1
|
Chang H, Luan C, Li C. Effect of Comprehensive Rehabilitation Training Based on Balance Function on Postoperative Recovery and Function of Hip Fracture in the Elderly: A Systematic Review and Meta-Analysis. Geriatr Orthop Surg Rehabil 2024; 15:21514593241261506. [PMID: 39086843 PMCID: PMC11289819 DOI: 10.1177/21514593241261506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction In China, the proportion of the elderly population is gradually increasing, followed by the increasing medical demands of elderly patients. Hip fracture is a common fracture in the elderly. The elderly are prone to serious postoperative complications, resulting in failure to restore normal hip function, which seriously affects patients' quality of life and further increases their mortality rate. Thus, hip fracture represents a remarkable public health issue within the realm of geriatric medical care. Significance This study systematically evaluated the impact of comprehensive rehabilitation training, with a focus on balance function, on elderly individuals with hip fractures' postoperative recovery and functional outcomes. Result Results showed a significant difference in BBS scores favoring comprehensive rehabilitation training based on balance function over conventional intervention. Similarly, AM-PAC scores favored the balance-focused training. TUTG meta-analysis indicated its adoption in comprehensive rehabilitation training. FIM scores showed improvement with balance-focused training. Harris score meta-analysis also favored this approach. A funnel plot analysis revealed potential publication bias, likely due to study heterogeneity and limited publications. Conclusions In conclusion, comprehensive rehabilitation training centered around balance function displayed clinical efficacy in enhancing postoperative hip joint function in elderly hip fracture patients. This approach improved balance, coordination, and posture control, facilitating lower limb function recovery and overall prognosis. It holds promise as a valuable treatment approach.
Collapse
Affiliation(s)
- Hai Chang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chunliang Luan
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chen Li
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
2
|
Betancur JF, Pérez LE, Bolaños-López JE, Bernal V. High and very high risk of osteoporotic fracture in Colombia, 2003-2022: identifying diagnostic and treatment gaps. Arch Osteoporos 2024; 19:52. [PMID: 38898155 DOI: 10.1007/s11657-024-01409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
This study examined the clinical characteristics and refracture rates of Colombian patients with high- and very high-risk osteoporosis. This reveals osteoporosis diagnoses and treatment gaps. Only 5.3% of the patients were diagnosed with osteoporosis at discharge and 70.5% had refractures. This finding underscores the need for national policies to enhance osteoporosis prevention and treatment. PURPOSE This study aimed to assess the clinical features and refracture rates among patients with high- and very-high-risk osteoporosis in Colombia, highlighting diagnostic and treatment gaps. METHODS A retrospective observational study was conducted using the medical records of patients aged ≥ 50 years who experienced fragility fractures between 2003 and 2022. Clinical and demographic characteristics at the time of the initial fracture were analyzed, as well as the subsequent imminent risk (refracture rate) and the diagnosis and treatment gap. RESULTS 303.982 fragility fractures occurred, and only 5.3% of patients were diagnosed with osteoporosis upon discharge. The most prevalent index fractures were forearm, vertebral, rib, and hip. Only 17.8% of the cohort had a matched osteoporosis diagnosis, indicating a low healthcare capture. Among the diagnosed patients, 10.08% were classified as high- and very high-risk of fracture, predominantly women with a mean age of 73 years. Comorbidities included diabetes, Sjögren's syndrome, and heart failure. The prevalence of osteoporosis has increased significantly from 2004 to 2022, possibly due to improved detection methods, an aging population, or a combination of both. Despite this increase, treatment delay was evident. Refractures affected 70.5% of the patients, with forearm, hip, humerus, and vertebral fractures being the most common, with a mean time of refracture of 7 months. CONCLUSION Significant delays were observed in the diagnosis and treatment of fragility fractures. Colombia's government and health system must address osteoporosis by implementing national policies that prioritize osteoporosis and fragility fracture prevention and reduce delays in diagnosis and treatment.
Collapse
Affiliation(s)
- Juan Felipe Betancur
- Internal Medicine Investigation Unit, Centro de Investigaciones Clínicas SURA, Medellín, Colombia.
| | - Luz Eugenia Pérez
- Gestora Metodológica Grupo de Investigación Clínica y Ensayos Clínicos SURA, Medellín, Colombia
| | | | - Verónica Bernal
- Investigation Unit, Grupo de Investigación Clínica y Ensayos Clínicos SURA, Medellín, Colombia
| |
Collapse
|
3
|
Luo ZQ, Huang YJ, Chen ZH, Lu CY, Zhou B, Gong XH, Shen Z, Wang T. A decade of insight: bibliometric analysis of gut microbiota's role in osteoporosis (2014-2024). Front Med (Lausanne) 2024; 11:1409534. [PMID: 38841589 PMCID: PMC11150527 DOI: 10.3389/fmed.2024.1409534] [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: 03/30/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Purpose Osteoporosis represents a profound challenge to public health, underscoring the critical need to dissect its complex etiology and identify viable targets for intervention. Within this context, the gut microbiota has emerged as a focal point of research due to its profound influence on bone metabolism. Despite this growing interest, the literature has yet to see a bibliometric study addressing the gut microbiota's contribution to both the development and management of osteoporosis. This study aims to fill this gap through an exhaustive bibliometric analysis. Our objective is to uncover current research hotspots, delineate key themes, and identify future research trends. In doing so, we hope to provide direction for future studies and the development of innovative treatment methods. Methods Relevant publications in this field were retrieved from the Web of Science Core Collection database. We used VOSviewer, CiteSpace, an online analysis platform and the R package "Bibliometrix" for bibliometric analysis. Results A total of 529 publications (including 351 articles and 178 reviews) from 61 countries, 881 institutions, were included in this study. China leads in publication volume and boast the highest cumulative citation. Shanghai Jiao Tong University and Southern Medical University are the leading research institutions in this field. Nutrients contributed the largest number of articles, and J Bone Miner Res is the most co-cited journal. Of the 3,166 scholars who participated in the study, Ohlsson C had the largest number of articles. Li YJ is the most co-cited author. "Probiotics" and "inflammation" are the keywords in the research. Conclusion This is the first bibliometric analysis of gut microbiota in osteoporosis. We explored current research status in recent years and identified frontiers and hot spots in this research field. We investigate the impact of gut microbiome dysregulation and its associated inflammation on OP progression, a topic that has garnered international research interest in recent years. Additionally, our study delves into the potential of fecal microbiota transplantation or specific dietary interventions as promising avenues for future research, which can provide reference for the researchers who focus on this research filed.
