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Avgerinou C, Petersen I, Clegg A, West RM, Osborn D, Walters K. Trends in incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fractures in people aged 50 years and above: retrospective cohort study using UK primary care data. Osteoporos Int 2023:10.1007/s00198-023-06739-1. [PMID: 37162537 PMCID: PMC10382342 DOI: 10.1007/s00198-023-06739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/29/2023] [Indexed: 05/11/2023]
Abstract
This study used primary care data to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK during 2000-2018 accounting for age, sex, calendar year and social deprivation. More than 3 million people aged 50-99 years were included. We found that men living in the most deprived areas had a 45% higher risk of being diagnosed with osteoporosis and 50% higher risk of fragility fracture compared to men living in the least deprived areas. PURPOSE a) To estimate the incidence trends of a recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK over time; b) to describe differences according to age, sex, and social deprivation. METHODS This is a longitudinal population-based cohort study using routinely collected primary care data obtained via IQVIA Medical Research Database (IMRD). All patients aged 50-99 years registered with a practice participating in THIN (The Health Improvement Network) between 2000-2018 were included. The first recorded diagnosis of osteoporosis, osteopenia, or fragility fracture was used to estimate incidence rates (IR) per 10,000 person-years at risk. Poisson regression was used to provide Incidence Rate Ratios (IRR) adjusted by age, sex, social deprivation, calendar year, and practice effect. RESULTS The year-specific adjusted IRR of recorded osteoporosis was highest in 2009 in women [IRR 1.44(95%CI 1.38-1.50)], whereas in men it was highest in 2013-2014 [IRR 1.94(95%CI 1.72-2.18)] compared to 2000. The year-specific adjusted IRR of fragility fracture was highest in 2012 in women [IRR 1.77(95%CI 1.69-1.85)], whereas in men it was highest in 2013 [IRR 1.64(95%CI 1.51-1.78)] compared to 2000. Men in the most deprived areas had a higher risk of being diagnosed with osteoporosis [IRR 1.45(95%CI 1.38-1.53)], osteopenia [IRR 1.17(95%CI 1.09-1.26)], and fragility fracture [IRR 1.50(95%CI 1.44-1.56)] compared to those living in the least deprived areas, but smaller differences were seen in women. CONCLUSION Use of fracture risk assessment tools may enhance the detection of osteoporosis cases in primary care. Further research is needed on the effect of social deprivation on diagnosis of osteoporosis and fractures.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, University of Leeds, Leeds, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Osborn
- Division of Psychiatry, University College London, Leeds, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Huyke-Hernández FA, Only AJ, Leslie EK, Schroder LK, Switzer JA. Creative bracing: A descriptive overview of an alternative technique for non-operative fracture management of frail older adults. Int J Orthop Trauma Nurs 2022; 47:100982. [PMID: 36459710 DOI: 10.1016/j.ijotn.2022.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
As the world population ages, a higher proportion of older and frailer patients will sustain fragility fractures. Considering their depleted physiologic reserve and potentially different goals of care at their stage in life, these patients; especially those enrolled in hospice care, with profound dementia, or at end-of-life care; may not benefit from traditional surgical methods of fracture care. Non-operative treatment using standard immobilization or casting techniques in older and frailer patients can still render them susceptible to complications and adverse events. Here we describe our alternative non-operative treatment method of creative bracing to address the needs of this specific population. Creative bracing can be done with simple supplies available in almost all healthcare settings. Through patient-specific pre-treatment assessment, a creative brace tailored to the patient's risk factors and goals of care can be designed to provide sufficient fracture immobilization and comfort. Creative bracing is a low-cost, low-technical demand modality for non-operative treatment of some fragility fractures. Its benefit can be appreciated to greatest effect in the frailest patients for whom standard, surgical treatment does not represent best care.
