Fat distribution may predict intra- or extra-capsular hip fracture in geriatric patients after falling

Heterogeneity in regional changes in body composition induced by androgen deprivation therapy in prostate cancer patients: potential impact on bone health-the BLADE study

BACKGROUND

It is not clear whether changes in body composition induced by androgen deprivation therapy (ADT) in prostate cancer (PC) patients are uniform or vary in the different body districts and whether regional lean body mass (LBM) and fat body mass (FBM) could have an impact on bone health.

OBJECTIVE

To prospectively evaluate the regional changes in LBM and FBM in PC patients submitted to degarelix; to explore the relationship of regional body composition and bone mineral density (BMD) and bone turnover markers.

DESIGN, SETTING, AND PARTICIPANTS

29 consecutive non metastatic PC patients enrolled from 2017 to 2019. FBM, LBM and bone mineral density (BMD) evaluated by dual-energy x-ray absorptiometry (DXA) at baseline and after 12-month of ADT. Alkaline phosphate (ALP) and C-terminal telopeptide of type I collagen (CTX) assessed at baseline, 6 and 12 months.

INTERVENTION

All patients underwent degarelix administration.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

T-test or sign test and Pearson or Spearman test for continuous variables were used when indicated.

RESULTS AND LIMITATIONS

Median percent increase in FBM ranged from + 14.5% in trunk to + 25.4% in the left leg after degarelix. LBM changes varied from + 2% in the trunk to - 4.9% in the right arm. LBM in both arms and legs and their variations after degarelix directly correlated with ALP and inversely correlated with CTX. Lean mass of limbs, trunk and legs significantly correlated with BMD of the hip, lean mass of the trunk significantly correlated with spine BMD. These are post-hoc analysis of a prospective study and this is the main limitation.

CONCLUSIONS

an heterogeneous change in body composition among body district is observed after ADT and bone turnover is influenced by lean mass and its variation. A supervised physical activity is crucial to maintain general physical performance and preserving bone health.

Adipose tissue deposition region affects fall risk in people with obesity: A systematic review and meta-analysis

This review sought to meta-analyze previous research observing the effects of fat mass distribution on the fall risk among people with obesity. The literature search yielded five qualified studies enrolling 1218 participants (650 with android vs. 568 with gynoid). The outcome variables included the annual fall prevalence (primary outcome) and the center of pressure (COP) movement measurements during a posturography test (secondary) among people with android or gynoid obesity. Meta-analyses were conducted using the inverse variance weighted random-effects model. The odds ratio (OR) and standardized mean difference (SMD) were used as the effect size for the primary and secondary variables, respectively. The results revealed that more people with android obesity fall annually than their gynoid obesity counterparts (OR = 1.78 [1.34, 2.37], p < 0.0001). People with android obesity also exhibited significantly faster overall COP velocity (SMD = 0.49 [0.11, 0.88], p = 0.01) during standing compared to individuals with gynoid obesity. Our results indicated that people with android obesity could have a greater fall risk than those with gynoid obesity. Given the limited number of studies included, more well-designed and quality work is desired to further clarify how fat mass distribution alters the fall risk among people with obesity. A standardized approach to quantify the fat mass distribution (android vs. gynoid) is imperatively needed for people with obesity.

The association of body composition and fat distribution with dysmobility syndrome in community-dwelling older adults: Bushehr Elderly Health (BEH) program

BACKGROUND AND OBJECTIVE

Dysmobility Syndrome (DS) is characterized as an accumulation of clinical risk factors for functional disability, such as osteoporosis, sarcopenia, and obesity. Neurological disorders that affect the motor and sensory systems can also contribute to the condition, resulting in gait and muscle strength disturbances, as well as a history of falls and fractures. The study aimed to determine the association between fat distribution in different body areas and the odds of older adults developing DS, as there is still uncertainty about the accumulation of fat in which area is most closely linked to the condition.

METHODS

This cross-sectional study was conducted according to the data from the second phase of the Bushehr Elderly Health Cohort (BEH). Dysmobility Syndrome was defined based on the co-occurrence of at least three outcomes of its criteria. Body composition was measured using dual-energy X-ray absorptiometry (DXA) and anthropometric studies. For evaluating the relationship, multivariate logistic regression and adjusted univariate linear regression were used.

RESULTS

Of 2,359 who were recruited in the study, 1,277 participants (54.13%) had DS. According to the final logistic regression model in the limb region, FM and FM to FFM ratios were significantly associated with DS [OR (95%CI) = 1.04 (1.02 to 1.05), and 3.42 (1.95 to 5.99), respectively]. Also, In the trunk region, the FM and FM to FFM ratio were significantly related to the odds of DS, although this relationship was weaker than in the limbs region [OR (95%CI) = 1.02 (1.00 to 1.03), and 2.45 (1.36 to 4.39), respectively].

CONCLUSION

Our findings indicate that a higher regional and whole-body amount of fat mass rather than fat-free mass is closely linked to an increased risk of DS, particularly in the elderly population. Notably, higher fat mass in the limbs (especially in the legs) is associated with greater odds of DS, while a higher android-to-gynoid fat mass ratio is associated with lower DS risk. Screening fat mass distribution in older individuals can be a valuable strategy for promptly diagnosing DS, implementing interventions to prevent disabilities, and improving their quality of life.

