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Chan LL, Ho YY, Taylor ME, Mcveigh C, Jung S, Armstrong E, Close JC, Harvey LA. Incidence of fragility hip fracture across the Asia-pacific region: A systematic review. Arch Gerontol Geriatr 2024; 123:105422. [PMID: 38579379 DOI: 10.1016/j.archger.2024.105422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE This systematic review aimed to update fragility hip fracture incidences in the Asia Pacific, and compare rates between countries/regions. METHOD A systematic search was conducted in four electronic databases. Studies reporting data between 2010 and 2023 on the geographical incidences of hip fractures in individuals aged ≥50 were included. Exclusion criteria were studies reporting solely on high-trauma, atypical, or periprosthetic fractures. We calculated the crude incidence, age- and sex-standardised incidence, and the female-to-male ratio. The systematic review was registered with PROSPERO (CRD42020162518). RESULTS Thirty-eight studies were included across nine countries/regions (out of 41 countries/regions). The crude hip fracture incidence ranged from 89 to 341 per 100,000 people aged ≥50, with the highest observed in Australia, Taiwan, and Japan. Age- and sex-standardised rates ranged between 90 and 318 per 100,000 population and were highest in Korea and Japan. Temporal decreases in standardised rates were observed in Korea, China, and Japan. The female-to-male ratio was highest in Japan and lowest in China. CONCLUSION Fragility hip fracture incidence varied substantially within the Asia-Pacific region. This observation may reflect actual incidence differences or stem from varying research methods and healthcare recording systems. Future research should use consistent measurement approaches to enhance international comparisons and service planning.
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Affiliation(s)
- Lloyd Ly Chan
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Y Y Ho
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Tengku Ampuan Afzan Hospital, Jalan Tanah Putih, Kuantan, Pahang 25100, Malaysia
| | - Morag E Taylor
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Mcveigh
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sonya Jung
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Elizabeth Armstrong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Ct Close
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Lara A Harvey
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
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Li L, Shen Y, Tan LH, Zhang H, Dai RC, Yuan LQ, Sheng ZF, Wu XY. Association of osteoporotic fractures of femoral neck and femoral neck geometric parameters in native Chinese women. BMC Musculoskelet Disord 2024; 25:349. [PMID: 38702706 PMCID: PMC11067106 DOI: 10.1186/s12891-024-07483-1] [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: 02/19/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Although it is generally believed that the femoral neck fracture is related to the femoral neck geometric parameters (FNGPs), the association between the risk of osteoporotic fracture of the femoral neck and FNGPs in native Chinese women is still unclear. METHODS A total of 374 female patients (mean age 70.2 ± 9.32 years) with osteoporotic fracture of the femoral neck, and 374 non-fracture control groups were completely matched with the case group according to the age ratio of 1:1. Using DXA bone densitometer to measured eight FNGPs: the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compressive strength index (CSI) at the narrowest point of the femoral neck. RESULTS Compared with the control group, the average values of OD (2.9%), ED (4.5%), and BR (26.1%) in the patient group significantly increased (p = 0.015 to < 0.001), while CSA (‒15.3%), CT (‒18.2%), SM (‒10.3%), CSMI (‒6.4%), and CSI (‒10.8%) significantly decreased (all p < 0.001). The prevalence of osteoporosis in the lumbar spine, femoral neck, and total hip was, respectively, 82%, 81%, and 65% in fracture patients. Cox proportional hazard model analysis showed that in the age adjusted model, the fracture hazard ratio (HR) of CSA, CT, BR, SM, and CSI significantly increased (HRs = 1.60‒8.33; 95% CI = 1.08‒16.6; all p < 0.001). In the model adjusted for age and femoral neck BMD, HRs of CT (HRs = 3.90‒8.03; 95% CI = 2.45‒15.1; all p < 0.001) and BR (HRs = 1.62‒2.60; 95% CI = 1.20‒5.44; all p < 0.001) were still significantly increased. CONCLUSION These results suggest that the majority of osteoporotic fractures of the femoral neck of native Chinese women occur in patients with osteoporosis. CT thinning or BR increase of FNGPs may be independent predictors of fragility fracture of femoral neck in native Chinese women unrelated to BMD.
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Affiliation(s)
- Lin Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
- Department of Endocrinology and Metabolism, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yi Shen
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Li-Hua Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Hong Zhang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
| | - Ru-Chun Dai
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
| | - Ling-Qing Yuan
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
| | - Xi-Yu Wu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China.
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Jiang M, Gao Y, Hou H, Guo J, Li W, Qin T, Shi M, Huang L. Bone mineral density in patients with primary ovarian insufficiency: A systematic review and Meta-Analysis. Eur J Obstet Gynecol Reprod Biol 2024; 295:219-227. [PMID: 38387304 DOI: 10.1016/j.ejogrb.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/13/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Premature menopause is a major complication of primary ovarian insufficiency (POI), and this loss is closely relates to bone mineral density (BMD). Previous research has indicated potential associations between BMD and POI. This study set out to provide the first systematic literature review and meta-analysison account of BMD content among women with POI. METHODS Studies including women with POI and controls were eligible from PubMed, Embase, Cochrane Library and Web of Science databases (from their inception to April 2022). Two reviewers independently evaluated study eligibility. The meta-analysis was performed using the DerSimonian and Laird random effects model. RESULTS Ten studies featuring 578 women with POI and 480 controls were selected. BMD content of femur neck (SMD:-0.76; 95 % CI: -1.20 to -0.31; P = 0.0008), the BMD content of nondominating forearm (SMD:-0.67; 95 % CI: -1.15 to -0.18; P = 0.007) were significantly decreased in women with POI. However, no differences were seen in other regions (lumbar spine, total hip, hipneck). DISCUSSION The results of this study indicate that BMD content altered in patients with primary ovarian insufficiency. An implication of this is the possibility that hormone replacement therapy to minimize the prevalence of fracture morbidity and mortality associated with osteopenia in patients with POI.
