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Ishizu H, Shimizu T, Arita K, Sato K, Takahashi R, Kusunoki K, Shimodan S, Asano T, Iwasaki N. Secondary fracture and mortality risk with very high fracture risk osteoporosis and proximal femoral fracture. J Bone Miner Metab 2024; 42:196-206. [PMID: 38308695 DOI: 10.1007/s00774-023-01492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/06/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION We aimed to investigate secondary fracture and mortality rates, and risk factors in patients with proximal femoral fractures. MATERIALS AND METHODS We conducted a multicenter prospective cohort study on female patients with proximal femoral fractures who underwent surgical treatment between April 2020 and March 2021. Postoperative follow-ups were performed at 6-, 12-, 18-, and 24-month intervals to determine the secondary fracture and mortality rates, and the risk factors and its influence were examined. RESULTS Of the 279 registered patients, 144 patients (51.6%) were diagnosed with very high fracture risk osteoporosis. The postoperative osteoporosis rate exceeded 96%; however, osteoanabolic agents were used sparingly. The risk factor of both secondary fracture and mortality was very high fracture risk osteoporosis, and secondary fractures within 12 months were markedly occurred. Secondary fracture rates increased as the number of matched very high fracture risk osteoporosis criteria increased. Notably, secondary fractures and mortality were recorded in 21.4% and 23.5% of the patients who met all criteria, respectively. CONCLUSION Over half of the female patients with proximal femoral fractures had very high fracture risk osteoporosis. Although, very high fracture risk osteoporosis demonstrated a notably increased risk of secondary fractures, particularly at 12 months post-surgery, the use of osteoanabolic agents was substantially low. Collectively, our findings highlight the need to consider the risk of very high fracture risk osteoporosis, expand the use of medications to include osteoanabolic agents, and reconsider the current healthcare approach for proximal femoral fractures.
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Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kosuke Arita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Komei Sato
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Iwamizawa City Hospital, Iwamizawa, Hokkaido, Japan
| | - Renya Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Kenichi Kusunoki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Central Hospital, Hakodate, Hokkaido, Japan
| | - Shun Shimodan
- Department of Orthopaedic Surgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Tsuyoshi Asano
- Department of Orthopaedic Surgery, KKR Sapporo Medical Center, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Cao J, Liao K, Li ZX, Wang D, Chen JL, Wang HY, Zhou ZK. Femoral and tibial cementless fixation neither increases blood loss nor impedes early functional recovery: A randomized controlled trial. Front Surg 2023; 9:1079120. [PMID: 36684221 PMCID: PMC9845638 DOI: 10.3389/fsurg.2022.1079120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
Background Whether cementless fixation on femoral and tibial components increases blood loss during total knee arthroplasty (TKA) is unclear. The purpose of this randomized controlled trial was to compare blood loss and early functional recovery between patients who underwent cementless or cemented TKA. Methods Between November 2021 and April 2022, sixty-one eligible patients at our medical center were randomized to cementless and cemented group. The primary outcome was total blood loss (TBL). Secondary outcomes were drainage, knee swelling, anemia, transfusion, hematological indicators, early functional recovery, and postoperative complications. The early functional recovery included range of motion (ROM), Hospital for Special Surgery (HSS) score, walking distance. Results A total of 61 patients were analyzed, of whom 30 underwent cementless fixation. On postoperative day 1, the mean TBL was 394.39 ml (SD 182.97 ml) in the cementless group and 382.41 ml (SD 208.67 ml) in the cemented group (P = 0.863). By postoperative day 3, the corresponding mean TBL was higher at 593.48 ml (SD 230.04 ml) and 603.80 ml (SD 213.16 ml) (P = 0.751). The two groups did not differ significantly in drainage, knee swelling, anemia, levels of hemoglobin or hematocrit or platelets, ROM, HSS score, walking distance, or rates of transfusion or postoperative complications. Conclusions Cementless fixation on femoral and tibial components during TKA does not increase blood loss or impede early functional recovery, which suggests that clinicians need not worry about blood loss and early functional recovery when deciding what type of fixation to perform during TKA. Trial registration Number: ChiCTR2100052857; Date: November 6, 2021.
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Affiliation(s)
- Jian Cao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Kai Liao
- Department of Radiology, West China Hospital, West China Hospital, Sichuan University, Chengdu, China
| | - Ze-xi Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-li Chen
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hao-yang Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Correspondence: Hao-yang Wang Zong-ke Zhou
| | - Zong-ke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Correspondence: Hao-yang Wang Zong-ke Zhou
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Hernández-Pascual C, Santos-Sánchez JÁ, Hernández-Rodríguez J, Silva-Viamonte CF, Pablos-Hernández C, Villanueva-Martínez M, Mirón-Canelo JA. New Prognostic Factors in Operated Extracapsular Hip Fractures: Infection and GammaTScore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11680. [PMID: 36141949 PMCID: PMC9517159 DOI: 10.3390/ijerph191811680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
There is no universal postoperative classification of extracapsular hip fractures (ECFs). We wondered if infection (according to infection after fracture fixation criteria (IAFF)), immediate partial weight bearing (PWB) and/or the new GammaTScore tool could predict early cut-out. We also examined the correlation between GammaTScore and time to consolidation and studied long-term survival. This was a retrospective cohort study of low-energy complete ECFs operated with Gamma3T nailing in 2014 and fully monitoring, in patients aged over 65. Ten not distally locked cases, one late cut-out, one cut-through, one osteonecrosis and one pseudarthrosis were discarded. Patients were classified into early cut-out (7/204; 3.55%) and no early cut-out (197/204; 96.45%). There was a lower percentage of A2 fractures according to the AO Foundation/Orthopaedic Trauma Association classification (AO/OTA, 1997) in early cut-out. IAFF and only the GammaTScore reduction parameter were different for early cut-out, in opposition to immediate PWB, tip-to-apex distance (TAD) or the Baumgaertner-Fogagnolo classification. GammaTScore inversely correlated with consolidation (p < 0.01). Long-term survival time was not statistically significantly lower in the early cut-out group. Small sample of cases may limit our results. Apart from an important role of IAFF, GammaTScore would be useful for predicting consolidation, avoiding complications and reducing costs. Further studies are needed for reliability.
