Bone Osteoporotic Fractures Research Articles

ERRATUMRosuvastatin Implant for Local Bone Specific Drug Delivery in Osteoporotic Bone Fracture (Journal of Biomaterials and Tissue Engineering, Vol. 5(7), pp. 565–569 (2015))

ERRATUMRosuvastatin Implant for Local Bone Specific Drug Delivery in Osteoporotic Bone Fracture (Journal of Biomaterials and Tissue Engineering, Vol. 5(7), pp. 565–569 (2015))

Einfluss des Beckenregisters der DGU auf die Versorgung von Beckenringfrakturen

Fractures of the pelvic ring are comparatively rare with an incidence of 2-8 % of all fractures depending on the study in question. The severity of pelvic ring fractures can be very different ranging from simple and mostly "harmless" type A fractures up to life-threatening complex type C fractures. Although it was previously postulated that high-energy trauma was necessary to induce a pelvic ring fracture, over the past decades it became more and more evident, not least from data in the pelvic trauma registry of the German Society for Trauma Surgery (DGU), that low-energy minor trauma can also cause pelvic ring fractures of osteoporotic bone and in a rapidly increasing population of geriatric patients insufficiency fractures of the pelvic ring are nowadays observed with no preceding trauma.Even in large trauma centers the number of patients with pelvic ring fractures is mostly insufficient to perform valid and sufficiently powerful monocentric studies on epidemiological, diagnostic or therapeutic issues. For this reason, in 1991 the first and still the only registry worldwide for the documentation and evaluation of pelvic ring fractures was introduced by the Working Group Pelvis (AG Becken) of the DGU. Originally, the main objectives of the documentation were epidemiological and diagnostic issues; however, in the course of time it developed into an increasingly expanding dataset with comprehensive parameters on injury patterns, operative and conservative therapy regimens and short-term and long-term outcome of patients. Originally starting with 10 institutions, in the meantime more than 30 hospitals in Germany and other European countries participate in the documentation of data. In the third phase of the registry alone, which was started in 2004, data from approximately 15,000 patients with pelvic ring and acetabular fractures were documented. In addition to the scientific impact of the pelvic trauma registry, which is reflected in the numerous national and international publications, the dramatically changing epidemiology of pelvic ring fractures, further developments in diagnostics and the changes in operative procedures over time could be demonstrated. Last but not least the now well-established diagnostic and therapeutic algorithms for pelvic ring fractures, which could be derived from the information collated in registry studies, reflect the clinical impact of the registry.

Outcome of Cemented Bipolar as Primary Management of Comminuted Unstable Intertrochanteric Fracture Femur in Elderly Sudanese Patients

Unstable intertrochanteric fractures in osteoporotic bones of elderly patients was a real challenge that face orthopedic surgeon because of difficult anatomical reduction, poor bone quality and complication of prolonged bed redden or limited ambulation. The aim of study was to assess the clinical outcome of cemented bipolar as primary management of comminuted intertrochanteric fracture femur in elderly Sudanese patients. Material and methods: (30) Elderly Sudanese patients with unstable intertrochanteric fractures (kyle type III or IV) treated by primary hemiarthroplasty using a cemented bipolar prosthesis. Suture or wire fixations were used for reconstruction of greater trochanter fracture. Harris hip score was used for the clinical evaluation. Result: There was a significant relation between age and kyle classification (p value 0.05). According to Harries hip score 17 out of 30 had a good to excellent result (56.7 %) If the patients with a fair result were also included, the percentage goes up to (93.4%). Conclusion: The primary cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients' dose provide staple, pain free with early mobilization, better range of motion and less complication rate in short term follow up.

The Challenge of Plate-Bone Construct Stiffness: A Swinging Pendulum: Commentary on an article by Michael Bottlang, PhD, et al.: "Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing".

