Femoral Neck Research Articles

Challenges of Hip Arthroplasty in a Paretic, Spastic Limb: A Case Study on Managing Femoral Neck Fracture Following Fixation Failure in a Hemiparetic Patient

Challenges of Hip Arthroplasty in a Paretic, Spastic Limb: A Case Study on Managing Femoral Neck Fracture Following Fixation Failure in a Hemiparetic Patient

Evaluation of fragility fracture risk using deep learning based on ultrasound radio frequency signal.

It was essential to identify individuals at high risk of fragility fracture and prevented them due to the significant morbidity, mortality, and economic burden associated with fragility fracture. The quantitative ultrasound (QUS) showed promise in assessing bone structure characteristics and determining the risk of fragility fracture. To evaluate the performance of a multi-channel residual network (MResNet) based on ultrasonic radiofrequency (RF) signal to discriminate fragility fractures retrospectively in postmenopausal women, and compared it with the traditional parameter of QUS, speed of sound (SOS), and bone mineral density (BMD) acquired with dual X-ray absorptiometry (DXA). Using QUS, RF signal and SOS were acquired for 246 postmenopausal women. An MResNet was utilized, based on the RF signal, to categorize individuals with an elevated risk of fragility fracture. DXA was employed to obtain BMD at the lumbar, hip, and femoral neck. The fracture history of all adult subjects was gathered. Analyzing the odds ratios (OR) and the area under the receiver operator characteristic curves (AUC) was done to evaluate the effectiveness of various methods in discriminating fragility fracture. Among the 246 postmenopausal women, 170 belonged to the non-fracture group, 50 to the vertebral group, and 26 to the non-vertebral fracture group. MResNet was competent to discriminate any fragility fracture (OR = 2.64; AUC = 0.74), Vertebral fracture (OR = 3.02; AUC = 0.77), and non-vertebral fracture (OR = 2.01; AUC = 0.69). After being modified by clinical covariates, the efficiency of MResNet was further improved to OR = 3.31-4.08, AUC = 0.81-0.83 among all fracture groups, which significantly surpassed QUS-SOS (OR = 1.32-1.36; AUC = 0.60) and DXA-BMD (OR = 1.23-2.94; AUC = 0.63-0.76). This pilot cross-sectional study demonstrates that the MResNet model based on the ultrasonic RF signal shows promising performance in discriminating fragility fractures in postmenopausal women. When incorporating clinical covariates, the efficiency of the modified MResNet is further enhanced, surpassing the performance of QUS-SOS and DXA-BMD in terms of OR and AUC. These findings highlight the potential of the MResNet as a promising approach for fracture risk assessment. Future research should focus on larger and more diverse populations to validate these results and explore its clinical applications.

Association between composite dietary antioxidant and bone mineral density in children and adolescents aged 8–19 years: findings from NHANES

Dietary antioxidants may have beneficial effects on bone health, but it remains uncertain in children and adolescents. This study investigates the association of composite dietary antioxidant index (CDAI) with bone mineral density (BMD) in children and adolescents aged 8–19 years from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. The study assessed the relationship between CDAI and BMD in 2994 individuals aged 8–19 years (average age 13.48 ± 3.32 years) from the NHANES 2007–2010. Multivariate linear regression analyses were utilized to detect the association between CDAI and total spine, femur neck, and total femur BMD, adjusting for confounders including age, race/ethnicity, sex, poverty income ratio (PIR), body mass index (BMI), serum phosphorus and calcium. Stratified analyses and interaction tests were performed to examine the stability of the results. The weighted characteristics showed that subjects in the fourth CDAI quartile were more likely to be older, men, and Non-Hispanic White. They have higher values of serum total calcium and phosphorus. After adjusting all confounders, CDAI was positively associated with the total spine (β = 0.0031 95% CI 0.0021–0.0040), total femur (β = 0.0039 95% CI 0.0028–0.0049), and femur neck BMD (β = 0.0031 95% CI 0.0021–0.0040) in children and adolescents. Furthermore, we found no interaction effects between different race/ethnicity, age, and sex groups. Our findings suggest that dietary intake of multiple antioxidants was positively associated with BMD in children and adolescents. These findings provide valuable evidence for improving bone health in the early stages of life. However, more prospective studies are required to validate our findings and their causal relationship.

