Lower Fracture Risk Research Articles

Influence of Dental Implant Diameters on Prosthesis Complications: a Systematic Review and Meta-analysis.

This systematic review and meta-analysis aims to analyze the risk of prosthesis complications across different implant diameters. An electronic search across PubMed (MEDLINE), Embase, Scopus, and Cochrane Central Register of Controlled Trials until December 2023 was performed. Studies comparing implant prosthesis complications among extra-narrow (<3.0 mm), narrow (≥3.0 to <3.75 mm), standard (≥3.75 to <5 mm), and wide-diameter (≥5 mm) implants were included. Meta-analyses were performed to evaluate the risk ratio of prosthesis complications across different diameters, particularly in non-full arch implant-supported fixed dental prostheses (ISFDP). Eighteen clinical studies were included. In non-full arch ISFDP, the most prevalent complication was screw loosening in narrow, standard, and wide-diameter implants (17.28%, 4.08% and 12.45%, respectively), and decementation (3.4%) in extra-narrow diameter implants. In implant overdentures, extra-narrow, narrow and standard-diameter implants demonstrated high rates of retentive cap wear (58.33%, 80.49% and 70%, respectively), whereas wide-diameter implants had 16.67% overdenture repair. The meta-analyses showed a risk ratio of 0.20 (95% confidence interval= 0.04 to 0.94, p= 0.04) and 0.17 (95% CI= 0.06 to 0.45, p< 0.0004) for abutment fracture in single crowns and ISFDP comparing narrow versus standard-diameter implants. No significant differences in risk ratios were observed for screw loosening, decementation, porcelain chipping, fracture, or screw fracture among the different diameter groups. This systematic review highlights that screw loosening and retentive cap wear are the most common prosthesis complications in ISFDP and overdentures, regardless of implant diameter. While narrow-diameter implants have a lower risk of abutment fracture compared to standard-diameter implants, clinicians should carefully consider patient characteristics, implant locations, and abutment features when selecting the ideal implant diameter.

P-567. Baseline Patient and Clinician Results for the Pilot Project I-CARE-4-PAH (Intervention for Collaborative Care to Assess Risk and Eliminate polyPharmacy, Falls, and Fragility Fractures for People Aging with HIV)

Abstract Background More than half of people living with HIV in the United States are 50 years of age or older. Understanding how best to assess and address conditions associated with aging in HIV primary care is important for this population. Methods We trained clinicians in an academic HIV clinic to assess and address the 4F’s (polypharmacy, Falls, and Fragility Fractures) in their patients aging with HIV (PAH). We share results of this screening as well as key knowledge, attitudes, and practices (KAP) from the pre-test assessment of our clinician champions. Results 126 patients 50+ years of age were enrolled. The mean age is 63±6 years. 49% were assigned female at birth and 1% are transwomen. 48% identify as Black, 48% White, and 14% Hispanic. 30% smoke tobacco, and 30% report ongoing marijuana use. Patients take 10±5 medications; 25% have hyperpolypharmacy ( &amp;gt;15 medications), and 66% are on potentially inappropriate medications (PIMs). At least a quarter of patients have peripheral neuropathy: 25% have decreased sensation on the plantar surface of either foot; 35% have decreased vibratory sense on the right great toe,37% on the left. 42% reported a fall/near-fall in the past year; 10% experienced a serious fall leading to a visit with a healthcare provider. Mean risk of a serious fall in the next year is moderate: 4.05%±4.13%. 34% reported a fracture as an adult. Mean FRAX scores indicate a low 10-year risk for fragility fracture (major osteoporotic fracture: 8.71%±6.95%; hip fracture 2.11%±3.58%). Eleven HIV clinicians are engaged with this project. Most (73%) regularly perform medication reconciliation. 55% report asking about falls only if the patient brings it up. 18% have never assessed their patients for fracture risk, and 36% have done so once. Conclusion Polypharmacy, peripheral neuropathy, PIMs, falls, and fractures are important intersectional risk factors for adverse outcomes in PAH and are inconsistently assessed by clinicians. Medication reconciliation is an important first step in identifying polypharmacy. Deprescribing, identifying patients with peripheral neuropathy, and discussing fall prevention are key foci for future interventions. Providing training resources for HIV clinicians to assess and prevent the 4F’s is crucial and feasible. Disclosures Richard Marottoli, MD, MPH, The Hartford: Advisory Panel on Older Driver Safety Michael D. Virata, MD, FACP, Janssen: Advisor/Consultant|Janssen: Honoraria|ViiV Pharmaceuticals: Advisor/Consultant|ViiV Pharmaceuticals: Honoraria

Preterm birth and risk of bone fractures during childhood and early adulthood.

