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Wu X, Park S. A Prediction Model for Osteoporosis Risk Using a Machine-Learning Approach and Its Validation in a Large Cohort. J Korean Med Sci 2023; 38:e162. [PMID: 37270917 DOI: 10.3346/jkms.2023.38.e162] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/15/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Osteoporosis develops in the elderly due to decreased bone mineral density (BMD), potentially increasing bone fracture risk. However, the BMD is not regularly measured in a clinical setting. This study aimed to develop a good prediction model for the osteoporosis risk using a machine learning (ML) approach in adults over 40 years in the Ansan/Anseong cohort and the association of predicted osteoporosis risk with a fracture in the Health Examinees (HEXA) cohort. METHODS The 109 demographic, anthropometric, biochemical, genetic, nutrient, and lifestyle variables of 8,842 participants were manually selected in an Ansan/Anseong cohort and included in the ML algorithm. The polygenic risk score (PRS) of osteoporosis was generated with a genome-wide association study and added for the genetic impact of osteoporosis. Osteoporosis was defined with < -2.5 T scores of the tibia or radius compared to people in their 20s-30s. They were divided randomly into the training (n = 7,074) and test (n = 1,768) sets-Pearson's correlation between the predicted osteoporosis risk and fracture in the HEXA cohort. RESULTS XGBoost, deep neural network, and random forest generated the prediction model with a high area under the curve (AUC, 0.86) of the receiver operating characteristic (ROC) with 10, 15, and 20 features; the prediction model by XGBoost had the highest AUC of ROC, high accuracy and k-fold values (> 0.85) in 15 features among seven ML approaches. The model included the genetic factor, genders, number of children and breastfed children, age, residence area, education, seasons to measure, height, smoking status, hormone replacement therapy, serum albumin, hip circumferences, vitamin B6 intake, and body weight. The prediction models for women alone were similar to those for both genders, with lower accuracy. When the prediction model was applied to the HEXA study, the correlation between the fracture incidence and predicted osteoporosis risk was significant but weak (r = 0.173, P < 0.001). CONCLUSION The prediction model for osteoporosis risk generated by XGBoost can be applied to estimate osteoporosis risk. The biomarkers can be considered for enhancing the prevention, detection, and early therapy of osteoporosis risk in Asians.
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Affiliation(s)
- Xuangao Wu
- Department of Bioconvergence, Hoseo University, Asan, Korea
| | - Sunmin Park
- Department of Bioconvergence, Hoseo University, Asan, Korea
- Department of Food and Nutrition, Obesity/Diabetes Research Center, Hoseo University, Asan, Korea.
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Association of apolipoprotein A1 with osteoporosis: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:157. [PMID: 36864426 PMCID: PMC9979473 DOI: 10.1186/s12891-023-06264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
Higher levels of apolipoprotein A1 (ApoA1) were associated with higher risk of osteoporosis, which supports the argument that lipid metabolism is involved in bone metabolism. BACKGROUND Although the current evidence shows that lipid metabolism and osteoporosis are closely related to cardiovascular disease, the association between ApoA1 and osteoporosis is still unknown. Therefore, the purpose of this study was to explore the relationship between ApoA1 and osteoporosis. METHODS In this cross-sectional study, we included 7743 participants in the Third National Health and Nutrition Examination Survey. ApoA1 was regarded as an exposure variable and osteoporosis was considered as an outcome variable. Multivariate logistic regression analysis, sensitivity analysis, and receiver operator characteristic (ROC) were used to assess the association of ApoA1 with osteoporosis. RESULTS Participants with higher ApoA1 had higher rates of osteoporosis compared to participants with lower ApoA1 (P < 0.05). Individuals with osteoporosis had higher levels of ApoA1 than individuals without osteoporosis (P < 0.05). In multivariate logistic regression analysis adjusted for age, sex, race, hypertension, diabetes, gout, hypotensive drugs, hypoglycemic drugs, systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, blood urea nitrogen, albumin, uric acid, hemoglobin A1c, alkaline phosphatase and total calcium, higher ApoA1 was strongly associated with higher risk of osteoporosis, whether as a continuous variable or a categorical variable [Model 3, OR (95% CI), P value: 2.289 (1.350, 3.881), 0.002 and 1.712 (1.183, 2.478), 0.004]. And after excluding individuals with gout, the correlation between them remained and was significant (P < 0.01). And ROC analysis also showed that ApoA1 could predict the development of osteoporosis (AUC = 0.650, P < 0.001). CONCLUSION ApoA1 was closely associated with osteoporosis.
