Significant Risk Factor For Fractures Research Articles

Physical activity in the prevention and treatment of osteoporosis: From biomarkers to quality of life

Introduction and Objective: Osteoporosis is a common skeletal disease typified by diminished bone density and deterioration of bone structure. It represents a significant risk factor for fractures, particularly in postmenopausal women. This study evaluates the role of physical activity and bone biomarkers in the prevention and treatment of osteoporosis. Review and Methods: A review of the literature was conducted with the objective of analysing the impact of weight-bearing exercise and resistance training on bone health and the use of biomarkers in diagnosing and monitoring osteoporosis. Moreover, the potential impact of dietary interventions and supplementation was examined. Abbreviated Description of the State of Knowledge: It is of the utmost importance to engage in regular physical activity, particularly weight-bearing exercises, in order to prevent and treat osteoporosis. It has been demonstrated to enhance bone density and moderate the likelihood of fracture. Biomarkers such as osteocalcin and alkaline phosphatase are of significant value in the assessment of bone health. Summary: The combination of physical activity, a balanced diet and appropriate supplementation is fundamental to the prevention and effective management of osteoporosis. This approach confers substantial benefits with respect to bone health and quality of life. Keywords: Osteoporosis; Physical activity; Bone health; Skeletal System

Low Hounsfield unit values on computed tomography as a potential predictor of vertebral fracture in patients with rheumatoid arthritis: The KURAMA cohort study.

Hounsfield units (HU) measured using computed tomography (CT) have gained considerable attention for the detection of osteoporosis. This study aimed to investigate whether opportunistic CT could predict vertebral fractures in patients with rheumatoid arthritis (RA). A total of 233 patients with RA who underwent chest CT were included in this study. The HU values of the anterior 1/3 of the vertebral bodies based on the sagittal plane at T11-L2 after reconstruction were measured. The incidence of vertebral fractures was investigated with respect to the HU value. Vertebral fractures were identified in 32 patients during a mean follow-up period of 3.8 years. In patients who experienced vertebral fractures within 2 years of CT imaging, the HU values of the vertebral bodies (T11-L2) were lower than those in patients who did not experience fractures. Receiver operating characteristic curve analysis identified that a T11 HU value of <125 was a risk factor for vertebral fracture within 2 years. Multivariate analysis showed that a T11 HU value of <125 and the existence of prevalent vertebral fractures were significant risk factors for fracture. HU measurements of the anterior 1/3 of the vertebral body are a potential predictor for vertebral fractures in patients with RA.

Association of secondhand smoke with fracture risk in community-dwelling nonsmoking adults in Korea.

Although the detrimental effects of active smoking on bone health have been widely recognized, the impact of secondhand smoke exposure on fracture risk in non-smokers remains less understood. A total of 4843 nonsmokers aged 40-69yr, who participated in the Korean Genome and Epidemiology Study from 2001 to 2018, were analyzed. The participants were categorized into two groups based on their exposure status to secondhand smoke: currently exposed and unexposed. The exposure group was subsequently divided into two subgroups based on the median weekly exposure time (high vs low). The incidence of new fractures was determined using self-reported questionnaires. The identified fractures were categorized according to the fracture site: overall, vertebral, hip, non-vertebral, and non-vertebral non-hip fractures. The mean age of the participants was 52.4yr (84.1% women). Exposure to secondhand smoke was associated with an increased risk of fracture (adjusted hazard ratio [aHR]: 1.27, P =0.028) after adjusting for multiple covariates including age, sex, BMI, household income, bone density of mid-shaft tibia, C-reactive protein, alcohol consumption, and fracture history. Secondhand smoke remained as a significant risk factor for fracture, independent of the major osteoporotic fracture probabilities estimated using a fracture risk assessment tool (aHR: 1.24, P =0.038). The high exposure group had higher risk of fracture than that of the unexposed group (aHR: 1.33, P =0.025), whereas the fracture risk did not differ significantly between low exposure and unexposed groups (aHR: 1.18, P =0.253), suggesting a potential dose-response relationship. Secondhand smoke showed robust association with increased risk of non-vertebral (aHR: 1.37, P =0.008) or non-vertebral non-hip fractures (aHR: 1.36, P =0.013), while its association with vertebral fracture was attenuated (aHR: 1.03, P =0.908). Secondhand smoke was associated with an elevated risk of fracture in nonsmokers, independent of clinical risk factors.