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Affiliation(s)
- Carlos Hernández-Pascual
- Department of Human Anatomy and Histology, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004 Salamanca, Spain
| | - José Ángel Santos-Sánchez
- Department of Biomedical and Diagnostic Sciences (Area of Radiology and Physical Medicine), Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Jorge Hernández-Rodríguez
- Department of Biomedical and Diagnostic Sciences (Area of Radiology and Physical Medicine), Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Carlos Fernando Silva-Viamonte
- Department of Statistics, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Carmen Pablos-Hernández
- Department of Geriatrics, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004 Salamanca, Spain
| | | | - José Antonio Mirón-Canelo
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
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Xiao BH, Zhu MSY, Du EZ, Liu WH, Ma JB, Huang H, Gong JS, Diacinti D, Zhang K, Gao B, Liu H, Jiang RF, Ji ZY, Xiong XB, He LC, Wu L, Xu CJ, Du MM, Wang XR, Chen LM, Wu KY, Yang L, Xu MS, Diacinti D, Dou Q, Kwok TYC, Wáng YXJ. A software program for automated compressive vertebral fracture detection on elderly women's lateral chest radiograph: Ofeye 1.0. Quant Imaging Med Surg 2022; 12:4259-4271. [PMID: 35919046 PMCID: PMC9338385 DOI: 10.21037/qims-22-433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Abstract
Background Because osteoporotic vertebral fracture (OVF) on chest radiographs is commonly missed in radiological reports, we aimed to develop a software program which offers automated detection of compressive vertebral fracture (CVF) on lateral chest radiographs, and which emphasizes CVF detection specificity with a low false positivity rate. Methods For model training, we retrieved 3,991 spine radiograph cases and 1,979 chest radiograph cases from 16 sources, with among them in total 1,404 cases had OVF. For model testing, we retrieved 542 chest radiograph cases and 162 spine radiograph cases from four independent clinics, with among them 215 cases had OVF. All cases were female subjects, and except for 31 training data cases which were spine trauma cases, all the remaining cases were post-menopausal women. Image data included DICOM (Digital Imaging and Communications in Medicine) format, hard film scanned PNG (Portable Network Graphics) format, DICOM exported PNG format, and PACS (Picture Archiving and Communication System) downloaded resolution reduced DICOM format. OVF classification included: minimal and mild grades with <20% or ≥20–25% vertebral height loss respectively, moderate grade with ≥25–40% vertebral height loss, severe grade with ≥40%–2/3 vertebral height loss, and collapsed grade with ≥2/3 vertebral height loss. The CVF detection base model was mainly composed of convolution layers that include convolution kernels of different sizes, pooling layers, up-sampling layers, feature merging layers, and residual modules. When the model loss function could not be further decreased with additional training, the model was considered to be optimal and termed ‘base-model 1.0’. A user-friendly interface was also developed, with the synthesized software termed ‘Ofeye 1.0’. Results Counting cases and with minimal and mild OVFs included, base-model 1.0 demonstrated a specificity of 97.1%, a sensitivity of 86%, and an accuracy of 93.9% for the 704 testing cases. In total, 33 OVFs in 30 cases had a false negative reading, which constituted a false negative rate of 14.0% (30/215) by counting all OVF cases. Eighteen OVFs in 15 cases had OVFs of ≥ moderate grades missed, which constituted a false negative rate of 7.0% (15/215, i.e., sensitivity 93%) if only counting cases with ≥ moderate grade OVFs missed. False positive reading was recorded in 13 vertebrae in 13 cases (one vertebra in each case), which constituted a false positivity rate of 2.7% (13/489). These vertebrae with false positivity labeling could be readily differentiated from a true OVF by a human reader. The software Ofeye 1.0 allows ‘batch processing’, for example, 100 radiographs can be processed in a single operation. This software can be integrated into hospital PACS, or installed in a standalone personal computer. Conclusions A user-friendly software program was developed for CVF detection on elderly women’s lateral chest radiographs. It has an overall low false positivity rate, and for moderate and severe CVFs an acceptably low false negativity rate. The integration of this software into radiological practice is expected to improve osteoporosis management for elderly women.
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Affiliation(s)
- Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Er-Zhu Du
- Department of Radiology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, China
| | - Wei-Hong Liu
- Department of Radiology, General Hospital of China Resources & Wuhan Iron and Steel Corporation, Wuhan, China
| | - Jian-Bing Ma
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hua Huang
- Department of Radiology, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Jing-Shan Gong
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Davide Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza University of Rome, Rome, Italy.,Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Kun Zhang
- Department of Radiology, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Heng Liu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ri-Feng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhong-You Ji
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiao-Bao Xiong
- Department of Radiology, Zhejiang Provincial Tongde Hospital, Hangzhou, China
| | - Lai-Chang He
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lei Wu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chuan-Jun Xu
- Department of Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mei-Mei Du
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Rong Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Li-Mei Chen
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kong-Yang Wu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,College of Electrical and Information Engineering, Jinan University, Guangzhou, China
| | - Liu Yang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mao-Sheng Xu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza University of Rome, Rome, Italy
| | - Qi Dou
- Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Y C Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Hernández-Pascual C, Santos-Sánchez JÁ, García-González JM, Silva-Viamonte CF, Pablos-Hernández C, Ramos-Pascua L, Mirón-Canelo JA. Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails. J Orthop Traumatol 2021; 22:48. [PMID: 34825977 PMCID: PMC8620307 DOI: 10.1186/s10195-021-00609-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/31/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the "orthopaedic school". MATERIALS AND METHODS This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. RESULTS Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. CONCLUSIONS Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5-6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. LEVEL OF EVIDENCE Therapeutic study, level 2b.