Collapse
Affiliation(s)
- Zhi Qiang Luo
- Department of Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Ya Jing Huang
- Department of Rheumatology, Kunming Municipal Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
| | - Ze Hua Chen
- Department of Orthopedics, The Orthopedics Hospital of Traditional Chinese Medicine, Zhuzhou, Hunan, China
| | - Chen Yin Lu
- Department of Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Biao Zhou
- Department of Orthopedics, The First People’s Hospital of Xiangtan City, Xiangtan, Hunan, China
| | - Xiang Hao Gong
- Department of Oncology, Hengyang Central Hospital, Hengyang, Hunan, China
| | - Zhen Shen
- Department of Rehabilitation, Kunming Municipal Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
| | - Tao Wang
- Department of Orthopedics, Kunming Municipal Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
4
|
Bowers KM, Anderson DE. Delayed Union and Nonunion: Current Concepts, Prevention, and Correction: A Review. Bioengineering (Basel) 2024; 11:525. [PMID: 38927761 PMCID: PMC11201148 DOI: 10.3390/bioengineering11060525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Surgical management of fractures has advanced with the incorporation of advanced technology, surgical techniques, and regenerative therapies, but delayed bone healing remains a clinical challenge and the prevalence of long bone nonunion ranges from 10 to 15% of surgically managed fractures. Delayed bone healing arises from a combination of mechanical, biological, and systemic factors acting on the site of tissue remodeling, and careful consideration of each case's injury-related, patient-dependent, surgical, and mechanical risk factors is key to successful bone union. In this review, we describe the biology and biomechanics of delayed bone healing, outline the known risk factors for nonunion development, and introduce modern preventative and corrective therapies targeting fracture nonunion.
Collapse
Affiliation(s)
| | - David E. Anderson
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, TN 37996-4550, USA;
| |
Collapse
|
5
|
Qi Z, Zhao S, Li H, Wen Z, Chen B. A study on vertebral refracture and scoliosis after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures. J Orthop Surg Res 2024; 19:302. [PMID: 38760662 PMCID: PMC11102204 DOI: 10.1186/s13018-024-04779-9] [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: 03/11/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE To analyze the association between scoliosis and vertebral refracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCFs). METHODS A retrospective study was conducted on 269 patients meeting the criteria from January 2014 to October 2022. All patients underwent PKP with complete data and were followed-up for > 12 months. First, it was verified that scoliosis was a risk factor in 269 patients. Second, patients with scoliosis were grouped based on the Cobb angle to evaluate the impact of the post-operative angle. The cox proportional hazards regression analysis and survival analysis were used to calculate the hazard ratio and recurrence time. RESULTS A total of 56 patients had scoliosis, 18 of whom experienced refractures after PKP. The risk factors for vertebral refractures included a T-score < - 3.0 and presence of scoliosis (both p < 0.001). The results indicated that the vertebral fractured arc (T10 - L4) was highly influential in scoliosis and vertebral fractures. When scoliotic and initially fractured vertebrae were situated within T10 - L4, the risk factors for vertebral refracture included a postoperative Cobb angle of ≥ 20° (p = 0.002) and an increased angle (p = 0.001). The mean recurrence times were 17.2 (10.7 - 23.7) months and 17.6 (7.9 - 27.3) months, respectively. CONCLUSION Osteoporosis combined with scoliosis significantly increases the risk of vertebral refractures after PKP in patients with OVCFs. A postoperative Cobb angle of ≥ 20° and an increased angle are significant risk factors for vertebral refractures when scoliotic and initially fractured vertebrae are situated within T10 - L4.
Collapse
Affiliation(s)
- Zhichao Qi
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shengli Zhao
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haonan Li
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhenxing Wen
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
- Department of Orthopaedic and Joint Surgery, Qingdao Municipal Hospital, No. 5 Donghai Middle Road, Shinan District, Qingdao City, Shandong Province, 266000, P. R. China.
| | - Bailing Chen
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
6
|
Zannetti EB, Cittadini N, Iovino P, De Maria M, D'Angelo D, Pennini A, Vellone E, Tarantino U, Alvaro R. Factors That Influence Quality of Life in Postmenopausal Osteoporotic Women With Nonvertebral Fractures: The Guardian Angel Multicenter Longitudinal Study. Orthop Nurs 2024; 43:151-157. [PMID: 38861745 DOI: 10.1097/nor.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
The knowledge of variables associated with quality of life in women with nonvertebral fractures is poor. The aim of this study was to examine the independent associations between sociodemographic and clinical factors, self-care, and quality of life in this specific population. We undertook a 3-year multicenter longitudinal study on a cohort of Italian postmenopausal osteoporotic women with three follow-ups at 1, 3, and 6 months. Nurses asked women to complete questionnaires on quality of life and self-care. The sample (n = 532) had a mean age of 74.78 years. The results showed that women taking more than two medications per day (p = .026) and those with nine or more years of education (p = .036) were more likely to exhibit better quality of life levels (p < .001) than their counterparts. Both self-care and quality of life scores improved over time in all participants. This study shows positive independent associations between quality of life and polypharmacy, education, and self-care behaviors, which were improved by educational interventions to attain a better quality of life in our participants.
Collapse
Affiliation(s)
- Emanuela Basilici Zannetti
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Noemi Cittadini
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Paolo Iovino
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Maddalena De Maria
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Daniela D'Angelo
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Annalisa Pennini
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Ercole Vellone
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Umberto Tarantino
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| | - Rosaria Alvaro
- Emanuela Basilici Zannetti, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-5330-9808 )
- Noemi Cittadini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0001-8862-6857 )
- Paolo Iovino, PhD, RN, Department of Health Sciences, University of Florence ( https://orcid.org/0000-0001-5952-881X )
- Maddalena De Maria, RN, MSN, PhD, Associate Professor of Nursing Science, Department of Life Health Sciences and Health Professions, Campus University, Rome, Italy https://orcid.org/0000-0003-0507-0158
- Daniela D'Angelo, PhD, RN, Research Nurse. Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi,12 00041 Albano Laziale ( https://orcid.org/0000-0001-9451-0885 )
- Annalisa Pennini, PhD, RN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-3676-5956 )
- Ercole Vellone, PhD, RN, FAAN, FESC, Associate Professor of Nursing, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy and Department of Nursing and Obstetrics, Wroclaw Medical University, Poland ( https://orcid.org/0000-0003-4673-7473 )
- Umberto Tarantino, PhD, MD, Department of Orthopaedics and Traumatology, Policlinic Tor Vergata Foundation, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0003-0330-2189 )
- Rosaria Alvaro, MSN, FESC, FAAN, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy ( https://orcid.org/0000-0002-4659-1569 )
| |
Collapse
|
7
|
De Mauro D, De Luca G, Marino S, Smakaj A, Rovere G, Liuzza F, Covino M, Fulignati P, Grandaliano G, El Ezzo O. Fragility Fractures in End-Stage Chronic Kidney Disease (CKD) Population: Patient-Related and CKD-Related Factor Analysis-A Single-Center Experience. J Clin Med 2024; 13:2430. [PMID: 38673703 PMCID: PMC11051570 DOI: 10.3390/jcm13082430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Chronic kidney disease (CKD) stands as a prevalent global health concern, and mineral and bone disease are among the most impactful consequences. A severe complication arising from mineral and bone disease is the occurrence of fragility fractures, which disproportionately affect individuals with CKD compared to the general population. The prevalence of these fractures impacts both survival rates and quality of life. The aims of this study are analyzing and identifying (i) patient-related risk factors and (ii) CKD-related risk factors to contribute to the development of preventive measures for fragility fractures for this population. Methods: A retrospective, single-center observational study was conducted, encompassing patient data from the years 2021 to 2023. Registry data were recorded, including patient-related and CKD-related data. Patients were interviewed about traumatological history, and their answers were recorded. Logistic regression analysis was employed to investigate the association between independent variables and dependent variables. Results: Eighty-four patients, with a mean age of 64.3 ± 15.2 years and a male percentage of 58.3%, were included in this study. Among them, 19.5% exhibited smoking habits. The mean Charlson Comorbidity Index was 3.06 ± 1.21. All patients were diagnosed with end-stage chronic kidney disease, with mean durations of 208 months from the diagnosis and 84.5 months from the beginning of dialysis. The logistic regression analysis, adjusted for age, sex, and CCI, revealed that smoking habits play a significant role as a risk factor for fragility fractures in lower limbs (p: 0.011 *). The incidence of fragility fractures increases directly proportionally to the time since diagnosis (p-value: 0.021 *) and the beginning of dialysis treatment (p-value: 0.001 *). Conclusions: Among patient-related factors, smoking habits seem to significantly affect lower-limb fracture rates (p < 0.05), whereas among CKD-related factors, time since CKD diagnosis and time since the beginning of dialysis treatment are directly related to higher risks of fragility fractures. No relevant correlations emerged in the studied treatments, except for a reduction in proximal femur fracture occurrence when patients underwent a combined treatment of a calcimimetic and a vitamin D analog.
