Femoral Neck Research Articles

From common to unreported: a real-world study of adverse events to duloxetine in the treatment of osteoarthritis

ABSTRACT Background In a review of drug guidelines published by the International Association for the Study of Osteoarthritis, it is recommended to support the conditional use of duloxetine in patients with osteoarthritis. However, there is a lack of comprehensive research on the adverse events of duloxetine for the treatment of osteoarthritis populations. Research design and methods We used the reporting odds ratio (ROR) to determine the strength of the adverse event signal. In addition, we investigated trends in the occurrence of adverse events using the Weibull shape parameter (WSP) test. Results The results showed that 50 and 14 adverse events were detected in both Asian and American populations. Four new adverse events, Mouth ulceration, femoral neck fracture, incontinence, long QT syndrome, were identified. There was a difference in the time of adverse event induction between the North American and Asian populations (p < 0.0001). The Weibull shape parameter (WSP) test showed that the incidence of AE decreased over time. Conclusion Our study contributes to an in-depth understanding of the safety of duloxetine in the treatment of osteoarthritis.

Liposomal Bupivacaine Does Not Decrease Postoperative Pain in Patients with Intracapsular Femoral Neck Fracture Treated with Hemiarthroplasty: HEAT-A Randomized, Controlled Trial.

Liposomal bupivacaine (LB) is a long-lasting local anesthetic agent that was developed for use in the surgical setting to help manage postoperative pain. The objective of this study was to evaluate the effect of LB on postoperative pain, function, and overall hospital course in patients with intracapsular hip fractures who were treated with hip hemiarthroplasty. This was a single-center, randomized prospective double-blinded study of 50 patients with an isolated intracapsular femoral neck fracture who were treated with hip hemiarthroplasty from 2018 to 2022. The study group consisted of 25 patients who were treated with intraoperative LB and bupivacaine hydrochloride injections, while the control group consisted of 25 patients who were treated with intraoperative bupivacaine hydrochloride injections only. Primary outcomes were a visual analog scale (VAS) score for pain, total morphine milligram equivalents (MME), delirium, and time to ambulation with physical therapy. No significant differences between the study and control groups were found in any of the outcomes measured. Most notably, there were no differences in the average postoperative pain score (VAS, 2.26 versus 2.7; p = 0.34), total MME used postoperatively (11.73 versus 9.98 MME; p = 0.71), and postoperative day of discharge (4.00 versus 3.88 days; p = 0.82). The results of our study suggest that use of LB is not associated with substantially improved postoperative pain or function or with a shorter hospital course following hip hemiarthroplasty for a femoral neck fracture. Given the higher cost of LB compared with standard postoperative pain modalities, it is worth questioning its use in the setting of geriatric hip fractures. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Patient Factors Associated with 10-Year Survival After Arthroplasty for Hip Fracture: A Population-Based Study in Ontario, Canada.

The aim of this study was to describe long-term (10-year) patient survival after arthroplasty for hip fracture and to determine what patient factors are associated with that outcome. We performed a retrospective cohort analysis of patients ≥60 years old who underwent either hemiarthroplasty or total hip arthroplasty for femoral neck fracture between 2002 and 2009. We used routinely collected, validated health-care databases linked through ICES (formerly known as the Institute for Clinical Evaluative Sciences). We estimated the association between baseline variables and survival 10 years post-fracture using Poisson regression. Restricted cubic spline functions modeled the probability of 10-year survival by age and tested whether there was an inflection point after which the probability of 10-year survival decreased more rapidly. We estimated 10-year survival probabilities for different patient groups. There were 19,659 patients in the final cohort. Eighteen percent (3,564) of the patients were alive at 10 years postoperatively. Factors associated with a higher likelihood of 10-year survival included younger age, female sex (risk ratio [RR] = 1.56, 95% confidence interval [CI] = 1.46 to 1.68), lower American Society of Anesthesiologists (ASA) class (ASA I or II versus IV or V: RR = 1.96, 95% CI = 1.76 to 2.19), independent living status (RR = 2.68, 95% CI = 2.23 to 3.22), and fewer specific comorbidities. A threshold age of 73 years was the inflection point after which the probability of 10-year survival decreased more rapidly in females. Estimated 10-year survival probabilities ranged from 79.0% (95% CI = 75.5% to 82.5%) to 0.8% (95% CI = 0.6% to 1.0%). Approximately 1 in 6 patients live at least 10 years following a hip fracture. This study identifies baseline characteristics that predict survival greater than 10 years, including an age of <75 years, an ASA class of I or II, and independent living status prior to the hip fracture. Results can inform discussions around treatment choices, anticipated outcomes, and the natural history of hip fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cardiometabolic index is associated with increased bone mineral density: a population-based cross-sectional study

