Osteoporotic Fractures Research Articles

Hands Up Program: Results of a feasibility study of a randomized controlled trial of a bone health exercise and education program for adults aged 50-65 post distal radius fracture.

Distal radius fractures (DRF) that occur from a fall from level ground are considered fragility fractures and may be the first indication that someone has compromised bone mineral density and is at risk of having osteoporosis. Women at about 50 years of age experience a dramatic increase risk of these fractures. Rehabilitation after DRF focuses on restoring range of motion and strength in the wrist, but rarely address future bone health concerns. We developed a 6-week therapist-developed remote full body exercise and osteoporosis/bone-health education program (called The Hands Up Program). This study was designed to evaluate the feasibility of a larger trial examining the effects of a whole-body exercise and education program for people 50-65 after a DRF. Community dwelling individuals between the age of 50-65 with a radiographically confirmed DRF were recruited from the Roth| McFarlane Hand and Upper Limb Center in London, Ontario. Participants were randomized in a 1:1 ratio into either the Hands Up Program which was a twice weekly exercise and education program for 6 weeks, or the control group where they proceeded with usual care. The intervention was delivered online through a website where participants created a unique username and password to access. The primary feasibility outcomes of the study were recruitment rate (74 participants in 1 year), retention rate (75% completion), and intervention adherence rate (60% of completion of the exercise program). Secondary outcomes included strength, range of motion, self-reported outcomes, and bone density. Overall, 74 participants were recruited in 14 months. Retention did not meet the criteria for success, as only 53% of the participants attended their 12-month visit. Adherence was also not met albeit close with 55% completing the exercise program. Twelve participants withdrew from the study, five due to the time commitment, four without explanation, one due to group allocation, one due to COVID and one participant moved. One participant was deemed ineligible after consent. Four of the participants that withdrew were in the intervention group, and four in the control group, five participants withdrew before they were allocated to a group. Feedback from patients indicated potential improvements to the program: lower assessment burden, spacing out the intervention so that the education portion could be delivered during the immobilization phase of recovery, and creating a more individualized program. Adherence and retention were both a challenge, although adherence was close to target. While achieving adherence to exercise in bone health is a known challenge, given the importance of prevention in the at-risk DRF population and the challenges in co-design and delivery during the pandemic, we believe evaluation of a revitalized program is warranted.

The impact of novel hormonal agents on fracture risk in prostate cancer patients: a nationwide population-based cohort study

Prostate cancer (PC) treatment, particularly androgen deprivation therapy (ADT), remains pivotal, albeit linked to increased fracture risk due to osteoporosis. The advent of novel hormonal agents (NHAs) has spurred inquiries into their influence on bone health. This study aimed to evaluate the impact of NHAs on bone health in patients receiving combination therapy. We conducted a retrospective analysis using Taiwan’s National Health Insurance Research Database, encompassing men aged 45 and above diagnosed with PC without bone metastasis and undergoing ADT between 2000 and 2018. The study involved 25,949 patients, categorized into those receiving standard ADT (n = 25,166) and those on NHA combination therapy (n = 783). Our analysis delved into fracture risk, comorbidities, and osteoporosis treatments. Patients on NHA combination therapy faced significantly higher risks of any osteoporotic fracture and major osteoporotic fracture than those on ADT alone (HR = 1.29, 95% CI 1.04–1.61; HR = 1.37, 95% CI 1.06–1.75, respectively). Notably, age emerged as a critical factor, with the highest risk observed in those aged 90 or above. The 5-year overall survival rates were lower for patients who experienced any osteoporotic fracture, major osteoporotic fracture, and hospitalization due to osteoporotic fracture compared to those who did not experience these fractures (51.5% vs. 56.5%, 47.1% vs. 56.7%, and 48.2% vs. 56.3%, respectively, p < 0.001). Furthermore, patients not using any bone-modifying agents had the highest risk for all fracture types. In conclusion, NHA combination therapy in PC patients potentially escalates the risk of osteoporotic fractures, especially in older individuals. Our findings underscore the pivotal role of osteoporosis treatments in preventing fractures, emphasizing the importance of evaluating fracture risk in patients undergoing NHA combination therapy.

