Femoral Neck Research Articles

Fully-threaded cannulated screws versus partially-threaded cannulated screws for femoral neck fractures: a systematic review and meta-analysis

ObjectiveFemoral neck fractures (FNFs) are a common orthopedic type, and there are many treatment methods for it, and cannulated screw internal fixation is currently one of the main treatment methods. The choice of fully threaded cannulated screw (FCS) or partially threaded cannulated screw (PCS) remains controversial. Therefore, we performed this meta-analysis to evaluate the outcomes of FCS and PCS in the treatment of FNF.MethodsArticles published before 29 April, 2024 were selected from PubMed, Embase, the Cochrane Library, and CNKI, using the PRISMA guidelines. Two independent reviewers searched and assessed the literature. The PICOS criteria were used to ensure that the included studies met the inclusion criteria. We used RevMan 5.3. Software to perform analysis.ResultsCompared with the PCS group, the FCS group had a lower femoral head necrosis rate (OR 0.60, 95% CI 0.37–0.98, P = 0.04), lower internal fixation failure rate (OR 0.37, 95% CI 0.22–0.62, P = 0.0002) and lower femoral neck shortening rate (OR 0.27, 95% CI 0.19–0.40, P < 0.00001). There was no statistically significant difference between the two groups in terms of the Harris hip score or nonunion rate.ConclusionsThe results of this meta-analysis revealed that compared with PCS, FCS had a lower incidence of postoperative complications and better postoperative outcomes in the treatment of FNF. Therefore, we believe that FCS may be a more effective treatment for FNF.

Impact of different antiretroviral therapy regimens on bone mineral density in people living with HIV: a retrospective and longitudinal study in China

BackgroundHIV infection and antiretroviral therapy (ART) are associated with bone loss of people living with HIV (PLWH), but limited studies exist on the impacts of ART regimens on bone mineral density (BMD) in China. This study evaluated BMD changes with three common ART regimens: tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + efavirenz (EFV), tenofovir alafenamide (TAF)-containing, and dolutegravir (DTG)-containing (non-TDF/non-TAF) therapies.MethodsIn this retrospective study, the prevalence of low BMD was analyzed in PLWH who underwent dual-energy X-ray absorptiometry (DXA) before ART initiation. BMD changes were assessed in participants who had follow-up DXA scans after ≥ 1 year of ART with TDF + 3TC + EFV, TAF-containing, or DTG-containing regimens. We used multivariate logistic regression to evaluate the impact of different ART regimens on > 3% BMD reduction, adjusting for demographic and clinical variables that were significant in univariate analysis (P < 0.10).Results22.99% (630/2740) of PLWH before ART initiation had low BMD. Among 571 individuals followed up for over 1 year, BMD at the femoral neck (FN) and total hip (TH) decreased significantly in the TDF + 3TC + EFV [FN: -0.03(-0.07, 0.00) g/cm2, TH: -0.02(-0.05, 0.00) g/cm2, P < 0.001 for both] and TAF-containing regimens [FN: -0.02(-0.05, 0.01) g/cm2, TH: -0.02(-0.04, 0.01) g/cm2, P < 0.001 for both]. Lumbar spine (LS) BMD decreased significantly only with TDF + 3TC + EFV [-0.02(-0.05, 0.01) g/cm2, P < 0.001]. TDF + 3TC + EFV caused greater BMD loss at the FN and LS than the TAF-containing regimen[FN: -3.66% (-8.05%, 0.34%) vs. -2.38% (-5.44%, 1.12%), P = 0.044; LS: -2.11% (-4.50%, 0.62%) vs.-0.06% (-2.05%, 2.57%), P < 0.001]. Compared to TDF + 3TC + EFV, DTG-containing regimens showed smaller BMD reductions across all sites [FN: -1.49% (-4.65%, 3.83%), TH: 0.00% (-3.98%, 3.18%), LS: 0.59% (-2.73%, 3.09%), P = 0.004, 0.008 and 0.004, respectively]. TAF-containing and DTG-containing regimens showed no significant differences in BMD changes. Multivariable logistic regression showed that TDF + 3TC + EFV, compared to DTG-containing regimens, had higher odds of > 3% FN and LS BMD reduction (FN: OR 2.91, 95% CI: 1.33 to 6.37, P = 0.009; LS: OR 2.93, 95% CI: 1.17 to 7.32, P = 0.022), while TAF-containing regimens were not independently linked to > 3% BMD loss (P > 0.05).ConclusionsTAF-containing and DTG-containing regimens caused less bone loss than TDF + 3TC + EFV, offering safer options for preserving bone health in Chinese PLWH.