BackgroundOsteoporosis is a multifactorial bone disease in which lipid metabolism plays an important role. Bone Mineral Density (BMD) measured by Dual-energy X-ray Absorptiometry (DXA) is a critical indicator for diagnosing osteoporosis. The cardiometabolic index (CMI) is a novel metric that combines two quantitative indicators of blood lipids—triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). This study explores the association between CMI and BMD and seeks to elucidate the role of lipid metabolism in the context of bone health.MethodsBased on the data of the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020-pre-pandemic, weighted multiple linear regression and smooth curve fitting were used to study the relationship between CMI and femoral BMD. Stratified analyses were also conducted for age, gender, BMI, ethnicity, diabetes and hypertension status. And, the saturation threshold effect of CMI was further analyzed using a two-stage linear regression model.ResultThis study enrolled a total of 1,650 participants (48.7% males), with an average age of 63.0 ± 8.6 years. After adjusting for multiple confounding factors, CMI was positively correlated with total femur BMD, trochanter BMD, and intertrochanter BMD, while the correlation with femur neck BMD was not statistically significant. In the fully adjusted model, each unit increase in CMI was associated with a 0.026 (g/cm2) increase in total femur BMD, a 0.022 (g/cm2) increase in trochanter BMD, and a 0.034 (g/cm2) increase in intertrochanter BMD. Subjects in the highest quartile of CMI had a 0.034 (g/cm2) increase in total femur BMD, a 0.035 (g/cm2) increase in trochanter BMD, and a 0.039 (g/cm2) increase in intertrochanter BMD in the fully-adjusted model compared to those in the lowest quartile. In addition, saturation was observed between CMI and total femur BMD, trochanter BMD and intertrochanter BMD, with saturation thresholds of 1.073, 1.431 and 1.073, respectively.ConclusionCMI is strongly associated with BMD, indicating its potential relevance in bone metabolism. However, the role of CMI in the context of bone health, especially regarding osteoporosis risk, requires further investigation in large-scale prospective studies.

Revision rate of displaced femoral neck fractures in non-elderly adults: a retrospective comparative study of the femoral neck system and cannulated screws

BackgroundDisplaced femoral neck fractures are associated with a high revision rate. The new femoral neck system(FNS) offers advantages in fixation stability, potentially reducing the need for revision. The purpose of this study was to compare the revision rate of patients with different reduction quality treated with the FNS and cannulated screws (CS).MethodsThis retrospective study included patients with Garden III or IV femoral neck fractures who underwent osteosynthesis in a level 1 trauma center between July 2019 and June 2023. A total of 141 cases met the inclusion criteria and received treatment with either the FNS (N = 65) or CS (N = 76). The quality of fracture reduction, surgical complications (such as femoral neck shortening, avascular necrosis of femoral head, nonunion of fracture, implant failure and withdrawal), revision surgery and the reasons for revision were analyzed.ResultsThe mean age of the 141 cases was 52.0 years (range 18–65); with sixty-five cases being male (46.1%). Eighty-four fractures (59.6%) were classified as Garden type III. Reduction quality was good in 71 cases (50.4%) and fair in 70 cases. The mean follow-up period was 25.9 months (range 12–46). A total of 26 cases(18.4%) underwent revision surgery. The revision rate in cases with good reduction was 11.3% (8/71 cases), with seven cases (four hardware removal and three arthroplasty) in the CS group and one case (arthroplasty for fracture nonunion and implant failure) in the FNS group, a significant difference was found between the two groups(P = 0.041). Among the 18 cases (25.7%, 18/70) with fair reduction who underwent revision surgery, nine cases (six hardware removal and three arthroplasty) in the CS group, and nine cases (arthroplasty for implant failure and cut-out) in the FNS group, and there was no significant difference between the two groups (P = 0.672). The total revision rate between the FNS group (15.4%, 10/65) and the CS group (21.1%, 16/76) was not significantly different (P = 0.387).ConclusionsThe total revision rate between the FNS and CS group showed no difference. However, in cases with good reduction, the revision rate was lower in the FNS group compared to the CS group.

