Probabilistic Fracture Research Articles

Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery

Patient: Male, 73-year-old Final Diagnosis: Subacute lower limb ischemia Symptoms: Coldness • pallor • numbness • rest pain of the right toes Medication: — Clinical Procedure: Percutaneous Fogarty thrombectomy Specialty: Cardiac Surgery • Cardiology Objective: Unusual setting of medical care Background:Subacute lower limb ischemia occurs more than 14 days and less than 3 months from symptom onset. Although endovascular procedures are the preferred treatment choice for a viable and not immediately threatened limb in patients with acute lower limb ischemia (<14 days), percutaneous catheter-directed thrombolysis, percutaneous mechanical thrombectomy, or percutaneous thromboaspiration are not recommended, and no treatment strategy has yet been established for nonacute lower limb ischemia (>14 days). A percutaneous Fogarty thrombectomy, an endovascular thrombus removal procedure with the use of a large-caliber sheath and a Fogarty balloon catheter, has recently been reported as a less invasive alternative to open surgery in patients with acute lower limb ischemia. In this report, we use this technique for a case of subacute lower limb ischemia caused by a resistant thrombus.Case Report:A 73-year-old man with a diagnosis of essential thrombocythemia presented with symptoms of right lower limb ischemia, which started about a month before. The diagnosis was subacute lower limb ischemia due to a resistant thrombus in the popliteal artery. First, we attempted percutaneous thromboaspiration and prolonged dilation with a large-caliber balloon catheter, but there were still severe residual stenoses with delayed blood flow. Although vascular scaffold implantation might have achieved complete revascularization, we avoided it because of a high probability of stent fracture in the popliteal artery. Thus, we performed a subsequent percutaneous Fogarty thrombectomy immediately after the conventional endovascular recanalization failed, achieving complete revascularization and next-day discharge without any complications.Conclusions:A percutaneous Fogarty thrombectomy could be a new treatment option for subacute lower limb ischemia due to a resistant thrombus, which can be performed immediately after failure of the conventional endovascular recanalization.

Effect of Neutron Irradiation on the Critical Event Size of Cleavage Fracture of the Chinese A508-3 Steel

In order to analyze the influence of neutron irradiation on the critical event of cleavage fracture for the Chinese A508-3 (RPV) steel, the fracture morphology, microstructure and grain size of the irradiated specimens are observed and analyzed by optical microscope (OM) and scanning electron microscope (SEM). The results show that with the increase of neutron doses, the fracture mode of Chinese RPV steel material changes gradually from ductile fracture to ductile-brittle mixed fracture transformation. The brittle part for fracture mode of ductile-brittle fracture is cleavage fracture, and the non-metallic inclusions, microstructure and grain size grades are not significantly different from those of the specimens without cleavage fracture. In the same material, with increasing of neutron doses, the critical event size of the cleavage fracture will be reduced, and the percentage of the grain that satisfies the grain size of the cleavage critical event will increase correspondingly, resulting in an increase of the probability of cleavage fracture of the material. The fine grain with uniform distribution can improve partly the fracture toughness of the material and withstand higher neutron doses under the same conditions.

Age-dependent assessment thresholds to optimize patient care in a resource-limited setting: an analysis based on the Sri Lankan FRAX model.

Age-dependent assessment thresholds of the FRAX algorithm help stratifying men and women aged 40years or more according to their fracture risk. This allows clinicians to decide on those who require interventions without BMD assessment and those who require BMD input for further assessment. Intervention thresholds were defined by 10-year probabilities of a major osteoporotic fracture (MOF) and hip fracture (HF) considering a woman with a BMI of 25.0kg/m2 having a prior fragility fracture but no other clinical risk factors. The lower assessment thresholds (LAT) were set at 0.8 times the 10-year probabilities of a MOF and HF in a woman with a BMI of 25.0kg/m2, without previous fracture or other clinical risk factors. The upper assessment thresholds (UAT) were set at 1.2 times the intervention thresholds of MOF and HF. Fracture probabilities were estimated for the age range of 40-80years, without BMD input. These values were applied to a group of women who underwent DXA for clinical reasons in a single center. The LATs of MOF and HF varied from 0.7 to 8.8% and 0.1 to 3.7%, from 40 to 80years, respectively. The corresponding values for UATs were 2.5 to 21.6% and 0.3 to 8.4%. ITs of MOF and HF varied from 2.1 to 18% and 0.2 to 7%, respectively. When applied to a group of 315 postmenopausal women who underwent DXA for clinical indications, 22.9% of women were above the UATs (high-risk category) while 8.6% were below the LATs (low-risk category). The proportion of women in the intermediate category who require BMD for further assessment was 68.6% (95% CI 59.7 to 77.5%). In nearly one-third of women aged 40years or more, the decision to treat or not to treat can be achieved without BMD estimation. The remaining two-thirds will require a BMD assessment for further evaluation.