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Affiliation(s)
- Carlos Hernández-Pascual
- Department of Trauma and Orthopaedic Surgery, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004, Salamanca, Spain.
| | - José Ángel Santos-Sánchez
- Department of Radiology, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004, Salamanca, Spain
| | | | - Carlos Fernando Silva-Viamonte
- Department of Statistics, Faculty of Medicine, Universidad de Salamanca, Campus Miguel de Unamuno, Avda. Alfonso X el Sabio s/n, 37007, Salamanca, Spain
| | - Carmen Pablos-Hernández
- Department of Geriatrics, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004, Salamanca, Spain
| | - Luis Ramos-Pascua
- Department of Trauma and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain
| | - José Antonio Mirón-Canelo
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad de Salamanca, Campus Miguel de Unamuno, Avda. Alfonso X el Sabio s/n, 37007, Salamanca, Spain
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Casella M, Becciolini A, Di Donato E, Basaglia M, Zardo M, Lucchini G, Riva M, Ariani A, Magalini F. Internal medicine inpatients' prevalence of misdiagnosed severe osteoporosis. Osteoporos Int 2021; 32:2361-2364. [PMID: 33950266 DOI: 10.1007/s00198-021-05976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED Vertebral fractures (VF) related to osteoporosis (i.e., severe OP) increase the risk of disability and mortality, but they are often neglected. We observed a severe OP misdiagnosis in 28.9% of inpatients with previous spinal imaging positive for VFs. Diagnosing severe OP is crucial to reduce the health care costs of inpatients. INTRODUCTION Vertebral fractures (VFs) related to osteoporosis (OP) increase the risk of additional fractures and death. In inpatients, VFs are often neglected with consequent delay in OP treatments, prolongation of hospitalization, and reduction of life expectancy. The aim of this study was to evaluate the prevalence of a misdiagnosed severe OP (i.e., with VF) in general medicine inpatients. METHODS We evaluated inpatients of a Medicine Unit between January 2019 and December 2019 without severe OP diagnosis, who had spinal imaging. For each patient, we collected demographic data, previous or current OP treatment, and presence/number of VFs. Descriptive data were presented by medians (interquartile range [IQR]) for continuous data or as numbers (percentages) for categorical data. Differences between subgroups were analyzed with chi-square or Kruskal-Wallis tests as appropriate. p-values <0.05 were considered statistically significant. RESULTS 793 subjects were admitted to inpatient's clinic: 235 (135 females and 100 males with a median age of 76.0 [64.0-83.0] years) were enrolled. One or more vertebral fractures were present in 28.9% (68/235) subjects; 47% (32/68) had two or more vertebral fractures. The majority of patients (55/68) with VFs had not previously received a severe OP diagnosis. CONCLUSIONS Severe OP was misdiagnosed in at least 8.6% of inpatients. The prevalence dramatically increases (about 29%) in subjects with previous spinal imaging showing one or more VFs. More attention should be given to this co-morbidity, which is known to be an additional risk factor for disability and mortality.
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Affiliation(s)
- M Casella
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - A Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - E Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - M Basaglia
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - M Zardo
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - G Lucchini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - M Riva
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - A Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy.
| | - F Magalini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
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The reliability and validity of the Turkish version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis-31 (QUALEFFO-31). Arch Osteoporos 2021; 16:128. [PMID: 34499238 PMCID: PMC8426330 DOI: 10.1007/s11657-021-00997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/05/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study reveals the Turkish version of QUALEFFO-31 has a sufficient level of reliability, validity, and psychometric properties. The questionnaire, which is potentially capable of differentiating patients with fractures, does not appear to have the differential capacity in terms of osteoporosis. PURPOSE This study aims to conduct the reliability and validity study of QUALEFFO-31 in Turkish and to evaluate the capacity of the questionnaire to distinguish patients in terms of osteoporosis. METHODS The original English version was translated into Turkish by two translators whose native language was Turkish. Subsequently, this Turkish version was translated back into English by two different bilingual translators whose native language was English. After this preliminary questionnaire was tested in 30 patients, words, terminology, information errors, and parts difficult to understand were revised, and the questionnaire was finalized. Internal consistency and test-retest analyses were used for the reliability study. For the validity study, convergent-discriminant validity, concurrent validity, factor analysis, known-group validity, and receiver operating characteristic (ROC) analyses were performed. RESULTS A total of 111 patients were evaluated. Internal consistency levels were optimal except for the mental function. ICC coefficients showed good retest reliability for all domains and total tests. The convergent and discriminant validity ratios for the mental function domain were 78% for both and 100% for the other domains. There was a moderate and good negative correlation between QUALEFFO-31 and SF-36 domains which had similar names. Exploratory factor analysis revealed 3 structures. However, there was a spread to the other factors in physical function domain items. Confirmatory factor analysis (CFA) markers were not at a very good fitting level except for the relative chi-square index. When CFA was performed according to the assumed model, the fitting level increased in all analyses. There was no significant differential capacity in terms of osteoporosis or fracture for either QUALEFFO-31 or SF-36. CONCLUSION The Turkish version of QUALEFFO-31 has a sufficient level of reliability, validity, and psychometric properties. Nevertheless, improvements in pain and mental function domains and some changes applying to the model may increase the psychometric capacity of the questionnaire. The questionnaire, which is potentially capable of differentiating patients with fractures, does not appear to have the differential capacity in terms of osteoporosis. CLINICALTRIALS. GOV IDENTIFIER NCT04259099 (date of registration: February 6, 2020).
