Risk Factors For Fracture Research Articles

Fractures at various skeletal sites are dependent on different risk factors: the results from 10 years of prospective longitudinal observation in postmenopausal women from the RAC-OST-POL Study.

The aim of the study was to present data on risk factors for fractures in various parts of the skeleton in a cohort of postmenopausal women during a 10-year prospective observation period. It can be hypothesised that fracture risk factors should be different for spine, hip, and peripheral fractures. 640 postmenopausal women at mean baseline age was 65.0 ± 6.9 years were enrolled into the study. The cohort was randomly selected from the population of the entire Racibórz district. Data on the incidence of fractures and falls were updated annually during the 10-year follow-up period. Information on clinical risk factors for fractures was collected at baseline. During the observation period, 190 low-traumatic fractures were recorded in 129 patients. The following number of fractures was observed: hip 15, spine 30, non-hip fractures other than spine 145 (including 81 forearm fractures). The effect of falls was insignificant in the case of spine fractures (chi-square test: 3.64; p = 0.06). For all other skeletal sites, the incidence of fractures was significantly increased by falls, with the greatest effect observed for forearm fractures and non-spine and non-hip fractures (chi-square test for hip, forearm, and all non-spine, non-hip fractures was 6.43, p < 0.05; 42.7, p < 0.0001 and 66.7, p < 0.0001, respectively). To determine the factors having a significant impact on the incidence of fractures during the observation period, logistic regression was used separately in subgroups. The following risk factors were taken into account: age, height, body weight, bone mineral density (BMD) at the femoral neck as expressed by T-score, rheumatoid arthritis, steroid use, falls reported at baseline, and the total number of risk factors. Spine fractures depended only on T-score, odds ratio (OR) = 0.42 (0.23-0.76); hip fractures depended only on age, OR = 1.15 (1.07-1.24); forearm fractures depended only on age T-score, OR = 0.69 (0.51-0.92); and non-hip, non-spine on fall rate, OR = 1.86 (1.20-2.87). Fractures at various skeletal sites recorded in long-term follow-up in postmenopausal women were dependent on various risk factors. Multivariate analysis identified a single, dominant risk factor for each fracture location analysed.

Risk Factors for Adjacent Vertebral Fractures Following Cement Vertebroplasty: The Clinical Significance of Multiple Preexisting Vertebral Compression Fractures.

A retrospective cohort study. The study retrospectively analyzed the factors associated with the development of adjacent vertebral fractures. Adjacent vertebral fractures (AVF) may occur following cement vertebroplasty, and several risk factors have been reported with controversies. A total of 123 patients, with a mean age of 79.2 years, who underwent single-level vertebroplasty were included in the investigation. We systematically collected data encompassing baseline demographics, osteoporosis parameters, surgical details, radiologic measurements, and Hounsfield unit (HU) values in the lumbar spine. Subsequently, univariable, followed by multivariable logistic regression analyses, were employed to identify the risk factors of AVFs. Thirty of 123 patients had AVFs within 6 months following vertebroplasty. The AVF group exhibited a higher percentage of multiple preexisting vertebral compression fractures (P=0.006), a greater volume of injected cement (P=0.032), and a more pronounced reduction in local kyphosis (P=0.007). Multivariable logistic regression analysis revealed multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees were independent risk factors for AVFs (P=0.008 and 0.003, respectively), with odds ratios of 3.78 (95% confidence interval: 1.41-10.12) and 4.16 (95% CI: 1.65-10.50), respectively. Subgroup analysis showed that patients with multiple preexisting vertebral compression fractures (VCFs) had significantly lower bone mineral density Z-score, T-score, and HU values compared with those without preexisting VCFs (P<0.05). Conversely, there were no significant differences in T-score or HU values between patients with no VCFs and those with a single VCF. This study demonstrated that both bone strength and local alignment are key factors associated with adjacent vertebral fractures. Specifically, having multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees are independent risk factors. The presence of more than one previous vertebral compression fracture serves as a significant clinical indicator of advanced bone density reduction in patients with osteoporosis, offering a quick and straightforward method for identifying high-risk patients. Patients exhibiting these risk factors should be monitored more closely for favorable clinical outcomes. Level III-retrospective nonexperimental study.

Falls and fractures in men with prostate cancer taking second-generation androgen receptor antagonists: A retrospective chart review.

