Fragility Fractures In Adults Research Articles

Effectiveness of fracture liaison service in reducing the risk of secondary fragility fractures in adults aged 50 and older: a systematic review and meta-analysis.

To determine and appraise the certainty of fracture liaison service (FLS) in reducing the risk of secondary fragility fractures in older adults aged ≥ 50years and to examine the nature of the FLS and the roles of various disciplines involved in the delivery of the FLS. Medline, EMBASE, PubMed, CINAHL, SCOPUS, and The Cochrane Library were searched from January 1st, 2010, to May 31st, 2022. Two reviewers independently extracted data. The risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the PEDro scale for randomized trials, while the GRADE approach established the certainty of the evidence. Thirty-seven studies were identified of which 34 (91.9%) were rated as having a low risk of bias and 22 (59.5%) were meta-analyzed. Clinically important low certainty evidence at 1year (RR 0.26, CI 0.13 to 0.52, 6 pooled studies) and moderate certainty evidence at ≥ 2years (RR 0.68, CI 0.55 to 0.83, 13 pooled studies) indicate that the risk of secondary fragility fracture was lower in the FLS intervention compared to the non-FLS intervention. Sensitivity analyses with no observed heterogeneity confirmed these findings. This review found clinically important moderate certainty evidence showing that the risk of secondary fragility fracture was lower in the FLS intervention at ≥ 2years. More high-quality studies in this field could improve the certainty of the evidence. Review registration: PROSPERO-CRD42021266408.

Factors associated with fragility fractures in type 2 diabetes: An analysis of the randomised controlled Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

Fracture risk is elevated in some type 2 diabetes patients. Bone fragility may be associated with more clinically severe type 2 diabetes, although prospective studies are lacking. It is unknown which diabetes-related characteristics are independently associated with fracture risk. In this post-hoc analysis of fracture data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial (ISRCTN#64783481), we hypothesised that diabetic microvascular complications are associated with bone fragility. The FIELD trial randomly assigned 9795 type 2 diabetes participants (aged 50-75years) to receive oral co-micronised fenofibrate 200mg (n=4895) or placebo (n=4900) daily for a median of 5years. We used Cox proportional hazards models to identify baseline sex-specific diabetes-related parameters independently associated with incident fractures. Over 49,470 person-years, 137/6138 men experienced 141 fractures and 143/3657 women experienced 145 fractures; incidence rates for the first fracture of 4∙4 (95% CI 3∙8-5∙2) and 7∙7 per 1000 person-years (95% CI 6∙5-9∙1), respectively. Fenofibrate had no effect on fracture outcomes. In men, baseline macrovascular disease (HR 1∙52, 95% CI 1∙05-2∙21, p=0∙03), insulin use (HR 1∙62, HR 1∙03-2∙55, p=0∙03), and HDL-cholesterol (HR 2∙20, 95% CI 1∙11-4∙36, p=0∙02) were independently associated with fracture. In women, independent risk factors included baseline peripheral neuropathy (HR 2∙04, 95% CI 1∙16-3∙59, p=0∙01) and insulin use (HR 1∙55, 95% CI 1∙02-2∙33, p=0∙04). Insulin use and sex-specific complications (in men, macrovascular disease; in women, neuropathy) are independently associated with fragility fractures in adults with type 2 diabetes.

Abstract 132: Reduction Of Bone Quality In A Murine Model Of Essential Hypertension Relative To Age