Association between bone turnover markers, bone mineral density, and serum osteoglycine in middle-aged men with Type 2 Diabetes mellitus

BackgroundPatients with Type 2 diabetes mellitus (T2DM) have decreased bone health. We aimed to investigate serum levels of bone turnover markers (BTMs) (markers of bone formation and bone resorption) and bone mineral density (BMD) at three sites (lumber, neck femur, and total femur) in middle-aged men with type 2 diabetes and to analyze the relationship between them. Also to evaluate serum osteoglycin as a novel marker and its relation to BTMs, BMD, and diabetic status.MethodsWe recruited seventy-eight patients with T2DM and thirteen non-diabetic, male volunteers as a control group. BMD was measured using a DEXA scan. BTMs (carboxy-terminal crosslinking telopeptide of type 1 collagen [CTX] and procollagen type 1 N propeptide [P1NP]), osteoglycin, PTH, and vitamin D were estimated. Data was compared among subjects and statistical analysis was performed.ResultsMost of the patients were having normal BMD with no significant difference between patients and the controls. BTMs and osteoglycin were significantly higher and vitamin D was significantly lower in the diabetic patients. Serum osteoglycin was positively correlated with DEXA Neck Femur (r = 0.233; p-value < 0.05).ConclusionBody mass index and Serum osteoglycin have a significant positive effect on BMD. Both markers of bone formation and bone resorption were increased indicating a state of increased bone turnover in T2DM.

Efficacy and safety of romosozumab: a meta-analysis of placebo-controlled trials.

We aimed to comprehensively compile placebo-controlled trials on the efficacy and safety of romosozumab (210mg, subcutaneously, once monthly) in postmenopausal women and men with osteoporosis. PubMed, Google Scholar, and ClinicalTrials.gov were searched for relevant placebo-controlled trials (as of January 1, 2024). Percent change in bone mineral density (BMD), falls, fractures, and adverse events (AEs) after drug administration were collected. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Six trials (7990 patients; follow-up period, 6-12months) were included. Compared with placebo, romosozumab significantly increased lumbar spine BMD (MD = 12.69; 95% CI 11.10-14.29), total hip BMD (MD = 4.42; 95% CI 3.03-5.80), and femoral neck BMD (MD = 3.99; 95% CI 2.42-5.57) at 12months. Romosozumab significantly decreased falls (RR = 0.80; 95% CI 0.68-0.93) and major osteoporotic fractures (RR = 0.37; 95% CI 0.25-0.54), but increased injection-site reactions (RR = 1.83; 95% CI 1.46-2.30) within 12months. No significant differences were observed in other AEs (including cardiovascular AEs) within 12months. Romosozumab treatment resulted in a significant BMD gain, reduced falls and major osteoporotic fractures. It was generally well-tolerated, including the cardiovascular aspects. However, clinicians should consider the occurrence of minor AEs (e.g., injection-site reactions).

Evaluating the efficacy of rehabilitation outcomes of the femoral neck system in treating femoral neck fractures: a two-year prospective study

Evaluating the efficacy of rehabilitation outcomes of the femoral neck system in treating femoral neck fractures: a two-year prospective study

Clinical outcomes of total hip arthroplasty after femoral neck fractures vs. osteoarthritis at one year follow up-A comparative, retrospective study.