The effects of elastic band exercise on the pain, kinesiophobia, functional, and psychological status after total knee arthroplasty: a randomized controlled trial

INTRODUCTION

Elastic band exercise not only improves muscle strength and elasticity, increases efficiency, balance, and quality of life but also decreases the injury risk. This study was conducted to determine the effect of elastic band exercise on pain, kinesiophobia, functional, and psychological status after total knee arthroplasty.

METHODS

This study was conducted out between October 2019 and April 2020 as a randomized controlled experimental study with a total of 60 patients. Data collection tools in this study included a descriptive information form, visual analog scale, Tampa Kinesiophobia, WOMAC Osteoarthritis Index, and Beck Depression Inventory.

RESULTS

Before intervention, the total score of VAS, WOMAC, Tampa Kinesiophobia, and Beck Depression showed no statistically significant difference between intervention group and control group. However, 4 weeks after intervention observed a statistically significant difference between the intervention and control groups in terms of VAS (U = 10,000; p < 0.001), WOMAC (U = 0.00; p < 0.001), Tampa Kinesiophobia (U = 221.5; p = 0.001), and Beck Depression means score (U = 112.5; p < 0.001). In addition, 4 weeks after the intervention, joint range and walking test assessments were statistically significant between the intervention and control groups (p < 0.001).

CONCLUSION

The results of the research showed that elastic band exercise had a positive effect on psychological and functional capacity.

TRIAL REGISTRATION

This study is registered in the Clinical Trial Registry (registration number NCT04981106) Key points • Patients with total knee arthroplasty require rehabilitation exercise to avoid physical function weakness. • Elastic band exercise significantly reduces patients' fear of movement and depression. • Elastic band exercise activities facilitate significant physical motion function. • Elastic band exercise inspires the will of patients to engage in home rehabilitation exercise patients after total knee arthroplasty.

Determinants of fracture type in the proximal femur: Biomechanical study of fresh frozen cadavers and finite element models

BACKGROUND

Proximal femur fractures are usually categorized as either a cervical or trochanteric fracture, but the relationship between fracture type and fall direction is not clear. By cadaveric mechanical testing and finite element analysis (FEA), the aims of this research were to verify the factors that define the proximal femur fracture type and to clarify the change in stress distribution based on fall direction.

METHODS

From fresh frozen cadavers, we obtained 26 proximal femora including ten pairs of 20 femora. We conducted quasi-static compression tests in two fall patterns (lateral and posterolateral), and identified the fracture type. We then examined the relationship between fracture type and the following explanatory variables: age, sex, neck shaft angle, femoral neck length, bone mineral density (cervical and trochanteric), and fall direction. In addition, for the ten pairs of femurs, the effect of fall direction on fracture type was examined by comparing the left and right sides. In addition, we generated the proximal femur finite element (FE) models from computed tomography data to simulate and verify the change of external force in different fall directions.

RESULTS

In mechanical tests, only fall direction was found to have a significant relationship with fracture type (p = 0.0227). The posterolateral fall group had a significantly higher incidence of trochanteric fractures than lateral fall group (p = 0.0325). According to FEA, the equivalent stress in the lateral fall was found to be more concentrated in the cervical area than in the posterolateral fall.

CONCLUSION

In proximal femur fractures, fall direction was significantly associated with fracture type; in particular, trochanteric fractures were more likely to occur following a posterolateral fall than a lateral fall.

Patients With Un-Displaced Or Displaced Intra Capsular Proximal Femur Fractures Do Not Represent A Different Patient Group And Have Similar Short And Long Term Mortality

BACKGROUND

Proximal femur fractures in geriatric patients are associated with substantial mortality. Management of intracapsular proximal femur fractures has been based on age, displacement, cognition, and pre-injury mobility. However, over the last decade, there has been a tendency to offer arthroplasty rather than internal fixation for these patients irrespective of displacement, to allow early mobilisation and negate the higher rate of reoperation due to failed internal fixation. There are no previous investigations analysing whether the severity of fracture displacement is related to different patient characteristics.

AIM

This study examines whether patients sustaining undisplaced or displaced intracapsular proximal femur fractures represent different patient groups with different pre-injury characteristics and post-operative mortality, irrespective of treatment modality.

METHODS

A retrospective series of 329 consecutive patients over the age of 55 years who sustained intracapsular proximal femur fractures, who underwent surgical management at a district general hospital over a period of 2 years (2012-2013) were identified using the national hip fracture database. Demographics, American Society of Anaesthesiologist (ASA) grade, pre-injury outdoor mobility status, cognitive status, and admission serum investigations, fracture displacement, type of surgery, and mortality rates at short term (2 years) & long-term (7-9 years) were reviewed.

RESULTS

There were 109 male and 220 female patients with a minimum follow-up of 7 years. The mean age at surgery was 81.6 years (range 55-103 years). There were 63 (19.1%) undisplaced fractures (Garden 1 &2) and, 265 (80.5%) displaced fractures (Garden 3 & 4). The median survival in this cohort was 2.95 years (95% CI 2.3-3.6). Mortality rates were 77.4% (n=257) at long-term (7-9 years) follow-up. Admission patient characteristics showed no statistically significant difference between displaced and undisplaced fracture groups. This included ASA, pre-operative cognition, and mobility status. Fracture displacement was not an independent predictor of mortality at short or long term.

CONCLUSION

In patients sustaining intracapsular proximal femur fractures, the degree of displacement is not a caveat for a different patient group. Fracture displacement is not predicted by the pre-injury level of function and does not predict short or long-term mortality.