Second-generation androgen receptor antagonists, including enzalutamide, apalutamide, and darolutamide, are commonly used to treat metastatic and non-metastatic prostate cancer. Although these medications are typically well-tolerated, falls were reported in 4.2-15.6% of patients and fractures in 4.2-11.7% of patients enrolled in the phase III clinical trials evaluating these drugs in prostate cancer. However, post-marketing studies have reported a lower incidence than reported in clinical trials. The objective of this study is to determine the prevalence of falls and fractures in patients with prostate cancer receiving second-generation androgen receptor antagonists at UConn Health and identify potential risk factors associated with falls and fractures in these patients. A retrospective chart review involving patients with prostate cancer treated with darolutamide, enzalutamide, or apalutamide from March 1, 2022, to March 31, 2023, at UConn Health Carole & Ray Neag Comprehensive Cancer Center. Data recorded includes basic demographics, history of fall or fracture, presence of metastases, fall risk, history of osteoporosis, prescribed second-generation androgen receptor antagonist, and other comorbidities. Data was evaluated using descriptive statistics. Twenty-six men were included, all of whom were receiving enzalutamide. At baseline, 96.1% of patients had bone metastases, 15.4% had osteoporosis, 15.4% had osteopenia, and 34.6% had neuropathy. The incidence of falls was 19.2% and the incidence of fractures was 26.9%. The mean length of therapy at time of a fall was 19.44 months (range, 6-31 months). The mean length of therapy at time of a fracture was 19 months (range, 1-33 months). In patients experiencing fall, 100% had arthralgia, 60% had neuropathy, 40% had a gait problem, 40% had hypertension, and 80% of them were at risk of fall. In patients experiencing fracture, 28.6% had osteoporosis, 42.9% had osteopenia, 100% had bone metastases, and 57.1% were on denosumab at time of fracture. The prevalence of falls and fractures in patients receiving enzalutamide were higher in this retrospective chart review than reported in clinical trials and post-marketing studies. This could be due to the small patient population or the patient's comorbidities such as osteoporosis, bone metastases, or neuropathy. Fall/fracture risk with enzalutamide and other risk factors for fall and fracture should be considered when discussing treatment and developing a monitoring plan.

Factors associated with rod fracture following surgery for adult spinal deformity: a single-center retrospective study.

Adult spinal deformity (ASD) has a significant impact on trunk balance and quality of life in the elderly. Postoperative rod fractures pose significant challenges, but the mechanisms of their occurrence are underexplored compared to other complications such as proximal junctional kyphosis. This study investigated factors associated with rod fracture in patients with ASD. A retrospective single-center study analyzed 110 adult patients who underwent spinal deformity correction between 2012 and 2020. Comparative analysis and univariate and multivariate Cox regression analyses were employed to identify factors associated with rod fracture. In this study, rod fracture occurred in 14.5% of patients. The rod fracture group exhibited a larger change in lumbar lordosis (LL), a higher proportion of patients with pre-operatively existing (pre-existing) vertebral fractures, and a greater percentage of patients with a rod diameter of 6mm or less compared to the non-rod fracture group. Univariate Cox regression analysis revealed that rod fracture was associated with pre-existing vertebral fracture, LL change, preoperative sagittal vertical axis, and preoperative pelvic tilt. Multivariate Cox regression analysis identified pre-existing vertebral fractures and the amount of LL change as independent factors associated with rod fractures. Pre-existing vertebral fractures and the magnitude of lumbar lordosis correction are independent risk factors for rod fracture following ASD surgery. Surgeons should consider these factors during preoperative planning to reduce the risk of postoperative rod fracture. IV.

Is decreased psoas volume a risk factor for hip fracture? A comparative study of patients with and without hip fractures using the exact matching technique

IntroductionSarcopenia is linked to increased fall and hip fracture risk. However, studies often overlook comprehensively controlling for age, sex, bone mineral density (BMD), and body mass index (BMI). Our study aimed to determine if sarcopenia, determined by evaluating the psoas muscle volume, is an independent risk factor for hip fractures. We employed a methodological approach that includes the exact matching technique. MethodsIn this cross-sectional comparative study, we compared the data of patients who sustained hip fractures between 2015 and 2021 with those of a control group from a health screening center in a single center. The study included 545 patients with hip fractures and 1292 without fractures. We collected data on demographics, BMD determined using dual-energy X-ray absorptiometry, and abdominal and pelvic computed tomography (APCT) scans for psoas muscle volume analysis. ResultsThe analysis after exact matching of 266 pairs revealed that psoas volume/height2 was the most significant and dominant risk factor among the evaluated indices. Multivariate logistic regression analysis, adjusting for age, sex, BMI, and BMD, identified height or height2-adjusted psoas muscle volume as an independent risk factor for hip fractures (p = 0.042 and p = 0.002, respectively). Age, female sex, lower BMI, and lower BMD were associated with an increased risk of hip fractures. ConclusionDecreased psoas muscle volume adjusted for patient height independently predicts hip fracture risk. Psoas volume assessment via APCT is a practical tool for identifying at-risk individuals, emphasizing the necessity of including sarcopenia in hip fracture risk assessments.