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Wáng YXJ, Du MM, Che-Nordin N, Ye PP, Qiu SW, Griffith JF, Yan ZH. Recognizing osteoporotic vertebral deformity on frontal view radiograph: a cohort analysis and a pictorial review. Arch Osteoporos 2020; 15:41. [PMID: 32144508 DOI: 10.1007/s11657-020-00716-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/10/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE Opportunities exist to detect osteoporotic vertebral deformities (VDs) on frontal radiograph (FR) indicated for lung or abdominal diseases, while literature have been mostly based on lateral radiograph (LR). This study analyzed the detectability of moderate and severe grades VD on FR. METHODS There were 105 female cases (mean 72 years, range 55~93 year), who were referred for digital spine FR and LR with back and/or leg pain. The LR and FR were read, osteoporotic VDs with < 20%, 20-25%, 25-40%, and > 40% vertebral body height loss were recorded as minimal, mild, moderate, and severe grades, respectively. After a 10-month interval, only FRs were read again, and each vertebra was classified as (1) no notable VD, (2) with notable VD, and (3) ambiguous. The first reading was the reference, while the second reading was allowed to miss minimal/mild VCD and endplate/cortex fracture. RESULTS Counting by subjects, for 98 cases, the two reading sessions had agreement, including 43 "true negative" cases and 55 true positive cases. There were two false positive cases, and five ambiguous cases. In total, 1286 vertebra were assessed, FR reading had 1126 vertebrae "true negative," 130 vertebrae true positive, one vertebra false negative, 3 vertebrae false positive, and 26 ambiguous vertebrae (65.4% being true negative and 34.6% being true positive). Most of the disagreements were associated with kyphosis or poor X-ray projection. Nineteen illustrative cases are presented graphically. CONCLUSION Moderate and severe grades of VD are identifiable on FR as long as the involved vertebrae are clearly filmed.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
| | - Mei-Mei Du
- Department of Radiology, Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou, Zhejiang Province, China
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Pei-Pei Ye
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Shi-Wen Qiu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Zhi-Han Yan
- Department of Radiology, Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou, Zhejiang Province, China.
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Wáng YXJ, Wang XR, Che-Nordin N, Xu FR, Huang QL. On the possibility of over-diagnosis of osteoporotic vertebral fracture at mid-thoracic level. J Thorac Dis 2019; 11:5708-5711. [PMID: 32030308 DOI: 10.21037/jtd.2019.11.50] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiao-Rong Wang
- Department of Radiology, Ningbo First Hospital, Ningbo 315000, China
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Fei-Rong Xu
- Department of Radiology, Ningbo Women and Children's Hospital, Ningbo 315000, China
| | - Qiu-Li Huang
- Department of Radiology, Ningbo First Hospital, Ningbo 315000, China
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10
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Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China. J Orthop Translat 2019; 23:152-158. [PMID: 32913707 PMCID: PMC7452293 DOI: 10.1016/j.jot.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/28/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
Aim Osteoporotic vertebral compressive fractures (VCFs) are known to be commonly missed in X-rays indicated for pulmonary or heart diseases. In this study, we investigated the underreporting status of VCF in back pain clinic patients when the spine was the focus of interest. Materials and methods This is a retrospective analysis of 105 female cases (mean: 72 years, range: 55–93 years) from a tertiary hospital in China (facility A, FA). The patients with back and/or leg pain were referred for a spine X-ray. The images were retrieved and transferred to a central reading facility (facility B, FB), where images were double-read by two readers experienced in evaluating osteoporotic vertebral compressive deformity (VCD)/VCF. A qualitative VCD with <20%, 20–25%, 25–40%, and >40% vertebral body height loss was recorded as minimal, mild, moderate, and severe grades, respectively. A VCD coexisted with endplate/cortex fracture (ECF) was VCF. FB readings were considered as the reference. Results There were 34 true negative cases where FA and FB had a consensus. In 7 cases with minimal VCD, 3 cases with ECF, and 7 cases with minimal or mild VCFs, the FA readings were false negative. No standalone singular moderate or severe VCD/VCF in a patient was missed in FA's reports. In 25 FA reading positive cases with multiple VCFs, one VCF was missed in 8 cases, more than one VCF was missed in 15 cases, and one additional ECF was missed in 2 cases. In 14 cases, FA and FB had VCF number agreement, with the term ‘vertebral fracture’ was used appropriately in FA reports. In 15 cases, FA and FB had agreement in VCF number; however, the appropriate term ‘vertebral fracture’ was not used in FA reports; instead the terms of ‘compressive change’ or ‘wedging change’ were used. In most VCFs, severity grading was not given in FA. In 13 VCFs where grading was reported, all were marked as ‘mild’, including seven mild VCFs, five moderate VCFs, and even one severe VCF. Conclusion Among the patients with VCD/VCF, the false negative rate among was 23.9% (17/71), but the missed cases were all minimal or mild grades. One or more VCFs were missed in 32.4% (23/71) of the cases with multiple VCFs. Appropriate severity grading was not reported for most cases. The translational potential of this article The underreporting rate of osteoporotic vertebral compressive fracture in back pain clinic patients in a typical tertiary hospital setting in China compared favorably with literature reports. However, there is a general lack of awareness of vertebral endplate/cortex fracture sign and vertebral fracture severity grading, while minimal and mild VCD with endplate/cortex fracture may have clinical significance. Moreover, after one VCF is spotted in a patient, it is highly advisable to carefully check the whole spine so that multiple VCFs will not be missed.