People born preterm have reduced bone mineral density, subnormal peak bone mass, and an increased risk of osteoporosis. Whether this translates to increased risk of bone fractures is uncertain. We assessed fracture risk from childhood to early adulthood in relation to gestational age and sex by conducting a nationwide register-linkage cohort study comprising all 223 615 liveborn (1/1987- 9/1990) singletons (9161, 4.1%, preterm) in Finland. Cox regression models provided hazard ratios (HR) for fracture diagnosis in public specialty healthcare in both first and recurrent event settings during the whole follow-up (0-29yr), and during different age periods (0-4/5-9/10-29yr). Gestational age was considered categorical (full-term, 39-41weeks, reference). A total of 39 223 (17.5%) children or young adults had at least one fracture. In analyses not stratified by sex, only extremely preterm birth (<28 completed weeks' gestation) was associated with risk of bone fracture at 0-29yr; adjusted HR (aHR) 0.46 (95% CI 0.28-0.74) compared with those born full-term. Among females, gestational age was unrelated to fracture risk at 0-29yr. Among males, extremely and very preterm (28-31weeks) birth was associated with lower risk of fracture at 0-29yr compared with those born full-term: aHR 0.38 (CI 0.21-0.71) and 0.75 (CI 0.59-0.95) respectively. Restricting the analyses to the individuals without severe medical condition(s) attenuated the associations. However, the fracture risk varied according age and sex: at 10-29yr moderately preterm (32-33wk) females, and extremely- and very preterm males had a lower risk: aHR 0.63 (0.43-0.94), 0.35 (0.17-0.69), and 0.74 (0.57-0.95) respectively, while late preterm birth (34-36wk) was associated to 1.6-fold higher risk among females at 0-5yr, and 1.4-fold risk among males at 5-10yr. Analyses on recurrent fractures showed similar pattern. Children and young adults, in particular males, born extremely or very preterm may have less bone fractures, this is partly explained by severe medical conditions in this group.

Risk of Osteoporotic Fractures among Patients with Thyroid Cancer: A Nationwide Population-Based Cohort Study.

The associations between thyroid cancer and skeletal outcomes have not been thoroughly investigated. We aimed to investigate the risk of osteoporotic fractures in patients with thyroid cancer compared to that in a matched control group. This retrospective cohort study included 2,514 patients with thyroid cancer and 75,420 matched controls from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC, 2006-2019). The rates of osteoporotic fractures were analyzed, and associations with the levothyroxine dose were evaluated. Patients with thyroid cancer had a significantly lower risk of fracture than did the control group (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.69 to 0.94; P=0.006). Patients diagnosed with thyroid cancer after the age of 50 years (older cancer group) had a significantly lower risk of fracture than did those in the control group (HR, 0.72; 95% CI, 0.6 to 0.85; P<0.001), especially those diagnosed with spinal fractures (HR, 0.66; 95% CI, 0.51 to 0.85; P=0.001). Patients in the older cancer group started osteoporosis treatment earlier than did those in the control group (65.5±7.5 years vs. 67.3±7.6 years, P<0.001). Additionally, a lower dose of levothyroxine was associated with a reduced risk of fractures. In the clinical setting, the risk of fracture in women diagnosed with thyroid cancer after the age of 50 years was lower than that in the control group, which was caused by more proactive osteoporosis treatment in postmenopausal women with thyroid cancer.

Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative).

Efficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality. The NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011-2015) or intervention period (2015-2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated. A total of 100,198 patients (mean age 69.6years) suffered an index fracture of any type. During a maximum follow-up of 4.7years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83-0.92) and 10% in men (HR 0.90, 95% CI 0.81-0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79-0.86) and 15% in men (HR 0.85, 95% CI 0.81-0.89). A standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.