Collapse
Affiliation(s)
- Domenico De Mauro
- Orthopedics and Traumatology Unit, Department of Ageing, Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00153 Rome, Italy
- Orthopedic Unit, Department of Public Health, “Federico II” University, 80138 Naples, Italy
| | - Gianmarco De Luca
- Nephrology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (P.F.)
| | - Silvia Marino
- Orthopedics and Traumatology Unit, Department of Ageing, Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00153 Rome, Italy
| | - Amarildo Smakaj
- Orthopedics and Traumatology Unit, Department of Ageing, Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00153 Rome, Italy
- Orthopedic and Traumatology Unit, “Tor Vergata” University, 00133 Rome, Italy
| | - Giuseppe Rovere
- Orthopedics and Traumatology Unit, Department of Ageing, Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00153 Rome, Italy
- Orthopedic and Traumatology Unit, “Tor Vergata” University, 00133 Rome, Italy
| | - Francesco Liuzza
- Orthopedics and Traumatology Unit, Department of Ageing, Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00153 Rome, Italy
| | - Marcello Covino
- Department of Emergency, Anesthesiological, and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Pierluigi Fulignati
- Nephrology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (P.F.)
| | - Giuseppe Grandaliano
- Nephrology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (P.F.)
| | - Omar El Ezzo
- Orthopedics and Traumatology Unit, Department of Ageing, Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 8, 00168 Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00153 Rome, Italy
| |
Collapse
|
8
|
Peng X, Xiao P, Liu Y, Huang T, Huang X, Xiao W, Deng S. Summary of best evidence for self-management in postoperative osteoporotic fracture patients. Int J Orthop Trauma Nurs 2024; 52:101060. [PMID: 37995574 DOI: 10.1016/j.ijotn.2023.101060] [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: 07/29/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
Osteoporotic fracture as a serious complication of osteoporosis which is usually treated surgically, and its recovery is closely related to one's own behavior and lifestyle, and is a long-term, complex management process that often requires the individual to self-manage many health-related factors. OBJECTIVE To gather and synthesize the most robust evidence regarding self-management in patients with postoperative osteoporotic fractures, in order to provide scientific, evidence-based guidance for clinical healthcare professionals to assist postoperative patients in self-management efforts, and to assist patients in optimizing their self-management practices and behavioral norms. METHODS Based on the "6 S" pyramid model of evidence resources (System, Summaries, Synopses of synthesis, Syntheses, Synopses of studies, Studies), we searched the Up To Date, BMJ Best Practice, The Cochrane Library, Australian Joanna Briggs Institute JBI Evidence-Based Medicine Center Healthcare Database, National Institute for Health and Clinical Excellence (NICE), Guidelines International Network (GIN), National Guideline Clearinghouse (NGC) and Scottish Intercollegiate Guide lines Network (SIGN), MedPulse, Embase, PubMed, CINAHL, Web of Science, SinoMed, Chinese Medical Journal Full Text Database, CNKI, Wanfang Data Knowledge Service Platform, and VIP database, etc, The search period for clinical decision-making, systematic evaluation, clinical guidelines, evidence summaries and expert consensus on self-management of postoperative osteoporotic fracture patients, and it was from the establishment of the database to 18 February 2023. To ensure the quality of the literature, three researchers strictly screened the literature according to the literature inclusion and exclusion criteria, and two or more researchers independently evaluated the quality of the included literature, and extracted and integrated the relevant evidence. RESULTS Thirteen documents were finally included, including 4 clinical practice guidelines, 5 expert consensus, 2 recommended practices, 1 systematic evaluation, and 1 clinical decision report. The research team summarized the evidence in 6 dimensions: multidisciplinary teamwork, management of daily living, management of treatment adherence, management of exercise, management of fall prevention and subsequent fracture, and management of emotions, and 33 pieces of evidence were extracted. CONCLUSION The study summarized 33 best evidence of self-management in postoperative osteoporotic fracture patients, which provides a scientific and reasonable self-management program for postoperative patients, and also provides important reference and information for clinical healthcare professionals to provide more comprehensive and scientific self-management health education to patients.
Collapse
Affiliation(s)
- Xiaoqiong Peng
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ping Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuanyuan Liu
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tianwen Huang
- Department of Bone Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Xiaomin Huang
- Department of Bone Tumor Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wanlian Xiao
- Department of Arthroplasty, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sijia Deng
- Department of Microtrauma Hand Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
9
|
She P, Huang C, Peng L, Yang J, Wang L, Liu Q, Tang H. The effects of osteoporosis education program for patients with fragility fracture in China. Int J Orthop Trauma Nurs 2024; 52:101064. [PMID: 37956632 DOI: 10.1016/j.ijotn.2023.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Pan She
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, No.87, Xiangya Road, Kaifu District, Changsha, 410008, Hunan, China; Orthopedics Department, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China.
| | - Chun Huang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, No.87, Xiangya Road, Kaifu District, Changsha, 410008, Hunan, China; Xiangya Nursing School, Central South University, No.172, Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China.
| | - Lingli Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, No.87, Xiangya Road, Kaifu District, Changsha, 410008, Hunan, China; Orthopedics Department, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China.
| | - Jiaqi Yang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, No.87, Xiangya Road, Kaifu District, Changsha, 410008, Hunan, China; Orthopedics Department, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China.
| | - Ling Wang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, No.87, Xiangya Road, Kaifu District, Changsha, 410008, Hunan, China; Orthopedics Department, Xiangya Hospital, Central South University, Changsha, 410008, Hunan province, China.
| | - Qingqing Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, No.87, Xiangya Road, Kaifu District, Changsha, 410008, Hunan, China; Xiangya Nursing School, Central South University, No.172, Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China.
| | - Hongying Tang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, No.87, Xiangya Road, Kaifu District, Changsha, 410008, Hunan, China.
| |
Collapse
|
10
|
Alito A, Fenga D, Portaro S, Leonardi G, Borzelli D, Sanzarello I, Calabrò RS, Milone D, Tisano A, Leonetti D. Early hip fracture surgery and rehabilitation. How to improve functional quality outcomes. A retrospective study. Folia Med (Plovdiv) 2023; 65:879-884. [PMID: 38351775 DOI: 10.3897/folmed.65.e99513] [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: 01/02/2023] [Accepted: 01/27/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Hip fractures are one of the major disability causes associated with a high morbidity and mortality rate. Early surgery and stable fixation could be associated with better pain control, possibly lower mortality rates, and early recovery of autonomy.