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Gough Courtney M, Roberts J, Godde K. Structural Inequity and Socioeconomic Status Link to Osteoporosis Diagnosis in a Population-Based Cohort of Middle-Older-Age Americans. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231155719. [PMID: 36789725 PMCID: PMC9932766 DOI: 10.1177/00469580231155719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
Socioeconomic status (SES) is an important social determinant of health inequities that has been linked to chronic conditions, including osteoporosis, but research tends to focus on socioeconomic disadvantage rather than how socioeconomic advantage may facilitate these inequities. This study accounts for structural inequities and assesses the relationship between early-life and later-life SES, and risk of osteoporosis diagnosis. Data come from the nationally representative, population-based cohort Health and Retirement Study and include individuals ages 50 to 90. The outcome variable is osteoporosis diagnosis. Logistic regression models of the relationship between SES and osteoporosis diagnosis are estimated, accounting for demographic, health, and childhood variables. Higher levels of childhood and adult SES link to lower odds of osteoporosis diagnosis. Structural inequities in income and underdiagnosis of osteoporosis among persons identifying as Black/African American were detected. Accounting for bone density scan access, inequities in osteoporosis diagnosis appear to stem from barriers to accessing health care due to financial constraints. The important role of SES and evidence of structural inequities leading to underdiagnosis suggest the critical importance of clinicians receiving Diversity, Equity, and Inclusion training to reduce health inequities.
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Yu X, Sun S, Zhang S, Hao Q, Zhu B, Teng Y, Long Q, Li S, Lv Y, Yue Q, Lu S, Teng Z. A pooled analysis of the association between sarcopenia and osteoporosis. Medicine (Baltimore) 2022; 101:e31692. [PMID: 36401390 PMCID: PMC9678526 DOI: 10.1097/md.0000000000031692] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Sarcopenia is a progressive generalized skeletal muscle disorder that causes the accelerated loss of muscle mass and function. Osteoporosis is a systemic condition of the skeleton that results in low bone mass and quality. Several studies have suggested that osteoporosis and sarcopenia are interrelated; however, a few studies indicate the lack of a significant association between sarcopenia and osteoporosis. We aimed to evaluate the association between sarcopenia and osteoporosis via a systematic review and pooled analysis. METHODS From the inception of the PubMed and Embase databases until September 2022, we conducted a systematic search for studies evaluating the relationship between sarcopenia and osteoporosis. Study appraisal and synthesis methods: We included observational studies that provided 95% confidence intervals (CIs) and risk estimates. Two reviewers independently extracted data and assessed the quality of the research. The random-effects model was applied to the pool analysis, and the odds ratios (ORs) and 95% CIs were finally calculated. RESULTS The primary statistic was the mutual risk between sarcopenia and osteoporosis. According to the inclusion criteria, 56 studies (796,914 participants) were finally included. Sarcopenia was significantly correlative to the risk of osteoporosis (OR, 3.06; 95% CI, 2.30-4.08), and each standard deviation increase in relative appendicular skeletal muscle mass was significantly related to a decreased risk of osteoporosis (OR, 0.65; 95% CI, 0.56-0.75). Osteoporosis observably referred to a higher risk of sarcopenia (OR, 2.63; 95% CI, 1.98-3.49). CONCLUSION Our research indicated that sarcopenia and osteoporosis are highly positively correlated. Osteoporosis is closely associated with the risk of sarcopenia. Our finding highlights the importance of sarcopenia screening for those at risk of osteoporosis, and vice versa. However, heterogeneity was noted among the studies, and this might have influenced the accuracy of the results. Therefore, the results of our study should be interpreted with caution.
