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Gao P, Pan X, Wang S, Guo S, Dong Z, Wang Z, Liang X, Chen Y, Fang F, Yang L, Huang J, Zhang C, Li C, Luo Y, Peng S, Xu F. Identification of the transcriptome signatures and immune-inflammatory responses in postmenopausal osteoporosis. Heliyon 2024; 10:e23675. [PMID: 38187229 PMCID: PMC10770509 DOI: 10.1016/j.heliyon.2023.e23675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 11/25/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024] Open
Abstract
Postmenopausal osteoporosis is the most common type of osteoporosis in women. To date, little is known about their transcriptome signatures, although biomarkers from peripheral blood mononuclear cells are attractive for postmenopausal osteoporosis diagnoses. Here, we performed bulk RNA sequencing of 206 samples (124 postmenopausal osteoporosis and 82 normal samples) and described the clinical phenotypic characteristics of postmenopausal women. We then highlighted the gene set enrichment analyses between the extreme T-score group and the heathy control group, revealing that some immune-inflammatory responses were enhanced in postmenopausal osteoporosis, with representative pathways including the mitogen-activated protein kinase (NES = 1.6, FDR <0.11) pathway and B_CELL_RECEPTOR (NES = 1.69, FDR <0.15) pathway. Finally, we developed a combined risk prediction model based on lasso-logistic regression to predict postmenopausal osteoporosis, which combined eleven genes (PTGS2, CXCL16, NECAP1, RPS23, SSR3, CD74, IL4R, BTBD2, PIGS, LILRA2, MAP3K11) and three pieces of clinical information (age, procollagen I N-terminal propeptide, β isomer of C-terminal telopeptide of type I) and provided the best prediction ability (AUC = 0.97). Taken together, this study filled a gap in the large-scale transcriptome signature profiles and revealed the close relationship between immune-inflammatory responses and postmenopausal osteoporosis, providing a unique perspective for understanding the occurrence and development of postmenopausal osteoporosis.
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Affiliation(s)
- Pan Gao
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
- BGI Cell, Shenzhen 518083, China
- BGI Research, Shenzhen 518083, China
| | - Xiaoguang Pan
- Qingdao-Europe Advanced Institute for Life Sciences, BGI-Shenzhen, Qingdao 266555, China
| | - Shang Wang
- Department of Spine Surgery, Shenzhen People's Hospital, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Sijia Guo
- BGI Research, Shenzhen 518083, China
| | | | - Zhefeng Wang
- Department of Spine Surgery, Shenzhen People's Hospital, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Xue Liang
- Qingdao-Europe Advanced Institute for Life Sciences, BGI-Shenzhen, Qingdao 266555, China
| | - Yan Chen
- BGI Research, Shenzhen 518083, China
| | - Fang Fang
- BGI Research, Shenzhen 518083, China
| | - Ling Yang
- BGI Research, Shenzhen 518083, China
| | - Jinrong Huang
- BGI Research, Shenzhen 518083, China
- Lars Bolund Institute of Regenerative Medicine, BGI-Qingdao, BGI-Shenzhen, Qingdao 266555, China
| | | | - Conghui Li
- BGI Research, Shenzhen 518083, China
- Qingdao-Europe Advanced Institute for Life Sciences, BGI-Shenzhen, Qingdao 266555, China
- Lars Bolund Institute of Regenerative Medicine, BGI-Qingdao, BGI-Shenzhen, Qingdao 266555, China
| | - Yonglun Luo
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
- BGI Research, Shenzhen 518083, China
- Qingdao-Europe Advanced Institute for Life Sciences, BGI-Shenzhen, Qingdao 266555, China
| | - Songlin Peng
- Department of Spine Surgery, Shenzhen People's Hospital, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Fengping Xu
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
- BGI Cell, Shenzhen 518083, China
- BGI Research, Shenzhen 518083, China
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Fuchs K, Backhaus R, Jordan MC, Lefering R, Meffert RH, Gilbert F. [The severely injured older cyclist-Evaluation of the TraumaRegister DGU® : Retrospective, multicenter cross-sectional study based on the TraumaRegister DGU®]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:952-959. [PMID: 36988660 PMCID: PMC10682217 DOI: 10.1007/s00113-022-01286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Contrary to the trend of decreasing traffic fatalities, the number of cyclists killed in Germany has been steadily increasing in recent years. With the increasing popularity of cycling in all age groups, the number of accidents with sometimes serious injuries is rising. In the course of this, the question arises what influence age has on the type and severity of injuries, the probability of survival and the length of hospital stay in seriously injured cyclists. METHODS A retrospective analysis of data from the TraumaRegister DGU® (TR-DGU) from 2010 to 2019 was performed. All severely injured cyclists with a maximum abbreviated injury scale (MAIS) of 3+ (n = 14,651) in the TR-DGU were included in this study and the available parameters were evaluated. A subdivision into three age groups (60-69, 70-79, and ≥ 80 years) and a control group (20-59 years) was carried out. RESULTS Injuries to the head were by far the most common, accounting for 64.2%. There was a marked increase in severe head injuries in the 60-plus years age group. Furthermore, with increasing age, the probability of prehospital intubation, catecholamine requirement, intensive care and hospital length of stay, and mortality increased. CONCLUSION Head injuries represent the most common serious injury, especially among older cyclists. As helmet wearing was not recorded in the TraumaRegister DGU® during the evaluation period, no conclusion can be drawn about its effect. Furthermore, a higher age correlates with a longer hospital stay and a higher mortality, but does not represent an independent risk factor for death in severely injured patients.
