Nonspine Fractures Research Articles

Fracture risk revisited: Bone mineral density T-score and fracture risk in type 2 diabetes.

To study the association between femoral neck (FN) bone mineral density (BMD) T-score and fracture risk in individuals with and without type 2 diabetes (T2D). We performed a single-centre retrospective cohort study using the Danish National Health Service. BMD of the FN was measured by dual-energy X-ray absorptiometry. Cox proportional hazards regression models were used to study the association between FN BMD T-score and fractures in individuals with and without T2D separately, adjusted for age, comorbidities and comedication. The results from this analysis were used to estimate the 10-year absolute fracture risk. In total, there were 35,129 women (2362 with T2D) and 7069 men (758 with T2D). The FN BMD T-score was significantly associated with risk of any, hip and major osteoporotic fracture in men and women with [adjusted hazard risk ratios (aHR) women, hip: 1.57; 95% confidence interval (CI) 1.24-2.00, incidence rate (IR) 8.7; aHR men, hip: 1.55; 95% CI 1.01-2.36, IR 4.6] and without T2D (aHR women, hip: 1.75; 95% CI 1.64-1.87, IR 7.0; aHR men, hip: 1.97, 95% CI 1.73-2.25, IR 6.3), and its ability to predict fracture risk was similar. Fracture IRs were not significantly different for individuals with or without T2D, nor was the estimated cumulative 10-year fracture risk. The FN BMD T-score was significantly associated with hip, non-spine and major osteoporotic fracture risk in men and women with and without T2D. Fracture risk for a given T-score and age was equal in individuals with and without T2D, as was the ability of the FN BMD T-score to predict fracture risk.

Balancing fracture risk versus risk of mortality before fracture among women aged 80 years or older.

Most fractures occur in women aged ≥80 years but competing mortality unrelated to fracture may limit the benefit of osteoporosis drug therapy for some women in late life. Our primary aim was to develop separate prediction models for non-spine fracture (NSF) and mortality before fracture to identify subsets of women with varying fracture versus mortality risks. Separate prediction models were developed for NSF and mortality before NSF for 4895 women aged ≥80 years enrolled in the Study of Osteoporotic Fractures (SOF) or the Health Aging and Body Composition (HABC) study. Proportional hazards models modified to account for competing mortality were used to identify candidate risk factors for each outcome. Predictors associated with NSF or mortality (p < 0.2) were included in separate competing risk models to estimate the cumulative incidence of NSF and mortality before NSF during 5 years of follow-up. This process was repeated to develop separate prediction models for hip fracture and mortality before hip fracture. Significant predictors of NSF (race, total hip BMD, grip strength, prior fracture, falls, and use of selective serotonin reuptake inhibitors, benzodiazepines, or oral/transdermal estrogen) differed from predictors of mortality before NSF (age, walking speed, multimorbidity, weight change, shrinking, smoking, self-rated health, dementia, and use of warfarin). Within nine subsets of women defined by tertiles of risk, 5-year outcomes varied from 28% NSF and 8% mortality in the high-risk NSF/low-risk mortality subset, to 9% NSF and 22% mortality in the low-risk NSF/high-risk mortality subset. Similar results were seen for predictors of hip fracture and mortality before hip fracture. Considerable variation in 5-year competing mortality risk is present among women in late life with similar 5-year NSF risk. Both fracture risk and life expectancy should inform shared clinical decision-making regarding initiation or continuation of osteoporosis drug therapy for women aged ≥80 years.

Ten-year experience of bone SBRT in breast cancer: analysis of predictive factors of effectiveness.