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Affiliation(s)
- Xiaochao Yu
- Kunming Medical University, Kunming, Yunnan, China
- The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Shuo Sun
- Kunming Medical University, Kunming, Yunnan, China
| | | | - Qinggang Hao
- School of Life Sciences, Yunnan University, Kunming, Yunnan, China
| | - Boheng Zhu
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yirong Teng
- Kunming Medical University, Kunming, Yunnan, China
| | - Qing Long
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shujun Li
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Lv
- The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Qiaoning Yue
- Kunming Medical University, Kunming, Yunnan, China
| | - Sheng Lu
- The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zhaowei Teng
- Kunming Medical University, Kunming, Yunnan, China
- The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
- * Correspondence: Zhaowei Teng, The First People’s Hospital of Yunnan Province, Kunming 650000, Yunnan, China (e-mail: )
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Mohammadi A, Behboodi Moghadam Z, Ghelichkhani F, Alidost F, Naghizadeh S, Haghparast Z, Azizi M. Prevention of osteoporosis in menopausal women: A systematic review of nonpharmacological clinical trials. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:287. [PMID: 36438990 PMCID: PMC9683465 DOI: 10.4103/jehp.jehp_1253_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/26/2021] [Indexed: 06/16/2023]
Abstract
Osteoporosis is a systemic skeletal disease that is associated with negative physical and psychosocial consequences, so understanding the effective strategies that can be used in the prevention of osteoporosis is especially important. The aim of this study was to integrative review the published interventional of nonpharmacological studies regarding the prevention and treatment of osteoporosis among menopausal women. In this systematic review, databases such as PubMed, PsycInfo, Web of Science (ISI), Scopus, ScienceDirect, EmBase, Cochrane library, Google scholar, and Iranian databases, such as Scientific Information Database and Magiran, were searched. The latest search was performed between "November 2020 and December 2020" separately by two researchers and then double-checked by them. The quality of the included studies was assessed using the Jadad score calculation tool. Twenty eight randomized controlled trials and quasi-experimental studies were included in this current study. The quality assessment indicated that 19 studies had acceptable (good) methodological quality and also 9 studies had weak methodological quality. The main results of this study were classified in three main categories such as exercise or physical activity training (n = 15), educational sessions (n = 11), and other interventions (n = 2). The results of most included studies showed that nonpharmacological strategies such as physical activity and educational interventions are considered as the appropriate actions to prevention of osteoporosis among menopausal women so implementing these strategies can be a good alternative for women with contraindication of hormone therapy or therapeutic treatment.
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Affiliation(s)
- Azam Mohammadi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Behboodi Moghadam
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ghelichkhani
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzane Alidost
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayyeh Naghizadeh
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Haghparast
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Azizi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Li YF, Wang QY, Xu LL, Yue C, Hu L, Ding N, Yang YY, Qu XL, Sheng ZF. Development of a Nomogram for Predicting Very Low Bone Mineral Density (T-Scores. Int J Gen Med 2022; 15:1121-1130. [PMID: 35153504 PMCID: PMC8824232 DOI: 10.2147/ijgm.s348947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yong-Fang Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Qin-Yi Wang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Lu-Lu Xu
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Chun Yue
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Li Hu
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Na Ding
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Yan-Yi Yang
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Xiao-Li Qu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- Correspondence: Zhi-Feng Sheng, Tel +86-13574806523, Email
