Absence Of Fracture Research Articles

Role of 18F-FDG PET/CT in differentiation of a benign lesion and metastasis on the ribs of cancer patients

ObjectiveIncidental 18-Fluoro-2-deoxyglucose positron emission tomography (18F-FDG) uptake in the ribs is a relatively common finding on positron emission tomography/computed tomography (PET/CT) images of cancer patients. This study examined the role of 18F-FDG PET/CT in differentiating between benign lesions and metastases on the ribs. MethodsThis study included 264 lesions in 172 PET/CT cases with underlying malignancy showing newly developed indeterminate 18F-FDG rib uptake between June 2009 and May 2010. Patients with more than five FDG rib uptakes or hematologic malignancy were excluded. Malignancy was confirmed either histologically or by imaging studies, and clinical follow-up with serial images was at least 6months. The maximum standardized uptake value (SUVmax) of the rib lesion was recorded. The FDG uptake patterns (focal or segmental; discrete or non-discrete) and CT findings (evidence of fracture, soft tissue lesions, osteoblastic and/or osteolytic lesions) were recorded. ResultsThere were 206 benign lesions and 58 metastases. The SUVmax was significantly higher in the metastatic group (3.0±1.8) than in the benign group (2.5±1.1), (P=.014). For the differential diagnosis between benign and metastatic lesions, the best SUVmax cut-off was determined to be 2.4. Significant indicators for metastasis were a segmental FDG uptake pattern (OR=10.262, 95% CI 4.151–25.371), presence of an osteoblastic/-lytic lesion (OR=22.903, 95% CI 10.468 to 50.108) and the absence of fractures on CT (OR=291.629, 95% CI 39.09–2175.666). ConclusionSUVmax alone is not sufficient to differentiate benign and metastatic rib lesions in cancer patients. The diagnostic accuracy can be further increased when findings of the CT part of PET/CT are considered.

Spinal cord injury without radiologic abnormalities in adults

There is increasing evidence that spinal cord injury without radiologic abnormalities (SCIWORA) is underreported in adults. The increasing availability of magnetic resonance imaging (MRI) has added substantial information, but there remains considerable disagreement concerning definition as well as diagnostic and therapeutic measures. Furthermore, the interpretability of the literature is constrained by the lack of a reliable classification system based on the morphologic abnormalities visualized by MRI. A comprehensive systematic review was performed to identify all the data published concerning adults experiencing SCIWORA. To assess a potential correlation between clinical and imaging findings, we developed a novel MRI classification system. Database searches were conducted for studies on SCIWORA in adults using PubMed and OvidSP. Inclusion criteria were (1) traumatic spinal cord injury with neurologic deficit, (2) absence of fractures and/or dislocations of the spinal column, and (3) a mature skeleton. Data collected included clinical and radiologic findings. MRI patterns and clinical course were correlated. Sixty-three articles reporting 1,393 patients were identified, of which 44 studies reported 1,132 cases with MRI imaging. At admission, neurologic deficit assessed by the American Spinal Injury Association impairment scale (AIS) in 567 patients was A in 19.1%, B in 18.5%, C in 39.7%, and D in 22.8%. At final follow-up, these were 6.5%, 4.8%, 20.1%, and 44.3%, respectively. In 7.1%, no MRI abnormalities (Type I) were detected, and 92.9% exhibited abnormal scan results (Type II). Of the latter, 11.7% revealed extraneural (Type IIa), 36.9% revealed intraneural (Type IIb), and 44.3% revealed combined abnormalities (Type IIc). Statistical analysis of neurologic impairment at admission and follow-up revealed significant differences in outcome between patients with different imaging findings. This review emphasizes the prognostic value of spinal MRI for adults with SCIWORA. Using the MRI classification system in future reports will enhance comparability and interpretability and might improve our understanding of the condition.