Association of higher potency statin use with risk of osteoporosis and fractures in patients with stroke in a Korean nationwide cohort study

This population-based cohort study aimed to evaluate the risk of osteoporosis and fractures associated with higher-potency statin use compared to lower-potency statin use in patients with stroke, using data from the Health Insurance and Review Assessment database of South Korea (2010–2019). Patients who received statin within 30 days after hospitalization for a new-onset stroke (n = 276,911) were divided into higher-potency (n = 212,215, 76.6%) or lower-potency (n = 64,696, 23.4%) statin initiation groups. The primary outcome was a composite of osteoporosis and osteoporotic fractures. Secondary outcomes were individual components of the primary outcome, including osteoporosis, vertebral fracture, hip fracture, and non-hip non-vertebral fracture. Cox proportional hazard models weighted by standardized morbidity ratios were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The risk of the composite outcome (HR 0.95, 95% CI 0.93–0.97), osteoporosis (0.93, 0.90–0.96), vertebral fracture (0.95, 0.91–0.99), and hip fracture (0.89, 0.84–0.95) were significantly lower in higher-potency statin users, while the risk for non-hip non-vertebral fracture was not significant (0.98, 0.95–1.02). The use of higher-potency statins compared to lower-potency statins was associated with a lower risk of osteoporosis, vertebral fracture, and hip fracture in patients with stroke.

Triglyceride glucose index is associated with vertebral fracture in older adults: a longitudinal study.

Diabetes is a risk factor for bone fractures. However, the association between insulin resistance and the risk of fracture has not been well studied. In the present study, we explored the association of the triglyceride glucose index as a measure of insulin resistance with the risk of vertebral fracture in older adults. A total of 1995 subjects aged 50 years or older who underwent computed tomography (CT) for lung cancer screening from 2016-2021 were included in this study. They were followed until July 2023. Demographic information and laboratory test data were collected from the electronic medical system. Vertebral fractures were evaluated on the basis of sagittal CT images of the spine. The triglyceride glucose (TYG) index was calculated via the following equation: Ln [fasting glucose (mg/dl)×fasting triglyceride (mg/dl)/2]. The association between the TYG index and vertebral fracture incidence was evaluated via a multivariable Cox proportional hazards model. Ninety-five cases of fracture were observed during the 60 months of follow-up. The incidence of fracture was lower for the fourth TYG index than for the first TYG index (3.26% vs. 6.00%, P = 0.04). The risk of vertebral fracture decreased with increasing TYG index (adjusted hazard ratio (aHR): 0.56, 95% confidence interval (CI): 0.35-0.90). Fracture risk was significantly lower in subjects with the highest TYG (the fourth quartile) than in those with the first quartile (aHR: 0.46, 95% CI: 0.22-0.96) according to the fully adjusted model. A similar association was observed in subjects without diabetes (aHR = 0.44, 95% CI: 0.21-0.95). Restricted cubic splines further revealed that the risk of vertebral fracture decreased with increasing TYG index. A greater TYG index was associated with a lower risk of vertebral fracture, independent of body mass index and bone mass.

Biomechanical stability of magnesium plate and screw fixation systems in LeFort I osteotomy: a three-dimensional finite element analysis

BackgroundTitanium (Ti–6Al–4 V) is used for fixation in LeFort I osteotomy, a procedure for treating midface deformities. This study assessed the biomechanical stabilities of two Mg alloys (WE43 and ZK60) as biodegradable alternatives and compared them against Ti using finite element analyses. The LeFort I osteotomy procedure was simulated, and various plate and screw configurations were tested. The maximum principal and peak von Mises stresses in the metal plates and bone screws were measured under four load conditions, and the stability was evaluated.ResultsThe holes in the Mg screws, as compared with the Ti counterparts, exhibited higher and lower stress levels in the cortical and cancellous bones, respectively. The Mg screws also exhibited a higher fracture risk. The ZK60 plate, as compared with the Ti and WE43 plates, exhibited a lower fracture risk under all load conditions. ZK60 exhibited higher biomechanical stability in terms of maintaining the gap between osteotomy surfaces and lower fracture risk; the osteotomy surfaces with Ti im-plants underwent bone impaction, resulting in gap closure.ConclusionsAlthough the Mg implants exhibited better stress distribution, their screw strength requires improvement. Appropriate improvements can promote the use of Mg alloys in bone fixation applications.

