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Cao W, Ye J, Yan Y, Xu C, Lv Q. General practice management of chronic post-surgical pain in patients with hip fracture: a qualitative study. Front Med (Lausanne) 2024; 10:1304182. [PMID: 38288303 PMCID: PMC10823000 DOI: 10.3389/fmed.2023.1304182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/12/2023] [Indexed: 01/31/2024] Open
Abstract
Background Hip fractures are common among elderly people and often lead to chronic post-surgical pain (CPSP). Effective CPSP management when patients transition from hospital to community settings is essential, but has not been sufficiently researched. This study examined general practitioner (GP) perspectives on managing patients with CPSP after hip fractures in Shanghai, China. Methods A descriptive qualitative study was performed wherein semi-structured interviews were conducted with GPs practicing in Shanghai who volunteered to participate. This study was initiated after a regional survey of general practice care for patients with CPSP following hip fracture. Results Six key themes emerged: (1) GPs' care priorities for patients with CPSP varied; (2) pharmacological management posed challenges in terms of selecting appropriate medications; (3) consultation time constraints hindered comprehensive management; (4) GPs desired better communication from hospitals at discharge; (5) limited access to services, such as pain specialists and allied health, obstructed optimal care delivery; and (6) patient nonadherence to CPSP treatment was an issue. Conclusion Multiple patient-, provider-, and system-level factors affected GP care for patients with CPSP after hip fracture. Improved interdisciplinary communication and education on evidence-based CPSP guidelines are needed to address the knowledge gaps among GPs. Barriers to healthcare access must be minimized to facilitate guideline-based care.
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Affiliation(s)
- Wenshu Cao
- Tianlin Community Health Center of Xuhui District, Shanghai, China
| | - Jizhong Ye
- Tianlin Community Health Center of Xuhui District, Shanghai, China
| | - Yini Yan
- Tianlin Community Health Center of Xuhui District, Shanghai, China
| | - Cheng Xu
- Department of Anaesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Qiwei Lv
- Tianlin Community Health Center of Xuhui District, Shanghai, China
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Becerril DV, Dirschl DR. Team Approach: Organizing and Empowering Multidisciplinary Teams in Postfragility Fracture Care. JBJS Rev 2023; 11:01874474-202311000-00003. [PMID: 37972214 DOI: 10.2106/jbjs.rvw.23.00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
» Numerous healthcare roles can be valuable and effective participants in postfracture care programs (PFCPs) and can also serve effectively as program liaisons/champions.» Greatest success seems to have been achieved when a single entity provides cohesive and consistent training, coordination, shared goals, and accountability for program sites and site leaders.» Few PFCPs have solved what seems to be the fundamental challenge of such programs: how to maintain program effectiveness and cohesion when the patient makes the inevitable transition from acute care to primary care? Creating a partnership with shared goals with primary care providers is a challenge for every program in every location.» Programs located in the United States, with its predominantly "open" healthcare system, seem to lag other parts of the world in overcoming this fundamental challenge.» It is hoped that all PFCPs in all systems can learn from the successes of other programs in managing this critical transition from acute to primary care.
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Affiliation(s)
- Daniela Varona Becerril
- División de Ciencias de la Salud, Universidad Anáhuac Querétaro, Santiago de Querétaro, Mexico
| | - Douglas R Dirschl
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
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El Miedany Y, Hasab El Naby MM, Abu-Zaid MH, Mahran S, Eissa M, Saber HG, Tabra SA, Ibrahim RA, Galal S, Elwakil W. Post-fracture care program in Egypt: merging subsequent fracture prevention and improving patients’ outcomes—an initiative by the Egyptian Academy of Bone Health. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-023-00173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Abstract
Background
Despite the associated high prevalence of morbidity and mortality, osteoporotic fragility fractures remain underdiagnosed and undertreated. Furthermore, those who sustain a fragility fracture are at imminent risk of sustaining subsequent fractures. Post-fracture care (PFC) programs are systematic, coordinated care programs that recognize, evaluate, and manage older adults who sustained a fragility fracture with the goal of managing all the risk factors and preventing succeeding fractures.
Main text
This work was carried out to outline the PFC program adopted in Egypt and its applicability in standard clinical practice. A review of literature was conducted to identify an evidence-informed PFC strategies and protocols, which outlines the optimal manner to manage older adults living with fragility fractures. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to guide the reporting of this review. Based on this, a PFC integrated model of care based on a patient-centered approach has been developed aiming to optimize the outcomes.
