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Vlachos C, Ampadiotaki MM, Papagrigorakis E, Galanis A, Patilas C, Sakellariou E, Rodis G, Vasiliadis E, Kontogeorgakos VA, Pneumaticos S, Vlamis J. Is Regional Bone Mineral Density the Differentiating Factor Between Femoral Neck and Femoral Trochanteric Fractures? Cureus 2024; 16:e53003. [PMID: 38406115 PMCID: PMC10894667 DOI: 10.7759/cureus.53003] [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] [Accepted: 01/26/2024] [Indexed: 02/27/2024] Open
Abstract
Background Osteoporosis is globally recognized as a prevalent bone disease, and proximal femoral fractures constitute a serious complication associated with it. In recent years, the frequency of hip fractures has increased rapidly, with ramifications that extend into the social and economic aspects of both patients' lives and healthcare systems. The primary goal of this study is to discover whether bone mineral density (BMD) in specific regions of the hip could be related to femoral neck or trochanteric fractures. Methodology This prospective cohort study employed dual-energy X-ray absorptiometry (DEXA) measurements on 70 individuals with proximal femoral fractures. The participants sought treatment at the emergency department of our unit for hip fractures and adhered to our predefined eligibility criteria. These criteria primarily included (i) age exceeding 60 years and (ii) a diagnosis of either femoral neck or trochanteric fracture attributed to (iii) a low-energy lateral fall and (iv) a previously established state of complete ambulation before the occurrence of the fracture. In this context, we recorded the BMD of the hip, as well as the BMD values of the upper and lower halves of the neck, trochanteric region, and diaphysis. For the comparison of the categorical variables, Pearson's χ2 criterion was used, whereas Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results No statistical differences were identified when comparing regional BMDs and T-scores with the fracture type. This conclusion was also reconfirmed concerning age, gender, and Tonnis classification. Only a moderate correlation was observed, demonstrating lower values of regional BMDs in women compared to men. Conclusions The inability of our study to establish a direct correlation between BMD measurements across diverse areas of the proximal femur underlines the imperative need for subsequent investigations. These studies should not only integrate more precise techniques for measuring and mapping the BMD of different hip regions but should also encompass a comprehensive examination that would consider both intrinsic and extrinsic characteristics of the proximal femur.
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Affiliation(s)
- Christos Vlachos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | | | - Eftychios Papagrigorakis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | - Athanasios Galanis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | - Christos Patilas
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | - Evangelos Sakellariou
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | | | - Elias Vasiliadis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT Trauma Hospital, Athens, GRC
| | | | - Spiros Pneumaticos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
| | - John Vlamis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, Athens, GRC
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Howlett DC, Drinkwater KJ, Mahmood N, Salman L, Griffin J, Javaid MK, Retnasingam G, Marzoug A, Greenhalgh R. Radiology reporting of incidental osteoporotic vertebral fragility fractures present on CT studies: results of UK national re-audit. Clin Radiol 2023; 78:e1041-e1047. [PMID: 37838545 DOI: 10.1016/j.crad.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/16/2023]
Abstract
AIM To describe a UK-wide re-audit of the 2019 Royal College of Radiologists (RCR) audit evaluating patient-related data and organisational infrastructure in the radiological reporting of vertebral fragility fractures (VFFs) on computed tomography (CT) studies and to assess the impact of a series of RCR interventions, initiated to raise VFF awareness, on reporting practice and outcomes. MATERIALS AND METHODS Patient specific and organisational questionnaires largely replicated those utilised in 2019. The patient questionnaire involved retrospective analysis of between 50 and 100 consecutive, non-traumatic CT studies which included the thoracolumbar spine. All RCR radiology audit leads were invited to participate. Data collection commenced from 1 April 2022. RESULTS Data were supplied by 129/194 (67%) departments. One thousand five hundred and eighty-six of 7,316 patients (21.7%) had a VFF on auditor review. Overall improvements were demonstrated in key initial/provisional reporting results; comment on spine/bone (93.2%, 14.4% improvement, p<0.0002); fracture severity assessment (34.7%, 8.5% improvement, p=0.0007); use of recommended terminology (67.8%, 7.5% improvement, p=0.0034); recommendations for further management (11.7%, 9.1% improvement, p<0.0002). CONCLUSIONS The 2022 national re-audit confirms improvements in diagnostic performance and practice in VFF reporting. Continuing work is required to build on this improvement and to further embed best practice.