The objective of the study is to determine if there was a difference in medical complications and in-hospital mortality among the patients who underwent THA for femoral neck fracture relative to same procedure for elective patients with coxarthrosis. We compared characteristics and short-term outcomes during the rehabilitative postsurgical period. We included all patients older than 45years who underwent THA for primary/secondary hip arthritis and displaced femoral neck fractures type Garden III and IV. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively, postoperatively at threedays, sixweeks, 12weeks and oneyear and we registered Visual Analogue Scale (VAS) pain score, Harris Hip Score (HHS), the Western Ontario McMaster Osteoarthritis Index (WOMAC), internal and external rotation of the hip and operated limb length compared with the opposite. There is no significant statistically differences between the two groups regarding the preoperative comorbidities. The frequencies of patients experiencing in-hospital and 30-day postoperative complications were generally low and same in groups we studied. The mean quantity of surgical blood loos during the operation was significantly higher in the hip fracture group compared with elective patient group with OA (340.09 ± 86.03 vs 309.43 ± 102.52). With respect to postoperative recovery the patients with THA after FNF were mobilized by active walking a little bit faster as the patient with OA (2.77 ± 1.18days vs 3.1 ± 1.14days). The average inpatient hospital length of stay after THA for OA was 11.07days compared to 13.41days following a THA for FNF. Our study showed that THA for treatment of an acute fracture of the femoral neck in an elderly patient can provide results comparable to those of patients who received THA for OA and we found that the results are similar.

Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis

The selection of implants for fixing unstable femoral neck fractures (FNF) remains contentious. This study employs finite element analysis to examine the biomechanics of treating Pauwels type III femoral neck fractures using cannulated compression screws (3CS), biplane double-supported screw fixation (BDSF), and the femoral neck system (FNS). A three-dimensional model of the proximal femur was developed using computed tomography scans. Fracture models of the femoral neck were created with 3CS, BDSF, and FNS fixations. Von Mises stress on the proximal femur, fracture ends, internal fixators, and model displacements were assessed and compared across the three fixation methods (3CS, BDSF, and FNS) during the heel strike of normal walking. The maximum Von Mises stress in the proximal fragment was significantly higher with 3CS fixation compared to BDSF and FNS fixations (120.45 MPa vs. 82.44 MPa and 84.54 MPa, respectively). Regarding Von Mises stress distribution at the fracture ends, the highest stress in the 3CS group was 57.32 MPa, while BDSF and FNS groups showed 51.39 MPa and 49.23 MPa, respectively. Concerning implant stress, the FNS model exhibited greater Von Mises stress compared to the 3CS and BDSF models (236.67 MPa vs. 134.86 MPa and 140.69 MPa, respectively). Moreover, BDSF displayed slightly lower total displacement than 3CS fixation (7.19 mm vs. 7.66 mm), but slightly higher displacement than FNS (7.19 mm vs. 7.03 mm). This study concludes that BDSF outperforms 3CS fixation in terms of biomechanical efficacy and demonstrates similar performance to the FNS approach. As a result, BDSF stands as a dependable alternative for treating Pauwels type III femoral neck fractures.

Development and evaluation of interpretable machine learning regressors for predicting femoral neck bone mineral density in elderly men using NHANES data.

Osteoporotic femoral neck fractures (OFNFs) pose a significant orthopedic challenge in the elderly population, accounting for up to 40% of all osteoporotic fractures and leading to considerable health deterioration and increased mortality. In addressing the critical need for early identification of osteoporosis through routine screening of femoral neck bone mineral density (FNBMD), this study developed a user-friendly prediction model aimed at men aged 50 years and older, a demographic often overlooked in osteoporosis screening. Utilizing data from the National Health and Nutrition Examination Survey (NHANES), the study involved outlier detection and handling, missing value imputation via the K nearest neighbor (KNN) algorithm, and data normalization and encoding. The dataset was split into training and test sets with a 7:3 ratio, followed by feature screening through the least absolute shrinkage and selection operator (LASSO) and the Boruta algorithm. Eight different machine learning algorithms were then employed to construct predictive models, with their performance evaluated through a comprehensive metric suite. The random forest regressor (RFR) emerged as the most effective model, characterized by key predictors such as age, body mass index (BMI), poverty income ratio (PIR), serum calcium, and race, achieving a coefficient of determination (R²) of 0.218 and maintaining robustness in sensitivity analyses. Notably, excluding race from the model resulted in sustained high performance, underscoring the model's adaptability. Interpretations using Shapley additive explanations (SHAP) highlighted the influence of each feature on FNBMD. These findings indicate that our predictive model effectively aids in the early detection of osteoporosis, potentially reducing the incidence of OFNFs in this high-risk population.

