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Benes GA, Dasa V, Krause PC, Jones DG, Leslie LJ, Chapple AG. Disparities in Elective and Nonelective Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00011-6. [PMID: 36690188 DOI: 10.1016/j.arth.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prior studies have shown disparities in utilization of primary and revision total hip arthroplasty (THA). However, little is known about patient population differences associated with elective and nonelective surgery. Therefore, the aim of this study was to explore factors that influence primary utilization and revision risk of THA based on surgery indication. METHODS Data were obtained from 7,543 patients who had a primary THA from 2014 to 2020 in a database, which consists of multiple health partner systems in Louisiana and Texas. Of these patients, 602 patients (8%) underwent nonelective THA. THA was classified as "elective" or "nonelective" if the patient had a diagnosis of hip osteoarthritis or femoral neck fracture, respectively. RESULTS After multivariable logistic regression, nonelective THA was associated with alcohol dependence, lower body mass index (BMI), women, and increased age and number of comorbid conditions. No racial or ethnic differences were observed for the utilization of primary THA. Of the 262 patients who underwent revision surgery, patients who underwent THA for nonelective etiologies had an increased odds of revision within 3 years of primary THA (odds ratio (OR) = 1.66, 95% Confidence Interval (CI) = 1.06-2.58, P-value = .025). After multivariable logistic regression, patients who had tobacco usage (adjusted odds ratio (aOR) = 1.36, 95% CI = 1.04-1.78, P-value = .024), alcohol dependence (aOR = 2.46, 95% CI = 1.45-4.15, P-value = .001), and public insurance (OR = 2.08, 95% CI = 1.18-3.70, P-value = .026) had an increased risk of reoperation. CONCLUSION Demographic and social factors impact the utilization of elective and nonelective primary THA and subsequent revision surgery. Orthopaedic surgeons should focus on preoperative counseling for tobacco and alcohol cessation as these are modifiable risk factors to directly decrease reoperation risk.
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Affiliation(s)
- Gregory A Benes
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Vinod Dasa
- LSUHSC Department of Orthopedic Surgery, New Orleans, Louisiana
| | - Peter C Krause
- LSUHSC Department of Orthopedic Surgery, New Orleans, Louisiana
| | - Deryk G Jones
- Ochsner Sports Medicine Institute, Jefferson, Louisiana
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Dayer SR, Mears SC, Pangle AK, Mendiratta P, Wei JY, Azhar G. Does Superior Bone Health Promote a Longer Lifespan? Geriatr Orthop Surg Rehabil 2021; 12:21514593211036231. [PMID: 34395047 PMCID: PMC8358490 DOI: 10.1177/21514593211036231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/21/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Public health achievements throughout the last century have resulted in a steady increase in life expectancy. An emergent subset has distinguished themselves, living well beyond the ninth decade by avoiding or delaying the onset of most age-related diseases, including bone diseases and fractures. In this study, we evaluated the bone health of the oldest community-dwelling individuals living in rural Arkansas. METHODS 299 patients aged ≥90 years were retrospectively reviewed for recorded fractures within 12 years prior to the investigation period. Records were also examined for medications and test results pertinent to bone health, including thyroid stimulating hormone, vitamin D levels, hematocrit, hemoglobin, body mass index, and bone densitometric values. RESULTS 68 patients (23%) had at least one fracture documented, and 15 had >1 fracture. 40% of patients with fractures had osteoporosis and 28% had osteopenia, respectively. 232 patients (78%) had no documented fractures, and of these, only 18% had osteoporosis and 16% had osteopenia. No significant clinical markers were found among the very old to explain the relatively low occurrence of fractures. CONCLUSIONS Patients over 90 years of age had an overall low prevalence of fractures and relative preservation of bone health, suggesting a preserved bone molecular profile in these individuals. Epigenetic factors and activity levels might also have favorably affected bone health. The low percentage of osteoporosis and fractures likely reduced the morbidity and mortality in this population, potentially contributing to their overall longevity.
