Treatment Of Osteoporotic Fractures Research Articles

Biomechanical evaluation of osteoporotic fracture: Metal fixation versus absorbable fixation in Sawbones models

ObjectiveThe failure of osteoporotic fracture after internal fixation is mainly caused by the underlying bone loss and strength compromise. The aim of this study is to investigate whether absorbable internal fixation can provide adequate mechanical stability and a reduction in the incidence of failure of fixation caused by bone loss and stress shielding. MethodsA low density cancellous bone model was selected to compare the insertion of screw (screw-in), removal of screw (screw -out) and pull - out strength of absorbable screw and metal screw. The long bone model of thin cortical bone was used to create the transverse fracture model. The model was fixed with absorbable plate-screw system and metal plate-screw system respectively. The fatigue test and static bending test were compared. Moreover, the size of screw hole area was assessed. ResultsThe maximal screw - in and screw - out torque of the absorbable screw was significantly greater than that of the metal screw (P < 0.05), but there was no significant difference in pull-out test (P > 0.05). No visible failure occurred in fatigue test. There was no significant difference between the maximum load of static bending test (P > 0.05). The screw hole area of absorbable samples was significantly smaller than that of metal samples (P < 0.05). ConclusionsIn this experimental set-up it was found that the stability of absorbable screws in osteoporotic bone was better than metal screws. The absorbable system tested can achieve good stability, and the destruction of osteoporotic bone is small, which can reduce the occurrence of bone failure. Considering that absorbable material avoids the need of second surgery (implant removal) and reduces the stress shielding effect, we believe that absorbable internal fixation can be considered for fixation treatment of osteoporotic fractures.

Investigation of Comorbidity, Trauma History, and Osteoporotic Fractures in the Postmenopausal Population: A Nationwide, Observational, and Cross-Sectional Study of Korean Orthopedic Outpatient Clinics.

Study DesignA nationwide, observational, and cross-sectional study targeting postmenopausal patients from 62 orthopedic outpatient clinics in Korea between October 2010 and February 2011.PurposeThis study was carried out to investigate comorbidity, trauma history, and the status of osteoporotic fracture treatment in Korean postmenopausal women.Overview of LiteratureThere has been little reports on the comorbidity, family history, trauma history, and treatment status of osteoporotic fractures in patients visiting the orthopedic outpatient clinics in Korea.MethodsA total of 1,255 postmenopausal women between the ages of 50 and 80 years were enrolled in the study and the population distribution was reflected by region. Comorbidity, familial history of osteoporosis, familial history of osteoporotic fracture, history of falls, and status of osteoporotic fracture management were evaluated using an interview and questionnaire. The relationship between family history of osteoporosis and bone mineral density was analyzed.ResultsA number of patients (23%) had a family history of osteoporosis and 16.5% had a family history of fractures. Most (64.7%) of the patients had one or more comorbidities, including 58.8% exhibiting a chronic disease and 16.4% suffering from diseases that restrict exercise or walking. The results of the questionnaire indicated that 21.8% of these fracture patients had experienced a fracture previously and that the most common type of fracture was that of the spine. Lumbar spine bone mineral density was found to be lower in the presence of family history of osteoporosis.Conclusions Postmenopausal women are liable to have osteoporotic fractures due to the high prevalence of osteoporosis, a history of falling, and the comorbidity with diseases that restrict ambulation. A better understanding of postmenopausal women in the orthopedic outpatient settings is important to the management of osteoporotic fractures.

Are CT Scans Overutilized in the Workup of Vertebral Compression Fractures?