Data on the benefit of stereotactic body radiation therapy (SBRT) in patients with breast cancer (BC) and bone metastases remain limited. The purpose of this study is to report our 10-year experience of bone SBRT, analyzing toxicity and prognostic factors for local control (LC); progression-free survival, and overall survival (OS). We analyzed all spine and non-spine bone SBRT performed in patients with BC during the 2012-2022 period at our institution. Treatments carried out with ablative intent in stereotactic conditions with dose/fraction ≥ 5Gy in 5 or fewer sessions were considered. Demographic, treatment, and toxicity data were recorded according to CTCAEv4. Risk factors were assessed through univariate and multivariate analysis by Cox regression. 60 bone SBRT treatments were performed during the study period. 75% were spine SBRT and 25% were non-spine SBRT (median BED4Gy was 80 Gy4). The median age was 52.5years (34-79). The median tumor volume was 2.9 cm3 (0.5-39.4). The median follow-up was 32.4months (1.2-101.7). 1 and 2years LC were 92.9 and 86.6%, respectively. 1 and 2years OS were 100 and 90.6%, respectively. Multivariate analysis (MVA) associated volume of the treated lesion ≥ 13 cm3 with worse LC (p = 0.046; HR 12.1, 95%CI = 1.1-140.3). In addition, deferring SBRT > 3months after lesion diagnosis to prioritize systemic treatment showed a significant benefit, improving the 2years LC up to 96.8% vs. 67.5% for SBRT performed before this period (p = 0.031; HR 0.1, 95%CI = 0.01-0.8). Hormonal receptors, the total number of metastases, and CA15-3 value were significantly associated with OS in MVA. During follow-up, three non-spine fractures (5%) were observed. According to our data, bone SBRT is a safe and effective technique for BC. Upfront systemic treatment before SBRT offers a benefit in LC. Therefore, SBRT should be considered after prior systemic treatment in this population.

Epidemiology of ballistic fractures in the United States: A 20-year analysis of the Firearm Injury Surveillance Study

IntroductionBallistic (i.e., gunshot-induced) fractures present unique treatment challenges and can be associated with high rates of complications and considerable morbidity. Large-scale epidemiologic data on these types of fractures are scarce. There is concern that gun-related violence may be on the rise, potentially increasing the burden of ballistic orthopaedic trauma, but there are few contemporary studies on the topic. The aim of this study, therefore, was to investigate the incidence and demographics of patients with ballistic fractures in the United States (US) over the last 20 years. Materials and MethodsThis descriptive epidemiology study retrospectively analyzed the Firearm Injury Surveillance Study to identify cases of ballistic fractures in the US from 2000 to 2019. Overall and annual numbers of fractures and fracture incidence rates (IRs), patient demographics, incident characteristics, and temporal trends were analyzed. Patients of all ages were included. Ballistic fractures were grouped by anatomic location for comparisons (non-spine axial, spine, upper extremity, lower extremity). ResultsAn estimated N = 240,555 patients (n = 8,322 unweighted cases) sustained ballistic fractures over the 20-year study period for an overall IR of 39.2 per 1,000,000 person-years at-risk (PYR). Overall, lower extremity fractures accounted for the largest percentage of cases (45.9%; IR=18.8 PYR), followed by upper extremity fractures (32.8%; IR=13.4 PYR), non-spine axial fractures (16.1%; IR=6.6 PYR), and spine fractures (5.2%; IR=2.1 PYR). Diaphyseal femur fractures were the most common ballistic fractures overall. Nearly three-fourths (71.2%) of all cases occurred in males in the second through fourth decades. The most common injury intent was assault (71.8%) and a majority of patients (71.2%) required hospital admission. Accounting for population growth yielded a significantly increasing incidence of all ballistic fractures over the study period from 15.7 PYR in 2000 to 96.8 PYR in 2019 (average annual percent change=10.3, p < 0.00001). ConclusionThese data suggest that the nationwide burden of ballistic fractures in the US has increased significantly in the last two decades. Ballistic fractures are associated with significant morbidity and societal cost, and increasing injury rates highlight the need for future research aimed at better understanding the ideal treatment of these types of fractures and their outcomes.

Geriatric fracture program centering age-friendly care associated with lower length of stay and lower direct costs.