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Affiliation(s)
- D C Howlett
- Department of Radiology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - K J Drinkwater
- Directorate of Education and Professional Practice, Royal College of Radiologists, London, UK.
| | - N Mahmood
- Department of Radiology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - L Salman
- Department of Radiology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - J Griffin
- The Royal Osteoporosis Society, Bath, UK
| | - M K Javaid
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - G Retnasingam
- Department of Radiology St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - A Marzoug
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - R Greenhalgh
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK
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Carey JJ, Erjiang E, Wang T, Yang L, Dempsey M, Brennan A, Yu M, Chan WP, Whelan B, Silke C, O'Sullivan M, Rooney B, McPartland A, O'Malley G. Prevalence of Low Bone Mass and Osteoporosis in Ireland: the Dual-Energy X-Ray Absorptiometry (DXA) Health Informatics Prediction (HIP) Project. JBMR Plus 2023; 7:e10798. [PMID: 37808396 PMCID: PMC10556270 DOI: 10.1002/jbm4.10798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 10/10/2023] Open
Abstract
Osteoporosis is a common disease that has a significant impact on patients, healthcare systems, and society. World Health Organization (WHO) diagnostic criteria for postmenopausal women were established in 1994 to diagnose low bone mass (osteopenia) and osteoporosis using dual-energy X-ray absorptiometry (DXA)-measured bone mineral density (BMD) to help understand the epidemiology of osteoporosis, and identify those at risk for fracture. These criteria may also apply to men ≥50 years, perimenopausal women, and people of different ethnicity. The DXA Health Informatics Prediction (HIP) project is an established convenience cohort of more than 36,000 patients who had a DXA scan to explore the epidemiology of osteoporosis and its management in the Republic of Ireland where the prevalence of osteoporosis remains unknown. In this article we compare the prevalence of a DXA classification low bone mass (T-score < -1.0) and of osteoporosis (T-score ≤ -2.5) among adults aged ≥40 years without major risk factors or fractures, with one or more major risk factors, and with one or more major osteoporotic fractures. A total of 33,344 subjects met our study inclusion criteria, including 28,933 (86.8%) women; 9362 had no fractures or major risk factors, 14,932 had one or more major clinical risk factors, and 9050 had one or more major osteoporotic fractures. The prevalence of low bone mass and osteoporosis increased significantly with age overall. The prevalence of low bone mass and osteoporosis was significantly greater among men and women with major osteoporotic fractures than healthy controls or those with clinical risk factors. Applying our results to the national population census figure of 5,123,536 in 2022 we estimate between 1,039,348 and 1,240,807 men and women aged ≥50 years have low bone mass, whereas between 308,474 and 498,104 have osteoporosis. These data are important for the diagnosis of osteoporosis in clinical practice, and national policy to reduce the illness burden of osteoporosis. © 2023 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)
- John J. Carey
- School of Medicine, College of Medicine, Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Department of RheumatologyGalway University HospitalsGalwayIreland
| | - E Erjiang
- School of ManagementGuangxi Minzu UniversityNanningChina
| | - Tingyan Wang
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Lan Yang
- Insight SFI Research Centre for Data Analytics, Data Science InstituteUniversity of GalwayGalwayIreland
| | - Mary Dempsey
- School of Engineering, College of Science and EngineeringUniversity of GalwayGalwayIreland
| | - Attracta Brennan
- School of Computer Science, College of Science and EngineeringUniversity of GalwayGalwayIreland
| | - Ming Yu
- Department of Industrial EngineeringTsinghua UniversityBeijingChina
| | - Wing P. Chan
- Department of Radiology, Wan Fang HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Bryan Whelan
- School of Medicine, College of Medicine, Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Department of RheumatologyOur Lady's HospitalManorhamiltonIreland
| | - Carmel Silke
- School of Medicine, College of Medicine, Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Department of RheumatologyOur Lady's HospitalManorhamiltonIreland