This was a retrospective chart review. Computed tomography (CT) does not aid in determination of compression fracture chronicity and contributes to higher cost and radiation exposure. An examination of extraneous imaging will help to guide appropriate workup. Cost for osteoporotic fracture treatment has been estimated at $17 billion annually; future costs are anticipated to increase by at least 50%. A chart review evaluated patients who received kyphoplasty or vertebroplasty as part of compression fracture treatment. The primary end point of the study was analysis of unnecessary imaging obtained during workup. The secondary outcome was excess radiation exposure incurred from unneeded imaging studies. There were 104 instances (40.2% of n=259 workups) where patients underwent only magnetic resonance imaging (MRI) or bone scan after radiographs. There were 28 instances (10.8%) where patients underwent only radiographs with a comparison study. There were a total of 76 instances (29.3%) where patients underwent extraneous CT scans and 13 instances (5%) where patients underwent both MRI and bone scan, causing an average of 979.4 mGy cm additional radiation exposure. We recommend an algorithm that favors radiographs with comparison study or acquiring either MRI or bone scan to determine acuity. If these are available, CT scan becomes unnecessary and incurs increased costs and radiation exposure.

Research progress of vertebral augmentation for bone cement leakage in osteoporotic vertebral compression fractures

Percutaneous vertebral augmentation is the most commonly used minimally invasive surgery in the treatment of osteoporotic vertebral compression fractures (OVCF). The efficacy and safety have been widely recognized, however, there are still some complications of percutaneous vertebral augmentation. And the most common complication is bone cement leakage, which can lead to nerve root and spinal cord injury, increase the risk of secondary fractures of adjacent vertebral, and even cause serious complications such as pulmonary embolism. The diagnosis, classification, hazard, influence factors and preventive measures of bone cement leakage in vertebral augmentation for OCVF are reviewed in this paper, which will provide reference for prevention and treatment of bone cement leakage in clinical practice. Key words: Osteoporotic fractures; Vertebroplasty; Kyphoplasty; Bone cement leakage

Reflections on diagnosis and treatment of osteoporotic vertebral compression fracture

Reflections on diagnosis and treatment of osteoporotic vertebral compression fracture

Maternal mineral and bone metabolism during lactation

Nursing mothers provide their infants with an average of 200-250mg of Ca/d, and as much as 400 mg/d. During lactation, maternal mineral ions and calciotropic hormones experience great changes. The main adaptations include increased skeletal resorption and reduced renal excretion of calcium, while the increased skeletal resorption plays a major role. In most cases, the physiological bone loss caused by breast-feeding does not cause clinical symptoms, which can be recovered completely after breast-feeding stopped. But among women with risk factors such as low bone mass before pregnancy, osteoporosis can occur during lactation and even to osteoporotic fractures. However, at present, there is still no definite conclusion for the treatment of osteoporosis and osteoporotic fracture related to lactation. The long-term effects of lactation on bone are still controversial. This article reviews the changes in the mineral and bone metabolism of women in lactation, so as to better understand and prevent the severe bone loss caused by breast-feeding. Key words: Lactation; Mineral; Calciotropic hormones; Bone metabolism; Mechanism; Treatment

Comparison of percutaneous vertebroplasty with bone filling container and percutaneous kyphoplasty via unilateral puncture approach for osteoporotic vertebral compression fractures