To evaluate outcomes associated with an integrated inpatient and outpatient program aimed at optimizing the care of geriatric fracture patients in a mixed community and academic health system setting. This study took place at a tertiary-care, 886-bed hospital system. The Geriatric Fracture Program (GFP) was designed in 2018 using the 4Ms Framework (What Matters, Medication, Mentation, and Mobility). Patients ≥65 years old with non-spine fractures managed by orthopedic faculty surgeons and participating hospitalist groups were included. A fracture liaison team educated patients regarding bone health and ensured ambulatory geriatrics follow-up. Outpatient geriatric visits focused on mobility, fall risk, bone health imaging, and medications. We compared GFP-enrolled patients (n=746) to patients seen by non-GFP-participating physicians (n=852) and used a generalized estimating equations approach and Poisson models to analyze associations between participation in the GFP program and four inpatient outcomes (time to surgery, length of stay, Vizient length of stay index, and total direct costs). We examined outcomes across all fractures and also stratified them by fracture type (hip vs. non-hip). We descriptively examined post-discharge care outcomes: fall, gait, and balance assessments; bone health imaging; and medications. We collected data through chart reviews/electronic health record extracts from July 2018 to June 2021. GFP-enrolled patients with all fracture types had a significantly lower length of stay (marginal effect [ME]: -2.12, 95%CI: -2.61, -1.63), length of stay index (ME: -0.33, 95%CI: -0.42, -0.25), and total direct costs (ME: -$5316, 95%CI: -$6806, -$3826); the magnitude of the effects was greater for non-hip fractures. There was no significant difference in time to surgery. Of 746 GFP patients, 170 (23%) had a post-discharge visit with a participating geriatrician ≥6months. A systematic approach to improving care for older adults with fractures improved length of stay and total direct costs.

Recent fall and high imminent risk of fracture in older men and women.

despite fall history being a well-known risk factor for falls and fractures, the association between very recent falls and imminent fracture risk is not clearly elucidated. to study the very recent (<4months) fall-related absolute risk of fractures in the following year. two large prospective cohort studies of women (Study of Osteoporotic Fractures [SOF]) and men (Osteoporotic Fractures in Men Study [MrOS]) aged 65years or older were included. Data on falls were collected every 4months, and the primary outcomes were any non-spine and hip fractures in the next 12months. a total of 9,704 women contributed 419,149, and 5,994 men contributed 223,885 four-monthly periods of observations during the 14.8-year SOF and 12.6-year MrOS follow-up. Falls within 4months indicated a high risk of non-spine and hip fractures in the following year for both sexes; in women, a recent fall indicated an 8.1% absolute risk of a non-spine fracture within 1year, a 2.5-fold higher risk than that in women without falls, a 2.5% absolute risk of hip fracture, and a 3.1-fold increased risk. Falls increased the risk of fractures regardless of whether a fracture occurred or not. Men had similar risk patterns, albeit with a lower absolute risk of fracture. in older people, a fall within 4months indicates a high risk of fracture in the next year, regardless of fracture occurrence. A recent fall warrants urgent evaluation and consideration of treatments to reduce the imminent risk of fractures.

Benefits and Harms of Deprescribing Antihyperglycemics for Adults With Type 2 Diabetes: A Systematic Review

ObjectivesContemporary guidelines suggest relaxed glycemic targets in populations with type 2 diabetes mellitus (T2DM) at risk of hypoglycemia, including people with multimorbidity, limited life expectancy or frailty. However, overtreatment remains commonplace. To inform safe deprescribing, a previous systematic review investigated the benefits and harms of deprescribing antihyperglycemics, but identified only limited, very low-quality evidence. We sought to update that review and identify and describe newly published literature on the effects of deprescribing antihyperglycemics in older adults with T2DM. MethodsWe searched MEDLINE, EMBASE and the Cochrane Library (July 2015 to January 2021) for controlled studies published in English addressing the effects of deprescribing vs continuing antihyperglycemics in adults with T2DM. Two independent reviewers performed title, abstract and full-text screening, data extraction and risk-of-bias assessment. Cochrane’s risk-of-bias tools, RoB 2 and ROBINS-I, were used. The findings were summarized narratively. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used to evaluate the evidence. ResultsWe identified 4 additional investigations—2 randomized controlled trials and 2 retrospective cohort studies. After deprescribing, 3 studies reported no clinically significant changes in glucose management and 2 studies reported reductions in adverse events (e.g. hypoglycemia, all-cause mortality and nonspine fractures). However, based on GRADE assessment, we found very low certainty of the evidence due to concerns of risk of bias (e.g. unmeasured confounding), imprecision, and indirectness. ConclusionsDeprescribing antihyperglycemic medications in older adults with T2DM is likely feasible and safe, and benefits may outweigh the harms. However, the evidence indicates very low certainty. Additional deprescribing studies are needed with rigorous methodologies and reporting.