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Affiliation(s)
- Mei Jiang
- Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Ying Gao
- Department of Acupuncture, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100101, China
| | - Hongping Hou
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Wenyuan Li
- Evidence Based Traditional Chinese Medicine Center of Sichuan Province, Chengdu 610075, China
| | - Tianyu Qin
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Minglu Shi
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Ling Huang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 102488, China.
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Jepsen KJ, Bigelow EMR, Casden MA, Goulet RW, Kennedy K, Hertz S, Kadur C, Nolan BT, Richards‐McCullough K, Merillat S, Karvonen‐Gutierrez CA, Clines G, Bredbenner TL. Associations Among Hip Structure, Bone Mineral Density, and Strength Vary With External Bone Size in White Women. JBMR Plus 2023; 7:e10715. [PMID: 36936363 PMCID: PMC10020918 DOI: 10.1002/jbm4.10715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
Bone mineral density (BMD) is heavily relied upon to reflect structural changes affecting hip strength and fracture risk. Strong correlations between BMD and strength are needed to provide confidence that structural changes are reflected in BMD and, in turn, strength. This study investigated how variation in bone structure gives rise to variation in BMD and strength and tested whether these associations differ with external bone size. Cadaveric proximal femurs (n = 30, White women, 36-89+ years) were imaged using nanocomputed tomography (nano-CT) and loaded in a sideways fall configuration to assess bone strength and brittleness. Bone voxels within the nano-CT images were projected onto a plane to create pseudo dual-energy X-ray absorptiometry (pseudo-DXA) images consistent with a clinical DXA scan. A validation study using 19 samples confirmed pseudo-DXA measures correlated significantly with those measured from a commercially available DXA system, including bone mineral content (BMC) (R 2 = 0.95), area (R 2 = 0.58), and BMD (R 2 = 0.92). BMD-strength associations were conducted using multivariate linear regression analyses with the samples divided into narrow and wide groups by pseudo-DXA area. Nearly 80% of the variation in strength was explained by age, body weight, and pseudo-DXA BMD for the narrow subgroup. Including additional structural or density distribution information in regression models only modestly improved the correlations. In contrast, age, body weight, and pseudo-DXA BMD explained only half of the variation in strength for the wide subgroup. Including bone density distribution or structural details did not improve the correlations, but including post-yield deflection (PYD), a measure of bone material brittleness, did increase the coefficient of determination to more than 70% for the wide subgroup. This outcome suggested material level effects play an important role in the strength of wide femoral necks. Thus, the associations among structure, BMD, and strength differed with external bone size, providing evidence that structure-function relationships may be improved by judiciously sorting study cohorts into subgroups. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Karl J Jepsen
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Erin MR Bigelow
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Michael A Casden
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Robert W Goulet
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Kathryn Kennedy
- Department of Biomedical EngineeringMarquette UniversityMilwaukeeWIUSA
| | - Samantha Hertz
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Chandan Kadur
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Bonnie T Nolan
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Kerry Richards‐McCullough
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Steffenie Merillat
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Carrie A Karvonen‐Gutierrez
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Gregory Clines
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
- EndocrinologyVA Medical CenterAnn ArborMIUSA
| | - Todd L Bredbenner
- Department of Mechanical and Aerospace EngineeringUniversity of Colorado Colorado SpringsColorado SpringsCOUSA
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Li L, Wu X, Zhang H, Liao E, Dai R, Wu X. Comparison of femoral neck geometric parameters between Chinese and Japanese females. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:319-327. [PMID: 35545324 PMCID: PMC10930054 DOI: 10.11817/j.issn.1672-7347.2022.210456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Femoral neck fracture is the most serious osteoporotic fractures that is responsible for high medical costs and high mortality. Femoral neck geometric parameters (FNGPs) are important parameters that reflect the geometrical characteristics of femoral neck, and are closely related to the strength of femoral neck and the risk of fragility fracture.There are differences in the incidence of femoral neck fractures among races. However, whether there is difference in FNGPs among races is unknown.Therefore, this study aims to compare the differences in FNGPs between Chinese and Japanese females. METHODS This study was a cross-sectional study, in which 3 859 healthy females aged 10-86 (45.7±17.1) years old were recruited from Changsha City of Hunan Province and surrounding areas. The weight and height were measured and recorded, and the body mass index (BMI) was calculated. A dual energy X-ray absorptiometry (DXA) bone densitometer was used to measure femoral neck projective bone area (BA) and bone mineral density (BMD). FNGPs were calculated using the BMD and BA, which included the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compression strength index (CSI). The data of FNGPs in Japanese females was collected from literature. These subjects were grouped by 10-year age. The mean and standard deviation of height, weight, BMI, femoral neck BMD, and FNGPs of each group were calculated. The model with the best goodness-of-fit was selected from various mathematical regression models to analyze the distribution trend and the best fitting curve of FNGPs with age. The differences in FNGPs between Chinese and Japanese females were analyzed by using age-corresponding mean fitting curve for paired t-test, and the relative change rates of FNGPs were compared. RESULTS The mean values of FNGPs were significantly different among different years old healthy females (all P<0.01). The mean values of OD, CSA, CT, SM, and CSMI in femoral neck were high at 30 to 39 years old, and then they were gradually decreased with age. The CSI reached its peak at 20-29 years old, and it was decreased gradually after 30 years old. ED and BR were at a low level before 40 years old, they were gradually increased after 40 years old, and reached the maximum average value at 80-86 years old. The variations in FNGPs with age were fitted with the best goodness-of-fit by applying the cubic regression model and the determination coefficients of regression equations (R2: 0.062-0.404) were significant (all P<0.01). The distribution trend of FNGPs with age varied with the indices, among which CSA, CT, SM, CSMI and CSI were increased with age before 35 years old, and then they were decreased with age; BR was at a low level in the early stage, and then it was increased with age after about 40 years. There were significant differences in the fitting curves of FNGPs related to age between Chinese and Japanese females (all P<0.01). The fitting curves of OD, ED, BR and SM in Chinese females were significantly higher than those in Japanese females (all P<0.01), while those of CSA and CT in Chinese females were significantly lower than those in Japanese females (all P<0.01). Before the age of 50, the curves of CSMI and CSI of Chinese females were significantly higher than those of Japanese females (all P<0.01), while after the age of 60 the situation was reversed (all P<0.01). Except for SM and CSI, there were significant differences in the rate of OD, CSA, CT, ED, BR and CSMI with age (all P<0.01). By the age of 80 years old, the rates of change in OD, ED, and BR with the age in Chinese females were increased by 0.91%,3.94%, and 47.5%, respectively, while those in Japanese females were increased by 8.57%, 15.8% and 85.3%, respectively;the rates of change of CSA, CT, and CSMI with the age in Chinese females were declined 28.0%, 29.6%, and 25.2%, respectively, while those in Japanese females were declined 29.9%, 36.2%, and 10.9%, respectively. There were significant difference in the rates of change in FNGPs with the age between Chinese and Japanese females (all P<0.01). CONCLUSIONS The study reveals the variation of FNGPs with age in Chinese, and confirms that there are racial differences in FNGPs between Chinese and Japanese females, which may be one of the important reasons for the difference in the incidence of femoral neck fracture between Chinese and Japanese females.