Collapse
|
11
|
Arachchilage Hasitha Maduranga Karunarathne W, Hyun Choi Y, Lee MH, Kang CH, Kim GY. Gamma-aminobutyric acid (GABA)-mediated bone formation and its implications for anti-osteoporosis strategies: Exploring the relation between GABA and GABA receptors. Biochem Pharmacol 2023; 218:115888. [PMID: 38084676 DOI: 10.1016/j.bcp.2023.115888] [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: 07/24/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023]
Abstract
Osteoporosis is a significant global health concern, linked to reduced bone density and an increased fracture risk, with effective treatments still lacking. This study explored the potential of gamma-aminobutyric acid (GABA) and its receptors as a novel approach to promote osteogenesis and address osteoporosis. GABA concentrations up to 10 mM were well-tolerated by MC3T3-E1 preosteoblast, stimulating osteoblast differentiation and mineralization in a concentration- and time-dependent manner. In vivo experiments with zebrafish larvae demonstrated the ability of GABA to improve vertebral formation and enhanced bone density, indicating the potential therapeutic value for osteoporosis. Notably, GABA countered the adverse effects of prednisolone on vertebral formation, bone density, and osteogenic gene expression in zebrafish larvae, suggesting a promising therapeutic solution to counteract corticosteroid-induced osteoporosis. Moreover, our study highlighted the involvement of GABA receptors in mediating the observed osteogenic effects. By using GABAA, GABAB, and GABAC receptor antagonists, we demonstrated that blocking these receptors attenuated GABA-induced osteoblast differentiation and vertebral formation in both MC3T3-E1 cells and zebrafish larvae, underscoring the importance of GABA receptor interactions in promoting bone formation. In conclusion, these findings underscore the osteogenic potential of GABA and its ability to mitigate the detrimental effects of corticosteroids on bone health. Targeting GABA and its receptors could be a promising strategy for the development of novel therapeutic interventions to address osteoporosis. However, further investigations are warranted to fully elucidate the underlying molecular mechanism of GABA and its clinical applications in treating osteoporosis.
Collapse
Affiliation(s)
| | - Yung Hyun Choi
- Department of Biochemistry, College of Korean Medicine, Dong-Eui University, Busan 47227, Republic of Korea
| | - Mi-Hwa Lee
- Nakdonggang National Institute of Biological Resources, Sangju 37242, Republic of Korea
| | - Chang-Hee Kang
- Nakdonggang National Institute of Biological Resources, Sangju 37242, Republic of Korea
| | - Gi-Young Kim
- Department of Marine Life Science, Jeju National University, Jeju 63243, Republic of Korea.
| |
Collapse
|
12
|
Barcelos A, Gonçalves J, Mateus C, Canhão H, Rodrigues AM. Costs of incident non-hip osteoporosis-related fractures in postmenopausal women from a payer perspective. Osteoporos Int 2023; 34:2111-2119. [PMID: 37596433 PMCID: PMC10651527 DOI: 10.1007/s00198-023-06881-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/28/2023] [Indexed: 08/20/2023]
Abstract
Osteoporosis-related fractures lead to high morbidity, mortality, and healthcare costs among post-menopausal women. This study showed that incident non-hip osteoporosis-related fractures are frequent among women aged 50 + in Portugal, leading to excessive healthcare costs of €74 million per year, in a conservative scenario. PURPOSE This study aimed to estimate the costs of incident non-hip osteoporosis-related fractures among postmenopausal women living in Portugal from a payer perspective. METHODS The study includes women ≥ 50 years old who participated in the baseline assessment (2011-2013) and the first follow-up wave (2013-2015) of the Epidemiology of Chronic Diseases cohort, a Portuguese community-based longitudinal prospective study (n = 2,762). Incident non-hip osteoporosis-related fractures were defined as any self-reported low impact non-hip fractures since baseline. Healthcare resource utilization during the year following fracture was obtained from an informal panel of experts. The amounts of resources used were multiplied by the national tariffs practiced in the National Health Service (NHS) to obtain the cost per patient in the year following a wrist, vertebral, or other site fracture, which was subsequently multiplied by the estimated annual number of incident fractures to obtain the total annual cost of incident non-hip osteoporosis-related fractures among postmenopausal women. RESULTS Each year approximately 5,000 wrist, 3,500 vertebral, and 39,000 other-site osteoporosis-related fractures occur in women aged 50 + in Portugal. Healthcare costs per patient in the year following fracture vary from €2,709.52 for vertebral fractures to €3,096.35 for other fractures. Non-hip incident osteoporosis-related fractures among 50 + women cost approximately €74 million per year. Among all healthcare services, physiotherapy represents the bulk of costs. CONCLUSIONS This study pinpoints the relevance of preventing non-hip osteoporosis-related fractures, as these cost about €74 million per year in direct healthcare costs, a substantial impact on the budget of the Portuguese NHS.
Collapse
Affiliation(s)
- Anabela Barcelos
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University of Lisbon, Lisbon, Portugal.
- EpiDoC Unit, CEDOC, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Rua Artur Ravara, Aveiro, 3814-501, Portugal.
| | - Judite Gonçalves
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University of Lisbon, Lisbon, Portugal.
- Nova School of Business and Economics, NOVA University of Lisbon, Lisbon, Portugal.
- School of Public Health, Department of Primary Care & Public Health, Imperial College London, Charing Cross Campus, London, W6 8RP, UK.
| | - Céu Mateus
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Helena Canhão
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University of Lisbon, Lisbon, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
- Rheumatology Unit, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Ana Maria Rodrigues
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University of Lisbon, Lisbon, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
- Rheumatology Unit, Hospital dos Lusíadas, Lisboa, Portugal
| |
Collapse
|
13
|
Zhu Y, Liu Y, Wang Q, Niu S, Wang L, Cheng C, Chen X, Liu J, Zhao S. Using machine learning to identify patients at high risk of developing low bone density or osteoporosis after gastrectomy: a 10-year multicenter retrospective analysis. J Cancer Res Clin Oncol 2023; 149:17479-17493. [PMID: 37897658 DOI: 10.1007/s00432-023-05472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Osteoporosis that emerges subsequent to gastrectomy poses a significant threat to the long-term health of patients. The primary objective of this investigation was to formulate a machine learning algorithm capable of identifying substantial preoperative, intraoperative, and postoperative risk factors. This algorithm, in turn, would enable the anticipation of osteoporosis occurrence after gastrectomy. METHODS This research encompassed a cohort of 1125 patients diagnosed with gastric cancer, including 108 individuals with low bone density or osteoporosis. A total of 40 distinct variables were collected, comprising patient demographics, pertinent medical history, medication records, preoperative examination attributes, surgical procedure specifics, and intraoperative details. Four distinct machine learning algorithms-extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor algorithm (KNN)-were employed to establish the predictive model. Evaluation of the models involved receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Shapley additive explanation (SHAP) was employed for visualization and analysis. RESULTS Among the four prediction models employed, the XGBoost algorithm demonstrated exceptional performance. The ROC analysis yielded excellent predictive accuracy, showcasing area under the curve (AUC) values of 0.957 and 0.896 for training and validation sets, respectively. The calibration curve further confirmed the robust predictive capacity of the XGBoost model. The DCA demonstrated a notably higher benefit rate for patients undergoing intervention based on the XGBoost model. Moreover, the AUC value of 0.73 for the external validation set indicated favorable extrapolation of the XGBoost prediction model. SHAP analysis outcomes unveiled numerous high-risk factors for osteoporosis development after gastrectomy, including a history of chronic obstructive pulmonary disease (COPD), inflammatory bowel disease (IBD), hypoproteinemia, postoperative neutrophil-to-lymphocyte ratio (NLR) exceeding 3, steroid usage history, advanced age, and absence of calcitonin use. CONCLUSION The osteoporosis prediction model derived through the XGBoost machine learning algorithm in this study displays remarkable predictive precision and carries significant clinical applicability.