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Salari N, Ghasemi H, Mohammadi L, Behzadi MH, Rabieenia E, Shohaimi S, Mohammadi M. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res 2021; 16:609. [PMID: 34657598 PMCID: PMC8522202 DOI: 10.1186/s13018-021-02772-0] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For example, it involves the patient and his/her family members, and government agencies in terms of the cost of treatment and medical care. Providing a comprehensive picture of the prevalence of osteoporosis globally is important for health policymakers to make appropriate decisions. Therefore, this study was conducted to investigate the prevalence of osteoporosis worldwide. METHODS A systematic review and meta-analysis were conducted in accordance with the PRISMA criteria. The PubMed, Science Direct, Web of Science, Scopus, Magiran, and Google Scholar databases were searched with no lower time limit up till 26 August 2020. The heterogeneity of the studies was measured using the I2 test, and the publication bias was assessed by the Begg and Mazumdar's test at the significance level of 0.1. RESULTS After following the systematic review processes, 86 studies were selected for meta-analysis. The sample size of the study was 103,334,579 people in the age range of 15-105 years. Using meta-analysis, the prevalence of osteoporosis in the world was reported to be 18.3 (95% CI 16.2-20.7). Based on 70 studies and sample size of 800,457 women, and heterogenicity I2: 99.8, the prevalence of osteoporosis in women of the world was reported to be 23.1 (95% CI 19.8-26.9), while the prevalence of osteoporosis among men of the world was found to be 11.7 (95% CI 9.6-14.1 which was based on 40 studies and sample size of 453,964 men.). The highest prevalence of osteoporosis was reported in Africa with 39.5% (95% CI 22.3-59.7) and a sample size of 2989 people with the age range 18-95 years. CONCLUSION According to the medical, economic, and social burden of osteoporosis, providing a robust and comprehensive estimate of the prevalence of osteoporosis in the world can facilitate decisions in health system planning and policymaking, including an overview of the current and outlook for the future; provide the necessary facilities for the treatment of people with osteoporosis; reduce the severe risks that lead to death by preventing fractures; and, finally, monitor the overall state of osteoporosis in the world. This study is the first to report a structured review and meta-analysis of the prevalence of osteoporosis worldwide.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Loghman Mohammadi
- Department of Statistics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad hasan Behzadi
- Department of Statistics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Elham Rabieenia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor Malaysia
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Qiu J, Li C, Dong Z, Wang J. Is diabetes mellitus a risk factor for low bone density: a systematic review and meta-analysis. BMC Endocr Disord 2021; 21:65. [PMID: 33849514 PMCID: PMC8045181 DOI: 10.1186/s12902-021-00728-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/30/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This systematic review aimed to investigate whether diabetes mellitus is a risk factor for low bone density, as this might be important and necessary for doctors specialized in treating patients with low bone density. METHODS PubMed, Embase, CINAHL, and SciELO were searched for cohort, case-control, and cross-sectional studies that investigated the effects of diabetes mellitus on bone mineral density till January 2020. Data screening and extraction are done independently, whereas the methodological quality of the studies was assessed according to the Newcastle-Ottawa Scale (NOS). RESULTS A total of 14 studies that met the eligibility criteria including 24,340 participants were enrolled. The overall quality of the studies had a scale of over 6 points. The overall odds ratio (OR) regarding the risk of diabetes mellitus in low bone density patients was 1.20 [95% confidence interval (CI)0.80-1.79, P = 0.30], and type 2 diabetes mellitus (T2DM) (OR = 0.69 [0.11, 4.55], P = 0.70). Subgroup analysis revealed that whether females or males, developed or developing countries, T2DM, studies after 2015, and quality over 7 points (all P values > 0.05) showed no significant differences with the risk of low bone density, except type 1 diabetes mellitus (T1DM) (OR = 3.83 [1.64, 8.96], P = 0.002), and studies before 2015 (OR = 1.76 [1.06, 2.92], P = 0.03), and quality below 7 points (OR = 2.27 [1.50, 3.43], P = 0.0001). Funnel plot showed no significant asymmetry. CONCLUSIONS These findings revealed no relationship between T2DM and low bone density, and also, the evidence between T1DM and low bone density is inadequate, requiring further analysis of well-designed cohort studies.