Efficacy and Safety of Anti-Osteoporotic Agents Across CKD Stages: A Meta-Analysis of Randomized Clinical Trials.

Osteoporosis poses a significant health concern, especially for individuals with chronic kidney disease (CKD). CKD disrupts mineral and bone metabolism, heightening the risk of fractures and complicating the management of osteoporosis. While anti-osteoporotic interventions aim to address bone health in CKD patients, ongoing research is essential to understand the comparative efficacy and safety of these medications, particularly in different CKD stages, notably in Stages 4 and 5. We searched PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL for randomized controlled trials assessing the efficacy and safety of osteoporosis interventions in CKD up to June 15, 2024. The analysis utilized the pooled odds ratio (OR) along with the corresponding 95% confidence interval (CI), employing Comprehensive Meta-Analysis software, version 3.0. To assess heterogeneity in the results of individual studies, we used Cochran's Q statistic and the I2 statistic. We analyzed 12 randomized controlled trials involving 31,027 participants, revealing a significantly lower risk of vertebral fractures with anti-osteoporotic agents (Teriparatide, Denosumab, Romosozumab, Raloxifene) compared to placebo (pooled OR, 0.28 [95% CI, 0.22 to 0.36]). Stratification by CKD stages showed a lower risk in Stages 1-3 but no significant reduction in Stages 4 and 5. Teriparatide, Denosumab, and Romosozumab were effective in lowering fracture risk, whereas Raloxifene showed no significant effect. The lumbar spine, femoral neck, and total hip BMD showed no significant differences between anti-osteoporotic agents (Denosumab, Raloxifene, Risedronate, Alendronate, Teriparatide) and placebo. However, Romosozumab demonstrated a significantly greater BMD change in all kidney function categories. No reported side effects were observed in CKD stages 1 to 5 across the trials. Our meta-analysis highlights the effectiveness of anti-osteoporotic agents in lowering vertebral fracture risk in CKD patients, particularly in Stages 1-3. However, this benefit is not apparent in Stages 4 and 5, necessitating further research. Despite the absence of reported side effects in CKD patients, clinicians should carefully assess the suitability of these medications, considering individual risks and benefits.

Early clinical outcomes of bipolar hemiarthroplasty for femoral neck fractures in elderly patients using the OCM approach: a retrospective study

Early clinical outcomes of bipolar hemiarthroplasty for femoral neck fractures in elderly patients using the OCM approach: a retrospective study

Risk factors for vertebral fracture in rheumatoid arthritis patients using biological disease-modifying anti-rheumatic drugs (cases over 5 years): An observational study.