A single-center experience on the management of pediatric blunt aortic injury

ObjectiveBlunt abdominal aortic injury in children is a rare clinical entity with which most vascular surgeons have minimal experience. The evidence for management recommendations is limited. We have reported a single institution’s experience in the care of pediatric abdominal aortic injuries. MethodsWe performed a retrospective review of consecutive pediatric patients who had been diagnosed with blunt traumatic abdominal aortic injury at our institution from 2008 to 2019. ResultsA total of 16 pediatric patients (50% male) were identified. They ranged in age from 4 to 17 years. All had been involved in motor vehicle collisions and had been restrained passengers with a seatbelt in use. Five patients (31%) were hypotensive en route or on arrival. Seven patients (44%) had been transferred from another hospital. The median injury severity score was 34 (interquartile range, 19-35). The infrarenal aortic injuries were stratified using the aortic injury grading classification (five, two, seven, and two with grade 1, 2, 3, and 4, respectively). Concurrent nonaortic injuries included solid organ (63%; n = 10), hollow viscus (88%; n = 14), brain (25%; n = 4), hemothorax or pneumothorax (25%; n = 4), spine fractures (81%; n = 13), and nonspine fractures (75%; n = 12). Of the 16 patients, 9 (56%) had required aortic repair. Three had required immediate revascularization for distal ischemia. The remaining six patients (38%) had undergone delayed repair, with a median interval to repair of 52 days (range, 2-916 days). One half of the delayed repairs were performed during the index hospitalization. On repeat axial imaging, the three patients who had undergone delayed repair were found to have enlarging pseudoaneurysms or flow-limiting dissections and had subsequently undergone repair during the index hospitalization. Only one patient had undergone endovascular repair. No deaths occurred, and the median follow-up was 7 months (interquartile range, 3-28 months) for our study population. All postoperative patients demonstrated stable imaging findings without requiring further intervention. Seven patients, whose injury grades had ranged from 1 to 3, were observed. Their repeat imaging studies demonstrated either stability or resolution of their aortic injury. However, one half of the patients had been lost to follow-up after discharge or after their first postoperative clinic visit. ConclusionsDelayed aortic intervention can be safely performed for most pediatric patients with blunt abdominal aortic injuries with preserved distal perfusion to the lower extremities. This finding suggests that transfer to a tertiary center with vascular expertise is a safe and feasible management strategy. However, the progression of aortic injuries was seen as early as within 48 hours and as late as 30 months after injury, underscoring the importance of long-term surveillance. However, in our cohort, 50% of the children were lost to follow-up, highlighting the need for a more structured surveillance strategy.

Association of green space with bone mineral density change and incident fracture in elderly Hong Kong Chinese: Mr. OS and Ms. OS study

BackgroundA large body of literature has reported positive effects of green space (GS) on various aspects of health and well-being, while no studies explore the role of GS in bone health. ObjectivesThe present study aimed to investigate the associations of GS with bone mineral density (BMD) change and incident fracture in a prospective cohort of elderly Hong Kong Chinese. MethodsBetween 2001 and 2003, 3944 participants aged 65 years and older at baseline were recruited. GS (%) within 300-m and 500-m buffers were calculated for each participant based on the Normalized Difference Vegetation Index. BMD at whole body, lumbar spine, total hip, and femoral neck were assessed by dual energy X-ray absorptiometry at baseline and 3 follow-ups. Incident fracture cases were ascertained from the electronic database of Hospital Authority of Hong Kong. Linear mixed-effects models and Cox proportional hazards models were used to investigate the associations of GS with changes in BMD and incident fracture, respectively. ResultsGreater GS within 300-m and 500-m buffers were associated with a slower increase in lumbar spine BMD over 14 years. After adjustment for potential confounders, β and 95% confidence intervals (CIs) of change in BMD across Q2-Q4 (quartiles of GS measured in a 300-m, compared with Q1) were −6.42 (−12.3, −0.59), −7.78 (−13.6, −1.97), and −7.83 (−13.7, −2.00) mg/cm3, respectively. GS was also positively associated with non-spinal fracture and major osteoporotic fracture incidence risks. Multivariable-adjusted hazard ratios (95%CIs) were 1.40 (1.09, 1.79; P-trend = 0.036) for non-spinal fracture and 1.53 (1.13, 2.07; P-trend = 0.010) for major osteoporotic fracture (Q4 compared with Q1 of GS measured in a 300-m buffer). Positive GS-fracture associations were also found for GS within a 500-m buffer. ConclusionsWe found that those who lived near higher GS levels had a slower increase in lumbar spine BMD and had higher incident fracture risk.

