Major Hip Research Articles

Real-World Effectiveness of Denosumab and Bisphosphonates on Risk of Vertebral Fractures in Women with Breast Cancer Undergoing Treatment with Aromatase Inhibitors.

Bone-active drugs are recommended to protect the skeleton from detrimental actions of aromatase inhibitors (AIs). However, most of literature data are focused on bone mineral density (BMD), whereas data on fractures are scant. The aim of this prospective study was to investigate the real-life effectiveness of denosumab, oral bisphosphonates (BPs) and intravenous zoledronate on risk of vertebral fractures (VFs) induced by AIs. 567 consecutive women (median age 62years, range 28-83) with early breast cancer undergoing treatment with AIs were evaluated for morphometric VFs and BMD at baseline and after 18-24months of follow-up. After enrollment, 268 women (47.3%) started denosumab 60mg subcutaneously every 6months, 115 (20.3%) BPs (59 with oral BPs and, 56 with intravenous zoledronate 5mg/12months), whereas 184 women (32.5%) were not treated with bone-active drugs for several reasons. During follow-up, 54 women (9.5%) developed incident VFs in association with age of subjects (P < 0.001), baseline FRAX scores for major fractures (P < 0.001) and hip fractures (P = 0.003), pre-existing VFs (P < 0.001), change in BMD at lumbar spine (P = 0.015), femoral neck (P = 0.003) and total hip (P < 0.001). Risk of VFs was higher in subjects who were untreated as compared to those treated with bone-active drugs (32/184 vs. 22/383; P < 0.001). Specifically, fracture risk was significantly decreased by denosumab [odds ratio (OR) 0.22; P < 0.001] and zoledronate (OR 0.27; P = 0.035), but not by oral BPs (P = 0.317). These data suggest that in real-world clinical practice, denosumab and zoledronate can reduce AI-related risk of VFs after only 24months of treatment.

Comparison of bone mineral density and Fracture Risk Assessment Tool in Saudi women with and without type 2 diabetes mellitus: A cross-sectional study.

To compare the bone mineral density and the fracture risks in Saudi women with and without type 2 diabetes mellitus (T2DM). This cross-sectional study was carried out at Taibah Early Diagnostic Center, Al Madinah Al Munawarah, Saudi Arabia. A total of 465 women with and without T2DM aged ≥40 years who visited the center for a dual-energy X-ray absorptiometry scan between December 2020 and July 2021 were randomly selected. The 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture (HF) were calculated using the Abu Dhabi Fracture Risk Assessment Tool (FRAX) with and without adjustment for T2DM. The adjustment was made by setting rheumatoid arthritis as the equivalent risk for T2DM in the FRAX. Bone mineral density values and the FRAX scores were compared between women with T2DM and non-diabetes. Of 465 women, 214 had T2DM, and 251 were non-diabetics. The mean age of women was 59.42±7.9 years. There were no significant differences in mean age, menopausal status, height, weight, and body mass index between T2DM and non-diabetic women. Bone mineral density values and the unadjusted FRAX scores were comparable between the 2 groups. However, after adjusting FRAX for T2DM, the FRAX for MOF and HF became significantly higher in T2DM women (p=0.000 and p=0.004). In Saudi women with T2DM, unadjusted FRAX underestimated the risk of MOF and HF. Type 2 diabetes mellitus should be included as one of the clinical risk factors for fracture in future versions of the FRAX score.

Study epidemiology of risk fracture in osteoporosis based on frax score, and osta score, with risk of fall using Ontario score in elderly Indonesia.

Background:Osteoporosis is characterized by a low bone mass of bone tissue. If osteoporosis is not treated properly, it will increase the high risk of fracture. The common causes of fracture on osteoporosis condition due to falls. This study aims to find the correlation between the risk of osteoporosis with fall risk (ONTARIO) based on osteoporosis fracture risk (FRAX)Methods:This study is an analytic study with a cross-sectional method. We collected the sample using random cluster sampling in the six primary health care in Malang on different times service since August–September 2021. Total patient 139, however only 132 patients were included in this study. After collecting data is complete, we analyze using Chi-square tests.Results:The mean age of participants was 63.9 ± 7.14. with the age group was dominated by the range of 60–64. It was found that the result of the FRAX SCORE had a low-risk category for major fracture osteoporosis and risk hip fracture. In contrast, from the OSTA score in this study, more than 68 participants (50.8%) were found medium and high-risk scores. Then, in ONTARIO score of the risk fall assessment, and high score in 57 participants (43.2%). If compared between OSTA and ONTARIO, there was a significant relationship between OSTA score and ONTARIO score (p < 0.000) with high-risk OSTA have a significant relationship with a high risk of falling and vice versa.Conclusion:In this study, there was a relationship between the risk of high osteoporosis and the risk of falling.