Rationale for osteoporosis screening in men.

The US Preventive Services Task Force (USPSTF) has found insufficient evidence for recommending for or against osteoporosis screening in men. Department of Veterans Affairs osteoporosis experts reviewed the literature on osteoporosis screening and treatment in men. Although not done systematically, the literature was reviewed by a panel of 20 Department of Veterans Affairs clinicians with extensive experience with osteoporosis in men. Virtual meetings and multiple email communications resulted in a consensus. Screening, particularly targeted screening in men, has been found to identify men at risk for fracture. Prior studies have shown osteoporosis drugs have similar effects in men and women. A recent large observational trial demonstrated that hip fracture risk is similarly reduced for both sexes by current medications. The consensus of the panel was that targeted screening of men for osteoporosis would lead to greater use of osteoporosis medication, lowering fracture risk.

Perioperative and short-term outcomes of cemented versus cementless total hip arthroplasty: a retrospective propensity-matched analysis.

Cement fixation for total hip arthroplasty (THA) remains a controversial topic. While cemented stems are associated with lower risk of periprosthetic fractures (PPF), cementless stems may offer superior biological fixation. This study analyzed peri-operative and short-term outcomes of cemented vs. cementless stem fixation in THA. A retrospective review was conducted on 15,012 patients who underwent primary elective THA at an academic medical center from 2011 to 2021. Of these patients, 429 were cemented. Patients were stratified into 3 age cohorts (25-69, 70-79 and ≥ 80 years). Cemented stem patients were 1:1 propensity-score matched to cementless stem patients for baseline characteristics. Perioperative and short-term outcomes were compared. The mean operative time for cemented cases was significantly longer across all age cohorts (25-69, P = 0.005; 70-79, P < 0.001; ≥80, P < 0.001). In the 70-79 and ≥ 80 cohorts, cemented patients demonstrated a significantly shorter length of stay (LOS) compared to cementless patients (2.2 vs. 2.6 days, P = 0.017; 3.0 vs. 3.4, P = 0.041, respectively). In the 70-79 and ≥ 80 cohorts, cemented patients were significantly more likely to be discharged home when compared to cementless patients (88.2 vs. 80.5%, P = 0.031; 64.0 vs. 54.2%, P = 0.046, respectively). Across age cohorts, there were no differences in all-cause revision rates (Cohort 1: 5.4% vs. 1.1%, P = 0.108; Cohort 2: 3.0% vs. 1.8%, P = 0.362; Cohort 3: 1.8% vs. 1.2%, P = 0.714). The ≥ 80 cohort demonstrated increased rates of PPF in the cementless cohort compared to cemented (1.2 vs. 0%, P = 0.082, respectively), but it did not reach significance. Patient age has a substantial impact on perioperative outcomes following cemented versus cementless stem THA. Patients > 70 with a cemented femoral stem had improved perioperative outcomes such as shorter LOS, increased discharge to home and reduced rates of PPF compared to their cementless stem counterparts. Patient age should be considered prior to selecting a stem fixation strategy. III, Therapeutic Study.

The Association Between Nutritional Risk and Bone Stiffness in Elderly Men and Women in a Population-Based Study in Northeast Germany.