Autoimmune and inflammatory diseases such as obesity and cancer are highly linked to altered bone growth and osteoporosis. Hypertension (HTN) is an inflammatory condition associated with reduced bone mineral density and increased risk for fragility fractures in adults. As cases of pediatric HTN rise in the United States, HTN may increase bone loss in children and future risk for osteoporosis. We hypothesized that HTN-induced osteoporosis in young mice reduces bone quality like that of aging. To assess this, 3.5- or 16-month-old male C57BL/6J mice received Angiotensin (Ang) II (490 ng/kg/day) or vehicle infusion by subcutaneous osmotic mini-pumps. After 6-weeks of infusion, the lumbar vertebral bodies (VB) were harvested, and analyzed by high-resolution micro-computed tomography and finite element analysis. In young mice, Ang-II induced HTN caused reductions in bone volume fraction (33.4 ± 0.8 vs 25.4 ± 1.1 %, p<0.0001) and trabecular thickness (66.4 ± 1.1 vs 54.3 ± 1.5 μm, p<0.0001). HTN reduced the estimated failure force (24.3 ± 0.7 vs 16.1 ± 1.1 N, p<0.0001) in young mice. In contrast to young mice, in aged mice Ang-II infusion did not induce bone loss; however, at baseline, the old mice exhibited reduced bone quality like that of hypertensive young mice: bone volume fraction (22.5 ± 0.7 vs 25.4 ± 1.1 %, p=0.2928), trabecular thickness (58.0 ± 1.5 vs 54.3 ± 1.1 μm, p=0.3866), and estimated failure force (17.6 ± 0.8 vs 16.1 ± 1.1 N, p=0.6517). To ascertain the impact of inflammation in the bone marrow microenvironment, the bone marrow was analyzed by flow cytometry. The number of CD4 + T cells producing IL-17A was increased in hypertensive vs normotensive young mice (230.0 ± 8.9 vs 167.3 ± 16.6 cells per 1 million events, p=0.0035), as were dendritic cells (408.3 ± 29.1 vs. 229.1 ± 20.5 cells per 1 million events, p<0.0001). CD4 + T cells producing IFN-γ also rose (2845 ± 129 vs 2437 ± 174 cells per 1 million events, p=0.07) in young hypertensive mice. Both normotensive and hypertensive old mice experienced overactive inflammatory responses compared to the young group. Thus, HTN mimics aspects of aging on bone health, causing inflammation in the bone marrow and osteoporosis. Efforts to detect and treat HTN in children may deter untoward events related to bone loss in adulthood.

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

ObjectiveTo establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.MethodsPoints to consider were developed...

Social Engagement versus Isolation in the Well-being of Individuals with Autism Spectrum Disorder

Osteoporosis is a detrimental disorder of bone that puts patients at increased risk of pathologic fractures. Patients with cerebral palsy (CP), due to a multitude of factors, are at increased risk of developing this disorder. Studies in the past have looked at various treatment options for these patients to reduce and/or prevent pathologic fractures. Most studies have looked into the use of bisphosphonates for prevention. Teriparatide is a recombinant PTH analog that has been shown to increase bone mineral density and reduce fragility fractures in adults with non- CP related osteoporosis. Despite the reduction seen in these studies, empirical evidence for the use of PTH analogs in CP related osteoporosis is scarce. PTH analogs, like Teriparatide, have shown to be beneficial in patients with non-CP related osteoporosis, further studies need to be performed to assess its benefit for patients with CP related osteoporosis.

Fracture Liaison Service at a University Hospital with Level 1 Trauma Center 1 year later

Introduction The Fracture Liaison Service (FLS) model improves osteoporosis care following fragility fractures in adults (1) . Our institution has implemented the FLS model housed within our Department of Orthopedics utilizing the American Orthopedic Association Own the Bone (OTB) program. Objectives To address the gap in osteoporosis care following fragility fracture a Type A FLS (2) was implemented in October 2016. The study purpose was to compare secondary fracture prevention before and after institution of the FLS program. We complete all steps from identifying patients, investigating for secondary osteoporosis, ordering bone mineral density (BMD) studies and prescribing medication. Methods The Study population was 305 adults >50 referred to FLS from 10/2016-9/2017. The FLS Physician Assistant(PA) completed a consult consisting of a detailed history, education regarding nutrition: calcium, vitamin D and protein and discussing weight bearing exercise and balance training with Physical Therapy and falls prevention and lifestyle changes: smoking cessation and limiting use of alcohol. BMD and lab work were ordered by the FLS PA. Outpatient follow up with the FLS PA was recommended to review the results and initiate osteoporosis medication. The reference control group, identified by chart review, was 1024 adults>50 with primary care in our system from 2008-2014 who sustained a hip, wrist or vertebral fracture. CPT codes were used to assess if patient had a BMD and 25(OH)D level after the fracture. Results In the reference group 14.5% of patients had a BMD study and 22.6% of patients had 25(OH)D level completed after the fracture. 305 adults with mean age 74 and 76% female were included in the study group. Hip fractures occurred in 50% and 27% had vertebral fractures. 63% had sustained a prior fracture over the age of 50. The FLS obtained a BMD in 47.5% of patients, 50% of patients had a 25(OH)D level checked and 34% of patients started medication treatment after the fracture(determined by phone call or in person follow up). Nearly half of the subjects were lost to follow up despite a phone call and letters to patient and primary care physician. 37% of the study group completed in person outpatient follow up with the FLS PA at our institution. Of that subset of patients, 90% had a BMD study, 97% had a 25(OH)D level checked and 65% are on medication treatment for osteoporosis. Comparing the two groups showed improvement in use of BMD and 25(OH) D assessment after fracture. Conclusion Implementing a Type A FLS model of care within our institution has led to improved osteoporosis care for patients >50 who sustained a fragility fracture.