Type Of Osteoporotic Fracture Research Articles

Incidence of four major osteoporotic fragility fractures among older individuals in Sado, Japan, in 2020.

This study compared the 2020 incidence of fragility fractures in Sado City with those from 2004 to 2015. Data from patients aged ≥ 60years living in Sado City with fragility fractures in the hip, vertebral, distal radius, and proximal humerus between January 1 and December 31, 2020, were collected. We examined the number and incidence of four types of osteoporotic fractures in the older population aged ≥ 60years living in Sado City in 2020. We compared the results with those of the 2004, 2010, and 2015 surveys, examining the temporal change and trend in the incidence of the four fracture types in this population. We investigated the use rate of anti-osteoporotic medications and the relationship between their administration and the occurrence of fragility fractures. The age-specific incidence of hip fractures slightly decreased from 2015. However, the incidence of the other three fractures slightly increased, although the difference was not statistically significant. The incidence of hip fractures markedly increased in the 80s. In 2020, the percentage of patients taking anti-osteoporotic agents before the occurrence of fractures decreased to 12.4% from 14.5% in 2015; it increased from 4% in 2004 to 7.6% in 2010. The 2020 incidence of the four fractures did not decrease, and the percentage of patients receiving anti-osteoporotic agents did not increase. A higher frequency of osteoporosis treatment is necessary to reduce the incidence of fragility fractures. We recommend using anti-osteoporotic agents to prevent hip fractures among individuals in their mid-70s and above.

Association between a history of major osteoporotic fractures and subsequent hip fracture: a systematic review and meta-analysis.

A history of fractures involving the distal radius, proximal humerus, spine, and hip may be associated with the incidence of subsequent hip fractures in older people. However, a comprehensive summary of this association using a rigorous methodology is lacking. Our objective was to systematically review the literature and examine the association between four major osteoporotic fractures and subsequent hip fractures in individuals aged ≥ 50years. We searched MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov on February 15, 2023. The search included cohort or case-control studies investigating the association between these four types of osteoporotic fractures and subsequent hip fractures. We pooled the hazard ratios (HRs) with 95% confidence intervals (CI) using the random-effects model. We used the Quality In Prognosis Studies tool to assess the risk of bias in the included studies, and the grading of recommendations assessment, development, and evaluation approach to determine the certainty of evidence. The selection process identified 48 studies for qualitative synthesis and 23 studies (2,239,217 participants) for meta-analysis. The overall methodological quality had a low risk of bias in 65% of the included studies. The association between a history of major osteoporotic fractures and subsequent hip fracture varied, with a high certainty of evidence for a history of proximal humerus and hip fractures (HR 2.02, 95% CI 1.75-2.33 and 2.86, 95% CI 1.92-4.25, respectively), moderate certainty for distal radius fractures (HR 1.66, 95% CI 1.53-1.81), and low certainty for spine fractures (HR 1.53, 95% CI 1.38-1.69). In conclusion, a history of major osteoporotic fractures, particularly distal radius, proximal humerus, and hip fractures, is associated with subsequent hip fractures in older adults. Further research is needed to verify the association between a history of spine fracture and subsequent hip fractures. Open Science Framework ( https://osf.io/7fjuc ).

An Automated Vertebrae Localization, Segmentation, and Osteoporotic Compression Fracture Detection Pipeline for Computed Tomographic Imaging.

Osteoporosis is the most common chronic metabolic bone disease worldwide. Vertebral compression fracture (VCF) is the most common type of osteoporotic fracture. Approximately 700,000 osteoporotic VCFs are diagnosed annually in the USA alone, resulting in an annual economic burden of ~$13.8B. With an aging population, the rate of osteoporotic VCFs and their associated burdens are expected to rise. Those burdens include pain, functional impairment, and increased medical expenditure. Therefore, it is of utmost importance to develop an analytical tool to aid in the identification of VCFs. Computed Tomography (CT) imaging is commonly used to detect occult injuries. Unlike the existing VCF detection approaches based on CT, the standard clinical criteria for determining VCF relies on the shape of vertebrae, such as loss of vertebral body height. We developed a novel automated vertebrae localization, segmentation, and osteoporotic VCF detection pipeline for CT scans using state-of-the-art deep learning models to bridge this gap. To do so, we employed a publicly available dataset of spine CT scans with 325 scans annotated for segmentation, 126 of which also graded for VCF (81 with VCFs and 45 without VCFs). Our approach attained 96% sensitivity and 81% specificity in detecting VCF at the vertebral-level, and 100% accuracy at the subject-level, outperforming deep learning counterparts tested for VCF detection without segmentation. Crucially, we showed that adding predicted vertebrae segments as inputs significantly improved VCF detection at both vertebral and subject levels by up to 14% Sensitivity and 20% Specificity (p-value = 0.028).