| | - Miriam O'Sullivan
- School of Medicine, College of Medicine, Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Department of RheumatologyOur Lady's HospitalManorhamiltonIreland
| | - Bridie Rooney
- Department of Geriatric MedicineSligo University HospitalSligoIreland
| | - Aoife McPartland
- Department of RheumatologyOur Lady's HospitalManorhamiltonIreland
| | - Gráinne O'Malley
- School of Medicine, College of Medicine, Nursing and Health SciencesUniversity of GalwayGalwayIreland
- Department of Geriatric MedicineSligo University HospitalSligoIreland
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Ng GSN, Lee LYK, Chu ECP. Undiagnosed Osteoporotic Vertebral Fractures in an Octogenarian During the Coronavirus Disease Pandemic. Cureus 2023; 15:e38585. [PMID: 37153836 PMCID: PMC10162351 DOI: 10.7759/cureus.38585] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
Osteoporotic vertebral fractures are frequently misdiagnosed or under-recognized in the older population, leading to disease progression and reduced quality of life. This case of an 87-year-old woman with acute back pain highlights the importance of early diagnosis and management of fragility fractures. During the coronavirus disease (COVID-19) pandemic, patients with a history of well-managed osteoporosis experienced worsening symptoms of vertebral collapse due to activity limitations and prolonged immobilization. The initial diagnosis of spinal stenosis delayed appropriate treatment for four months. Serial magnetic resonance imaging revealed compression fractures at L1 and L3, and a dual-energy x-ray absorptiometry scan showed osteoporosis with a T-score of -3.2. Pharmacological therapy, including bisphosphonates, was initiated. A comprehensive rehabilitation program with a multidisciplinary approach, with bracing, and lifestyle changes helped stabilize the spine, reduce pain, and maximized function. Her condition improved with close monitoring and guidance during home exercises. This case exemplifies the necessity of a precise and timely diagnosis of osteoporotic vertebral fractures to initiate management and mitigate disease progression.
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Affiliation(s)
- Gabriel Siu Nam Ng
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
| | - Linda Yin-King Lee
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Kowloon, HKG
| | - Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
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Wang L, Zhang G. Analysis of the effect of mini-nutrition nursing plus Baduanjin rehabilitation exercise on fracture healing, mobility and nutritional status of elderly patients with vertebral or hip fractures. Biotechnol Genet Eng Rev 2023:1-12. [PMID: 37037001 DOI: 10.1080/02648725.2023.2200302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Hip fractures (VOHF) are a type of bone fracture that occurs in the hip bone, typically affecting older adults. Recovery from hip fractures in older adults can be challenging due to factors such as decreased mobility, weakened bones, and other health issues. This paper intends to determine the effect of mini-nutrition nursing plus Baduanjin rehabilitation exercise on postoperative rehabilitation of elderly patients with vertebral or hip fractures (VOHF). 106 senile VOHF patients were chosen for the study between May 2020 and May 2022. The research group (RG) consisted of 60 patients who received mini-nutrition nursing + Baduanjin rehabilitation exercise, while the control group (CG) had 46 patients who received mini-nutrition nursing + routine rehabilitation training. The study compared the fracture healing effect, MAMC, CC, and MNA-SF scores. The rehabilitation status of patients was evaluated using FMA, BI, BBS, and VAS. Adverse reactions during hospitalization and SF-36 scores were also recorded. Better fracture healing efficacy and higher MAMC, CC, and MNA-SF scores were determined in RG versus CG (P < 0.05). Elevated FMA, BI and BBS scores were observed in both groups after rehabilitation training, with more evident elevations in RG; while the VAS score reduced markedly and was lower in RG compared with CG (P < 0.05). In addition, RG was observed with fewer adverse reactions and higher SF-36 scores (P < 0.05). Mini-nutrition nursing + Baduanjin rehabilitation exercise can effectively accelerate the postoperative rehabilitation of elderly patients with VOHF, improve mobility, and enhance their quality of life.
