Decrease Fracture Risk Research Articles

Effects of growth hormone therapy on bone density and fracture risk in age-related osteoporosis in the absence of growth hormone deficiency: a systematic review and meta-analysis.

In adults, growth hormone deficiency (GHD) has been associated with low bone mineral density (BMD), an effect counteracted by growth hormone (GH) replacement. Whether GH is beneficial in adults with age-related bone loss and without hypopituitarism is unclear. We conducted a systematic literature search using Medline, Embase and the Cochrane Register of Controlled Trials. We extracted and analyzed data according to the bone outcome included [bone mineral content (BMC), BMD, and bone biomarker, fracture risk]. We performed a meta-analysis when possible. We included eight studies. Seven randomized 272 post-menopausal women, 61-69 years, to GH or control, for 6-24 months, and the eighth was an extension trial. Except for one study, all women received concurrent osteoporosis therapies. There was no significant effect of GH, as compared to control, on BMD at the lumbar spine (Weighted mean difference WMD = -0.01 [-0.04, 0.02]), total hip (WMD = 0 [-0.05, 0.06]) or femoral neck (WMD = 0 [-0.03, 0.04]). Similarly, no effect was seen on BMC. GH significantly increased the bone formation marker procollagen type-I carboxy-terminal propeptide (PICP) (WMD = 14.03 [2.68, 25.38]). GH resulted in a trend for increase in osteocalcin and in bone resorption markers. Patients who received GH had a significant decrease in fracture risk as compared to control (RR = 0.63 [0.46, 0.87]). Reported adverse events were not major, mostly related to fluid retention. GH may not improve bone density in women with age-related bone loss but may decrease fracture risk. Larger studies of longer duration are needed to further explore these findings in both genders, and to investigate the effect of GH on bone quality.

Potential risk factors for birth fractures: a case-control study.

Birth fractures are uncommon but remain a concern among obstetricians. Although such fractures usually heal without long-term sequelae, some are associated with lifelong disabilities, such as brachial plexus injuries. The purpose of this study was primarily to investigate risk factors related to birth fractures. This study comprised newborns delivered at our institute between 2003 and 2013. All 46 birth fractures were reviewed and compared with 223 randomly selected normal neonates. Demographic data of newborns and their mothers, as well as the details of delivery and fracture characteristics, were recorded. Univariate and multiple logistic regression analyses were applied to differentiate the risk factors. Forty-six babies had birth fractures, and 223 babies were without fracture. Forty-five cases were midclavicular fractures and one was a humeral-shaft fracture. Babies with a fracture had significantly higher birthweight and length and were larger for gestational age (p≤0.001 for all factors). After multivariate analysis, parameters that remained significantly correlated with higher fracture risk included nurse attendant [odds ratio (OR) 34.8, p=0.004], large for gestational age (OR 12.1, p<0.001), instrumented delivery (OR 10.62, p<0.001), and meconium stain (OR 3.10, p=0.004). A high Apgar score at one minute and cesarean delivery were associated with decreased fracture risk (OR 0.39, p=0.004 and OR 0.12, p=0.001, respectively). Patient (including large for gestational age) and peripartum (including meconium stain, shoulder dystocia, instrumented delivery, and nurse attendant) factors were associated with a higher risk of birth fracture. Factors related to a decreased risk were a high Apgar score at one minute and cesarean delivery. Careful prenatal assessments are recommended to evaluate the risk of birth fracture and prompt cesarean section for patients at high risk.

Fracture Risk Assessment in Patients With Diabetes Mellitus

Diabetes mellitus, both type 1 and type 2 (T2DM), is associated with decreased bone strength as well as increased fracture risk. Bone mineral density is decreased in type 1 diabetes but increased in T2DM, compared with controls. This suggests alterations in bone quality are a major player in the pathogenesis of fragility fractures in patients with diabetes. The link between diabetes and bone appears to be mediated by complex pathways, including the insulin-insulin growth factors system, accumulation of advanced glycation end-products in bone collagen, microangiopathy, and increased bone marrow fat content. Bone fragility in T2DM, which is not reflected by bone mineral density and bone mass reduction, depends on deterioration of bone quality. Also, at least in T2DM, the classical diagnosis of osteoporosis by dual-energy X-ray absorptiometry and the fracture risk estimation by FRAX (fracture risk assessment tool) are only partially useful in assessing fracture risk. Trabecular bone score and trabecular bone score-adjusted FRAX offer an enhanced estimation of fracture risk in these patients. Specific risk stratification criteria are needed in the future. The development of improved methods to assess the material properties of bone to better characterize fracture risk is also a priority. Adequate glycemic control is generally associated with decreased fracture risk, with the exception of specific antidiabetics (thiazolidinediones, canagliflozin) that have been shown to have a detrimental effect. Most currently used antiosteoporotic treatments seem equally effective in diabetic patients as compared with patients without diabetes, but clinical data regarding the reduction in fracture risk specifically in patients with diabetes mellitus are lacking.

