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Cameron ID, Kurrle SE, Sherrington C. Preventing falls and fall-related injuries in older people. Med J Aust 2024; 221:140-144. [PMID: 38952144 DOI: 10.5694/mja2.52374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 03/27/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW
- University of Sydney, Sydney, NSW
| | | | - Cathie Sherrington
- University of Sydney, Sydney, NSW
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW
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Danazumi MS, Lightbody N, Dermody G. Effectiveness of fracture liaison service in reducing the risk of secondary fragility fractures in adults aged 50 and older: a systematic review and meta-analysis. Osteoporos Int 2024; 35:1133-1151. [PMID: 38536447 PMCID: PMC11211169 DOI: 10.1007/s00198-024-07052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/01/2024] [Indexed: 06/28/2024]
Abstract
To determine and appraise the certainty of fracture liaison service (FLS) in reducing the risk of secondary fragility fractures in older adults aged ≥ 50 years and to examine the nature of the FLS and the roles of various disciplines involved in the delivery of the FLS. Medline, EMBASE, PubMed, CINAHL, SCOPUS, and The Cochrane Library were searched from January 1st, 2010, to May 31st, 2022. Two reviewers independently extracted data. The risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the PEDro scale for randomized trials, while the GRADE approach established the certainty of the evidence. Thirty-seven studies were identified of which 34 (91.9%) were rated as having a low risk of bias and 22 (59.5%) were meta-analyzed. Clinically important low certainty evidence at 1 year (RR 0.26, CI 0.13 to 0.52, 6 pooled studies) and moderate certainty evidence at ≥ 2 years (RR 0.68, CI 0.55 to 0.83, 13 pooled studies) indicate that the risk of secondary fragility fracture was lower in the FLS intervention compared to the non-FLS intervention. Sensitivity analyses with no observed heterogeneity confirmed these findings. This review found clinically important moderate certainty evidence showing that the risk of secondary fragility fracture was lower in the FLS intervention at ≥ 2 years. More high-quality studies in this field could improve the certainty of the evidence. Review registration: PROSPERO-CRD42021266408.
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Affiliation(s)
- Musa Sani Danazumi
- Discipline of Physiotherapy, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC, Australia
- Department of Physiotherapy, Federal Medical Centre Nguru, 02 Machina Road, Nguru, 630101, Yobe, Nigeria
| | - Nicol Lightbody
- Queensland Government Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Gordana Dermody
- School of Health, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, 4556, Australia.
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Huang KC, Chuang PY, Yang TY, Tsai YH, Li YY, Chang SF. Diabetic Rats Induced Using a High-Fat Diet and Low-Dose Streptozotocin Treatment Exhibit Gut Microbiota Dysbiosis and Osteoporotic Bone Pathologies. Nutrients 2024; 16:1220. [PMID: 38674910 PMCID: PMC11054352 DOI: 10.3390/nu16081220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) presents a challenge for individuals today, affecting their health and life quality. Besides its known complications, T2DM has been found to contribute to bone/mineral abnormalities, thereby increasing the vulnerability to bone fragility/fractures. However, there is still a need for appropriate diagnostic approaches and targeted medications to address T2DM-associated bone diseases. This study aims to investigate the relationship between changes in gut microbiota, T2DM, and osteoporosis. To explore this, a T2DM rat model was induced by combining a high-fat diet and low-dose streptozotocin treatment. Our findings reveal that T2DM rats have lower bone mass and reduced levels of bone turnover markers compared to control rats. We also observe significant alterations in gut microbiota in T2DM rats, characterized by a higher relative abundance of Firmicutes (F) and Proteobacteria (P), but a lower relative abundance of Bacteroidetes (B) at the phylum level. Further analysis indicates a correlation between the F/B ratio and bone turnover levels, as well as between the B/P ratio and HbA1c levels. Additionally, at the genus level, we observe an inverse correlation in the relative abundance of Lachnospiraceae. These findings show promise for the development of new strategies to diagnose and treat T2DM-associated bone diseases.
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Affiliation(s)
- Kuo-Chin Huang
- School of Medicine, Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan; (K.-C.H.); (P.-Y.C.); (T.-Y.Y.); (Y.-H.T.); (Y.-Y.L.)
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Po-Yao Chuang
- School of Medicine, Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan; (K.-C.H.); (P.-Y.C.); (T.-Y.Y.); (Y.-H.T.); (Y.-Y.L.)
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Tien-Yu Yang
- School of Medicine, Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan; (K.-C.H.); (P.-Y.C.); (T.-Y.Y.); (Y.-H.T.); (Y.-Y.L.)
