History Of Previous Fracture Research Articles

In-Hospital Mortality following Proximal Femur Fractures in Elderly Population.

Context In India, hip fracture crude incidence above the age of 50 years was 129 per 100,000. Aims The aim of this study is to analyze the in-hospital mortality following proximal femur fractures in elderly Indian population. Methods and Material The study was done in Sri Ramachandra Medical Center, Chennai, India. Patient's records were retrospectively evaluated for a period of 3 years from January 1, 2015 to January 1, 2018. The inclusion criteria were patients both male and female aged more than 65 years admitted with the diagnosis of neck of femur or intertrochanteric or subtrochanteric fractures. The exclusion criteria were patients having any associated fracture or previous hip fracture history or diagnosed primary or secondary malignancies. To evaluate any surgical delay two groups were formed. After eliminating cases based on exclusion criteria, we had 270 patients for evaluation. Statistical Analysis Used The collected data were analyzed with IBM.SPSS statistics software 23.0 Version. To describe about the data descriptive statistics frequency analysis, percentage analysis were used for categorical variables and the mean and standard deviation (SD) were used for continuous variables. To find the significant difference between the bivariate samples, Student's t -test and analysis of variance (ANOVA) were used. The p -value of 0.05 is considered as significant level. Results We had a total of 24 mortalities with 15 males and 9 females. The in-hospital mortality of patients who underwent replacement surgeries for proximal femur fractures was 14 in our study. Sixteen of the in-hospital mortality patients had low Parker's mobility score. Twenty patients had mortality when surgery was delayed more than 48 hours. Conclusions In-hospital mortality in elderly patients having proximal femur fracture increases significantly if the patient was having low-preoperative mobility status, if surgery was delayed more than 48 hours, and if patient undergoes replacement surgeries.

Assessment of incidence and various demographic risk factors of traumatic humeral shaft fractures in China

As a sub-study of the China National Fracture Study, this study aimed to better determine the incidence and risk factors of humeral shaft fracture in mainland China. We obtained all the data on humeral shaft fracture from the China National Fracture Study reported in 2017. Trained research teams personally interviewed all qualifying household members using a standardised questionnaire. A total of 512,187 (259649 boys and men, 252538 girls and women) questionnaires were collected and analysed from 112 neighbourhood communities and 223 administrative villages using stratified random sampling and the probability proportional to size method. The population-weighted incidence rate of humeral shaft fracture was 7.22 (95% confidence interval 4.90, 9.55) per 100,000 populations in 2014. Previous fracture history was an independent risk factor in adults of both sexes. Smoking was identified as an independent risk factor for humeral shaft fracture for men. Alcohol consumption and menstruation ceasing before the age of 46 years were considered as independent risk factors for women. Given the above data, specific public-health policies focusing on promoting a smoke-free environment and reducing alcohol intake should be encouraged. People who have had a fracture and women whose menstruation had ceased before the age of 46 should be vigilant against humeral shaft fracture.

Effect of benign prostatic hyperplasia on the development of spine, hip, and wrist fractures.

The relationship between benign prostatic hyperplasia and the development of fall-related fractures, especially vertebral compression fractures, has been seldom mentioned in the literature. This study aimed to evaluate the risk of developing vertebral compression fracture, hip fracture, and wrist fracture in patients with benign prostatic hyperplasia. This study obtained claims data retrospectively from the National Health Insurance Research Database of Taiwan and identified 48,114 patients who were diagnosed as having benign prostatic hyperplasia. Subjects of the control cohort were individually matched at a ratio of 4:1 with those in the benign prostatic hyperplasia cohort according to age and the index day. Comorbidities were classified as those existing before the index day and included a previous fracture history, osteoporosis, myocardial infarction, congestive heart failure, diabetes mellitus, hypertension, cerebrovascular accident, etc. The end of the follow-up period of the analyses was the day when the patient developed new vertebral compression fractures, hip fractures, or wrist fractures, terminated enrollment from the National Health Insurance, or died or until the end of 2012. The study used the Cox proportion hazard model to determine the hazard ratio for developing new hip fractures. Patients with benign prostatic hyperplasia were significantly more likely than those in the control cohort to develop new vertebral compression fractures in the thoracic spine (0.43% vs. 0.40%, adjusted hazard ratio 3.03, confidence interval 2.12-4.31) and lumbar spine (1.26% vs. 1.23%, adjusted hazard ratio 4.12, confidence interval 3.39-5.01), and hip fracture (1.47% vs. 2.09%, adjusted hazard ratio 1.22, confidence interval 1.10-1.36), but does not increase the risk of wrist fracture (0.61% vs. 0.67%, adjusted hazard ratio 1.07, confidence interval 0.85-1.34). Patients with benign prostatic hyperplasia exhibited an increased risk of developing vertebral compression fractures in both the thoracic and lumbar spine and also hip fractures, but did not increase the risk of wrist fracture. However, more research is needed to confirm this trend in the clinical setting.