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Affiliation(s)
- Jingying Qiu
- Department of Endocrinology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang, China), No. 666, Dangui Road, Shengzhou, 312400 Zhejiang China
| | - Chengjiang Li
- Department of Endocrinology, The First Affiliated Hospital Zhejiang University, Hangzhou, Zhejiang China
| | - Zhichun Dong
- Department of Endocrinology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang, China), No. 666, Dangui Road, Shengzhou, 312400 Zhejiang China
| | - Jing Wang
- Department of Endocrinology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang, China), No. 666, Dangui Road, Shengzhou, 312400 Zhejiang China
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Influence of Osteoporosis Following Spine Surgery on Reoperation, Readmission, and Economic Costs: An 8-Year Nationwide Population-Based Study in Korea. World Neurosurg 2021; 149:e360-e368. [PMID: 33601076 DOI: 10.1016/j.wneu.2021.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the relationship between prevalence of osteoporosis and risk factors, medical costs, reoperation, and readmission in patients after spine surgery. METHODS Patients >50 years old with thoracic or lumbar spine diseases who underwent spine surgery between 2005 and 2008 were selected from the Korean National Health Insurance Service databases for analysis. There were 147,676 patients selected, who were divided into 2 groups (osteoporosis and non-osteoporosis) and followed for 8 years. Multiple logistic regressions were performed to examine the effect of osteoporosis following spine surgery. RESULTS Patients with osteoporosis showed significant increases in readmission rates (odds ratio = 1.26, P < 0.001). Osteoporosis was found to be significantly associated with longer hospital stays and increased medical costs regardless of the cause of spine disease. For readmission, there was a 62-day difference in hospitalization time and U.S. dollars $2040 difference in medical costs between the osteoporosis group and non-osteoporosis group. Total medical costs of the osteoporosis group were about U.S. dollars $310 million more than total medical costs of the non-osteoporosis group. Osteoporosis increased the risk of reoperation in fusion surgery, particularly in the first 3 months postoperatively (odds ratio = 1.34, P < 0.001). CONCLUSIONS Osteoporosis was significantly associated with higher readmission rates, longer hospitalization, and greater medical costs during the 8-year follow-up. It also increased the risk of reoperation in fusion surgery. Proper management of osteoporosis is essential before spine surgery, particularly fusion surgery, to help reduce patients' socioeconomic burden and produce more satisfactory surgical outcomes.
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Lee JS, Lee HS, Jang BI, Kim ES, Kim SK, Kim KO, Lee YJ, Lee HJ, Kim EY, Jung YJ, Yang CH. Low Bone Mineral Density in Young Patients Newly Diagnosed with Inflammatory Bowel Disease. Dig Dis Sci 2021; 66:605-611. [PMID: 32222926 DOI: 10.1007/s10620-020-06220-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 03/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The prevalence and risk factors of low bone mineral density (BMD) in Asian patients newly diagnosed with inflammatory bowel disease (IBD) have not been fully suggested. AIMS We aimed to examine the prevalence and risk factors of low BMD in young Korean patients newly diagnosed with IBD. METHODS We prospectively enrolled 132 patients aged less than 50 years and newly diagnosed with IBD from six tertiary referral centers in Korea between November 2014 and April 2017. BMD was measured by dual-energy X-ray absorptiometry, and then the Z-score was determined. We defined low BMD as a Z-score ≤ - 1.0. RESULTS Of 68 patients with ulcerative colitis (UC), 22 (32.4%) had low BMD. Also, of 64 patients with Crohn's disease (CD), 24 (37.5%) showed low BMD. Results from multivariate regression analysis identified the risk factors for low BMD as a high level of alkaline phosphatase (ALP) (≥ 140 U/L) (P = 0.010) in UC patients, and being underweight (body mass index ≤ 18.5 kg/m2) (P = 0.017) in CD patients. CONCLUSIONS Our study showed that about one-third of newly diagnosed IBD Asian patients had low BMD. The clinical factors associated with low BMD were a high level of ALP in UC patients, and being underweight, in CD patients. Therefore, measurements of BMD in young patients should be considered at the diagnosis of IBD.
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Affiliation(s)
- Joon Seop Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 807 Hokuk-ro, Buk-gu, Daegu, 41404, Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 807 Hokuk-ro, Buk-gu, Daegu, 41404, Korea.