Higher FSH Level Is Associated With Increased Risk Of Incident Hip Fracture In Older Adults, Independent Of Sex Hormones.

Higher levels of FSH are associated with bone loss among women during the perimenopausal transition and among older men, independent of estradiol and testosterone levels, but whether higher FSH is an independent fracture risk factor is unknown. Determine whether baseline FSH level predicts subsequent hip fracture in older adults. Using a case-cohort design, we randomly sampled 295 participants stratified by sex from the Age, Gene/Environment Susceptibility (AGES)-Reykjavik cohort, including 25 participants with incident hip fracture within 10 years after baseline. We sampled an additional 230 sex-stratified participants with incident hip fracture. Serum FSH and sex hormone levels were measured at baseline. Robust weighted Cox proportional hazards models were used to determine the relationship between FSH and hip fracture risk. Incident hip fracture. As no interaction was identified between FSH and sex for the relationship with fracture, men and women were pooled for analysis. Higher levels of FSH were associated with a significantly increased risk of incident hip fracture in models adjusted for age and sex [hazard ratio (HR) 1.24 (95% CI 1.04-1.48, p=0.02)] and after further adjustment for estradiol, testosterone, and sex hormone binding globulin levels [HR 1.20 (95% CI 1.01-1.44, p=0.04) per sex-specific SD increase in FSH level]. Higher FSH is associated with increased risk of subsequent hip fracture. Our findings support a growing body of evidence for direct pleiotropic effects of FSH on bone, and for a role for FSH in aging and disability independent of sex hormone levels.

7459 Predictors of a Second Fracture in Men With Osteoporosis-related Fractures

Abstract Disclosure: R.H. Lee: None. Y. Wang: Employee; Self; Radius Health, Inc. S.A. Williams: Employee; Self; Star Biopharma, LLC. N. Pyrih: Employee; Self; Cobbs Creek Healthcare. B.H. Mitlak: Employee; Self; Radius Health, Inc. J.R. Curtis: Consulting Fee; Self; Amgen Inc, Eli Lilly &amp; Company, Radius Health, Inc, UCB. Grant Recipient; Self; Amgen Inc, Eli Lilly &amp; Company, Radius Health, Inc, UCB. Background: Management of osteoporosis (OP)-related fractures in men is suboptimal. Real-world evidence suggests that, after men sustain a first fracture, they experience a higher risk for subsequent fracture and greater mortality compared to women. There is limited knowledge regarding absolute risk and predictors of second fractures in men and fracture risk assessment tools may be less accurate in men (Vilaca et al 2022). The objective of this study was to develop a model to identify risk factors for a second fracture in men in the year following an initial fracture. Methods: Anonymized patient-level medical and pharmacy claims data from Symphony Health PatientSource® were used. The study criteria included males ≥40 years with a case-qualifying OP-related fracture between January 1, 2017 to May 31, 2021 based on a claims-based validated algorithm (Wright et al 2019). Logistic regression models with a binary outcome of a second fracture versus no second fracture within one year of index fracture were created to predict second fracture occurrence. The study built upon a previous model (Williams et al 2021) developed for OP-related fractures for both men and women incorporating additional variables relevant to men based on the current literature. A separate model to identify risk factors for a secondary nonvertebral fracture (NVF) in men was also developed. Results: Of 956,828 men identified with an index fracture (677,047 commercial; 279,781 Medicare Advantage), 13% (126,106) experienced a second fracture within 1 year following the index fracture. More than two thirds of secondary fractures were NVFs. Multivariable logistic regression showed that patients with an index fracture at the spine (OR [95% CI] 1.71 [1.68, 1.74]) or hip (OR [95% CI] 1.79 [1.75, 1.82]) were the most likely to have a second fracture within a year of index fracture. An index clinical spine fracture was not associated with an increased risk of secondary NVFs. Nonfracture spinal cord injury was included among the predictors with the greatest magnitude of estimate for NVF (OR [95% CI] 1.21 [1.08, 1.36]). In addition to fracture history, advanced age, history of falls, use of medications that increase fall risk, OP diagnosis, treatment with OP medication, low body weight, and excessive alcohol use were significant and the numerically largest predictors for a second fracture. Type 2 diabetes, but not GLP-1 use, also increased risk of secondary fracture. Variables negatively associated with future fractures included treatment history with alpha blockers (beta blockers in the Medicare cohort) and diuretics. Conclusion: Predictors of fracture in men were overall consistent with the literature (and risk factors identified in the FRAX risk calculator). Regardless of gender, recent fracture is always the highest risk factor for a secondary fracture. Presentation: 6/3/2024