Management of Hip Fractures at an Academic Center: Challenges and Opportunities

Objective: To assess characteristics of patients with hip fractures and investigate the extent of osteoporosis-related care they receive at a tertiary referral center in Lebanon. Methods: A retrospective review of charts of 400 patients admitted with a hip fracture to the American University of Beirut-Medical Center, between January 1, 2011 and December 31, 2015. We reviewed medical records of adults admitted with a nonpathologic/nontraumatic hip fracture, and evaluated basic demographics and relevant clinical information, associated risk factors, and the management received. Results: The mean age of the population was 78 ± 10 years and men constituted 37%. Women were more likely to be assessed and/or treated. On admission, 21% were taking calcium and 18% vitamin D supplementation. During hospitalization, vitamin D level was assessed in only 39% of patients; a dietary and an osteoporosis consult were requested on only 32% and 22% of the cases, respectively. One-fourth to a third of patients were discharged on calcium or vitamin D, and less than 5% on bisphosphonates. Bone mineral density was measured in a minority although 21% had a history of previous contralateral hip fracture. One year mortality rate in a subset where follow-up available was 12% in men and 7% in women. Conclusion: A large care gap in the management of patients admitted with hip fracture persists despite clear national osteoporosis guidelines. This study provides a strong impetus for establishing and monitoring a fracture liaison service to understand and address barriers to providing optimal care to patients with osteoporosis.

Incidence and risk factors for foot fractures in China: A retrospective population-based survey.

PurposeThe literature lacks population-based epidemiologic studies on the incidence and risk factors for traumatic foot fractures. The purpose of this study was to update information concerning the incidence of foot fractures in China and to identify associated risk factors.MethodsAll the data on foot fractures were available from the China National Fracture Survey (CNFS), which was conducted between January and May in 2015. A total of 8 provinces, 24 urban cities and 24 rural counties in China were selected, using stratified random sampling and the probability proportional to size method. Individuals who had lived in their current residence for 6 months or longer were personally interviewed about any foot fracture that had occurred in 2014. Questionnaires were completed by every participant for data collection and quality control was accomplished by our research team members. The information included age, gender, height, weight, ethnic group, education, occupation, smoking, alcohol consumption, sleeping time per day, dietary habits and others. Fracture was initially identified by patients' self report and further confirmed by their providing medical records.ResultsA total of 512187 individuals participated in the CNFS. There were 201 patients with foot fractures in 2014. Mean age at the time of fracture was 45.4 years. The incidence rate of foot fractures was 39.2 (95%CI: 33.8–44.7)/100000/year. Fall and traffic accident were the most common causes for foot fractures and over 60% of these occurred at home or on the road. Alcohol consumption, history of previous fracture and average sleep time <7h/d were identified as independent risk factors for foot fractures both in males and females. Cigarette smoking was identified as a significant risk factor for foot fracture in males. For females, BMI >24 kg/m2 was a risk factor whilst living in the west region was associated with a lower incidence rate of foot fracture.ConclusionsThe present study shows an incidence of 39.2/100000/year of foot fractures in China. Specific public health policies focusing on decreasing alcohol consumption and encouraging individuals to obtain sufficient sleep should be implemented. Females with a higher BMI should focus more on foot health care, especially in those with history of previous fracture.

Functional and Oncological Outcome After Treatment of Chondroblastoma With Intralesional Curettage.