Objective To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) with bone filling container (BFC) and percutaneous kyphoplasty (PKP) by unilateral puncture approach in the treatment of osteoporotic vertebral compression fractures. Methods A retrospective case control study was conducted on 65 patients (65 vertebral bodies) with osteoporotic vertebral compression fractures (OVCF) who received PVP from March 2015 to March 2017 in Henan Provincial People's Hospital. There were 21 males and 44 females, aged 60-91 years, with an average of 76.2 years. The patients were divided into PVP with BFC group (BFC group) and PKP group treated by unilateral puncture approach. There were 10 males and 23 females in BFC group, with an average age of 75.8 years (range, 60-91 years). The injured segments were distributed at T10 in seven patients, T11 in nine, T12 in eight, L1 in five, and L2 in four patients. There were 11 males and 21 females in PKP group, with an average age of 76.7 years (range, 60-88 years). The injured segments were distributed at T10 in five patients, T11 in seven, T12 in ten, L1 in eight, and L2 in two patients. The operation time, cement leakage, as well as pain visual analogue score (VAS), modified Oswestry dysfunction index (ODI) and the Cobb angle of the fractured vertebral body at 3 days after operation and 12 months after operation were recorded and compared. Results All operations were completed successfully, without serious complications. The patients were followed up for 16-29 months [(21.2±4.5)months] in BFC group and 15-32 months [(23.8±6.2) months] in PKP group. The operation time was (27.8±3.6)minutes in BFC group and (31.0±5.2)minutes in PKP group (P 0.05). The modified ODI at 3 days after operation in BFC group and PKP group were (31.5±4.7)% and (30.4±5.7)%, respectively. The modified ODI at 12 months after operation in BFC group and PKP group was (16.7±4.9)% and (15.1±5.6)%, respectively. The postoperative ODI were significantly decreased compared with the preoperative ODI(P 0.05). The Cobb angle of the fractured vertebral body at 3 days after operation in BFC group and PKP group was (9.2±3.0)° and (10.0±2.9)°, respectively. The Cobb angle of the fractured vertebral body at 12 months after operation was (9.6±2.8)° and (10.3±3.0)°respectively. The postoperative Cobb angle was significantly decreased compared with the preoperative Cobb angle (P 0.05). Conclusions For OVCF, PVP with BFC by unilateral puncture approach can shorten the operation time and reduce the leakage rate of bone cement. It has similar effects with PKP in pain relief, function improvement of daily life and the correction of fracture vertebral kyphosis. Key words: Spinal fractures; Vertebroplasty; Kyphoplasty; Osteoporotic fractures

Current situation and prospects of percutaneous vertebroplasty

Percutaneous vertebroplasty and percutaneous kyphoplasty play an increasingly important role in the treatment of osteoporotic vertebral compression fractures, but complications such as intraoperative cement leakage can not be ignored. At the same time, a large number of radiation exposure during surgery has become an important factor restricting the development of vertebroplasty. This paper analyzes the current situation and future prospects of the above two issues. For the leakage of bone cement, finding a substitute for bone cement is a hot spot of current research. The application of unilateral vertebroplasty and surgical robots will be the key to solve the problem of radiation exposure. Key words: Vertebroplasty; Cement leakage; Radiation exposure

We miss the opportunity: Pretreament of osteoporosis in a German trauma center.

Osteoporosis remains a major health concern due to high incidence of fragility fractures followed by higher mortality and morbidity. Implementation of guidelines for diagnosis and treatment of osteoporosis is critically discussed internationally. Aim of this study was to evaluate implementation of these guidelines regarding diagnosis and therapy of osteoporosis in a developed western country. We hypothesized that (a) prior diagnosis of osteoporosis in patients with low-energy fractures is higher than the estimated incidence and (b) diagnosis and therapy of osteoporosis in patients with prior low-energy fractures is higher than in patients without prior low-energy fractures. 399 patients >60 years suffering low-energy-fractures of their spine, femur, humerus or forearm between 03/2014 and 04/2015 were recruited in a German trauma center. All received a standardized interview. In 21% (84/399) of all patients, osteoporosis was diagnosed prior to current admission. 34% (136/399) suffered a prior risk-fracture after age of 50. Of these, only 54% (73/136) reported about following dual-energy X-ray absorptiometry (DXA) to test for decreased bone-marrow-density with positive results in 68% (50/73). 38% (19/50) of these patients with fragility fractures and prior osteoporosis diagnosis received anti-osteoporotic medication. 66% (263/399) of all patients had no prior risk-fracture and were tested for osteoporosis by DXA in 36% (95/263), leading to positive results in 34% (32/95). 44% (14/32) of these patients received anti-osteoporotic medication. Applying FRAX, 33% of all patients showed a calculated 10-year-risk >20% for suffering a major osteoporotic fracture. 61% (83/136) of patients with a prior fracture had a 10-year-risk >20% of which 47% (39/83) patients received no prior DXA. Although guidelines recommend diagnosis and treatment of patients with low-energy fractures, opportunity for early treatment following risk fractures seems rarely used. Expedient risk assessment is necessary to indicate further diagnostics and therapy of osteoporosis to ensure adequate and efficient treatment for osteoporotic fractures.