The observation that older men suffer from hip fracture at DXA T-scores higher than older women and a proposal of a new low BMD category, osteofrailia, for predicting fracture risk in older men.

The clinical significance of osteoporosis lies in the occurrence of fragility fractures (FFx), and the most relevant fracture site is the hip. The T-score is defined as follows: (BMDpatient-BMDyoung adult mean)/SDyoung adult population, where BMD is bone mineral density and SD is the standard deviation. When the femoral neck (FN) is measured in adult Caucasian women, a cutpoint value of patient BMD of 2.5 SD below the young adult mean BMD results in a prevalence the same as the lifetime risk of hip FFx for Caucasian women. The FN T-score criterion for classifying osteoporosis in older Caucasian men has been provisionally recommended to be - 2.5, but debates remain. Based on a systematic literature review, we noted that older men suffer from hip FFx at aFN T-score approximately 0.5-0.6 higher than older women. While the mean hip FFx FN T-score of around - 2.9 for women lies below - 2.5, the mean hip FF FN T-score of around - 2.33 for men lies above - 2.5. This is likely associated with that older male populations have a higher mean T-score than older female populations. We propose a new category of low BMD status, osteofrailia, for older Caucasian men with T-score ≤ - 2 (T-score ≤ - 2.1 for older Chinese men) who are likely to suffer from hip FFx. The group withT-score ≤ - 2 for older Caucasian men is comparable in prevalence to the group withT-score ≤ - 2.5 for older Caucasian women. However, older men in such category on average have only half the FFx risk as that of older women with osteoporotic T-score.

Assessment of Cup Placement Impact on Functional Outcomes in Total Hip Replacement: A Retrospective Analysis of 20 Patients

Introduction:Total hip replacement surgery is gaining popularity as a treatment for hip disorders, replacing alternative treatments like excisional arthroplasty, osteotomy, arthrodesis, and hemiarthroplasty. This research aims to evaluate the effect of the acetabular cup on functional outcomes, particularly in younger patients with hip arthritis and femur neck fractures.Materials And Methods:This study aimed to evaluate the placement of the acetabular cup and its association with functional outcomes in total hip replacement (THR). 20 patients were randomly selected from the MRD department and underwent pelvic CT scans postoperatively. Functional results have been analyzed using the Harris Hip Score. The acceptable cup version range was 15 ± 10 degrees, and patients outside this range were closely examined for rotational movements. Results: A study of 20 patients with a neck or femur fracture found that 11 patients had a right knee injury, while 9 had a left knee injury. After a year postoperatively, 18 patients reported no pain, while 2 had mild pain. Functional assessment depicted better outcomes in 17 patients, good outcomes in 2 patients, and fair outcomes in 1 patient. Radiological analysis revealed a mean cup version of 17.77 degrees, with complications including one dislocation and three limb length discrepancies. None of the patients developed an infection.Conclusion:The study found that 90% of patients had excellent functional outcomes, with only 10% exhibiting excessive anteversion. CT scan-based measurements of cup placement provided reliable predictions, consistent with intraoperative assessment of cup positioning.

The Alpha Angle.

➢ The alpha angle was originally defined on magnetic resonance imaging (MRI) scans, using a plane, parallel to the axis of the femoral neck. However, much of the literature on the alpha angle has used radiographs or other imaging modalities to quantify the alpha angle.➢ The measurement of the alpha angle can be unreliable, particularly on radiographs and ultrasound.➢ If radiographs are used to measure the alpha angle, the circle of best-fit method should be used on multiple different views to capture various locations of the cam lesion, and "eyeballing" or estimating the alpha angle should be avoided.➢ The cam lesion is a dynamic and 3-dimensional (3D) problem and is unlikely to be adequately defined or captured by a single angle.➢ Modern technology, including readily available 3D imaging modalities, as well as intraoperative and dynamic imaging options, provides novel, and potentially more clinically relevant, ways to quantify the alpha angle.