Chondroblastoma is a rare cartilaginous benign bone tumor that commonly arises in long bones of young people. Surgical management is the primary treatment of choice for chondroblastoma and it entails adequate intralesional curettage alone or in combination with adjuvants. This study was performed to describe the epidemiological characteristics and clinical and radiologic results of intralesional curettage of chondroblastoma. This was a retrospective study which included an analysis of 91 patients with chondroblastoma who were treated with intralesional curettage and were followed up between 1994 and 2014 for at least 3 years. Epidemiological data, clinical symptoms, radiologic and histologic investigations, surgery, functional outcomes, complications, and local recurrence rate were analyzed. There were 60 males (65.9%) and 31 females (34.1%) with a mean age of 16.4 years. The most commonly involved bone was the proximal tibia in 24 patients (26.4%), followed by distal femur in 20 patients (22%), proximal humerus in 17 patients (18.7%) and proximal femur in 15 patients (16.6%). All patients underwent intralesional curettage. High-speed burr was used in 66 patients (72.5%). The resultant cavity was filled with autogenous bone graft, bone substitute, bone cement or a combination of bone graft and cement. Four patients (4.4%) had complications. Three patients (3.3%) developed local recurrence. Age, site, history of previous intervention or pathologic fracture had no impact on the rate of recurrence. The mean Musculoskeletal Tumor Society (MSTS) score was 28.88 (range, 24 to 30) points. Thorough curettage using high-speed burr and bone-grafting or bone cement in the treatment of chondroblastoma has good local control, low recurrence rate and excellent functional long-term outcome. Level IV, retrospective case series.

Comparison study of Bone Mineral Density (BMD) in native Chinese and American Caucasian populations

Background/Objective: Osteoporosis and osteoporotic fracture risk are extraintestinal manifestations of the inflammatory bowel disease, whose etiopathogenic mechanisms have not been determined yet. Anti-tumor necrosis factor (TNF)-α are used in treatment of inflammatory bowel disease (IBD), but it is unknown if they play a role in osteoporotic fracture prevention. The objective of this study was to know if anti-TNF decreases fracture risk or modifies bone mineral density. To determine the possible risk factors associated with fractures, and assess the incidence of vertebral fractures in IBD patients. Methods: Longitudinal prospective cohort study (7 yr of follow-up); which included 71 IBD patients, 23 received anti-TNF-α; the remaining 48 received conventional treatment, constituted the control group. Patients participated in a questionnaire which gathered risk factors associated with the development of osteoporosis and fractures. Radiographs of the dorsolumbar-spine were performed and also a bone density measurement. Their biochemical and bone remodeling parameters were determined. Results: Although patients who did not receive anti-TNF-α, suffered more fractures but biologic therapy did not reduce the risk of new vertebral fractures. The increase of bone mass was significantly higher the group treated with anti-TNF-α. The increase in the lumbar spine was of 8% and in the femoral neck was of 6.7%. The only determinant factor for the incidence of vertebral fractures was a history of previous fractures (odds ratio of 12.8; confidence interval 95% 2.37–69.9; p = 0.003). The incidence of vertebral fractures in IBD patients was considerably high: 26.7/700 patient-yr. Conclusions: Anti-TNF-α, although increased bone mass in these patients, did not reduce the risk of new vertebral fractures. In this study, patients with IBD have a considerably high incidence of fractures. Only the existence of previous vertebral fractures was a predictive factor for consistent fractures.

Cost-effectiveness analysis of drugs for osteoporosis treatment in elderly Japanese women at high risk of fragility fractures: comparison of denosumab and weekly alendronate