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Affiliation(s)
- Lin Li
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; National Clinical Research Center for Metabolic Diseases; Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Changsha 410011.
- Department of Endocrinology and Metabolism, First Hospital of Changsha, Changsha 410005, China.
| | - Xianping Wu
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; National Clinical Research Center for Metabolic Diseases; Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Changsha 410011
| | - Hong Zhang
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; National Clinical Research Center for Metabolic Diseases; Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Changsha 410011
| | - Eryuan Liao
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; National Clinical Research Center for Metabolic Diseases; Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Changsha 410011
| | - Ruchun Dai
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; National Clinical Research Center for Metabolic Diseases; Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Changsha 410011.
| | - Xiyu Wu
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; National Clinical Research Center for Metabolic Diseases; Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Changsha 410011.
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Aftab R, Dixit D, Williams S, Baker L, Raindle Clarke D, Jack C. Cognitive impairment and pain relief following hip fractures: a case control study. Br J Pain 2021; 16:203-213. [PMID: 35419199 PMCID: PMC8998528 DOI: 10.1177/20494637211041146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hip fractures represent a significant workload of both emergency and orthopaedic departments within the National Health Service (NHS). Pain relief is key in treating hip fractures as highlighted by both National Institute of Clinical Excellence (NICE) and British Orthopaedic Association Standards for Trauma (BOAST) guidelines. However, the literature shows that patients with cognitive impairment tend to have inconsistent pain management, leading to worse outcomes. We conducted a case–control study looking at 296 patients who presented with hip fractures to a major trauma centre between 1 December 2019 and 30 May 2020. Cognition was assessed using pre-recorded Abbreviated Mental Test Scores (AMTS). There was no significant difference between pain relief provided to patients with or without cognitive impairment in both the pre-hospital (p = 0.208) and Accident & Emergency (A&E) (p = 0.154) setting. A larger proportion of patients in A&E did not receive any pain relief (18.6% versus 42.2%). Pre-hospital, the higher the pain score, the stronger the analgesia given (R = 0.435, p = 0.000). This relationship was present in both the cognitively impaired (R = 0.572, p = 0.000) and cognitively intact groups (R = 0.390 p = 0.000). Strength of analgesia and pain scores did not correlate in A&E (R = 0.014, p = 0.826). Cognition did not impact the time to analgesia both pre-hospital (p = 0.291) and in A&E (p = 0.332); however, patients waited significantly longer to receive pain relief in A&E (29.61 minutes versus 150.28 minutes). Fascia-iliaca blocks were administered to 58.4% of the cohort, with no significant difference noted between cognition status. Overall, cognition does not impact pain management both pre-hospital and in A&E. There is still room for improvement, particularly in the assessment of pain in the cognitively impaired. A possible solution is the utilisation of the Bolton Pain Assessment Tool, a validated pain assessment tool for the cognitively impaired that has been utilised in the trauma setting with good effect.
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Affiliation(s)
- Raiyyan Aftab
- Department of Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Divyansh Dixit
- School of Medicine, University of Southampton, Southampton, UK
| | - Simon Williams
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Laurence Baker
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Christopher Jack
- Department of Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Pedrosa M, Ferreira MT, E Batista de Carvalho LA, M Marques MP, Curate F. The association of osteochemometrics and bone mineral density in humans. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 176:434-444. [PMID: 33852736 DOI: 10.1002/ajpa.24283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/12/2021] [Accepted: 03/24/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Even though much is known about bone mineral and matrix composition, studies about their relationship with several bone properties and its alterations related to bone diseases such as osteoporosis are practically non-existent in humans. Thus, the development of methods to understand the effects of bone properties at a microscopic level is paramount. This research aimed to evaluate whether Fourier transform infrared-attenuated total reflectance (FTIR-ATR) band intensity ratios correlate with femoral bone mass, bone mineral content (BMC) (total and femoral neck), bone mineral per unit area (BMD) (total, femoral neck, greater trochanter, intertrochanteric region, and Ward's area) and the area (total and femoral neck). A sample of femora from the 21st Century Identified Skeleton Collection (N = 78, 42 females and 36 males) was employed and BMC, BMD, and the femoral areas were acquired by DXA. RESULTS It was found that only females' BMD had a significant association with the femoral FTIR-ATR indices under study, whereas bone collagen (Am/P) and the content of carbonate Type A (API) in males correlated with the total proximal femur area of the regions of interest and the femoral neck area. DISCUSSION Men and women showed different changes related to their chemical composition in BMD, BMC, and probed area, most likely due to differences in structure and physiology, as well as mechanical strength in the proximal femoral sites where BMD was analyzed.
