Risk Of Long Bone Fractures Research Articles

Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia.

Bone fractures are a significant public health issue among elderly subjects. This study examines the impact of diet and vitamin D status on the risk of long bone fractures due to falls in elderly subjects in Vojvodina, Serbia. Conducted at the University Clinical Center of Vojvodina in autumn/winter 2022-2023, the study included 210 subjects >65 years: 105 (F: 80/M: 15) with long bone fractures due to falls and 105 (F: 80/M: 15) controls. Groups were similar regarding age and BMI. Dietary intakes (by two 24-h recalls) and serum vitamin D levels were analyzed. The fracture group had a significantly lower median daily vitamin D intake (1.4 μg/day vs. 5.8 μg/day), intake of calcium, energy, proteins, fats, fibers, dairy products, eggs, fish, edible fats/oils, and a higher intake of sweets (p < 0.001 for all). Serum vitamin D levels were significantly lower in the fracture group (40.0 nmol/L vs. 76.0 nmol/L, p < 0.001). Logistic regression identified serum vitamin D as the most important protective factor against fractures, and ROC curve analysis indicated that serum vitamin D levels > 50.5 nmol/L decreased fracture risk. Nutritional improvements (increased intake of vitamin D and protein sources such as fish, eggs, and dairy), increased sun exposure, and routine vitamin D supplementation during winter are advised.

Administration of Human Non-Diabetic Mesenchymal Stromal Cells to a Murine Model of Diabetic Fracture Repair: A Pilot Study.

Individuals living with type 1 diabetes mellitus may experience an increased risk of long bone fracture. These fractures are often slow to heal, resulting in delayed reunion or non-union. It is reasonable to theorize that the underlying cause of these diabetes-associated osteopathies is faulty repair dynamics as a result of compromised bone marrow progenitor cell function. Here it was hypothesized that the administration of non-diabetic, human adult bone marrow-derived mesenchymal stromal cells (MSCs) would enhance diabetic fracture healing. Human MSCs were locally introduced to femur fractures in streptozotocin-induced diabetic mice, and the quality of de novo bone was assessed eight weeks later. Biodistribution analysis demonstrated that the cells remained in situ for three days following administration. Bone bridging was evident in all animals. However, a large reparative callus was retained, indicating non-union. µCT analysis elucidated comparable callus dimensions, bone mineral density, bone volume/total volume, and volume of mature bone in all groups that received cells as compared to the saline-treated controls. Four-point bending evaluation of flexural strength, flexural modulus, and total energy to re-fracture did not indicate a statistically significant change as a result of cellular administration. An ex vivo lymphocytic proliferation recall assay indicated that the xenogeneic administration of human cells did not result in an immune response by the murine recipient. Due to this dataset, the administration of non-diabetic bone marrow-derived MSCs did not support fracture healing in this pilot study.

PREDICTION OF LONG BONE FRACTURES VIA RECONSTRUCTION OF PEDESTRIAN ACCIDENTS USING MULTI-BODY SYSTEM AND FE MODELS

This study aimed at prediction of long bone fractures and analysis of lower extremity injury mechanisms in real world passenger car to pedestrian collision. For this purpose, two cases of car to pedestrian accidents with detail recorded lower extremity injuries were reconstructed using Multi-body system (MBS) and Finite element (FE) models. The MBS models were used to determine lower extremity impact conditions, such as impact velocity, contact location as well as impact orientation. Furthermore, impact conditions were used to define initial boundary conditions in the simulation of lower extremity colliding with car front end using FE models. The bending moment and von Mises stress distributions of long bone were calculated in FE model to evaluate long bone fracture risks. Then, injury outcomes from simulations were compared with hospital recorded injury data. The simulation results of long bone fracture were consistent with the injury pattern and positions from hospital records. Moreover, the calculated fracture moments of tibia and fibula shaft as well as femur neck region were 310.8, 21.4 and 304.7 Nm, respectively. The FE model is capable to reproduce the dynamic injury process and is an effective tool to demonstrate the dynamic response of the injury and to predict the risk of long bone fractures.