While biological disease-modifying anti-rheumatic drugs (bDMARDs) are considered beneficial for preventing osteoporosis and bone fracture, it is unclear whether bone loss is involved in the development of vertebral fracture, and few reports have examined the factors related to vertebral fracture in rheumatoid arthritis (RA) patients using bDMARDs. This study aims to identify factors influencing vertebral fracture in RA patients treated with bDMARDs. We retrospectively examined the records of 129 RA patients treated with bDMARDs for over 5 years. The lumbar spine and femoral bone mineral density, Disease Activity Score-28-C-Reactive Protein (DAS28-CRP) value, Simplified Disease Activity Index (SDAI), and modified Health Assessment Questionnaire (mHAQ) score were evaluated. The frequency of new vertebral fracture during the study and their risk factors were investigated. A comparison between the fracture group and the nonfracture group was performed. Multivariate analysis was performed using logistic regression analysis to detect risk factors for new vertebral fracture. The number of patients with new vertebral fracture during follow-up was 15 (11.6%) of the 129 patients in the study. Age and mHAQ score were significantly higher and lumbar spine and femoral neck bone mineral density were significantly lower in the fracture group than the nonfracture group. The risk factors for new vertebral fracture during the disease course were older age and higher mHAQ score indicating no remission over the 5 years of follow-up. In this study, there was no significant difference in disease indices such as the DAS28-CRP value and the SDAI between the fracture and nonfracture groups, suggesting an effective control of RA with bDMARDs. However, age and the mHAQ score, an index of RA dysfunction, were significantly higher in the fracture group. These results suggest that improving functional impairment may be important to prevent vertebral fracture in patients using bDMARDs.

Acquisition of peak bone mass in a Norwegian youth cohort: longitudinal findings from the Fit Futures study 2010–2022

SummaryIn a Norwegian youth cohort followed from adolescence to young adulthood, bone mineral density (BMD) levels declined at the femoral neck and total hip from 16 to 27 years but continued to increase at the total body indicating a site-specific attainment of peak bone mass.PurposeTo examine longitudinal trends in bone mineral density (BMD) levels in Norwegian adolescents into young adulthood.MethodIn a prospective cohort design, we followed 980 adolescents (473 (48%) females) aged 16–19 years into adulthood (age of 26–29) on three occasions: 2010–2011 (Fit Futures 1 (FF1)), 2012–2013 (FF2), and 2021–2022 (FF3), measuring BMD (g/cm2) at the femoral neck, total hip, and total body with dual x-ray absorptiometry (DXA). We used linear mixed models to examine longitudinal BMD changes from FF1 to FF3.ResultsFrom the median age of 16 years (FF1), femoral neck BMD (mean g/cm2 (95% CI)) slightly increased in females from 1.070 (1.059–1.082) to 1.076 (1.065–1.088, p = 0.015) at the median age of 18 years (FF2) but declined to 1.041 (1.029–1.053, p < 0.001) at the median age of 27 years (FF3). Similar patterns were observed in males: 16 years, 1.104 (1.091–1.116); 27 years, 1.063 (1.050–1.077, p < 0.001); and for the total hip in both sexes (both p < 0.001). Total body BMD increased from age 16 to 27 years in both sexes (females: 16 years, 1.141 (1.133–1.148); 27 years, 1.204 (1.196–1.212), p < 0.001; males: 16 years, 1.179 (1.170–1.188); 27 years, 1.310 (1.296–1.315), p < 0.001).ConclusionBMD levels increased from 16 to 18 years at the femoral and total hip sites in young Norwegian females and males, and a small decline was observed at the femoral sites when the participants were followed up to 27 years. Total body BMD continued to increase from adolescence to young adulthood.

Outcome of Internal Fixation by Cephalomedullary Nail versus Outcome of Bipolar Hemiarthroplasty in the Treatment of Unstable Pertrochanteric Femoral Fractures in Elderly: Systematic Review and Meta-analysis

