Predictors Of Fractures In Patients Research Articles

PREDICTORS OF FRACTURES IN PATIENTS WITH STAGE VD CHRONIC KIDNEY DISEASE TREATED WITH HEMODIALYSIS

Bone pathology begins in the early stages of chronic kidney disease (CKD), but clinical consequences — bone pain and fractures — occur mainly at stage 5 of the disease (VD) in patients who use methods renal replacement therapy. Objective. To find out the frequency, localization and possible predictors of fractures in patients with CKD VD stage on the background of hemodialysis according to the results of a prospective study. Methods. 254 patientswere included in the cohort prospective open study with CKD VD stage, which was treated with hemodialysis hemodialysis during 2018‒2022. The study was conducted in two stages. On the first, based on the analysis of medical documentation, received data on the presence of fractures of all localizations, diabetes, hypertension, secondary hyperparathyroidism, hyperhydration, type of initial vascular access, eKt/V, body mass index (IMT), peripheral vasculardisease. At the second stage, a prospective study of new cases of fractures was conducted. Results. Examined72 (32.3 %) women and 151 (67.7 %) men, average age — (49.4 ± 14.03) years — did not differ significantly depending on gender (p = 0.1088). The most frequent cause of CKD stage VD was glomerulonephritis — 111 patients (49.77 %). At the time of the beginning of observation, 30 cases were ascertained fractures in 26 patients, and at the end — 62 in 51 patients. By the results of univariate Cox regression analysis it was established that independent predictors of occurrence new fractures are the patientʼs age, female gender, smoking, presence of peripheral vascular diseases, BMI, as well as serum albumin, parathyroid hormone, calcium, phosphorus, alkaline phosphatase, and vitamin D levels. Conclusions. The developed method of fracture risk assessment for patients with CKD VD stage on the background of hemodialysis is individualized, accessible in execution and interpretation, allows to distinguish patients with increased risk the occurrence of fractures with the help of standard bases clinical and laboratory indicators.

Clinical predictors of fracture in patients with shoulder dislocation: systematic review of diagnostic test accuracy studies

BackgroundPrereduction radiographs are conventionally used to exclude fracture before attempts to reduce a dislocated shoulder in the ED. However, this step increases cost, exposes patients to ionising radiation and may...

P141 What are the predictors of fragility fracture in patients with low body mass index: an observational cohort study

Abstract Background/Aims Low body mass index (BMI) is known to be associated with increased risk of fracture and therefore measurements of height and weight contribute towards the Fracture Risk Assessment Tool (FRAX) score, an estimation tool used to calculate approximate risk of fracture to guide therapy decisions. However, data is lacking on which measurement of bone mineral density is best in those that are underweight. Using a large population of patients with low BMI, we aimed to determine which measurement of bone mineral density (BMD) is the most accurate predictor of fragility fracture in this group of patients. We also aimed to explore the relationship of other traditional risk factors for fracture in this subpopulation. Methods Data on risk factors for osteoporosis and fragility fractures was collected on patients presenting for BMD estimation at a district general hospital in North West England between June 2004 and October 2016. All analysis was performed on those with low BMI, defined as < 18.5kg/m2. Firstly, univariate logistic regression was performed to assess risk of fracture using BMD for lumbar spine, femoral neck and total hip; as well as smoking, alcohol use, presence of rheumatoid arthritis, history of steroid use and history of hip fracture in a parent. Risk factors were defined as per FRAX. This was followed by multivariate regression of available risk factors, using the best BMD predictor identified from univariate analysis. All models were controlled for sex and age at first scan. Results for continuous variables are reported as beta coefficients and for categorical variables as odds ratios. All results are reported with 95% confidence intervals. Area under ROC curve for each model was calculated. Results 921 of 35,759 patients had a BMI of under 18.5 and were included in analysis. Of these, 88.4% were female, mean age at time of scan was 58.6 years. Results are shown in the table. Conclusion In those with low BMI, BMD of left total hip was the best predictor of fragility fracture. Smoking, alcohol use and history of hip fracture were also associated, but previous steroid use and diagnosis of rheumatoid arthritis was not. Disclosure S.D. Sharma: None. M. Bukhari: None.