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Soo Kim
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 807 Hokuk-ro, Buk-gu, Daegu, 41404, Korea
| | - Sung Kook Kim
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 807 Hokuk-ro, Buk-gu, Daegu, 41404, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun Jik Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Yun Jin Jung
- Department of Internal Medicine, Fatima Hospital of Daegu, Daegu, Korea
| | - Chang Heon Yang
- Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju, Korea
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Abstract
OBJECTIVE To explore the relationship between dietary patterns and physical fitness among older Chinese (≥60 years) individuals. DESIGN Cross-sectional survey. Dietary data were collected by a simplified semi-quantitative FFQ. The 30-s Chair Stand test (30sCST), 30-s Arm Curl test (30sACT), 8-foot Time Up-and-Go test (8fTUAGT) and 6-min Walking test (6mWT) were used to assess physical fitness. Dietary patterns were obtained by factor analysis. The association between dietary patterns and physical fitness was explored by multiple logistic regression. SETTING Six communities (villages) of three districts in Liaocheng City (Shandong Province, China). PARTICIPANTS A total of 596 residents were recruited from April to May 2017. RESULTS Among 556 residents who were finally enrolled, 196 were men (35 %) and 360 were women (65 %). Three dietary patterns were identified: 'Western', 'Vegetarian' and 'Modern'. The 30sACT revealed that men in the fourth quartile of the Western pattern were less likely to be classified in the 'high-level' group, but men in the fourth quartile of the Vegetarian pattern were classified in the high-level group. The 6mWT revealed that men in the fourth quartile of the Modern pattern were classified in the high-level group. These associations were independent of confounding factors. CONCLUSIONS Adherence to the Vegetarian pattern and Modern pattern may be protective factors for maintaining good physical fitness in older Chinese individuals. The Western pattern may lead to poor physical fitness in this population.
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Valeh T, Gharibzadeh S, Tajrishi FZ, Fahimfar N, Meibodi HRA, Shafiee G, Heshmat R, Ostovar A, Sanjari M, Nabipour I, Larijani B. The association of tobacco smoking and bone health in the elderly population of Iran: results from Bushehr elderly health (BEH) program. J Diabetes Metab Disord 2020; 19:461-468. [PMID: 32550198 DOI: 10.1007/s40200-020-00532-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/22/2020] [Indexed: 01/12/2023]
Abstract
Purpose Smoking has been linked with osteoporosis, but further evidence is required, especially concerning the effects of different types of tobacco smoking. We sought to examine the association between smoking and bone health in a large cohort of elderly Iranians. Methods The data from 2377 participants aged >60 years of Bushehr Elderly Health (BEH) program were used. Regardless of the type of smoking, participants were initially classified as non-smokers, ex-smokers and current smokers. Current smokers were also categorized based on the smoking type (pure cigarette, pure hookah and both). Dual-energy X-ray absorptiometry was used to evaluate bone density as well as Trabecular Bone Score (TBS). T-score ≤ -2.5 in either of the femoral neck, total hip or spinal sites was applied to determine the osteoporosis. The association of smoking and osteoporosis was assessed using multivariable modified Poisson regression model and reported as adjusted prevalence ratios (APR). The linear regression model was used to assess the association between smoking and TBS, adjusting for potential factors. Results A total of 2377 (1225 women) were enrolled [mean age: 69.3 (±6.4) years], among which 1054 (44.3%) participants were nonsmokers. In all, 496 (20.9%) participants were current smokers. Multivariable regression analysis revealed no significant association between smoking (either current or past) and osteoporosis in women. In men, current smoking was negatively associated with osteoporosis (APR: 1.51, 95%CI: 1.16-1.96). Among current users, cigarette smoking was associated with osteoporosis (APR: 1.57, 95%CI: 1.20-2.03); however, we could not detect a significant association between current smoking of hookah and osteoporosis. In men, a significant association was also detected between current cigarette smoking and TBS (coefficient: -0.03, 95%CI: -0.01, -0.04). Conclusion Current cigarette smoking is associated with both the quantity and quality of bone mass in elderly men. Although we could not detect a significant association between hookah and osteoporosis in men, considering the prevalence of hookah smoking in the middle eastern countries, further studies are needed to determine the effect of hookah smoking on bone health.