In Japan's super-aged society, the prevention and treatment of osteoporosis are a critical issue with implications for the medical economy. This study's purpose was to clarify the cost-effectiveness of osteoporosis treatment with denosumab versus weekly alendronate for elderly Japanese women at high risk of fragility fractures. A Markov model was used for simulation analysis. The modeled population was 75-year-old Japanese women with a bone mineral density (BMD) of 65% of the young adult mean (YAM) (T-score, - 2.87) and a history of previous vertebral body fracture. The simulation model was repeated until patient age reached 100years or death. Analysis was performed from the societal perspective. Costs and epidemiological data were derived from previous studies. The incremental cost-effectiveness ratio (ICER) was calculated from the simulation. We compared the ICER with willingness-to-pay. Additional analyses were performed with different combinations of age and BMD. Sensitivity analysis verified the robustness of the analysis. For the modeled population, the ICER of denosumab versus alendronate treatment was estimated at US$40,241/quality-adjusted life year (QALY). The ICER of denosumab for 80-year-old women whose BMD was 60% of YAM was estimated at US$22,469/QALY. Assuming willingness-to-pay as US$50,000/QALY, denosumab treatment for 75-year-old Japanese women with a BMD of 65% of YAM and a history of previous vertebral body fracture was cost-effective compared with alendronate treatment. Among over 75years of age, denosumab treatment might be more cost-effective than alendronate for patients with a BMD of 65% of YAM or lower.

Prevalence of Indicators of Low Energy Availability in Elite Female Sprinters.

Low energy availability (LEA), and subsequent relative energy deficiency in sport, has been observed in endurance, aesthetic, and team sport athletes, with limited data on prevalence in athletes in short-burst activities such as sprinting. We examined prevalence of signs and symptoms of LEA in elite female sprinters at the start of the training season (PRE), and at the end of a 5-month indoor training period (POST). Four of 13 female sprinters (31%) presented at PRE testing with at least one primary (amenorrhea, low bone mineral density, low follicle-stimulating hormone, luteinizing hormone, or estradiol, resting metabolic rate ≤29kcal/kg fat-free mass, Low Energy Availability in Females Questionnaire score ≥8) and one secondary indicator of LEA (fasting blood glucose <4mmol/L, free triiodothyronine <3.5pmol/L, ferritin <25μg/L, low-density lipoprotein cholesterol >3.0mmol/L, fasting insulin <20pmol/L, low insulin-like growth factor-1, systolic blood pressure <90mmHg, and/or diastolic blood pressure <60mmHg). At POST, seven out of 13 athletes (54%) presented with at least one primary and one secondary indicator of LEA, three of whom had also presented with indicators of LEA at PRE. Five out of 13 (39%) athletes had previous stress fracture history, though this was not associated with current indicators of LEA (PRE: r = .52, p = .07; POST: r = -.07, p = .82). In conclusion, elite female sprinters may present with signs and symptoms of LEA, even after off-season rest. Medical and coaching staff should be aware of the signs and symptoms of LEA and relative energy deficiency in sport and should include appropriate screening and intervention strategies when working with sprinters.

Does the Antitumor Necrosis Factor-α Therapy Decrease the Vertebral Fractures Occurrence in Inflammatory Bowel Disease?

Background/Objective: Osteoporosis and osteoporotic fracture risk are extraintestinal manifestations of the inflammatory bowel disease, whose etiopathogenic mechanisms have not been determined yet. Anti-tumor necrosis factor (TNF)-α are used in treatment of inflammatory bowel disease (IBD), but it is unknown if they play a role in osteoporotic fracture prevention. The objective of this study was to know if anti-TNF decreases fracture risk or modifies bone mineral density. To determine the possible risk factors associated with fractures, and assess the incidence of vertebral fractures in IBD patients. Methods: Longitudinal prospective cohort study (7 yr of follow-up); which included 71 IBD patients, 23 received anti-TNF-α; the remaining 48 received conventional treatment, constituted the control group. Patients participated in a questionnaire which gathered risk factors associated with the development of osteoporosis and fractures. Radiographs of the dorsolumbar-spine were performed and also a bone density measurement. Their biochemical and bone remodeling parameters were determined. Results: Although patients who did not receive anti-TNF-α, suffered more fractures but biologic therapy did not reduce the risk of new vertebral fractures. The increase of bone mass was significantly higher the group treated with anti-TNF-α. The increase in the lumbar spine was of 8% and in the femoral neck was of 6.7%. The only determinant factor for the incidence of vertebral fractures was a history of previous fractures (odds ratio of 12.8; confidence interval 95% 2.37–69.9; p = 0.003). The incidence of vertebral fractures in IBD patients was considerably high: 26.7/700 patient-yr. Conclusions: Anti-TNF-α, although increased bone mass in these patients, did not reduce the risk of new vertebral fractures. In this study, patients with IBD have a considerably high incidence of fractures. Only the existence of previous vertebral fractures was a predictive factor for consistent fractures.