Tibial Insufficiency Fracture with Characteristics of an Atypical Fracture: A Rare Case and Literature Review

Background and Objectives: Osteoporosis is becoming more prevalent with the rise in the aging population, leading to the increased use of bisphosphonates for treatment. While these medications are effective in preventing osteoporotic fractures, long-term use has been associated with atypical insufficiency fractures, primarily in the femur. However, atypical fractures in other weight-bearing bones, such as the tibia, have rarely been reported. This study aims to present a case of an atypical insufficiency fracture of the tibia in an elderly female who has been on long-term bisphosphonate therapy and to review treatment outcomes within the context of the current literature. Patient concerns: A 76-year-old female presented with pain in the proximal right tibia, developing two months prior without trauma. She had been receiving long-term bisphosphonate therapy for osteoporosis, initially taking sodium risedronate orally for 4 years, followed by intravenous ibandronate for 10 years. Physical examination revealed localized tenderness, and radiographs showed cortical thickening and a horizontal fracture line in the proximal right tibia. MRI confirmed these findings, along with surrounding edema. The laboratory results were mostly normal, but the bone formation marker osteocalcin was significantly reduced. The patient had a history of insufficiency fractures in the ipsilateral tibia and contralateral femur, previously treated conservatively with teriparatide. A similar conservative approach was attempted but failed, leading to surgical intervention with intramedullary nailing and supplementary plating. At the 8-month follow-up, the patient showed successful fracture union and resolution of symptoms. Conclusion: Long-term use of bisphosphonates, though effective for osteoporosis, can lead to atypical insufficiency fractures, primarily in the femur but also occasionally in the tibia. Clinicians should consider this possibility when patients present with pain in weight-bearing bones without a history of trauma. Prompt diagnosis through thorough history-taking, physical examination, and appropriate imaging is essential to ensure timely management.

Analysis of the Effect of Bone Cement Distribution Patterns on Surgical Outcomes of Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

Objective: To evaluate the impact of bone cement distribution patterns on the surgical outcomes of percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF). Methods: Sixty-four patients with OVCF treated at our hospital from January 2022 to December 2023 were included and divided into two groups based on bone cement distribution patterns: the clustered group and the diffuse group. Both groups underwent PVP. We compared the incidence of bone cement leakage, operative time, blood loss, changes in Visual Analog Scale (VAS) pain scores, and Oswestry Disability Index (ODI) scores before and after treatment between the two groups. Results: The number of cases with bone cement leakage was significantly higher in the diffuse group compared to the clustered group (P &lt; 0.05). There were no significant differences between the two groups in terms of volume of bone cement injected, intraoperative blood loss, or surgical time (P &gt; 0.05). Post-treatment, both VAS and ODI scores were lower than pre-treatment scores in both groups, with the diffuse group showing significantly lower scores than the clustered group (P &lt; 0.05). No postoperative adverse complications were observed in either group. Conclusion: PVP is highly effective for treating OVCF. A more uniform distribution of bone cement is associated with a greater reduction in postoperative pain and improved functional outcomes. However, careful attention is needed to prevent bone cement leakage.

General health and social outcomes 50 years after exposure to antenatal betamethasone: follow-up of a randomised controlled trial

BackgroundAntenatal corticosteroids are recommended for women at risk of preterm birth from 24 to 34 weeks’ gestation as they reduce neonatal morbidity and mortality, but evidence regarding their long-term effects on offspring is limited. This study assessed general health and social outcomes 50 years after antenatal exposure to corticosteroids.MethodsWe assessed 424 adult offspring of women who participated in the first randomised, double-blind, placebo-controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. The first 717 mothers received two intramuscular injections of betamethasone (6 mg betamethasone sodium phosphate and 6 mg betamethasone acetate) or placebo given 24 h apart and the subsequent 398 received two injections of double dose betamethasone (12 mg betamethasone sodium phosphate and 12 mg betamethasone acetate) or equivalent volume of placebo. Follow-up included a health questionnaire and consent for access to administrative data sources. Outcome categories included mental health (depression, anxiety, bipolar affective disorder, schizophrenia and treatment or hospital admission for any mental health disorder), general health (chronic kidney disease, cancer diagnosis, bone fracture, oral health, allergies, functional difficulties and physical activity) and social outcomes (educational attainment, employment and criminal convictions). Investigators remained blinded to treatment allocation. Analyses were adjusted for gestational age at entry, sex and clustering.ResultsWe assessed 424 adult offspring (46% of survivors; mean [SD] age 49.3 [1.0] years; 212 [50%] female). There was no difference in mental health, general health and social outcomes between those exposed to betamethasone and those exposed to placebo, with the exception that osteoporotic site fracture in adulthood was more likely to have occurred in the betamethasone group compared with placebo (adjusted relative risk 1.57, 95% CI 1.00, 2.48, p = 0.05). No dose–effect relationship was evident and there was no difference in the proportion with at least one fracture. Follow-up rate and lack of in-person assessments were the main limitations.ConclusionsThere is no evidence that antenatal corticosteroids have clinically important effects on general health and social outcomes up to 50 years of age.