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Affiliation(s)
- Fernando A Huyke-Hernández
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Arthur J Only
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Erin K Leslie
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
| | | | - Julie A Switzer
- Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN, USA; Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN, USA; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
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Thomas T, Tubach F, Bizouard G, Crochard A, Maurel F, Perrin L, Collin C, Roux C, Paccou J. The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study. J Bone Miner Res 2022; 37:1811-1822. [PMID: 36203366 PMCID: PMC9828635 DOI: 10.1002/jbmr.4720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/12/2023]
Abstract
Osteoporosis carries a high medical, economic, and societal burden principally because of the risk of severe fractures. The objective of this cost-of-illness study was to describe health resource utilization and associated costs in all patients aged ≥50 years hospitalized for a severe osteoporotic fracture over a 6-year period (2009 to 2014) in France. Data were extracted from the French national healthcare database (SNDS) on all health care resource utilization between the index date (date of hospitalization for first fracture during the enrollment period) and study end (December 31, 2016) or until the patient died. Costing was restricted to direct costs and determined from the payer perspective. Variables related to costs were identified through multivariate logistic regression analysis. A total of 356,895 patients were included (median follow-up 39.1 months). In the year after the index fracture, 36,622 patients (10.5%) were rehospitalized for a fracture-related reason. Only 18,474 (5.3%) underwent bone densitometry and 58,220 (16.7%) received a specific treatment. The total annual per capita osteoporosis-related cost in the year after the index severe osteoporotic fracture was €18,040 (from €8598 for multiple ribs to €21,085 for hip fracture) of which €17,905 was incurred by fracture-related costs. The cost incurred by management of osteoporosis was €135. Over years 2 to 5, the mean annual per capita costs of fracture treatment (€806, mostly attributable to the treatment of refractures) continued to dominate those of osteoporosis management (€99). Total annual cost of care was €1260 million (year 2014). Variables associated with higher cost were older age, male sex, site of fracture, a history of prior osteoporotic fracture, and the number of refracture events. The 5-year cost of severe osteoporotic fractures to the French health care system is high and mostly attributable to the treatment of refractures. Improved fracture prevention measures in patients with osteoporosis is crucial to reduce the economic burden of the disease. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Thierry Thomas
- Department of Rheumatology, University Hospital of Saint-Étienne, INSERM U1059, Lyon University, Saint-Etienne, France
| | - Florence Tubach
- Department of Public Health, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | | | | | | | | | | | - Christian Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, INSERM, Unités Mixtes de Recherche (UMR) 1153, Université de Paris, Paris, France
| | - Julien Paccou
- Department of Rheumatology, CHU Lille, MABlab ULR 4490, Lille University, Lille, France
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Launois R, Cabout E, Benamouzig D, Velpry L, Briot K, Alliot F, Perrin L, Grange L, Sellami R, Touboul C, Joubert JM, Roux C. Barriers and Expectations for Patients in Post-Osteoporotic Fracture Care in France: The EFFEL Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:571-581. [PMID: 35365301 DOI: 10.1016/j.jval.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/12/2021] [Accepted: 10/10/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to quantify the relative importance of barriers to better secondary prevention of osteoporotic fractures and of care expectations expressed by patients with osteoporotic fractures in France. METHODS A qualitative exploration of potential barriers to care and expectations was undertaken through a systematic literature review and in-depth patients interviews. A list of 21 barriers and 21 expectations was identified. These were presented to 324 subjects with osteoporotic fractures, identified in a representative sample of the French population, in the form of best-worst scaling questionnaires. Patients rated the relative importance of the attributes, and arithmetic mean importance scores were calculated and ranked. A Bayesian hierarchical model was also performed to generate a relative importance score. Latent class analysis was performed to identify potential subgroups of patients with different response profiles. RESULTS A total of 7 barriers were rated as the most important, relating to awareness of osteoporosis and coordination of care. The highest-ranked barrier, "my fracture is not related to osteoporosis," was significantly more important than all the others (mean importance score 0.45; 95% confidence interval 0.33-0.56). A similar ranking of attributes was obtained with both the arithmetic and the Bayesian approach. For expectations, no clear hierarchy of attributes was identified. Latent class analysis discriminated 3 classes of respondents with significant differences in response profiles (the educated environmentalists, the unaware, and the victims of the system). CONCLUSIONS Better quality of care of osteoporosis and effective secondary fracture prevention will require improvements in patient education, training of healthcare professionals, and coordination of care.