Impact of accumulating risk factors on the acromial and scapular fracture rate after reverse total shoulder arthroplasty with a medialized glenoid-lateralized humerus onlay prosthesis.

Identifying risk factors for acromial and scapular fractures improves our understanding about which variables are relevant to these fracture complications; however, these data are difficult to integrate into clinical practice because the majority of reverse total shoulder arthroplasty (rTSA) patients have ≥1 risk factor. The goal of this study was to better facilitate preoperative identification of patients at risk of acromial and scapular fractures and quantify the impact of accumulating risk factors on the incidence of fracture. We retrospectively analyzed 9079 rTSA patients from a multicenter database of rTSA procedures performed with a single medialized glenoid-lateralized humerus onlay rTSA prosthesis to quantify the rate of acromial and scapular fractures. Univariate and multivariate analyses were performed to identify risk factors for fracture. Next, we quantified the number of patients with 1 or multiple significant risk factors for fracture. Finally, to facilitate preoperative identification of patients most at risk of fracture, we stratified our data set using multiple combinations of age, sex, and diagnosis risk factors and calculated the odds ratio for each cohort to quantify the impact of accumulating risk factors on the incidence of fracture. A fracture of the acromion or scapula was radiographically identified in 138 of 9079 patients, for a rate of 1.52%. Patients with fractures were more likely to be older, of female sex, to have a diagnosis of rheumatoid arthritis and/or cuff tear arthropathy, and were less likely to have a diagnosis of diabetes. Eighty-five percent of rTSA patients had ≥1 fracture risk factor. Individually, age, sex, or diagnosis failed to identify any patient cohort with an odds ratio >2.5. Use of multiple combinations of patient risk factors refined the identification of at-risk patients better than any individual risk factor or 2-risk factor combination and demonstrated that the patients with the greatest fracture risk were female patients with a rheumatoid arthritis diagnosis who were aged >70, >75, and >80 years. This 9079-rTSA multicenter study demonstrated that 1.52% of patients experienced acromial and/or scapular fractures with a single medialized glenoid-lateralized humerus onlay rTSA prosthesis. Our analysis identified numerous risk factors and quantified the impact of accumulating risk factors on fracture incidence. Patients who are considering rTSA and who have these age, sex, and diagnosis risk factors should be made aware of their elevated complication risk.

Risk factors for fracture in patients with fibrous dysplasia of the proximal femur

The primary aim of this retrospective observational clinical study was to explore the risk factors for fracture in patients with fibrous dysplasia (FD) of the proximal femur. We investigated body mass index, bilateral radiographs on both sides, femoral neck shaft angle measurements, and markers of bone metabolism in patients with FD of the proximal femur according to whether or not they had sustained a hip fracture. Nine clinical parameters (age, sex, clinical classification, anatomic classification, femoral neck shaft angle, and procollagen type 1 N-terminal propeptide, C-terminal telopeptide of type I collagen, and osteocalcin levels) were selected for univariate analysis. Factors that were significant in univariate analysis were then subjected to multivariate logistic analysis. Clinical classification, anatomic classification, femoral neck shaft angle, and the osteocalcin level were identified to be statistically significant risk factors for fracture in univariate analysis. Anatomic classification, femoral neck shaft angle, and the osteocalcin level remained significant risk factors in multivariate analysis. Anatomic classification, femoral neck shaft angle, and the osteocalcin level are important risk factors for fracture in patients with FD of the proximal femur and could be used to guide implementation of a fracture prevention strategy in these patients.

EVALUATION OF THE CONCOMITANT PRESENCE OF HYPERTENSION AND OSTEOPOROSIS AND THE IMPORTANCE OF SCREENING IN LEBANON: A PILOT STUDY