Impact of Dementia on Outcomes Following Hemiarthroplasty for Femoral Neck Fracture: A National Database Study

BackgroundDementia poses an elevated risk of femoral neck fracture (FNF) in the elderly, often leading to the need for hemiarthroplasty. Yet, the outcomes of hemiarthroplasty in patients who have dementia remain uncertain. The purpose of this study was to assess whether dementia serves as a potential risk factor for outcomes following hemiarthroplasty. MethodsDementia patients who underwent hemiarthroplasty for FNF with at least 1 year of follow-up were identified using a national insurance database. A 1:1 matched control cohort of patients who do not have dementia was created for comparison. Logistic regression analyses were used to evaluate the rates of complications between the two cohorts. A total of 89,072 patients, of whom half have dementia and half do not, undergoing hemiarthroplasty for FNF were identified. ResultsAside from increased risks of medical complications (P < 0.01), including pneumonia, cerebrovascular accident, acute kidney injury, urinary tract infection, and sepsis, within 90 days, dementia patients also demonstrated higher rates of surgical complications within 1 year, such as dislocation (Odds Ratio (OR) 1.87, 95% Confidence Interval (CI) 1.71 to 2.04), periprosthetic fractures (PPF) (OR 1.29, 95% CI 1.16 to 1.45), and revision (OR 1.23, 95% CI 1.10 to 1.36). On the other hand, dementia patients displayed slightly reduced rates of 90-day deep vein thrombosis and pulmonary embolism. However, no significant increase was found in transfusion, myocardial infarction, wound complications, periprosthetic joint infection (PJI), or aseptic loosening between the two cohorts. Additionally, patients who have dementia demonstrated a higher likelihood of 90-day emergency department visits, whereas rates of 90-day hospital readmission remained similar. ConclusionAlthough dementia patients do not exhibit an elevated risk of PJI, or aseptic loosening, they are more prone to experiencing higher risks of prosthetic dislocation, PPF, and revision. Furthermore, specific medical complications tend to be more prevalent among individuals who have dementia.

Sex-Specific Association of Clinical Parameters and Components of Femoral Bone Quality in Patients Undergoing Total Hip Arthroplasty.

Poor bone quality is a critical factor associated with an increased risk of complications after total hip arthroplasty (THA). However, no consistent recommendations have yet been established for assessing indicators of bone quality preoperatively. Thus, it remains unclear which preoperatively available and readily accessible parameters are most closely associated with femoral bone quality. Here, we obtained femoral neck specimens from 50 patients undergoing THA. Preoperative Dual-energy X-ray absorptiometry (DXA) scans, pelvic radiographs, and laboratory parameters were analyzed. In the obtained specimens, bone microstructure was assessed using micro-CT and histomorphometry. Additionally, matrix mineralization and osteocyte lacunar morphology were evaluated using quantitative backscattered electron imaging. Our analysis revealed that DXA-derived T-scores correlated with trabecular microstructure. Furthermore, radiographic indices and body mass index correlated differentially with aspects of bone quality in women and men. Contrary to previous observations, no correlation was found between serum vitamin D levels and osteoid indices, nor between clinical parameters and matrix mineralization. Age was strongly associated with the number of mineralized osteocyte lacunae, a factor that appeared to be independent of sex. Taken together, our study demonstrates that no single preoperatively available parameter exhibits a strong and consistent association with femoral bone quality. However, DXA remains a reliable preoperative measure for determining the trabecular microstructure of the femoral neck. In clinical practice, surgeons should adopt an individualized approach to preoperative assessments by considering age, sex, BMI, and radiographic indices to enhance their insight into femoral bone quality, particularly when DXA is unavailable.