Conclusion
This manuscript described the integrated model of care adopted in Egypt to provide care for older adults presenting with fragility fractures. This will pave the way to standardize patient identification and management. Additionally, to prevent occurrence of subsequent fractures and to enhance equity of care for patients with fragility fracture and osteoporosis, expansion of such service to rural and remote areas is highly recommended.
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Kim SJ, Kim JW, Lee DW. Denosumab versus zoledronic acid in elderly patients after hip fracture. J Orthop Surg (Hong Kong) 2022; 30:10225536221147082. [PMID: 36541833 DOI: 10.1177/10225536221147082] [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] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Two injectable anti-osteoporosis medications, denosumab and zoledronic acid, have been widely used to treat patients with severe osteoporosis. The purpose of this study was to evaluate the real-world effectiveness and adherence of denosumab compared to zoledronic acid in geriatric patients after a hip fracture. METHODS A total of 282 patients treated with osteoporotic hip fracture between March 2014 and Aug 2022 were retrospectively reviewed. The patients were asked to select the anti-osteoporosis medication after surgery. Treatment persistence was monitored by follow-up visit to the outpatient clinic at postoperative 2 years. RESULTS Of 282 individuals with baseline data, 162 patients took subcutaneous denosumab and 120 patients took intravenous zoledronic acid. At postoperative 2 years, the change in bone mineral density (BMD) from baseline was greater in the denosumab group compared with the zoledronic acid group (p < 0.001). The rate of persistence to denosumab was significantly higher than that for 12-months zoledronic acid (p = 0.01). Serious adverse events were similar in the two groups. CONCLUSIONS Our study revealed the effectiveness and patients' persistence for two commonly used anti-osteoporosis agents after hip fracture. In this frail, elderly population, half-yearly denosumab was superior to yearly zoledronic acid in BMD and demonstrated significant higher persistence rate, indicating a potential therapeutic advantage that warrants further validation.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, 371135Hanil General Hospital, Dobong-gu, Republic of Korea
| | - Ji Woon Kim
- Department of Orthopaedics, 371135Hanil General Hospital, Dobong-gu, Republic of Korea
| | - Dong-Woo Lee
- Department of Orthopaedics, 371135Hanil General Hospital, Dobong-gu, Republic of Korea
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Lin AG, Shaheen N, Ganda K, Cullen J, Waite LM, Seibel MJ. Improving osteoporosis treatment rates in inpatients admitted with hip fracture: A healthcare improvement initiative in a tertiary referral hospital. Aging Med (Milton) 2022; 5:264-271. [PMID: 36606266 PMCID: PMC9805288 DOI: 10.1002/agm2.12229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/23/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022] Open
Abstract
Objective This healthcare improvement initiative was designed to increase inpatient osteoporosis treatment after hip fracture. Methods A new protocol was developed by Geriatric Medicine and Endocrinology departments at a tertiary care hospital in Sydney. Its aim was to standardize assessment and treatment of osteoporosis in patients admitted with hip fracture. Eligible inpatients would receive intravenous zoledronic acid during their admission. A 6-month sample of hip fracture patients admitted after the protocol's implementation was compared to a group admitted before. Data collected included demographics, biochemistry, treatment rates, adverse effects, and admission survival. Results There was a considerable increase in osteoporosis treatment after introducing the protocol. Before the protocol's introduction, none of 36 eligible patients received treatment. After the intervention 79% (23 out of 29) of eligible patients were treated.All treated patients had renal function and serum calcium levels checked post-infusion with no adverse outcomes. Eight patients developed flu-like symptoms within 24 h of the infusion. There were no instances of arrhythmias, ocular inflammation, or death. The cost per patient treated was AUD $87. Conclusion Adopting a standardized protocol for osteoporosis treatment in patients admitted for hip fracture was effective in improving treatment rates whilst being relatively safe and inexpensive.