The Geriatric Nutritional Risk Index (GNRI) has shown promising potential for identifying individuals at risk for osteoporosis in various patient cohorts. However, data from the general population confirming or refuting the usefulness of the GNRI as a risk factor for osteoporosis are sparse. We therefore aimed to clarify whether the GNRI is associated with the ultrasound-based bone stiffness index and the osteoporotic fracture risk in a sample of elderly men and women from the general population. Data from 1417 participants in the Study of Health in Pomerania START-2 or TREND-0 aged 65 years or older with quantitative ultrasound measurements at the heel and GNRI values were examined. In cross-sectional linear and logistic regression models, associations between the GNRI and heel stiffness index or ultrasound-based osteoporotic fracture risk were examined. All analyses were repeated after stratification of the study population according to BMI (underweight/normal weight, overweight and obese). In underweight/normal weight individuals, higher, i.e., better, GNRI values had a positive effect on the stiffness index (β-coefficient per standard deviation increase in GNRI = 2.69, standard error = 1.00, p = 0.007). With increasing GNRI values, underweight/normal weight elderly men and women also had higher chances of a low osteoporotic fracture risk (odds ratio 1.42, 95% confidence interval 1.04-1.94, p = 0.026). Corresponding associations in overweight or obese individuals were absent. In elderly men and women with underweight/normal weight, the GNRI is positively associated with the bone stiffness index and the related osteoporotic fracture risk. In this group, the GNRI may prove useful in identifying individuals with an elevated fracture risk.

Effectiveness of Bisphosphonates in Young Adults with Fragility Fractures: Representative Population-Based Cohort Study.

Fragility fractures in young adults present significant clinical challenges due to the limited evidence on the effectiveness of bisphosphonates in preventing subsequent fractures. To evaluate the effectiveness of bisphosphonate therapy in reducing the fracture risk among premenopausal women with a history of osteoporotic fractures. A population-based retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in South Korea, covering the years 2003 to 2014. A nationwide healthcare setting utilizing a representative cohort database. Among 2,087 premenopausal women with osteoporotic fractures, participants were propensity score-matched based on age and body mass index at a 1:3 ratio, resulting in 132 bisphosphonate users and 396 non-users. Bisphosphonate treatment. The incidence of osteoporotic fractures. Bisphosphonate users had a significantly lower risk of major osteoporotic fractures (HR 0.618, 95% CI 0.396 - 0.963) compared to non-users. Ibandronate users showed significant reductions in both major osteoporotic (HR 0.376, 95% CI 0.164 - 0.861) and nonvertebral fractures (HR 0.214, 95% CI 0.052 - 0.877). Also, longer duration of bisphosphonate use (≥180 days) was associated with a significantly lower risk of major osteoporotic and nonvertebral fractures (HR 0.528, 95% CI 0.300 - 0.929; HR 0.409, 95% CI 0.187 - 0.895, respectively). Bisphosphonate therapy significantly reduces fracture risk in premenopausal women with previous osteoporotic fractures, especially at higher cumulative doses. These findings support considering bisphosphonates as a treatment option in premenopausal women at high risk of fractures.

Evaluation of polyaryletherketone materials as post-core abutments for removable partial dentures: A finite element analysis

ObjectiveThe purpose was to compare the biomechanical behavior of single-piece post-core restorations made from polyaryletherketone materials with fiber post-core restorations when serving as abutments for RPD using finite element analysis (FEA). MethodsPhantom maxillary central incisor and mandibular second premolar were trimmed 1-mm coronally to cemento-enamel junction; root canals were enlarged and the teeth were scanned. Data was transferred to a solid modeling software.Twenty four models, including six post-core restorations:glass-fiber post/composite core (GFH/GFL) and single-piece post-core groups as, PEKK(PKH/PKL);Ti02-reinforced PEEK(TH/TL);ceramic reinforced PEEK(CeH/CeL);carbon fiber reinforced PEEK(CaH/CaL);glass fiber reinforced PEEK(GFPH/GFPL) with hybrid ceramic/lithium disilicate crowns on each tooth were constructed.Loads of 100 N for central incisor, and 300 N for premolar in a 45°oblique direction were applied to simulate masticatory forces. Clasp removal force of a RPD was simulated as 5 N vertically.FEA was employed to evaluate the von Mises stresses.Strain at cement layer was also investigated. ResultsCaH/CaL groups revealed the lowest stress for both teeth at root while TH/TL groups revealed the highest stress. The lowest stress values in the post-core were in GFH/GFL groups while the highest stress occurred in the CaH/CaL groups for both teeth. SignificanceGlass-fiber post-cores exhibited the lowest stresses in the post under masticatory and clasp removal forces. It may suggest a potentially lower risk of post fracture compared to polyaryletherketone group materials. TiO2-reinforced PEEK post-cores exhibited the lowest stresses among PAEK materials, indicating a potentially high fracture resistance.