Capturing the Temperature Dependence of Cleavage Fracture Toughness in the Ductile-to-Brittle Transition Regime in Ferritic Steels Using an Improved Engineering Local Approach

Abstract Ferritic steels, which are typically used for critical reactor components, including reactor pressure vessels (RPV), exhibit a temperature-dependent probability of cleavage fracture, termed ductile-to-brittle transition. The fracture process has been linked to the interaction between matrix plasticity and second-phase particles. Under high-enough loads, a competition exists between cleavage and ductile fracture, which results from particles rupturing to form microcracks or particles decohering to form microvoids, respectively. Currently, there is no sufficiently adequate model that can predict accurately the reduced probability of cleavage with increasing temperature and the associated increase of plastic deformation. In this work, failure probability has been estimated using a local approach to cleavage fracture incorporating the statistics of microcracks. It is shown that changes in the deformation material properties are not enough to capture the significant changes in fracture toughness. Instead, a correction to the fraction of particles converted to eligible for cleavage microcracks, with an exponential dependence on the plastic strains, is proposed. The proposed method is compared with previous corrections that incorporate the plastic strains, and its advantages are demonstrated. The method is developed for the RPV steel 22NiMoCr37 and using experimental data for a standard compact tension C(T) specimen. The proposed approach offers more accurate calculations of cleavage fracture toughness in the ductile-to-brittle transition regime using only a decoupled model, which is attractive for engineering practice.

FC094: Frax is Useful Tool for Predicting All-Cause Mortality in Addition to the Risk of Fragile Fracture in Hemodialysis Patients

Abstract BACKGROUND AND AIMS The fracture risk assessment tool (FRAX®) was developed to predict the probability of fragile fractures during the next 10 years for the general population, and it is calculated by inputting risk factors of fractures such as age, gender, height, weight, fracture history, presence or absence of rheumatoid arthritis and steroid therapy. Although contents of FRAX do not include CKD as a risk factor, previous studies have shown that FRAX was useful in predicting fracture risk in maintenance dialysis patients. However, many reports are short-term observational studies targeting fracture risk. In the present study, we examined whether FRAX can be useful to predict the risk of fragile fractures and all-cause mortality in hemodialysis patients through the long-term observation. METHOD A retrospective cohort study was conducted in 273 patients aged 40 to under 90 who started hemodialysis at our hospital between March 2004 and the present and who could be followed for at least 3 years or had a fracture within 3 years. In order to assess the association between FRAX score and fragile fracture or all-cause mortality, a multivariate analysis was performed using the Cox proportional hazard model with factors related to fractures and mortality as covariates. The 10-year probability (%) of major osteoporotic fracture without bone mineral density was adopted as the FRAX score. RESULTS The average follow-up period was 6.7 years, and the average age of patients was 66 years, with women accounting for 29%. Of all 273 patients, 55 developed fragile fractures and 97 died. FRAX scores were divided into two groups (lower FRAX score and higher FRAX score) in accordance with a cut-off value of 8.2%, determined by ROC curve for fracture. Univariate analysis of factors associated with fractures revealed that higher FRAX score (8.2 or more) was a significant factor [hazard ratio (HR): 4.49 (2.59–7.85)]. Multivariate analysis conducted with significant factors in univariate analysis (mean serum albumin level, serum phosphorus level, magnesium level, C-reactive protein level and use or non-use of phosphate binder during the 3 years) as the covariates revealed that higher FRAX score was significantly associated with fractures [HR: 2.40 (1.27–4.5)]. Regarding the association between FRAX score and all-cause mortality, in univariate analysis, higher FRAX score was a significant predictive factor [HR: 4.34 (2.84–6. 64)]. In multivariate analysis adjusted with mean serum albumin level, creatinine level, magnesium level, C-reactive protein level, hemoglobin level, use or non-use of phosphate binder and calcimimetics as the covariates, higher FRAX score was found to be a significant factor of all-cause mortality [HR: 3.22 (1.97–5.22)]. CONCLUSION FRAX score was also a useful tool for predicting fractures and all-cause mortality in hemodialysis patients even in long-term analysis.