Abstract Objective: Hypertension and osteoporosis are two age-related diseases whose interlinkage are under investigated. In Lebanon, given the high morbidity and mortality rates due to cardiovascular diseases, and the low national health priority given to osteoporosis, we conducted a pilot study to investigate the relationship between the two diseases and the need to screen for them. Design and method: In the summer of 2019, Lebanon participated for a second year in the May Measurement Month. As part of this campaign, a cross-sectional pilot study was launched based on a convenient sampling. It included 730 participants of both genders, aged 18 and above; consent was obtained from all participants. Participants answered a questionnaire about blood pressure and bone health, and were screened for hypertension, following which lifestyle tips were distributed. Results: Our data showed a hypertension prevalence of 41%. When asked about the last time they checked their blood pressure, participants’ response was: 11.4% never, 19.8% more than a year ago, and 68.8% within the last 12 months. 45% of hypertensive participants were not aware of their hypertensive status. Concerning osteoporosis, 8.3% of participants claimed they had it, while 24.8% did not know whether they had it or not. Furthermore, 80.5% mentioned never screening for bone thinning in their lifetime (with 35.6% of them being 43 years and above). A significant association was observed between hypertension and osteoporosis (P = 0.0424). Osteoporosis was a significant risk factor for fractures (P = 0.0068), with an OR of 2.2 CI (1.23–3.99). Height was significantly associated with blood pressure (P &lt; 0.0001), with a higher correlation among participants less than 43 years of age (P &lt; 0.0001). Hypertensive status was significantly associated with bone fractures (P = 0.011). Conclusions: An association exists between hypertension, osteoporosis and bone fractures. This makes screening for both diseases important, given that hypertension is the leading risk factor for cardiovascular death in Lebanon and that the country lacks national comprehensive data about incidence and prevalence of hypertension and osteoporosis. This pilot study can serve as a foundation for an upcoming nationwide screening campaign, and an evidence base for future preventative measures.

Fracture risk assessment in celiac disease: a registry-based cohort study.

The fracture risk assessment tool (FRAX®) uses clinical factors and bone mineral density (BMD) measurement to predict 10-year major osteoporotic (MOF) fracture probability. The study aim was to determine whether celiac disease affects MOF risk independent of FRAX score. The Manitoba BMD Registry includes clinical data, BMD measurements, 10-year probability of MOF calculated for each individual using the Canadian FRAX tool and diagnosed celiac disease. Using linkage to population-based healthcare databases, we identified incident MOF diagnoses over the next 10years for celiac disease and general population cohorts. Celiac disease (N = 693) was associated with increased fracture risk adjusted for FRAX score computed without secondary osteoporosis or BMD (adjusted hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.11-1.86). Celiac disease was no longer a significant risk factor for fracture when secondary osteoporosis or BMD were included in the FRAX calculation (p > 0.1). In subjects with celiac disease, each SD increase in FRAX score (calculated with and without secondary osteoporosis or BMD) was associated with higher risk of incident MOF (adjusted HR 1.66 to 1.80), similar to the general population (p-interaction > 0.2). Including celiac disease as secondary osteoporosis or including BMD in FRAX 10-year MOF probability calculations (10.1% and 8.6% respectively) approximated the observed cumulative 10-year MOF probability (10.8%, 95% CI 7.8-13.9%). Celiac disease is associated with an increased risk of major osteoporotic fractures. When celiac disease is considered as a secondary osteoporosis risk factor or BMD is included in FRAX assessment, FRAX accurately predicts fracture risk.

Acromial and spine fractures after reverse arthroplasty: Prevalence and risk factors

BackgroundStress fractures of the acromion and spine of the scapula are a known complication after reverse shoulder arthroplasty (RSA). Most reports on these fractures include single implants and relatively small numbers. Controversy remains regarding risk factors and optimal management for these fractures. The purpose of this study was to assess the prevalence and risk factors for periprosthetic scapular acromion and spine fractures in a large series of consecutive primary RSA. MethodsBetween 2004 and 2016, 2,172 primary RSAs were performed at a single tertiary referral center using various implants over time. Medical records were reviewed to identify all shoulders (n = 36) that sustained a postoperative fracture of the scapular spine or acromion. Univariate and multivariable-adjusted logistic regression analyses were used to determine whether any of the following were significant risk factors for fracture: age, gender, BMI, diagnosis, prior acromioplasty, prior cuff repair, and implant type. ResultsThere were 34 acromial and 2 scapular spine stress fractures, resulting in a prevalence rate of 2%. The mean interval between the index arthroplasty and the diagnosis of fracture was 12 months. The majority of the fractures (89%) were treated non-operatively with shoulder immobilization for 6 weeks. The remaining four fractures (11%) were treated open reduction internal fixation (ORIF). In the multivariate regression analysis, there was a trend towards increased risk of fracture for females (HR = 1.71, p = 0.09) and those with a prior acromioplasty (HR = 2.55, p = 0.07). No significant associations were found with age (HR = 0.84, p = 0.26), BMI (HR = 1.01, p = 0.62), previous rotator cuff repair (HR = 1.47, p = 0.25), diagnosis (HR = 1.03, p = 0.97), medialized (HR = 1.30, p = 0.44), or lateralized center of rotation (HR = 0.77, p = 0.44). ConclusionsPostoperative stress fractures of the acromion or spine of the scapula complicated the course of 1.6% of all primary RSAs included in this study. Female gender and a prior acromioplasty may predispose to these fractures. The majority of the fractures involve the acromion, with much less frequent involvement of the spine of the scapula. With the numbers available, no associations were found with age, BMI, diagnosis and various implant features. Level of EvidenceLevel III; Retrospective comparative study; Treatment study.