Percutaneous kyphoplasty treatment of osteoporotic vertebral compression fracture under the guidance of G-arm X-ray machine

Objective To explore the clinical application value of percutaneous kyphoplasty (PKP) under the guidance of G arm X ray machine in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods The medical records of eighty-two patients (94 vertebral bodies) with OVCF treated with PKP were collected retrospectively.Thirty-nine cases (44 vertebral bodies) were guided by G-arm X-ray machine to implement PKP, which were recorded as G-arm group.Forty-three cases (50 vertebral bodies) were guided by C-arm X-ray machine to carry out PKP, which were recorded as C-arm group.The operation time, intraoperative fluoroscopy times, bone cement leakage cases, preoperative and postoperative anterior height of injured vertebrae, Cobb angle of injured vertebrae, visual analogue scale scores and Oswestry disability index of the two groups were recorded. Results There was significant difference in operation time and intraoperative fluoroscopy times between the G-arm group and C-arm group (the operation time: (31.6±5.2) vs.(45.8±6.7) min, the intraoperative fluoroscopy times: (9.5±2.3) times vs.(18.7±3.5) times, t=-10.64, -13.91, P 0.05). Compared postoperative and preoperative anterior height of injured vertebrae, Cobb angle of injured vertebrae, visual analogue scale scores and Oswestry disability index scores of G-arm group and C-arm group respectively, the differences were significant( t=-3.41 vs.-3.28, 6.67 vs.7.66, 26.63 vs.25.75 and 10.41 vs.11.90, P 0.05). Conclusion The treatment of OVCF with PKP guided by G-arm X-ray machine could significantly shorten operation time, reduce the intraoperative fluoroscopy times and the operative difficulty, and increase operation safety than PKP guided by traditional C-arm X-ray machine. Key words: Osteoporotic vertebral compression fracture; Percutaneous kyphoplasty; G-arm X-ray machine; C-arm X-ray machine

Percutaneous vertebroplasty in the treatment of thoracolumbar fractures

Objective The objective was to determine the effect of percutaneous vertebroplasty (PV) through cement injection in relief of pain in case of painful osteoporotic and pathological thoracolumbar fractures. Background Vertebroplasty is a percutaneous polymethylmethacrylate cement injection inside the vertebral body through the pedicle and used mainly in the treatment of painful osteoporotic and pathological spinal fractures. Patients and methods A total of 20 patients in this study had thoracolumbar fractures (15 of them had osteoporotic fractures and five of them had pathological fractures). Patients were submitted into one of the three age groups. Group 1: less than 60 years, group 2: between 60 and 70 years, and group 3: above 70 years. Results The analgesic effect of PV was evaluated using visual analogue scale and activities of daily living immediately after operation and the patients were followed for 6 months radiologically and clinically using these scales. All of them were improved and four of them had cement leakage with no neurological insult. One of them had leakage with neurological insult which is improved by overnight injection of methylprednisolone. Conclusion PV has become common in many practices worldwide. It has been used by surgeons as a good therapy for the treatment of painful osteoporotic and pathological compression fractures of the spine which do not respond to medical treatment of osteoporosis. Nowadays, it has been the best option of treatment for these compression fractures in the world. PV is a simple operation and can be done in an outpatient clinic. Pain relief has been high and risks low, when done by experienced surgeons who exercise good judgment.