Frailty transition and burden on mortality risk in middle-aged and older population: a prospective cohort study

The effect of frailty transition and burden on the risk of all-cause mortality in South Korea remains unclear. This study aimed to investigate the risk of all-cause mortality using the most recent frailty index (FI), changes in FI, and frailty burden. We analyzed data from the Korean Genome and Epidemiology Study (2013–2020). A total of 3,134 participants aged 53–87 years with a computable FI based on the osteoporotic fracture index during their initial visit. The FI was updated biennially during re-examinations and changes between the initial and last visits were categorized into four groups: (1) improved or maintained to non-frail, (2) worsened to pre-frail, (3) improved or maintained to pre-frail, and (4) worsened or maintained to frail. We used the Cox proportional hazards model, adjusted for age, sex, education, lifestyle factors, and diseases. During the follow-up, 218 participants died. Compared to those who were robust at the last visit, pre-frailty and frailty were associated with an increased risk of all-cause death. Of those who visited > 2 times, 62.3% improved or remained robust, and had a decreased risk of all-cause death. Those with > 63% of pre-frailty or frailty burden significantly higher risk of death, with > 60% increase compared to their non-frail counterparts. Maintaining or achieving robustness is associated with a decreased risk of mortality. To prevent premature death and extend healthy life expectancy, identifying biological aging through surrogate measures and implementing interventions to maintain or achieve a robust health status are needed.

Dual-Fluoroscopy vs. Single-Fluoroscopy in Balloon Kyphoplasty: A Study of Efficiency and Safety

Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) for anteroposterior (AP) and lateral views. We have implemented a dual-fluoroscopy (DF) technique to reduce procedure time and radiation exposure. The goal of this study was to determine whether dual-fluoroscopy could optimize surgical efficiency without compromising safety, offering a more effective alternative to traditional single-fluoroscopy methods. Methods: This retrospective study included 126 patients who underwent BK with either SF (n = 74, 58.7%) or DF (n = 52, 41.3%) between 2020 and 2024. We collected data on procedure duration per pedicle (PDPP), radiation exposure (reference air kerma and dose-area product [DAP]), and radiation duration. A sub-analysis of post-learning phase cases was performed. Results: A learning curve was identified for the first 24 cases and 15 cases using the SF technique and DF technique, respectively, which was followed by a stabilization in procedure duration per pedicle (Levene’s statistic = 10.623, p = 0.002 for SD difference, p &lt; 0.001 for mean PDPP difference). After the completion of the learning phase for both techniques, the DF group demonstrated a significantly shorter PDPP (11.83 ± 4.3 vs. 14.03 ± 5.57 min, p = 0.049). No significant differences were found in radiation exposure, including radiation duration (p = 0.577), reference air kerma, or DAP. Conclusions: Dual-fluoroscopy significantly reduces procedure time after the learning curve is overcome, improving efficiency without increasing radiation exposure. This technique holds promise for optimizing kyphoplasty workflow and safety, supporting broader clinical adoption.

Novel radiological predictors for the progression of proximal junctional kyphosis in osteoporotic vertebral compression fracture with kyphosis following posterior corrective surgery.