Abstract Background Pertrochanteric femoral fractures are extracapsular metaphyseal fractures of proximal femur that involve the region between the femoral neck and shaft. Intertrochanteric femur fractures, the most common type of fragility fractures in the elderly, account for 55% of proximal femoral fractures. Intertrochanteric femur fractures have high fatality and disability rates, resulting in a huge burden on the economy and on society. Objective To compare the advantages and disadvantages of the PFN and BHA to provide reliable evidence for clinicians in selecting the optimal treatment for unstable pertrochanteric fractures. Patients and Methods This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Data Extraction Data were independently extracted by two reviewers and cross-checked. Results This study included 12 samples which recruited 1019 patients with unstable intertrochanteric fractures, form which 515 patients underwent bipolar hemiarthroplasty (BHA) and 504 patients underwent proximal femoral nail (PFN). No significant difference between BHA and PFN in operative time and post-operative hospital stay was found. Intra-operative blood loss and incidence of blood transfusion was higher in BHA compared with PFN. HHS was higher after PFN than after BHA. Patients underwent PFN required larger period for partial weight bearing compared with who underwent BHA. There were no statistically significant difference between both groups regarding postoperative mobility scores, reoperation rate, incidence of infection and limb length alteration. The overall mortality rate risk ratio revealed that the incidence of mortality was higher after BHA than PFN. Conclusion Both PFN and BHA can be used in managing fractures of the Intertrochanteric in elderly patients. PFN establishes itself as a better modality than BHA due to lower postoperative mortality and better functional outcomes. BHA should ideally be reserved for lower life expectancies and those requiring immediate weight bearing patients.

Valgus Osteotomy versus Arthroplasty for Ununited Femoral Neck Fractures: A Systematic Review

Abstract Background Fractures of the neck of femur in young adults tend, unlike their counterparts in older people, to be a relatively higher energy injury and require timely and meticulous diagnosis and management. Anatomical reduction and stable internal fixation are essentials for achieving the goals of treatment in this young population allowing preservation of the femoral head while minimizing rates of non-union and osteonecrosis. Aim of the Work The aim of this systematic review is to collate evidence from comparative studies to look for significant differences between valgas osteotomy &amp;arthroplasty in non united femoral neck fractures in &amp;lt; 50yr old patients. Patients and Methods Only studies with Randomized controlled trials and comparative non controlled trials had been included. The study included Valgas osteotomy &amp; arthroplasty for ununited femoral neck fractures. Application of inclusion and exclusion criteria to study Abstracts yielded 11articles. The full-text articles for these 40 studies were then reviewed and subjected to our inclusion criteria. A total of 11 articles were eligible for final systematic review. Results There was improvement in Harris hip score in all included studies ranged from 79.8 to 95. In comparison between two groups, groups with THA had significantly higher Harris hip score than osteotomy score. In this review reoperation and infection were common among osteotomy group than total hip arthroplasty group. Conclusion Although non-union problems following femoral neck fractures are common, the primary objective is to preserve the hip, by seeking alternative methods, specifically in young patients, and considering that the femoral neck can usually remain viable. Therefore, alternatives such as valgus osteotomy, which enables union by solving mechanical issues and allows patients to live with their own bones, have long been in use and successful Valgus intertrochanteric osteotomy is the treatment of choice for active patients aged less than 50 years with a nonunion of a femoral neck fracture. This technique requires precise preoperative planning and intraoperative skill. Patients should be warned of the risk of avascular necrosis, as well as the difficulty in performing revision arthroplasty in this setting.

Total Hip Arthroplasty versus Hemiarthroplasty for the Treatment of Displaced Femoral Neck Fracture in Elderly

Abstract Background Displaced intracapsular hip fractures are most commonly treated using either total hip arthroplasty (THA) or hemiarthroplasty. Aim of the Work To review systematically studies about the use of Total hip arthroplasty Versus hemiarthoplasty in management of displaced femoral neck fracture in elderly. Patients and Methods We included randomized controlled trials, including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies. We excluded cross-sectional studies, case series, and case reports. Search results were uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart were produced based on the search results and the inclusion/exclusion criteria. Results In our study there was statistically significant increase in the incidence of Reoperation in total hip arthroplasty (3.5%) than hemiarthroplasty (2.3%) with p-value &amp;lt; 0.001. Regarding Dislocation, there was statistically significant increase in the incidence of Dislocation in total hip arthroplasty (3.2%) than hemiarthroplasty (1.7%) with p-value &amp;lt; 0.001. Regarding Infection there was statistically significant increase in the incidence of Infection in total hip arthroplasty (4.5%) than hemiarthroplasty (3.4%) with p- value &amp;lt; 0.001. Regarding General Complications including: (Pneumonia – DVT- Pulmonary embolism- Myocardial infarct- Cerebral vascular lesion- Acute kidney failure- life threatening complications there was statistically no significant difference in the incidence of General complications in hemiarthroplasty (5.5%) and total hip arthroplasty (5.4%) with p-value = 0.608. Conclusions The authors concluded that DMTHA offered a better functional outcome than BA with no significant complications or mortality, and there was no significant difference between DMTHA and BA in the rate of dislocation.