Clinical risk factor status in patients with vertebral fracture but normal bone mineral density

BACKGROUND CONTEXTNormal bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DXA) is present in approximately 10% of older adults with fracture. BMD alone does not evaluate bone quality or clinical risk factors, and therefore, may not adequately capture a patient's fracture risk. Thus, despite a normal DXA-measured BMD, the underlying bone may be abnormal, suggesting that further bone health evaluation, and potentially, pharmacologic treatment may be warranted. PURPOSETo determine the prevalence of normal BMD, clinical fracture risk factors, and quantitative risk of fracture using the Fracture Risk Assessment Tool (FRAX) in vertebral fracture patients with normal BMD enrolled in the Own the Bone registry, thus facilitating identification of those who meet criteria for anti-osteoporosis therapy. STUDY DESIGN/SETTINGRetrospective, national registry-based cohort. PATIENT SAMPLEFrom July 2016 to July 2021, 1,807 patients age ≥50 who sustained a vertebral fracture and had DXA data available from within 2 years prior to enrollment in the American Orthopaedic Association's Own the Bone (AOA OTB) registry were included. OUTCOME MEASURESWorld Health Organization (WHO) DXA T-score based bone classification criteria; FRAX risk scores of major osteoporotic fracture or hip fracture. METHODSDemographic data, prior fracture site, and clinical fracture risk factors were collected. BMD status was classified by the WHO T-score criteria: ≥ -1.0 normal, -1.1 to -2.4 osteopenia, and ≤ -2.5 osteoporosis, with low bone mass including either osteopenia or osteoporosis. In normal BMD patients, FRAX scores were calculated with and without BMD, with the treatment threshold defined as a major osteoporotic fracture risk ≥20% or hip fracture risk ≥3%. RESULTSMean±SD age was 72.0±9.7, 78.1% were female, and 92.4% were Caucasian. Normal BMD was present in 7.9%. Clinical fracture risk factors including alcohol use ≥3 units/day and history of ≥2 falls in the year prior to enrollment were more common in normal BMD (11.2% and 28%, respectively) compared to low bone mass patients (3.4% and 25.2%, respectively). A prior vertebral fracture had occurred in 49.5% with normal BMD compared to 45.8% with low bone mass, while a prior non-major osteoporotic fracture occurred in 28.9% and 29.3% of normal BMD and low bone mass patients, respectively. In normal BMD patients, either a prior fracture or FRAX risk with BMD meeting treatment thresholds was present in 85%. CONCLUSIONSClear indications for receipt of pharmacologic therapy, ie, prior fracture or elevated fracture risk, were present in most patients with vertebral fracture and normal BMD enrolled in the AOA OTB. Prior non-major osteoporotic fractures were common and may be useful indicators of underlying bone disease. Surgeons must recognize that other important risk factors apart from BMD may indicate poor bone health, and thus, help guide further bone health evaluation.

Reduced All-Cause Mortality With Bisphosphonates Among Post-Fracture Osteoporosis Patients: A Nationwide Study and Systematic Review.

We assessed the survival outcomes associated with real-world bisphosphonate use, stratified by fracture site, type, administration, and duration of treatment, among patients with osteoporosis. A systematic review that incorporates our findings was conducted to provide up-to-date evidence on survival outcomes with bisphosphonate treatment in real-world settings. Patients diagnosed with osteoporosis who had been hospitalized for major fractures were identified from Taiwan's National Health Insurance Research Database 2008-2017 and followed until 2018. There were 24,390 new bisphosphonate users who were classified and compared with 76,725 nonusers of anti-osteoporosis medications in terms of survival outcomes using Cox model analysis. An inverse probability of treatment weighted Cox model and landmark analyses for minimizing immortal time bias were also performed. Bisphosphonate users vs. nonusers had a significantly lower mortality risk, regardless of fracture site (hazard ratios (95% confidence intervals) for patients with any major fracture, hip fracture, and vertebral fracture: 0.90 (0.88, 0.93), 0.83 (0.80, 0.86), and 0.86 (0.82, 0.89), respectively). Compared with nonuse, zoledronic acid (0.77 (0.73, 0.82)) was associated with the lowest mortality, followed by ibandronate (0.85 (0.78, 0.93)) and alendronate/risedronate (0.93 (0.91, 0.96)). Using bisphosphonates for ≥ 3 years had lower mortality (0.60 (0.53, 0.67)) than using bisphosphonates for < 3 years (0.98 (0.95, 1.01)). Intravenous bisphosphonates had a lower mortality than that of oral bisphosphonates. Our results are consistent with the systematic review findings among real-world populations. In conclusion, bisphosphonate use, especially persistence to intravenous bisphosphonates (e.g., zoledronic acid), may reduce post-fracture mortality among patients with osteoporosis, particularly those with hip/vertebral fractures. This supports the rational use of bisphosphonates in post-fracture care.