Collapse
Affiliation(s)
- Yanfei Zhu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yuan Liu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Qi Wang
- Department of Gastroenterology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Sen Niu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Lanyu Wang
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Chao Cheng
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Xujin Chen
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Jinhui Liu
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Songyun Zhao
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China.
| |
Collapse
|
14
|
Ahmad I, Reddy RS, Alqhtani RS, Tedla JS, Dixit S, Ghulam HSH, Alyami AM, Al Adal S, Jarrar MAM. Exploring the Nexus of lower extremity proprioception and postural stability in older adults with osteoporosis: a cross-sectional investigation. Front Public Health 2023; 11:1287223. [PMID: 38098834 PMCID: PMC10720312 DOI: 10.3389/fpubh.2023.1287223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Background Osteoporosis, characterized by reduced bone mass and micro-architectural deterioration, poses a significant public health concern due to increased fracture susceptibility. Beyond bone health, this cross-sectional study aimed to assess and compare lower extremity proprioception and postural stability in individuals with and without osteoporosis and to explore their correlation within the osteoporosis group. Method In this prospective cross-sectional study, 80 participants were divided into two groups: osteoporosis (n = 40) and control (n = 40). The demographic characteristics and clinical parameters of the participants were as follows: Age (years) - Osteoporosis group: 65.04 ± 4.33, Control group: 65.24 ± 4.63; Sex (%) - Osteoporosis group: Male 30%, Female 70%; Control group: Male 30%, Female 70%; Body mass index (kg/m2) - Osteoporosis group: 23.7 ± 3.2, Control group: 24.5 ± 4.6; T-score (Lumbar) - Osteoporosis group: -2.86 ± 1.23, Control group: 0.27 ± 0.58; T-score (hip) - Osteoporosis group: -2.28 ± 0.79, Control group: 0.68 ± 0.86. Joint Position Sense (JPS) at the hip, knee, and ankle was assessed using a digital inclinometer, and postural stability was measured using computerized force platforms. Result Osteoporosis participants exhibited higher errors in hip (5.63° vs. 2.36°), knee (4.86° vs. 1.98°), and ankle (4.46° vs. 2.02°) JPS compared to controls. Postural stability measures showed increased anterior-posterior sway (10.86 mm vs. 3.98 mm), medial-lateral sway (8.67 mm vs. 2.89 mm), and ellipse area (966.88 mm2 vs. 446.19 mm2) in osteoporosis participants. Furthermore, correlation analyses within the osteoporosis group unveiled significant positive associations between lower extremity proprioception and postural stability. Specifically, hip JPS exhibited a strong positive correlation with anterior-posterior sway (r = 0.493, p = 0.003), medial-lateral sway (r = 0.485, p = 0.003), and ellipse area (r = 0.496, p < 0.001). Knee JPS displayed a moderate positive correlation with anterior-posterior sway (r = 0.397, p = 0.012), medial-lateral sway (r = 0.337, p = 0.032), and ellipse area (r = 0.378, p < 0.001). Similarly, ankle JPS showed a moderate positive correlation with anterior-posterior sway (r = 0.373, p = 0.023), medial-lateral sway (r = 0.308, p = 0.045), and ellipse area (r = 0.368, p = 0.021). Conclusion These findings underscore the interplay between proprioceptive deficits, compromised postural stability, and osteoporosis, emphasizing the need for targeted interventions to improve fall prevention strategies and enhance the quality of life for individuals with osteoporosis.
Collapse
Affiliation(s)
- Irshad Ahmad
- Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Ravi Shankar Reddy
- Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Raee S. Alqhtani
- Physical Therapy Department Medical Applied Sciences College, Najran University, Najran, Saudi Arabia
| | - Jaya Shanker Tedla
- Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Snehil Dixit
- Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Hussain Saleh H. Ghulam
- Physical Therapy Department Medical Applied Sciences College, Najran University, Najran, Saudi Arabia
| | - Abdullah Mohammed Alyami
- Rehabilitation Sciences Department, Applied Medical Sciences College, Najran University, Najran, Saudi Arabia
| | - Saeed Al Adal
- Physical Therapy Department Medical Applied Sciences College, Najran University, Najran, Saudi Arabia
| | - Mohammad A. M. Jarrar
- Rehabilitation Sciences Department, Applied Medical Sciences College, Najran University, Najran, Saudi Arabia
| |
Collapse
|
15
|
Liu F, Zhu H, Ma J, Miao L, Chen S, Yin Z, Wang H. Performance of iCare quantitative computed tomography in bone mineral density assessment of the hip and vertebral bodies in European spine phantom. J Orthop Surg Res 2023; 18:777. [PMID: 37845720 PMCID: PMC10578019 DOI: 10.1186/s13018-023-04174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Osteoporosis is a systemic bone disease which can increase the risk of osteoporotic fractures. Dual-energy X-ray absorptiometry (DXA) is considered as the clinical standard for diagnosing osteoporosis by detecting the bone mineral density (BMD) in patients, but it has flaws in distinguishing between calcification and other degenerative diseases, thus leading to inaccurate BMD levels in subjects. Mindways quantitative computed tomography (Mindways QCT) is a classical QCT system. Similar to DXA, Mindways QCT can directly present the density of trabecular bone, vascular or tissue calcification; therefore, it is more accurate and sensitive than DXA and has been widely applied in clinic to evaluate osteoporosis. iCare QCT osteodensitometry was a new phantom-based QCT system, recently developed by iCare Inc. (China). It has been gradually applied in clinic by its superiority of taking 3-dimensional BMD of bone and converting BMD values to T value automatically. This study aimed at evaluating the osteoporosis detection rate of iCare QCT, compared with synchronous Mindways QCT (USA). METHODS In this study, 131 patients who underwent hip phantom-based CT scan were included. Bone mineral density (BMD) of the unified region of interests (ROI) defined at the European spine phantom (ESP, German QRM) including L1 (low), L2 (medium), and L3 (high) vertebral bodies was detected for QCT quality control and horizontal calibration. Every ESP scan were taken for 10 times, and the mean BMD values measured by iCare QCT and Mindways QCT were compared. Hip CT scan was conducted with ESP as calibration individually. T-scores gained from iCare QCT and Mindways QCT were analyzed with Pearson correlation test. The detection rates of osteoporosis were compared between iCare QCT and Mindways QCT. The unified region of interests (ROI) was delineated in the QCT software. RESULTS The results showed that there was no significant difference between iCare QCT and Mindways QCT in the evaluation of L1, L2, and L3 vertebrae bodies in ESP. A strong correlation between iCare QCT and Mindways QCT in the assessment of hip T-score was found. It was illustrated that iCare QCT had a higher detection rate of osteoporosis with the assessment of hip T-score than Mindways QCT did. In patients < 50 years subgroup, the detection rate of osteoporosis with iCare QCT and Mindways QCT was equal. In patients ≥ 50 years subgroup, the detection rate of osteoporosis with iCare QCT (35/92, 38.0%) was higher than that with Mindways QCT. In female subgroup, the detection rate of osteoporosis with iCare QCT was significantly higher than Mindways QCT. In male subgroup, the detection rate of osteoporosis with iCare QCT was also markedly higher than Mindways QCT. The detection rate of osteoporosis by iCare QCT was higher than Mindways QCT with hip bone assessment. Of course, the results of the present study remain to be further verified by multicenter studies in the future.