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Affiliation(s)
- Li Wang
- Department of Joint Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Guojun Zhang
- Department of Joint Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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Yang L, Dempsey M, Brennan A, Whelan B, Erjiang E, Wang T, Egan R, Gorham K, Heaney F, Armstrong C, Ibarrola GM, Gsel A, Yu M, Carey JJ. Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX. Arch Osteoporos 2023; 18:43. [PMID: 36939937 PMCID: PMC10027809 DOI: 10.1007/s11657-023-01232-y] [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: 12/08/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. PURPOSE FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. METHOD A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland-Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. RESULTS Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. CONCLUSIONS Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.
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Affiliation(s)
- Lan Yang
- Insight SFI Research Centre for Data Analytics, Data Science Institute, University of Galway, IDA Business Park, Lower Dangan, Galway, H91 AEX4, Ireland.
| | - Mary Dempsey
- School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Bryan Whelan
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - E Erjiang
- School of Management, Guangxi Minzu University, Nanning, China
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rebecca Egan
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Kelly Gorham
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | | | | | - Amina Gsel
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - John J Carey
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
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O 'Sullivan D, Silke C, Whelan B, McGowan B, O 'Sullivan M, McCabe JP, Heaney F, Armstrong C, Gsel AM, Connaughton B, Carey JJ. Osteoporotic fracture admissions compared to other major medical admissions in Irish public hospitals. Arch Osteoporos 2022; 18:12. [PMID: 36527534 DOI: 10.1007/s11657-022-01199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis. Hospital care represents the costliest portion of health services. We found public hospital bed days for fragility fractures in Ireland increased by 43% between 2008 and 2017 which exceeded those for other common diseases. INTRODUCTION Recent multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis, manifesting clinically as fragility fractures (FF). International reports show that FF incidence, rate of hospital admission and cost are similar or greater than those for breast cancer, myocardial infarction and stroke. Studies addressing the illness burden of osteoporosis in Ireland are few, and none compares fragility fractures to other common chronic diseases. METHODS A retrospective analysis of national administrative data for all public hospital admissions was performed on adults aged 50 years and older from January 2008 to December 2017. RESULTS In 2017, public hospital bed days for FF totalled 249,887 outnumbering Chronic Obstructive Pulmonary Disease (COPD): 131,897; 6 solid cancers (CA): 118,098; myocardial infarction (MI): 83,477; and diabetes mellitus (DM): 31,044. Bed days for FF increased by 43% between 2008 and 2017, in contrast to a 32%, 28% and 31% reduction for CA, MI and DM, respectively, and a 12% increase for COPD. Public hospital bed days for FF in 2016 were greater than MI, stroke, atrial fibrillation and chest pain combined but less than a combination of COPD, pneumonia and lower respiratory tract infection. CONCLUSION Osteoporotic fractures represent a large and rapidly increasing illness burden amongst older Irish adults, with substantial care requirements and the resulting onus on our healthcare system. Urgent action is needed to address this public health issue and the services for those at risk of fracture.
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Affiliation(s)
- D O 'Sullivan
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
| | - C Silke
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - B Whelan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - B McGowan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
| | - M O 'Sullivan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - J P McCabe
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
| | - F Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - C Armstrong
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - A M Gsel
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - B Connaughton
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - J J Carey
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland.
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
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Zhong X, Xia H, Li Y, Tang C, Tang X, He S. Effectiveness and safety of ultrasound-guided thoracic paravertebral block versus local anesthesia for percutaneous kyphoplasty in patients with osteoporotic compression fracture. J Back Musculoskelet Rehabil 2022; 35:1227-1235. [PMID: 35599464 DOI: 10.3233/bmr-210131] [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: 02/04/2023]
Abstract
BACKGROUND Kyphoplasty for osteoporotic vertebral compression fractures (OVCF) is a short but painful intervention. Different anesthetic techniques have been proposed to control pain during kyphoplasty; however, all have limitations. OBJECTIVE To compare the effectiveness and safety of ultrasound-guided thoracic paravertebral block with local anesthesia for percutaneous kyphoplasty (PKP). METHODS In this prospective study, non-randomized patients with OVCF undergoing PKP received either ultrasound-guided thoracic paravertebral block (group P) or local anesthesia (group L). Perioperative pain, satisfaction with anesthesia, and complications were compared between the groups. RESULTS Mean intraoperative (T1-T4) perioperative visual analog scale (VAS) scores were significantly lower in group P than in group L (2 [1-3] vs. 3 [2-4], 2 [2-3] vs. 4 [2-4], 2 [2-3] vs. 5 [3-5], and 3 [2-3] vs. 5 [3-5], respectively; P< 0.05). Investigators' satisfaction scores, patients' anesthesia satisfaction scores, and anesthesia re-administration intention rate were significantly higher in group P than in group L (4 [3-5] vs. 3 [2-4], 2 [2-3] vs. 2 [1-3], 90.63% vs. 69.70%; P< 0.05). There was no significant intergroup difference in complications. CONCLUSIONS Ultrasound-guided thoracic paravertebral block has similar safety to and better effectiveness than local anesthesia in PKP.