Fracture plating has evolved in parallel with better understanding of the biology and mechanics of bone healing. Although treatment of the simple plane fracture with compression plating and absolute stability has been successful in most instances, clinicians still largely rely on experience and judgment to decide how to best treat comminuted fractures and fractures in osteoporotic bone where compression is not an option. Stephan M. Perren’s strain theory1 and studies that followed have taught us that, for bone to heal, there needs to be an ideal amount of micromotion at the fracture site. Too much, and the callus never consolidates; too little, and no bone is formed. Locking fixation seemed to be an excellent solution to the problem of poor fixation in osteoporotic bone; however, with its use in some instances, we created a new problem of constructs with such stiffness that osteocytes at the fracture are not signaled to form callus1,2. One solution to this new problem has been far cortical locking, where the near cortex is effectively overdrilled to allow for increased micromotion while still using locking screws to maintain the benefits of fixed angle stability. This technique arose from the observation that healing callus in locked constructs is often seen …

Evaluation of functional outcome of cemented bipolar hemiarthroplasty for treatment of osteoporotic proximal femoral fractures in elderly people

Background: In India the estimated geriatric population is going to rise from 8% of total population in 2010 to 19% by 2050. Incidence of osteoporosis and associated fractures will rise in coming years with increasing elderly population. Management of fracture neck of femur and unstable intertrochanteric fractures in osteoporotic bone is challenging in elderly as they are more prone for fracture associated complications like pressure sore, deep vein thrombosis and pneumonia. Aim: The purpose of this study is to evaluate the role of cemented bipolar hemiarthroplasty in management of osteoporotic proximal femoral fractures in elderly people. Patients and Methods: In this prospective study twenty patients with osteoporosis having proximal femoral fractures (fracture neck of femur/unstable intertrochanteric fracture) were treated by cemented bipolar hemiarthroplasty. Patients were followed up at 3 weeks, 3, 6, and 12 months to evaluate the function outcome. Mean age of the patients in this study was 73.84 years. Results: Average duration follow up in this study was 14.63 month. Mean Harris Hip Score in the post-operative period was 42.73±8.78 which improved to 81.57±9.11 at 6 months. Average post-operative mobilization duration was 3.84 day and average hospital stay was 11.31 day. At 1 year follow up 85% patients had excellent to fair outcome and 10% had poor outcome. Conclusion: Treatment of osteoporotic proximal femoral fractures with cemented bipolar hemiarthroplasty gives better functional outcome. Keywords: Proximal Femoral Fractures, Elderly, Osteoporosis, Cemented Bipolar Hemiarthroplasty

Relationship between Serum Gamma-Glutamyltransferase (GGT) Activity and Indices of Iron Metabolism with Bone-Mineral Parameters in Orthogeriatric Patients

Purpose: To examine serum levels of GGT activity and biomarkers of iron metabolism in relation to parameters of bone and mineral metabolism in elderly patients with and without osteoporotic bone fractures in the absence of overt liver diseases. Methods: In a cross-sectional study of 416 older (>60 years) patients (168 subjects with hip fracture, 89 with other fractures of the peripheral skeleton and 160 without any fracture; mean age 78.9 ± 8.7 years; 282 women) we simultaneously measured serum levels of two bone formation markers (osteocalcin, OC; procollagen type 1 Nterminal propeptide, P1NP), bone resorption marker (β- isomerised carboxy-terminal cross-linking telopeptide of type I collagen, βCTX), their ratios (PINP/OC, PINP/βCTX, OC/βCTX), 25(OH) vitamin D, PTH, calcium, phosphate, magnesium, GGT activity, other liver function tests and indices of iron metabolism (serum ferritin, iron, transferrin and transferrin saturation [TSAT]). Results: Multivariate regression analyses demonstrated significant bidirectional links between P1NP and GGT, P1NP/OC ratio and GGT, P1NP and TSAT, OC and ferritin, GGT and ferritin. GGT, ferritin and TSAT were independent indicators of βCTX, while ferritin and TSAT were also independent predictors of the P1NP/OC ratio, and TSAT was an independent predictor of the P1NP/βCTX ratio. In multivariate regression, P1NP, βCTX, P1NP/βCTX ratio, ferritin, magnesium and age were independent indicators of fracture. Conclusions: The study highlighted the bidirectional links between serum GGT activity, indices of iron and bone metabolism and the role of GGT and iron homeostasis in maintaining bone health and identified indicators for osteoporotic fractures. The GGT- and iron-related factors contributing to bone integrity warrant further investigations.