Impedance Measuring to Detect Fractures in Steel Frames Using Resonance Circuit on Fire Resistive Covering

In order to detect the presence or absence of fractures in constructional members for steel buildings caused by external forces such as earthquakes without the removal of any fire resistive covering materials, we are developing a new nondestructive inspection (NDI) system. This system detects the presence or absence of fractures in a steel frame by measuring the impedance of a coil which exposes the test material to a magnetic field. The system is easy to handle and detection takes only a short time. In this system, the coil is connected to a compensating capacitor with a series-resonant circuit to reduce the impedance and multiply the impedance change by increasing the quality factor. First, the rates of change of impedance and phase angles were measured with the impedance meter of the proposed NDI system. Two types of test samples were investigated. One type of sample had a fracture in the steel plate. The others imitated the beam to column connection with or without a fracture. In both types of samples, the differences in the rates of change of impedance and phase caused by the presence or absence of fractures were measured. Second, in order to confirm the experimental result and establish the design method for optimizing the arrangement and shape of the coil, we calculated the fractional deviation of inductance between presence or absence of the fracture in the steel frame for two types of test samples through a 3-D magnetic field analysis taking eddy current into account. Since the analyzed the fractional deviations of inductance were in good agreement with those measured, the validity of our analysis was confirmed.

AB1021 2012 update of the french guidelines for the pharmacological treatment of postmenopausal osteoporosis

ObjectivesTo update the evidence-based position statement published by the French National Authority for Health (HAS) in 2006 regarding the treatment of postmenopausal osteoporosis under the auspices of the French Society...

Acute Compartment Syndrome of the Upper Extremity Secondary to Blunt Trauma That Resulted in Closed Disruption of an Arteriovenous Fistula in the Absence of Fracture: A Case Report.

Acute compartment syndrome (ACS) occurs when the pressure within a fibro-osseous compartment increases to such a point that the perfusion gradient is decreased at the capillary level. In the upper extremity, ACS can be caused by anything that increases volume within the confined spaces of the fascia or physically restricts expansion of the compartment externally1. This case report describes the unreported incidence of ACS in the upper extremity as a consequence of hemorrhage from a ruptured brachiocephalic arteriovenous (AV) fistula following closed blunt trauma. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-three-year-old male driver was involved in a rollover motor vehicle collision; he presented to our level-1 trauma facility within one hour of injury. He had been wearing a seat belt and had not been ejected from the vehicle. He had a history of hypertension and renal failure. Four years ago, a brachiocephalic AV fistula had been created in his left arm for hemodialysis. One year prior to presentation, he had received a cadaveric renal transplant and had been off dialysis since then; the fistula was no longer being used. He had been taking Prograf (tacrolimus) and prednisone as immunosuppressive therapy for the renal transplant. The patient was alert and oriented upon presentation, with a score of 15 on the Glasgow Coma Scale. The airway was adequate, breathing was spontaneous, and there was no obvious external bleeding on arrival. Symptoms included mild shortness of breath and pain in the left upper extremity. There were multiple areas of ecchymosis along the anteromedial aspect of the arm and forearm, but no open wounds were present (Fig. 1). The skin overlying the arm and forearm was taut, and the compartments were noncompressible. He had palpable radial pulses and was …

Cystic avascular necrosis of the triquetrum

Carpal bones are rarely affected by avascular necrosis (AVN) in the absence of fractures. The lunate is the most frequently affected carpal bone, followed by the scaphoid and the capitate. The triquetrum is rarely affected by AVN. We report a case of multiple cystic changes in the triquetrum in a patient with a history of trauma. He was treated by below elbow Colles plaster cast for 3 months, with no improvement. Cystic changes resulted from irreversible AVN of the triquetrum. This is the first case to be reported in the literature with cystic AVN changes in the triquetrum.