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Affiliation(s)
- Konrad Fuchs
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Roman Backhaus
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Martin C Jordan
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Rolf Lefering
- MUM - Muskuloskelettales Universitätszentrum München, Ludwigs-Maximilians-Universität München, Campus Innenstadt, Ziemssenstr. 5, 80336, München, Deutschland
| | - Rainer H Meffert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Fabian Gilbert
- MUM - Muskuloskelettales Universitätszentrum München, Ludwigs-Maximilians-Universität München, Campus Innenstadt, Ziemssenstr. 5, 80336, München, Deutschland.
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Aghajanloo M, Abdoli A, Poorolajal J, Abdolmaleki S. Comparison of clinical outcome of lumbar spinal stenosis surgery in patients with and without osteoporosis: a prospective cohort study. J Orthop Surg Res 2023; 18:443. [PMID: 37344883 DOI: 10.1186/s13018-023-03935-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Osteoporosis is one of the most important risk factors for failure of the spine instrumentation. Management of patients with osteoporosis who requires spinal surgery because of the difficulty in instrument placement and the potential complications is still a challenge. This study was designed to evaluate the clinical outcome of lumbar spinal canal stenosis after instrumentation in patients with and without osteoporosis. METHODS This prospective cohort study was performed from June 2018 to December 2020, in Be'sat Hospital, Hamadan, Iran. The sample consisted of patients over 50 years old referred to Be'sat Hospital with a diagnosis of lumbar spinal canal stenosis who underwent instrumental surgery (n = 107). Based on bone densitometry, the sample was divided into two groups with osteoporosis (n = 34) and without osteoporosis (n = 73). To collect data, we used a three-part researcher-made questionnaire (demographic information, medical records information, and paraclinical parameters). Statistical analyzes were performed by the Fisher Exact, chi-square, independent t-test, Multiple ANCOVA, Mann-Whitney and the Rank Wilcoxson tests using Stata version 17 software. RESULTS The mean age (SD) of patients in the two groups with and without osteoporosis was 67.9 (7.0) and 59.1 (5.1) years, respectively (p = 0.001). The results indicated that a significant difference was observed between the two groups in sex (p = 0.032), educational status (p = 0.001), marital status (p = 0.023), employment status (p = 0.004), menopausal status (p = 0.018), taking corticosteroids (p = 0.028), and body mass index (p = 0.015). Also, there was a significant difference between two groups in the loosening of instrument (p = 0.039), the postoperative pain intensity (p = 0.007), fusion (p = 0.047), and neurogenic claudication (p = 0.003). Based on multiple ANCOVA test, there was not a significant difference between two groups in the clinical and paraclinical charatecristics (p > 0.05). The mean (SD) of T-Score in the osteoporosis group was 3.06 (0.37). CONCLUSION This study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.
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Affiliation(s)
- Mashhood Aghajanloo
- Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Abdoli
- Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sajjad Abdolmaleki
- Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran.
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Hmamouchi I, Paruk F, Tabra S, Maatallah K, Bouziane A, Abouqal R, El Maidany Y, El Maghraoui A, Kalla AA. Prevalence of glucocorticoid-induced osteoporosis among rheumatology patients in Africa: a systematic review and meta-analysis. Arch Osteoporos 2023; 18:59. [PMID: 37129714 DOI: 10.1007/s11657-023-01246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
The prevalence of glucocorticosteroid-induced osteoporosis (GIOP) is well established in higher income countries. There are limited studies showing a wide prevalence of GIOP in Africa. Prospective studies are needed on GIOP in African rheumatology patients to implement appropriate management algorithms. PURPOSE The prevalence of glucocorticosteroid-induced osteoporosis (GIOP) is well established in developed countries, but little is known about GIOP in African adult patients with inflammatory rheumatic musculoskeletal diseases (RMDs). This study aimed to determine the prevalence of GIOP and osteoporotic fracture risk in African patients with inflammatory RMDs according to radiographic and bone mineral density (BMD) findings. METHODS PubMed, Google Scholar, Scopus, and African Index Medicus were searched up to 31 December 2020. Heterogeneity was assessed using I2 statistic across the included studies. A random-effects model was applied to estimate the pooled effect size across studies. All statistical analyses were performed using STATA™ version 14 software. The study was registered with PROSPERO, number CRD42021256252. RESULTS In this meta-analysis, a total of 7 studies with 780 participants, stratified by geographical region were included. The pooled prevalence of GIOP based on BMD data was 47.7% (95% CI 32.9-62.8) with 52.2% (95% CI 36.5-67.6) in North African countries and 15.4% (95% 1.9-45.4%) in South Africa with a high heterogeneity (I2 = 93.3%, p = 0.018). There was no data from the rest of African countries. We were unable to complete the meta-analysis of osteoporotic fractures due to the lack of available data. CONCLUSION This study revealed that the prevalence of GIOP varies significantly in Africa. There is no information, however, for most of Africa, and further prospective studies are needed to develop context-specific GIOP preventive strategies in patients with RMDs.
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Affiliation(s)
- Ihsane Hmamouchi
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco.