High prevalence of risk factors for low bone mineral density and estimated fracture and fall risk among elderly medical inpatients: a missed opportunity.

(1) To calculate the absolute fracture risk by using the fracture risk assessment (FRAX) model among elderly medical inpatients; (2) to assess the risk of falls, especially among patients with increased risk of fractures; and (3) to design and implement a bone health protocol to improve the assessment of fracture risk. The study participants were all inpatients admitted to the medical wards at University Hospital Kerry, Ireland. All consecutive eligible patients aged ≥ 65years were prospectively evaluated to populate clinical risk factor variables used in the FRAX model and the fall assessment was made by using Fracture Risk Questionnaire. Consecutive 465 medical inpatients were screened, and 200 eligible medical inpatients were evaluated. The mean age of the cohort was 73.8 ± 9years and 56% were male. The body mass index of the cohort was 27 ± 5, and only 21% (n = 42) of patients reported having ever had a DXA scan. Previous personal history of low fragility fracture was present in 20.5% (n = 41) of the patients. The absolute 10-year risk of major osteoporotic and hip fracture was 15 ± 12 and 7.6 ± 11, respectively, and 25.5% (n = 51) and 64.5% (n = 129) respectively of the cohort had fracture risks exceeding the National Osteoporosis Federation (NOF) thresholds for treatment. High fall risk was noted in 63% of the cohort. A very high prevalence of fracture and fall risk was noted. A medical inpatient stay offers a window of opportunity for assessment of osteoporotic fracture risk. With these findings, a bone health protocol has been developed.

National incidence of traumatic spinal fractures in China: Data from China National Fracture Study.

To provide a basis for disease prevention, this article aimed to clarify the incidence and risk factors of traumatic fractures in China.The China National Fracture Study (CNFS) was a retrospective epidemiological study that recruited a nationally representative sample from 8 provinces, 24 urban cities, and 24 rural counties in China using stratified random sampling and the probability proportional to size method. A total of 512,187 individuals were involved in CNFS. Incidence rates for traumatic spinal fractures were estimated from the database of CNFS. The distributions by age and sex; as well as by demographic factors such as ethnic origin, occupation, and geographical region were also analyzed. The potential risk factors for traumatic spinal fractures were also identified, such as gender, age, ethnic origin, education, occupation, cigarette smoking, alcohol drinking, calcium or vitamin D taking, body mass index (BMI), sleep time per day, history of previous fracture, and urbanization. This study is registered with the Chinese Clinical Trial Registry, number ChiCTR-EPR-15005878.Around 168 individuals (92 men and 76 women, mean age 55.36 ± 16.19 years) reported 178 (10 individuals with 2 segments) segments of spinal fractures that had occurred in 2014. The incidence rate for traumatic spinal fractures was 32.80 per 100,000 people. Stratified by occupation, retired and unemployed individuals had the highest incidence rates: 72.45 (42.19–102.71) and 64.08 (36.68–91.48) per 100,000 people. According to education level, illiterate individuals had the highest incidence rate (73.39, 54.00–92.79 per 100,000 population). Among all age groups, fractures of thoracolumbar vertebra (T11-L2) were the most common for both sexes, followed by fractures of lumbar vertebra (L3–L5). Four independent risk factors for traumatic spinal fractures were found, including aging, alcohol drinking, sleeping <7 hours per day, and having a previous fracture history.The current study provides detailed information about the national incidence of traumatic spinal fractures, distribution, and risk factors. Aging, alcohol drinking, sleeping <7 hours per day, and having a previous fracture history were the independent risk factors for traumatic spinal fractures in China.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT Low energy distal radius and vertebral fragility fractures (VFF) are common injuries in the osteoporotic patient. In this study, the Own the Bone (OTB) database was examined to (1) examine the specific demographics of patients presenting with a VFF or a distal radius fracture and, (2) compare fracture-specific risk factors between patients with VFF against patients with a distal radius fracture. PURPOSE To determine whether or not there are differences between patients sustaining VFF versus distal radius fractures. STUDY DESIGN/SETTING This study uses data from the Own the Bone registry which is the largest, multicenter data registry in the United States to analyze patients presenting with fragility fractures. METHODS This study used the American Orthopaedic Assocation's OTB program registry which contains data on 42,862 patients presenting with insufficiency fractures. After excluding all other fracture types, there were 4,841 VFF and 2,557 distal radius fractures. These fracture types account for 11.2% and 6.0% of the preseting fractures at OTB enrollment. RESULTS The majority of both VFF and distal radius fracture patients were Caucasian, postmenopausal females (72.8% and 80.6%, respectively). Multivariate analysis demonstrated that patients with a prior history of at least one distal radius fracture are more likely to sustain an additional distal radius fracture (OR 2.25, p CONCLUSIONS VFF and distal radius fractures remain common sites for insufficiency fractures. Multiple patient-related factors significantly increase the risk of vertebral fragility fracture compared to distal radius fractures including vitamin D insufficiency and active smoking. Patients with a history of a fragility fracture of the vertebral column after age 50 had a substantially increased risk of sustaining a secondary vertebral fracture. Interestingly, patients with a previous history of a vertebral fracture after age 50 as well as a previous distal radius fracture were more likely to sustain an additional vertebral fragility fracture. Understanding the risk factors unique to these fracture types is critical in allowing physicians to appropriately treat these patients to mitigate the negative sequelae of osteoporosis in this patient population.