Minimally Invasive Treatment of Displaced Proximal Humeral Fractures in Patients Older Than 70 Years Using the Humerusblock.

Background. Surgical treatment of proximal humeral fractures (PHF) in osteoporotic bone of elderly patients is challenging. The aim of this retrospective study was to evaluate the clinical and radiological outcome after percutaneous reduction and internal fixation of osteoporotic PHF in geriatric patients using the semirigid Humerusblock device. Methods. In the study period from 2005 to 2010, 129 patients older than 70 years were enrolled in the study. After a mean follow-up of 23 months, a physical examination, using the Constant-Murley score and the VAS pain scale, was performed. Furthermore radiographs were taken to detect signs of malunion, nonunion, and avascular necrosis. Results. The recorded Constant-Murley score was 67.7 points (87.7% of the noninjured arm) for two-part fractures, 67.9 points (90.8%) for three-part fractures, and 43.0 points (56.7%) for four-part fractures. In ten shoulders (7.8%) loss of reduction and in four shoulders (3.1%) nonunion were the reason for revision surgery. Avascular humeral head necrosis developed in eight patients (6.2%). Conclusions. In two- and three-part fractures postoperative results are promising. Sufficient ability for the activities of daily living was achieved. In four-part fractures the functional results were less satisfying regarding function and pain with a high postoperative complication rate. In those patients other treatment strategies should be considered. Study design. Therapeutic retrospective case series (evidence-based medicine (EBM) level IV).

A Biomechanical Comparison of Locking Versus Conventional Plate Fixation for Distal Fibula Fractures in Trimalleolar Ankle Injuries

Previous biomechanical studies have advocated the use of locking plates for isolated distal fibula fractures in osteoporotic bone. Complex rotational ankle injuries involve an increased number of fractures, which can result in instability, potentially requiring the same fixed angle properties afforded by locking plates. However, the mechanical indication for locking plate technology has not been tested in this fracture model. The purpose of the present study was to compare the biomechanical properties of locking and conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. Fourteen (7 matched pairs) fresh-frozen cadaver leg specimens were used. The bone mineral density of each was obtained using dual x-ray absorptiometry scans. The fracture model simulated an OTA 44-B3.3 fracture. The syndesmosis was not disrupted. Each fracture was fixated in the same fashion, except for the distal fibula plate construct: locking (n = 7) and one-third tubular (n = 7). The specimens underwent axial and torsional cyclic loading, followed by torsional loading to failure. No statistically significant differences were found between the locking and conventional plate constructs during both fatigue and torque to failure testing (p > .05). Our specimen bone mineral density averages did not represent poor bone quality. The clinical implication of the present study is that distal fibular locking plates do not provide a mechanical advantage for trimalleolar ankle injuries in individuals with normal bone density and in the absence of fracture comminution.

Three-times-weekly administration of teriparatide improves vertebral and peripheral bone density, microarchitecture, and mechanical properties without accelerating bone resorption in ovariectomized rats.

Daily and weekly administration of teriparatide (PTH1–34) reduces the risk of osteoporotic bone fractures. However, their effects on markers of bone formation and bone resorption differ. These results indicate that the dosing frequency of teriparatide may affect bone metabolism and bone structure, with different effects on bone strength. In the present study, to evaluate the dose-related effects of a low administration frequency of teriparatide on bone status, we investigated the effects of three-times-weekly administration of teriparatide (1.1, 5.6, or 28.2 µg/kg) for 12 months on bone parameters, including bone metabolism markers, bone mineral density (BMD), micro-computed tomography, and bone strength, using 6-month-old ovariectomized (OVX) rats. Three-times-weekly administration of teriparatide dose-dependently increased the BMD of the lumbar vertebra and femur in OVX rats, and increased serum osteocalcin (a marker of bone formation), but not type I collagen C-telopeptide (a marker of bone resorption). The trabecular number and thickness increased in the vertebrae and femur, as in prior reports of daily teriparatide administration in OVX rats. Cortical thickness increased only toward the endocortical side of the femur, unlike with daily administration. Bone strength of the vertebrae and proximal and shaft of the femur was correlated with the changes in BMD and bone structure. These results demonstrate the effects of low frequency, intermittent administration of teriparatide on the biomechanical, and microstructural properties of bone in OVX rats.Electronic supplementary materialThe online version of this article (doi:10.1007/s00223-015-9998-0) contains supplementary material, which is available to authorized users.