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Affiliation(s)
- Andrew Gan Lin
- Department of EndocrinologyConcord HospitalConcordNew South WalesAustralia
| | - Nargis Shaheen
- Centre for Education and Research on Ageing (CERA), Department of Geriatric MedicineConcord HospitalConcordNew South WalesAustralia
| | - Kirtan Ganda
- Department of EndocrinologyConcord HospitalConcordNew South WalesAustralia
- Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - John Cullen
- Centre for Education and Research on Ageing (CERA), Department of Geriatric MedicineConcord HospitalConcordNew South WalesAustralia
- Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Louise M. Waite
- Centre for Education and Research on Ageing (CERA), Department of Geriatric MedicineConcord HospitalConcordNew South WalesAustralia
- Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Markus J. Seibel
- Department of EndocrinologyConcord HospitalConcordNew South WalesAustralia
- Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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González-Quevedo D, Pérez-Del-Río V, Moriel-Garceso D, Fernández-Arroyabe N, García-Meléndez G, Montañez-Ruiz M, Bravo-Bardají M, García-de-Quevedo D, Tamimi I. A 2-year follow-up of a novel Fracture Liaison Service: can we reduce the mortality in elderly hip fracture patients? A prospective cohort study. Osteoporos Int 2022; 33:1695-1702. [PMID: 35357521 PMCID: PMC8967686 DOI: 10.1007/s00198-022-06298-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
Abstract
UNLABELLED Osteoporosis is an underdiagnosed disease that results in bone fragility and risk of fractures. Fracture Liaison Service (FLS) is a secondary prevention model which identifies patients at risk for fragility fractures. The introduction of a FLS protocol showed an increase of anti-osteoporotic drug prescription and significant reduction of all-cause mortality. INTRODUCTION Hip fractures are the most severe osteoporotic fracture due to their associated disability and elevated risk of mortality. FLS programs have enhanced the management of osteoporosis-related fractures. Our objective is to analyze the effect of the FLS model over survival and 2-year mortality rate following a hip fracture. METHODS We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture during 3 consecutive years, before and after the implementation of the FLS in our center (i.e., between January 2016 and December 2018). Patients' information was withdrawn from our local computerized database. Patients were followed for 2 years after the hip fracture. Mortality and re-fracture rates were compared between the two groups using a multivariate Cox proportional hazard model. RESULTS A total of 1101 patients were included in this study (i.e., 357 before FLS implementation and 744 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation (583 (78.4%) vs 44 (12.3%); p < 0.01). There was an increase of adherence to treatment after FLS implementation (227 (38.9%) vs 12 (3.3%); p = 0.03). A total of 222 (29.8%) patients after FLS implementation and 114 (31.9%) individuals before FLS implementation (p = 0.44) died during the follow-up period. A second fracture occurred in 49 (6.6%) patients after FLS implementation and in 26 (7.3%) individuals before FLS implementation (p = 0.65). Patients who were treated with anti-osteoporotic drugs after the implementation of the FLS protocol had a lower all-cause 1-year and 2-year mortality compared with patients managed before the implementation of the FLS protocol (adjusted hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.59-0.96; HR 0.87, 95% CI 0.69-1.09, respectively). CONCLUSIONS The implementation of a FLS protocol was associated with an increase of anti-osteoporotic treatment, higher adherence, and greater survival in elderly hip fracture patients. There was a significant reduction of all-cause mortality in the FLS patients treated with anti-osteoporotic. However, the application of the FLS did not affect the risk of suffering a second fragility fracture.
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Affiliation(s)
- D González-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain.
- School of Medicine, University of Málaga, Málaga, Spain.
| | - V Pérez-Del-Río
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - D Moriel-Garceso
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - N Fernández-Arroyabe
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - G García-Meléndez
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - M Montañez-Ruiz
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - M Bravo-Bardají
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - D García-de-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
| | - I Tamimi
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Carlos Haya Avenue, 29010, Málaga, Spain
- School of Medicine, University of Málaga, Málaga, Spain
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Åkesson KE, Ganda K, Deignan C, Oates MK, Volpert A, Brooks K, Lee D, Dirschl DR, Singer AJ. Post-fracture care programs for prevention of subsequent fragility fractures: a literature assessment of current trends. Osteoporos Int 2022; 33:1659-1676. [PMID: 35325260 PMCID: PMC8943355 DOI: 10.1007/s00198-022-06358-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/18/2022] [Indexed: 01/07/2023]
Abstract
Post-fracture care (PFC) programs evaluate and manage patients with a minimal trauma or fragility fracture to prevent subsequent fractures. We conducted a literature review to understand current trends in PFC publications, evaluate key characteristics of PFC programs, and assess their clinical effectiveness, geographic variations, and cost-effectiveness. We performed a search for peer-reviewed articles published between January 2003 and December 2020 listed in PubMed or Google Scholar. We categorized identified articles into 4 non-mutually exclusive PFC subtopics based on keywords and abstract content: PFC Types, PFC Effectiveness/Success, PFC Geography, and PFC Economics. The literature search identified 784 eligible articles. Most articles fit into multiple PFC subtopics (PFC Types, 597; PFC Effectiveness/Success, 579; PFC Geography, 255; and PFC Economics, 98). The number of publications describing how PFC programs can improve osteoporosis treatment rates has markedly increased since 2003; however, publication gaps remain, including low numbers of publications from some countries with reported high rates of osteoporosis and/or hip fractures. Fracture liaison services and geriatric/orthogeriatric services were the most common models of PFC programs, and both were shown to be cost-effective. We identified a need to expand and refine PFC programs and to standardize patient identification and reporting on quality improvement measures. Although there is an increasing awareness of the importance of PFC programs, publication gaps remain in most countries. Improvements in established PFC programs and implementation of new PFC programs are still needed to enhance equitable patient care to prevent occurrence of subsequent fractures.