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Affiliation(s)
- Mariana Pedrosa
- Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal.,Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - Maria Teresa Ferreira
- Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal.,Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal
| | | | - Maria Paula M Marques
- Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal.,Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - Francisco Curate
- Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal.,Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, Coimbra, Portugal.,School of Technology of Tomar, Polytechnic Institute of Tomar, Tomar, Portugal
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Nam YJ, Hwang SY, Kim DW, Kim D, Shin SJ, Yoon HE. Sex-specific relationship between vascular calcification and incident fracture in patients with end-stage renal disease. Kidney Res Clin Pract 2020; 39:344-355. [PMID: 32522894 PMCID: PMC7530357 DOI: 10.23876/j.krcp.20.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background Vascular calcification (VC) is a major component of mineral bone disorders in patients with end-stage renal disease (ESRD). Bone metabolism is affected by various factors, including sex hormones. This study investigated whether there was a sex-specific relationship between VC and incident fracture in patients with ESRD. Methods This was a retrospective cohort study of dialysis patients from a single center. VC was assessed by the aortic calcification index (ACI) using abdominal computed tomography. Patients were grouped by sex and stratified into low or high ACI groups, according to the median ACI value. The association between ACI and incident fracture was analyzed. Results Data from 593 patients (male n = 328, median ACI, 14.57; female n = 265, median ACI, 19.44) were included. During a median follow-up of 36.7 months, 71 patients (12.0%) developed fractures. The fracture-free survival rate was significantly lower in the high ACI group versus the low ACI group, both in males (P = 0.021) and females (P = 0.001). In males, multivariate analysis showed that the high ACI group and ACI per se were not significant risks for fracture. However, in females, both the high ACI group (adjusted hazard ratio, 2.720; P = 0.003) and ACI per se (adjusted hazard ratio, 1.768; P = 0.035) were independently associated with fracture after adjustment for confounding variables. Conclusion VC was independently associated with incident fracture in female patients with ESRD. There may be a sex-specific relationship between VC and fracture in patients with ESRD.
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Affiliation(s)
- Yun Jung Nam
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - So Yeon Hwang
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Da Won Kim
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dongryul Kim
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Seok Joon Shin
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Hye Eun Yoon
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
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9
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Gluek C, Zdero R, Quenneville CE. Evaluating the mechanical response of novel synthetic femurs for representing osteoporotic bone. J Biomech 2020; 111:110018. [PMID: 32891014 DOI: 10.1016/j.jbiomech.2020.110018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
Osteoporosis is a disease prevalent in older adults, characterized by high porosity in bone and subsequent decrease in fracture resistance. This demographic is also the population that most frequently receives devices such as hip implants. However, high porosity complicates surgery and reduces the fixation and effectiveness of orthopaedic devices, which are typically designed using cadaveric specimens from the general population. Synthetic bones are also used in the design of such devices but need to represent the properties of the patient population. Thus, the mechanical response of two iterations of novel synthetic femurs were evaluated for their ability to represent osteoporotic cadaveric specimens and were tested and compared against cadaveric specimens across four loading modes. The first iteration had reduced density and wall thickness compared to standard models and was typically too rigid or too stiff to be a feasible alternative to cadaveric specimens. The second iteration, with similarly reduced wall thickness and further reduced density, was quite representative, with no statistical differences identified against the cadaveric specimens in any loading mode, except in screw pullout. Such a model can provide a foundation for the development of orthopaedic devices better suited to osteoporotic bone, potentially improving surgical outcomes, reducing medical expense, and improving quality of life for patients.
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Affiliation(s)
- Cooper Gluek
- Department of Mechanical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - Radovan Zdero
- Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Department of Surgery (Division of Orthopaedic Surgery), Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Cheryl E Quenneville
- Department of Mechanical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada.
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Sànchez-Riera L, Wilson N. Fragility Fractures & Their Impact on Older People. Best Pract Res Clin Rheumatol 2017; 31:169-191. [PMID: 29224695 DOI: 10.1016/j.berh.2017.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/05/2017] [Accepted: 09/14/2017] [Indexed: 01/31/2023]
Abstract
Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective. Predictive tools including clinical risk factors, minimisation of falls risk and public authorities' support to create Fracture Liaison Services are paramount strategies.
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Affiliation(s)
- Lídia Sànchez-Riera
- University Hospital Bristol NHS Foundation Trust, Bristol, UK; Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, St Leonards, NSW, Australia.