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11
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Kim JH, Park YS, Oh KJ, Choi HS. Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis. Osteoporos Sarcopenia 2017; 3:164-169. [PMID: 30775525 PMCID: PMC6372822 DOI: 10.1016/j.afos.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/25/2017] [Accepted: 11/30/2017] [Indexed: 01/25/2023] Open
Abstract
Severe osteoporosis is classified as those with a bone mineral density (BMD) T-score of -2.5 or lower, and demonstrate one or more of osteoporotic, low-trauma, fragility fractures. According to the general principle of surgical approach, patients with severe osteoporosis require not only more thorough pre- and postoperative treatment plans, but improvements in surgical fixtures and techniques such as the concept of a locking plate to prevent bone deformity and maximizing the blood flow to the fracture site by using a minimally invasive plate osteosynthesis. Arthroplasty is often performed in cases of displaced femoral neck fracture. Otherwise internal fixation for the goal of bone union is the generally accepted option for intertrochanteric, subtrochanteric, and femoral shaft fractures. Most of osteoporotic spine fracture is stable compression fracture, but vertebroplasty or kyphoplasty may be performed some selective patients. If neurological paralysis, severe spinal instability, or kyphotic deformity occurs, open decompression or fusion surgery may be considered. In order to overcome shortcomings of the World Health Organization definition of osteoporosis, we proposed a concept of 'advanced severe osteoporosis,' which is defined by the presence of proximal femur fragility fracture or two or more fragility fractures in addition to BMD T-score of -2.5 or less. In conclusion, we need more meticulous approach for surgical treatment of severe osteoporosis who had fragility fracture. In cases of advanced severe osteoporosis, we recommend more aggressive managements using parathyroid hormone and receptor activator of nuclear factor kappa-B ligand monoclonal antibody.
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Affiliation(s)
- Jin Hwan Kim
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ye-Soo Park
- Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Kwang Jun Oh
- Department of Orthopedic Surgery, SungMin Hospital, Incheon, Korea
| | - Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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12
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Clinical guidelines for the prevention and treatment of osteoporosis from the Italian Society for Orthopaedics and Traumatology: preface. J Orthop Traumatol 2017; 18:1-2. [PMID: 29052803 PMCID: PMC5688965 DOI: 10.1007/s10195-017-0475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Abstract
INTRODUCTION Osteoporosis is characterised by poor bone quality arising from alterations to trabecular bone. However, recent studies have also described an important role of alterations to cortical bone in the physiopathology of osteoporosis. Although dual-energy X-ray absorptiometry (DXA) is a valid method to assess bone mineral density (BMD), real bone fragility in the presence of comorbidities cannot be evaluated with this method. The aim of this study was to evaluate if cortical thickness could be a good parameter to detect bone fragility in patients with hip fracture, independent of BMD. METHODS A retrospective study was conducted on 100 patients with hip fragility fractures. Cortical index was calculated on fractured femur (femoral cortical index [FCI]) and, when possible, on proximal humerus (humeral cortical index [HCI]). All patients underwent densitometric evaluation by DXA. RESULTS Average value of FCI was 0.43 and of HCI was 0.25. Low values of FCI were found in 21 patients with normal or osteopenic values of BMD, while low values of HCI were found in three patients with non-osteoporotic values of BMD. DISCUSSION AND CONCLUSION Cortical thinning measured from X-Ray of the femur identifies 21% additional fracture cases over that identified by a T-score <-2.5 (57%). FCI could be a useful tool to evaluate bone fragility and to predict fracture risk even in patients with normal and osteopenic BMD.
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14
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Deleskog L, Laursen NØ, Nielsen BR, Schwarz P. Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis. Osteoporos Int 2016; 27:2317-2326. [PMID: 26892040 DOI: 10.1007/s00198-016-3532-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Spine fractures are diagnosed by X-ray or vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) scanning. The use of VFA evaluation by DXA is still debated. We demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine and therefore with a reduced diagnostic performance in detecting fractures. INTRODUCTION Vertebral fracture assessment (VFA) by DXA has been evaluated for many years, and its use in clinical practice is still debated. In a cross-sectional setting, we aimed to compare VFA with traditional radiography in vertebral fracture (VF) diagnosis in severe osteoporotic patient. METHODS A total of 207 patients referred to the outpatient clinic for teriparatide treatment were screened, out of whom 35 (16.9 %) severe osteoporotic patients were identified (mean age 67.5 ± 11.3 years and median T-score -3.2 interquartile range (IQR) (-1.9 to -3.7). VF diagnosis was performed independently using VFA and X-ray in accordance with the semiquantitative (SQ) approach. The same technician performed the primary interpretation on both sets of images, after which a radiologist and an endocrinologist reviewed the evaluation for a conclusive judgement. RESULTS In total, 180 radiographic fractures were detected, corresponding to 5.1 fractures per individual. Using VFA, 18.5 % of vertebrae were considered unreadable, compared to 2.0 % on X-ray. The accuracy of VFA in VF detection using X-ray as a reference resulted in sensitivity and specificity of 75.5 and 86.7 %, respectively. Sensitivity decreased from the lumbar to thoracic level. Nevertheless, VFA only identified fractures consistently between Th11 and L3. CONCLUSION Our data, based on a severe osteoporotic population, demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine, resulting in vertebrae not being assessable for analysis and a reduced diagnostic performance in detecting fractures. Improvements in DXA techniques are needed for it to be comparable with X-ray in VF diagnosis.