Association between biologic therapy and fracture incidence in patients with selected rheumatic and autoimmune diseases: A systematic review and meta-analysis of randomized controlled trials

ObjectivesTo investigate the effect of biologic therapy on risk of fracture in selected rheumatic and autoimmune diseases. MethodsThe PubMed, Cochrane library, and EMBASE databases were systematically searched from the inception dates to June 4, 2021. Randomized clinical trials (RCTs) comparing biological disease-modifying antirheumatic drugs (bDMARDs) with non-bDMARDs or placebo in patients with five selected rheumatic and autoimmune diseases were included. Meta-analyses were conducted to calculate the odds ratio (OR) with 95 % confidence intervals (CIs) for major osteoporotic fracture, hip fracture, osteoporotic non-vertebral fracture, and total fracture. ResultsA total of 100 RCTs involving 51,413 participants fulfilled the inclusion criteria. In patients with psoriasis (Ps), and psoriatic arthritis (PsA), compared with placebo or non-bDMARDs therapy, the risk of major osteoporotic fracture (OR, 0.34 [95 %Cl, 0.15–0.76], p = 0.009), hip fracture (OR, 0.22 [95 %Cl, 0.05–0.89], p = 0.03), and osteoporotic non-vertebral fracture (OR, 0.26 [95 %Cl, 0.10–0.62], p = 0.003) were significantly decreased with the use of bDMARDs. In patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), systemic lupus erythematosus (SLE), and inflammatory bowel diseases (IBD), the risk of fracture were not changed with biologic treatment. ConclusionsThe existing evidence from RCTs indicated the use of bDMARDs was associated with a low risk of major osteoporotic fracture, hip fracture, and osteoporotic non-vertebral fracture in patients with Ps and PsA. There are still urgent needs for studies regarding the actions of biologic therapies on the risk of bone fractures in systemic inflammatory diseases.

Age-dependent assessment thresholds to optimize patient care in a resource-limited setting: an analysis based on the Sri Lankan FRAX model.

Age-dependent assessment thresholds of the FRAX algorithm help stratifying men and women aged 40years or more according to their fracture risk. This allows clinicians to decide on those who require interventions without BMD assessment and those who require BMD input for further assessment. Intervention thresholds were defined by 10-year probabilities of a major osteoporotic fracture (MOF) and hip fracture (HF) considering a woman with a BMI of 25.0kg/m2 having a prior fragility fracture but no other clinical risk factors. The lower assessment thresholds (LAT) were set at 0.8 times the 10-year probabilities of a MOF and HF in a woman with a BMI of 25.0kg/m2, without previous fracture or other clinical risk factors. The upper assessment thresholds (UAT) were set at 1.2 times the intervention thresholds of MOF and HF. Fracture probabilities were estimated for the age range of 40-80years, without BMD input. These values were applied to a group of women who underwent DXA for clinical reasons in a single center. The LATs of MOF and HF varied from 0.7 to 8.8% and 0.1 to 3.7%, from 40 to 80years, respectively. The corresponding values for UATs were 2.5 to 21.6% and 0.3 to 8.4%. ITs of MOF and HF varied from 2.1 to 18% and 0.2 to 7%, respectively. When applied to a group of 315 postmenopausal women who underwent DXA for clinical indications, 22.9% of women were above the UATs (high-risk category) while 8.6% were below the LATs (low-risk category). The proportion of women in the intermediate category who require BMD for further assessment was 68.6% (95% CI 59.7 to 77.5%). In nearly one-third of women aged 40years or more, the decision to treat or not to treat can be achieved without BMD estimation. The remaining two-thirds will require a BMD assessment for further evaluation.

MO539: Use of FRAX® Scale to Estimate Bone Fracture Risk in Patients Undergoing Haemodialysis