Current Evidence on the Association of Dietary Patterns and Bone Health: A Scoping Review.

Nutrition is an important modifiable factor that affects bone health. Diet is a complex mixture of nutrients and foods that correlate or interact with each other. Dietary pattern approaches take into account contributions from various aspects of diet. Findings from dietary pattern studies could complement those from single-nutrient and food studies on bone health. In this study we aimed to conduct a scoping review of the literature that assessed the impact of dietary patterns (derived with the use of both a priori and data-driven approaches) on bone outcomes, including bone mineral status, bone biomarkers, osteoporosis, and fracture risk. We retrieved 49 human studies up to June 2016 from the PubMed, Embase, and CINAHL databases. Most of these studies used a data-driven method, especially factor analysis, to derive dietary patterns. Several studies examined adherence to a variety of the a priori dietary indexes, including the Mediterranean diet score, the Healthy Eating Index (HEI), and the Alternative Healthy Eating Index (AHEI). The bone mineral density (BMD) diet score was developed to measure adherence to a dietary pattern beneficial to bone mineral density. Findings revealed a beneficial impact of higher adherence to a "healthy" dietary pattern derived using a data-driven method, the Mediterranean diet, HEI, AHEI, Dietary Diversity Score, Diet Quality Index-International, BMD Diet Score, Healthy Diet Indicator, and Korean Diet Score, on bone. In contrast, the "Western" dietary pattern and those featuring some aspects of an unhealthy diet were associated inversely with bone health. In both a priori and data-driven dietary pattern studies, a dietary pattern that emphasized the intake of fruit, vegetables, whole grains, poultry and fish, nuts and legumes, and low-fat dairy products and de-emphasized the intake of soft drinks, fried foods, meat and processed products, sweets and desserts, and refined grains showed a beneficial impact on bone health. Overall, adherence to a healthy dietary pattern consisting of the above-mentioned food groups can improve bone mineral status and decrease osteoporosis and fracture risk.

Nutritional Aspects of Bone Health and Fracture Healing.

Introduction Fractures are quite common, especially among the elderly. However, they can increase in prevalence in younger ages too if the bone health is not good. This may happen as a result of bad nutrition. Methods A customized, retrospective review of available literature was performed using the following keywords: bone health, nutrition, and fractures. Results Insufficient intake of certain vitamins, particularly A and D, and other nutrients, such as calcium, may affect bone health or even the time and degree of bone healing in case of fracture. The importance of different nutrients, both dietary and found in food supplements, is discussed concerning bone health and fracture healing. Conclusion A healthy diet with adequate amounts of both macro- and micronutrients is essential, for both decreasing fracture risk and enhancing the healing process after fracture.

A vitamin D analogue, eldecalcitol, enhances expression of fast myosin heavy chain subtypes in differentiated C2C12 myoblasts.

Several lines of evidence indicate that the active form of vitamin D has an anabolic effect on skeletal muscle. Eldecalcitol, an analogue of the active form of vitamin D, has the potential to increase bone density and decrease fracture risk. The objective of this study was to investigate the effect of eldecalcitol in C2C12 myogenic cells. C2C12 cells were grown to confluency and the culture medium was replaced with low-glucose DMEM containing 2% horse serum. Eldecalcitol was added at a concentration of 1, 10 or 100nM. Gene expression profiles of vitamin D receptor (VDR), MyoD, IGF-1, neonatal myosin heavy chain (MHC), and the fast MHC subtypes Ia, IIa, IIb and IId/x were analyzed by quantitative RT-PCR. Protein expression of MHC subtypes was evaluated by western blotting and immunostaining. Eldecalcitol upregulated gene expression of VDR, MyoD and IGF-1. Incubation with eldecalcitol in the absence of serum followed by the addition of serum after 1h was associated with greater increases in the expression of these genes compared with co-incubation with eldecalcitol and serum. Gene expression of MHC subtypes IIa, IIb and IId/x was significantly increased by eldecalcitol. Protein expression of fast MHC subtypes was significantly increased by eldecalcitol at 1 and 10nM. Similar to the active form of vitamin D, eldecalcitol had an anabolic effect on fast MHC subtypes. Taking into account its pharmacokinetic profile, eldecalcitol is expected to be beneficial for the maintenance and improvement of muscle function in elderly individuals.