Cumulative incidence and treatment effectiveness of low bone mineral density among people living with HIV in Iran (2021–2023)

BackgroundThe introduction of antiretroviral therapy (ART) has significantly improved the life expectancy of people living with HIV (PLHIV), leading to an increased prevalence of age-related comorbidities such as osteoporosis. This study investigates the incidence and characteristics of low bone mineral density (BMD) and the treatment effectiveness of low BMD participants among PLHIV in Kerman, Iran.MethodsA longitudinal study utilized dual-energy X-ray absorptiometry (DEXA) to screen 94 PLHIV in Kerman, Iran, for low BMD. Participants were aged 30 or older and had received antiretroviral therapy (ART) for at least 12 months. Those with low BMD were entered into a single-arm clinical trial and received the appropriate treatment. These people were checked to assess the treatment effectiveness 11 months after completion of the treatment. Those with normal BMD entered a cohort study and were checked to determine the cumulative incidence of low BMD. Data on demographics, medical history, and laboratory tests were collected. A chi-square test was used to assess the association between the categorical variables. A t-test (for normally distributed variables), or Mann-Whitney U (for non-normally distributed variables) was used to assess the differences of BMD between the two groups. Statistical significance was set at p ≤ 0.05, with analyses conducted in Stata 17.ResultsAmong 94 PLHIV at baseline, 48 participants (51%) had low BMD. During the follow-up, 11 participants (11.7%) missed the follow-up visits. In the follow-up, 83 PLHIV (40 with low BMD and 43 with normal BMD at baseline) were available. Among 40 participants who received treatment, 5 had normal BMD (treatment effectiveness: 12.5%). However, among 43 PLHIV with normal BMD at baseline, 7 PLHIV had low BMD at the follow-up visit (cumulative Incidence 16.3%). Those with lower body mass index (BMI) had a higher prevalence of low BMD than those with normal BMI during the follow-up (p-value: 0.003). Lumbar spine BMD increased modestly (0.005 g/cm2), while femoral neck and total hip BMD declined in total participants (0.011, 0.007 g/cm2, respectively). Osteocalcin and β-isomerized C-terminal telopeptides (β-CTx) levels were higher in the low BMD group in the follow-up, indicating increased bone turnover.ConclusionsThe study highlights the high cumulative incidence of 16.3% and treatment effectiveness of 12.5% of low BMD among PLHIV in Kerman, Iran, with implications for fracture risk. Despite a steady state in spine BMD decline, the risk of fracture remains elevated due to continued femoral neck and total hip BMD reduction. Gender-specific factors and BMI may influence susceptibility to low BMD.

Modification of bone architecture following sleeve gastrectomy: a 5-year follow-up.

Bariatric surgery induces a decrease in areal bone mineral density (aBMD), but the long-term effect on trabecular and cortical volumetric bone mineral density (vBMD) has not been well assessed. The main aim of this 5-year longitudinal study was to investigate the changes following sleeve gastrectomy (SG) in aBMD, bone turnover markers and trabecular and cortical vBMD. Forty-five patients with obesity were assessed before and 1, 2 and 5years after SG. Trabecular and cortical vBMD, cortical thickness and structural parameters were assessed by 3D-Shaper® software at hip. Values of bone turnover markers peaked after 1year and decreased after 2 and 5years, but without returning to baseline values. aBMD decreased mostly at femoral neck(-9.7%) and total hip(-10.7%) over the 5years, with the greatest loss occurring at 1year(-5.9% and -6.3%, respectively). A similar profile of decrease was observed for integral hip vBMD with significant decreases of 6.6%, 7.7% and 10.7% after 1, 2 and 5years, mainly due to a reduction in the trabecular (10.5%, 12.0% and 17.2%, respectively) rather than cortical (1.4%, 1.9% and 2.9%, respectively) component. A modest decrease in mean cortical thickness (2.5%, 2.8% and 3.9%, respectively) and an alteration in the structural parameters were concomitantly observed. Older age and greater body weight loss were the factors most associated with an increased loss of aBMD and vBMD. In conclusion, the study demonstrates that SG induces not only an alteration in bone turnover and aBMD, but also a reduction in vBMD at hip, predominantly due to trabecular component deterioration as determined by 3D-Shaper® software. The maintenance of bone deterioration for at least 5years - that is, after 4years of relative body weight stabilization or minimal weight regain - suggests the need for a therapeutic approach to preserve bone health in patients who undergo SG.