MO546: Association Between T Scores, FRAX, Frailty, Falls and Fractures in Patients Undergoing Maintenance Hemodialysis

Abstract BACKGROUND AND AIMS Despite the negative impact of fracture in hemodialysis (HD) patients, optimal risk assessment tools in this population are not well explored. Frailty (a syndrome of diminished capacity to respond to health stressors) and falls—known risk factors for fracture—are common in HD patients. While the relationship between T scores in relation to fractures in these patients is recognized, there is a paucity of data to the additional contributions of fracture risk assessment tool (FRAX), frailty and falls in relation to fractures. The clinical, societal and economic impact of fractures necessitates an active response from the HD programs. Therefore, we intended to evaluate the clinical utility of adding these factors to T scores at the femoral neck to determine whether it enhances fracture discrimination in HD patients. METHOD We conducted a cross-sectional study on 131 adult patients receiving HD at two dialysis units in Regina, Saskatchewan, Canada (January 2017–December 2018). After undergoing frailty assessments, patients were referred for dual-energy X-ray absorptiometry (DXA) scans and FRAX questionnaires. They were additionally sent for lumbar X-rays and contacted for a history of falls. The presence of fracture (hips, femur, pelvis, knee, foot, leg, toe, shoulder, elbow, ankle, arm, wrist, spine and lumbar) was documented based on the review of medical charts, self-recall and additionally vertebral fractures were identified by an X-ray. Bone mineral density (BMD) was measured by DXA. FRAX score (the 10-year probability of hip and major osteoporotic fracture) was calculated using an online algorithm based on 11 clinical risk factors with and without the inclusion of BMD. Frailty was assessed using the FRIED criteria (Figure 1). Patients were enquired about the history and frequency of falls. Association between the BMD-T score, FRAX score, frailty status, falls, with fracture were examined with sequential multivariable logistic regression models. The area under the receiver operating characteristic curve analysis was conducted for each model to assess its discrimination ability for fracture outcome (α = 0.05). RESULTS A total of 109 HD patients were included in the data analysis. The composite of fracture occurred in 38% of patients. About 60% were identified as frail, and 29% had at least one fall in the last year. Low T score and FRAX were both independent risk factors in patients on HD therapy. On multivariate analysis, each lower standard deviation in T score was associated with 48% higher odds of fracture [odds ratio (OR) = 1.48; 95% confidence interval (95% CI) 1.20–1.68, P = 0.005]. With the inclusion of FRAX score for hip fracture, the OR for fracture remained significant at 1.38 (OR = 1.38, 95% CI 1.04–1.63, P = 0.04). The addition of frailty status and history of falls did not further improve the model. Model 2 showed better discrimination ability and goodness-of-fit for fracture compared to Model 1 (P = 0.004) (Table). CONCLUSION This is the first study to our knowledge that looked at the independent contribution of frailty and falls in addition to T scores and FRAX in assessing for fractures in patients on HD. Our study showed both BMD measurements by DXA scans and FRAX are useful tools to assess fracture in patients receiving HD. The addition of frailty status and history of falls is not associated with fractures in this population. Results of this study should lead to prospective studies with larger sample sizes prior to DXA scans, FRAX and falls assessment being recommended as standards of care.

