High Fracture Probability Research Articles

Using Discrete Element Method to Analyse the Drop Ball Test

The drop ball test (DBT) is a common quality control procedure used in many grinding media manufacturing units to evaluate the quality of manufactured balls. Whilst DBTs have provided reasonable data over many years, the quantitative comparison of the energy that the balls are subjected to during the DBT and in high-impact loading environments such as semi-autogenous grinding (SAG) mills remains a grey area. To that end, DBT experiments were conducted, and the discrete element method (DEM) was used to assess the grinding media collision behaviour and the extent of ball impact loading to determine the impact energy spectra of the ball collisions. The impact energy spectra data obtained were used to quantify the energy that the grinding balls are exposed to in the DBT environment. The results showed that larger balls were exposed to relatively higher energy levels and had a higher probability of fracture than smaller balls. Furthermore, early ball breakage in a grinding environment is mostly attributed to the existence of imperfections or pre-existing defaults within the ball, whilst continuous wear is a gradual consequence that deplete balls in the mill.

Sarcopenia in Egypt: epidemiology of sarcopenia risk among older adults presenting with fragility fractures—an initiative by the Egyptian Academy of Bone Health

Purpose(1) This was a multi-center, cross-sectional, observational study. Both old men and postmenopausal women over 50 years old who were admitted with an osteoporotic fracture (whether hip fracture or major osteoporosis) were consecutively recruited for this work and managed under the Fracture Liaison Service. All the patients were assessed for their sarcopenia risk (SARC-F), fracture risk (FRAX), and fall risk (FRAS) as well as functional disability (HAQ). The aim was to assess the prevalence of sarcopenia risk among older adult Egyptians presenting with fragility fractures. (2) To identify the relation between sarcopenia risk with the risk of falling as well as sustaining a fragility fracture.ResultsTwo hundred and thirty-six patients (69 males, 167 females) were included in this work. The mean age was 70.1 (SD = 9.2) years. The prevalence of sarcopenia was 69.7%. The sarcopenia risk score was positively correlated with the FRAX score (p = 0.01). The prevalence of high sarcopenia risk was 78% of the patients presenting with a high 10-year probability of major osteoporosis fracture as well as a 10-year probability of hip fracture. The sarcopenia risk score was positively correlated with the increased fall risk (p = 0.01) as scored by the FRAS scale. There was a significant relation (p < 0.05) between the functional disability score and the SARC-F score. This was persistent when assessed in relation to fall risk.ConclusionThis study highlighted the high sarcopenia risk in the patients presenting with fragility fractures. Identification of patients at increased risk of sarcopenia should be a component of the standard practice.

Thermally/mechanically robust anodic aluminum oxide (AAO) microheater platform for low power chemoresistive gas sensor

The semiconductor metal oxide gas sensors are getting high attention owing to their high sensitivities and fast responses. They require high temperature for the reaction with target gases, and suspended silicon membrane microheaters are typically used to reduce the heating power consumption. However, they have low durability for long-term uses, and high probability of fracture by thermal stress or mechanical impact. In this study, as an alternative to the silicon membrane microheater, anodic aluminum oxide (AAO)-based microheater platform gas sensor was fabricated for low power consumption and high thermal/mechanical stabilities. Nanoscale air gaps of the AAO substrate reduce the heat loss transferred to the substrate. Therefore, AAO-based microheater platforms do not require suspended structures sustained by very thin bridges, which dramatically enhances thermal/mechanical stabilities. The temperature of fabricated microheater platform reached to 250 °C by a heating power of 27.4 mW. The excellent thermal/mechanical stabilities of the AAO-based microheater platforms were verified by cyclic on-off and mechanical shock test. The pulsed heating operation was adopted, and it reduced the heating power consumption to 9 mW. The fabricated AAO-based gas sensors showed much higher responses to NO2 gas compared to the SiO2 membrane-based gas sensors.

Osteoporosis is the cause of spontaneous humeral fracture in dairy cows from New Zealand.