This study aimed to identify the effect of some novel risk factors associated with L1 vertebrae and parameters closely related to the sagittal alignment for the occurrence of proximal junctional kyphosis (PJK) following surgery for patients with osteoporotic vertebral compression fractures (OVCF)kyphosis. 74 OVCF patients undergoing posterior corrective surgery between January 2008 and June 2021 with a minimum 2-year follow-up were included. These patients were divided into PJK and non-PJK groups. Spinopelvic parameters, includingthoracolumbar slope (TLS)and the L1 plumb line (L1PL) were measured preoperatively, postoperatively, and at follow-up. Multivariate logistic analysis was performed on various risk factors and Global Alignment and Proportion (GAP) scores. Associations between novel parameters and PJK were analyzed using receiver operating characteristic(ROC) analysis. PJK was identified in 28.4% of patients. The mean age and follow-up were 63.45years and 38.17months, respectively. There was no difference between the PJK and the non-PJK groups in baseline demographics, pre-operative and immediate post-operative pelvic incidence-lumbar lordosis mismatch. Multiple comparisonsshowed that the proportion of PJK in the severely disproportioned group(the group with the highest GAP scores) and that of the other two groups with lower GAP scores were statistically different (P < 0.001). Potential risk factors for PJK included preoperative thoracic kyphosis (TK) (P < 0.001), TLS (P = 0.016), postoperative TLS (P < 0.001), and L1PL (P < 0.001). Postoperative TLS and L1PL were respectively independent risk factors for PJK, with the cut-off values set at 8.6° and 10.4mm to predict the occurrence of PJK. TLS and L1PL can be used to predict the occurrence of PJK in patients undergoing surgery for OVCF and are crucial for preventing the progression of PJK. Achieving a proportionate GAP Score postoperatively seems to be a viable option as higher GAP scores were associated with higher rates of PJK.

The effect of pin distractor assistance on the reduction of fibular fractures in the treatment of ankle fracture: A retrospective case-control study.

This study will evaluate the therapeutic effect of pin distractor assisted reduction of fibular fracture on ankle fracture. A retrospective analysis was performed on 98 patients diagnosed as ankle fracture or pilon fracture. These patients were all combined with fibular fracture. Retrospective analysis included 48 patients in the experimental group (distractor assisted reduction) and 48 patients in the control group (without pin distractor). The statistical indexes include: the time spent in fracture reduction and fixation, the length of surgical incision, the operative blood loss of fracture operation, the incidence of incision skin necrosis, the incidence of fracture end splitting during reduction, the quality of fracture reduction, the time of fracture healing, infection rate, and The American Orthopedic Foot and Ankle Society score at the last follow-up. There were statistical differences between the 2 groups in the time spent in the reduction and fixation of fractures, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fractures, and the healing time of fractures. The experimental group was better than the control group. In addition, for patients with long spiral fracture, comminuted fracture, osteoporotic fracture and preoperative delay time for operation more than 2 weeks, the time spent in the reduction and fixation of fracture, the operative blood loss of fracture operation, the incidence of fracture end splitting during reduction, the quality of anatomical reduction of fracture, and the healing time of fracture in the experimental group are also better than those in the control group. The pin distractor assisted reduction of fibular fracture has the advantages of simple operation, less trauma, short operation time, less operative blood loss, and fewer complications. It is especially suitable for patients with long spiral fibular fracture, comminuted fracture, osteoporotic fracture, and long preoperative delay time in ankle fracture.

Correlation of thyroid function and sensitivity to thyroid hormone with spinal bone mineral content, bone mineral density, and osteoporotic vertebral fracture: A cross-sectional study based on NHANES.