Bone fracture risk is not associated with the use of glucagon-like peptide-1 receptor agonists: a population-based cohort analysis.

Glucagon-like Peptide-1 receptor agonists (GLP1-ra) are a relatively new class of anti-hyperglycemic drugs which may positively affect bone metabolism and thereby decrease (osteoporotic) bone fracture risk. Data on the effect of GLP1-ra on fracture risk are scarce and limited to clinical trial data only. The aim of this study was to investigate, in a population-based cohort, the association between the use of GLP1-ra and bone fracture risk. We conducted a population-based cohort study, with the use of data from the Clinical Practice Research Datalink (CPRD) database (2007–2012). The study population (N = 216,816) consisted of all individuals with type 2 diabetes patients with at least one prescription for a non-insulin anti-diabetic drug and were over 18 years of age. Cox proportional hazards models were used to estimate the hazard ratio of fracture in GLP1-ra users versus never-GLP1-ra users. Time-dependent adjustments were made for age, sex, lifestyle, comorbidity and the use of other drugs. There was no decreased risk of fracture with current use of GLP1-ra compared to never-GLP1-ra use (adjusted HR 0.99, 95 % CI 0.82–1.19). Osteoporotic fracture risk was also not decreased by current GLP1-ra use (adjusted HR 0.97; 95 % CI 0.72–1.32). In addition, stratification according to cumulative dose did not show a decreased bone fracture risk with increasing cumulative GLP1-ra dose. We showed in a population-based cohort study that GLP1-ra use is not associated with a decreased bone fracture risk compared to users of other anti-hyperglycemic drugs. Future research is needed to elucidate the potential working mechanisms of GLP1-ra on bone.

Disability-adjusted-life-years losses in postmenopausal women with osteoporosis: a burden of illness study.

BackgroundTo estimate the disability-adjusted life years (DALY) in a nationwide representative sample of postmenopausal women with osteoporosis. The effects of drug-based therapy and risk factors for osteoporotic bone fractures on DALY losses were also explored.MethodsDALY were estimated based on participant’s clinical characteristics and Health-Related Quality-of-Life (HRQoL) data obtained from a cross-sectional, epidemiological one-visit study (the GINERISK study). The study enrolled postmenopausal women (at least 12-months after their last menstrual period) with osteoporosis, above 18-years old, who attended Spanish outpatient Gynaecology clinics. HRQoL was assessed using the generic SF-12v2 questionnaire, which was used to derive disutility values. Mortality rates were extracted from the Spanish national statistics database. Factors explored to be associated with DALY losses were examined using ANOVA, ANCOVA and MANCOVA models.ResultsDALY could be computed in 2,782 (67%) out of 4,157 postmenopausal women, with a mean (95% CI) age of 61.0 (60.7-61.2) years. Overall individual undiscounted DALY per woman were 6.1 (5.9-6.2), resulting to be significantly higher in women with severe osteoporosis with prior bone fracture; 7.8 (7.2-8.4) compared to osteoporotic women [5.8 (5.6-6.0)] or postmenopausal women with a BMD > −2.5 T-score that received a drug-based therapy [6.2 (5.8-6.5)]; F = 27.0 (P < 0.01). Models explaining the variation in the levels of health based on the use of a selective estrogen receptor modulator (SERM) or possession of risk factors for osteoporotic BF were found (P < 0.05).ConclusionsDALY losses were considerable amongst postmenopausal women with osteoporosis. Not having a prior bone fracture, being older, using a SERM and having less osteoporotic risk factors were all linked to less DALY losses.