Comparative Study of Preoperative Ultrasound Guided Pericapsular Nerve Group Block and Femoral Nerve Block for Analgesia before Spinal Anesthesia for Proximal Femur Fracture Fixation

Abstract Background Proximal femur fractures are most common fractures especially in elderly population. Regional anaesthesia is preferred during surgery in these patients. However, the severe pain associated with these injuries makes appropriate positioning difficult for the regional anaesthesia, thus altering their overall success rate, also the majority of patients often experience moderate to severe postoperative pain. Aim of the Work The study aimed to compare between ultrasound guided PENG and FNB using VAS score to assess the overall efficacy for pain relief during patient positioning for spinal anesthesia. Patients and Methods After approval of anaesthesiology department scientific and ethical committees in Ain Shams University Hospitals, 50 patients were included in the study, and were divided into two groups (n = 25; each); group PENG and FNB group. The two groups were adequately monitored and assessed before spinal anesthesia and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total amount of analgesia required. Results This study documented that PENG block is comparable to femoral block for postoperative pain control. The PENG block has been described very first in 2018 for preoperative management of femur neck fracture. We observed no statistically significant difference in pain scores during positioning for spinal anesthesia and for first 24 hrs post-operative. Similarly, no significant difference was also found in first rescue analgesia time and Cumulative nalbuphine consumption at 24 hours after surgery between the two groups. Conclusion In the management of hip fractures, PENG block is not associated in the present study with a significant change in pain score during positioning for spinal anesthesia compared to femoral nerve block.

Vitamin D levels and bone mineral density of middle-aged premenopausal female football and volleyball players in Japan: a cross-sectional study

BackgroundThe number of football teams in senior categories has increased. As outdoor sports entail players being exposed to sunlight, playing football may contribute to maintaining vitamin D stores and body mineral density while preventing osteoporosis. This study aimed to determine the bone mineral density and vitamin D levels in middle-aged premenopausal female football players.MethodsParticipants were premenopausal females in their 40s. We evaluated bone mineral density of the second to the fourth lumbar vertebrae and femoral neck, serum 25-hydroxy vitamin D (25-OHD) levels, which is an indicator of vitamin D stores, and body composition. In addition, we administered a questionnaire survey on exercise habits and lifestyle. Ninety-two participants were categorised into three groups: the football group (n = 27), volleyball group (n = 40), and non-exercise group (n = 25).ResultsBone mineral density was higher in the football and volleyball groups than in the non-exercise group (P < 0.01). The volleyball group had a significantly higher bone mineral density of the lumbar spine and femoral neck than the non-exercise group (P < 0.01). The football group had a significantly higher bone mineral density of the femoral neck than the non-exercise group (P < 0.01). Although the football group had played fewer years than the volleyball group (P < 0.01), serum 25-OHD levels were the highest in the football group and were significantly higher than those in the volleyball and non-exercise groups (P < 0.01).ConclusionsMiddle-aged premenopausal football players had higher body vitamin D levels and bone mineral densities than non-active females. These results suggest that playing football may contribute to the prevention of osteoporosis.Trial registrationUMIN Clinical Trials Registry UMIN000054235. 2024/04/23. Retrospectively registered.

Effects of differences in dose and frequency of teriparatide on bone structure in Proximal Femur. - Analysis by DXA-based 3D-modeling (3D-SHAPER Software) -TRIPLE-BONE study (The effects of TeRIParatide preparation on bone mineraL density increase and BONE structure).

