Incidence Of Fractures Research Articles

Estimated frequency and economic burden of incident fragility fractures during 2023 in Mexico.

Osteoporosis and its fractures impose a high clinical and economic burden. The objective of this analysis was to estimate the frequency and costs owing to incident fragility fractures (FFs) during the year 2023 in Mexico. This is an incidence-based cost-of-illness study. The target population is adults ≥ 50years old sustaining a fracture related to osteoporosis (caused by a fall on the same level). The model estimates the costs and productivity losses associated with their treatment within 1year post-fracture. National epidemiologic databases supplemented with information, derived from literature when appropriate, were used to estimate the frequency of new FFs during 2023 in the study population. Resource use included surgical and non-surgical inpatient or ambulatory care the patients received immediately after fracture plus the outpatient physiotherapy post-discharge and the eventual follow-up with a specialist who may prescribe pharmacotherapy. Sick days taken in employed patients were estimated from the literature. Local unitary costs of services and drugs for both public and private settings as well as average income in those occupied were applied. All costs are reported in Mexican pesos (MXN) from 2023. The model estimated a total of 229,239 FFs, among which 63% were classified as a major osteoporotic fracture, including 53,842 and 41,459 fractures located at the hip and vertebral, respectively. The total costs were estimated at 15,593 million MXN; most of them (75.2%) were attributable to acute-phase care. Fragility fractures represent a serious health problem for Mexico. Better preventive/therapeutic strategies may help to mitigate their significant financial toll.

Vertebral fracture prevalence and risk factors for fracture in the Gambia, West Africa: the Gambian bone and muscle ageing study

Abstract There are limited data describing the epidemiology of vertebral fractures (VF) from resource-limited settings, where the ageing population is growing most rapidly. We aimed to determine the prevalence, incidence, and risk factors for VF in The Gambia, West Africa. The Gambian Bone and Muscle Ageing Study is a prospective observational study in men and women aged 40 years and over. Rural participants had baseline measurements and plasma samples collected and were followed up 6-8 years later; urban participants had a single measurement. DXA scans were obtained to assess areal bone mineral density (aBMD), body composition and VF. Prevalence and incidence were calculated. Risk factors for prevalent and incident fracture were tested using logistic regression, in men and women separately, with and without adjustment for age and BMI. At baseline, 581 individuals (298 women) had useable scans, 214 (127 women) at follow-up. Prevalence of VF was 14.8%. Those with VF were older (65.6(11.2) vs 61.7(12.3) years, P=.01) and had lower aBMD Z-scores. For example, in women, a 1SD increase in femoral neck Z-score resulted in a lower risk of having a prevalent VF (OR [95% CI]) 0.51 [0.38, 0.73]. In men, lumbar spine Z-scores were predictive of prevalent fracture; (0.71 [0.53, 0.97]). The incidence of VF over follow-up was 12.1%. Low BMD and grip strength were associated with the odds of having an incident VF. Given the importance of prevalent VF in predicting future VF and other fragility fractures in other populations, our findings are a major cause for concern. VF prevalence in Gambian older adults is similar to elsewhere despite fractures not being a perceived issue. Risk factors were like those identified elsewhere including age, aBMD and bone resorption. Understanding the impact of these fractures is important in a region where health of the ageing population needs to be prioritized.

A retrospective epidemiological analysis of maxillofacial fractures at a tertiary referral hospital in istanbul: a seven-year study of 1,757 patients