Efficacy of Bisphosphonates in Reducing Fracture Risk Among Postmenopausal Women With Osteoporosis.

Postmenopausal women are often affected by osteoporosis, a disorder that lowers bone density, increases the risk of fractures, and has a major negative influence on quality of life. This study aimed to assess the efficacy of bisphosphonates in reducing fracture risk among postmenopausal women with osteoporosis by analyzing their impact across various fracture sites, treatment durations, and patient subgroups. A retrospective cohort research was conducted between January 2021 and December 2022 at Hayatabad Medical Complex (HMC), Peshawar. Women 50 years of age and older who had been diagnosed with osteoporosis (BMD T-score < -2.5) and receiving bisphosphonates for at least a year were included in the research. We gathered information on treatment adherence, fracture history, and demographics. SPSS version 25 was used to conduct statistical studies, such as logistic regression and paired t-tests. A total of 323 participants were included, with a mean age of 65.40 ± 8.20 years. The incidence of new fractures decreased significantly from 121 patients (37.48%) before therapy to 48 patients (14.85%) post-therapy (p < 0.0001), demonstrating the efficacy of bisphosphonates in fracture prevention. Notably, the most common fracture types were vertebral fractures in 49 patients (15.18%) and hip fractures in 42 patients (12.99%). Logistic regression analysis indicated that age (OR 1.05, 95% CI: 1.02 - 1.09) and baseline BMD T-score (OR 0.78, 95% CI: 0.67 - 0.90) were significantly associated with fracture risk reduction, highlighting the importance of these factors in treatment outcomes. The significance of bisphosphonates in clinical therapy is highlighted by their ability to successfully lower fracture risk in postmenopausal women with osteoporosis.

The Management of Osteoporosis in Chronic Kidney Disease: A Review of Diagnostic and Therapeutic Approaches.

Chronic kidney disease (CKD) has shown a growing association with osteoporosis, comprising part of the broader CKD-mineral and bone disorder (CKD-MBD). CKD-MBD is marked by alterations in calcium, phosphorus, parathyroid hormone (PTH), and vitamin D metabolism, significantly elevating fracture risk. While traditional osteoporosis treatments such as bisphosphonates, denosumab, and teriparatide have been adapted for CKD patients, recent innovations have introduced agents aimed at enhancing bone mass and reducing fracture incidence. This study aims to evaluate the pathophysiology, diagnostic methods, and tailored management strategies for osteoporosis in CKD patients. A detailed review of the literature was conducted, involving an in-depth search of PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Library databases for studies published between 2017 and 2024. Studies were selected based on inclusion criteria focusing on CKD-related osteoporosis, diagnostic criteria, and treatment outcomes. Data extraction and quality assessment were independently performed by multiple reviewers to ensure thoroughness and reduce bias. Findings highlight that conventional treatments, such as bisphosphonates, denosumab, and teriparatide, when tailored to CKD stages, demonstrate variable effectiveness in lowering fracture risk. Additionally, emerging pharmacologicagents hold promise in improving bone density, though evidence on these newer therapies remains limited. Osteoporosis management in CKD patients necessitates a personalized approach guided by the disease's stage and individual profile. This review underscores the potential of emerging therapies and emphasizes the need for further research to refine treatment protocols, aiming to enhance patient outcomes in this complex population.

Bisphosphonate Use after Kidney Transplantation Is Associated with Lower Fracture Risk.

Kidney transplant recipients are at higher risk of fractures compared to the general population. The use of bisphosphonates has been shown to increase bone mineral density after transplantation but has not been shown to lower fracture rates. Here, we aim to determine if exposure to bisphosphonates associates with lower incidence of non-vertebral fractures after kidney transplantation. We conducted a retrospective review for all Southern California Kaiser Permanente kidney transplant recipients with osteoporosis transplanted between 2000 and 2019. Baseline variables were collected. Those prescribed an oral bisphosphonate were compared to those who were not. The primary outcome was non-vertebral fracture. Chi square was used to evaluate categorical variables and Wilcoxson rank sum test for continuous variables. Propensity scores were generated to balance covariates in the bisphosphonate and non-bisphosphonate groups. Cause-specific hazard and sub distribution (Fine-Gray) methods were performed for competing risk analysis. Death censored graft survival was evaluated as a secondary outcome using standard Cox regression. There were 489 patients included in the study, 203 of which were in the bisphosphonate group. The cause specific hazard model suggested a 64% lower risk of non-vertebral fracture in the bisphosphonate group (p=0.02). The Fine-Gray hazard model treating death as a competing risk did not show lower relative incidence of non-vertebral fracture. Bisphosphonate treatment was associated with lower death censored graft failure (p=0.002). Bisphosphonate use after kidney transplantation may associate with lower risk of non-vertebral fracture after transplant. Bisphosphonate use in this study was also associated with lower death censored graft failure. Caution is advised when interpreting these results given the retrospective nature of the study.