Clinical outcomes of open reduction and internal fixation combined with sartorius muscle iliac bone graft transplantation for displaced femoral neck fractures in middle-aged and young adults: a retrospective analysis of 24 cases

ObjectiveThis study aimed to evaluate the clinical outcomes and complications of open reduction and internal fixation (ORIF) combined with sartorius muscle iliac bone graft transplantation (SIBFT) in the treatment of displaced femoral neck fractures in middle-aged and young adults.MethodsA retrospective analysis was performed on 26 patients under the age of 60 with displaced femoral neck fractures (Pauwels III or Garden III-IV) treated at our institution between April 2019 to July 2022. All patients underwent open reduction and internal fixation (ORIF) through the Smith-Petersen (S-P) approach, augmented with a sartorius muscle iliac bone graft transplantation.The fractures were secured with either three cannulated screws or three cannulated screws combined with a medial support steel plate. Postoperative follow-ups were scheduled at 1, 2, 3, 6, and 12 months to record bone healing time, complications, and assess Harris Hip Scores.ResultsTwo patients were lost to follow-up, resulting in 24 patients who completed the follow-up with an average duration of 25.7 months. Bone healing was observed in 95.8% (23/24) of the patients, with a mean healing time of 5.0 months. Avascular necrosis of the femoral head occurred in 8.3% (2/24) of the patients after fracture healing. Harris Hip Score at the last follow-up was 89.75 (range 73–98).ConclusionOur preliminary results suggest that ORIF combined with sartorius muscle iliac bone graft transplantation for the treatment of displaced femoral neck fractures in middle-aged and young adults achieved satisfactory clinical outcomes.

Causes of revision hip arthroplasty after hemiarthroplasty for femoral neck fracture

Background. Hemiarthroplasty as a surgical choice for elderly patients with femoral neck fractures is still a matter of scientific controversy. The aim of the study is to analyse unsatisfactory outcomes of hemiarthroplasty and compare them with the similar outcomes of total hip arthroplasty in elderly patients with femoral neck fractures. Methods. We conducted a retrospective randomized study, which enrolled 36 patients who underwent revision endoprosthetics after various types of arthroplasty for a femoral neck fracture. The patients were divided into 3 groups. Group 1 included 10 patients who underwent arthroplasty with the use of hemiendoprostheses; Group 2 — 15 patients with cemented acetabular components; Group 3 — 11 patients who had cementless acetabular components. Results. The average age of patients in Group 1 at the time of revision arthroplasty was 79 years and was statistically significantly different from the age of patients in Groups 2 and 3 (74.4 and 74.9 years, respectively). The average time for revision interventions after hemiarthroplasty was 40.2 months and significantly differed from the time for the revisions after total cemented (82.7) as well as total cementless (86.6) arthroplasties. The average time for the onset of pain among patients in Group 2 was 68.2 months, and among patients in Group 3 — 71.2 months. The most common bone defects were types 2C and 3A (total of 41.6% in all groups). There were errors in choice of the size of the acetabular bipolar or monopolar component in all 100% of hemiarthroplasty cases. The use of a larger hemiendoprosthesis cup compared to the femoral head led to early erosion of cartilage tissue. Smaller hemiendoprosthesis cups were complicated by early protrusions of the acetabulum floor. The main errors in total arthroplasty were malposition of the acetabular component (33.3-54.5%) and inadequate cement mantle (20%). It should be noted that infections among patients from Groups 2 and 3 developed up to 24.7 months after primary arthroplasty. Conclusions. Errors associated with incorrect choice of the acetabular endoprosthesis component size during primary hemiarthroplasty lead to early complications: erosion and protrusion of the acetabulum. Severe pain syndrome due to incorrect selection of the acetabular hemiendoprosthesis component size develops on average after 13.9 months, and the time period for revision endoprosthetics is 40.2 months after the primary operation. With erosions of the acetabulum, there are no bone defects; with protrusions — bone defects of type 2C and 3A more often occur. In comparison with the outcomes of total hip arthroplasty, the use of hemiendoprostheses shows a low survival rate of 40.2 months.

Associations of Habitual Skeletal Loading with Bone Changes During the Menopausal Transition: A Follow-up Study.

While weight-bearing physical activity (PA) benefits bone health, it remains unclear whether PA can counteract hormone-driven menopausal bone deterioration. This secondary analysis of a population-based prospective follow-up study examined changes in bone health indicators around menopause and evaluated whether accelerometer-measured habitual skeletal loading is associated with these changes. A total of 189 initially perimenopausal women without estrogen therapy (mean age 52 [SD 2] years) were followed until they became postmenopausal (mean follow-up time 15 [9] months). Femoral neck bone mineral density (FN BMD) and bone mineral content (BMC) were measured with dual x-ray absorptiometry (DXA). Femoral and tibial shaft volumetric BMD (vBMD), cross-sectional geometry, and stress-strain index (SSI) were assessed using quantitative computed tomography (QCT) in a subset of 61 women. Habitual skeletal loads (mean daily osteogenic index [OI] and low, medium, and high-intensity impact counts) were evaluated with multiple-day free-living accelerometry records. Longitudinal associations of habitual skeletal loads and bone outcomes were analyzed with GEE models. Consistent decreases were observed in FN BMD and BMC, and femoral and tibial shaft vBMD and SSI (p < 0.001) over the follow-up. Slight decreases over the follow-up were also observed in OI and medium impacts in the full sample, and medium and high impact counts in the subsample (p < 0.05). Medium impacts were associated with tibial shaft vBMD and SSI (β = 0.204, 95% CI [0.018, 0.391] and β = 0.077 95% CI [0.000, 0.154], respectively). High impacts were associated with femoral shaft vBMD (β = 0.186 95% CI [0.006, 0.366]. However, no association was observed between habitual skeletal loads and changes in bone characteristics over the follow-up. We observed a rather uniform skeletal response to the menopausal transition at all measured bone sites. Positive associations were found between medium and high-intensity impacts and bone characteristics at the femoral and tibial shafts. However, habitual skeletal loading did not seem to counteract bone deterioration during the menopausal transition.

