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Reider L, Owen EC, Dreyer HC, Fitton LS, Willey MC. Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation. Curr Osteoporos Rep 2023; 21:710-718. [PMID: 38019345 DOI: 10.1007/s11914-023-00836-0] [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] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
PURPOSEOF REVIEW To summarize what is known about the deleterious effect of hip fracture on muscle mass and strength as well as the scientific evidence for post-surgical nutrition supplementation to maintain muscle and improve function. RECENT FINDINGS This review provides a discussion of the relationship between muscle mass, strength, and physical function following hip fracture, briefly describes the approaches to measuring lean mass, discusses prevalence of sarcopenia and malnutrition among older men and women with hip fracture, and reviews the effects of essential amino acids on muscle. Loss of muscle mass and strength following hip fracture is substantial with consequences for recovery of functional independence. EAA-based nutrition supplementation, which directly effects muscle, has potential to improve outcomes.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Room 648, Baltimore, MD, 21205, USA.
| | | | - Hans C Dreyer
- Department of Human Physiology, University of Oregon, Eugene, OR, 97403, USA
| | - Lori S Fitton
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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2
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Pacicco T, Ratner S, Xi Y, Yokoo T, Fetzer D, Oz OK, Rubin CD, Chhabra A. Pelvic muscle size and myosteatosis: Relationship with age, gender, and obesity. Indian J Radiol Imaging 2021; 29:155-162. [PMID: 31367086 PMCID: PMC6639865 DOI: 10.4103/ijri.ijri_414_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate interreader performance in the measurement of the cross-sectional area and myosteatosis of pelvic skeletal muscles using fat quantification magnetic resonance imaging (MRI) and correlate with patient anthropomorphic characteristics. Materials and Methods A Health Insurance Portability and Accountability Act-compliant retrospective cross-sectional study was performed. Between January and April 2016, 61 patients (26 males and 35 females) underwent a lumbosacral plexus 3T MRI with a modified three-dimensional spoiled gradient echo sequence dedicated to fat quantification (mDixon Quant; Philips Healthcare). Two independent reviewers outlined muscle cross-sectional area on axial images using a freehand region of interest tool and documented proton-density fat fraction (FF) and muscle area (cm2) of the psoas, gluteus medius, gluteus maximus, and rectus femoris muscles on each side. Interreader agreement was assessed by intraclass correlation coefficient (ICC), and correlation between the measurements and subject's age, gender, and body mass index (BMI) was assessed using multiple linear regression analysis. Results Excellent interreader agreement was obtained (ICC ≥0.74) for all muscle groups except for the left gluteus medius area and right psoas FF which showed good agreement (0.65 and 0.61, respectively). Statistically significant (P ≤ 0.05) positive correlation was seen between the gluteal muscle FF and area with BMI, and rectus muscle FF with age and BMI. Statistically significant negative correlation between the rectus femoris area and age was also observed. Conclusion Fat quantification MRI is a highly reproducible imaging technique for the assessment of myosteatosis and muscle size. Intramuscular FF and cross-sectional area were correlated with age and BMI across multiple muscle groups.
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Affiliation(s)
- Thomas Pacicco
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shayna Ratner
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Takeshi Yokoo
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Advanced Imaging Research Center, UT Southwestern School of Medicine, Dallas, TX, USA
| | - David Fetzer
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Orhan K Oz
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Craig D Rubin
- Geriatric Division, Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Trantham L, Sikirica MV, Candrilli SD, Benson VS, Mohan D, Neil D, Joshi AV. Healthcare costs and utilization associated with muscle weakness diagnosis codes in patients with chronic obstructive pulmonary disease: a United States claims analysis. J Med Econ 2019; 22:319-327. [PMID: 30580639 DOI: 10.1080/13696998.2018.1563414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS Muscle weakness (MW)-attributable healthcare resource utilization (HCRU) and costs in patients with chronic obstructive pulmonary disease (COPD) have not been well-characterized in US insurance claims databases. The primary objective of this study was to estimate HCRU in patients with evidence of COPD with and without MW diagnosis codes. MATERIALS AND METHODS This retrospective analysis used the MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. Between January 2007 and March 2016, we identified patients aged ≥40 years with diagnosis codes for COPD (≥1 emergency department or inpatient claim or ≥2 outpatient claims within 1 year). The cohort was divided into patients with and without ≥1 MW diagnosis code. Propensity score matching was used to generate pairs of patients with and without MW (1:1). Multivariable regression analyses were used to estimate adjusted incremental costs and utilization attributable to the presence of MW diagnosis codes among patients with COPD. RESULTS Of 427,131 patients who met the study inclusion criteria, 14% had evidence of MW. After matching, 107,420 unique patients remained equally distributed across MW status. Patients with MW diagnosis codes had greater predicted annual HCRU, $2,465 greater total predicted annual COPD-related costs, and $15,179 greater total all-cause costs than those without MW diagnosis codes. Overall, <1% of patients received COPD-related pulmonary rehabilitation services. LIMITATIONS Study limitations include the potential for undercoding of MW and lack of information on severity of MW in claims data. CONCLUSION The presence of MW diagnosis codes yielded higher HCRU in this COPD population and suggests that the burden of MW affects both all-cause and COPD-related care. However, utilization of pulmonary rehabilitation, a known effective treatment for MW, remains low. Future research should expand on our results by assessing data sources that allow for clinical confirmation of MW among patients with COPD.