BackgroundThe aim of the study was to evaluate the etiology, incidence, demographics, and characteristics of maxillofacial fractures treated at a university hospital over a seven-year period.MethodsWe performed a retrospective analysis of 1,757 patients with maxillofacial fractures who were referred to our department between May 2012 and March 2019. The patients’ demographic and clinical characteristics were noted, as well as the fracture type, location, and etiology. The treatment modalities were also analyzed.ResultsA total of 2,173 maxillofacial fractures were seen in 1,757 patients. The male to female ratio was 3.9:1, and the mean patient age was 31.89 ± 17.70 years (range: 0–95 years). Maxillofacial injuries were most prevalent in the 19–28 years age group (23.9% of cases), with a general increase in injuries observed between 2013 and 2018 across all age groups. The most common etiological factor was assault (29.1%), followed by falls (26%). In male patients, assault was reported as the main cause, while in female patients, falls were identified as the main cause. The nasal bone was the most common site of fracture, followed by the maxilla. The average time from admission to surgery was 2.8 days, with local anesthesia being the most frequent surgical intervention. The average time from admission to surgery was 2.8 ± 2.5 days (range: 0–20 days), with surgeries performed under local anesthesia being more frequent than those carried out under general anesthesia. Among the surgical interventions, the most common general anesthesia technique for fracture reduction was open reduction and internal fixation with plates and screws. Plate exposure, wound-site infection, and temporomandibular joint ankylosis were the major complications encountered in the study population.ConclusionThe study reveals significant variability in maxillofacial fractures based on gender, age, and etiology. Assault emerged as the leading cause of these fractures, followed by falls and road traffic accidents. Men were affected by maxillofacial trauma four times more often than women, with the highest incidence occurring in the 19–28 years age group. Nasal fractures were the most frequently observed (78.7%), while condylar-subcondylar process fractures were the most common type of mandibular fracture. Given these findings, a targeted, lifelong prevention strategy focused on high-risk groups could significantly reduce the burden of maxillofacial trauma.

Bisphosphonate Use After Kidney Transplantation Is Associated with Lower Fracture Risk.

Kidney transplant recipients are at higher risk of fractures compared to the general population. The use of bisphosphonates has been shown to increase bone mineral density after transplantation but has not been shown to lower fracture rates. Here, we aim to determine if exposure to bisphosphonates associates with lower incidence of non-vertebral fractures after kidney transplantation. We conducted a retrospective review for all Southern California Kaiser Permanente kidney transplant recipients with osteoporosis transplanted between 2000 and 2019. Baseline variables were collected. Those prescribed an oral bisphosphonate were compared to those who were not. The primary outcome was non-vertebral fracture. Chi square was used to evaluate categorical variables and Wilcoxson rank sum test for continuous variables. Propensity scores were generated to balance covariates in the bisphosphonate and non-bisphosphonate groups. Cause-specific hazard and sub distribution (Fine-Gray) methods were performed for competing risk analysis. Death censored graft survival was evaluated as a secondary outcome using standard Cox regression. There were 489 patients included in the study, 203 of which were in the bisphosphonate group. The cause specific hazard model suggested a 64% lower risk of non-vertebral fracture in the bisphosphonate group (p=0.02). The Fine-Gray hazard model treating death as a competing risk did not show lower relative incidence of non-vertebral fracture. Bisphosphonate treatment was associated with lower death censored graft failure (p=0.002). Bisphosphonate use after kidney transplantation may associate with lower risk of non-vertebral fracture after transplant. Bisphosphonate use in this study was also associated with lower death censored graft failure. Caution is advised when interpreting these results given the retrospective nature of the study.

Geographical variation in osteoporosis in Australian women: a longitudinal analysis over 23years.

To determine whether the prevalence of osteoporosis, fractures, and dual-X-ray absorptiometry (DXA) differs between Australian women living in rural compared with urban areas. The Australian Longitudinal Study on Women's Health, a prospective longitudinal study of Australian women, includes a cohort of women born 1946-1951, surveyed nine times from 1996-2019. Data from administrative health records were linked to survey data. Geographic area was classified as major city, inner regional, outer regional, or remote. Generalised estimating equations (GEE) explored outcomes of osteoporosis, fracture, and DXA rates. Univariable and multivariable regression were performed and bootstrapping with 100 repetitions at 95% sampling of the original dataset to ensure robust results. A total of 13,712 women were included: 5000 (36.5%) living in major cities, 5214 (38.0%) inner regional, 2798 (20.41%) outer regional, and 700 (5.1%) remote areas. Baseline age, 47.6 (1.46) years (mean (SD)), was similar; but education, marital status, country of birth, smoking, BMI, and comorbidities varied between areas. Over 23years, 2956 (21.6%) were diagnosed with osteoporosis, 3185 (23.2%) had an incident fracture, and 8151 (59.4%) had a DXA. On univariable analysis, women living outside major cities had lower risk of osteoporosis (inner regional OR 0.92; 95% CI 0.84, 0.99; outer regional 0.70; 0.63, 0.79; remote 0.43; 0.34, 0.53), and lower risk of fractures (inner regional area OR 0.92, 95% CI 0.84, 0.99; outer regional 0.81; 0.73, 0.90; remote 0.54; 0.42, 0.67), than women living in major cities. These differences were no longer significant on multivariable analysis, suggesting differences might be related to the distribution of risk factors. Women living in inner regional and outer regional areas were significantly less likely to have a DXA, than those living in a major city (OR 0.75, 95% CI 0.70, 0.81; OR 0.72; 95% CI 0.64, 0.77, respectively), and this remained significant on multivariable analysis. Osteoporosis or fracture affected one-third of older Australian women, and women living outside major cities had lower rates of osteoporosis, fractures, and DXA completion.