The use of incretins and fractures - a meta-analysis on population-based real life data.

The aim of the present study was to estimate the effect of incretins on fracture risk in the real-world situation by meta-analysis of the available population-based cohort data. Pubmed and Embase were searched for original articles investigating use of incretin agents, and fracture risk up to December 2015. Adjusted results were extracted and pooled by use of generic inverse variance methods, assuming a random-effects model. Neither current dipeptidyl peptidase 4-inhibitor use nor current glucagon-like peptide 1 receptor agonist use was associated with a decreased risk of fracture: pooled relative risk (pooled RR [95% confidence interval]: 1.02 [0.91-1.13] and 1.03 [0.87-1.22]), respectively. This meta-analysis demonstrated that current use of incretin agents, was not associated with decreased fracture risk. Our findings show the value of representative real-world populations, and the risks associated with suggesting benefits for medications on the basis of safety reporting in randomized controlled trials.

Parathyroidectomy for asymptomatic primary hyperparathyroidism: A revised cost-effectiveness analysis incorporating fracture risk reduction

Recent data demonstrate decreased fracture risk after operation for asymptomatic primary hyperparathyroidism. We performed a revised cost-effectiveness analysis comparing parathyroidectomy versus observation while incorporating fracture risk reduction. A Markov transition-state model was created comparing parathyroidectomy and guideline-based medical observation for a 60-year-old female patient with mild asymptomatic primary hyperparathyroidism. Costs were estimated using published Medicare reimbursement data. Treatment strategy outcomes, including risk of fracture, were identified by literature review. Quality adjustment factors were used to weight treatment outcomes. A threshold of $100,000/quality-adjusted life year was used to determine cost-effectiveness. Sensitivity analyses and Monte Carlo simulation were performed to examine the effect of uncertainty on the model. Parathyroidectomy was the dominant strategy (less costly and more effective) with an incremental cost savings of $1,721 and an incremental effectiveness of 0.185 quality-adjusted life years. Parathyroidectomy remained dominant when the relative risk reduction of fracture after operation was ≥14%, the cost of fracture was ≥$7,600, or the probability of recurrent laryngeal nerve injury was <12.5%. Monte Carlo simulation showed parathyroidectomy was cost-effective in 995/1,000 hypothetical patients. When fracture risk reduction is considered, parathyroidectomy for mild asymptomatic primary hyperparathyroidism is the dominant strategy when compared to observation.

Age and Sex Differences in Body Mass Index as a Predictor of Hip Fracture: A NOREPOS Study.

It is unclear whether very high body mass index (BMI; weight (kg)/height (m)2) lowers risk of hip fracture. Our objectives in this study were 1) to examine the association between BMI and subsequent hip fracture according to sex and age and 2) to explore whether the importance of known risk factors varied across BMI. We followed 61,787 participants (29,511 female and 32,276 male) in the Cohort of Norway (ages 50-79 years at baseline in 1994-2003) with regard to hip fracture. BMI was calculated from measured height and weight. During a median follow-up period of 8.4 years, 1,603 women and 951 men suffered a hip fracture. Hazard ratios for hip fracture and associated 95% confidence intervals were estimated. After adjustment for potential confounders, women with BMI <22 had a hazard ratio of 1.38 (95% confidence interval (CI): 1.18, 1.60) for hip fracture, as compared with women with BMI 22-24.9; and women with BMI ≥30 had a hazard ratio of 0.57 (95% CI: 0.49, 0.66). Corresponding results in men were hazard ratio = 1.66 (95% CI: 1.35, 2.05) and hazard ratio = 0.77 (95% CI: 0.62, 0.96), respectively. Below age 70 years, there was no further decrease in fracture risk at BMIs of 25 or more, while in women aged 70-79 years, the risk continued to decrease with increasing BMI. The associations between risk factors and hip fracture were similar in strength across BMI strata.