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Affiliation(s)
- K E Åkesson
- Faculty of Medicine, Lund University, Malmö, Sweden.
- Department of Orthopedics, Skåne University Hospital, Inga Marie Nilssons gata 22, S-205 02, Malmö, Sweden.
| | - K Ganda
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Endocrinology, Concord Repatriation General Hospital, Sydney, Australia
| | - C Deignan
- Global Clinical Development, Amgen Inc., CA, Thousand Oaks, USA
| | - M K Oates
- Global Clinical Development, Amgen Inc., CA, Thousand Oaks, USA
| | - A Volpert
- BioScience Communications, New York, NY, USA
| | | | - D Lee
- Global Marketing, Amgen Inc., Thousand Oaks, CA, USA
- Health Collaboration Partners LLC, Thousand Oaks, CA, USA
| | - D R Dirschl
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - A J Singer
- Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA
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Wu H, Yang S, Xiao J, Ouyang Z, Yang M, Zhang M, Zhao D, Huang Q. Facile synthesis of multi-functional nano-composites by precise loading of Cu 2+ onto MgO nano-particles for enhanced osteoblast differentiation, inhibited osteoclast formation and effective bacterial killing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 130:112442. [PMID: 34702527 DOI: 10.1016/j.msec.2021.112442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Biomaterials with multi-functions including enhancing osteogenesis, inhibiting osteoclastogenesis and effectively removing bacteria are urgently needed in the treatment of osteoporotic bone defects. In this study, MgO nano-particles were employed as a platform for precise Cu2+ loading. By immersing MgO into CuSO4 solution with a pre-defined concentration (0.1, 1 or 10 mM), 1 mg MgO adsorbed 3.25, 32.5 or 325 μg Cu2+ from the solution. As-synthesized nano-composites were referred as MgO-0.1Cu, MgO-1Cu or MgO-10Cu depending on the concentration of employed CuSO4 solution. The results revealed that MgO-xCu (x = 0.1, 1 and 10) nano-composites were lamella-shaped and composed of amorphous Cu(OH)2, crystalline Mg(OH)2 and minor MgO. The extracellular release of Cu2+ was rather limited due the capture of Cu2+ by Mg(OH)2. In vitro results revealed that MgO-xCu (x = 0.1, 1 and 10) nano-composites modulated osteoblast, osteoclast and bacterium response in a Cu2+ loading amount-dependent manner. MgO-0.1Cu nano-composite exhibited stimulatory function on osteoblast proliferation without influencing osteoblast maturation, osteoclast formation and bacterial survival. MgO-1Cu nano-composite enhanced osteoblast proliferation and differentiation, inhibited osteoclast formation and effectively killed bacteria. When larger amount of Cu2+ was loaded, MgO-10Cu nano-composite exhibited stronger stimulatory effect on osteoblast maturation, enhanced inhibitory function on osteoclast formation and promoted bactericidal performance, although it showed a certain degree of initial cyto-toxicity. Together, the results suggest that MgO nano-particles could be employed as potential platform for precise Cu2+ loading and intracellular Cu2+ delivery. MgO-xCu (x = 1 and 10) nano-composites are promising to be employed as multi-functional fillers in bone tissue engineering scaffolds for osteoporotic bone regeneration.
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Affiliation(s)
- Hong Wu
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Si Yang
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhengxiao Ouyang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Minghua Yang
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Mingming Zhang
- Department of Neurosurgery, The Second Xiangya Hospital, Central South University. Changsha 410013, China
| | - Dapeng Zhao
- College of Biology, Hunan University, Changsha 410082, China
| | - Qianli Huang
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China; Foshan (Southern China) Institute for New Materials, Foshan 528200, China.