Comparison of Bone Mineral Density Between Veterans and Non-Veterans and Its Impact on Fracture Risk Assessment

Background and Objectives: Osteoporosis poses significant health risks, especially among veterans, due to lifestyle factors. This study compares bone density and fracture risks between male veterans and non-veterans. Materials and Methods: We conducted a retrospective analysis of 1427 veterans from the Taichung Veterans General Hospital osteoporosis database (2010–2022), matched 1:1 by age and gender with non-veterans. Bone mineral density (BMD) was measured via dual-energy X-ray absorptiometry (DXA). Comorbidities, fracture sites, and mortality data were tracked. Conditional logistic regression was used to identify factors influencing fracture risk. Results: The study found that veterans have a higher fracture risk (univariable OR 1.24, multivariable OR 1.20, p < 0.001). Fracture victims were slightly younger in the veterans group (78.7 ± 10.0 years vs. 80.1 ± 9.2 years, p = 0.010), who also had better T-scores in the lumbar spine and left femoral neck. Veterans showed a higher post-fracture mortality rate (39.9% vs. 31.9%, p = 0.001) and a greater incidence of radial fractures (5.01% vs. 2.96%, p = 0.036). Importantly, veterans exhibited a trend toward more hip fractures compared with non-veterans (27.0% vs. 23.6%, p = 1.017), suggesting a potential difference despite not reaching statistical significance. Conclusions: In the present study, we found that veterans have higher rates of comorbidities, and higher mortality after a fracture event, highlighting the need for targeted medical interventions to address these differences. Further intervention to prevent avoidable fractures and the provision of adequate care for long-term osteoporosis management remain critical issues.

Romosozumab following denosumab improves lumbar spine bone mineral density and trabecular bone score greater than denosumab continuation in postmenopausal women.

Romosozumab following anti-resorptive can be an effective sequential treatment strategy to improve bone strength. However, whether the transition to romosozumab after denosumab is associated with greater improvement in bone mineral density (BMD) and trabecular bone score (TBS) compared to denosumab continuation remains unclear. In this propensity score-matched cohort study, we analyzed data from postmenopausal women who initiated denosumab between 2017 and 2020. Individuals who were transited to 12months of romosozumab after denosumab were 1:1 matched to those who continued an additional 12months of denosumab (n = 86 for each group; denosumab-romosozumab [DR] and denosumab-denosumab [DD]). Mean BMD gain by denosumab treatment in matched DR and DD groups from denosumab initiation to transition (median 4 times [range 2 to 8]) was +4.8% and + 2.0% in the lumbar spine and total hip. DR group showed greater LS BMD gain compared to the DD group (+6.8 vs. +3.3% point, P<.001) for 12months post-transition independent of the duration of prior denosumab treatment, yielding greater overall LS BMD gain in DR compared to DD (+11.6% vs. +8.0%, P<.001). DD group showed continued improvement of hip BMD, whereas hip BMD was maintained but not improved in the DR group. DR group was associated with greater TBS improvement than the DD group (2.9% vs 1.0%, P=.042). One month after the transition to romosozumab from denosumab, P1NP immediately increased above the level of denosumab initiation with relatively suppressed CTx, creating a transient anabolic window. For 12months follow-up, one incident morphometric vertebral fracture and one patella fracture were observed in DD, whereas one ankle fracture was observed in the DR group. Romosozumab following denosumab improved lumbar spine BMD and TBS greater than denosumab continuation in postmenopausal women.

A Multidisciplinary and a Comprehensive Approach to Reducing Fragility Fractures in Preterm Infants.