Description of fracture zones based on the structural inhomogeneity of the reflector deformation field

The role of fracture and faulting zones in the filtration inhomogeneity of productive formations in oil and gas fields has been considered. The absence of fracture or faulting zones from geological and, consequently, hydrodynamical models reduces the flooding efficiency and the oil recovery factor in general.The current situation results from the underdevelopment of methods for the mapping and classification of fracture zones based on seismic-prospecting data. For example, the use of the seismic-horizon gradient method makes it possible to describe only complete rock fracturing at tectonic-block boundaries.We propose to use the structural inhomogeneity of the deformation field of seismic horizons for a more complete description and classification of fracture zones by the faulting regime. This parameter is suitable not only for late but also for early stages of faulting and describes block-boundary deformations more accurately than gradients. The example of a West Siberian oil and gas field showed that the production wells from the J1 productive formation in the faulting zones with the calculated post-Cenomanian structural inhomogeneity of the deformation field have considerably higher discharges owing to fracture permeability.

Pore-lining phases and capillary breakthrough pressure of mudstone caprocks: Sealing efficiency of geologic CO2 storage sites

Subsurface containment of CO2 requires an effective caprock seal. Many previous studies on seals have relied on macroscopic measurements of capillary breakthrough pressure and other petrophysical properties without direct examination of solid phases that line pore networks and contact fluids. However, pore-lining phases strongly contribute to sealing behavior through interfacial interactions among CO2, brine, and the mineral or non-mineral phases. We examined continental and marine mudstones using high resolution (i.e., sub-micron), direct observations of pore-lining phases and X-ray diffraction (XRD). Our results indicate that sealing efficiency (i.e., breakthrough pressure) is governed by pore shapes and pore-lining phases that are not identifiable except through direct characterization of pores. Bulk XRD data do not indicate which phases line the pores and may be especially lacking for mudstones with organic material. Organics can line pores and may represent once-mobile organics that modified wettability of an originally clay-lined pore network. For shallow formations (i.e., <800m depth), interfacial tension and contact angles result in breakthrough pressures that may be as high as those needed to fracture the rock—thus, in the absence of fractures, high capillary sealing efficiency is indicated. Deeper seals have poorer capillary sealing if some reduction in water-wetting occurs, with an increase in pressure and temperature, on minerals and/or pore-lining organic phases.

Pediatric Head Injury

1. Jeff E. Schunk, MD* 2. Sara A. Schutzman, MD† 1. *Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Medical Center, Salt Lake City, UT. 2. †Assistant Professor, Department of Pediatrics, Harvard Medical School, Senior Associate Physician in Medicine, Division of Emergency Medicine, Department of Medicine, Children’s Hospital Boston, Boston, MA. * Abbreviations: BSF: : basilar skull fracture CSF: : cerebrospinal fluid CT: : computed tomography EDH: : epidural hemorrhage GCS: : Glasgow Coma Scale ICI: : intracranial injury ICP: : intracranial pressure PECARN: : Pediatric Emergency Care Applied Research Network SAH: : subarachnoid hemorrhage SDH: : subdural hemorrhage TBI: : traumatic brain injury Recent studies have provided updated guidelines for the diagnosis of head injury and the management of patients who experience concussions. A multidisciplinary panel has recently issued new guidelines for return to play after head injury. After reading this article, readers should be able to: 1. Understand the anatomy and pathophysiology relevant to pediatric head injuries. 2. Take an appropriate history, perform an appropriate physical examination, and decide what imaging, if any, is warranted in the case of a child with a head injury. 3. Know the characteristics of the various types of intracranial injuries. 4. Understand the proper management of both minor and severe head injuries in children. Pediatric head injury is extremely common. Although the vast majority of children with head trauma have minor injuries, a small number, even among well-appearing children, will have more serious injuries with the potential for deterioration and significant sequelae. The clinician is challenged to discern which few among the many injured are at high risk for intracranial complications. Clinical symptoms are neither completely sensitive nor specific for significant injury: vomiting may be associated with intracranial injury (ICI), but most children who experience vomiting do not have a complication. Computed tomography (CT) accurately identifies ICIs requiring intervention, but also identifies minor lesions with unclear clinical importance (ie, not requiring intervention) and exposes developing brains to ionizing radiation with the associated risks. Although clinical decision rules determine which children are at highest risk and provide a useful clinical framework, they may not necessarily direct care. Additionally, in this era of reliance on imaging, it is important to remember what the clinical examination tells us regarding brain function, information that …