Treatment of severe osteoporotic vertebral compression fracture with 3D printing-assisted percutaneous vertebroplasty in the elderly

Objective To investigate the clinical effect of 3D printing assisted percutaneous vertebroplasty (PVP) in treating severe osteoporotic vertebral compression fracture (OVCF) in elder patients. Methods A retrospective case series study was conducted on the clinical data of 58 elderly patients (58 vertebrae) with severe OVCF who underwent PVP treatment in spinal surgery department of Henan Provincial People's Hospital from June 2014 to June 2016. According to the treatment method, the patients were divided into Group A which adopted 3D printing of injured vertebrae before PVP and Group B which adopted routine PVP operation. Group A consisted of 28 cases (28 vertebrae), including eight males and 20 females, aged 64-91 years [(78.1±8.5)years]. In terms of the distribution of injured vertebrae, there were four cases of T10, six cases of T11, eight cases of T12, four cases of L1, and six cases of L2 in Group A. Group B consisted of 30 cases (30 vertebrae), including 10 males and 20 females, aged 65-90 years[(77.8±8.2)years]. In terms of the distribution of injured vertebrae, there were three cases of T10, seven T11, nine T12, six L1, and five L2. The operation time, visual analogue scale (VAS) before operation, 1 day after operation and at the last follow up, Japanese Orthopedic Association (JOA) score, anterior compression ratio of injured vertebrae, and cement leakage rate were compared between the two groups. Results All the operations were completed successfully. The patients were followed up for 14-26 months [(18.7±3.4)months] in Group A and for 12-28 months[(20.0±5.4 )months] in Group B. The operation time was (28.0±3.4)min in Group A and (30.9±5.3)min in Group B (P 0.05). Both the JOA at day 1 after operation of Group A [(21.3±2.2)points] and Group B [(20.7±2.1)points] and the JOA at the last follow up of Group A [(24.7±2.3)points] and Group B [(24.1±2.0)points] were significantly higher than those before operation (P 0.05). The anterior compression ratio of injured vertebrae 1d after operation of Group A(59.4±7.9)% and Group B (59.1±6.8)% and that at the last follow up of Group A (59.1±7.8)% and Group B (58.7±5.4)% were significantly improved than those before operation (P 0.05). There were three cases of bone cement leakage in Group A (11%) and 11 cases of bone cement leakage in Group B (37%) after PVP, and the difference was statistically significant (P<0.05). Conclusion Compared with conventional PVP, 3D printing-assisted PVP has lower leakage rate, shorter operation time, and better clinical effect in treating severe OVCF in the elderly. Key words: Osteoporotic fractures; Vertebroplasty; 3D printing

Effects of hemiarthroplasty with different hip prostheses on prognosis of unstable osteoporotic intertrochanteric fractures in elderly patients

Objective To investigate the effects of hemiarthroplasty with different hip prostheses on the prognosis of unstable osteoporotic intertrochanteric fractures in elderly patients. Methods A retrospective case series study was conducted on the clinical data of 556 elderly patients with unstable osteoporotic femoral intertrochanteric fractures treated with hemiarthroplasty from January 2008 to December 2014. There were 142 males and 414 females, aged (83.1±6.9) years (range, 75-103 years). The T value of bone mineral density was -3.5--2.5 SD [(-2.8±0.2)SD]. There were 306 cases of type A2.2 and 250 cases of type A2.3 according to AO classification. There were 296 cases of cement type and 260 biological type according to prosthesis type. Operation time, blood loss, time for ambulation, Harris hip score, and incidence of perioperative major complications were used to compare the therapeutic outcomes between the two types of prostheses. Results The operation time[(75.5±9.2)minutes], blood loss [(992.9±94.2)ml], and time for ambulation[(7.1±1.8)days] in cement type group were all less than those [(86.1±9.3)minutes, (1 139.5±96.0)ml, and (8.6±2.1)days] in biological type group, but the lung infection rate (19.9%), incidence of cardio-cerebrovascular complications (15.9%) and total death rate (7.1%) in cement type group were significantly greater than the those (13.5%, 8.8% and 1.9%) in biological type group (P 0.05). Conclusions In the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients by hemiarthroplasty, the use of cement type prosthesis can reduce operation time, blood loss and bed rest time, but it will lead to significant increases of cardio-cerebrovascular complication and overall mortality. The prosthesis type has no significant effect on the improvement of hip function. Key words: Arthroplasty, replacement, hip; Aged; Osteoporotic fractures; Femoral fractures

Multilevel Percutaneous Vertebroplasty (More than Three Levels) in the Management of Osteoporotic Fractures.

