Diagnosis Of Osteoporotic Fractures Research Articles

Higher high-density lipoprotein cholesterol levels increased vertebral osteoporotic fracture, but reduced hip fracture in men based on the National Health Insurance Service-National Health Screening Cohort

BACKGROUND CONTEXTLipids are currently known to play an important role in bone metabolism. PURPOSEThis study aimed to investigate the effect of high-density lipoprotein cholesterol (HDL-C) on osteoporotic fractures beyond its beneficial effects on the cardiovascular system. STUDY DESIGN/SETTINGThis was a retrospective, observational study that used data from the National Health Insurance Service-Health Screening cohort database. PATIENT SAMPLEThis study included 318,237 participants who were 50 years or older and with HDL-C levels of 10 to 200 mg/dL. OUTCOMES MEASURESPhysiologic measure—Diagnosis of osteoporotic fracture during the follow-up period. METHODSThe study participants were categorized into four quartiles according to baseline HDL-C levels. The Cox proportional hazards model was used to assess osteoporotic fracture risk according to HDL-C levels. RESULTSAfter full adjustment and with the Q1 group as the reference group, estimates of hazard ratios (HRs; 95% confidence intervals [CIs]) for any osteoporotic fracture in men were 1.03 (0.94–1.12), 1.02 (0.93–1.11), and 1.07 (0.98–1.18) for the Q2, Q3, and Q4 groups, respectively. After classifying osteoporotic fractures according to the body location, the fully adjusted HRs for vertebral and hip fractures in the men's Q4 groups were 1.16 (1.02–1.31) and 0.74 (0.57–0.96), respectively. In women, fully adjusted HRs (95% CIs) of the female Q4 group for any osteoporotic, vertebral, and hip fractures were 1.03 (0.95–1.11), 0.96 (0.86–1.07), and 1.06 (0.80–1.41), respectively. CONCLUSIONIn this study, HDL-C levels were positively associated with vertebral fractures in both men and women but inversely related to hip fractures in men. Therefore, monitoring the lipid profiles of patients with osteoporosis may be beneficial for the prevention of osteoporotic fractures.

BURDEN OF ILLNESS OF OSTEOPOROTIC FRACTURES COMPARED TO OTHER SERIOUS DISEASES AMONG IBD PATIENTS

Abstract INTRODUCTION Inflammatory bowel disease (IBD) patients are off and on treated with steroids which is associated with increased risk of osteoporosis and fragility fractures. We conducted an analysis to study the burden of osteoporotic fractures compared to acute myocardial infarction (AMI) or stroke in hospitalized patients with IBD. METHODS We used the National Inpatient Sample database from 2007 through 2014, to identify patients admitted with primary or secondary diagnosis of IBD using the ICD-9 codes. We identified primary diagnosis of osteoporotic fractures (excluding traumatic injuries, open fracture, readmission indicators), acute myocardial infarction and stroke using respective diagnostic codes. We analyzed trends in nationwide estimates for annual admissions, age at admission, length of stay (LOS), in-patient mortality and total hospital charge (adjusted for inflation). RESULTS Over the eight-year study period, there were an estimated 2,296,145 admissions with IBD. Overall, hip fractures as primary diagnosis accounted for 0.5% of these hospitalizations, non-hip fractures for 0.6%, AMI for 0.8% and stroke for 0.6%. Among patients over 50 years old, the prevalence was 1.0% for hip fractures, 0.9% for non-hip fractures, 1.3% for AMI and 1.0% for stroke. Temporal trend was unchanged over the studied period. More females were admitted with fractures (70.5%) and strokes (55.7%) as compared to AMI (42.4%). Highest mortality was seen among patients admitted for stroke (7.1%), followed by AMI (4.1%) and fractures where mortality with hip fractures was significantly higher than non-hip fractures (2.7% vs 1.7%, p<0.05). The median age for patients with hip fractures was 78, much higher than for non-hip fractures (72), which was close to age for stroke (71), but higher than AMI (67). Mean LOS for stroke was 5.9 days, followed by hip fractures 5.8 days, non-hip fractures 5.6 days, and AMI 5.2 days. Mean charge for hospitalization was similar for hip fractures and non-hip fractures, ($52,399 vs $50,545) which was less than that for stroke ($55,569) and AMI ($70,970). After adjusting for inflation, there was a trend of increase in charge for all four admission diagnoses (Figure 1). CONCLUSION Proportion of IBD patients admitted primarily for nontraumatic fractures is similar to stroke admission, particularly in patients older than 50. Hip fractures are more common than non-hip fractures. Mortality is higher with hip fractures than non-hip fractures. LOS among studied causes is highest for hip fractures and stroke. Cost of hospitalization although not as much with fractures than AMI, showed a rising trend during the study period.