Low‐level chronic exposure to cadmium enhances the risk of long bone fractures: a study on a female rat model of human lifetime exposure

In the present paper, the hypothesis that low chronic exposure to cadmium (Cd) enhances the risk of long bone fractures was investigated in a female rat model simulating human lifetime exposure in non-Cd-polluted areas. For this purpose, the femur and both tibias of control female rats and those exposed to Cd (1 mg Cd I(-1) in drinking water for 24 months since weaning) were assigned to geometric, densitometric (bone mineral content, BMC, and density, BMD), radiographic and biomechanical studies as well as assessing their chemical composition. The exposure to Cd disturbed mineralization (decreased BMD and minerals content, including calcium, magnesium, zinc, copper and iron) and weakened the biomechanical strength of the femur and tibia, enhancing their fragility. The Z-score values for the BMD revealed osteopenia of the femur and tibia in 20 and 30% of the Cd-exposed female rats, respectively, and osteoporosis in 80 and 70%, respectively. In 30% of the Cd-exposed animals, femoral neck fracture was evident in the radiographic picture. The findings seem to confirm the hypothesis that a low exposure to Cd during the lifetime may be an important risk factor for osteoporosis and fractures of long bones, and especially for femoral neck fracture in elderly women. The results indicate that greater attention should be paid to Cd as an environmental risk factor for the increasing rate of osteoporosis and bone fractures in old population.

Virtual Reconstruction of Long Bone Fracture in Car-to-pedestrian Collisions Using Multi-body System and Finite Element Method

Lower limb injures are frequently observed in passenger car traffic accidents. Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinematics, which lack in-depth study on the fractures in stress analysis. This paper aims to investigate lower limb impact biomechanics in real-world car to pedestrian accidents and to predict fractures of long bones in term of stress parameter for femur, tibia, and fibula. For the above purposes, a 3D finite element (FE) model of human body lower limb (HBM-LL) is developed based on human anatomy. The model consists of the pelvis, femur, tibia, fibula, patella, foot bones, primary tendons, knee joint capsule, meniscus, and ligaments. The FE model is validated by comparing the results from a lateral impact between simulations and tests with cadaver lower limb specimens. Two real-world accidents are selected from an in-depth accident database with detailed information about the accident scene, car impact speed, damage to the car, and pedestrian injuries. Multi-body system (MBS) models are used to reconstruct the kinematics of the pedestrians in the two accidents and the impact conditions are calculated for initial impact velocity and orientations of the car and pedestrian during the collision. The FE model is used to perform injury reconstructions and predict the fractures by using physical parameters, such as von Mises stress of long bones. The calculated failure level of the long bones is correlated with the injury outcomes observed from the two accident cases. The reconstruction result shows that the HBM-LL FE model has acceptable biofidelity and can be applied to predict the risk of long bone fractures. This study provides an efficient methodology to investigate the long bone fracture suffered from vehicle traffic collisions.

Effect of High-frequency, Low-magnitude Vibration on Bone and Muscle in Children With Cerebral Palsy

Children with cerebral palsy (CP) have decreased strength, low bone mass, and an increased propensity to fracture. High-frequency, low-magnitude vibration might provide a noninvasive, nonpharmacologic, home-based treatment for these musculoskeletal deficits. The purpose of this study was to examine the effects of this intervention on bone and muscle in children with CP. Thirty-one children with CP ages 6 to 12 years (mean 9.4, SD 1.4) stood on a vibrating platform (30 Hz, 0.3 g peak acceleration) at home for 10 min/d for 6 months and on the floor without the platform for another 6 months. The order of vibration and standing was randomized, and outcomes were measured at 0, 6, and 12 months. The outcome measures included computed tomography measurements of vertebral cancellous bone density (CBD) and cross-sectional area, CBD of the proximal tibia, geometric properties of the tibial diaphysis, and dynamometer measurements of plantarflexor strength. They were assessed using mixed model linear regression and Pearson correlation. The main difference between vibration and standing was that there was a greater increase in the cortical bone properties (cortical bone area and moments of inertia) during the vibration period (all P's ≤ 0.03). There was no difference in cancellous bone or muscle between vibration and standing (all P's > 0.10) and no correlation between compliance and outcome (all r's < 0.27; all P's > 0.15). The results did not depend on the order of treatment (P > 0.43) and were similar for children in gross motor function classification system (GMFCS) 1 to 2 and GMFCS 3 to 4. The primary benefit of the vibration intervention in children with CP was to the cortical bone in the appendicular skeleton. Increased cortical bone area and the structural (strength) properties could translate into a decreased risk of long bone fractures in some patients. More research is needed to corroborate these findings, to elucidate the mechanisms of the intervention, and to determine the most effective age and duration of the treatment. Level II, prospective randomized cross-over study.