Preliminary results of Vitamin D supplementation in residents of aged care facilities

Introduction: Inadequate vitamin D is associated with osteoporosis and fractures. Vitamin D can be obtained in sufficient amounts from adequate sunlight exposure; however, residents of aged care facilities (ACFs) typically have little sunlight exposure. Subsequently, residents may be at an increased risk of premature death or prolonged rehabilitation due to osteoporotic fractures. It is recommended that all residents be supplemented with 1000 IU vitamin D daily and consume an adequate calcium intake. Aims: To determine the current rate of vitamin D supplementation amongst residents of ACFs in Tasmania. Methods: Resident details from consenting Tasmanian ACFs were recorded. Information included demographics, daily vitamin D and calcium supplementation, estimated daily calcium intake, estimated sun exposure, diagnosis of osteoporosis, and history of falls and fractures. Results: Details of 448 mobile, non-palliative residents (309 female and 139 male) from eight ACFs were obtained. Residents were 849 years of age. Most (n=281, 63%) had little or no sunlight exposure. One hundred and forty-four residents (32%) were recorded as having osteoporosis or a past fracture. Daily vitamin D supplementation of at least 1000 IU occurred in 87 of these residents (60%) and in 162 of 304 residents with neither (53%). There was no statistical difference in supplementation between the groups (P=0.16). Discussion: Vitamin D supplementation rates remain below desired levels amongst the residents of Tasmanian ACFs, even in the higher risk group of those with a documented history of osteoporosis or fractures. According to the current guidelines for residents of ACFs, all residents should be taking a vitamin D supplement (combined with adequate calcium intake) to improve bone strength and decrease fracture risk. In this population the consequences of fractures include death or a lengthy rehabilitation. Therefore, all positive fracture avoidance measures, such as adequate vitamin D supplementation, should be implemented. Our results strongly suggest the need for an intervention targeted at improving the rates of vitamin D supplementation within ACFs.

Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data.

SummaryPatient characteristics contributing to imminent risk for fracture, defined as risk of near-term fracture within the next 12 to 24 months, have not been well defined. In patients without recent fracture, we identified factors predicting imminent risk for vertebral/nonvertebral fracture, including falls, age, comorbidities, and other potential fall risk factors.PurposeSeveral factors contribute to long-term fracture risk in patients with osteoporosis, including age, bone mineral density, and fracture history. Some patients may be at imminent risk for fracture, defined here as a risk of near-term fracture within 12–24 months. Many patient characteristics contributing to imminent risk for fracture have not been well defined. This case-control study used US commercial and Medicare supplemental insured data for women and men without recent fracture to identify factors associated with imminent risk for fracture.MethodsPatients included were aged ≥50 with osteoporosis, had a vertebral or nonvertebral fracture claim (index date; fracture group) or no fracture claim (control group) from January 1, 2006, to September 30, 2012, continuously enrolled and without fracture in the 24 months before index. Potential risk factors during the period before fracture were assessed.ResultsUsing data from 12 months before fracture, factors significantly associated with imminent risk for fracture were previous falls, older age, poorer health status, specific comorbidities (psychosis, Alzheimer’s disease, central nervous system disease), and other fall risk factors (wheelchair use, psychoactive medication use, mobility impairment). Similar findings were observed with data from 24 months before fracture.ConclusionsIn patients with osteoporosis and no recent fracture, falls, older age, poorer health status, comorbidities, and other potential fall risk factors were predictive of imminent risk for fracture. Identification of factors associated with imminent risk for vertebral/nonvertebral fracture may help identify and risk stratify those patients most in need of immediate and appropriate treatment to decrease fracture risk.Electronic supplementary materialThe online version of this article (doi:10.1007/s11657-016-0280-5) contains supplementary material, which is available to authorized users.

Sex hormones in women with kidney disease.

Menstrual disorders, infertility and premature menopause are common but often underrecognized phenomena among women with chronic kidney disease. Hypothalamic, rather than ovarian dysfunction, may be the cause of the abnormal reproductive milieu, which can be at least partially reversed by kidney transplantation and increased intensity of hemodialysis. Endogenous sex hormones, and specifically estradiol, appear to be renoprotective in women, although the effects of exogenous estradiol (as an oral contraceptive and postmenopausal hormone therapy) on kidney function are more controversial. Treatment with postmenopausal hormone therapy in women with end-stage kidney disease (ESKD) has been associated with improved quality of life, bone health and markers of cardiovascular risk, as well as an increased risk of arteriovenous access thrombosis. The selective estrogen receptor modulator raloxifene has been associated with both a decreased fracture risk as well as renoprotection in women with kidney disease. Young women with ESKD are more likely to die from infection or develop malignancy, suggesting an immunomodulatory role of estrogen. Whether the premature menopause commonly observed in female patients with kidney disease results in increased cardiovascular morbidity and mortality is unknown, although preliminary studies have suggested a possible therapeutic role for manipulation of the sex hormone milieu to mitigate risk in this population. Large, prospective, randomized studies examining the role of sex hormones in women with kidney disease are required to address the question.