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Affiliation(s)
- Touraj Valeh
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoora Gharibzadeh
- Department of Epidemiology and Biostatistics, Pasteur Institute of Iran, Tehran, Iran
| | | | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Aghaei Meibodi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, the Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, No.10- Jalal -e-ale-ahmad st, chamran hwy, Tehran, Iran
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Segheto KJ, Pereira M, Silva DCGD, Carvalho CJD, Massardi FR, Kakehasi AM, Juvanhol LL, Longo GZ. Vitamin D and bone health in adults: a systematic review and meta-analysis. CIENCIA & SAUDE COLETIVA 2020; 26:3221-3244. [PMID: 34378711 DOI: 10.1590/1413-81232021268.15012020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Abstract
Low bone health is associated with vitamin D deficiency in older individuals; however, this association is not well established in adults. The aim of the study was to analyze the association between serum concentrations of 25-hydroxyvitamin D and bone health in adults by systematic review and meta-analysis. The search was carried out in the LILACS, PubMed, Scopus, Web of Science, ScienceDirect databases from March 2017 to October 2018 with adult individuals (20-59 years). Bone health was evaluation performed through dual X-ray absorptiometry and serum concentrations of 25(OH)D. The random effect model was used to analyze data from bone mineral content and bone mineral. Random effects models were used and the sources of heterogeneity were explored by means of meta-regression. Thirty-five articles were selected. There was positive correlation between vitamin D and bone health in most of the evaluated sites. Correlation was observed in the analysis of subgroups for lumbar spine among men. When stratified, the studies presented high heterogeneity, which was explained by the sample size, mean serum vitamin D levels and risk of bias. Vitamin D is positively correlated to bone health in adult individuals.
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Affiliation(s)
- Kátia Josiany Segheto
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Ed. Centro de Ciências Biológicas II s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | | | | | | | | | - Leidjaira Lopes Juvanhol
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Ed. Centro de Ciências Biológicas II s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Giana Zarbato Longo
- Departamento de Nutrição, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
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Qiao D, Liu X, Tu R, Zhang X, Qian X, Zhang H, Jiang J, Tian Z, Wang Y, Dong X, Luo Z, Liu X, Tian H, Zhang G, Pan J, Wang C. Gender-specific prevalence and influencing factors of osteopenia and osteoporosis in Chinese rural population: the Henan Rural Cohort Study. BMJ Open 2020; 10:e028593. [PMID: 31932385 PMCID: PMC7044856 DOI: 10.1136/bmjopen-2018-028593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aims of this study were to describe distributions of the prevalence of osteopenia and osteoporosis and identify the potential risk factors by gender in a Chinese rural population. DESIGN A cross-sectional survey. SETTING AND PARTICIPANTS A total of 8475 participants (18-79 years) were obtained from the Henan Rural Cohort Study. Bone mineral density (BMD) of the calcaneus for each individual was measured by ultrasonic bone density apparatus. Logistic regression models were used to evaluate associations of potential risk factors with prevalence of osteopenia and osteoporosis. Furthermore, a meta-analysis of prevalence of osteoporosis which included eight studies was conducted to confirm this study results. RESULTS The mean of BMD were 0.42 and 0.32 g/cm2 for men with osteopenia and osteoporosis (p<0.001), as well as 0.40 and 0.30 g/cm2 (p<0.001) for women with osteopenia and osteoporosis, respectively. The overall age-standardised prevalence of osteopenia and osteoporosis were 42.09% and 11.76% in all participants. The age-standardised prevalence of osteopenia in men (45.98%) was significantly higher than that in women (39.73%), whereas the age-standardised prevalence of osteoporosis in men (7.82%) was lower than that in women (14.38%). Meta-analysis results displayed pooled prevalence of osteoporosis of 18.0% (10.1%-25.8%) in total sample, 7.7% (5.7%-9.7%) in men and 22.4% (17.1%-27.6%) in women. Multivariable logistic regression models showed that ageing, women, low education level or income, drinking or underweight was related to increased risk for osteopenia or osteoporosis. CONCLUSIONS About one-sixth of the participants suffered osteoporosis in rural China, and the prevalence in women was higher than men. Although the results were lower than that of meta-analysis, osteoporosis still accounts for huge burden of disease in rural population due to limited medical service and lack of health risk awareness rather than urban area. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR-OOC-15006699; Pre-results).