Prevalence of Fracture of Forearm Bones in Obese and Non-obese Children: A Cross-sectional Study

Introduction: Through much history of mankind, the overt manifestation of bodyweight gain in children and adults have been considered as a sign of personal health and family wealth and an indicator of the economic prosperity of the society. As developing societies are industrialised and urbanised, the standards of living continued to rise; obesity and weight gain began to pose a growing threat to the health of the citizens. Aim: To determine the prevalence of forearm bones fracture in obese and non-obese children between age group of 2-15 years. Materials and Methods: A cross-sectional study was conducted in the Department of Orthopaedics and Paediatrics at Dr BC Roy Post Graduate Institute of Paediatric Science, Kolkata, West Bengal, India from September 2017 to October 2018. Children were classified into obese and non-obese group according to Body Mass Index (BMI). Calculation of BMI was done by the formula BMI=weight (kg)/{height(m)}2. Obese children were determined by the BMI percentile by plotting the BMI number on the appropriate Centers for Diseases Control and Prevention (CDC) BMI-for-age growth chart. Doubtful cases classification was confirmed by the paediatric surgeon. Injury mechanism was graded into three trauma kinetics (direct trauma, slow motion trauma and high motion trauma). The validated paediatric Physical Activity Questionnaire (PAQ-A and PAQ-C) were used to grade the average daily activities during the week prior to trauma. Statistical analysis was done by using the Chi-square test and p-value of &lt;0.05 was considered to be statistically significant. Results: Total 583 children were treated during the study period in the hospital including both Outpatient Department (OPD) and Emergency Department. About 433 children were excluded due to below age two years, refracture, chronic illness, and major congenital malformation. Among them only 150 patients met the criteria of present study. Out of 150 children, 69 (46%) were found obese and non-obese were 81 (54%). The distribution by gender was the same in obese group which had 26 (37.68%) female and 43 (62.32%) male, in non-obese group 34 (41.97%) female and 47 (58.03%) male. It was observed that both bones fracture of forearm in obese children was more at risk than non-obese children, p-value of &lt;0.5 which was statistically significant. Conclusion: Present study shows higher prevalence of forearm bone fracture in obese children than non-obese children. Obesity and other certain factors might have been significant risk factor for fracture required for operation. Both radius-ulna fracture in obese were found significant.

The Importance of Physiotherapy in Promoting Bone Health for Children Supported by VAD: Early Mobilisation and Weight Bearing Guidelines

