIFs. Retrospective evaluation. The spine and joint specialized hospital's research center. We reviewed cases of percutaneous sacroplasty performed since 2009. We used data only from patients with osteoporotic SIFs who were followed for more than 12 months after sacroplasty. Tumor-related SIFs were excluded from our analysis. The following clinical parameters were investigated: initial diagnosis, symptoms, visual analog scale (VAS) of pain, functional mobility scale (FDC) score, past history of illness, amount of bone cement infused, and complications related to sacroplasty. Also, the following radiological parameters were analyzed: the pattern of SIFs, T-score cement leakage, and concomitant fractures in other sites. Sixty-eight patients were enrolled in our study (4 men and 64 women). The mean age of the patients was 76.8 ± 6.2 years. All patients had severe osteoporosis (mean T score: -3.9 ± 0.5). Percutaneous sacroplasty was performed under fluoroscopic guidance. No major complications or procedure-related morbidity occurred. FDS and VAS scores significantly improved after sacroplasty, and the improvements lasted through the final follow-up period (P osteoporotic SIFs refractory to conservative management. The study patients experienced significant relief of pain and increased mobility.Key words: Sacrum, sacroplasty, insufficiency fractures, osteoporosis, minimally invasive surgery.

  4. 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)

  5. Kyphoplasty for osteoporotic vertebral fractures with posterior wall injury.

    Science.gov (United States)

    Abdelgawaad, Ahmed Shawky; Ezzati, Ali; Govindasamy, Ramachandran; Krajnovic, Branko; Elnady, Belal; Said, Galal Zaki

    2017-11-14

    Cement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction; however, posterior wall fractures are relative, but not absolute; contraindications for both techniques and hence treatment practices vary among spine centers. The primary aim of this study was to assess our center's incidence of posterior cement leakage in osteoporotic vertebral fractures with posterior wall injury treated by balloon kyphoplasty (BKP). Secondarily, physiological results, pain relief, complication rates, and non-posterior cement leakage were also evaluated. This is a prospective cohort study done in a high-volume spine center in Germany. Eighty-two patients with 98 osteoporotic vertebral fractures with posterior wall cortical injury were studied from 2012 to 2016. The following were the outcome measures: (1) physiological measures: standing plain x-rays (anteroposterior and lateral views), with the following parameters evaluated: cement leak behind the posterior vertebral body border, Cobb angle for local sagittal deformity, vertebral wedge angle, and anterior vertebral height; (2) cement volume injected in each vertebra; and (3) self-report measures: visual analog scale (VAS). All patients underwent BKP using a bipedicular approach. Preoperative clinical and neurologic evaluations were done. Radiological evaluations included plain x-rays, computed tomography scans and magnetic resonance imaging. The average follow-up period was 18 months. No cement leakage into the spinal canal occurred in any of the patients. Asymptomatic leakage into other sites was seen in 22 vertebrae (22.45%). There was significant improvement in the Cobb angle, the vertebral wedge angle, and the anterior vertebral height in all cases. The mean preoperative VAS was 8.1, and this improved to 2.3 on the third postoperative day. Balloon kyphoplasty is a viable option

  6. 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)

  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. Characteristics of bone biochemical indices in predicting secondary osteoporotic fracture after intertrochanteric fracture in elderly women

    Directory of Open Access Journals (Sweden)

    Shaofeng Yang

    2018-01-01

    The Translational Potential of this Article: Besides BMD, bone microstructure and remodeling levels can be accurately measured by bone biochemical indices. The main objective of this research is to explore the change of BMD and the serum level of bone biochemical indices of elderly women who suffered unilateral intertrochanteric fracture within 12 months. Simultaneously, with aim to better obtain bone remodeling level and predict more accurately the risk of a secondary osteoporotic fracture, bone biochemical indices of these patients, who undergo secondary osteoporotic fracture or not, are collected during follow-up and compared respectively.

  9. Combined pubic rami and sacral osteoporotic fractures: a prospective study.

    Science.gov (United States)

    Alnaib, M; Waters, S; Shanshal, Y; Caplan, N; Jones, S; St Clair Gibson, A; Kader, D

    2012-06-01

    Pelvic osteoporotic fractures (POFs) are often associated with considerable morbidity and mortality mainly as a result of infections and cardiovascular events. Patients usually need prolonged institutionalization, rehabilitation, and follow-up, with a high rate of dependency and cost. The most common sites of POFs include the pubic rami, sacrum, ilium, and acetabulum. Combined pubic rami (PROFs) and sacral osteoporotic fractures (SOFs) have been reported, mostly in retrospective studies, describing the mechanism of injury and incidence. The aim of this study was to evaluate the association between PROFs and SOFs and to assess the effect of combined PROFs and SOFs on patients' mobility, discharge destination, and length of stay. We prospectively studied 67 patients with low-impact PROFs and/or SOFs. There were 54 (80.4%) female and 13 (19.6%) male patients, and the average age was 87.5 (range 65-96) years. All patients were assessed by the fracture liaison service. Patients had magnetic resonance imaging or bone scan when there was history of low back pain following the injury or lumbosacral tenderness on clinical examination. The mean length of stay for all patients was 45 (± 35) days. Mortality rate was 10.4%. A significant relationship was found between low back pain and a positive finding of sacral fracture. Patients with combined PROFs and SOFs showed significantly longer length of stay than those with isolated PROFs. The presence of low back pain and tenderness in patients who had low-impact pelvic injuries was highly suggestive of the presence of an associated SOF. There was a high association between sacral and PROFs. The length of stay of patients with PROFs associated with sacral osteoporotic fractures was significantly longer than that of patients with PROFs only. Therefore, we recommend considering the high association between SOFs and PROFs in planning the management and rehabilitation of patients with POFs.

  10. Exercise for improving outcomes after osteoporotic vertebral fracture

    Science.gov (United States)

    Giangregorio, Lora M; MacIntyre, Norma J; Thabane, Lehana; Skidmore, Carly J; Papaioannou, Alexandra

    2016-01-01

    Background Vertebral fractures are associated with increased morbidity (e.g., pain, reduced quality of life), and mortality. Therapeutic exercise is a non-pharmacologic conservative treatment that is often recommended for patients with vertebral fractures to reduce pain and restore functional movement. Objectives Our objectives were to evaluate the benefits and harms of exercise interventions of four weeks or greater (alone or as part of a physical therapy intervention) versus non-exercise/non-active physical therapy intervention, no intervention or place boon the incidence of future fractures and adverse events among adults with a history of osteoporotic vertebral fracture(s). We were also examined the effects of exercise on the following secondary outcomes: falls, pain, posture, physical function, balance, mobility, muscle function, quality of life and bone mineral density of the lumbar spine or hip measured using dual-energy X-ray absorptiometry (DXA). We also reported exercise adherence. Search methods We searched the following databases: The Cochrane Library (Issue 11 of 12, November 2011), MEDLINE (2005 to 2011), EMBASE (1988 to November 23, 2011), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to November 23, 2011), AMED (1985 to November 2011), and PEDro (Physiotherapy Evidence Database, www.pedro.fhs.usyd.edu.au/index.html, 1929 to November 23, 2011. Ongoing and recently completed trials were identified by searching the World Health Organization International Clinical Trials Registry Platform (to December 2009). Conference proceedings were searched via ISI and SCOPUS, and targeted searches of proceedings of the American Congress of Rehabilitation Medicine and American Society for Bone and Mineral Research. Search terms or MeSH headings included terms such as vertebral fracture AND exercise OR physical therapy. Selection criteria We considered all randomized controlled trials and quasi-randomized trials comparing exercise or active

  11. 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.

  12. Percutaneous vertebroplasty in osteoporotic vertebral body compression fracture

    International Nuclear Information System (INIS)

    Kim, Hyuk Jung; Lee, Seon Kyu; Hwang, Hee Young; Kim, Hyung Sik; Ko, Joon Seok; Park Si Hyun; Park, Cheol Hee

    2001-01-01

    To determine the clinical efficacy of percutaneous vertebroplasty in cases of painful and medically intractable osteoporotic vertebral compression fracture. Ninety-eight patients (20 men and 78 women: mean age, 69 years) underwent 122 percutaneous vertebroplasty procedures for the treatment of osteoporotic vertical compression fracture. For the evaluation of bone mass, bone densitometry was performed in 45 patients, and to assess the recent evolution of the fracture, all 98 underwent MRI. Percutaneous vertebroplasty involves percutaneous transpedicular puncture of the involved verteb666rae followed by the injection of a polymethylmethacrylate(PMMA)-Barium mixture into the vertebral body. To assess leakage of the mixture into the epidural tissue, neural foramina, venous plexus and paravertebral tissue, we then immediately obtained a computerized tomographic (CT) scan, assessing the clinical efficacy of the procedure on the basis of time required for pain relief (defined as more than 60% reduction of initial pain), and time required for ambulation without significant pain. Percutaneous vertebroplasty was successful in all patients. Pain relief was accomplished within 1-5 (mean, 1.8) days and early ambulation without significant pain was possible within 2-15 (mean, 3.3) days. Post-procedural CT scanning revealed leakage of the PMMA-barium mixture into paravertebral tissue(n=41).the paravertebral venous plexus (n=34) and epidural tissue (n=4). No neural foraminal leakage was identified, and no procedure-related complication requiring surgical treatment occurred. Percutaneous vertebroplasty is an effective new interventional procedure for the treatment of osteoporotic vertebral compression fracture. It relieves pain, provides early mobilization, and strengthens involved vertebral bodies

  13. The Value of Radionuclide Bone Imaging in Defining Fresh Fractures Among Osteoporotic Vertebral Compression Fractures.

    Science.gov (United States)

    Zhao, Quan-Ming; Gu, Xiao-Feng; Liu, Zhong-Tang; Cheng, Li

    2016-05-01

    Vertebral fractures are the most common osteoporotic fractures. To perform percutaneous vertebral body cement augmentation, it is essential to accurately identify the affected vertebrae. The study evaluated the role of radionuclide bone imaging in identifying fresh osteoporotic vertebral compression fractures. A prospective study of 39 patients with acute osteoporotic vertebral compression fractures was carried out. All patients underwent magnetic resonance imaging (MRI) and radionuclide bone imaging to determine if the fractures were fresh, followed by percutaneous kyphoplasty for the fresh fractures. The positive rate on radionuclide bone imaging was 92.1% (82/89), and the positive rate on MRI was 93.3% (83/89), with no statistically significant difference (P > 0.05). Eighty-one vertebrae had the same positive identification by both radionuclide bone imaging and MRI, and 5 of the same vertebrae were diagnosed negative by both techniques. One patient with positive radionuclide bone imaging was negative according to MRI, and 2 patients were entirely positive by MRI but negative by radionuclide bone imaging. A kappa test showed good consistency between the 2 methods for detecting the affected vertebrae (Kappa = 0.751, P osteoporotic vertebral compression fracture, making it an effective method for detecting affected vertebrae for percutaneous vertebroplasty.

  14. Biomechanical Characteristics of Osteoporotic Fracture Healing in Ovariectomized Rats: A Systematic Review.

    Science.gov (United States)

    Chen, Lin; Yang, Long; Yao, Min; Cui, Xue-Jun; Xue, Chun-Chun; Wang, Yong-Jun; Shu, Bing

    2016-01-01

    Biomechanical tests are widely used in animal studies on osteoporotic fracture healing. However, the biomechanical recovery process is still unknown, leading to difficulty in choosing time points for biomechanical tests and in correctly assessing osteoporotic fracture healing. To determine the biomechanical recovery process during osteoporotic fracture healing, studies on osteoporotic femur fracture healing with biomechanical tests in ovariectomized rat (OVX) models were collected from PUBMED, EMBASE, and Chinese databases. Quadratic curves of fracture healing time and maximum load were fitted with data from the analyzed studies. In the fitted curve for normal fractures, the predicted maximum load was 145.56 N, and the fracture healing time was 88.0 d. In the fitted curve for osteoporotic fractures, the predicted maximum load was 122.30 N, and the fracture healing time was 95.2 d. The maximum load of fractured femurs in OVX rats was also lower than that in sham rats at day 84 post-fracture (D84 PF). The fracture healing time was prolonged and maximum load at D84 PF decreased in OVX rats with closed fractures. The maximum load of Wister rats was higher than that of Sprague-Dawley (SD) rats, but the fracture healing time of SD and Wister rats was similar. Osteoporotic fracture healing was delayed in rats that were 12 weeks old at ovariectomy. There was no significant difference in maximum load at D84 PF between rats with an osteoporosis modeling time = 12 weeks. In conclusion, fracture healing was delayed and biomechanical property decreased by osteoporosis. Time points around D95.2 PF should be considered for biomechanical tests of osteoporotic femur fracture healing in OVX rat models. Osteoporotic fracture healing in OVX rats was affected by the fracture type but not by the strain of the rat.

  15. VERTEBROPLASTY – NEW OPERATIVE PROCEDURE FOR OSTEOPOROTIC VERTEBRAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Rok Vengust

    2002-06-01

    Full Text Available Background. Vertebroplasty is a new minimally invasive operative method used for treatment of osteoporotic vertebral fractures. The aim of vertebroplasty is to diminish pain and to gain the mechanical stability of fractured vertebra.Methods and results. From June to November 2001 vertebroplasty was performed on eleven vertebrae in seven patients. The mean age of patients at the operation was 49 years (24 to 63 years. The mean time interval from injury to operation was 13 days (1 to 30 days. Preoperatively the mean level of pain according to visual analogue scale was 6 (4 to 9, 24 hours after operation the mean pain level was 0 (0 do 1 and three months after the operation 0 (od 0 do 1. In one patient minor leak of bone cement occured into the spinal canal during the procedure. No consequent nevrologic deficit was noted.Conclusions. In all our patients vertebroplasty was followed by total resolution of pain inside the first 24 hours. In the hands of experienced spinal surgeon vertebroplasty proved to be a safe method which enables the patient to proceed with an active lifestyle despite osteoporotic fractures of vertebrae.

  16. Meta-analysis of hypertension and osteoporotic fracture risk in women and men.

    Science.gov (United States)

    Li, C; Zeng, Y; Tao, L; Liu, S; Ni, Z; Huang, Q; Wang, Q

    2017-08-01

    The present meta-analysis synthesized evidence from 10 articles encompassing 28 independent studies to verify the association between hypertension and osteoporotic fracture risk in women and men. Our results indicate that the risk of osteoporotic fracture among individuals with hypertension was higher than that among individuals without hypertension. Epidemiological studies have suggested that hypertension is related to osteoporotic fracture. However, discrepancies exist in the reported findings. In this study, a systematic review of relevant published articles was conducted to verify the association between hypertension and osteoporotic fracture risk in women and men. PubMed (1953_October 5th, 2016) and Embase (1974_October 5th, 2016) were systematically searched for relevant articles. Odds ratios (ORs) and confidence intervals (CIs) were derived using random effect models. Categorical, subgroup, heterogeneity, publication bias, and meta-regression analyses were conducted. We analyzed 10 articles encompassing 28 independent studies, 1,430,431 participants, and 148,048 osteoporotic fracture cases. The risk of osteoporotic fracture among individuals with hypertension was higher (pooled OR = 1.33, 95% CI 1.25-1.40; I 2  = 72.3%, P osteoporotic fracture risk. However, the biological mechanisms underlying the effect of hypertension on osteoporotic fracture remain to be elucidated.

  17. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: What is the evidence?

    NARCIS (Netherlands)

    E.M.M. van Lieshout (Esther); V. Alt (Volker)

    2016-01-01

    textabstractDespite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft

  18. The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality.

    Science.gov (United States)

    Marques, A; Lourenço, Ó; da Silva, J A P

    2015-11-01

    The study rationale was to provide a detailed overview of the costs, quality of life and mortality of hip fractures in Portugal. Mean individual fracture-related costs were estimated at €13,434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. Osteoporotic fractures represent a remarkable burden to health care systems and societies worldwide, which will tend to increase as life expectancy expands and lifestyle changes favour osteoporosis. The cost-effectiveness evaluation of intervention strategies demands accurate data on the epidemiological and economical reality to be addressed. Information was collected retrospectively on consumption of resources and changes in quality of life attributable to fracture as well as mortality, regarding 186 patients randomly selected to represent the distribution of hip fractures in the Portuguese population, in terms of gender, age and geographical provenience. Data were cross-tabulated with socio-demographic variables and individual resource consumption to estimate the burden of disease. A societal perspective was adopted, including direct and indirect costs. Multivariate analyses were carried out to assess the main determinants of health-related quality of life (HrQoL). Mean individual fracture-related costs were estimated at €13,434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. In 2011 the economic burden attributable to osteoporotic hip fractures in Portugal could be estimated at €216 million. Mean reduction in HrQoL 12 months after fracture was estimated at 0.34. Regression analysis showed that age was associated with a higher loss of HrQoL, whereas education had the opposing effect. We observed 12 % excess mortality in the first year after hip fracture, when compared to the gender and age-matched general population. Results of this study indicate that osteoporotic hip fractures are, also in Portugal

  19. Clopidogrel and the risk of osteoporotic fractures

    DEFF Research Database (Denmark)

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

    2012-01-01

    Objectives:  The P2Y(12) inhibitor clopidogrel inhibits platelet aggregation and is used in the treatment and prevention of coronary artery disease. It is widely used and, in combination with acetylsalicylic acid, is the standard of care for acute coronary syndrome and percutaneous coronary...

  20. Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury: its clinical and radiologic significances.

    Science.gov (United States)

    Lee, Seonjong; Park, Moon Soo; Kim, Yong-Chan; Kim, Tae-Hwan

    2016-11-01

    To assess the clinical and radiologic outcome of osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture (SPF) without posterior ligament injury. A total of 391 patients with single-level osteoporotic thoracolumbar junctional (T10-L2) fracture were selectively enrolled. The patients were divided into two groups by absence (group I) or presence (group II) of SPF. Clinical and radiologic parameters were compared between the two groups. Group I comprised of 332 patients with only vertebral body fracture, and group II comprised of 59 patients with both vertebral body and SPFs. In all cases of group II, SPFs were located just one level above the fractured vertebral body, and the injury of the posterior ligament was not found. At the time of injury, group II patients showed worse outcomes in anterior vertebral body compression percentage, kyphotic Cobb angle, cranial disk status, and the rate of the initial neurologic injury. Kyphotic alignment changes during 1-year follow-up were compared between the conservative subgroups of groups I and II. At the time of injury, there were no statistical differences in anterior vertebral body compression percentage and Cobb angle between the two conservative subgroups. However, the difference was significant after 1-year follow-up. Comparison of kyphotic alignment change at 12 months after diagnosis within group II was done according to the treatment method. Vertebroplasty subgroup in group II did not show benefit even in preventing such kyphotic alignment change, whereas instrumentation subgroup in group II showed lordotic alignment restoration despite more severe kyphotic alignment at the time of injury. Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury represented more severe injury with flexion forces on the anterior column and tensile forces on the posterior column, and was related with more severe posttraumatic kyphotic

  1. Kyphoplasty for the treatment of incomplete osteoporotic burst fractures

    Science.gov (United States)

    Zettl, Ralph; Ziring, Ewgeni; Mann, Dieter; Schnabel, Michael; Ruchholtz, Steffen

    2010-01-01

    Kyphoplasty has become a standard procedure in the treatment of painful osteoporotic compression fractures. According to current guidelines, involvement of the posterior wall of the vertebral body is a relative contraindication. From February 2002 until January 2008, 97 patients with at least one AO classification A 3.1 fracture were treated by kyphoplasty. There was a structured follow-up for the medium-term evaluation of the patients’ outcome. Ninety-seven patients (68 of whom were females and 29 of whom were males) with involvement of the vertebra’s posterior margin averaging 76.1 ± 12.36 (59–98) years were treated by kyphoplasty. The fractures of 75 patients were caused by falls from little height, 5 patients had suffered traffic accidents and in the case of 17 patients, no type of trauma was remembered. According to the AO classification, there were 109 A 3.1.1 and one A3.1.3 injuries. Prior to surgery, all patients were neurologically without pathological findings. Seventy-nine fractures were accompanied by a narrowing of the spinal canal [average of 15% (10–40)]. Overall, 134 vertebras were treated by Balloon kyphoplasty (81 × 1 segment, 22 × 2 segments, 3 × 3 segments). In 47.4% of the patients, cement leakage was observed after surgery. All patients with cement extravasation, however, were clinically unremarkable. Using the visual analog scale, patients stated that prior to surgery their pain averaged 8.1, whereas after surgery it significantly decreased and averaged 1.6 (p osteoporotic vertebral fractures with partial inclusion of the posterior wall of the vertebral body, kyphoplasty is an effective procedure with few complications. PMID:20135334

  2. Vertebroplasty and Kyphoplasty Can Restore Normal Spine Mechanics following Osteoporotic Vertebral Fracture

    Science.gov (United States)

    Luo, Jin; Adams, Michael A.; Dolan, Patricia

    2010-01-01

    Osteoporotic vertebral fractures often lead to pain and disability. They can be successfully treated, and possibly prevented, by injecting cement into the vertebral body, a procedure known as vertebroplasty. Kyphoplasty is similar, except that an inflatable balloon is used to restore vertebral body height before cement is injected. These techniques are growing rapidly in popularity, and a great deal of recent research, reviewed in this paper, has examined their ability to restore normal mechanical function to fractured vertebrae. Fracture reduces the height and stiffness of a vertebral body, causing the spine to assume a kyphotic deformity, and transferring load bearing to the neural arch. Vertebroplasty and kyphoplasty are equally able to restore vertebral stiffness, and restore load sharing towards normal values, although kyphoplasty is better at restoring vertebral body height. Future research should optimise these techniques to individual patients in order to maximise their beneficial effects, while minimising the problems of cement leakage and adjacent level fracture. PMID:20981329

  3. Epidemiology of Osteoporosis and Osteoporotic Fractures in South Korea

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    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 TREATMENT OF OSTEOPOROTIC VERTEBRAL FRACTURES USING KYPHOPLASTY

    Directory of Open Access Journals (Sweden)

    G. M. Kavalersky

    2010-01-01

    Full Text Available In article results of treatment of 20 patients more senior 60 years with osteoporotic fractures of thoracolumbar spine. To all patients has been executed percutaneous kyphoplasty. In process kyphoplasty restoration of ventral departments of the broken vertebra on 15+6.2 % is reached. Correction of a local kyphosis angle is reached in limits 5-10e (7,3+2,5e. Recourse of a painful syndrome with 7,1+1,9 to 2,1+1,7 on a visual analogue scale is noted. In the remote period it is noted increases in a painful syndrome, increase of a local kyphosis angle and deformations of a body of a vertebra. Thus, percutaneous kyphoplasty, being a minimally invasive astabilisation technique, allows to restore strengthening characteristics of bodies of vertebras, to increase height ventral departments of bodies, correction of the biomechanical infringements resulting fracture thereby is reached.

  5. Relationship between clinical symptoms of osteoporotic vertebral fracture with intravertebral cleft and radiographic findings.

    Science.gov (United States)

    Nakamae, Toshio; Fujimoto, Yoshinori; Yamada, Kiyotaka; Hiramatsu, Takeshi; Hashimoto, Takashi; Olmarker, Kjell; Adachi, Nobuo

    2017-03-01

    With aging of the population, the numbers of osteoporotic vertebral fractures with intravertebral cleft have been increasing. However, the details of clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft are poorly understood. The purpose of this study was to evaluate the relationship between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings. Two hundred seventeen patients with single-level osteoporotic vertebral fractures with intravertebral cleft were examined. Clinical symptoms were evaluated using Numerical Rating Scale for back pain and the Oswestry Disability Index for physical disability. The presence of delayed neurologic deficit was also detected. Radiography and computed tomography were used to measure local kyphotic angle and vertebral instability and to detect the presence of posterior wall fracture of the vertebral body. Correlations between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings were investigated. Mean Numerical Rating Scale and Oswestry Disability Index were 7.4 and 58.0%, respectively. Delayed neurologic deficit occurred in 41 patients (19%). The mean local kyphotic angle, vertebral instability, and rate of posterior wall fracture of the vertebral body were 19.4°, 7.3°, and 91%, respectively. Numerical Rating Scale and Oswestry Disability Index were statistically correlated with vertebral instability but not with local kyphotic angle and presence of posterior wall fracture. In the patients with delayed neurologic deficit, vertebral instability was significantly higher and posterior wall fractures were significantly more frequent than in the patients without delayed neurologic deficit. Local kyphotic angle was not correlated with delayed neurologic deficit. Vertebral instability is a factor causing symptoms of osteoporotic vertebral fractures with intravertebral cleft. In addition, vertebral

  6. Osteoporotic Fracture Risk Assessment Using Bone Mineral Density in Korean: A Community-based Cohort Study.

    Science.gov (United States)

    Jang, Eun Jin; Lee, Young-Kyun; Choi, Hyung Jin; Ha, Yong-Chan; Jang, Sunmee; Shin, Chan Soo; Cho, Nam Han

    2016-02-01

    Fracture-risk assessment tool (FRAX) using just clinical risk factors of osteoporosis has been developed to estimate individual risk of osteoporotic fractures. We developed prediction model of fracture risk using bone mineral density (BMD) as well as clinical risk factors in Korean, and assessed the validity of the final model. To develop and validate an osteoporotic FRAX, a total of 768 Korean men and women aged 50 to 90 years were followed for 7 years in a community-based cohort study. BMD as well as clinical risk factors for osteoporotic fracture including age, sex, body mass index, history of fragility fracture, family history of fracture, smoking status, alcohol intake, use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis were assessed biannually. During the follow-up period, 86 osteoporotic fractures identified (36 in men and 50 in women). The developed prediction models showed high discriminatory power and had goodness of fit. The developed a Korean specific prediction model for osteoporotic fractures can be easily used as a screening tool to identify individual with high risk of osteoporotic fracture. Further studies for validation are required to confirm the clinical feasibility in general Korean population.

  7. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series

    Directory of Open Access Journals (Sweden)

    Sancheti K

    2010-01-01

    Full Text Available Background: The management of unstable osteoporotic intertrochantric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure secondary to osteoporosis. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study is to analyze the role of primary hemiarthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures. Materials and Methods: We retrospectively analyzed 37 cases of primary hemiarthroplasty performed for osteoporotic unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3 and Evans type III or IV fractures. There were 27 females and 10 males with a mean age of 77.1 years (range, 62-89 years. Results: Two patients died due to unrelated cause (myocardial infarction within 6 months of surgery and remaining 35 patients were followed up to an average of 24.5 months (range,18-39 months. The average surgery time was 71 min (range, 55-88 min with an average intraoperative blood loss of 350 ml (range, 175-500 ml. Six patients needed blood transfusion postoperatively. The patients walked on an average 3.2 days after surgery (range, 2-8 days. One patient had superficial skin infection and one had bed sore with no other significant postoperative complications. One patient of Alzheimer′s disease refused to walk and had a poor result. A total of 32 out of 35 patients (91% had excellent to fair functional results and 2 had poor result with respect to the Harris hip score (mean 84.8΁9.72, range 58-97. One patient who had neurological comorbidity refused to walk post operatively and was labeled as failed result. Conclusion: Hemiarthroplasty for unstable osteoporotic intertrochanteric

  8. Complication of cemented vertebra after kyphoplasty in osteoporotic compression fracture.

    Science.gov (United States)

    Lee, Jung Hee; Jeong, Bi O

    2012-11-01

    The reported case is of a postmenopausal woman with kyphoplasty for an L1 osteoporotic compression fractures (OCF) presenting with progressive kyphosis and paraparesis that developed with no history of other traumas. Serial radiographs and computed tomography were performed, followed by magnetic resonance (MR) imaging. On serial radiographs, local kyphosis and neurologic deficit progressed with collapse of the cemented vertebra. MR scan and histologic examination diagnosed avascular necrosis (AVN). The symptoms resolved after posterior vertebral column resection of the collapsed cemented vertebral body and correction of the deformity. Although kyphoplasty is a simple and safe procedure for the management of pain in OCFs, careful follow-up is required as collapse of the cemented vertebra may be an AVN of the cemented vertebra and lead to neurologic deficit over time.

  9. Metabolic syndrome and osteoporotic fracture: a population-based study in China.

    Science.gov (United States)

    Qin, Li; Yang, Zhen; Zhang, Weiwei; Gu, Hongxia; Li, Xiaoyong; Zhu, Lingfei; Lu, Shuai; Xing, Yin; Zhang, Hongmei; Niu, Yixin; Ning, Guang; Su, Qing

    2016-05-27

    Associations between metabolic syndrome (MetS) and osteoporotic fracture have been reported. However, the epidemiological studies are not conclusive. The objective of the study was to determine whether metabolic syndrome associates with osteoporotic fracture. This was a cross-sectional study of 9930 Chinese adults aged 40 year or older in the Chongming District, Shanghai, China. A questionnaire, anthropometric measurements and laboratory tests were conducted. MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low-trauma in 2 years prior to the study. Among women, the prevalence of osteoporotic fractures was significantly higher in those with MetS (3.5 vs. 2.6 %, P =0.028). However, the difference was not found in men (2.6 vs. 2.4 %, P =0.737). The presence of Mets was significantly associated with increased odds of osteoporotic fracture among women (odds ratio 1.22; 95 % confidence interval 1.12-1.54; P = 0.039) after controlling for potential confounders. The significant associations were not detected in men. The presence of MetS was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese women.

  10. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

    Science.gov (United States)

    Ando, Yoshihiro; Hirata, Soichiro; Ishikawa, Hitoshi; Kurosaka, Masahiro

    2008-01-01

    A case of bilateral pedicle stress fracture of L4 in a patient with osteoporotic compression fracture of L5 and without a history of major trauma or surgery is reported, and the literature is reviewed. Bilateral pedicle fracture is a rare entity and few cases have been reported in the literature. All reported cases had some underlying causative factors like previous spine surgery or stress related activities. To the best of the authors’ knowledge, only one case of bilateral pedicle stress fracture without a history of trauma, previous spine surgery, or stress-related activities has been reported. A 77-year-old woman presented with severe low back pain and radiating pain in the right leg that was exacerbated after standing and walking. Plain radiograph showed pathological fracture at L5 level. Magnetic resonance imaging (MRI) revealed the compression of dural sac at L5 level. CT scan taken 3 months after admission revealed bilateral pedicle fractures through L4. The patient was treated with decompressive laminectomies of L4, followed by posterior spinal fusion with rigid pedicle screw fixation and autogenous bone graft mixed with hydroxyapatite. The patient achieved pain relief and returned to normal activity. Stress fracture of the pedicle within the proximal vertebra of an osteoporotic compression fracture of lumbar spine is an uncommon entity. It may, however, be an additional source of symptoms in patients with osteoporosis who present with further back pain. Surgeons caring for this group of patients should be aware of this condition. PMID:19005693

  11. Association between renin-angiotensin-aldosterone system blockade and future osteoporotic fracture risk in hypertensive population: A population-based cohort study in Taiwan.

    Science.gov (United States)

    Chen, Chang-I; Yeh, Jong-Shiuan; Tsao, Nai-Wen; Lin, Fen-Yen; Shih, Chun-Ming; Chiang, Kuang-Hsing; Kao, Yung-Ta; Fang, Yu-Ann; Tsai, Lung-Wen; Liu, Wen-Chi; Nakagami, Hironori; Morishita, Ryuichi; Kuo, Yi-Jie; Huang, Chun-Yao

    2017-11-01

    Tissue renin-angiotensin-aldosterone system (RAAS) activation in sites of osteoporosis had been demonstrated in animal studies; however, the possibility of RAAS blockade to prevent future osteoporotic fracture had rarely been verified in clinical studies. We Used the Taiwan Longitudinal Health insurance database 2000 to 2008, the cohort study comprised patients age over 40 with a recorded new diagnosis of hypertension between January 1, 2000 to December 31, 2008, in addition, patients who had diagnosis of osteoporosis before the date of cohort enter were excluded. After the definite diagnosis of hypertension, each patient was followed until osteoporotic fracture happened or the end of 2008. The occurrence of osteoporotic fracture was evaluated in patients who either were or without taking RAAS blockade agents. Cox proportional hazard regressions were used to evaluate the osteoporotic fracture incidence after adjusting for known confounding factors. In total, 57,132 hypertensive patients comprised the study cohort. Our study results showed that the incidence of osteoporosis fracture in the whole cohort was significantly higher in the RAAS blockade non-user group than the user group. This phenomenon was observed in both sex and all age categories. Sensitivity analysis further showed the concordant lower osteoporosis fracture risk in patients with various RAAS blockers usage durations; the risk of osteoporosis fracture was the lowest in those drug use >365 days when compared with the non-user cohort. In conclusion, our study result demonstrated the lower future osteoporotic fracture risk in hypertensive subjects who received long term RAAS blocker treatment.

  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. A meta-analysis of breastfeeding and osteoporotic fracture risk in the females.

    Science.gov (United States)

    Duan, X; Wang, J; Jiang, X

    2017-02-01

    Our meta-analysis included 12 studies from PubMed, Embase, and Web of Science. Finding indicated breastfeeding may well reduce the risk of osteoporotic fracture. Several epidemiologic studies have investigated that breastfeeding is associated with short-term bone loss in the women, but the long-term effect on osteoporotic fracture risk remains unclear. Thus, we conducted this meta-analysis to explore the potential association between breastfeeding and osteoporotic fracture risk in the females and possible dose-response relationship between them. We searched PubMed, Embase, and Web of Science (ISI) up to April 2016 for relevant articles associated between breastfeeding and osteoporotic fracture. Pooled relative risks (RRs) with 95 % confidence intervals (CIs) were calculated with a random-effects model. Dose-response analysis was performed by restricted cubic spline. Twelve articles including 14,954 participants were identified. The pooled RRs of osteoporotic hip and forearm fracture for the highest vs lowest duration of breastfeeding were 0.84 (95 % CI 0.67-1.05), 0.72 (95 % CI 0.52-0.99), and 0.82 (95 % CI 0.56-1.19), respectively. In subgroup analysis, breastfeeding was associated with a decreased risk of osteoporotic fracture in case-control study (RR = 0.70, 95 % CI 0.49-0.99) and postmenopausal women (RR = 0.66, 95 % CI 0.47-0.93). In dose-response analysis, osteoporotic and hip fracture risk decreased by 0.9 and 1.2 % for each month increment of breastfeeding, respectively. Our meta-analysis revealed that breastfeeding may well reduce the risk of osteoporotic fracture. More cohort studies with large sample sizes are needed to confirm the conclusion.

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

    Science.gov (United States)

    Mackert, Gina A; Schulte, Matthias; Hirche, Christoph; Kotsougiani, Dimitra; Vogelpohl, Julian; Hoener, Bernd; Fiebig, Teresa; Kirschner, Stefanie; Brockmann, Marc A; Lehnhardt, Marcus; Kneser, Ulrich; Harhaus, Leila

    2017-01-01

    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.

  15. 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.

  16. Comparison of effectiveness of kyphoplasty and vertebroplasty in patients with osteoporotic vertebra fractures

    OpenAIRE

    Ahmet Ateş; Halil Can Gemalmaz; Mehmet Ali Deveci; Sezai Aykın Şimşek; Engin Çetin; Alpaslan Şenköylü

    2016-01-01

    Objective: The aim of this study was to compare the functional and radiological outcomes of vertebroplasty and kyphoplasty in patients with osteoporotic vertebra fractures. Methods: The files of the patients who underwent vertebroplasty or kyphoplasty for osteoporotic vertebrae fractures were retrieved from the archives. Forty-three patients with complete follow-up data were included in the study group. The patients were evaluated for radiological outcomes in terms of local kyphosis angle,...

  17. 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.)

  18. 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.)

  19. Tea and flavonoid intake predict osteoporotic fracture risk in elderly Australian women: a prospective study.

    Science.gov (United States)

    Myers, Gael; Prince, Richard L; Kerr, Deborah A; Devine, Amanda; Woodman, Richard J; Lewis, Joshua R; Hodgson, Jonathan M

    2015-10-01

    Observational studies have linked tea drinking, a major source of dietary flavonoids, with higher bone density. However, there is a paucity of prospective studies examining the association of tea drinking and flavonoid intake with fracture risk. The objective of this study was to examine the associations of black tea drinking and flavonoid intake with fracture risk in a prospective cohort of women aged >75 y. A total of 1188 women were assessed for habitual dietary intake with a food-frequency and beverage questionnaire. Incidence of osteoporotic fracture requiring hospitalization was determined through the Western Australian Hospital Morbidity Data system. Multivariable adjusted Cox regression was used to examine the HRs for incident fracture. Over 10 y of follow-up, osteoporotic fractures were identified in 288 (24.2%) women; 212 (17.8%) were identified as a major osteoporotic fracture, and of these, 129 (10.9%) were a hip fracture. In comparison with the lowest tea intake category (≤1 cup/wk), consumption of ≥3 cups/d was associated with a 30% decrease in the risk of any osteoporotic fracture (HR: 0.70; 95% CI: 0.50, 0.96). Compared with women in the lowest tertile of total flavonoid intake (from tea and diet), women in the highest tertile had a lower risk of any osteoporotic fracture (HR: 0.65; 95% CI: 0.47, 0.88), major osteoporotic fracture (HR: 0.66; 95% CI: 0.45, 0.95), and hip fracture (HR: 0.58; 95% CI: 0.36, 0.95). For specific classes of flavonoids, statistically significant reductions in fracture risk were observed for higher intake of flavonols for any osteoporotic fracture and major osteoporotic fracture, as well as flavones for hip fracture (P < 0.05). Higher intake of black tea and particular classes of flavonoids were associated with lower risk of fracture-related hospitalizations in elderly women at high risk of fracture. © 2015 American Society for Nutrition.

  20. A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality

    Science.gov (United States)

    Nazrun, Ahmad Shuid; Tzar, Mohd Nizam; Mokhtar, Sabarul Afian; Mohamed, Isa Naina

    2014-01-01

    Purpose Osteoporotic fracture is the main complication of osteoporosis. The current management is to discharge patients as early as possible so they can get back to their daily activities. Once discharged, there are three main issues relating to morbidity, mortality, and risk of a subsequent fracture that need to be addressed and discussed. Therefore, the aim of this systematic review was to summarize and evaluate the evidence from published literature, to determine the outcome of osteoporotic fracture patients after their hospital discharge. Methods The MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched, using the terms “osteoporosis”, “fracture”, “osteoporotic fracture”, “hip fracture”, and “vertebral fracture”. We included only human studies published in English between 2004 and 2014. The reference lists of included studies were thoroughly reviewed in search for other relevant studies. Results A total of 18 studies met the selection criteria. Most were observational and cohort studies. Out of all the studies, five studies looked into the morbidity, six studies looked into the risk of subsequent fractures, and seven studies looked into mortality. Vertebral fracture caused the greatest health burden, but hip fracture patients were the main users of informal care after hospital discharge. There was an increased risk of a subsequent fracture after a primary fracture compared with the control group, a cohort comparison, or the general population. Osteoporotic fractures, especially hip fractures, are associated with higher mortality rate despite the advances in the management of osteoporotic fracture cases. Conclusion There is strong evidence to show that after hospital discharge, osteoporotic fracture patients are faced with higher morbidity, subsequent fractures, and mortality. PMID:25429224

  1. The role of impairment of mesenchymal stem cell function in osteoporotic bone fracture healing.

    Science.gov (United States)

    Zhang, Lihai; Miramini, Saeed; Richardson, Martin; Mendis, Priyan; Ebeling, Peter

    2017-09-01

    With demographic change and increasing life expectancy, osteoporotic fractures have become one of the most prevalent trauma conditions seen in daily clinical practice. A variety of factors are known to affect the rate of healing in osteoporotic conditions (e.g. both biochemical and biomechanical environment of callus cells). However, the influence of impairment of mesenchymal stem cell function in the osteoporotic condition on bone fracture healing has not been fully understood. In the present study, we develop a mathematical model that quantifies the change in biological processes within the fracture callus as a result of osteoporosis. The model includes special features of osteoporosis such as reduction in mesenchymal stem cell (MSC) number in osteoporotic bone, impaired response of osteoporotic MSCs to their biomechanical microenvironment and the effects of configuration of locking compression plate (LCP) system on healing in this context. The results presented here suggest that mechanically-mediated MSCs differentiation at early stages of healing are significantly affected under osteoporotic conditions, while it is predicted that the flexible fixation achieved by increasing bone-plate distance of LCP could alleviate the negative effects of osteoporosis on healing. The outcomes of this study could potentially lead to patient specific surgical solutions, and thus achieve optimal healing outcomes in osteoporotic conditions.

  2. Serum uric acid and incident osteoporotic fractures in old people: The PRO.V.A study.

    Science.gov (United States)

    Veronese, Nicola; Bolzetta, Francesco; De Rui, Marina; Maggi, Stefania; Noale, Marianna; Zambon, Sabina; Corti, Maria Chiara; Toffanello, Elena Debora; Baggio, Giovannella; Perissinotto, Egle; Crepaldi, Gaetano; Manzato, Enzo; Sergi, Giuseppe

    2015-10-01

    Although high serum uric acid (SUA) levels are associated with negative outcomes in older people, recent studies reported that hyperuricemia could help protect against the onset of bone fractures. We consequently examined whether baseline SUA levels were associated with risk of incident osteoporotic fractures in a representative group of elderly people with no fractures or other bone-modifying conditions or drugs at the baseline. Among 3099 people aged ≥ 65 years initially involved in the PRO.V.A. study, 1586 participants with no prior diagnosis of osteoporotic fractures, and no conditions or medication affecting bone metabolism at the baseline were followed up for 4.4 ± 1.2 years. Baseline SUA levels were classified in gender-specific quintiles. Incident osteoporotic fractures were considered as any new fractures occurring at the usual sites of osteoporotic fractures. At the baseline, participants with higher SUA levels had significantly less osteoporosis and lower serum beta cross-laps levels, but higher serum parathormone concentrations irrespective of gender. Over a 4.4-year follow-up, 185 subjects were diagnosed with a new osteoporotic fracture, giving rise to an incidence of 25 events per 1,000 person-years. Cox's regression analysis, adjusted for potential baseline and follow-up confounders, revealed no relationship between high SUA levels and incident fractures during the follow-up in the sample as a whole (p for trend=0.46) or by gender (p for trend=0.14 in males and 0.64 in females). Baseline SUA concentrations were not associated with the onset of new osteoporotic fractures over a 4.4-year follow-up in our sample of community-dwelling older men and women. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. 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.

  4. 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.