A positive correlation between blood glucose level and bone mineral density in Taiwan.

This study was undertaken to assess the effect of blood glucose on BMD and possible interactions with age, sex, and BMI in a Taiwanese population. This study was a retrospective cross-sectional study using data from the Health Examination Database of Changhua Christian Hospital. Data on BMD of the lumbar spine and femoral neck were obtained by dual X-ray absorptiometry (DXA), and other relevant clinical and laboratory data were recorded. The type 2 diabetes (T2DM) group had a higher BMD than the controls. When comparing the prevalence of osteoporosis between subjects by glucose and HbA1c level, the prevalence of osteoporosis significantly decreased with blood glucose and HbA1c. In addition, the BMD of the lumbar spine and femoral neck was higher in the T2DM group than in the controls. Osteoporosis was negatively associated with DM, BMI, and drinking, but positively associated with age, female gender, previous fracture history, and other diseases of the musculoskeletal system and connective tissue. The association between diabetes and osteoporosis remained statistically significant after adjusting for the above factors. T2DM was associated with lower odds of osteoporosis in both obese (OR = 0.77) and non-obese (OR = 0.63) (p for interaction = 0.555). Both obese and non-obese people with T2DM had higher BMD, at lumbar spine and femoral neck, compared with healthy subjects. In addition, the prevalence of osteoporosis significantly decreased with blood glucose and HbA1c.

Demographic and socioeconomic factors influencing the incidence of ankle fractures, a national population-based survey of 512187 individuals

This study aimed to investigate the population-based incidence rate of ankle fracture and associated risk factors in China. All the data on ankle fractures were available from the China National Fracture Survey (CNFS) conducted between January and May in 2015. All eligible household members were sampled from 8 provinces, 24 urban cities and 24 rural counties in China, using stratified random sampling and the probability proportional to size method. Questionnaires were sent to every participant for data collection and quality control was accomplished by our quality control team members. A total of 512187 valid questionnaires were collected and relevant data were abstracted and analyzed. One hundred and ninety patients sustained 193 ankle fractures in 2014, indicating the incidence rate was 37.1 (95% CI, 31.8–42.4)/100,000 person-year. Alcohol consumption, living alone and average sleep time <7 h/d were identified as independent risk factors for ankle fracture in both males and females. Previous history of fracture was identified as significant risk factor of ankle fracture in females but not in males. Therefore, specific public health policies focusing on decreasing alcohol consumption and encouraging individuals to obtain sufficient sleep should be implemented. Individuals living alone should focus more on healthcare, especially in those with previous fracture.