The study of risk factors for osteoporosis with prolonged use of anticonvulsants: intermediate results

The mechanisms of anticonvulsant effects on bone metabolism are not studied sufficiently. This determines the relevance of research on factors that influence the development of osteoporosis in patients taking long-term anticonvulsants. The aim of the study to evaluate the effect of modifiable and non-modifiable osteoporosis risk factors on changes in bone mineral density during long-term therapy with anticonvulsants. Materials and methods. The study included 100 adult patients receiving anticonvulsants for moren12 months and 58 healthy volunteers. All participants underwent a clinical screening with assessment of factors affecting bone metabolism and a densitometric study using quantitative computed tomography at three points (L1, L2 and femoral neck). Results. CT-densitometry results showed decrease bone mineral density in the most part of the participants in both study groups. According to the data of the analysis of the influence of osteoporosis risk factors on bone mineral density values, it was found that the presence of fractures in the anamnesis and low level of motor activity increased the risk of osteoporosis development in patients taking long-term anticonvulsants (p (χ2) &lt; 0.001). Conclusion. The results of the study confirm the importance of continuing research on factors affecting bone metabolism and developing a set of preventive measures to prevent the development of osteoporosis.

The nonpathogenic role of hyponatremia in the onset of osteoporosis: A Mendelian randomization study.

The relationship between hyponatremia and osteoporosis is controversial, and it remains unclear if there is a causal link between the two. This study employed a 2-sample Mendelian randomization (MR) analysis to investigate the potential causal relationship between hyponatremia and osteoporosis. The instrumental variables were derived from genome-wide association studies conducted in European populations. These included hyponatremia (n = 465,348) as the exposure factor, with genetic summary data for bone mineral density (BMD) at the forearm (n = 8134), femoral neck (n = 32,735), lumbar spine (n = 28,498), and heel (n = 265,627) as outcomes. The inverse variance weighted method did not identify any causal effect of hyponatremia on BMD. Additionally, other methods, such as MR-Egger, weighted median, simple mode, and weighted mode, also did not show evidence of a causal relationship between hyponatremia and BMD. Pleiotropy and heterogeneity analyses indicated that the MR findings were robust. There is no significant causal relationship between hyponatremia and osteoporosis. The previously observed associations may be due to confounding factors. It is unlikely that hyponatremia is a causal factor for osteoporosis.

Can We Predict 30-day Readmission Following Hip Fracture?

To determine the most common reason for 30-day readmission following hospitalization for hip fractures. Design: A retrospective review. Single academic medical center that includes a Level 1 Trauma Center. Included were all patients operatively treated for hip fractures (OTA 31) between October 2014 and November 2023. Patients that died during their initial admission were excluded. Patient demographics, hospital quality measures, outcomes and readmission within 30-days following discharge for each patient were reviewed. 30-day readmission reason was recorded and correlation analysis was performed. A total of 3,032 patients were identified with a mean age of 82.1 years and 70.5% of patients being female. The 30-day readmission cohort was 2.6 years older (p<0.001) and 8.8% more male patients (p=0.027), had 0.5 higher CCI (p<0.001), 0.3 higher ASA class (p<0.001) and were 9.2% less independent at the time of admission (p= 0.003). Hemiarthroplasty procedure (32.7% vs. 24.1%) was associated with higher 30-day readmission compared to closed percutaneous screw fixation (4.5% vs. 8.8%) and cephalomedullary nail fixation (52.2% vs. 54.4%, p<0.001). Those readmitted by 30-days developed more major (16.7% vs. 8.0%) (p<0.001) and minor (50.5% vs. 36.4%) (p<0.001) complications during their initial hospitalization and had a 1.5 day longer LOS during their first admission (p<0.001). Those discharged home were less likely to be readmitted within 30-days (20.7% vs. 27.6%, (p=0.008). Multivariate regression revealed increasing ASA class (O.R. 1.47, p=0.002) and pre-injury ambulatory status (O.R. 1.42, p=0.007) were most associated with increased 30-day readmission. The most common reason for readmission was pulmonary complications (17.1% of complications) including acute respiratory failure, COPD exacerbation and pneumonia. Thirty-day readmission following hip fracture was associated with older, sicker patients with decreased pre-injury ambulation status. Hemiarthroplasty for femoral neck fracture was also associated with readmission. The most common reason for 30-day readmission following hip fracture was pulmonary complications. Prognostic Level III.