Outbreaks of humeral fractures in dairy cows have been reported in New Zealand for several years. Gross, histologic, and histomorphometric findings in the humerus from primiparous cows with spontaneous humeral fracture were compared to age-matched control cows. Affected cows had a complete nonarticular spiral fracture of the humerus. Histologically affected humeri had a thicker growth plate with abnormal architecture, thinner cortex with increased abnormal resorption, increased resorption in the distal humerus, decreased trabecular density, abnormal trabecular architecture, presence of growth arrest lines and woven bone formation. Histomorphometry showed reduction in bone volume, trabecular perimeter, and trabecular width. Cows grazed on fodder beet had thicker growth plates with an abnormal appearance compared with cows grazed on pasture, and cows with low/marginal liver copper concentration had more resorption cavities in the distal humerus and thinner cortical bone compared with cows with adequate liver copper concentration. Decreased trabecular density (OR = 249.5), abnormal cortical resorption (OR = 54.2), presence of woven bone formation in the proximal metaphysis (OR = 37.2), and the number of resorption cavities in the distal humerus were significantly associated with a high probability of fracture. Ribs had enlargement of the costochondral junction with fractures in different stages of healing. Histology of the ribs revealed abnormal growth plate appearance, presence of fracture lines, callus tissue, fibrosis, and microfractures. Cows with humeral fracture have osteoporosis due to decreased bone formation and increased bone resorption, likely associated with inadequate feed quality and perhaps copper deficiency leading to a reduction in bone strength and fracture.

Is zirconium or stainless steel the most suitable crown material for less dentin stress in endodontically treated teeth?

Stainless steel crowns (SSCs), which have been used frequently in the treatment of first permanent molars in children until now, has become less applicable due to its poor aesthetic appearance. Zirconia crowns (ZCs) have become more popular due to their aesthetic advantage. However, stress transmission of ZCs to dental tissues under occlusal forces in endodontically treated teeth has not been described. The aim of this study was to compare the stress distribution of different crown materials (ZCS, SSCs) and adhesive materials on dentin in endodontically treated permanent teeth and to specify the crown-adhesive model with lower stress. Finite element analysis (FEA) was used to apply a force of 300 N from the inner part of the buccal tubercles (vertical loading) and a lingo-buccal at an angle of 30 degrees (oblique loading) of the first permanent molars (FPM) with different crown (ZCS, SSCs) and adhesive (Glass ionomer cement, Resin modified glass ionomer cement, Resin cement) materials in twelve separate models. The von Mises values obtained from the models were compared and the optimal stress values were determined by FEA. The lowest stress values of dentin were found in zirconia crown model with glass ionomer cement (GIC) adhesive under vertical loading (26,793 Mpa). In the zircon crown and GIC adhesive model, less von Mises stress occurred on the dentin under all conditions. ZCs and GIC adhesive may be recommended for teeth with a high probability of dentin fracture.

A neural network based framework to model particle rebound and fracture

The current state of the art approach in the simulation of particle-laden flow in turbomachinery is to handle particle–wall interactions via rebound and erosion models. Rebound models often require a priori parameter tuning to match experimental measurements. Moreover, the actual stochastic nature of the rebound is neglected, and the particle is assumed not to fracture upon impact. However, this affects the resulting particle trajectories and is particularly critical at high (normal) impact velocities, where particles in typical aero engine flow exhibit a high probability of fracture, as illustrated in our previous work. In this work, we propose a method to develop a generalized rebound model which is parameter-free for the user and considers the stochasticity of the rebound. To this end, state of the art methods from function approximation, more precisely, deep dense neural networks are employed. The networks are trained through a supervised learning approach, where the neural network maps the impacting particles’ characteristics to its new particle trajectory after rebound. For this, we present an efficient method to predict probability distributions in a supervised learning context without a priori parameter tuning of known PDFs. In a second step, we extend the network to account for particle fracture, where the particle breakage is based on a fracture probability distribution to determine whether a particle breaks. The performance of the proposed framework is illustrated by the use of experimental measurements of the statistical rebound of sand particles in an erosion test rig specifically designed to match flow and impact conditions (including particle fracture) as well as particle sizes in aero engine compressors.