With advances in neonatal care, bone fractures prior to discharge from the hospital in preterm infants receiving contemporary neonatal care, are rare. Nevertheless, such fractures do occur in very low birth weight and extremely low birth weight infants who go on to develop metabolic bone disease of prematurity (MBDP), with or without secondary hyperparathyroidism. MBDP is a multifactorial disorder arising from the disruption of bone mass accrual due to premature birth, postnatal immobilisation, and loss of placental oestrogen resulting in bone loss, inadequate provision of bone minerals from enteral and parenteral nutrition, and medications that leach out bone minerals from the skeleton. All of these factors lead to skeletal demineralisation and a decrease in bone strength and an increased risk of fractures of the long bones and ribs. Secondary hyperparathyroidism resulting from phosphate supplements, or enteral/parenteral feeds with a calcium-tophosphate ratio of < 1.3:1.0 leads to subperiosteal bone resorption, cortical thinning, and further skeletal weakening. Such fractures may occur from routine handling and procedures such as cannulation. Most fractures are asymptomatic and often come to light incidentally on radiographs performed for other indications. In 2015, we instituted a comprehensive and multidisciplinary Neonatal Bone Health Programme (NBHP), the purpose of which was to reduce fragility fractures in highrisk neonates, by optimising enteral and parenteral nutrition, including maintaining calcium-tophosphate ratio ≥1.3:1, milligram to milligram, biochemical monitoring of MBDP, safe-handling of at-risk neonates, without compromising passive physiotherapy and skin-to-skin contact with parents. The at-risk infants in the programme had radiographs of the torso and limbs at 4 weeks and after 8 weeks from enrolment into the program or before discharge. Following the introduction of the NBHP, the bone fracture incidence reduced from 12.5% to zero over an 18-month period.

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.

Frequency and mechanism of injury for unintentional paediatric femoral fractures associated with consumer products over a 10-year period in the USA.

Femoral shaft fractures tend to be rare among children; however, these injuries are the most common major paediatric injuries treated by orthopaedic surgeons. The purpose of this study is to characterise the demographics and mechanisms of femoral injury associated with consumer products in the age group treated with spica casting, children 6 months to 6 years, to identify areas for injury prevention. Data from 2012 to 2021 were obtained from the National Electronic Injury Surveillance System maintained by the Consumer Products Safety Commission, documenting emergency department visits for unintentional injuries associated with consumer products. Narrative descriptions were analysed to identify common factors in the injury events such as location, products and mechanisms of action. From 2012 to 2021, the estimated incidence of femur fractures was 23.5 cases per 100 000 children with no significant difference in yearly frequency. The most common mechanism of injury was a fall with the most frequent fracture sources being bed/bunk beds (16.1%), floor (slips/falls, 9.7%) and trampolines (9.7%). Most fractures occurred at the patient's home (58.4%). The incidence of injury outside of the home and frequency of fractures involving play structures/trampolines increased with age. The incidence and demographic characteristics of paediatric femur fractures associated with consumer products have remained consistent over the past 10 years. As home was the most common location of fracture, prevention of femur fractures should focus on caregiver education around high-risk sources of fracture (bed, stairs and trampolines) and manufacturers should consider design alternatives that discourage potential misuse.

Falls in RAC-OST-POL Study: the results from 10-year prospective longitudinal observation.

The aim of the study was presentation of the data on falls in a cohort of postmenopausal women in a 10-year prospective longitudinal observation. 640 postmenopausal women at baseline age above 55 years were included. The cohort was randomly selected from the population of the whole Racibórz district. Data on falls and fracture incidence were gathered yearly. 256 (40%) women had no falls, and in 384 (60%) subjects at least one fall was noted. The number of women with 1, 2, and 3 or more falls were 115, 62, and 207, respectively. The total number of falls was 1988. Mean baseline age in those who noted falls was 65.7 ± 7.02 years, and it was significantly higher than in the rest of the patients (64.1 ± 6.75; p<0.01). During follow-up 190 osteoporotic fractures were noted in 129 patients. Falls were proven to have a strong, significant relationship with fracture (chi-square test = 80.5; p < 0.0001). Among potential clinical factors only diabetes type 1 (chi-square test = 5.80; p < 0.05) and depression (chi-square test = 3.82; p < 0.05) influenced falls incidence. The risk of falls was increased in cases of greater numbers of clinical risk factors (chi-square test = 28.4 df = 5; p < 0.0001). In long-term follow-up in postmenopausal women, falls were frequently observed, and their occurrence increased the fracture rate. Diabetes type 1 and depression increase the fall rate, which suggests the necessity of implementation of some preventive procedures.