Risk Factors for Refracture following Primary Osteoporotic Vertebral Compression Fractures

In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the most common type of osteoporotic fractures and patients are at risk of secondary vertebral compression fracture. To identify risk factors for secondary vertebral compression fracture following primary osteoporotic vertebral compression fractures. Retrospective study. Department of Orthopedic, an affiliated hospital of a medical university. This retrospective cohort study evaluated the risk factors for secondary vertebral compression fracture in 317 consecutive patients with systematic osteoporotic vertebral compression fractures who received percutaneous vertebroplasty and kyphoplasty or conservative treatment. Patients were divided into secondary vertebral compression fracture (n = 43) and non- secondary vertebral compression fracture (n = 274) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including gender, age, body mass index, number of primary fractures, primary treatment (percutaneous vertebroplasty and kyphoplasty or conservative treatment), nonspinal fracture history before primary fracture, primary fracture at the thoracolumbar junction, steroid use, bisphosphonate therapy, and Hounsfield units value of L1. Comparison between the groups showed significant differences in age (P = 0.001), nonspinal fracture history (P < 0.001), and Hounsfield units value of L1 (P < 0.001). The receiver operating characteristic curves demonstrated that the optimal thresholds for age and Hounsfield units value of L1 were 75 (sensitivity: 55.8%; specificity: 67.5%) and 50 (sensitivity: 88.3%; specificity: 67.4%), respectively. In multivariate logistic regression analysis, nonspinal fracture history (OR = 6.639, 95% CI = 1.809 - 24.371, P = 0.004) and Hounsfield units value of L1 < 50 (OR = 15.260, 95% CI = 6.957 - 33.473, P < 0.001) were independent risk factors for secondary vertebral compression fracture. The main limitation is the retrospective nature of this study. Patients with low Hounsfield units value of L1 or non-spinal fracture history are an important population to target for secondary fracture prevention.

Bisphosphonate Drug Holidays in Primary Care: When and What to Do Next?

This review describes the rational for bisphosphonate holidays, summaries key evidence to support the concept, and provides a roadmap to help clinicians initiate, monitor, and discontinue a bisphosphonate drug holiday. Randomized trials and data from large observational studies are available to determine the short and long-term bisphosphonate benefits (prevention of fracture) and harms (principally atypical femoral fractures and osteonecrosis of the jaw). Mounting evidence points towards a causal relationship between bisphosphonate use and AFF and ONJ, particularly with > 5years of use. Multiple studies now confirm the risk of AFF falls rapidly after BPs are discontinued. Osteoporosis patients without previous hip, vertebral, or multiple non-spine fractures who are successfully treated with oral bisphosphonates for 5years (3years if intravenous), should be offered a 3-5year drug holiday, particularly if hip BMD T-score is > - 2.5. Bisphosphonates should only be continued beyond 10years (6years if parenteral) in patients at very high risk of fracture.

The significance of height loss in postmenopausal women. The results from GO Study.

The aim of the study was the assessment of clinical significance of height loss (HL) in female population. The study cohort was recruited from GO Study. Data from 1735 postmenopausal women aged over 55years (mean age 68.15±8.16years) were analysed. Data on clinical risk factors for osteoporosis and fractures were collected. Bone densitometry at hip was performed using a device Prodigy (GE, USA). Height was established using stadiometer and was compared with maximal height in early adulthood. The mean HL was 3.9±3.2cm. HL was significantly higher in women with fractures in comparison with those without fracture (4.9±3.6cm vs 3.4±2.8cm; P<.0001). HL increased with the number of fractures, and was 4.1±3.2cm, 5.3±3.5cm and 6.7±4.1cm in women with one, two and three or more fractures respectively. Women with spine fractures presented with HL higher in comparison with all the other subjects (6.3±4.0 vs 3.6±2.9cm, P<.0001) and women with all non-spine fractures (6.3±4.0 vs 4.0±3.0cm, P<.0001). In women with steroid use and falls, HL was significantly greater than in subjects without this factor. HL correlated significantly with age and BMI (positively) and current height (negatively). Mean T-score for FN BMD was -1.75±0.9 and correlate significantly with HL (r=-.21, P<.0001). For the HL threshold above 4cm, the fracture incidence was above 50%. Height loss value is a simple and very informative measure describing fracture risk and functional status in postmenopausal women. HL exceeding 4cm is related to fracture probability above 50%.