Subcapital Femoral Neck Fracture in a Professionally Active Patient Undergoing Palliative Treatment for Endothelial Cell-Derived Epithelioid Haemangioendothelioma (EHE)

Background and Clinical Significance: Femoral neck fracture frequently occurs in the elderly population but may also present in patients diagnosed with primary cancer or bone metastases. A pathological, oligosymptomatic fracture associated with epithelioid haemangioendothelioma (EHE), a rare endothelial cell-derived sarcoma, is uncommon. Case Presentation: A 44-year-old patient underwent biopsy procedures three times (2010, 2012, 2013) for a focal lesion of the left ischium, none confirming its malignant nature. The last biopsy revealed a neoplastic tissue with features of discrete dysplasia. The lesion did not undergo medical follow-up for seven consecutive years. In August 2020, the patient presented with right lower limb pain. A CT scan, PET/CT scan, and biopsy confirmed EHE with spindle/sarcomatous features. In November 2020, chemotherapy (5xADIC) started (PET/CT confirmed a partial response). After its completion in July 2021, bone progression occurred and sirolimus-based therapy was started. After 3 months, a small liver metastasis was visualized on PET/CT, which did not result in the termination of treatment. In December 2021, pamidronate-based antiresorptive therapy was started. Liver metastasis remained stable in follow-up CT scans. Due to pelvic and spinal lesions, the patient was assisted by elbow crutches and underwent radiotherapy, remaining professionally active. The patient did not report any trauma, but in August 2023, a subsequent CT scan revealed a subcapital fracture of the left femoral neck in the fusion phase. Due to pelvic changes and the stable nature of the fracture, surgical treatment was abandoned. Conclusions: An oligosymptomatic femoral neck fracture, not requiring medical intervention is considered a rare complication of bone cancer.

A Novel Premature Termination Codon Mutation in TRAPPC2 is associated with X-linked Spondyloepiphyseal Dysplasia Tarda

Introduction: Spondyloepiphyseal dysplasia tarda (SEDT) is an inherited disorder that is typically diagnosed in childhood or adolescence. It is characterized by disproportionate short stature and premature osteoarthritis, and it frequently affects males. Here, we described a novel nonsense mutation, c.406A&gt;T; p(Lys136Ter), in TRAPPC2 (NM_001011658.4) in a Turkish patient with X-linked SEDT. Case Presentation: A 15-year-old boy, born to non-consanguineous Turkish parents, exhibited a decline in height velocity over three years and complained of back pain despite minimal physical activity. Growth and development were normal until adolescence, with the patient's weight at 35 kg (SDS -3.85), height at 134 cm (SDS -5.44), and a predicted adult height of 137.6 cm. Dysmorphic facial features, microtia, synophrys, hypotelorism, and barrel chest were noted. Radiological examination revealed osteopenic bone structure, hypoplastic odontoid process, platyspondyly, scoliosis, short femoral necks, and coxa vara. Genetic analysis identified a hemizygous novel stop codon mutation (c.406A&gt;T; pLys136Ter) in TRAPPC2, also detected as heterozygous in the patient's mother. Conclusion: In adolescence or childhood, X-linked SEDT should be considered in cases of disproportionate short stature, short trunk, osteoarthritis, and a family history that is appropriate for X-linked inheritance. Skeletal survey should be performed to suspect to SEDT and radiological findings may be supported to diagnosis.

Comparison between in situ fixation and fixation after closed reduction in valgus impacted femoral neck fractures: A Multicenter Study.

The objective of this study was to compare clinical outcomes between in situ fixation and fixation after closed reduction (CR) in patients aged 50 and above with valgus impacted femoral neck fractures using data from multiple centers. Design: Retrospective multicenter cohort study. Five tertiary-care university hospitals. Patients aged 50 and above, treated with operative fixation of valgus impacted femoral neck fractures using multiple cannulated screws from 2003 to 2019. Complications such as fixation failure, osteonecrosis of femoral head (ONFH), and reoperation were compared between the groups (in situ fixation group and fixation after CR group). Postoperative EuroQol-5 Dimension (EQ-5D), Harris Hip Score (HHS), and Koval's grade were compared. The mean age of the 206 patients (161 in situ fixation group, 45 in fixation after CR group) who met the inclusion criteria was 68.9 ± 10.9 years (range, 50 to 95 years). There were 39 men and 167 women. Fixation failure occurred in 11.2% (6.8% of in situ fixation group vs 26.7% of fixation after CR group, p = 0.002). Reoperation was required for 10.2% (7.5% of in situ fixation group vs 20% of fixation after CR group, p = 0.023). Fixation failure and reoperation rates were significantly higher in the fixation after CR group than in the in-situ fixation group (odds ratio = 4.757, p = 0.002 and odds ratio = 3.104, p = 0.023, respectively). At the two-year follow-up, ONFH occurred in 5.8% (9 out of 161, in situ fixation group vs 3 out of 45, fixation after CR group). There was no significant difference in the occurrence of ONFH between the two groups (p = 0.727). The Koval's grade at 6 and 12 months demonstrated better results in the in-situ group (p = 0.027, 0.044, respectively). Postoperative EQ-5D and HHS scores showed no statistically significant differences between the two groups. In patients aged 50 years or older with valgus impacted femoral neck fractures, when fixation was done after reduction, the reoperation rate was higher due to fixation failure compared to in-situ fixation. There was no significant difference in the incidence of ONFH in valgus impacted femoral neck fractures regardless of whether reduction was performed. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Improving Femoral Torsion Evaluation in Infants Through Analysis of Variability and Reliability in 2D and 3D Imaging Measurements of the Femoral Neck Axis