Bone Mineral Density in the Scaphoid

Introduction: The scaphoid bone is essential for wrist stability and movement. While fractures commonly occur at the scaphoid's waist, those at the proximal pole, though rarer, tend to result in nonunion, potentially linked to variations in bone mineral density (BMD). Previous studies have shown an increase in BMD at the proximal pole in fractured scaphoids, but BMD distribution in intact scaphoids has not been well studied. This study aims to map the BMD distribution of the intact scaphoid to better understand the etiology of fractures and optimize treatment approaches. Methods: Conducted under ethical approval, this study included 100 individuals, using computed tomography to assess the BMD in distal, middle, and proximal thirds of the scaphoid. Measurements were performed in the defined regions and analyzed using SPSS software, with significance accepted at P &lt; .05. Results: The study comprised 34 females and 66 males, with no significant BMD difference between the right and left wrists. The proximal third exhibited significantly higher BMD (542.2 HU) compared to the middle (293.1 HU) and distal thirds (298.4 HU). A statistically significant higher BMD was observed in males, particularly in the proximal and distal thirds. A weak negative correlation between age and BMD was noted across all sections. Conclusion: The proximal scaphoid shows significantly higher BMD, potentially explaining its lower fracture incidence but higher nonunion rate. This insight into the BMD distribution within an intact scaphoid may guide the clinical management of scaphoid fractures, highlighting the need for targeted treatment strategies based on BMD variations.

Hospitalization of patients with Down syndrome in acute care hospitals in Japan

AbstractBackgroundDown syndrome is the most common genetic disorder, and the life expectancy of patients with Down syndrome has increased over the decades. However, the diseases and social problems experienced by patients with Down syndrome remain unknown in Japan. Therefore, we aimed to investigate the disease status of such patients admitted to acute care hospitals in Japan.MethodsThis observational study was conducted using the Diagnosis Procedure Combination data from 2016 to 2021 to evaluate routes of admission, principal diagnoses, comorbidity of dementia, orthopedic surgeries for limb fractures, and discharge destinations of patients with Down syndrome (International Classification of Diseases, Tenth Revision code: Q90).ResultsOverall, 26,195 individuals with Down syndrome were included, of whom 5195 were ≥20 years of age. As the age increased, the number of admissions from home decreased and that from nursing homes increased. Pneumonia was the most common principal diagnosis, with the incidence of aspiration pneumonia increasing in patients &gt;40 years of age. We observed an increase in the incidence of dementia and surgery for limb fractures after 40 years of age. The number of discharges to home decreased with increasing age, whereas that to nursing homes increased with increasing age.ConclusionsThese results suggest that patients with Down syndrome are often hospitalized because of pneumonia and that the incidence of aspiration pneumonia, dementia, and limb fractures increases after 40 years of age. Therefore, a system to prevent pneumonia, especially aspiration pneumonia, and limb fractures in patients with Down syndrome is needed.

Associations of Serum Lipid Traits With Fracture and Osteoporosis: A Prospective Cohort Study From the UK Biobank.

Previous studies reveal inconsistent associations between serum lipid traits and the risks of fractures and osteoporosis in the general population. This prospective cohort study analysed data from 414 302 UK Biobank participants (223 060 women and 191 242 men, aged 37-73 years) with serum lipid measurements: apolipoprotein A (Apo A), apolipoprotein B (Apo B), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and lipoprotein A (Lp(a)). Multivariable Cox proportional hazard models with penalized cubic splines were used to explore potential nonlinear associations of each lipid trait with the risks of fractures and osteoporosis. Subgroup analyses by age, sex, BMI categories and pre-existing cardiovascular disease were conducted. Mediation analyses using the g-formula were performed to quantify to which extent bone mineral density (BMD) may mediate the association between serum lipids and fracture risk. Over a median follow-up period of 13.8 years, 25 918 (6.8%) of the 383 530 participants without prior fracture had incident fracture cases, and 7591 (4.1%) of the 184 919 participants with primary care data and without baseline osteoporosis were diagnosed with osteoporosis. TG had nonlinear associations with fractures and osteoporosis, whereas Apo B, TC and LDL-C had linear associations. There were also nonlinear associations of Apo A and HDL-C with fractures. Individuals in the highest quintiles for Apo A (fracture: HR 1.15 [95% CI 1.10, 1.21]; osteoporosis: HR 1.13 [1.02, 1.25]) and HDL-C (fracture: HR 1.27 [1.20, 1.34]; osteoporosis: HR 1.31 [1.18, 1.46]) were associated with higher risks of fractures and osteoporosis. Conversely, those in the highest quintile for Apo B (fracture: HR 0.85 [0.81, 0.89]; osteoporosis: HR 0.86 [0.79, 0.94]), LDL-C (fracture: HR 0.89 [0.85, 0.93]; osteoporosis: HR 0.91 [0.83, 1.00]) and TG (fracture: HR 0.78 [0.74, 0.82]; osteoporosis: HR 0.75 [0.68, 0.82]) were associated with lower risks. The associations of Apo A (ratio of HR [RHR] 1.05 [1.02, 1.09]) and HDL-C (RHR 1.06 [1.03, 1.09]) with fracture risk were more pronounced in men compared to women. Except for TG and Lp(a), the associations between serum lipids and fractures appear to be partially mediated through BMD (mediation proportions: 5.30% to 40.30%), assuming causality. Our study reveals a complex interplay between different lipid markers and skeletal health, potentially partially mediated through BMD. Routine lipid profile assessments, including HDL-C and Apo A among other lipid traits, may be integrated into the strategies for fracture risk stratification.