Increased Risk of 10-Year Revision Following Total Hip Arthroplasty for Femoral Neck Fracture

As the incidence of femoral neck fracture (FNF) increases with the aging population, understanding its impact on surgical outcomes is important to improving implant survival and patient satisfaction. Despite increasing use of total hip arthroplasty (THA) as management for FNF, few studies have examined long-term implant survivability. Thus, this study sought to determine the 10-year cumulative incidence of revision and indications for revision in patients undergoing THA for FNF in comparison to osteoarthritis. Patients who underwent primary THA for FNF or osteoarthritis were identified using a national administrative claims database and propensity-score matched in a 1:2 ratio based on age, gender, the Charlson Comorbidity Index (CCI), smoking, obesity, and diabetes mellitus. Kaplan-Meier and Cox proportional hazards analyses were used to observe the cumulative incidence and risk of all-cause revision, periprosthetic joint infection (PJI), dislocation, mechanical loosening, and periprosthetic fracture (PPF) within 10 years of primary THA. In total, 19,735 patients who underwent THA for FNF and 39,383 patients who underwent THA for osteoarthritis were included. The 10-year cumulative incidences of all-cause revision (7.1 versus 4.9%), PJI (5.0 versus 3.3%), dislocation (6.8 versus 3.8%), mechanical loosening (3.1 versus 1.9%), and PPF (7.8 versus 4.0%) were significantly higher for those who underwent THA for FNF versus osteoarthritis. Femoral neck fractures were associated with higher risks of revision (hazard ratio [HR]: 1.6), PJI (HR: 1.7), dislocation (HR: 2.0), mechanical loosening (HR: 1.6), and PPF (HR: 2.2) (P < 0.001 for all). Despite the advantages of THA, femoral neck fractures remain a major risk factor for long-term complications. Tailored preoperative planning, surgical techniques, and postoperative bone health optimization in these patients may help minimize poor outcomes.

Bone Marrow Adiposity Alterations in Postmenopausal Women with Type 2 Diabetes Are Site-Specific

Abstract Context Bone marrow adiposity (BMAT) alterations in patients with type 2 diabetes mellitus (T2DM) may contribute to adverse bone effects. Objective Characterization of BMAT content and composition in patients with well-controlled T2DM. Design cross-sectional study with two groups of postmenopausal women: one with T2DM and the other without. Main outcome measures The proton density fat fraction (PDFF) of the lumbar spine and proximal femur, comprising the femoral head, neck, and diaphysis, was assessed using chemical shift-based water-fat separation imaging (WFI). MRI with spectroscopy (¹H-MRS) was performed in a subgroup of participants to confirm the PDFF measurements and determine the apparent lipid unsaturation level (aLUL) at the L3 vertebrae and femoral neck. The association of imaging-based PDFFs and aLUL between diabetes groups was investigated by adjusting for confounding factors using a linear mixed model. Results Among 199 participants, patients with T2DM (n = 29) were significantly heavier (p &amp;lt; 0.001) and had a higher BMD (p&amp;lt;0.001 for all sites) than non-diabetic patients (n = 170). When PDFFs were compared after adjusting for age, BMI, and BMD, the femoral head WFI-based PDFF was lower in patients with T2DM (mean (standard error) 88.0% (0.7) versus 90.6% (0.3), p &amp;lt; 0.001). Moreover, the aLUL at the L3 vertebrae was lower in patients with T2DM (n = 16) than in without (n = 97) (mean (standard error) 3.9% (0.1) versus 4.3% (0.1), p = 0.02). Conclusions The content and composition of BMAT are modified in postmenopausal women with T2DM and these changes occur at specific sites.

Early-life famine exposure and risk of osteoporosis and low bone mineral density: a systematic review and meta-analysis.