Abstract The femoral neck axis serves as a critical parameter in evaluating hip joint health, particularly in the pediatric population. Commonly used metrics for evaluating femoral torsion, such as the femoral neck-shaft and femoral anteversion angles, rely heavily on precise definitions of the position and orientation of the femoral neck axis. Current measurement methods employing radiographs and performing two-dimensional (2D) measurements on computed tomography (CT) scans are susceptible to errors due to their reliance on reader experience and the inherent limitations in 2D measurements. We hypothesized that utilizing volumetric data would mitigate these errors and enable more accurate and reproducible measurements of the femoral neck axis using the femoral anteversion and femoral neck-shaft angles. To test this hypothesis, we analyzed a historical collection of post-mortem infant femoral and pelvic bones (28 hips) aged 0 to 6.5 months, with an average estimated age of 4.68 months ± 1.80 months. Our findings revealed an average neck-shaft angle of 128.00 ± 4.92± and femoral anteversion angle of 35.56 ± 11.68± across all femurs, consistent with literature values. These measurements obtained from volumetric image data were found to be repeatable and reliable compared to conventional methods. Our study suggests that the proposed methodology offers a standardized approach for obtaining repeatable and reproducible measurements, thus potentially enhancing diagnostic accuracy and clinical decision-making in assessing hip developmental conditions in pediatric patients.

Verifying the effectiveness of romosozumab re-administration on bone mineral density.

Upon completing romosozumab therapy for osteoporosis, sequential treatment with other agents is required. However, for patients at high fracture risk despite such therapy, re-administration of romosozumab might be a potent option for subsequent medication to prevent additional fractures. Currently, there is still insufficient real-world clinical data verifying the efficacy of romosozumab re-administration, therefore, this study aimed to evaluate its efficacy. We enrolled 72 osteoporosis patients who remained at high risk of fractures after a 12-month course of romosozumab, followed by sequential therapy either with bisphosphonates, denosumab, or teriparatide. Patients were re-administered another 12-month romosozumab to assess changes in bone mineral density and the percentages of patients achieving a T-score >-2.5 at the completion. Our result exhibited that bone mineral density at the lumbar spine and femoral neck increased significantly through the re-administration phase (P<0.001). The percentage of patients achieving a T-score >-2.5 in the lumbar spine, total hip and femoral neck increased significantly compared to before initial romosozumab therapy, with the greatest improvement seen after re-administration (all P<0.001). Bone formation markers increased significantly (P<0.001) during re-administration, while bone resorption markers showed no significant change (P=0.408). The impact of prior sequential therapy was also evaluated. Bone mineral density increased significantly at all sites for patients who received bisphosphonates as sequential therapy (P<0.05). After denosumab therapy, significant bone mineral density increases were observed only in the lumbar spine (P<0.01), while the total hip and femoral neck showed no significant change. After teriparatide therapy, bone mineral density temporarily decreased during the sequential period but increased significantly after romosozumab re-administration, especially in the lumbar spine and femoral neck (both P<0.001). In conclusion, romosozumab re-administration is an effective treatment. Furthermore, its efficacy varies depending on the sequential therapy used, with the highest effectiveness seen in the order of teriparatide, bisphosphonates, and denosumab.

Comparing Austin Moore and Bipolar Prostheses for Management of Femoral Neck Fractures in Low-Resource Hospitals in Rural India.