Association Between Muscle Mass Determined by D3 -Creatine Dilution and Incident Fractures in a Prospective Cohort Study of Older Men.

The relation between a novel measure of total skeletal muscle mass (assessed by D3 -creatine dilution [D3 Cr]) and incident fracture is unknown. In 1363 men (mean age 84.2 years), we determined D3 Cr muscle mass; Fracture Risk Assessment Tool (FRAX) 10-year probability of hip and major osteoporotic (hip, humerus, vertebral, forearm) fracture; and femoral neck bone mineral density (BMD) (by dual-energy X-ray absorptiometry [DXA]). Incident fractures were centrally adjudicated by review of radiology reports over 4.6 years. Correlations adjusted for weight and height were calculated between femoral neck BMD and D3 Cr muscle mass. Across quartiles of D3 Cr muscle mass/weight, proportional hazards models calculated hazard ratios (HRs) for any (n=180); nonspine (n=153); major osteoporotic fracture (n=85); and hip fracture (n=40) after adjustment for age, femoral neck BMD, recurrent fall history, and FRAX probability. Models were then adjusted to evaluate the mediating influence of physical performance (walking speed, chair stands, and grip strength). D3 Cr muscle mass was weakly correlated with femoral BMD (r=0.10, p < 0.001). Compared to men in the highest quartile, those in the lowest quartile of D3 Cr muscle mass/weight had an increased risk of any clinical fracture (HR 1.8; 95% confidence interval [CI], 1.1-2.8); nonspine fracture (HR 1.8; 95% CI, 1.1-3.0), major osteoporotic fracture (HR 2.3; 95% CI, 1.2-4.6), and hip fracture (HR 5.9; 95% CI, 1.6-21.1). Results were attenuated after adjustment for physical performance, but associations remained borderline significant for hip and major osteoporotic fractures (p ≥ 0.05 to 0.10). Low D3 Cr muscle mass/weight is associated with a markedly high risk of hip and potentially other fractures in older men; this association is partially mediated by physical performance. © 2022 American Society for Bone and Mineral Research (ASBMR).

Associations Between Sedentary Behaviors And Visceral Adiposity On Bone Mineral Density In Women

American society has become increasingly sedentary putting this population at higher risks of developing chronic disease such as osteoporosis. One potential link between sedentary behaviors and risk of chronic disease progression is obesity. Studies comparing fracture incidence in obese and non-obese women have demonstrated that obesity is associated with increased risk of fracture at some skeletal sites but seems to be protective at others. Researchers have suggested that certain types of obesity may be a strong predictor of risk of osteoporosis-related non-spine fractures. PURPOSE: The purpose of this study is to examine the relationships between physical activity levels (PA), obesity and bone mineral density (BMD) in adult sedentary women. METHODS: Twenty-three women, aged 45-65, were instructed to wear an accelerometer for one week, and participate in a Dual energy X-ray absorptiometry (DXA) scan for determining BMD of the whole body (WBBMD), lumbar spine (L1-L4), femoral neck (FN) and forearm as well as body fat mass and lean mass. Participants were divided based on obesity status into two groups, high and low BMI. A one-way ANOVA analysis was used to detect differences in BMD and PA levels by group. Multiple linear regression was used to analyze the effect of PA measures and body composition on BMD. RESULTS: Light PA decreased whole body BMD (WBBMD) (β= -13.5, p=.012) while body fat percentage (BF%) and fat free mass (FFM) increased it (β=1754.7, p=.041 and β=3.558, p=.001). Light PA, BF% and FFM all yielded a higher L1-L4 lumbar spine BMD (β=-.003, p=.05, β=0.641, p=.037 and β=.001, p=.017, respectively). The higher the total amount and the longer the length of sedentary bouts increased arm BMD (β=.052, p=.038 and β=.016, p=.000). In addition, greater MET values yielded higher forearm BMD (β=6.085, p=.020). CONCLUSIONS: These results demonstrate that PA levels and fat mass have a significant effect on sedentary adult women’s bone density levels. Further investigation of causal mechanisms underlying these associations is warranted.