Abstract BACKGROUND AND AIMS Decreased bone mineral density in patients undergoing haemodialysis (HD) is related to the development of fractures that lead to increased morbimortality. There is limited evidence on fracture risk factors that would allow to identify patients at risk to prompt early treatment. In this context, FRAX® (Fracture Risk Assessment scale, which is freely available online at https://www.sheffield.ac.uk/FRAX/tool.aspx?country=4) scale aids in the risk prediction (as a percentage over a 10-year span) of both major and hip osteoporotic fractures in specific populations, including patients with chronic kidney disease (CKD) [1]. However, the evidence of its utility in HD patients is scarce [2]. The aim of our study is to identify patients on HD with increased risk of fractures based on FRAX® scale, blood-test and densitometric parameters. Also, we aim to demonstrate a correlation between a higher risk of fractures as assessed by FRAX® scale and densitometry-established osteoporosis. METHOD This is a single-centre retrospective study including patients undergoing periodic intermittent haemodiafiltration. Data regarding clinical and blood-test parameters were collected. FRAX® scale was used to estimate the risk of hip and major fractures. Patients were divided accordingly into high and low fracture risk, with a threshold set at a 10-year 3% risk of hip fracture and 10% for other major fractures, according to definitions for the general population given by FRIDEX (Fracture RIsk factors and bone DEnsitometry type central dual X-ray) and FROCAT cohorts[3]. The relationship between clinical, blood-test parameters and the degree of osteopaenia and osteoporosis was evaluated. Osteopaenia was defined as a T-score between −1 and −2.5 in femoral neck densitometry. Osteoporosis was established as a T-score lower than −2.5. Qualitative parameters were analysed using Fisher's exact test, whilst Mann–Whitney U test was employed in the analysis of quantitative parameters. RESULTS A total of 54 patients (59.26% male) with a median age of 60 years [interquartile range (IQR), 50–72.25] were recruited. Six low intensity fractures were observed (11.1%), five of them occurred in high-risk-FRAX-scale-classified patients (P 0.095). The observed median FRAX score for our sample was 7.35% (IQR, 4.97–13.25) for major fractures and 1.70% (IQR, 0.78–6.13) for hip fractures. Patients with a higher risk of major fracture, according to FRAX® scale (&amp;gt;7.5%), were older (P &amp;lt; 0.001) and had been on renal replacement therapy (RRT) for a longer period of time (P 0.008). Furthermore, a significantly higher proportion of patients with prior kidney transplantation (0.012) and osteoporosis (0.002) was found in this group. No differences were observed in blood-test parameters, KtV and dialysate composition between low and high-risk patients. Densitometry was performed in 26 patients (48.14%). In this subset, osteopaenia was observed in 14 patients (53.84%) and osteoporosis in 11 (42.31%). Patients with osteoporosis had a higher FRAX score for major fracture (21%, IQR 11.50–26.50; P 0.001) and hip fracture (7.80%, IQR 5.75–14.50; P &amp;lt; 0.001). No correlation was found between prior kidney transplantation or exposure to steroids and densitometry-established osteoporosis. CONCLUSIONS Despite not being validated yet in Spain, our results demonstrate that FRAX® scale significantly correlates with the degree of osteoporosis in patients undergoing HD, representing an effective tool for the identification of patients at high risk of suffering fractures, prompting early prevention and management.

Do Modular Dual Mobility Cups Offer a Reliable Benefit? Minimum 5-Year Follow-Up of 102 Cups.

Among various options suggested to prevent hip instability after total hip replacement, the MDM-tritanium (modular dual mobility) cup features a cobalt-chrome liner (CoCr) positioned in a titanium acetabular shell and matched with a mobile insert in highly cross-linked annealed X3 polyethylene. The purpose of this study aimed to confirm whether there was no significant release of ions (Co and Cr) or higher occurrence of dislocation or even cases of aseptic loosening of the cementless shell with the use of MDM-tritanium cups at minimum of 5-year follow-up. The clinical study was carried out on a homogeneous consecutive and nonselective series with 102 MDM cups (98 patients) implanted in 2 centers. This MDM-tritanium cup had been systematically used for surgical revisions (70% of cases) or for patients with major hip dysplasia or in elderly patients with poor bone quality. A biological assessment of ion releases has been performed in a specific cohort of 39 cases that had an internal ceramic head. None of the following complications was observed: no case of immunoallergic event, no aseptic loosening, and the dislocation rate was 4.9% involving only the difficult primary and revision cases. The clinical results were encouraging, with 89.7 points for Harris Hip Score, 41.16 points/48 for the OHS-12. The Agora Roentgenographic Assessment (ARA) radiologic score was graded "excellent" in 94.4%. The MDM-tritanium survivorship with revision for any cause in 102 cups at 7.95 years was 92.7%. Based on the results of our first 102 cases, there were no immunoallergic complications-contrary to what was initially feared with the CoCr bearing-titanium pair-and no postoperative instability, including for complex primary and revisions total hip replacements. Individual Cohort Study: 2B.