Purpose Critically ill children are at risk of bone loss due to a multitude of factors including immobility. For children who require cardiac transplantation, with or without ventricular assist device (VAD) support, reduced mobility is particularly evident. This is due in part to the severity of the child's condition and environmental limitations. Bone loss is known to be a significant risk factor for fractures which can perpetuate immobility. We reviewed patients who developed bone fractures at our institution and aimed to describe the impact of physiotherapy on their care. Methods Patients listed or within 6 months of cardiac transplant were identified from the physiotherapy transplant/VAD database. We performed a retrospective case series analysis identifying risk factors for the development of bone fractures and analysed the physiotherapy programmes. We subsequently carried out a literature review looking at factors in physiotherapy management which impact outcomes and provided guidelines for patient management. Results Between 2015 to 2017 3 of 45 cardiac transplant patients developed an atraumatic femoral bone fracture: two whilst supported on VAD and one immediately post discharge after transplantation. The children on VAD were 18 weeks and 19months old. Diagnosis was dilated DCM and late presentation ALCAPA. Both children required long tern ventilation support via tracheostomy . The third child was 37 months with a failing Fontan circulation supported medically in our PICU before transplant. All 3 received prolonged unfractionated heparin. All three children had daily physiotherapy as per our standard protocol. Conclusion Physical activity, complete nutrition and exposure to sunlight are known key elements of optimal bone health and all of these are severely limited in a young child on VAD support. Physiotherapy is a key factor in improving physical activity in children on VAD support but there are currently no published recommendations for the prevention of bone fractures while on VAD. We believe aggressive physiotherapy using protocols similar to those used for children not on VAD support with a focus on weight bearing are needed for these patients. We present a mobilisation protocol including weight bearing guidelines, as part of a comprehensive bone health strategy.

Hypoglycaemia is associated with increased risk of fractures in patients with type 2 diabetes mellitus: a cohort study.

Objective Type 2 diabetes is associated with an increased risk of fracture. Any factor that incrementally increases this risk should be taken into account when individualising treatment. Hypoglycaemia is a common complication of antidiabetes medications and suggested as a risk factor for fractures; yet, its real-life clinical impact is unclear. Design A population-based, retrospective open cohort study using routinely collected data between 1st of January 1995 and 1st of May 2016 in The Health Improvement Network (THIN) database. Methods Patients with type 2 diabetes mellitus with documented hypoglycaemic events were compared to randomly matched patients with type 2 diabetes mellitus without documented hypoglycaemic events matched to exposed patients on age, sex, duration of diabetes and BMI. The primary outcome was any incident fracture. Secondary outcome was incident fragility (osteoporotic) fracture. Results A total of 41 163 patients with type 2 diabetes were included: 14 147 patients in the exposed cohort and 27 016 patients in the unexposed cohort. Patients with a documented hypoglycaemic event were significantly more likely to sustain any fracture compared to patients with no record of hypoglycaemic events: adjusted IRR = 1.20 (95% CI: 1.12-1.30; P < 0.0001). Patients who had a documented hypoglycaemic event were significantly more likely to suffer a fragility fracture compared to controls: adjusted IRR = 1.24 (95% CI: 1.13-1.37; P < 0.0001). Conclusions Hypoglycaemic events are a significant risk factor for fractures in patients with diabetes mellitus. This observation is clinically relevant when individualising targets for glycaemic control and selecting antidiabetic agents.

The serum creatinine to cystatin C ratio predicts bone fracture in patients with type 2 diabetes: The Fukuoka Diabetes Registry

AimsSarcopenia is involved in the pathogenesis of increased fracture risk associated with diabetes. The serum creatinine to cystatin C (Cr/CysC) ratio has been reported as a surrogate marker for muscle mass. We aimed to prospectively investigate the relationship between the Cr/CysC ratio and fracture risk. MethodsWe followed 1911 postmenopausal women and 2689 men with type 2 diabetes (mean age, 66 years) for a median of 5.3 years, and divided into Cr/CysC ratio quartiles by sex. The primary outcome was fragility fractures and the secondary outcome was any fracture. ResultsFragility fractures occurred in 192 participants, and any fracture occurred in 645 participants. Multivariate-adjusted hazard ratios (95% CI) for fragility fractures were 2.15 (1.19–3.88) (Q1), 1.63 (0.89–2.98) (Q2), 1.34 (0.72–2.51) (Q3) and 1.0 (ref.) (Q4) in postmenopausal women, and 1.75 (0.64–4.50) (Q1), 2.09 (0.83–5.26) (Q2), 1.56 (0.58–4.18) (Q3) and 1.0 (ref.) (Q4) in men. Those for any fracture were 1.46 (1.07–1.98) (Q1), 1.33 (0.98–1.81) (Q2), 1.40 (1.03–1.88) (Q3) and 1.0 (ref.) (Q4) in postmenopausal women, and 2.33 (1.54–3.54) (Q1), 2.02 (1.54–3.04) (Q2), 1.13 (0.71–1.78) (Q3) and 1.0 (ref.) (Q4) in men. ConclusionsA lower Cr/CysC ratio is a significant risk factor for fractures in patients with type 2 diabetes.