Surgical management and outcomes following atypical subtrochanteric femoral fractures − results from a matched-pair analysis of the registry for geriatric trauma of the German Trauma Society

Background and objectivesThe outcomes of patients with atypical subtrochanteric fractures (ASFs) remain unclear. Data from a large international geriatric trauma registry were analysed to examine the outcome of patients with ASFs compared to patients with typical osteoporotic subtrochanteric fractures (TSFs).Materials and methodsData from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (ATR-DGU) were analysed. All patients treated surgically for ASFs or TSFs were included in this analysis. Across both fracture types, a paired matching approach was conducted, where statistical twins were formed based on background characteristics sex, age, American Society of Anesthesiologists (ASA) score and walking ability. In-house mortality and mortality rates at the 120-day follow-up, as well as mobility at 7 and 120 days, the reoperation rate, hospital discharge management, the hospital readmission rate at the 120-day follow-up, health-related quality of life, type of surgical treatment and anti-osteoporotic therapy at 7 and 120 days, were assessed as outcome measures using a multivariate logistic regression analysis.ResultsAmongst the 1,800 included patients, 1,781 had TSFs and 19 had ASFs. Logistic regression analysis revealed that patients with ASFs were more often treated with closed intramedullary nailing (RR = 3.59, p < 0.001) and had a higher probability of vitamin D supplementation as osteoporosis therapy at 120 days (RR = 0.88, p < 0.002). Patients with ASFs were also more likely to live at home after surgery (RR = 1.43, p < 0.001), and they also tended to continue living at home more often than patients with TSFs (RR = 1.33, p < 0.001). Accordingly, patients with TSFs had a higher relative risk of losing their self-sufficient living status, as indicated by increased rates of patients living at home preoperatively and being discharged to nursing homes (RR = 0.19, p < 0.001) or other hospitals (RR = 0.00, p < 0.001) postoperatively.ConclusionsSurgical treatment of ASFs was marked by more frequent use of closed intramedullary fracture reduction. Furthermore, patients with ASFs were more likely to be discharged home and died significantly less often in the given timeframe. The rate of perioperative complications, as indicated by nonsignificant reoperation rates, as well as patient walking abilities during the follow-up period, remained unaffected.

Abaloparatide promotes bone repair of vertebral defects in ovariectomized rats by increasing bone formation

Osteoporotic vertebral fracture (OVF) is the most common type of osteoporotic fracture and is associated with immobility and mortality. Bone anabolic agents, such as abaloparatide (ABL), are usually administered to patients with OVF to prevent subsequent fractures. Although several studies have shown that bone anabolic agents promote healing of long bone fractures, there is little evidence of their healing effect on vertebral bone fractures. In the present study, we investigated the effect of ABL on vertebral bone defects using ovariectomized (OVX) rats with vertebral body drill-hole defects, an animal model of OVF. Eight-week-old female Sprague-Dawley rats were subjected to OVX, followed by the 32–36 days of bone depletion period, once-daily subcutaneous ABL was administered to OVX rats at a dose of 30 μg/kg for a maximum of 6 weeks from the day of the vertebral defect surgery. We found that ABL significantly increased bone mineral content and improved trabecular structural parameters at the vertebral defect site. Moreover, ABL significantly increased bone strength of the defected vertebrae. Bone histochemical analysis revealed formation of thick trabecular bone networks at the defect site after ABL administration, consistent with an improvement in trabecular structural parameters by ABL. ABL increased ALPase- and PHOSPHO1-positive osteoblastic cells and ALPase/PCNA double-positive cells, indicating enhanced preosteoblast proliferation as well as bone formation at the defect site. On the other hand, ABL did not affect the number of cathepsin K-positive osteoclasts per bone surface, suggesting that ABL did not promote excessive bone resorption. Our findings suggest that ABL is useful not only for preventing secondary vertebral fractures but also for promoting bone healing in OVF.

