1
|
Grogan G, Stephens KL, Chou J, Abdalla J, Wagner R, Peek KJ, Freilich AM, DeGeorge BR. The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture. Hand (N Y) 2024:15589447241233369. [PMID: 38411105 DOI: 10.1177/15589447241233369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries. METHODS PearlDiver Mariner insurance claims database was analyzed for treatment patterns of DRF in patients aged 18 to 65 years based on the presence or absence of social determinants of health disparities (SDHDs). Outcome variables included the primary mode of management of DRF, including operative versus non-operative, as well as concomitant procedures. Multivariate logistic regression was used to compare fracture management modality in patients with and without SDHDs. RESULTS Of 161 704 patients identified with DRF, 38.3% had at least 1 reported SDHD. The majority of SDHDs were economic. Patients identified with 1 or more SDHDs had a higher medical comorbidity index. Patients with environmental SDHD were more likely to receive non-operative management. Within any SDHD and economic subgroups, odds of operative management were higher. No relationship was identified between SDHD and concomitant procedures. CONCLUSIONS The presence of environmental disparities in SDH may predispose patients disproportionately to non-operative management. The presence of SDHDs may influence medical decision-making in favor of open reduction and internal fixation in patients with DRF treated operatively. In treating at-risk populations, providers should be aware of the potential for implicit bias associated with SDHDs and prioritize shared decision-making between patients and physicians.
Collapse
Affiliation(s)
- Graham Grogan
- University of Mississippi Medical Center, Jackson, USA
| | - Kristen L Stephens
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
| | - Jesse Chou
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
| | - Jasmina Abdalla
- University of Virginia School of Medicine, Charlottesville, USA
| | - Ryan Wagner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Kacy J Peek
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Aaron M Freilich
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Brent R DeGeorge
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| |
Collapse
|
2
|
Wei X, Cooper DML. The various meanings and uses of bone "remodeling" in biological anthropology: A review. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:318-329. [PMID: 37515465 DOI: 10.1002/ajpa.24825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/28/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES In modern bone biology, the term "remodeling" generally refers to internal bone turnover that creates secondary osteons. However, it is also widely used by skeletal biologists, including biological anthropologists as a catch-all term to refer to different skeletal changes. In this review, we investigated how "remodeling" is used across topics on skeletal biology in biological anthropology to demonstrate potential problems with such pervasive use of a generalized term. METHODS Using PubMed and Google Scholar, we selected and reviewed 205 articles that use the term remodeling to describe skeletal processes and have anthropological implications. Nine edited volumes were also reviewed as examples of collaborative work by different experts to demonstrate the diverse and extensive use of the term remodeling. RESULTS Four general meanings of bone "remodeling" were identified, namely, internal turnover, functional adaptation, fracture repair, and growth remodeling. Additionally, remodeling is also used to refer to a broad array of pathological skeletal changes. DISCUSSION Although we initially identified four general meanings of bone remodeling, they are not mutually exclusive and often occur in combination. The term "remodeling" has become an extensively used catch-all term to refer to different processes and outcomes of skeletal changes, which inevitably lead to misunderstanding and a loss of information. Such ambiguity and confusion are potentially problematic as the field of biological anthropology becomes increasingly multidisciplinary. Therefore, we advocate for precise, context-specific definitions and explanations of bone remodeling as it continues to be used across disciplines within and beyond biological anthropology.
Collapse
Affiliation(s)
- Xuan Wei
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David M L Cooper
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
3
|
Miszkiewicz JJ, Buckley HR, Feldman M, Kiko L, Carlhoff S, Naegele K, Bertolini E, Guimarães NRD, Walker MM, Powell A, Posth C, Kinaston RL. Female bone physiology resilience in a past Polynesian Outlier community. Sci Rep 2022; 12:18857. [PMID: 36344562 PMCID: PMC9640697 DOI: 10.1038/s41598-022-23171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Remodelling is a fundamental biological process involved in the maintenance of bone physiology and function. We know that a range of health and lifestyle factors can impact this process in living and past societies, but there is a notable gap in bone remodelling data for populations from the Pacific Islands. We conducted the first examination of femoral cortical histology in 69 individuals from ca. 440-150 BP Taumako in Solomon Islands, a remote 'Polynesian Outlier' island in Melanesia. We tested whether bone remodelling indicators differed between age groups, and biological sex validated using ancient DNA. Bone vascular canal and osteon size, vascular porosity, and localised osteon densities, corrected by femoral robusticity indices were examined. Females had statistically significantly higher vascular porosities when compared to males, but osteon densities and ratios of canal-osteon (~ 8%) did not differ between the sexes. Our results indicate that, compared to males, localised femoral bone tissue of the Taumako females did not drastically decline with age, contrary to what is often observed in modern populations. However, our results match findings in other archaeological samples-a testament to past female bone physiology resilience, also now observed in the Pacific region.