  5. Risk of osteoporotic fractures in multiple sclerosis patients in southwest Finland.

    Science.gov (United States)

    Åivo, J; Kurki, S; Sumelahti, M-L; Hänninen, K; Ruutiainen, J; Soilu-Hänninen, M

    2017-05-01

    Increased risk of osteoporotic fractures in multiple sclerosis (MS) patients compared with general population has been reported. The purpose of this study was to assess the risk of osteoporotic and other low-energy fractures in an MS cohort from a large hospital district in southwest Finland. Age-adjusted total and gender-specific prevalence for definite MS per 100 000 in a population of 472 139 was calculated as a point prevalence in December 31, 2012. Patients with MS and comorbid fractures were identified by searching for ICD-9 and ICD-10 codes during a period from 2004 to 2012 from hospital administrative data in Turku University Hospital (TYKS) in southwest Finland Case ascertainment was performed by review of medical records. Osteoporotic fracture was defined as a low-energy fracture of the pelvis, hip, femur, tibia, humerus, collar bone, ulna/radius, vertebrae, or rib. The control population was a 10-fold age- and gender-matched population. The point prevalence (N 1004) of MS was 212.6/10 5 (CI 199.5-225.8) in December 31, 2012. A total of 100 (9.9%) of 1004 confirmed MS cases experienced at least one fracture during the study period. Relative risks (RRs) for all fractures (1.33, 95% CI 1.10-1.60) and osteoporotic fractures (1.50, 95% CI 1.18-1.90) were significantly increased in patients with MS compared with controls. In particular, RRs for hip fractures (5.00, 95% CI 2.96-8.43) and fractures of humerus (2.36, 95% CI 1.32-4.42) were elevated in patients with MS vs controls. We observed high prevalence of MS in southwest Finland and confirmed increased age-adjusted comorbid risk for osteoporotic fractures and other low-energy fractures compared with individually matched controls. © 2016 John Wiley & Sons A/S.Published by John Wiley & Sons Ltd.

  6. Use of systemic glucocorticoids and the risk of major osteoporotic fractures in patients with sarcoidosis.

    Science.gov (United States)

    Oshagbemi, O A; Driessen, J H M; Pieffers, A; Wouters, E F M; Geusens, P; Vestergaard, P; van den Bergh, J; Franssen, F M E; de Vries, F

    2017-10-01

    This study revealed the risk of major osteoporotic fracture in patients with sarcoidosis exposed to glucocorticoids. Current use of glucocorticoids was associated with a risk of fracture, with no difference between patients with and without sarcoidosis. Sarcoidosis per se was not associated with an increased fracture risk. Sarcoidosis is a multi-organ, chronic inflammatory, granulomatous disorder that most frequently affects the lungs, lymph nodes, skin, eyes, and liver, but may occur in any organ, including the bones. While oral glucocorticoids (GCs) are commonly used as initial treatment, little is known about the risk of major osteoporotic fractures in patients with sarcoidosis exposed to GCs. A case-control study was conducted using the Danish National Hospital Discharge Registry (NHDR) between January 1995 and December 2011. Conditional logistics regression models were used to derive adjusted odds ratios (OR) of major osteoporotic fractures in subjects with and without sarcoidosis stratified by average daily and cumulative dose exposures. A total of 376,858 subjects with a major osteoporotic fracture and the same number of subjects without this event were identified (mean age 64.2 ± 19.5 years, 69% female). In patients with sarcoidosis (n = 124), current use of GC was associated with an increased risk of major osteoporotic fracture (adjusted (adj.) OR 1.74; 95% CI 1.17-2.58), which dropped to baseline levels after discontinuation. In subjects without sarcoidosis, this risk was comparable (adj. OR 1.36; 95% CI 1.32-1.40). In sarcoidosis patients, cumulative dose 1.0-4.9 g and >10 g prednisolone equivalents were associated with increased risk of major osteoporotic fracture (adj. OR 2.75; 95% CI 1.06-7.14 and 2.22; 95% CI 1.17-4.22, respectively), whereas a cumulative dose of osteoporotic fracture risk. Both in subjects with and without sarcoidosis, current expose to GC is associated with increased risk of major osteoporotic fractures, with no between

  7. Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Chuang, Po-Yao; Lin, Shih-Jie; Lee, Chien-Yin; Huang, Kuo-Chin; Shih, Hsin-Nung; Lee, Mel S; Hsu, Robert Wen-Wei; Shen, Wun-Jer

    2016-05-01

    Osteoporotic intertrochanteric fractures result in serious health problems and decrease health-related quality of life (HRQoL). Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture healing, but the literature is sparse on this topic. The aim of this study is to assess whether teriparatide accelerates fracture healing.Between 2008 and 2014, patients with osteoporotic intertrochanteric fractures who underwent surgical interventions were enrolled in this retrospective cohort study. Group 1 included patients who were not on any osteoporosis medication prior to fracture and who postoperatively received only calcium and vitamin D; patients in Group 2 were not on any osteoporosis medication prior to fracture, and received teriparatide and calcium and vitamin D postoperatively. Patients in Group 3 were those who were on alendronate prior to fracture and postfracture received teriparatide as well as calcium and vitamin D. Demographics, time-to-union, HRQoL (short-form health survey [SF]-12 physical component summary [PCS] and SF-12 mental component summary [MCS]), morbidities, mortalities, and radiographic and functional outcomes between groups were compared.A total of 189 patients were enrolled in this study. There were 83 patients in Group 1, 47 patients in Group 2, and 59 patients in Group 3. A significantly shorter time-to-union was found in the teriparatide-treated groups (mean, 13.6, 12.3, and 10.6 weeks, respectively [P = 0.002]). With regard to SF-12 PCS, the scores were significantly better in teriparatide-treated groups at 3 months (mean, 19, 28, and 29, respectively [P = 0.002]) and 6 months (mean, 28, 37, and 38, respectively [P = 0.008]). Similar inter-group differences were noted when comparing the pain scores, the ability to get around the house, the ability to get out of the house, and the ability to go shopping at 3 and 6 months. Complications

  8. 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

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

    DEFF Research Database (Denmark)

    Abrahamsen, B; Rubin, Katrine Hass; Eiken, Pia Agnete

    2013-01-01

    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 and in...... and included dementia, ulcer disease, and Parkinson's disease....

  10. Use of systemic glucocorticoids and the risk of major osteoporotic fractures in patients with sarcoidosis

    NARCIS (Netherlands)

    Oshagbemi, Olorunfemi A; Driessen, J H M; Pieffers, A.; Wouters, E F M; Geusens, P.; Vestergaard, P.; van den Bergh, J; Franssen, F M E; de Vries, F

    2017-01-01

    This study revealed the risk of major osteoporotic fracture in patients with sarcoidosis exposed to glucocorticoids. Current use of glucocorticoids was associated with a risk of fracture, with no difference between patients with and without sarcoidosis. Sarcoidosis per se was not associated with an

  11. Use of anti-osteoporotic drugs in central Norway after a forearm fracture

    DEFF Research Database (Denmark)

    Hoff, Mari; Skurtveit, Svetlana; Meyer, Haakon E

    2015-01-01

    UNLABELLED: Use of anti-osteoporotic drugs (AOD) the first year after a forearm fracture in central Norway was low in the period 2005-2012. Women with fractures used more AOD compared to the general population only in 2006, 2007, and 2011. Female gender, age ≥ 60 years, use of glucocorticosteroids...

  12. The association between plasma homocysteine levels, methylation capacity and incident osteoporotic fractures

    NARCIS (Netherlands)

    Enneman, A. W.; van der Velde, N.; de Jonge, R.; Heil, S. G.; Stolk, L.; Hofman, A.; Rivadeneira, F.; Zillikens, M. C.; Uitterlinden, A. G.; van Meurs, J. B. J.

    2012-01-01

    Background: An elevated level of plasma homocysteine (Hey) is a known risk factor for osteoporotic fractures. In addition, Hey is related to DNA-methylation metabolism. To determine whether the association between Hey and fractures is explained by an altered methylation capacity, we investigated the

  13. Is balloon kyphoplasty better than percutaneous vertebroplasty for osteoporotic vertebral biconcave-shaped fractures?

    Science.gov (United States)

    Gan, Minfeng; Zou, Jun; Song, Dawei; Zhu, Xuesong; Wang, Genlin; Yang, Huilin

    2014-10-01

    Osteoporotic vertebral biconcave-shaped fractures are not commonly seen in clinical practice. Some articles have been published showing the outcome of vertebroplasty (PV) and balloon kyphoplasty (BKP), but few comparative studies have been performed. To compare the effect and safety of PV and BKP in treating osteoporotic vertebral biconcave-shaped fractures. In this retrospective comparative study, 38 patients with osteoporotic vertebral biconcave-shaped fractures were treated by PV, and 41 patients were treated by BKP from May 2005 to July 2011. The heights of the compromised vertebral body and the kyphotic angles were measured. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate pain and functional activity, respectively. The occurrence of refracture and cement leakage were determined, and the costs were recorded. The mean VAS and ODI scores significantly improved for both procedures at postsurgical measurements (P osteoporotic vertebral fractures in the PV group and two in the BKP group during the follow-up period. The mean cost in the BKP group (6200 ± 122.1 USD) was higher than the PV group (2100 ± 112.5 USD) (P osteoporotic vertebral biconcave-shaped fractures. BKP had a significant advantage over PV in terms of the restoration of the middle vertebral height and fewer cement leakages than PV. © The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  14. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence?

    Science.gov (United States)

    Van Lieshout, Esther M M; Alt, Volker

    2016-01-01

    Despite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substitutes are often used for stabilizing the implant and for providing a scaffold for ingrowth of new bone. Both synthetic and naturally occurring biomaterials are available. Products generally contain hydroxyapatite, tricalcium phosphate, dicalcium phosphate, calcium phosphate cement, calcium sulfate (plaster of Paris), or combinations of the above. Products have been used for the treatment of osteoporotic fractures of the proximal humerus, distal radius, vertebra, hip, and tibia plateau. Although there is generally consensus that screw augmentation increased the biomechanical properties and implant stability, the results of using these products for void filling are not unequivocal. In osteoporotic patients, Bone Morphogenetic Proteins (BMPs) have the potential impact to improve fracture healing by augmenting the impaired molecular and cellular mechanisms. However, the clinical evidence on the use of BMPs in patients with osteoporotic fractures is poor as there are no published clinical trials, case series or case studies. Even pre-clinical literature on in vitro and in vivo data is weak as most articles focus on the beneficial role for BMPs for restoration of the underlying pathophysiological factors of osteoporosis but do not look at the specific effects on osteoporotic fracture healing. Limited data on animal experiments suggest stimulation of fracture healing in ovariectomized rats by the use of BMPs. In conclusion, there is only limited data on the clinical relevance and optimal indications for the use of bone graft substitute materials and BMPs on the treatment of osteoporotic fractures despite the clinical benefits of these materials in other clinical indications. Given the

  15. Acetylcholinesterase inhibitors and the risk of osteoporotic fractures: nested case-control study.

    Science.gov (United States)

    Tamimi, I; Nicolau, B; Eimar, H; Arekunnath Madathil, S; Kezouh, A; Karp, I; Tamimi, F

    2018-04-01

    The objective of this study was to analyze the effect of acetylcholinesterase inhibitors (AChEIs) on the risk of osteoporotic fractures in Alzheimer patients. A nested case-control study was conducted on 1190 cases and 4760 controls. The use of AChEIs was found to decrease the risk of osteoporotic fractures in these patients. The objective of this study is to estimate the extent to which the use of AChEIs is associated with a reduction in the risk of osteoporotic fractures. A nested case-control study was conducted using data from the UK Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) database (1998-2013). The study cohort consisted of Alzheimer's Disease (AD) patients aged ≥ 65 years with no previous history of osteoporotic fractures at cohort baseline. Cases were individuals who suffered an osteoporotic fracture during the study period, whereas controls were subject who did not experience any osteoporotic fractures during the same period. Controls were drawn from the population time at risk while being matched to the cases in respect to age, sex, up-to-standard follow-up in the CPRD, calendar time, and duration of AD (control-to-case ratio: 4-to-1). Information on the use of AChEIs and the relevant potential confounders was ascertained from the CPRD database for all the cases and controls. We identified 1190 cases and 4760 controls. Compared to non-users, any use of AChEIs prior to the fracture was associated with a reduction in the fracture risk [adjusted odds ratio (OR) 0.80 (confidence interval (CI) 95%, 0.70-0.91)]. The use of AChEIs corresponding to a proportion of days covered of 0.8-1.0 was associated with a lower osteoporotic fracture risk compared to non-use [adjusted OR 0.76 (CI 95%, 0.66-0.87)]. In this study using large primary care databases, the use and treatment adherence to AChEIs were associated with a decreased risk of osteoporotic fractures in elderly AD patients.

  16. Chondrosis of the disc - risk factor for osteoporotic vertebral fractures (biomechanical analysis).

    Science.gov (United States)

    Wendlová, Jaroslava

    2010-09-01

    Based on biomechanical analysis, we present an until now unrecognised new view on pathological interactive relations in basic functional motor segments of the spine (vertebra - disc - vertebra), elevating the risk of osteoporotic vertebral fractures. They are classified as follows: 1. Degenerative alterations of intervertebral disc (chondrosis); 1a) decrease of intervertebral disc viscoelasticity; 1b) increase of compressive and tensile stress in the intervertebral disc. Loading the spine increases the compressive and tensile stress in the disc, afflicted by chondrosis, beyond physiological values. This increase conditions the non-physiological elevation of reaction compression forces in adjacent vertebrae, representing a fracture risk for endplates of these vertebrae. 2. Osteoporosis of vertebrae; 2a) decrease of vertebra elasticity and strength; 2b) phenomenon of local elevated compressive stress in the vertebra fracture site. In the vertebral body endplate infraction or fracture site develop a locus minoris of resistance and it contributes to the progression of breaking the vertebra and its whole compression by loading the spine with compressive force. With regard to the fact that above-mentioned risk factors are influenceable, we suggest preventive measures.

  17. 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

    Hormone replacement therapy (HRT) is often prescribed for a few years to suppress menopausal symptoms. Although its long-term use of HRT for the primary prevention of osteoporosis is not currently recommended, the long-term skeletal benefits of the limited therapy are of great interest......-controlled HRT trials and who were reexamined 5, 11, or 15 years after stopping HRT. Of these women, 263 received either HRT or placebo for 2-3 years with no further bone-sparing treatment until follow-up, and the remaining 84 women reported either prolonged or current use of HRT at reexamination. Bone mineral...... with that of the placebo-treated women, the BMD and BMC of HRT-treated women continued to show significantly higher values (>5%) even many years after stopping HRT. After stopping treatment, the rate of bone loss returned to normal postmenopausal rates. The preservation of bone mass in the HRT group was accompanied...

  18. Differentiation of Acute Osteoporotic and Malignant Vertebral Fractures by Quantification of Fat Fraction With a Dixon MRI Sequence.

    Science.gov (United States)

    Kim, Dong Hyun; Yoo, Hye Jin; Hong, Sung Hwan; Choi, Ja-Young; Chae, Hee Dong; Chung, Bo Mi

    2017-12-01

    The purpose of this study was to differentiate malignant compression fractures from acute osteoporotic compression fractures of the spine by use of a Dixon MRI sequence to quantify fat fraction (FF). Forty-four vertebral compression fractures were assessed with turbo spin-echo T1-weighted and six-echo Dixon sequences for FF quantification at 3-T MRI. The fractures were divided into malignant compression fractures (n = 24) and acute osteoporotic compression fractures (n = 20). Two radiologists independently measured quantitative parameters from ROIs in the fractures, including the T1 signal intensity of the fracture, the FF of the fracture, and the FF ratio (fracture FF divided by normal marrow FF). The mean values of the parameters were compared between the two groups, interobserver reliability between two radiologists was assessed, ROC curves were analyzed, and logistic regression analysis was performed. The fracture FF and FF ratio of malignant compression fractures were significantly lower than those of acute osteoporotic compression fractures (fracture FF, 2.73% vs 14.36% [p ratio, 0.05 vs 0.22 [p ratio was 0.95. In logistic regression analysis, fracture FF remained a significant variable that could be used to independently differentiate malignant from acute osteoporotic compression fractures (odds ratio, 0.33; p ratio obtained from FF maps obtained with a six-echo Dixon MRI sequence may be useful for differentiating acute osteoporotic compression fractures from malignant compression fractures.

  19. Clinical and radiological factors affecting progressive collapse of acute osteoporotic compression spinal fractures.

    Science.gov (United States)

    Goldstein, Sergei; Smorgick, Yossi; Mirovsky, Yigal; Anekstein, Yoram; Blecher, Ronen; Tal, Sigal

    2016-09-01

    Osteoporotic compression spine fractures have a different clinical course and outcomes when compared to spinal fractures occurring in the younger population. Only a few studies have investigated the risk factors for progressive osteoporotic compression spine fractures. The purpose of this study was to investigate clinical and radiological factors related to progressive collapse following acute osteoporotic compression spine fractures. We retrospectively identified all patients treated for thoracolumbar fractures in our institution between January 2008 and July 2013. Included cases were examined by plain radiographs and CT scans. For each patient we classified the fracture according to the AOSpine Thoracolumbar Spine Injury Classification System. The difference between initial and final height loss and initial and final local kyphosis was documented as height loss difference and kyphotic angle difference. The presence of old fractures and intravertebral cleft were also documented. The study included 153 patients, comprising 102 women and 51 men. The mean patient age was 68.9years. The mean length of follow up was 15months. A statistically significant correlation was found between patient age, final height loss, height loss difference and kyphotic angle difference. Height loss difference and kyphotic angle difference were significantly correlated to type of fracture according to the AO classification system. The height loss difference was 18.1% in A1 type fractures, 27.1% in A2 type fractures, 24.2% in A3 type fractures and 25.7% in A4 type fractures. During a minimum 3-month follow up of conservative treatment for acute osteoporotic vertebral compression fractures, age and the AOSpine Thoracolumbar Spine Injury Classification System were predictive factors for progressive collapse. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Conservative management of a lumbar compression fracture in an osteoporotic patient: a case report

    Science.gov (United States)

    Papa, John A.

    2012-01-01

    Objective: To chronicle the conservative treatment and management of an osteoporotic patient presenting with acute back pain resulting from a lumbar compression fracture. Clinical features: A 74-year old male presented with acute back pain in the thoracolumbar region after an episode of lifting. Radiographic evaluation revealed generalized demineralization and a moderate wedge compression fracture at L1. Intervention and outcome: The conservative treatment approach included postural education, activity modification, interferential current, taping into extension, Graston Technique®, and rehabilitative exercise prescription. Outcome measures included verbal pain rating scale, medication use, and a return to activities of daily living (ADLs). The patient attained long-term symptom resolution with no recurrence of pain at 12 month follow-up. Summary: A combination of conservative rehabilitation strategies may be successfully implemented to treat osteoporotic patients with mild to moderate osteoporotic vertebral compression fracture of the lumbar spine. PMID:22457539

  1. Risk factors and clinical outcomes of delirium in osteoporotic hip fractures.

    Science.gov (United States)

    Kim, Joon Yub; Yoo, Jeong Hyun; Kim, Eugene; Kwon, Ki Bum; Han, Byeong-Ryong; Cho, Yongun; Park, Jai Hyung

    2017-01-01

    This study is performed to identify risk factors for delirium in osteoporotic hip fractures and to evaluate the hospitalization cost and clinical outcomes of delirium in osteoporotic hip. A total of 221 patients with osteoporotic hip fractures were assessed for eligibility between 2010 and 2014. Among them, 37 patients with delirium were allocated into the delirium group (group D) and 37 patients without delirium were allocated into the non-delirium group (group ND) by matching demographic factors. Risk factors such as time between admission and operation, body mass index, American Society of Anesthesiologists status, cognitive impairment, preoperative urinary catheter, electrolyte imbalance, preoperative hemoglobin, polymedication (medications > 5), pneumonia, anesthesia time, operation time, estimated blood loss, and total amount of transfusion were evaluated for correlation with incidence of delirium. The hospitalization cost was evaluated, and clinical outcomes such as readmission, mortality, and activity level at 1-year follow-up were evaluated. In multivariate analysis, polymedication ( p = 0.028) and preoperative indwelling urinary catheter insertion status ( p = 0.007) were related to the incidence of delirium in patients with osteoporotic hip fractures. Group D showed a significantly higher hospitalization cost compared to group ND. However, delirium did not have a significant effect on length of hospital stay, readmission rate, postoperative 1-year mortality, and activity level. Polymedication and preoperative urinary catheter were related to perioperative delirium. In addition, delirium in osteoporotic hip fractures may not have a detrimental effect on clinical outcomes; however, hospitalization cost seemed to be increased due to delirium.

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

    Science.gov (United States)

    Baum, Thomas; Bauer, Jan S; Klinder, Tobias; Dobritz, Martin; Rummeny, Ernst J; Noël, Peter B; Lorenz, Cristian

    2014-04-01

    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 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 osteoporotic vertebral fractures so that appropriate therapy can be initiated. • This spine segmentation algorithm automatically localised, identified, and segmented the vertebrae in MDCT images. • Osteoporotic vertebral fractures could be automatically detected using this prototype algorithm. • The prototype algorithm helps radiologists to report underdiagnosed osteoporotic vertebral fractures.

  3. Percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fracture adjacent to lumbar instrumented circumferential fusion.

    Science.gov (United States)

    Yang, Shih-Chieh; Chen, Hung-Shu; Kao, Yu-Hsien; Ma, Ching-Hou; Tu, Yuan-Kun; Chung, Kao-Chi

    2012-07-01

    The purpose of this study was to evaluate the efficacy and safety of percutaneous vertebroplasty for patients with symptomatic osteoporotic vertebral compression fractures adjacent to lumbar instrumented circumferential fusion. Between January 2005 and June 2010, eighteen patients in the authors' institution with lumbar instrumented circumferential fusion had adjacent symptomatic osteoporotic vertebral compression fractures. The patients received percutaneous vertebroplasty using polymethylmethacrylate bone cement augmentation. Radiographs and magnetic resonance imaging were used. The visual analog pain scale and modified Brodsky's criteria were used to compare clinical outcomes pre- and postoperatively. Minimum follow-up was 18 months. Dual-energy x-ray absorptiometry scan confirmed osteoporosis in all patients. The average interval between fusion surgery and sustaining osteoporotic vertebral compression fractures was 24.8 months. The average interval between sustaining osteoporotic vertebral compression fractures and undergoing percutaneous vertebroplasty was 49.3 days. One-level percutaneous vertebroplasty was performed in 13 patients, and 2 levels were performed in 5 patients. The patients' visual analog pain scale scores improved by an average of 53 points postoperatively. Fifteen patients returned to preinjury activities of daily living. The average restoration of the fractured vertebral body height was 12.1%. No major surgery-related complications, occurred except asymptomatic cement leakage in 3 patients. Elderly patients undergoing lumbar instrumented fusion surgery should be aware of the possibility of adjacent vertebral compression fractures. Percutaneous vertebroplasty is a minimally invasive and effective procedure to treat such adjacent segment disease. Copyright 2012, SLACK Incorporated.

  4. Contribution of catastrophizing to disability and pain intensity after osteoporotic vertebral compression fracture.

    Science.gov (United States)

    Kim, Ho-Joong; Kim, Yun-Ho; Kang, Kyoung-Tak; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

    2016-05-01

    Pain catastrophizing is a key variable that contributes to disability not only in chronic pain disorders but also after trauma. However, there is little evidence concerning the effect of catastrophizing on pain intensity and disability after osteoporotic vertebral compression fracture. Therefore, the purpose of this study was to evaluate the contribution of catastrophizing to disability and pain intensity after osteoporotic vertebral compression fracture. We analyzed 35 patients with acute single-level osteoporotic vertebral compression fractures within 3 days of trauma. Data on demographics, education level, Charlson comorbidity index, pain catastrophizing scale (PCS) score, visual analog scale (VAS) score for back pain, and Oswestry Disability Index (ODI) were collected. VAS score for back pain and ODI were assessed at enrollment as well as at 2, 6, and 12 weeks after fracture. Each VAS score for back pain and ODI significantly improved compared to the initial values (P osteoporotic vertebral compression fracture. As the compression fracture heals, however, age is the critical determinant of disability. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  5. The effect of homocysteine-lowering with B-vitamins on osteoporotic fractures in patients with cerebrovascular disease: substudy of VITATOPS, a randomised placebo-controlled trial.

    Science.gov (United States)

    Gommans, John; Yi, Qilong; Eikelboom, John W; Hankey, Graeme J; Chen, Christopher; Rodgers, Helen

    2013-09-03

    Homocysteine has been postulated as a novel, potentially reversible risk factor for osteoporosis and related fractures. We evaluated whether homocysteine-lowering therapy with B-vitamins in patients with symptomatic cerebrovascular disease reduced the incidence of osteoporotic fractures. VITAmins To Prevent Stroke (VITATOPS) was a prospective randomised double-blind placebo-controlled trial in which 8,164 patients with recent (within 7 months) stroke or transient ischemic attack were randomly allocated to double-blind treatment with one tablet daily of either placebo (n = 4,075) or B-vitamins (folic acid 2 mg, vitamin B6 25 mg, vitamin B12 500 μg; n = 4,089). Patients were reviewed every six months. Any osteoporotic fracture and osteoporotic hip fractures were secondary outcome events, and were reviewed by a masked adjudication committee. Analysis was by intention to treat. Logistic regression was used to identify independent predictors of fracture. Participants had a mean age of 62.6 years (SD 12.5 years) and 64% were male, 42% of Western European descent and 75% were functionally independent (Oxford Handicap Scale of two or less). After a median duration of 2.8 years therapy and 3.4 years follow-up, there was no significant difference in the incidence of any osteoporotic fracture between participants assigned B-vitamins (67 [1.64%]) and placebo (78 [1.91%]; risk ratio [RR] 0.86, 95% confidence interval [CI] 0.62-1.18) or the incidence of hip fractures (34 [0.83%] B-vitamins vs. 36 [0.88%] placebo; RR 0.94, 95% CI 0.59-1.5). There was no significant impact of B-vitamin therapy on time to first fracture. Baseline homocysteine levels did not predict any osteoporotic fracture (p =0.43). Independent predictors of any osteoporotic fracture were female sex, age > 64 years, Western European ethnicity and use of anti-osteoporosis medication at randomization (all p B-vitamins had no effect on incidence of osteoporotic fractures during a median of 3.4 years follow-up in

  6. The effect of homocysteine-lowering with B-vitamins on osteoporotic fractures in patients with cerebrovascular disease: substudy of VITATOPS, a randomised placebo-controlled trial

    Science.gov (United States)

    2013-01-01

    Background Homocysteine has been postulated as a novel, potentially reversible risk factor for osteoporosis and related fractures. We evaluated whether homocysteine-lowering therapy with B-vitamins in patients with symptomatic cerebrovascular disease reduced the incidence of osteoporotic fractures. Methods VITAmins To Prevent Stroke (VITATOPS) was a prospective randomised double-blind placebo-controlled trial in which 8,164 patients with recent (within 7 months) stroke or transient ischemic attack were randomly allocated to double-blind treatment with one tablet daily of either placebo (n = 4,075) or B-vitamins (folic acid 2 mg, vitamin B6 25 mg, vitamin B12 500 μg; n = 4,089). Patients were reviewed every six months. Any osteoporotic fracture and osteoporotic hip fractures were secondary outcome events, and were reviewed by a masked adjudication committee. Analysis was by intention to treat. Logistic regression was used to identify independent predictors of fracture. Results Participants had a mean age of 62.6 years (SD 12.5 years) and 64% were male, 42% of Western European descent and 75% were functionally independent (Oxford Handicap Scale of two or less). After a median duration of 2.8 years therapy and 3.4 years follow-up, there was no significant difference in the incidence of any osteoporotic fracture between participants assigned B-vitamins (67 [1.64%]) and placebo (78 [1.91%]; risk ratio [RR] 0.86, 95% confidence interval [CI] 0.62-1.18) or the incidence of hip fractures (34 [0.83%] B-vitamins vs. 36 [0.88%] placebo; RR 0.94, 95% CI 0.59-1.5). There was no significant impact of B-vitamin therapy on time to first fracture. Baseline homocysteine levels did not predict any osteoporotic fracture (p =0.43). Independent predictors of any osteoporotic fracture were female sex, age > 64 years, Western European ethnicity and use of anti-osteoporosis medication at randomization (all p osteoporotic fractures during a median of 3.4 years follow

  7. The risks of major osteoporotic fractures in patients with schizophrenia: a population-based 10-year follow-up study.

    Science.gov (United States)

    Tsai, Kuan-Yi; Lee, Ching-Chih; Chou, Yu-Mei; Shen, Shih-Pei; Su, Chao-Yueh; Wu, Hung-Chi; Huang, Min-Wei; Shie, Jia-Pei; Chou, Frank Huang-Chih

    2014-11-01

    The aim of the study is to explore the incidence and the risks associated with major osteoporotic fractures, all-cause mortality with osteoporotic fractures and the effect of the psychiatric drug exposure in patients with schizophrenia during a 10-year follow-up period. Two nationwide cohorts were selected from the Taiwan National Health Insurance Research Database (NHIRD) consisting of 30,335 patients with schizophrenia (age ≥ 40 years) and 121,340 age- and sex-matched control participants without schizophrenia. The psychiatric proportion of days covered (PDC) is an indicator of the intensity of drug exposure in patients with schizophrenia. The incidence and risk factors of major osteoporotic fractures were calculated for both cohorts. Additionally, the patient survival rate after major osteoporotic fractures was also calculated. During a 10-year follow-up period, 1677 (5.53%) schizophrenia and 4257 (3.51%) control subjects had major osteoporotic fractures (P 0.1 showed a significantly higher incidence of major osteoporotic fractures than did the non-schizophrenia controls; however, those with a psychiatric PDC ≤ 0.1 did not. After adjustment, the psychiatric PDC was significantly and independently associated with the risk of major osteoporotic fractures except some medical morbidities but the schizophrenia diagnosis was not. In addition, among all 5934 patients with major osteoporotic fracture, the adjusted mortality hazard ratio for psychiatric PDC was 1.92 (95% CI = 1.63-2.26). Patients with schizophrenia are at a higher risk for major osteoporotic fractures than the general population and also have a higher mortality rate due to major osteoporotic fractures. These findings may be caused by psychiatric drug use rather than schizophrenia, which suggests that directions can be taken in future studies. Copyright © 2014 Elsevier B.V. All rights reserved.

  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. The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan.

    Science.gov (United States)

    Chang, C-Y; Tang, C-H; Chen, K-C; Huang, K-C; Huang, K-C

    2016-02-01

    This study estimated the fracture-related mortality and direct medical costs among postmenopausal women in Taiwan by fracture types and age groups by utilizing a nationwide population-based database. Results demonstrated that hip fractures constituted the most severe and expensive complication of osteoporosis across fracture sites. The aims of the study were to evaluate the risk of death and direct medical costs associated with osteoporotic fractures by fracture types and age groups among postmenopausal women in Taiwan. This nationwide, population-based study was based on data from the National Health Insurance Research Database in Taiwan. Female patients aged 50 years and older in the fracture case cohort were matched in 1:1 ratio with randomly selected subjects in the reference control cohort by age, income-related insurance amount, urbanization level, and the Charlson comorbidity index. There were two main outcome measures of the study: age-differentiated mortality and direct medical costs in the first and subsequent years after osteoporotic fracture events among postmenopausal women. The bootstrap method by resampling with replacement was conducted to generate descriptive statistics of mortality and direct medical costs of the case and control cohorts. Student's t tests were then performed to compare mortality and costs between the two cohorts. A total of 155,466 postmenopausal women in the database met the inclusion criteria for the fracture case cohort, including 22,791 hip fractures, 72,292 vertebral fractures, 15,621 upper end humerus (closed) fractures, 36,774 wrist fractures, and 7,988 multiple fractures. Analytical results demonstrated that patients experiencing osteoporotic fractures were at considerable excess risk of death and incurred substantially higher treatment costs, notably for hip fractures. Furthermore, results also revealed that the risk of mortality increased with advancing age across the spectrum of fracture sites. The present study

  10. Association of cystatin C- and creatinine-based eGFR with osteoporotic fracture in Japanese postmenopausal women with osteoporosis: sarcopenia as risk for fracture.

    Science.gov (United States)

    Kurajoh, Masafumi; Inaba, Masaaki; Nagata, Yuki; Yamada, Shinsuke; Imanishi, Yasuo; Emoto, Masanori

    2018-02-20

    Coexistence of chronic kidney disease (CKD) is regarded as a risk for osteoporotic fracture particularly in postmenopausal women, not only because of increased parathyroid hormone level but also uremic sarcopenia. We examined the relationships of cystatin C-based glomerular filtration rate (eGFRcys) and creatinine-based GFR (eGFRcr), as well as their ratio with occurrence of osteoporotic fracture in postmenopausal osteoporotic women. This cross-sectional study included 555 postmenopausal women with osteoporosis. eGFRcr and eGFRcys were simultaneously measured, while occurrence of osteoporotic fracture was obtained by a medical chart review. Patients with osteoporotic fractures (n = 211) exhibited significantly lower levels of physical activity, eGFRcr, eGFRcys, and eGFRcys/eGFRcr ratios, while a higher percentage was CKD stage 3 or more, estimated by eGFRcr or eGFRcys (CKDcys), than those without (n = 344). Lower eGFRcys, but not lower eGFRcr, was independently associated with osteoporotic fracture in the entire cohort and that association was retained in CKDcys patients. Of great interest, higher eGFRcr was associated with osteoporotic fracture independent of eGFRcys in CKDcys patients. Furthermore, lower eGFRcys/eGFRcr ratio was independently associated with osteoporotic fracture in both CKDcys patients and the entire cohort. eGFRcys reduction might be associated with osteoporotic fracture in postmenopausal osteoporotic women, indicating the involvement of renal osteopathy in its occurrence. Furthermore, the association of higher, but not lower, eGFRcr with osteoporotic fracture in CKDcys cases might be explained by underestimation of renal dysfunction by eGFRcr resulting from decreased muscle mass and quality in those patients.

  11. Is Turkish FRAX® Model Sufficient? The Analysis of Osteoporotic Fracture Risk in Turkish Population by Using Frax

    Directory of Open Access Journals (Sweden)

    Ahmet Aslan

    2014-04-01

    Full Text Available Objectives: In this study, we aimed to evaluate the effectiveness of Turkish FRAX model in the prediction of osteoporotic fracture risk and to determine the factors that may affect the results in this model. Material and Methods: Data of 104 patients with hip fracture who had underwent bone densitometry scan between 2009-2012, in Kastamonu and Afyon cities in Turkey, were assessed in this study. Patients were divided into 3 groups. Group-1; patients with osteoporotic hip fractures (n=36, Group-2; patients with other osteoporotic bone fractures (n=33, Group-3; patients with no osteoporotic fracture history (n=35. The recent osteoporotic fractures in patients were ruled out and by noting the former fractures and previously determined risk factors, fracture risks were calculated by Frax method. The groups were compared on the basis of fracture risks, t-scores and demographical characteristics. Results: A statistically significant difference was found between the patients with major osteoporotic fracture (MOF in Group-1 and Group-2 and patients with no MOF history in Group-3 (p0.05. With respect to average age in patients, a significant difference was found between Group-1 and 3(p0.05. Also, no statistically meaningful difference with regard to other risk factors was found between the groups (p>0.05. Conclusion: Results of this study: previous MOFs, advanced age and a remarkable decrease in t-scores are the main risk factors in osteoporotic fractures. Turkish FRAX® model may be useful in the prediction of fracture risk in patients with increased risk factors in Turkish population. However, this study may not be adequate to rule out the concerns that Turkish Frax model must be revised to fulfill the expectations in determining osteoporotic fracture risk. (Turkish Journal of Osteoporosis 2014;20: 21-5

  12. Bilateral L5 Radiculopathy Due to Osteoporotic L1 Vertebral Fracture: A Case Report

    Science.gov (United States)

    Tezer, Mehmet; Ozturk, Cagatay; Erturer, Erden; Aydogan, Mehmet; Hamzaoglu, Azmi

    2006-01-01

    Background: The true incidence of osteoporotic vertebral fractures is not well defined because many osteoporotic vertebral fractures are asymptomatic. Although the true incidence of neurological compromise as a result of osteoporotic vertebral fractures is not known, it is thought to be low. In this case report, we present a case of L1 osteoporotic vertebral fracture causing bilateral L5 nerve root compression and manifestation of bilateral foot-drop. Methods: Pedicle screws were inserted in the vertebrae, 2 above and 2 below the L1 vertebra. A temporary rod was placed on the left. An L1 right hemilaminectomy via a posterior approach and a corpectomy were performed. The spinal cord was decompressed. Anterior fusion was carried out by placing titanium mesh cage into the vertebrectomy site as a strut graft via posterior approach, and posterolateral fusion with spongious allografts were added to the procedure. Results: Two years later the patient was completely symptom free and receiving medical treatment for osteoporosis, which was diagnosed as primary type. Conclusion: If a fracture is detected on the posterior wall of the vertebral body in computerized tomography (CT) examination with plain radiographs, a magnetic resonance imaging (MRI) examination should be conducted in the presence of symptoms and physical findings suggestive of neurological compression. Follow-up neurological examinations should be carried out, and it should be kept in mind that most of the neurological symptoms may develop late and manifest as radiculopathy. The majority of the osteoporotic vertebral fractures can be managed conservatively with bed rest and orthosis, but cases with accompanying neurological deficit should be managed surgically using decompression and stabilization by fusion and instrumentation. PMID:17044395

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

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    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.

  14. 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.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance each tool was sufficient for practical use and lastly to examine whether the complexity of the tools influenced their discriminative power. We searched Pub...

  16. Indirect costs account for half of the total costs of an osteoporotic fracture: a prospective evaluation

    NARCIS (Netherlands)

    Eekman, D.A.; ter Wee, M.M.; Coupe, V.M.H.; Erisek-Demirtas, S.; Kramer, M.H.; Lems, W.F.

    2014-01-01

    Data on direct and indirect costs of clinical fractures in 116 osteoporotic patients 50 years and older were prospectively collected using cost diaries. Indirect costs accounted for roughly half of the total costs, with a contribution of at least 81 % of these costs in employed patients.

  17. MRI diagnosis of intravertebral at fluid osteoporotic and metastatic vertebral compression fractures

    Directory of Open Access Journals (Sweden)

    Александр Павлович Мягков

    2015-04-01

    Full Text Available Therefore, the aim of the work was to evaluate the value of intravertebral fluid with osteoporosis and metastatic vertebral compression fractures using magnetic resonance imaging. Objectives of the study were to investigate: MRI semiotics of osteoporotic compression fractures with their diagnostic value; intravertebral fluid in pathological fractures.Methods. 120 patients with pathologic compression fractures of the spine, which included 70 patients with acute osteoporotic and 50 - with metastatic, are examined. Among patients with osteoporotic fractures were 62 women (88.6 % men - 8 (11.4 % with an average age of 65.6 ± 11.1 years, and among patients with MCP fractures was 30 (60.0 % men and 20 (40.0 % women with a mean age 60.8 ± 12.5 years. All patients underwent an MRI on devices with a magnetic field strength of 0.2, 1.5 and 0.36 Tс (AIRIS Mate, ECHELON firm "Hitachi medical Corp.", Japan, "I-Open 0.36", China. Dual-energy X-ray absorptiometry (DXA held 59 (39.1 % patients. DXA was performed on the unit «Lunar PRODIGY Primo DHA"Results. The basic structural and morphological changes with osteoporotic compression fractures of the spine such as - bone marrow edema, annular seal paravertebral soft tissue, compression of the veins bazivertebrales, remains of yellow bone marrow, involvement arches and rear elements of the vertebra, curved (intact the back surface of the body, the fracture of the reflex plates, rear corner pieces with indicators of sensitivity, specificity, and accuracy. It was shown that the intravertebral fluid of the compressed vertebral bodies found in 72 (88.9 % patients. This feature may also be an indicator of the seam (or splice the data fractures.Conclusions. Intravertebral fluid in the compressed vertebral bodies was found in 88.9 % of patients with osteoporotic fractures, and this feature can be another tool in the diagnosis of this category of fractures with high sensitivity, specificity and accuracy. This feature

  18. 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, osteoporotic fracture. Additional study, perhaps including randomized clinical trials, may be warranted to further understand

  19. Vertebroplasty and Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures

    Directory of Open Access Journals (Sweden)

    Işıl Taş

    2004-12-01

    Full Text Available In our study which is carried out to detect the effect of kyphoplasty over acute vertebral fractures, 8 patients; presenting with 6 osteoporotic, 1 tumoral, 1 traumatic acute vertebra fractures underwent kyphoplasty procedure at a total of 12 levels. No postoperative complications were detected, and as achieved, in the 6 th and 12 th month follow up periods, no adjacent vertebral fracture was observed with X ray imaging. With this small series, kyphoplasty has been shown to have affirmative effects in the treatment of acute vertebral fractures with respect to the visual analogue scale, Qualeffo-41 questionnaire and morphometric vertebral height measurements.

  20. Current Role and Application of Teriparatide in Fracture Healing of Osteoporotic Patients: A Systematic Review

    Science.gov (United States)

    Kim, Sang-Min; Kang, Kyung-Chung; Kim, Ji Wan; Lim, Seung-Jae

    2017-01-01

    Background The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients. Methods We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including “Fracture” [tiab] AND “Teriparatide [tiab] OR “PTH” [tiab]. Results This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3. Conclusions Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials. PMID:28326303

  1. Bone three-dimensional microstructural features of the common osteoporotic fracture sites

    Science.gov (United States)

    Chen, Huayue; Kubo, Kin-ya

    2014-01-01

    Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density (BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporotic fracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age. PMID:25232524

  2. Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population-based nested case-control study.

    Science.gov (United States)

    Kumar, S; Drake, M T; Schleck, C D; Johnson, M L; Alexander, J A; Katzka, D A; Iyer, P G

    2017-12-01

    Proton pump inhibitors (PPI) are inconsistently associated with osteoporotic fractures. Barrett's oesophagus (BO) patients are treated with high PPI doses for prolonged periods, but there are limited data on the incidence of osteoporosis and fractures in this group pf patients. To estimate the incidence of (and risk factors for) low bone mass (osteoporosis and/or osteopenia) related fractures in a population-based BO cohort. All subjects with BO and a diagnosis of osteoporosis and fractures were identified using Rochester Epidemiology Project resources. The incidence rates of all and osteoporotic fractures in these subjects were compared to an age- and gender similar population in Olmsted County to determine standardised incidence ratios (SIR). Predictors were assessed using Cox proportional hazards models. Five hundred and twenty-one patients were included (median [IQR] age 61 [52, 72] years; 398 [76%] men) of whom 113 (21.7%) had fractures, and 46 (8.8%) had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that of an age- and gender-matched population (SIR 1.09; 95% CI 0.92-1.29: SIR 1.05; 95% CI 0.85-1.29). PPI use, dose or duration of use was not associated with osteoporotic fracture risk (HR 0.87; 95% CI 0.12-6.39). Independent risk factors for osteoporotic fractures included older age, female gender and higher co-morbidity index. The incidence of osteoporotic fractures was not increased in BO patients compared to the general population. In addition, PPI use was not associated with increased fracture risk regardless of the duration of therapy or dose. © 2017 John Wiley & Sons Ltd.