- Health Sciences College, International University of Rabat (UIR), Rabat, Morocco.
| | - Farhanah Paruk
- Department of Rheumatology, Inkosi Albert Luthuli Central Hospital, School of Clinical Medicine, College of Health Science, University of Kwa-Zulu Natal, Durban, South Africa
| | - Samar Tabra
- Lecturer of Rheumatology, Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Amal Bouziane
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Department of Periodontology, Faculty of Dental Medicine, Mohammed V University in Rabat, Rabat, Morocco
| | - Redouane Abouqal
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Rabat, Morocco
- Acute Medical Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - Yasser El Maidany
- Rheumatology Department, Canterbury Christ Church University, Canterbury, UK
| | - Abdellah El Maghraoui
- Private Medical Office, Rabat, Morocco
- Mohammed V University in Rabat, Rabat, Morocco
| | - Asgar Ali Kalla
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Oyedeji CI, Hodulik KL, Telen MJ, Strouse JJ. Management of Older Adults with Sickle Cell Disease: Considerations for Current and Emerging Therapies. Drugs Aging 2023; 40:317-334. [PMID: 36853587 PMCID: PMC10979738 DOI: 10.1007/s40266-023-01014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
People with sickle cell disease (SCD) are living longer than ever before, with the median survival increasing from age 14 years in 1973, beyond age 40 years in the 1990s, and as high as 61 years in recent cohorts from academic centers. Improvements in survival have been attributed to initiatives, such as newborn screening, penicillin prophylaxis, vaccination against encapsulated organisms, better detection and treatment of splenic sequestration, and improved transfusion support. There are an estimated 100,000 people living with SCD in the United States and millions of people with SCD globally. Given that the number of older adults with SCD will likely continue to increase as survival improves, better evidence on how to manage this population is needed. When managing older adults with SCD (defined herein as age ≥ 40 years), healthcare providers should consider the potential pitfalls of extrapolating evidence from existing studies on current and emerging therapies that have typically been conducted with participants at mean ages far below 40 years. Older adults with SCD have historically had little to no representation in clinical trials; therefore, more guidance is needed on how to use current and emerging therapies in this population. This article summarizes the available evidence for managing older adults with SCD and discusses potential challenges to using approved and emerging drugs in this population.
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Affiliation(s)
- Charity I Oyedeji
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA.
| | - Kimberly L Hodulik
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
| | - Marilyn J Telen
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - John J Strouse
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA
- Division of Pediatric Hematology-Oncology, Duke University, Durham, NC, USA
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Osteoporosis among Postmenopausal Women in Jordan: A National Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148803. [PMID: 35886655 PMCID: PMC9315755 DOI: 10.3390/ijerph19148803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/17/2022]
Abstract
Osteoporosis is considered a widespread health problem that affects senior citizens, particularly older women, after the menopause. This national study aimed to estimate the prevalence of osteoporosis among Jordanian postmenopausal women and to determine the association of demographic and nutritional factors, such as calcium and vitamin D supplement intake, with osteoporosis in postmenopausal women. A cross-sectional study was conducted among 884 postmenopausal women aged ≥50 years. A multistage sampling technique was used to select participants from three geographic regions of Jordan (north, middle, and south). The data were collected from the participants by a team of field researchers comprising men and women through a standard questionnaire. The prevalence of osteoporosis was 19.8% among postmenopausal Jordanian women. The study results showed that age (p ˂ 0.001), geographic region (p = 0.019), occupation (p = 0.002), and educational level (p = 0.001) were significantly associated with osteoporosis. Moreover, osteoporosis was significantly associated with calcium and vitamin D supplement intake (p < 0.05). There is a high prevalence of osteoporosis among postmenopausal Jordanian women. Therefore, there is a need to educate women at this age, and probably at an earlier age, to prevent or reduce the development of osteoporosis.
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How relevant is lumbar bone mineral density for the stability of symphyseal implants? A biomechanical cadaver study. Eur J Trauma Emerg Surg 2021; 48:3101-3108. [PMID: 34881391 PMCID: PMC9360150 DOI: 10.1007/s00068-021-01850-6] [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] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Osteoporotic bone tissue appears to be an important risk factor for implant loosening, compromising the stability of surgical implants. However, it is unclear whether lumbar measured bone mineral density (BMD) is of any predictive value for stability of surgical implants at the pubic symphysis. This study examines the fixation strength of cortical screws in human cadaver specimens with different BMDs. METHODS The lumbar BMD of ten human specimens was measured using quantitative computed tomography (qCT). A cut-off BMD was set at 120 mg Ca-Ha/mL, dividing the specimens into two groups. One cortical screw was drilled into each superior pubic ramus. The screw was withdrawn in an axial direction with a steady speed and considered failed when a force decrease was detected. Required force (N) and pull-out distance (mm) were constantly tracked. RESULTS The median peak force of group 1 was 231.88 N and 228.08 N in group 2. While BMD values differed significantly (p < 0.01), a comparison of peak forces between both groups showed no significant difference (p = 0.481). CONCLUSION Higher lumbar BMD did not result in significantly higher pull-out forces at the symphysis. The high proportion of cortical bone near the symphyseal joint allows an increased contact of pubic screws and could explain sufficient fixation. This condition is not reflected by a compromised lumbar BMD in a qCT scan. Therefore, site-specific BMD measurement could improve individual fracture management.