A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOMES FOR CLOSED FRACTURE PROXIMAL HUMERUS TREATED WITH EXTERNAL FIXATOR

Background:In the aging population, the proximal humerus fracture is the third most common osteoporotic fracture type after hip and distal radius fractures, accounting for 4% of all fractures. More than 70% of the patients that present with proximal humerus fracture are over 60 years of age and 75% are women. The mechanism of low-energy injury in elderly patients is usually falling from standing height. Aims And Objective: To study the functional outcomes for closed fracture proximal humerus treated with external fixator. Materials And Methods:A prospective study using a clinical and X-ray assessment of 86 two-and three-part fracture of the humerus in patients that underwent external fixation. Result:Mean scores of points were obtained using the DASH SCORE, with 80% satisfactory results. The following variables did not influence results: sex (p &gt;0.05), age (p &gt;0.05), laterality (p &gt;0.05), nor type of fracture (p &gt;0.05). Union was obtained in all cases. Reduction was considered good in 70(81%) cases, there were 11 cases of union in varus and 4 in valgus. Conclusion:This procedure makes it possible to obtain early satisfactory functional results and helps rehabilitation as it limits postoperative mobility to a lesser degree than other techniques it is also less aggressive than open reduction and internal fixation and has a low complication rate.

Management of Osteoporotic Vertebral Fracture: Review Update 2022.

A vertebral fracture is the most common type of osteoporotic fracture. Osteoporotic vertebral fractures (OVFs) cause a variety of morbidities and deaths. There are currently few "gold standard treatments" outlined for the management of OVFs in terms of quantity and quality. Conservative treatment is the primary treatment option for OVFs. The treatment of pain includes short-term bed rest, analgesic medication, anti-osteoporotic medications, exercise, and a brace. Numerous reports have been made on studies for vertebral augmentation (VA), including vertebroplasty and kyphoplasty. There is still debate and controversy about the effectiveness of VA in comparison with conservative treatment. Until more robust data are available, current evidence does not support the routine use of VA for OVF. Despite the fact that the majority of OVFs heal without surgery, 15%-35% of patients with an unstable fracture, persistent intractable back pain, or severely collapsed vertebra that causes a neurologic deficit, kyphosis, or chronic pseudarthrosis frequently require surgery. Because no single approach can guarantee the best surgical outcomes, customized surgical techniques are required. Surgeons must stay current on developments in the osteoporotic spine field and be open to new treatment options. Osteoporosis management and prevention are critical to lowering the risk of future OVFs. Clinical studies on bisphosphonate's effects on fracture healing are lacking. Teriparatide was intermittently administered, which dramatically improved spinal fusion and fracture healing while lowering mortality risk. According to the available literature, there are no standard management methods for OVFs. More multimodal approaches, including conservative and surgical treatment, VA, and medications that treat osteoporosis and promote fracture healing, are required to improve the quality of the majority of guidelines.

Factors affecting the quality of life in the chronic phase of thoracolumbar osteoporotic vertebral fracture managed conservatively with a brace

BACKGROUND CONTEXTAlthough osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have closely investigated the factors contributing to the quality of life (QOL) in the chronic phase after thoracolumbar OVFs using detailed radiographic evaluation. PURPOSEThis study aimed to identify factors associated with the QOL in the chronic phase after thoracolumbar OVF. DESIGNPost hoc analysis of a prospective randomized study. PATIENT SAMPLEParticipants included 195 patients with fresh thoracolumbar OVF managed conservatively with a brace who were available for radiographic analysis 48 weeks after injury. OUTCOME MEASURESThe degree of QOL impairment at 48 weeks after thoracolumbar OVF was assessed using the Japanese three-level version of the EuroQol five-dimensional questionnaire (EQ-5D) score. METHODSUnivariate and multivariate regression analyses were used to evaluate the relationships between the QOL and radiographic factors. RESULTSThe univariate analysis showed that age, analgesic use, T10/L5 Cobb angle on magnetic resonance imaging (MRI), subsequent vertebral fracture, and nonunion were significantly associated with the EQ-5D score at 48 weeks after thoracolumbar OVF. The multiple regression analysis showed that nonunion, analgesic use, subsequent vertebral fracture, and sacral slope on MRI were independently associated with the EQ-5D score at 48 weeks after thoracolumbar OVF. Receiver operating characteristic analysis for the deterioration of QOL showed that the cutoff value for sacral slope on MRI was 35 degrees. CONCLUSIONSThis study demonstrated that nonunion, subsequent vertebral fracture, and lower sacral slope were independently associated with poorer QOL in the chronic phase of thoracolumbar OVF managed conservatively with a brace. Therefore, improving or preventing these factors in patients with thoracolumbar OVF in the chronic phase may improve the QOL of the affected patients.