Prevalence of Major Neurocognitive Disorder in Patients Admitted with Hip Fractures and the Associated Postoperative Delirium and Other Surgical Outcomes - A Prospective Cohort Study (Hippod Study)

Introduction: Major Neurocognitive disorder (NCD) and hip fractures are two serious problems in aging population. They are associated with morbidities including postoperative delirium (POD). We aimed to look at the prevalence of major NCD in hip fractures in our locality and their association with POD. Methods: It was a prospective cohort study. Patients ≥ 65 years old with hip fractures communicable in Cantonese were included. They were screened with Hong Kong Montreal Cognitive Assessment 5-min protocol before operation. They were reviewed postoperatively with 3-Minute Diagnostic Interview for Confusion Assessment Method to assess the presence of POD. The primary outcome was the incidence of delirium between patients with or without preoperative major NCD. Secondary outcomes including surgical outcomes and length of hospital stay were investigated. Results: The study was conducted between November 2020 and March 2021. One hundred ninety-two patients were screened, and 122 patients were included. Among the 192 patients screened, 97 (50.5%) were found to have major NCD. POD was found in 68.1% and 21.3% of patients with or without major NCD respectively. (p&lt;0.001, odds ratio 4.857 (95% CI 2.046-11.531)). Total length of stay in hospital was longer when POD developed (p&lt;0.05). Conclusion: High prevalence of major NCD was found in geriatric hip fracture patients. Pre-existing major NCD was an independent risk factor in developing POD. Both major NCD and POD were prevalent but not sufficiently addressed in our locality. A multidisciplinary collaboration between anesthetists, geriatricians and allied health workers may help to prevent POD and reduce its severity.

Incidence of hip fracture in Saudi Arabia and the development of a FRAX model

SummaryA prospective hospital-based survey in representative regions of Saudi Arabia determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX® model to facilitate fracture risk assessment in Saudi Arabia.ObjectiveThis paper describes the incidence of hip fracture in the Kingdom of Saudi Arabia that was used to characterize the current and future burden of hip fracture, to develop a country-specific FRAX® tool for fracture prediction and to compare fracture probabilities with neighbouring countries.MethodsDuring a 2-year (2017/2018) prospective survey in 15 hospitals with a defined catchment population, hip fractures in Saudi citizens were prospectively identified from hospital registers. The number of hip fractures and future burden was determined from national demography. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Saudi Arabia. Fracture probabilities were compared with those from Kuwait and Abu Dhabi.ResultsThe incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 2,949 and is predicted to increase nearly sevenfold to 20,328 in 2050. Hip fracture rates were comparable with estimates from Abu Dhabi and Kuwait. By contrast, probabilities of a major osteoporotic fracture or hip fracture from the age of 70 years were much lower than those seen in Abu Dhabi and Kuwait due to higher mortality estimates for Saudi Arabia.ConclusionA country-specific FRAX tool for fracture prediction has been developed for Saudi Arabia which is expected to help guide decisions about treatment.

DXA FRAX® May Differ Significantly and Substantially To Web FRAX®

Osteoporosis and the associated fractures are a major global health burden for patients, their social network and societies. Access to quality risk assessment, diagnosis and treatment is heterogeneous and inadequate around the globe. Many algorithms have been developed for deciding who to test, assessing fracture risk, when to intervene, and how to monitor the effects of interventions. FRAX® has become the dominant fracture risk assessment tool worldwide which estimates the average 10 year risk of major osteoporotic fracture risk and hip fracture, and is recommended by our global partners: ISCD and IOF. A particular attraction of the FRAX® algorithm is that on-line calculations can be made with or without DXA testing, which is particularly attractive when access to DXA is limited or non-existent. In our centre public waiting times for non-urgent DXA are up to 10 years, so reducing unnecessary testing is a laudable and overarching service goal. A recent Japanese study comparing 4 FRAX calculation tools suggested little difference exists. However in our unit we have noticed at times very different results when using the Ireland embedded DXA-FRAX® tool to the Web-FRAX® Ireland tool. 1) To Compare DXA-FRAX® to Web-FRAX® 10-year estimates for MOF and HF. 2) To Compare Web-FRAX® 10-year estimates for MOF and HF with and without DXA-measured T-scores. We used a sub-group of the DXA-HIP Cohort as previously published to gain initial insights into DXA-FRAX® to Web-FRAX® as part of a larger calibration and validation project, which has been approved by our hospitals Ethics and Research Committee. All scans are performed and reported by staff trained to ISCD standards and recommendations. At the time of reporting DXA-FRAX® scores are calculated as part of the analysis as recommended by ISCD and IOF, and more recently Web-FRAX® for Ireland has been calculated and stored with and without BMD data. All data are cleaned, merged, anonymized and stored for analysis. Summary cross-sectional data, and comparison of differences were completed using absolute and relative scales, and Bland-Altman Plots for agreement between measures. Weights were reduced to 125kg for the on-line tool and age to 90 years when values exceeded these thresholds. Data on 588 adults aged ≥40 years were available of whom 108 (18%) were men. Mean age was 67 years, BMI: 28kg/m2, 249 had a prior fracture, 64 a parental hip fracture, 40 smokers, 42 taking glucocorticoid therapy, 39 had rheumatoid arthritis, 5 were excess alcohol users while 107 had other FRAX®-listed secondary causes of osteoporosis. Mean WF femoral neck BMD T-score was -1.4. Mean MOF DXA-FRAX® was 15.3 (SD:11.1) compared to 12.6 (SD:8.5) for Web-FRAX®, while HF means were 6.7 (SD:8.4) Vs 3.8 (SD:5.5) respectively. Bland-Altman plots showed there was much greater discrepancy for men, and those with higher risk estimates. Comparisons between DXA-FRAX® and Web-FRAX® revealed similar results. Significant differences exist in results of DXA-FRAX® and Web-FRAX® for Ireland, particularly for men and those with higher risk estimates so these results should be interpreted cautiously. Reassuringly results were similar for those deemed at lower risk and for women.