Collapse
Affiliation(s)
- Feng Liu
- Department of Medical Imaging, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, 130 Renmin Zhong Lu, Jiangyin City, 214400, Jiangsu Province, China
| | - Hongmei Zhu
- Department of Medical Imaging, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, 130 Renmin Zhong Lu, Jiangyin City, 214400, Jiangsu Province, China
| | - Jinlian Ma
- Department of Medical Imaging, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, 130 Renmin Zhong Lu, Jiangyin City, 214400, Jiangsu Province, China
| | - Liqiong Miao
- Department of Medical Imaging, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, 130 Renmin Zhong Lu, Jiangyin City, 214400, Jiangsu Province, China
| | - Shuang Chen
- Department of Medical Imaging, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, 130 Renmin Zhong Lu, Jiangyin City, 214400, Jiangsu Province, China
| | - Zijie Yin
- Department of Medical Imaging, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, 130 Renmin Zhong Lu, Jiangyin City, 214400, Jiangsu Province, China
| | - Huan Wang
- Department of Medical Imaging, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, 130 Renmin Zhong Lu, Jiangyin City, 214400, Jiangsu Province, China.
| |
Collapse
|
16
|
Gold LS, Suri P, O'Reilly MK, Kallmes DF, Heagerty PJ, Jarvik JG. Mortality among older adults with osteoporotic vertebral fracture. Osteoporos Int 2023; 34:1561-1575. [PMID: 37233794 PMCID: PMC10718299 DOI: 10.1007/s00198-023-06796-6] [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: 01/10/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
We evaluated whether older adults who received kyphoplasty had reduced risk of mortality compared to those who did not. In unmatched analyses, those receiving kyphoplasty were at reduced risk of death but after matching on age and medical complications, patients who received kyphoplasty were at increased risk of death. PURPOSE In previous observational studies, kyphoplasty for treatment of osteoporotic vertebral fractures has been associated with decreased mortality compared to conservative management. The purpose of this research was to determine whether older adults who received kyphoplasty had reduced risk of mortality compared to matched patients who did not. METHODS Retrospective cohort study of US Medicare enrollees with osteoporotic vertebral fractures between 2017-2019 comparing patients who underwent kyphoplasty to those who did not. We identified 2 control groups a priori: 1) non-augmented patients who met inclusion criteria (group 1); 2) propensity-matched patients on demographic and clinical variables (group 2). We then identified additional control groups using matching for medical complications (group 3) and age + comorbidities (group 4). We calculated hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with mortality. RESULTS A total of 235,317 patients (mean (± standard deviation) age 81.1 ± 8.3 years; 85.8% female) were analyzed. In the primary analyses, those who received kyphoplasty were at reduced risk of death compared to those who did not: adjusted HR (95% CI) in group 1 = 0.84 (0.82, 0.87); and in group 2 = 0.88 (0.85, 0.91). However, in post hoc analyses, patients who received kyphoplasty were at increased risk of death: adjusted HR (95% CI) in group 3 = 1.32 (1.25, 1.41) and 1.81 (1.58, 2.09) in group 4. CONCLUSION An apparent benefit of kyphoplasty on mortality among patients with vertebral fractures was not present after rigorous propensity matching, illustrating the importance of comparing similar individuals when evaluating observational data.
Collapse
Affiliation(s)
- Laura S Gold
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA.
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.
| | - Pradeep Suri
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
- Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Michael K O'Reilly
- Department of Radiology, University of Limerick Hospital Group, Limerick, Ireland
| | | | - Patrick J Heagerty
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jeffrey G Jarvik
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
| |
Collapse
|
17
|
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.
Collapse
|
18
|
Deutschbein J, Lindner T, Möckel M, Pigorsch M, Gilles G, Stöckle U, Müller-Werdan U, Schenk L. Health-related quality of life and associated factors after hip fracture. Results from a six-month prospective cohort study. PeerJ 2023; 11:e14671. [PMID: 36942001 PMCID: PMC10024485 DOI: 10.7717/peerj.14671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/11/2022] [Indexed: 03/17/2023] Open
Abstract
Background Hip fractures are a major public health problem with increasing relevance in aging societies. They are associated with high mortality rates, morbidity, and loss of independence. The aim of the EMAAge study was to determine the impact of hip fractures on patient-reported health-related quality of life (HRQOL), and to identify potential risk factors for worse outcomes. Methods EMAAge is a multicenter, prospective cohort study of patients who suffered a hip fracture. Patients or, if necessary, proxies were interviewed after initial treatment and after six months using standardized questionnaires including the EQ-5D-5L instrument, the Oxford Hip Score, the PHQ-4, the Short Nutritional Assessment Questionnaire, and items on patients living situation. Medical data on diagnoses, comorbidities, medications, and hospital care were derived from hospital information systems. Results A total of 326 patients were included. EQ-5D index values decreased from a mean of 0.70 at baseline to 0.63 at six months. The mean self-rated health on the EQ-VAS decreased from 69.9 to 59.4. Multivariable linear regression models revealed three relevant associated factors with the six-months EQ-5D index: symptoms of depression and anxiety, pre-fracture limitations in activities of daily living, and no referral to a rehabilitation facility had a negative impact. In addition, the six-months EQ-VAS was negatively associated with polypharmacy, living in a facility, and migration background. Conclusions Hip fractures have a substantial negative impact on patients HRQOL. Our results suggest that there are modifying factors that need further investigation including polypharmacy and migration background. Structured and timely rehabilitation seems to be a protective factor.