  3. Integrity of the osteocyte bone cell network in osteoporotic fracture: Implications for mechanical load adaptation

    International Nuclear Information System (INIS)

    Kuliwaba, J S; Truong, L; Codrington, J D; Fazzalari, N L

    2010-01-01

    The human skeleton has the ability to modify its material composition and structure to accommodate loads through adaptive modelling and remodelling. The osteocyte cell network is now considered to be central to the regulation of skeletal homeostasis; however, very little is known of the integrity of the osteocyte cell network in osteoporotic fragility fracture. This study was designed to characterise osteocyte morphology, the extent of osteocyte cell apoptosis and expression of sclerostin protein (a negative regulator of bone formation) in trabecular bone from the intertrochanteric region of the proximal femur, for postmenopausal women with fragility hip fracture compared to age-matched women who had not sustained fragility fracture. Osteocyte morphology (osteocyte, empty lacunar, and total lacunar densities) and the degree of osteocyte apoptosis (percent caspase-3 positive osteocyte lacunae) were similar between the fracture patients and non-fracture women. The fragility hip fracture patients had a lower proportion of sclerostin-positive osteocyte lacunae in comparison to sclerostin-negative osteocyte lacunae, in contrast to similar percent sclerostin-positive/sclerostin-negative lacunae for non-fracture women. The unexpected finding of decreased sclerostin expression in trabecular bone osteocytes from fracture cases may be indicative of elevated bone turnover and under-mineralisation, characteristic of postmenopausal osteoporosis. Further, altered osteocytic expression of sclerostin may be involved in the mechano-responsiveness of bone. Optimal function of the osteocyte cell network is likely to be a critical determinant of bone strength, acting via mechanical load adaptation, and thus contributing to osteoporotic fracture risk.

  4. Integrity of the osteocyte bone cell network in osteoporotic fracture: Implications for mechanical load adaptation

    Science.gov (United States)

    Kuliwaba, J. S.; Truong, L.; Codrington, J. D.; Fazzalari, N. L.

    2010-06-01

    The human skeleton has the ability to modify its material composition and structure to accommodate loads through adaptive modelling and remodelling. The osteocyte cell network is now considered to be central to the regulation of skeletal homeostasis; however, very little is known of the integrity of the osteocyte cell network in osteoporotic fragility fracture. This study was designed to characterise osteocyte morphology, the extent of osteocyte cell apoptosis and expression of sclerostin protein (a negative regulator of bone formation) in trabecular bone from the intertrochanteric region of the proximal femur, for postmenopausal women with fragility hip fracture compared to age-matched women who had not sustained fragility fracture. Osteocyte morphology (osteocyte, empty lacunar, and total lacunar densities) and the degree of osteocyte apoptosis (percent caspase-3 positive osteocyte lacunae) were similar between the fracture patients and non-fracture women. The fragility hip fracture patients had a lower proportion of sclerostin-positive osteocyte lacunae in comparison to sclerostin-negative osteocyte lacunae, in contrast to similar percent sclerostin-positive/sclerostin-negative lacunae for non-fracture women. The unexpected finding of decreased sclerostin expression in trabecular bone osteocytes from fracture cases may be indicative of elevated bone turnover and under-mineralisation, characteristic of postmenopausal osteoporosis. Further, altered osteocytic expression of sclerostin may be involved in the mechano-responsiveness of bone. Optimal function of the osteocyte cell network is likely to be a critical determinant of bone strength, acting via mechanical load adaptation, and thus contributing to osteoporotic fracture risk.

  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. Calcium and phosphorus metabolism and lithogenic factors in patients with osteoporotic fracture.

    Science.gov (United States)

    Ochoa-Hortal Rull, M Á; Cano-García, M C; Arrabal Martín, M; Cano Gea, R; Reyes García, R; Arrabal-Polo, M A

    2015-06-01

    To demonstrate the attendance of mineral metabolism disorders and lithogenic factors in patients' urine with osteoporotic fracture without previously known stones 67 patients with osteoporotic fractures surgically treated in trauma service are included. The area of the fracture site, fracture mechanism and the presence of osteoporosis were the factors taken into account to diagnose osteoporotic fracture. Mineral metabolism, calciuria, oxaluria, uricosuria and citraturia in 24hours urine were analyzed. The presence of abnormal calcium and phosphorus metabolism was proved comparing hypercalciuria patients with normocalciuria ones. 12 men and 55 women with mean age 68.8±14.5 years old were included. Mean Body Mass Index (BMI) was 27.4±4.1kg/m2. 42% of patients showed hypercalciuria, 34% hyperoxaluria, 34% hypocitraturia and 7% hyperuricosuria. Statistically significant differences were observed only in fasting calcium/creatinine ratio (0.17 vs. 0.08; Purine, mainly hypercalciuria, always in fasting conditions. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Use of anti-osteoporotic drugs in central Norway after a forearm fracture

    DEFF Research Database (Denmark)

    Hoff, Mari; Skurtveit, Svetlana; Meyer, Haakon E

    2015-01-01

    UNLABELLED: Use of anti-osteoporotic drugs (AOD) the first year after a forearm fracture in central Norway was low in the period 2005-2012. Women with fractures used more AOD compared to the general population only in 2006, 2007, and 2011. Female gender, age ≥ 60 years, use of glucocorticosteroids......, age ≥ 60 years, use of glucocorticosteroids, or ≥ 4 different drugs the last year before fracture were associated with AOD use. In women, 54.8 % were adherent during 3 years after fracture. CONCLUSIONS: The use of AOD after a forearm fracture was low. An increased focus on osteoporosis in fracture......, or ≥ 4 different drugs were associated with AOD use. PURPOSE: The primary aim of this study was to examine time trends in prevalence and incidence of AOD use the first year after a forearm fracture from 2005-2012. Further, secondary aims were to investigate if gender, the number of drugs used before...

  8. Biomechanical Comparison of Cadaveric and Commercially Available Synthetic Osteoporotic Bone Analogues in a Locked Plate Fracture Model Under Torsional Loading.

    Science.gov (United States)

    Becker, Edward H; Kim, Hyunchul; Shorofsky, Michael; Hsieh, Adam H; Watson, Jeffrey D; OʼToole, Robert V

    2017-05-01

    Biomechanical studies of osteoporotic bone have used synthetic models rather than cadaveric samples because of decreased variability, increased availability, and overall ease of the use of synthetic models. We compared the torsional mechanical properties of cadaveric osteoporotic bone with those of currently available synthetic osteoporotic bone analogues. We tested 12 osteoporotic cadaveric humeri and 6 specimens each of 6 types of synthetic analogues. A 5-mm fracture gap model and posterior plating technique with 4.5-mm narrow 10-hole locking compression plate were used. Torque was applied to a peak of ±10 N·m for 1000 cycles at 0.3 Hz. Data were continuously collected during cyclical and ramped loading with a servohydraulic materials testing system. Cadaveric bone had a 17% failure rate before completing 1000 cycles. Three osteoporotic bone models had 100% failure (P Osteoporotic bone analogues had torsional mechanical properties different from those of osteoporotic cadaveric specimens. The differences between osteoporotic cadaveric humeri and synthetic osteoporotic bone analogues ranged from profound with complete catastrophic failure after a few cycles to subtler differences in stiffness and strain hardening. These findings suggest that different bone analogue models vary substantially in their torsional mechanical properties and might not be appropriate substitutes for cadaveric bone in biomechanical studies of osteoporotic bone.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    could include reduction of excessive alcohol intake, smoking cessation, adequate nutrition, patient education, daily physical activity and a careful review of medications that could increase the risk of falls and fractures. There remains, however, an unmet need for high-quality intervention studies......Although many strong risk factors for osteoporosis-such as family history, fracture history and age-are not modifiable, a number of important risk factors are potential targets for intervention. Thus, simple, non-pharmacological intervention in patients at increased risk of osteoporotic fractures...

  10. Breast cancer survivors are at an increased risk for osteoporotic fractures not explained by lower BMD: a retrospective analysis

    Science.gov (United States)

    Fraenkel, Merav; Geffen, David B; Novack, Victor; Shafat, Tali; Mizrakli, Yuval; Ariad, Samuell; Koretz, Michael; Norton, Larry; Siris, Ethel

    2015-01-01

    Background: An association between higher bone mineral density (BMD) and the diagnosis of breast cancer (BC) has been reported. Data on the risk of osteoporotic fractures in women with BC are conflicting. Aims: The objective of this study was to assess fracture risk adjusted for BMD in women with and without BC, and to assess whether fracture risk in BC patients is attributed to BMD or BC characteristics. Methods: Using electronic medical records of patients who underwent dual energy X-ray absorptiometry BMD studies at Soroka University Medical Center between February 2003 and March 2011, we identified women with subsequent diagnosis of osteoporotic fractures. BC status, demographic, health characteristics, BMD, and other laboratory findings were assessed. In BC patients data on grade, stage, and treatment were collected. Primary outcome was osteoporotic fracture, analyzed by Cox proportional hazards regression models. Results: During a median follow-up of 4.9 years in 17,110 women with BMD testing (658 BC patients), 1,193 women experienced an osteoporotic fracture (62 in BC and 1,131 in no-BC groups). In multivariate analysis adjusted for age, body mass index (BMI) and BMD, hazard ratio (HR) for any osteoporotic fracture in women with BC was 1.34 (P=0.026). BMD was similar among women with and without BC who fractured. BC patients who experienced an osteoporotic fracture had a trend for less-advanced BC, lower rates of chemotherapy treatment, and higher rates of tamoxifen treatment. Conclusions: BC survivors are at increased risk of an osteoporotic fracture, which is not explained by worse BMD. Chemotherapy or aromatase inhibitors did not contribute substantially to fracture risk among our BC survivors. PMID:28721367

  11. Osteoporotic pertrochanteric hip fractures: management and current controversies.

    Science.gov (United States)

    Lorich, Dean G; Geller, David S; Nielson, Jason H

    2004-01-01

    The treatment of intertrochanteric hip fractures has evolved over the past 80 years because of a better understanding of fracture anatomy, application of biomechanical principles, and novel technologic advances. Surgical treatment of intertrochanteric hip fractures is the current standard of care, with short-term goals of fracture stabilization and early patient mobilization and the long-term objective of restoring patients to their previous level of independence and function. Treatment for stable intertrochanteric hip fractures includes use of percutaneous intramedullary devices and open reduction and internal fixation using a sliding hip screw. To date, none of these devices has shown any clear clinical advantage over the dynamic hip screw. Intramedullary fixation has multiple theoretical advantages for the treatment of unstable fracture patterns; however, it remains unclear if ultimate functional outcome warrants the added expense of such treatment. For patients with a reverse obliquity fracture pattern, the advantage of the intramedullary construct has been shown.

  12. 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.

  13. Locally applied simvastatin improves fracture healing at late period in osteoporotic rat

    Science.gov (United States)

    Tian, Faming; Zhang, Liu; Kang, Yuchuan; Zhang, Junshan; Ao, Jiao; Yang, Fang

    effect of simvastatin locally applied from a bioactive polymer coating of implants on osteoporotic fracture healing at late period. Methods:Femur fracture model was established on normal or osteotoporotic mature female SD rats, intramedullary stabilization was achieved with uncoated titanium Kirschnerwires in normal rats(group A),with polymer-only coated vs. polymer plus simvastatin coated titanium Kirschner wires in osteoporotic rats(group B and C, respectively).Femurs were harvested after 12 weeks, and underwent radiographic and histologic analysis, as well as immunohistochemical evaluation for BMP-2 expression. Results:Radiographic results demonstrated progressed callus in the simvastatin-treated groups compared to the uncoated group.The histologic analysis revealed a significantly processed callus with irregular-shaped newly formed bone trabeculae in simvastatin-treated group. Immunohistochemical evaluation showed markedly higher expression levels of B:MP-2 in simvastatin-treated group.Conclusions: The present study revealed a improved fracture healing under local application of simvastatin in osteoporotic rat,which might partially from upregulation of the B:MP-2 expression at fractured site.

  14. 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

  15. The second hip fracture in osteoporotic patients: not only an orthopaedic matter.

    Science.gov (United States)

    Scaglione, Michelangelo; Fabbri, Luca; Di Rollo, Federica; Bianchi, Maria Giulia; Dell'omo, Dario; Guido, Giulio

    2013-05-01

    The second hip fracture indicates the fracture of the osteoporotic femoral neck which occurs in patients already operated on the opposite side. It is a growing problem, especially in Italy where the ageing rate of the population is one of the highest in the world. Only in recent years this issue has been discussed in the international literature about timing and the treatment methods as a consequence linked to the social costs, mortality, disability of this pathology. The aim of our study is the evaluation of the incidence of hip fractures in a sample of patients that already substained a surgical procedure for a proximal femour fracture. The evaluation was based on the time elapsed between the two fractures, the quality of life after the second fractural episode through a telephone questionnaire (EQ-5D), the incidence of mortality, the adhesion to the antifractural therapy and the comparison of the obtained data to the international standards.

  16. Comparison between bipolar hemiarthroplasty and total hip arthroplasty for unstable intertrochanteric fractures in elderly osteoporotic patients.

    Directory of Open Access Journals (Sweden)

    Lihong Fan

    Full Text Available The present study was conducted to compare bipolar hemiarthroplasty (BA with total hip arthroplasty (THA in treatment of unstable intertrochanteric fractures in elderly osteoporotic patients. The THA group included 14 males and 26 females with a mean age of 73.4 years, and the BA group included 27 males and 45 females with a mean age of 76.5 years. Significant difference existed between the two groups in operation time, blood loss, transfusion volume and cost of hospitalization, while no remarkable difference was identified in hospitalization period, general complications, joint function, pain, rate of revision and mortality. No dislocation was observed in BA group while 3 occurred in THA group. The results indicated that for unstable intertrochanteric fractures in elderly osteoporotic patients, BA seems to be a better or more reasonable choice compared with THA for the reason of less blood loss, shorter operation time, lower cost and no dislocation.

  17. Teriparatide Treatment Following Osteoporotic Hip Fracture in a Male Patient with Multiple Sclerosis and Current Recommendations

    Directory of Open Access Journals (Sweden)

    Sibel Başaran

    2015-12-01

    Full Text Available A 58-year-old male patient with a diagnosis of multiple sclerosis (MS who had been operated due to a low-energy subtrochanteric femoral fracture was admitted in order to plan anti-osteoporotic treatment and rehabilitation at post-operative first week. Although the patient had a history of glucocorticoid use, he had never received any preventative treatment for osteoporosis. T-scores detected by Dual energy x-ray absorptiometry (DXA method were -4.7, -4.9 and -3.3 at femoral neck, total hip and L1-L4 vertebrae, respectively. Since the patient had severe osteoporosis, teriparatide treatment was planned. Following vitamin D supplementation, teriparatide 20 mcg/day was started. After 6 months of treatment, patient improved significantly in terms of symptoms and DXA scores. T-scores of the femoral neck, total hip and L1-L4 vertebrae improved to -3.4, -3.9 and -3.0, respectively. When teriparatide therapy was continued up to 18 months, further increase in DXA values was observed (T-scores of femoral neck, total hip and L1-L4 vertebrae were -2.9, -2.4 and -2.2, respectively. No adverse event was seen during the treatment period. Following the cessation of teriparatide therapy, alendronate and cholecalciferol combination (70 mg/2800 IU was started. Bone health and vitamin D level are affected negatively in patients with MS due to multifactorial reasons. In order to avoid serious consequences such as hip fracture, awareness about osteoporosis should be increased and preventative strategies should be tailored from the early stages of the disease

  18. Do osteoporotic fractures constitute a greater recalcitrant challenge for skeletal regeneration? Investigating the efficacy of BMP-7 and zoledronate treatment of diaphyseal fractures in an open fracture osteoporotic rat model.

    Science.gov (United States)

    Mathavan, N; Tägil, M; Isaksson, H

    2017-02-01

    Osteoporotic fractures may pose a challenge for skeletal regeneration. This study investigates if pharmaceutical interventions such as bone morphogenetic protein 7 (BMP-7) alone or in combination with Zoledronate have equivalent efficacy in osteoporotic bone? Our findings suggest they do and that an osteoporotic bone environment may increase sensitivity to BMP-7. Osteoporosis is thought to contribute to delayed or impaired bone healing. Bone morphogenetic protein 7 (BMP-7) alone or synergistically combined with zoledronate (ZA) has proven effective in augmenting the regenerative response in healthy young male rats. Yet their comparative efficacy in an osteoporotic bone environment is unknown. Our study aimed to answer the following questions using the ovariectomized (OVX) rat model of osteoporosis: Do osteoporotic fractures pose a greater challenge for skeletal regeneration? Are interventions with BMP-7-alone or combined with ZA of equivalent efficacy in osteoporotic bone? Sham operations (n = 33) or ovariectomies (n = 34) were performed in 12-week-old female Sprague-Dawley rats. Mid-diaphyseal open femoral osteotomies were created at 24 weeks of age and the rats allocated to either (i) untreated, (ii) BMP-7-only or (iii) BMP-7 + ZA treatment groups. At 6 weeks post-osteotomy, fracture healing was evaluated by radiography, μCT and 3-point bending mechanical tests. Cumulatively, radiological, micro-structural and mechanical measures were equivalent in both healthy and osteoporotic environments. A reduced response to BMP-7-alone was observed in healthy rats that may be age/gender- or protocol/fracture-model dependent. Conversely, the BMP-7-only treated OVX group attained 100 % union in addition to significantly increased measures of mineralized bone volume, total callus volume, peak force and absorbed energy relative to untreated OVX fractures. Our findings refute the hypothesis that osteoporotic fractures constitute a greater recalcitrant challenge for

  19. 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.)

  20. Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men.

    Science.gov (United States)

    Schousboe, John T; Vo, Tien; Taylor, Brent C; Cawthon, Peggy M; Schwartz, Ann V; Bauer, Douglas C; Orwoll, Eric S; Lane, Nancy E; Barrett-Connor, Elizabeth; Ensrud, Kristine E

    2016-03-01

    Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual-energy X-ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10-year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non-cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other

  1. 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.

  2. 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

    Introduction Despite the fact that the first osteoporotic fracture is preventable, osteoporosis is still a major health challenge. The disease is highly prevalent among postmenopausal women. However little is known about how to meet and support women, when they are diagnosed with osteoporosis...... without preceding fractures. Therefore this study aims at gaining a deeper understanding of how women experience being diagnosed. Furthermore to describe and identify their needs, which should be met in future healthcare services. Methods We conducted a phenomenological qualitative study. We included 17...... women aged 52–65 and collected data through semi-structured interviews. We analysed data following Giorgi's methodology. Findings Needs among the women were classified into three main themes: (1) needs of targeted and tailored information about osteoporosis, (2) needs of being prepared for GP visit...

  3. A biomechanical evaluation of locked plating for distal fibula fractures in an osteoporotic sawbone model.

    Science.gov (United States)

    Bariteau, Jason T; Fantry, Amanda; Blankenhorn, Brad; Lareau, Craig; Paller, David; Digiovanni, Christopher W

    2014-03-01

    Supination external rotation (SER) injuries are commonly fixed with a one third tubular neutralization plate. This study investigated if a combination locked plate with additional fixation options was biomechanically superior in osteoporotic bone and comminuted fracture models. Using an osteoporotic and a comminuted Sawbones model, SER injuries were fixed with a lag screw for simple oblique fibula fractures, and either a one third tubular neutralization plate or a locking plate. Samples were tested in stiffness, peak torque, displacement at failure, and torsion fatigue. There was no statistically significant difference in biomechanical testing for fractures treated with a lag screw and plate. For comminuted fractures, locked plating demonstrated statistically significant stiffer fixation. A combination locked plate is biomechanically superior to a standard one third tubular plate in comminuted SER ankle fractures. There was no biomechanical superiority between locked and one third tubular plates when the fracture was amenable to a lag screw. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  4. 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

    The incidence of hip fractures in Denmark declined by about 20% from 1997 to 2006 in both men and women aged 60 and over. The decrease in hip fracture rates was much too large to be explained by the extent of anti-osteoporotic medication used in the country. INTRODUCTION: The purpose of this study.......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...... visit programmes, improved general health and vitamin D supplementation....

  5. 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

    2010-01-01

    The incidence of hip fractures in Denmark declined by about 20% from 1997 to 2006 in both men and women aged 60 and over. The decrease in hip fracture rates was much too large to be explained by the extent of anti-osteoporotic medication used in the country.......The incidence of hip fractures in Denmark declined by about 20% from 1997 to 2006 in both men and women aged 60 and over. The decrease in hip fracture rates was much too large to be explained by the extent of anti-osteoporotic medication used in the country....

  6. OSTEOPOROTIC FRACTURES OF HIPS, WRISTS AND VERTEBRA WITH COST OF TREATMENT

    Directory of Open Access Journals (Sweden)

    Jože Ferk

    2002-12-01

    Full Text Available Background. Osteoporosis becomes a serious illness when the patient breaks a bone. Osteoporotic fractures emerge in a larger number after the patients reach age 60 or above. The fracture of the wrist is the earliest osteoporotic fracture, vertebral fracture then follows and it is the most common fracture. The most serious and the most costly fracture is the hip fracture. The analysis of data on fractures of hips in General Hospital Maribor (GHM between the years 1968 and 2000 has shown that the number of fractures has been steadily increasing from 76 in the year 1968 to 258 in the year 2000. In 1968 the treatment was mainly conservative and the death rate was at 60%. With the introduction of operative treatment, which is being used on 95% of the patients nowadays, the death rate fell to 5%. The cost of acute treatment, as assessed by the Health Insurrance at the end of the year 2000, amounted to 599,360 tolars per case. The cost of the treatment of the vertebral fracture, which has been treated in outpatient’s department in 60% of the cases, amounted to 113,076 per case in the year 2000 in GHM. The cost of wrist fracture treatment, which has been handled in outpatient’s department in 90% of the cases, added up to 30,831 tolars per case.Conclusions. The osteoporotic fracture of the hip is caused by senile osteoporosis and it affects both men and women equally. That means that the menopausal osteoporosis does not have an important effect on the fracture of the hip. The number of hip fractures is increasing exponentially with the life span lengthening. With the introduction of operative treatment of hip fractures the early mortality decreased from 60% to only 5%. The cost of acute treatment of hip fracture has been three times lower in GHM compared to the same treatment in Great Britain in the year 2000. In 85% of the cases, the fracture of the wrist occurs in women shortly after the age of 60. This confirms the thesis that the menopausal

  7. A randomised sham controlled trial of vertebroplasty for painful acute osteoporotic vertebral fractures (VERTOS IV

    Directory of Open Access Journals (Sweden)

    Juttmann Job R

    2011-04-01

    Full Text Available Abstract Background The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF is conservative therapy. Percutaneous vertebroplasty (PV, a minimally invasive technique, is a new treatment option. Recent randomized controlled trials (RCT provide conflicting results: two sham-controlled studies showed no benefit of PV while an unmasked but controlled RCT (VERTOS II found effective pain relief at acceptable costs. The objective of this study is to compare pain relief after PV with a sham intervention in selected patients with an acute osteoporotic VCF using the same strict inclusion criteria as in VERTOS II. Secondary outcome measures are back pain related disability and quality of life. Methods The VERTOS IV study is a prospective, multicenter RCT with pain relief as primary endpoint. Patients with a painful osteoporotic VCF with bone edema on MR imaging, local back pain for 6 weeks or less, osteopenia and aged 50 years or older, after obtaining informed consent, are included and randomized for PV or a sham intervention. In total 180 patients will be enrolled. Follow-up is at regular intervals during a 1-year period with a standard Visual Analogue Scale (VAS score for pain and pain medication. Necessary additional therapies and complications are recorded. Discussion The VERTOS IV study is a methodologically sound RCT designed to assess pain relief after PV compared to a sham intervention in patients with an acute osteoporotic VCF selected on strict inclusion criteria. Trial registration This study is registered at ClinicalTrials.gov., NCT01200277.

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

    DEFF Research Database (Denmark)

    Roerholt, C; Eiken, P; Abrahamsen, B

    2009-01-01

    SUMMARY: Initiation and compliance with anti-osteoporotic therapy was assessed in 152,777 fracture patients in a national population-based cohort study. Prescription rates were low, especially following hip fracture. Persistence has improved with almost 2/3 of patients who began raloxifene...... 1945 or earlier who sustained a fracture 1997-2004 (N = 152,777). Initiation of anti-osteoporotic therapy was defined as redemption of at least one prescription in the year following fracture. Persistence was defined as duration of time maintaining a medication possession ratio >75%. RESULTS: Treatment...... 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...

  9. Percentage of the population at high risk of osteoporotic fracture in South Korea: analysis of the 2010 Fifth Korean National Health and Nutrition Examination survey data.

    Science.gov (United States)

    Kim, J W; Jeon, Y-J; Baek, D-H; Kim, T N; Chang, J S

    2014-04-01

    Osteoporosis and high-risk osteopenia (high-risk of osteoporotic fractures) are highly prevalent in South Korean postmenopausal women and men aged 50 years and over. This study determined the percentages of the population at high risk of osteoporotic fractures according to the World Health Organization (WHO) criteria and the Fracture Risk Assessment (FRAX) model. Data collected from the 2010 Fifth Korean National Health and Nutrition Examination Survey, a cross-sectional survey of the general South Korean general population, were analyzed. The percentages of the population with high-risk osteopenia according to the US National Osteoporosis Foundation (NOF) and Japanese treatment guidelines were subsequently determined and compared. Based on the WHO criteria and FRAX model, 37.7% of the menopausal women and 12.7% of the men aged 50 years and older are at high risk of osteoporotic fracture. According to the Japanese and NOF guidelines, 10.9 (10.6% of men and 11.2% of women) and 10.7% (10.6% of men and 10.9% of women), respectively, of the study population with osteopenia are at high risk of fracture. By age group, 49.3% of Korean women aged 55 years and older, 67.7% of Korean women aged 65 years and older, and 33.5% of Korean men aged 75 years and older are at high risk. As a very large percentage of the South Korean postmenopausal population has osteoporosis or high-risk osteopenia, greater effort at identifying and treating this population should be expended to prevent osteoporotic fracture.

  10. 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 (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 (osteoporotic women, particularly the very elderly.

  11. The Effect of FRAX on the Prediction of Osteoporotic Fractures in Urban Middle-aged and Elderly Healthy Chinese Adults.

    Science.gov (United States)

    Wang, Jun; Wang, Xuejun; Fang, Zhen; Lu, Nanjia; Han, Liyuan

    2017-05-01

    We aimed to analyze the applicability of a fracture risk assessment tool for the prediction of osteoporotic fractures in middle-aged and elderly healthy Chinese adults. A standard questionnaire was administered, and bone mineral density was measured in residents visiting the Dongliu Street Community Health Service Center. Paired t-tests were used to compare the FRAX-based probabilities of fractures estimated with and without consideration of bone mineral density. Risk stratification and partial correlation analyses were applied to analyze the associations between FRAX-based probabilities and body mass index or bone mineral density at different sites. A total of 444 subjects were included in this study. Of these subjects, 175 (39.59%) were diagnosed as osteoporotic, and 208 (47.06%) were diagnosed as osteopenic. The Kappa value for the detection of osteoporosis at the L1-L4 lumbar spine and femoral neck was 0.314. The FRAX-based 10-year major osteoporotic fracture probability and hip osteoporotic fracture probability estimated without considering bone mineral density were 4.93% and 1.64%, respectively; when estimated while considering bone mineral density, these probabilities were 4.97% and 1.54%, respectively. A significant positive association was observed between the FRAX-based fracture probabilities estimated with and without consideration of bone mineral density, while significant negative associations between body mass index and the estimated FRAX-based fracture probabilities after adjustment for age and the estimated FRAX-based fracture probabilities and femoral neck bone mineral density were identified. These results remained the same after controlling for lumbar spine bone mineral density. The Chinese FRAX model could predict osteoporotic fracture risk regardless of whether bone mineral density was considered and was especially appropriate for predicting osteoporotic fractures of the femoral neck.

  12. 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)

  13. 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)

  14. Comparison of modern locked plating and antiglide plating for fixation of osteoporotic distal fibular fractures.

    Science.gov (United States)

    Switaj, Paul J; Wetzel, Robert J; Jain, Neel P; Weatherford, Brian M; Ren, Yupeng; Zhang, Li-Qun; Merk, Bradley R

    2016-09-01

    Fractures in osteoporotic patients can be difficult to treat because of poor bone quality and inability to gain screw purchase. The purpose of this study is to compare modern lateral periarticular distal fibula locked plating to antiglide plating in the setting of an osteoporotic, unstable distal fibula fracture. AO/OTA 44-B2 distal fibula fractures were created in sixteen paired fresh frozen cadaveric ankles and fixed with a lateral locking plate and an independent lag screw or an antiglide plate with a lag screw through the plate. The specimens underwent stiffness, cyclic loading, and load to failure testing. The energy absorbed until failure, torque to failure, construct stiffness, angle at failure, and energy at failure was recorded. The lateral locking construct had a higher torque to failure (p=0.02) and construct stiffness (p=0.04). The locking construct showed a trend toward increased angle at failure, but did not reach statistical significance (p=0.07). Seven of the eight lateral locking plate specimens failed through the distal locking screws, while the antiglide plating construct failed with pullout of the distal screws and displacement of the fracture in six of the eight specimens. In our study, the newly designed distal fibula periarticular locking plate with increased distal fixation is biomechanically stronger than a non-locking one third tubular plate applied in antiglide fashion for the treatment of AO/OTA 44-B2 osteoporotic distal fibula fractures. V: This is an ex-vivo study performed on cadavers and is not a study performed on live patients. Therefore, this is considered Level V evidence. Copyright © 2015. Published by Elsevier Ltd.

  15. 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.

  16. Delayed bleeding and pelvic haematoma after low-energy osteoporotic pubic rami fracture in a warfarin patient: an unusual cause of abdominal pain.

    Science.gov (United States)

    Sandri, Andrea; Regis, Dario; Bizzotto, Nicola

    2014-01-01

    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.

  17. Successful conservative treatment: multiple atypical fractures in osteoporotic patients after bisphosphate medication: a unique case report.

    Science.gov (United States)

    Kim, Hyo-Sang; Jung, Han Young; Kim, Myeong-Ok; Joa, Kyung-Lim; Kim, Yeo Ju; Kwon, Su-Yeon; Kim, Chang-Hwan

    2015-02-01

    Bisphosphonates have been commonly used for the treatment of osteoporosis. However, there have been recent case reports of atypical fractures citing their long-term use, which inhibits the turnover of bone components. A 64-year-old woman visited the outpatient clinic with pain in her right thigh and ambulation difficulty. We found fractures at both pedicles of L4 vertebra. subtrochanteric region of right femur, and left femoral shaft upon a radiologic examination. She had taken intravenous ibandronic sodium for osteoporosis over 3 years. We changed the bishophonates to a parathyroid hormone because it was suspected that the multiple fractures were caused by the medication. Further, rehabilitation, including progressive weight bearing, was started. After 3 months of the conservative treatment, she was able to walk independently. In conclusion, it is necessary to evaluate the possibility of atypical fractures in osteoporotic patients when they complain of lower extremity pain and to consider alternative treatments instead of bisphosphonates.

  18. 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.

  19. The use of augmentation techniques in osteoporotic fracture fixation

    NARCIS (Netherlands)

    Kammerlander, Christian; Neuerburg, Carl; Verlaan, JJ|info:eu-repo/dai/nl/269057285; Schmoelz, Werner; Miclau, Theodore; Larsson, Sune

    2016-01-01

    There are an increasing number of fragility fractures, which present a surgical challenge given the reduced bone quality of underlying osteoporosis. Particularly in aged patients, there is a need for early weight bearing and mobilization to avoid further complications such as loss of function or

  20. Reduced Sirtuin1 expression at the femoral neck in women who sustained an osteoporotic hip fracture.

    Science.gov (United States)

    El-Haj, M; Gurt, I; Cohen-Kfir, E; Dixit, V; Artsi, H; Kandel, L; Yakubovsky, O; Safran, O; Dresner-Pollak, R

    2016-07-01

    To investigate the role of Sirtuin1 in osteoporosis, Sirtuin1 was determined at the femoral neck in female patients undergoing hip operation for fractured hip or osteoarthritis. Reduced Sirtuin1 was found in osteoporotic patients. Pharmacologic activation of Sirtuin1 reduced sclerostin, an inhibitor of bone formation. Activation of Sirtuin1 may be a new direction to generate therapies for osteoporosis. The aim of the study are to investigate the role of Sirtuin1 (Sirt1), an anti-aging factor and a player in age-associated diseases, in osteoporotic hip fractures, and test the hypothesis that Sirt1 is a negative regulator of sclerostin, a bone formation inhibitor, in human femoral bone marrow mesenchymal cells (BM-MSCs). Sirt1 and sclerostin were determined by western blot in bone samples obtained intra-operatively from the inferior medial cortex of the femoral neck (calcar region) in female patients undergoing partial hip replacement for fractured neck of femur (N = 10) or hip replacement for osteoarthritis (N = 8) (mean ± SD age 81 ± 8.1 vs. 68 ± 9.3 years; BMI 26.2 ± 3.6 vs. 25.9 ± 7.1 kg/m(2) in osteoporotic and osteoarthritis patients). Calcar thickness and femoral bone mineral density (BMD) were determined preoperatively by X-ray using a digital TraumaCad(™) software and DEXA. Femoral BM-MSCs were collected intra-operatively and treated with SRT3025, a Sirt1 activator. Sclerostin and dentin matrix acidic phosphoprotein (DMP1) were determined by western blot and messenger RNA (mRNA) expression of Lef1 and DMP1 was evaluated by quantitative real-time PCR. Osteoporotic (OP) patients had reduced cortical thickness, femoral neck, and total hip BMD compared to osteoarthritis (OA) patients. Calcar Sirt1 expression was significantly reduced, while sclerostin was markedly increased in OP compared to OA patients. Sirt1 and sclersotin expressions were inversely correlated (r = -0.49, P = 0.047). SRT3025 administration down

  1. The effects of alpha-tocopherol supplementation on fracture healing in a postmenopausal osteoporotic rat model

    Directory of Open Access Journals (Sweden)

    Sharlina Mohamad

    2012-09-01

    Full Text Available OBJECTIVE: Osteoporosis increases the risk of bone fractures and may impair fracture healing. The aim of this study was to investigate whether alpha-tocopherol can improve the late-phase fracture healing of osteoporotic bones in ovariectomized rats. METHOD: In total, 24 female Sprague-Dawley rats were divided into three groups. The first group was sham-operated, and the other two groups were ovariectomized. After two months, the right femora of the rats were fractured under anesthesia and internally repaired with K-wires. The sham-operated and ovariectomized control rat groups were administered olive oil (a vehicle, whereas 60 mg/kg of alpha-tocopherol was administered via oral gavage to the alpha-tocopherol group for six days per week over the course of 8 weeks. The rats were sacrificed, and the femora were dissected out. Computed tomography scans and X-rays were performed to assess fracture healing and callus staging, followed by the assessment of callus strengths through the biomechanical testing of the bones. RESULTS: Significantly higher callus volume and callus staging were observed in the ovariectomized control group compared with the sham-operated and alpha-tocopherol groups. The ovariectomized control group also had significantly lower fracture healing scores than the sham-operated group. There were no differences between the alpha-tocopherol and sham-operated groups with respect to the above parameters. The healed femora of the ovariectomized control group demonstrated significantly lower load and strain parameters than the healed femora of the sham-operated group. Alpha-tocopherol supplementation was not able to restore these biomechanical properties. CONCLUSION: Alpha-tocopherol supplementation appeared to promote bone fracture healing in osteoporotic rats but failed to restore the strength of the fractured bone.

  2. FRAX®: Prediction of Major Osteoporotic Fractures in Women from the General Population: The OPUS Study

    Science.gov (United States)

    Briot, Karine; Paternotte, Simon; Kolta, Sami; Eastell, Richard; Felsenberg, Dieter; Reid, David M.; Glüer, Claus-C.; Roux, Christian

    2013-01-01

    Purposes The aim of this study was to analyse how well FRAX® predicts the risk of major osteoporotic and vertebral fractures over 6 years in postmenopausal women from general population. Patients and methods The OPUS study was conducted in European women aged above 55 years, recruited in 5 centers from random population samples and followed over 6 years. The population for this study consisted of 1748 women (mean age 74.2 years) with information on incident fractures. 742 (43.1%) had a prevalent fracture; 769 (44%) and 155 (8.9%) of them received an antiosteoporotic treatment before and during the study respectively. We compared FRAX® performance with and without bone mineral density (BMD) using receiver operator characteristic (ROC) c-statistical analysis with ORs and areas under receiver operating characteristics curves (AUCs) and net reclassification improvement (NRI). Results 85 (4.9%) patients had incident major fractures over 6 years. FRAX® with and without BMD predicted these fractures with an AUC of 0.66 and 0.62 respectively. The AUC were 0.60, 0.66, 0.69 for history of low trauma fracture alone, age and femoral neck (FN) BMD and combination of the 3 clinical risk factors, respectively. FRAX® with and without BMD predicted incident radiographic vertebral fracture (n = 65) with an AUC of 0.67 and 0.65 respectively. NRI analysis showed a significant improvement in risk assignment when BMD is added to FRAX®. Conclusions This study shows that FRAX® with BMD and to a lesser extent also without FN BMD predict major osteoporotic and vertebral fractures in the general population. PMID:24386199

  3. Is there a benefit of proximal locking screws in osteoporotic distal radius fractures? - A biomechanical study.

    Science.gov (United States)

    Bockmann, Benjamin; Budak, Can; Figiel, Jens; Lechler, Philipp; Bliemel, Christopher; Debus, Florian; Schwarting, Tim; Oberkircher, Ludwig; Frink, Michael

    2016-08-01

    The distal radial fracture is a common fracture and frequently seen in geriatric patients. During the last years, volar plating has become a popular treatment option. While the application of locking screws at the distal fragment is widely accepted, there is no evidence for their use at the radial shaft. In six osteoporotic pairs of matched human cadaver radii an extra-articular model creating an AO 23-A2.1 fracture was employed. Osteosynthesis were performed using the APTUS 2.5 Adaptive TriLock Distal Radius System (Medartis AG) with locking (LS) or non-locking screws (NLS) for proximal fixation. Biomechanical testing was performed in a staircase fashion: starting with 50 cycles at 200N, the load was continuously increased by 50N every 80 cycles up to a maximum force of 400N. Finally, load to failure was analyzed with failure defined as sudden loss of force measured (20%) or major deformation of the radii (10mm). At 200N, 250N, 300N, 400N and load to failure, the NLS group showed a higher degree of elastic modulus. In contrast, the LS group showed higher elastic modulus at 350N. Maximum force was higher in the LS group without reaching statistical significance. Reasons for loss of fixation were longitudinal shaft fractures, horizontal peri-implant fractures and distal cutting out. No difference was seen between the two groups concerning the development of the above mentioned complications. Our study did not show biomechanical superiority for distal radius fracture fixation by using locking screws in the proximal holes in an osteoporotic cadaver study. At load to failure, longitudinal shaft fractures and peri-implant fractures seemed to be a more relevant problem rather than failure of the proximal fixation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Balloon kyphoplasty for aged osteoporotic vertebral compressive fractures using instruments made in China

    International Nuclear Information System (INIS)

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

    2006-01-01

    Objective: To evaluated the efficacy and safety of balloon kyphoplasty in treatment of painful osteoporosis vertebral compressive fractures using instruments made in China. Methods: Sixteen cases of painful osteoporotic vertebral compressive fractures, involved 19 vertebrae. Under X-ray fluoroscopy monitoring, the inflatable balloon were inserted into the fractured vertebral body via transpedieular route bilaterally. The balloon was inflated with injected contrast agent, restored vertebral height and formed a cavity within vertebral body. The cavity was than filled with bone cement in toothpaste period. The postoperative symptoms and the radiographic finding of vertebral height were observed. Results: Balloon kyphoplasty was successful in all 16 cases with dramatic pain relief within 48 hours after the procedure. No clinical complication was found. The posttreatment mean anterior and mid portion of the vertebral body heights were (10.7±3.5) mm and (5.4±2.7) mm respectively, while that of the pretreatment were (14.8±4.1) mm and (10.4±4.4) mm, respectively (t=3.96, 5.37; P<0.01). Before the procedure, the mean Kyphosis was (22.4±5.8) degree, after the procedure, the mean kyphosis was measured (12.1± 5.3) degree (t=5.93, P<0.01). Leakage of a small quantity of bone cement occurred at one level. Conclusion: kyphoplasty using instruments made in China for painful osteoporotic vertebral compressive fractures was effective and safe. (authors)

  5. 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

    . Clopidogrel use was not associated with increased fracture risk in subjects with ischaemic stroke or TIA. In contrast, after adjusting for multiple confounders clopidogrel treatment was associated with a 10-35% reduced risk of fracture. Conclusion: Patients with stroke have increased risk of osteoporotic...

  6. Ferric carboxymaltose with or without erythropoietin for the prevention of red-cell transfusions in the perioperative period of osteoporotic hip fractures: a randomized contolled trial. The PAHFRAC-01 project

    Directory of Open Access Journals (Sweden)

    Bernabeu-Wittel Máximo

    2012-02-01

    Full Text Available Abstract Background Around one third to one half of patients with hip fractures require red-cell pack transfusion. The increasing incidence of hip fracture has also raised the need for this scarce resource. Additionally, red-cell pack transfusions are not without complications which may involve excessive morbidity and mortality. This makes it necessary to develop blood-saving strategies. Our objective was to assess safety, efficacy, and cost-effictveness of combined treatment of i.v. ferric carboxymaltose and erythropoietin (EPOFE arm versus i.v. ferric carboxymaltose (FE arm versus a placebo (PLACEBO arm in reducing the percentage of patients who receive blood transfusions, as well as mortality in the perioperative period of hip fracture intervention. Methods/Design Multicentric, phase III, randomized, controlled, double blinded, parallel groups clinical trial. Patients > 65 years admitted to hospital with a hip fracture will be eligible to participate. Patients will be treated with either a single dosage of i.v. ferric carboxymaltose of 1 g and subcutaneous erythropoietin (40.000 IU, or i.v. ferric carboxymaltose and subcutaneous placebo, or i.v. placebo and subcutaneous placebo. Follow-up will be performed until 60 days after discharge, assessing transfusion needs, morbidity, mortality, safety, costs, and health-related quality of life. Intention to treat, as well as per protocol, and incremental cost-effectiveness analysis will be performed. The number of recruited patients per arm is set at 102, a total of 306 patients. Discussion We think that this trial will contribute to the knowledge about the safety and efficacy of ferric carboxymaltose with/without erythropoietin in preventing red-cell pack transfusions in patients with hip fracture. ClinicalTrials.gov identifier: NCT01154491.

  7. Effects of teriparatide on cementless bipolar hemiarthroplasty in patients with osteoporotic femoral neck fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Huang, Kuo-Chin; Lin, Shih-Jie; Chuang, Po-Yao; Shih, Hsin-Nung; Lee, Mel S; Hsu, Robert Wen-Wei; Shen, Wun-Jer

    2016-07-19

    For osteoporotic femoral neck fractures, suitable bone-implant stability is critical for pain relief, early return to daily activities and reduction of complications. Teriparatide (parathyroid hormone [PTH1-34]) can improve bone-implant stability in some basic studies. However it's use in osteoporotic femoral neck fractures treated by cementless hemiarthroplasties for the beneficial effects on bone-implant stability is sparse in the literature. The aim of this study was to determine if post-operative teriparatide administration can reduce femoral stem migration and improve early functional recovery and health-related quality of life (HRQoL). Between 2010 and 2014, patients with osteoporotic femoral neck fracture who underwent cementless bipolar hemiarthroplasty were included into this retrospective cohort study. Group A included patients treated with cementless bipolar hemiarthroplasty only; Group B patients had additional teriparatide. Demographic data, complications, radiographic and functional outcomes as well as health-related quality of life (HRQoL) were compared. There were 52 hips in group A (no teriparatide) and 40 hips in group B (patient who received teriparatide). The subsidence of the femoral stem tended to be significantly decreased in the teriparatide group at 6 and 12 weeks post-operatively (p = 0.003 and p = 0.008, respectively). The Harris Hip Score (HHS) increased significantly from pre-operation to 6 weeks post-operatively and thereafter up to one year in both groups. However, there were no significant differences in terms of subsequent fracture, mortality, HHS, and HRQoL between two groups during the entire study period. Teriparatide significantly reduces the subsidence of the cementless femoral stem in elderly patients in the early post-operative period, but this benefit does not reflect better functional outcomes and HRQoL. Further prospective randomized large-scale cohort study is warranted for evidence-based recommendations.