Geographical variation in osteoporosis in Australian women: a longitudinal analysis over 23years.

To determine whether the prevalence of osteoporosis, fractures, and dual-X-ray absorptiometry (DXA) differs between Australian women living in rural compared with urban areas. The Australian Longitudinal Study on Women's Health, a prospective longitudinal study of Australian women, includes a cohort of women born 1946-1951, surveyed nine times from 1996-2019. Data from administrative health records were linked to survey data. Geographic area was classified as major city, inner regional, outer regional, or remote. Generalised estimating equations (GEE) explored outcomes of osteoporosis, fracture, and DXA rates. Univariable and multivariable regression were performed and bootstrapping with 100 repetitions at 95% sampling of the original dataset to ensure robust results. A total of 13,712 women were included: 5000 (36.5%) living in major cities, 5214 (38.0%) inner regional, 2798 (20.41%) outer regional, and 700 (5.1%) remote areas. Baseline age, 47.6 (1.46) years (mean (SD)), was similar; but education, marital status, country of birth, smoking, BMI, and comorbidities varied between areas. Over 23years, 2956 (21.6%) were diagnosed with osteoporosis, 3185 (23.2%) had an incident fracture, and 8151 (59.4%) had a DXA. On univariable analysis, women living outside major cities had lower risk of osteoporosis (inner regional OR 0.92; 95% CI 0.84, 0.99; outer regional 0.70; 0.63, 0.79; remote 0.43; 0.34, 0.53), and lower risk of fractures (inner regional area OR 0.92, 95% CI 0.84, 0.99; outer regional 0.81; 0.73, 0.90; remote 0.54; 0.42, 0.67), than women living in major cities. These differences were no longer significant on multivariable analysis, suggesting differences might be related to the distribution of risk factors. Women living in inner regional and outer regional areas were significantly less likely to have a DXA, than those living in a major city (OR 0.75, 95% CI 0.70, 0.81; OR 0.72; 95% CI 0.64, 0.77, respectively), and this remained significant on multivariable analysis. Osteoporosis or fracture affected one-third of older Australian women, and women living outside major cities had lower rates of osteoporosis, fractures, and DXA completion.

Finite element study of stress distribution in medial UKA under varied lower limb alignment

Knee osteoarthritis (KOA) has a high incidence among the elderly, significantly impacting their quality of life and overall health. Medial unicompartmental knee arthroplasty (UKA) is an excellent choice for treating knee single-compartment lesions, and lower limb alignment has a profound impact on medial UKA. To explore the influence of different lower limb alignments on medial UKA. In this study, we selected MR and CT data of healthy adult male knee joints to establish a complete finite element analysis (FEA) model of the knee joint. After validation, we established a finite element model of medial UKA. Subsequently, we created 60 sets of FEA models with different lower limb alignments to analyze the impact of different lower limb alignments on medial UKA. A vertical load of 1000 N was applied to the FEA models with different lower limb alignments. During the process of shifting the Mikulicz line from the midpoint of the knee joint towards the medial side, the lower limb load was primarily concentrated on the medial compartment. The stress values of the lateral meniscus, tibial cartilage, and femoral cartilage gradually decreased. ROI (region of interest) 1 and ROI 2 showed the maximum principal strain changes, while ROI 3 and ROI 4 exhibited less pronounced fluctuations, with the maximum principal strain roughly proportionally increased. During the process of shifting the Mikulicz line towards the lateral side from the midpoint of the knee joint, the stress on the lateral compartment increased observably. ROI 1, ROI 2, ROI 3, and ROI 4 showed decreased maximum principal strains, approximately inversely proportional changes, but the overall reduction was relatively small. Different lower limb alignments have a profound impact on the short- and long-term joint function after UKA. When the Mikulicz line is 10 mm inside the midpoint of the knee joint or slightly outside, there is a relatively lower risk of tibial component fractures, lower stress on the lateral compartment, and lower load on the prosthesis. During medial UKA, measures such as bone resection and prosthesis selection should be taken to ensure that the Mikulicz line is in the ideal position.