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Gao Y, Liu X, Gu Y, Song D, Ding M, Liao L, Wang J, Ni J, He G. The Effect of Bisphosphonates on Fracture Healing Time and Changes in Bone Mass Density: A Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:688269. [PMID: 34526966 PMCID: PMC8435630 DOI: 10.3389/fendo.2021.688269] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/03/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Osteoporosis is a common complication of acute fracture, which can lead to fracture delayed union or other complications and resulting in poor fracture healing. Bisphosphate is a common anti-osteoporosis drug, but its application in fracture patients is still controversial because of its inhibitory effect on bone resorption. METHOD Studies were acquired from literature databases in accordance with established inclusion criteria. Standard mean difference (SMD) and 95% confidence intervals (Cls) were calculated to evaluate the effectiveness of the bisphosphonates treatment in fracture patients. Data analysis was conducted with the Review Manager 5.4.1 software. RESULTS A total of 16 studies involving 5022 patients obtained from selected databases were examined. As expected, bisphosphate had no significant effect on fracture healing time, but it could significantly increase BMD and prevent osteoporosis. Meanwhile, bisphosphate can inhibit both bone resorption and bone formation markers, resulting in low bone turnover state. CONCLUSION This meta-analysis showed that bisphosphonate have no significant effect on fracture healing time but they do increase the changes in BMD and reduce bone synthesis and resorption markers. Early application of bisphosphonates after injury in the appropriate patient population should be considered.
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Affiliation(s)
- Yongquan Gao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaochen Liu
- Department Radiology, University of Toledo Medical Center, Toledo, OH, United States
| | - Yuan Gu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Deye Song
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Muliang Ding
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lele Liao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Junjie Wang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiangdong Ni
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guangxu He
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
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Hopkins RE, Warner V, Sztal‐Mazer S, Poole S, Page A. The assessment and pharmacological management of osteoporosis after admission for minimal‐trauma fracture at a major metropolitan centre. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ria E. Hopkins
- Pharmacy Department Alfred Health Melbourne Australia
- Department of Epidemiology and Preventative Medicine Monash University Melbourne Australia
- Centre for Medicine Use and Safety Monash University Melbourne Australia
| | | | - Shoshana Sztal‐Mazer
- Department of Endocrinology and Diabetes Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - Susan Poole
- Pharmacy Department Alfred Health Melbourne Australia
- Centre for Medicine Use and Safety Monash University Melbourne Australia
| | - Amy Page
- Pharmacy Department Alfred Health Melbourne Australia
- Centre for Medicine Use and Safety Monash University Melbourne Australia
- Centre for Optimisation of Medicine University of Western Australia Perth Australia
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11
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Factors Affecting Persistent Postoperative Pain in Patients with Hip Fractures. Pain Res Manag 2020; 2020:8814290. [PMID: 33204378 PMCID: PMC7657670 DOI: 10.1155/2020/8814290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
Abstract
Osteoporotic fractures are common among older people, and hip fractures (HF) can be devastating. Surgery is indicated for most cases of HF, and chronic persistent postoperative pain is likely to occur. This study investigated the multifaceted factors related to persistent pain occurring during the acute phase and subacute phase of recovery after HF surgery. We conducted a prospective 8-week study of older HF patients after surgery. We evaluated pain intensity, depression symptoms, the fear of falling, pain catastrophizing, cognition and attention, the ability to perform activities of daily living, and the physical performance at 2 weeks (acute phase) and at 4 weeks (subacute phase) after surgery. Patients were divided into the light group (Verbal Rating Scale (VRS) score ≤1) and severe group (VRS score ≥2) according to pain intensity at 8 weeks (recovery phase) after surgery. Factors affecting persistent postoperative pain during recovery were examined using logistic regression analysis. Seventy-two patients were analyzed: 50 in the light group and 22 in the severe group. In the severe group, pain with movement and Pain Catastrophizing Scale scores were higher than those of the light group at 2 weeks and at 4 weeks after surgery. The regression analysis showed that pain with movement at 2 weeks and at 4 weeks after surgery and pain catastrophizing at 4 weeks after surgery were related to persistent postoperative pain. HF patients may have persistent pain if they continue to experience pain and catastrophize their pain during the acute phase and subacute phase after surgery.