Investigation the prevalence and risk factors of vertebral fracture in community-dwelling elderly in Shanghai

Objective To investigate the prevalence and risk factors of vertebral fractures in the elderlys in Shanghai community. Methods Stratified sampling was performed according to the age distribution of the population in 3 urban and 2 suburban communities in Shanghai, and a total of 2 929 old people aged over 65 years were enrolled. The thoracic and lumbar radiographs and questionnaires were obtained in all the participants. The diagnosis of vertebral fractures were evaluated using Genant′s semi-quantitative method, and the prevalence of vertebral fracture was calculated. Logistic regression was used to analyze the risk factors of vertebral fracture. Results (1) The prevalence of vertebral fractures in community-dwelling elderly was 14.4% totally, and 20.1% in individuals above 80 years old, which was significantly higher than the others (P<0.05). The prevalence of vertebral fractures in females was significantly higher than that in males (18.5% vs 12.4%, P<0.05). (2) The most common vertebral fracture sites were T12 and L1. Grade 1 vertebral fracture was most common in our cohort. The proportions of grade 2 and grade 3 were significant higher in females than that in males (30.6% vs 17.0%, P<0.05). (3) Gender and sex had an interaction effect on the prevalence of vertebral fractures. Prevalence of vertebral fractures increased steadily with age in both genders, although the gradient was steeper for women (P<0.001). (4) Logistic regression analysis showed that: female, age, parental hip fracture history, previous fracture history, and alcohol consumption were risk factors of vertebral fractures in community elderly. Smoking, long-term use of glucocorticoid, various diseases associated with secondary osteoporosis had no significant correlation with vertebral fracture. Conclusion The vertebral fractures were more common and serious in women than in men in community elderly. Age was significantly correlated with the presence of vertebral fracture in women than that in men. Female, age, parental hip fracture history, previous fracture history, and alcohol consumption were risk factors of vertebral fractures in community elderlys. (Chin J Endocrinol Metab, 2018, 34: 498-504) Key words: Vertebral fractures; Prevalence; Risk factors; Community-dwelling elderly

Lumbar spondylolisthesis is a risk factor for osteoporotic vertebral fractures: a case-control study.

ObjectiveThis study aimed to identify the risk factors for vertebral compression fractures in patients with osteoporosis.MethodsA total of 864 patients with osteoporosis were enrolled in a retrospective study from February 2010 to June 2016. Patients with diseases, such as pathological fractures, high-energy direct injury to the thoracic or lumbar vertebrae, and severe spinal deformity, were excluded. The patients were divided into two groups: those with vertebral compression fractures (288) and those with no vertebral compression fractures (576). Information on the patients’ age, sex, lumbar bone mineral density (BMD), trauma, body mass index, previous history of vertebral compression fractures, and spondylolisthesis was recorded. Logistic regression analysis and the chi-square test were applied for comparisons.ResultsUnivariate logistic regression analysis and chi-square test results showed no significant differences in age, sex, body mass index, type 2 diabetes, previous history of vertebral fracture, and trivial trauma between the groups. Multivariate analysis showed significant associations between spondylolisthesis and BMD. Logistic regression analysis showed that spondylolisthesis and BMD were risk factors for vertebral compression fractures.ConclusionsLumbar spondylolisthesis is an independent risk factor for vertebral compression fractures in patients with osteoporosis. Therefore, patients with osteoporosis and lumbar spondylolisthesis require more attention.

Socioeconomic factors and individual lifestyles influencing the incidence of patella fractures: a national population-based survey in China.

We aimed to do a national survey on the population-based incidence of patella fractures and related risk factors fracture in China. All the data on patella fractures were available from the China National Fracture Survey (CNFS) between January and May in 2015. And in the CNFS, all eligible household members were selected from 24 urban cities and 24 rural counties of eight provinces of China, with stratified random sampling and the probability proportional to size method used. Questionnaire was sent to every participant for data collection and quality control was accomplished by our research team members. A total of 512,187 valid questionnaires were collected, and relevant data were abstracted. There were a total of 69 patients with 69 patella fractures that occurred in 2014, indicating that the incidence was 13.5 (95% CI, 10.3-16.7))/100,000 person-years. Slip, trip, or fall from standing height was the most common cause, leading to 69.6% (48/69) of patella factures, followed by traffic accidents (18.8%, 13/69). Home and road were the first two most common places, where 86.9% of the overall injuries occurred. Age of 45-64 and 65-74years, alcohol consumption and previous history of fractures were identified as independent risk factors for patella fracture. Specific public health policies focusing on decreasing alcohol consumption should be implemented. Individuals aged 45-64 and 65-74 should pay more attention to bone mass density and prevention of falls, especially those with previous history of fracture.