412.11: New-Onset Osteoporotic Fracture After Kidney Transplantation: A Matched Comparative Nationwide Cohort Study

Background: Successful kidney transplantation (KT) has brought better survival and quality of life to patients with end-stage kidney disease (ESKD), although long-term immunosuppressive agent-related side effects such as osteoporosis remain unresolved. We aim to explore the incidence risk of de novo osteoporotic fractures after KT compared with matched dialysis patients. Method: We constructed a nation-wide retrospective cohort consist of 141,674 ESKD patients from 2008 to 2020 using the National Health Insurance System database of Korea. After 1-year of wash out periods, patients younger than 18-year-old, having previous history of any kind of cancer, experiencing parathyroidectomy, re-transplantation, osteoporotic fracture, or taking osteoporosis-treating medication were excluded. Then, we extracted KT recipients and 1:1-matched dialysis patients according to the age, sex, era, and the presence of hypertension or diabetes. Osteoporotic fractures are defined as fractures associated with low bone mineral density including hip, spine, forearm, and humerus. We compared the de novo osteoporotic fracture incidence between the two groups. Result: After exclusion of 26883 patients in wash-out periods, 483 children, 6953 having cancers, 336 experiencing parathyroidectomy, 8907 preexisting osteoporotic fractures, 3755 established osteoporosis medications, and 110 re-transplantations, we finally identified 12760 matched KT-dialysis pairs. Their average age was 51.0 ± (10.1) (standard deviation (SD)) years and 7951 (62.3%) were male. Patients with having hypertension and diabetes were 11800 (92.5%) and 4548 (35.6%), respectively. About 30.5% KT patients received their graft preemptively. New-onset osteoporotic fractures after inclusion occurred in 631 (4.9%) of dialysis patients and 588 (4.6%) of KT recipients, respectively. The most common fracture site was forearm in both groups. During overall 4.7 ± 3.1 years of follow up, KT recipients showed similar risk for the development of new-onset osteoporotic fracture compared with matched dialysis controls even after adjustment of matching variables, previous use of steroid or anti-depressants, vitamin D or its analog, calcium-based phosphate binders. In subgroup analysis, they showed a lower risk of hip fracture (adjusted hazard ratio 0.51, 95% CI 0.38-0.67, p <0.001), but similar risks of other types of osteoporotic fractures including spine, forearm, or humerus compared to dialysis controls. Conclusion: In this study, overall new-onset osteoporotic fracture risk of KT recipients was not different from matched dialysis controls except a lower risk of hip fractures.

Surgical Management and Outcomes following Pathologic Hip Fracture-Results from a Propensity Matching Analysis of the Registry for Geriatric Trauma of the German Trauma Society.

Background and Objectives: The outcomes of patients with pathologic hip fractures remain unclear. Data from a large international geriatric trauma registry were analyzed to examine the outcomes of patients with pathologic hip fractures compared with patients with typical osteoporotic hip fractures. Materials and Methods: Data from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) were analyzed. All patients treated surgically for osteoporotic or pathologic hip fractures were included in this analysis. Across both fracture types, a 2:1 optimal propensity score matching and multivariate logistic regression analysis were conducted. In-house mortality rate and mortality at the 120-day follow-up, as well as mobility after 7 and 120 days, reoperation rate, discharge management from the hospital and readmission rate to the hospital until the 120-day follow-up were analyzed as outcome parameters for the underlying fracture type—pathologic or osteoporotic. Results: A total of 29,541 cases met the inclusion criteria. Of the patients included, 29,330 suffered from osteoporotic fractures, and 211 suffered from pathologic fractures. Multivariate logistic regression analysis revealed no differences between the two fracture types in terms of mortality during the acute hospital stay, reoperation during the initial acute hospital stay, walking ability after seven days and the likelihood of being discharged back home. Walking ability and hospital readmission remained insignificant at the 120-day follow-up as well. However, the odds of passing away within the first 120 days were significantly higher for patients suffering from pathologic hip fractures (OR: 3.07; p = 0.003). Conclusions: Surgical treatment of pathologic hip fractures was marked by a more frequent use of arthroplasty in per- and subtrochanteric fractures. Furthermore, the mortality rate among patients suffering from pathologic hip fractures was elevated in the midterm. The complication rate, as indicated by the rate of readmission to the hospital and the necessity for reoperation, remained unaffected.