Femoral neck fractures in elderly individuals cause significant morbidity, and their management is particularly challengingin rural areas where healthcare access is limited. The recommended treatment for displaced femoral neck fractures in elderly patients with poor mobility, cognitive dysfunction and multiple comorbidities is a hemiarthroplasty, which can be performed with various implants, including monopolar implants like Austin Moore prosthesis (AMP) and bipolar prosthesis (BP). In developing countries like India, rural areas often have constraints with healthcare resources. Furthermore, the per-capita income is low, limiting access to affordable healthcare.As a result, treatment is often tailored to ensure affordability, and AMP continues to be used as it is a relatively inexpensive implant. The objective of our study is to assess and compare themortality, infection rate andfunctional outcomes (Harris hip score [HHS]) of AMP and BP in treating femoral neck fractures one year following surgery in a resource-constrained setting in a rural district general hospital in India. This retrospective observational study analysed all patients who underwent a hemiarthroplasty for acutely displaced femoral neck fractures between 1 January 2017 and 31 December 2017, with a minimum one-year follow-up following surgery. Pathological hip fractures, patients with pre-existing hip pathologies and those with an abbreviated mental test score of six or less were excluded. Medical records were reviewed, and demographic data, mortality, infection ratesand HHS one year following surgery were recorded and compared for patients who underwent hemiarthroplasty with an AMP and BP. A total of 118 patients underwent hemiarthroplasty, with two (1.69%) lost to follow-up. Therefore, 116 patients were included, comprising 81 (69.83%) women and 35 (30.17%) men, with similar demographics between both groups. No statistically significant difference was found in mortality rate (AMP 1, 1.79%, vs. BP 1, 1.67%, P= 0.96), infection rate (AMP 1, 1.82%, vs. BP 1, 1.69%, P= 0.96) and HHS (AMP 85.2 vs. BP 88.5; P= 0.08). No dislocations or periprosthetic fractures were noted at one-year follow-up in both groups. While AMP and BP have similar clinical and functional outcomes, AMP is more cost-effective and perhaps more suitable in low socioeconomic demographics and low-resource settings. Further research is suggested to evaluate long-term outcomes inunderserved populations with a low per-capita income.

Dehydroepiandrosterone and Bone Health: Mechanisms and Insights

Background/Objectives: Dehydroepiandrosterone (DHEA), a steroid hormone produced by the adrenal glands, plays a key role in various physiological processes, including bone health. Its age-related decline is linked to reduced bone density, though the mechanisms by which DHEA affects bone metabolism remain complex. This review summarises the diverse effects of DHEA on bone metabolism and density, highlighting its therapeutic potential; Methods: A literature search on the effects of DHEA on bone-related parameters was conducted from PubMed and Scopus using a specific search string, and after removing duplicates and irrelevant articles, 36 relevant full-text studies were included; Results: DHEA promotes osteoblast differentiation and proliferation, regulates the RANKL/OPG ratio, and inhibits osteoclastogenesis and bone resorption. Its osteogenic effects are mediated through multiple signalling pathways. In ovariectomised rat models, DHEA enhances trabecular bone volume, stimulates osteoblast proliferation, and increases oestradiol production and aromatase activity. In elderly individuals with low androgen levels, DHEA supplementation increases sulphated DHEA and oestradiol levels and improves bone mineral density, particularly in the ultra-distal radius of women and the femoral neck of men. However, the clinical use of DHEA remains debated due to inconsistent study results. Its effects on bone health may vary based on factors such as age, gender, and health conditions, emphasising the need for further research to clarify its mechanisms and optimise its use; Conclusions: In conclusion, while DHEA shows potential as a modulator of bone health, comprehensive clinical trials are required to assess its efficacy and safety, particularly in at-risk populations.

Effects of One-Year Anti-seizure Treatment with Add-On Cenobamate on Bone Density and Bone Turnover in Adults with Drug-Resistant Focal Epilepsy: An Observational Study.

Cenobamate is a novel anti-seizure medication (ASM) with unusually high responder rates even in patients with refractory epilepsy. Due to its enzyme-inducing properties, cenobamate could negatively affect bone metabolism, similar to other ASMs; however, effects of long-term cenobamate treatment on bone health have not yet been investigated. The aim of this longitudinal observational study was to assess the effects of 1 year of continuous, adjunctive cenobamate treatment on bone health in patients with drug-resistant, focal epilepsy. Adult patients from a tertiary epilepsy centre received cenobamate add-on to their concomitant anti-seizure medication. Bone mineral density at femoral neck and lumbar spine, as well as bone formation biomarkers, electrolytes and liver enzymes in serum were assessed at baseline and after 12 months of continuous cenobamate therapy. Forty-seven patients (29 male, median age 40 years) were included in the study. Median daily dose of cenobamate at 12 months was 250 mg. Moderate, yet statistically significant reduction of the T-score at femoral neck but not lumbar spine was found after 1 year of cenobamate treatment, also in a subgroup of patients (n = 37) without enzyme inducers in the comedication. Additionally, we observed statistically significant changes in bone formation biomarkers: decreased serum level of osteocalcin and increased bone-specific alkaline phosphatase. Bone minerals (calcium and phosphorus) as well as vitamin D3 remained unchanged. Parathormone was statistically significantly reduced. There was a highly statistically significant increase in serum gamma-glutamyl transferase (GGT) levels after 12 months of treatment, reflecting an underlying hepatic enzyme induction by cenobamate. A statistically significant decrease of the T-score at femoral neck, as well as prominent alterations in the bone formation biomarkers, suggest an increase in bone turnover after 1 year of cenobamate treatment. The underlying mechanism is most likely attributed to the hepatic enzyme activation, indicated by a prominent elevation of serum GGT. The results alert for bone density control in susceptible patient groups. DRKS00027568, March 2, 2022 retrospectively registered.

