Non-fracture Group Research Articles

Analysis of the bone microRNome in osteoporotic fractures.

Osteoporosis causes important morbidity among elderly individuals. Fragility fractures, and especially hip fractures, have a particularly negative impact on the patients' quality of life. The role of epigenetic mechanisms in the pathogenesis of many disorders is increasingly recognized, yet little is known about their role in non-malignant bone disorders such as osteoporosis. The aim of this study was to explore the expression of miRNAs in patients with osteoporotic hip fractures. Trabecular bone samples were obtained from the femoral heads of patients undergoing replacement surgery for osteoporotic hip fractures and non-fracture controls with hip osteoarthritis. Levels of 760 miRNA were analyzed by real-time PCR. Thirteen miRNAs showed nominally significant (p<0.05) differences between both groups. Six miRNAs (miR-187, miR-193a-3p, miR-214, miR518f, miR-636, and miR-210) were selected for the replication stage. These miRNAs were individually analyzed in a larger group of 38 bone samples. At this stage, we confirmed statistically significant differences across groups for mir-187 and miR-518f. The median relative expression levels of miR-187 were 5.3-fold higher in the non-fracture group (p=0.002). On the contrary, miR-518f was preferentially expressed in bones from osteoporotic patients (8.6-fold higher in fractures; p=0.046). In this first hypothesis-free study of the bone microRNome we found two miRNAs, miR-187, and miR-518f, differentially regulated in osteoporotic bone. Further studies are needed to elucidate the mechanisms involved in the association of these miRNAs with fractures.

Relationship between sagittal spinal alignment and the incidence of vertebral fracture in menopausal women with osteoporosis: a multicenter longitudinal follow-up study.

To investigate the relationship between sagittal spinal alignment and the incidence of vertebral fracture in patients with osteoporosis. A cohort of 1,044 postmenopausal women with osteoporosis were prospectively observed for the incidence of lumbar vertebral fracture. Baseline characteristics of the subjects were recorded, including age, year post-menopause, body height and weight, lumbar spine BMD (LSBMD) and femoral neck BMD (FNBMD). Patients with radiologically diagnosed lumbar vertebral fractures were assigned to the fracture group, and 150 randomly selected participants were assigned to the non-fracture group. Parameters depicting sagittal spinal alignment, including sacral slope (SS), pelvic tilt, pelvic incidence (PI), thoracic kyphpsis, lumbar lordosis (LL), lumbar lordosis index (LLI) and sagittal vertical axis, were measured for both groups. Comparison between the two groups was carried out by Student's t test. Variables showing significant differences were entered into a logistic regression analysis to determine the independent risk factors. Patients with fracture events had significantly lower LSBMD as well as a significantly longer year post-menopause. Besides, patients with vertebral fracture were found to have significantly lower LL, LLI, SS and PI. Regression analysis showed that LSBMD (OR = 0.27), LL (OR = 0.3), LLI (OR = 0.43) and PI (OR = 0.67) had significant associations with the risk of vertebral fracture. Osteoporosis patients with low LL, LLI, and PI could be at high risk of lumbar vertebral fracture. In addition to BMD, the abnormal sagittal spinal profile should also be taken into consideration when predicting the incidence of vertebral fracture in such patients.

Fracture history in osteoporosis: risk factors and its effect on quality of life.

Fractures are one of the main outcomes in osteoporosis and have an important effect on the general health status. The purpose of this study was to determine the effect of major fracture history on quality of life. We also investigated the important risk factors and their effect on bone mineral density and fracture history. Cross-sectional study. We recruited 105 patients who were admitted to an osteoporosis outpatient clinic. Medical history, family history, calcium intake, physical activity level and biochemical tests were evaluated. Lumbar spine and femur neck bone mineral density were measured. The Qualeffo-41 questionnaire was also used for evaluating quality of life. The average age of the 105 patients included in the study was 56.04±13.73 and 89% of them were post-menopausal women. The average body mass index was 26.84±5.99, which means that the women were overweight. Also, 48.5% of the patients were diagnosed with osteoporosis and 51.5% of them were diagnosed as low bone density. A total of 34 patients had a fracture history with minor trauma and some of the patients had more than one fracture (12 ankle and foot, 10 forearm, 9 vertebral, 4 hand, 3 hip, 2 rib, 1 tibial). When the patients with and without fracture history were compared, the mean Qualeffo-41 score in patients with fracture was 43.85±2.57 and in the non-fracture group was 36.27±2.01. Forearm, ankle and foot fractures can be commonly seen in osteoporosis patients with fracture history. We suggest that it is important to recognise osteoporosis prior to first fracture and disease-specific quality of life assessment should be done.