The clinician’s guide to prevention and treatment of osteoporosis

Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2- to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF) – formerly the National Osteoporosis Foundation – first published the Clinician’s Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician’s Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued—sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores are above − 2.5. Ongoing monitoring and strategic interventions will be necessary if fractures are to be avoided. In addition to pharmacotherapy, adequate intake of calcium and vitamin D, avoidance of smoking and excessive alcohol intake, weight-bearing and resistance-training exercise, and fall prevention are included in the fracture prevention armamentarium. Where possible, recommendations in this guide are based on evidence from RCTs; however, relevant published data and guidance from expert clinical experience provides the basis for recommendations in those areas where RCT evidence is currently deficient or not applicable to the many osteoporosis patients not considered for RCT participation due to age and morbidity.

Management of Osteoporosis and Spinal Fractures: Contemporary Guidelines and Evolving Paradigms.

Physicians involved in treating spine fractures secondary to osteopenia and osteoporosis should know the pathogenesis and current guidelines on managing the underlying diminished bone mineral density, as worldwide fracture prevention campaigns are trailing behind in meeting their goals. This is a narrative review exploring the various imaging and laboratory tests used to diagnose osteoporotic fractures and a comprehensive compilation of contemporary medical and surgical management. We have incorporated salient recommendations from the Endocrine Society, the American Association of Clinical Endocrinology (AACE), and the American Society for Bone and Mineral Research (ASBMR). The use of modern scoring systems such as Fracture Risk Assessment Tool (FRAX®) for evaluating fracture risk in osteoporosis with a 10-year probability of hip fracture and major fractures in the spine, forearm, hip, or shoulder is highlighted. This osteoporosis risk assessment tool can be easily incorporated into the preoperative bone health optimization strategies, especially before elective spine surgery in osteoporotic patients. The role of primary surgical intervention for vertebral compression fracture and secondary fracture prevention with pharmacological therapy is described, with randomized clinical trial-based wisdom on its timing and dosage, drug holiday, adverse effects, and relevant evidence-based literature. We also aim to present an evidence-based clinical management algorithm for treating osteoporotic vertebral body compression fractures, tumor-induced osteoporosis, or hardware stabilization in elderly trauma patients in the setting of their impaired bone health. The recent guidelines and recommendations on surgical intervention by various medical societies are covered, along with outcome studies that reveal the efficacy of cement augmentation of vertebral compression fractures via vertebroplasty and balloon kyphoplasty versus conservative medical management in the elderly population.

Evaluation of Tensile Bond Strength between Self-Adhesive Resin Cement and Surface-Pretreated Zirconia.

The tensile bond strength between zirconia subjected to different surface-pretreatment methods and methacryloyloxydecyl-dihydrogen-phosphate (MDP)-containing self-adhesive resin cement was evaluated herein. Eighty-eight cylindrical zirconia specimens were randomly divided into the following four groups based on the pretreatment method: (1) no treatment, (2) air abrasion, (3) HNO3/HF etching, and (4) zirconia-nanoparticle coating. The tensile bond strength of the zirconia–resin-cement complexes was investigated. One-way ANOVA and post hoc tests were performed at a 95% significance level, and the Weibull modulus was calculated. Fracture patterns were visualized by SEM. The surface roughness of the specimens without resin bonding was evaluated by AFM. The tensile bond strength of the specimens decreased as follows: Groups 3 > 4 > 2 > 1 (28.2 ± 6.6, 26.1 ± 5.7, 16.6 ± 3.3, and 13.9 ± 3.0 MPa, respectively). Groups 3 and 4 had significantly higher tensile bond strengths (p < 0.05) and lower fracture probabilities than those of Groups 1 and 2. They also showed both mixed failure and resin-cement cohesive failure, whereas Groups 1 and 2 showed mixed failure exclusively. The zirconia–resin tensile bond was stronger after HNO3/HF etching or ZrO2-nanoparticle coating than after air abrasion or no treatment. The estimated surface roughness decreased as follows: Groups 3 > 4 > 2 > 1. The combination of zirconia pretreated with HNO3/HF etching or ZrO2-nanoparticle coating and an MDP-containing self-adhesive resin cement can increase the clinical longevity of zirconia restorations by preventing their decementation.

P142 Fracture risk in diabetes: to FRAX or not to FRAX?