Report of a Muscular Dystrophy Campaign funded workshop Birmingham, UK, January 16th 2004. Osteoporosis in Duchenne muscular dystrophy; its prevalence, treatment and prevention

A Muscular Dystrophy Campaign funded workshop to look into the potential problems of osteoporosis occurring in boys with DMD treated with steroids took place in Birmingham (UK) on the 16th January 2004. Fourteen participants met from varied backgrounds including, paediatric neuromuscular disease, neurology, paediatric and adult metabolic bone disease, paediatric rheumatology, genetics, physiotherapy and medical physics together with a representative from the Muscular Dystrophy Campaign. The aims of the workshop were to assess the evidence for the risk of osteoporosis in Duchenne muscular dystrophy (DMD), to assess the adverse effects of corticosteroid (steroid) treatment relating to bone mineral density and longitudinal growth and to assess the current evidence for the prevention and treatment of osteoporosis. Steroids are increasingly used in boys with DMD following the evidence from randomised controlled trials on their short-term benefit. However, the balance between long-term benefit and side effects has not been established. Long-term steroid use may be associated with significant side effects including weight gain, growth failure, cataracts and osteoporosis, so the development of strategies to prevent or treat these complications is important. We reviewed the literature to determine

Chemical and biomechanical characterization of hyperhomocysteinemic bone disease in an animal model.

BackgroundClassical homocystinuria is an autosomal recessive disorder caused by cystathionine β-synthase (CBS) deficiency and characterized by distinctive alterations of bone growth and skeletal development. Skeletal changes include a reduction in bone density, making it a potentially attractive model for the study of idiopathic osteoporosis.MethodsTo investigate this aspect of hyperhomocysteinemia, we supplemented developing chicks (n = 8) with 0.6% dl-homocysteine (hCySH) for the first 8 weeks of life in comparison to controls (n = 10), and studied biochemical, biomechanical and morphologic effects of this nutritional intervention.ResultshCySH-fed animals grew faster and had longer tibiae at the end of the study. Plasma levels of hCySH, methionine, cystathionine, and inorganic sulfate were higher, but calcium, phosphate, and other indices of osteoblast metabolism were not different. Radiographs of the lower limbs showed generalized osteopenia and accelerated epiphyseal ossification with distinct metaphyseal and suprametaphyseal lucencies similar to those found in human homocystinurics. Although biomechanical testing of the tibiae, including maximal load to failure and bone stiffness, indicated stronger bone, strength was proportional to the increased length and cortical thickness in the hCySH-supplemented group. Bone ash weights and IR-spectroscopy of cortical bone showed no difference in mineral content, but there were higher Ca2+/PO43- and lower Ca2+/CO32- molar ratios than in controls. Mineral crystallization was unchanged.ConclusionIn this chick model, hyperhomocysteinemia causes greater radial and longitudinal bone growth, despite normal indices of bone formation. Although there is also evidence for an abnormal matrix and altered bone composition, our finding of normal biomechanical bone strength, once corrected for altered morphometry, suggests that any increase in the risk of long bone fracture in human hyperhomocysteinemic disease is small. We also conclude that the hCySH-supplemented chick is a promising model for study of the connective tissue abnormalities associated with homocystinuria and an important alternative model to the CBS knock-out mouse.