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Affiliation(s)
- Stephanie R. Dayer
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, UAMS, Little Rock, AR, USA
| | - Simon C. Mears
- Department of Orthopaedic Surgery, UAMS, Little Rock, AR, USA
| | - Amanda K. Pangle
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, UAMS, Little Rock, AR, USA
| | - Priya Mendiratta
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, UAMS, Little Rock, AR, USA
| | - Jeanne Y. Wei
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, UAMS, Little Rock, AR, USA
| | - Gohar Azhar
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, UAMS, Little Rock, AR, USA
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Lim KT, Choi WJ. Effect of fall characteristics on the severity of hip impact during a fall on the ground from standing height. Osteoporos Int 2020; 31:1713-1719. [PMID: 32346772 DOI: 10.1007/s00198-020-05432-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
UNLABELLED The magnitude of hip impact force during a fall on the ground (i.e., concrete surface) from standing height was determined. We found that this force decreases up to 59%, depending on how they land on the ground. INTRODUCTION We determined the magnitude of hip impact force that humans may experience in the event of a fall from standing height on the ground, in order to examine how the hip impact force was affected by characteristics of a fall. METHODS Twenty subjects mimicked a typical older adults' falls on a mat. Trials were acquired with three initial fall directions: forward, sideways, and backward. Trials were also acquired with three knee positions at the time of hip impact: knee together, knee on the mat, and free knee. During falls, attenuated vertical hip impact forces and corresponding depression of the mat were measured via a force plate placed under the mat and motion capture system, respectively. Using a mass-spring model, actual hip impact force and body stiffness during a fall on the ground were estimated. RESULTS Hip impact force averaged 4.0 kN (SD = 1.7). The hip impact force was associated with knee condition (F = 25.6, p < 0.005), but not with fall direction (F = 0.4, p = 0.599). Compared with "knee on the mat," hip impact force averaged 59% and 45% greater in "free knee" and "knee together," respectively (4.6 versus 2.9 kN, p < 0.005; 4.3 versus 2.9 kN, p < 0.005). However, the hip impact force did not differ between "free knee" and "knee together (4.6 versus 4.3 kN, p = 0.554). CONCLUSION Our results suggest that hip fracture risk during a fall decreases substantially, depending on how they land on the ground, informing the development of safe landing strategies to prevent fall-related hip fractures in older adults.
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Affiliation(s)
- K-T Lim
- Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do, 26493, South Korea
| | - W J Choi
- Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do, 26493, South Korea.
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Murena L, Ratti C, Maritan G, Rasio N, Pistorio S, Cusitore M, Canton G. Epidemiology and risk factors for contralateral proximal femur fracture: a single center retrospective cohort study on 1022 patients. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:115-121. [PMID: 32555086 PMCID: PMC7944826 DOI: 10.23750/abm.v91i4-s.9716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/23/2022]
Abstract
Summary. BACKGROUND AND AIM OF THE WORK Given the high impact of proximal femur fractures (PFFs) on elderly patients and healthcare systems, the burden of contralateral PFFs might be overlooked. Aim of the study is to analyze the epidemiology and risk factors of contralateral proximal femur fractures. Secondary aim is to detect mortality rate differences in first and contralateral PPF. METHODS A population of 1022 patients admitted for proximal femur fractures in a single center was studied. Prevalence at admission as well as incidence of contralateral PFF during a 18 to 36 months follow-up was recorded. Epidemiology of contralateral PFF was studied recording number of events, time to second fracture and fracture type. Mortality at 1-year was recorded for all patients and compared between first and second PFF patients. Comorbidities, pharmacotherapy, BMI, MNA and SPMSQ were studied as possible risk factors. RESULTS Prevalence and incidence of contralateral PFFs were 9.4% and 6.5% respectively. Median time to second fracture was 12 months. One-year mortality of contralateral PFFs was significantly lower (20.5% vs 25.1%, p 0.003) than first PFF. Contralateral fracture patients had a significantly lower BMI and a significantly lower proportion of malnourished patients. CONCLUSIONS The incidence and prevalence of contralateral PFFs is relevant. Mortality of contralateral PFFs results to be lower than first PFF. Patients with higher BMI and malnourished patients have a lower risk of contralateral PFF.
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Affiliation(s)
- Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Guido Maritan
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Nicholas Rasio
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Sabrina Pistorio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Marcello Cusitore
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Strada di Fiume 447, 34149 Trieste (Italy).