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Is Timing to Surgery an Independent Risk Factor for Complications Following Operative Treatment of Periprosthetic Lower Extremity Fractures? J Orthop Trauma 2021; 35:315-321. [PMID: 33165205 DOI: 10.1097/bot.0000000000001993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify whether timing to surgery was related to major 30-day morbidity and mortality rates in periprosthetic hip and knee fractures [OTA/AO 3 (IV.3, V.3), OTA/AO 4 (V4)]. DESIGN Retrospective database review. SETTING Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. PATIENTS Patients in the NSQIP database with periprosthetic hip or knee fractures between 2007 and 2015. INTERVENTION Surgical management of periprosthetic hip and knee fractures including revision or open reduction internal fixation. MAIN OUTCOME MEASUREMENTS Major 30-day morbidity and mortality after operative treatment of periprosthetic hip or knee fractures. RESULTS A total of 1265 patients, mean age 72, including 883 periprosthetic hip and 382 periprosthetic fractures about the knee were reviewed. Delay in surgery greater than 72 hours is a risk factor for increased 30-day morbidity in periprosthetic hip and knee fractures [relative risk = 2.90 (95% confidence interval: 1.74-4.71); P-value ≤ 0.001] and risk factor for increased 30-day mortality [relative risk = 8.98 (95% confidence interval: 2.14-37.74); P-value = 0.003]. CONCLUSIONS Using NSQIP database to analyze periprosthetic hip and knee fractures, delay to surgery is an independent risk factor for increased 30-day major morbidity and mortality when controlling for patient functional status and comorbidities. Although patient optimization and surgical planning are paramount, minimizing extended delays to surgery is a potentially modifiable risk factor in the geriatric periprosthetic lower extremity fracture patient. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Oyedeji CI, Hall K, Luciano A, Morey MC, Strouse JJ. Geriatric assessment for older adults with sickle cell disease: protocol for a prospective cohort pilot study. Pilot Feasibility Stud 2020; 6:131. [PMID: 32974042 PMCID: PMC7495855 DOI: 10.1186/s40814-020-00673-3] [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] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background The life expectancy for people with sickle cell disease (SCD) has improved tremendously over the last 50 years. This population experiences hemolysis and vaso-occlusion in multiple organs that lead to complications such as cardiopulmonary disease, strokes, and avascular necrosis. These complications can limit mobility and aerobic endurance, similar to limitations that often occur in geriatric populations. These sickle-cell and age-related events lead to frequent hospitalization, which further increases the risk of functional decline. We have few tools to measure functional decline in people with SCD. The purpose of this paper is to describe a protocol to evaluate the feasibility of sickle cell disease geriatric assessment (SCD-GA). Methods/design We will enroll 40 adults with SCD (20 age 18–49.99 years and 20 age ≥ 50 years) in a prospective cohort study to assess the feasibility of SCD-GA. The SCD-GA includes validated measures from the oncology geriatric assessment enriched with additional physical and cognitive measures. The SCD-GA will be performed at the first study visit, at 10 to 20 days after hospitalization, and at 12 months (exit visit). With input from a multidisciplinary team of sickle cell specialists, geriatricians, and experts in physical function and physical activity, we selected assessments across 7 domains: functional status (11 measures), comorbid medical conditions (1 measure), psychological state (1 measure), social support (2 measures), weight status (2 measures), cognition (3 measures), and medications (1 measure). We will measure the proportion completing the assessment with feasibility as the primary outcome. Secondary outcomes include the proportion consenting and completing all study visits, duration of the assessment, acceptability, and adverse events. Discussion We present the protocol and rationale for selection of the measures included in SCD-GA. We also outline the methods to determine feasibility and subsequently to optimize the SCD-GA in preparation for a larger multicenter validation study of the SCD-GA.
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Affiliation(s)
- Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 315 Trent Dr. Suite 261, DUMC Box 3939, Durham, NC 27710 USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA
| | - Katherine Hall
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC USA
| | - Alison Luciano
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA
| | - Miriam C Morey
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC USA
| | - John J Strouse
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 315 Trent Dr. Suite 261, DUMC Box 3939, Durham, NC 27710 USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, Durham, NC USA.,Division of Pediatric Hematology-Oncology, Duke University, Durham, NC USA
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10
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Ostrakhovitch EA, Tabibzadeh S. Homocysteine and age-associated disorders. Ageing Res Rev 2019; 49:144-164. [PMID: 30391754 DOI: 10.1016/j.arr.2018.10.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/30/2018] [Accepted: 10/25/2018] [Indexed: 12/26/2022]
Abstract
There are numerous theories of aging, a process which still seems inevitable. Aging leads to cancer and multi-systemic disorders as well as chronic diseases. Decline in age- associated cellular functions leads to neurodegeneration and cognitive decline that affect the quality of life. Accumulation of damage, mutations, metabolic changes, failure in cellular energy production and clearance of altered proteins over the lifetime, and hyperhomocysteinemia, ultimately result in tissue degeneration. The decline in renal functions, nutritional deficiencies, deregulation of methionine cycle and deficiencies of homocysteine remethylation and transsulfuration cofactors cause elevation of homocysteine with advancing age. Abnormal accumulation of homocysteine is a risk factor of cardiovascular, neurodegenerative and chronic kidney disease. Moreover, approximately 50% of people, aged 65 years and older develop hypertension and are at a high risk of developing cardiovascular insufficiency and incurable neurodegenerative disorders. Increasing evidence suggests inverse relation between cognitive impairment, cerebrovascular and cardiovascular events and renal function. Oxidative stress, inactivation of nitric oxide synthase pathway and mitochondria dysfunction associated with impaired homocysteine metabolism lead to aging tissue degeneration. In this review, we examine impact of high homocysteine levels on changes observed with aging that contribute to development and progression of age associated diseases.
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Affiliation(s)
- E A Ostrakhovitch
- Frontiers in Bioscience Research Institute in Aging and Cancer, Irvine, CA, USA.
| | - S Tabibzadeh
- Frontiers in Bioscience Research Institute in Aging and Cancer, Irvine, CA, USA.