Collapse
Affiliation(s)
- Justyna J. Miszkiewicz
- grid.1001.00000 0001 2180 7477School of Archaeology and Anthropology, Australian National University, Canberra, Australia ,grid.1003.20000 0000 9320 7537School of Social Science, University of Queensland, St Lucia, Australia
| | - Hallie R. Buckley
- grid.29980.3a0000 0004 1936 7830Department of Anatomy, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Michal Feldman
- grid.10392.390000 0001 2190 1447Archaeo- and Palaeogenetics Group, Institute for Archaeological Sciences, University of Tübingen, Tübingen, Germany ,grid.10392.390000 0001 2190 1447Senckenberg Centre for Human Evolution and Palaeoenvironment, University of Tübingen, Tübingen, Germany ,grid.419518.00000 0001 2159 1813Department of Archaeogenetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Lawrence Kiko
- The Solomon Islands National Museum, Honiara, Solomon Islands
| | - Selina Carlhoff
- grid.419518.00000 0001 2159 1813Department of Archaeogenetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Kathrin Naegele
- grid.419518.00000 0001 2159 1813Department of Archaeogenetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Emilie Bertolini
- grid.469873.70000 0004 4914 1197Department of Archaeogenetics, Max Planck Institute for the Science of Human History, Jena, Germany
| | - Nathalia R. Dias Guimarães
- grid.1001.00000 0001 2180 7477School of Archaeology and Anthropology, Australian National University, Canberra, Australia
| | - Meg M. Walker
- grid.1001.00000 0001 2180 7477School of Archaeology and Anthropology, Australian National University, Canberra, Australia
| | - Adam Powell
- grid.419518.00000 0001 2159 1813Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Cosimo Posth
- grid.10392.390000 0001 2190 1447Archaeo- and Palaeogenetics Group, Institute for Archaeological Sciences, University of Tübingen, Tübingen, Germany ,grid.10392.390000 0001 2190 1447Senckenberg Centre for Human Evolution and Palaeoenvironment, University of Tübingen, Tübingen, Germany ,grid.419518.00000 0001 2159 1813Department of Archaeogenetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Rebecca L. Kinaston
- grid.29980.3a0000 0004 1936 7830Department of Anatomy, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand ,grid.1022.10000 0004 0437 5432Centre for Social and Cultural Research, Griffith University, Southport, QLD Australia ,BioArch South, Waitati, New Zealand
| |
Collapse
|
4
|
Miszkiewicz JJ, Valentin F, Vrahnas C, Sims NA, Vongsvivut J, Tobin MJ, Clark G. Bone loss markers in the earliest Pacific Islanders. Sci Rep 2021; 11:3981. [PMID: 33597553 PMCID: PMC7889909 DOI: 10.1038/s41598-021-83264-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022] Open
Abstract
Kingdom of Tonga in Polynesia is one of the most obese nations where metabolic conditions, sedentary lifestyles, and poor quality diet are widespread. These factors can lead to poor musculoskeletal health. However, whether metabolic abnormalities such as osteoporosis occurred in archaeological populations of Tonga is unknown. We employed a microscopic investigation of femur samples to establish whether bone loss afflicted humans in this Pacific region approximately 3000 years ago. Histology, laser confocal microscopy, and synchrotron Fourier-transform infrared microspectroscopy were used to measure bone vascular canal densities, bone porosity, and carbonate and phosphate content of bone composition in eight samples extracted from adult Talasiu males and females dated to 2650 BP. Compared to males, samples from females had fewer vascular canals, lower carbonate and phosphate content, and higher bone porosity. Although both sexes showed evidence of trabecularised cortical bone, it was more widespread in females (35.5%) than males (15.8%). Our data suggest experiences of advanced bone resorption, possibly as a result of osteoporosis. This provides first evidence for microscopic bone loss in a sample of archaeological humans from a Pacific population widely afflicted by metabolic conditions today.