| | - Nicholas Wilson
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, St Leonards, NSW, Australia
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11
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Shen Y, Tang ML, Wu XP, Yuan LQ, Dai RC, Zhang H, Sheng ZF, Peng YQ, Luo XH, Wu XY, Liao EY. Gender differences in a reference database of age-related femoral neck geometric parameters for Chinese population and their association with femoral neck fractures. Bone 2016; 93:64-70. [PMID: 27641474 DOI: 10.1016/j.bone.2016.09.014] [Citation(s) in RCA: 2] [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: 05/31/2016] [Revised: 08/15/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
Femoral neck geometric parameters (FNGPs) are closely related to the strength of the femoral neck and the risk of fragility fractures. No reference database is available for FNGPs for Chinese population, and gender-related differences in FNGPs as well as their association with the risk of femoral neck fractures are unknown. This investigation aimed to set up reference databases for FNGPs, understand gender-related differences in FNGPs, and examine the association between FNGPs and the risk of osteoporotic fractures of the femoral neck. This study included 5268 females and 2156 males (aged 15-91years) from Chinese population. A total of 384 patients (282 females and 102 males) had sustained femoral neck fractures; 384 age- and sex-matched individuals without any fractures served as controls. Femoral neck DXA images were used to measure bone mineral density (BMD) and eight FNGPs. Our results showed that the age-related trends of FNGPs were fitted with the best goodness-of-fit by applying the cubic regression model. The trends shown by FNGPs were significantly different between male and female subjects, and the fitting curves were significantly higher in male subjects. After adjustments were made for age, height, weight, and body mass index, Cox regression analysis showed that changes in all FNGPs were related to increased hazard ratios (HRs) of femoral neck fractures. After further adjustment was made for BMD of the femoral neck, the HRs related to a cortical thickness (CT) decrease and buckling ratio (BR) increase in females went up by 3.35-folds (95% CI: 2.75-4.07) and 1.86-folds (95% CI: 1.33-2.60), respectively. In males, the HRs related to the decrease in CT and cross-sectional area (CSA) increased by 3.21-folds (95% CI: 2.32-4.45) and 1.88-folds (95% CI: 1.03-3.44), respectively. In conclusions, the reference databases of FNGPs established in this study will assist in the evaluation and prediction of femoral neck fracture risk in the clinic. The decrease in CT and increase in BR of the femoral neck were independent risk factors for osteoporotic fractures of the femoral neck in females from mainland China, while a decrease in CT and CSA were risk factors in male.
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Affiliation(s)
- Yi Shen
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Orthopedics, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Meng-Lu Tang
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Heze Hospital of Traditional Chinese Medicine, Shandong Province, No.1036 Danyang Road, Heze, Shandong 274000, PR China
| | - Xian-Ping Wu
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Ling-Qing Yuan
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Ru-Chun Dai
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Hong Zhang
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Yi-Qun Peng
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Xiang-Hang Luo
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Xi-Yu Wu
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China.
| | - Er-Yuan Liao
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
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12
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Curtis EM, van der Velde R, Moon RJ, van den Bergh JPW, Geusens P, de Vries F, van Staa TP, Cooper C, Harvey NC. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone 2016; 87:19-26. [PMID: 26968752 PMCID: PMC4890652 DOI: 10.1016/j.bone.2016.03.006] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/09/2016] [Accepted: 03/07/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED Rates of fracture worldwide are changing. Using the Clinical Practice Research Datalink (CPRD), age, and gender, geographical, ethnic and socioeconomic trends in fracture rates across the United Kingdom were studied over a 24-year period 1988-2012. Previously observed patterns in fracture incidence by age and fracture site were evident. New data on the influence of geographic location, ethnic group and socioeconomic status were obtained. INTRODUCTION With secular changes in age- and sex-specific fracture incidence observed in many populations, and global shifts towards an elderly demography, it is vital for health care planners to have an accurate understanding of fracture incidence nationally. We aimed to present up to date fracture incidence data in the UK, stratified by age, sex, geographic location, ethnicity and socioeconomic status. METHODS The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 6.9% of the UK population. Information comes from General Practitioners, and covers 11.3 million people from 674 practices across the UK, demonstrated to be representative of the national population. The study population consisted of all permanently registered individuals aged ≥18years. Validated data on fracture incidence were obtained from their medical records, as was information on socioeconomic deprivation, ethnicity and geographic location. Age- and sex-specific fracture incidence rates were calculated. RESULTS Fracture incidence rates by age and sex were comparable to those documented in previous studies and demonstrated a bimodal distribution. Substantial geographic heterogeneity in age- and sex adjusted fracture incidence was observed, with rates in Scotland almost 50% greater than those in London and South East England. Lowest rates of fracture were observed in black individuals of both sexes; rates of fragility fracture in white women were 4.7 times greater than in black women. Strong associations between deprivation and fracture risk were observed in hip fracture in men, with a relative risk of 1.3 (95% CI 1.21-1.41) in Index of Multiple Deprivation category 5 (representing the most deprived) compared to category 1. CONCLUSIONS This study presents robust estimates of fracture incidence across the UK, which will aid decisions regarding allocation of healthcare provision to populations of greatest need. It will also assist the implementation and design of strategies to reduce fracture incidence and its personal and financial impact on individuals and health services.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- Correspondence and reprint requests to: Professor Cyrus Cooper, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK. Tel: +44 (0) 23 8077 7624 Fax: +44 (0) 23 8070 4021,
| | - Robert van der Velde
- Dept of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, the Netherlands
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Joop P W van den Bergh
- Dept of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, the Netherlands
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Piet Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- University Hasselt, Hasselt, Belgium
| | - Frank de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tjeerd P van Staa
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, 1.003 Vaughan House, Portsmouth Road, M13 9PL, UK
- Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands, 3508 TB
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopedic Centre, Headington, Oxford, OX3 7HE, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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13
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Gong J, Tang M, Guo B, Shang J, Tang Y, Xu H. Sex- and age-related differences in femoral neck cross-sectional structural changes in mainland Chinese men and women measured using dual-energy X-ray absorptiometry. Bone 2016; 83:58-64. [PMID: 26475501 DOI: 10.1016/j.bone.2015.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/05/2015] [Accepted: 09/29/2015] [Indexed: 11/23/2022]
Abstract
We investigated age-related changes in estimated bone strength and cross-sectional structure of the femoral neck (FN) in mainland Chinese men and women (according to age and sex) using dual-energy X-ray absorptiometry (DXA). A total of 3855 healthy adults (2713 women, 1142 men; ages 25-91years) were analyzed by FN bone mineral density (BMD) assessment and hip structural/strength analysis (HSA), including cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), section modulus (Z), periosteal diameter (PD), endocortical diameter (ED), and cortical thickness (CT) using DXA. HSA differences between age and sex groups were adjusted for body weight, height and FN BMD. Trends according to age were estimated by linear regression analysis. There was no inverse correlation between HSA parameters and age in young adults. Some HSA parameters (CSMI, CSA, Z, CT) decreased significantly with age, whereas PD and ED increased significantly. Older adults had less estimated bone strength and CT and higher PD and ED (p<0.05) than young adults. Men had greater increases in PD and ED than women across all ages. FN strength decreases with age in both sexes, caused by FN cross-sectional structural deterioration. Indirect comparison of our data with those from other populations showed less age-related FN periosteal apposition in Chinese than Caucasian men, but similar amounts in women. This may partly explain different male/female hip fracture rates among ethnic groups. Chinese men have more structural disadvantages regarding FN geometry during aging than Caucasian men, possibly conferring added susceptibility to hip fracture.