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Jeng YT, Lin SY, Hu HY, Lee OK, Kuo LL. Osteoporosis and dry eye syndrome: A previously unappreciated association that may alert active prevention of fall. PLoS One 2018; 13:e0207008. [PMID: 30395639 PMCID: PMC6218084 DOI: 10.1371/journal.pone.0207008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/23/2018] [Indexed: 01/13/2023] Open
Abstract
Objective Osteoporosis is a multifactorial disease associated with inflammation and hormone imbalance. It is noteworthy that dry eye syndrome shares a similar pathophysiology with osteoporosis. Both diseases are more prevalent among the elderly and females. Dry eye syndrome can result in impaired vision, which increases the risk of fall and fracture when osteoporosis exists. In this study, we investigated whether osteoporosis is associated with an increased risk of developing dry eye syndrome. Methods Claims data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective population-based cohort study covering the period from January 1, 2000, to December 31, 2011. Multiple logistic regression was used to determine whether osteoporosis is an independent factor in the risk of developing dry eye syndrome, with risk estimates presented in the form of odds ratios (ORs). Results The exclusion of patients with specific autoimmune diseases and those younger than 50 years old resulted in 42,365 patients in the osteoporosis group and 147,460 patients in the comparison group during the study period. The number of patients newly diagnosed with dry eye syndrome was 6,478 (15.29%) in the osteoporosis group and 15,396 (10.44%) in the comparison group. The crude OR of patients with osteoporosis developing dry eye syndrome was 1.55 and the 95% confidence interval (95% CI) was 1.50–1.60. After adjusting for patients’ age, sex, and underlying comorbidities, the adjusted OR was 1.26 and the 95% CI was 1.22–1.30. Subgroup analysis revealed this association in each age group and among females but not among males. Conclusions Our results demonstrate that osteoporosis is a risk factor for the subsequent development of dry eye syndrome. Clinicians should be aware of the early symptoms of dry eye syndrome in osteoporotic patients in order to prevent further complications.
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Affiliation(s)
- Yu-Ting Jeng
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Shu-Yi Lin
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Oscar K. Lee
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Lin Kuo
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Zhongxiao Branch, Taipei City Hospital, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- * E-mail:
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12
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Techapatiphandee M, Tammachote N, Tammachote R, Wongkularb A, Yanatatsaneejit P. VDR and TNFSF11 polymorphisms are associated with osteoporosis in Thai patients. Biomed Rep 2018; 9:350-356. [PMID: 30233789 DOI: 10.3892/br.2018.1137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Determining molecular markers for osteoporosis may be valuable for improving the quality of life of affected elderly patients by aiding in early detection and disease management. In the present study, the association between single nucleotide polymorphisms (SNPs) of the vitamin D receptor (VDR) and tumour necrosis factor superfamily number 11 (TNFSF11) genes and the susceptibility of developing osteoporosis was investigated in a Thai female cohort. The study group consisted of 105 Thai postmenopausal patients diagnosed with osteoporosis and 132 healthy Thai postmenopausal female volunteers. DNA extracted from blood samples was used to genotype the VDR and TNFSF11 genes using polymerase chain reaction-restriction fragment length polymorphism and sequencing analysis. For VDR, the frequencies of the genotypes TT, CT and CC for the TaqI SNP (rs731236) were 87.88, 11.36 and 0.76%, respectively, in the control group, while in the osteoporosis cohort were 92.38, 5.71 and 1.91%, respectively. For the FokI SNP (rs2228570), the frequencies of the genotypes CC, CT and TT were 31.06, 55.30 and 13.64%, respectively, in the control group, and in the osteoporosis group were 29.52, 43.81 and 26.67%, respectively. For BsmI SNP (rs1544410), the frequencies of the genotypes GG, GA and AA were 78.03, 18.94 and 3.03%, respectively, in control group, and in the osteoporosis group were 80.95, 18.10 and 0.95%, respectively. The significant risk of osteoporosis associated with the FokI SNP was determined. The odds ratio (95% confidence interval) was 2.30 (1.14-4.69; P=0.01) among patients with osteoporosis with TT as the susceptibility genotype. For TNFSF11, the frequencies of the genotypes TT, CT and CC for the -290C>T SNP (rs9525641) in the control group were 36.36, 50.76 and 12.88%, respectively, while in the osteoporosis group were 31.43, 56.19 and 12.38%, respectively. For the -643C>T SNP (rs9533156), the frequencies of the genotypes TT, CT and CC in the control group were 35.61, 48.48 and 15.91%, respectively, while in the osteoporosis group were 32.38, 55.24 and 12.38%, respectively. For the -693G>C SNP (rs9533155), the frequencies of the genotypes CC, CG, and GG in the control group were 39.39, 46.97 and 13.64%, respectively, and in the osteoporosis group were 36.19, 53.33 and 10.48%, respectively. No significant associations of the TNFSF11 SNPs with osteoporosis were determined; however, it was notable that the GCT haplotype of TNFSF11 may be a protective haplotype for osteoporosis. Therefore, it was concluded that the SNP FokI of VDR may be a potential molecular biomarker for the development of osteoporosis in Thai females.
