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Thoors O, Mellner C, Hedström M. Good clinical outcome for the majority of younger patients with hip fractures: a Swedish nationwide study on 905 patients younger than 50 years of age. Acta Orthop 2021; 92:292-296. [PMID: 33478319 PMCID: PMC8231413 DOI: 10.1080/17453674.2021.1876996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Studies regarding hip fractures in young patients are rare since the patient population is small. We assessed clinical outcomes 4 months after hip fracture in patients < 50 years of age and whether there were differences between sexes and different age groups.Patients and methods - We included adult patients < 50 years with a hip fracture between January 1, 2014 and December 31, 2018. Baseline data were extracted from the Swedish Registry for Hip Fracture Patients and Treatment (RIKSHÖFT) and mortality data was obtained from Statistics Sweden. The outcome variables were change of walking ability, pain in fractured hip, use of analgesics, living conditions, and mortality rate at 4 months.Results - Of the 905 patients included, 72% were men and femoral neck fractures were most common (58%). 4 months after surgery, 23% used a walking aid and 7% reported severe pain. Women reported slightly more pain and higher usage of analgesics. Patients aged 40-49 reported higher usage of analgesics than patients aged 15-39, although the latter group reported more pain. Nearly all of those who lived independently before fracture did so at 4 months. The mortality rate was < 1%.Interpretation - Most patients did not use any walking aid and few had severe pain at 4 months. Furthermore, a hip fracture is not a life-threatening event in a patient < 50 years. The living conditions did not change for those who lived independently before the fracture.
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Affiliation(s)
- Oscar Thoors
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm; ,*Correspondence:
| | | | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm; ,Department of Orthopedics, Karolinska Hospital Stockholm, Sweden
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Abstract
PURPOSE OF REVIEW This review outlines the scope of the problem in osteoporosis care and secondary fracture prevention and describes fracture prevention strategies, with a focus on the frail elderly. RECENT FINDINGS Despite heightened awareness among patients and clinicians alike and the availability of efficacious anti-osteoporosis medications, osteoporosis is still underdiagnosed and undertreated. However, the introduction of systematic risk assessment and secondary fracture prevention programmes has gained momentum, and evidence of success is accumulating. We possess today the knowledge required to close the osteoporosis care gap. The basic components in a secondary prevention model are similar in all health care settings, number one being a dedicated fracture coordinator, with anti-osteoporosis medications and multifaceted falls prevention as cornerstones, particularly in the frailest, both in the near and long-term. Initiation of structured care pathways including the key elements - identification, investigation, intervention and follow-up of adherence - demonstrably reduces re-fracture rates and is cost-effective.
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Affiliation(s)
- Kristina E. Åkesson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - Fiona E. A. McGuigan
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
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Egund L, McGuigan FE, Egund N, Besjakov J, Åkesson KE. Patient-related outcome, fracture displacement and bone mineral density following distal radius fracture in young and older men. BMC Musculoskelet Disord 2020; 21:816. [PMID: 33287782 PMCID: PMC7722451 DOI: 10.1186/s12891-020-03843-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/26/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Distal radius fractures can adversely affect wrist function; for men with this fracture, the role played by fracture severity, age and osteoporosis on fracture outcome has not been sufficiently studied. OBJECTIVE To describe patient-reported outcome and the association with bone integrity, fracture severity and future fracture risk among young and older men with distal radius fracture. METHODS This prospective study includes 133 men with acute distal radius fracture, mean age 54 (range 21-88), who were followed for 12 months. They were categorized as younger (< 65) and older (65+). Main outcome was DASH (Disability of the Arm, Shoulder and Hand) at 12 months; DASH > 15 was defined as poor outcome. Fractures were classified and radiographic displacement identified at initial presentation and follow-up. BMD was measured and FRAX 10-year probability of fracture calculated. RESULTS Disability was higher in older men (DASHmedian 10 vs 2; p = 0.002); a clinically meaningful difference (ΔDASH = 10, p = 0.017) remained after adjustment for displacement, fracture classification and treatment method. Almost 50% of older men vs 14% in younger had poor outcome, p < 0.001. Bone mineral density did not independently predict outcome. Older men with a displaced fracture at initial presentation had greater disability (DASHmedian, IQR 45, 14;73) and risk of fracture (FRAXmajor osteoporotic 14, 8;21). CONCLUSION Men over the age of 65 with a distal radius fracture are more likely to have post-fracture disability regardless of radiographic appearance. Fracture displacement, indicating impaired bone strength, is also more common and associated with an increased risk of fracture within 10-years. Secondary fracture prevention should therefore be considered in men presenting with distal radius fracture.