Abstract Background/Aims Diabetes mellitus is associated with decreased bone strength as well as increased fracture risk. The risk of fragility fracture increases with an increase in the duration of diabetes and worsening of glycemic control. However, this increased fracture risk often goes unidentified. Identifying patients at risk of fracture is fundamental in helping to prevent fractures. WHO FRAX (fracture risk assessment) tool computing the 10-year probability of hip fracture or a major osteoporotic fracture helps ascertain fracture risk. In Type 2 Diabetes Mellitus (T2DM), the diagnosis of osteoporosis by dual-energy X-ray absorptiometry (DXA) and the FRAX are only partially useful in assessing fracture risk. Our aims were: 1. To identify the fracture risk in patients with diabetes and 2. To assess the impact of adding diabetes as a risk factor in the calculation of FRAX score. Methods One hundred patients above the age of 50 years with duration of diabetes above a year who attended the diabetes clinic from December 2020 to June 2021 were included. Data was collected on demographics (age, sex, ethnicity), diabetes-related factors (the type, duration, complications and medications) and clinical risk factors for osteoporotic fracture (parental fracture, previous fracture, smoking, alcohol intake) from patient interviews and the FRAX score was calculated. FRAX tool was modified for diabetes by adding either 10 years of age or Rheumatoid arthritis as risk factor. Results Mean age of our cohort of patients was 67 years and their mean BMI was 33 kg/sq m. Duration of diabetes was over 5 years in 95% of the patients. T2DM was seen in 82% and Type 1 Diabetes mellitus (T1DM) in 18%. The mean HbA1c was 8.4%. Unadjusted mean FRAX score for a major osteoporotic fracture was 8.9% and hip fracture 2.3%. High risk of future fracture was seen in 4% of the patients and intermediate risk in 23% and low risk in 73%. Four patients had Rheumatoid arthritis and 21 had previous fragility fractures. Modifying the FRAX tool by adding 10 years to age moved 15% more patients to the intermediate-risk category needing DXA and 5% more to the high-risk category needing osteoporosis treatment. However, adding Rheumatoid arthritis changed 20% more patients to the intermediate-risk category needing DXA and 7% more to the high-risk category needing osteoporosis treatment. Conclusion Modifying FRAX tool in patients with diabetes mellitus will enable more patients to have a DXA scan and to receive osteoporosis treatment and the strategy using rheumatoid arthritis as a risk factor identified more patients than adding 10 years of age. Disclosure M. Mathew: None. S. Dwivedi: None. H. Buch: None. S. Venkatachalam: None.

Improved fracture risk prediction by adding VFA-identified vertebral fracture data to BMD by DXA and clinical risk factors used in FRAX

SummaryVertebral fracture (VF) is a strong predictor of subsequent fracture. In this study of older women, VF, identified by dual-energy X-ray absorptiometry (DXA) vertebral fracture assessment (VFA), were associated with an increased risk of incident fractures and had a substantial impact on fracture probability, supporting the utility of VFA in clinical practice.PurposeClinical and occult VF can be identified using VFA with dual-energy X-ray absorptiometry (DXA). The aim of this study was to investigate to what extent VFA-identified VF improve fracture risk prediction, independently of bone mineral density (BMD) and clinical risk factors used in FRAX.MethodsA total of 2852 women, 75–80 years old, from the prospective population-based study SUPERB cohort, were included in this study. At baseline, BMD was measured by DXA, VF diagnosed by VFA, and questionnaires used to collect data on risk factors for fractures. Incident fractures were captured by X-ray records or by diagnosis codes. An extension of Poisson regression was used to estimate the association between VFA-identified VF and the risk of fracture and the 5- and 10-year probability of major osteoporotic fracture (MOF) was calculated from the hazard functions for fracture and death.ResultsDuring a median follow-up of 5.15 years (IQR 4.3–5.9 years), the number of women who died or suffered a MOF, clinical VF, or hip fracture was 229, 422, 160, and 124, respectively. A VFA-identified VF was associated with an increased risk of incident MOF (hazard ratio [HR] = 1.78; 95% confidence interval [CI] 1.46–2.18), clinical VF (HR = 2.88; 95% [CI] 2.11–3.93), and hip fracture (HR = 1.67; 95% [CI] 1.15–2.42), adjusted for age, height, and weight. For women at age 75 years, a VFA-identified VF was associated with 1.2–1.4-fold greater 10-year MOF probability compared with not taking VFA into account, depending on BMD.ConclusionIdentifying an occult VF using VFA has a substantial impact on fracture probability, indicating that VFA is an efficient method to improve fracture prediction in older women.

