Impact Of Fragility Fractures Research Articles

Impact of fragility fractures in postmenopausal Spanish women with osteoporosis

Impact of fragility fractures in postmenopausal Spanish women with osteoporosis

Targeting the Fragility Fracture Prevention Message

Abstract Background: The impact of fragility fractures on human suffering is underappreciated. Fragility fractures increase mortality and the risk of recurrent fracture. Notwithstanding these facts, only a minority of patients suffering osteoporotic fractures receive fracture preventing therapy. Education about the burden of disease and the benefits of prompt treatment are important means to increase the treatment rate. We propose that the focus of the educational message should be varied for distinct audiences. Method: We searched existing literature to determine perceptions about the importance of treating fractures and osteoporosis among the following groups: the general population, primary care physicians, specialist physicians, hospital administrators, and government health officials. Result: Extensive data focusing on patients and primary care physicians exist about barriers to treatment initiation. In these groups, lack of perceived treatment benefit is a widespread, common finding. To address this gap, we have produced a primary care education toolkit, patient booklet and education directory as Asia Pacific Fragility Fracture Alliance (APFFA)-sponsored initiatives. Data are more limited for specialist physicians, hospital administrators, and government officials. Health economic arguments have been found to be persuasive among policy makers. Conclusion: Information about the importance of treating fragility fractures and osteoporosis is far more abundant with reference to patients and primary care providers than to specialty physicians, hospital administrators, and government officials. Understanding the state of knowledge and belief is an essential first step in developing educational materials that address the concerns and misperceptions of each key constituency. Existing data suggest that patients will be more receptive to materials emphasising independence and quality of life, while policy makers will be more receptive to materials highlighting the burden of disease.

The impact of fragility fractures on health-related quality of life in patients with primary sclerosing cholangitis.

Background:Osteoporosis occurs frequently in patients with chronic cholestatic liver diseases, yet data are scarce regarding the prevalence of osteoporosis and fragility fractures and their impact on Health-Related Quality of Life (HRQoL) in Primary Sclerosing Cholangitis (PSC).Objectives:We aimed to assess Bone Mineral Density (BMD), physical activity and incidence of fragility fractures in patients with PSC. We also sought associations between prior fractures and HRQoL.Patients and Methods:The study was performed on 33 patients (11 females, 22 males) aged 35.3 ± 13 years. HRQoL was assessed by Short Form (SF)-36, Primary Biliary Cirrhosis (PBC)-40 and PBC-27 questionnaires. BMD was measured by densitometry in the lumbar spine and hip. Physical activity was assessed by questionnaire.Results:In 32% of patients, BMD measured in the hip or spine was below 1.0 Standard Deviation. A history of fragility fractures (distal forearm and ribs) was reported in six patients (18%). In SF-36 assessment, patients with fractures had lower scores in the role functioning, general health and vitality domains and Physical Component Summary (PCS) than those without fractures. Prior fractures adjusted for gender and PSC duration were associated with lower PCS and Mental Component Summary (MCS) scores. Symptoms and fatigue (assessed by PBC) and prior fractures were inversely associated with MCS (P = 0.007).Conclusions:In middle-aged subjects with PSC, we found a high rate of non-vertebral fractures and a moderately decreased BMD in lumbar spine and hip. Fragility fractures had an impact on physical and mental aspects of HRQoL.

The impact of osteoporosis on health-related quality of life in patients after liver transplantation - a pilot study.

IntroductionLiver transplantation (LT) is now a well-established procedure with 5-year survival rates over 70%, and one of its ultimate goals is the improvement of patient health-related quality of life (HRQOL). Osteoporosis remains a serious potential complication of LT, leading to fragility fractures, pain, and functional impairment.AimTo assess the degree of osteoporosis and the impact of fragility fractures on HRQOL in patients with chronic liver diseases treated with LT.Material and methodsTwenty-seven patients (14 female, 13 male) at a median period of 3.5 years post LT participated in the study. HRQOL was assessed by Short Form-36 and PBC-40 instruments. Bone mineral density (BMD) in the lumbar spine and hip neck were measured by dual-energy X-ray absorptiometry. Physical activity was assessed by questionnaire. Data on the duration of the liver disease, time from LT, and fragility fractures were also collected.ResultsAs many as 74.1% of the patients had reduced BMD (t-score < -1.0 SD) in the hip. Mean values of the spine and hip BMD z-scores were -1.1 and -0.9 SD, respectively. Time after LT, percentage of lean tissue, and physical activity were positively associated with BMD. The prevalence of fractures was 48%. We did not find significant differences in age, gender, body composition parameters, physical activity, BMD, and HRQOL scores between the subjects with and without fractures.ConclusionsWe found a high prevalence of fragility fractures and a decreased BMD in LT recipients. Patients with a history of fractures had similar HRQOL scores to those without fractures.

Fragility fracture programs: are they effective and what is the surgeon's role?

Fragility fractures are occurring at an ever-increasing rate, creating an enormous economic and societal impact. Outpatient-based fragility fracture programs have been developed to identify at-risk patients, initiate effective treatment of metabolic bone disease, and improve coordination between members of the patient's care team with the goal of reducing future fractures. Inpatient programs focus on effective, efficient management of patients presenting with acute fractures. Both have proven successful in reducing the impact of fragility fractures, but many challenges exist. The orthopedic surgeon, as part of an integrated team of providers, is integral in identifying at-risk patients, ensuring appropriate care of acute fractures, and initiating treatment protocols to reduce the risk of further injuries.