Application of the soil parameter random field in the 3D random finite element analysis of Guanyinyan composite dam

Due to the inhomogeneous of dam materials, effect of the compaction environment and experimental data errors, the soil properties of the Guanyinyan composite dam present obvious spatial variability, resulting in the occurrence of obvious discordant settlements and cracks during the impounding period. The traditional finite element method (FEM) using inversion parameters that are modified by monitoring displacement back-analysis can neither simulate spatial variability in soil parameters nor predict dam safety before dam displacements occur. In this research, soil parameter random fields are developed considering spatial variability, and a three-dimensional random FEM (RFEM) analysis of the Guanyinyan composite dam is applied. According to soil dry density samples and experimental results, the autocorrelation of the same soil parameter in different positions in dam is determined. The cross-autocorrelation of different soil parameters is conducted using the Nataf transformation. The RFEM analysis shows that the mean values of maximum settlement, the mean values of maximum deformation gradient and area ratio with high hydraulic fracture probability exceeding 0.3 are close to those calculated by inversion parameters. The cumulative frequencies of maximum settlement and maximum deformation gradient show 51% and 33% probabilities of exceeding the inversion calculation results. The area ratio and distribution range of elements with hydraulic failure probabilities greater than 0.2 are significantly larger than those calculated by the inversion parameters. The traditional certain security indexes, which ignore spatial variability of soil parameters, have a certain probability to overestimate the security of the dam. The uncertain security index considering spatial variability of soil parameters can provide a more reasonable and accurate reference for dam safety evaluation before water impounding.

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.

Effects of high-intensity interval exercise on obesity

With the increasing improvement of people's living standards, obesity has become a chronic disease all over the world, which can make people's physical shape and various physical indicators abnormal, resulting in a variety of complications, posing a threat to people's lives. Osteoporosis (OP) is one of the complications caused by Osteoporosis, which is mainly characterized by decreased bone density and easy to fracture. Obese people with OP have a higher probability of fracture than normal people. Once fracture occurs, they will lose their ability to exercise and may even threaten their lives. Exercise is one of the measures against obesity. High-intensity Interval Training (HIIT) has been widely used in the field of weight loss, and the right amount of exercise can prevent OP. In this paper, a large number of literature was reviewed to find out the possible mechanism of HIIT in preventing and treating OP in obese people, so as to reduce the probability of obesity and obese people suffering from OP.

Digital-image-correlation-based thermomechanical diagnostics of Bismuth Telluride pillars in a thermoelectric cooler

Fatigue-induced fracture of Bi2Te3 pillars in a thermoelectric cooler (TEC) due to thermal stress is a prevailing occurrence in the device during dynamic operation, which has been a major reliability concern from manufacturing perspectives. However, it remains a crucial challenge to explore global pillar-level deformation of TEC with simple experiment methodology. Herein, digital-image-correlation-based thermomechanical diagnostics is introduced to experimentally characterize the in-plane thermal deformation of Bi2Te3 pillars. Highly contrasted surface pattern generated by He-Ne laser was utilized, exempted from extra speckle fabrication while simultaneously guaranteeing high experimental accuracy. By imposing different thermal loadings to specimen, corresponding full-court pillar-level displacements are respectively observed. Furthermore, shear strain and stress distribution and their dependence on ΔT are studied with stress concentration region identified. The maximum in-plane shear stress at around ΔT= 60 K is indicated to exceed material fracture limit, resulting in high probability of fracture. The good agreement of experimental results and empirical simulation indicates the viability of the proposed technique. Due to its capability of direct observation of thermomechanical behavior of Bi2Te3 pillars, the approach employed in this study is of significant practical appeal and notable potential for thermal reliability prediction of thermoelectric device.

Preoperative Vitamin D Deficiency is Associated with Postoperative Functional Recovery and Complications after Hip Fracture Surgery.

BackgroundLow concentrations of vitamin D are considered one of the risk factors for hip fracture and are associated with worse outcomes. The purpose of this retrospective study was to compare vitamin D deficient group and vitamin D sufficient group and assess the association preoperative vitamin D deficiency and postoperative walking ability after hip fracture surgery.MethodsBetween January 2014 and January 2020, 1,029 elderly patients with hip fracture (243 in men and 785 in women) were measured preoperative serum 25-hydroxy-vitamin D3 levels. Among 1,029 elderly patients, 702 patients were classified as Vitamin D deficient group (<20 ng/mL). Outcome parameters for functional recovery were the length of the hospital stay and KOVAL score, and those for complications were delirium, pneumonia, and thromboembolism.ResultsThe mean length of the hospital stay in the vitamin D deficient group was significantly longer than in the vitamin D sufficient group (27.7±17.8 vs. 2.9±11.8 days; odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02–1.05; P=0.001). The mean postoperative KOVAL score in the deficient group was significantly higher than in the sufficient group (4.0±2.1 vs. 3.1±1.9 days; OR, 1.21; 95% CI, 1.11–1.32; P=0.001). Vitamin D deficiency was significantly associated with a higher risk of delirium and pneumonia in deficiency group.ConclusionsPreoperative vitamin D deficiency in hip fractures patients was associated with prolonged duration of hospital stay and decrease of postoperative ambulatory status, and may increase the risk of delirium and pneumonia. Therefore, it is necessary to evaluate the preoperative vitamin D level and recommend vitamin D supplementation in elderly patients with a high probability of hip fracture.