Previous studies have demonstrated that thyroid hormone plays an important role in normal bone development, bone metabolism, and establishment of peak bone mass. However, the correlation of thyroid status with bone mineral content (BMC), bone mineral density (BMD), and osteoporotic vertebral fracture (OVF) is rarely discussed. The current study probes into the potential association between thyroid status and spinal BMC, BMD, and OVF from a novel perspective of thyroid function (TF) and sensitivity to thyroid hormone based on the National Health and Nutrition Examination Survey database. A total of 1844 participants were included in this study. The association of thyroid status with outcome variables, like spinal BMC, BMD, and OVF, was analyzed using thyroid function indices and sensitivity to thyroid hormone indices as influence factors. The correlation of them were assessed using univariate and multivariable weighted linear regression, weighted logistic regression models, restricted cubic spline model, and subgroup analyses. The results of this study showed that the association of free triiodothyronine (FT3)/free thyroxine (FT4) with BMC remained negatively associated after adjustment for all covariates. Higher thyroid peroxidase antibody (TPOAb) was significantly associated with an increased risk of developing OVF in both unadjusted and adjusted models. In addition, the results of the restricted cubic spline model were consistent with the weighted multivariate regression analysis after adjustment. The results of this cross-sectional study showed that higher FT3/FT4 and TPOAb were associated with decreased spinal BMC and the increased risk of OVF, indicating a complex link between thyroid status and bone health. Therefore, patients with hyperthyroidism, hypothyroidism, autoimmune thyroid disease, or abnormal peripheral thyroid sensitivity, especially who with elevated TPOAb or FT3/FT4, should focus on the prevention of vertebral osteopenia, osteoporosis, and OVF.

Primary Care Considerations for Individuals With Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is an uncommon genetic neuromuscular condition manifesting as progressive and irreversible muscular weakness. It is usually diagnosed in childhood, and, unfortunately, individuals living with DMD have a shortened lifespan. DMD has an effect on multiple body systems, leading to complications such as cardiomyopathy, respiratory infections, fragility fractures, and mood disorders. Nurse practitioners working in the primary care setting are in a key position to support the individual by approaching the disease from a multisystem lens, incorporating preventive care to maximize health and well-being at varying stages of the disease process.

A prospective study of vitamin D, proinflammatory cytokines, and risk of fragility fractures in women on aromatase inhibitors for breast cancer.

Vitamin D is critical to bone health by regulating intestinal absorption of calcium, whereas proinflammatory cytokines, including IL-1, IL-6, IL-12, and TNF-α, are known to increase bone resorption. We hypothesized that vitamin D and these cytokines at the time of breast cancer diagnosis were predictive for fragility fractures in women receiving aromatase inhibitors (AIs). In a prospective cohort of 1,709 breast cancer patients treated with AIs, we measured the levels of 25-hydroxyvitamin D (25OHD), IL-1β, IL-6, IL-12, and TNF-α from baseline blood samples. The associations of these biomarkers were analyzed with bone turnover markers (BALP and TRACP), bone regulatory markers (OPG and RANKL), bone mineral density (BMD) close to cancer diagnosis, and risk of fragility fractures during a median of 7.5 years of follow up. Compared to patients with vitamin D deficiency, patients with sufficient levels had higher bone turnover, lower BMD, and higher fracture risk; the latter became non-significant after controlling for covariates including BMD and no longer existed when patients taking vitamin D supplement or bisphosphonates or with history of fracture or osteoporosis were excluded. There was a non-significant trend of higher levels of IL-1β and TNF-α associated with higher risk of fracture (highest vs. lowest tertile, IL-1β: adjusted HR=1.37, 95% CI=0.94-1.99; TNF-α: adjusted HR=1.38, 95% CI=0.96-1.98). Our results do not support proinflammatory cytokines or vitamin D levels as predictors for risk of fragility fractures in women receiving AIs for breast cancer.

Decreased mortality in patients with fragility fracture of a fracture liaison service coordinated by Chile's first nurse practitioner.

Fragility fractures have significant sequelae, including pain, loss of mobility, and increased risk of mortality. Fracture liaison services (FLS) represent a coordinated, interdisciplinary approach to secondary prevention and reduce mortality. To investigate the effectiveness and patient outcomes regarding readmission and mortality of a newly developed, nurse practitioner (NP) coordinated FLS in Chile. Retrospective longitudinal analysis of 214 patients who agreed to participate in a FLS was conducted. Variables studied include patient age, gender, anatomical fracture site, dual x-ray absorptiometry scans, medication, readmission information, and mortality. Demographics and clinical data were collected and analyzed with bivariate and multivariate statistics. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who did and did not participate in the FLS. The study sample was predominantly female (85%) with a mean age of 76 (SD: 12; range 41-101) years. The most frequently noted fracture sites were hip (n = 167), wrist (n = 132), and spine (n = 72). At one-year follow-up, the FLS group had a significantly lower mortality (5%, 10 patients) than those who did not participate in the program (12% [N = 50], p = .005). The Kaplan-Meier analysis indicated that patients who participated in the FLS had significantly better survival rates than those who did not participate. Significantly improved survival rates were observed in FLS patients. Chile's first FLS demonstrated improved patient outcomes, specifically a reduced mortality in patients who were enrolled in the FLS. The NP role was fundamental in the screening, diagnosis, and treatment of patients with osteoporosis.