  8. Can MRI predict subsequent pseudarthrosis resulting from osteoporotic thoracolumbar vertebral fractures?

    Science.gov (United States)

    Omi, Hirotsugu; Yokoyama, Toru; Ono, Atsushi; Numasawa, Takuya; Wada, Kanichiro; Fujisawa, Yoichi

    2014-12-01

    The purpose of this study was to assess the ability of short inversion time inversion-recovery (STIR) in magnetic resonance imaging for predicting the prognosis of osteoporotic vertebral fractures. We analyzed 63 vertebrae of 56 patients who had osteoporotic vertebral fracture (Th10-L2) prospectively. Image finding of a homogeneous high signal change on a fractured vertebra was evaluated and all vertebrae were divided into "homogenous high signal change group" or "non-homogenous high signal change group". On the other hand, image finding of linear black signal area was evaluated and all vertebrae were divided into "linear black signal area group" or "non-linear black signal area group". Sixteen and 24 vertebrae were included in the homogenous high signal change group or the linear black signal area group, respectively. The 16 homogenous high signal change cases did not result in non-union, and 47 non-homogenous high signal change cases resulted in 14 non-unions, a significant difference. Twenty-four linear black signal area and 39 non-linear black signal area cases resulted in 10, and 4 non-unions, respectively, also a significant difference. The kyphosis progression rate of the linear black signal area group (mean 35%) was significantly higher than that of non-linear black signal area group (mean 23%). The visual analog scale of back pain of the linear black signal area group (mean 35 mm) was significantly higher than that of the non-linear black signal area group (mean 23 mm). STIR was useful for predicting bone union, kyphosis, and back pain in patients with osteoporotic vertebral fracture.

  9. 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.

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

    Science.gov (United States)

    Kim, Ha Young; Jang, Eun Jin; Park, ByeongJu; Kim, Tae-Young; Shin, Soon-Ae; Ha, Yong-Chan; Jang, Sunmee

    2016-01-01

    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.

  11. Exercise prevented the lansoprazole-induced reduction of anti-osteoporotic efficacy of alendronate in androgen deficiency rats.

    Science.gov (United States)

    Cegieła, Urszula; Pytlik, Maria; Folwarczna, Joanna; Miozga, Rafał; Piskorz, Szymon; Nowak, Dorota

    2014-01-01

    Clinical studies indicate that proton pump inhibitors (PPIs), used long-term in elderly patients, increase the risk of osteoporotic fractures, and decrease the anti-fracture efficacy of alendronate. The aim of the present study was to examine the effect of physical exercise on the anti-osteoporotic efficacy of alendronate administered concurrently with lansoprazole, a PPI, in male rats with androgen deficiency induced by orchidectomy. Male Wistar rats at 3 months of age were divided into: sham-operated control rats, orchidectomized (ORX) control rats, ORX rats receiving alendronate, ORX rats receiving alendronate and lansoprazole, ORX rats receiving alendronate and subjected to exercise, and ORX rats receiving alendronate and lansoprazole and subjected to exercise. The orchidectomy or sham-operation was performed 7-8 days before the start of drug administration. The rats were subjected to the exercise on the treadmill 1 hour/day for 7 weeks (6 days a week). Alendronate sodium (3 mg/kg p.o.) and lansoprazole (4 mg/kg p.o.) were administered once daily for 7 weeks (6 days a week). Mechanical properties of the tibial metaphysis and femoral neck were assessed. Bone turnover markers, histomorphometric parameters, bone mass and mass of bone mineral were also studied. Lansoprazole weakened the anti-osteoporotic efficacy of alendronate. The exercise increased the alendronate effect. Similar changes were observed in the rats treated with lansoprazole and alendronate, subjected to exercise; no deleterious effects of lansoprazole were observed. In conclusion, the exercise prevented the lansoprazole-induced reduction the anti-osteoporotic efficacy of alendronate in orchidectomized rats.

  12. Healthcare Costs of Osteoporotic Fracture in Korea: Information from the National Health Insurance Claims Database, 2008-2011.

    Science.gov (United States)

    Kim, Ha Young; Ha, Yong-Chan; Kim, Tae-Young; Cho, Hyemin; Lee, Young-Kyun; Baek, Ji-Yeon; Jang, Sunmee

    2017-05-01

    The present study estimated healthcare costs of osteoporotic fractures including spine, hip, distal radius and humerus in Koreans over 50 years of age using national claims data. Korea National Health Insurance data between 2008 and 2011 was searched for all claims records of outpatient visits or hospital admissions of patients ≥50-year-of-age. Osteoporosis-related fractures were identified using certain the International Classification of Diseases, Tenth Revision codes and site-specific physician claims for procedures in a patient age cut-off value of 50 years. The healthcare costs included acute phase costs accounting for emergency medical care given immediately after fracture, costs due to further hospitalization and surgical procedures, physiotherapy sessions according to the site of the fracture, and outpatient visits in the year after discharge. The total estimated healthcare costs of osteoporotic fractures in 2011 was $722 million. From 2008 to 2011, the total number and healthcare costs of osteoporotic fractures increased 28.9% (from 127,070 to 163,823) and 31.6% (from $549 million to $722 million), respectively. The portion of national health care expenditure was ranged from 2.3% in 2008 to 2.2% in 2011. The mean healthcare cost of osteoporotic fractures per person increased 2.1% from $4,321 in 2008 to $4,410 in 2011.The mean healthcare costs were highest for hip fractures followed by spine, humerus, and distal radius fractures. Total Healthcare costs of osteoporotic fractures in South Koreans ≥50-year-of-age increased between 2008 and 2011. This trend will likely continue, which is an important health problem in the elderly population and economically.

  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. Comparison of effectiveness of kyphoplasty and vertebroplasty in patients with osteoporotic vertebra fractures.

    Science.gov (United States)

    Ateş, Ahmet; Gemalmaz, Halil Can; Deveci, Mehmet Ali; Şimşek, Sezai Aykın; Çetin, Engin; Şenköylü, Alpaslan

    2016-12-01

    The aim of this study was to compare the functional and radiological outcomes of vertebroplasty and kyphoplasty in patients with osteoporotic vertebra fractures. The files of the patients who underwent vertebroplasty or kyphoplasty for osteoporotic vertebrae fractures were retrieved from the archives. Forty-three patients with complete follow-up data were included in the study group. The patients were evaluated for radiological outcomes in terms of local kyphosis angle, wedging index, compression ratio, visual analog pain scale (VAS) and Oswestry Disability Index (ODI). In the study group, kyphoplasty was performed on 24 vertebrae of 22 patients (17 females, 5 males; mean age: 73 years) whereas vertebroplasty was applied on 24 vertebrae of 21 (16 females, 5 males; mean age: 74.7 years) patients. The mean follow-up time was 26 months. When the VAS and ODI values of the groups were analyzed, both groups showed statistically significant progress after the operation. Radiological data showed that the kyphoplasty group showed statistically significant improvement in the sagittal index values whereas the vertebroplasty group did not. The overall complication ratio was 4%. Both vertebroplasty and kyphoplasty are effective treatment methods for functional recovery and pain relief in osteoporotic fractures of the vertebra. Although radiological outcomes of the kyphoplasty seem to be better, this does not have any clinical relevance. We suggest vertebroplasty over kyphoplasty since it is an easier method to manage. Level III, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  15. Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report.

    Science.gov (United States)

    Chen, Hsin-Yao; Chen, Chiu-Liang; Chen, Wei-Liang

    2016-01-01

    Pedicle screw instrumentation for treating spinal disorder is becoming increasingly widespread. Many studies have advocated its use to facilitate rigid fixation for spine; however, adjacent segmental disease is a known complication. Instrumented fusion for osteoporotic spines remains a significant challenge for spine surgeons. Prophylactic vertebroplasty for adjacent vertebra has been reported to reduce the complications of junctional compression fractures but has raised a new problem of vertebral subluxation. This case report is a rare and an extreme example with many surgical complications caused by repeated instrumented fusion for osteoporotic spine in a single patient. This patient had various complications including adjacent segmental disease, vertebral subluxation, and junctional fractures on radiographs and magnetic resonance images. An 81-year-old Taiwanese woman underwent decompression and instrumented fusion of L4-L5 in Taiwan 10 years ago. Due to degenerative spinal stenosis of L3-L4 and L2-L3, she had decompression with instrumented fusion from L5 to L1 at the previous hospital. However, catastrophic vertebral subluxations with severe neurologic compromise occurred, and she underwent salvage surgeries twice with prolonged instrumented fusion from L5 to T2. The surgeries did not resolve her problems of spinal instability and neurologic complications. Eventually, the patient remained with a Frankel Grade C spinal cord injury. Adjacent segmental disease, junctional fracture, and vertebral subluxation are familiar complications following instrumented spinal fusion surgeries for osteoporotic spines. Neurologic injuries following long instrumentation are often serious and difficult to address with surgery alone. Conservative treatments should always be contemplated as an alternative method for patients with poor bone stock.

  16. 10-year probability of major osteoporotic fractures and hip fractures according to Ukrainian model of FRAX® in women with vertebral fractures

    Directory of Open Access Journals (Sweden)

    N.V. Grygorieva

    2017-02-01

    Full Text Available Background. Vertebral fractures are one of the severe complications of systemic osteoporosis, which lead to the low-back pain, decrease or loss of efficiency and increase of mortality in older people. FRAX and dual-energy X-ray absorptiometry (DXA are important methods in determining major osteoporotic fractures risk, including vertebral fractures. Materials and methods. We studied the parameters of Ukrainian model of FRAX in women depending on the presence of vertebral fractures. 652 patients aged 40–89 years examined at the Ukrainian Scientific Medical Center of Osteoporosis were divided into two groups: the first one — 523 women without any previous fractures, the second one — 129 patients with previous vertebral fractures. The assessment of bone mineral density (BMD was performed using DXA (Prodigy, General Electric. The 10-year probability of major osteoporotic fractures (FRAX-MOF and hip fractures (FRAX-HF has been determined using Ukrainian model of FRAX according to two methods — with body mass index (FRAXBMI and BMD. Results. According the distribution of FRAXBMI-MOF parameters in women depending on the presence of vertebral fractures, it was found that index of FRAXBMI-MOF was less than 20 % (the limit indicated as the criterion for treatment initiation in US guidelines in 100 and 100 % of subjects, respectively. The indices of FRAX BMD-HF were less than 3 % (the limit for starting treatment in US guidelines in 95 and 55 % of women, respectively. It was shown the significant moderate correlation between the indices of two methods in all groups for both parameters of the algorithm — FRAX-MOF and FRAX-HF. Conclusions. The study of the age-specific features of FRAX in women depending on the presence of vertebral fractures showed a significant increase in the risks for both major osteoporotic and hip fractures, regardless of the used technique (with BMI or BMD in women with vertebral fractures or without any fractures. Our

  17. Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report

    Directory of Open Access Journals (Sweden)

    Chen HY

    2016-07-01

    Full Text Available Hsin-Yao Chen,1 Chiu-Liang Chen,1,2 Wei-Liang Chen3 1Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua City, 2Liberal Arts Center of Da Yeh University, Dacun Township, Changhua County, Taiwan; 3Department of Clinical Image, Changhua Christian Hospital, Changhua City, Changhua County, Taiwan Background: Pedicle screw instrumentation for treating spinal disorder is becoming increasingly widespread. Many studies have advocated its use to facilitate rigid fixation for spine; however, adjacent segmental disease is a known complication. Instrumented fusion for osteoporotic spines remains a significant challenge for spine surgeons. Prophylactic vertebroplasty for adjacent vertebra has been reported to reduce the complications of junctional compression fractures but has raised a new problem of vertebral subluxation. This case report is a rare and an extreme example with many surgical complications caused by repeated instrumented fusion for osteoporotic spine in a single patient. This patient had various complications including adjacent segmental disease, vertebral subluxation, and junctional fractures on radiographs and magnetic resonance images.Case presentation: An 81-year-old Taiwanese woman underwent decompression and instrumented fusion of L4-L5 in Taiwan 10 years ago. Due to degenerative spinal stenosis of L3-L4 and L2-L3, she had decompression with instrumented fusion from L5 to L1 at the previous hospital. However, catastrophic vertebral subluxations with severe neurologic compromise occurred, and she underwent salvage surgeries twice with prolonged instrumented fusion from L5 to T2. The surgeries did not resolve her problems of spinal instability and neurologic complications. Eventually, the patient remained with a Frankel Grade C spinal cord injury.Conclusion: Adjacent segmental disease, junctional fracture, and vertebral subluxation are familiar complications following instrumented spinal fusion surgeries for

  18. Assessing Risk of Osteoporotic Fractures in Primary Care: Development and Validation of the FRA-HS Algorithm.

    Science.gov (United States)

    Francesco, Lapi; Elisa, Bianchini; Raffaella, Michieli; Alessandro, Pasqua; Iacopo, Cricelli; Giampiero, Mazzaglia; Bruno, Frediani; Daniel, Prieto-Alhambra; Luisa, Brandi Maria; Claudio, Cricelli

    2017-06-01

    We aimed to develop and validate the FRActure Health Search (FRA-HS) score for prediction of risk of osteoporotic fractures in primary care in Italy. We selected a cohort of patients aged 40 years between 1999 and 2002. They were followed until the occurrence of osteoporotic fracture, death, end of data registration, or end of data availability (December 31, 2012). Age, sex, history of osteoporotic fractures, secondary osteoporosis, long-term use of corticosteroids, rheumatoid arthritis, body mass index, smoking, and alcohol abuse/alcohol-related diseases, and the interaction terms sex*use of corticosteroids and age*secondary osteoporosis were entered in a competing-risk regression (Fine and Gray method) to predict the risk of hip/femur or overall major osteoporotic fractures. The coefficients were combined to obtain the FRA-HS for individual patients. Explained variance, discrimination, and calibration measures were computed to evaluate the models accuracy. The final model was tested using an independent data source. The FRA-HS explained 47.36 and 20.6% of the variation for occurrence of hip/femur and overall major osteoporotic fractures, respectively. Area Under Curve was 0.77 and 0.73, respectively. Predicted/observed ratios revealed a margin of error lower than 30% in the 80% of the population. After stratifying by sex, prediction models for hip/femur fractures confirmed acceptable accuracy in both sexes, while poor explained variance (<20%) was observed for overall major fractures. These findings indicate that FRA-HS might be implemented in primary care for risk prediction of hip/femur fractures. General practitioners could be therefore supported by this tool in clinical decision making.

  19. Application of calcium phosphates and fibronectin as complementary treatment for osteoporotic bone fractures.

    Science.gov (United States)

    Plaza, Javier Quintana; Garzón, Lorena Benito; Gimenez, Beatriz Bravo; Moraleda, Belén Fernández-Montes; Collía, Francisco; Rodríguez-Lorenzo, Luis M

    2016-09-01

    The gradual aging of the population results in increased incidence of osteoporotic bone fractures. In a good quality bone, the fixation with the usual methods is adequate, but not in osteoporotic bone, in which consolidation delays and other complications are common, with failure rates for screws up to 25%. To test fibronectin loaded hydroxyapatite as a complementary treatment for osteoporotic fractures. This study was performed in a vivo model; 42 female osteoporotic adult rabbits 4-5kg (White New Zealand) were used. Two groups (hydroxyapatite and fibronectin loaded hydroxyapatite) and a control group were tested. 3 time points 24h, 48h and 5days were studied. Defects were created in both femurs, in one of them, a cannulated screw (4mm) and a biocompatible material were placed; in the other femur a screw was inserted without supplemented material forming the control group. Osteoporosis was induced from models already known throughout administration of steroids. Samples were analyzed histologically and through imaging (micro Ct). Basal levels of BMD are observed below to normal when compared to other studies (0.25/0.3 instead of 0.4). Global and dependent of time analysis of samples, show no significant differences for samples analyzed. However, an important trend was noted for variables that define the trabecular bone microarchitecture. Indices that define trabecular microarchitecture in the comparative analysis found to have statistical differences (p<0.01). Osteosynthesis in an osteoporotic bone is a challenge for the surgeon, due to a reduced bone mineral density and different bone architecture. The main finding was the verification of the hypothesis that the trabecular bone parameters increases with our augmentation material in weak rabbit bone quality. Also, the histological analyses of samples show an increase of non inflammatory cells in protein samples (OHAp-Fn) from the first 24hours. An early response of rabbit osteroporotic bone to a complementary

  20. 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

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

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    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

  2. 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.

  3. The Effect of Fracture on Quality of Life in Postmenopausal Osteoporotic Women - Original Investigation

    Directory of Open Access Journals (Sweden)

    Belgin Erhan

    2006-06-01

    Full Text Available Prolonged human life span and amelioration of the current health conditions brings up the risk of fracture related to osteoporosis as an important medical problem. In this study, we aim to study the effect of fracture on quality of life with 29 postmenopopausal women with fracture and 33 without osteoporotic fracture. Demographic data, height, maximum height, body weight, body weight at age 25, localization of fracture of the patients were recorded. All of the patients' bone mineral densities (BMD were evaluated with Dual energy X ray absorbtiometri (DXA. For evaluating quality of life Short Form 36 (SF 36 survey was used. In this study there were no statistical differences between the 2 groups when their age, menarc age, menopause age, number of pregnancies, height, body weight, maximum height and body weight at age 25 were compared. There was statistical difference between the groups in their shortening of height. When BMD levels were compared with DXA it was noted that the T scores at femur neck area and lowest area of BMD were statistically lower in the group with fractures; however there was no statistical difference in T scores of L2-L4. When we compared the quality of life of the 2 groups using SF 36 there was no statistical difference. (Osteoporoz Dünyasından 2006; 12 (2: 31-34

  4. 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.

  5. [Effects of vertebral height restoration of vertebroplasty for osteoporotic vertebra compression fractures].

    Science.gov (United States)

    Li, Hai-Peng; Sun, Tian-Sheng; Li, Fang; Guan, Kai; Zhao, Guang-Min; Shan, Jian-Lin; Zhang, Zhi-Cheng

    2012-08-01

    To evaluate the effect of vertebral height restoration of vertebroplasty for osteoporotic vertebra compression fractures (VCFs). From October 2004 to June 2007, a total of 37 patients with 40 VCFs were treated by vertebroplasty. There were 12 males and 25 females with a mean age of (72.4 +/- 12.7) years (ranged, 48 to 87). Pain easement state was evaluated by visual analog scale (VAS) before and after operation, as well as in followed-up. Preoperative and postoperative vertebral height, kyphosis angle at fractured levels were measured on X-rays. All of patients were followed-up for 12 to 47 months (averaged, 35.8 +/- 9.6). The VAS score was 8.4 +/- 1.6 before operative, 2.1 +/- 1.2 at the 2nd day after operative, there were significant difference between pre-and postoperative (P osteoporotic VCFs, it can relieve the pain effectively. Failure to restore vertebaral height does not seem to interfere with the excellent pain management.

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

    Energy Technology Data Exchange (ETDEWEB)

    Guglielmi, Giuseppe [Department of Radiology, University of Foggia, Viale Luigi Pinto, Foggia 71100 (Italy); Department of Radiology, Scientific Institute Hospital ' CSS' , Viale Cappuccini, San Giovanni Rotondo 71013 (Italy)], E-mail: g.guglielmi@unifg.it; Palmieri, Francesco [Department of Radiology, Scientific Institute Hospital ' CSS' , Viale Cappuccini, San Giovanni Rotondo 71013 (Italy)], E-mail: francescopalmieri@hotmail.com; Placentino, Maria Grazia [Department of Radiology, Scientific Institute Hospital ' CSS' , Viale Cappuccini, San Giovanni Rotondo 71013 (Italy)], E-mail: placentino_mg@tiscali.it; D' Errico, Francesco [Department of Radiology, Scientific Institute Hospital ' CSS' , Viale Cappuccini, San Giovanni Rotondo 71013 (Italy)], E-mail: fra.derrico@tiscali.it; Stoppino, Luca Pio [Department of Radiology, University of Foggia, Viale Luigi Pinto, Foggia 71100 (Italy)], E-mail: l.stoppino@hotmail.it

    2009-04-15

    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.

  7. 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

    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.......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...... period was associated with an increase in back extensor strength of 50% (p = 0.01). The study demonstrated a 33% reduction in back pain and a 6.5-point improvement in physical functioning. The differences in pain and physical functioning were borderline significant.Conclusion:The women demonstrated...

  8. 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)

  9. 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

  10. Treatment and Management of Osteoporotic Fractures: A Nation-wide Survey of 484 Senior Orthopaedists in China.

    Science.gov (United States)

    Man, Yi; Pan, Wei; Lu, Jin; Li, Sen-Yuan; Zhang, Pian; Guo, Jun-Zhe; Yu, Shu-Fang; Zhang, Bei; Xiao, En; Zhang, Chao; Zuo, Wei; Jin, He-Juan; Chen, Yi; Wu, Bin; Shi, Xiao-En; Hong, Di; Liu, Xun; Gao, Ying-Xu; Li, Jing; Yin, Lu; Xue, Qing-Yun

    2016-11-01

    To investigate the treatment given to osteoporotic fracture patients by orthopaedists at major hospitals in China. A 25-item quantitative questionnaire survey, categorized into five domains, including primary purpose of osteoporosis treatment, anti-osteoporosis therapy, calcium and vitamin D supplement, monitoring of osteoporosis, and knowledge of osteoporosis treatment, was designed to elicit information on orthopaedists' views on the treatment of osteoporotic fracture. A pre-survey test was conducted with a sample of 40 orthopaedic specialists to confirm the reliability and validity of the questionnaire. Each interview of the survey took approximately 15 min and did not directly involve any patients. The survey was conducted through face-to-face interviews at 119 tier 3 hospitals in 28 cities across Mainland China. A total of 484 valid responses were received. Seven in ten respondents have ≥10 years of professional practice. While two-thirds believed that osteoporosis treatment was to prevent fractures or re-fractures, 95.0% agreed that anti-osteoporosis medication should be administered to patients with a history of fragility fractures. Three in four would prescribe anti-osteoporosis medication perioperatively. Of these, 79.0% regarded bisphosphonates as the first-line drug. Approximately 86.0% of the 21-30 years cohort chose bisphosphonates compared to 71.4% for those with ≤10 years. More of the younger (≤10 years) cohort chose calcitonin compared to their older (21-30 years) colleagues (25.7% vs 11.6%). The most commonly prescribed daily dose is 800 IU for vitamin D supplements and 600 mg/day for calcium. Our respondents generally adhered to guidelines for the treatment and management of osteoporosis. A significant number had recommended lower dosages of vitamin D and calcium. Some differences exist between the younger cohort and their older colleagues in the prescription of pharmacological therapies. The criteria for initiating therapy

  11. Pulsed electromagnetic field treatment enhances healing callus biomechanical properties in an animal model of osteoporotic fracture.

    Science.gov (United States)

    Androjna, Caroline; Fort, Brian; Zborowski, Maciej; Midura, Ronald J

    2014-09-01

    Delayed bone healing has been noted in osteoporosis patients and in the ovariectomized (OVX) rat model of estrogen-depletion osteopenia. Pulsed electromagnetic field (PEMF) devices are clinically approved as an adjunct to cervical fusion surgery in patients at high risk for non-fusion and for the treatment of fracture non-unions. These bone growth stimulating devices also accelerate the healing of fresh fracture repair in skeletally mature normal rats but have not been tested for efficacy to accelerate and/or enhance the delayed bone repair process in OVX rats. The current study tested the hypothesis that daily PEMF treatments would improve the fracture healing response in skeletally mature OVX rats. By 6 weeks of healing, PEMF treatments resulted in improved hard callus elastic modulus across fibula fractures normalizing the healing process in OVX rats with respect to this mechanical property. Radiographic evidence showed an improved hard callus bridging across fibula fractures in OVX rats treated with PEMF as compared to sham treatments. These findings provide a scientific rationale for investigating whether PEMF might improve bone-healing responses in at-risk osteoporotic patients. © 2014 Wiley Periodicals, Inc.

  12. A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality

    Directory of Open Access Journals (Sweden)

    Nazrun AS

    2014-11-01

    Full Text Available Ahmad Shuid Nazrun,1 Mohd Nizam Tzar,2 Sabarul Afian Mokhtar,3 Isa Naina Mohamed1 1Department of Pharmacology, 2Department of Medical Microbiology and Immunology, 3Department of Orthopedic, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia Purpose: Osteoporotic fracture is the main complication of osteoporosis. The current management is to discharge patients as early as possible so they can get back to their daily activities. Once discharged, there are three main issues relating to morbidity, mortality, and risk of a subsequent fracture that need to be addressed and discussed. Therefore, the aim of this systematic review was to summarize and evaluate the evidence from published literature, to determine the outcome of osteoporotic fracture patients after their hospital discharge.Methods: The MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL databases were searched, using the terms “osteoporosis”, “fracture”, “osteoporotic fracture”, “hip fracture”, and “vertebral fracture”. We included only human studies published in English between 2004 and 2014. The reference lists of included studies were thoroughly reviewed in search for other relevant studies.Results: A total of 18 studies met the selection criteria. Most were observational and cohort studies. Out of all the studies, five studies looked into the morbidity, six studies looked into the risk of subsequent fractures, and seven studies looked into mortality. Vertebral fracture caused the greatest health burden, but hip fracture patients were the main users of informal care after hospital discharge. There was an increased risk of a subsequent fracture after a primary fracture compared with the control group, a cohort comparison, or the general population. Osteoporotic fractures, especially hip fractures, are associated with higher mortality rate despite the advances in the management of osteoporotic fracture cases

  13. Thiazide diuretics and the risk of osteoporotic fractures in hypertensive patients. Results from the Swedish Primary Care Cardiovascular Database.

    Science.gov (United States)

    Bokrantz, Tove; Ljungman, Charlotta; Kahan, Thomas; Boström, Kristina B; Hasselström, Jan; Hjerpe, Per; Mellström, Dan; Schiöler, Linus; Manhem, Karin

    2017-01-01

    The objective is to investigate if treatment with thiazides reduces the risk of osteoporotic fractures in hypertensive patients in primary healthcare. Further we aimed to examine the impact of duration of thiazide use, the consequences of discontinuation of treatment, and the possible difference in effect between men and women. This retrospective cohort study includes 57 822 individuals, 45 years and older, diagnosed with hypertension during 2001-2008 in the Swedish Primary Care Cardiovascular Database. Patients were followed from 1 January 2006 (or the date of their first diagnosis of hypertension if that date came later), until they had an incident osteoporotic fracture, died, or reached the end of the study at 31 December 2012. Patients exposed to thiazides were compared with patients never exposed to thiazides. Current use of thiazides was associated with significantly reduced risk of osteoporotic fractures [hazards ratio 0.89; 95% confidence interval (CI) 0.81-0.98], and increased with longer treatment periods (hazards ratio 0.87; 95% CI 0.78-0.97 after 2 years). However, discontinuation of thiazides increased the risk of osteoporotic fractures (hazards ratio 1.18; 95% CI 1.04-1.33), but attenuated with longer duration past treatment period. When analyzing men and women separately, similar results were seen, although only significant in men. This large observational study confirms that thiazide therapy in hypertensive patients is associated with a reduced risk of osteoporotic fractures. The protective effect increased with longer treatment periods. However, discontinuation of treatment increased the risk of fractures, which emphasizes the importance of continuous treatment.

  14. The Association Between Protein Intake by Source and Osteoporotic Fracture in Older Men: A Prospective Cohort Study.

    Science.gov (United States)

    Langsetmo, Lisa; Shikany, James M; Cawthon, Peggy M; Cauley, Jane A; Taylor, Brent C; Vo, Tien N; Bauer, Douglas C; Orwoll, Eric S; Schousboe, John T; Ensrud, Kristine E

    2017-03-01

    Dietary protein is a potentially modifiable risk factor for fracture. Our objectives were to assess the association of protein intake with incident fracture among older men and whether these associations varied by protein source or by skeletal site. We studied a longitudinal cohort of 5875 men (mean age 73.6 ± 5.9 years) in the Osteoporotic Fractures in Men (MrOS) study. At baseline, protein intake was assessed as percent of total energy intake (TEI) with mean intake from all sources = 16.1%TEI. Incident clinical fractures were confirmed by physician review of medical records. There were 612 major osteoporotic fractures, 806 low-trauma fractures, 270 hip fractures, 193 spine fractures, and 919 non-hip non-spine fractures during 15 years of follow-up. We used Cox proportional hazards models with age, race, height, clinical site, TEI, physical activity, marital status, osteoporosis, gastrointestinal surgery, smoking, oral corticosteroids use, alcohol consumption, and calcium and vitamin D supplements as covariates to compute hazard ratios (HRs) with 95% confidence intervals (CIs), all expressed per unit (SD = 2.9%TEI) increase. Higher protein intake was associated with a decreased risk of major osteoporotic fracture (HR = 0.92; 95% CI, 0.84 to 1.00) with a similar association found for low-trauma fracture. The association between protein and fracture varied by protein source; eg, increased dairy protein and non-dairy animal protein were associated with a decreased risk of hip fracture (HR = 0.80 [95% CI, 0.65 to 0.98] and HR = 0.84 [95% CI, 0.72 to 0.97], respectively), whereas plant-source protein was not (HR = 0.99 [95% CI, 0.78 to 1.24]). The association between protein and fracture varied by fracture site; total protein was associated with a decreased risk of hip fracture (HR = 0.84 [95% CI, 0.73 to 0.95]), but not clinical spine fracture (HR = 1.06 [95% CI, 0.92 to 1.22]). In conclusion, those with high protein intake

  15. The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Lou, Shenghan; Lv, Houchen; Wang, Guoqi; Zhang, Licheng; Li, Ming; Li, Zhirui; Zhang, Lihai; Tang, Peifu

    2016-01-01

    Purpose. This meta-analysis is to assess the effectiveness of teriparatide in fracture healing and clinical function improvement of the osteoporotic patients. Methods. We searched PubMed, Embase, Web of Science, and the Cochrane databases for randomized and quasi-randomized controlled trials comparing teriparatide to placebo, no treatment, or comparator interventions in the osteoporotic patients. Results. Five studies with 251 patients were included. Patients treated with teriparatide therapy had a significant shorter radiological fracture healing time compared with those in the control group (mean difference [MD] -4.54 days, 95% confidence interval [CI] -8.80 to -0.28). Stratified analysis showed that lower limb group had significant shorter healing time (MD -6.24 days, 95% CI -7.20 to -5.29), but upper limb group did not (MD -1 days, 95% CI -2.02 to 0.2). Patients treated with teriparatide therapy showed better functional outcome than those in the control group (standardized mean difference [SMD] -1.02, 95% CI -1.81 to -0.22). Patients with therapy duration over 4 weeks would have better functional outcome (SMD -1.68, 95% CI -2.07 to -1.29). Conclusions. Teriparatide is effective in accelerating fracture healing and improving functional outcome of osteoporotic women. However, more clinical studies are warranted in order to determine whether the results are applicable to males and the clinical indications for teriparatide after osteoporotic fractures.

  16. Association of circulating dipeptidyl-peptidase 4 levels with osteoporotic fracture in postmenopausal women.

    Science.gov (United States)

    Kim, H; Baek, K H; Lee, S-Y; Ahn, S H; Lee, S H; Koh, J-M; Rhee, Y; Kim, C H; Kim, D-Y; Kang, M-I; Kim, B-J; Min, Y-K

    2017-03-01

    Postmenopausal women with osteoporotic fracture (OF) had higher plasma dipeptidyl-peptidase 4 (DPP4) levels than those without. Furthermore, higher plasma DPP4 levels were significantly associated with higher bone turnover and a higher prevalence of OF. These results indicated that DPP4 may be associated with OF by mediating bone turnover rate. Evidence indicates that dipeptidyl-peptidase 4 (DPP4) plays a distinct role in bone metabolism. However, there has been no report on the association, if any, between circulating DPP4 levels and osteoporosis-related phenotypes, including osteoporotic fracture (OF). Therefore, we performed a case-control study to investigate these associations in postmenopausal women. This study was conducted in multiple centers in Korea. We enrolled 178 cases with OF and 178 age- and body mass index-matched controls. OF was assessed by an interviewer-assisted questionnaire and lateral thoracolumbar radiographs. Bone turnover markers (BTMs), bone mineral density (BMD), and plasma DPP4 levels were obtained in all subjects. After adjustment for potential confounders, subjects with OF had significantly higher DPP4 levels than those without (P = 0.021). Higher DPP4 levels were significantly positively associated with higher levels of all BTMs, but not with BMD at all measured sites. The differences in DPP4 levels according to OF status disappeared after an additional adjustment for each BTM, but not after adjustment for any BMD values. BTMs explained approximately half of the relationship between DPP4 and OF. The risk of OF was 3.80-fold (95% confidence interval = 1.53-9.42) higher in subjects in the highest DPP4 quartile than in those in the lowest quartile after adjustment for potential confounders, including femoral neck BMD. DPP4 may be associated with OF by at least partly mediating the bone turnover rate. Circulating DPP4 levels may be a potential biomarker that could increase the predictive power of current fracture risk assessment

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

    DEFF Research Database (Denmark)

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

    2006-01-01

    Using digital X-ray radiogrammetry (DXR) on hand radiographs from a large population-based study, 1,370 postmenopausal women were evaluated in a prospective fashion; fracture occurrence was compared with DXR measurements of historic radiographs. Further, the aim of the study was to evaluate facto...... later osteoporotic fracture and seems to provide meaningful information on bone mass in epidemiological studies, where DXA measurements are not available....

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

    OpenAIRE

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

    2013-01-01

    Background and purpose 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. Material and methods 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 ?m, and bone volume ratio (BV/...

  19. [Percutaneous vertebroplasty to treat osteoporotic vertebral compression fractures combined with intravertebral clefts by unilateral approach].

    Science.gov (United States)

    Gao, Wanxu; Mi, Shijun; Gao, Jingchun

    2012-11-01

    To evaluate the effectiveness of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures with or without intravertebral clefts by unilateral approach and the impact of intravertebral clefts on the effectiveness. The clinical data of 65 patients who met the inclusion criteria of osteoporotic vertebral compression fracture were retrospectively analyzed. According to having intravertebral clefts or not, the patients were divided into 2 groups: cleft group (group A, n=25) and non-cleft group (group B, n=40). There was no significant difference in gender, age, cause of injury, the level of fracture vertebrae, degree of damage, and interval of injury and operation between 2 groups (P > 0.05). All patients were given PVP procedure by unilateral approach. The operation time, the injected volume of bone cement, time to ambulate, complications, and adjacent vertebral re-fracture were recorded. The height of anterior and middle column and the posterior convex Cobb angle of injured spine were measured on the lateral X-ray film in standing position at preoperation and 1, 48 weeks after operation. The visual analogue scale (VAS) score and Oswestry disability index (ODI) system were used to evaluate the pain relief and improvement of daily activity function respectively at preoperation and 1, 4, and 48 weeks after operation. There was no significant difference in the operation time and time to ambulate between 2 groups (P > 0.05). The injected volume of bone cement in group B was significantly less than that in group A (t=1.833, P=0.034). Asymptomatic cement leakage occurred in 6 patients (4 in group A and 2 in group B), in group A including 1 case of venous leakage, 2 cases of paravertebral leakage, and 1 case of intradiscal leakage; in group B including 2 cases of venous leakage. No symptomatic pulmonary embolism was observed. The vital sign was stable during operation and postoperatively. All patients were followed up 12-30 months

  20. A comparison study on the efficacy of SpinoMed® and soft lumbar orthosis for osteoporotic vertebral fracture.

    Science.gov (United States)

    Li, Meng; Law, Sheung-wai; Cheng, Jack; Kee, Ho-man; Wong, Man Sang

    2015-08-01

    Osteoporosis is one of the major health problems in aging population and may lead to osteoporotic vertebral fracture that causes severe back pain and reduced functional independency. To compare the efficacy of SpinoMed® and soft lumbar orthosis at the subacute stage (the second and third weeks of disease onset) of the patients with osteoporotic vertebral fracture. Prospective randomized trial, pilot trial. A total of 51 female subjects aged 55 years or above with osteoporotic vertebral fracture were randomly distributed to the soft lumbar orthosis (control group, n = 24) and SpinoMed® (test group, n = 27) groups after the acute stage (the first week of disease onset). The pain level was assessed by obtaining verbally feedback in 10-point scale scoring, while functional mobility level was estimated with Functional Independence Measure-motor Scores, Elderly Mobility Scale, and Modified Functional Ambulation Category. The thoracic kyphosis angle was measured from standing X-ray on 10 out of 51 subjects. Both groups showed significant reduction in the patients' pain level and limitations of daily life (p 0.05) at the subacute stage. In this study, SpinoMed® could not provide additional treatment benefits to patients with osteoporotic vertebral fracture regarding pain relief and functional independence improvement at the subacute stage. The effects of SpinoMed® in muscle-strengthening and thoracic kyphotic angle reduction for patients with osteoporotic vertebral fracture need to be further verified in a more intensive and longer-term training program. © The International Society for Prosthetics and Orthotics 2014.

  1. BMP7 gene polymorphisms are not associated with bone mineral density or osteoporotic fractures in postmenopausal Chinese women

    Science.gov (United States)

    Gao, Li-hong; Li, Shan-shan; Shao, Chong; Fu, Wen-zhen; Liu, Yu-juan; He, Jin-wei; Zhang, Zhen-lin

    2016-01-01

    Aim: A previous study shows that bone morphogenetic protein 7 (BMP7) gene polymorphisms are associated with bone mineral density (BMD) in 920 European Americans. To determine the association of BMP7 polymorphisms and BMD and osteoporotic fracture susceptibility, we performed a case-control association study in postmenopausal Chinese women with or without osteoporotic fracture. Methods: A total of 3815 unrelated postmenopausal Chinese women (1238 with osteoporotic fracture and 2577 healthy controls) were recruited. BMDs of the lumbar spine 1–4 (L1–4) and proximal femur (including total hip and femoral neck) were measured using dual-energy X-ray absorptiometry. Eight tagging single nucleotide polymorphisms (SNPs) in BMP7 gene, including rs11086598, rs4811822, rs12481628, rs6025447, rs230205, rs17404303, rs162316 and rs6127980, were genotyped. Results: Among the 8 SNPs, rs6025447 and rs230205 were associated with total hip BMD (P=0.013 and 0.045, respectively). However, the associations became statistically insignificant after adjusting for age, height and weight. The TGTG haplotype of BMP7 gene was associated with total hip BMD (P=0.032), even after adjusting for age, height and weight (P=0.048); but the association was insignificant after performing the Bonferroni multiple-significance-test correction. Moreover, the 8 SNPs and 9 haplotypes of BMP7 gene were not associated with L1–4 or femoral neck BMD or osteoporotic fracture. Conclusion: This large-sample case-control association study suggests that the common genetic polymorphisms of BMP7 gene are not major contributors to variations in BMD or osteoporotic fracture in postmenopausal Chinese women. PMID:27264311

  2. Using vital statistics to estimate the population-level impact of osteoporotic fractures on mortality based on death certificates, with an application to France (2000-2004

    Directory of Open Access Journals (Sweden)

    Jougla Eric

    2009-09-01

    Full Text Available Abstract Background We developed a methodology using vital statistics to estimate the impact of osteoporotic fractures on the mortality of an entire population, and applied it to France for the period 2000-2004. Methods Current definitions of osteoporotic fractures were reviewed and their components identified. We used the International Classification of Diseases with national vital statistics data for the French adult population and performed cross-classifications between various components: age, sex, I-code (site and E-code (mechanism of fracture. This methodology allowed identification of appropriate thresholds and categorization for each pertinent component. Results 2,625,743 death certificates were analyzed, 2.2% of which carried a mention of fracture. Hip fractures represented 55% of all deaths from fracture. Both sexes showed a similar pattern of mortality rates for all fracture sites, the rate increased with age from the age of 70 years. The E-high-energy code (present in 12% of death certificates with fractures was found to be useful to rule-out non-osteoporotic fractures, and to correct the overestimation of mortality rates. Using this methodology, the crude number of deaths associated with fractures was estimated to be 57,753 and the number associated with osteoporotic fractures 46,849 (1.85% and 1.78% of all deaths, respectively. Conclusion Osteoporotic fractures have a significant impact on overall population mortality.

  3. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam [Kyunghee University Hospital, Seoul (Korea, Republic of)

    2006-11-15

    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 ({rho} = 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 ({rho} = 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

  5. Incidence and risk factors of medical complications and direct medical costs after osteoporotic fracture among patients in China.

    Science.gov (United States)

    Liu, Ruiqi; Chao, Aijun; Wang, Ke; Wu, Jing

    2018-02-27

    We analyzed the incidence of medical complications after osteoporotic fractures and estimated its risk factors and cost impacts. Osteoporotic fractures can result in lots of serious medical complications, which is associated with patients' baseline characteristics such as patients' disease history and significantly increased patients' direct medical costs. The purpose of the study is to investigate the incidence and identify the risk factors of medical complications after osteoporotic fracture, and quantify patients' economic burden. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2009-2014). Patients aged ≥ 50 years, had ≥ 1 diagnoses of hip or vertebral fracture between 2010 and 2012, and continuously enrolled from 12 months before to 24 months after the first identified fracture were included. The incidence of medical complications was estimated within 12 months before and after fracture. Direct medical costs were measured and compared between patients with at least one medical complication and without any medical complications. Logistic regression was applied to identify risk factors for any medical complications. Three thousand seven hundred nineteen patients were identified; 45.0% had hip fracture, and 56.2% had vertebral fracture. After osteoporotic fracture, the accumulative incidence of the most common medical complications including constipation (25.6%, RR 1.38 [1.28, 1.48]), stroke (25.2%, 1.16 [1.09, 1.24]), pneumonia (17.0%, 1.55 [1.40, 1.73]), urinary tract infection (16.3%, 1.23 [1.12, 1.36]), and arrhythmia (11.8%, 1.39 [1.23, 1.56]) was significantly higher than that before fracture. Advanced age; male sex; retirement status; diagnosis of hypertension, chronic heart disease, cerebrovascular disease, hemiplegia, or Parkinson's disease; and higher direct medical costs at baseline were significant predictors of complications. The all-cause direct medical cost during 24-month follow-up was $5665. Medical

  6. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

    Directory of Open Access Journals (Sweden)

    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  7. A new metaphyseal bone defect model in osteoporotic rats to study biomaterials for the enhancement of bone healing in osteoporotic fractures.