9397 Shatter Proofing Bones: Revamping Osteoporosis Screening

Abstract Disclosure: R. Subramani: None. T. Gupta: None. M. Anwar: None. J. Pamula: None. Background: Osteoporosis is a common disease characterized by low bone mass, structural deterioration of bone tissue, and increased risk of fractures. The World Health Organization (WHO) has defined osteoporosis based on bone density measurements. According to their definition, osteoporosis is diagnosed when the bone density at the hip or spine is at least 2.5 standard deviations (SDs) below the mean bone density of a reference population of young, healthy women (T score ≤ -2.5). According to NHANES data from 2017-2018, the overall prevalence of osteoporosis among adults over 50 was found to be 12.6%. It was observed that the prevalence of osteoporosis was higher among women (19.6%) compared to men (4.4%). According to US Preventative Services Task Force (USPSTF), the guidelines for screening are as follows: BMD Testing (DEXA) for all women aged 65 and older, postmenopausal women younger than 65 with clinical risk factors for fracture including advancing age, previous fracture, glucocorticoid therapy, parental history of hip fracture, low body weight, current cigarette smoking, excessive alcohol consumption, rheumatoid arthritis, secondary osteoporosis. BMD Testing for Men is not recommended. The most used bone measurement test to screen for osteoporosis is central DXA which measures BMD at the hip and lumbar spine. Goal: To improve the osteoporosis screening using DXA scan in the outpatient internal medicine resident patient panel by 5% Study Design:Subjects were identified by an EPIC report and will include retrospective chart review of records from July 2022 and prospective screening until April 2024 for the outpatient IM clinic list of patients including both resident panel. Methods: Pre-intervention data analysis of current rates; Educating residents about appropriate screening; Utilization of osteoporosis screening as care-gap in EPIC ;Calling patients who are due for screening from IM residents patient panels; Post-interventional data analysis Results: The total number of patients on the residents panel was 196. Before interventions, screening rate for osteoporosis were 71.2% among residents' patients. After intervention, screening rates increased to 75.5%. There was a 4.3 % improvement in screening rate. Conclusion: Resident education, addressing Osteoporosis care gaps in EPIC and patient outreach are effective interventions to improve screening rates. Discussion: Osteoporosis screening remains an area of needed improvement in IM clinic. EPIC system should not only take age for prompting osteoporosis screening but also other factors such as family history, pre-mature fractures, steroid use, etc. Adding osteoporosis screening into the metric system are few steps to be considered for future directions. Presentation: 6/3/2024

Incidence and risk factors for limb fracture in greyhound racing in Western Australia.

Identification of risk factors for race day injury can improve greyhound welfare. Race day fractures are the most significant injury event and have the greatest negative impact on dog welfare and the industry's social license to operate. This study aimed to describe the incidence and risk factors for race-related fractures in greyhounds racing in Western Australia. Electronic extracts describing race level data and race day injuries were provided by Racing and Wagering Western Australia (RWWA). The incidence rate (IR) of fractures for all greyhound race starts in Western Australia from 1 January 2017-31/12/2023 was calculated per 1000 starts. Univariable and multivariable models using Poisson regression were used to calculate the IR ratio of fracture type based on race and greyhound-level factors. There were 198,008 racing starts and 662 (n = 643, 97.1% involving the limbs) fractures resulting in an IR of 3.3 fractures per 1000 starts (95%CI 3.1-3.6). Greyhounds that had an injury in their previous race were 2.3 times (95%CI1.4-4.3) more likely to have a forelimb fracture than greyhounds that did not have an injury (P = 0.013). The risk of tarsal bone fracture was greater in greyhounds older than 30 months and greyhounds that had not raced in the previous 15 days. Risk factors for fractures in the forelimb were associated with trauma after interference or dog collisions, whereas tarsal fractures were associated with strain and cyclic loading from race training/racing. Changes to racing structure, rules and policies based on these risk factors may help to reduce fracture incidence in racing greyhounds.