The Landscape of microRNAs in Bone Tumor: A Comprehensive Review in Recent Studies.

Cancer, the second greatest cause of mortality worldwide, frequently causes bone me-tastases in patients with advanced-stage carcinomas such as prostate, breast, and lung cancer. The existence of these metastases contributes to the occurrence of skeletal-related events (SREs), which are defined by excessive pain, pathological fractures, hypercalcemia, and spinal cord com-pression. These injurious incidents leave uncomfortably large holes in each of the cancer patient's life quality. Primary bone cancers, including osteosarcoma (OS), chondrosarcoma (CS), and Ewing's sarcoma (ES), have unclear origins. MicroRNA (miRNA) expression patterns have been changed in primary bone cancers such as OS, CS, and ES, indicating a role in tumor development, invasion, metastasis, and treatment response. These miRNAs are persistent in circulation and ex-hibit distinct patterns in many forms of bone tumors, making them potential biomarkers for early detection and treatment of such diseases. Given their crucial regulatory functions in various bio-logical processes and conditions, including cancer, this study aims to look at miRNAs' activities and possible contributions to bone malignancies, focusing on OS, CS, and ES. In conclusion, miRNAs are valuable tools for diagnosing, monitoring, and predicting OS, CS, and ES outcomes. Further research is required to fully comprehend the intricate involvement of miRNAs in these bone cancers and to develop effective miRNA-based treatments.

Towards optimized biopsy use in vertebral compression fractures: integrating risk assessment for better clinical decision-making.

Tissue biopsy is the gold standard for differentiating osteoporotic vertebral compression fractures from malignant lesions. However, the necessity of routine biopsies during percutaneous vertebroplasty and kyphoplasty is debated due to the low malignancy detection rates. This study aims to identify key predictors of positive biopsy outcomes in patients undergoing these procedures, with the goal of refining biopsy selection criteria to enhance diagnostic yield and improve clinical decision-making. We conducted a retrospective cohort study involving 295 patients who underwent percutaneous vertebroplasty and kyphoplasty with biopsy between June and December 2023. Clinical data, including age, gender, fracture aetiology, imaging findings, and biopsy results, were collected. Binary logistic regression analysis was employed to identify significant predictors of positive biopsy outcomes. The biopsy results revealed an overall malignancy rate of 1.01% (3/295). Among the 17 cases with abnormal (positive) biopsy findings, 17.6% were malignant, while the remainder were benign. Significant predictors included age (OR = 0.936), gender (OR = 0.307 for males), fracture aetiology (OR = 5.300 for fractures with no apparent cause), and imaging abnormalities (OR = 8.388). This study underscores the low malignancy detection rate in routine biopsies for vertebral compression fractures, advocating for a more selective approach by reserving biopsies for patients with specific high-risk factors. A targeted biopsy strategy, informed by enhanced pre-operative screening, could improve diagnostic accuracy and treatment outcomes, optimizing clinical management.