Collapse
Affiliation(s)
- Justyna J Miszkiewicz
- School of Archaeology and Anthropology, Australian National University, 44 Linnaeus Way, Canberra, ACT, 2601, Australia.
| | - Frédérique Valentin
- CNRS, UMR 7041, ArScAn, Ethnologie préhistorique, Maison René-Ginouvès, Archéologie et Ethnologie, 21 Allée de l'Université, 92023, Nanterre Cedex, France.,Archaeology and Natural History, School of Culture History and Language, College of Asia and the Pacific, Australian National University, Canberra, ACT, 2601, Australia
| | - Christina Vrahnas
- Bone Biology and Disease Unit, St. Vincent's Institute of Medical Research, 9 Princes Street, Fitzroy, Melbourne, VIC, 3065, Australia.,Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, 3065, Australia.,MRC Protein Phosphorylation and Ubiquitylation Unit, James Black Centre, University of Dundee, Dundee, DD1 5EH, UK
| | - Natalie A Sims
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, 3065, Australia.,MRC Protein Phosphorylation and Ubiquitylation Unit, James Black Centre, University of Dundee, Dundee, DD1 5EH, UK
| | - Jitraporn Vongsvivut
- Infrared Microspectroscopy Beamline, ANSTO - Australian Synchrotron, 800 Blackburn Road, Clayton, VIC, 3168, Australia
| | - Mark J Tobin
- Infrared Microspectroscopy Beamline, ANSTO - Australian Synchrotron, 800 Blackburn Road, Clayton, VIC, 3168, Australia
| | - Geoffrey Clark
- Archaeology and Natural History, School of Culture History and Language, College of Asia and the Pacific, Australian National University, Canberra, ACT, 2601, Australia
| |
Collapse
|
5
|
Wilson LAB, De Groote I, Humphrey LT. Sex differences in the patterning of age-related bone loss in the human hallucal metatarsal in rural and urban populations. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 171:628-644. [PMID: 31925961 DOI: 10.1002/ajpa.24002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/18/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Age-degenerative features of the metatarsals are poorly known despite the importance of metatarsal bone properties for investigating mobility patterns. We assessed the role of habitual activity in shaping the patterning and magnitude of sexual dimorphism in age-related bone loss in the hallucal metatarsal. MATERIALS AND METHODS Cross-sections were extracted at midshaft from micro-computed tomography scan models of individuals from medieval rural (Abingdon Vineyard) and early industrial urban (Spitalfields) settings (n = 71). A suite of cross-sectional geometry dimensions and biomechanical properties were compared between populations. RESULTS The rural group display generally stronger and larger metatarsals that show a greater capacity to resist torsion and that have comparatively greater bending strength along the medio-lateral plane. Men in both groups show greater values of cortical area than women, but only in the urban group do men show lower magnitudes of age-related decline compared to females. Women in rural and urban populations show different patterns of age-related decline in bone mass, particularly old women in the urban group show a marked decline in cortical area that is absent for women in the rural group. DISCUSSION Lifetime exposure to hard, physical activity in an agricultural setting has contributed to the attainment of greater bone mass and stronger bones in young adults. Furthermore, over the life-course, less of this greater amount of bone is lost, such that sustained activity levels may have acted to buffer against age-related decline, and this is most pronounced for women, who are expected to experience greater bone loss later in life than men.
Collapse
Affiliation(s)
- Laura A B Wilson
- School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Isabelle De Groote
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
- Department of Archaeology, Section Prehistory of western Europe, Ghent University, Ghent, Belgium
| | - Louise T Humphrey
- Department of Earth Sciences, The Natural History Museum London, London, UK
| |
Collapse
|