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Affiliation(s)
- Mananya Techapatiphandee
- Human Genetics Research Group, Department of Botany, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nattapol Tammachote
- Department of Orthopaedics, Faculty of Medicine, Thammasat University Hospital, Khlong Nueng, Pathumthani 12120, Thailand
| | - Rachaneekorn Tammachote
- Human Genetics Research Group, Department of Botany, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand
| | - Anna Wongkularb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pattamawadee Yanatatsaneejit
- Human Genetics Research Group, Department of Botany, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand
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Fernandez-Rebollo E, Eipel M, Seefried L, Hoffmann P, Strathmann K, Jakob F, Wagner W. Primary Osteoporosis Is Not Reflected by Disease-Specific DNA Methylation or Accelerated Epigenetic Age in Blood. J Bone Miner Res 2018; 33:356-361. [PMID: 28926142 DOI: 10.1002/jbmr.3298] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022]
Abstract
Osteoporosis is an age-related metabolic bone disease. Hence, osteoporotic patients might suffer from molecular features of accelerated aging, which is generally reflected by specific age-associated DNA methylation (DNAm) changes. In this study, we analyzed genomewide DNAm profiles of peripheral blood from patients with manifest primary osteoporosis and non-osteoporotic controls. Statistical analysis did not reveal any individual CG dinucleotides (CpG sites) with significant aberrant DNAm in osteoporosis. Subsequently, we analyzed if age-associated DNAm patterns are increased in primary osteoporosis (OP). Using three independent age-predictors we did not find any evidence for accelerated epigenetic age in blood of osteoporotic patients. Taken together, osteoporosis is not reflected by characteristic DNAm patterns of peripheral blood that might be used as biomarker for the disease. The prevalence of osteoporosis is age-associated-but it is not associated with premature epigenetic aging in peripheral blood. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Eduardo Fernandez-Rebollo
- Helmholtz-Institute for Biomedical Engineering, Stem Cell Biology and Cellular Engineering, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Medical School, Aachen, Germany.,Institute for Biomedical Technology-Cell Biology, RWTH Aachen University Medical School, Aachen, Germany
| | - Monika Eipel
- Helmholtz-Institute for Biomedical Engineering, Stem Cell Biology and Cellular Engineering, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Medical School, Aachen, Germany.,Institute for Biomedical Technology-Cell Biology, RWTH Aachen University Medical School, Aachen, Germany
| | - Lothar Seefried
- Orthopedic Center for Musculoskeletal Research, Orthopedic Department, University of Würzburg, Würzburg, Germany
| | - Per Hoffmann
- Department of Genomics, Institute of Human Genetics, University of Bonn, Bonn, Germany.,Human Genomics Research Group, Department of Biomedicine, University of Basel, Switzerland
| | - Klaus Strathmann
- Institute for Transfusion Medicine, RWTH Aachen University Medical School, Aachen, Germany
| | - Franz Jakob
- Orthopedic Center for Musculoskeletal Research, Orthopedic Department, University of Würzburg, Würzburg, Germany
| | - Wolfgang Wagner
- Helmholtz-Institute for Biomedical Engineering, Stem Cell Biology and Cellular Engineering, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Medical School, Aachen, Germany.,Institute for Biomedical Technology-Cell Biology, RWTH Aachen University Medical School, Aachen, Germany
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14
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Klemm HT, Albers W, Krumbiegel A, Willauschus W. [Osteoporosis in private accident insurance]. Unfallchirurg 2017; 121:83-88. [PMID: 29230487 DOI: 10.1007/s00113-017-0448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Osteoporosis is a multifactorial disease resulting in reduced bone strength and increased bone fragility. The cause of osteoporosis is underexplored. The manifestation of osteoporosis makes a significant contribution to the development of bone fractures. In the medical assessment, the question arises to what extent osteoporosis is considered to be a previous disability or in particular as a contributory factor. In particular, there are some uncertainties relating to the degree of possible participation, as there are only insufficient scientific evaluation systems. From the authors' point of view no valid assessment of the degree of participation exists on the basis of technical examinations or even the severity of the trauma. At the current time there is no possibility to indicate the level of contribution in 10% or 20% steps. Taking the total picture, including clinical and radiological findings into consideration, it seems possible to assess the contribution only in larger percentage steps (e.g. 0%, 50% or ≥80%). The mere diagnosis of osteoporosis does not justify a participation rate unless its effects can be pathomorphologically proven.
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Affiliation(s)
- Holm-Torsten Klemm
- Freies Institut für medizinische Begutachtungen Bayreuth/Erlangen (FIMB), Ludwigstraße 25, 95444, Bayreuth, Deutschland.
| | - Wolfgang Albers
- alphaMED®, Orthopädisch-unfallchirurgische Praxisklinik, Bamberg, Deutschland
| | - Andreas Krumbiegel
- Interdisziplinäre Medizinische Begutachtung - Sachverständige am Tibarg, Hamburg, Deutschland
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15
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Peng C, Wang HP, Yan JH, Song TX. Locking system strengthened by biomimetic mineralized collagen putty for the treatment of osteoporotic proximal humeral fractures. Regen Biomater 2017; 4:289-294. [PMID: 29026642 PMCID: PMC5633693 DOI: 10.1093/rb/rbx016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/28/2017] [Accepted: 05/12/2017] [Indexed: 12/19/2022] Open
Abstract
The current study is to observe the effect of the locking system strengthened by biomimetic mineralized collagen putty for the treatment of senile proximal humeral osteoporotic fractures. From January 2012 to December 2015, 80 cases of senile patients with osteoporotic proximal humeral fractures were randomly divided into an observation group and a control group, each group with a total of 40 cases. The control group was simply treated with locking plate. The observation group was treated with locking plate in combination with biomimetic mineralized collagen putty. The therapeutic effect thereby was observed. The excellent and satisfactory rate was 90% in observation group and was 72.5% in control group. The difference between the two groups was statistically significant (χ2 = 5.3312, P < 0.05). The fracture healing time was 11.82 ± 3.62 weeks in observation group and 19.78 ± 5.46 weeks in control group. The shoulder joint function score was 89.63 ± 8.12 in observation group and 76.92 ± 8.18 in control group. There was significant difference between the two groups (t = 7.1272; 12.7834, P < 0.05). The complication rate was 10% in the observation group and 32.5% in the control group (χ2 = 7.3786, P < 0.05). Locking system strengthened by biomimetic mineralized collagen putty has advantages such as accelerating healing of senile proximal humeral fracture, improving the therapeutic effect, reducing the complications. As one of the optimal internal fixation method, it provides a new option for better treatment of senile osteoporotic fracture.