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Affiliation(s)
- Lisa Egund
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 205 02, Malmö, Sweden
- Department of Orthopedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - Fiona E McGuigan
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 205 02, Malmö, Sweden
| | - Niels Egund
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jack Besjakov
- Department of Radiology, Skåne University Hospital, Malmö, Sweden
| | - Kristina E Åkesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 205 02, Malmö, Sweden.
- Department of Orthopedics, Skåne University Hospital, 205 02, Malmö, Sweden.
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Egund L, Önnby K, Mcguigan F, Åkesson K. Disability and Pain are the Best Predictors of Sick Leave After a Distal Radius Fracture in Men. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:656-664. [PMID: 32052265 PMCID: PMC7716915 DOI: 10.1007/s10926-020-09880-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Distal radius fracture often compromises working ability, but clinical implications are less studied in men due to its lower incidence. This study therefore describes sick leave in men with distal radius fracture, specifically exploring the impact of patient- and fracture-related factors. Methods Professionally active men aged 20-65 with distal radius fracture were followed prospectively for 1-year (n = 88). Data included treatment method, radiographic parameters pre/post treatment, complications, health, lifestyle and occupational demand. Patient outcomes were self-reported sick leave; Disability of the Arm, Shoulder and Hand (DASH) score; pain (5 likert scale); SF-36: Physical Component Scale (PCS) and Mental Component Scale (MCS). Results Median sick leave was 4 weeks (IQR 0; 8); almost a third reported taking no sick leave. Categorizing sick leave into 3 groups (0-6, 7-12 and > 12 weeks), men with the longest sick leave had 22 points higher DASH score (p = 0.001) and 5 points lower PCS (p = 0.02) at 1 week and the difference remained over time; they were also older and more often treated surgically. The strongest predictors of length of sick leave were one-week post-fracture DASH score (rs = 0.4, p < 0.001), pain intensity (rs = 0.4, p < 0.001) and PCS (rs = - 0.4, p = 0.002). The correlation between sick leave and pain was even stronger analyzing treatment groups separately (closed reduction and cast rs = 0.56, p = 0.007, surgery rs = 0.42, p = 0.04). Conclusions Self-reported disability, pain and global health measurements as early as 1 week post-fracture are the strongest predictors of length of sick leave regardless of treatment; an important finding easily transferrable to clinical management of distal radius fractures.
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Affiliation(s)
- Lisa Egund
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - Karin Önnby
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
| | - Fiona Mcguigan
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
| | - Kristina Åkesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden.
- Department of Orthopedics, Skåne University Hospital, 205 02, Malmö, Sweden.
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Egund L, Isaksson S, McGuigan FE, Giwercman A, Åkesson KE. High Luteinizing Hormone and Lower Levels of Sex Hormones in Younger Men With Distal Radius Fracture. JBMR Plus 2020; 4:e10421. [PMID: 33210067 PMCID: PMC7657392 DOI: 10.1002/jbm4.10421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/09/2020] [Accepted: 09/25/2020] [Indexed: 11/06/2022] Open
Abstract
This study investigates the sex steroid hormone profile in younger men with distal radius fracture (DRF) to elucidate if this could explain the low bone density and osteoporosis previously observed. In a case-control study, 73 men with DRF (mean age 38 ± 9 years; range, 20-51) was compared with 194 age-matched, population controls. Performed assays: total testosterone (TT), calculated free testosterone (cFT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (SHBG), and total estradiol (E2). BMD hip and spine were measured. Fracture cases had lower cFT (298 versus 329 pmol/L; p = 0.008), but not TT, compared with controls. FSH and SHBG were not statistically different. LH was almost 30% higher (5.7 versus 4.5 IU/L; p < 0.001) and a lower E2 was observed (80.0 versus 87.1; p = 0.098). Men with DRF had a lower E2/SHBG ratio compared with controls (2.3 versus 2.9; p = 0.013). A higher proportion of the fracture group had low TT (<10.5 nmol/L; 21% versus 11%; p = 0.052), low cFT (<220 pmol/L; 18% versus 8%; p = 0.017), and low E2 (<73 pmol/L; 48% versus 35%; p = 0.044). Odds ratio (OR) for fracture when having low cFT was 2.3 (95% CI, 1.02-5.49; p = 0.044); with low E2, the OR was 1.7 (95% CI, 0.96-2.96). In this study in young men with DRF exploring sex hormone levels, we find that sex hormone profiles may be disturbed with a lower E2/SHBG ratio, lower cFT, and higher LH. Estrogen is also a strong determinant of bone mass in men; hence, low levels of E2 may be contributing to the observed lower BMD and these differences may be relevant to fracture risk. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Lisa Egund