    Science.gov (United States)

    Alt, Volker; Thormann, Ulrich; Ray, Seemun; Zahner, Daniel; Dürselen, Lutz; Lips, Katrin; El Khassawna, Thaqif; Heiss, Christian; Riedrich, Alina; Schlewitz, Gudrun; Ignatius, Anita; Kampschulte, Marian; von Dewitz, Helena; Heinemann, Sascha; Schnettler, Reinhard; Langheinrich, Alexander

    2013-06-01

    The intention of this study was to establish a new critical size animal model that represents clinically relevant situations with osteoporotic bone status and internally fixated metaphyseal defect fractures in which biomaterials for the enhancement of fracture healing in osteoporotic fracture defects can be studied. Twenty-eight rats were ovariectomized (OVX) and treated with a calcium-, phosphorus-, vitamin D3-, soy- and phytoestrogen-free diet. After 3months Dual-energy X-ray absorptiometry measurements showed statistically significant reductions in bone mineral density of the spine of -25.9% and of the femur of -21.3% of the OVX rats compared with controls, confirming osteoporosis in the OVX rats. The OVX rats then underwent either 3 or 5mm wedge-shaped osteotomy of the distal metaphyseal area of the femur that was internally stabilized with a T-shaped mini-plate. After 42days biomechanical testing yielded completely unstable conditions in the 5mm defect femora (bending stiffness 0Nmm(-2)) and a bending stiffness of 12,500Nmm(-2) in the 3mm defects, which showed the beginning of fracture consolidation. Micro-computed tomography showed statistically significant more new bone formation in the 3mm defects (4.83±0.37mm(2)), with bridging of the initial fracture defect area, compared with the 5mm defects (2.68±0.34mm(2)), in which no bridging of the initial defect was found. These results were confirmed by histology. In conclusion, the 5mm defect can be considered as a critical size defect model in which biomaterials can be tested. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  8. [Analysis of clinical effects of percutaneous vertebroplasty and percutaneous kyphoplasty in treating osteoporotic vertebral compression fracture].

    Science.gov (United States)

    Wu, Yao; Wang, Feng; Zhou, Jian-Qiang; Liu, Cai-Yun; Wu, Rui-Xing

    2014-05-01

    To explore the clinical outcomes of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF). From January 2007 to February 2010, the data of 40 patients with osteoporotic vertebral compression fracture underwent treatment were retrospectively analyzed. Of them,20 patients were treated with PVP (PVP group), there were 8 males and 12 females with an average age of (66.37 +/- 2.34) years old (54 to 81); 20 patients were treated with PKP (PKP group), there were 11 males and 9 females with an average of (65.12 +/- 3.21) years old (56 to 79). Postoperative at 1 week, 12 weeks, 1 year, pain and daily life function were respectively assessed by visual analogue scale (VAS) and Barthel index (BI); and anterior height of responsibility vertebra, Cobb angle were measured by X-rays. In PVP group, 1 case complicated with bone cement leakage without clinical symptoms and no operation to treat. No postoperative infection and deep vein thrombosis were found between two groups. All patients were followed up more than 1 year, pain and daily life function has obviously improved than preoperative (P 0.05); there was no significant difference between two groups (P > 0.05). In PVP group, there was no significant difference in anterior height of responsibility vertebra, Cobb angle before and after operation;and in PKP group, postoperative data has obviously improved than preoperative (P 0.05); there was no significant difference between two groups at 1 week, 12 weeks, 1 year after operation. Both the methods can obviously relieve pain and completely or partly recover daily life function in treating OVCF. But PKP has advantages of recovery of anterior height of responsibility vertebra and correction of Cobb angle, especially for serious compression.

  9. 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.

  10. A biomechanical comparison of one-third tubular plates versus periarticular plates for fixation of osteoporotic distal fibula fractures.

    Science.gov (United States)

    Davis, Adrian T; Israel, Heidi; Cannada, Lisa K; Bledsoe, J Gary

    2013-09-01

    The purpose of this study was to test the biomechanical properties of locking and nonlocking plates using one-third tubular and periarticular plate designs in an osteoporotic distal fibula fracture model. Twenty-four cadaveric specimens, whose bone mineral densities were obtained using dual x-ray absorptiometry scans, were tested. The fracture model simulated an OTA 44-B2.1 fracture. The constructs included (1) nonlocking one-third tubular plate, (2) locking one-third tubular plate, (3) nonlocking periarticular plate, and (4) locking periarticular plate. The specimens underwent axial loading followed by torsional loading to failure. Statistical analysis was performed using Kruskal-Wallis testing and further analysis with Mann-Whitney testing. The periarticular plates had greater rotational stiffness compared with the one-third tubular plates (P = 0.04). The nonlocking plates had greater torque to failure than the locking plates (P = 0.01). The nonlocking one-third tubular plate had greater torque to failure than the locking one-third tubular plate (P = 0.03). No significant differences were found in any of the comparisons regarding axial stiffness. In biomechanical testing using an osteoporotic model of OTA 44-B2.1 fractures, periarticular plates were superior to one-third tubular plates in rotational stiffness only. Locking plates did not outperform their nonlocking counterparts. Periarticular plates should be considered when treating osteoporotic distal fibula fractures, but one-third tubular plates and nonlocking plates provide adequate fixation for these injuries.

  11. Sarcopenia and sarcopenic leg as potential risk factors for acute osteoporotic vertebral fracture among older women.

    Science.gov (United States)

    Hida, Tetsuro; Shimokata, Hiroshi; Sakai, Yoshihito; Ito, Sadayuki; Matsui, Yasumoto; Takemura, Marie; Kasai, Takehiro; Ishiguro, Naoki; Harada, Atsushi

    2016-11-01

    Sarcopenia-related falls and fractures among women with osteoporosis are becoming an emerging problem because of rapid aging worldwide. We aimed to investigate the association between sarcopenia, given by the muscle mass of the arms and legs, and osteoporotic vertebral fracture (OVF) among female patients. This cross-sectional study examined 216 women with fresh OVF (OVF group) diagnosed by magnetic resonance imaging and 1,608 women from an outpatient clinic who did not have a OVF [non-fracture (NF) group]. We performed whole-body dual-energy X-ray absorptiometry to analyze body composition, including skeletal muscle mass index (SMI; lean mass/height 2 ) and bone mineral density (BMD). We used stepwise logistic regression analysis to determine the risk factors associated with OVF. After controlling for age, the OVF group showed lower appendicular SMI (5.62 vs. 5.97 kg/m 2 , P sarcopenia (42.3 vs. 25.9 %, P sarcopenia were independent risk factors for acute OVF in multivariate analysis (odds ratio = 1.4, P = 0.002; odds ratio = 1.96, P sarcopenia and lower leg muscle mass among patients with acute OVF compared with patients who did not have an OVF. These results suggest that sarcopenia may be a risk factor for OVF.

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

    International Nuclear Information System (INIS)

    Haruki, Funao; Takahiro, Koyanagi

    2016-01-01

    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 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

  13. 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.

  14. Combined Percutaneous Iliosacral Screw Fixation With Sacroplasty Using Resorbable Calcium Phosphate Cement for Osteoporotic Pelvic Fractures Requiring Surgery.

    Science.gov (United States)

    Collinge, Cory A; Crist, Brett D

    2016-06-01

    Osteoporotic sacral fractures, including acute and chronic insufficiency fractures, are increasing in frequency and present a number of management problem. Many of these patients are treated nonoperatively with relative immobility (eg, bedrest, wheelchair, or weight-bearing restrictions) and analgesics, which likely make the osteoporotic component worse. Surgery in this patient population may be desirable in some cases with the goals of improving mobility, relieving pain, and healing in an aligned position while minimizing deformity progression. However, internal fixation of the osteoporotic pelvis can be difficult. Large unicortical lag screws are the workhorse of posterior pelvic fixation, and yet fixation in cancellous bone corridors of an osteoporotic sacrum seems unlikely to achieve optimal fixation. As a result, the operative management and clinical results of these difficult injuries may not be uniformly successful. The authors present a technique for treating osteoporotic patients with a sacral fracture when operative treatment is indicated using percutaneous screw fixation combined with screw augmentation using a resorbable calcium phosphate bone substitute or "cement." The guide wire for a 7.3-mm or other large cannulated lag screw is fully inserted along the desired bony sacral corridor as is standard. The lag screw is then inserted over the wire to the depth where cement is desired. The guide wire is removed, and the aqueous calcium phosphate is injected through the screw's cannulation. For acute fractures, cement was applied to the areas distant to the fracture; whereas in insufficiency fractures, the cement was inserted along most of the screw path. The guide wire then can be reinserted and the lag screw fully inserted. The rationale for using these 2 modalities is their synergistic effect: the cannulated screw provides typical screw fixation and also a conduit for cement application. The cement augments the lag screw's purchase in osteoporotic bone

  15. The Ability of a Single BMD and Fracture History Assessment to Predict Fracture Over 25 Years in Postmenopausal Women: The Study of Osteoporotic Fractures.

    Science.gov (United States)

    Black, Dennis M; Cauley, Jane A; Wagman, Rachel; Ensrud, Kristine; Fink, Howard A; Hillier, Teresa A; Lui, Li-Yung; Cummings, Steven R; Schousboe, John T; Napoli, Nicola

    2018-03-01

    The ability of bone mineral density (BMD) and other risk factors to predict fracture risk is well-established for as long as 5 to 10 years. However, their value to predict risk over a longer term has not been directly studied. We investigated whether a single assessment of femoral neck BMD and fracture history can predict fracture risk over 20 to 25 years. We used data from the Study of Osteoporotic Fractures (SOF) that assessed BMD and risk factors in 7959 women age ≥67 (mean = 73.4) in 1988-1990. Follow-up for fractures continued for 25 years for hip fracture, and for 20 years for any nonvertebral fracture. Using age-adjusted proportional hazards models, we analyzed the relationships between a single baseline assessment of femoral neck BMD, fracture history and age, and 20-25-year fracture incidence. The 25-year cumulative incidence of hip fracture was 17.9%; 20-year incidence of any nonvertebral fracture was 46.2%. The 25-year hip fracture incidence was highest in those ≥80 years old (22.6%) compared to 13.9% in women aged hip fracture risk to 25 years: 29.6% risk in the lowest BMD quartile versus 7.6% with the highest relative hazard (RH) = 4.9 (95% CI, 4.1 to 6.0). Femoral neck BMD predicted hip fracture with little degradation over time from RH/SD = 2.6 (2.2 to 3.0) for 0 to 5 years to RH/SD = 1.8 (1.4 to 2.4) for 20 to 25 years. Lifetime hip fracture risk was similar (∼30%) regardless of age from 67 to >80 years. History of hip fracture predicted hip fractures only slightly better than history of nonvertebral fracture (RH = 1.6 [95% CI, 1.1 to 2.2] versus RH = 1.4 [95% CI, 1.2 to 1.5], respectively). Fracture history remained strongly predictive up to 25 years. We conclude that a single BMD and fracture history assessment can predict fracture risk over 20 to 25 years. Long-term risk of hip fracture remains extremely high in the oldest age groups, supporting risk assessment and consideration of treatment even in the oldest

  16. Fracture prevention in men

    NARCIS (Netherlands)

    Geusens, PP; Sambrook, P.N.; Lems, W.F.

    2009-01-01

    The lifetime risk of experiencing a fracture in 50-year-old men is lower (20%) than the risk in women (50%). Consequently, much less research has been carried out on osteoporosis and fracture risk in men. Differences in the risk and incidence of fractures between men and women are related to

  17. Inpatient cost of treating osteoporotic fractures in mainland China: a descriptive analysis

    Directory of Open Access Journals (Sweden)

    Yang YC

    2015-04-01

    -day costs of osteoporotic fracture increased rapidly (60% and 89%, respectively between 2008 and 2010. Conclusion: The analysis showed that hospitalization cost increases were associated with increasing per-day hospitalization costs. The proportion of the costs reimbursed by health insurances increased, while the mean absolute patient copayment amounts decreased. The incidence and prevalence of osteoporosis and osteoporosis-related fractures may rise rapidly due to the projected growth of the aged population in mainland China. Therefore, the combination of greater anticipated total fractures and rising hospital costs may lead to a tremendously increased economic burden in the future. Keywords: inpatients, hospital costs, length of stay, osteoporosis burden, mainland China

  18. Ergotropic effect of bone cement on pedicle screw fixation in treatment of osteoporotic thoracolumbar fracture

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    Da LIU

    2017-02-01

    Full Text Available Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo¬rotic thoracolumbar fracture. Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob¬served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi¬sual analogue scale (VAS and neurological function score (ASIA of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured. Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P0.05. Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo¬porosis, restore the

  19. Self-ratings of Health and Change in Walking Speed Over 2 Years: Results From the Caregiver-Study of Osteoporotic Fractures

    OpenAIRE

    Ashburner, Jeffrey M.; Cauley, Jane A.; Cawthon, Peggy; Ensrud, Kristine E.; Hochberg, Marc C.; Fredman, Lisa

    2011-01-01

    Although poorer self-rated health (SRH) is associated with increased mortality, less is known about its impact on functioning. This study evaluated whether poorer SRH was associated with decline in walking speed and whether caregiving, often considered an indicator of chronic stress, modified this relation. The sample included 891 older US women from the Caregiver-Study of Osteoporotic Fractures. SRH was assessed at the baseline Caregiver-Study of Osteoporotic Fractures interview, conducted i...

  20. Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: a case control study

    OpenAIRE

    Hsieh, Jui-Yang; Wu, Chung-Ding; Wang, Ting-Ming; Chen, Hsuan-Yu; Farn, Chui-Jia; Chen, Po-Quang

    2013-01-01

    Background Osteoporotic vertebral compression fracture is the leading cause of disability and morbidity in elderly people. Treatment of this condition remains a challenge. Osteoporotic vertebral compression fractures can be managed with various approaches, but each has limitations. In this study, we compared the clinical outcomes obtained using short-segment fixation with intravertebral expandable pillars (I-VEP) to those obtained with percutaneous kyphoplasty in patients who had suffered ver...

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

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    Nik Fatin Farhana Binti Mohd Rahhim

    2015-09-01

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

  2. 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

  3. 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

  4. Secondary prevention of fractures after hip fracture: a qualitative study of effective service delivery.

    Science.gov (United States)

    Drew, S; Judge, A; Cooper, C; Javaid, M K; Farmer, A; Gooberman-Hill, R

    2016-05-01

    There is variation in how services to prevent secondary fractures after hip fracture are delivered and no consensus on best models of care. This study identifies healthcare professionals' views on effective care for the prevention of these fractures. It is hoped this will provide information on how to develop services. Hip fracture patients are at high risk of subsequent osteoporotic fractures. Whilst fracture prevention services are recommended, there is variation in delivery and no consensus on best models of care. This study aims to identify healthcare professionals' views on effective care for prevention of secondary fracture after hip fracture. Forty-three semi-structured interviews were undertaken with healthcare professionals involved in delivering fracture prevention across 11 hospitals in one English region. Interviews explored views on four components of care: (1) case finding, (2) osteoporosis assessment, (3) treatment initiation, and (4) monitoring and coordination. Interviews were audio-recorded, transcribed, anonymised and coded using NVivo software. Case finding: a number of approaches were discussed. Multiple methods ensured there was a 'backstop' if patients were overlooked. Osteoporosis assessment: there was no consensus on who should conduct this. The location of the dual energy X-ray absorptiometry (DXA) scanner influenced the likelihood of patients receiving a scan. Treatment initiation: it was felt this was best done in inpatients rather request initiation in the post-discharge/outpatients period. Monitoring (adherence): adherence was a major concern, and participants felt more monitoring could be conducted by secondary care. Coordination of care: participants advocated using dedicated coordinators and formal and informal methods of communication. A gap between primary and secondary care was identified and strategies suggested for addressing this. A number of ways of organising effective fracture prevention services after hip fracture were

  5. 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.

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

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    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.

  7. Non-union of osteoporotic vertebral fractures - identification and treatment of an underestimated pathology in elderly patients with persistent back pain.

    Science.gov (United States)

    Adler, Daniel; Tschoeke, Sven K; von der Hoeh, Nicolas; Gulow, Jens; von Salis-Soglio, Georg; Heyde, Christoph-E

    2014-12-01

    Non-union of osteoporotic vertebra fractures are a seldom entity. However, when back pain persists in the course of conservatively treated osteoporotic vertebra fractures, a non-union should be considered. We thus sought to validate our diagnostic algorithm in patients with known osteoporotic vertebra fractures presenting persistent back pain and advert to the diagnosis and treatment of vertebral non-unions. Patients admitted with preexisting osteoporotic vertebra fractures and therapy-resistant back pain were retrospectively analysed. All admitted patients were subject to standard plain radiographs in erect position and conventional CT or MR imaging of the spine, respectively. In addition, patients with suspected non-union were subject to lateral fulcrum radiographs in supine position. From a total of 172 admitted patients, four patients presented with non-union of a fractured osteoporotic vertebra (2%). The subsequent surgical therapy included cement-augmented rod-and-screw stabilization, with or without additional correction of deformity, and kyphoplasty (N = 3) or kyphoplasty alone (N = 1). All surgical interventions were successful in pain reduction and allowed immediate and improved postoperative mobilisation. Non-union of osteoporotic vertebra fractures must be considered when symptoms outlast conservative treatment. In these cases, plain lateral fulcrum radiographs are a simple and effective adjunct to the conventional diagnostic methods. Surgical stabilization then proves to be the effective treatment of choice.

  8. Automatic Estimation of Osteoporotic Fracture Cases by Using Ensemble Learning Approaches.

    Science.gov (United States)

    Kilic, Niyazi; Hosgormez, Erkan

    2016-03-01

    Ensemble learning methods are one of the most powerful tools for the pattern classification problems. In this paper, the effects of ensemble learning methods and some physical bone densitometry parameters on osteoporotic fracture detection were investigated. Six feature set models were constructed including different physical parameters and they fed into the ensemble classifiers as input features. As ensemble learning techniques, bagging, gradient boosting and random subspace (RSM) were used. Instance based learning (IBk) and random forest (RF) classifiers applied to six feature set models. The patients were classified into three groups such as osteoporosis, osteopenia and control (healthy), using ensemble classifiers. Total classification accuracy and f-measure were also used to evaluate diagnostic performance of the proposed ensemble classification system. The classification accuracy has reached to 98.85 % by the combination of model 6 (five BMD + five T-score values) using RSM-RF classifier. The findings of this paper suggest that the patients will be able to be warned before a bone fracture occurred, by just examining some physical parameters that can easily be measured without invasive operations.

  9. Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using high-viscosity bone cement via bilateral percutaneous vertebroplasty.

    Science.gov (United States)

    Guo, Dan; Cai, Jun; Zhang, Shengfei; Zhang, Liang; Feng, Xinmin

    2017-04-01

    Osteoporotic vertebral compression fractures with intraosseous vacuum phenomena could cause persistent back pains in patients, even after receiving conservative treatment. The aim of this study was to evaluate the efficacy of using high-viscosity bone cement via bilateral percutaneous vertebroplasty in treating patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena.Twenty osteoporotic vertebral compression fracture patients with intraosseous vacuum phenomena, who received at least 2 months of conservative treatment, were further treated by injecting high-viscosity bone cement via bilateral percutaneous vertebroplasty due to failure of conservative treatment. Treatment efficacy was evaluated by determining the anterior vertebral compression rates, visual analog scale (VAS) scores, and Oswestry disability index (ODI) scores at 1 day before the operation, on the first day of postoperation, at 1-month postoperation, and at 1-year postoperation.Three of 20 patients had asymptomatic bone cement leakage when treated via percutaneous vertebroplasty; however, no serious complications related to these treatments were observed during the 1-year follow-up period. A statistically significant improvement on the anterior vertebral compression rates, VAS scores, and ODI scores were achieved after percutaneous vertebroplasty. However, differences in the anterior vertebral compression rate, VAS score, and ODI score in the different time points during the 1-year follow-up period was not statistically significant (P > 0.05).Within the limitations of this study, the injection of high-viscosity bone cement via bilateral percutaneous vertebroplasty for patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena significantly relieved their back pains and improved their daily life activities shortly after the operation, thereby improving their life quality. In this study, the use of high-viscosity bone

  10. Prevalence of Frailty in Patients with Osteoporotic Vertebral Compression Fracture and Its Association with Numbers of Fractures.

    Science.gov (United States)

    Kim, Ho Joong; Park, Saejong; Park, Soo Hyun; Park, Jiwon; Chang, Bong Soon; Lee, Choon Ki; Yeom, Jin S

    2018-03-01

    To assess the association between frailty and osteoporotic vertebral compression fracture (OVCF) and to evaluate the relationship between numbers of OVCFs and frailty. We enrolled 760 subjects, including 59 patients (with OVCF) and 701 controls (without OVCF). Successful matching provided 56 patient-control pairs. We analyzed principal clinical and demographic information, which included sex, age, height, weight, body mass index (BMI), variable frailty phenotypes, and Oswestry Disability Index (ODI) and EuroQol 5-dimension questionnaire (EQ-5D) scores. The association between frailty and OVCF was ascertained. In addition, the degrees of disability and quality of life attributable to frailty were determined. The prevalence of frailty was significantly higher in the OVCF group than in the control group (pratio (OR)=0.704; 95% confidence interval (CI), 0.543-0.913] and ≥3 fractures (OR=9.213; 95% CI, 1.529-55.501) within the OVCF group were associated with higher odds of frailty. The present study showed significant relationships between frailty and OVCF, severity of symptoms, and disability induced by OVCF. Furthermore, frailty could be a causal and/or resulting factor of OVCFs. © Copyright: Yonsei University College of Medicine 2018

  11. 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)

  12. 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

  13. Prophylactic adjacent-segment vertebroplasty following kyphoplasty for a single osteoporotic vertebral fracture and the risk of adjacent fractures: a retrospective study and clinical experience.

    Science.gov (United States)

    Eichler, Martin C; Spross, Christian; Ewers, Alexander; Mayer, Ryan; Külling, Fabrice A

    2016-10-01

    OBJECTIVE This study investigated the benefit of prophylactic vertebroplasty of the adjacent vertebrae in single-segment osteoporotic vertebral body fractures treated with kyphoplasty. METHODS All patients treated with kyphoplasty for osteoporotic single-segment fractures between January 2007 and August 2012 were included in this retrospective study. The patients received either kyphoplasty alone (kyphoplasty group) or kyphoplasty with additional vertebroplasty of the adjacent segment (vertebroplasty group). The segmental kyphosis with the rate of adjacent-segment fractures (ASFs) and remote fractures were studied on plain lateral radiographs preoperatively, postoperatively, at 3 months, and at final follow-up. RESULTS Thirty-seven (82%) of a possible 45 patients were included for the analysis, with a mean follow-up of 16 months (range 3-54 months). The study population included 31 women, and the mean age of the total patient population was 72 years old (range 53-86 years). In 21 patients (57%), the fracture was in the thoracolumbar junction. Eighteen patients were treated with additional vertebroplasty and 19 with kyphoplasty only. The segmental kyphosis increased in both groups at final follow-up. A fracture through the primary treated vertebra (kyphoplasty) was found in 4 (22%) of the vertebroplasty group and in 3 (16%) of the kyphoplasty group (p = 0.6). An ASF was found in 50% (n = 9) of the vertebroplasty group and in 16% (n = 3) of the kyphoplasty group (p = 0.03). Remote fractures occurred in 1 patient in each group (p = 1.0). CONCLUSIONS Prophylactic vertebroplasty of the adjacent vertebra in patients with single-segment osteoporotic fractures as performed in this study did not decrease the rate of adjacent fractures. Based on these retrospective data, the possible benefits of prophylactic vertebroplasty do not compensate for the possible risks of an additional cement augmentation.

  14. Minimal invasive therapy of painful osteoporotic vertebral fractures; Minimal-invasive Therapie osteoporotischer Wirbelkoerperfrakturen

    Energy Technology Data Exchange (ETDEWEB)

    Krepler, P.; Grohs, J.G. [Klinik fuer Orthopaedie, Medizinische Universitaet Wien (Austria)

    2003-09-01

    Osteoporosis is the most common bone disease. Due to an increase of the older population an higher impact of osteoporosis and its treatment can be expected. Painful osteoporotic vertebral fractures result in an increased morbidity and mortality. Standard treatment of painful osteoporotic vertebral fractures comprises analgetics, bed rest and, if needed, orthotics. By mere augmentation of the vertebra with polymethylmet acrylate (PMMA), the so called ''vertebroplasty'' a good pain reduction and increase in function and quality of life can be achieved. With the technique of kyphoplasty (Kyphon trademark) it is feasable to correct a kyphotic deformity. Inflatable ballons are introduced to the vertebra to lift the endplates. The created cavity is filled with bone cement (PMMA). Kyphoplasty is able to correct osteoporosis induced kyphotic deformity. Compared to the technique of vertebroplasty, kyphoplasty is less riskful but is more time consuming and more expensive. Time will show whether the expected advantage of deformity correction will result in a better outcome for the patient, e. g. in a lower incidence of refractures. (orig.) [German] Osteoporose ist die haeufigste Knochenerkrankung. Es ist abzusehen, dass durch zunehmende Ueberalterung der Bevoelkerung auch die Bedeutung der Osteoporose und ihrer Behandlung einen steigenden Stellenwert einnehmen wird. Schmerzhafte osteoporotische Wirbelkoerperfrakturen fuehren zu einer signifikant erhoehten Morbiditaet und Mortalitaet. Die Standardbehandlung des osteoporotisch induzierten Wirbelkoerpereinbruchs umfasst Schmerztherapie, Schonung und im Bedarfsfall orthetische Versorgung. Mithilfe der reinen Zementaugmentierung kann eine gute Schmerzreduzierung und damit auch eine Verbesserung der Lebensqualitaet erzielt werden. Mit der Technik der Kyphoplastik kann zusaetzlich die durch die Fraktur entstandene Deformitaet korrigiert werden. Nach Punktion des Wirbels wird durch eine Fuehrungshuelse ein Ballon

  15. 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.

  16. Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO study

    Directory of Open Access Journals (Sweden)

    M. Rossini

    2017-05-01

    Full Text Available Osteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GC treatment. Reliable information regarding the epidemiology of GC induced osteoporosis (GIOP comes exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dosage and primary diagnosis. The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GC dosage, bone mineral density, risk factors, specific treatment for GIOP in a large cohort of consecutive patients aged >21 years, on chronic treatment with GC (≥5 mg prednisone - PN - equivalent and attending rheumatology centers located all over Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO is a national multicenter cross-sectional and longitudinal observational study. 553 patients suffering from Rheumatoid Arthritis (RA, Polymyalgia Rheumatica (PMR and Connective Tissue Diseases (CTDs and in chronic treatment with GCs were enrolled. Osteoporotic BMD values (T score <-2.5 were observed in 28%, 38% and 35% of patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment, prevalent clinical fractures were reported by 12%, 37% and 17% of patients with CTDs, PMR, or RA, respectively. New clinical fragility fractures during GC treatment were reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA patients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. The GIOTTO study might provide

  17. Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture.

    Science.gov (United States)

    Lee, Jae Hyup; Lee, Dong-Oh; Lee, Ji-Ho; Lee, Hyeong-Seok

    2014-10-01

    Percutaneous kyphoplasty is effective for pain reduction and vertebral height restoration in patients with osteoporotic vertebral fractures. However, in cases of severely collapsed fractures involving the loss of more than 70% of the vertebral height, kyphoplasty is technically difficult to perform and the outcomes remain unknown. To compare the vertebral height restoration rate, kyphotic angle, and clinical results of patients who underwent kyphoplasty according to the degree of anterior vertebral height loss. In addition, to determine the feasibility and effects of kyphoplasty on severely collapsed osteoporotic vertebral fractures. A retrospective study. A total of 129 patients (145 vertebrae) who underwent kyphoplasty for osteoporotic painful vertebral fracture and followed up for more than 1 year between September 2005 and August 2012 were recruited for the analysis. The patients' kyphotic angle, anterior vertebral height, and anterior vertebral height restoration ratio 1 year after surgery were compared. Pre- and postoperative pain around the fractured vertebra and the radiological and clinical results according to bone mineral density (BMD) were also compared. Patients were divided into three groups for comparison, according to radiographic findings. Patients with an anterior height compression ratio more than 70% at the time of fracture comprised Group I, patients with a compression ratio of 50-70% comprised Group II, and those with a compression ratio of 30-50% comprised Group III. Group I showed a greater extent of anterior height restoration immediately after surgery compared with the other groups, which noticeably decreased over time. All three groups showed significant restoration of the anterior vertebral height between pre- and postoperative values. The anterior vertebral height 1 year after surgery did not differ between Group I and Group II but was significantly higher in Group III. There was no correlation between the BMD and restoration or

  18. 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.

  19. Balloon-assisted percutaneous vertebroplasty in patients with osteoporotic compression fractures - first results

    International Nuclear Information System (INIS)

    Schulte, B.U.; Trompeter, M.; Remy, C.; Reimer, P.; Bruecher, D.

    2006-01-01

    Purpose: To determine the feasibility, efficacy and safety of balloon-assisted percutaneous vertebroplasty (BA-VP) in patients with osteoporotic vertebral compression fractures (VCFs). Materials and Methods: In 47 patients (29 women, 18 men; mean age: 70 years and 4 months) with severe VCFs, 66 BA-VPs were performed via a unipedicular access. After initial puncture (under combined fluoroscopy and CT guidance) of the vertebral body (VB), the needle was retraced by 1.5 cm, and a 12-mm Fogarty balloon catheter was introduced and inflated using 2-4 ml diluted contrast media (CM). After the subsequent removal of the catheter and repositioning of the needle, vertebroplasty was performed. Results: The mean volume of PMMA injected was 4.4 ml (2.5-7.2 ml). Pain reduction (measured by the Visual Analogue Scale) was achieved in 95% of the patients, dropping from on average 8.0 preinterventionally to 2.2 after a mean follow-up of 8 months. A reduction of the pain relieving medication was achieved in 68% of the cases and patient activity improved markedly. No severe or clinically relevant complications were observed. Cement leakage occurred by filling of epidural and paravertebral veins in 9.1 and 6.1% of the cases, respectively. Leakage into the paravertebral soft tissues was seen in 3.0% of the patients and to the adjacent disc space in 10.6% of the cases. (orig.)

  20. Nocturia is Associated with Poor Sleep Quality Among Older Women in the Study of Osteoporotic Fractures.

    Science.gov (United States)

    Fung, Constance H; Vaughan, Camille P; Markland, Alayne D; Huang, Alison J; Mitchell, Michael N; Bliwise, Donald L; Ancoli-Israel, Sonia; Redline, Susan; Alessi, Cathy A; Stone, Katie

    2017-11-01

    (1) To examine relationships between frequency of nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of nocturia. Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). Community-dwelling women aged ≥80 years. Frequency of nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). Of 1,520 participants, 25% (n = 392) reported their nocturia frequency was 3-4 times/night and an additional 60% (n = 917) reported their nocturia frequency was 1-2 times/night. More frequent nocturia was associated with poor sleep quality (3-4/night: 26.8% reported fairly bad or very bad sleep quality; 1-2/night: 14.7%; 0/night: 7.7%; P sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P sleep quality and longer wake time at night. Interventions that improve nocturia may be useful in improving sleep quality and wake time at night. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

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

    Science.gov (United States)

    Röhrl, B; Sadick, M; Brocker, K; Brade, J; Voggenreiter, G; Obertacke, U; Düber, C

    2006-08-01

    To evaluate the value of MDCT in the monitoring of vertebral body architecture after balloon kyphoplasty and observe morphological changes of the vertebral body. 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. After kyphoplasty, the treated vertebral bodies showed a significant gain in the height of the leading edge (0.15 cm; p architecture after treatment with balloon kyphoplasty. Morphological changes in the vertebral bodies, and complications such as pallacos leakage and progression of osteoprosis can be accurately documented. The significant increase in the vertebral body height after treatment is closely correlated with a gain in the sagittal index and reduced kyphosis and COBB angle.

  2. EMG-Guided Percutaneous Placement of Cement-Augmented Pedicle Screws for Osteoporotic Thoracolumbar Burst Fractures.

    Science.gov (United States)

    Iacopino, Domenico Gerardo; Certo, Francesco; Graziano, Francesca; Basile, Luigi; Gulì, Carlo; Visocchi, Massimiliano; Conti, Alfredo; Maugeri, Rosario

    2017-01-01

    Percutaneous techniques have increasingly gained popularity in recent years. The application of technological innovation, including neuromonitoring techniques, has the potential to increase the safety and efficacy of these procedures. Thirty patients suffering from osteoporotic dorsolumbar burst fracture were prospectively enrolled in this study. The patients underwent percutaneous fenestrated pedicle screw fixation augmented with polymethylmethacrylate (PMMA) injection. A novel surgeon-dedicated neuromonitoring device was used in order to increase the safety and the accuracy of the screw insertion. A second group of 30 patients who did not undergo neuromonitoring during percutaneous pedicle screw placement, matched for demographic characteristics, constituted the control group. A total of 296 screws were inserted. All treated patients had a good outcome, documented by an improvement in visual analogue scale (VAS) scores. Excellent trajectories were achieved in all patients. Cobb's angle and anterior vertebral height were satisfactorily restored in all study group patients. Three misplaced screws in three patients and a case of PMMA leakage without neurological deficits were observed in the control group, whereas no complication was recorded in the study group (p = 0.03). Neuromonitoring in cement-augmented percutaneous pedicle screw placement appears to improve surgeon confidence during surgery, reducing the risk of screw misplacement or cement leakage.

  3. [Three-dimensional finite element model of thoracolumbar spine with osteoporotic vertebral compression fracture].

    Science.gov (United States)

    Fei, Qi; Li, Qiu-jun; Yang, Yong; Li, Dong; Tang, Hai; Li, Jin-jun; Wang, Bing-qiang; Wang, Yi-peng

    2010-11-09

    To build a three-dimensional finite element model of thoracolumbar spine with osteoporotic vertebral compression fracture (OVCF) and analyze its biomechanical change. The T10-L2 segment data were obtained from computed tomography (CT) scans of an elderly female with a single T12 OVCF. A three-dimensional finite element model of thoracolumbar spine was constructed with the MIMICS and ABAQUS software. The model was composed of bony vertebrae, articulating facets, intervertebral disc and associated ligaments. The basic stress analysis of T10-L2 motion segment was made for different material properties of bone, ligaments and facet joints contacting frictional property. The stress on the annulus fiber, nucleus pulposus, endplate and facet joints under axial pressure (0.3 MPa, 1.0 MPa, 4.0 MPa) were analyzed. A three-dimensional finite element model of human T12-L2 motion segment had 617468 elements. And the stress was higher in vertebral body than posterior structure. The distribution of pressure stresses in intervertebral disc was asymmetrical. The stress increased with a rising axial pressure. 3D finite element model of thoracolumbar OVCF and adjacent segments are successfully established. The results of stress analysis are both feasible and reliable.

  4. Calcaneal quantitative ultrasound-bone mineral density value for evaluating bone metabolism and bone turnover in patients with osteoporotic fracture

    Directory of Open Access Journals (Sweden)

    Hong-Wei Yan

    2017-09-01

    Full Text Available Objective: To study the calcaneal quantitative ultrasound-bone mineral density (QUS-BMD value for evaluating bone metabolism and bone turnover in patients with osteoporotic fracture. Methods: A total of 150 patients who were diagnosed with osteoporotic fracture in Nuclear Industry 417 Hospital between January 2010 and March 2017 were selected as the fracture group of the research, and 70 subjects with normal bone mineral density confirmed by physical examination during the same period were selected as the control group of the research. QUSBMD apparatus was used to measure bone mineral density of calcaneus, and the serum was collected to determine the biochemical indexes of bone metabolism and bone turnover. Results: QUS-BMD value as well as serum BALP, OC, OPG levels of fracture group was significantly lower than those of control group while serum TRACP5b, RANKL, PINP, PICP, CTX and NTX levels were significantly higher than those of control group; serum BALP, OC, OPG levels of patients with osteoporosis and osteopenia were significantly lower than those of subjects with normal bone mass while TRACP5b, RANKL, PINP, PICP, CTX and NTX levels were significantly higher than those of subjects with normal bone mass; serum BALP, OC, OPG levels of patients with osteoporosis was significantly lower than those of patients with osteoporosis while TRACP5b, RANKL, PINP, PICP, CTX and NTX levels were significantly higher than those of patients with osteoporosis. Conclusion: Calcaneal QUS-BMD is valuable for evaluating the bone metabolism activity and bone turnover process in patients with osteoporotic fracture.

  5. Role of major revision spine surgery in recurrent adjacent segment osteoporotic vertebral body fracture: a case report.

    Science.gov (United States)

    Ghani, Imtiaz; Kroeber, Markus

    2012-08-01

    Case report. To report the beneficial effects of kyphoplasty, cement augmentation and extension of posterior instrumentation in a patient with recurrent adjacent segment osteoporotic vertebral body fracture. A 72-year-old lady underwent multiple revision spine surgeries for recurrent adjacent segment osteoporotic vertebral body fracture. The patient underwent four surgeries in 6 years: (1) in 2005, posterior lumbar interbody fusion with stabilization (L4-S1) was done; (2) in August 2010, implants from L4-S1 were removed and revised, transforaminal lumbar interbody fusion was done at L2/L3 and L3/L4 along with pedicle screw stabilization from T12-S1; (3) in September 2011, revision surgery was attempted, wherein a kyphoplasty was done at T12 and the stabilization was extended to T4; (4) again in October 2011, a revision surgery was attempted, wherein a kyphoplasty was done at T5 along with stabilization using pedicular screws in the T2 and T3 vertebrae and lateral mass screws in the C6 vertebra. To current date, the patient is stable with good sagittal and coronal balance and walking pain free without support. The current case demonstrates the need for posterior spinal reconstruction in osteoporotic vertebral collapse. Cement augmentation and extension of posterior instrumentation are both viable techniques that could be used to improve stabilization in the elderly spine.

  6. A predictive mechanical model for evaluating vertebral fracture probability in lumbar spine under different osteoporotic drug therapies.

    Science.gov (United States)

    López, E; Ibarz, E; Herrera, A; Puértolas, S; Gabarre, S; Más, Y; Mateo, J; Gil-Albarova, J; Gracia, L

    2016-07-01

    Osteoporotic vertebral fractures represent a major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture from bone mineral density (BMD) measurements. A previously developed model, based on the Damage and Fracture Mechanics, was applied for the evaluation of the mechanical magnitudes involved in the fracture process from clinical BMD measurements. BMD evolution in untreated patients and in patients with seven different treatments was analyzed from clinical studies in order to compare the variation in the risk of fracture. The predictive model was applied in a finite element simulation of the whole lumbar spine, obtaining detailed maps of damage and fracture probability, identifying high-risk local zones at vertebral body. For every vertebra, strontium ranelate exhibits the highest decrease, whereas minimum decrease is achieved with oral ibandronate. All the treatments manifest similar trends for every vertebra. Conversely, for the natural BMD evolution, as bone stiffness decreases, the mechanical damage and fracture probability show a significant increase (as it occurs in the natural history of BMD). Vertebral walls and external areas of vertebral end plates are the zones at greatest risk, in coincidence with the typical locations of osteoporotic fractures, characterized by a vertebral crushing due to the collapse of vertebral walls. This methodology could be applied for an individual patient, in order to obtain the trends corresponding to different treatments, in identifying at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. 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

    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...... fractures. Summary of Background Data. PVP is a therapeutic procedure performed to reduce pain in vertebral lesions. Despite the lack of comparative randomised clinical trials PVP is generally seen as a safe and efficient procedure for painful osteoporotic fractures. Methods. Fifty patients (41 females......) were included from January 2001 until January 2008. Patients with acute (osteoporotic fractures were included and randomised to either PVP or conservative treatment. Pain was assessed with a visual analogue scale and physical and mental outcome were...

  8. 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...... the risk of adjacent fractures. SUMMARY OF BACKGROUND DATA: PVP is a therapeutic procedure performed to reduce pain in vertebral lesions. Despite the lack of comparative randomized clinical trials PVP is generally seen as a safe and efficient procedure for painful osteoporotic fractures. METHODS: Fifty...... patients (41 females) were included from January 2001 until January 2008. Patients with acute (osteoporotic fractures were included and randomized to either PVP or conservative treatment. Pain was assessed with a visual analogue scale and physical and mental...

  9. 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

  10. Height restoration of osteoporotic vertebral compression fractures using different intravertebral reduction devices: a cadaveric study.

    Science.gov (United States)

    Krüger, Antonio; Oberkircher, Ludwig; Figiel, Jens; Floßdorf, Felix; Bolzinger, Florent; Noriega, David C; Ruchholtz, Steffen

    2015-05-01

    The treatment of osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly during the past two decades. Balloon kyphoplasty was developed to restore vertebral height and improve sagittal alignment. Several studies have shown these theoretical improvements cannot be transferred universally to the clinical setting. The aim of the current study is to evaluate two different procedures used for percutaneous augmentation of vertebral compression fractures with respect to height restoration: balloon kyphoplasty and SpineJack. Twenty-four vertebral bodies of two intact, fresh human cadaveric spines (T6-L5; donor age, 70 years and 60 years; T-score -6.8 points and -6.3 points) were scanned using computed tomography (CT) and dissected into single vertebral bodies. Vertebral wedge compression fractures were created by a material testing machine (Universal testing machine, Instron 5566, Darmstadt, Germany). The axial load was increased continuously until the height of the anterior edge of the vertebral body was reduced by 40% of the initial measured values. After 15 minutes, the load was decreased manually to 100 N. After postfracture CT, the clamped vertebral bodies were placed in a custom-made loading frame with a preload of 100 N. Twelve vertebral bodies were treated using SpineJack (SJ; Vexim, Balma, France), the 12 remaining vertebral bodies were treated with balloon kyphoplasty (BKP; Kyphon, Medtronic, Sunnyvale, CA, USA). The load was maintained during the procedure until the cement set completely. Posttreatment CT was performed. Anterior, central, and posterior height as well as the Beck index were measured prefracture and postfracture as well as after treatment. For anterior height restoration (BKP, 0.14±1.48 mm; SJ, 3.34±1.19 mm), central height restoration (BKP, 0.91±1.04 mm; SJ, 3.24±1.22 mm), and posterior restoration (BKP, 0.37±0.57 mm; SJ, 1.26±1.05), as well as the Beck index (BKP, 0.00±0.06 mm; SJ, 0

  11. 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 measured on sagital CT images was 8.288 at the initial presentation, 8.554 postoperatively, 8

  12. Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: a case control study.