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Yao-Hung Tsai
- School of Medicine, Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan; (K.-C.H.); (P.-Y.C.); (T.-Y.Y.); (Y.-H.T.); (Y.-Y.L.)
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Yen-Yao Li
- School of Medicine, Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan; (K.-C.H.); (P.-Y.C.); (T.-Y.Y.); (Y.-H.T.); (Y.-Y.L.)
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Shun-Fu Chang
- Department of Medical Research and Development, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
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Lee JK, Mitchell PJ, Ang SB, Mercado-Asis LB, Rey-Matias R, Li J, Flicker L, Leung E, Choon D, Chandrasekaran SK, Close JCT, Seymour H, Cooper C, Halbout P, Blank RD, Zhao Y, Malhotra R, Unnanuntana A, Woo YL, Noor Z, Yang RS, Tabu I, Islam SS, Chinoy MA, Pande S, Thapa B, Wong RMY, Pande K, Chan DCD. Survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association. Arch Osteoporos 2024; 19:24. [PMID: 38565791 DOI: 10.1007/s11657-024-01375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific. PURPOSE Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies. The current incidence of hip and other fragility fractures across the Asia Pacific region is enormous and set to escalate rapidly in the coming decades. This publication describes findings of a survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association (APOA) conducted in 2022. METHODS The survey was developed as a collaboration between the Asia Pacific Osteoporosis and Fragility Fracture Society and the Asia Pacific Fragility Fracture Alliance, and included questions relating to aspects of care upon presentation, during surgery and mobilisation, secondary fracture prevention, and access to specific services. RESULTS In total, 521 APOA members completed the survey and marked variation in delivery of care was evident. Notable findings included: Fifty-nine percent of respondents indicated that analgesia was routinely initiated in transit (by paramedics) or within 30 minutes of arrival in the Emergency Department. One-quarter of respondents stated that more than 80% of their patients underwent surgery within 48 hours of admission. One-third of respondents considered non-hip, non-vertebral fractures to merit assessment of future fracture risk. One-third of respondents reported the presence of an Orthogeriatric Service in their hospital, and less than a quarter reported the presence of a Fracture Liaison Service. CONCLUSION A Call to Action for all National Orthopaedic Associations affiliated with APOA is proposed to improve the care of fragility fracture patients across the region.
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Affiliation(s)
- Joon Kiong Lee
- Beacon Hospital, Department of Orthopedics, Petaling Jaya, Malaysia.
| | - Paul James Mitchell
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Synthesis Medical NZ Limited, Dunedin, Otago, New Zealand
| | - Seng Bin Ang
- Asian Federation of Osteoporosis Societies, c/o, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
- Menopause Unit and Family Medicine Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Leilani Basa Mercado-Asis
- Asian Federation of Osteoporosis Societies, c/o, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
- University of Santo Tomas, Faculty of Medicine and Surgery and Public Health Program, Department of Medicine, Section of Endocrinology and Metabolism, Manila, Philippines
| | - Reynaldo Rey-Matias
- Asia-Oceanian Society of Physical and Rehabilitation Medicine, Kowloon, Hong Kong SAR, China
- Department of Physical and Rehabilitation Medicine, St. Luke's Medical Center, Quezon City, Philippines
- Philippine Academy of Rehabilitation Medicine, Manila, Philippines
| | - Jianan Li
- Asia-Oceanian Society of Physical and Rehabilitation Medicine, Kowloon, Hong Kong SAR, China
- College of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
- First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Leon Flicker
- Asia Pacific Geriatric Network, virtual network, Perth, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Edward Leung
- Asia Pacific Geriatric Network, virtual network, Perth, Australia
- Geriatric Medicine Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong SAR, China
| | - David Choon
- Asia Pacific Orthopaedic Association, Bukit Jalil, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sankara Kumar Chandrasekaran
- Asia Pacific Orthopaedic Association, Bukit Jalil, Kuala Lumpur, Wilayah Persekutuan, Malaysia
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Jacqueline Clare Therese Close
- Fragility Fracture Network, Reinacherstrasse 131, 4053, Basel, Switzerland
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Hannah Seymour
- Fragility Fracture Network, Reinacherstrasse 131, 4053, Basel, Switzerland
- Department of Geriatrics and Aged Care, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Cyrus Cooper
- International Osteoporosis Foundation, Nyon, Switzerland
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | - Robert Daniel Blank
- International Society for Clinical Densitometry, Middletown, CT, USA
- Osteoporosis and Translational Research Laboratory, Garvan Institute of Medical Research, Sydney, Australia
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Yanling Zhao
- International Society for Clinical Densitometry, Middletown, CT, USA