Role of mir-32-3p in the diagnosis and risk assessment of osteoporotic fractures

BackgroundOsteoporotic fractures (OPF) are fractures that occur with low-energy injuries or during daily activities, representing a serious consequence of osteoporosis (OP). With the worsening of population aging, the number of OPF patients continues to expand, causing a significant burden on families and society. Consequently, it is significant to diagnose and analyze OPF at the molecular level.ObjectiveThe aim of this research was to explore the diagnostic value of miR-32-3p in OPF patients and to exploit new biomarkers for clinical applications.MethodsThe miR-32-3p expression level of patients was detected by RT-qPCR. Diagnostic accuracy of miR-32-3p analyzed adopting ROC curve. Additionally, the risk factors correlation with the occurrence of OPF were assessed by logistic analysis. The effect of miR-32-3p on BMSCs was verified by in vitro transfection experiments.ResultsmiR-32-3p expression was lower in OPF patients than in OP patients. ROC curve implied that miR-32-3p exhibits commendable sensitivity (88.9%) and specificity (75.6%) to differentiate between OP and OPF patients (AUC = 0.905, P < 0.001). Furthermore, miR-32-3p was correlated with the development of OPF and was a risk factor for OPF (P < 0.001). Functional assays revealed that transfection with miR-32-3p mimic could promote proliferation and inhibit apoptosis, whereas transfection with miR-32-3p inhibitor had the opposite effect.ConclusionmiR-32-3p demonstrates significant diagnostic potential for OPF patients. It is likely that miR-32-3p probably is a new diagnosis biomarker for OPF, offering promising therapeutic avenues through targeted interventions.

A Multidisciplinary and a Comprehensive Approach to Reducing Fragility Fractures in Preterm Infants.

With advances in neonatal care, bone fractures prior to discharge from the hospital in preterm infants receiving contemporary neonatal care, are rare. Nevertheless, such fractures do occur in very low birth weight and extremely low birth weight infants who go on to develop metabolic bone disease of prematurity (MBDP), with or without secondary hyperparathyroidism. MBDP is a multifactorial disorder arising from the disruption of bone mass accrual due to premature birth, postnatal immobilisation, and loss of placental oestrogen resulting in bone loss, inadequate provision of bone minerals from enteral and parenteral nutrition, and medications that leach out bone minerals from the skeleton. All of these factors lead to skeletal demineralisation and a decrease in bone strength and an increased risk of fractures of the long bones and ribs. Secondary hyperparathyroidism resulting from phosphate supplements, or enteral/parenteral feeds with a calcium-tophosphate ratio of < 1.3:1.0 leads to subperiosteal bone resorption, cortical thinning, and further skeletal weakening. Such fractures may occur from routine handling and procedures such as cannulation. Most fractures are asymptomatic and often come to light incidentally on radiographs performed for other indications. In 2015, we instituted a comprehensive and multidisciplinary Neonatal Bone Health Programme (NBHP), the purpose of which was to reduce fragility fractures in highrisk neonates, by optimising enteral and parenteral nutrition, including maintaining calcium-tophosphate ratio ≥1.3:1, milligram to milligram, biochemical monitoring of MBDP, safe-handling of at-risk neonates, without compromising passive physiotherapy and skin-to-skin contact with parents. The at-risk infants in the programme had radiographs of the torso and limbs at 4 weeks and after 8 weeks from enrolment into the program or before discharge. Following the introduction of the NBHP, the bone fracture incidence reduced from 12.5% to zero over an 18-month period.

Predictors for 1-year mortality in geriatric patients following fragile intertrochanteric fracture surgery

ObjectiveTo investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals.MethodsThe medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan–Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality.ResultsThe mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI < 18.5), coronary heart disease, stroke, dementia, pneumonia, number of comorbidities ≥ 3, hypoproteinemia and injury-to-surgery time ≤ 2 days were associated with the 1-year postoperative survival status (P < 0.1). Multivariate analysis revealed that advanced age, male sex, dementia, number of comorbidities ≥ 3, hypoalbuminemia, and being underweight were independent risk factors for 1-year postoperative mortality. Subgroup analysis showed that being underweight was associated with 1-year postoperative mortality only in male patients but not in female patients, whereas hypoproteinemia was associated with 1-year postoperative mortality in both male and female patients. Furthermore, an injury-to-surgery time of less than 2 days improved patient survival, and patients more than 80 years old showed an elevated risk of postoperative mortality.ConclusionsPreoperative health status is a critical predictor of postoperative outcomes in elderly patients with fragile intertrochanteric fractures. Priority care should be given to the patients who are elderly, male, have dementia, have comorbidities, or are malnourished. Prompt nutritional reinforcement should be provided to patients with intertrochanteric fractures with comorbid hypoproteinemia and underweight. Furthermore, surgery should be performed as early as possible in patients with fewer comorbidities.