    Science.gov (United States)

    Hsieh, Jui-Yang; Wu, Chung-Ding; Wang, Ting-Ming; Chen, Hsuan-Yu; Farn, Chui-Jia; Chen, Po-Quang

    2013-03-02

    Osteoporotic vertebral compression fracture is the leading cause of disability and morbidity in elderly people. Treatment of this condition remains a challenge. Osteoporotic vertebral compression fractures can be managed with various approaches, but each has limitations. In this study, we compared the clinical outcomes obtained using short-segment fixation with intravertebral expandable pillars (I-VEP) to those obtained with percutaneous kyphoplasty in patients who had suffered vertebral compression fractures. The study included 46 patients with single-level osteoporotic thoracolumbar fractures. Twenty-two patients in Group I underwent short-segment fixation with I-VEP and 24 patients in Group II underwent kyphoplasty. All patients were evaluated pre- and postoperatively using a visual analogue scale, anterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra. The latter 2 radiological parameters were measured at the adjacent segments as well. There was no significant difference between the groups in terms of gender or fracture level, but the mean age was greater in Group II patients (p = 0.008). At the 1-year follow-up, there were no significant differences in the visual analogue scale scores, anterior height of the fractured vertebra, or the value representing anterior height above the fractured vertebra and kyphotic angle below the fractured vertebra, after adjusting for the patients' gender, fracture level, and age. When considered separately, the anterior height below the fractured vertebra was significantly higher and the kyphotic angle above the fractured vertebra was significantly smaller in Group I than in Group II (p = 0.029 and p = 0.008, respectively). The kyphotic angle of the fractured vertebra was significantly smaller in Group II than in Group I (p osteoporotic kyphotic spines.

  13. [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

  14. FRAX-based Estimates of 10-year Probability of Hip and Major Osteoporotic Fracture Among Adults Aged 40 and Over: United States, 2013 and 2014.

    Science.gov (United States)

    Looker, Anne C; Sarafrazi Isfahani, Neda; Fan, Bo; Shepherd, John A

    2017-03-01

    The FRAX algorithm estimates the 10-year probability of hip and major osteoporotic (clinical spine, forearm, hip, or humerus) fracture for adults aged 40 and over. An expert panel developed criteria to define elevated FRAX probabilities for U.S. adults aged 50 and over. This report uses FRAX estimates from the National Health and Nutrition Examination Survey 2013-2014 to describe the hip and major osteoporotic fracture probability distribution (for adults aged 40 and over) and prevalence of elevated probabilities (for adults aged 50 and over) in the United States. FRAX U.S. version 3.05 was used to calculate fracture probability from risk factors that were measured (i.e., femur neck bone mineral density, height, and weight) or self-reported (i.e., fracture history, glucocorticoid use, rheumatoid arthritis, smoking, and alcohol intake). Among adults aged 50 and over, elevated probabilities were defined as 3% or greater for hip fracture and 20% or greater for major osteoporotic fracture. Mean skew-adjusted fracture probabilities were 0.5% for hip fracture and 5.3% for major osteoporotic fracture among adults aged 40 and over, and 0.9% and 7.4%, respectively, among adults aged 50 and over. The percentages of adults aged 50 and over with an elevated hip or major osteoporotic fracture probability were 19% and 8%, respectively. Fracture probabilities varied significantly by age (older groups had higher probabilities than younger groups), sex (women had higher probabilities than men), and race and Hispanic origin (non-Hispanic white persons had higher probabilities than all other race and Hispanic groups) (p osteoporotic fracture probabilities were 0.5% and 5.3%, respectively, for adults aged 40 and over. Among adults aged 50 and over, mean hip and major osteoporotic fracture probabilities were 0.9% (19% with elevated values) and 7.4% (8% with elevated values), respectively. All material appearing in this report is in the public domain and may be reproduced or copied

  15. 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.)

  16. 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

  17. 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.

  18. 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

     = 222,138; comparator). We used a Cox proportional hazards analysis incorporating additional time-dependent covariates to represent initiation of thyroxine replacement and cumulative number of periods with high versus low TSH after index date with a mean follow-up of 7.2 years. Elevated baseline TSH...... 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...... of periods with low TSH-likely from excessive replacement. An independent effect of elevated TSH could only be observed in young and middle-aged men, suggesting gender-discrepant consequences on risk. © 2015 American Society for Bone and Mineral Research....

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

    Science.gov (United States)

    Hsieh, Ming-Kai; Chen, Lih-Huei; Chen, Wen-Jer

    2013-01-01

    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.

  20. 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.

  1. 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.

  2. 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)

  3. Significance of sagittal reformations in routine thoracic and abdominal multislice CT studies for detecting osteoporotic fractures and other spine abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Dirk; Bauer, Jan S.; Zeile, Martin; Rummeny, Ernst J. [Klinikum Rechts der Isar, TU Muenchen, Department of Radiology, Muenchen (Germany); Link, Thomas M. [Musculoskeletal and Quantitative Imaging Research, UCSF, Department of Radiology, San Francisco, CA (United States)

    2008-08-15

    The purpose was to assess osteoporotic vertebral fractures and other spinal lesions in sagittal reformations obtained from routine multidetector computed tomography (MDCT) studies of the thorax and abdomen, to compare sagittal reformations with axial images in detecting these lesions and to investigate how frequently they were missed in the official radiology report. Routine abdominal or thoracoabdominal MDCT using a standard protocol was performed in 112 postmenopausal women. Axial images and sagittal reformations were analyzed separately by two radiologists in consensus and were compared in order to evaluate how often spinal lesions could be detected. In addition the official radiology reports were assessed to determine how many of those abnormalities were identified. Spine abnormalities were visualized in 101/112 postmenopausal women. In 27 patients osteoporotic vertebral deformities were found; 6 of these were shown in the axial images, but none of these were diagnosed in the official radiology report. Additional abnormalities included degenerative disc disease, osteoarthritis of the facet joints, scoliosis, hemangiomas and bone metastases. In only 9/101 patients spine abnormalities were mentioned in the radiology report. Sagittal reformations of standard MDCT images provide important additional information on spinal abnormalities; in particular, osteoporotic vertebral deformities are substantially better detected. (orig.)

  4. Preventing falls and fractures.

    Science.gov (United States)

    Ulfarsson, J; Robinson, B E

    1994-11-01

    One of four persons over age 65 in the community falls; those over age 75 in institutions fall more frequently. Falls, a complex phenomena suggesting present disease and predicting future disability, are caused by interactions between the environment and dynamic balance which is determined by the quality of sensory input, central processing, and motor responses. Clinical factors which predispose to falling often produce observable disturbances in gait and balance, making observation critical in assessment. Acute illness and drug therapy produce particularly preventable falls. Therapeutic exercise and environmental modification for safety are the clinical interventions most likely to successfully prevent fall-related injury.

  5. Osteoporotic Vertebral Fractures, Secondary Developing to Long Term Glucocorticoid and Cyclosyporin-A Use: A Case Report

    Directory of Open Access Journals (Sweden)

    Selda Çiftci

    2018-01-01

    Full Text Available Many side effects are encountered during the use of glucocorticoids. Osteoporosis is a common side effect of bone metabolism. The side effect increase with high dose and long-term use of steroids. In this article, we report a case of uncontrolled glucocorticoid use for 6 years due to ocular involvement due to Behçet’s disease and a young male with osteoporotic fracture of the dorsal and lumbar vertebrae due to cyclosporine use for 3 years. To sum up, this case shows that steroids and combination treatments should be used with appropriate dose and duration in absolute indications and patients should be monitored in order.

  6. The effect of vertebroplasty on pulmonary function in patients with osteoporotic compression fractures of the thoracic spine.

    Science.gov (United States)

    Lee, Jun-Seok; Kim, Ki-Won; Ha, Kee-Yong

    2011-04-01

    Prospective clinical study. To determine the effect of vertebroplasty on pulmonary function in patients with osteoporotic compression fractures of the thoracic spine. A percutaneous vertebroplasty is an excellent method for relieving pain and improving the quality of life in patients with osteoporotic compression fractures of the thoracic spine. However, the effect of vertebroplasty on pulmonary functions in such patients has not been reported. This study included 72 patients (85 vertebrae) who underwent percutaneous vertebroplasty for thoracic osteoporotic compression fractures (male/female, 10/62; mean age, 75.7±7.6 y). Pulmonary function tests (PFTs) were conducted preoperatively on the study patients, and 2 days, 1 month, and 3 months postoperatively. PFT parameters [% predicted forced expiratory volume in 1 s (% pred FEV1), % predicted forced vital capacity (% pred FVC), and FEV1/FVC ratio] were measured using a spirometer. A visual analogue scale (VAS) score, the thoracic kyphotic angles, and the local kyphotic angles were obtained before and after vertebroplasty to evaluate the clinical and radiologic outcomes. The correlations among variables (PFT parameters, age, gender, the number of vertebrae involved in the vertebroplasty, the change of thoracic kyphotic angles, the change of local kyphotic angles, and the VAS scores) were analyzed. The preoperative and postoperative (2 d, 1 mo, and 3 mo) PFT parameters were as follows: % pred FVC, 58±23.8, 71.8±22.2, 75.4±21.4, and 76±22.1; % pred FEV1, 58.3±24.3, 66.1±23.7, 67.5±24.2, and 68±24.5; FEV1/FVC ratio (%), 101.2±17.8, 91.3±15.5, 88.8±15.2, and 88.6±14.2, respectively. The preoperative mean VAS score was 7.93±1.5 and significantly decreased to 3.15±1.59, 1.76±1.26, and 1.67±1.23 at 2 days, 1 month, and 3 months after the vertebroplasty, respectively. There were no significant differences in the thoracic and local kyphotic angles after the vertebroplasty compared with the preoperative values

  7. Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study.

    Science.gov (United States)

    Takahashi, S; Hoshino, M; Takayama, K; Iseki, K; Sasaoka, R; Tsujio, T; Yasuda, H; Sasaki, T; Kanematsu, F; Kono, H; Toyoda, H; Nakamura, H

    2017-02-01

    This study revealed the time course of osteoporotic vertebral fracture by magnetic resonance imaging using a simple classification. Signal changes were associated with the compression degree and mobility of the fractured vertebral body. This classification showed sufficient reliability in categorizing magnetic resonance imaging findings of osteoporotic vertebral fractures. Magnetic resonance imaging (MRI) is useful in diagnosing osteoporotic vertebral fractures (OVFs). This study investigated the time course of OVFs by MRI using a simple classification. This multicenter cohort study was performed from 2012 to 2015. Consecutive patients with ≤2-week-old OVFs were enrolled in 11 institutions. MRI was performed at enrollment and at 1-, 3-, 6-, and 12-month follow-up. Signal changes on T1-weighted imaging (T1WI), T2WI, and short τ inversion recovery (STIR) were classified according to signal intensity. Height and angular motion of vertebral bodies were also measured. The 6-month follow-up was completed by 153 patients. At enrollment, fractured vertebrae signal changes were 43 % diffuse and 57 % confined low on T1WI; on T2WI, 56, 24, and 5 % were confined low, high, and diffuse low, respectively; on STIR, 100 % were high. On T1WI, diffuse low remained most common (90 % at 1 month and 60 % at 3 months) until 6 and 12 months, when most were confined low (54 and 52 %, respectively). On T2WI, confined low remained most common (decreasing to 41 % at 12 months). On STIR, high signal change was shown in 98, 87, and 64 % at 3, 6, and 12 months, respectively. At 3, 6, and 12 months, diffuse low signal change was associated with significantly lower vertebral height, and high signal change was associated with significantly greater angular motion. MRI signal changes were associated with the compression degree and angular motion of fractured vertebrae. This classification showed sufficient reliability in categorizing MRI findings of OVFs.

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

    Energy Technology Data Exchange (ETDEWEB)

    Biffar, Andreas [Josef Lissner Laboratory for Biomedical Imaging, Department of Clinical Radiology - Grosshadern, LMU Ludwig Maximilian University of Munich, Munich (Germany); Sourbron, Steven [Josef Lissner Laboratory for Biomedical Imaging, Department of Clinical Radiology - Grosshadern, LMU Ludwig Maximilian University of Munich, Munich (Germany); Division of Medical Physics, University of Leeds, Leeds (United Kingdom); Dietrich, Olaf [Josef Lissner Laboratory for Biomedical Imaging, Department of Clinical Radiology - Grosshadern, LMU Ludwig Maximilian University of Munich, Munich (Germany); Schmidt, Gerwin [Department of Clinical Radiology - Grosshadern, LMU Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich (Germany); Ingrisch, Michael [Josef Lissner Laboratory for Biomedical Imaging, Department of Clinical Radiology - Grosshadern, LMU Ludwig Maximilian University of Munich, Munich (Germany); Reiser, Maximilian F. [Josef Lissner Laboratory for Biomedical Imaging, Department of Clinical Radiology - Grosshadern, LMU Ludwig Maximilian University of Munich, Munich (Germany); Department of Clinical Radiology - Grosshadern, LMU Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich (Germany); Baur-Melnyk, Andrea, E-mail: andrea.baur@med.uni-muenchen.de [Department of Clinical Radiology - Grosshadern, LMU Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich (Germany)

    2010-12-15

    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{sup 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{sup 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 < 0.001) different in the fractures compared to adjacent normal appearing vertebrae (K{sup 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{sup -3} mm{sup 2}/s vs. 0.57 x 10{sup -3} mm{sup 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

  9. Number of daily antihypertensive drugs and the risk of osteoporotic fractures in older hypertensive adults: National health insurance service - Senior cohort.

    Science.gov (United States)

    Kim, So Yeon; Kim, Sunyoung; Choi, Sung Eun; Kim, Byung Sung; Choi, Hyun Rim; Hwang, Deri; Won, Chang Won

    2017-07-01

    Antihypertensive medication represents one of the most common prescriptions for senior individuals. Numerous studies have assessed the influence of antihypertensive treatment on the risk for osteoporotic fracture, yet much controversy remains. We analyzed the relationship between the incidence of osteoporotic fracture and the average number of daily antihypertensive drugs (NDAD) included in the prescription of elderly hypertensive patients. The study population was derived from the National Health Insurance Service-Senior Cohort (2002-2013), and consisted of elderly patients (≥60 years) diagnosed with hypertension in 2009, who did not have osteoporotic fractures in 2008, and underwent at least one national health check-up between 2009 and 2013, and had complete records after 2010. The outcome measured was the incidence of osteoporotic fractures between 2010 and 2013. The study population was stratified into the three groups (low, moderate, and high), in terms of NDAD. A total of 137,304 hypertensive patients were included. A multivariate model corrected by age, gender, body mass index, systolic blood pressure, underlying disease, smoking status, and use of medicines showed that the groups with moderate and high NDAD exhibited, respectively, 12% and 16% lower risk of osteoporotic fracture compared to that in the group with low NDAD. In terms of the risk of osteoporotic fracture associated with the number of daily thiazide diuretics (NDTD), the adjusted odds ratios (aOR; 95%CI) were 0.89 (0.84-0.94) and 0.93 (0.84-1.02) in the groups with moderate and high NDTD, respectively compared to low NDTD as reference. As to NDADnotTD, the aOR (95%CI) were 0.90 (95%CI, 0.86-0.94) and 0.89 (95%CI, 0.84-0.95) in the groups with moderate and high NDADnotTD, respectively compared to low NDADnotTD as reference. In elderly hypertensive patients, the incidence of osteoporotic fracture decreased as the NDAD increased. The incidence rate of osteoporotic fracture also decreased with

  10. Osteoporotic Fractures and Posture Problem in Association with Vitamin D Level in Patients with Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Havva Talay Çalış

    2017-04-01

    Full Text Available Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteoporotic vertebral fracture and posture problems in parkinson’s disease patients with and without vertebral fracture. Materials and Methods: In this study 59 Parkinson’s disease patients (aged ≥40 years were included. Patients with a disease that may impair their vitamin D metabolism were not included to the study. 25-OH Vitamin D levels in plasma, Ca, P, ALP, PTH, TSH, BUN and Cr values and DXA values were measured from the obtained blood samples by high performance liquid chromatography method. Bone mineral density was measured. Lateral thoracic and lumbar vertebra radiographs were obtained, and vertebra fracture were recorded in as lumbar thoracic fracture with degree and level. Parkinson’s disease staging was done using Hoehn Yahr Scale. Results: There were 33 men and 26 women patients. In the study population, mean age was 66.1±10.2 years while mean body mass index was 29.5±5.1 kg/m2. Osteoporotic vertebral fracture was detected in 35 patients and it was not detected in 24 patients. Vitamin D level was less than 10 IU/dL in 46.9% of the patients and it was less than 20 IU/dL in 83.7% of them. This was lower than the normal population value. Mean vitamin D concentration was 15.0±1.84 in Parkinson’s disease patients with vertebral fracture and posture problems while it was 12.7±1.1 in patients without vertebral fracture. There was no significant relation between vitamin D and fracture presence (p>0.005. In our study, no significant correlation was found between posture problem and vitamin D levels. However, it was shown that vitamin D levels were lower in Parkinson’s disease patients than in general population. Conclusion: It should be kept in mind that vitamin D levels might be low in patients with Parkinson’s disease. Given the high risk for pelvic fracture, fall and osteoporosis, periodical vitamin D and osteoporosis

  11. Association of Plasminogen Activator Inhibitor-1 (PAI-1 Gene Polymorphisms with Osteoporotic Vertebral Compression Fractures (OVCFs in Postmenopausal Women

    Directory of Open Access Journals (Sweden)

    Jung Oh Kim

    2016-12-01

    Full Text Available Osteoporosis and osteoporotic fractures are strongly associated with mortality and morbidity, both in developing and developed countries. Menopause accelerates bone loss due to estrogen deficiency and age-related linear bone loss. We investigated plasminogen activator inhibitor-1 (PAI-1 gene polymorphisms in postmenopausal women with osteoporotic vertebral compression fractures (OVCFs. In this case-control study, 355 postmenopausal women were genotyped for the presence of PAI-1 gene polymorphisms −844A > G, −675 4G > 5G, 43G > A, 9785A > G, and 11053T > G. Genetic polymorphisms of PAI-1 were analyzed by the polymerization chain reaction restriction fragment length polymorphism assay, and their association with disease status and folate and homocysteine levels was determined in 158 OVCF patients and 197 control subjects. The PAI-1 −675 5G5G (adjusted odds ratio (AOR, 3.302; p = 0.017 and 43GA + AA (AOR, 2.087; p = 0.042 genotype frequencies showed significant association with the increased prevalence of OVCFs in postmenopausal women. In addition, we performed gene–environment interaction studies and demonstrated an association between PAI-1 gene polymorphisms and OVCF prevalence. Our novel finding is the identification of several PAI-1 genetic variants that increase susceptibility to OVCF. Our findings suggest that polymorphisms in PAI-1 may contribute to OVCF, and that they can be developed as biomarkers for evaluating OVCF risk.

  12. 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

  13. International Classification of Diseases (ICD-coded obesity predicts risk of incident osteoporotic fracture.

    Directory of Open Access Journals (Sweden)

    Shuman Yang

    Full Text Available International Classification of Diseases (ICD codes have been used to ascertain individuals who are obese. There has been limited research about the predictive value of ICD-coded obesity for major chronic conditions at the population level. We tested the utility of ICD-coded obesity versus measured obesity for predicting incident major osteoporotic fracture (MOF, after adjusting for covariates (i.e., age and sex. In this historical cohort study (2001-2015, we selected 61,854 individuals aged 50 years and older from the Manitoba Bone Mineral Density Database, Canada. Body mass index (BMI ≥30 kg/m2 was used to define measured obesity. Hospital and physician ICD codes were used to ascertain ICD-coded obesity and incident MOF. Average cohort age was 66.3 years and 90.3% were female. The sensitivity, specificity and positive predictive value for ICD-coded obesity using measured obesity as the reference were 0.11 (95% confidence interval [CI]: 0.10, 0.11, 0.99 (95% CI: 0.99, 0.99 and 0.79 (95% CI: 0.77, 0.81, respectively. ICD-coded obesity (adjusted hazard ratio [HR] 0.83; 95% CI: 0.70, 0.99 and measured obesity (adjusted HR 0.83; 95% CI: 0.78, 0.88 were associated with decreased MOF risk. Although the area under the receiver operating characteristic curve (AUROC estimates for incident MOF were not significantly different for ICD-coded obesity versus measured obesity (0.648 for ICD-coded obesity versus 0.650 for measured obesity; P = 0.056 for AUROC difference, the category-free net reclassification index for ICD-coded obesity versus measured obesity was -0.08 (95% CI: -0.11, -0.06 for predicting incident MOF. ICD-coded obesity predicted incident MOF, though it had low sensitivity and reclassified MOF risk slightly less well than measured obesity.

  14. International Classification of Diseases (ICD)-coded obesity predicts risk of incident osteoporotic fracture

    Science.gov (United States)

    Lix, Lisa M.; Yan, Lin; Hinds, Aynslie M.; Leslie, William D.

    2017-01-01

    International Classification of Diseases (ICD) codes have been used to ascertain individuals who are obese. There has been limited research about the predictive value of ICD-coded obesity for major chronic conditions at the population level. We tested the utility of ICD-coded obesity versus measured obesity for predicting incident major osteoporotic fracture (MOF), after adjusting for covariates (i.e., age and sex). In this historical cohort study (2001–2015), we selected 61,854 individuals aged 50 years and older from the Manitoba Bone Mineral Density Database, Canada. Body mass index (BMI) ≥30 kg/m2 was used to define measured obesity. Hospital and physician ICD codes were used to ascertain ICD-coded obesity and incident MOF. Average cohort age was 66.3 years and 90.3% were female. The sensitivity, specificity and positive predictive value for ICD-coded obesity using measured obesity as the reference were 0.11 (95% confidence interval [CI]: 0.10, 0.11), 0.99 (95% CI: 0.99, 0.99) and 0.79 (95% CI: 0.77, 0.81), respectively. ICD-coded obesity (adjusted hazard ratio [HR] 0.83; 95% CI: 0.70, 0.99) and measured obesity (adjusted HR 0.83; 95% CI: 0.78, 0.88) were associated with decreased MOF risk. Although the area under the receiver operating characteristic curve (AUROC) estimates for incident MOF were not significantly different for ICD-coded obesity versus measured obesity (0.648 for ICD-coded obesity versus 0.650 for measured obesity; P = 0.056 for AUROC difference), the category-free net reclassification index for ICD-coded obesity versus measured obesity was -0.08 (95% CI: -0.11, -0.06) for predicting incident MOF. ICD-coded obesity predicted incident MOF, though it had low sensitivity and reclassified MOF risk slightly less well than measured obesity. PMID:29216254

  15. Racial and health insurance disparities of inpatient spine augmentation for osteoporotic vertebral fractures from 2005 to 2010.

    Science.gov (United States)

    Gu, C N; Brinjikji, W; El-Sayed, A M; Cloft, H; McDonald, J S; Kallmes, D F

    2014-12-01

    Vertebroplasty and kyphoplasty are frequently utilized in the treatment of symptomatic vertebral body fractures. While prior studies have demonstrated disparities in the treatment of back pain and care for osteoporotic patients, disparities in spine augmentation have not been investigated. We investigated racial and health insurance status differences in the use of spine augmentation for the treatment of osteoporotic vertebral fractures in the United States. Using the Nationwide Inpatient Sample from 2005 to 2010, we selected all discharges with a primary diagnosis of vertebral fracture (International Classification of Diseases-9 code 733.13). Patients who received spine augmentation were identified by using International Classification of Diseases-9 procedure code 81.65 for vertebroplasty and 81.66 for kyphoplasty. Patients with a diagnosis of cancer were excluded. We compared usage rates of spine augmentation by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander) and insurance status (Medicare, Medicaid, self-pay, and private). Comparisons among groups were made by using χ(2) tests. A multivariate logistic regression analysis was fit to determine variables associated with spine augmentation use. A total of 228,329 patients were included in this analysis, of whom 129,206 (56.6%) received spine augmentation. Among patients with spine augmentation, 97,022 (75%) received kyphoplasty and 32,184 (25%) received vertebroplasty; 57.5% (92,779/161,281) of white patients received spine augmentation compared with 38.7% (1405/3631) of black patients (P vertebral fracture. © 2014 by American Journal of Neuroradiology.

  16. Comparative stability of perpendicular versus parallel double-locking plating systems in osteoporotic comminuted distal humerus fractures.

    Science.gov (United States)

    Stoffel, Karl; Cunneen, Sam; Morgan, Robert; Nicholls, Rochelle; Stachowiak, Gwidon

    2008-06-01

    In distal humerus fractures, the restoration of stability is important to allow early mobilization and hence more favorable functional outcomes. In this article, we compare the biomechanical stability of perpendicular and parallel locking plating systems for the internal fixation of AO Type C2 distal humerus fractures in osteoporotic bone. Fractures were simulated in paired cadaveric bones and fixed using either the perpendicular 3.5 mm LCP distal humerus plating system (Synthes; Sydney, Australia) or the parallel Mayo Clinic Congruent elbow plate system (Acumed; Hillsboro, OR), using locking screws in both systems. Both systems were then tested for their stiffness (in compression and internal/external rotation), plastic deformation, and failure in torsion. Comparatively, the parallel locking plate system provided a significantly higher stability in compression (p = 0.005) and external rotation (p = 0.006), and a greater ability (p = 0.005) to resist axial plastic deformation. Stability for both constructs appeared to be dependent on bone quality, however the stability of the perpendicular system was generally more sensitive to bone mineral density, indicating a possible need for additional independent interfragmentary screws. A disadvantage of the parallel locking plate system was wear debris produced by its tapping system. In summary, the biomechanical findings of this study suggest that both locking plate systems allow early mobilization of the elbow in patients with osteoporotic bone following fixation of a comminuted distal humerus fracture. However, the parallel locking system showed improved stability compared with the perpendicular locking system, and therefore may be more indicated. (c) 2008 Orthopaedic Research Society.

  17. 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.

  18. 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

  19. 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...

  20. Differences of bone healing in metaphyseal defect fractures between osteoporotic and physiological bone in rats.

    Science.gov (United States)

    Thormann, Ulrich; El Khawassna, Thaqif; Ray, Seemun; Duerselen, Lutz; Kampschulte, Marian; Lips, Katrin; von Dewitz, Helena; Heinemann, Sascha; Heiss, Christian; Szalay, Gabor; Langheinrich, Alexander C; Ignatius, Anita; Schnettler, Reinhard; Alt, Volker

    2014-03-01

    Discrepancies in bone healing between osteoporotic and non-osteoporotic bone remain uncertain. The focus of the current work is to evaluate potential healing discrepancies in a metaphyseal defect model in rat femora. Female Sprague-Dawley rats were either ovariectomized (OVX, n=14) and combined with a calcium-, phosphorus- and vitamin D3-, soy- and phytoestrogen-free diet or received SHAM operation with standard diet rat (SHAM, n=14). Three months post-ovariectomy, DEXA measurement showed a reduction of bone mineral density reflecting an osteoporotic bone status in OVX rats. Rats then underwent a 3 mm wedge-shaped osteotomy at the distal metaphyseal area of the left femur stabilized with a T-shaped mini-plate and allowed to heal for 6 weeks. Biomechanical competence by means of a non-destructive three-point bending test showed significant lower flexural rigidity in the OVX rats at 3 mm lever span compared to SHAM animals (p=0.048) but no differences at 10 mm lever span. Microcomputer tomography (μCT) showed bridging cortices and consolidation of the defect in both groups, however, no measurable differences were found in either total ossified tissue or vascular volume fraction. Furthermore, histology showed healing discrepancies that were characterized by cartilaginous remnant and more unmineralized tissue presence in the OVX rats compared to more mature consolidation appearance in the SHAM group. In summary, bone defect healing in metaphyseal bone slightly differs between osteoporotic and non-osteoporotic bone in the current 3 mm defect model in both 3mm lever span biomechanical testing and histology. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. 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

  2. Dual modulation of bone formation and resorption with zoledronic acid-loaded biodegradable magnesium alloy implants improves osteoporotic fracture healing: An in vitro and in vivo study.

    Science.gov (United States)

    Li, Guoyuan; Zhang, Lei; Wang, Lei; Yuan, Guangyin; Dai, Kerong; Pei, Jia; Hao, Yongqiang

    2018-01-01

    Osteoporotic fracture (OPF) remains a major clinical challenge for skeletal regeneration. Impaired osteogenesis and excessive remodeling result in prolonged and poor quality of fracture healing. To augment bone formation and inhibit excessive resorption simultaneously, we constructed a biodegradable magnesium-based implant integrated with the anti-catabolic drug zoledronic acid (ZA); this implant exhibits controllable, sustained release of magnesium degradation products and ZA in vitro. The extracts greatly stimulate the osteogenic differentiation of rat-bone marrow-derived mesenchymal stem cells (rBMSCs), while osteoclastogenesis is inhibited by ZA. Implantation of intramedullary nails to fix femur fracture in ovariectomy-induced osteoporotic rats for up to 12 weeks demonstrates magnesium implants alone can enhance OPF repair through promoting callus formation compared to conventional stainless steel, while the combinatory treatment with local ZA release from implant coating further increases bone regeneration rate and callus size, remarkably improves bone quality and mechanical strength and suppresses osteoclasts and bone remodeling, due to the synergistic effect of both agents. The slow and uniform degradation of the implant ensures a steady decrease in bending force, which meets clinical requirements. In summary, biodegradable magnesium-based implants can locally co-deliver magnesium degradation products and zoledronic acid in a controlled manner, and can be superior alternatives for the reconstruction of osteoporosis-related fracture. Management of osteoporotic fracture has posed a major challenge in orthopedics, as the imbalance between diminished osteogenesis and excessive bone remodeling often leads to delayed and compromised fracture repair. Among various efforts expended on augmenting osteoporotic fracture healing, herein we reported a new strategy by engineering and utilizing a biodegradable magnesium-based implant integrated with local drug delivery

  3. Self-reported everyday physical activities in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis.

    Science.gov (United States)

    Al-Sari, U A; Tobias, J H; Clark, E M

    2018-01-01

    Previous work has shown that patients with vertebral fractures do less physical activity. However, the association between vertebral fracture and different components of physical activity is unclear. Our results suggest that vertebral fracture (VF) is associated with a reduction in activities involving bending, ambulation, and daily living, regardless of age. The aim of this study was to determine whether osteoporotic VF is associated with reduced self-reported everyday routine physical activity and/or ability (PAA). A comprehensive search was undertaken using the databases of PubMed, Embase, Medline, Web of Science, and the "grey" literature from 1950 to the end of July 2016. Standardised search terms for VF and PAAs were used. Four categories of PAA were included: (1) bending ability, (2) ambulatory activities, (3) reaching arms above shoulder level, and (4) activities of daily living (ADLs). Strict inclusion and exclusion criteria were used, and only studies that adjusted for age were included. For the meta-analysis, pooled OR and 95% confidence interval (CI) were calculated using a random-effects model. Eleven studies in total were identified which had investigated the associations between the prevalent VF and the selected PAAs and expressed these as ORs or RR. Women (six studies) with VF had a 64% increase in difficulty forward bending compared to those without VF. Women (nine studies) with VF had a 27% increase in difficulty doing ambulatory activities, while no association was observed for men (four studies). Women also have 73% (five studies), 127% (three studies), and 100% (four studies) increase in difficulty reaching arms above shoulder, shopping, and preparing meals, respectively. Studies consistently show women with VF have reduced everyday activities, while much less research has been carried out in men. This information may be useful when designing interventions to improve physical function in people with osteoporotic VFs.

  4. Finger Fractures as an Early Manifestation of Primary Hyperparathyroidism Among Young Patients: A Case Report of a 30-Year-Old Male With Recurrent Osteoporotic Fractures.

    Science.gov (United States)

    Ozaki, Akihiko; Tanimoto, Tetsuya; Yamagishi, Eiki; Sato, Shunsuke; Tsukada, Manabu; Sawano, Toyoaki; Leppold, Claire; Tsuda, Kenji; Asakura, Takanori; Tsubokura, Masaharu; Kato, Shigeaki; Kami, Masahiro; Ohira, Hiromichi

    2016-05-01

    Osteoporosis and osteoporotic fractures represent a substantial health burden, and predominantly affect the elderly. Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism. However, little information is available regarding early skeletal manifestations of primary hyperparathyroidism.A 30-year-old Japanese male presented with pain in his left wrist, and was diagnosed with a distal radius fracture. During surgery, we noticed decreased bone strength of the fracture site. Further investigation found osteoporosis and primary hyperparathyroidism owing to a solitary parathyroid adenoma, which was resected without significant complications. History revealed that the patient suffered a metacarpal bone fracture of his right fifth bone 6 months earlier. Although serial x-rays at that time had shown rapidly developed cortical bone erosion around the fractured finger, the possibility of primary hyperparathyroidism was overlooked because of poor awareness of the condition, leading to a 6-month delay in the diagnosis of primary hyperparathyroidism.Clinicians should be aware that finger fractures may be an early skeletal manifestation of primary hyperparathyroidism that can help achieve a prompt diagnosis of the condition, especially when they occur in young adults in the absence of major trauma.

  5. “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.

  6. [Bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients].

    Science.gov (United States)

    Zhang, Hua; Zhang, Jian; Zhou, Aiguo; Jiang, Dianming; Shen, Honglin; Yan, Wenlong

    2013-08-01

    To explore the effectiveness of bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients. Bipolar femoral head replacement combined with tension band wire fixation were used for intertrochanteric fracture in 48 elderly osteoporotic patients between January 2004 and December 2010. Of 48 patients, 15 were male and 33 were female, aged 90-99 years (mean, 94.1 years). All fractures were caused by falling, and pathological fracture was excluded. It was 2-7 days (mean, 4.2 days) from fracture to surgery. According to the Tronzo Evans classification, 25 cases were rated as type IV, 20 cases as type III, and 3 cases as type II. And all of the cases were accompanied with severe osteoporosis and accompanied by more than one medical diseases, and 10 cases had spinal compression fracture. All patients underwent the operation successfully. Six cases died of underlying medical illness within 2 years postoperatively. A total of 39 cases were followed up 2-7 years, averaged 3.1 years. After operation, short-term mental disorders occurred in 9 cases, suspected urinary tract infection in 2 cases, sacral rear bedsore in 1 case, hip pain in 1 case, thigh pain in 1 case, and deep vein thrombosis of affected limb in 1 case. All the incisions healed by first intension, and X-ray film showed bone union in all cases; no complications of bone osteolysis, prosthesis loosening, subsidence, rupture, and heterotopic ossification occured postoperatively. No case needed revision. According to the Harris score system, the results were excellent in 5 cases, good in 28 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 84.6%; the score at 2 years was significantly higher than that at 6 weeks (t = -14.79, P = 0.00). The physical health score and mental health score of SF-12 at 2 years postoperatively were significantly higher than those at 6 weeks postoperatively (P load bearing, pain

  7. BODE INDEX AND THE RISK OF OSTEOPOROTIC FRACTURES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

    Directory of Open Access Journals (Sweden)

    E. V. Kochetova

    2016-01-01

    Full Text Available The goal of the study: to define theoretic correlation between BODE index in men with chronic obstructive pulmonary disease (COPD and risk of osteoporotic fractures assessed as per bone mineral density and FRAX integral rate.Materials and methods. 125 men suffering from COPD smoking for a long period of time (the smoker index of 240 and time of smoking (packs/years of 40 were included into the study. 10 year risk of osteoporotic fractures was assessed by FRAX software. The respiratory function was evaluated by the multi-module unit of MasterLab/Jaeger type. BODE index was defined in the patients.Results. The minimum level of BODE was observed in those suffering from COPD of the 2nd stage – 2.23 ± 0.88. In case of the 3rd stage of COPD BODE made 5.05 ± 1.19, in the 4th stage of COPD it made 7.0 ± 1.0. The maximum risk of fractures was detected in the patients of the 4th stage of COPD. The minimum risk of fractures was diagnosed in the patients of the 2nd stage of COPD. The confident correlations were found between BODE and bone mineral density (r = -0.71, p < 0.005, as well as confident correlations between BODE and the risk of fractures (r = -0.54, p < 0.05. Conclusions. The correlation has been found between BODE index and the risk of fractures

  8. Increased risk of incident osteoporosis and osteoporotic fracture in tuberculosis patients: a population-based study in a tuberculosis-endemic area.

    Science.gov (United States)

    Chen, Y-Y; Feng, J-Y; Ting, W-Y; Yen, Y-F; Chuang, P-H; Pan, S-W; Su, V Y-F; Su, W-J

    2017-05-01

    The occurrence of osteoporosis in tuberculosis, a chronic infection, has rarely been evaluated. In this study, we found significantly higher incidence rates of osteoporosis (Adjusted hazard ratio (AHR) 1.82) and osteoporotic fracture (AHR 2.33) in tuberculosis patients than matched cohorts, which suggest that osteoporosis screening should be considered in tuberculosis patients' follow-up program. The aim of this study is to determine the occurrence of incident osteoporosis in patients who completed anti-tuberculosis (TB) treatment. Chronic inflammatory disorders are associated with an increased risk of osteoporosis. Although TB is an infectious disease characterized by systemic inflammatory responses, the impact of active TB on incident osteoporosis is unclear. We used the Taiwan National Health Insurance Research Database to investigate the association between history of active TB and incident osteoporosis and osteoporotic fracture. In this nationwide retrospective cohort study, active TB patients and their age- and sex-matched controls were identified from the National Health Insurance Research Database in Taiwan during 2000-2012. The occurrence of incident osteoporosis, osteoporotic fractures, and risk factors associated with osteoporosis among TB patients and matched controls were analyzed. We observed incident osteoporosis in 2.2% (n = 86) of the TB patients and in 1.1% (n = 162) of the matched controls. The incidence rate of osteoporosis was 4.31 and 1.80 per 1000 person-years, which was significantly higher in TB patients (p osteoporotic fracture was significantly higher in TB patients. Patients with a history of active TB have a higher incidence rate of osteoporosis and osteoporotic fracture.

  9. 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

  10. The incidence of secondary vertebral fracture of vertebral augmentation techniques versus conservative treatment for painful osteoporotic vertebral fractures: a systematic review and meta-analysis.

    Science.gov (United States)

    Song, Dawei; Meng, Bin; Gan, Minfeng; Niu, Junjie; Li, Shiyan; Chen, Hao; Yuan, Chenxi; Yang, Huilin

    2015-08-01

    Percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) are minimally invasive and effective vertebral augmentation techniques for managing osteoporotic vertebral compression fractures (OVCFs). Recent meta-analyses have compared the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques or conservative treatment; however, the inclusions were not thorough and rigorous enough, and the effects of each technique on the incidence of secondary vertebral fractures remain unclear. To perform an updated systematic review and meta-analysis of the studies with more rigorous inclusion criteria on the effects of vertebral augmentation techniques and conservative treatment for OVCF on the incidence of secondary vertebral fractures. PubMed, MEDLINE, EMBASE, SpringerLink, Web of Science, and the Cochrane Library database were searched for relevant original articles comparing the incidence of secondary vertebral fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (NRCTs) were identified. The methodological qualities of the studies were evaluated, relevant data were extracted and recorded, and an appropriate meta-analysis was conducted. A total of 13 articles were included. The pooled results from included studies showed no statistically significant differences in the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques and conservative treatment. Subgroup analysis comparing different study designs, durations of symptoms, follow-up times, races of patients, and techniques were conducted, and no significant differences in the incidence of secondary fractures were identified (P > 0.05). No obvious publication bias was detected by either Begg's test (P = 0.360 > 0.05) or Egger's test (P = 0.373 > 0.05). Despite current thinking in the

  11. Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison.

    Science.gov (United States)

    Weiser, L; Dreimann, M; Huber, G; Sellenschloh, K; Püschel, K; Morlock, M M; Rueger, J M; Lehmann, W

    2016-08-01

    Loosening of pedicle screws is a major complication of posterior spinal stabilisation, especially in the osteoporotic spine. Our aim was to evaluate the effect of cement augmentation compared with extended dorsal instrumentation on the stability of posterior spinal fixation. A total of 12 osteoporotic human cadaveric spines (T11-L3) were randomised by bone mineral density into two groups and instrumented with pedicle screws: group I (SHORT) separated T12 or L2 and group II (EXTENDED) specimen consisting of T11/12 to L2/3. Screws were augmented with cement unilaterally in each vertebra. Fatigue testing was performed using a cranial-caudal sinusoidal, cyclic (1.0 Hz) load with stepwise increasing peak force. Augmentation showed no significant increase in the mean cycles to failure and fatigue force (SHORT p = 0.067; EXTENDED p = 0.239). Extending the instrumentation resulted in a significantly increased number of cycles to failure and a significantly higher fatigue force compared with the SHORT instrumentation (EXTENDED non-augmented + 76%, p osteoporotic spine compared with cement augmentation. Cite this article: Bone Joint J 2016;98-B:1099-1105. ©2016 The British Editorial Society of Bone & Joint Surgery.

  12. Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures.

    Science.gov (United States)

    Marques, Andréa; Rodrigues, Ana M; Romeu, José Carlos; Ruano, Afonso; Barbosa, Ana Paula; Simões, Eugénia; Águas, Fernanda; Canhão, Helena; Alves, José Delgado; Lucas, Raquel; Branco, Jaime Cunha; Laíns, Jorge; Mascarenhas, Mário; Simões, Susete; Tavares, Viviana; Lourenço, Oscar; da Silva, José António Pereira

    2016-01-01

    To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures. A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions. 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible. Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.

  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. Biomechanical Analysis of Range of Motion and Failure Characteristics of Osteoporotic Spinal Compression Fractures in Human Cadaver

    Science.gov (United States)

    Heary, Robert F; Parvathreddy, Naresh K; Agarwal, Nitin

    2017-01-01

    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. PMID:29200483

  15. Percutaneous Imaging-Guided Screw Fixation of Osteoporotic Transverse Fractures of the Lower Sacrum with Cement Augmentation: Report of 2 Cases.

    Science.gov (United States)

    Garnon, Julien; Koch, Guillaume; Ramamurthy, Nitin; Bauones, Salem; Caudrelier, Jean; Tsoumakidou, Georgia; Cazzato, Roberto Luigi; Gangi, Afshin

    2017-07-01

    Osteoporotic fractures of the sacrum usually involve the sacral ala and can be managed with percutaneous cementoplasty if conservative therapy failed to achieve bone consolidation. On the other hand, isolated transverse fractures of the lowest sacrum are more rare, with little literature focusing on their management in the osteoporotic population. If pseudoarthrosis occurs in this location, sacroplasty is not an optimal therapeutic option because of the poor biomechanical resistance of cement to multi-directional stresses. Hence, we report two cases of chronic unhealed transverse fractures of the lowest sacrum successfully managed with percutaneous image-guided screw fixation augmented with cement injection. At last follow-up available, both patients experienced complete pain relief, without evidences of failure of the osteosynthesis on CT-scan controls.

  16. Determination of the painful level in osteoporotic vertebral fractures--Retrospective comparison between plain film, bone scan, and magnetic resonance imaging.