Collapse
Affiliation(s)
- Johannes Deutschbein
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| | - Tobias Lindner
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Germany
| | - Martin Möckel
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Germany
| | - Mareen Pigorsch
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Germany
| | - Gabriela Gilles
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| | - Ulrich Stöckle
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculosceletal Surgery (CMSC), Germany
| | - Ursula Müller-Werdan
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Germany
| | - Liane Schenk
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| |
Collapse
|
19
|
Wang F, Wang Q, Zhao Y, Tian Z, Chang S, Tong H, Liu N, Bai S, Li X, Fan J. Adipose-derived stem cells with miR-150-5p inhibition laden in hydroxyapatite/tricalcium phosphate ceramic powders promote osteogenesis via regulating Notch3 and activating FAK/ERK and RhoA. Acta Biomater 2023; 155:644-653. [PMID: 36206975 DOI: 10.1016/j.actbio.2022.09.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 02/02/2023]
Abstract
Adipose-derived mesenchymal stem cells (ADSCs) are multipotent stromal cells and play huge role in forming and repairing bone tissues. Emerging evidence shows that MicroRNAs (miRNAs) are involved in ADSCs differentiation. Here, we explored the role of miR-150-5p and its related mechanisms in ADSCs osteogenesis. Real-time PCR was used to determine miR-150-5p expression during ADSCs osteogenesis. miR-150-5p inhibitors, miR-150-5p ADV or short hairpin RNA (shRNA) of Notch3 were transfected to ADSCs for analyzing the effects on osteogenesis. The mixture of hydroxyapatite/tricalcium phosphate (HA/TCP) ceramic powders and transfected ADSCs was implanted into BALB/C nude mice. Micro-CT and histological methods were performed to evaluate the new bone formation. Compared with negative control (NC) and miR-150-5p overexpression, inhibition of miR-150-5p increased ADSCs osteogenesis by regulating Notch3. MiR-150-5p overexpression decreased the expression of pFAK, pERK1/2, and RhoA, while these were up-regulated when miR-150-5p was inhibited, or notch3 was silenced. Furthermore, miR-150-5p inhibition partially reversed the suppression effect of notch3 knockdown on osteogenesis in vitro and in vivo. This study demonstrated the critical function of miR-150-5p during osteogenesis. The combination of ADSCs with miR-150-5p inhibition and HA/TCP might be a promising strategy for bone damage repair. STATEMENT OF SIGNIFICANCE: Osteoporosis is a common chronic metabolic bone disease in humans. Bone tissue engineering based on mesenchymal stem cells, biomaterials, and growth factors, provides a promising way to treat osteoporosis and bone defects. ADSCs commonly differentiate into adipose cells, they can also differentiate into osteogenic cell lineages. Nucleic acids and protein have usually been considered as regulators of ADSCs osteogenic differentiation. In the current study, we demonstrated the combination of ADSCs with miR-150-5p inhibition and hydroxyapatite/tricalcium phosphate ceramic powders enhanced bone regeneration. Furthermore, miR-150-5p/Notch3 axis regulating osteogenesis via the FAK/ERK1/2 and RhoA pathway was assessed. The current study showed the application of ADSCs in bone regeneration might be a promising strategy for osteoporosis and bone damage repairing.
Collapse
Affiliation(s)
- Fanglin Wang
- Department of Tissue Engineering, School of Intelligent Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China
| | - Qiao Wang
- Department of Tissue Engineering, School of Intelligent Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China
| | - Yu Zhao
- Department of Plastic Surgery, Shengjing Hospital, Affiliated Hospital of China Medical University, No.36 Sanhao Street, Heping area, Shenyang, Liaoning 110004, PR China
| | - Zhiyu Tian
- Clinical Primary Department 105K, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China
| | - Shijie Chang
- Division of Biomedical Engineering, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China
| | - Hao Tong
- Department of Tissue Engineering, School of Intelligent Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China
| | - Ningwei Liu
- 5+3 Integration of Clinical Medicine 106K, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China
| | - Shuling Bai
- Department of Tissue Engineering, School of Intelligent Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China
| | - Xiang Li
- Department of Tissue Engineering, School of Intelligent Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China; Department of Cell Biology, School of Life Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China.
| | - Jun Fan
- Department of Tissue Engineering, School of Intelligent Medicine, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, PR China.
| |
Collapse
|
20
|
Shah A, Iyengar KP, Azzopardi C, Haleem S, Mehta J, Botchu R. Alteration in the Cross-sectional Area (CSA) Ratio of the Paraspinal Muscles following Vertebral Insufficiency Fractures. Indian J Radiol Imaging 2022; 33:8-11. [PMID: 36855732 PMCID: PMC9968526 DOI: 10.1055/s-0042-1758522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Vertebral insufficiency fractures in the elderly are associated with increased morbidity and mortality. Early diagnosis is essential to direct patient-specific rehabilitation. Aims We hypothesize that in patients with vertebral insufficiency fractures, there is atrophy of the psoas and paraspinal muscles with alteration in the cross-sectional area (CSA) of the muscles. Materials and Methods Magnetic resonance imaging (MRI) studies for 100 consecutive patients, older than 60 years presenting with lower back pain, were included in the study. For each MRI study, the CSA of the psoas and paraspinal muscles (multifidus) at the level of L4/5-disc space was measured to calculate the cross-sectional area ratio (CSAR) by two readers. One reader repeated the measurements after an interval of 2 weeks. We divided the patients ( n = 100) into various groups based on the number of vertebral fractures. Results In total, 77 patients with vertebral body fractures (48 with one, 16 with two and 13 with more than two fractures) were identified with a mean age of 73 (range 60-92) years. The ratio of multifidus CSA to psoas CSA was calculated with mean values of each group (1-4) as 2.56, 1.89, 2.09 and 2.16, respectively. There was statistically significance difference of the CSAR between the cohorts ( p -value = 0.0115). Conclusion Vertebral insufficiency fractures in the elderly are associated not only with atrophy of psoas and the multifidus group of muscles as evident by the CSA values, but they also affect the CSAR depending on the number of fractures. This finding may help to direct targeted patient-specific physiotherapy rehabilitation and interventions to prevent further such fractures.
Collapse
Affiliation(s)
- Ali Shah
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | | | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Shahnawaz Haleem
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Jwalant Mehta
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom,Address for correspondence Rajesh Botchu Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road SouthNorthfield, BirminghamUnited Kingdom
| |
Collapse
|
21
|
Ulivieri FM, Rinaudo L. The Bone Strain Index: An Innovative Dual X-ray Absorptiometry Bone Strength Index and Its Helpfulness in Clinical Medicine. J Clin Med 2022; 11:jcm11092284. [PMID: 35566410 PMCID: PMC9102586 DOI: 10.3390/jcm11092284] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 12/27/2022] Open
Abstract
Bone strain Index (BSI) is an innovative index of bone strength that provides information about skeletal resistance to loads not considered by existing indexes (Bone Mineral Density, BMD. Trabecular Bone Score, TBS. Hip Structural Analysis, HSA. Hip Axis Length, HAL), and, thus, improves the predictability of fragility fractures in osteoporotic patients. This improved predictability of fracture facilitates the possibility of timely intervention with appropriate therapies to reduce the risk of fracture. The development of the index was the result of combining clinical, radiographical and construction-engineering skills. In fact, from a physical point of view, primary and secondary osteoporosis, leading to bone fracture, are determined by an impairment of the physical properties of bone strength: density, internal structure, deformation and fatigue. Dual X-ray absorptiometry (DXA) is the gold standard for assessing bone properties, and it allows measurement of the BMD, which is reduced mainly in primary osteoporosis, the structural texture TBS, which can be particularly degraded in secondary osteoporosis, and the bone geometry (HSA, HAL). The authors recently conceived and developed a new bone deformation index named Bone Strain Index (BSI) that assesses the resistance of bone to loads. If the skeletal structure is equated to engineering construction, these three indexes are all considered to determine the load resistance of the construct. In particular, BSI allows clinicians to detect critical information that BMD and TBS cannot explain, and this information is essential for an accurate definition of a patient’s fracture risk. The literature demonstrates that both lumbar and femoral BSI discriminate fractured osteoporotic people, that they predict the first fragility fracture, and further fragility fractures, monitor anabolic treatment efficacy and detect patients affected by secondary osteoporosis. BSI is a new diagnostic tool that offers a unique perspective to clinical medicine to identify patients affected by primary and, specially, secondary osteoporosis. This literature review illustrates BSI’s state of the art and its ratio in clinical medicine.