Effect of capillary adhesion on fracture of photovoltaic silicon wafers during diamond wire slicing

As the photovoltaic industry needs to reduce manufacturing costs, the kerf loss and the wafer thickness of diamond wire slicing will be further reduced in the future, which will make the spacing and bending rigidity of the wafers decrease to the extent that the effect of capillary adhesion of wafers is more significant during slicing, thus increasing the risk of silicon wafer fracture. Therefore, a hierarchical capillary adhesion model of wafers during the diamond wire slicing based on the principle of minimum potential energy is established in this paper. The variation of the maximum bending stress and the number of adhered wafers with sawing depth, kerf width, and wafer thickness and the effect of capillary adhesion on the silicon wafer fracture are studied. The results show that the maximum bending stress and the number of adhered wafers increased with the increase of the sawing depth, which meant that the risk of wafer fracture was greater for sawing large-sized wafers. And they also tended to increase as the kerf width and the wafer thickness decreased, that was, the effect of capillary adhesion on the thin wafer sawn with a fine diamond wire was more significant. In addition, the probability of the mono-Si wafers fracture caused by capillary adhesion increased significantly when the wafer thickness was less than 100 μm. The research work is of great significance for further research on the thin wafers slicing technology with the fine diamond wire to reduce the manufacturing costs of silicon wafers in the photovoltaic industry.

Epidemiology of risk factors and estimating 10-year probability of osteoporotic fractures in the Russian Federation.

To investigate the prevalence of osteoporotic fractures (OPF) RFs and estimate absolute risk (AR) of OPF among urban vs rural residents of the Russian Federation. In total, 13,391 Russian women and men 40-69years old from 12 regions participated in the study. Groups of urban (n = 12,237) and rural (n = 1154) subjects were comparable in terms of their age. Participants were interviewed using a standard modular questionnaire. AR of OPF was calculated using the Russian FRAX model. Age-dependent diagnostic and therapeutic intervention thresholds (DIT, TIT) were employed to stratify AR of OPF. Among the OPF RFs, the most common were as follows: previous OPF (16.3%), causes of secondary osteoporosis (20.8%), and current smoking (17.9%). The frequencies of previous OPF and alcohol abuse in rural men were higher than in urban male residents. Urban women, compared with rural females, were characterized by such more frequent RFs as smoking and glucocorticoids' intake. AR increased with age and prevailed in women, compared with men, regardless of their age, region of residence, and settlement type. According to TIT, the frequency of high AR of major OPF in the sample was 7.0%. According to DIT, high, medium, and low AR of major OPF was detected in 3.1%, 42.2%, and 54.7% of participants, respectively. Among urban women compared with rural females, high AR of major OPF was more often detected (p < 0.05), using TIT, whereas there was no such pattern for men. We discovered the territorial variability of RFs and OPF AR. Prevalence of OPF RFs varied in Russia depending on age, gender, constituent entities, and the settlement type. Our data have demonstrated the typical age-gender causation pattern of OPF AR. Over 40% of participants required densitometry and fracture risk reclassification.

Role of Fracture Risk Assessment Tool and Bone Turnover Markers in Predicting All-Cause and Cardiovascular Mortality in Hemodialysis Patients.