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUITS, Strada di Fiume 447, 34149 Trieste (Italy).
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Huang HL, Pan CC, Hsiao YF, Chen MC, Kung CY, Kung PT, Tsai WC. Associations of body mass index and diabetes with hip fracture risk: a nationwide cohort study. BMC Public Health 2018; 18:1325. [PMID: 30497430 PMCID: PMC6267014 DOI: 10.1186/s12889-018-6230-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 11/19/2018] [Indexed: 01/18/2023] Open
Abstract
Background The high prevalence of diabetes is associated with body mass index (BMI), and diabetes can cause many complications, such as hip fractures. This study investigated the effects of BMI and diabetes on the risk of hip fractures and related factors. Methods We retrospectively reviewed data from 22,048 subjects aged ≧ 40 years from the National Health Interview Survey in Taiwan (NHIST) in 2001, 2005, and 2009. We linked the NHIST data for individual participants with the National Health Insurance Research Database (NHIRD), which includes the incidence of hip fracture from 2000 to 2013. We defined five categories for BMI: low BMI (BMI < 18.5), normal BMI (18.5 ≦ BMI < 24), overweight (24 ≦ BMI < 27), mild obesity (27 ≦ BMI < 30), and moderate obesity (BMI ≧ 30). The Cox proportional hazards model was used to analyze the effects of BMI and diabetes on risk of hip fracture. Results The Cox proportional hazards model shows that hip fracture risk in participants with diabetes was 1.64 times that of non-diabetes patients (95% confidence interval [CI]:1.30–2.15). Participants with low BMIs showed a higher hip fracture risk (HR: 1.75) than those with normal BMI. Among the five BMI groups, compared with non-diabetes patients, only diabetes patients with a normal BMI showed a significantly higher risk on hip fracture (HR: 2.13, 95% CI: 1.48–3.06). In participants with diabetes, compared with those with normal BMI, those with overweight or obesity showed significantly lower hip fracture risks (HR: 0.49 or 0.42). The hip fracture risk in participants who expend ≧ 500 kcal/week in exercise was 0.67 times lower than in those who did not exercise. Conclusions Diabetes and low BMI separately are important risk factors for hip fracture. There was an interaction between diabetes and BMI in the relationship with hip fracture (p = 0.001). The addition of energy expenditure through exercise could effectively decrease hip fracture risk, regardless of whether the participants have diabetes or not. The results of this study could be used as a reference for health promotion measures for people with diabetes.
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Affiliation(s)
- Hsiu-Ling Huang
- Department of Social Work, Toko University, Chiayi County, Taiwan, Republic of China.,Department of Health Services Administration, China Medical University, 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, Republic of China
| | - Cheng-Chin Pan
- Department of Urology, Ministry of Health and Welfare, Hengchun Tourism Hospital, Hengchun, Taiwan, Republic of China
| | - Yu-Fen Hsiao
- Department of Social Work, Toko University, Chiayi County, Taiwan, Republic of China
| | - Ming-Chih Chen
- Department of Orthopedics, Ministry of Health and Welfare, Hengchun Tourism Hospital, Hengchun, Taiwan, Republic of China
| | - Chuan-Yu Kung
- Department of Nursing, Ministry of Health and Welfare, Hengchun Tourism Hospital, Hengchun, Taiwan, Republic of China
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, Republic of China.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, Republic of China
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, Republic of China.
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Aurégan JC, Bosser C, Bensidhoum M, Bégué T, Hoc T. Correlation between skin and bone parameters in women with postmenopausal osteoporosis: A systematic review. EFORT Open Rev 2018; 3:449-460. [PMID: 30237903 PMCID: PMC6134882 DOI: 10.1302/2058-5241.3.160088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Skin and bone share similarities in terms of biochemical composition.Some authors have hypothesized that their properties could evolve concomitantly with age, allowing the estimation of the parameters of one from those of the other.We performed a systematic review of studies reporting the correlation between skin and bone parameters in women with postmenopausal osteoporosis.Fourteen studies - including 1974 patients - were included in the review.Three of these studies included two groups of participants - osteoporotic and non-osteoporotic - in order to compare skin parameters between them: two studies found a significant difference between the two groups and one did not.Eleven of these studies included one population of interest and compared its skin and bone parameters in a continuous manner: eight studies compared dermal thickness to bone mineral density (seven found a significant correlation [R = 0.19-0.486] and one did not); two studies compared skin elasticity to bone mineral density (both found a significant correlation [R = 0.44-0.57); and one study compared skin collagen to bone mineral density and found a significant correlation (R = 0.587).It can be assumed that the estimation of skin alterations from ageing could help in estimating concomitant bone alterations. Cite this article: EFORT Open Rev 2018;3:449-460. DOI: 10.1302/2058-5241.3.160088.