Diagnostic and therapeutic problems of back pain syndromes and their distribution according to a colour coding system of flags

Back pain poses a serious clinical problem in some cases, because under the clinical symptoms of back pain might be other hidden diseases. The aim of this study was to present difficulties in diagnosis and treatment of various diseases of the spine and 2. description to the flagship division, based on the traffic lights. The clinical material is based on a group of 20 patients with diagnostic and therapeutic difficulties, among 1825 patients treated due to low back pain. Diagnosis was based on clinical examination and various imaging techniques. In the case of cancer biopsy was performed, and in specific and nonspecific infections of the spine treated surgically toward the microscopic examination of tuberculous granulation tissue or inflammatory. The diagnosis of osteoporotic fractures was based on the digital 3D CT. The studied group of 20 patients were divided according to color flag system. Among the analyzed patients 14 received red flag, 5 yellow and 1 black. The red flag has received seven patients with spinal infection, 3 patients with cancer and two with osteoporotic fracture, and 2 patients with low back pain due to an aortic aneurysm. Yellow flag received 5 patients with compensation claims. 1. In patients with back pain, diagnostic examinations should be administered according to a particular order. Clinical and radiographic examinations are basic tools which should be supplemented by the modern techniques of MRI and CT. 2. Histopathological evaluation of tissue preparations facilitates the diagnosis of an infection or tumour. 3. Classification according to colored flags are useful in clinical practice. It describes the degree of risk of serious illness and difficulties in therapy.

Diagnosis of osteoporotic fracture

The concept and terminology for bone fractures is now in some confusion between two academic fields, one of osteoporosis and the other of orthopedic fracture treatment, concerning the treatment of osteoporosis and the prevention of fragility fractures. In the former field, the terms of "incident or prevalent" fracture are commonly used ; by contrast, bone fracture simply means "fresh" fracture in the latter. Used to be based of X-ray films, diagnosis of osteoporotic fracture are now changing to depend on MRI, because its sensitivity and specificity of detecting fresh fracture of vertebral body is far better than other methods.

Interventions to improve inpatient osteoporosis management following first osteoporotic fracture: the PREVENT project

To establish a protocol for the treatment of fragility fractures in the hospital setting based on treatment of osteoporosis. An intervention protocol was implemented in patients with fragility fractures based on (1) indicating the diagnosis of osteoporotic fracture in the summary of discharge; (2) "lifestyle recommendations"; and (3) therapy for osteoporosis. Thirty-one hospitals were involved and they were informed of the importance of protocol compliance. In the first phase, a retrospective study was conducted to establish the number of low-energy fractures treated and the percentage of them that had complied with the protocol (n = 887). Then, prospectively, the same data were collected for the patients managed for 1 year (n = 6,826) in three sections of 4-month intervals. The percentage of compliance increased from 8.2 to 57.2% in the first point, from 12.6 to 42.4% in the second, and from 10.3 to 43.2% in the third. The implementation of programs to improve osteoporosis treatment is very useful for ensuring adherence in the management of osteoporosis following admission due to fragility fracture.