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit Lund University Lund Sweden.,Department of Orthopedics Skåne University Hospital Malmö Sweden
| | - Sigrid Isaksson
- Department of Oncology Skåne University Hospital Malmö Sweden.,Molecular Reproductive Medicine Unit, Department of Translational Medicine Lund University Malmö Sweden
| | - Fiona E McGuigan
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit Lund University Lund Sweden
| | - Aleksander Giwercman
- Molecular Reproductive Medicine Unit, Department of Translational Medicine Lund University Malmö Sweden.,Department of Translational Medicine, Molecular Reproductive Medicine Lund University Lund Sweden
| | - Kristina E Åkesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit Lund University Lund Sweden.,Department of Orthopedics Skåne University Hospital Malmö Sweden
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Hanusch BC, Tuck SP, McNally RJQ, Wu JJ, Prediger M, Walker J, Tang J, Piec I, Fraser WD, Datta HK, Francis RM. Does regional loss of bone density explain low trauma distal forearm fractures in men (the Mr F study)? Osteoporos Int 2017; 28:2877-2886. [PMID: 28685278 DOI: 10.1007/s00198-017-4122-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/08/2017] [Indexed: 01/02/2023]
Abstract
UNLABELLED The pathogenesis of low trauma wrist fractures in men is not fully understood. This study found that these men have lower bone mineral density at the forearm itself, as well as the hip and spine, and has shown that forearm bone mineral density is the best predictor of wrist fracture. INTRODUCTION Men with distal forearm fractures have reduced bone density at the lumbar spine and hip sites, an increased risk of osteoporosis and a higher incidence of further fractures. The aim of this case-control study was to investigate whether or not there is a regional loss of bone mineral density (BMD) at the forearm between men with and without distal forearm fractures. METHODS Sixty-one men with low trauma distal forearm fracture and 59 age-matched bone healthy control subjects were recruited. All subjects underwent a DXA scan of forearm, hip and spine, biochemical investigations, health questionnaires, SF-36v2 and Fracture Risk Assessment Tool (FRAX). The non-fractured arm was investigated in subjects with fracture and both forearms in control subjects. RESULTS BMD was significantly lower at the ultradistal forearm in men with fracture compared to control subjects, in both the dominant (mean (SD) 0.386 g/cm2 (0.049) versus 0.436 g/cm2 (0.054), p < 0.001) and non-dominant arm (mean (SD) 0.387 g/cm2 (0.060) versus 0.432 g/cm2 (0.061), p = 0.001). Fracture subjects also had a significantly lower BMD at hip and spine sites compared with control subjects. Logistic regression analysis showed that the best predictor of forearm fracture was ultradistal forearm BMD (OR = 0.871 (0.805-0.943), p = 0.001), with the likelihood of fracture decreasing by 12.9% for every 0.01 g/cm2 increase in ultradistal forearm BMD. CONCLUSIONS Men with low trauma distal forearm fracture have significantly lower regional BMD at the ultradistal forearm, which contributes to an increased forearm fracture risk. They also have generalised reduction in BMD, so that low trauma forearm fractures in men should be considered as indicator fractures for osteoporosis.
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Affiliation(s)
- B C Hanusch
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - S P Tuck
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - R J Q McNally
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - J J Wu
- Biophysical Sciences Institute and School of Engineering and Computing Sciences, Durham University, Lower Mountjoy, South Road, Durham, DH1 3LE, UK
| | - M Prediger
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - J Walker
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - J Tang
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - I Piec
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - W D Fraser
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - H K Datta
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - R M Francis
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
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