Federal clinical guidelines for diagnosis, treatment and prevention of osteoporosis

Due to continuous aging of population and increase in the number of elderly people, osteoporosis became socially significant disease leading to disability, increasing mortality and thereby putting an additional burden on the public healthcare system.Screening to identify groups with a high probability of fracture is recommended using the FRAX®Tool for all postmenopausal women and men over 50 years old (А1). In the presense of major pathological fractures (hip, spine, multiple fractures) it is recommended to diagnose osteoporosis and prescribe treatment regardless of the results of spine and hip double X-ray absorptiometry (DXA) or FRAX®(B2).It is recommended to evaluate C-terminal telopeptide when prescribing antiresorptive therapy and procollagen type 1 N-terminal propeptide (P1NP) when prescribing anabolic therapy to patients receiving osteoporosis treatment at baseline and 3 months after the start of therapy in order to assess the effectiveness of treatment early and adherence to the therapy (А2). It is recommended to diagnose osteoporosis and prescribe treatment to patients with high individual 10-year probability of major pathological fractures (FRAX®) regardless of the results of spine and hip DXA (В3).It is recommended to diagnose osteoporosis and prescribe treatment with a decrease in BMD, measured by DXA, by 2.5 or more T-score standard deviations in femoral neck, and/or in total hip, and/or in lumbar vertebrae, in postmenopausal women and men over 50 years old (А2).It is recommended to prescribe bisphosphonates, denosumab or teriparatide to prevent pathological fractures and increase BMD in patients with postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis (А2). When the clinical effect of therapy in osteoporotic patients without pathological fractures is achieved (BMD T-score &gt; -2.0 SD in femoral neck and absence of new fractures), it is recommended to interrupt bisphosphonates therapy for 1-2 years with subsequent follow-up (B2). In patients with vertebral fractures, hip fractures or multiple fractures, it is recommended to continue ceaseless long-term treatment of osteoporosis (В3).All drugs for the treatment of osteoporosis are recommended to be prescribed in combination with calcium and cholecalciferol (А2). In order to reduce the risk of recurrent fractures by prescribing osteoporosis therapy timely and maintaining long-term follow-up of patients over 50 years old with pathological fractures, it is recommended to create Fracture Liaison Services (В2).

Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study.

BackgroundKidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients.Patients-methodPatients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD.ResultsOne hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX.ConclusionExploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.

Damage mechanisms evolution of TiN/Ti multilayer films with different modulation periods in cyclic impact conditions

The evolution of cyclic impact damage mechanisms ofTiN/Ti multilayer films were investigated in terms of microstructural transformation as the modulation period decreased sharp from micron-scale (1000 nm) to nano-scale (60 nm). It was found that the ductile Ti phases reduced with decreasing modulation period, and the microstructures of films transformed from TiN/TixNy/Ti to TiN/TixNy (x > y). The cyclic impact results showed that both impact resistance and damage mechanisms of TiN/Ti multilayer films were strongly associated with modulation period. In the cyclic nano-impact conditions, the smaller modulation period of TiN/Ti film, the lower critical fracture load and higher fracture probability, thus worse impact resistance. Furthermore, the evolution of cyclic impact damage mechanisms ofTiN/Ti multilayer films were revealed that in T1000 film, only few cracks were observed and the Ti interlayers could prevent cracks from extending deeper into film, resulting in slight fracture with small chippings. While there were many more cracks in T60 film and these cracks could easily across multilayers, leading to severe brittle spalling with multiple layers. It was demonstrated that with the microstructural transformation from TiN/ TixNy/Ti to TiN/ TixNy, a higher cracking probability was found in TiN/Ti films, and the crack propagation mode changed from horizontal along interface to vertical across multilayers.