Early-life exposure to famine has been hypothesized to influence long-term bone health, potentially increasing the risk of osteoporosis and fractures in later life. This systematic review and meta-analysis aimed to investigate the association between early-life famine exposure and the risk of osteoporosis, bone mineral density (BMD) loss, and fractures. A comprehensive literature search was conducted across MEDLINE/PubMed, Scopus, Web of Science, and Embase, supplemented by manual searches on Google Scholar. Observational studies examining the impact of early-life famine exposure on osteoporosis, BMD, and fracture risk were included. Data were extracted and quality assessed independently by two reviewers, and meta-analyses were performed using the Mantel-Haenszel method for odds ratios (OR) and Hedges' g for standardized mean differences (SMD). Heterogeneity was assessed using the I2 statistic, and meta-regression analyses were conducted to explore potential sources of heterogeneity. From 6147 initial studies, 10 met the inclusion criteria, with 8 included in the meta-analysis. The early-life famine-exposed group showed a significantly higher incidence of osteoporosis (OR = 2.12, 95%CI [1.35, 3.34], I2 = 88%) and fractures (OR = 1.58, 95%CI [1.07, 2.33], I2 = 92%) compared to non-exposed individuals. Meta-regression indicated that higher female prevalence in studies made the association with osteoporosis stronger, while higher ages strengthened the association with fractures. Exposure during fetal and childhood stages was particularly associated with increased risks of osteoporosis and fractures. Additionally, famine exposure correlated with lower BMD, particularly in the heels, femoral neck, and total hip regions. Early-life famine exposure is significantly associated with an increased risk of osteoporosis, fractures, and lower BMD in later life. These results emphasize the lasting effects on bones from early lack of nutrition and stress the importance of specific interventions for bone health in groups with past famine experiences. Future studies should investigate the reasons behind these connections and assess preventative approaches to reduce the negative effects on bone health in those impacted.

Causal relationship between neuroticism and bone mineral density: A univariable and multivariable Mendelian randomization study.

Recent observational studies have indicated that psychiatric disorders were associated with risk of bone mineral density (BMD) reduction. But the causal relationship between neuroticism and BMD remained unclear. By using public genome-wide association study data, a 2-sample bidirectional Mendelian randomization (MR) study was performed to investigate the causal relationship between neuroticism and BMD (heel BMD, forearm BMD, femoral neck BMD, lumbar spine BMD, and total body BMD). Inverse-variance weighted, weighted median, and MR-Egger were used to assess the causal effects. Multiple sensitivity analyses were conducted to assess the potential bias of the causal estimates. Multivariable MR analysis was used to assess the direct causal effects of neuroticism on BMD with adjustment of common risk factors of BMD reduction. Univariable MR analysis indicated that genetically predicted higher neuroticism was significantly associated with an increased risk of heel BMD reduction (inverse-variance weighted β = -0.039; se = 0.01; P = .0001; Bonferroni-corrected P = .0005) but not with other BMD (forearm BMD, femoral neck BMD, lumbar spine BMD, and total body BMD) potentially due to limited statistical power. The causal effects remained significant after accounting for the effects of body mass index, smoking, and drinking. Genetic proxy for higher neuroticism was significantly associated with an increased risk of heel BMD reduction. Further studies were warranted to elucidate the underlying biological mechanisms and explore the potential application in disease early screening and management.

Deep Learning for Automated Classification of Hip Hardware on Radiographs.

To develop a deep learning model for automated classification of orthopedic hardware on pelvic and hip radiographs, which can be clinically implemented to decrease radiologist workload and improve consistency among radiology reports. Pelvic and hip radiographs from 4279 studies in 1073 patients were retrospectively obtained and reviewed by musculoskeletal radiologists. Two convolutional neural networks, EfficientNet-B4 and NFNet-F3, were trained to perform the image classification task into the following most represented categories: no hardware, total hip arthroplasty(THA), hemiarthroplasty, intramedullary nail, femoral neck cannulated screws, dynamic hip screw, lateral blade/plate, THA with additional femoral fixation, and post-infectious hip. Model performance was assessed on an independent test set of 851 studies from 262 patients and compared to individual performance of five subspecialty-trained radiologists using leave-one-out analysis against an aggregate gold standard label. For multiclass classification, the area under the receiver operating characteristic curve (AUC) for NFNet-F3 was 0.99 or greater for all classes, and EfficientNet-B4 0.99 or greater for all classes except post-infectious hip, with an AUC of 0.97. When compared with human observers, models achieved an accuracy of 97%, which is non-inferior to four out of five radiologists and outperformed one radiologist. Cohen's kappa coefficient for both models ranged from 0.96 to 0.97, indicating excellent inter-reader agreement. A deep learning model can be used to classify a range of orthopedic hip hardware with high accuracy and comparable performance to subspecialty-trained radiologists.

Temporal declines in bone mineral density and trabecular bone score during androgen deprivation therapy.