Association of diuretics with falls and wrist fractures: a Mendelian randomization study

BackgroundThe association between diuretics and falls in older adult has been reported in previous studies, but discrepancy remains between the different types of diuretics. The association of diuretics with the risk of wrist fractures due to diuretics is also unclear. Therefore, in this study, we determined the association of diuretics with falls and wrist fractures by Mendelian randomization.MethodsWe used a two-sample Mendelian randomization (MR) approach to evaluate the effects of the loop diuretics\potassium-sparing diuretics\thiazide diuretics (LDs\PSDs\TDs) on the risk of falls and wrist fracture using the three diuretic-associated genetically-predicted single nucleotide polymorphisms (SNPs) as genetic tools. The inverse variance weighting (IVW) method was used as the main evaluation method, with odds ratio (OR) as the evaluation criterion. Additionally, weighted median (WME), MR-Egger, weighted mode (WM) and simple mode (SM) methods were used together for the MR analysis, and sensitivity analyses were performed to assess the robustness of the main results.ResultA total of 35 SNPs were included in this study as instrumental variables to replace LDs, PSDs, and TDs, which were 24, 7, and 4. Genetic substitutions for diuretics associated with increased risk of falls were LDs (OR = 1.012043, 95%CI: 1.001607–1.022588, p = 0.022337), PSDs (OR = 1.023794, 95%CI: 1.005605–1.042312, p = 0.010138). Genetically proxied TDs showed no association with falls, but the use of TDs showed a negative correlation with the incidence of wrist fracture (OR = 0.833, 95%CI: 0.767–0.905, p &amp;lt; 0.001). The Cochran Q-test showed no heterogeneity and MR-PRESSO method excluded data pleiotropy.ConclusionOur findings suggest that the use of loop diuretics (LDs) or potassium-sparing diuretics (PSDs) increases the incidence of falls, but there is no causal relationship between thiazide diuretics (TDs) and falls, and TDs may actually reduce the risk of wrist fractures. Clinical use of diuretics necessitates vigilance and appropriate preventive measures to minimize fall-related events.

Construction of a nomogram for preoperative deep vein thrombosis in pelvic fracture patients

BackgroundIn recent years, the incidence of pelvic fractures has been on the rise, predominantly affecting the elderly population. Deep vein thrombosis may lead to poor prognosis in patients. monocyte-to-lymphocyte ratio is novel biomarkers of inflammation, and this study aims to verify their predictive effect and construct the nomogram model.MethodThis study used binary logistic regression analysis to predict the predictive effect of MLR on the occurrence of DVT in pelvic fractures patients. And use R studio to construct nomogram model.ResultThe results showed that Age (1.04 [1.01, 1.07], p = 0.006), WBC (1.44 [1.28, 1.61], p < 0.001), and MLR (2.11 [1.08, 4.13], p = 0.029) were independent predictive factors. The nomogram demonstrated good predictive performance with small errors in both the training and validation groups, and most clinical patients could benefit from them.ConclusionThe nomogram constructed based on MLR can assist clinicians in early assessment of the probability of DVT occurrence.