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12
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Wind LS, Knight TG, Auten JJ, Bates JS, Marucci L, Creedle CJ, Foster MC, Muluneh B. Evaluation and optimization of a clinical pharmacist driven transitions of care model for malignant hematology. J Oncol Pharm Pract 2020; 27:283-287. [PMID: 32290764 DOI: 10.1177/1078155220916516] [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: 11/16/2022]
Abstract
PURPOSE To implement and optimize a pilot transitions of care model for scheduled chemotherapy admissions in patients with hematologic malignancies at our institution.Methodology: We utilized the plan-do-study-act (PDSA) quality improvement technique to prospectively measure success of interventions related to improving transitions of care processes that occurred in multiple stages including development of standardized operating procedures, electronic medical record documentation, and education to the malignant hematology multidisciplinary group. Chart review was performed retrospectively for at least nine patients per PDSA cycle. Areas of intervention addressed and measured regarding communication between the ambulatory care and acute care settings included: admission purpose, processes related to insurance benefits investigations for specialty medications required in the post-discharge setting, and plan for growth factors, prophylactic antimicrobials, and follow-up.Results and conclusions: We included 28 patients and performed a total of three PDSA cycles demonstrating specific improvements in: communication regarding status of benefits investigations performed for specialty medications prior to admission, resolution of these benefits investigations at various time points, improvement in efficient use of the electronic medical record for chemotherapy orders, and patient instructions for appropriate use of prophylactic antimicrobials. Although improvement was noted initially with prescribing of discharge antiemetics and antimicrobials, regression to baseline was noted with the third PDSA cycle.
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Affiliation(s)
- Lucas S Wind
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | | | - Jessica J Auten
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jill S Bates
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Leonardo Marucci
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Crista J Creedle
- Division of Nursing, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Matthew C Foster
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benyam Muluneh
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
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13
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Behanova M, Reichardt B, Stamm TA, Zwerina J, Klaushofer K, Kocijan R. Treatment Effects of Bisphosphonates and Denosumab on Survival and Refracture from Real-World Data of Hip-Fractured Patients. Calcif Tissue Int 2019; 105:630-641. [PMID: 31531720 DOI: 10.1007/s00223-019-00611-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022]
Abstract
We examined differences in patients' survival after hip fracture (HF) and risk for subsequent HF among patients treated with oral and intravenous bisphosphonates (oBPs, iBPs), denosumab (DMAB), and patients without therapy. We used data from all patients in Austria aged ≥ 50 who sustained a HF between 2012 and 2017 and were followed for a subsequent HF and all-cause mortality until 2017. Antiosteoporotic treatment-naïve patients, who were incident users of BPs and DMAB, were eligible for propensity score matching 1:1 to obtain comparable user groups. We applied competing risk approach and calculated cumulative incidence functions and subdistribution-hazards for refracture. Cox regression models were applied for mortality risk. A total of 54,145 hip-fractured patients were observed (1919 oBPs; 1870 iBPs; 555 DMAB users; and 42,795 untreated patients were included in the matched sets) and followed up for a median (interquartile range) of 22.6 months (26.2). Patients treated with antiresorptive medications had significantly longer survival time than patients without treatment. Receiving treatment significantly decreased a hazard of dying only for women by 17% for iBPs (HR 0.83, 95% CI 0.71-0.98, p = 0.023). For DMAB and oBPs, the results were not statistically significant. Higher risk of a subsequent HF was observed in women on DMAB (SHR 1.77, 95% CI 1.08-2.91) and on iBP (SHR 1.81, 95% CI 1.35-2.41), and in men on oBPs (SHR 2.89, 95% CI 1.58-5.30). Patients who were treated with antiresorptive medications after HF had longer survival than patients without treatment, highlighting the importance of initiation of antiresorptive treatment after HF.
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Affiliation(s)
- Martina Behanova
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria.