Comparison of screening tools for optimizing fracture prevention in Canada.

To inform clinical practice guidelines in Canada, we compared multiple screening tools using the population-based Manitoba BMD Program registry. The study populations consisted of (a) 28,906 individuals > 50 years or older, and (b) 15,429 women age > 65 years undergoing baseline BMD assessment (2010-2018). We considered two treatment qualifications: Treatment Approach 1: prior high-risk fracture, high fracture probability (FRAX-MOF with BMD > 20%), or vertebral fracture on VFA; Treatment Approach 2: Approach 1 or an osteoporotic BMD T score. Candidate screening tools were FRAX-MOF without BMD, age alone, weight alone, SCORE, ORAI, SOFSURF, OSIRIS, ABONE, and OST. Healthcare records were assessed for the presence of incident fracture diagnoses. Among all individuals, FRAX-MOF without BMD demonstrated the best ability to identify those satisfying Treatment Approach 1 (area under the curve [AUC 0.863]) and was significantly better than all other screening tools (P < 0.001). For identification of individuals satisfying Treatment Approach 2, FRAX-MOF without BMD showed moderate stratification (AUC 0.735), slightly lower than OSIRIS (AUC 0.752, P < 0.05), similar to SCORE (AUC 0.739, P > 0.05) and significantly better than all other screening tools (P < 0.05). For prediction of incident MOF, FRAX-MOF without BMD achieved the highest performance (AUC 0.652), and was significantly better than all other screening tools except OSIRIS. AUCs among women age > 65 years tended to be greater with a similar ranking, and no tool outperformed FRAX-MOF without BMD. Based upon a summary score, the highest ranked strategy was FRAX-MOF without BMD using a cutoff of 10%. All screening tools show some ability to identify individuals qualifying for treatment and stratify risk for incident fracture. For treatment based upon indicators of high fracture risk, the best performing strategy was FRAX-MOF without BMD using a cutoff of ≥ 10%.

Cost-effectiveness of FRAX\xae-based intervention thresholds for management of osteoporosis in Singaporean women

SummaryCost-effectiveness analysis of FRAX® intervention thresholds (ITs) in Singaporean women > 50 years of age showed that generic alendronate was cost-effective at age-dependent major osteoporotic fracture (MOF) IT from the ages of 65 years for both full and real-world adherence whilst hip fracture (HF) ITs were cost-effective from the ages of 60 and 65 years. Alendronate was cost-effective irrespective of age only at fixed MOF IT of 14% and HF IT of 3.5%.IntroductionFRAX®-based intervention thresholds (ITs) were recently identified for osteoporosis management in Singapore. This study aimed to assess the cost-effectiveness of ITs in Singaporean women over the age of 50 years.MethodsA validated Markov microsimulation model was used to estimate the lifetime healthcare costs (SGD2019) per quality-adjusted life-years (QALY) of generic alendronate compared with no treatment. Cost-effectiveness of age-dependent FRAX® major osteoporotic fracture (MOF) and hip fracture (HF) ITs was explored. In addition, ITs that would lead to cost-effectiveness were computed. Fracture incidence and cost data were obtained from the Ministry of Health and a previously published Singaporean study. A cost-effectiveness threshold of SGD 62,500/QALY gained was used, based conservatively on 0.7 times the Singapore GDP per capita.ResultsGeneric alendronate was shown to be cost-effective at MOF ITs from the ages of 65 years, while HF ITs were cost-effective from the ages of 60 and 65 years, assuming full and real-world adherence, respectively. A 14% MOF and a 3.5% HF ITs were required for alendronate to be cost-effective above 50 years.ConclusionThis study suggests that the treatment of Singaporean women with alendronate is cost-effective at age-dependant FRAX® intervention thresholds at 65 years and older. Furthermore, identifying women at any age above 50 years with a 10-year risk of MOF or HF of 14% or 3.5% would lead to efficient use of resources. Cost-effective access to therapy for patients at high fracture probability based on FRAX® could contribute to reduce the growing burden of osteoporotic fractures in Singapore.