The Acute VertEbRal AugmentaTion (AVERT) study: protocol for a randomised controlled, feasibility trial of spinal medial branch nerve block in hospitalised older patients with vertebral fragility fractures

IntroductionVertebral fragility fractures (VFFs) are the most common type of osteoporotic fracture found in older people, resulting in increasing morbidity and excess mortality. These fractures can cause significant pain, requiring...

Factors Contributing to Residual Low Back Pain after Osteoporotic Vertebral Fractures.

Although osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have investigated the factors contributing to residual low back pain in the chronic phase after OVFs by using radiographic evaluation. We examined the contribution of nonunion, vertebral deformity, and thoracolumbar alignment to the severity of residual low back pain post-OVF. This post hoc analysis of a prospective randomized study included 195 patients with a 48-week follow-up period. We investigated the associations between radiographic variables with the visual analog scale (VAS) scores for low back pain at 48 weeks post-OVF using a multiple linear regression model. Univariate analysis revealed that analgesic use, the local angle on magnetic resonance imaging, anterior vertebral body compression percentage on X-ray, and nonunion showed a significant association with VAS scores for low back pain. Multiple regression analysis produced the following equation: VAS for low back pain at 48 weeks = 15.49 + 0.29 × VAS for low back pain at 0 weeks + (with analgesics: +8.84, without analgesics: −8.84) + (union: −5.72, nonunion: −5.72). Among local alignment, thoracolumbar alignment, and nonunion, nonunion independently contributed to residual low back pain at 48 weeks post-OVF. A treatment strategy that reduces the occurrence of nonunion is desirable.

Оцінка мікроархітектури хребта за допомогою TBS допомагає розрізнити пацієнтів з основними остеопоротичними переломами та контрольну групу залежно та незалежно від МЩКТ: Східноєвропейське дослідження TBS

Метою дослідження була оцінка клінічної ефективності моделі, що поєднує показники мінеральної щільності (МЩКТ) і мікроархітектури (TBS) кісткової тканини хребта, щодо виявлення остеопоротичних переломів. Східноєвропейське багатоцентрове дослідження (Сербія, Болгарія, Румунія, Україна) оцінювало роль TBS у рутинній клінічній практиці як доповнення до МЩКТ. Усі відскановані дані були отримані на денситометрах Hologic Discovery й GE Prodigy звичайним способом, що застосовується в клінічній практиці. Клінічні значення МЩКТ хребта і TBS для всіх типів остеопоротичних переломів (All-OP Fx) додатково були проаналізовані методом двохетапного дерева класифікації (МЩКТ супроводжувалось аналізом тертилів TBS). Були визначені чутливість, специфічність і точність виявлення переломів, а також був розрахований Net Reclassification Index (NRI). Дослідження включало 1031 жінку віком 45 років і старше з різних країн Східної Європи. Клінічні центри були перехресно відкалібровані за МЩКТ і TBS. Як і очікувалось, мінеральна щільність кісткової тканини хребта і TBS корелювали помірно (r2 = 0,19). Показник поширеності для всіх типів остеопоротичних переломів (All-OP Fx) становив 26%. Пацієнти з переломами мали значимо нижчі показники TBS і МЩКТ хребта, ніж особи без переломів (p = 0,01). Показник TBS асоціювався з наявністю переломів навіть після поправки на вік і МЩКТ хребта з OR (odds ratio) 1,27 [1,07–1,51]. Показники МЩКТ хребта за Т-критерієм –2,5 і нижче та TBS нижнього тертиля були подібні з погляду чутливості (35 проти 39%), специфічності (78 проти 80%) і точності (64 проти 66%). Комбінація МЩКТ хребта і TBS приводила до значного підвищення чутливості (+28%) і точності (+17%) порівняно з використанням тільки МЩКТ хребта, у той час як специфічність покращувалась помірно (+9%). Загальний коефіцієнт ефективності комбінації, визначений за допомогою NRI, становив 36%. Поєднане застосування МЩКТ хребта і TBS істотно зменшило кількість суб’єктів, які потребують додаткової діагностики МЩКТ, із 7 до 2. Ми показали, що в східноєвропейській когорті використання TBS як доповнення до МЩКТ хребта дозволяє правильно класифікувати більше ніж третину з усіх пацієнтів. Крім того, кількість осіб, які потребують додаткової діагностики, зменшилась до 2. Щоб оцінити вигоду використання TBS для системи охорони здоров’я, необхідно провести додаткові економічні дослідження.