Bone biochemical markers, bone mineral density, and the risk of osteonecrosis of the femoral head: a Mendelian randomization study

BackgroundAlterations in bone metabolism may play a significant role in the early stages of femoral head necrosis, yet the causal relationship remains unclear. This study utilizes a two-sample Mendelian randomization (MR) approach to explore the genetic causal links between biochemical markers of bone metabolism, bone mineral density, and the risk of femoral head necrosis.MethodsThis study utilizes publicly available genome-wide association study (GWAS) datasets, with exposure factors including biochemical bone markers (25OHD, calcium, and alkaline phosphatase) and bone mineral density (measured at the lumbar spine, heel, femoral neck, and total body). The outcome of interest is osteonecrosis of the femoral head. We selected validated single nucleotide polymorphisms that are strongly associated with the exposure factors as instrumental variables. Mendelian randomization analysis was conducted using inverse variance weighting(IVW), MR-Egger regression, and weighted median estimation. Additionally, we performed analyses for horizontal pleiotropy, heterogeneity, and sensitivity.ResultsA total of 934 SNPs were included in this study. The MR analysis results indicate that the IVW analysis of 25OHD, Ca, and ALP did not reach statistical significance (25OHD OR = 1.006, 95%CI: 0.69–1.47, P = 0.975; Ca OR = 0.856, 95%CI: 0.43–1.70, P = 0.657; ALP OR = 1.022, 95%CI: 0.86–1.21, P = 0.801). However, bone density, including heel, lumbar spine, and total body bone density, showed a protective causal relationship with the onset of ONFH, while the results for femoral neck bone density did not reach statistical significance (lumbar spine BMD OR = 0.662, 95%CI: 0.48–0.91, P = 0.010; heel BMD OR = 0.726, 95%CI: 0.62–0.85, P < 0.001; total body BMD OR = 0.726, 95%CI: 0.62–0.85, P < 0.001; femoral neck BMD OR = 0.748, 95%CI: 0.53–1.05, P = 0.096). Cochran’s Q statistic for IVW and MR-Egger methods indicated no intergenic heterogeneity for all exposure outcomes’ SNPs, and the tests for pleiotropy suggested a low likelihood of pleiotropy in all causal analyses.ConclusionsThe results of this study indicate that there is no genetically mediated causal relationship between serum levels of 25-hydroxyvitamin D, calcium, and alkaline phosphatase and osteonecrosis of the femoral head. However, heel, lumbar spine, and total body bone mineral density can be considered protective factors for the occurrence of ONFH. There is no genetic causality between femoral neck bone mineral density and ONFH development.

Physical therapy after femur fracture in elderly patients at the long-term rehabilitation stage

Femoral neck fractures are the leading cause of disability among the elderly. Rehabilitation is fundamental to restore functionality that was before the fracture. Aim. To conduct an observational cohort study to compare the effectiveness of rehabilitation programs in different therapeutic settings. Materials and methods. Elderly patients who underwent surgical stabilization of femur fracture were included in the study. The participants were divided into 3 groups: group 1 – outpatient rehabilitation; group 2 – inpatient rehabilitation; group 3 – rehabilitation at home. Rehabilitation results were determined at the initial stage, 3 and 6 months after the fracture. The Barthel index, passive and active range of motion in hip flexion and extension, and the muscle strength in flexion, extension, and extension of the knee joint were assessed. Results. In 6 months, all three groups showed statistically significant improvement (p &lt; 0.05) in all indices compared to baseline. Considering the intergroup analysis, the final Barthel index score was significantly higher in patients who were treated as outpatients (88.00 ± 9.6) than inpatients (68.57 ± 11.7), but no statistical difference was found between patients who were treated as outpatients and at home (82.5 ± 10.4). In general, patients who were treated in outpatient settings showed better functional outcomes, while patients who were rehabilitated in inpatient settings had worse outcomes. Patients treated at home showed intermediate final functional outcomes more similar to outpatients. Patients with hip fracture undergoing outpatient rehabilitation were more likely to have better long-term effects of the rehabilitation protocol regarding the functional status, muscle strength in hip flexion, hip extension, and knee extension. Patients referred to home rehabilitation showed intermediate results, closer to outpatients, although they started rehabilitation treatment faster after the hospital discharge. Conclusions. The data obtained indicate that rehabilitation leads to significant functional recovery after femur fracture in elderly patients. Both outpatient and home-based rehabilitation are acceptable rehabilitation options for femoral fractures.