HCV co-infection among people living with HIV Is associated with Higher fracture risk

IntroductionThe purpose of this study was to predict the 10-year risk of fracture among people living with HIV (PLWH) using FRAX™, and to determine the risk factors related to a high probability of fractures. MethodologyThis study consisted of 288 subjects aged 40 years and above. The ten-year probability of major osteoporotic fractures (MOF) and hip fractures was assessed using the FRAX™ algorithm with bone mineral density (BMD) data. A logistic regression was used to determine risk factors related to a high probability of major osteoporotic fracture and hip fracture. ResultsThe median 10-year probability of fracture was 3.7% (IQR 2.2–6.2) for MOF and 0.8% (IQR 0.3–2.5) for hip fractures. In addition to old age, previous fracture history, and low T-scores, HCV co-infection was associated with a higher risk of hip fractures in PLWH (AOR: 4.3, 95% CI: 1.29–14.33). Old age and low T-scores were also associated with a high probability of MOF. ConclusionsHCV co-infection among PLWH is associated with a higher risk of hip fracture. Sustained efforts in terms of pharmacologic and non-pharmacologic interventions in PLWH are necessary to prevent osteoporotic fractures, especially in those with HCV co-infections.

Craniomaxillofacial Trauma in Dogs-Part I: Fracture Location, Morphology and Etiology.

Treatment of craniomaxillofacial (CMF) trauma in dogs often requires a multidisciplinary approach and a thorough understanding of the CMF skeletal structures involved. The aim of this retrospective study was to use a large number of CT studies of dogs evaluated for CMF trauma and to describe fracture location and morphology in relation to demographic data and trauma etiology. The medical records and CT studies of 165 dogs over a 10-year period were evaluated. The skeletal location of CMF fractures as well as the severity of displacement and fragmentation of each fracture was recorded. Patient demographic data and trauma etiology were also recorded. Animal bites accounted for the majority of trauma (50%), followed by unknown trauma (15%), vehicular accidents (13%), and blunt force trauma (13%). Small dogs, <10 kg, and juveniles accounted for the majority of patients (41.8 and 25.5%, respectively). The most likely bone or region to be fractured was the maxillary bone, followed by the premolar and molar regions of the mandible. Up to 37 bones or regions were fractured in any given patient, with an average of 8.2 fractured bones or regions per dog. The most commonly fractured location varied according to trauma etiology. Specifically, vehicular accidents tended to result in more locations with a higher probability of fracture than other trauma types. A major conclusion from this study is that every bone of the CMF region was fractured in at least one case and many cases had a large number of fractured regions. Thus, the need for comprehensive assessment of the entire CMF region, preferably using CT, is underscored.

FRAX-based intervention and assessment thresholds for osteoporosis in Iran.

The fracture risk assessment algorithm FRAX® has been recently calibrated for Iran, but guidance is needed on how to apply fracture probabilities to clinical practice. The age-specific ten-year probabilities of a major osteoporotic fracture were calculated in women with average BMI to determine fracture probabilities at two potential intervention thresholds. The first comprised the age-specific fracture probabilities associated with a femoral neck T-score of - 2.5 SD, in line with current guidelines in Iran. The second approach determined age-specific fracture probabilities that were equivalent to a woman with a prior fragility fracture, without BMD. The parsimonious use of BMD was additionally explored by the computation of upper and lower assessment thresholds for BMD testing. When a BMD T-score ≤ - 2.5 SD was used as an intervention threshold, FRAX probabilities in women aged 50years was approximately two-fold higher than in women of the same age but with an average BMD and no risk factors. The relative increase in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80years or more, a T-score of - 2.5 SD was actually protective. The 10-year probability of a major osteoporotic fracture by age, equivalent to women with a previous fracture rose with age from 4.9% at the age of 50years to 17%, at the age of 80years, and identified women at increased risk at all ages. Intervention thresholds based on BMD alone do not effectively target women at high fracture risk, particularly in the elderly. In contrast, intervention thresholds based on fracture probabilities equivalent to a "fracture threshold" target women at high fracture risk.

Effects of the falls and fractures clinic as an integrated multidisciplinary model of care in Australia: a pre–post study

ObjectivesTraditionally, the approach to fracture prevention has focused on increasing bone mineral density while typically lacking a combined clinical approach to falls prevention and vice versa. To resolve this gap,...