Clinical features of methotrexate osteopathy in rheumatic musculoskeletal disease: A systematic review

BackgroundThere is growing evidence from case reports that methotrexate (MTX) therapy may impair bone metabolism in individual patients leading to low bone mass, atraumatic stress fractures and immobilizing bone pain – referred to as ‘MTX osteopathy’. However, the clinical features, risk factors and treatment options of this condition are still elusive. MethodsA systematic review was conducted according to PRISMA guidelines. Two databases (MEDLINE, Embase) were searched for published cases of MTX osteopathy in patients with rheumatic musculoskeletal diseases (RMD). Data from the included publications were extracted and descriptive statistical analysis was performed. ResultsWe report data from 32 studies describing 80 adult RMD patients with stress fractures in MTX osteopathy. Most cases were found in elderly women with longstanding RMD, especially rheumatoid arthritis (72.5%). MTX osteopathy commonly presented as stress fracture of the distal tibia (51.3%), calcaneus (35.0%) and proximal tibia (27.5%), mimicking arthritis in some cases. Although a majority of the patients met the densitometric criteria for osteoporosis (58.1%), typical osteoporotic fractures (e.g., vertebral fractures) were rarely seen. Patients frequently suffered from bilateral (55.0%), multiple (71.3%) and recurrent fractures (25.0%). Fractures mainly occurred at low to moderate doses of MTX therapy (45.0%). It should be noted that half (48.8%) of the patients did not receive systemic steroid therapy for at least 3 years. ConclusionsLow-dose MTX therapy in RMD may result in atraumatic stress fractures of the lower extremity that can mimic arthritis. MTX osteopathy is characterized by a pathognomonic type of stress fractures with band- or meander-shaped appearance along the growth plate.

Obesity and Bone: A Complex Relationship.

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.

Spatial distribution of hip cortical thickness in postmenopausal women with different osteoporotic fractures.

Cortical bone is critical for bone strength. Hip cortical thickness is reported to be closely associated with the incidence of hip fractures, but its relationship with nonhip fractures is rarely studied. As the hip is a major site for fracture risk assessment, it would be of great benefit to investigate the association between hip cortical thickness and different osteoporotic fractures. One hundred age-matched postmenopausal women were equally assigned to 4 osteoporotic fracture groups (trochanteric, femoral neck, vertebral, and peripheral fractures) and a nonfracture group. Each subject had a clinical quantitative computed tomography scan of the bilateral hips and the lumbar spine. A cortical bone mapping algorithm was adopted to calculate hip cortical thickness. Hip and lumbar trabecular density and the hip cortical thickness distribution were compared among the groups. All the fracture groups presented lower lumbar trabecular density. Compared with nonfracture controls, patients with hip or vertebral fractures but not peripheral fractures showed decreased cortical thickness and trabecular density of the hip. Fracture-specific distributions of cortical thickness were revealed, including zonal defects on the neck-intertrochanter junction, greater trochanter, and the periphery of the lesser trochanter for trochanteric fractures, a focal defect on the anterosuperior neck for femoral neck fractures, a moderate and average distribution for vertebral fractures, and focally thicker cortices on the anterosuperior greater trochanter and the periphery of the lesser trochanter for peripheral fractures. The spatial distribution of hip cortical thickness was different for each type of osteoporotic fracture, and patients with centrally located fractures demonstrated more severe cortical deterioration. This finding needs to be validated in a larger sample.