Health-related quality of life in patients with osteoporosis in the absence of vertebral fracture: a systematic review

To review whether osteoporosis in the absence of vertebral fracture (VFX) affects health-related quality of life (HRQoL), a systematic search of the main literature databases for HRQoL in patients with osteoporosis without VFX was undertaken. This was undertaken. This identified 1,327 articles as potentially relevant to the review. After screening of abstracts and reviewing 168 articles in detail, 27 were considered relevant. HRQoL data were extracted and collated into tables and, where possible, were converted into normative scores and further analysed. Data relating to the associations between HRQoL and bone mineral density (BMD) were also collated. Of the 27 articles included, only 5 directly compared osteoporosis without VFX with a control group (BMD T-score > -1.0, without VFX). Extracted raw data from 21 articles demonstrated that patients with osteoporosis without VFX had clinically relevant reductions in role physical, general health, vitality, mental health domains and the mental component summary score, using SF36. Using Qualeffo-41, pain and physical function were worse in these patients. Also, HRQoL was related to upper femur, but not lumbar spine BMD. HRQoL data in patients with osteoporosis without VFX are limited and variable but suggest that HRQoL is adversely affected by osteoporosis in the absence of VFX. The association of lower BMD and worse HRQoL suggests that more attention should be paid to HRQoL in those without VFX. Future studies are needed to investigate HRQoL in patients with osteoporosis in the absence of fracture, controlling for co-morbidities and social and economic status.

A case of fatal cervical discoligamentous hyperextension injury without fracture: Correlation of postmortem imaging and autopsy findings

We present a case of fatal cervical discoligamentous hyperextension injury without fracture. Postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMRI) disclosed cervical instability and spinal cord injury in the absence of fracture, which was confirmed by autopsy. Cervical discoligamentous injury without fracture may be unnoticeable on PMCT because signs of cervical misalignment change depending on the posture of the neck at the time of postmortem imaging. Because of its greater sensitivity for soft tissue injury, PMMRI is especially useful for detecting pathological changes in cases of death due to cervical discoligamentous injury. In this paper, findings on postmortem imaging for this injury are described in detail and correlated with findings on autopsy.

Incidence of Associated Injury in Posterior Shoulder Dislocation

Posterior shoulder dislocations are rare and often missed. Classically associated with seizures, very little is known about the incidence and type of associated injuries. Unfortunately, the majority of the literature consists of incidental reports or small case series. Our goal was to increase the strength of available data by performing a systematic review. We searched EMBASE and PubMed for the terms "posterior shoulder dislocation." Our inclusion criteria were articles in either English or French with the words "posterior" and "dislocation" in the abstract or title. All reports of chronic cases or instability as well as those without patient information were excluded. Data regarding demographics, etiology, investigations, associated injuries, treatments, and outcomes were extracted. All data were analyzed by using SPSS 18.0 (IBM, Chicago, IL). A total of 766 articles were found of which 108 were retained for analysis. A total of 475 patients (543 shoulders) were compiled. Seizures were reported in 34% of cases. A majority of dislocations (65%) had associated injuries. Fracture was most common followed by reverse Hill-Sachs and cuff tears. In the absence of fracture or reverse Hill-Sachs injury, the risk of cuff tear increased nearly fivefold (odds ratio, 4.6; P = 0.016). Our results suggest the amount of associated injuries related to posterior shoulder dislocation is far greater than thought. We propose an investigation algorithm for acute posterior shoulder dislocations.

Spinal Cord Injury Resulting From Injury Missed on CT Scan: The Danger of Relying on CT Alone for Collar Removal