External validation of the Garvan nomograms for predicting absolute fracture risk: the Tromsø study.

BackgroundAbsolute risk estimation is a preferred approach for assessing fracture risk and treatment decision making. This study aimed to evaluate and validate the predictive performance of the Garvan Fracture Risk Calculator in a Norwegian cohort.MethodsThe analysis included 1637 women and 1355 aged 60+ years from the Tromsø study. All incident fragility fractures between 2001 and 2009 were registered. The predicted probabilities of non-vertebral osteoporotic and hip fractures were determined using models with and without BMD. The discrimination and calibration of the models were assessed. Reclassification analysis was used to compare the models performance.ResultsThe incidence of osteoporotic and hip fracture was 31.5 and 8.6 per 1000 population in women, respectively; in men the corresponding incidence was 12.2 and 5.1. The predicted 5-year and 10-year probability of fractures was consistently higher in the fracture group than the non-fracture group for all models. The 10-year predicted probabilities of hip fracture in those with fracture was 2.8 (women) to 3.1 times (men) higher than those without fracture. There was a close agreement between predicted and observed risk in both sexes and up to the fifth quintile. Among those in the highest quintile of risk, the models over-estimated the risk of fracture. Models with BMD performed better than models with body weight in correct classification of risk in individuals with and without fracture. The overall net decrease in reclassification of the model with weight compared to the model with BMD was 10.6% (p = 0.008) in women and 17.2% (p = 0.001) in men for osteoporotic fractures, and 13.3% (p = 0.07) in women and 17.5% (p = 0.09) in men for hip fracture.ConclusionsThe Garvan Fracture Risk Calculator is valid and clinically useful in identifying individuals at high risk of fracture. The models with BMD performed better than those with body weight in fracture risk prediction.

Experience with sandwich liner and its high rate of failure.

Composite ceramic with polyethylene backing was introduced to enhance the quality of ceramic articulation, but the liner's high rate of ceramic fracture has brought serious concern. In this study, the authors investigated the failure rate of sandwich liner in long-term follow-up patients at single institution. In this series, we retrospectively reviewed 134 patients (143 hips), and six patients (6.2%) were found to have liner fracture. They were compared to nonfracture patients to identify the associating factors. General patient characteristics were obtained through review of charts. All patients were implanted with SPH Contact acetabular cup and sandwich liner. Function (Harris hip score) and activity (Devane score) were recorded preoperatively and at final follow-up. Radiologically, inclination and abduction angles were measured for comparison. The study did not show any statistical differences between fracture and nonfracture groups in age, weight or body mass index. Side, type of stem used and radiologic parameters were not also significantly different. The operation had significantly improved function and activity postoperatively in both groups, but no statistical significance was noted between the two groups exception to preoperative Harris hip score. On inspection, retrieved ceramic heads and liners showed substantial metal transfer on their surfaces, and linear wears were evident on the ceramic heads. Compared to other studies, our series also experienced high rate of sandwich liner fracture. Though its use was generally discontinued, it is worrisome to note that failure rate of the liner will substantially increase over time.

FRI0199 Does Lower Bone Mineral Density in A Single Hip PREDICT Fracture Better than Average Bone Mineral Density across Both Hips?

BackgroundLow BMD taken from a single non-dominant hip is typically used to predict fracture; especially in FRAX. However, the average BMD from both hips could be used to predict fracture....

Incidence of fractures after cardiac and lung transplantation: a single center experience.