    Science.gov (United States)

    Lin, Hsi-Hsien; Chou, Po-Hsin; Wang, Shih-Tien; Yu, Jung-Kuang; Chang, Ming-Chau; Liu, Chien-Lin

    2015-12-01

    Determining the actual painful vertebral level is difficult when evaluating osteoporotic vertebral fracture, especially when there are acute and chronic fractures simultaneously. In this study, we retrospectively evaluated and compared the findings between plain film, bone scan, and magnetic resonance imaging (MRI) in the diagnosis of new fracture in osteoporotic vertebral fractures. This is a retrospective clinical study of patients who were diagnosed with osteoporotic vertebral fractures using plain film, bone scan, and MRI within a 1-month interval between February 2008 and December 2012. The findings in plain film, the extent of increased uptake in bone scan, and signal change in MRI were compared to evaluate the actual level of pain. All patients received percutaneous vertebroplasty according to MR finding. Pain scores (visual analog scale) of the study patients were compared prior to and after the procedure. A total of 52 patients with a mean age of 79.1 years (range 59-92 years) were enrolled in this study, and were treated by vertebroplasty confirmed by MRI. It was observed that patient pain score (visual analog scale) improved from 7.6 to 2.8. Plain film examination revealed 79 vertebrae that were suspected to be compression fractures. Among the suspected vertebrae, 62 showed increased uptake in bone scan, and MRI showed bony edema change in 58 vertebrae. The consistency between bone scan and MRI was 96.9% in patients with single-level suspected fracture on plain film. There was moderate agreement (kappa was 0.56) in patients where multiple levels were noted. Fifteen vertebrae with vacuum cleft sign on plain film showed total concordance in both bone scan and MRI. For patients with single-level compression fracture, the painful level in osteoporotic vertebral fractures can be determined by plain film and bone scan testing. Vacuum cleft sign noted on plain film may be enough to localize the level of pain. However, MRI testing is further needed in multiple

  17. Cement leakage as a possible complication of balloon kyphoplasty--is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)?

    Science.gov (United States)

    Walter, Jan; Haciyakupoglu, Ersin; Waschke, Albrecht; Kalff, Rolf; Ewald, Christian

    2012-02-01

    Besides the treatment of osteoporotic vertebral compression fractures of AO type A1, balloon kyphoplasty (BKP) is seen as a therapeutic option even in the treatment of incomplete osteoporotic burst fractures (AO type A3.1). However, due to involvement of the posterior vertebral body wall, the risk of cement leakages is considered to be higher. This study focuses on the frequency and pattern of cement leakages in AO type A3.1 fractures compared with osteoporotic compression fractures (AO type A1). Retrospective cohort analysis was done of all patients (n = 138) treated by BKP for osteoporotic vertebral fractures (n = 173) between January 2007 and December 2010 in our department. Cement extravasations into three pre-defined anatomical compartments were evaluated on postoperative CT scans of the augmented vertebral bodies, with even minor cement detections beyond the vertebral body's wall being strictly inidicated as leakages. The frequency of cement leakages in relation to the fracture type was statistically analyzed using Pearson's chi-square test. Clinical and radiological follow-up was done 6 weeks, 3 and 6 months postoperatively. The overall cement leakage rate of BKP in 173 treated osteoporotic vertebral fractures was 30.6%. Cement extravasations were detected in 20.3% of A1.1, 30.5% of A1.2, 37.8% of A1.3, and 39.0% of A3.1 fractures, respectively. There was no statistically significant difference in the leakage rate between A3.1 and all A1 fractures (28.0%; p > 0.05), but between A3.1 and A1.1 fractures (p AO type A3.1 and all A1 fractures, subgroup analysis revealed a statistically significant higher risk of cement extrusions in A3.1 compared to A1.1 fractures. None of the affected patients showed new neurological deficits due to cement extravasations. Still, balloon kyphoplasty can be considered a safe procedure, even in the treatment of painful osteoporotic vertebral fractures of AO type A3.1.

  18. Biomechanical Analysis of Stability of Posterior Antiglide Plating in Osteoporotic Pronation Abduction Ankle Fracture Model With Posterior Tibial Fragment.

    Science.gov (United States)

    Hartwich, Kathleen; Lorente Gomez, Alejandro; Pyrc, Jaroslaw; Gut, Radosław; Rammelt, Stefan; Grass, René

    2017-01-01

    = .016). Construct stiffness trended to be higher in group 2 (179 ± 100 kNn) compared to group 1 (127 ± 73 kN/m) but this difference was not statistically significant ( P = .120). BMD correlated with bone-construct failure. Fixation of the posterior tibial edge with a posterolateral locking plate resulted in higher biomechanical stability than anterior-posterior lag screw fixation in an osteoporotic pronation-abduction fracture model. The clinical implication of this biomechanical study is that the posterior antiglide plating might be advantageous in patients with osteoporotic pronation abduction stage III ankle fracture.

  19. 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.

  20. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Grossman, David C; Curry, Susan J; Owens, Douglas K; Barry, Michael J; Caughey, Aaron B; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Krist, Alex H; Kubik, Martha; Landefeld, Seth; Mangione, Carol M; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen

    2018-04-17

    Because of the aging population, osteoporotic fractures are an increasingly important cause of morbidity and mortality in the United States. Approximately 2 million osteoporotic fractures occurred in the United States in 2005, and annual incidence is projected to increase to more than 3 million fractures by 2025. Within 1 year of experiencing a hip fracture, many patients are unable to walk independently, more than half require assistance with activities of daily living, and 20% to 30% of patients will die. To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on vitamin D supplementation, with or without calcium, to prevent fractures. The USPSTF reviewed the evidence on vitamin D, calcium, and combined supplementation for the primary prevention of fractures in community-dwelling adults (defined as not living in a nursing home or other institutional care setting). The review excluded studies conducted in populations with a known disorder related to bone metabolism (eg, osteoporosis or vitamin D deficiency), taking medications known to be associated with osteoporosis (eg, long-term steroids), or with a previous fracture. The USPSTF found inadequate evidence to estimate the benefits of vitamin D, calcium, or combined supplementation to prevent fractures in community-dwelling men and premenopausal women. The USPSTF found adequate evidence that daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium has no benefit for the primary prevention of fractures in community-dwelling, postmenopausal women. The USPSTF found inadequate evidence to estimate the benefits of doses greater than 400 IU of vitamin D or greater than 1000 mg of calcium to prevent fractures in community-dwelling postmenopausal women. The USPSTF found adequate evidence that supplementation with vitamin D and calcium increases the incidence of kidney stones. The USPSTF concludes that the current evidence is insufficient to assess the balance of the

  1. 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.

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

    DEFF Research Database (Denmark)

    Harsløf, Torben; Nielsen, Morten Frost Munk; Nielsen, T L

    2013-01-01

    .02 (95 % CI 1.20-3.41, p = 0.01). The same allele was associated with increased bone loss (BMC) at the total hip of 4.1 versus 0.5 % in individuals either heterozygous or homozygous for the common allele (p = 0.006), a reduced 10-year growth in bone area at the total hip of 0.4 versus 2.2 and 2......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...

  3. 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

  4. Clinical risk factors for fracture in postmenopausal osteoporotic women: a review of the recent literature.

    Science.gov (United States)

    LaFleur, Joanne; McAdam-Marx, Carrie; Kirkness, Carmen; Brixner, Diana I

    2008-03-01

    To review recent literature regarding relationships among age, weight or body mass index (BMI), bone mineral density (BMD), maternal history of fracture, or personal prior history of fracture and fragility fractures in women with postmenopausal osteoporosis (PMO). A MEDLINE database search (1995-June 30, 2007) was conducted to identify literature related to risk factors of interest for PMO-related fractures. Cohort studies, case-control studies, and meta-analyses that reported fracture outcomes were included if they provided an estimate of relative risk for at least 1 of the 5 selected clinical risk factors (CRFs) and studied women with PMO or stratified risk estimates by age and sex. Of 313 identified studies that evaluated fractures as an endpoint, 245 did not report risk estimates for a CRF of interest and/or did not report data for a PMO population. In the 68 included articles, the risks associated with the evaluated CRFs were high and significant. Prior fracture was a strong predictor of fracture and increased risk up to 18 times. Each standard deviation below the referent mean for BMD was associated with an increased fracture risk of up to 4.0 times; maternal fracture history increased risk 1.3-2.9 times. Age (per 5 year increment) increased risk by 1.2-5.0 times; low weight or BMI inconsistently showed a 0.5-3.0 times greater risk. Low BMD is widely used as a diagnostic indicator for osteoporosis; however, other CRFs play an important role in determining fracture risk among women with PMO.

  5. 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

  6. 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...

  7. Does Balloon Kyphoplasty Deliver More Cement Safely into Osteoporotic Vertebrae with Compression Fractures Compared with Vertebroplasty? A Study in Vertebral Analogues

    Science.gov (United States)

    Abduljabbar, Fahad H.; Al-jurayyan, Abdulaziz; Alqahtani, Saad; Sardar, Zeeshan M.; Saluja, Rajeet Singh; Ouellet, Jean; Weber, Michael; Steffen, Thomas; Beckman, Lorne; Jarzem, Peter

    2015-01-01

    Study Design A biomechanical and radiographic study using vertebral analogues. Objectives Kyphoplasty and vertebroplasty are widely used techniques to alleviate pain in fractures secondary to osteoporosis. However, cement leakage toward vital structures like the spinal cord can be a major source of morbidity and even mortality. We define safe cement injection as the volume of the cement injected into a vertebra before the cement leakage occurs. Our objective is to compare the amount of cement that can be safely injected into an osteoporotic vertebra with simulated compression fracture using either vertebroplasty or balloon kyphoplasty techniques. Methods Forty artificial vertebral analogues made of polyurethane with osteoporotic cancellous matrix representing the L3 vertebrae were used for this study and were divided into four groups of 10 vertebrae each. The four groups tested were: low-viscosity cement injected using vertebroplasty, high-viscosity cement injected using vertebroplasty, low-viscosity cement injected using balloon kyphoplasty, and high-viscosity cement injected using balloon kyphoplasty. The procedures were performed under fluoroscopic guidance. The injection was stopped when the cement started protruding from the created vascular channel in the osteoporotic vertebral fracture model. The main outcome measured was the volume of the cement injected safely into a vertebra before leakage through the posterior vascular channel. Results The highest volume of the cement injected was in the vertebroplasty group using high-viscosity cement, which was almost twice the injected volume in the other three groups. One-way analysis of variance comparing the four groups showed a statistically significant difference (p osteoporotic vertebrae with compression fractures. PMID:26225279

  8. A Study on the Correlation of Pertrochanteric Osteoporotic Fracture Severity with the Severity of Osteoporosis.

    Science.gov (United States)

    Hayer, Prabhnoor Singh; Deane, Anit Kumar Samuel; Agrawal, Atul; Maheshwari, Rajesh; Juyal, Anil

    2016-04-01

    Osteoporosis is a metabolic bone disease caused by progressive bone loss. It is characterized by low Bone Mineral Density (BMD) and structural deterioration of bone tissue leading to bone fragility and increased risk of fractures. When classifying a fracture, high reliability and validity are crucial for successful treatment. Furthermore, a classification system should include severity, method of treatment, and prognosis for any given fracture. Since it is known that treatment significantly influences prognosis, a classification system claiming to include both would be desirable. Since there is no such classification system, which includes both the fracture type and the osteoporosis severity, we tried to find a correlation between fracture severity and osteoporosis severity. The aim of the study was to evaluate whether the AO/ASIF fracture classification system, which indicates the severity of fractures, has any relationship with the bone mineral status in patients with primary osteoporosis. We hypothesized that fracture severity and severity of osteoporosis should show some correlation. An observational analytical study was conducted over a period of one year during which 49 patients were included in the study at HIMS, SRH University, Dehradun. The osteoporosis status of all the included patients with a pertrochanteric fracture was documented using a DEXA scan and T-Score (BMD) was calculated. All patients had a trivial trauma. All the fractures were classified as per AO/ASIF classification. Pearson Correlation between BMD and fracture type was calculated. Data was entered on Microsoft Office Excel version 2007 and Interpretation and analysis of obtained data was done using summary statistics. Pearson Correlation between BMD and fracture type was calculated using the SPSS software version 22.0. The average age of the patients included in the study was 71.2 years and the average bone mineral density was -4.9. The correlation between BMD and fracture type was

  9. Role of Medicinal Plants and Natural Products on Osteoporotic Fracture Healing

    Directory of Open Access Journals (Sweden)

    Mohd Azri Abd Jalil

    2012-01-01

    Full Text Available Popularly known as “the silent disease” since early symptoms are usually absent, osteoporosis causes progressive bone loss, which renders the bones susceptible to fractures. Bone fracture healing is a complex process consisting of four overlapping phases—hematoma formation, inflammation, repair, and remodeling. The traditional use of natural products in bone fractures means that phytochemicals can be developed as potential therapy for reducing fracture healing period. Located closely near the equator, Malaysia has one of the world’s largest rainforests, which are homes to exotic herbs and medicinal plants. Eurycoma longifolia (Tongkat Ali, Labisia pumila (Kacip Fatimah, and Piper sarmentosum (Kaduk are some examples of the popular ethnic herbs, which have been used in the Malay traditional medicine. This paper focuses on the use of natural products for treating fracture as a result of osteoporosis and expediting its healing.

  10. Role of medicinal plants and natural products on osteoporotic fracture healing.

    Science.gov (United States)

    Abd Jalil, Mohd Azri; Shuid, Ahmad Nazrun; Muhammad, Norliza

    2012-01-01

    Popularly known as "the silent disease" since early symptoms are usually absent, osteoporosis causes progressive bone loss, which renders the bones susceptible to fractures. Bone fracture healing is a complex process consisting of four overlapping phases-hematoma formation, inflammation, repair, and remodeling. The traditional use of natural products in bone fractures means that phytochemicals can be developed as potential therapy for reducing fracture healing period. Located closely near the equator, Malaysia has one of the world's largest rainforests, which are homes to exotic herbs and medicinal plants. Eurycoma longifolia (Tongkat Ali), Labisia pumila (Kacip Fatimah), and Piper sarmentosum (Kaduk) are some examples of the popular ethnic herbs, which have been used in the Malay traditional medicine. This paper focuses on the use of natural products for treating fracture as a result of osteoporosis and expediting its healing.

  11. Tamoxifen use reduces the risk of osteoporotic fractures in women with breast cancer in Asia: a nationwide population-based cohort study.

    Science.gov (United States)

    Tzeng, Huey-En; Muo, Chih-Hsin; Chen, Hsien-Te; Hwang, Wen-Li; Hsu, Horng-Chang; Tsai, Chun-Hao

    2015-05-20

    Bone mineral density changes with tamoxifen treatment have been reported in pre- and post-menopausal women with breast cancer. However, there remains controversy as to whether tamoxifen significantly reduces fracture rates in different age groups. Breast cancer occurs at 10-20 years younger in Asian women compared with Western women. Therefore we conducted this population-based case-control study to determine whether or not tamoxifen use is associated with osteoporotic fractures. We selected 75488 women with breast cancer with no prior history of fractures from the Longitudinal Health Insurance Database for Catastrophic Illness Patients in 2000-2011. They were followed from the date of the diagnosis of breast cancer to the date a hip, vertebral or wrist fracture occurred. Because the use of tamoxifen was a time-dependent variable, we used a Cox proportional hazard model with time-dependent exposure covariates to estimate the risk of a fracture. There were 50257 and 25231 women with breast cancer who did and did not receive tamoxifen treatment, respectively. The tamoxifen users had lower risks for overall fractures with hazard ratios (HRs) of 0.52 and 0.59 in the crude and adjusted models (95 % CI = 0.45-0.61 and 0.51-0.69), respectively. They also had lower risks for hip (HR = 0.55, 95 % CI = 0.45-0.67) and vertebral (HR = 0.64, 95 % CI = 0.50-0.82) fractures in the adjusted model. The risk of fractures decreased with an increasing dosage of tamoxifen. Regardless of the age group, the tamoxifen users had a lower risk of fractures than the non-users. In this Asian population-based case-control study, tamoxifen use was associated with a reduction in osteoporotic fractures, especially in hip fractures.

  12. 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.

  13. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions

    Science.gov (United States)

    Zimmermann, Elizabeth A.; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N.; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; Tang, Simon; Amling, Michael; Ritchie, Robert O.; Busse, Björn

    2016-02-01

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibril deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. The significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates.

  14. Difference of clinical course between cases with bone union and those with delayed union following osteoporotic vertebral fractures.

    Science.gov (United States)

    Yasuda, Hiroyuki; Hoshino, Masatoshi; Tsujio, Tadao; Terai, Hidetomi; Namikawa, Takashi; Kato, Minori; Matsumura, Akira; Suzuki, Akinobu; Takayama, Kazushi; Takahashi, Shinji; Nakamura, Hiroaki

    2017-12-28

    In this prospective multicenter study of osteoporotic vertebral fractures (OVFs), delayed union of OVF at 6-month follow-up caused prolonged pain, QOL impairment, ADL impairment, cognitive status deterioration, and vertebral collapse progression. Delayed union following osteoporotic vertebral fracture displayed as an intravertebral cleft on plain X-rays was reported to be a factor for prolonged severe pain. However, the difference of clinical course between bone union and delayed union cases still remains unclear. The purpose of this study was to identify how OVF delayed union following conventional conservative treatment influences the clinical course with a prospective multicenter study. A total of 324 OVF patients from 25 institutes in Osaka, Japan, were included in the study. At the 6-month follow-up after initial visit to each institute, the patients were classified into bone union and delayed union groups based on plain X-ray findings. The outcome assessments included a VAS for back pain, SF-36 for quality of life (QOL), severity of bed-ridden state for activities of daily living (ADL), MMSE for cognitive functions, and degree of vertebral collapse on plain X-rays. Overall, 280 patients were included into the union group and 44 into the delayed union group. The VAS score at 6 months was significantly worse in the delayed union group (p = 0.01). The scores for the SF-36 scales of physical functioning and bodily pain at 6 months were significantly lower in the delayed union group (p = 0.019, p = 0.01, respectively). The percentage of nearly or completely bed-ridden patients was significantly higher in the delayed union group. The percentage of newly developed cognitive impairment was significantly higher in the delayed union group (p = 0.02). Progression of vertebral collapse during the 6-month follow-up was more pronounced in the delayed union group (p union following OVF causes prolonged pain, QOL impairment, ADL impairment, cognitive

  15. Ultra-early injection of low-viscosity cement in vertebroplasty procedure for treating osteoporotic vertebral compression fractures: A retrospective cohort study.

    Science.gov (United States)

    Zhang, Zhao-Fei; Liu, Dong-Hua; Wu, Pei-Yu; Xie, Chun-Liang; Qin, Feng-Wei; Huang, He

    2018-02-15

    To evaluate the clinical effect of ultra-early injection (before the phase of "tooth-paste-like") of low-viscosity cement in percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures (OVCFs). Two hundred sixty-one patients who had PVP procedures with low-viscosity cement (ultra-early injection: 145, normal injection: 135) were included from July 2010 to July 2016 in our hospital. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, cement leakage, and adjacent vertebral fractures were evaluated. The follow-up period was over 12 months. VAS 3.0 d after surgery was significantly reduced in the ultra-early injection group compared to that in the control group (P = 0.00), but no difference was found at the final follow-up (P = 0.53). Similar results were found for ODI. The Cobb angle in both groups was recovered after PVP (P < 0.05); however, in the control group, the Cobb angle at the final follow-up was significantly increased compared with that 3.0 d after surgery (P = 0.00). There was a significant difference in the Cobb angle between the two groups at the final follow-up (P = 0.00). Regarding cement leakage, there were no significant differences in terms of mild (P = 0.58), moderate (P = 0.68), or severe leakage (P = 0.52). Seven patients in the control group had adjacent vertebral fractures, but only one patient in the ultra-early injection group experienced adjacent fractures (P = 0.03). Ultra-early injection of low-viscosity cement during PVP procedures in the treatment of OVCFs not only quickly and significantly relieves pain, reduces the incidence of adjacent vertebral fractures, and prevents progressive kyphotic deformity, but also does not increase the risk of cement leakage when compared with that of the traditional injection procedure. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  16. A Case Report of Bisphosphonate-induced Bilateral Osteoporotic Subtrochanteric Fracture Femurii: Review of Literature.

    Science.gov (United States)

    Uppin, Rajendra; Gupta, Srinath; Prakash, Shivank

    2016-01-01

    Osteoporosis is a significant health-care problem characterized by excessive skeletal fragility, susceptibility to low-trauma fractures in men as well as women. Any abnormality of the bone that reduces the strength of the bone predisposes it to mechanical failure during normal activity or with minimum trauma. The mechanical failure manifests itself as a fracture, and this fracture must be recognized as a pathological fracture if the patient is to be treated properly. Osteoporosis is one of the leading causes of such pathological fractures and accounts for 1.5 million fractures annually. In the following case report, we present a 56-year-old postmenopausal female patient with bilateral pathological subtrochanteric fracture femurii due to intake of bisphosponates for 4 years for osteoporosis. Bilateral pathological subtrochanteric femurii fractures are extremely uncommon injuries which occur in adults who sustain injuries due to trivial trauma. A variety of management modalities has been tried to treat this complex fracture pattern. Standard fixation treatment is intramedullary nailing. A postmenopausal female of rheumatoid arthritis aged 56 years, presented to our emergency department with a history of trivial fall at home. Following the fall, she was unable to bear weight on bilateral feet and complained of deformity. History revealed consumption of bisphosphonates (tablet alendronate 10 mg) for the last 4 years and glucocorticoids for rheumatiod arthritis. Radiographs were taken, which revealed bilateral pathological subtrochanteric fracture femurii. After obtaining necessary fitness, the patient was taken up for surgery. Closed reduction and Internal fixation with long proximal femoral nail were done. Bisphosphonate intake was stopped and teriparatide 20 µg/day subcutaneously given for 3 months. Fracture healed after 3 months and patient resumed her daily activities. In people taking long-term bisphoshponate therapy, symptomatic cortical stress reactions

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

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Vestergaard, Peter; Rud, Bo

    2006-01-01

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

  18. 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.

  19. 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.

  20. 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...... 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...... was evident for fracture rates in men. CONCLUSION: Gouty arthritis requiring allopurinol is associated with an excess risk of major or hip fracture, with an allopurinol dose effect evident in women such that women taking the highest doses of allopurinol--suggestive of more severe disease--were at increased...

  1. 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

    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...... 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...

  2. Prophylactic vertebroplasty can decrease the fracture risk of adjacent vertebrae: An in vitro cadaveric study

    NARCIS (Netherlands)

    Aquarius, R.; Homminga, Jasper Johan; Hosman, A.J.F.; Verdonschot, Nicolaas Jacobus Joseph; Tanck, E.

    2014-01-01

    Adjacent level vertebral fractures are common in patients with osteoporotic wedge fractures, but can theoretically be prevented with prophylactic vertebroplasty. Previous tests on prophylactic vertebroplasties have been performed under axial loading, while in vivo changes in spinal alignment likely

  3. Prophylactic vertebroplasty can decrease the fracture risk of adjacent vertebrae: an in vitro cadaveric study

    NARCIS (Netherlands)

    Aquarius, R.; Homminga, J.; Hosman, A.J.F.; Verdonschot, N.J.; Tanck, E.J.

    2014-01-01

    Adjacent level vertebral fractures are common in patients with osteoporotic wedge fractures, but can theoretically be prevented with prophylactic vertebroplasty. Previous tests on prophylactic vertebroplasties have been performed under axial loading, while in vivo changes in spinal alignment likely

  4. Evolution of bone mineral density after percutaneous kyphoplasty in fresh osteoporotic vertebral body fractures and adjacent vertebrae along with sagittal spine alignment.

    Science.gov (United States)

    Korovessis, Panagiotis; Zacharatos, Spyridon; Repantis, Thomas; Michael, Andreas; Karachalios, Dionysios

    2008-06-01

    Prospective controlled cohort study of 27 adult osteoporotic patients who underwent kyphoplasty for fresh osteoporotic spinal fractures. To define the evolution of vertebral bone mineral density (BMD) at kyphoplasty and adjacent levels along with sagittal spinal alignment to contribute to the etiology of adjacent vertebral fractures after augmentation. Osteoporotic compression fractures can be effectively treated with methylmethacrylate vertebral augmentation. However, to the authors' knowledge the effect of vertebral augmentation on the vertebral endplate BMD of the augmented and adjacent nonaugmented levels has not as yet been described. Twenty-seven consecutive selected patients (9 men, 18 women), with an average age of 72+/-9 years underwent 1, 2, or 3-level percutaneous kyphoplasty for painful fresh osteoporotic vertebral fractures at the thoracolumbar spine. All patients were radiologically examined with plain roentgenograms, computed tomography, and magnetic resonance imaging. Lateral dual energy x-ray absorptiometry in the augmented and on the adjacent vertebrae (1 level above and below kyphoplasty) was used to measure BMD preoperatively to the last postoperative observation in the subchondral bone of the vertebral endplates. Anthropometric data, sagittal global balance (plumbline), and segmental spine reconstruction (vertebral body height, Gardner kyphotic angle) were recorded and analyzed. The patients were followed for at least 2 years. Kyphoplasty was performed between T12 and L5. A total of 48 vertebral bodies were augmented. Thirteen patients received 1 level and the remaining 14 received 2 or 3-level kyphoplasty. No significant changes in the sagittal spinal balance were shown postoperatively. Gardner kyphotic angle and posterior vertebral body height improved postoperatively, however, insignificantly. Significant [analysis of variance (ANOVA), P=0.008] increase of anterior vertebral body height in the fractured vertebra was achieved postoperatively

  5. Association between insomnia symptoms and weight change in older women: caregiver--study of osteoporotic fractures study.

    Science.gov (United States)

    Ross, Craig; Ancoli-Israel, Sonia; Redline, Susan; Stone, Katie; Fredman, Lisa

    2011-09-01

    To determine whether self-reported insomnia symptoms were associated with weight change in older women and whether caregiving, comorbidities, sleep medication, or stress modified this association. One-year prospective study conducted in four communities from 1999 to 2003 nested within a larger cohort study. Home-based interviews. Nine hundred eighty-eight participants (354 caregivers and 634 noncaregivers) from the Caregiver--Study of Osteoporotic Fractures. Self-reported insomnia symptoms in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble getting back to sleep. Weight was measured at baseline and 12 months. The average weight change was -1.9 ± 7.8 pounds. Trouble staying asleep was significantly associated with an average weight loss of 1.3 pounds (P = .03) in multivariable analyses. Neither of the other insomnia symptoms was associated with weight change. Use of sleep medications modified the association between trouble falling asleep (interaction term P = .03) and weight change. Insomnia symptoms were associated with weight loss only in women not taking sleep medications. Neither caregiving status, presence of multiple comorbidities, nor stress modified the association. Trouble staying asleep was associated with weight loss over 12 months in older women. Practitioners should inquire about sleep habits of patients presenting with weight loss, because this may identify a marker of declining health and may be a factor that can be modified. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

  6. At least one cyclic teriparatide administration can be helpful to delay initial onset of a new osteoporotic vertebral compression fracture.

    Science.gov (United States)

    Suk, Kyung Soo; Lee, Hwan Mo; Moon, Seong-Hwan; Kim, Hee June; Kim, Hak Sun; Park, Jin-Oh; Lee, Byung Ho

    2014-11-01

    Teriparatide markedly increases bone formation and strength, while reducing the incidence of new-onset osteoporotic vertebral compression fractures (OVCFs). In some countries, expenses for teriparatide use are covered by medical insurance for up to 6 months; however, the national medical insurance of the authors' country does not cover these expenses. This retrospective cohort study compared the therapeutic effects of teriparatide on the initial onset of a new OVCF after treatment of osteoporosis and/or related OVCFs with regard to therapeutic durations of longer than 3 months (LT3M) or shorter than 3 months (ST3M). From May 2007 to February 2012, 404 patients who were prescribed and administered teriparatide and who could be followed-up for longer than 12 months were enrolled. They were divided into two groups depending on teriparatide duration: LT3M (n=132) and ST3M (n=272). The group with the teriparatide duration of LT3M showed significantly less development of an initial OVCF within 1 year (p=0.004, chi-square). Duration of teriparatide use, body mass index, pre-teriparatide lowest spinal bone mineral density, and severity of osteoporosis significantly affected multiple regression analysis results (pteriparatide administration is recommended to provide a protective effect against the initial onset of a new OVCF for up to one year after therapy.

  7. Comparison the clinical outcomes and complications of high-viscosity versus low-viscosity in osteoporotic vertebral compression fractures.

    Science.gov (United States)

    Guo, Zhao; Wang, Wei; Gao, Wen-Shan; Gao, Fei; Wang, Hui; Ding, Wen-Yuan

    2017-12-01

    To compare the clinical outcomes and complications of high viscosity and low viscosity bone cement percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF).From September 2009 to September 2015, 100 patients with OVCF were randomly divided into 2 groups: group H, using high viscosity cement (n = 50) or group L, using low viscosity cement (n = 50). The clinical outcomes were assessed by the visual analog scale (VAS), Oswestry Disability Index (ODI), kyphosis Cobb angle, vertebral height, and complications.Significant improvements in the VAS, ODI, kyphosis Cobb angle, and vertebral height were noted in both groups, and the VAS score in the H group showed greater benefit than in the L group. Cement leakage was observed less in group H. Postoperative assessment using computed tomography identified cement leakage in 27 of 98 (27.6%) vertebrae in group H and in 63 of 86 (73.3%) vertebrae in group L (P = .025).Compared with PVP using low viscosity bone cement, PVP using high viscosity bone cement can provide the same clinical outcomes with fewer complications and is recommended for routine clinical use.

  8. 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.

  9. Kyphoplasty for Intractable Pain Due to Glucocorticosteroid-induced Osteoporotic Vertebra Fracture of a 9-Year-Old Patient With Systemic Lupus Erythematosus: 8-Year Follow-up.

    Science.gov (United States)

    Kanatli, Ulunay; Ataoğlu, Baybars; Özer, Mustafa; Şenköylü, Alpaslan; Çetinkaya, Mehmet

    2015-09-01

    The incidence of glucocorticoid-induced osteoporosis is approximately 50% in patients treated for >6 months, and in the long-term usage fracture risk is approximately 34%. The awareness of pediatric vertebral fractures due to glucocorticoid-induced osteoporosis is increasing. Although most of these fractures are asymptomatic, a small number of children may have severe pain. In this case report we are presenting long-term result of a 9-year-old patient with intractable pain due to glucocorticoid-induced osteoporotic vertebral fracture managed by kyphoplasty. Case report. Case report of a 9-year-old girl who had L3 vertebral fracture due to glucocorticoid-induced osteoporosis treated by kyphoplasty. The patient was a 9-year-old girl with severe back pain, and lupus nephritis. Glucocorticoid-induced L3 vertebral fracture was detected and the case was resistant to conservative treatment. Seeing this, we have performed balloon kyphoplasty procedure to L3 vertebrae. No complication and pain was observed after the operation although L3 vertebral height could not restored. On the 8-year control, L3 vertebral height was almost totally restored with a compression index of 10% without any clinical problem. To the best of the authors' knowledge, the patient sample of this case report is the first and the youngest patient who was treated with kyphoplasty for vertebral compression fracture intractable pain due to glucocorticoid-induced osteoporosis, mentioned in literature. During the 8-year follow-up, no adverse effect was reported that was related to kyphoplasty procedure. This case report indicates that kyphoplasty can be an alternative method for selective pediatric intractable painful vertebral glucocorticoid-induced osteoporotic fractures, but it should be performed after careful consideration in pediatric group. We do not advise routine usage of kyphoplasty for pediatric vertebral fractures.

  10. 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.

  11. 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

  12. Safety and clinical performance of kyphoplasty and SpineJack(®) procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study.

    Science.gov (United States)

    Noriega, D C; Ramajo, R H; Lite, I S; Toribio, B; Corredera, R; Ardura, F; Krüger, A

    2016-06-01

    Clinical performance and safety of two percutaneous vertebral cement augmentation (VA) procedures (SpineJack® and Kyphx Xpander® balloon) were compared in patients with osteoporotic compression fractures. Both techniques were safe, efficient, and led to a rapid and marked improvement in clinical signs; nevertheless, SpineJack showed better restoration of vertebral heights and angles, maintained over time. In patients with osteoporotic vertebral compression fractures (VCFs), both SpineJack® (SJ) and balloon kyphoplasty (BKP) led to a rapid and marked improvement in clinical signs. This pilot, monocentric, investigator-initiated, prospective study aimed to compare two percutaneous vertebral augmentation procedures in the painful osteoporotic VCF treatment. Thirty patients were randomized to receive SJ (n = 15) or BKP (n = 15). Analgesic consumption, back pain intensity (visual analog scale (VAS)), and Oswestry Disability Index (ODI) scores were recorded preoperatively, at 5 days and 1, 3, 6, and 12 months post-surgery. Quality of life (EQ-VAS score) was evaluated at 1, 3, 6, and 12 months. Spine X-rays were taken 48 h prior to procedure and 5 days and 6 and 12 months after. SpineJack® led to a significantly shorter intervention period (23 vs 32 min; p SpineJack® procedure has a higher potential for vertebral body height restoration and maintenance over time.

  13. Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures

    International Nuclear Information System (INIS)

    Link, Thomas M.; Vieth, Volker; Matheis, Julia; Newitt, David; Lu, Ying; Majumdar, Sharmila; Rummeny, Ernst J.

    2002-01-01

    The aim of this study was to compare structure measures obtained from high-resolution MR images of the calcaneus and the distal radius with bone mineral density (BMD) of the spine and hip in the prediction of osteoporotic spine fracture status. High-resolution MR images of the calcaneus and radius were obtained in 24 post-menopausal women with spine fractures and 22 age-matched controls. Imaging was performed at 1.5 T using a T1-weighted spin-echo sequence (slice thickness 1 mm, in-plane spatial resolution 195 x 195 μm 2 ). Structure analysis was performed using parameters analogous to standard histomorphometry. Bone mineral density of the spine was obtained using quantitative CT and of the hip with dual-energy X-ray absorptiometry. Significant differences between both patient groups were obtained with BMD and all structure parameters (p<0.05). Using receiver operating characteristic analysis to determine the diagnostic performance in differentiating both groups, the best results were found for BMD of the spine, one of the radial structure measures and a combination of the calcaneal structure measures. In this study BMD of the spine and structure measures of the distal radius were best suited to predict the osteoporotic fracture status of the spine. A combination of BMD and structure measures did not yield any additional information on fracture status. (orig.)

  14. Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures

    Energy Technology Data Exchange (ETDEWEB)

    Link, Thomas M. [Department of Clinical Radiology, University of Muenster (Germany); Department of Diagnostic Radiology, Technical University Munich (Germany); Department of Radiology, University of California, San Francisco, CA (United States); Vieth, Volker; Matheis, Julia [Department of Clinical Radiology, University of Muenster (Germany); Newitt, David; Lu, Ying; Majumdar, Sharmila [Department of Radiology, University of California, San Francisco, CA (United States); Rummeny, Ernst J. [Department of Diagnostic Radiology, Technical University Munich (Germany)

    2002-02-01

    The aim of this study was to compare structure measures obtained from high-resolution MR images of the calcaneus and the distal radius with bone mineral density (BMD) of the spine and hip in the prediction of osteoporotic spine fracture status. High-resolution MR images of the calcaneus and radius were obtained in 24 post-menopausal women with spine fractures and 22 age-matched controls. Imaging was performed at 1.5 T using a T1-weighted spin-echo sequence (slice thickness 1 mm, in-plane spatial resolution 195 x 195 {mu}m{sup 2}). Structure analysis was performed using parameters analogous to standard histomorphometry. Bone mineral density of the spine was obtained using quantitative CT and of the hip with dual-energy X-ray absorptiometry. Significant differences between both patient groups were obtained with BMD and all structure parameters (p<0.05). Using receiver operating characteristic analysis to determine the diagnostic performance in differentiating both groups, the best results were found for BMD of the spine, one of the radial structure measures and a combination of the calcaneal structure measures. In this study BMD of the spine and structure measures of the distal radius were best suited to predict the osteoporotic fracture status of the spine. A combination of BMD and structure measures did not yield any additional information on fracture status. (orig.)

  15. Effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures

    Directory of Open Access Journals (Sweden)

    Bao-Ning Luo

    2017-09-01

    Full Text Available Objective: To study the effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures. Methods: A total of 72 patients with osteoporotic distal radial fractures who were treated in the hospital between September 2015 and January 2017 were collected and divided into control group (n=36 and observation group (n=36 according to the random number table method. Control group received routine external fixation, and observation group received mid-frequency pulse therapy combined with external fixation. The differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were compared between two groups of patients before and after treatment. Results: Before treatment, differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were not statistically significant between the two groups. After 1 month of treatment, serum BGP, TAC and SOD levels of both groups of patients were higher than those before treatment while β-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those before treatment, and serum BGP, TAC and SOD levels of observation group were higher than those of control group while β-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those of control group. Conclusion: Mid-frequency pulse therapy combined with external fixation can promote fracture healing and reduce postoperative inflammatory response and oxidative stress response in patients with osteoporotic distal radial fracture.

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

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Jin Bo; Tang, Xue Ming; Xu, Nan Wei; Bao, Hong Tao [Changzhou No 2. Hospital, Changzhou (China)

    2008-10-15

    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

  17. 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.

  18. 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.

  19. Postoperative change in sagittal balance after Kyphoplasty for the treatment of osteoporotic vertebral compression fracture.

    Science.gov (United States)

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kawabata, Shinji; Kuroiwa, Toshihiko

    2015-04-01

    The influence of vertebral cement augmentation on spinal sagittal balance is unknown. The present study aimed to analyze the changes in total spinal alignment after Kyphoplasty in VCF patients. The study involved 21 VCF patients who underwent Kyphoplasty. In all patients, lateral radiographs of the entire spine were taken preoperatively and 1 month after surgery, to measure the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), and spinosacral angle (SSA). These parameters were compared between VCF patients and 30 healthy volunteers. In VCF patients, the parameters were compared before and after Kyphoplasty. In VCF patients, preoperative SVA was 7.00 ± 3.9 cm, showing a significant shift to anterior sagittal balance as compared to the healthy group (1.45 ± 2.7 cm) (P vertebra (r = 0.792, P < 0.01). VAS score decreased from 7.98 ± 1.8 before Kyphoplasty to 2.38 ± 2.3 postoperatively (P < 0.0001). Total spinal alignment is shifted to anterior sagittal balance in VCF patients. Kyphoplasty plays a role not only in reducing pain associated with fractures but also in improving sagittal imbalance in the treatment of painful vertebral compression fracture.

  20. The development of a clinical decision making algorithm for detection of osteoporotic vertebral compression fracture or wedge deformity.

    Science.gov (United States)

    Roman, Matthew; Brown, Christopher; Richardson, William; Isaacs, Robert; Howes, Cameron; Cook, Chad

    2010-03-01

    The clinical diagnosis of an osteoporotic vertebral compression fracture (OVCF) is challenging and requires detailed assessment using comprehensive imaging methods. Further complicating matter is that the clinical sequelae associated with OVCF typically involves asymptomatic findings and variable pain patterns. The purpose of this study was to identify clinical characteristics and assessment findings that were associated with a diagnosis of OVCF. The study evaluated routine clinical findings in over 1400 subjects seen at an adult spine surgery clinic for thoracolumbar spine-related conditions within the years 2005-2009. All patients underwent a standardized clinical examination that included a self-report, observational, physical examination and imaging assessment. The diagnosis of OVCF was made after assessment of radiographic findings in sagittal alignment, vertebral body compression, and spinal canal dimensions. Data from the patient history and observational findings were then statistically analyzed and compared between those patients with a diagnosis of OVCF and those with an alternative diagnosis. Based on the results, a diagnostic support tool was created to predict the likelihood of OVCF. The most diagnostic combination included a cluster of: (1) age > 52 years; (2) no presence of leg pain; (3) body mass index ⩽ 22; (4) does not exercise regularly; and (5) female gender. A finding of two of five positive tests or less demonstrated high sensitivity of 0.95 (95% CI  =  0.83-0.99) and low negative likelihood ratio of 0.16 (95% CI  =  0.04-0.51), providing moderate value to rule out OVCF. Four of five yielded a positive likelihood ratio (LR+) of 9.6 (95% CI  =  3.7-14.9) providing moderate value in ruling in the diagnosis of OVCF. Further validation is necessary prospectively to determine the value of these findings on a disparate sample of patients in other unique environments.

  1. 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.

  2. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, Michael B.; Morgen, Nadine; Herber, Sascha; Dueber, Christoph [University Hospital of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Drees, Philipp; Boehm, Bertram [University Hospital, Johannes Gutenberg University of Mainz, Department of Orthopedia, Mainz (Germany)

    2008-03-15

    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] and group II (moderate compression index >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.)

  4. Relationship of Bone Metabolism Biomarkers and Periodontal Disease: The Osteoporotic Fractures in Men (MrOS) Study.

    Science.gov (United States)

    Schulze-Späte, Ulrike; Turner, Ryan; Wang, Ying; Chao, Raylien; Schulze, P Christian; Phipps, Kathy; Orwoll, Eric; Dam, Thuy-Tien

    2015-06-01

    Periodontitis is an inflammatory disease of tooth-supporting tissue leading to bone destruction and tooth loss. Periodontitis affects almost 50% of adults greater than 30 years of age. This study evaluated the association between biomarkers linked to bone formation and resorption with the occurrence and progression of periodontal disease in older men (≥ 65 y). The Osteoporotic Fractures in Men (MrOS) study is a prospective, observational study among men 65 years of age and older. This ancillary study, Oral and Skeletal Bone Loss in Older Men, was conducted at two of the six MrOS study sites (Birmingham, AL and Portland, OR). Patients underwent medical and dental evaluation. Diagnoses of periodontitis were based on clinical attachment loss, pocket depth, calculus, plaque, and bleeding on a random half-mouth. Bone metabolism biomarkers included serum levels of calcium, phosphate (Pi), alkaline phosphatase, albumin, carboxy-terminal collagen crosslinks (CTX), N-terminal propeptides of type I procollagen, isoform 5b of tartrate-resistant acid phosphatase, and urine alpha- carboxy-terminal collagen crosslinks (alpha-CTX) and beta-CTX and serum levels of calciotropic hormones vitamin D (25(OH)D) and PTH. The aim of this study is to correlate bone metabolism biomarkers with prevalence and progression of periodontal disease in older men. Patients with more severe periodontitis had significantly higher levels of PTH (P trend = .0004), whereas 25(OH)D was lower (P trend = .001). In a subset of men reevaluated at a second dental visit, improvement of periodontitis was associated with lower alpha-CTX, beta-CTX, and CTX levels at baseline after adjusting for age, site, and body mass index. This study suggests that a distinct set of biomarkers of bone metabolism are associated with more severe periodontal disease (PTH, 25(OH)D) and periodontal progression (alpha-CTX, beta-CTX, and CTX) over time.

  5. 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.

  6. Validation of an osteoporosis self-assessment tool to identify primary osteoporosis and new osteoporotic vertebral fractures in postmenopausal Chinese women in Beijing

    Science.gov (United States)

    2013-01-01

    Background This study aimed to validate the effectiveness of the Osteoporosis Self-assessment Tool for Asians (OSTA) in identifying postmenopausal women at increased risk of primary osteoporosis and painful new osteoporotic vertebral fractures in a large selected Han Chinese population in Beijing. Methods We assessed the performance of the OSTA in 1201 women. Subjects with an OSTA index > -1 were classified as the low risk group, and those with an index ≤ -1 were classified as the increased risk group. Osteoporosis is defined by a T-score ≤ 2.5 standard deviations according to the WHO criteria. All painful, new vertebral fractures were identified by X-ray and MRI scans with correlating clinical signs and symptoms. We determined the sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve for correctly selecting women with osteoporosis and painful new vertebral fractures. Results Of the study subjects, 29.3% had osteoporosis, and the prevalence of osteoporosis increased progressively with age. The areas under the ROC curves of the OSTA index (cutoff = -1) to identify osteoporosis in the femoral neck, total hip, and lumbar spine were 0.824, 0.824, and 0.776, respectively. The sensitivity and specificity of the OSTA index (cutoff = -1) to identify osteoporosis in healthy women were 66% and 76%, respectively. With regard to painful new vertebral fractures, the area under the ROC curve relating the OSTA index (cutoff = -1) to new vertebral fractures was 0.812. Conclusions The OSTA may be a simple and effective tool for identifying the risk of osteoporosis and new painful osteoporotic vertebral fractures in Han Chinese women. PMID:24053509

  7. Intrabody application of eptotermin alpha enhances bone formation in osteoporotic fractures of the lumbar spine; however, fails to increase biomechanical stability - results of an experimental sheep model.