The trabecular bone score (TBS) has emerged as a convenient measure for assessing the microstructure of trabecular bone in the second through fourth lumbar vertebrae (L2-4) and can be conducted concurrently with bone mineral density (BMD) assessment. This study was performed to evaluate changes in BMD and the TBS during ADT for prostate cancer. Consecutive patients who had prostate cancer without bone metastases at Kobe University Hospital were studied from March 2020 to December 2021. BMD and TBS were measured every 6 months from the start of treatment using Hologic Horizon devices (Hologic, Inc., Marlborough, MA, USA). Thirty-four patients were followed for 2 years. Significant declines in BMD (-3.8% for femoral neck, -4.2% for total hip, and -6.1% for lumbar spine) and TBS (-16.6%) were noted after 2 years of ADT. Correlation analyses revealed a weak correlation between lumbar spine BMD and TBS at ADT initiation, but this correlation strengthened after 2 years. The multiple regression analysis results suggested that the rate of BMD loss may be slower in patients with a preserved pretreatment TBS. In patients without bone metastases undergoing ADT for prostate cancer, notable decreases were found in both BMD and TBS over a 2-year treatment period. Factors influencing the TBS decline remain unclear; however, patients with a lower pretreatment TBS exhibited a more rapid decline in BMD.

Femoral neck–shaft angle changes based on the severity of neurologic impairment in children with cerebral palsy and spinal muscular atrophy

Introduction: The neck–shaft angle and head–shaft angle in children with varying levels of neurological disability were evaluated to define change over different ages. Methods: Children aged 1–12 years with spastic cerebral palsy, spinal muscular atrophy types 1 and 2, or typical development were reviewed to evaluate the neck–shaft angle and head–shaft angle. Patients were divided into five groups: Gross Motor Function Classification System levels I and II, Gross Motor Function Classification System level III, Gross Motor Function Classification System levels IV and V, spinal muscular atrophy types 1 and 2, and typical development. A linear mixed model was utilized to evaluate neck–shaft angle and head–shaft angle. Results: Data from 196 children (mean age 4.8 ± 4.5 years) were included. Gross Motor Function Classification System levels I and II: 22 children, 130 hip radiographs measured, neck–shaft angle 143.7 ± 7.4, and head–shaft angle 160.0 ± 7.1. Gross Motor Function Classification System level III: 8 children, 33 hips evaluated, neck–shaft angle 153.1 ± 4.3, and head–shaft angle 163.4 ± 4.2. Gross Motor Function Classification System levels IV and V: 30 children, 137 hip radiographs measured, neck–shaft angle 156.4 ± 5.6, and head–shaft angle 167.9 ± 6.8. Spinal muscular atrophy types 1 and 2: 32 children, 83 hip radiographs measured, neck–shaft angle 161.9 ± 9.7, and head–shaft angle 173.4 ± 7.4. Typical development: 104 children, 222 hip radiographs measured, neck–shaft angle 138.6 ± 7.0, and head–shaft angle 156.4 ± 5.9. There were significant statistical differences when comparing neck–shaft angle and head–shaft angle. Conclusion: As children grow, neck–shaft angle and head–shaft angle tend to decrease in typical development and Gross Motor Function Classification System levels I and II groups. However, in low-tone (spinal muscular atrophy types 1 and 2) and high-tone groups (Gross Motor Function Classification System levels IV and V), neck–shaft angle and head–shaft angle tend to increase with age. In both low-tone and high-tone groups, coxa valga is observed. When evaluating the effect of proximal femur-guided growth, these defined normal growth patterns should be considered. Level of Evidence: Level III Retrospective comparative study.

Comparative analysis of the quality of the cement mantle in hip hemiarthroplasty after femoral neck fracture between three different surgical approaches: a single-center retrospective observational study.