BackgroundFracture Risk Assessment Tool (FRAX) and bone turnover markers (BTMs) predict fractures in the general population. However, the role of FRAX and BTMs in predicting mortality remains uncertain in hemodialysis (HD) patients.MethodsOne hundred and sixty-four HD patients stratified by low or high risk of 10-year fracture probability using FRAX. High risk of fracture was defined as 10-year probability of hip fracture ≥3% or major osteoporotic fracture ≥20%. The association of high risk of fracture and BTMs with all-cause mortality and cardiovascular (CV) mortality were evaluated using multivariate-adjusted Cox regression analysis.ResultsEighty-five (51.8%) patients were classified as high risk of fracture based on FRAX among 164 HD patients. During a mean follow-up period of 3.5 ± 1.0 years, there were 39 all-cause deaths and 23 CV deaths. In multivariate-adjusted Cox regression, high risk of fracture based on FRAX was independently associated with all-cause mortality [hazard ratio (HR): 2.493, 95% confidence interval (CI): 1.026–6.056, p = 0.044) but not with CV mortality (HR: 2.129, 95% CI: 0.677–6.700, p = 0.196). There were no associations between BTMs and mortality risk. Furthermore, lower geriatric nutritional risk index (GNRI) was significantly associated with increased CV mortality (HR: 0.888, 95% CI: 0.802–0.983, p = 0.022) after adjusting by confounding variables.ConclusionHigh risk of fracture using FRAX was an independent predictor of all-cause mortality in patients undergoing HD. FRAX, rather than BTMs, has an important role of prognostic significance in HD patients.

Shock-absorbing effect of flooring-adopted mechanical metamaterial technology and its influence on the gait and balance of older adults

ObjectiveTo elucidate the performance of a shock-absorbing floor material with a mechanical metamaterial (MM-flooring) structure and its effect on the gait and balance of older adults.MethodsThe drop-weight impact was applied...

Crustal Deformation Patterns in the Tibetan Plateau and Its Adjacent Regions as Revealed by Receiver Functions

ABSTRACT In the past decades, several mechanisms (e.g., the crustal flow and thin viscous sheet models) and combinations of them have been proposed to explain the uplift and outgrowth of the Tibetan plateau. These mechanisms, however, cannot account for all the features observed, and the issue is still highly debated. In this study, we computed receiver functions (RFs) at 254 permanent and portable stations in the Tibetan plateau and its adjacent regions to provide large-scale constraints for the crustal deformation. A harmonic analysis, which has been recently proposed to help distinguishing a dipping Moho from crustal anisotropy, was employed here to investigate the accurate crustal anisotropy. We further applied the H-κ stacking technique to determine the crustal composition using the RFs after harmonic correction or moveout correction. Our results showed the following: (1) Harmonic corrections on Ps phases led to average differences of 2.6 km and 0.04 in crustal thickness and in the VP/VS ratio, respectively; notably, the weighting factors of the Ps, PpPs, and PpSs + PsPs phases affected the uncertainties more obviously than the harmonic corrections. (2) The crustal deformation of the central–southern Tibetan plateau was controlled by the faulting and subduction of the Indian plate; meanwhile, faulting played a dominant role in the crustal deformation of the northern and eastern Tibetan plateau. (3) Widespread upper crustal or crustal shortening and thickening should have occurred beneath the entire study region, except for the Chuan–Dian block (which likely underwent tectonic extension). (4) Crustal partial melting might have enhanced the crustal anisotropy, and promoted the accumulation and release of strain, increasing the probability of fracture in the upper crust.

Incidence of hip fracture in Saudi Arabia and the development of a FRAX model

SummaryA prospective hospital-based survey in representative regions of Saudi Arabia determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX® model to facilitate fracture risk assessment in Saudi Arabia.ObjectiveThis paper describes the incidence of hip fracture in the Kingdom of Saudi Arabia that was used to characterize the current and future burden of hip fracture, to develop a country-specific FRAX® tool for fracture prediction and to compare fracture probabilities with neighbouring countries.MethodsDuring a 2-year (2017/2018) prospective survey in 15 hospitals with a defined catchment population, hip fractures in Saudi citizens were prospectively identified from hospital registers. The number of hip fractures and future burden was determined from national demography. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Saudi Arabia. Fracture probabilities were compared with those from Kuwait and Abu Dhabi.ResultsThe incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 2,949 and is predicted to increase nearly sevenfold to 20,328 in 2050. Hip fracture rates were comparable with estimates from Abu Dhabi and Kuwait. By contrast, probabilities of a major osteoporotic fracture or hip fracture from the age of 70 years were much lower than those seen in Abu Dhabi and Kuwait due to higher mortality estimates for Saudi Arabia.ConclusionA country-specific FRAX tool for fracture prediction has been developed for Saudi Arabia which is expected to help guide decisions about treatment.