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Affiliation(s)
| | - Elise Cabout
- Health Economic Assessment Network, Paris, France
| | - Daniel Benamouzig
- French National Center for Scientific Research, Paris, France; Sciences Po, Center of the Sociology of Organizations, Paris, France
| | - Livia Velpry
- Sociology and Anthropology Department, Paris 8 University, Paris, France
| | - Karine Briot
- Rhumatology Department, Cochin Hospital, Paris, France
| | | | | | - Laurent Grange
- Rhumatology Department, Grenobles Alpes University Hospital, Echirolles, France
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McCloskey E, Rathi J, Heijmans S, Blagden M, Cortet B, Czerwinski E, Hadji P, Payer J, Palmer K, Stad R, O'Kelly J, Papapoulos S. Prevalence of FRAX risk factors and the osteoporosis treatment gap among women ≥ 70 years of age in routine primary care across 8 countries in Europe. Arch Osteoporos 2022; 17:20. [PMID: 35064844 PMCID: PMC8783912 DOI: 10.1007/s11657-021-01048-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
We studied whether elderly women at risk for fractures receive primary care treatment to prevent fracture. We found that across Europe, women at risk are often not identified, and less than half of such women receive appropriate treatment. Finally, women diagnosed with osteoporosis are much more likely to receive treatment. PURPOSE To examine the relationship between risk factors for fragility fracture (FF) and osteoporosis (OP) treatment gap in elderly women across Europe, and compare the prevalence of risk factors between countries. METHODS Demographic and clinical information was collected from women ≥ 70 years visiting primary care physicians in Belgium, France, Germany, Ireland, Poland, Slovakia, Switzerland, and the UK. Increased risk of FF was defined by the presence of 1 or more criteria (history of fracture, 10-year fracture probability, or T-score ≤ - 2.5). RESULTS There were 3798 women in total. Treatment gap (proportion at increased risk of FF not receiving treatment for OP) varied from 53.1 to 90.8% across countries, and the proportion of patients at increased risk of FF varied from 41.2 to 76.1%. Across countries, less than 50% of patients with increased risk of FF had a diagnosis of OP. Previous fracture was the most common risk factor, with similar prevalence across most countries; other risk factors varied widely. The treatment gap was reduced in patients with an OP diagnosis in all countries, but this reduction varied from 36.5 to 79.4%. The countries with the lowest rates of bone densitometry scans (Poland, France, and Germany; 8.3-12.3%) also had the highest treatment gap (82.2 to 90.8%). CONCLUSIONS This study highlights differences across Europe in clinical risk factors for fracture, rates of densitometry scanning, and the rates of OP diagnosis. More emphasis is needed on risk assessment to improve the identification and treatment of elderly women at risk for fracture.
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Affiliation(s)
- Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | | | | | | | - Bernard Cortet
- Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
| | - Edward Czerwinski
- Department of Bone and Joint Diseases, FHS, Jagiellonian University Medical College, Kopernika 32, 31-501, Krakow, Poland
| | - Peyman Hadji
- Frankfurt Center of Bone Health, Frankfurt, Germany.,Philipps-University of Marburg, Marburg, Germany
| | - Juraj Payer
- Faculty of Medicine, 5th Department of Internal Medicine in University Hospital Bratislava, Comenius University, Bratislava, Slovakia
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Smith JS, Shaffrey CI, Baldus CR, Kelly MP, Yanik EL, Lurie JD, Ames CP, Bess S, Schwab FJ, Bridwell KH. Orthopedic disease burden in adult patients with symptomatic lumbar scoliosis: results from a prospective multicenter study. J Neurosurg Spine 2021; 35:743-751. [PMID: 34416734 PMCID: PMC10193469 DOI: 10.3171/2021.1.spine201911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although the health impact of adult symptomatic lumbar scoliosis (ASLS) is substantial, these patients often have other orthopedic problems that have not been previously quantified. The objective of this study was to assess disease burden of other orthopedic conditions in patients with ASLS based on a retrospective review of a prospective multicenter cohort. METHODS The ASLS-1 study is an NIH-sponsored prospective multicenter study designed to assess operative versus nonoperative treatment for ASLS. Patients