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Affiliation(s)
- Cheng Peng
- Department of Orthopaedics, Jing'an District Centre Hospital, Jing'an Branch, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Hai-Peng Wang
- Department of Orthopaedics, Jing'an District Centre Hospital, Jing'an Branch, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Jia-Hua Yan
- Department of Orthopaedics, Jing'an District Centre Hospital, Jing'an Branch, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Tian-Xi Song
- Beijing Allgens Medical Science and Technology Co., Ltd., Beijing 100176, China
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16
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Jakob F, Genest F, Baron G, Stumpf U, Rudert M, Seefried L. [Regulation of bone metabolism in osteoporosis : novel drugs for osteoporosis in development]. Unfallchirurg 2016; 118:925-32. [PMID: 26471379 DOI: 10.1007/s00113-015-0085-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Bone is continuously regenerated and remodeled as an adaptation to mechanical load. Bone mass and fracture resistance are maintained by a balanced equilibrium between bone formation and bone resorption. Regeneration and response to mechanical load are, however, impaired in osteoporosis and during aging. Bone resorption is enhanced by chronic inflammation while bone formation is altered by rising levels of inhibitors in the aging organism. Core molecular principles of the regulation of bone metabolism in health and disease have been characterized and developed as therapeutic targets. The receptor activator of nuclear factor kappaB ligand (RANKL) and osteoclast-derived protease cathepsin K are important regulators and effectors of osteoclast differentiation and bone resorption. Bone formation is stimulated by bone morphogenetic proteins (BMP) and via the parathyroid hormone receptor and the Wnt signaling pathway. The principles of osteoclast inhibition using bisphosphonates have now been known for almost three decades. Based on more recent knowledge RANKL and cathepsin K have been developed as new therapeutic targets to inhibit bone resorption. While denosumab, a RANKL antibody, has already been introduced into routine treatment strategies, the cathepsin K antagonist odanacatib is currently in the licensing process. Bone formation can also be stimulated by local administration of BMPs, by systemic treatment with the parathyroid hormone fragment teriparatide and by using antibodies targeting the Wnt inhibitor sclerostin. The latter are presently being tested in phase III clinical studies. In the near future a panel of traditional and novel treatment strategies will be available that will enable us to meet the individual clinical needs during aging and for the treatment of osteoporosis.
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Affiliation(s)
- F Jakob
- Experimentelle und Klinische Osteologie, Orthopädie und Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland.
| | - F Genest
- Experimentelle und Klinische Osteologie, Orthopädie und Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - G Baron
- Experimentelle und Klinische Osteologie, Orthopädie und Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - U Stumpf
- Osteologisches Schwerpunktzentrum, Chirurgische Klinik und Poliklinik, Nußbaumstr. 20, 80336, München, Deutschland
| | - M Rudert
- Experimentelle und Klinische Osteologie, Orthopädie und Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
| | - L Seefried
- Experimentelle und Klinische Osteologie, Orthopädie und Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg, Brettreichstraße 11, 97074, Würzburg, Deutschland
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17
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Bergdahl C, Ekholm C, Wennergren D, Nilsson F, Möller M. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register. BMC Musculoskelet Disord 2016; 17:159. [PMID: 27072511 PMCID: PMC4830043 DOI: 10.1186/s12891-016-1009-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/01/2016] [Indexed: 12/23/2022] Open
Abstract
Background Humeral fractures are common, but the association between the patho-anatomical fracture pattern and patient characteristics has been inadequately studied and epidemiological knowledge is scarce. Following the introduction of the Swedish Fracture Register (SFR), risk factors for various fractures can be studied, as well as the outcome of different treatments. The objective of this study was to analyse adult humeral fractures in Gothenburg from a descriptive epidemiological perspective. Methods All humeral fractures registered in the SFR at Sahlgrenska University Hospital in 2011–2013 in patients aged ≥ 16 years were included. The fractures were divided into humeral segments (proximal, shaft and distal humerus) and analysed according to patient characteristics and patho-anatomical pattern. Furthermore, overall and age-specific incidence rates were calculated. Results A total of 2,011 humeral fractures were registered in the SFR, of which 79 % were proximal, 13 % shaft and 8 % distal humeral fractures. The mean age was 66.8 years and women ran a higher risk of humeral fractures than men (female/male ratio 2.4:1). On average, women were older than men at the time of fracture (mean age 70.1 years for women vs. 58.9 years for men). The overall incidence of humeral fractures was 104.7 per 100,000 inhabitants per year, with a segment-specific incidence of 83.0 for proximal fractures, 13.4 for shaft fractures and 8.3 per 100,000 person-years for distal fractures. There was a distinct increase in the age-specific incidence from the fifth decade and onwards, regardless of fracture site. Most fractures occurred in older patients (83 % > 50 years) as a result of a simple or an unspecified fall (79 % > 50 years). Only 1.2 % of all fractures were open injuries and 1.3 % were pathological. Conclusion This population-based study provides updated epidemiological data on humeral fractures in a Western-European setting. Most humeral fractures occur as the result of low-energy falls in the elderly population, indicating the influence of age-related risk factors in these fractures. The SFR will be a useful tool for providing continuous information on fracture epidemiology, risk factors and treatment outcome and these population-based data are essential in the planning of future fracture prevention and management.