Strict criteria have been used before removing cervical collars in patients with injuries who have midline pain or are unable to be reliably examined. This sometimes leads to prolonged immobilization in cervical collars or use of MRI to rule out injury. Several studies suggest a collar may be removed in the absence of fractures, dislocation, or pathologic subluxation on a cervical CT scan. This may avoid the morbidity of prolonged cervical immobilization or cost of advanced imaging study but risks devastating consequences from missing injuries. We report a patient with a cervical spinal cord injury after removal of a collar after a CT scan was misinterpreted as normal. Retrospective review of the CT showed subtle signs of widening between the spinous processes of the injured level, a finding easily missed without the use of further imaging studies. Several articles suggest cervical collars may be safely removed from awake and alert patients and in patients who cannot be reliably examined after a negative CT scan without the need for further imaging. CT scans are excellent at detecting bony injuries but not ligamentous injuries. Removing cervical collars based on CT scans alone may be expeditious, but some injuries may be missed without further imaging. Our case demonstrates the catastrophic consequences of missing a cervical spine injury and emphasizes the need for maintaining the cervical collar in high-risk patients until proper imaging can be obtained.

Deteção de fratura radicular vertical utilizando tomografia computadorizada na presença ou ausência de núcleos metálicos

The objectives were: (1)test accuracy of CT in detection of vertical root fracture and (2) investigate the influence of the metallic post in detection of vertical root fracture. Four teeth with vertical root fractures were selected and tested in four conditions determined by the presence or absence of metallic post and location of fracture. Two teeth without fracture were used as controls, one receiving metallic post. These teeth were inserted into a jaw and underwent a CT scan. The results were interpreted by ten radiologists by the presence or absence of fractures. The results showed an inconsistency in interpretation of fractures, having been found a greater number of false-positive results (10%) and false negatives (53.3%) that the accurate diagnosis of fractures (37.6%). Can still be seen less accurate diagnosis of these fractures in teeth that had metallic posts than in teeth that did not.

Liquid-like platinum-rich glasses

Bulk platinum-rich glasses exhibiting high bulk moduli and Poisson ratios are introduced. A bulk modulus of 217 GPa and a Poisson’s ratio of 0.43 are measured, the highest values reported to date for a metallic glass. The present glasses demonstrate an unusual capacity for “liquid-like” deformation characterized by low resistance to shear flow and high resistance to cavitation, enabling extensive bending ductility in the absence of fracture. An indirect estimate of the fracture toughness yields a value of ∼125 MPa m^(1/2).

The Predictive Value of a Normal Radiographic Anterior Fat Pad Sign Following Elbow Trauma in Children

The purposes of this study were to describe the characteristics of a normal anterior fat pad (AFP) and to determine the association between a normal AFP and the absence of fracture. A prospective cohort of children aged 1 to 18 years with elbow trauma underwent radiographic examination. All patients received standard orthopedic management and follow-up 7 to 14 days after injury. A pediatric radiologist evaluated all radiographs for the presence or absence of fracture and documented whether the AFP was normal or abnormal on the lateral view. The radiologist also recorded specific measurements of the AFP including the apical angle, which is formed by the intersection of the humerus and the superior aspect of the AFP. The interpretation of the AFP on the initial lateral radiograph was compared with the final patient outcome (fracture/no fracture). Two hundred thirty-one patients had elbow radiographs; 34 patients (15%) were lost to follow-up. A total of 56 fractures were identified: 49 (87%) on the initial radiograph and an additional 7 (13%) on follow-up radiographs. This latter group was defined as occult fractures. Among the 197 patients available for analysis, 113 (57%) had a normal AFP on the initial radiograph. Of these, 2 children had a final diagnosis of fracture. The sensitivity of a normal AFP was 96.4% (95% confidence interval, 86.6%-99.4%), and the negative predictive value was 98.2% (95% confidence interval, 93.1%-99.7%). There was a significant difference in mean AFP angle when the AFP was read as normal (14.7 [SD, 3.3] degrees) compared with when it was read as abnormal (27.0 [SD, 6.8] degrees) (P < 0.01). Our data suggest that a normal AFP is highly associated with absence of elbow fracture and that the determination of a normal AFP can be aided by measuring the apical angle of the AFP.

A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

BackgroundElbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation.Methods/DesignThe design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36).DiscussionThe outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and additional stabilization with a hinged elbow fixator.Trial RegistrationThe trial is registered at the Netherlands Trial Register (NTR1996).