Osteoporotic fractures are well-known complications of organ transplantation. Fracture rates up to 35% have been previously reported following heart and lung transplantations. Our institutional pretransplant protocols include DXA scans, vitamin D screening, and appropriate antiresorptive therapy. We aimed to assess the incidence of fragility fractures following cardiac or lung transplantation. In a retrospective study 210 electronic medical records of patients who underwent LT (110 men, 100 women) and 105 HT (88 men, 17 women) between 2005 and 2010 were analyzed. Both clinical and radiographic fractures were recorded. DXA scans were obtained immediately after transplant. 17 out of 210 LT patients (8.0%) had fractures after transplantation and 9 out of 105 HT patients (8.6%) had fractures. The median time to the first fracture was 12 months and the mean time was 18 months for both LT and HT. In the HT recipients, the median femoral neck T score was statistically lower in the fracture group versus the nonfracture group. Similar results were seen in the LT patients. Conclusion. Our findings demonstrate a much lower incidence of fractures in heart and lung transplant recipients in comparison with earlier reports. Comprehensive bone care and early initiation of antiresorptive therapy are possible contributors to these improved outcomes.

Femoral Neck Fracture After Removal of the Compression Hip Screw From Healed Intertrochanteric Fractures

To evaluate the incidence of femoral neck fracture (FNF) after removal of a compression hip screw (CHS) without trauma and to determine the risk factors for this type of fracture. Retrospective study of consecutive patient series. University teaching hospital. Sixty-seven patients with a mean age of 65.3 years (45 women and 22 men). A total of 67 implants were removed in the presence of bony consolidation of the fracture site; most of them were due to hardware pain. The incidence of FNF after a CHS removal, clinical parameters (age, gender, bone mineral density, body mass index, and fracture stability), and radiologic parameters (the femoral neck-shaft angle, femoral neck width, distance between thread of lag screw, and neck cortex). Univariate analysis was performed for those parameters of the fracture group and the nonfracture group. To assess which variables were associated with FNF, a multiple logistic regression was used. Six (9.0%) FNFs occurred within 1 month after a CHS removal. The mean anterior and lateral neck widths were significantly smaller, and the mean anterior and inferior thread-to-cortex distances were significantly shorter in the fracture group compared with the nonfracture group. The risk factor significantly associated with FNF was the inferior thread-to-cortex distance (odds ratio, 0.462; 95% confidence interval, 0.217-0.988). CHS should not be removed routinely due to the risk of FNF. Furthermore, attention should be paid to at-risk patients with a hip screw positioned close to the inferior femoral neck cortex. Prognostic level II.

Vertebral deformities and fractures are associated with MRI and pQCT measures obtained at the distal tibia and radius of postmenopausal women.

We investigated the association of postmenopausal vertebral deformities and fractures with bone parameters derived from distal extremities using MRI and pQCT. Distal extremity measures showed variable degrees of association with vertebral deformities and fractures, highlighting the systemic nature of postmenopausal bone loss. Prevalent vertebral deformities and fractures are known to predict incident further fractures. However, the association of distal extremity measures and vertebral deformities in postmenopausal women has not been fully established. This study involved 98 postmenopausal women (age range 60-88 years, mean 70 years) with DXA BMD T-scores at either the hip or spine in the range of -1.5 to -3.5. Wedge, biconcavity, and crush deformities were computed on the basis of spine MRI. Vertebral fractures were assessed using Eastell's criterion. Distal tibia and radius stiffness was computed using MRI-based finite element analysis. BMD at the distal extremities were obtained using pQCT. Several distal extremity MRI and pQCT measures showed negative association with vertebral deformity on the basis of single parameter correlation (r up to 0.67) and two-parameter regression (r up to 0.76) models involving MRI stiffness and pQCT BMD. Subjects who had at least one prevalent vertebral fracture showed decreased MRI stiffness (up to 17.9 %) and pQCT density (up to 34.2 %) at the distal extremities compared to the non-fracture group. DXA lumbar spine BMD T-score was not associated with vertebral deformities. The association between vertebral deformities and distal extremity measures supports the notion of postmenopausal osteoporosis as a systemic phenomenon.