Diagnosis and secondary prevention of osteoporosis. National study of osteoporotic fractures in outpatient trauma care

Objective: To study the degree of correlation between final diagnosis (osteoporotic fracture) and emergency department discharge diagnosis. To evaluate the degree of diagnosis and implementation of minimum measures for secondary prevention of osteoporosis. Materials and methods: This prospective, observational, multicenter national study collected data for five months in 358 specialty centers on all osteoporotic fractures (wrist, proximal humerus, vertebra and rib) treated for a period of 30 consecutive days in postmenopausal women aged≥50 years. Fractures were classified as osteoporotic if they were due to low-energy trauma. Pathological fractures and those requiring surgery were excluded. The number of patients with a diagnosis of osteoporosis prior to the current fracture and if theywere receiving any treatment for this disease was assessed. Inclusion of a diagnosis of fragility fracture in emergency department discharge reports and agreement with subsequent diagnosis in the specialty center were also assessed. Results: Of the total women studied, 2125 (41%) had suffered 2390 fractures prior to the current fracture. The most common prior fracture site was the distal radius. 1865 women (36%) had a prior diagnosis of osteoporosis and 1641 (32%) had been prescribed treatment for their disease. The most common treatments were vitamin D and calcium supplements (50%) followed by biphosphonates (39%). The total number of current fractures recorded was 5317, and the most common fracture site was the distal radius (2364 fractures, 46%). The risk of suffering a new fracture was consistently greater in the site of the previous fracture for all sites studied. Only 40% of fragility fractures were identified as such in the emergency department report, with the lowest percentages for wrist and humerus fractures (37% and 36%, respectively). There was a significant difference in the number of fragility fractures diagnosed in the trauma clinic (94% identified). Prevention of a new fragility fracture was recommended in 91% of women. Biphosphonates were the treatment chosen in over 86% of cases, followed by vitamin D and calcium supplements in 45%. Conclusion: Fragility fractures are an increasing health problem, and patients may have various fractures over their lifetime if available preventive measures are not applied. A diagnosis of osteoporotic fracture at discharge is lacking in 60% of patients treated in the emergency department. Only 45% of patients who were administered treatment for osteoporosis were prescribed vitamin D and calcium supplements.

Bone imaging: Traditional techniques and their interpretation

Patients with osteoporosis have to be diagnosed at an early stage to prevent fractures, the worst complication of this disease. Currently, measurements of bone mineral density (BMD) are used most frequently in the diagnosis of osteoporosis. According to the World Health Organization, osteoporosis is defined on the basis of BMD measurements that are compared with those of a healthy, young, female population. The best established techniques to measure BMD are dual x-ray absorptiometry of the lumbar spine and proximal femur and quantitative computed tomography of the lumbar spine. Conventional radiographs are not suited to assess bone mass, but they are important in the diagnosis and differential diagnosis of osteoporotic fractures. Quantitative ultrasound and structure analysis, based on high-resolution magnetic resonance imaging and computed tomography, are newer techniques in the diagnosis of osteoporosis that also focus on the assessment of bone structure.

Bone mineral mass associated with postmenopausal vertebral deformities

Vertebral morphometry on thoracic and lumbar spine radiographs and bone mass measurements were carried out on 215 patients investigated for postmenopausal osteoporosis. Bone mineral mass was measured on the central third of the skeleton by neutron activation analysis and the result, normalized for body size, expressed as a calcium bone index (CaBI). The normal CaBI value for females (20–40 years) is 0.97 (0.11) with a lower limit for these young, normal women, of 0.75. Vertebral compression deformity was defined as a mean height more than 15% lower than adjacent normal vertebrae. Thoracic and lumbar anterior wedge deformities and central compression were defined as anterior/posterior ( A P ) or mid/posterior ( M P ) height ratios of <0.75. For the 129 patients without vertebral deformities, the mean CaBI was 0.80 (0.12) (1 SD) and 32% of these patients had CaBI values below the normal young adult range (CaBI < 0.75). In 20 patients, vertebral deformities were limited to 1 or 2 mid-thoracic vertebrae, and the mean CaBI values for these 20 patients was 0.81 (0.15), equal to that for patients without any vertebral deformity. For the remaining 67 patients, (i.e., patients with one or more vertebral deformities involving at least one distal thoracic or one lumbar vertebra) the mean CaBI value was 0.66 (0.10), 17% below the value for patients without vertebral deformities. Low CaBI values (CaBI <0.75) were observed in 87% of these patients, consistent with the diagnosis of osteoporotic fractures. Based on our CaBI results, however, mid-thoracic deformity was not associated with significant osteopenia and is not, therefore, diagnostic of osteoporotic fracture.