Incidence and predictors of fragility fracture in postmenopausal rheumatoid arthritis patients receiving oral bisphosphonates: a longitudinal observational study

BackgroundAlthough many studies have reported the predictors of fractures in patients with rheumatoid arthritis (RA) who are not receiving anti-osteoporotic treatments or who are receiving unspecified treatments, studies focusing on the predictors of fracture in patients with RA who are currently being treated with oral bisphosphonates (BP) are quite scarce. This study aims to investigate the incidence and predictors of fragility fracture in postmenopausal patients with RA receiving oral BP.MethodsThis retrospective longitudinal observational study comprised 98 postmenopausal RA patients receiving oral BP for a minimum of 6 months between April 2015 and December 2020. The cumulative incidence of fragility fractures including vertebral and nonvertebral fractures was investigated using the Kaplan–Meier method. Cox proportional hazards analysis was used to analyze baseline predictors of future fragility fractures. To determine a cutoff value of continuous predictors, the receiver-operating characteristic curve was applied.ResultsTwenty patients developed fractures during the study period, with a cumulative incidence of 6.1% at 12 months, 10.5% at a median follow-up of 28 months, and 14.4% at 36 months. Multivariable Cox hazards analysis showed a history of prior vertebral fracture (hazard ratio [HR] 6.26, 95% confidence interval [CI] 1.99‒19.68, P = 0.001) and dose of methotrexate (HR 0.87, 95% CI 0.76‒0.99, P = 0.041) to be independent predictors. The cutoff value for methotrexate dose was 4 mg/week.ConclusionsWe found a cumulative incidence of any fractures of 10.5% at 28 months in patients with RA currently being treated with oral BP. A history of prior vertebral fractures and methotrexate dose were positive and negative predictors for fractures, respectively. Practitioners should consider selecting another anti-osteoporotic drug in patients with RA who remain at risk despite receiving oral BP.

P196 Predictors of fracture in patients with primary hyperparathyroidism

Abstract Background Primary hyperparathyroidism (PHPT) is a recognised risk factor for fractures as the persistently elevated parathyroid hormone levels are associated with lower bone mineral density (BMD). In early osteoporosis (<65 years), there is mainly trabecular bone loss while with increasing age, the largest loss of absolute bone mass occurs in cortical sites. Our aim was to compare cortical versus trabecular bone sites to determine which sites better predict fracture in PHPT patients referred for dual-energy X-ray absorptiometry (DEXA) scan in an observational cohort. Methods 508 patients with PHPT referred for DEXA scan at Royal Lancaster Infirmary (UK) between 2006-2016 were included in a retrospective data analysis. Data collected included femoral and lumbar BMD, age, gender, height, weight, BMI, rheumatoid arthritis, smoking, alcohol, family history of fractures, secondary osteoporosis and long-term steroid use and was used to look at predictors of fractures using BMD at different sites. Simple statistics using independent t-tests and chi-squared tests were initially used and subsequently, logistic models were fitted unadjusted and adjusted confounding variables. Results 97 males (19%) and 411 females (81%) were included, with 111 patients sustaining at least one fracture (21.9%). Mean age was 65 years (SD 0.55). Advanced age, female gender and a reduced BMD were all statistically significant factors associated with an increased risk of fractures. Smoking and long-term steroid use were also shown to increase risk of fracture however these were non-statistically significant. Adjusting for age and gender, a reduced L4 BMD was the strongest statistically significant predictor of fracture (OR 0.139, 95% CI: 0.112-0.782). Multivariate analysis revealed that a reduced L3 BMD was the strongest statistically significant predictor of fracture (OR 0.170, 95% CI: 0.071-0.72). Conclusion Overall, our study suggests that a reduced BMD at trabecular sites is a stronger predictor of fracture compared to cortical sites [Table 1]. Older age and female gender significantly increased the risk of fracture in PHPT patients. To the best of our knowledge, this is the first study looking at specific bone sites as independent predictors of fracture in PHPT patients. This analysis should be repeated using a larger cohort to validate our results. Disclosures D. Mariannis None. M. Bukhari None.