Of Fracture Thresholds and Bone Mineral Density Reference Data: Does One Size Really Fit All?

Men who fracture have greater mean bone mineral density (BMD) than women who fracture, and to some this suggests that BMD fracture “thresholds” are greater in men than women, justifying use of a male BMD reference standard. Others disagree and argue that because BMD distribution in men is right-shifted (higher) compared with women, anything that occurs with equal probability for men and women will occur at a greater mean BMD in men. If the latter is true, it supports using a common (female) BMD reference standard. We directly tested this latter principle and, indirectly, the validity of using a constant BMD reference standard, in 51,326 women (3722 major fractures) and 4691 men (276 fractures), by comparing mean BMD in fracture vs nonfracture groups defined by sex, age, race and body mass index because these 4 factors affect both mean BMD and risk of fractures. Among those who fractured, mean BMD for all measurement sites were significantly greater in men vs women, youngest vs oldest, whites vs Asian, and heaviest vs the lightest (all p < 0.001). However, the same BMD pattern was seen in those who did not fracture and the absolute difference in BMD between those who fractured and those who did not was essentially constant regardless of sex, age, race, or weight class (all p-interaction nonsignificant). This finding suggests that use of a common reference standard for BMD (i.e., young white women) for men, and indeed all subgroups defined by osteoporosis risk factors, is reasonable and consistent with empiric observations.

Radiographic bone texture analysis is correlated with 3D microarchitecture in the femoral head, and improves the estimation of the femoral neck fracture risk when combined with bone mineral density

PurposeFemoral neck fracture is a major public health problem in elderly persons, representing the main source of osteoporosis-related mortality and morbidity. In this study, we aimed at comparing radiographic texture analysis with three-dimensional (3D) microarchitecture in human femurs, and at evaluating whether bone texture analysis improved the assessment of the femoral neck fracture risk other than that obtainable by bone mineral density (BMD). Materials and methodsThirteen osteoporotic femoral heads from patients who fractured their femoral neck and twelve non-fractured femoral heads from osteoarthritic patients were studied using respectively (1) a new high-resolution digital X-ray device (BMA™, D3A Medical Systems) allowing for bone texture analysis with fractal parameter Hmean, and (2) a micro-computed tomograph (CT) for 3D microarchitecture. BMD was measured postoperatively by DXA in all patients in the contralateral femur. ResultsIn these femoral heads, we found that fractal parameter Hmean was correlated with 3D microarchitecture parameters: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular separation (Tb.Sp) and fractal dimension (FD) respectively (p<0.05). Then, fractal parameter Hmean was significantly lower in the femoral heads from the fractured group than from the non-fractured group (p<0.01). Finally, multiple regression analysis showed that combining bone texture analysis and total hip BMD significantly improved the estimation of the femoral neck fracture risk from adjusted r2=0.46 to adjusted r2=0.67 (p<0.05). ConclusionRadiographic bone texture analysis was correlated with 3D microarchitecture parameters in the femoral head, provided accurate discrimination between the femoral heads from the fractured and non-fractured groups, and significantly improved the estimation of the femoral neck fracture risk when combined with BMD.

THU0386 Hip Structural Analysis (HSA) and Prediction of Hip Fractures in Men

BackgroundIt is well documented that low bone mineral density is a predictor of hip fracture. 1 Hip structural analysis (HSA) is also useful for predicting fractures in women. 2,3 It...

SAT0344 Does proximal femur shape contribute to femoral neck fracture risk in osteoporotic individuals?

BackgroundHip Structural Analysis (HSA) has been used to investigate the relationship between proximal femoral neck shape and femoral neck fracture risk; studies have reported contrasting findings. Although previous work has...