Change in ultrasound-assessed speed of sound at the tibia and distal radius as a function of age: The Canadian Multicentre Osteoporosis Study.

Introduction Speed of sound (SOS in m/s) measured with the BeamMed Sunlight Multi-site quantitative ultrasound (QUS) can predict fracture in women over a five-year period, independent of bone mineral density and other significant risk factors for fracture. The rate of SOS decline may better identify patients with an elevated risk for fracture than a single SOS measurement. Objectives To assess the average rate of change in SOS as a function of age among Canadians 30-90y, stratified by sex. Methods This investigation included all participants of the Canadian Multicenter Osteoporosis Study (CaMOS) with two SOS measurements approximately five years apart, allowing for calculation of rate of change. SOS measurements were at the distal radius (DR) and tibia (TIB) sites. Participants were grouped in 10-year bands according to baseline age (≤40 y, >40-50y, >50-60y, >60-70y, >70-80y and >80y) and mean five-year rates of change were calculated. All changes were normalized to five-year rates. Standard descriptive and comparative statistics were employed. Results There were 720 participants (211 men and 509 women) with SOS measurements at the DR and/or TIB sites at baseline and approximately five years later (mean 1841 days; SD 68.5 days). The mean (SD) change over the five-year follow-up at the DR was -83.7 m/s (112.2) and at the TIB was -17.1 m/s (114.8). Please see the table for the mean (SEM) changes in SOS over the age groups. There were no significant differences in the mean change in DR SOS in the total, men or women's sites among the age groups, although there was a trend for a decreasing DR at the approximate time of menopause in the women's group. At the TIB site, there were also no significant differences in mean change in SOS among the age groups for the total and men's groups, but there were significant differences (p Conclusions There were clear trends in the data that men had a relatively stable loss in SOS, whereas women tended to have a greater loss in the age group most associated with menopause. The relatively small sample size of men as compared to women may have limited the power to detect differences among groups in men. Use of antiresorptive therapy during the observation period may also be a confounding factor. However, the overall trend is one of almost-consistent loss of SOS at all age groups, as to be expected following the attainment of peak bone mass.

Recurrent vertebral fractures in a young adult: a closer look at bone health in type 1 diabetes mellitus.

SummaryThe association between type 1 diabetes mellitus (T1DM) and bone health has garnered interest over the years. Fracture risk is known to be increased in individuals with T1DM, although bone health assessment is not often performed in the clinical setting. We describe the case of a 21-year-old male with longstanding T1DM with multilevel vertebral fractures on imaging, after presenting with acute back pain without apparent trauma. Dual-energy X-ray absorptiometry (DXA) revealed significantly reduced bone mineral density at the lumbar spine and femoral neck. Extensive investigations for other secondary or genetic causes of osteoporosis were unremarkable, apart from moderate vitamin D deficiency. High-resolution peripheral quantitative computed tomography and bone biospy revealed significant alterations of trabecular bone microarchitecture. It later transpired that the patient had sustained vertebral fractures secondary to unrecognised nocturnal hypoglycaemic seizures. Intravenous zoledronic acid was administered for secondary fracture prevention. Despite anti-resorptive therapy, the patient sustained a new vertebral fracture after experiencing another hypoglycaemic seizure in his sleep. Bone health in T1DM is complex and not well understood. There are significant challenges in the assessment and management of osteoporosis in T1DM, particularly in young adults, where fracture prediction tools have not been validated. Clinicians should be aware of hypoglycaemia as a significant risk factor for fracture in patients with T1DM.Learning points:Type 1 diabetes mellitus (T1DM) is a secondary cause of osteoporosis, characterised by reduced bone mass and disturbed bone microarchitecture.Hypoglycaemic seizures generate sufficient compression forces along the thoracic column and can cause fractures in individuals with compromised bone quality.Unrecognised hypoglycaemic seizures should be considered in patients with T1DM presenting with fractures without a history of trauma.Patients with T1DM have increased fracture risk and risk factors should be addressed. Evaluation of bone microarchitecture may provide further insights into mechanisms of fracture in T1DM.Further research is needed to guide the optimal screening and management of bone health in patients with T1DM.