Dosimetric Predictors of Sacral Insufficiency Fractures in Patients With Cervical and Endometrial Cancer Treated With Postoperative Intensity Modulated Radiation Treatment

Dosimetric Predictors of Sacral Insufficiency Fractures in Patients With Cervical and Endometrial Cancer Treated With Postoperative Intensity Modulated Radiation Treatment

A Qualitative and Quantitative Angiographic Analysis of Stent Fracture Late Following Sirolimus-Eluting Stent Implantation

Repetitive mechanical forces within the coronary artery may result in stent fracture after stent implantation, particularly in patients with complex coronary disease. This study sought to estimate the incidence of Cypher stent fracture in patients with moderately severe coronary disease and to identify the angiographic predictors of fractures in patients identified in a global Cypher fracture registry. Stent fracture analysis was performed in 305 patients treated with the Cypher stent in SIRIUS and in 39 patients with stent fractures reported in the Cypher fracture registry. Fractures were classified as isolated strut fractures (type 1, single-strut fracture; type 2, incomplete transverse fracture) and stent fracture (type 3, complete transverse fracture without displacement; type 4, transverse fracture with displacement). Isolated strut fractures were identified in 4 patients (1.3%) enrolled in SIRIUS (type 1 1.0%, type 2 0.3%); no stent fractures were identified. In 39 patients with 44 clinically reported Cypher fractures, isolated strut fractures were present in 15.4% (all type 2) and stent fractures were found in 84.6% (type 3 38.4%, type 4 46.2%). Compared with patients in SIRIUS, patients with clinically reported fractures had much greater lesion complexity, including extensive calcification, angulation > or =45 degrees , lesion length > or =20 mm, proximal vessel tortuosity, total occlusions, and an ostial location. Clinically reported fractures were associated with a high rate of repeat target lesion revascularization (52.6%). In conclusion, stent fracture after Cypher stent placement occurs more often in patients with "ultra"-complex coronary anatomy, but is an uncommon event in patients treated with mild to moderate lesion complexity.

Age and drug therapy are key prognostic factors for first clinical fracture in patients with primary osteoporosis

We evaluated the characteristics of 1,142 women and men who attended Canadian osteoporosis clinics and had T-score < or = -2.0 and no prior fractures to determine the predictors of first clinical fracture. Greater age and failure to start osteoporosis drug treatment increased the risk of first clinical fracture. Although risk factors for osteoporotic fractures are well-known, it is unclear which factors predict poor prognosis in patients with primary osteoporosis. The purpose of this study was to determine prognostic factors for first clinical fracture in patients with T-score < or = -2.0 and no previous clinical fracture. We examined prospectively collected data from 1,142 patients aged 40 and over in the Canadian Database of Osteoporosis and Osteopenia. We used prognosis methodology and performed survival analysis to determine factors that increase the risk of first clinical fracture. Our inception cohort (mean age = 60.6 years, 91% females) had a cumulative fracture incidence of 5.1% (incidence rate: 2.53/100 person-years). Age and osteoporosis drug use predicted incident clinical fractures in multivariable regression analyses. The risk of first fracture increased by 3% per year. Failing to initiate osteoporosis treatment increased fracture risk by 2.4 times. In addition, low physical activity, high body mass index and low T-scores were found to predict fracture risk in certain patient subgroups using tree-structured survival analysis. These findings were robust and did not change with most sensitivity analyses. Age and osteoporosis drug treatment are the main prognostic predictors of first clinical fracture in patients with T-score < or = -2.0.