MFFE CT-like MRI Sequences for the Assessment of Vertebral Fractures

Objectives: The aim of this study was to evaluate the diagnostic performance, image quality, and inter- and intra-observer agreement of the 3D T1 multi-echo fast field echo (mFFE) sequence in cervico-thoraco-lumbar vertebral fractures compared with conventional computed tomography (CT) as the gold standard. Methods: We conducted a prospective single-centre study including 29 patients who underwent spinal magnetic resonance imaging (MRI) at the surgeon’s request, in addition to CT for vertebral fracture assessment and classification. A 3D T1 mFFE sequence was added to the standard MRI protocol. Consecutively, two readers analyzed the 3D mFFE sequence alone, the 3D mFFE sequence with the entire MRI protocol, including the STIR and T1 sequences, and, finally, the CT images in random order and 1 month apart. A standardized assessment was performed to determine the presence or absence of a fracture, its location, its classification according to the Genant and AO classifications for traumatic and osteoporotic fractures, respectively, the loss of height of the anterior and posterior walls of the vertebral body, and the presence of concomitant disco-ligamentous lesions. Contingency tables, intraclass correlation coefficients, and Cohen’s kappa tests were used for statistical analysis. Results: A total of 25 fractures were recorded (48% cervical, 20% thoracic, and 32% lumbar), of which 52% were classified A, according to the AO classification system. The quality of the 3D mFFE image was good or excellent in 72% of cases. Inter-observer agreement was near perfect (0.81–1) for vertebral body height and for AO and Genant classifications for all modalities. Intra-observer agreement was strong-to-near perfect between CT and the 3D mFFE sequence. Regarding the diagnostic performance of the 3D mFFE sequence, the sensitivity was 0.9200 and 0.9600, the specificity was 0.9843 and 0.9895, and the accuracy was 0.9861 and 0.9769 for Readers 1 and 2, respectively. In addition, up to 40% of intervertebral disc lesions and 33% of ligamentous lesions were detected by the 3D mFFE sequence compared to CT, allowing four AO type A fractures to be reclassified as type B. Conclusions: The 3D mFFE sequence allows accurate diagnosis of vertebral fractures, with superiority over CT in detecting disco-ligamentous lesions and a more precise classification of fractures, which can prompt clinicians to adapt their management despite an image quality that still requires improvement in some cases. Key points: Vertebral fractures and disco-ligamentous lesions can be assessed using CT-like MRI sequences, with 3D T1 mFFE being superior to CT for the detection of disco-ligamentous lesions. CT-like images using the 3D T1 mFFE sequence improve the diagnostic accuracy of bone structures in MRI.

A novel unilateral extrapedicular approach applied to percutaneous vertebral augmentation to treat thoracic and lumbar Osteoporotic Vertebral Compression Fracture: a retrospective study

ObjectiveTo design and apply a novel puncture method, named P TO P technique, and to evaluate its efficacy and safety.MethodThe data of patients treated with PVA in medical institution from January 2020 to December 2022 were reviewed and analyzed. The degree of pain relief and recovery from daily activities were evaluated using VAS and LAS scores, and radiological parameters were evaluated using local kyphosis angle and excellent cement distribution. Complications such as cement leakage and recurrent vertebral fractures were also recorded.Results157 patients with thoracolumbar OVCF were successfully treated with novel puncture techniques. All postoperative clinical and radiological parameters significantly decreased in all patients, except for an increase in local kyphosis angle at the last follow-up compared to postoperative. All other above indicators remained statistically significant at the last follow-up compared to postoperative improvement. Except for 2 patients with poor cement distribution, the remaining 155 patients successfully achieved satisfactory results in unilateral puncture and bilateral cement distribution, achieving an excellent rate of 98.73%. In addition, 18 cases (11.46%) of cement leakage occurred during the operation, fortunately none of them were uncomfortable. During the postoperative follow-up period, 4 cases (2.55%) of recurrent fractures occurred. No other serious complications such as neurologic or named vascular injuries occurred.ConclusionThe application of P TO P technology in thoracolumbar OVCF patients is safe and effective. It can not only reduce pain and quickly recover daily activities, but also achieve the perfect effect of unilateral puncture and bilateral cement filling.