Risk of first hip fracture under treatment with zoledronic acid versus alendronate: a NOREPOS cohort study of 88,000 Norwegian men and women in outpatient care

SummaryWe aimed to investigate the risk of hip fracture associated with zoledronic acid treatment compared to alendronate on a population level. The risk of hip fracture was lower in women using zoledronic acid and higher in women who had discontinued treatment. The findings support the effectiveness of intravenous bisphosphonate.PurposeTo investigate whether zoledronic acid (ZOL) was associated with a lower risk of the first hip fracture than alendronate (ALN) in Norway using real-world data.MethodsNationwide data on drugs dispensed in outpatient pharmacies were individually linked with all hospital-treated hip fractures. Individuals aged 50–89 years without previous hip fracture were included at their first filling of a prescription for ALN or ZOL during 2005–2016. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) for first hip fracture by time-varying exposure to ZOL versus ALN were estimated in sex-stratified flexible parametric survival analyses. Covariates included time-varying accumulated ALN exposure and comorbidity level expressed by the prescription-based Rx-Risk Comorbidity Index, marital status, education, and residential urbanity.ResultsOf 75,250 women who initiated treatment, 72,614 (96.5%) were exposed to ALN and 6366 (8.5%) to ZOL. Of 12,739 men who initiated treatment, 12,311 (96.6%) were exposed to ALN and 784 (6.2%) to ZOL. In women, the HR for first hip fracture was 0.75 (95% CI: 0.61–0.91) for ZOL versus ALN. In men, the corresponding HR was 0.59 (95% CI: 0.32–1.07). Discontinued treatment was associated with increased risk compared with current ALN treatment in women (HR: 1.33; 95% CI: 1.24–1.42, men: HR 1.13 (95% CI: 0.95–1.35)).ConclusionsIn women, the risk of first hip fracture when treated with ZOL was 25% lower than when treated with ALN. Discontinued treatment was associated with a 33% increase in hip fracture risk. Similar, albeit statistically non-significant, results were observed in men.

Associations of Serum Testosterone and Sex Hormone-Binding Globulin with Incident Fractures in Middle-Aged to Older Men.

As men age, circulating testosterone (T) decreases, circulating sex-hormone binding globulin (SHBG) increases, and risk of fracture increases. It is unclear if circulating T, independently of comorbidities, is associated with fracture risk in men. To determine associations for T and SHBG with incident fractures in men. We utilized the large (n=205,973 participants, 11,088 any fracture cases, 1,680 hip fracture cases, 1,366 forearm fracture cases) and well-characterized UK Biobank cohort. Associations were modelled using Cox regressions, adjusting for multiple comorbidities/covariates, imputing for missing information, and assessing non-linearity using cubic splines. For T, not considering SHBG, there was a non-linear association with hip but not forearm fractures, with the lowest risk in the second quintile. However, in models adjusted for SHBG or using calculated free T, lower T was associated with higher risk for fractures at all evaluated bone sites. Lower SHBG was strongly associated with lower risk of hip and forearm fractures (Q1 vs Q5, hip 0.55, 0.47-0.65; forearm 0.62, 0.52-0.74). Low circulating SHBG is strongly associated with low risk of fracture at all evaluated bone sites, while the associations of circulating T with fracture risk are of lesser magnitude, non-linear, inconsistent among fracture site, and affected by adjustment for SHBG. These findings demonstrate that circulating SHBG, rather than T, is a major independent biomarker of fracture risk in men. Consequently, both total T and SHBG should be assessed when examining the relationship of endogenous T concentrations with fractures in middle-aged to older men.