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Affiliation(s)
- Jian Gong
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Min Tang
- Department of Ophthalmology, Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Bin Guo
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - JingJie Shang
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yongjin Tang
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Hao Xu
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China.
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14
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Wang Q, Chen D, Cheng SM, Nicholson P, Alen M, Cheng S. Growth and aging of proximal femoral bone: a study with women spanning three generations. J Bone Miner Res 2015; 30:528-34. [PMID: 25195663 DOI: 10.1002/jbmr.2353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/30/2014] [Accepted: 09/03/2014] [Indexed: 02/05/2023]
Abstract
Osteoporotic hip fracture is a serious clinical event associated with high morbidity and mortality. Understanding femoral growth patterns is important for promoting bone health in the young and preventing fractures in later life. In this study, growth patterns of areal bone mineral density (aBMD) and geometric properties of the proximal femur were measured by dual-energy X-ray absorptiometry. They were studied in 251 girls from premenarche (11.2 ± 0.7 years) to late adolescence (18.3 ± 1.1 years) and compared with their premenopausal mothers (n = 128, aged 44.9 ± 4.1 years) and postmenopausal grandmothers (n = 128, aged 70.0 ± 6.3 years). Hip axis length (HAL) was the first to reach peak growth velocity (-10.5 months before menarche), followed by neck diameter (ND) and neck cross-sectional area (CSA), (-7.1 and -4.1 months before menarche, respectively). Both neck-shaft angle (NSA) and aBMD of neck and total hip peaked at menarche. At 18 years (7-year follow-up), girls already had higher femoral neck aBMD but similar HAL and NSA compared with their mothers. Grandmothers had the longest HAL, narrowest NSA, widest ND but lowest aBMD and CSA. Hip strength index (HSI), an index of femoral neck strength during a fall, dropped rapidly after menarche in girls but thereafter remained relatively constant. Grandmothers had lower HSI than either mothers or girls. In conclusion, differences in proximal femoral bone mass and structure in adulthood are largely established before menarche, indicating that heritable factors are responsible for most of the individual variance. The development of geometric properties precedes aBMD in puberty, resulting in relatively constant hip strength after menarche. This asynchronous growth leads to adaptation of bone strength to the imposed loads, avoiding fractures in a biologically efficient manner. Both deterioration of aBMD and inadequate compensatory change in bone geometry after menopause contribute to the increased fracture risk later in life.
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Affiliation(s)
- Qin Wang
- Department of Endocrinology, West China Hospital of Sichuan University, Sichuan, China; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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15
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Cong E, Walker MD. The Chinese skeleton: insights into microstructure that help to explain the epidemiology of fracture. Bone Res 2014; 2:14009. [PMID: 26273521 PMCID: PMC4472143 DOI: 10.1038/boneres.2014.9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 01/12/2023] Open
Abstract
Osteoporotic fractures are a major public health problem worldwide, but incidence varies greatly across racial groups and geographic regions. Recent work suggests that the incidence of osteoporotic fracture is rising among Asian populations. Studies comparing areal bone mineral density and fracture across races generally indicate lower bone mineral density in Asian individuals including the Chinese, but this does not reflect their relatively low risk of non-vertebral fractures. In contrast, the Chinese have relatively high vertebral fracture rates similar to that of Caucasians. The paradoxically low risk for some types of fractures among the Chinese despite their low areal bone mineral density has been elucidated in part by recent advances in skeletal imaging. New techniques for assessing bone quality non-invasively demonstrate that the Chinese compensate for smaller bone size by differences in hip geometry and microstructural skeletal organization. Studies evaluating factors influencing racial differences in bone remodeling, as well as bone acquisition and loss, may further elucidate racial variation in bone microstructure. Advances in understanding the microstructure of the Chinese skeleton have not only helped to explain the epidemiology of fracture in the Chinese, but may also provide insight into the epidemiology of fracture in other races as well.