Mathematical model of the bone biological age based on the bone mineral density and quality indicex and Ukrainian FRAX model

Background. It is well-known that with aging there is a loss of bone mass and its strength, which leads to the development of osteoporosis and its complications. The aim of the study was to create a modern mathematical model for determining the biological age of the bone system, taking into account indices of bone mineral density (BMD) and quality and the FRAX® questionnaire. Materials and methods. 77 women and 44 men aged 30 to 90 years without any significant somatic pathology were included in the study. Patients were divided into 4 age groups: 30–44 years old — young, 45–59 years — mature, 60–74 years — old age and 75–90 years— senile age. We measured the parameters of BMD in the different areas of the skeleton by means of the dual-photon X-ray absorptiometry (DXA, “Prodigy”). The 10-year probability of major osteoporotic and hip fractures was measured using the Ukrainian version of the FRAX®. Statistical analysis was performed in the Statistica 7.0 program (StatSoft Inc., USA). Results. The dependence of the indices of BMD and bone quality, risk of osteoporotic fractures on age and the need for their early determination in young people to predict the risk of osteoporosis and its complications have been proven. The coefficient of determination of the R2 model was 0.62, which indicates that 62% of the variance of the “Age” can be explained by the predictors included in the model (DXA and FRAX indices); adjusted R2 index was 0.59 (p&lt;0.001), which indicates high significance of the model. Conclusions. The developed model for estimating the bone biological age has high accuracy and can be used to assess the risk of osteoporosis and its complications in young people for the purpose of predicting the disease.

Epidemiology of hip fracture in Qatar and development of a country specific FRAX model

SummaryHip fracture data were retrieved from electronical medical records for the years 2017–2019 in the State of Qatar and used to create a FRAX® model to facilitate fracture risk assessment. Hip fracture rates were comparable with estimates from Saudi Arabia, Abu Dhabi, and Kuwait but fracture probabilities varied due to differences in mortality.ObjectiveThis paper describes the epidemiology of osteoporotic fractures in the State of Qatar that was used to develop the country-specific fracture prediction FRAX® tool.MethodsHip fracture data were retrieved from electronic medical records for the years 2017–2019 in the State of Qatar. The age and sex specific incidence of hip fracture in Qatari residents and national mortality rates were used to create a FRAX® model. Fracture probabilities were compared with those from neighboring countries having FRAX models.ResultsHip fracture rates were comparable with estimates from Saudi Arabia, Abu Dhabi and Kuwait. In contrast, probabilities of a major osteoporotic fracture or hip fracture were lower in Qatar than in Kuwait but higher than those in Abu Dhabi and Saudi Arabia due to differences in mortality.ConclusionThe FRAX model should enhance accuracy of determining fracture probability among the Qatari population and help guide decisions about treatment.

Prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease

ObjectiveThis study aimed to investigate the prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease undergoing hemodialysis. MethodsThis cross-sectional study included 80 patients with end-stage renal disease undergoing hemodialysis. Medical history, Fracture Risk Assessment Tool and anteroposterior and lateral radiographs of the thoracolumbar and lumbosacral spine were obtained. Vertebral fractures were identified using the Genant semiquantitative assessment. ResultsRadiography demonstrated asymptomatic vertebral fracture in 22 patients (27.5%). FRAX® results for major osteoporotic fracture (area under the curve, 0.64) and hip fracture (area under the curve, 0.62) were able to discriminate patients with prevalent asymptomatic vertebral fracture. A multivariate analysis demonstrated that a 1-year average corrected calcium (odds ratio, 0.38), steroid use (odds ratio, 8.99), and a serum albumin concentration <25 g/dL (odds ratio, 28.82) significantly predicted prevalent asymptomatic vertebral fracture (clinical model; area under the curve, 0.82). Combining the 1-year average corrected calcium and serum albumin concentration <25 g/dL with FRAX® results for major osteoporotic fracture (area under the curve, 0.78) and FRAX® results for hip (area under the curve, 0.75) produced a significantly greater area under the curve value to predict fracture when compared with FRAX® result for major osteoporotic fracture and FRAX® result for hip (P = 0.022). ConclusionAsymptomatic vertebral fracture is prevalent. FRAX® results for major osteoporotic fracture and hip provided lower ability in predicting asymptomatic vertebral facture when compared to the clinical model. Combining a 1-year average corrected calcium and serum albumin concentration <25 g/dL with FRAX® result for major osteoporotic fracture or hip improved the model's performance and provided comparable area under the curve to the clinical model.