Dynamization at the near cortex in locking plate osteosynthesis by means of dynamic locking screws: an experimental study of transverse tibial osteotomies in sheep.

Locking plates are widely used in fracture fixation, mainly for meta-diaphyseal fractures, comminuted fractures, fractures with a critical-size bone defect, periprosthetic fractures, osteotomies, and fractures in osteoporotic bone. The aim of this animal study was to evaluate the effect on bone-healing of dynamization of locking plate constructs by means of new 5.0-mm dynamic locking screws (in the DLS group), which allow near-cortex micromotion, compared with a more rigid construct utilizing standard bicortical locking-head screws (in the LS group). Use of dynamic locking screws allows modulation of the stiffness of existing locking compression plate systems via parallel interfragmentary micromotion. A standardized diaphyseal tibial osteotomy (90°, 3-mm fracture gap) was performed and stabilized with a six-hole large-fragment locking compression plate in twelve female sheep (six in each group). Radiographs were made postoperatively and then weekly from week three until sacrifice at nine weeks. Macroscopic, biomechanical, histologic, and radiographic assessments and microcomputed tomography were performed. The callus in the tested specimens in the DLS group had better biomechanical stability, with a significantly greater maximum failure moment (mean and standard deviation [SD] as a percentage of intact, 55.15 ± 20.65 compared with 26.80 ± 14.96 in the LS group; p = 0.021). The DLS group also had greater periosteal callus volume at the near cortex (mean volume and SD as a percentage of the tibial shaft volume, 36.21% ± 10.08% compared with 18.98% ± 8.61% in the LS group; p = 0.026) and in the intercortical region (mean volume and SD as a percentage of the bone volume of the tibial shaft, 3.56% ± 0.52% compared with 2.64% ± 0.98% in the LS group; p = 0.045), as shown by microcomputed tomography. The DLS group also had significantly greater torsional stiffness (mean and SD as a percentage of intact, 84.88 ± 13.51 compared with 58.89 ± 20.61 in the LS group; p = 0.027). Controlled micromotion and nearly homogeneous interfragmentary strain at the fracture site, together with the stable bicortical fixation achieved by the new dynamic locking screw, led to more uniform callus formation, significantly more callus formation at the near cortex, and biomechanically more competent bone-healing compared with use of rigid locking plate constructs with locking-head screws.

“Treatment of Comminuted Unstable Inter-Trochanteric Fracture in Elderly Patients with Cemented Bipolar Prosthesis”

Introduction: Unstable intertrochanteric fractures in osteoporotic bones are difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure in internal fixation, with dynamic hip screws or intramedullary nail has been found high, especially in osteoporotic bones. The weak and porotic bone tolerates screws poorly so cut out is the major problem in internal fixation. The aim of this study was to assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis. Material and Methods: 25 patients (11 males and 14 females) above 65 years of age with unstable intertrochanteric fractures who underwent bipolar arthroplasty were prospectively evaluated. Transtrochanteric approach was used in all patients. Greater trochanter encirclage was done in all patients. Harris hip score was used for the clinical evaluation. The minimum follow up period was one year. Results: In our study 25 cases were taken, which had a mean age 73.44 ± 7.11years. The mean Harris hip score at one year was 80.54 ± 19.74. Excellent to good results were obtained at one year in 17(68%) cases and fair in 4 (16%) cases, poor in 2 (8%). Death of two patients occurs due to age related factors. Mean hospital stay was 14.24 ± 10.46 days. There was one case of superficial infection and one case of dislocation which where managed conservatively. Mean hospital stay was 14.24 ± 10.46. Radiological follow-up showed no case with loosening of the prosthesis, break in the cement or sinking of the prosthesis. Conclusion: Cemented bipolar hemiarthroplasty through trans-trochanteric approach give good result in a majority of elderly patient with unstable intertrochanteric fracture. It has advantage of an early ambulation and less hospital stay, as compared to the internal fixation. Also, the patient rehabilitation is easy and

Use of Teriparatide to improve fracture healing: What is the evidence?