ObjectivePercutaneous vertebroplasty (PV) is a minimally invasive procedure designed to treat various spinal pathologies. The maximum number of levels to be injected at one setting is still debatable. This study was done to evaluate the usefulness and safety of multilevel PV (more than three vertebrae) in management of osteoporotic fractures. MethodsThis prospective study was carried out on consecutive 40 patients with osteoporotic fractures who had been operated for multilevel PV (more than three levels). There were 28 females and 12 males and their ages ranged from 60 to 85 years with mean age of 72.5 years. We had injected 194 vertebrae in those 40 patients (four levels in 16 patients, five levels in 14 patients, and six levels in 10 patients). Visual analogue scale (VAS) was used for pain intensity measurement and plain X-ray films and computed tomography scan were used for radiological assessment. The mean follow-up period was 21.7 months (range, 12–40). ResultsAsymptomatic bone cement leakage has occurred in 12 patients (30%) in the present study. Symptomatic pulmonary embolism was observed in one patient. Significant improvement of pain was recorded immediate postoperative in 36 patients (90%). ConclusionMultilevel PV for the treatment of osteoporotic fractures is a safe and successful procedure that can significantly reduce pain and improve patient’s condition without a significant morbidity. It is considered a cost effective procedure allowing a rapid restoration of patient mobility.

Proximal humerus internal locking system combined with allogeneic femoral head bone graft for osteoporotic proximal humeral fractures in the elderly

Objective To evaluate the efficacy of proximal humerus internal locking system (PHILOS) combined with allogeneic femoral head bone graft for the treatment of osteoporotic proximal humerus fractures in the elderly patients. Methods A total of 36 osteoporotic proximal humerus fractures were analyzed retrospectively which had been treated at Department of Orthopaedics, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from April 2015 to April 2017. They involved 14 men and 22 women, aged from 60 to 78 years(average, 67 years). By the Neer classification, 20 cases were two-part fractures, 11 three-part fractures and 5 four-part fractures. They were all treated by PHILOS plating combined with allogeneic femoral head bone grafting. The outcomes were assessed using Neer evaluation system for shoulder function. Results All the 36 cases were followed up for 3 to 18 months (average, 12 months). All the incisions healed postoperatively by the first intention, with no postoperative infection, nonunion, humeral head varus, screw cut-out, humeral head necrosis, or loosening of implants. Clinical healing of the fractures was achieved after 8 to 24 weeks (average, 12 weeks). According to the Neer evaluation, shoulder function was excellent in 18, good in 15 and poor in 3 cases. Conclusion In the treatment of osteoporotic proximal humerus fractures in the elderly, combination of PHILOS plating and allogeneic femoral head bone grafting can effectively prevent such postoperative complications as humeral head varus, screw cut-out and loosening of implants. Key words: Humerus fractures, proximal; Bone plate; Osteoporosis; Bone graft

Comparison of the clinical effects of percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures

Objective To investigate the effect and safety of percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures, thus to provide reference for clinical treatment. Methods 67 patients with osteoporotic vertebral compression fractures were selected as study subjects.According to the different operation type, the patients were divided into PVP group(n=32) and PKP group(n=35). The operation condition, pain degree, relative height of vertebral body, Cobb angle and incidence of cement leakage were compared between the two groups. Results The operation time, X-ray times, bone cement injection volume, postoperative injury vertebral height of the PKP group were significantly higher than those of the PVP group(all P 0.05). Conclusion PVP and PKP are the effective methods for the treatment of osteoporotic vertebral compression fractures, which can significantly improve the degree of pain in patients, but PKP surgery is more conducive to promote the restoration of vertebral height, and can reduce the occurrence of bone cement leakage. Key words: Fractures, compression; Osteoporotic fractures; Percutaneous vertebroplasty; Percutaneous kyphoplasty; Clinical effect