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Affiliation(s)
- Xiqiang Zhong
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haijie Xia
- Department of Anesthesiology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yimin Li
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chengxuan Tang
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaojun Tang
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shaoqi He
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Dziedzic M, Janiszewska M, Goździewska M, Kowalska W, Roliński J. Assessment of the Quality of Life of Women after Osteoporotic Vertebral Fracture with Consideration of Socio-Demographic Characteristics and Selected Factors Concerning the State of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12237. [PMID: 36231538 PMCID: PMC9566652 DOI: 10.3390/ijerph191912237] [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: 08/13/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Introduction: Fractures of the vertebral bodies are a frequent complication of osteoporosis, hospitalization, decline in physical fitness and, in consequence, deterioration in the quality of life. Objective: The aim of the study was assessment of the quality of life according to the QUALEFFO-41 questionnaire in patients who had undergone fractures of the vertebral bodies, and presentation of the relationships between the quality of life, socio-demographic characteristics, and selected factors concerning the state of health. Materials and Method: The study included 243 women with osteoporotic vertebral fractures, and was conducted in the Outpatient Departments for the Treatment of Osteoporosis in the city of Lublin (eastern Poland). For the purposes of the study, the Quality of Life Questionnaire (QUALEFFO-41) and the author's questionnaire were employed, and Spearman's rank correlation coefficient, t-Student test, and Tukey test were used, along with analysis of variance (ANOVA). The level of statistical significance was set at α = 0.05. Results: The quality of life of woman with vertebral compression fractures remains on a mediocre level. Significant relationships were observed between the respondents' quality of life and certain socio-demographic characteristics, duration of the disease, and complaints related with osteoporosis. Conclusions: It is important to implement appropriate therapy and provide comprehensive, holistic care to women after fractures.
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Affiliation(s)
- Małgorzata Dziedzic
- Independent Public Regional Specialist Hospital in Chełm, Ceramiczna 1, 22-100 Chełm, Poland
| | - Mariola Janiszewska
- Department of Medical Informatics and Statistics with e-Health Lab, Medical University of Lublin, K. Jaczewskiego 5 Street, 20-059 Lublin, Poland
| | | | - Wioleta Kowalska
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jacek Roliński
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland
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10
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Carey JJ, Chih-Hsing Wu P, Bergin D. Risk assessment tools for osteoporosis and fractures in 2022. Best Pract Res Clin Rheumatol 2022; 36:101775. [PMID: 36050210 DOI: 10.1016/j.berh.2022.101775] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoporosis is one of the frequently encountered non-communicable diseases in the world today. Several hundred million people have osteoporosis, with many more at risk. The clinical feature is a fragility fracture (FF), which results in major reductions in the quality and quantity of life, coupled with a huge financial burden. In recognition of the growing importance, the World Health Organisation established a working group 30 years ago tasked with providing a comprehensive report to understand and assess the risk of osteoporosis in postmenopausal women. Dual-energy X-ray absorptiometry (DXA) is the most widely endorsed technology for assessing the risk of fracture or diagnosing osteoporosis before a fracture occurs, but others are available. In clinical practice, important distinctions are essential to optimise the use of risk assessments. Traditional tools lack specificity and were designed for populations to identify groups at higher risk using a 'one-size-fits-all' approach. Much has changed, though the purpose of risk assessment tools remains the same. In 2022, many tools are available to aid the identification of those most at risk, either likely to have osteoporosis or suffer the clinical consequence. Modern technology, enhanced imaging, proteomics, machine learning, artificial intelligence, and big data science will greatly advance a more personalised risk assessment into the future. Clinicians today need to understand not only which tool is most effective and efficient for use in their practice, but also which tool to use for which patient and for what purpose. A greater understanding of the process of risk assessment, deciding who should be screened, and how to assess fracture risk and prognosis in older men and women more comprehensively will greatly reduce the burden of osteoporosis for patients, society, and healthcare systems worldwide. In this paper, we review the current status of risk assessment, screening and best practice for osteoporosis, summarise areas of uncertainty, and make some suggestions for future developments, including a more personalised approach for individuals.