    Science.gov (United States)

    Eschler, Anica; Roepenack, Paula; Herlyn, Philipp Karl Ewald; Roesner, Jan; Martin, Heiner; Vollmar, Brigitte; Mittlmeier, Thomas; Gradl, Georg

    2015-01-01

    This study analyses the effect of eptotermin α application into fractured vertebrae. It is hypothesized that eptotermin α is capable to enhance bony healing of the osteoporotic spine. In 10 Merino sheep osteoporosis induction was performed by ovariectomy, corticosteroid therapy and calcium/phosphorus/vitamin D-deficient diet; followed by standardized creation of lumbar vertebral compression fractures (VCFs) type A3.1 and consecutive fracture reduction/fixation using expandable mesh cages. Randomly, intravertebral eptotermin α (G1) or no augmentation was added (G2). Macroscopic, micro-CT, and biomechanical evaluation assessed bony consolidation two months postoperatively: Micro-CT data revealed bony consolidation for all cases with significant increased callus development for G2 (60%) and BV/TV (bone volume/total volume 73.45%, osteoporotic vertebrae 35.76%). Neither group showed improved biomechanical stability. Eptotermin α enhanced mineralisation in VCFs in an experimental setup with use of cementless augmentation via an expandable cage. However, higher bone mineral density did not lead to superior biomechanical properties.

  8. VERTOS II: Percutaneous vertebroplasty versus conservative therapy in patients with painful osteoporotic vertebral compression fractures; rationale, objectives and design of a multicenter randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van der Graaf Y

    2007-10-01

    Full Text Available Abstract Background The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF is conservative therapy. Percutaneous vertebroplasty (PV, a minimally invasive technique, is gaining popularity as a new treatment option. Many prospective and retrospective studies have reported on the effectiveness and safety of PV, but no large randomized controlled trial (RCT has been published. Objective To estimate cost-effectiveness of PV compared to conservative therapy in terms of: pain reduction, quality of life, complications, secondary fractures and mortality. Materials and methods The VERTOS II study is designed as a prospective, multicenter RCT. Patients with a painful VCF with bone edema on MR imaging, local back pain for 6 weeks or less, osteopenia and aged 50 years or older, after obtaining informed consent are included and randomized for PV or conservative therapy. In total 200 patients will be enrolled. Follow-up is at regular intervals during a 1-year period with standard questionnaires, addressing: clinical symptoms, pain medication, Visual Analogue Scale (VAS score, quality of life and cost-effectiveness. Secondary fractures, necessary additional therapies and complications are recorded. Conclusion The VERTOS II study is the first methodologically sound RCT designed to assess the cost-effectiveness of PV compared to conservative therapy in patients with an acute osteoporotic VCF. Trial registration http://www.clinicaltrials.gov, NCT00232466

  9. Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the Osteoporotic Fractures in Men (MrOS) Study.

    Science.gov (United States)

    Fink, H A; Litwack-Harrison, S; Taylor, B C; Bauer, D C; Orwoll, E S; Lee, C G; Barrett-Connor, E; Schousboe, J T; Kado, D M; Garimella, P S; Ensrud, K E

    2016-01-01

    We investigated the value of routine laboratory testing for identifying underlying causes in older men diagnosed with osteoporosis. Most osteoporotic and nonosteoporotic men had ≥1 laboratory abnormality. Few individual laboratory abnormalities were more common in osteoporotic men. The benefit of routine laboratory testing in older osteoporotic men may be low. To evaluate the utility of recommended laboratory testing to identify secondary causes in older men with osteoporosis, we examined prevalence of laboratory abnormalities in older men with and without osteoporosis. One thousand five hundred seventy-two men aged ≥65 years in the Osteoporotic Fractures in Men study completed bone mineral density (BMD) testing and a battery of laboratory measures, including serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), 25-OH vitamin D, total testosterone, spot urine calcium/creatinine ratio, spot urine albumin/creatinine ratio, creatinine-derived estimated glomerular filtration rate, 24-h urine calcium, and 24-h urine free cortisol. Using cross-sectional analyses, we calculated prevalence ratios (PRs) and 95 % confidence intervals (CI) for the association of any and specific laboratory abnormalities with osteoporosis and the number of men with osteoporosis needed to test to identify one additional laboratory abnormality compared to testing men without osteoporosis. Approximately 60 % of men had ≥1 laboratory abnormality in both men with and without osteoporosis. Among individual tests, only vitamin D insufficiency (PR, 1.13; 95 % CI, 1.05-1.22) and high alkaline phosphatase (PR, 3.05; 95 % CI, 1.52-6.11) were more likely in men with osteoporosis. Hypercortisolism and hyperthyroidism were uncommon and not significantly more frequent in men with osteoporosis. No osteoporotic men had hypercalciuria. Though most of these older men had ≥1 laboratory abnormality, few routinely recommended individual tests were

  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......A genetic contribution to the development of osteoporosis is well documented. Although the association between the common allelic variation of apolipoprotein E (APOE), fracture risk, bone loss and bone mineral density (BMD) has been examined in several studies, the results of these investigations...... 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...

  11. Caregiving Intensity and Change in Physical Functioning Over a 2-Year Period: Results of the Caregiver-Study of Osteoporotic Fractures

    OpenAIRE

    Fredman, Lisa; Doros, Gheorghe; Ensrud, Kristine E.; Hochberg, Marc C.; Cauley, Jane A.

    2009-01-01

    It is unknown whether caregivers who perform more caregiving tasks have a greater decline in health from higher stress or less decline because of better health, staying active, or psychological factors. This 1999−2004 US study examined caregiving intensity and 2-year change in performance-based functioning among 901 elderly women from the Caregiver-Study of Osteoporotic Fractures sample. Caregivers were categorized as high (n = 167) or low (n = 166) intensity based on how many activities of d...

  12. Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis.

    Science.gov (United States)

    Zhao, Wen-Tao; Qin, Da-Ping; Zhang, Xiao-Gang; Wang, Zhi-Peng; Tong, Zun

    2018-02-08

    Clinical results have shown that different vertebral heights have been restored post-augmentation of osteoporotic vertebral compression fractures (OVCFs) and the treatment results are consistent. However, no significant results regarding biomechanical effects post-augmentation have been found with different types of vertebral deformity or vertebral heights by biomechanical analysis. Therefore, the present study aimed to investigate the biomechanical effects between different vertebral heights of OVCFs before and after augmentation using three-dimensional finite element analysis. Four patients with OVCFs of T12 underwent computed tomography (CT) of the T11-L1 levels. The CT images were reconstructed as simulated three-dimensional finite-element models of the T11-L1 levels (before and after the T12 vertebra was augmented with cement). Four different kinds of vertebral height models included Genant semi-quantitative grades 0, 1, 2, and 3, which simulated unilateral augmentation. These models were assumed to represent vertical compression and flexion, left flexion, and right flexion loads, and the von Mises stresses of the T12 vertebral body were assessed under different vertebral heights before and after bone cement augmentation. Data showed that the von Mises stresses significantly increased under four loads of OVCFs of the T12 vertebral body before the operation from grade 0 to grade 3 vertebral heights. The maximum stress of grade 3 vertebral height pre-augmentation was produced at approximately 200%, and at more than 200% for grade 0. The von Mises stresses were significantly different between different vertebral heights preoperatively. The von Mises stresses of the T12 vertebral body significantly decreased in four different loads and at different vertebral body heights (grades 0-3) after augmentation. There was no significant difference between the von Mises stresses of grade 0, 1, and 3 vertebral heights postoperatively. The von Mises stress significantly

  13. Collagen type 1 (COL1A1) Sp1 binding site polymorphism is associated with osteoporotic fractures but not with bone density in post-menopausal women from the Canary Islands: a preliminary study.

    Science.gov (United States)

    Navarro, Mary C; Sosa, Manuel; del Pino-Montes, Javier; Torres, Armando; Salido, Eduardo; Saavedra, Pedro; Corral-Gudino, Luis; Montilla, Carlos A

    2007-02-01

    An association between the polymorphism for transcription factor Sp1 in the gene COL1A1 and low bone density (BMD) and osteoporotic fractures has been described but not confirmed for all races and ages. The aim of this preliminary work was to ascertain whether this association is present in women from the Canary Islands. Polymerase chain reaction RFLP was used to determine COL1A1 polymorphism Sp1 in 199 consecutive outpatient post-menopausal Caucasian women from the Canary Islands, aged 50-70 years. BMD was measured at lumbar spine and hip by DXA and at third lumbar vertebrae by QCT. Prevalent vertebral fractures were recorded on standard lateral X-ray film. Non-vertebral osteoporotic fractures were registered by medical record and self-reported history. Biochemical markers (serum osteocalcin, tartrate-resistant acid phosphatase), blood calcium and phosphate were also assessed. Distribution genotypes were 113 (50.8%) GG homozygotes, 73 (36.7%) Ss heterozygotes and 7 (3.5%) TT homozygotes. All patients with osteoporotic fractures carried the GG allele more frequently than TT homozygotic women. The odds ratio was 3.01 (95% CI 1.6-5.7) for prevalent vertebral fractures (n=62) and 2.33 (95% CI 1.2-4.4) for all osteoporotic fractures (n=65) for the T-carrying allele vs TT homozygotic women. There was no difference in BMD measured by DXA or QCT, nor in bone markers, blood calcium or phosphate. This preliminary study confirmed that the presence of at least one copy of the T allele is associated with osteoporotic fractures, but not with low BMD, in women from the Canary Islands.

  14. Use and evaluation of a semi-permeable mesh implant in vertebral augmentation for the treatment of painful osteoporotic vertebral compression fractures.

    Science.gov (United States)

    Ortiz, A Orlando

    2016-03-01

    To assess the efficacy of a semi-permeable mesh implant in the treatment of painful thoracic and lumbar osteoporotic vertebral compression fractures. Patients with painful thoracic and lumbar osteoporotic vertebral compression fractures which were refractory to conventional medical management and less than 3 months of age were considered possible candidates for this vertebral augmentation technique. Data recorded for the procedure included patient age, gender, fracture level and morphology, mesh implant size, amount of cement injected, cement extravasation, complications, and pre- and post-procedure numeric pain scores and Oswestry Disability Index (ODI) scores. 17 patients were included in this retrospective study; 12 women and 5 men, with an average age of 78.6 years. Each patient had one level treated with the mesh implant; 4 thoracic levels and 13 lumbar levels. The 10×15 mm implant was used in 13 treated vertebrae, including the two thoracic vertebrae; the 10×20 mm implant was used to treat 3 lumbar vertebrae, and one 10×25 mm implant was used to treat an L1 vertebra. An average of 2.4 mL of acrylic bone cement was injected, and there was fluoroscopic evidence of a small amount of cement leakage in one case. No patient related complications were seen and there were no device failures. All patients, followed-up to at least 3 weeks, showed significant pain relief. The average pretreatment numeric pain score of 9 and ODI of 50 decreased to an average post-treatment score of 0.6 and 12, respectively (posteoporotic vertebral compression fractures within the lower thoracic and lumbar spine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. 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

  16. Compliance of an elderly hip fracture population with secondary preventative measures. Efficacy of a simple clinical practice intervention.

    LENUS (Irish Health Repository)

    Street, John

    2012-02-03

    Secondary pharmaceutical measures are effective in all age groups for the prevention of osteoporotic fractures. This prospective study determines the demographics of 566 consecutive osteoporotic hip fractures presenting to a Level 1 Trauma Center. We examine the efficacy of simple treatment recommendations for pharmaceutical treatment of osteoporosis and the factors determining general practitioner and patient compliance with these recommendations in a community setting. One out of four patients (24.5%) had sustained a previous fragility fracture. Mean age was 80 years. Twenty five percent were resident in a nursing home and only 10% were taking anti-resorptive therapy preoperatively. In hospital mortality was 6%, and 39% of recruited patients were dead at 12 months. By this time more than half the survivors were resident in a nursing home. The compliance with anti-resorptive therapy had increased to over 70% consequent to our simple recommendations. Significant differences in GP and patient compliance were observed between nursing home and own residence dwellers. This study demonstrates the efficacy of a simple clinical practice intervention in increasing patient and GP compliance with secondary fracture prevention measures. We also discuss many of the confounding issues determining this compliance.

  17. Feasibility, safety and cement leakage in vertebroplasty of osteoporotic and malignant compression fractures using ultra-viscous cement and hydraulic delivery system.

    Science.gov (United States)

    Georgy, Bassem A

    2012-01-01

    The major complications arising from vertebroplasty or kyphoplasty are related to leakage of cement beyond the confines of the collapsed vertebral body. Traditionally, a liquid (low viscosity) cement is used in most vertebroplasty systems available on the market, coupled with mechanical injection devices or one mL syringes. The purpose of this study is to evaluate the feasibility and safety, as well as study cement leakage patterns, in vertebroplasty performed for both osteoporotic and malignant vertebral compression fractures using ultraviscous cement injected by the hydraulic CONFIDENCE Vertebral Augmentation System. Retrospective evaluation of postoperative images. Single center inpatient and outpatient population. A retrospective evaluation of clinical charts and postoperative X-ray imaging was performed in 122 cases; a total of 214 levels were treated. The study group comprised a total of 163 levels of benign osteoporotic fractures and 51 levels of various malignant lesions. The degree of leakage, seen in postoperative films, was assessed at each treated level using a strict 4-point scale (none, mild, moderate, severe). For benign lesions, there was no leakage in 82 levels (50%), mild venous leakage in 38 levels (23%), moderate venous leakage in 4 levels (2%), mild disc leakage in 28 levels (17%), moderate disc leakage in 7 levels (4%), mild paravertebral leakage in 2 levels (1%), and moderate paravertebral leakage in 2 levels (1%). No severe leakage or epidural leakage were seen. For malignant lesions, there was no leakage in 25 levels (49%), mild venous leakage in 12 levels (24%), moderate venous leakage in 4 levels (8%), mild disc leakage in 7 levels (14%), moderate disc leakage in one level (2%), mild paravertebral leakage in one level (2%), and one level showed a mild epidural leakage (2%). Retrospective study, single center. Percutaneous cement augmentation in osteoporotic and malignant compression fractures using a highly viscous cement that can be

  18. Osteoporotic Vertebral Compression Fractures

    NARCIS (Netherlands)

    Venmans, A.

    2011-01-01

    In Chapter 1, an outline of the thesis is given. In Chapter 2 we concluded that most conservatively treated patients with VCFs had sufficient pain relief during the first 3 months. After one year a substantial proportion of patients still had disabling pain despite higher class pain medication used.

  19. 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

  20. Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein-2 and Osteoprotegerin in Osteoporotic Fracture in Rats

    Science.gov (United States)

    Huang, Hai-Ming; Li, Xiao-Lin; Tu, Shu-Qiang; Chen, Xiao-Feng; Lu, Chang-Chun; Jiang, Liang-Hua

    2016-01-01

    Background: Roughly focused extracorporeal shock waves therapy (ESWT) is characterized by a wide focal area, a large therapy zone, easy positioning, and less pain during treatment. The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin (OPG) and bone morphogenetic protein-2 (BMP-2) in osteoporotic fractures in rats. Methods: Seventy-two female Sprague-Dawley (SD) rats, 3 months old, were divided into sham-operated group (n = 6) and an ovariectomized (OVX) group (n = 66). Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation. The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm2, 60 doses/min, and 2000 pact quantities. The contralateral right tibia was left untreated and served as a control. Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry, real-time polymerase chain reaction (PCR), and Western blotting analysis. Results: Bone mineral density (BMD) at the proximal tibia, femur, and L5 spine was significantly reduced after ovariectomy. BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group. Meanwhile, bilateral oophorectomy resulted in a lower trabecular bone volume fraction (BV/TV) in the proximal tibia of the sham-OVX animals. Three months after bilateral oophorectomy, BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs (P < 0.001). These data showed that the SD rats became a suitable model of osteoporosis, 3 months after they were OVX. Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group. Compared with the contralateral controls, decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT, followed by a later increase at 7 days, was indicated by real-time PCR and Western

  1. Comparison of the efficacy and safety of 3 treatments for patients with osteoporotic vertebral compression fractures: A network meta-analysis.

    Science.gov (United States)

    Zhao, Song; Xu, Chang-Yan; Zhu, Ao-Ran; Ye, Long; Lv, Long-Long; Chen, Long; Huang, Qi; Niu, Feng

    2017-06-01

    Osteoporotic vertebral compression fractures (OVCFs) constitute an age-related health problem that affects approximately 200 million people worldwide. Currently, various treatments are performed with the goal of reducing pain, stabilizing the vertebrate, and restoring mobility. In this study, we aimed to assess the efficacy and safety of vertebroplasty (VP), kyphoplasty (KP), and conservative treatment (CT) for the treatment of OVCFs. We performed a network meta-analysis. PubMed and Embase databases were searched to identify randomized controlled trials (RCTs) that contained at least one of the following outcomes: visual analog scale (VAS), Roland-Morris Disability Questionnaire (RDQ), European Quality of Life-5 Dimensions (EQ-5D), and new fractures. Odds ratios with 95% confidence intervals (CIs) were used to calculate the risk of new fractures, and mean differences (MDs) with 95% CIs were utilized to express RDQ, EQ-5D, and VAS outcomes. Sixteen RCTs with 2046 participants were included in this meta-analysis. Compared with CT, patients treated with VP had improved pain relief, daily function, and quality of life; however, no significant differences were found between VP and KP for these 3 outcomes. All treatment options were associated with comparable risk of new fractures. When the rank probability was assessed to distinguish subtle differences between the treatments, VP was the most effective treatment for pain relief, followed by KP and CT; conversely, KP was the most effective in improving daily function and quality of life and decreasing the incidence of new fractures, followed by VP and CT. VP might be the best option when pain relief is the principle aim of therapy, but KP was associated with the lowest risk of new fractures and might offer better outcomes in terms of daily function and quality of life.

  2. Percutaneous vertebroplasty in the management of vertebral osteoporotic fractures. Short-term, mid-term and long-term follow-up of 285 patients

    Energy Technology Data Exchange (ETDEWEB)

    Masala, Salvatore; Mammucari, Matteo; Angelopoulos, Georgios; Fiori, Roberto; Massari, Francesco; Simonetti, Giovanni [University Hospital of Tor Vergata, Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, Rome (Italy); Faria, Skerdilajd [University Hospital of Tor Vergata, Department of Anesthesia and Intensive Care Medicine, Rome (Italy)

    2009-09-15

    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.)

  3. Screw locking elements: a means to modify the flexibility of osteoporotic fracture fixation with DCPs without compromising system strength or stability.

    Science.gov (United States)

    Yánez, A; Cuadrado, A; Carta, J A; Garcés, G

    2012-07-01

    This paper analyses whether it is possible to use dynamic compression plates (DCPs) and screw locking elements (SLEs) to vary the flexibility of osteoporotic fracture fixation without compromising the strength and stability of the construct. Compression, torsion and four-point bending static strength tests were conducted. Cyclic load tests of up to 10,000 load cycles were also carried out to determine stiffness performance. Four fixation systems were mounted onto polyurethane bone models. Group 1 consists of the DCP and six cortical screws. Group 2, idem, but with the addition of two SLEs. Group 3, idem, but with the addition of six SLEs. Group 4 used the locking compression plate (LCP) and locking screws. The results indicated no significant difference (p>0.05) in the strength of groups 2-4. It was also observed that the torsional stiffness of group 3 (0.30 Nm/°) was higher than that of group 2 (0.23 Nm/°) and similar to that of group 4 (0.28 Nm/°). Compression stiffness of group 4 (124 N/mm) was higher than that of group 2 (102 N/mm), but lower than that of group 3 (150 N/mm). No notable differences were observed for structural bending stiffness. It is concluded that by using the DCP with SLEs it is possible to modify the stiffness of the fixation construct for the repair of osteoporotic fractures and, in this way, facilitate the conditions suitable on secondary bone healing. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

  4. Presenting a Method to Improve Bone Quality Through Stimulation of Osteoporotic Mesenchymal Stem Cells by Low-Level Laser Therapy.

    Science.gov (United States)

    Bayat, Mohammad; Jalalifirouzkouhi, Ali

    2017-11-01

    This review aims to present a method to improve bone quality through stimulation of osteoporotic mesenchymal stem cells (MSCs) by low-level laser therapy (LLLT). Osteoporosis (OP) is characterized by decreased bone mass and bone strength, which results in an increased incidence of bone fractures. These fractures often lead to additional disability and mortality. Osteoporotic MSCs have reduced osteogenic differentiation when cultured in their standard differentiation media. LLLT has a biostimulatory effect on fibroblasts and osteoblasts. MSCs have the ability to generate cells of connective tissue lineages, which includes the bones. Recently, transplantation of in vitro cultured bone marrow (BM) MSCs into sites at risk for development of osteoporotic bone has resulted in improved bone structure. Comprehensive research was performed using PubMed, and biostimulatory effect of LLLT on bony cells and MSCs were studied. LLLT can stimulate growth, proliferation, and differentiation of SCs in vitro and in vivo. This ability of LLLT is an essential prerequisite for performing experiments related to disease control in humans. Thus, laser-treated osteoporotic autologous BMMSCs may represent a promising therapeutic method to protect the bones in patients with OP and prevent fractures in these patients. Therefore, researchers hypothesize that transplantation of in vitro laser-treated autologous cultured osteoporotic BMMSCs that have the appropriate osteogenic phenotype into sites at risk for development of osteoporotic bone may result in improved bone structure. In this respect, investigators have successfully used LLLT to restore autologous osteoporotic MSCs in vitro. Subsequently, these cells have been differentiated into osteoblast cell lines with the use of laser treatment after which they were transplanted into osteoporotic animal models. This technique might improve bone quality and structure. However, additional research must be undertaken to understand the underlying

  5. The effects of once-weekly teriparatide on hip geometry assessed by hip structural analysis in postmenopausal osteoporotic women with high fracture risk.

    Science.gov (United States)

    Sone, Teruki; Ito, Masako; Fukunaga, Masao; Tomomitsu, Tatsushi; Sugimoto, Toshitsugu; Shiraki, Masataka; Yoshimura, Takeshi; Nakamura, Toshitaka

    2014-07-01

    Weekly administration of teriparatide has been shown to reduce the risk of vertebral and non-vertebral fractures in patients with osteoporosis at higher fracture risk in Japan. However, its efficacy for hip fracture has not been established. To gain insight into the effect of weekly teriparatide on the hip, hip structural analysis (HSA) based on dual-energy X-ray absorptiometry (DXA) was performed using the data of 209 postmenopausal osteoporotic women who had participated in the original randomized, multicenter, double-blind, placebo-controlled trial assessing the effects of once-weekly 56.5 μg teriparatide for 72 weeks. The DXA scans, obtained at baseline, 48 weeks and 72 weeks, were analyzed to extract bone mineral density (BMD) and cross-sectional geometrical indices at the narrowest point on the neck (NN), the intertrochanteric region (IT), and the proximal shaft. Compared with placebo after 72 weeks, the teriparatide group showed significantly higher BMD, average cortical thickness, bone cross-sectional area, and section modulus, and lower buckling ratio at both the NN and IT regions. No significant expansion of periosteal diameter was observed at these regions. There were no significant differences in BMD and HSA indices at the shaft region. The results indicate that overall structural strength in the proximal femur increased compared to placebo, suggesting that once-weekly teriparatide effectively reverses changes in hip geometry and strength with aging. Copyright © 2014. Published by Elsevier Inc.

  6. Health-related quality of life during the first year after a hip fracture: results of the Mexican arm of the International Cost and Utility Related to Osteoporotic Fractures Study (MexICUROS).

    Science.gov (United States)

    Guirant, L; Carlos, F; Curiel, D; Kanis, J A; Borgström, F; Svedbom, A; Clark, P

    2018-02-20

    We investigated changes in health-related quality of life (HRQoL) due to hip fracture in Mexican adults aged ≥ 50 years during the first year post-fracture. Mean accumulated loss was 0.27 quality-adjusted life years (QALYs). HRQoL before fracture was the main contributor to explain the loss of QALYs. We aimed to estimate the health-related quality of life (HRQoL) loss over 1 year in patients sustaining a hip fracture in Mexico. Individuals aged ≥ 50 years old with diagnosis of a low-energy-induced hip fracture enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) composed the study population. After a recall of their own pre-fracture status, HRQoL was prospectively collected in three phases over 12 months of follow-up using EQ-5D-3L. The UK preference weight set was applied to calculate the utility values. The accumulated quality-adjusted life years (QALYs) loss in the first year post-fracture was estimated using the trapezoid method. Multivariate regression analysis allowed identifying determinants of QALYs loss. One hundred ninety-three patients (mean ± SD age 77.2 ± 9.9 years; 80% women; 15.5% with prior fracture in the last 5 years; 78% in low-income category) were evaluated. Mean (95% CI) utility value before fracture was 0.64 (0.59-0.68). It dropped to 0.01 (0.01-0.02) immediately after fracture and then improved to 0.46 (0.42-0.51) and 0.60 (0.55-0.64) at 4 and 12 months post-fracture, respectively. Disregarding fracture-related mortality, accumulated QALYs loss over the first year was 0.27 (0.24-0.30) QALYs. Mobility, self-care, and usual activities were the most affected domains throughout the whole year. HRQoL before fracture was the main contributor to explain the loss of QALYs. Hip fractures reduce dramatically the HRQoL, with the loss sustained at least over the first year post-fracture in Mexico. The utility values derived from this study can be used in future economic evaluations.

  7. 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

  8. 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.

  9. May "Dubel" be a solution for pullout problem of the pedicle screws at osteoporotic spine?

    Science.gov (United States)

    Cakir, Ertugrul; Eyuboglu, Eylem Eren; Yazar, Ugur; Gazioglu, Gurkan; Guvercin, Ali Riza; Baykal, Suleyman

    2014-01-01

    To improve the strength of stabilization systems currently used in osteoporotic spinal fractures, essentially by increasing the fixation force of pedicle screws. Six human cadaveric vertebrae were used. Bone mineral densities of the specimens were measured with Dual Energy X-ray Absorptiometry in order to assess the osteoporosis. All vertebrae were found to be severely osteoporotic. Standard pedicle screws were applied to left pedicles of vertebrae. Pedicle screws reinforced by fixing plugs "Dubel" were applied to right pedicles of vertebrae. Afterwards the vertebrae were embedded in acrylic casts to prevent possible fracture of the osteoporotic vertebrae and to obtain a correct vertical pull-out vector. The biomechanical pullout tests were performed with biomechanical testing machine. Pullout forces in each group were recorded and compared with Mann-Whitney U test. The pedicle screws strengthened by "Dubel" were found to be four times stronger than the standard pedicle screws, in the osteoporotic human cadaveric vertebrae. "Dubel"-augmented pedicle screws may contribute to developing better stabilization systems for osteoporotic thoracolumbar fractures needing surgery and in the revision of the previous fusion surgeries of the spine.

  10. Randomized controlled trial of a primary care-based screening program to identify older women with prevalent osteoporotic vertebral fractures: Cohort for Skeletal Health in Bristol and Avon (COSHIBA).

    Science.gov (United States)

    Clark, Emma M; Gould, Virginia; Morrison, Leigh; Ades, A E; Dieppe, Paul; Tobias, Jon H

    2012-03-01

    Approximately 12% of postmenopausal women have osteoporotic vertebral fractures (VFs); these are associated with excess morbidity and mortality and a high risk of future osteoporotic fractures. Despite this, less than one-third come to clinical attention, partly due to lack of clear clinical triggers for referral for spinal radiographs. The aim of this study was to investigate whether a novel primary care-based screening tool could be used to identify postmenopausal women with osteoporotic VFs and increase appropriate management of osteoporosis. A randomized controlled trial was undertaken in 15 general practices within the Bristol area of the UK. A total of 3200 women aged 65 to 80 years were enrolled, with no exclusion criteria. A simple screening tool was carried out by a nurse in primary care to identify women at high risk of osteoporotic VFs. All identified high-risk women were offered a diagnostic thoracolumbar radiograph. Radiographs were reported using standard National Health Service (NHS) reporting, with results sent back to each participant's general practitioner (GP). Participants in the control arm did not receive the screening tool or radiographs. The main outcome measure was self-reported prescription of medication for osteoporosis at 6 months with a random 5% subsample verified against electronic GP records. Secondary outcome was self-reported incidence of new fractures. Results showed that allocation to screening increased prescription of osteoporosis medications by 124% (odds ratio [OR] for prescription 2.24 at 6 months; 95% confidence interval [CI], 1.16 to 4.33). Allocation to screening also reduced fracture incidence at 12-month follow-up (OR for new fracture 0.60; 95% CI, 0.35-1.03; p = 0.063), although this did not reach statistical significance. This study supports the use of a simple screening tool administered in primary care to increase appropriate prescription of medications for osteoporosis in postmenopausal women in the UK. © 2012

  11. A comprehensive fracture prevention strategy in older adults

    DEFF Research Database (Denmark)

    Blain, H.; Masud, T.; Dargent-Molina, P.

    2016-01-01

    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest group on falls and fracture prevention of the European union geriatric medicine society (EUGMS...... of osteoporosis and osteoarthritis (ECCEO), outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people....

  12. Risk and clinical predictors of osteoporotic fracture in East Asian patients with chronic obstructive pulmonary disease: a population-based cohort study

    Directory of Open Access Journals (Sweden)

    Ping-Hsueh Lee

    2016-10-01

    Full Text Available Introduction Osteoporosis is becoming an impending epidemic in the Asia-Pacific region. The association between risk of osteoporotic fracture (OTPF and chronic obstructive pulmonary disease (COPD in East Asian patients is yet to be fully examined. We conducted a nationwide population-based retrospective cohort study of 98,700 patients aged ≥50 years with or without COPD using a national administrative claims dataset. Materials and Methods The patients were divided into COPD and comparison groups comprising 19,740 and 78,960 patients, respectively. The groups were 1 to 4 matched for age, gender, index date, diabetes mellitus, pre-existing osteoporosis and chronic kidney disease. Information such as the geographic area where southern part represented more sunshine exposure, smoking-related diagnoses, alcohol use disorder, whether there was regular use of inhaled corticosteroids and oral corticosteroids, vitamin D prescriptions, Charlson-Deyo comorbidity index score, and other relevant medical comorbidities were extracted for analysis. They were followed up until OTPF or the end of the year 2013. The outcome measure was an osteoporotic vertebral fracture and other long-bone fractures. A multivariate Cox model was constructed to derive adjusted hazard ratios (aHR for OTPF with corresponding 95% confidence intervals (CI after controlling for age, sex, insurance premium category, vitamin D prescription, osteoporosis, and coronary heart disease (CHD. Kaplan–Meier curves of the probability of OTPF-free survival for each cohort were compared using the log-rank test. Patients with OTPF during the first follow-up year were excluded from the overall risk calculation. Contributing factors to the increased risk of OTPF in COPD patients were examined in a sensitivity analysis. Results After a total follow-up of 68,743 patient-years for the COPD group and 278,051 patient-years for the matched comparison group, the HR for OTPF was 1.24 (95% CI [1.02–1

  13. 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

  14. [Biomechanical effect on adjacent vertebra after percutaneous kyphoplasty with cement leakage into disc: a finite element analysis of thoracolumbar osteoporotic vertebral compression fracture].

    Science.gov (United States)

    Fei, Qi; Li, Qiu-Jun; Li, Dong; Yang, Yong; Tang, Hai; Li, Jin-Jun; Wang, Bing-Qiang; Wang, Yi-Peng

    2011-01-04

    To explore the biomechanical effects on adjacent vertebra of thoracolumbar osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP) with cement leakage into the disc by using finite element analysis. T10-L2 segment data were obtained from computed tomography (CT) scans of an elder female with single T12 OVCF undergoing a cement leakage into the T12-L1 disc after PKP. A three-dimensional finite element Model of thoracolumbar spine (T10-L2) was built in the Mimics and the ABAQUS software. The stress on annulus fiber, nucleus pulposus, endplate and facet joints under axial pressure (0.3, 1.0, 4.0 MPa) were analyzed. The 3D finite element after percutaneous kyphoplasty (PKP) with cement leakage into the disc may be strongly related with the changes of biomechanical effects on adjacent vertebra of thoracolumbar OVCF. Models of thoracolumbar OVCF before and after PVP with a cement leakage into the T12-L1 disc were successfully established. The stresses increased with a rising axial pressure in the model of cement leakage into the disc after PVP, the stress augmentation scope on adjacent end plates(T11 low plate & L1 top plate) and intervertebral disc (T11-12 & T12-L1) increased. The maximal Von Mises stress on adjacent vertebra (T11 & L1) increased while but the maximal Von Mises stress on end vertebra (T10 & L2) decreased. Postoperative adjacent vertebral fracture.

  15. Osteoporotic vertebral body fractures of the thoracolumbar spine: indications and techniques of a 360°-stabilization.

    Science.gov (United States)

    Spiegl, Ulrich; Jarvers, J-S; Heyde, C-E; Josten, C

    2017-02-01

    Unstable vertebral body fragility fractures of the thoracolumbar spine can occur with or without relevant trauma. Initially, a standardized diagnostic algorithm including magnetic resonance tomography is recommended to detect accompanied further vertebral body fractures, to interpret the individual fracture stability, and to screen for relevant traumatic intervertebral disc lesions. Aim of the therapy is to assure fast mobilization and to maintain spinal alignment. Unstable fracture morphology is defined by vertebral body fractures including a relevant defect of the posterior vertebral cortex as well as type B or C fractures. With respect of type A fractures, a combined anterior-posterior approach including a primary cement-augmented posterior stabilization and anterior spondylodesis is indicated in those patients with relevant intervertebral lesions or in those suffering from high-energy accidents resulting in unstable burst-type fractures. The others will benefit from hybrid stabilizations including cement-augmented posterior stabilizations and cement augmentation (kyphoplasty) of the fractured level to gain a ventral transosseous stability. In addition, individually adapted antiosteoporotic therapy is essential.

  16. 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.

  17. What Are Ways to Prevent Falls and Related Fractures?

    Science.gov (United States)

    ... feet. Repeat five times. How Can I Prevent Broken Bones if I Fall? Sometimes you cannot prevent ... Falls and Fractures (NIA) Caídas y fracturas (NIA) Home Bone Basics Osteoporosis Osteogenesis Imperfecta Paget’s Disease of ...

  18. The Effects of Bisphosphonates Used Continually or Intermittently on Fractures, Bone Mineral Density and Biochemical Parameters in Osteoporotic Patients - Original Investigation

    Directory of Open Access Journals (Sweden)

    Alev Çevikol

    2010-04-01

    Full Text Available Aim: The aim of this study was to evaluate the effects of bisphosphonates on new fracture development, bone mineral density and biochemical parameters in osteoporotic patients who were treated with these drugs for 5 years. Material and Methods: Thirty nine patients from our osteoporosis outpatient clinic, using bisphosphonates treatment for 5 years were included in this retrospective study. The patients were questioned in terms of demographic features, osteoporosis risk factors, spine and total hip BMD scores measured during the diagnosis and the last follow-up, duration of bisphosphonates use, adverse-effect profile and compliance to the treatment. Serum calcium, phosphorus, alkaline phosphatase levels and 24 houred-urine calcium level were examined. Patients were divided into 2 groups as the patients who were using bisphosphonates continually after diagnosis were group 1 and the patients left using bisphosphonates for some time because of several reasons treated intermittently were group 2. Results: After the diagnosis, 11 (28.2% patients received bisphosphonate treatment continually (Group 1 while 28 (71.8% used the treatment intermittently (Group 2 for 5 years. The break in bisphosphonate use in Group 2 was 1.25±0.63 years. No statistical differences were determined between the 2 groups with respect to DEXA measurement, biochemical parameters or new fracture development identified clinically (p>0.05. Conclusion: Efficacy of bisphosphonates on new fracture development identified clinically, biochemical parameters and DEXA measurement was sustained in patients using bisphosphonates regularly for 5 years, even when treatment was interrupted for approximately 1.5 years. (From the World of Osteoporosis 2010;16:1-8

  19. 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.

  20. Effect of teriparatide (rh-PTH 1-34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study.

    Science.gov (United States)

    Iwata, Akira; Kanayama, Masahiro; Oha, Fumihiro; Hashimoto, Tomoyuki; Iwasaki, Norimasa

    2017-04-07

    Teriparatide (recombinant human parathyroid hormone 1-34) is increasingly used for the treatment of severe osteoporosis because it stimulates bone formation and may potentially enhance fracture healing. The objective of this study was to investigate the effects of teriparatide versus a bisphosphonate on radiographic outcomes in the treatment of osteoporotic vertebral compression fractures (OVCF). A total of 98 patients undergoing non-operative treatment for recent single-level OVCF were reviewed retrospectively. Thirty-eight patients were treated by a once-daily subcutaneous injection of 20 micrograms of teriparatide (TPD group), whereas 60 patients received 35 mg of alendronate weekly (BP group). Except for these medications, the same treatment protocol was applied to both groups. The radiographic assessments included union status, vertebral kyphosis, and mid-vertebral body height. The rates of fracture site surgical intervention were also compared between the two groups. The mean follow-up period was 27 months (median 22.5, range 2 - 75 months). Cox regression analysis showed that TPD reduced the time-to-union (adjusted relative hazard ratio: 1.86, 95% C.I.: 1.21 - 2.83). The union rate at six months after treatment was 89% in the TPD group and 68% in the BP group; the surgical intervention rate was significantly higher in the TPD group (p = 0.026, adjusted odds ratio: 8.15, 95% C.I.: 2.02 - 43.33). The change in local kyphosis was 4.6° in the TPD group and 3.8° in the BP group (p = 0.495, paired t-test). The change of mid-vertebral body height was 4.4 mm in the TPD group and 3.4 mm in the BP group (p = 0.228, paired t-test). Fracture site surgical interventions were not required in the TPD group; however, two patients in the BP group eventually underwent surgical treatment for symptomatic non-union or vertebral collapse. This retrospective study suggests that teriparatide may enhance fracture healing and improve the union rate in OVCF.

  1. A scoping review of the public health impact of vitamin D-fortified dairy products for fracture prevention.

    Science.gov (United States)

    Hiligsmann, Mickael; Neuprez, Audrey; Buckinx, Fanny; Locquet, Médéa; Reginster, Jean-Yves

    2017-12-01

    Dairy products are rich in nutrients that positively influence bone health and hence fracture risk, and have therefore been recommended and used for fracture prevention. To help decision makers to efficiently allocate scare resources, it is further important to assess the public health and economic impact of any health intervention. In recent years, several studies have been conducted to estimate the public health and/or economic impact of dairy products but no overview is currently available. This article aims therefore to summarize evidence and review articles that estimated the public health and/or economic impact of vitamin D-fortified dairy products for fracture prevention. A literature review was conducted using PubMed to identify original studies that assessed the public health and/or economic impact of dairy products (or of calcium/vitamin D supplementation) for fracture prevention up to January 15, 2017. Seven articles were identified. Different strategies were used by the authors to model the economic/public health impact of dairy products. The four studies assessing the public health impact of dairy products revealed a substantial benefit in terms of fracture prevented, life years, disability-adjusted life years and/or quality-adjusted life years gained. Studies assessing the cost-effectiveness revealed that the use of dairy products is generally cost-effective in the general population aged above 70 years, and from the age of 60 years in populations at high risk of fractures. This systematic review suggests that the use of dairy products could substantially reduce the burden of osteoporotic fractures and seem to be an economically beneficial strategy.

  2. Modified tension band wiring fixation for avulsion fractures of the calcaneus in osteoporotic bone: a review of three patients.

    Science.gov (United States)

    Nagura, Issei; Fujioka, Hiroyuki; Kurosaka, Masahiro; Mori, Hiroyuki; Mitani, Makoto; Ozaki, Akihiro; Fujii, Hideo; Nabeshima, Yuji

    2012-01-01

    Calcaneal avulsion fractures are not uncommon, and they are probably more likely in patients with osteoporosis. Closed manipulation for this type of fracture often fails to achieve acceptable reduction, and open reduction and internal fixation are usually required. However, open reduction and internal fixation with either a lag screw or Steinmann pins do not provide satisfactory fixation in patients with diabetes and elderly patients because of the presence of porotic bone. Levi described a tension band fixation system used to treat a calcaneal avulsion fracture using a simple technique performed with a transverse Kirschner wire through the os calcaneus, securing a figure-of-8 metal tension band wiring to the fragment. We report the successful treatment of 3 patients with calcaneal avulsion fractures using a modified tension band wiring technique, resulting in satisfactory recovery. Re-displacement of the fragment during the initial follow-up period was not reported, and bony union was achieved in all patients. We believe this technique is a useful surgical option for the treatment of calcaneal avulsion fractures. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Balloon-assisted percutaneous vertebroplasty in patients with osteoporotic compression fractures - first results; Ballonassistierte perkutane Vertebroplastie bei Patienten mit osteoporotischen Wirbelkoerperkompressionsfrakturen - erste Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schulte, B.U.; Trompeter, M.; Remy, C.; Reimer, P. [Zentralinstitut fuer Bildgebende Diagnostik, Staedtisches Klinikum Karlsruhe (Germany); Bruecher, D. [Abt. fuer Unfallchirurgie, Staedtisches Klinikum Karlsruhe (Germany)

    2006-02-15

    Purpose: To determine the feasibility, efficacy and safety of balloon-assisted percutaneous vertebroplasty (BA-VP) in patients with osteoporotic vertebral compression fractures (VCFs). Materials and Methods: In 47 patients (29 women, 18 men; mean age: 70 years and 4 months) with severe VCFs, 66 BA-VPs were performed via a unipedicular access. After initial puncture (under combined fluoroscopy and CT guidance) of the vertebral body (VB), the needle was retraced by 1.5 cm, and a 12-mm Fogarty balloon catheter was introduced and inflated using 2-4 ml diluted contrast media (CM). After the subsequent removal of the catheter and repositioning of the needle, vertebroplasty was performed. Results: The mean volume of PMMA injected was 4.4 ml (2.5-7.2 ml). Pain reduction (measured by the Visual Analogue Scale) was achieved in 95% of the patients, dropping from on average 8.0 preinterventionally to 2.2 after a mean follow-up of 8 months. A reduction of the pain relieving medication was achieved in 68% of the cases and patient activity improved markedly. No severe or clinically relevant complications were observed. Cement leakage occurred by filling of epidural and paravertebral veins in 9.1 and 6.1% of the cases, respectively. Leakage into the paravertebral soft tissues was seen in 3.0% of the patients and to the adjacent disc space in 10.6% of the cases. (orig.)