The Analysis for Anemia Increasing Fracture Risk.

BackgroundFractures are a major public health problem for elderly people throughout the world. Anemia is also a common, important health problem among elderly populations. The aim of this article was to estimate the association between anemia and fracture incidence via a systematic review and meta-analysis.Material/MethodsThe participant, intervention, observation, and study design (PICOS) reporting guidelines were followed, and databases were searched from their inception to May 2020 to identify relevant studies. When heterogeneity was significant, and a random-effects model was used. Subgroup analysis was conducted to explore the source of heterogeneity based on sex, study design, and region.ResultWe found that anemia significantly increased fracture risk [relative risk (RR)=1.26, 95% confidence interval (CI)=1.14–1.39, P<0.001], specifically, hip fracture (RR=1.44, 95% CI=1.29–1.61), spine fracture (RR=1.15, 95% CI=1.08–1.23), and nonspine fracture (RR=1.42, 95% CI=1.33–1.52). Males with anemia had a 1.51-fold higher fracture risk, females had a 1.09-fold higher fracture risk. And the association was stronger in Asian (RR=1.22, 95% CI=1.07–1.40), but not in American and European study populations.ConclusionsIn conclusion, a significantly increased fracture risk was observed, and anemia can be a predictor of fracture risk.

Uptrend of cervical and sacral fractures underlie increase in spinal fractures in the elderly, 2003-2017: analysis of a state-wide population database.

Traumatic spinal injuries can be life-threatening conditions. Despite numerous epidemiological studies, reports on specific spinal regions affected are lacking. We hypothesized that fractures at specific regions, such as the cervical spine (including the axis segment), have been affected to a greater degree. We also hypothesized that advanced age may be a significant contributing factor. To longitudinally analyze trend of spine fractures and specific fracture subtypes. Longitudinal trend analysis of discharged patient state database. Discharged patient's data from 15years (2003-2017) METHODS: We retrieved pertinent ICD-9 and 10 codes depicting fractures involving the entire spine and specific subtypes. To assess possible association with age, we analyzed the trend of the average age in patients discharged with and without spinal fractures as well as in specific fracture subtypes. Similar analysis was performed for other common fragility fractures. FDA device/drug status: The manuscript submitted does not contain information about medical device(s) or drug(s). We found that within 15years, the overall proportion of spinal fractures has increased by 64% (from 0.47 to 0.77% of all discharged patients) with the greatest increase noted in fractures of the cervical spine (123%) and specifically of the second cervical vertebra (84%). Age was found to have increased more in patients with spinal fractures than in the general discharged population. Surprisingly, other non-spinal fractures among patients above 60 remained relatively stable, demonstrating a spine-specific effect. Our findings confirm a recent increase in all spinal fractures and in the cervical and sacral regions in particular. Advanced age may be an important underlying factor.

Association of air pollution with osteoporotic fracture risk among women over 50years of age.

Air particulate matter (PM) is an environmental exposure associated with oxidation and inflammation. Whether particulate matter is associated with risk of osteoporotic bone fracture is unclear. We investigated the association between exposure to PM and risk of bone fractures. We collected data of 44,602 participants living in three metropolitan cities in Republic of Korea from National Health Insurance Service database. We examined the association of 2year averaged concentrations of PM and osteoporotic fracture over 4years. Exposure to 2-year averaged air pollution [PM2.5 (< 2.5μm in aerodynamic diameter), PM10 [< 10μm in aerodynamic diameter], PM coarse (PM ranging from 2.5μm to 10μm)] concentrations were estimated from 2008 to 2009 in Air Korea data. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for osteoporotic fractures were calculated using the multivariate Cox proportional hazards model. After adjusting for age, household income, and Charlson Comorbidity Index, PM 2.5 in one pollutant model increased the risk of osteoporotic fractures, compared to the first quartile group (4th quartile group aHR = 1.13, 95% CI 1.02-1.24). Also, PM 2.5 increased the risk of spine and non-spine fractures compared to the first quartile group (4th quartile group aHR = 1.17, 95% CI 1.00-1.38, aHR = 1.16, 95% CI 1.01-1.33). We found no association between PM10/PM coarse and osteoporotic fractures. We found that PM2.5 is a risk factor for osteoporotic bone fractures.