| | - Berthold Reichardt
- Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Siegfried Marcus Straße 5, 7000, Eisenstadt, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1st Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria
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14
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Sheikh Z, Chen G, Al-Jaf F, Thévenin M, Banks K, Glogauer M, Young RN, Grynpas MD. In Vivo Bone Effects of a Novel Bisphosphonate-EP4a Conjugate Drug (C3) for Reversing Osteoporotic Bone Loss in an Ovariectomized Rat Model. JBMR Plus 2019; 3:e10237. [PMID: 31844825 PMCID: PMC6894726 DOI: 10.1002/jbm4.10237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 01/30/2023] Open
Abstract
Pathological bone loss is a regular feature of postmenopausal osteoporosis, and the microstructural changes along with the bone loss make the individual prone to getting hip, spine, and wrist fractures. We have developed a new conjugate drug named C3, which has a synthetic, stable EP4 agonist (EP4a) covalently linked to an inactive alendronate (ALN) that binds to bone and allows physiological remodeling. After losing bone for 12 weeks, seven groups of rats were treated for 8 weeks via tail‐vein injection. The groups were: C3 conjugate at low and high doses, vehicle‐treated ovariectomy (OVX) and sham, C1 (a similar conjugate, but with active ALN at high dose), inactive ALN alone, and a mixture of unconjugated ALN and EP4a to evaluate the conjugation effects. Bone turnover was determined by dynamic and static histomorphometry; μCT was employed to determine bone microarchitecture; and bone mechanical properties were evaluated via biomechanical testing. Treatment with C3 significantly increased trabecular bone volume and vertebral BMD versus OVX controls. There was also significant improvement in the vertebral load‐bearing abilities and stimulation of bone formation in femurs after C3 treatment. This preclinical research revealed that C3 resulted in significant anabolic effects on trabecular bone, and EP4a and ALN conjugation components are vital to conjugate anabolic efficacy. A combined therapy using an EP4 selective agonist anabolic agent linked to an inactive ALN is presented here that produces significant anabolic effects, allows bone remodeling, and has the potential for treating postmenopausal osteoporosis or other diseases where bone strengthening would be beneficial. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Zeeshan Sheikh
- Lunenfeld-Tanenbaum Research Institute Mount Sinai Hospital Toronto Ontario Canada.,Department of Laboratory Medicine and Pathology University of Toronto Toronto Ontario Canada.,Faculty of Dentistry University of Toronto Toronto Ontario Canada.,Faculty of Dentistry Dalhousie University Halifax Nova Scotia Canada
| | - Gang Chen
- Department of Chemistry Simon Fraser University Burnaby British Columbia Canada
| | - Faik Al-Jaf
- Faculty of Dentistry University of Toronto Toronto Ontario Canada
| | - Marion Thévenin
- Department of Chemistry Simon Fraser University Burnaby British Columbia Canada
| | - Kate Banks
- Division of Comparative Medicine University of Toronto Toronto Ontario Canada.,Department of Physiology University of Toronto Toronto Ontario Canada
| | - Michael Glogauer
- Faculty of Dentistry University of Toronto Toronto Ontario Canada.,Department of Dental Oncology and Maxillofacial Prosthetics Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Robert N Young
- Department of Chemistry Simon Fraser University Burnaby British Columbia Canada
| | - Marc D Grynpas
- Lunenfeld-Tanenbaum Research Institute Mount Sinai Hospital Toronto Ontario Canada.,Department of Laboratory Medicine and Pathology University of Toronto Toronto Ontario Canada.,Institute of Biomaterials and Biomedical Engineering University of Toronto Toronto Ontario Canada
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15
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Spechbach H, Fabreguet I, Saule E, Hars M, Stirnemann J, Ferrari S, Rizzoli R, Chevalley T. Higher rates of osteoporosis treatment initiation and persistence in patients with newly diagnosed vertebral fracture when introduced in inpatients than later in outpatients. Osteoporos Int 2019; 30:1353-1362. [PMID: 30820609 DOI: 10.1007/s00198-019-04900-3] [Citation(s) in RCA: 4] [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: 09/19/2018] [Accepted: 02/12/2019] [Indexed: 01/02/2023]
Abstract
UNLABELLED Whether in-hospital management of patients with newly identified vertebral fractures leads to a higher rate of osteoporosis medication than delayed outpatient management remains unknown. Our study showed that early osteoporosis therapy initiation in a fracture liaison service during hospital stay was a more efficacious strategy for secondary fracture prevention. INTRODUCTION Fracture liaison services are standard care for secondary fracture prevention. A higher rate of osteoporosis treatment initiation may be considered when introduced in the hospital rather than an outpatient recommendation to a primary care physician (PCP). Whether this applies to patients with newly detected vertebral fractures in a general internal medicine ward remains unknown. We prospectively investigated whether in-hospital management of newly identified vertebral fractures led to a higher rate of osteoporosis medication initiation and persistence at 3 and 6 months than delayed outpatient management by a PCP. METHODS We conducted a prospective study including hospitalized patients > 60 years systematically searched for asymptomatic vertebral fractures on lateral chest and/or abdominal radiographs. Patients were included either in phase 1 (outpatient care recommendations on osteoporosis management to a PCP) or in phase 2 (inpatient care management initiated during hospitalization). The percentage of patients under osteoporosis treatment was evaluated by telephone interview at 3 and 6 months. RESULTS Outpatients' (84 with fracture/407 assessed (21%); 75.7 ± 7.7 years) and inpatients' (100/524 (19%); 77.8 ± 9.4 years) characteristics were similar. Osteoporosis medication was more often prescribed in inpatients at 3 (67% vs. 19%, respectively; p < 0.001) and 6 months (69 vs. 27%, respectively; p < 0.001). The percentage under treatment was also higher in inpatients than in outpatients at 3 (52 vs. 19%, p < 0.001) and 6 months (54 vs. 22%, p < 0.001). Length of stay and destination post-discharge were not different between groups. CONCLUSIONS Early patient management after a newly detected vertebral fracture during hospitalization was a more efficacious strategy of secondary fracture prevention than delayed outpatient management following discharge.