Achieving the initial stability of implants is necessary for hip hemiarthroplasty (HHA), especially in elderly patients, and this can be achieved with a cement mantle of quality. The direct anterior approach (DAA) for HHA lately has shown positive results. However, evidence is lacking of HHA in elderly patients with osteoporosis after femoral neck fracture (FNF). This study compares differences in cement mantle quality after HHA, its complications, radiological outcomes and functional status in elderly patients with FNF intervened through different approaches. A non-interventional, retrospective case-control study was conducted. 150 cases were selected based on the surgical approach (DAA, DLA and PLA) in a 1:1:1 proportion between 2018 and 2019. Under 75years old suspicion or confirmation of a pathological fracture were excluded. Antibiotic-loaded cement was utilized. Cement preparation involved vacuum centrifugation and standard instructions for preparation canal and filling, and prosthesis placement were followed. No statistically significant differences in cement mantle quality, radiological outcomes, and the majority of the postoperative complications and functional status considering the surgical approach (p > 0.05). However, the DAA was associated significantly with shorter hospital stays (8.3days vs 11.3 and 13days for DLA and PLA) a decrease in postoperative blood transfusion (22% vs 34% and 53%), and lower rate of loss of walking (8% vs 20% and 28.6%). The DAA for HHA in patients with FNF provides a high-quality cement mantle, similar to other approaches. Also, the DAA shows advantages like shorter hospital stays and lower transfusion rates in elderly patients.

Mechanical impact of regional structural deterioration and tissue-level compensation on proximal femur trabecular bone

IntroductionOsteoporosis-induced changes in bone structure and composition significantly reduce bone strength, particularly in the human proximal femur. This study examines how these changes affect the mechanical performance of trabecular bone to enhance diagnosis, prevention, and treatment strategies.MethodsA proximal femur sample was scanned using micro-CT at 40 μm resolution. Five regions of interest were selected within the femoral head, femoral neck, and greater trochanter. Structural models simulating various stages of osteoporosis were created using image processing software. Micro-finite element analysis evaluated the mechanical properties of trabecular bone under different conditions of structural deterioration and tissue-level elastic modulus variations. The combined effects of structural deterioration and tissue-level mechanical properties on trabecular bone mechanical performance were further analyzed.ResultsThe mechanical performance of trabecular bone generally follows a power-law relationship with its microstructural characteristics. However, in any specific region, the apparent mechanical properties linearly decrease with structural deterioration. The femoral neck and greater trochanter are more sensitive to structural deterioration than the femoral head. A 5% bone mass loss in the femoral head led to a 7% reduction in mechanical performance, while the femoral neck experienced a 12% loss. Increasing tissue-level elastic modulus improved mechanical performance, partially offsetting bone mass reduction effects.ConclusionTrabecular bone in low bone mass regions is more affected by bone mass loss. Structural deterioration primarily reduces bone strength, but improvements in tissue-level properties can mitigate this effect, especially in early osteoporosis. Targeted assessments and interventions are crucial for effective management. Future research should explore heterogeneous deterioration models to better understand osteoporosis progression.

Effects of Cannabidiol on Bone Quality in Ovariectomized Rats.

The incidence of osteoporosis and related fractures increases significantly with age, impacting public health and associated costs. Postmenopausal osteoporosis results from increased bone resorption due to decreased estrogen levels. The endocannabinoid system, especially cannabidiol (CBD), has shown therapeutic potential in modulating bone formation. This study investigated the effects of administration of CBD in rats after the onset of with ovariectomy-induced osteopenia (OVX). Forty-eight female Sprague‒Dawley rats were divided into four groups (n = 12): OVX + CBD, SHAM + CBD, OVX + vehicle, and SHAM + vehicle. CBD was administered intraperitoneally for 3weeks. After euthanasia, the bone quality, mechanical properties, and bone microarchitecture of the femurs and lumbar vertebrae were assessed by microcomputed tomography (micro-CT), bone densitometry, mechanical tests, and histological and immunohistochemical analyses. CBD treatment improved the bone mineral density (BMD) of the lumbar vertebrae and increased the BV/TV% and Tb.N in the femoral neck. There were also improvements in the mechanical properties, such as the maximum force and stiffness of the femurs and vertebrae. CBD significantly increased the bone matrix in osteopenic femurs and vertebrae, Although did not significantly influence the expression of RANKL and OPG, in ovariectomized animals, there was an increase in osteoblasts and a decrease in osteoclasts. Determining the optimal timing for CBD use in relation to postovariectomy bone loss remains a crucial issue. Understanding when and how CBD can be most effective in preventing or treating bone loss is essential to emphasize the importance of early diagnosis and treatment of osteoporosis. However, further studies are needed to explore in more detail the efficacy and safety of CBD in the treatment of postmenopausal osteoporosis.