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Affiliation(s)
- L Deleskog
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark
| | - N Ø Laursen
- Department of Radiology, Frederiksberg University Hospital, Copenhagen, Denmark
| | - B R Nielsen
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark
| | - P Schwarz
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark.
- Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
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15
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Choi HS, Park SY, Kim YM, Kim SH, Kim KM, Chung YS. Medical treatment of severe osteoporosis including new concept of advanced severe osteoporosis. Osteoporos Sarcopenia 2016; 2:13-19. [PMID: 30775462 PMCID: PMC6372737 DOI: 10.1016/j.afos.2016.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/05/2016] [Accepted: 02/12/2016] [Indexed: 11/24/2022] Open
Abstract
Osteoporosis is a metabolic bone disease characterized by decreased bone strength, leading to an increased risk of fracture. The World Health Organization (WHO) defines osteoporosis as a bone mineral density (BMD) of 2.5 standard deviations below that of a young adults (T-score of −2.5 or lower). Severe osteoporosis is differentiated from osteoporosis by the presence of one or more fragility fractures in addition to this T-score. However, the current WHO definition may be insufficient to reflect the diverse spectrum of osteoporosis or severe osteoporosis, which can encompass various number and severity of prevalent fractures. To overcome these shortcomings of the WHO definition of osteoporosis, we propose a concept of ‘advanced severe osteoporosis’, which is defined by the presence of proximal femur fragility fracture or two or more fragility fractures in addition to BMD T-score of −2.5 or less. Based on the previous clinical trials and post-hoc analyses, we recommend selective estrogen receptor modulators, bisphosphonates, receptor activator of nuclear factor kappa-B ligand (RANKL) monoclonal antibody, and parathyroid hormone for the medical treatment of severe osteoporosis. In cases of advanced severe osteoporosis or osteoporosis that does not respond to previous anti-osteoporotic treatments, we also recommend parathyroid hormone, bisphosphonates, and RANKL monoclonal antibody. In conclusion, we need more precise assessment of osteoporosis and further stratification of the disease by number of prevalent fractures in addition to BMD. More aggressive managements should be provided for those with advanced severe osteoporosis.
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Affiliation(s)
- Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Koyang, Gyeonggi-do, South Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, South Korea
| | - Yoo Mee Kim
- Division of Endocrinology, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, South Korea
| | - Se Hwa Kim
- Division of Endocrinology, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, South Korea
| | - Kyoung Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, South Korea
| | - Yoon-Sok Chung
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
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16
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Feola M, Rao C, Tempesta V, Gasbarra E, Tarantino U. Femoral cortical index: an indicator of poor bone quality in patient with hip fracture. Aging Clin Exp Res 2015; 27 Suppl 1:S45-50. [PMID: 26226860 DOI: 10.1007/s40520-015-0423-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/09/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Osteoporosis is a common disease in elderly, characterized by poor bone quality as a result of alterations affecting trabecular bone. However, recent studies have described also an important role of alterations of cortical bone in the physiopathology of osteoporosis. Although dual-energy X-ray absorptiometry (DXA) is a valid method to assess bone mineral density, in the presence of comorbidities real bone fragility is unable to be evaluated. The number of hip fractures is rising, especially in people over 85 years old. AIMS The aim is to evaluate an alternative method so that it can indicate fracture risk, independent of bone mineral density (BMD). Femoral cortical index (FCI) assesses cortical bone stock using femur X-ray. METHODS A retrospective study has been conducted on 152 patients with hip fragility fractures. FCI has been calculated on fractured femur and on the opposite side. The presence of comorbidities, osteoporosis risk factors, vitamin D levels, and BMD have been analyzed for each patient. RESULTS Average values of FCI have been 0.42 for fractured femurs and 0.48 at the opposite side with a statistically significant difference (p = 0.002). Patients with severe hypovitaminosis D had a minor FCI compared to those with moderate deficiency (0.41 vs. 0.46, p < 0.011). 42 patients (27.6%) with osteopenic or normal BMD have presented low values of FCI. DISCUSSION AND CONCLUSION A significant correlation among low values of FCI, comorbidities, severe hypovitaminosis D. and BMD in patients with hip fractures has been found. FCI could be a useful tool to evaluate bone fragility and to predict fracture risk even in the normal and osteopenic BMD patients.
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Affiliation(s)
- M Feola
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - C Rao
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
| | - V Tempesta
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - E Gasbarra
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - U Tarantino
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy
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17
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Sørensen VN, Wojtek P, Pedersen DS, Andersen S. An efficient case finding strategy to diagnose osteoporosis in a developing society with low treatment frequency. J Endocrinol Invest 2015; 38:841-7. [PMID: 26122488 DOI: 10.1007/s40618-015-0343-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/13/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Osteoporosis is a debilitating condition with rising frequency of fragility fractures with advancing age. Life expectancy increases in developing societies with the emergence of osteoporosis. There is a need for a simple protocol to diagnose fractures that merit treatment for osteoporosis. METHODS Evaluation of all consecutive lateral chest radiographs performed at the National Hospital in the capital city in Greenland over a 3-month period for vertebral body heights at the anterior, middle and posterior regions. Use of anti-osteoporotic drug was evaluated from records of dispensed drugs from Greenland National Pharmacy. RESULTS 1869 vertebrae were evaluated on radiographs from 203 subjects. On average 9.2 vertebrae (range 5-13) qualified for evaluation in each individual. Median (range) age was 55 (30-82) years. Any vertebral deformity above 25 (20) % was seen in 28.6 (50.2) %. More than one fracture was seen in 10.3 (27.1) %. Fractures occurred in 18.5 (36.9) % of patients from the General Medicine Clinic and in 33.3 (56.5) % of inpatients (p = 0.029). The occurrence of vertebral fractures increased with age (p < 0.001) and hosting more than one vertebral fracture was markedly more frequent after the age of 60 years [OR, 95 % CI 9.6, 3.1-30 (5.7, 2.9-11); p < 0.001] after correction for gender in logistic regressions. The National Pharmacy handed out anti-osteoporotic drugs equal to the treatment of 36 individuals. CONCLUSIONS Vertebral fractures that merit treatment can be readily diagnosed from lateral chest radiographs taken in routine clinical work-up. They are common in Greenland as demonstrated by this simple protocol to improve diagnosis and treatment of osteoporosis in a developing society.