Collapse
Affiliation(s)
- Fabio Massimo Ulivieri
- Centro per la Diagnosi e la Terapia dell’Osteoporosi, Casa di Cura La Madonnina, Via Quadronno 29, 20122 Milan, Italy
- Correspondence:
| | - Luca Rinaudo
- Tecnologie Avanzate T.A. Srl, Lungo Dora Voghera 36, 10153 Torino, Italy;
| |
Collapse
|
22
|
Multidisciplinary Care of a Vertebral Fracture in a Patient with Hematopoietic Stem Cell Transplant: Safety Appropriateness in Interventional Pain Management and Rehabilitation Considerations. Healthcare (Basel) 2022; 10:healthcare10030497. [PMID: 35326975 PMCID: PMC8950403 DOI: 10.3390/healthcare10030497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 12/21/2022] Open
Abstract
Bone loss leading to fragility fracture is a highly prevalent late effect in hematopoietic stem-cell transplant patients, who are affected 8–9 times more than the general population, particularly for vertebral compression fractures. Spinal interventions such as lumbar epidural steroid injections and vertebral augmentation may be helpful for providing pain relief and improved function, quality of life and return to ambulation. However, interventional procedures should be approached with caution in these patients. Our study found that there is a paucity of scientific studies addressing the risks of spinal injections in these patients and there is no absolute recommendation specific to spinal injections in patients receiving immunosuppressive agents or who have a history of solid organ or hematopoietic stem cell transplant. It is imperative to consider proper timing of the intervention to minimize risks while optimizing the benefits of the intervention combined with a well-defined post-transplant rehabilitation plan. Moreover, the decision to proceed with spinal interventions should be done case by case and with caution. Therefore, this article reports the case of a multidisciplinary treatment for a vertebral compression fracture in a patient with a hematopoietic stem-cell transplant, in particular discussing safety appropriateness in interventional pain management and rehabilitation considerations for this condition in this patient population.
Collapse
|
23
|
Kuo YR, Cheng TA, Chou PH, Liu YF, Chang CJ, Chuang CF, Su PF, Lin RM, Lin CL. Healing of Vertebral Compression Fractures in the Elderly after Percutaneous Vertebroplasty-An Analysis of New Bone Formation and Sagittal Alignment in a 3-Year Follow-Up. J Clin Med 2022; 11:jcm11030708. [PMID: 35160158 PMCID: PMC8836520 DOI: 10.3390/jcm11030708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Vertebral compression fractures, resulting in significant pain and disability, commonly occur in elderly osteoporotic patients. However, the current literature lacks long-term follow-up information related to image parameters and bone formation following vertebroplasty. PURPOSE To evaluate new bone formation after vertebroplasty and the long-term effect of vertebroplasty. METHODS A total of 157 patients with new osteoporotic compression fractures who underwent vertebroplasty were retrospectively analyzed. The image parameters, including wedge angles, compression ratios, global alignment, and new bone formation, were recorded before and after vertebroplasty up to three years postoperatively. RESULTS The wedge angle improved and was maintained for 12 months. The compression ratios also improved but gradually deteriorated during the follow-up period. New bone formation was found in 40% of the patients at 36 months, and the multivariate analysis showed that this might have been related to the correction of the anterior compression ratio. CONCLUSIONS Vertebroplasty significantly restored the wedge angles and compression ratios up to one year postoperatively, and new bone formation was noted on plain radiographs, which increased over time. Last, the restoration of vertebral parameters may contribute to new bone formation.
Collapse
Affiliation(s)
- Yuh-Ruey Kuo
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan City 704, Taiwan; (Y.-R.K.); (T.-A.C.); (C.-J.C.)
| | - Ting-An Cheng
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan City 704, Taiwan; (Y.-R.K.); (T.-A.C.); (C.-J.C.)
| | - Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yuan-Fu Liu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital Douliu Branch, Douliu City 640, Taiwan;
| | - Chao-Jui Chang
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan City 704, Taiwan; (Y.-R.K.); (T.-A.C.); (C.-J.C.)
| | - Cheng-Feng Chuang
- Department of Statistics, National Cheng Kung University, Tainan City 701, Taiwan; (C.-F.C.); (P.-F.S.)
| | - Pei-Fang Su
- Department of Statistics, National Cheng Kung University, Tainan City 701, Taiwan; (C.-F.C.); (P.-F.S.)
| | - Ruey-Mo Lin
- Department of Orthopedic Surgery, An-Nan Hospital, China Medical University, Tainan City 709, Taiwan;
| | - Cheng-Li Lin
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan City 704, Taiwan; (Y.-R.K.); (T.-A.C.); (C.-J.C.)
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan City 701, Taiwan
- Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan City 701, Taiwan
- Correspondence:
| |
Collapse
|
24
|
Chen X, Hu Y, Geng Z, Su J. The "Three in One" Bone Repair Strategy for Osteoporotic Fractures. Front Endocrinol (Lausanne) 2022; 13:910602. [PMID: 35757437 PMCID: PMC9218483 DOI: 10.3389/fendo.2022.910602] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/09/2022] [Indexed: 12/17/2022] Open
Abstract
In aging society, osteoporotic fractures have become one major social problem threatening the health of the elderly population in China. Compared with conventional fractures, low bone mass, bone defect and retarded healing issues of osteoporotic fractures lead to great difficulties in treatment and rehabilitation. Addressing major concerns in clinical settings, we proposed the "three in one" bone repair strategy focusing on anti-osteoporosis therapies, appropriate bone grafting and fracture healing accelerating. We summarize misconceptions and repair strategies for osteoporotic fracture management, expecting improvement of prognosis and clinical outcomes for osteoporotic fractures, to further improve therapeutic effect and living quality of patients.
Collapse
Affiliation(s)
- Xiao Chen
- Department of Traumatic Orthopedics, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Yan Hu
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Zhen Geng
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Jiacan Su
- Department of Traumatic Orthopedics, First Affiliated Hospital of Navy Medical University, Shanghai, China
- Institute of Translational Medicine, Shanghai University, Shanghai, China
- *Correspondence: Jiacan Su,
| |
Collapse
|