Teriparatide is a recombinant form of the biologically active component of Parathyroid hormone. It has been shown to increase bone mass and prevent fractures in osteoporotic bone. It is licensed by the Food and Drug Administration for the treatment of Osteoporosis. Over the last decade, a growing body of evidence has accumulated suggesting a role for Teriparatide in the management of fractures. Studies in both normal and delayed healing models have shown improvement in callus volume and mineralisation, bone mineral content, rate of successful union and strength at fracture sites. However most of these results have been derived from animal studies. The majority of this research on humans has comprised low level evidence, with few randomised controlled trials, many case reports and case series. Nevertheless, the results from these studies seem to support research from animal models. This has led to a growing number of clinicians using Teriparatide "off license" to treat fractures and non-unions in their patients. This review presents a critical appraisal of the current evidence supporting the use of Teriparatide for fracture healing, delayed unions and non unions and in the setting of osteoporotic fractures, the studies producing this evidence and their transferability to human beings.

Three-dimensional parametric mapping in quantitative micro-CT imaging of post-surgery femoral head-neck samples: preliminary results.

Osteoporosis and pathological increased occurrence of fractures are an important public health problem. They may affect patients' quality of life and even increase mortality of osteoporotic patients, and consequently represent a heavy economic burden for national healthcare systems. The adoption of simple and inexpensive methods for mass screening of population at risk may be the key for an effective prevention. The current clinical standards of diagnosing osteoporosis and assessing the risk of an osteoporotic bone fracture include dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) for the measurement of bone mineral density (BMD). Micro-computed tomography (micro-CT) is a tomographic imaging technique with very high resolution allowing direct quantification of cancellous bone microarchitecture. The Authors performed micro-CT analysis of the femoral heads harvested from 8 patients who have undergone surgery for hip replacement for primary and secondary degenerative disease to identify possible new morphometric parameters based on the analysis of the distribution of intra-subject microarchitectural parameters through the creation of parametric images. Our results show that the micro-architectural metrics commonly used may not be sufficient for the realistic assessment of bone microarchitecture of the femoral head in patients with hip osteoarthritis. The innovative micro-CT approach considers the entire femoral head in its physiological shape with all its components like cartilage, cortical layer and trabecular region. The future use of these methods for a more detailed study of the reaction of trabecular bone for the internal fixation or prostheses would be desirable.

The Photodynamic Bone Stabilization System: a minimally invasive, percutaneous intramedullary polymeric osteosynthesis for simple and complex long bone fractures.

The treatment of osteoporotic long bone fractures is difficult due to diminished bone density and compromised biomechanical integrity. The majority of osteoporotic long bone fractures occur in the metaphyseal region, which poses additional problems for surgical repair due to increased intramedullary volume. Treatment with internal fixation using intramedullary nails or plating is associated with poor clinical outcomes in this patient population. Subsequent fractures and complications such as screw pull-out necessitate additional interventions, prolonging recovery and increasing health care costs. The Photodynamic Bone Stabilization System (PBSS) is a minimally invasive surgical technique that allows clinicians to repair bone fractures using a light-curable polymer contained within an inflatable balloon catheter, offering a new treatment option for osteoporotic long bone fractures. The unique polymer compound and catheter application provides a customizable solution for long bone fractures that produces internal stability while maintaining bone length, rotational alignment, and postsurgical mobility. The PBSS has been utilized in a case series of 41 fractures in 33 patients suffering osteoporotic long bone fractures. The initial results indicate that the use of the light-cured polymeric rod for this patient population provides excellent fixation and stability in compromised bone, with a superior complication profile. This paper describes the clinical uses, procedural details, indications for use, and the initial clinical findings of the PBSS.

Osteoporotic fracture models.