- Beijing United Family Hospital (Department of Obstetrics and Gynecology), Beijing, China
| | - Rajesh Malhotra
- Department of Orthopaedics, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Zairin Noor
- Department of Orthopaedic and Traumatology, Ulin General Hospital, Banjarmasin, Indonesia
| | - Rong-Sen Yang
- Department of Orthopaedic Surgery, National Taiwan University & Hospital, Taipei, Taiwan
| | - Irewin Tabu
- Department of Orthopedics, University of the Philippines-Philippine General Hospital, Manila, Philippines
- Institute on Aging, National Institutes of Health, UP Manila, Manila, Philippines
| | - Syed Shahidul Islam
- Department of Orthopaedics and Spine Surgery, Evercare Hospital, Dhaka, Bangladesh
| | - Muhammad Amin Chinoy
- Department of Trauma and Orthopaedics, The Indus Hospital, Korangi Crossing, Karachi, Pakistan
| | | | - Buland Thapa
- Department of Orthopaedics and Trauma, Nepal Academy of Science and Technology, Bir Hospital, Kathmandu, Nepal
| | - Ronald Man Yeung Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ketan Pande
- Department of Orthopaedics, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
- Jerudong Park Medical Centre, Brunei-Muara District, Brunei Darussalam
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link Gadong BE1410, Brunei Darussalam
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Fang F, Yang J, Wang J, Li T, Wang E, Zhang D, Liu X, Zhou C. The role and applications of extracellular vesicles in osteoporosis. Bone Res 2024; 12:4. [PMID: 38263267 PMCID: PMC10806231 DOI: 10.1038/s41413-023-00313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024] Open
Abstract
Osteoporosis is a widely observed condition characterized by the systemic deterioration of bone mass and microarchitecture, which increases patient susceptibility to fragile fractures. The intricate mechanisms governing bone homeostasis are substantially impacted by extracellular vesicles (EVs), which play crucial roles in both pathological and physiological contexts. EVs derived from various sources exert distinct effects on osteoporosis. Specifically, EVs released by osteoblasts, endothelial cells, myocytes, and mesenchymal stem cells contribute to bone formation due to their unique cargo of proteins, miRNAs, and cytokines. Conversely, EVs secreted by osteoclasts and immune cells promote bone resorption and inhibit bone formation. Furthermore, the use of EVs as therapeutic modalities or biomaterials for diagnosing and managing osteoporosis is promising. Here, we review the current understanding of the impact of EVs on bone homeostasis, including the classification and biogenesis of EVs and the intricate regulatory mechanisms of EVs in osteoporosis. Furthermore, we present an overview of the latest research progress on diagnosing and treating osteoporosis by using EVs. Finally, we discuss the challenges and prospects of translational research on the use of EVs in osteoporosis.
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Affiliation(s)
- Fei Fang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Jie Yang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Jiahe Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Tiantian Li
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Erxiang Wang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Demao Zhang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Xiaoheng Liu
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China.
| | - Chenchen Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Skjødt MK, Abrahamsen B. New Insights in the Pathophysiology, Epidemiology, and Response to Treatment of Osteoporotic Vertebral Fractures. J Clin Endocrinol Metab 2023; 108:e1175-e1185. [PMID: 37186550 DOI: 10.1210/clinem/dgad256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT Vertebral fractures (VFs) make up an important but challenging group of fractures often caused by osteoporosis. Osteoporotic fractures pose unique diagnostic challenges in generally requiring imaging for diagnosis. The objective of this narrative mini-review is to provide an overview of these recent advances in our knowledge of VF pathophysiology and epidemiology with particular focus on endocrine diseases, prevention, and treatment. EVIDENCE ACQUISITION We searched PubMed on May 23, 2022, for studies of VFs in humans. Results were limited to papers available as full-text publications in English, published from 2020 and onward. This yielded 3457 citations. This was supplemented by earlier publications selected to add context to the recent findings. EVIDENCE SYNTHESIS Studies addressed VF risk in hyperthyreosis, hyperparathyroidism, acromegaly, Cushing syndrome, primary aldosteronism, and diabetes. For pharmaceutical treatment, new studies or analyses were identified for romosozumab and for weekly teriparatide. Several studies, including studies in the immediate pipeline, were intervention studies with vertebroplasty or kyphoplasty, including combination with stem cells or pharmaceuticals. CONCLUSIONS Endocrinologists should be aware of the high likelihood of osteoporotic VFs in patients with endocrine diseases. Though licensed treatments are able to substantially reduce the occurrence of VFs in patients with osteoporosis, the vast majority of recent or ongoing randomized controlled trials in the VF area focus on advanced invasive therapy of the fracture itself.