Bone fractures in patients with type 2 diabetes mellitus: prevalence and risk factors

Aim. To estimate the prevalence of and risk factors for low-traumatic fractures in patients with type 2 diabetes mellitus (T2DM).Materials and methods. We questioned 214 patients with T2DM from a single outpatient clinic located in Moscow to evaluate the prevalence of and risk factors for low-traumatic fractures, the duration of and complications from TD2M and HbA1c levels.Results. Of 214 patients, 65 reported low-traumatic bone fractures. Patients with a history of low-traumatic fractures reported falls in the previous year (28%), whereas only 13% of patients without fractures reported falls. The difference was statistically significant, with an odds ratio of 2.34 (1,144,76), P=0,022. Men reported fractures more frequently than women (43.3% vs. 24.7%, respectively, P = 0.01). Patients with bone fractures had a lower body mass index (P = 0.022); however, a multivariate analysis revealed that a history of falls and male sex were the most significant risk factors for fracture.Conclusion. Around 30% of patients with T2DM from a Moscow outpatient clinic reported bone fractures. The most significant risk factors for fracture were a history of falls in the previous year and male sex.&#x0D; &#x0D; The article is the RePrint from the original article inDiabetes Mellitus (2016); 19(5) pp. 359-365. doi: 10.14341/DM7796

Increased fragility fracture risk in Korean women who snore: a 10-year population-based prospective cohort study

BackgroundSnoring is frequently associated with obstructive sleep apnea (OSA). Previous studies have shown that bone mineral density was significantly lower in patients with OSA than in controls; however, these studies did not focus on fractures. Fragility fractures can lead to long-term disabilities and a decrease in quality of life. The present study aimed to investigate the association between snoring and fragility fractures.MethodsThis study included 2969 men and 3220 women aged 40 years and older from the Ansung and Ansan cohort studies in Korea. During a 10-year follow-up period, 129 and 273 fracture cases were reported in men and women, respectively.ResultsSevere snoring (6–7 nights per week or sleep disturbance by snoring in the next room) was a statistically significant risk factor for fracture (p = 0.006, hazard ratio 1.68, 95% confidence interval 1.16–2.43) after adjusting for covariates related to fragility fracture in women. However, both snoring and severe snoring groups did not show significant associations with the fracture risk in men.ConclusionsThus, information on the frequency of snoring in women may improve the accuracy of fragility fracture risk prediction, which can help in deciding whether intervention or treatment is necessary.

Bone fractures in patients with type 2 diabetes mellitus: prevalence and risk factors

Aim. To estimate the prevalence of and risk factors for low-traumatic fractures in patients with type 2 diabetes mellitus (T2DM).Materials and methods. We questioned 214 patients with T2DM from a single outpatient clinic located in Moscow to evaluate the prevalence of and risk factors for low-traumatic fractures, the duration of and complications from TD2M and HbA1c levels.Results. Of 214 patients, 65 reported low-traumatic bone fractures. Patients with a history of low-traumatic fractures reported falls in the previous year (28%), whereas only 13% of patients without fractures reported falls. The difference was statistically significant, with an odds ratio of 2.34 (1,14–4,76), P=0,022. Men reported fractures more frequently than women (43.3% vs. 24.7%, respectively, P = 0.01). Patients with bone fractures had a lower body mass index (P = 0.022); however, a multivariate analysis revealed that a history of falls and male sex were the most significant risk factors for fracture.Conclusion. Around 30% of patients with T2DM from a Moscow outpatient clinic reported bone fractures. The most significant risk factors for fracture were a history of falls in the previous year and male sex.

Patterns and injuries associated with orbital wall fractures in elderly patients who visited the emergency room: a retrospective case-control study.