Частота і локалізація остеопоротичних переломів залежно від віку, мінеральної щільності та якості кісткової тканини в українських жінок у постменопаузальному періоді

Актуальність. Низькотравматичні переломи є важливими ускладненнями системного остеопорозу, що призводять до зниження якості життя, збільшення захворюваності, інвалідності та смертності. У наш час мінеральна щільність кісткової тканини (МЩКТ) і трабекулярний кістковий індекс (ТКI), що визначаються за допомогою двохенергетичної рентгенівської абсорбцiометрiї, є двома основними параметрами міцності кістки. Вони широко використовуються при діагностиці остеопорозу. Метою дослідження було вивчення частоти і локалізації різних остеопоротичних переломів у жінок в постменопаузальному періоді залежно від віку, МЩКТ і ТКI. Матеріали та методи. Проведено одномоментне дослідження і проаналізовані дані 1369 жінок у постменопаузальному періоді (вік 45–89 років). Пацієнтки були розділені на групи залежно від МЩКТ згідно з критеріями Всесвітньої організації охорони здоров’я: нормальний стан кісткової тканини (T-індекс &gt; –1,0 стандартного відхилення (СВ)), остеопенія (≤ –1,0 T-індекс &gt; –2,5 СВ), остео­пороз (T-індекс ≤ –2,5 СВ), і в залежності від квартилів (груп) ТКI (L1-L4): QI — найнижча квартиль (0,36–1,08); QII — нижня квартиль (1,08–1,20); QIII — верхня квартиль (1,20–1,32); QIV — найвища квартиль (1,32–1,79). МЩКТ і ТКI поперекового відділу хребта (L1-L4) вимірювали за допомогою денситометра Prodigy (GE Medical systems, Lunar, модель 8743, 2005). ТКI визначали з використанням програмного забезпечення TBS Insight (Med-Imaps, Bordeaux, France, 2006). Результати. Встановлено, що ризик усіх типів остеопоротичних переломів у жінок достовірно збільшується з віком (вертебральних переломів — у 1,97–4,26 раза, невертебральних — у 1,96–5,45, комбінованих — у 1,54—3,14 раза). Крім того, ми ви­явили, що остеопоротичні переломи присутні у всіх групах жінок iз різною МЩКТ: при остеопорозі (45,5 %), остеопенiї (26,9 %) та за нормального стану кісткової тканини (18,1 %). Найбільшою частота остеопоротичних переломів була при остеопорозі (46,5 %), переважно в жінок iз хребцевими і комбінованими переломами. Тільки в 25,5 % пацієнток iз невертебральними переломами спостерігається остеопороз. Низький ТКI відзначався в 50,8 % жінок iз вертебральними, 43,7 % — невертебральними і в 32,8 % — iз комбінованими (хребцевими і невертебральними) остеопоротичними переломами. Висновки. Остеопоротичні переломи частково пов’язані з віком, МЩКТ і ТКI. Однак існують й інші важливі чинники, що впливають на ризик переломів, і їх поєднання вимагає подальшого вивчення.

Incidence of Atypical Femoral Fracture and Its Mortality in a Single Center in Singapore.

ABSTRACTBisphosphonates (BP) are the most commonly prescribed effective form of osteoporosis treatment with adverse effects associated with prolonged use such as atypical femoral fractures (AFF). Asians have an elevated risk of AFF at 5 to 6 times those of whites and Hispanics. In this study, we characterize factors associated with AFF and its mortality in a single center in Singapore. We conducted a cohort study of subjects older than 50 years admitted to Changi General Hospital (CGH), Singapore, with fragility subtrochanteric femoral fractures from 2009 to 2015. Using the ASBMR 2014 criteria, fractures are classified into atypical and typical subtrochanteric femoral fractures. CGH uses a nationalized electronic health record that allows review of information on patients' demographics, clinical history and previous investigations. Mortality was assessed as of December 31, 2019. Between 2009 and 2015, there were 3097 hip fractures, of which 393 were subtrochanteric femoral fractures and 69 were classified as AFF by ASBMR 2014 criteria. A total of 52.2% of AFF occurred with BP exposure of median duration 56.5 (28 to 66) months. Multivariate regression showed that BP exposure was associated with the highest risk of AFF (odds ratio [OR] = 6.65 [2.35–18.9]). AFF patients had higher 5‐year survival (0.85 versus 0.62, p = 0.001) compared with typical subtrochanteric fracture patients. However, after adjusting for variables, the type of subtrochanteric femoral fractures were no longer significantly associated with progression to death, whereas older age, higher mean Charlson comorbidity score, and Malay ethnicity were the strongest predictors of death. AFF constitutes a small proportion of hip and femoral fractures with prolonged BP use being the highest risk factor for its development. There is no evidence of increased mortality or morbidity in patients with AFF compared with the typical subtrochanteric fracture. The fear of AFF should not impede treatment of typical osteoporotic fractures in this population. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Bisphosphonate treatment and the risk of atypical femoral fracture among patients participating in a Fracture Liaison Service of a tertiary medical center.