were 40-80 years old with ASLS, defined as a lumbar coronal Cobb angle ≥ 30° and Oswestry Disability Index ≥ 20, or Scoliosis Research Society-22 questionnaire score ≤ 4.0 in pain, function, and/or self-image domains. Nonthoracolumbar orthopedic events, defined as fractures and other orthopedic conditions receiving surgical treatment, were assessed from enrollment to the 4-year follow-up. RESULTS Two hundred eighty-six patients (mean age 60.3 years, 90% women) were enrolled, with 173 operative and 113 nonoperative patients, and 81% with 4-year follow-up data. At a mean (± SD) follow-up of 3.8 ± 0.9 years, 104 nonthoracolumbar orthopedic events were reported, affecting 69 patients (24.1%). The most common events were arthroplasty (n = 38), fracture (n = 25), joint ligament/cartilage repair (n = 13), and cervical decompression/fusion (n = 7). Based on the final adjusted model, patients with a nonthoracolumbar orthopedic event were older (HR 1.44 per decade, 95% CI 1.07-1.94), more likely to have a history of tobacco use (HR 1.63, 95% CI 1.00-2.66), and had worse baseline leg pain scores (HR 1.10, 95% CI 1.01-1.19). CONCLUSIONS Patients with ASLS have high orthopedic disease burden, with almost 25% having a fracture or nonthoracolumbar orthopedic condition requiring surgical treatment during the mean 3.8 years following enrollment. Comparisons with previous studies suggest that the rate of total knee arthroplasty was considerably greater and the rates of total hip arthroplasty were at least as high in the ASLS-1 cohort compared with the similarly aged general US population. These conditions may further impact health-related quality of life and outcomes assessments of both nonoperative and operative treatment approaches in patients with ASLS.
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Affiliation(s)
- Justin S. Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher I. Shaffrey
- Departments of Neurosurgery and Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Christine R. Baldus
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michael P. Kelly
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Elizabeth L. Yanik
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jon D. Lurie
- Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire
| | - Christopher P. Ames
- Department of Neurosurgery, University of California, San Francisco, California
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, Colorado; and
| | | | - Keith H. Bridwell
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Nawrat-Szołtysik A, Miodońska Z, Piejko L, Szołtys B, Błaszczyszyn M, Matyja B, Zarzeczny R, Zając-Gawlak I, Kucio E, Polak A. Assessment of Quality of Life and Pain Severity in Older Men with Osteoporosis: Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111276. [PMID: 34769791 PMCID: PMC8583218 DOI: 10.3390/ijerph182111276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The quality of life in osteoporosis is studied for men rather than for women. Aim of the study was to determine how bone mass density (BMD) relates to life quality components and the severity of pain felt by men affected by osteoporosis. METHODS Presented research is a cross-sectional study. The cohort of 62 men aged 65 to 85 years was divided into a group with osteoporosis (N = 27) and a group without osteoporosis (N = 35). The participants' quality of life was measured with the Qualeffo41 Questionnaire, BMD was quantified by densitometry, and pain intensity was assessed on the Visual Analogue Scale. RESULTS We found that lower BMD was strongly correlated to participants' quality of life (r = -0.72), especially the quality of leisure and social activities (r = -0.66), general health perception (r = -0.59), and mobility (r = -0.57). Pain significantly affected general health perception in older men with osteoporosis. General health assessment and pain were highly correlated with each other (r = 0.888). CONCLUSION BMD and the overall quality of life of the study participants were related to each other. The strongest relationship occurred between reduced BMD and leisure and social activities component. The pain significantly affected participants' general health perception. The results may be employed to create new prophylactic strategies to improve life quality in men with osteoporosis.
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Affiliation(s)
- Agnieszka Nawrat-Szołtysik
- Institute of Physiotherapy and Health Sciences, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (L.P.); (B.S.); (A.P.)