Animal models are widely used to investigate the pathogenesis of osteoporosis and for the clinical testing of anti-resorptive drugs. However, osteoporotic fracture models designed to investigate novel ways to treat fractures of osteoporotic bone must fulfil requirements distinct from those of pharmacological testing. Bone strength and toughness, implant fixation and osteointegration and fracture repair are of particular interest. Osteoporotic models should reflect the underlying clinical scenario be that primary type 1 (post-menopausal) osteoporosis, primary type 2 (senile) osteoporosis or secondary osteoporosis. In each scenario, small and large animal models have been developed. While rodent models facilitate the study of fractures in strains specifically established to facilitate understanding of the pathologic basis of disease, concerns remain about the relevance of small animal fracture models to the human situation. There is currently no all-encompassing model, and the choice of species and model must be individualized to the scientific question being addressed.

A New Method to Intra-Operatively Measure Local Bone Strength in Osteoporotic Bone Using a Modified Surgical Tool

The aim of this study was to test a novel method for intra-operative assessment of osteoporotic bone fracture strength using a surgical tool instrumented with a strain gauge and compare the device with cortical width (CW) measurements in the distal radius. The force needed to puncture the cortex (FNP) was quantified with the device and found to strongly correlate with bone mineral density (BMD) in the diaphysis (adj. R2 = 0.66, p &lt; 0.001). Screw pullout studies were performed and correlation between FNP and screw pullout strength (SPS) was modest (adj. R2 = 0.34 with p &lt; 0.05). CW correlated well with BMD (adj. R2 = 0.7, p &lt; 0.0001) and SPS (adj. R2 = 0.5, p = 0.002) in the diaphysis. This technology may allow objective intra-operative assessment of bone strength to provide surgeons another tool for decision making on fixation strategies appropriate to the area of bone treated.

Low-magnitude high-frequency vibration enhances gene expression related to callus formation, mineralization and remodeling during osteoporotic fracture healing in rats.

Low magnitude high frequency vibration (LMHFV) has been shown to improve anabolic and osteogenic responses in osteoporotic intact bones and during osteoporotic fracture healing; however, the molecular response of LMHFV during osteoporotic fracture healing has not been investigated. It was hypothesized that LMHFV could enhance osteoporotic fracture healing by regulating the expression of genes related to chondrogenesis (Col-2), osteogenesis (Col-1) and remodeling (receptor activator for nuclear factor- κ B ligand (RANKL) and osteoproteger (OPG)). In this study, the effects of LMHFV on both osteoporotic and normal bone fracture healing were assessed by endpoint gene expressions, weekly radiographs, and histomorphometry at weeks 2, 4 and 8 post-treatment. LMHFV enhanced osteoporotic fracture healing by up-regulating the expression of chondrogenesis-, osteogenesis- and remodeling-related genes (Col-2 at week 4 (p=0.008), Col-1 at week 2 and 8 (p<0.001 and p=0.008) and RANKL/OPG at week 8 (p=0.045)). Osteoporotic bone had a higher response to LMHFV than normal bone and showed significantly better results as reflected by increased expression of Col-2 and Col-1 at week 2 (p<0.001 for all), larger callus width at week 2 (p=0.001), callus area at week 1 and 5(p<0.05 for all) and greater relative area of osseous tissue (p=0.002) at week 8. This study helps to understand how LMHFV regulates gene expression of callus formation, mineralization and remodeling during osteoporotic fracture healing.

Development of a risk assessment tool to predict fall-related severe injuries occurring in a hospital.

Inpatient falls are the most common adverse events that occur in a hospital, and about 3 to 10% of falls result in serious injuries such as bone fractures and intracranial haemorrhages. We previously reported that bone fractures and intracranial haemorrhages were two major fall-related injuries and that risk assessment score for osteoporotic bone fracture was significantly associated not only with bone fractures after falls but also with intracranial haemorrhage after falls. Based on the results, we tried to establish a risk assessment tool for predicting fall-related severe injuries in a hospital. Possible risk factors related to fall-related serious injuries were extracted from data on inpatients that were admitted to a tertiary-care university hospital by using multivariate Cox’ s regression analysis and multiple logistic regression analysis. We found that fall risk score and fracture risk score were the two significant factors, and we constructed models to predict fall-related severe injuries incorporating these factors. When the prediction model was applied to another independent dataset, the constructed model could detect patients with fall-related severe injuries efficiently. The new assessment system could identify patients prone to severe injuries after falls in a reproducible fashion.