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Affiliation(s)
- Jean-Charles Aurégan
- Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, France
- Laboratory of Tribology and System Dynamics, Ecole Centrale Lyon, France
- Laboratory of Bioengineering and Bioimagery for Bone and Articulation, Paris-Diderot University, France
| | - Catherine Bosser
- Laboratory of Tribology and System Dynamics, Ecole Centrale Lyon, France
| | - Morad Bensidhoum
- Laboratory of Bioengineering and Bioimagery for Bone and Articulation, Paris-Diderot University, France
| | - Thierry Bégué
- Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, France
| | - Thierry Hoc
- Laboratory of Tribology and System Dynamics, Ecole Centrale Lyon, France
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Deloumeau A, Moltó A, Roux C, Briot K. Determinants of short term fracture risk in patients with a recent history of low-trauma non-vertebral fracture. Bone 2017; 105:287-291. [PMID: 28842362 DOI: 10.1016/j.bone.2017.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/30/2017] [Accepted: 08/19/2017] [Indexed: 12/16/2022]
Abstract
Low-trauma fractures tend to cluster in time, and subsequent fractures have a role in increased morbidity and mortality in osteoporotic patients. The aim of this study was to identify the risk factors of short-term subsequent non-vertebral fracture (NVF). Patients were included from the Fracture Liaison Service (FLS) which provides assessment for osteoporosis to all in-hospital patients admitted for a low-trauma NVF in the Orthopaedics department. Location and date of occurrence of previous fractures, risk factors for osteoporosis and falls were collected. Bone mineral density was measured at the lumbar spine and total hip; presence of vertebral fractures was evaluated using vertebral fracture assessment (VFA). Nine hundred and fifty patients were included (84% women; 75±12years), with a mean T-score at the femoral neck of -2.3±1.0. Four hundred and sixty eight (49%) patients were in the FLS because of a hip fracture. Using multivariable analysis, the risk of being in the FLS with a previous fracture ≤3years before was associated with: history of fall in the year before the admission (OR=2.75, CI 95% 1.55-4.93), history of severe low-trauma NVF (OR=2.54; CI 95% 1.45-4.52), and BMI lower than 20kg/m2 (OR=2.45, CI 95% 1.25-4.87); age older than 78years-old was protective to the risk of re-fracture (OR=0.44, CI 95% 0.24-0.80). Some risk factors (age, history of fall and of previous severe non-vertebral fracture) can help in the selection of patients at high risk of refracture, who should receive the highest priority for a treatment.
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Affiliation(s)
- Aude Deloumeau
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France.
| | - Anna Moltó
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France
| | - Christian Roux
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France
| | - Karine Briot
- Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France; U1153 Institut National de la Santé et de la Recherche Médicale, PRESS Sorbonne Paris Cité, Paris Descartes University, Cochin Hospital, Department of Rheumatology, Paris, France.
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Yamada S, Taniguchi M, Tokumoto M, Yoshitomi R, Yoshida H, Tatsumoto N, Hirakata H, Fujimi S, Kitazono T, Tsuruya K. Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study. Am J Kidney Dis 2017; 70:270-280. [PMID: 28450093 DOI: 10.1053/j.ajkd.2017.01.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/26/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. STUDY DESIGN Cross-sectional study and prospective longitudinal cohort study. SETTING & PARTICIPANTS An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. PREDICTOR Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. OUTCOMES Bone fracture at any site. RESULTS In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95% CI, 1.50-13.11], 2.33 [95% CI, 0.86-6.31], 1.96 [95% CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). LIMITATIONS One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. CONCLUSIONS Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients.
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Affiliation(s)
- Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | | | - Hisako Yoshida
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Narihito Tatsumoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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