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Affiliation(s)
- Laurel Trantham
- a Health Economics, RTI Health Solutions , Research Triangle Park , NC , USA
| | - Mirko V Sikirica
- b Value Evidence and Outcomes , GlaxoSmithKline , Collegeville , PA , USA
| | - Sean D Candrilli
- a Health Economics, RTI Health Solutions , Research Triangle Park , NC , USA
| | - Victoria S Benson
- c Real World Evidence and Epidemiology, GlaxoSmithKline , West Drayton , Uxbridge , UK
| | - Divya Mohan
- d Research and Development, GlaxoSmithKline , Collegeville , PA , USA
| | - David Neil
- b Value Evidence and Outcomes , GlaxoSmithKline , Collegeville , PA , USA
| | - Ashish V Joshi
- b Value Evidence and Outcomes , GlaxoSmithKline , Collegeville , PA , USA
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Marcon M, Berger N, Manoliu A, Fischer MA, Nanz D, Andreisek G, Ulbrich EJ. Normative values for volume and fat content of the hip abductor muscles and their dependence on side, age and gender in a healthy population. Skeletal Radiol 2016; 45:465-74. [PMID: 26739300 DOI: 10.1007/s00256-015-2325-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine normative values for volume and fat content of the gluteus medius (GMed) and minimus (GMin) muscle in healthy volunteers and to evaluate their dependence on age, gender and leg dominance. MATERIALS AND METHODS The IRB approval was obtained for this study. 80 healthy volunteers (females, 40; males, 40; age range 20-62 years), divided into four age groups, were included. Fat- and water-signal-separated MR images of the pelvis were acquired on a 3.0 T MR with a 3-point mDIXON sequence. Normalized volume and fat-signal fraction (FSF) of the GMed (ViGMed, FSFGMed) and GMin (ViGMin, FSFGMin) muscles were determined. RESULTS The overall mean volumes (normalized) and FSF ± SD: ViGMed 105.13 ± 16.30 cm(3); ViGMin 30.24 ± 5.15 cm(3); FSFGMed 8.13 ± 1.70 % and FSFGMin 9.89 ± 2.72 %. Comparing different age subgroups within each gender no significant differences were found concerning the volumes and FSFs (except FSFGMin in male subgroup aged 20-29 versus 50-62 years, P = 0.014). Comparing FSFs differences between the two genders, only in 20-29 years subgroup, FSFGMed (P =0.003) and FSFGMin (P =0.002) were greater in female. Volume differences between the two legs were not significant (P > 0.077); FSFGMed and FSFGMin (P =0.005 for both) were significantly lower in the dominant leg in female but not in male group (P = 0.454 for FSFGMed and P = 0.643 for FSFMin). CONCLUSION No age dependency was evident for volume normative data for GMed and GMin and normative data for FSF values showed no age- or gender dependency.