An anatomical study of thenar and hypothenar soft tissue thickness in men and women.

We hypothesized that reduced thenar soft tissue thickness may be a risk factor for distal radial fractures. We assessed MRI scans of the wrist in 78 adults. The 51 men had significantly higher palmar soft tissue thickness compared to the 27 women, even after adjusting for hand size.Level of evidence: IV.

Prior fragility fractures are associated with a higher risk of 8-year complications following total shoulder arthroplasty.

As the population ages, more patients with osteoporosis are undergoing total shoulder arthroplasty (TSA), including those who have sustained a prior fragility fracture. Sustaining a fragility fracture before TSA has been associated with increased risk of short-term revision rates, periprosthetic fracture (PPF), and secondary fragility fractures but long-term implant survivorship in this patient population is unknown. Therefore, the purpose of this study was to characterize the association of prior fragility fractures with 8-year risks of revision TSA, periprosthetic fracture, and secondary fragility fracture. Patients aged 50years and older who underwent TSA were identified in a large national database. Patients were stratified based on whether they sustained a fragility fracture within 3years prior to TSA. Patients who had a prior fragility fracture (7631) were matched 1:1 to patients who did not based on age, gender, Charlson Comorbidity Index (CCI), smoking, obesity, diabetes mellitus, and alcohol use. Kaplan-Meier and Cox Proportional Hazards analyses were used to observe the cumulative incidences of all-cause revision, periprosthetic fracture, and secondary fragility fracture within 8years of index surgery. The 8-year cumulative incidence of revision TSA (5.7% vs. 4.1%), periprosthetic fracture (3.8% vs. 1.4%), and secondary fragility fracture (46.5% vs. 10.1%) were significantly higher for those who had a prior fragility fracture when compared to those who did not. On multivariable analysis, a prior fragility fracture was associated with higher risks of revision (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.24-1.74; p < 0.001), periprosthetic fracture (HR, 2.98; 95% CI, 2.18-4.07; p < 0.001) and secondary fragility fracture (HR, 8.39; 95% CI, 7.62-9.24; p < 0.001). Prior fragility fracture was a significant risk factor for revision, periprosthetic fracture, and secondary fragility fracture within 8years of primary TSA. Identification of these high-risk patients with an emphasis on preoperative and postoperative bone health optimization may help minimize these complications. III.

Effects of Lumbar Spine Vertebral Fractures on Trabecular Bone Score (TBS): The Manitoba BMD Registry

Trabecular bone score (TBS) is a BMD-independent risk factor for fracture. During BMD reporting, it is standard practice to exclude lumbar vertebral levels affected by structural artifact. It is uncertain whether TBS is affected by lumbar spine fractures. The current study examined the effect of lumbar spine compression fractures on TBS measurements. We identified 656 individuals with vertebral fractures (mean age 75.8 ± 7.9 years, 90.9% female) who had lumbar spine DXA, TBS measurements from L1-L4 and vertebral fracture assessment (VFA) for identifying vertebral fractures. There were 272 cases with lumbar spine fractures and 384 controls with only thoracic spine fractures. L1 TBS and BMD were significantly greater in those with than without lumbar fractures (p< 0.001) but did not significantly differ for other vertebral levels or for L1-L4 combined. TBS and BMD measurements were then renormalized to remove level-specific differences (denoted rTBS and rBMD). The mean difference (all fractured minus all non-fractured vertebrae) was +0.040 (+3.3%) for rTBS and +0.088 g/cm2 (+9.5%) for rBMD (both p <0.001). The largest effect was for L1 with mean difference +0.058 (+4.9%) for rTBS and +0.098 g/cm2 (+10.6%) for rBMD (both p <0.001). The mean difference between fractured and non-fractured levels for rTBS was +0.028 (+2.4%) for grade 1, +0.036 (+3.0%) for grade 2 and +0.059 (+5.0%) for grade 3 fractures; for rBMD +0.051 (+5.5%), +0.076 (+8.2%) and +0.151 (+16.4%) g/cm2, respectively. The impact of excluding lumbar vertebral levels with fracture from the L1-L4 TBS measurement overall was small (-0.011 [-1.0%]; p<0.001) and was also small for grade 3 fractures (-0.020 [-1.7%]; p<0.001). In summary, TBS is mildly increased by VFA-confirmed lumbar vertebral fractures, but the percentage effect is much smaller (less than half) than seen for BMD and minimally affects TBS measured from L1-L4. This would support the use of L1-L4 without exclusions in individuals with lumbar vertebral fractures.