ObjectivesThis study aimed to determine orbital wall fracture (OWF) patterns and associated facial injuries in elderly patients and compare them with those in their younger adult counterparts.DesignA retrospective case–control study.SettingAn emergency department of a university-affiliated hospital located in an urban area.ParticipantsA total of 1378 adult patients with OWF diagnosed by CT from 1 January 2004 through 31 March 2014 were enrolled. Patients were categorised into elderly (≥65 years) and non-elderly (<65 years) groups.ResultsThe elderly group (n=146) had a mean age of 74.0 years compared with 37.5 years in the non-elderly group (n=1232). Slipping was the most common cause of OWF in the elderly group (43.8%, p<0.001), whereas violence was the most common cause in the non-elderly group (37.3%, p<0.001). The lateral orbital wall was the more common site of fracture in the elderly group, and their injuries were more often associated with concurrent facial bone fractures, including the mandible, maxilla and zygoma, compared with the non-elderly group. After adjusting for sex and the mechanism of injury, inclusion in the elderly group was a significant risk factor for fracture of the lateral wall (OR 1.658; 95% CI 1.074 to 2.560) and concomitant facial bone fractures of the maxilla (OR 1.625; 95% CI 1.111 to 2.377) and zygoma (OR 1.670; 95% CI 1.126 to 2.475).ConclusionsElderly patients were vulnerable to facial trauma, and concurrent facial bone fracture associated with OWF was more commonly observed in this age group. Therefore, a high index of suspicion and thorough investigation, including CT, for OWF-associated facial bone fractures are important.

Fractures in spina bifida from childhood to young adulthood.

The aims of this study are to study the prevalence and types of fractures according to age group in spina bifida and examine risk factors associated with fracture. This is a retrospective cohort study of 146 individuals with spina bifida aged 2years or older who attended the paediatric or adult spina bifida multidisciplinary clinic at a single tertiary hospital. Median age at which first fracture occurred was 7years (interquartile range 4-13years). Fracture rates in children (ages 2-10), adolescents (ages 11-18) and adults (age>18) were 10.9/1000 (95% confidence interval 5.9-18.3), 5.4/1000 (95% CI 1.5-13.8) and 2.9/1000 (95% CI 0.6-8.1) patient years respectively. Childhood fractures predominantly involved the distal femur and femoral shaft; these fractures were rarely seen in adulthood. Non-ambulatory status was associated with a 9.8 times higher risk of fracture compared with ambulatory patients (odds ratio 9.8, p=0.016, 95% CI 1.5-63.0). Relative risk of re-fracture was 3.1 (95% CI 1.4-6.8). Urological intervention with intestinal segments was associated with renal calculi (p=0.037) but neither was associated with fracture. The risk of fracture is lower in adults compared with children with spina bifida. The predominant childhood fracture affects the distal femur, and immobility is the most significant risk factor for fracture. Clinical factors contributing to fracture risk need to be elucidated to enable selection of patients who require investigation and treatment of osteoporosis.

Kidney Function and Fracture Risk: The Atherosclerosis Risk in Communities (ARIC) Study

People with end-stage renal disease are at high risk for bone fracture. Less is known about fracture risk in milder chronic kidney disease and whether chronic kidney disease-associated fracture risk varies by sex or assessment with alternative kidney markers. Prospective cohort study. 10,955 participants from the Atherosclerosis Risk in Communities (ARIC) Study followed up from 1996 to2011. Kidney function as assessed by creatinine-based estimated glomerular filtration rate (eGFRcr), urine albumin-creatinine ratio, and alternative filtration markers. Fracture-related hospitalizations determined by diagnostic code. Baseline kidney markers; hospitalizations identified by self-report during annual telephone contact and active surveillance of local hospital discharge lists. Mean age of participants was 63 years, 56% were women, and 22% were black. During a median follow-up of 13 years, there were 722 incident fracture-related hospitalizations. Older age, female sex, and white race were associated with higher risk for fracture (P<0.001). The relationship between eGFRcr and fracture risk was nonlinear:<60mL/min/1.73m(2), lower eGFRcr was associated with higher fracture risk (adjusted HR per 10mL/min/1.73m(2) lower, 1.24; 95% CI, 1.05-1.47); there was no statistically significant association for ≥60mL/min/1.73m(2) in the primary analysis. In contrast, there was a graded association between other markers of kidney function and subsequent fracture, including albumin-creatinine ratio (HR per doubling, 1.10; 95% CI, 1.06-1.14), cystatin C-based eGFR (HR per 1-SD decrease, 1.15; 95% CI, 1.06-1.25), and 1/β2-microglobulin (HR per 1-SD decrease, 1.26, 95% CI, 1.15-1.37). No bone mineral density assessment; one-time measurement of kidney function. Both low eGFR and higher albuminuria were significant risk factors for fracture in this community-based population. The shape of the association in the upper ranges of eGFR varied by the filtration marker used in estimation.