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Affiliation(s)
- Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland. .,Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", P.le S. Maria della Misericordia, 33100, Udine, Italy.
| | - Nicole Berger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Andrei Manoliu
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Michael A Fischer
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Daniel Nanz
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Gustav Andreisek
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Erika J Ulbrich
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Maguire C, Sieben JM, Scheidhauer H, Romkes J, Suica Z, de Bie RA. The effect of crutches, an orthosis TheraTogs, and no walking aids on the recovery of gait in a patient with delayed healing post hip fracture: A case report. Physiother Theory Pract 2016; 32:69-81. [PMID: 26756323 DOI: 10.3109/09593985.2015.1075640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Accelerated rehabilitation following hip fracture and joint replacement, including early unrestricted weight-bearing and muscle strengthening, has gained importance in hastening functional recovery and hospital discharge. The influence of walking aids on these parameters is sparsely investigated. In this case report, we document the effect of walking with crutches; an orthotic garment and strapping system, TheraTogs; and no walking aids over 3-4-week periods on walking speed, trunk sway, and muscle activity measured with electromyography (EMG). The patient was a 49-year-old female showing delayed healing following a conservatively treated avulsion fracture of the greater trochanter 12 weeks previously with a 14-year history of total hip arthroplasty. EMG analysis showed muscle activity increased with TheraTogs and decreased with crutches compared with walking with no aids. Walking speed improved at a faster rate in the TheraTogs phase than in the crutches phase and reduced in no-walking-aids phase. Mean speed (SD) for each phase was: crutches 1.11 (0.08) m/s, TheraTogs 1.35 (0.11) m/s, and no-aids 1.19 (0.14) m/s. Trunk sway increased in the crutch and no-aids phases, and became more stable in the TheraTogs phase. In this patient, function and recovery rate of all measured parameters increased more in the TheraTogs phase than the crutches or no-aids phase. This may be because muscle activity was facilitated enabling active support of recovering structures.
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Affiliation(s)
- Clare Maguire
- a Bildungszentrum Gesundheit Basel-Stadt , Muenchenstein , Switzerland.,b Faculty of Health , Bern University of Applied Science , Bern , Switzerland
| | - Judith M Sieben
- c Department of Anatomy and Embryology , Maastricht University , Maastricht , The Netherlands
| | - Heike Scheidhauer
- a Bildungszentrum Gesundheit Basel-Stadt , Muenchenstein , Switzerland
| | - Jacqueline Romkes
- d Laboratory for Movement Analysis, Basel University Children's Hospital , Basel , Switzerland
| | - Zorica Suica
- a Bildungszentrum Gesundheit Basel-Stadt , Muenchenstein , Switzerland.,e Reha Rheinfelden , Rheinfelden , Switzerland
| | - Robert A de Bie
- f Department of Epidemiology , Maastricht University , Maastricht , The Netherlands
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Lambrelli D, Burge R, Raluy-Callado M, Chen SY, Wu N, Schoenfeld MJ. Retrospective database study to assess the economic impact of hip fracture in the United Kingdom. J Med Econ 2014; 17:817-25. [PMID: 25164473 DOI: 10.3111/13696998.2014.959588] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Publications containing recent, real-world data on the economic impact of hip fractures in the UK are lacking. This retrospective electronic medical records database analysis assessed medication and healthcare resource use, direct healthcare costs, and factors predicting increased resource use and costs in adult UK hip fracture patients. METHODS Data were obtained from the Clinical Practice Research Datalink linked to the Hospital Episode Statistics for adult patients hospitalized for their first hip fracture between January 1, 2006 and March 31, 2011 (index event); healthcare costs were calculated from the National Health Service perspective using 2011-2012 cost data. RESULTS Data from 8028 patients were analyzed. Resource use and costs were statistically significantly higher in the year following fracture (mean total [standard deviation (SD)] cost £7359 [£14,937]) compared with the year before fracture (mean total [SD] cost £3122 [£9435]; p < 0.001), and were similar to the total amount of the index hospitalization (mean total [SD] cost £8330 [£2627]). Multivariate regression analysis (using an estimated generalized linear model) showed that older age, male gender, higher comorbidity, osteoporosis, discharge to another institution compared with home, and pre-index hospitalization and outpatient visits were associated with increased post-index hospitalization healthcare costs (all p < 0.05). CONCLUSIONS Although we did not capture all pre- and post-index costs and healthcare utilization, this study provides important insights regarding the characteristics of patients with hip fracture, and information that will be useful in burden-of-illness and economic analyses.
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