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Affiliation(s)
- Elaine Cong
- New York Presbyterian Hospital, New York, USA
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16
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Vale AC, Aleixo IP, Lúcio M, Saraiva A, Caetano-Lopes J, Rodrigues A, Amaral PM, Rosa LG, Monteiro J, Fonseca JE, Vaz MF, Canhão H. At the moment of occurrence of a fragility hip fracture, men have higher mechanical properties values in comparison with women. BMC Musculoskelet Disord 2013; 14:295. [PMID: 24131745 PMCID: PMC4015558 DOI: 10.1186/1471-2474-14-295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/01/2013] [Indexed: 02/04/2023] Open
Abstract
Background It is well established that males have lower fracture risk in comparison with females, which suggests a higher bone resistance in men. The aim of our study was to find out if in older patients with hip fragility fractures, gender has also an impact on trabecular bone material behaviour, specifically to determine whether trabecular mechanical properties under compressive loading differ between men and women who suffered a fragility hip fracture. Methods Femoral epiphyses were consecutively collected during hip replacement surgery due to proximal femur fragility fracture. Trabecular bone cylinders were drilled and submitted to uniaxial compression tests and mechanical properties were assessed. Results Seventy-three patients, 55 women (mean age 81 years and standard deviation of 7 years) and 18 men (mean age 81 years and standard deviation of 8 years) were evaluated. The ultimate stress of trabecular bone was significantly higher in men than in women: the median values and the interquartile range (IQR) were respectively 8.04(5.35-10.90) MPa vs. 4.46(3.02-7.73) MPa, (p-value = 0.005). The same difference between male and female was observed in the Young’s modulus: 293.68(166.67-538.18) MPa vs. 174.26(73.07-322.28) MPa, (p-value = 0.028), and also in the energy to failure: 0.25(0.07-0.42) MJ/m3 vs. 0.11(0.05-0.25) MJ/m3, (p-value = 0.058). These differences were also verified after adjusting the analysis for age in a multivariate model analysis. Conclusions Our observations demonstrated that, even in a population who suffered a fragility hip fracture, men still have higher trabecular bone mechanical properties in comparison with women.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - João E Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
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17
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Ran S, Pei YF, Liu YJ, Zhang L, Han YY, Hai R, Tian Q, Lin Y, Yang TL, Guo YF, Shen H, Thethi IS, Zhu XZ, Deng HW. Bivariate genome-wide association analyses identified genes with pleiotropic effects for femoral neck bone geometry and age at menarche. PLoS One 2013; 8:e60362. [PMID: 23593202 PMCID: PMC3617200 DOI: 10.1371/journal.pone.0060362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/26/2013] [Indexed: 02/05/2023] Open
Abstract
Femoral neck geometric parameters (FNGPs), which include cortical thickness (CT), periosteal diameter (W), buckling ratio (BR), cross-sectional area (CSA), and section modulus (Z), contribute to bone strength and may predict hip fracture risk. Age at menarche (AAM) is an important risk factor for osteoporosis and bone fractures in women. Some FNGPs are genetically correlated with AAM. In this study, we performed a bivariate genome-wide association study (GWAS) to identify new candidate genes responsible for both FNGPs and AAM. In the discovery stage, we tested 760,794 SNPs in 1,728 unrelated Caucasian subject, followed by replication analyses in independent samples of US Caucasians (with 501 subjects) and Chinese (with 826 subjects). We found six SNPs that were associated with FNGPs and AAM. These SNPs are located in three genes (i.e. NRCAM, IDS and LOC148145), suggesting these three genes may co-regulate FNGPs and AAM. Our findings may help improve the understanding of genetic architecture and pathophysiological mechanisms underlying both osteoporosis and AAM.
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Affiliation(s)
- Shu Ran
- Center of System Biomedical Sciences, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, P. R. China
| | - Yu-Fang Pei
- Center of System Biomedical Sciences, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, P. R. China
| | - Yong-Jun Liu
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Lei Zhang
- Center of System Biomedical Sciences, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, P. R. China
| | - Ying-Ying Han
- Center of System Biomedical Sciences, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, P. R. China
| | - Rong Hai
- Inner Mongolia People’s Hospital, Hohhot, P. R. China
| | - Qing Tian
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Yong Lin
- Center of System Biomedical Sciences, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, P. R. China
| | - Tie-Lin Yang
- School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shanxi, P. R. China
| | - Yan-Fang Guo
- School of Basic Medical Science, Institute of Bioinformatics, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Hui Shen
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Inderpal S. Thethi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Xue-Zhen Zhu
- Center of System Biomedical Sciences, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, P. R. China
| | - Hong-Wen Deng
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
- Center of System Biomedical Sciences, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, P. R. China
- * E-mail:
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18
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Danielson ME, Beck TJ, Lian Y, Karlamangla AS, Greendale GA, Ruppert K, Lo J, Greenspan S, Vuga M, Cauley JA. Ethnic variability in bone geometry as assessed by hip structure analysis: findings from the hip strength across the menopausal transition study. J Bone Miner Res 2013; 28:771-9. [PMID: 23044816 PMCID: PMC3586935 DOI: 10.1002/jbmr.1781] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/17/2012] [Accepted: 10/01/2012] [Indexed: 11/10/2022]
Abstract
Racial/ethnic origin plays an important role in fracture risk. Racial/ethnic differences in fracture rates cannot be fully explained by bone mineral density (BMD). Studies examining the influence of bone geometry and strength on fracture risk have focused primarily on older adults and have not included people from diverse racial/ethnic backgrounds. Our goal was to explore racial/ethnic differences in hip geometry and strength in a large sample of midlife women. We performed hip structure analysis (HSA) on hip dual-energy X-ray absorptiometry (DXA) scans from 1942 premenopausal and early perimenopausal women. The sample included white (50%), African American (27%), Chinese (11%), and Japanese (12%) women aged 42 to 52 years. HSA was performed using software developed at Johns Hopkins University. African American women had higher conventional (8.4% to 9.7%) and HSA BMD (5.4% to 19.8%) than other groups with the exception being Japanese women, who had the highest HSA BMD (9.7% to 31.4%). HSA indices associated with more favorable geometry and greater strength and resistance to fracture were more prevalent in African American and Japanese women. Femurs of African American women had a smaller outer diameter, a larger cross-sectional area and section modulus, and a lower buckling ratio. Japanese women presented a different pattern with a higher section modulus and lower buckling ratio, similar to African American women, but a wider outer diameter; this was offset by a greater cross-sectional area and a more centrally located centroid. Chinese women had similar conventional BMD as white women but a smaller neck region area and HSA BMD at both regions. They also had a smaller cross-sectional area and section modulus, a more medially located centroid, and a higher buckling ratio than white women. The observed biomechanical differences may help explain racial/ethnic variability in fracture rates. Future research should explore the contribution of hip geometry to fracture risk across all race/ethnicities.
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Affiliation(s)
- Michelle E Danielson
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA 15261, USA.