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Affiliation(s)
- H Spechbach
- Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, CH - 1205, Geneva, Switzerland
| | - I Fabreguet
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, CH - 1205, Geneva, Switzerland
| | - E Saule
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, CH - 1205, Geneva, Switzerland
| | - M Hars
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, CH - 1205, Geneva, Switzerland
| | - J Stirnemann
- Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, CH - 1205, Geneva, Switzerland
| | - S Ferrari
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, CH - 1205, Geneva, Switzerland
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, CH - 1205, Geneva, Switzerland
| | - T Chevalley
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, CH - 1205, Geneva, Switzerland.
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16
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Wan Q, Zhang Q, Zhang Y, Liu Y, Yang X. [Effectiveness comparison between proximal femoral nail anti-rotation and proximal femoral locking compression plate for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 32:1411-1416. [PMID: 30417616 DOI: 10.7507/1002-1892.201805073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction. Methods The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups ( P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared. Results Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant ( P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant ( t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups ( χ 2=2.053, P=0.152). At 6 months after operation, the Harris total score and individual scores in the PFNA group were higher than those in the PFLCP group ( P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group ( P>0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group ( t=4.112, P=0.000). Conclusion For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.
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Affiliation(s)
- Qian Wan
- Department of Traumatic Orthopedics, the Affiliated Hospital of Chengde Medical University, Chengde Hebei, 067000, P.R.China
| | - Qingzhu Zhang
- Department of Traumatic Orthopedics, the Affiliated Hospital of Chengde Medical University, Chengde Hebei, 067000,
| | - Yi Zhang
- Department of Traumatic Orthopedics, the Affiliated Hospital of Chengde Medical University, Chengde Hebei, 067000, P.R.China
| | - Yuexing Liu
- Department of Traumatic Orthopedics, the Affiliated Hospital of Chengde Medical University, Chengde Hebei, 067000, P.R.China
| | - Xiaohua Yang
- Department of Traumatic Orthopedics, the Affiliated Hospital of Chengde Medical University, Chengde Hebei, 067000, P.R.China
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17
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Risk Factors for Poor Functional Recovery, Mortality, Recurrent Fractures, and Falls Among Patients Participating in a Fracture Liaison Service Program. J Am Med Dir Assoc 2019; 20:1129-1136.e1. [PMID: 30723057 DOI: 10.1016/j.jamda.2018.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/09/2018] [Accepted: 12/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A fracture liaison service (FLS) for patients with fractures is a promising approach for improving outcomes, but barriers to the successful implementation of an FLS remain. The factors influencing the outcomes of patients already receiving FLS care are unclear. DESIGN A prospective multicenter cohort study. SETTINGS AND PARTICIPANTS Patients with incident hip and clinical vertebral fractures treated at 2 institutions between January 2014 and June 2016 were prospectively enrolled. Demographic profiles, comorbidities, prior fracture experiences, T scores, Fracture Risk Assessment Tool (FRAX) scores, and serum markers were examined. MEASURES Self-reported functional status (at the 4th month), mortality, recurrent fractures, and falls (at the 2-year follow-up). RESULTS Of 712 patients screened for eligibility, 600 (84%) participants (age 78 ± 10 years) were enrolled in the FLS program. At 4 months, 58%, 53%, and 60% of the participants reported improved mobility, self-care, and daily activities after FLS care, respectively. After 2 years, 85 (14%) died, 36 (6%) developed recurrent fractures, and 199 (33%) had 1 or more fall episodes. Multivariate logistic regression showed that neurologic disorders, heart disease, and diabetes were associated with a decreased probability of functional recovery. Cox regression showed that older age and chronic kidney disease (CKD) were predictive of increased mortality, whereas heart disease was correlated with an increased refracture risk. Older age and cancer or osteoarthritis were associated with a higher risk of falls. Importantly, a higher body mass index predicted a lower risk of mortality and a higher probability of improved self-care but a higher risk of fall at follow-up. CONCLUSIONS/IMPLICATIONS We discovered that comorbidities including CKD, heart disease, cancer, and osteoarthritis could influence short-term functional changes, survival, and the risk of refractures or falls among patients participating in FLSs. These factors are expected to aid in prognosis estimation and management planning for those with fractures.
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