Treatment costs and cost drivers among osteoporotic fracture patients in Japan: a retrospective database analysis

SummaryThis study estimated the direct medical costs of osteoporotic fractures from a large claim database in Japan. We further identified several comorbidities which drove the treatment costs. The results would contribute to health economic analysis as well as understanding of individual financial burden in Japan.IntroductionThe purposes of this study were to estimate treatment costs of osteoporotic fractures and to investigate the cost drivers.MethodsMale and female patients aged 50 years and older with a hip, vertebral, or non-hip/non-vert (NHNV) fracture between April 2008 and December 2016 were analyzed from claim database. Two types of costs were estimated. The incremental yearly costs of fractures and comorbidity treatments (total medical costs) were calculated by subtracting pre-fracture costs from post-fracture costs. The costs exclusive for fracture treatments (fracture treatment costs) were estimated by summing up the costs of fracture treatments within 1 year after fracture. The associations between comorbidities and costs were examined with a generalized linear model.ResultsTotal 12,898 patients were identified (83% was female). The total medical costs of fractures were $14,592 for male-hip, $15,691 for female-hip, $4268 for male-vertebral, $3819 for female-vertebral, $3790 for male-NHNV, and $4259 for female-NHNV. The fracture treatment costs were $4506 for male-hip, $5427 for female-hip, $1022 for male-vertebral, $1044 for female-vertebral, $1035 for male-NHNV, and $1408 for female NHNV. Three comorbidities were associated with increasing fracture treatment costs whereas four comorbidities were associated with decreasing fracture treatment costs. Five comorbidities were associated with increasing total medical costs whereas one comorbidity was associated with decreasing total medical costs.ConclusionsYearly treatment costs were increased considerably after fracture. Several comorbidities were considered to be cost drivers for osteoporotic fracture treatment. The cost estimates with different patient profile would support conducting health economic analysis in the future.

Extrapedicular unilateral percutaneous vertebroplasty via transverse process for osteoporotic vertebral compression fractures of upper lumbar

Objective To investigate the effect of transverse extrapedicular unilateral percutaneous vertebroplasty (PVP) via transverse process in treating the osteoporotic vertebral compression fractures. Methods A retrospective study was performed on 16 patients with osteoporotic vertebral compression fractures of upper lumbar treated from August 2016 through December 2016. There were seven males and nine females, at a mean age of 73.5 years (range, 62-90 years). All the patients reported severe back pain, with an average history of 2 weeks (range, 1-24 weeks). MRI confirmed the diagnosis of osteoporotic vertebral compression fractures, and the compression degree of the affected vertebral body was (25.4±5.3)%. All the patients were treated with extrapedicular unilateral PVP via transverse process under local anesthesia. The operation time, fluoroscopy frequency, bone cement injection volume, and bone cement dispersion were recorded. Back pain and function recovery were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Results All patients were followed up for 6-12 months (mean, 8 months). All operations were successful without complications. The average operation time was 20 min (range, 15-30 minutes), and there were 3-6 times of fluoroscopy with successful incubation. The average volume of bone cement injected to each injured vertebral body was 6.2 ml (range, 5-9 m1). The bone cement dispersed satisfactorily in the vertebral body. Complete relief of lumbar and back pain was achieved in 14 patients, and remarkable relief in two patients. The postoperative VAS and ODI at 24 hours, 72 hours, and 6 months were significantly lower than those before operation (P<0.01). Conclusion Extrapedicular unilateral percutaneous vertebroplasty via transverse process has the advantages of uniform fractured bone cement perfusion, significant pain relief, and rapid recovery, and hence is a simple, safe and effective treatment for osteoporotic vertebral compression fractures of the upper lumbar vertebrae. Key words: Spinal fractures; Osteoporotic fractures; Vertebroplasty; Spinal puncture