To examine the effects of differences in the amount of teriparatide (TPTD) per administration and its dosing frequency on the bone structure in the proximal femur by dual-energy X-ray absorptiometry (DXA)-based 3D-modeling (3D-SHAPER software). This was a multicenter retrospective study. Patients aged 50 years or older with primary osteoporosis who continuously received once-/twice-weekly (1・2/W, n= 60) or 1/D TPTD (n= 14) administration for at least one year were included in the study. Measurement regions included the femoral neck (FN), trochanter (TR), femoral shaft (FS), and total proximal hip (TH). Concurrently, the bone mineral density (BMD) and Trabecular Bone Score (TBS) were measured. The cross-sectional area, cross-sectional moment of inertia, and section modulus in the FS were significantly improved in the 1・2/W TPTD group, as compared to the 1/D TPTD group. However, significant improvement of the cortical thickness and buckling ratio in the FN was observed in the 1/D TPTD group, as compared to the 1・2/W TPTD group. Trabecular BMD values in the FS and TH were significantly increased in the 1/D TPTD group, as compared to the 1・2/W TPTD group, while the cortical BMD values in the TR, FS, and TH were significantly increased in the 1・2/W TPTD group, as compared to the 1/D TPTD group. Trends toward more favorable improvement of the cortical bone by 1・2/W TPTD and that of the trabecular bones by 1/D TPTD were observed.

Denosumab Prevents Bone Loss and Microarchitectural Deterioration in Premenopausal Women With Breast Cancer Receiving Estradiol Suppression Therapy: A Randomized Controlled Trial.

Suppression of ovarian function and aromatase inhibition (AI) increases disease-free survival in premenopausal women with estrogen receptor (ER)-positive early-stage breast cancer but accelerates bone loss. We therefore hypothesized that suppressing bone remodeling using denosumab (DMAB) would prevent bone loss in these women. In a 12-month double-blind randomized trial, 68 women with ER-positive early-stage breast cancer commencing ovarian function suppression and AI were randomly assigned to 60 mg DMAB (n = 34) or placebo (PBO; n = 34) once every 6 months (at 0 and 6 months). Volumetric bone mineral density (BMD), microarchitecture, and estimated bone strength of the distal tibia and distal radius were measured using high-resolution peripheral quantitative computed tomography, and spine and hip BMD were measured using dual-energy X-ray absorptiometry at 0, 6, and 12 months. The primary end point and treatment effect was the mean adjusted between group difference (MAD; [95% CI]) in distal tibial total volumetric BMD over 12 months, with a single P value tested over all time points. The study is registered with the Australian New Zealand Clinical Trials Registry (anzctr.org.au; identifier: ACTRN12616001051437). Intention-to-treat analysis included all 68 randomly assigned women. Over 12 months, compared with PBO, DMAB prevented the decrease in distal tibial total BMD (MAD, 20.8 mg HA/cm3 [95% CI, 17.3 to 24.2]), cortical BMD (42.9 mg HA/cm3 [95% CI, 32.1 to 53.9]), trabecular BMD (3.32 mg HA/cm3 [95% CI, 1.45 to 5.20], P = .004), estimated stiffness (11.6 kN/m [95% CI, 7.6 to 15.6]), and failure load (563 N [95% CI, 388 to 736]). Findings were similar at the distal radius. Decreases in BMD at the lumbar spine (MAD, 0.13 g/cm2 [95% CI, 0.11 to 0.15]), total hip (0.08 g/cm2 [95% CI, 0.07 to 0.09], and femoral neck (0.06 g/cm2 [95% CI, 0.05 to 0.07]) were also prevented. All P < .001 unless otherwise noted. Treatment with DMAB at commencement of estradiol suppression therapy preserves BMD, bone microarchitecture, and estimated strength, and is likely to increase fracture-free survival.