Predictors of lumbar spine trabecular bone score in women with postsurgical hypoparathyroidism

Hypoparathyroidism is a rare disease that markedly reduces bone remodeling, leading to increased bone mineral density and changes in bone microarchitecture. However, it is currently unclear how these changes affect fracture risk. In this study, we investigated bone mass by dual-energy x-ray absorptiometry, the occurrence of morphometric vertebral fractures, and bone microarchitecture by assessing trabecular bone score in women with postsurgical hypoparathyroidism. We included 67 women with hypoparathyroidism aged 52.9 ± 12.3 years and 63 age (52.9 ± 12.3 years) and body mass index-matched controls, which were assessed for femoral and lumbar spine bone mineral density, trabecular bone score, and vertebral fractures by dual-energy x-ray absorptiometry. Women with hypoparathyroidism had significantly higher bone mineral density at the lumbar spine, femoral neck, and total hip compared with controls despite similar trabecular bone score values. Vertebral fracture assessment indicated that two women with hypothyroidism presented vertebral fractures, both aged over 65 years. Conversely, no vertebral fractures were detected in control women. In a multivariate linear regression model, we found that older age, diabetes, and lower lumbar spine mineral density were significant predictors of lower trabecular bone score values. Our findings indicate that vertebral fractures are not common among women with postsurgical hypoparathyroidism aged under 65 years. Moreover, trabecular bone score values were similar in women with hypoparathyroidism and age-matched controls and were associated with traditional risk factors for fractures, such as older age, type 2 diabetes, and lower spine bone mineral density. Lay summaryChronic parathyroid hormone deficiency decreases bone turnover and modifies skeletal properties, although the impact of these changes on fracture risk remains unclear. We studied 67 women with postsurgical hypoparathyroidism and 63 age and body mass index-matched healthy controls and found that bone mineral density is increased in women with hypoparathyroidism despite similar trabecular bone score values and a low occurrence of morphometric vertebral fractures. This suggests that the low bone turnover in hypoparathyroidism increases bone mass, but this is not accompanied by improved bone microarchitecture, indicating that trabecular bone score may be a valuable tool to complement the assessment of skeletal health and the risk of fractures in this condition.

Incidence and Risk Factors of Proximal Junctional Complications and Rod Fractures After Long-Segment Fusion Surgery With Anterior Column Realignment for Adult Spinal Deformity: A Minimum 2-Year Follow-Up.

To investigate the incidence and risk factors of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and rod fractures in patients undergoing long-segment (≥4 levels) fusion surgery with anterior column realignment (ACR) for adult spinal deformity. Patients aged ≥60 years with at least a 2-year follow-up were grouped based on PJK, PJF, and rod fracture occurrence. Patient, surgical, and radiographic factors were compared to identify risk factors for these complications. Independent risk factors were identified using univariate and multivariate logistic regression. Among 106 patients, the incidence rates of PJK, PJF, and rod fractures were 15.1%, 28.3%, and 17.9%, respectively. PJK was significantly associated with fewer fusion levels (odds ratio [95% CI], 0.30 [0.13-0.69]), a cranially directed uppermost instrumented vertebra (UIV) screw angle (1.40 [1.13-1.72]), postoperative overcorrection of age-adjusted pelvic incidence-lumbar lordosis (LL) (7.22 [1.13-45.93]), and a large increase in thoracic kyphosis (1.09 [1.01-1.17]). PJF risks were associated with a cranial UIV screw orientation (1.23 [1.09-1.39]), overcorrection of age-adjusted pelvic incidence-LL (10.80 [2.55-45.73]), and a smaller change in sacral slope (0.87 [0.80-0.94]). For rod fractures, prominent factors included a greater number of fusion levels (1.70 [1.17-2.46]), a larger postoperative LL (1.07 [1.01-1.15]), a smaller postoperative thoracic kyphosis (0.92 [0.86-0.98]), and smaller changes in sacral slope (0.73 [0.58-0.92]) and pelvic tilt (0.72 [0.56-0.91]). The incidence and risk factors of PJK, PJF, and rod fractures were similar to those observed in previous studies on long-segment fusion surgery without ACR. The number of ACR levels was not a significant risk factor for PJK, PJF, or rod fractures. When performing deformity correction using ACR, surgeons should carefully consider the direction of the UIV screw and ensure that overcorrection is avoided.