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Affiliation(s)
- John J Carey
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland.
| | - Paulo Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Director, Obesity/Osteoporosis Special Clinic, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Diane Bergin
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland; Galway University Hospitals, Ireland
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Carey JJ, Yang L, Erjiang E, Wang T, Gorham K, Egan R, Brennan A, Dempsey M, Armstrong C, Heaney F, McCabe E, Yu M. Vertebral Fractures in Ireland: A Sub-analysis of the DXA HIP Project. Calcif Tissue Int 2021; 109:534-543. [PMID: 34085087 PMCID: PMC8484104 DOI: 10.1007/s00223-021-00868-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Osteoporosis is an important global health problem resulting in fragility fractures. The vertebrae are the commonest site of fracture resulting in extreme illness burden, and having the highest associated mortality. International studies show that vertebral fractures (VF) increase in prevalence with age, similarly in men and women, but differ across different regions of the world. Ireland has one of the highest rates of hip fracture in the world but data on vertebral fractures are limited. In this study we examined the prevalence of VF and associated major risk factors, using a sample of subjects who underwent vertebral fracture assessment (VFA) performed on 2 dual-energy X-ray absorptiometry (DXA) machines. A total of 1296 subjects aged 40 years and older had a valid VFA report and DXA information available, including 254 men and 1042 women. Subjects had a mean age of 70 years, 805 (62%) had prior fractures, mean spine T-score was - 1.4 and mean total hip T-scores was - 1.2, while mean FRAX scores were 15.4% and 4.8% for major osteoporotic fracture and hip fracture, respectively. Although 95 (7%) had a known VF prior to scanning, 283 (22%) patients had at least 1 VF on their scan: 161 had 1, 61 had 2, and 61 had 3 or more. The prevalence of VF increased with age from 11.5% in those aged 40-49 years to > 33% among those aged ≥ 80 years. Both men and women with VF had significantly lower BMD at each measured site, and significantly higher FRAX scores, P < 0.01. These data suggest VF are common in high risk populations, particularly older men and women with low BMD, previous fractures, and at high risk of fracture. Urgent attention is needed to examine effective ways to identify those at risk and to reduce the burden of VF.
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Affiliation(s)
- John J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
| | - Lan Yang
- School of Engineering, National University of Ireland Galway, Galway, Ireland
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - E Erjiang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kelly Gorham
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Rebecca Egan
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland Galway, Galway, Ireland
| | | | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Eva McCabe
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
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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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de Sire A, Ammendolia A, Gimigliano A, Tiberi R, Cisari C, Invernizzi M. Spinal Orthoses Prescription for Vertebral Fragility Fractures by Italian Physical and Rehabilitation Medicine Physicians: The SPIN-VER Survey. Healthcare (Basel) 2021; 9:healthcare9070892. [PMID: 34356276 PMCID: PMC8303444 DOI: 10.3390/healthcare9070892] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fractures, related to pain and disability. In this scenario, physical and rehabilitative medicine (PRM) physicians prescribe a patient-tailored rehabilitation plan, including spinal orthoses. However, there is a high heterogeneity in the clinical indications of spinal orthoses. Thus, the aim of this survey was to investigate common clinical practice in terms of the prescription of spinal orthoses. This nationwide cross-sectional survey recruited Italian PRM physicians commonly involved in the management of patients with VFFs. One hundred twenty-six PRM physicians completed the survey. The results showed that most PRM physicians prescribe spinal orthoses in outpatients suffering from VFFs (n = 106; 83.9%). The most prescribed spinal orthosis for acute VFF patients was the three-point rigid orthosis (n = 64; 50.8%), followed by the semirigid thoraco-lumbar orthosis (n: 20; 15.9%). However, most PRM physicians prescribed dynamic orthoses in outpatients with chronic VFFs (n = 66; 52.4%). Albeit that a correct management of VFFs is mandatory to improve pain and reduce disability, our findings highlighted uncertainty in the type of spinal orthosis prescription in both the acute and chronic VFF phase. Therefore, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-096-171-2819
