1
|
Shepard S, Bartholomew A, Houserman D, Bamberger HB, Manocchio AG. Assessing osteoporosis screening compliance in total joint surgery: a retrospective chart review. J Osteopath Med 2024; 0:jom-2024-0044. [PMID: 38963265 DOI: 10.1515/jom-2024-0044] [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: 03/07/2024] [Accepted: 05/24/2024] [Indexed: 07/05/2024]
Abstract
CONTEXT Osteoporosis is a prevalent concern, particularly among aging populations, leading to increased risk of fractures, including those related to hip and knee arthroplasty procedures. Screening for osteoporosis, especially with dual X-ray absorptiometry (DXA) scans, is crucial for early detection and management. OBJECTIVES This study aimed to assess adherence to osteoporosis screening guidelines among patients aged 65 and older undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) within a single health network. Factors influencing screening adherence were also explored. METHODS A retrospective chart review of 2,160 patients undergoing elective THA or TKA between January 2019 and January 2023 was conducted. Demographic data, osteoporosis screening status, and occurrence of periprosthetic fractures were analyzed. Statistical analysis included descriptive statistics and chi-square tests. RESULTS Only 24.1 % of eligible patients underwent a DXA scan prior to surgery. Females were more likely to undergo screening than males, and race was also associated with screening status. A total of 45 periprosthetic fractures were identified, with no significant correlation between osteoporosis status, DXA screening, and fracture occurrence. CONCLUSIONS Adherence to osteoporosis screening guidelines among geriatric patients undergoing elective total joint arthroplasty remains low within the studied health network. Despite the lack of correlation between screening and fracture occurrence in this study, the importance of screening and potential optimization in high-risk patients is emphasized. Further research is needed to assess outcomes associated with different care pathways in bone health screening and management for elective geriatric total joint patients.
Collapse
Affiliation(s)
- Samuel Shepard
- Department of Orthopedic Surgery, Kettering Health Dayton, Dayton, OH, USA
| | - Ania Bartholomew
- Department of Orthopedic Surgery, Kettering Health Dayton, Dayton, OH, USA
| | - David Houserman
- Department of Orthopedic Surgery, Kettering Health Dayton, Dayton, OH, USA
| | - H Brent Bamberger
- Department of Orthopedic Surgery, Kettering Health Dayton, Dayton, OH, USA
| | | |
Collapse
|
2
|
Boonrod A, Piyaprapaphan P, Kittipongphat N, Theerakulpisut D, Boonrod A. Deep learning for osteoporosis screening using an anteroposterior hip radiograph image. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04032-3. [PMID: 38896146 DOI: 10.1007/s00590-024-04032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Osteoporosis is a common bone disorder characterized by decreased bone mineral density (BMD) and increased bone fragility, which can lead to fractures and eventually cause morbidity and mortality. It is of great concern that the one-year mortality rate for osteoporotic hip fractures could be as high as 22%, regardless of the treatment. Currently, BMD measurement is the standard method for osteoporosis diagnosis, but it is costly and requires special equipment. While a plain radiograph can be obtained more simply and inexpensively, it is not used for diagnosis. Deep learning technologies had been applied to various medical contexts, yet few to osteoporosis unless they were trained on the advanced investigative images, such as computed tomography. The purpose of this study was to develop a deep learning model using the anteroposterior hip radiograph images and measure its diagnostic accuracy for osteoporosis. METHODS We retrospectively collected all anteroposterior hip radiograph images of patients from 2013 to 2021 at a tertiary care hospital. The BMD measurements of the included patients were reviewed, and the radiograph images that had a time interval of more than two years from the measurements were excluded. All images were randomized using a computer-generated unequal allocation into two datasets, i.e., 80% of images were used for the training dataset and the remaining 20% for the test dataset. The T score of BMD obtained from the ipsilateral femoral neck of the same patient closest to the date of the performed radiograph was chosen. The T score cutoff value of - 2.5 was used to diagnose osteoporosis. Five deep learning models were trained on the training dataset, and their diagnostic performances were evaluated using the test dataset. Finally, the best model was determined by the area under the curves (AUC). RESULTS A total of 363 anteroposterior hip radiograph images were identified. The average time interval between the performed radiograph and the BMD measurement was 6.6 months. Two-hundred-thirteen images were labeled as non-osteoporosis (T score > - 2.5), and the other 150 images as osteoporosis (T score ≤ - 2.5). The best-selected deep learning model achieved an AUC of 0.91 and accuracy of 0.82. CONCLUSIONS This study demonstrates the potential of deep learning for osteoporosis screening using anteroposterior hip radiographs. The results suggest that the deep learning model might potentially be used as a screening tool to find patients at risk for osteoporosis to perform further BMD measurement.