Utility of Radiographic Parameter in Assessing Bone Density and Subsequent Fractures in Patients With Osteoporotic Vertebral Compression Fracture.

To investigate the ability of radiological parameter canal bone ratio (CBR) to assess bone mineral density and to differentiate between patients with primary and multiple osteoporotic vertebral compression fracture (OVCF). A retrospective analysis was conducted on OVCF patients treated at our hospital. CBR was measured through full-spine x-rays. Patients were categorized into primary and multiple fracture groups. Receiver operating characteristic curve analysis and area under the curve (AUC) calculation were used to assess the ability of parameters to predict osteoporosis and multiple fractures. Predictors of T values were analyzed by multiple linear regression, and independent risk factors for multiple fractures were determined by multiple logistic regression analysis. CBR showed a moderate negative correlation with dual-energy x-ray absorptiometry T values (r = -0.642, p < 0.01). Higher CBR (odds ratio [OR], -6.483; 95% confidence interval [CI], -8.234 to -4.732; p < 0.01) and lower body mass index (OR, 0.054; 95% CI, 0.023-0.086; p < 0.01) were independent risk factors for osteoporosis. Patients with multiple fractures had lower T values (mean ± standard deviation [SD]: -3.76 ± 0.73 vs. -2.83 ± 0.75, p < 0.01) and higher CBR (mean ± SD: 0.54 ± 0.07 vs. 0.46 ± 0.06, p < 0.01). CBR had an AUC of 0.819 in predicting multiple fractures with a threshold of 0.53. T values prediction had an AUC of 0.816 with a threshold of -3.45. CBR > 0.53 was an independent risk factor for multiple fractures (OR, 14.66; 95% CI, 4.97-43.22; p < 0.01). CBR is negatively correlated with bone mineral density (BMD) and can be a novel opportunistic BMD assessment method. It is a simple and effective measurement index for predicting multiple fractures, with predictive performance not inferior to T values.

Fragility Fracture of Proximal Tibia in A Wheelchair-Bound 54-Year-Old Female Patient

Sedentary behavior is one of the risk factors of fracture, in which mild activity was found to be inversely associated with hip, vertebral, and total fracture. Other study also found non-linear association of fracture risk with lower and higher physical activity was associated with higher risk of any fracture compared to a mean physical activity. In this study, we reported a 54-year-old wheelchair bound female with fracture on the proximal tibia cause by low-energy trauma. This research underscores the importance of early identification of fracture risk factors, especially in vulnerable populations such as older adults who are wheelchair-bound. Early interventions that include lifestyle changes, increased physical activity, and nutritional management are essential to prevent further fractures and improve bone health. Identifying the risk of fractures on elderly patient may be beneficial for prevention of fractures especially in wheelchair-bound elderly individual.

DXA In People Living With HIV

Abstract Background As people with HIV now live a near normal life-span, prevention of fractures is increasingly important. Alongside conventional risk factors for fractures, antiretrovirals and chronic inflammation are believed to contribute to their increased fracture risk compared to the general population. Methods We audited a 1-year series of consecutive DXA scans conducted on people living with HIV vs the European AIDS Clinical Society guidelines on bone health. These guidelines specify indications for DXA, for repeat DXA and for osteoporosis treatment. We recorded DXA results, any prior DXA, fracture history, fracture risks and drug treatment history. We assessed frequency of scanning and pharmacological management of low bone mass vs. guidelines. Results N=90 referred for DXA, of whom 18% did not attend, leaving n=74; 58% female, 42% male, median age 52 years [36-64] and 56 years [49-69] respectively. Of the 18% (n=14) who were aged under 50, 43% had no clear indication (fracture risk factor) for DXA. Of those aged &amp;gt;50 years (n=60), all scans were indicated as the guidelines advises this in those aged &amp;gt;50 years. Bone density was normal in n=32 (43%), osteopenic in 36 (49%) and osteoporotic in 7 (9%). Fifteen percent overall had a fragility fracture history, none of whom were taking osteoporosis treatment though it was indicated in at least 4 based on their DXA result. N=12 (16%) had a DXA in preceding years, and just 2 of the repeat scans were indicated according to guidelines. For the 12 with serial scans, there was no significant change in T score after a median three-year period. Conclusion Through an audit of consecutive DXA referrals, rather than consecutive individuals, low bone mass and fragility fractures are prevalent in people living with HIV. With advancing age, fracture incidence may rise sizeable in this group therefore due attention to bone health guidelines in required.

Among people on osteoporosis medication, loss of appendicular or total body lean mass is an independent risk factor for hip and major osteoporotic fractures.