New adjuvant chemotherapy combined with limb salvage for osteosarcoma combined with pathologic fracture

Objective To analyze the curative effect of neoadjuvant chemotherapy combined with limb salvage for osteosarcoma with pathologic fracture.Methods The cases were divided into combined group (68 cases of osteosarcoma with pathologic fracture who received limb salvage after neoadjuvant chemotherapy),non-chemotherapy group (22 cases of osteosarcoma with pathologic fracture who received operation without concurrent chemotherapy or chemotherapy only after operation),non-fracture group (48 cases of osteosarcoma without synchronous pathologic fracture who received limb salvage after neoadjuvant chemotherapy) and amputation group (32 cases of osteosarcoma combined with pathologic fracture who received amputation).Survival rate,local recurrence rate,metastasis rate and quality of life were compared between groups.Results Average estimated survival period of the combined group was obviously longer than that of the non-chemotherapy group (P ＜ 0.05),but had no significant difference from the non-fracture group or amputation group.Of the 5-year survival rate between groups,the combined group was evidently higher than the non-chemotherapy group (P ＜ 0.05),but without significant difference from the non-fracture group or amputation group.Whereas,non-chemotherapy group showed a lower 5-year survival rate than the amputation group or non-fracture group (P ＜ 0.05).Localized recurrence rate and metastasis rate of the combined group were markedly decreased when compared to the nonchemotherapy group (both P ＜ 0.01),but were not significantly different from the non-fracture group or the amputation group.The combined group showed a significantly higher score of social function than the amputation group (P ＜0.01),a significantly higher score of biological pofession than the non-chemotherapy group or the amputation group (P ＜ 0.05),and a significantly higher score of general health than the nonchemotherapy group (P ＜ 0.05).However,no significant differences were observed between groups regarding the scores for other items.Conclusion New adjuvant chemotherapy combined with limb salvage is a rational treatment of osteosarcoma with pathologic fracture for it saves the limb after the guarantee of survival rate without increasing the localized recurrence rate or metastasis rate,and improves quality of life. Key words: Fractures, spontaneous; Osteosarcoma; Antineoplastic combined chemotherapy protocols

Imaging reasons for periprosthetic femoral fractures during the operation of total hip arthroplasty with anatomic prosthesis

To explore the imaging reasons for periprosthetic femoral fractures during the operation of total hip arthroplasty with anatomic prosthesis. The fracture group consisted of 7 cases with periprosthetic femoral fracture (PPFF) and the non-fracture group 21 cases without PPFF during the operation of total hip arthroplasty (THA) among the 144 cases of primary THA with anatomic prosthesis. The preoperative plain films of hip joint were taken to calibrate the Sharp's angle, centre edge (CE) angle, femoral neck shaft angle, femoral anteversion angle of neck, bowing angle of proximal femoral shaft part, width of narrowest part in proximal femoral shaft. For each case, surgical details, age, height and weight were recorded. The results were analyzed with independent sample t test by software SPSS 17.0. No significant difference existed in general situation, Sharp's angle and CE's angle between two groups. And there were significant differences in femoral neck shaft angle (P = 0.040), femoral anteversion angle of neck (P = 0.026), bowing angle of proximal femoral shaft part (P = 0.024), width of narrowest part in proximal femoral shaft (P = 0.021). Dysplasia of proximal femur is a major cause of periprosthetic femoral fracture during the operation of total hip arthroplasty with anatomic prosthesis.

Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors

BackgroundAs stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated.MethodsBetween November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1–10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio.ResultsRib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy.ConclusionsRib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients.