Tackling the challenge of 90-day readmissions in hip fracture management: a retrospective study

Background: Hip fracture readmissions within 90 days pose a significant challenge in orthopaedics, burdening healthcare systems and affecting patient outcomes. This study, set against the backdrop of an aging population and rising hip fracture incidences, seeks to analyse the factors contributing to these readmissions and propose viable management strategies. Methods: Conducted as a single centre study at a hospital which is part of the NHS UK, this retrospective study reviewed 1264 patients treated for neck of femur (NOF) fractures between April 2020 and December 2022. Data on patient demographics, comorbidities, surgical interventions, and readmission reasons were collected and analysed using descriptive statistics and multivariable logistic regression. Results: The study found a 21.8% readmission rate, with the majority being for non-orthopaedic reasons such as infections and cardiovascular events. Age and comorbidities were significant predictors of readmission, while surgical factors had a less pronounced impact. A year-wise trend showed a peak in readmissions during the COVID-19 pandemic. Conclusions: The findings emphasize the complexity of managing NOF fractures and the importance of a comprehensive, multidisciplinary approach to care. Targeted interventions, including orthogeriatric co-management and falls assessment, are recommended to mitigate readmission risks and enhance patient care, though further research is needed for more definitive strategies.

Adverse impacts of corticosteroid treatment on osteoporosis/osteopenia in adult asthmatics: A retrospective ICARUS cohort study

Inhaled corticosteroid (ICS) and oral corticosteroid (OCS) are often used in asthma management. This study evaluated the long-term effect of ICS/OCS on osteoporosis, osteopenia, fractures, and bone metabolism in adult asthmatics in real-world clinical practice. This is a retrospective study investigating de-identified electronic health records from Ajou University Medical Center (Korea). Adult asthmatics receiving maintenance ICS with/without OCS for at least 1 year were enrolled. They were classified into the high/low-dose of ICS or OCS groups. Primary outcomes (incidences of osteoporosis, osteopenia, and fractures) and secondary outcomes (drug prescription and laboratory values related to bone metabolism including albumin and alkaline phosphatase [ALP]) were compared after 5 years of follow-up. After propensity score matching, both high- and low-dose OCS groups included 468 patients, and high/low-dose ICS groups each comprised 1,252 patients. The risk of osteoporosis/major fracture was higher (hazard ratio [95% CI]; 2.00 [1.15-3.57]/3.03 [1.04-11.11]) in the high-dose OCS group (especially in females aged ≥50 years) than in the low-dose group, although the ICS groups showed no significant differences. The high-dose ICS group showed a higher risk of osteopenia (1.92 [1.05-3.70]) than the low-dose ICS group. The linear mixed model of laboratory values showed significantly decreased serum albumin and increased ALP in the high-dose OCS group than in the low-dose OCS group. The results of this study suggest that long-term use of OCS can increase the risk of osteoporosis and osteoporosis-related fractures, while long-term use of ICS may increase the risk of osteopenia in adult asthmatics.

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.

Association between Chronic Hepatitis B/C and Incidence of Osteoporosis and Bone Fractures: Results from a Retrospective Cohort Study.

Background: Osteoporosis and bone fractures affect health and quality of life. Since bone disease is multifactorial, identifying risk factors is key in prevention. There are multiple reports on how viral hepatitis, especially chronic hepatitis B (CHB) and chronic hepatitis C (CHC), are affecting bone disease, but results vary. Here, we analyzed the potential association between CHB/CHC and osteoporosis or bone fractures in a large outpatient cohort in Germany. Methods: We included 3136 outpatients with CHB and 15,608 matched non-hepatitis individuals as well as 2867 outpatients with CHC and 14,335 matched non-hepatitis individuals from the Disease Analyzer Database between 2005 and 2022. The main outcome was the 5-year cumulative incidence of osteoporosis and bone fractures as a function of either CHB or CHC. Results: Within 5 years of the index date, 2.9% vs. 1.6% of patients with and without CHB were diagnosed with osteoporosis (p = 0.001) and 1.0% vs. 0.4% were diagnosed with bone fractures (p < 0.001). Moreover, 3.3% of CHC patients and 2.2% of individuals without hepatitis C were diagnosed with osteoporosis (p = 0.002). In Cox regression analyses, CHB was significantly associated with an increased risk for osteoporosis (HR: 1.76) and fractures (HR:2.43) and CHC with osteoporosis (HR: 1.54). For both CHB and CHC, the association with osteoporosis was restricted to the female subgroup. Conclusions: CHB and CHC are associated with osteoporosis in women. CHB in male patients is associated with a higher risk of fractures. More research is needed to understand the underlying pathophysiological mechanisms.