A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network

SummaryThe International Osteoporosis Foundation (IOF) Capture the Fracture® Campaign with the Fragility Fracture Network (FFN) and National Osteoporosis Foundation (NOF) has developed eleven patient-level key performance indicators (KPIs) for fracture liaison services (FLSs) to guide quality improvement.IntroductionFracture Liaison Services (FLSs) are recommended worldwide to reduce fracture risk after a sentinel fracture. Given not every FLS is automatically effective, the IOF Capture the Fracture working group has developed and implemented the Best Practice Framework to assess the organisational components of an FLS. We have now developed a complimentary KPI set that extends this assessment of performance to the patient level.MethodsThe Capture the Fracture working group in collaboration with the Fragility Fracture Network Secondary Fragility Fracture Special Interest Group and National Osteoporosis Foundation adapted existing metrics from the UK-based Fracture Liaison Service Database Audit to develop a patient-level KPI set for FLSs.ResultsEleven KPIs were selected. The proportion of patients: with non-spinal fractures; with spine fractures (detected clinically and radiologically); assessed for fracture risk within 12 weeks of sentinel fracture; having DXA assessment within 12 weeks of sentinel fracture; having falls risk assessment; recommended anti-osteoporosis medication; commenced of strength and balance exercise intervention within 16 weeks of sentinel fracture; monitored within 16 weeks of sentinel fracture; started anti-osteoporosis medication within 16 weeks of sentinel fracture; prescribed anti-osteoporosis medication 52 weeks after sentinel fracture. The final KPI measures data completeness for each of the other KPIs. For these indicators, levels of achievement were set at the < 50%, 50–80% and > 80% levels except for treatment recommendation where a level of 50% was used.ConclusionThis KPI set compliments the existing Best Practice Framework to support FLSs to examine their own performance using patient-level data. By using this KPI set for local quality improvement cycles, FLSs will be able to efficiently realise the full potential of secondary fracture prevention and improved clinical outcomes for their local populations.

Severe Phenotype of APECED (APS1) Increases Risk for Structural Bone Alterations.

Objective: Immunological abnormalities, the resulting endocrinopathies and their treatments may impact bone health in patients with autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy (APECED, APS1). The aim of the present study was to describe skeletal characteristics in patients with APECED and the prevalence and risk factors of compromised bone health.Patients and methods: We performed a cross-sectional study on 44 patients (27 females) with APECED and 82 age-, gender- and ethnicity-matched control subjects (54 females). We determined the prevalence of osteoporosis by dual-energy X-ray absorptiometry and skeletal characteristics by peripheral quantitative computed tomography at radius and tibia.Results: Patients were examined at the median age of 37.8 years (range, 7.0–70.1). Dual-energy X-ray absorptiometry indicated osteoporosis in four adult patients (9%); radiographs showed vertebral fractures in three patients. The prevalence of multiple non-spinal fractures was higher in patients than in controls. On peripheral quantitative computed tomography, bone characteristics at distal and proximal radius did not differ between the groups. At distal tibia, patients had lower total (p = 0.009) and trabecular (p = 0.033) volumetric bone mineral density. At the proximal tibia, patients had lower cortical thickness (p < 0.001) than controls. Severity of APECED phenotype influenced both radial and tibial characteristics: cortical thickness and total and trabecular volumetric bone mineral density were lower in patients with ≥7 disease manifestations as compared with more mildly affected patients, whose values were similar to controls.Conclusions: APECED associated with bone structural alterations, especially in patients with a high number of disease manifestations. This may increase the risk of fractures with aging, but symptomatic osteoporosis was rare.

Blunt chest trauma in the elderly: an expert practice review

Trauma in the elderly (>65 years) is an increasingly common presentation to the ED. A fall from standing height is the most common mechanism after which such patients present, and...