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Affiliation(s)
- Carl Bergdahl
- Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg/Mölndal, SE-431 80, Mölndal, Sweden.
| | - Carl Ekholm
- Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg/Mölndal, SE-431 80, Mölndal, Sweden
| | - David Wennergren
- Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg/Mölndal, SE-431 80, Mölndal, Sweden
| | - Filip Nilsson
- Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg/Mölndal, SE-431 80, Mölndal, Sweden
| | - Michael Möller
- Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg/Mölndal, SE-431 80, Mölndal, Sweden
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18
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Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients. Injury 2015; 46:1631-6. [PMID: 26052052 DOI: 10.1016/j.injury.2015.04.036] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 02/03/2015] [Accepted: 04/25/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoporotic posterior ring fractures of the pelvis are common injuries in the elderly, but the treatment of these fractures still remains controversial. Percutaneous iliosacral screw fixation is one surgical option if conservative treatment cannot provide sufficient pain reduction. The aim of this study is to provide short-term results of elderly patients with percutaneous screw fixation. METHODS 30 patients with posterior ring fractures were treated between 12/2009 and 01/2014 with percutaneous iliosacral screw fixation. Patients' mean age was 78.4 years. Concerning short-term outcome, we focused on initial pain level and postoperative pain reduction together with intra- and postoperative complications. RESULTS The average hospital stay was 23.7 days, with surgical treatment performed after an average of 9.2 days. 90% of our patients were female. All 30 patients had a lower level of pain at discharge compared with admission or immediately prior to surgery. The difference in pain level at admission compared with the pain level upon discharge showed a mean reduction from 6.8 to 1.8 with a statistically significant change (P≤0.001). 24 of 30 patients had no registered complications, one screw malpositioning with postoperative nerve irritation occurred. DISCUSSION Conventional percutaneous iliosacral screw fixation is a successful operative treatment for elderly patients with persistent lower back pain after unstable posterior ring fractures of the pelvis. Intra- and postoperative complications are rare, so this treatment can be regarded as a safe procedure. LEVEL OF EVIDENCE IV (retrospective study).
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Sun J, Zhang C, Xu L, Yang M, Yang H. The transforming growth factor-β1 (TGF-β1) gene polymorphisms (TGF-β1 T869C and TGF-β1 T29C) and susceptibility to postmenopausal osteoporosis: a meta-analysis. Medicine (Baltimore) 2015; 94:e461. [PMID: 25634187 PMCID: PMC4602965 DOI: 10.1097/md.0000000000000461] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED The aim of the present study was to integrate all the eligible studies and investigate whether the transforming growth factor-β1 (TGF-β1) gene polymorphisms (TGF-β1 T869C and TGF-β1 T29C) are correlated with postmenopausal osteoporosis (PMOP) risk. PMOP is a common skeletal disease and several genetic factors play an important role in the development and progression of PMOP. Significant associations between TGF-β1 gene polymorphisms (TGF-β1 T869C and TGF-β1 T29C) and PMOP risk have been reported; however, some of these results are controversial. A systematic online search was performed using PubMed, EMBASE, Web of Science, and the Cochrane Library to identify case-control studies investigating the relationship between TGF-β1 T869C and TGF-β1 T29C polymorphisms and the susceptibility of PMOP. The pooled odds ratio (OR) with 95% confidence interval (95% CI) was calculated to assess the associations, and subgroup meta-analyses were performed according to the ethnicity of the study populations. Eight studies involving 1851 cases and 2247 controls met the inclusion criteria after assessment by 2 reviewers. Overall, there were significant associations between TGF-β1 T869C and TGF-β1 T29C polymorphisms and PMOP (TGF-β1 T869C—C vs T: OR = 1.18, 95% CI = 1.02-1.36, P = 0.030; CC vs TT: OR = 1.38, 95% CI = 1.01-1.88, P = 0.042; CC vs CT/TT OR = 1.39, 95% CI = 1.09-1.76, P = 0.008; TGF-β1 T29C—CT vs TT: OR = 1.25, 95% CI = 1.02-1.53, P = 0.032; CT/CC vs TT: OR = 1.37, 95% CI = 1.02-1.84, P = 0.035). In the subgroup analysis of ethnicity, significant association was observed between TGF-β1 T869C polymorphism and PMOP risk in Asian population (C vs T: OR = 1.18, 95% CI = 1.01-1.38, P = 0.043; CC vs TT: OR = 1.41, 95% CI = 1.01-1.97, P = 0.047; CT/CC vs TT: OR = 1.31, 95% CI = 1.03-1.66, P = 0.026; CC vs CT/TT OR = 1.35, 95% CI = 1.03-1.75, P = 0.028); however, there was no significant association between TGF-β1 T869C polymorphism and PMOP risk in Caucasian population. With regard to TGF-β1 T29C polymorphism, significant association was also observed in Asian population (CT vs TT: OR = 1.37, 95% CI = 1.07-1.75, P = 0.013; CT/CC vs TT: OR = 1.54, 95% CI = 1.16-2.05, P = 0.003), while there was no significant association in Caucasian population. The TGF-β1 T869C and TGF-β1 T29C polymorphisms may be involved in susceptibility to PMOP, particular in Asian patients.
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Affiliation(s)
- Jiajia Sun
- From the Department of Orthopaedic Surgery (JS, CZ, LX, HY), The First Affiliated Hospital of Soochow University; and Department of Orthopaedics (MY), Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
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Abstract
Osteoporosis (OP) and cardiovascular diseases (CVD) are the most important causes of mortality and morbility in the elderly. Lots of studies showed a correlation between bone loss and cardiovascular risk mediated by the vascular calcification. The relationship between OP and CVD could be firstly explained by their common risk factors such as age, smoking, alcohol consumption, physical activity and menopause. However, other different hypotheses were proposed to clarify this link. Multiple factors, for example bone morphogenetic proteins, osteoprotegerin, receptor activator of nuclear factor κB ligand, parathyroid hormone, phosphate, oxidized lipids and vitamins D and K seemed to be involved in both conditions, indicating a possible common pathophysiologic mechanism. We review and discuss the available data describing this association. Further studies are necessary to better investigate similarities between OP and CVD.
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Affiliation(s)
- S Lello
- a Department of Woman and Child Health , Catholic University , Rome , Italy
| | - A Capozzi
- a Department of Woman and Child Health , Catholic University , Rome , Italy
| | - G Scambia
- a Department of Woman and Child Health , Catholic University , Rome , Italy
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