Femoral strain during walking predicted with muscle forces from static and dynamic optimization

Mechanical strain plays an important role in skeletal health, and the ability to accurately and noninvasively quantify bone strain in vivo may be used to develop preventive measures that improve bone quality and decrease fracture risk. A non-invasive estimation of bone strain requires combined musculoskeletal – finite element modeling, for which the applied muscle forces are usually obtained from static optimization (SO) methods. In this study, we compared finite element predicted femoral strains in walking using muscle forces obtained from SO to those obtained from forward dynamics (FD) simulation. The general trends in strain distributions were similar between FD and SO derived conditions and both agreed well with previously reported in vivo strain gage measurements. On the other hand, differences in peak maximum (εmax) and minimum (εmin) principal strain magnitudes were as high as 32% between FD (εmax/εmin=945/−1271με) and SO (εmax/εmin=752/−859με). These large differences in strain magnitudes were observed during the first half of stance, where SO predicted lower gluteal muscle forces and virtually no co-contraction of the hip adductors compared to FD. The importance of these results will likely depend on the purpose/application of the modeling procedure. If the goal is to obtain a generalized strain distribution for adaptive bone remodeling algorithms, then traditional SO is likely sufficient. In cases were strain magnitudes are critical, as is the case with fracture risk assessment, bone strain estimation may benefit by including muscle activation and contractile dynamics in SO, or by using FD when practical.

Prevention and Treatment of Bone Disease in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE), an autoimmune chronic inflammatory disease, can be associated with significant morbidity and mortality of which bone disease such as osteoporosis is a contributor. Patients with SLE are at risk for low bone mineral density (BMD) due to a variety of reasons including inflammation, glucocorticoid use, vitamin D deficiency, premature ovarian failure, increased damage, and traditional risk factors such as age and gender. With better treatments for SLE, survival has improved; therefore, complications from morbidity including osteoporosis need better prevention and treatment strategies. In SLE patients with osteoporosis or those on glucocorticoids who meet guidelines for therapeutic intervention, we prefer bisphosphonates as first-line therapy for most patients. They have proven efficacy in increasing BMD and decreasing fracture risk, known safety profiles, and have a favorable cost-effectiveness profile. The newer agents, teriparatide and denosumab, have not only demonstrated improvement in BMD but also decreased risk of fracture. We typically recommend these medications for some high-risk populations, those who have failed bisphosphonate therapy or those who are intolerant of oral bisphosphonates. Estrogen-containing drugs are not recommended for first-line prevention and treatment of osteoporosis given the elevated risk of cardiovascular disease. Calcitonin has also been used in osteoporosis; however, the bisphosphonates and newer drugs have proven to be more efficacious. Supplementation with calcium and vitamin D is recommended in particular with those patients who are vitamin D deficient and those on glucocorticoids, although data documenting fracture prevention with this strategy is limited. Therapeutic strategies for premenopausal women of child-bearing potential remain controversial because of limited data about safety in subsequent pregnancies. Decisions for these patients need to be made on a case by case basis weighing the risks and benefits to the individual patient. Future therapies targeting different mechanisms within bone resorption and formation are currently under investigation and will significantly add to our limited armamentarium.

Smoking & Bone.

Smoking is associated with decreased bone mineral density(BMD)and increased fracture risk. Conversely, smoking cessation results in BMD gain and decreased fracture risk, suggesting that smoking-induced bone metabolic changes are partially reversible. However, the mechanism of bone fragility induced by smoking is unknown. Meta-analyses have shown that aberrant PTH-vitamin D axis may affect bone metabolism in smokers. Previous animal studies have also reveled that nicotine, one of the major toxic substances of cigarettes, negatively regulates bone formation. This brief review will summarize recent studies on the effects of smoking on bone metabolism, including our recent results evaluating bone metabolic changes after smoking cessation.