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18
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Zhou C, Li Q, Huang S, Fan L, Wang B, Dai J, Tang X. Validation of the simplified Chinese version of the quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO-31). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:318-324. [PMID: 26070551 DOI: 10.1007/s00586-015-4066-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 05/30/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To translate quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO-31) into a simplified Chinese version, and test its reliability and validity in osteoporosis patients from mainland Chinese population. METHODS Postmenopausal osteoporosis women with history of vertebral fracture were included as cases, and age-matched healthy female were included as controls. All subjects were from mainland China. The simplified Chinese version of QUALEFFO-31 and SF-36 were assigned to the two groups. Reliability was assessed using kappa statistics of agreement for each item and the intra-class correlation coefficient (ICC). The internal consistency was assessed with Cronbach's α. Pearson's correlation was used to assess convergent and discriminant validity. RESULTS Overall, 66 cases and 66 age-matched controls were included. The ICC for the test-retest reliability ranged from 0.76 to 0.91. Cronbach's α for pain, physical function, and mental function domains were 0.94, 0.87, and 0.79, respectively. Convergent validity and discriminant validity showed that each correlation coefficient between score of each item with total score of related domain was higher than that with total score of unrelated domain. Pearson's correlation coefficients indicated significantly high correlations between corresponding domains of QUALEFFO-31 and SF-36. CONCLUSIONS The simplified Chinese version of the QUALEFFO-31 is a reliable and valid outcome measure of functional status in patients with osteoporosis. This Chinese version of the QUALEFFO-31 can be utilized for future clinical studies in mainland China.
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Affiliation(s)
- Chuanwen Zhou
- Department of Public Health, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China.,Department of Internal Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Qianjun Li
- Department of Public Health, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China.,Department of Internal Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Shushu Huang
- Department of Internal Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Lu Fan
- Department of Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Bingjian Wang
- Department of Public Health, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China.,Department of Internal Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Jian Dai
- Department of Orthopedics Surgery, Huai'an First People's Hospital, Nanjing Medical University, 6 Beijing Road West, 223300, Huai'an, Jiangsu, China
| | - Xiaoming Tang
- Department of Orthopedics Surgery, Huai'an First People's Hospital, Nanjing Medical University, 6 Beijing Road West, 223300, Huai'an, Jiangsu, China.
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Bone mineral density evaluation in osteoporosis: why yes and why not? Aging Clin Exp Res 2013; 25 Suppl 1:S47-9. [PMID: 24046042 DOI: 10.1007/s40520-013-0074-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
Osteoporosis is a diffuse skeletal disease in which a decrease in bone strength leads to an increased risk of fractures. A wide variety of types of bone densitometry measurements are available, including quantitative computed tomography measurements of the spine, quantitative ultrasound devices for measurements of the heel and other peripheral sites and dual-energy X-ray absorptiometry (DXA) for measurement of bone mineral density (BMD) at the lumbar spine, proximal femur, forearm and total body scans. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting anti-fracture therapies, and the ability to monitor response to treatment. However, in recent years, the authors have raised some important questions about the objective limits of this method that have led to doubts about its effectiveness in terms of clinical outcome.
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20
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Adami S, Bertoldo F, Gatti D, Minisola G, Rossini M, Sinigaglia L, Varenna M. Treatment thresholds for osteoporosis and reimbursability criteria: perspectives associated with fracture risk-assessment tools. Calcif Tissue Int 2013; 93:195-200. [PMID: 23754490 DOI: 10.1007/s00223-013-9748-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
The definition of osteoporosis was based for several years on bone mineral density values, which were used by most guidelines for defining treatment thresholds. The availability of tools for the estimation of fracture risk, such as FRAX™ or its adapted Italian version, DeFRA, is providing a way to grade osteoporosis severity. By applying these new tools, the criteria identified in Italy for treatment reimbursability (e.g., "Nota 79") are confirmed as extremely conservative. The new fracture risk-assessment tools provide continuous risk values that can be used by health authorities (or "payers") for identifying treatment thresholds. FRAX estimates the risk for "major osteoporotic fractures," which are not counted in registered fracture trials. Here, we elaborate an algorithm to convert vertebral and nonvertebral fractures to the "major fractures" of FRAX, and this allows a cost-effectiveness assessment for each drug.