Sarcopenia increases fracture risk. If the risk persists after starting osteoporosis medication, patients may need to be encouraged to pursue strategies to prevent loss of lean mass. To estimate the effects of loss in appendicular lean mass (ALM) or total body lean mass (TBLM) on subsequent fracture risk and effect modification with anti-osteoporosis medication use. We conducted a registry-based cohort study linked to population-based data. We identified individuals ≥ 40years of age with two DXA assessments ≥ 1year apart and minimum 0.5years of observation. ALM and TBLM were estimated from weight, sex, and percent fat from DXA (R2 = 0.91 and 0.84 vs total body DXA, respectively). We report hazard ratios (HR) from Cox regression models estimating time to first incident major osteoporotic fracture (MOF) and hip fracture, adjusted for fracture risk; osteoporosis medication was included as an interaction term and used to stratify analyses. We included 21,249 individuals (mean 67 [SD 10] years, 95% female, 37% on osteoporosis medication). The mean follow-up was 7years (SD 4). A total of 1868 and 548 people had incident MOF and hip fracture, respectively. People with prior ALM loss (HR per SD 1.09, 95% CI 1.04-1.15) or TBLM loss (HR per SD 1.09, 95% CI 1.42-1.14) had a higher risk of MOF. Hip fracture risk was greater in people with prior ALM loss (HR per SD 1.22, 95% CI 1.12-1.33) and TBLM loss (HR per SD 1.26, 95% CI 1.16-1.38). There were no interactions with anti-osteoporosis medication use (all p > 0.3). When restricted to people on anti-osteoporosis medication, each SD in ALM or TBLM loss was associated with 8-9% increased MOF risk and 18-23% increased hip fracture risk. Loss of lean mass is associated with increased fracture risk among individuals on anti-osteoporosis medication. Patients should be encouraged to pursue strategies to prevent sarcopenia.

Risk Factors for Neonatal Clavicular Fractures: A Population-Based Case-Control Study.

Neonatal clavicular fractures represent the most common fracture during delivery. We aimed to define risk factors associated with these fractures in a large population-based database. Data were extracted from Clalit Health Services' electronic health records from 2000 to 2020. Newborns with clavicular fractures were compared with a healthy control group. The following parameters were compared-for the newborns: sex, birth weight, birth height, and head circumference; for the delivery process: assisted delivery, cesarean section, use of epidural, birth week, and number of fetuses; and for the mother: age at delivery, socioeconomic status, height, weight, and body mass index (BMI). We found a rate of 0.28% for neonatal clavicular fractures (5015 clavicular fractures/1 755 660 deliveries). Male gender and heavier birth weight were found to be significantly associated with clavicular fractures (P < .001). Increased risk was also associated with lower socioeconomic status, baseline weight, and maternal BMI (P < .001 for all). Assisted delivery increased the risk of clavicular fracture (OR = 2.274; 95% CI, 1.661-3.115; P < .0001), while cesarean section and use of epidural were found to be protective (OR = 0.149; 95% CI, 0.086-0.26; P < .0001; and OR = 0.687; 95% CI, 0.0531-0.89; P < .004, respectively). This study provides insight into the risk factors associated with neonatal clavicular fractures on the largest group of patients reported to date.

Physical activity in the prevention and treatment of osteoporosis: From biomarkers to quality of life

Introduction and Objective: Osteoporosis is a common skeletal disease typified by diminished bone density and deterioration of bone structure. It represents a significant risk factor for fractures, particularly in postmenopausal women. This study evaluates the role of physical activity and bone biomarkers in the prevention and treatment of osteoporosis. Review and Methods: A review of the literature was conducted with the objective of analysing the impact of weight-bearing exercise and resistance training on bone health and the use of biomarkers in diagnosing and monitoring osteoporosis. Moreover, the potential impact of dietary interventions and supplementation was examined. Abbreviated Description of the State of Knowledge: It is of the utmost importance to engage in regular physical activity, particularly weight-bearing exercises, in order to prevent and treat osteoporosis. It has been demonstrated to enhance bone density and moderate the likelihood of fracture. Biomarkers such as osteocalcin and alkaline phosphatase are of significant value in the assessment of bone health. Summary: The combination of physical activity, a balanced diet and appropriate supplementation is fundamental to the prevention and effective management of osteoporosis. This approach confers substantial benefits with respect to bone health and quality of life. Keywords: Osteoporosis; Physical activity; Bone health; Skeletal System