New national osteoporosis guidance-implications for geriatricians.

Fragility fractures are painful, debilitating, often life-changing and accounted for an estimated 2.4% of pre-pandemic health care spending in the UK. Those who are older, frail and multimorbid have the highest fracture risk and therefore the most to gain from anti-osteoporosis treatments to reduce this risk. Currently, an unacceptable treatment gap exists between those eligible for and those who receive treatment. This commentary discusses the major changes to the new, National Institute for Health and Care Excellence accredited, UK National Osteoporosis Guideline Group (NOGG) guidance (published March 2022) most relevant to the management of older people's bone health. Changes include intervention thresholds; using fracture probabilities from FRAX; for patients too frail to undergo DXA; greater emphasis on vertebral fracture detection and the use of intravenous zoledronate as a first-line anti-osteoporosis therapy; the new concept of 'very high fracture risk' which should prompt consideration of use of parenteral anti-osteoporosis therapy; new guidance regarding anabolic treatment options; concerns regarding denosumab cessation; and the urgent need to get patients with a fragility fracture onto treatment to reduce re-fracture risk with follow-up to check tolerance and ensure adherence.

Assessment of failure probabilities and the allowable size of defects in structural elements using the criteria of fracture mechanics

The possibility of assessing the safe size of the defects of metal continuity using risk criteria are considered. Such defects occur at all stages of the life cycle of structures. Assessment of their hazard and determination of their allowable size becomes important when the defects can lead to brittle or quasi-brittle fracture. In this case, models of linear and nonlinear fracture mechanics are used. In these models, defects are considered as internal elliptical or surface semi-elliptical cracks. The stochastic variety of shapes, sizes, locations, and orientations of defects has a significant effect on the destruction mechanisms. In this regard, the relevant probabilistic problem of assessing the permissible size of defects according to the criteria of the risk of destruction comes to the fore. We consider a general approach to assessing hazard of defects by risk criteria. Two settings of the probabilistic problem of risk assessment based on of one- and two-parameter fracture criteria are presented. The risk function in the form of the probability of fracture according to a given criterion is used as the main calculated characteristic. The expression of the risk function based on one-parameter criteria of fracture mechanics is presented. The main attention is paid to the probabilistic model based on the two-parameter fracture criterion by E. M. Morozov. This criterion provides ample opportunities for analyzing fracture mechanisms with a change in the size of defects. An expression for the risk function based on the family of two-dimensional probability distributions of Lu – Bhattacharya of the Weibull type is obtained. It is shown that the correlations of the fracture mechanisms can significantly affect the values of the fracture probabilities, and, consequently, the allowable size of defects.

Mathematical model of the bone biological age based on the bone mineral density and quality indicex and Ukrainian FRAX model

Background. It is well-known that with aging there is a loss of bone mass and its strength, which leads to the development of osteoporosis and its complications. The aim of the study was to create a modern mathematical model for determining the biological age of the bone system, taking into account indices of bone mineral density (BMD) and quality and the FRAX® questionnaire. Materials and methods. 77 women and 44 men aged 30 to 90 years without any significant somatic pathology were included in the study. Patients were divided into 4 age groups: 30–44 years old — young, 45–59 years — mature, 60–74 years — old age and 75–90 years— senile age. We measured the parameters of BMD in the different areas of the skeleton by means of the dual-photon X-ray absorptiometry (DXA, “Prodigy”). The 10-year probability of major osteoporotic and hip fractures was measured using the Ukrainian version of the FRAX®. Statistical analysis was performed in the Statistica 7.0 program (StatSoft Inc., USA). Results. The dependence of the indices of BMD and bone quality, risk of osteoporotic fractures on age and the need for their early determination in young people to predict the risk of osteoporosis and its complications have been proven. The coefficient of determination of the R2 model was 0.62, which indicates that 62% of the variance of the “Age” can be explained by the predictors included in the model (DXA and FRAX indices); adjusted R2 index was 0.59 (p&lt;0.001), which indicates high significance of the model. Conclusions. The developed model for estimating the bone biological age has high accuracy and can be used to assess the risk of osteoporosis and its complications in young people for the purpose of predicting the disease.