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21
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Dai Z, Wang R, Ang LW, Yuan JM, Koh WP. Dietary B vitamin intake and risk of hip fracture: the Singapore Chinese Health Study. Osteoporos Int 2013; 24:2049-59. [PMID: 23238962 PMCID: PMC9254692 DOI: 10.1007/s00198-012-2233-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/26/2012] [Indexed: 12/31/2022]
Abstract
UNLABELLED This prospective cohort study that comprehensively examined effects of different B vitamins in an Asian population showed an inverse relationship between dietary intake of pyridoxine and hip fracture risk in elderly women. These findings suggest that maintaining sufficient pyridoxine intake may be beneficial in preserving bone health in postmenopausal women. INTRODUCTION B vitamins have recently been investigated for their possible roles in maintaining bone health. Incidence of osteoporotic hip fracture has been rising in Asia, but epidemiological data on dietary B vitamins and risk of osteoporotic fractures are sparse. We aimed to examine the association between dietary intakes of B vitamins (thiamin, riboflavin, niacin, pyridoxine, folate, and cobalamin) and hip fracture risk among elderly Chinese in Singapore. METHODS The current study was conducted in the Singapore Chinese Health Study, which is a population-based cohort prospective study that enrolled a total of 63,257 men and women aged 45-74 years between 1993 and 1998. Dietary intakes of B vitamins were derived from a validated food frequency questionnaire and the Singapore Food Composition Database. RESULTS After a mean follow-up period of 13.8 years, 1,630 hip fracture incident cases were identified. A statistically significant inverse relationship between dietary pyridoxine intake and hip fracture risk was observed among women (p for trend = 0.002) but not among men. Compared to women in the lowest quartile intake (0.37-0.61 mg/1,000 kcal/day), women in the highest quartile intake (0.78-1.76 mg/1,000 kcal/day) had a 22 % reduction in hip fracture risk (hazard ratio 0.78, 95 % confidence interval 0.66-0.93). Dietary intakes of the other B vitamins of interest were not related to hip fracture risk. CONCLUSIONS Our findings suggest that maintaining adequate intake of pyridoxine may prevent osteoporotic fractures among elderly women.
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Affiliation(s)
- Z Dai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Yesil Y, Kuyumcu M, Ozturk Z, Ulger Z, Sahin U, Cankurtaran M, Halil M, Yavuz B, Vural H, Kara Y, Demirin H, Akyol O, Ariogul S. The relationship between metabolic bone diseases and fingernail calcium levels in the elderly. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lim V, Li J, Gong Y, Yuan JM, Wu TS, Hammond G, Jin A, Koh WP, Yong E. Serum free estradiol and estrogen receptor-α mediated activity are related to decreased incident hip fractures in older women. Bone 2012; 50:1311-6. [PMID: 22445734 PMCID: PMC3353105 DOI: 10.1016/j.bone.2012.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/01/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
There is paucity of data from Asian women on the association between serum estrogens and osteoporotic hip fracture risk. We conducted a case-control study nested within a population-based prospective cohort, The Singapore Chinese Health Study, to evaluate serum estrogens levels, ERα-mediated estrogenic activity and hip fracture risk in postmenopausal Asian women. Among 35,298 women who were recruited between 1993 and 1998, 15,410 women donated blood for research between 1999 and 2004. From this subcohort, we identified 140 cases who subsequently suffered hip fracture after blood donation, and 278 age-matched controls. Serum levels of total estrone, estradiol and sex hormone binding globulin levels were measured in a blinded fashion among cases and controls. ERα-mediated estrogenic activity of serum samples was quantified using a sensitive ERα-driven cell bioassay. Women with hip fracture had lower serum estrogens than control women. Compared to the lowest quintile, women in the highest quintile of free estradiol exhibited a statistically significant 57% reduction in risk of hip fracture (95% confidence interval (CI), 6-80%), with a dose-dependent relationship (p for trend=0.021). High levels of ERα-mediated estrogenic activity were also associated with decreased risk of hip fracture (p for trend=0.048). Overall, women with relatively high levels of both free estradiol and ERα-mediated estrogenic activity had a 55% reduction in hip fracture risk (95% CI, 17-76%) compared to women with low levels of both. High levels of free estradiol and ERα-mediated estrogen activity in sera were associated with reduced hip fracture risk in Chinese postmenopausal women.
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Affiliation(s)
- Vanessa Lim
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Jun Li
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Yinhan Gong
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Tsung Sheng Wu
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | - Geoffrey Hammond
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | - Aizhen Jin
- National Registry of Diseases Office, Ministry of Health, Singapore
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore
| | - E.L. Yong
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore
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Koh WP, Wang R, Ang LW, Heng D, Yuan JM, Yu MC. Diabetes and risk of hip fracture in the Singapore Chinese Health Study. Diabetes Care 2010; 33:1766-70. [PMID: 20504896 PMCID: PMC2909059 DOI: 10.2337/dc10-0067] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Asian populations are documenting rapid increases in the rates of diabetes and hip fracture, but there are no prospective data linking both diseases in Asian studies. We investigated this association among a cohort of Chinese in Singapore. RESEARCH DESIGN AND METHODS A prospective cohort of 63,257 Chinese in the Singapore Chinese Health Study, established between 1993 and 1998, was followed up for a mean duration of 12 years. Diabetes status was ascertained by baseline interviews, and incidence of hip fracture post-enrollment was identified through a nationwide hospital discharge database. RESULTS The risk of hip fracture, after adjustment for other risk factors, was almost double among people with diabetes compared with people without diabetes (relative risk 1.98, 95% CI 1.71-2.29). When stratified by BMI, the increase in risk of hip fracture among people with diabetes relative to people without diabetes was similar in all four strata. There was a very strong dose-dependent relationship between duration of diabetes and risk of hip fracture (P for trend <0.0001). Compared with people without diabetes, the relative risk (95% CI) among subjects with diabetes for <5 years at recruitment was 1.40 (1.08-1.82), and this risk increased to 2.66 (2.04-3.47) among individuals with diabetes for >or=15 years. CONCLUSIONS Asians with diabetes, like their Western counterparts, experience an increased risk of hip fracture. Early assessment for osteoporosis and increased fracture risk, as well as prevention of falls, should be part of the management of diabetes.
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Affiliation(s)
- Woon-Puay Koh
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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