Collapse
Affiliation(s)
- Artit Boonrod
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Nut Kittipongphat
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Daris Theerakulpisut
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 123 Mittraparp Rd, Khon Kaen, Thailand
| | - Arunnit Boonrod
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 123 Mittraparp Rd, Khon Kaen, Thailand.
| |
Collapse
|
3
|
Li M, Sun G, Cui J, Lou Q. Risk factors for surgical site infection after closed proximal humerus fractures. Int Wound J 2024; 21:e14515. [PMID: 38009983 PMCID: PMC10898375 DOI: 10.1111/iwj.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
Proximal humerus fractures are common in clinical practice, and there are relatively a few studies on postoperative incision infections of such fractures. The purpose of this study was to explore the risk factors for surgical site infection (SSI) after internal fixation in patients with closed proximal humerus fractures. Patients with closed proximal humerus fractures who underwent surgery from January 2016 to January 2022 were retrospectively analysed. Cases with superficial or deep infections within 3 months after surgery were in the infection group and the remaining cases were in the non-infection group. The types of pathogenic bacteria in the infection group were analysed. The potential risk factors for SSI in all patients were recorded: (1) patient-related factors: gender, age, body mass index (BMI), smoking, comorbidities; (2) trauma-related factors: mechanism of injury, Injury Severity Score, visual analogue scale, fracture type, soft tissue condition and combined dislocation; (3) laboratory-related indexes: haemoglobin, albumin; (4) surgery-related factors: time from injury to surgery, American Society of Anesthesiologists anaesthesia classification, surgical time, fixation mode, intraoperative blood loss, suture method, bone graft and postoperative drainage. The risk factors for the occurrence of SSI were analysed using univariate analysis and multivariate logistic regression. The incidence of SSI was 15.7%. The most common bacterium in the infection group was Staphylococcus aureus. High BMI (p = 0.033), smoking (p = 0.030), an increase in mean time from injury to definitive surgery (p = 0.013), and prolonged surgical time (p = 0.044) were independent risk factors for the development of SSI after closed proximal humeral fractures. In patients with closed proximal humerus fractures, weight loss, perioperative smoking cessation, avoidance of delayed surgery, and shorter surgical time may be beneficial in reducing the incidence of SSI.
Collapse
Affiliation(s)
- Ming Li
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Guang‐chen Sun
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Jun Cui
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Qi‐liang Lou
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| |
Collapse
|
4
|
Han H, Chen S, Wang X, Jin J, Li X, Li Z. Association between muscle strength and mass and bone mineral density in the US general population: data from NHANES 1999-2002. J Orthop Surg Res 2023; 18:397. [PMID: 37264353 DOI: 10.1186/s13018-023-03877-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE It is known that muscle strength and muscle mass play a crucial role in maintaining bone mineral density (BMD). Despite this, there are uncertainties about how muscle mass, lower extremity muscular strength, and BMD are related. We examined the impact of lower extremity muscle strength and mass on BMD in the general American population using cross-sectional analysis. METHODS In the study, we extracted 2165 individuals from the National Health and Nutrition Examination Survey 1999-2002. Multivariate logistic regression models were used to examine the association between muscle strength, muscle mass, and BMD. Fitted smoothing curves and generalized additive models were also performed. To ensure data stability and avoid confounding factors, subgroup analysis was also conducted on gender and race/ethnicity. RESULTS After full adjustment for potential confounders, significant positive associations were detected between peak force (PF) [0.167 (0.084, 0.249) P < 0.001], appendicular skeletal muscle index (ASMI) [0.029 (0.022, 0.036) P < 0.001], and lumbar spine BMD. A positive correlation was also found between PF, ASMI, and pelvis and total BMD. Following stratification by gender and race/ethnicity, our analyses illustrated a significant correlation between PF and lumbar spine BMD in both men [0.232 (0.130, 0.333) P < 0.001] and women [0.281 (0.142, 0.420) P < 0.001]. This was also seen in non-Hispanic white [0.178 (0.068, 0.288) P = 0.002], but not in non-Hispanic black, Mexican American and other race-ethnicity. Additionally, there was a positive link between ASMI and BMD in both genders in non-Hispanic whites, and non-Hispanic blacks, but not in any other racial group. CONCLUSION PF and ASMI were positively associated with BMD in American adults. In the future, the findings reported here may have profound implications for public health in terms of osteopenia and osteoporosis prevention, early diagnosis, and treatment.
Collapse
Affiliation(s)
- Huawei Han
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China
| | - Shuai Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China
| | - Xinzhe Wang
- Department of Gynecology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China
| | - Xianghui Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China.
| | - Zhiwei Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China.