- Center Saint Elizabeth, 41-700 Ruda Śląska, Poland;
- Correspondence: ; Tel.: +48-793-481-081
| | - Zuzanna Miodońska
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland;
| | - Laura Piejko
- Institute of Physiotherapy and Health Sciences, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (L.P.); (B.S.); (A.P.)
| | - Bogna Szołtys
- Institute of Physiotherapy and Health Sciences, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (L.P.); (B.S.); (A.P.)
| | - Monika Błaszczyszyn
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-027 Opole, Poland;
| | - Beata Matyja
- Center Saint Elizabeth, 41-700 Ruda Śląska, Poland;
| | - Ryszard Zarzeczny
- Institute of Health Sciences, The Jan Kochanowski University of Kielce, 25-369 Kielce, Poland;
| | - Izabela Zając-Gawlak
- Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
| | - Ewa Kucio
- Department of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
- American Heart of Poland, St. Elizabeth’s Hospital, 40-008 Katowice, Poland
| | - Anna Polak
- Institute of Physiotherapy and Health Sciences, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (L.P.); (B.S.); (A.P.)
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Schwagten K, Gill J, Thorisdottir V. Epidemiology of dancers fracture. Foot Ankle Surg 2021; 27:677-680. [PMID: 33229215 DOI: 10.1016/j.fas.2020.09.001] [Citation(s) in RCA: 4] [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] [Received: 06/17/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dancer's fracture is a spiral, oblique fracture of the diaphysis of the fifth metatarsal. Although it is a well-known fracture in high performance athletes, it is less studied in a general population. The article investigates the epidemiology within an adult population consulting a regional trauma and orthopedic center in the United Kingdom. METHODS Study population included all patients older than 16 years presenting with a dancer's fracture. Recorded data were age, sex, side and energy of trauma mechanism, applied treatment and time of healing. RESULTS Of all fifth metatarsal fractures, 25% was found to have a dancer's fracture. About 80% were women, and about 80% was older than 40 years. In the +40 y age group, all patients had a low energy trauma mechanism, where in the -40y age group this was only 27%. All patients were treated conservatively and no correlation was found between type of treatment (walker boot, stiff soled shoe) and time of healing. The time of healing was similar in both age groups and in general 1 out of 3 patients needed longer than 6 weeks to heal. CONCLUSION There is an increased incidence of dancer's fracture observed in the female general population +40y age. A strong correlation was found between the +40y age group and low-energy trauma mechanism. This shows the importance of treating dancer's fracture as a fragility fracture. LEVEL OF EVIDENCE Retrospective cohort study: level 3.
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Roux C, Thomas T, Paccou J, Bizouard G, Crochard A, Toth E, Lemaitre M, Maurel F, Perrin L, Tubach F. Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study. JBMR Plus 2021; 5:e10507. [PMID: 34258503 PMCID: PMC8260818 DOI: 10.1002/jbm4.10507] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/17/2022] Open
Abstract
Severe osteoporotic fractures (hip, proximal humerus, pelvic, vertebral and multiple rib fractures) carry an increased risk of mortality. This retrospective cohort study in the French national healthcare database aimed to estimate refracture and mortality rates after severe osteoporotic fractures at different sites, and to identify mortality‐related variables. A total of 356,895 patients hospitalized for severe osteoporotic fracture between 2009 and 2014 inclusive were analyzed. The cohort was followed for 2 to 8 years up to the study end or until the patient died. Data were extracted on subsequent hospitalizations, refracture events, treatments, comorbidities of interest and survival. Time to refracture and survival were described using Kaplan‐Meier analysis by site of fracture and overall. Mortality risk factors were identified using a Cox model. Hip fractures accounted for 60.4% of the sample (N = 215,672). In the 12 months following fracture, 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate was 6.3% (95% confidence interval [CI], 6.2%–6.3%), ranging from 4.0% (95% CI, 3.7%–4.3%) for multiple rib fractures to 7.8% (95% CI, 7.5%–8.1%) for pelvic fractures. Twelve‐month all‐cause mortality was 12.8% (95% CI, 12.7%–12.9%), ranging from 5.0% (95% CI, 4.7%–5.2%) for vertebral fractures to 16.6% (95% CI, 16.4%–16.7%) for hip fractures. Osteoporosis‐related mortality risk factors included fracture site, previous osteoporotic fracture (hazard ratio 1.21; 95% CI, 1.18–1.23), hip refracture (1.74; 95% CI, 1.71–1.77), and no prior osteoporosis treatment (1.24; 95% CI, 1.22–1.26). Comorbid cancer (3.15; 95% CI, 3.09–3.21) and liver disease (2.54; 95% CI, 2.40–2.68) were also strongly associated with mortality. In conclusion, severe osteoporotic fractures, including certain non‐hip nonvertebral fractures, carry a high burden in terms of mortality and refracture risk. However, most patients received no anti‐osteoporotic treatment. The findings emphasize the importance of better management of patients with severe fractures, and of developing effective strategies to reduce fracture risk in patients with osteoporosis. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Christian Roux
- Department of Rheumatology Cochin Hospital, Assistance Publique - Hôpitaux de Paris Centre, Institut National de la Santé et de la Recherche Médicale (INSERM) Unités Mixtes de Recherche (UMR) 1153, Université de Paris Paris France
| | - Thierry Thomas
- Department of Rheumatology Hôpital Nord, Centre Hospitalier Universitaire (CHU) Saint-Etienne, INSERM U1059, Lyon University Saint-Etienne France
| | - Julien Paccou
- Department of Rheumatology Lille University, CHU Lille, Marrow Adiposity and Bone Laboratory (MABlab) ULR 4490 Lille France
| | | | | | | | | | | | | | - Florence Tubach
- Department of Public Health, Pharmacoepidemiology Center (Cephepi) Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP Sorbonne University, Pitié-Salpêtrière Hospital, CIC-1422 Paris France
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Bettag C, Abboud T, von der Brelie C, Melich P, Rohde V, Schatlo B. Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis? Neurosurg Focus 2020; 49:E16. [DOI: 10.3171/2020.5.focus20267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPyogenic spondylodiscitis affects a fragile patient population. Surgical treatment in cases of instability entails instrumentation, and loosening of this instrumentation is a frequent occurrence in pyogenic spondylodiscitis. The authors therefore attempted to investigate whether low bone mineral density (BMD)—which is compatible with the diagnosis of osteoporosis—is underdiagnosed in patients with pyogenic spondylodiscitis. How osteoporosis was treated and how it affected implant stability were further analyzed.METHODSCharts of patients who underwent operations for pyogenic spondylodiscitis were retrospectively reviewed for clinical data, prior medical history of osteoporosis, and preoperative CT scans of the thoracolumbar spine. In accordance with a previously validated high-fidelity opportunistic CT assessment, average Hounsfield units (HUs) in vertebral bodies of L1 and L4 were measured. Based on the validation study, the authors opted for a conservative cutoff value for low BMD, being compatible with osteoporosis ≤ 110 HUs. Baseline and outcome variables, including implant failure and osteoporosis interventions, were entered into a multivariate logistic model for statistical analysis.RESULTSOf 200 consecutive patients who underwent fusion surgery for pyogenic spondylodiscitis, 64% (n = 127) were male and 66% (n = 132) were older than 65 years. Seven percent (n = 14) had previously been diagnosed with osteoporosis. The attenuation analysis revealed HU values compatible with osteoporosis in 48% (95/200). The need for subsequent revision surgery due to implant failure showed a trend toward an association with estimated low BMD (OR 2.11, 95% CI 0.95–4.68, p = 0.067). Estimated low BMD was associated with subsequent implant loosening (p < 0.001). Only 5% of the patients with estimated low BMD received a diagnosis and pharmacological treatment of osteoporosis within 1 year after spinal instrumentation.CONCLUSIONSRelying on past medical history of osteoporosis is insufficient in the management of patients with pyogenic spondylodiscitis. This is the first study to identify a substantially missed opportunity to detect osteoporosis and to start pharmacological treatment after surgery for prevention of implant failure. The authors advocate for routine opportunistic CT evaluation for a better estimation of bone quality to initiate diagnosis and treatment for osteoporosis in these patients.
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Affiliation(s)
- Christoph Bettag
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
| | - Tammam Abboud
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
| | | | - Patrick Melich
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
- 2Department of Neurosurgery, University Hospital Cologne, Germany
| | - Veit Rohde
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
| | - Bawarjan Schatlo
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
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