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19
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Wang XF, Seeman E. Epidemiology and structural basis of racial differences in fragility fractures in Chinese and Caucasians. Osteoporos Int 2012; 23:411-22. [PMID: 21853371 DOI: 10.1007/s00198-011-1739-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 07/25/2011] [Indexed: 01/23/2023]
Abstract
Chinese have similar vertebral fracture prevalence but lower incidence of hip and distal forearm fractures than in Caucasians. The underlying structural and biomechanical basis of racial differences in bone fragility is still largely undefined but Chinese assemble their smaller appendicular skeleton with thicker cortices and trabeculae compared with Caucasians. Vertebral fracture prevalence is similar by race, but the incidence of hip and distal forearm fractures is lower in Chinese than in Caucasians. This racial dimorphism cannot be explained by differences in areal bone mineral density (aBMD) as aBMD is lower in Chinese mainly due to their smaller size. The underlying structural and biomechanical basis of racial differences in bone fragility is still largely undefined but Chinese assemble their smaller appendicular skeleton with more mineralised bone matrix within it; the cortices are thicker and perhaps less porous while trabeculae are fewer but thicker and more connected. This configuration produces a bone with a lower surface/volume ratio, which in turn reduces the surface available for remodelling to occur upon so that the lower surface/volume ratio may make the bone less exposed to remodelling and the thicker cortices and trabeculae less vulnerable to remodelling when it does occur during advancing age. However, prospective studies are needed to define racial differences at the age of onset, rate of bone loss from the intracortical, endocortical and trabecular components of the endosteal envelope and bone formation upon the periosteal envelope; notions of bone 'loss' are derived mainly from cross-sectional studies. Studies of the site- and surface-specific changes in bone modelling and remodelling are needed to better define racial differences in bone fragility in old age.
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Affiliation(s)
- X-F Wang
- Endocrine Centre, Austin Health, the University of Melbourne, PO Box 5444, West Heidelberg, 3081 Melbourne, Australia.
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20
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Jackowski SA, Kontulainen SA, Cooper DML, Lanovaz JL, Baxter-Jones ADG. The timing of BMD and geometric adaptation at the proximal femur from childhood to early adulthood in males and females: a longitudinal study. J Bone Miner Res 2011; 26:2753-61. [PMID: 21773991 DOI: 10.1002/jbmr.468] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
During adolescence, the peak velocity in bone mass accretion preceded the peak velocity of estimated geometry at the hip. Whether this pattern continues into adulthood when maximum values are achieved remains unknown. The purpose of this study was (1) to identify the ages at which peak values of areal BMD (aBMD), cross-sectional area (CSA), and section modulus (Z) occur, (2) to determine the percent of adult peak attained during adolescence, and (3) to determine the relationship between body composition and the timing of the adult peak values. One-hundred and sixty-five (92 females) individuals' aBMD, CSA, and Z values were assessed serially at the narrow neck (NN), intertrochanter (IT), and shaft (S) using hip structural analysis (HSA). Peak bone values and the ages of attainment were assessed using factorial MANOVA. In males, aBMDp (NN 19.4 ± 2.7 years, IT 20 ± 3.4 years, and S 21.8 ± 2.8 years) occurred significantly earlier than CSAp at all sites (NN 21.6 ± 3.2 years, IT 21.1 ± 3.4 years, and S 22.3 ± 3.1 years) and earlier than Zp at the NN (22 ± 3.2 years) and IT (21.3 ± 2.9 years). In females, aBMDp (NN 17.9 ± 2.7 years, IT 18.7 ± 3.5 years, and S 19.7 ± 3.3 years) occurred significantly earlier than CSAp at all sites (NN 20.6 ± 3.6 years, IT 19.4 ± 3.9 years, and S 21.0 ± 3.3 years) and earlier than Zp at the NN (20.7 ± 3.4 years) and S (20.6 ± 3.5 years). The changes in bone mass precede changes in geometric CSA, and this timing may be integral for the development and maintenance of bone strength.
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Affiliation(s)
- Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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21
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Zhang H, Hu YQ, Zhang ZL. Age trends for hip geometry in Chinese men and women and the association with femoral neck fracture. Osteoporos Int 2011; 22:2513-22. [PMID: 21210083 DOI: 10.1007/s00198-010-1479-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 10/25/2010] [Indexed: 11/29/2022]
Abstract
UNLABELLED Hip dual-energy X-ray absorptiometry (DXA) images were used to calculate hip bone mineral density (BMD) and hip geometry parameters of 18,502 healthy Chinese people (14,435 women and 4,067 men), 254 subjects sustained a femoral neck fracture and 254 age- and sex-matched controls. Our study showed that thinning of the cortical shell and deterioration of the strength index (SI) in femoral neck with aging in both Chinese men and women. SI may be a risk factor for hip fracture in Chinese women. INTRODUCTION The purpose of this study was to evaluate age-related trends in the hip geometry of healthy Chinese men and women and to examine whether changes in hip geometric parameters is one of the risk factors of hip fracture. METHODS We recruited 14,435 women and 4,067 men as the study population. There were 254 subjects (216 women, 38 men) who had sustained a femoral neck fracture; 254 age- and sex-matched healthy persons served as controls. Hip DXA images were used to calculate hip BMD and hip geometry parameters, including the hip axis length (HAL), cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), neck-shaft angle (NSA) and femoral SI. RESULTS Hip BMD, CSMI, CSA and SI showed significantly negative correlations with age. However, after adjustment for height and weight, HAL increased with age, and there was no strong correlation between CSMI and age in either sex. In both genders, hip BMD and CSA were significant lower in fracture cases compared with controls. After adjustment for hip BMD, in women only smaller SI (odds ratio [OR] 1.53; 95% confidence interval [CI], 1.04-2.26) was predictive of hip fracture but in men, none of the geometry parameters was associated with hip fracture risk. CONCLUSIONS This study demonstrated thinning of the cortical shell and deterioration of the resistance to bending and SI with aging in femoral neck in Chinese men and women. SI may be a risk factor for hip fracture that is independent of BMD measurement in Chinese women.
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Affiliation(s)
- H Zhang
- Department of Osteoporosis and Bone Diseases, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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