Comparison of parameters of bone profile and homocysteine in physically active and non-active postmenopausal females.

Background and objectives:Optimal physical activity is important in attaining a peak bone mass. Physically active women have better bone mineral density and reduce fracture risk as compared to females living a sedentary life. The objective of this study was to compare parameters of bone profile and serum homocysteine levels in physically active and non-active postmenopausal females.Methods:In this cross sectional study postmenopausal females between 50-70 years of age were recruited and divided into two groups: Physically inactive (n=133) performing light physical activity and Physically active (n=34) performing moderate physical activity. Physical activity (in metabolic equivalents), bone mineral density and serum homocysteine levels were assessed. Spearman’s rho correlation was applied to observe correlations. Two independent sample t test and Mann Whitney U test were applied to compare groups. P-value ≤ 0.05 was taken statistically significant.Results:Parameters of bone profile were significantly higher and serum homocysteine levels were significantly lower in postmenopausal females performing moderate physical activity as compared to females performing light physical activity. Homocysteine was not significantly related to T-score and Z-score in both groups.Conclusion:Improving physical activity could be beneficial for improving the quality of bone, decreasing fracture risk and decreasing serum homocysteine levels.

On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Osteoporosis associated with sex hormone depletion treatment

Breast cancer and prostate cancer are sex hormone-dependent cancers and suppression of estrogen or androgen function is the standard therapy for those cancers. One of its important adverse effects is bone loss or osteoporosis. Recent evidences are : 1) Endocrine therapy for breast cancer or prostate cancer is associated with significant bone loss. 2) Treatment with aromatase inhibitors (AI) for breast cancer is associated with significant increase of pathologic fractures. Androgen depletion treatment (ADT) for prostate cancer is also probably associated with increased risk of fracture. 3) Bisphosphonates and denosumab treatment increases bone mineral density of patients treated with endocrine therapy for breast cancer. Bisphosphonates, denosumab and SERMs (raloxifene and toremifene) increase bone mineral density of patients treated with ADT for prostate cancer. 4) Bisphosphonates and denosumab decrease fracture risk of AI-treated breast cancer patients. Toremifene and denosumab decrease fracture risk of ADT-treated prostate cancer patients.

Intraoperative Periprosthetic Fractures in Proximal Interphalangeal Joint Arthroplasty

To examine the frequency, risk factors, and postoperative outcomes associated with intraoperative periprosthetic fractures during proximal interphalangeal (PIP) joint arthroplasty. We examined 382 consecutive PIP joint arthroplasties in 205 patients. Procedures were performed from 1998 to 2012. The patients were identified and outcomes were collected through a single institution's total joints registry, collecting additional information not contained in the prospectively collected registry through medical record examination. Multiple outcomes were analyzed relating to the fractures, the hard surgical outcomes, finger function, and radiographic findings. Statistical analysis was performed utilizing Kaplan-Meier survival models, log-rank tests, univariate analysis, Student t test and Fisher exact test. Intraoperative periprosthetic fracture occurred in 5% (n= 20) of 383 PIP joint arthroplasties. All of the patients who had an intraoperative fracture were women. Lower body mass index and a diagnosis of rheumatoid arthritis were associated with a significantly higher risk of intraoperative fracture. The use of pyrocarbon implants also significantly increased fracture risk. At a median follow-up of 5.3 years, there were no refractures in the patients who sustained an intraoperative fracture. Six patients underwent revision surgery, with a 2- and 5-year survival rate free of revision surgery of 76% and 64%, respectively. These rates were not significantly different from those without intraoperative fractures. There was no significant difference in the incidence ofpostoperative complications between patients with or without an intraoperative fracture. Intraoperative fractures occur in about 5% of PIP joint arthroplasties. These periprosthetic fractures do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications. Female sex, lower body mass index, rheumatoid arthritis, and the use of pyrocarbon implants were associated with increased risk for intraoperative fractures. This information may help decrease fracture risk and help surgeons identify andtreat the fractures when they do occur. Prognostic II.

SSRI use and risk of fractures among perimenopausal women without mental disorders

BackgroundSelective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among...

A randomised controlled trial of low-dose aspirin for the prevention of fractures in healthy older people: protocol for the ASPREE-Fracture substudy

BackgroundDisability, mortality and healthcare burden from fractures in older people is a growing problem worldwide. Observational studies suggest that aspirin may reduce fracture risk. While these studies provide room for...