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Affiliation(s)
- Michael Kriegbaum Skjødt
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
| | - Bo Abrahamsen
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford OX3 7LD, UK
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Teigland C, Pulungan Z, Schinkel J, Agatep BC, Yeh EJ, McDermott M, Silverman SL, Lewiecki EM. Economic and Humanistic Burden Among Medicare-Aged Women With Fragility Fracture in the United States. J Am Med Dir Assoc 2023; 24:1533-1540. [PMID: 37271183 DOI: 10.1016/j.jamda.2023.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Describe patient characteristics, health care resource utilization, costs, and humanistic burden of women with Medicare insurance with incident fragility fracture who were admitted to post-acute-care (PAC). DESIGN Retrospective cohort study using 100% Medicare Fee-for-Service (FFS) data. SETTING AND PARTICIPANTS Community-dwelling female Medicare beneficiaries with incident fragility fracture January 1, 2017, to October 17, 2019, resulting in PAC admission to a skilled nursing facility (SNF), home-health care, inpatient-rehabilitation facility, or long-term acute-care hospital. METHODS Patient demographic/clinical characteristics were measured during 1-year baseline. Resource utilization and costs were measured during baseline, PAC event, and PAC follow-up. Humanistic burden was measured among SNF patients with linked Minimum Data Set assessments. Multivariable regression examined predictors of PAC costs after discharge and changes in functional status during SNF stay. RESULTS A total of 388,732 patients were included. Compared with baseline, hospitalization rates were 3.5, 2.4, 2.6, and 3.1 times higher and total costs 2.7, 2.0, 2.5, and 3.6 times higher for SNF, home-health, inpatient-rehabilitation, and long-term acute-care, respectively, following PAC discharge. Utilization of dual-energy X-ray absorptiometry (DXA) and osteoporosis medications remained low: 8.5% to 13.7% received DXA during baseline vs 5.2% to 15.6% following PAC; 10.2% to 12.0% received osteoporosis medication during baseline vs 11.4% to 22.3% following PAC. Dual eligibility for Medicaid (ie, low income) was associated with 12% higher costs; Black patients had 14% higher costs. Activities of daily living scores improved 3.5 points during SNF stay, but Black patients had 1.22-point lower improvement than White patients. Pain intensity scores showed small improvement (-0.8 points). CONCLUSIONS AND IMPLICATIONS Women admitted to PAC with incident fracture had high humanistic burden with little improvement in pain and functional status and significantly higher economic burden after discharge compared with baseline. Disparities in outcomes related to social risk factors were observed, with consistently low utilization of DXA and osteoporosis medications even after fracture. Results indicate a need for improved early diagnosis and aggressive disease management to prevent and treat fragility fractures.
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Affiliation(s)
| | | | | | | | | | | | - Stuart L Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA; OMC Clinical Research Center, Beverly Hills, CA, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA
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Al-Hashimi L, Klotsche J, Ohrndorf S, Gaber T, Hoff P. Trabecular Bone Score Significantly Influences Treatment Decisions in Secondary Osteoporosis. J Clin Med 2023; 12:4147. [PMID: 37373840 DOI: 10.3390/jcm12124147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
The trabecular bone score (TBS) can be determined in addition to the Dual Energy X-ray Absorptiometry (DXA) for bone mineral density (BMD) measurement to diagnose, evaluate, and stratify bone loss and decide on appropriate treatment in patients at risk. Especially in patients with secondary osteoporosis, TBS detects restricted bone quality. To investigate the influence of an additional evaluation of TBS on patients' treatment strategy decisions, we enrolled 292 patients, with a high proportion of patients with secondary osteoporosis, from one outpatient unit over one year. Patients eligible for BMD measurement had the option to opt-in for TBS measurement. We analyzed demographic data, leading diagnoses, bone metabolism parameters, and results of BMD and TBS measurements. More than 90% of patients consented to TBS measurement. TBS measurement influenced the decision in approximately 40% of patients with a treatment indication for anti-osteoporotic drugs. We demonstrate that depending on the underlying disease/risk spectrum, 21-25.5% of patients had an unremarkable BMD measurement with poor bone quality shown in the TBS measurement. In patients with secondary osteoporosis, the use of TBS supplementary to DXA seems useful to better assess fracture risk and, thus, to initiate therapy for osteoporosis in these patients in time.