Future Fracture Risk in Upper Extremity Fracture and Non-Fracture Patients.

Upper extremity (UE) fragility fractures are common and strong predictors of subsequent fractures. To investigate the relative importance of an UE fragility fracture in determining future fracture risk, we conducted a cross-sectional study to compare future fracture risk between patients presenting for osteoporosis evaluation after an UE fragility fracture and a similarly aged cohort of patients without an UE fracture. In all, 129 UE fracture patients seen in our bone health clinic (BHC) and 114 non-fracture UE fracture patients seen in an UE clinic completed clinic intake surveys assessing for fracture risk factors. Prefracture fracture risk (PFFR) and fracture risk assessment tool (FRAX) scores estimated the future fracture risks at the timepoint before and after the UE fragility fracture event, respectively. The primary study outcome was the 10-year risk of future fracture. The 10-year probability of major osteoporotic and hip fractures were significantly higher among the BHC group when estimated with FRAX. When estimated with PFFR score, there was no difference in the 10-year probability of hip fracture between the groups. Prevalence of secondary osteoporosis and glucocorticoid use was higher in the BHC group, and prevalence of rheumatoid arthritis was higher in the UE clinic group. This study underscores the importance of an UE fragility fracture in determining the risk of future fracture. A fragility fracture of the UE should be considered a sentinel event and physicians who evaluate these patients should recognize them as a high-risk group for future hip fracture.

Fast-track revision hip arthroplasty: a multicenter cohort study on 1,345 elective aseptic major component revision hip arthroplasties.

Background and purposeData on application of fast-track/enhanced recovery protocols in revision hip arthroplasty (R-THA) surgery is scarce. We report length of stay (LOS), risk of LOS > 5 days, and readmission ≤ 90 days after revision hip arthroplasty in centers with a well-established fast-track protocol in both primary and revision procedures.Patients and methodsThis is an observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Hip Arthroplasty Register. Consecutive elective aseptic major component revision hip arthroplasties from 6 dedicated fast-track centers from 2010 to 2018 were included.Results1,345 R-THAs were analyzed, including 23% total revisions, 52% acetabular component revisions, and 25% femoral component revisions. Mean age was 70 years (SD 12) and 61% were female. Median LOS was 3 days (interquartile range [IQR] 2–6), decreasing from median 6 (IQR 3–10) days in 2010 to 2 (IQR 1–4) days in 2018. The 90-day readmission rate was 20%, but showed a fluctuating and increasing trend from 13% in 2010 to 28% in 2018. Risk factors for LOS > 5 days and readmission were use of walking aid, preoperative hemoglobin ≤ 13 g/dL, pharmacological treated psychiatric disorder, age ≥ 80 years, age 70–79 years (only LOS > 5 days), cardiac disease (only LOS > 5 days), pulmonary disease (only readmission), BMI ≥ 35 (only LOS > 5 days) and ≥ 1 previous revision (only LOS > 5 days).InterpretationLOS decreased to median 2 days at the end of the study period, but the 90 days readmission risk remained high (> 20%). Several risk factors for postoperative complications were identified, suggesting that at-risk patients should be treated using an extended fast-track/enhanced recovery protocol focusing on preoperative optimization and postoperative monitoring as well as surgical techniques to reduce hip dislocations.

Evaluation of fracture risk in Egyptian rheumatoid arthritis patients by the Fracture Risk Assessment Tool

BackgroundRheumatoid arthritis (RA) patients have a risk of fractures due to secondary osteoporosis. This study aimed to evaluate the probability of fractures in the next 10 years in Egyptian RA patients by the Fracture Risk Assessment Tool (FRAX).ResultsThe study was a case–control study. It included a hundred RA patients as well as 51 apparently healthy volunteers. Bone mineral density (BMD) means of lumbar vertebra, femoral neck, and total femur were significantly lower in the RA patient group. Additionally, FRAX of the major osteoporotic and hip fractures means were significantly higher in the RA group than in the control group. It was also found that age, body mass index (BMI), Health Assessment Questionnaire Disability Index (HAQ-DI), and BMD of the femoral neck were significant predictors of FRAX of major osteoporotic and hip fractures (P ≤ 0.05). The cumulative dose of steroids was a significant predictor for FRAX of major osteoporotic fractures; however, the 28 joints disease activity score calculated with erythrocyte sedimentation rate (ESR) (DAS28-ESR) was a significant predictor for FRAX of hip fractures.ConclusionsRA patients have a high fracture risk probability. Regular annual screening for BMD and FRAX of major osteoporotic and hip fractures is necessary for those patients.