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | | | - Roberto Tiberi
- MyEvent SRL, Events Organization, Monte Porzio Catone, 00078 Rome, Italy;
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (C.C.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Which patients are at risk for not receiving anti-osteoporosis treatment following hip fracture?: An ACS NSQIP analysis. J Clin Orthop Trauma 2021; 17:169-175. [PMID: 33854944 PMCID: PMC8039719 DOI: 10.1016/j.jcot.2021.03.009] [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: 12/31/2020] [Revised: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Screening and management of osteoporosis is often only considered by providers when patients present with multiple fragility fractures. The objective was to determine which patients are at risk for not receiving anti-osteoporotic medication and screening immediately following open reduction internal fixation (ORIF) for hip fracture. METHODS The 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture Database was queried to identify patients ≥ 50 years old who underwent ORIF of femoral neck, intertrochanteric hip, and subtrochanteric hip fractures. Patients with concurrent polytrauma, malignancy, and other fragility fractures were excluded. Patients taking osteoporotic medications immediately prior to hospitalization were excluded to prevent an overlap in the screening and/or antiresorptive medication initiation rates. Multi-variate logistic regression was used to assess for factors associated with not receiving anti-osteoporotic medication immediately postoperatively. RESULTS A total of 6179 patients were identified of whom 3304 (53.5%) were treated at a facility with a documented standardized hip fracture care program. Only 28.5% (N = 1766) patients received anti-osteoporosis medication immediately following ORIF. Independent factors associated with increased odds of not initiating bone protective medication were those without a standardized hip fracture care program (odds ratio [OR] 1.80 [1.58-2.06], P < 0.001), length of stay ≤ 5 days (odds ratio [OR] 1.47 [1.28-1.69], P < 0.001), patients waiting > 1 day until operation (odds ratio [OR] 1.35 [1.13-1.60], P = 0.001), patients requiring a mobility aid preoperatively (odds ratio [OR] 1.29 [1.13-1.47], P < 0.001), and patients who could not weight bear as tolerated (WBAT) on postoperative day 1 (POD 1) (odds ratio [OR] 1.25 [1.06-1.47], P = 0.008). CONCLUSION Patients starting anti-osteoporotic medication immediately following a hip fracture in the United States remains low (28.5%). Standardized hip fracture care programs have the greatest impact with regards to initiating anti-osteoporotic medication following hip fracture.
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McCarthy CJ, Kelly MA, Kenny PJ. Assessment of previous fracture and anti-osteoporotic medication prescription in hip fracture patients. Ir J Med Sci 2021; 191:247-252. [PMID: 33687665 DOI: 10.1007/s11845-021-02571-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hip fracture prevention is an essential component in elderly patient care. History of prior fracture is a significant risk factor for subsequent hip fracture. There are variable rates of treatment for these groups of patients. The aims of this study were to make an assessment of how many hip fracture patients over a 1 year period had a previous fracture and to assess whether or not these patients were on anti-osteoporotic medication. METHODS Assessment on whether or not patients had a prior fracture using the national radiology imaging system checking radiology reports for all previous imaging performed. Checking patients bone health status using the hip fracture database for our hospital. RESULTS There were 225 hip fractures in 221 patients over a 1-year period. About 42.6% of females and 35.9% of males had a history of previous fracture. Vertebral fractures were the most common type of fracture. We found 7% of patients had a contralateral hip fracture. There were 81% of patients with prior fracture, and 71% of those without prior fracture were on anti-osteoporotic medication. DISCUSSION Vertebral fractures were the most common preceding fracture in hip fracture patients. There were many patients with a history of fragility fractures that were not on preventative medication. Overall there were good prescription rates of anti-osteoporotic medication. There were significantly higher rates of prescription amongst females compared with males.
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