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Affiliation(s)
- Leith Al-Hashimi
- MVZ Endokrinologikum Berlin am Gendarmenmarkt, 10117 Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre (DRFZ) Berlin, a Leibniz Institute, 10117 Berlin, Germany
| | - Sarah Ohrndorf
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Timo Gaber
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Paula Hoff
- MVZ Endokrinologikum Berlin am Gendarmenmarkt, 10117 Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, 10117 Berlin, Germany
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Sato K, Takegami Y, Tokutake K, Shimamoto Y, Ueno H, Ando T, Imagama S. Retrospective multicenter (TRON group) study of humeral shaft fragility fractures: Analysis of mortality rates and risk factors. Injury 2023:110855. [PMID: 37296013 DOI: 10.1016/j.injury.2023.110855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
AIMS This study aimed to show the mortality rate following humeral shaft fragility fractures (HSFF) in the elderly. The secondary aim was to examine the predictors associated with mortality in elderly patients who have sustained HSFF. METHODS From 2011 to 2020, all elderly patients aged 65 years and older with HSFF managed at our nine hospitals were retrospectively identified from our TRON database. Patient demographics and surgical characteristics were extracted from medical records and radiographs, and multivariable Cox regression analysis was used to identify factors affecting mortality. RESULTS In total, 153 patients who sustained HSFF were included. The mortality rate for HSFF in the elderly was 15.7% at 1 year and 24.6% at 2 years. Multivariable Cox regression analysis showed significant differences in survival for the following variables: older age (p < 0.001), underweight (p = 0.022), severely ill (p = 0.025), mobility limited to indoors (p = 0.003), dominant-side injury (p = 0.027), and nonoperative treatment (p = 0.013). CONCLUSION The outcome following HSFF in the elderly population appears to be relatively grim. The prognosis of elderly patients with HSFF is closely related to their medical history. In the elderly patients with HSFF, operative treatment should be positively considered while taking into account their medical status.
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Affiliation(s)
- Ken Sato
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuya Shimamoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Ueno
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihiro Ando
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Liu N, Dong J, Li L, Liu F. Osteoimmune Interactions and Therapeutic Potential of Macrophage-Derived Small Extracellular Vesicles in Bone-Related Diseases. Int J Nanomedicine 2023; 18:2163-2180. [PMID: 37131544 PMCID: PMC10149074 DOI: 10.2147/ijn.s403192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/19/2023] [Indexed: 05/04/2023] Open
Abstract
Due to the aging of the global population, the burden of bone-related diseases has increased sharply. Macrophage, as indispensable components of both innate immune responses and adaptive immunity, plays a considerable role in maintaining bone homeostasis and promoting bone establishment. Small extracellular vesicles (sEVs) have attracted increasing attention because they participate in cell cross-talk in pathological environments and can serve as drug delivery systems. In recent years, an increasing number of studies have expanded our knowledge about the effects of macrophage-derived sEVs (M-sEVs) in bone diseases via different forms of polarization and their biological functions. In this review, we comprehensively describe on the application and mechanisms of M-sEVs in various bone diseases and drug delivery, which may provide new perspectives for treating and diagnosing human bone disorders, especially osteoporosis, arthritis, osteolysis, and bone defects.
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Affiliation(s)
- Nan Liu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Jinlei Dong
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Lianxin Li
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Fanxiao Liu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
- Correspondence: Fanxiao Liu, Department of Orthopedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China, Tel/Fax +86-0531-68773195, Email
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Chin KY, Ng BN, Rostam MKI, Muhammad Fadzil NFD, Raman V, Mohamed Yunus F, Syed Hashim SA, Ekeuku SO. A Mini Review on Osteoporosis: From Biology to Pharmacological Management of Bone Loss. J Clin Med 2022; 11:6434. [PMID: 36362662 PMCID: PMC9657533 DOI: 10.3390/jcm11216434] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 07/25/2023] Open
Abstract
Osteoporosis refers to excessive bone loss as reflected by the deterioration of bone mass and microarchitecture, which compromises bone strength. It is a complex multifactorial endocrine disease. Its pathogenesis relies on the presence of several endogenous and exogenous risk factors, which skew the physiological bone remodelling to a more catabolic process that results in net bone loss. This review aims to provide an overview of osteoporosis from its biology, epidemiology and clinical aspects (detection and pharmacological management). The review will serve as an updated reference for readers to understand the basics of osteoporosis and take action to prevent and manage this disease.
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