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Affiliation(s)
- Dou Qiao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xia Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xinling Qian
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jingjing Jiang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhongyan Tian
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhicheng Luo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xue Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Huiling Tian
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Gongyuan Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jun Pan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- The Second Clinical Medical School, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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Zeng X, Liu D, Zhao X, Chao L, Li Y, Li H, Li W, Gui L, Wu W. Association of bone mineral density with lung function in a Chinese general population: the Xinxiang rural cohort study. BMC Pulm Med 2019; 19:239. [PMID: 31818275 PMCID: PMC6902516 DOI: 10.1186/s12890-019-1008-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022] Open
Abstract
Background Bone mineral density (BMD) has been positively associated with lung function in patients diagnosed with respiratory diseases such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis. However, the relationship between BMD and lung function is inconsistent in the general population. Methods To investigate the association between BMD and lung function in a Chinese general population, a total of 1024 adults aged 40–70 years old from Qiliying (an industrial polluted exposure area) and Langgongmiao (the reference area with non-industrial pollution) were recruited and underwent BMD and spirometry tests. Results Both BMD and lung function levels were lower in the exposed area compared to the reference area. In addition, BMD and lung function levels were also lower in females compared to males. Both Spearman and partial correlation analyses showed that BMD was positively correlated with FVC and FEV1. After adjusting linear regression analyses for potential confounding factors, every 0.1 g/cm2 drop in BMD was associated with 53.0 mL decrease in FVC and 33.5 mL decrease in FEV1. Conclusions A reduction of BMD is associated with lower lung function in a general population from China.
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Affiliation(s)
- Xiang Zeng
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China.,Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China.,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Dongling Liu
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, China
| | - Xiangmei Zhao
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Ling Chao
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Yuchun Li
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Huijun Li
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Wen Li
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Lihui Gui
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, 453003, Henan, China. .,Henan International Collaborative Laboratory for Health Effects and Intervention of Air Pollution, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China. .,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
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Fedida B, Schermann H, Ankory R, Rotman D, Shichman I, Yoffe V, Shlaifer A, Luger E. Fracture risk of young adults receiving proton-pump inhibitors and H2-receptor antagonists. Int J Clin Pract 2019; 73:e13339. [PMID: 30829427 DOI: 10.1111/ijcp.13339] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/24/2019] [Accepted: 03/02/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Proton-pump inhibitors (PPI) and histamine (type 2) receptor antagonists (H2RA) have the potential to interfere with calcium metabolism. Several authors have evaluated the effect of these medications on fracture incidence in older adults. A recent large epidemiologic study demonstrated a higher risk of fractures in young adults receiving PPI. AIM To evaluate the effect of PPI and H2RA use on fracture incidence in a large retrospective cohort of military recruits representative of general population of young adults. METHODS A retrospective cohort of 254 265 male and 234 670 female non-combat military conscripts ages 18-25. Subjects were divided into three groups by PPI use (no PPI use, 1-100 tablets and more than 100 tablets) and two groups by H2RA use (no H2RA use, any H2RA use). Multivariate logistic regression was used to adjust fracture risk for age, BMI, education level, socio-economic level, ethnic origin, occupation and duration of follow-up in months. MAIN OUTCOME MEASURES At least one fracture during the study period. RESULTS Use of PPI and H2RA was not associated with an increased risk of fractures. In men, the predictors of an increased fracture risk were higher BMI (OR = 1.007, P < 0.001), origin from a developing country (OR = 1.15, P < 0.001) and service as a driver (OR = 1.11, P < 0.001). Higher education, higher socioeconomic status and service as an officer or as an administrative worker had a protective effect on fracture incidence. In women, fractures were associated with higher BMI (OR = 1.035, P < 0.001). Origin from a developed country, as well as service as an officer or an administrative worker was associated with lower fracture risk. CONCLUSIONS There was no association between the use of PPI or H2-antagonists and fracture incidence in this retrospective cohort of healthy young military recruits.
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Affiliation(s)
- Benjamin Fedida
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Haggai Schermann
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ran Ankory
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Medical Corps, Israeli Defence Forces, Tel Aviv, Israel
| | - Dani Rotman
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ittai Shichman
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Vicky Yoffe
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amir Shlaifer
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Medical Corps, Israeli Defence Forces, Tel Aviv, Israel
| | - Elhanan Luger
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
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