Atypical femoral fractures (AFF) are a rare complication of bisphosphonate (BP) treatment. We evaluated the correlation between BP exposure and AFF risk among hip fracture patients. This retrospective nested case-control study included patients over age 50years, operated for osteoporotic hip fracture between July 2014 and November 2018, who attended our Fracture Liaison Service. We classified fracture radiographs and compared demographic, clinical, biochemical, and drug purchase data between patients with AFF and those with typical osteoporotic hip fracture (controls). To correct for the younger age of patients with AFF, we matched each case (AFF) with three controls according to age ([Formula: see text] 1year) and sex and performed a conditional logistic regression model. Of 989 patients, 31 (3%) had AFF. Patients with AFF were younger than those with inter-trochanteric fractures (mean ± SD: 72.3 ± 10.3 vs. 80.2 ± 9.6years, p < 0.001). Following matching, the mean Charlson's Comorbidity Index (CCI) was lower in the AFF than in the control group (2.9 ± 3.7 vs. 4.7 ± 4.2; p = 0.030) and a higher proportion of them were treated with BP for 5years or more (58.1 vs. 16.0%; p < 0.001). Among patients admitted with hip fracture who were treated with BP for 5years or more, the odds ratio of this fracture being atypical was significantly higher compared with no BP treatment (21.7; 95% CI-4.1-113.9). Patients with AFF compared to typical hip fractures showed better baseline medical conditions irrespective of their younger age. Five years of BP treatment may be associated with an increased risk for AFF, though the absolute risk remains very low.

P115 Improved reporting of vertebral fractures by radiologists: a success story!

Abstract Background/Aims Vertebral fractures (VF) are the most common type of osteoporotic fracture and affect &amp;gt;20% women over the age of 80. However, the majority remain undiagnosed. Even when imaging has been performed, VF are under-reported by radiologists. This results in a missed opportunity for treatment to reduce fracture risk and morbidity. We conducted this project to improve the reporting of VF (incidental or symptomatic), thus enabling our fracture liaison service to identify cases more easily and optimise patient care. Methods Using SYNAPSE (imaging software), cohorts of patients aged more than 75 years of age who had CT scans of chest/abdomen/pelvis in 2012 and 2017 were selected. Images were reviewed by a single rheumatologist with an interest in osteoporosis, looking for the presence of VF. For patients with VF, radiology reports were reviewed to assess whether there was documentation of this. Results There was improvement in the reporting of VF between 2012 and 2017 (see Table 1) but identification remained suboptimal. Specific use of the term “fracture” remained in the minority. The data was presented to our radiologists in December 2017 along with information about the importance of identifying and treating patients with VF. Agreement was reached for the radiologists to include a code (FLS) in reports where a non-pathological VF was identified. Searches for the presence of the code through the hospital’s radiology information system have allowed easy identification of VF cases. Letters are sent to Primary Care teams informing them that we have identified an incidental VF along with suggested management advice. This project has substantially increased the number of VF identified (in patients aged &amp;gt;50) by our fracture liaison service over time. 82 cases of VF were identified in 2017 (pre-intervention), 350 cases in 2018, and 848 cases in 2019. P115 Table 1:No. of patients, nVF identified in audit, n (%)Terminology alluding to fracture in radiology report, n (% of identified fractures)Use of the word “fracture” in radiology report, n (% of identified fractures)Mention of osteoporosis or osteopaenia, n (% of identified fractures)2012 cohort10315 (15)5 (33)1 (7)3 (20)2017 cohort10226 (25)18 (69)8 (31)4 (15) Conclusion Collaboration with our radiologists through education and the use of a code in radiology reports has resulted in a sustained and dramatic increase in the number of VF annually identified by our fracture liaison service. We strongly recommend that other services adopt this approach to help them achieve national audit targets and improve patient care. Disclosure M. Nazir: None. M. Jamal: None. D. Hart: None. J. Shipley: None. S. Warren: None. S. Hardcastle: None. T. Ahmed: None.