Sacral Fracture After Instrumented Lumbosacral Fusion

Retrospective comparative study. To examine the incidence and characteristics of key spinopelvic parameters that are correlated with sacral fracture development after lumbosacral fusion. Sacral fracture is a possible complication of instrumented lumbosacral fusion and this has recently been documented in the literature. Preoperative awareness of risk factors concerning spinopelvic parameters and sacral fracture may aid in surgical planning to prevent its occurrence. All patients who underwent instrumented lumbosacral fusion from L2 or above, between 2010 and 2011 at Gakkentoshi Hospital, were included. A total of 116 patients (47 men and 69 women) were evaluated in this study. Average age at surgery was 71 years, and the average follow-up period was 19 months. The average number of fixed segments was 5, and the average time interval between index surgery and sacral fracture development was 42 days. Notably, sacral fractures were identified in 5 patients (4.3%), all of whom were women. We, therefore, compared the 2 groups of female patients (fracture group, n = 5 vs. nonfracture group, n = 64). The fracture group had a substantially higher mean pelvic incidence (PI) than the nonfracture group (72° ± 8° vs. 51° ± 12°, respectively, P < 0.01). The fracture group also had a larger postoperative lumbar lordosis (LL)-PI mismatch than the nonfracture group (-26° ± 7° vs. -7° ± 18°, respectively, P < 0.01). The current review of our patients informs appropriate preoperative planning in cases involving lumbosacral fusion for postmenopausal women with a high PI. Surgeons should plan to achieve large increases in LL to restore not only spinopelvic harmony but also to avoid postoperative sacral fracture. For such patients, because it is difficult to consistently achieve a sufficiently large LL, we recommend prophylactic iliosacral fixation to protect the sacrum. 4.

The Influence of Fat Infiltration of Back Extensor Muscles on Osteoporotic Vertebral Fractures

Study DesignRetrospective study.PurposeTo investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture.Overview of LiteratureIn persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial.MethodsTwo hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors.ResultsA negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%±14.5% and 64.2%±9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015).ConclusionsFat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.

Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk--a study in 5,420 women and 2,837 men.

ObjectivesTo assess whether digital X-ray radiogrammetry (DXR) analysis of standard clinical hand or wrist radiographs obtained at emergency hospitals can predict hip fracture risk.MethodsA total of 45,538 radiographs depicting the left hand were gathered from three emergency hospitals in Stockholm, Sweden. Radiographs with insufficiently included metacarpal bone, fractures in measurement regions, foreign material or unacceptable positioning were manually excluded. A total of 18,824 radiographs from 15,072 patients were analysed with DXR, yielding a calculated BMD equivalent (DXR-BMD). Patients were matched with the national death and inpatient registers. Inclusion criteria were age ≥ 40 years, no prior hip fracture and observation time > 7 days. Hip fractures were identified via ICD-10 codes. Age-adjusted hazard ratio per standard deviation (HR/SD) was calculated using Cox regression.Results8,257 patients (65.6 % female, 34.4 % male) met the inclusion criteria. One hundred twenty-two patients suffered a hip fracture after their radiograph. The fracture group had a significantly lower DXR-BMD than the non-fracture group when adjusted for age. The HR/SD for hip fracture was 2.52 and 2.08 in women and men respectively. The area under the curve was 0.89 in women and 0.84 in men.ConclusionsDXR analysis of wrist and hand radiographs obtained at emergency hospitals predicts hip fracture risk in women and men.Key Points• Digital X-ray radiogrammetry of emergency hand/wrist radiographs predicts hip fracture risk. • Digital X-ray radiogrammetry (DXR) predicts hip fracture risk in both women and men. • Osteoporosis can potentially be identified in patients with suspected wrist fractures. • DXR can potentially be used for selective osteoporosis screening.

Risk Factors for Ceramic Liner Fracture after Total Hip Arthroplasty

The aim of this study was to detect risk factors for ceramic liner fractures. 26 cementless ceramic on ceramic (COC) total hip arthroplasties (THA) revised because of ceramic liner fracture in 24 patients were compared with 49 well-functioning COC THA performed in 49 patients. Demographic parameters, type of ceramic of the liner, size and neck length of the femoral head, cup abduction angle, cup anteversion, femoral off-set, height of the centre of rotation and the incidence of noisy hips during follow-up examination were compared. A greater number of cups placed outside the optimal range of cup anteversion was found in the fracture group (p = 0.03). An audible noise was detected in 21 cases (80.7%) in the fracture group and in 3 cases (6.1%) in the non-fracture group (p = 0.001). A cup anteversion angle out of the optimal range of 15˚+/-10˚ was found to be a risk factor for ceramic liner fracture and the presence of a noisy hip frequently anticipated the failure. In our opinion neck-to-cup impingement with head subluxation and edge loading on the liner rim could have an important role in the onset of noise and subsequent liner failure, and cup malposition contributes to this mechanism of failure.