Relação entre qualidade de vida e fratura vertebral em mulheres idosas residentes no Sul do Brasil

To investigate the relationship between quality of life and spinal fracture in women aged over 60 living in Southern Brazil. A case-control study was conducted with the application of the WHOQOL-bref questionnaire to 100 women living in the city of Chapecó (SC), aged over 60, postmenopausal, white or Caucasian, with no important cognitive impairment or a history of diseases known to affect bone metabolism, or malignant neoplasias. The population was divided into two groups depending on the presence or absence of fractures in the spine radiography. We analyzed variables related to the current and previous medical history, life habits and family history of fractures, and the domains and facets that compose the WHOQOL-bref. All participants were informed about the objectives and methodologies adopted and gave written informed consent to participate in the study. The mean age of the women in the fracture group was older than that of women with fractures (p<0.05). Also women with fractures tended to belong to a higher social class, to have more years of study, a higher family income, and a greater use of alcoholic drinks (p<0.05). In the evaluation of the WHOQOL-bref domains, the fracture group had the highest average in the psychological field (χ=63.6±3.0) and the lowest in the environment field (χ=9.3±58.8). In the group without fracture, the highest average also occurred in the psychological domain (χ=67.2±9.3) and the lowest in the field of social relations (χ=57.5±7.7). Statistical analysis showed no significant correlation between the averages of the facets that make up the areas between the groups with and without fractures. This study suggests that there is no impairment of quality of life among older women with vertebral fractures, but the relation between QL and time of occurrence and severity of the fractures should be better evaluated. Both groups had higher scores in the psychological domain, showing that the respondents rely on personal beliefs, spirituality and religion, accept their physical appearance while maintaining self-esteem and the ability to think, to learn and to concentrate despite the presence of this disease. There was no statistically significant difference between groups or between domains in the same group.

Design of medium–temperature solid oxide fuel cells on porous supports of deformation strengthened Ni–Al alloy

An approach was developed towards design of medium-temperature solid-oxide fuel cells based on a deformation strengthened Ni-Al alloy. Methods of sintering were described that allowed obtaining layers of complex oxides with ionic and mixed conductivity and with regulated porosity in the range of 40–1%. Power density of a fuel cell on a metallic support reaches 500 mW/cm2 already at 700°C when humid H2 was used as fuel and air was used as an oxidant. Analysis of fuel cell cross-section after tests showed absence of fractures, flaking, and new phases with low conductivity, which proves good compatibility of all materials used in fuel cell design.

Health-related quality of life and treatment of postmenopausal osteoporosis: Results from the HORIZON-PFT

Osteoporosis-related fractures are associated with reductions in health-related quality of life (HRQL). We examined the benefits of zoledronic acid (ZOL) on HRQL in patients sustaining vertebral and clinical fractures from HORIZON-Pivotal Fracture Trial using mini-Osteoporosis quality of life Questionnaire (OQLQ). In this multicenter, double-blind, placebo-controlled trial, 1434 patients from a cohort of postmenopausal women with osteoporosis (mean age 73years) were randomized to receive annual infusions of ZOL 5mg or placebo for 3years. Baseline HRQL scores were comparable between ZOL and placebo groups based on the presence or absence of fractures, with exception of prevalent vertebral fractures where patients (irrespective of the treatment group) had lower baseline HRQL scores than those without prevalent vertebral fractures. Greater number of prevalent vertebral fractures was associated with lower baseline HRQL (p<0.001). No significant difference between ZOL and placebo in the overall summary score was observed but a significant benefit was noted in certain domains with ZOL, especially in patients sustaining incident clinical fractures. Improvements in HRQL were marked at first assessment after a morphometric vertebral fracture with significant differences favouring ZOL in pain (p=0.0115), standing pain (p=0.0125)), physical (lifting, p=0.0333) and emotional function (fear of fractures, p=0.0243; fear of falls, p=0.0075) but not for activities of daily living or leisure domains. HRQL is reduced in patients with vertebral fractures. Treatment with ZOL over 3years was associated with improvements in specific domains of quality of life vs. placebo, particularly in patients sustaining incident fractures.