FREM predicts 10-year incident fracture risk independent of FRAX® probability: a registry-based cohort study.

FREM was developed from Danish public health registers without DXA information to identify high imminent risk of major osteoporotic fracture (MOF) and hip fracture (HF), while FRAX® estimates 10-year fracture probability from clinical risk factors and femoral neck bone mineral density (BMD) from DXA. The FREM algorithm showed significant 1- and 2-year fracture risk stratification when applied to a clinical population from Manitoba, Canada. We examined whether FREM predicts 10-year fracture risk independent of 10-year FRAX probability computed with BMD. Using the Manitoba BMD Program registry, we identified women and men aged ≥ 45years undergoing baseline BMD assessment. We calculated FREM and FRAX scores, and identified incident fractures over 10years. Hazard ratios (HRs) for incident fracture were estimated according to FREM quintile, adjusted for FRAX probability. We compared predicted with observed 10-year cumulative fracture probability estimated with competing mortality. The study population comprised 74,446 women, mean age 65.2years; 7945 men, mean age 67.5years. There were 7957 and 646 incident MOF and 2554 and 294 incident HF in women and men, respectively. Higher FREM scores were associated with increased risk for MOF (highest vs middle quintile HRs 1.49 women, 2.06 men) and HF (highest vs middle quintile HRs 2.15 women, 2.20 men) even when adjusted for FRAX. Greater mortality with higher FREM scores attenuated its effect on 10-year fracture probability. In the highest FREM quintile, observed slightly exceeded predicted 10-year probability for MOF (ratios 1.05 in women, 1.49 in men) and HF (ratios 1.29 in women, 1.34 in men). Higher FREM scores identified women and men at increased fracture risk even when adjusted for FRAX probability that included BMD; hence, FREM provides additional predictive information to FRAX. FRAX slightly underestimated 10-year fracture probability in those falling within the highest FREM quintile.

The Efficacy of Alendronate Versus Denosumab on Major Osteoporotic Fracture Risk in Elderly Patients With Diabetes Mellitus: A Danish Retrospective Cohort Study.

ObjectivePatients with diabetes mellitus have an increased risk of fractures; however, the underlying mechanism is largely unknown. We aimed to investigate whether the risk of major osteoporotic fractures in diabetes patients differs between subjects initiated with alendronate and denosumab, respectively.Methods and Research DesignWe conducted a retrospective nationwide cohort study through access to all discharge diagnoses (ICD-10 system) from the National Danish Patient Registry along with all redeemed drug prescriptions (ATC classification system) from the Health Service Prescription Registry. We identified all subjects with a diabetes diagnosis between 2000 and 2018 and collected data on the first new prescription of anti-osteoporotic treatment between 2011 and 2018. Exposure was defined as either alendronate or denosumab treatment initiated after diabetes diagnosis. Outcome information was collected by identification of all major osteoporotic fracture (MOF) diagnoses, i.e., hip, spine, forearm, and humerus, from exposure until 2018 or censoring by emigration or death. The risk of fracture was calculated as hazard ratios (HR) using multiply adjusted Cox proportional models with death as a competing risk.ResultsWe included 8,745 subjects initiated with either alendronate (n = 8,255) or denosumab (n = 490). The cohort consisted of subjects with a mean age of 73.62 (SD ± 9.27) years, primarily females (69%) and suffering mainly from type 2 diabetes (98.22%) with a median diabetes duration at baseline of 5.45 years (IQR 2.41–9.19). Those in the denosumab group were older (mean 75.60 [SD ± 9.72] versus 73.51 [SD ± 9.23] years), had a higher proportion of women (81% versus 68%, RR 1.18 [95% CI 1.13–1.24], and were more comorbid (mean CCI 2.68 [95% CI 2.47–2.88] versus 1.98 [95% CI 1.93–2.02]) compared to alendronate initiators. In addition, denosumab users had a higher prevalence of previous fractures (64% versus 46%, RR 1.38 [95% CI 1.28–1.48]). The adjusted HR for any MOF after treatment initiation with denosumab was 0.89 (95% CI 0.78–1.02) compared to initiation with alendronate.ConclusionThe risk of incident MOF among subjects with diabetes was similar between those initially treated with alendronate and denosumab. These findings indicate that the two treatment strategies are equally effective in preventing osteoporotic fractures in subjects with diabetes.