Frequency and Associated Factors of Bone Fractures in Russians: The Ural Eye and Medical Study

With information about frequency of bone fractures in Russia mostly missing, we assessed the frequency of previous bone fractures in a Russian population. The population-based study Ural Eye and Medical Study included 5899 (80.5%) out of 7328 eligible individuals (mean age: 59.0 ± 10.7 years; range: 40–94 years). The history of previous bone fractures was assessed in a standardized interview for 5397 (91.5%) individuals. Mean frequency of any previous bone fracture was 1650/5397 (30.6%; 95% confidence interval (CI): 29, 3, 31.8). In multivariate analysis, higher frequency of bone fractures was associated with male sex (P < 0.001; odds ratio (OR): 1.67; 95% CI: 1.41, 2.00), urban region (P < 0.001; OR: 1.45; 95% CI: 1.23, 1.72), higher prevalence of vigorous activity during leisure (P < 0.001; OR: 1.42; 95% CI: 1.20, 1.68), current smoking (P = 0.001; OR: 1.46; 95% CI: 1.16, 1.82) and higher prevalence of cardiovascular disease (P = 0.007; OR: 1.29; 95% CI: 1.07, 1.56), low blood pressure episodes with hospital admission (P = 0.001; OR: 2.08; 95% CI: 1.37, 3.16), tumbling (P < 0.001; OR: 2.58; 95% CI: 1.37, 3.16) and thoracic spine pain (P < 0.001; OR: 1.43; 95% CI: 1.18, 1.73). In women, menopause (P < 0.001; OR: 2.17; 95% CI: 1.47, 3.22) was additionally associated. The most common single-bone fractures involved leg and knee (229/5397; 4.2%), hand in general (n = 169; 3.1%) or hand wrist only (n = 97; 1.8%), arm (n = 94; 1.7%) and ankle (n = 67; 1.2%). Severe fractures included spine (n = 35; 0.6%), os sacrum (n = 10; 0.2%), skull (n = 6; 0.1%), pelvis (n = 5; 0.1%) and hip (n = 22; 0.4%). Most frequent combined fractures included as most important part the leg (n = 90; 1.7%), spine (n = 18; 0.3%), and hip (n = 18; 0.3). These data give hints on the epidemiology of bone fractures in Russia.

Failure in diagnosis and under-treatment of osteoporosis in elderly patients with fragility fractures.

We evaluated whether osteoporosis is adequately managed and treated in patients suffering from fragility fractures. Factors that influenced osteoporosis diagnosis and treatment rates were also assessed. To this end, patients with the principal diagnosis of low-energy hip, vertebral, or distal radius fractures were recruited for the study. Collected data included risk factors for osteoporosis, history of previous fractures, known history of osteoporosis, and osteoporosis treatment at the time of admission. The patients' prefracture risk profile was also assessed to determine whether osteoporosis could have been identified prior to the index fracture. We identified 308 patients with fragility fractures, including 214 hip, 41 vertebral, and 53 distal radius fractures. Overall, 238 patients (77.3%) had at least one risk factor for osteoporosis. Eighty-eight patients (28.6%) had sustained ≥ 1 prior fragility fractures in the past. However, only 79 patients (25.6%) were aware that they had osteoporosis and even fewer (66 patients, 21.4%) had been receiving osteoporosis treatment preceding the current admission. Anti-osteoporotic agents were more commonly prescribed in patients 66-75years old (p = 0.008), with a family history of osteoporosis (p = 0.009) or history of a prior fragility fracture (p = 0.012). The treatment rate was higher in women than men (p = 0.026) and in patients with vertebral or multiple prior fractures compared to patients with prior hip fractures. The current study provides evidence that individuals who experience fragility fractures are not adequately managed for osteoporosis. Only few of the historically known risk factors for osteoporosis were adequately recognized and associated with osteoporosis evaluation and treatment.