Estradiol-Loaded Poly(ε-caprolactone)/Silk Fibroin Electrospun Microfibers Decrease Osteoclast Activity and Retain Osteoblast Function

Estrogen, a steroid hormone, plays an important role in modulating osteoclast proliferation and development. Estrogen deficiency boosts osteoclast activity, leading to osteoporosis in elderly women. In this study, 17-ß estradiol (E2)-loaded poly(ε-caprolactone) (PCL)/silk fibroin (SF) electrospun microfibers were developed as a proposed localized E2 delivery system to treat osteoporotic fractures. PCL is a synthetic polymer known for its biocompatibility and excellent mechanical properties. The bioactivity of PCL was enhanced by mixing it with a natural SF polymer that has low immunogenicity and inherent bioactivity. Different ratios of PCL/SF blends were electrospun and characterized by scanning electron microscopy, Fourier transform infrared spectroscopy, and water contact angle measurement. PCL and SF at a ratio of 50:50 (PCL50/SF50) augmented cell proliferation of murine preosteoblast MC3T3-E1 cells and murine preosteoclast RAW 264.7 cells. Hence, PCL50/SF50 was selected and mixed with three concentrations of E2 to produce electrospun fiber mesh (0.1% E2@PCL/SF, 1% E2@PCL/SF, and 5% E2@PCL/SF). Sustained release of E2 was obtained for about 3 weeks at higher E2 concentration 5% E2@PCL/SF. An E2-loaded PCL50/SF50 elecrospun microfiber (1% E2@PCL/SF and 5% E2@PCL/SF) reduced tartrate-resistant acid phosphate activity, total DNA, and multinucleated cell formation of osteoclasts. On the other hand, the alkaline phosphatase activity and collagen I expression of osteoblasts were retained on all E2-loaded electrospun microfibers. The E2@PCL/SF system shows potential to be used for localized E2 delivery for the treatment of osteoporotic fractures.

Effects of new beta-type Ti-40Nb implant materials, brain-derived neurotrophic factor, acetylcholine and nicotine on human mesenchymal stem cells of osteoporotic and non osteoporotic donors.

IntroductionTreatment of osteoporotic fractures is still challenging and an urgent need exists for new materials, better adapted to osteoporotic bone by adjusted Young’s modulus, appropriate surface modification and pharmaceuticals.Materials and methodsTitanium-40-niobium alloys, mechanically ground or additionally etched and titanium-6-aluminium-4-vanadium were analyzed in combination with brain-derived neurotrophic factor, acetylcholine and nicotine to determine their effects on human mesenchymal stem cells in vitro over 21 days using lactate dehydrogenase and alkaline phosphatase assays, live cell imaging and immunofluorescence microscopy.ResultsCell number of human mesenchymal stem cells of osteoporotic donors was increased after 14 d in presence of ground titanium-40-niobium or titanium-6-aluminium-4-vanadium, together with brain-derived neurotrophic factor. Cell number of human mesenchymal stem cells of non osteoporotic donors increased after 21 d in presence of titanium-6-aluminium-4-vanadium without pharmaceuticals. No significant increase was measured for ground or etched titanium-40-niobium after 21 d. Osteoblast differentiation of osteoporotic donors was significantly higher than in non osteoporotic donors after 21 d in presence of etched, ground titanium-40-niobium or titanium-6-aluminium-4-vanadium accompanied by all pharmaceuticals tested. In presence of all alloys tested brain-derived neurotrophic factor, acetylcholine and nicotine increased differentiation of cells of osteoporotic donors and accelerated it in non osteoporotic donors.ConclusionWe conclude that ground titanium-40-niobium and brain-derived neurotrophic factor might be most suitable for subsequent in vivo testing.