| |
Collapse
|
5
|
Yang Y, Wang S, Cong H. Association between age at menarche and bone mineral density in postmenopausal women. J Orthop Surg Res 2023; 18:51. [PMID: 36650576 PMCID: PMC9843934 DOI: 10.1186/s13018-023-03520-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Age at menarche (AAM) directly affects female estrogen levels, which play a vital role in bone metabolism. The exact relationship between bone mineral density (BMD) and AAM remains controversial. Thus, this study aimed to determine the association between AAM and lumbar spine (LS) BMD in postmenopausal women. METHODS Our data were based on the National Health and Nutrition Examination Survey (NHANES) 2011-2018. AAM was divided into three categories including ≤ 12, 13-15, and ≥ 16 years, and the ≤ 12 years old category was used as the reference group. To examine the association between AAM and LS BMD, we used three weighted linear regression models, Model 1 (without adjustment), Model 2 (with adjustment for age, race, and body mass index [BMI]), and Model 3 (with adjustment for all covariates). RESULTS This study included 1195 postmenopausal women aged 40-59 years. In the unadjusted model, a menarche age of ≥ 16 years compared with a menarche age of ≤ 12 years was associated with lower LS BMD (β = - 0.083, 95% CI - 0.117, - 0.048, P < 0.001). After adjusting for potential confounding factors, there was still a negative correlation in model 2 (β = - 0.078, 95% CI - 0.113, - 0.042, P < 0.001) and model 3 (β = - 0.065, 95% CI - 0.096, - 0.033, P < 0.001). Moreover, this significant relationship persisted after excluding participants who used female hormones (β = - 0.053, 95% CI - 0.089, - 0.016, P = 0.006). CONCLUSION Our study found that postmenopausal women with a menarche age of ≥ 16 years had significantly lower LS BMD than that had by those with a menarche age of ≤ 12 years. As a result of this study, postmenopausal women with a late menarche age may have a higher risk of lumbar osteoporotic fractures and need better bone health care.
Collapse
Affiliation(s)
- Yimei Yang
- grid.440642.00000 0004 0644 5481Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, 226001 China
| | - Shanshan Wang
- grid.440642.00000 0004 0644 5481Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, 226001 China
| | - Hui Cong
- grid.440642.00000 0004 0644 5481Department of Blood Transfusion, Affiliated Hospital of Nantong University, #20 Xisi Road, Nantong, 226001 China ,grid.440642.00000 0004 0644 5481Department of Laboratory Medicine, Affiliated Hospital of Nantong University, Nantong, 226001 China
| |
Collapse
|
6
|
Johnson T, Fox E, Hassanbein S. Implementing an Electronic Medical Record Osteoporosis Self-Assessment Tool Score Which Identifies Patients at Risk for Osteoporosis Promotes Osteoporosis Evaluation. Geriatr Orthop Surg Rehabil 2022; 12:21514593211002157. [PMID: 35186418 PMCID: PMC8848097 DOI: 10.1177/21514593211002157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Osteoporosis affects nearly half of the U.S. population. Screening methods are improving but remain inadequate, leaving the disease underdiagnosed and undertreated. The purpose of this study is to determine the effectiveness of an EMR implemented system that identifies patients at risk for osteoporosis via an OST (osteoporosis screening tool) score in prompting patients toward osteoporosis evaluation. Methods: OST scores are generated on every patient 50 years of age and older that is admitted to the Penn State Hershey Medical Center (PSHMC) and recorded in their electronic medical record. An OST score < 2 indicates that a patient has a potential risk for osteoporosis. Information Technology (IT) implemented the EMR OST calculation, which currently generates a daily filtered list of all patients with an OST score <2; patients with an OST score < 2 are then mailed letters approximately 3 months after their admission informing them of their risk for osteoporosis and suggesting that they schedule a follow-up appointment with a physician for further evaluation. To test the effectiveness of this system in prompting patients toward osteoporosis evaluation, approximately 3 months after letters were mailed, the patients were contacted via telephone and asked a series of questions to determine if the patients had sought osteoporosis evaluation. Results: In the intervention group, 67 (58.26%) of 115 did not schedule a follow-up, while the remaining 48 (41.74%) did seek a follow-up. Thus, the patient follow-up response rate improved with letter intervention using the OST score as an indicator (P < .0001) compared to historical controls (14.29%). Conclusion: Implementing an EMR OST score which identifies patients at risk for osteoporosis, which generates an automatic letter to the patient, significantly promotes patient driven osteoporosis evaluation compared to historical controls.
Collapse
Affiliation(s)
| | - Edward Fox
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Sue Hassanbein
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
7
|
Sciamanna CN, Ballentine NH, Bopp M, Chinchilli VM, Ciccolo JT, Delauter G, Fisher A, Fox EJ, Jan De Beur SM, Kearcher K, Kraschnewski JL, Lehman E, McTigue KM, McAuley E, Paranjape A, Rodriguez-Colon S, Rovniak LS, Rutt K, Smyth JM, Stewart KJ, Stuckey HL, Tsay A. Working to Increase Stability through Exercise (WISE): screening, recruitment, and baseline characteristics. Trials 2021; 22:809. [PMID: 34781994 PMCID: PMC8591922 DOI: 10.1186/s13063-021-05761-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this paper is to describe the utility of various recruitment modalities utilized in the Working to Increase Stability through Exercise (WISE) study. WISE is a pragmatic randomized trial that is testing the impact of a 3-year, multicomponent (strength, balance, aerobic) physical activity program led by trained volunteers or delivered via DVD on the rate of serious fall-related injuries among adults 65 and older with a past history of fragility fractures (e.g., vertebral, fall-related). The modified goal was to recruit 1130 participants over 2 years in three regions of Pennsylvania. Methods The at-risk population was identified primarily using letters mailed to patients of three health systems and those over 65 in each region, as well as using provider alerts in the health record, proactive recruitment phone calls, radio advertisements, and presentations at community meetings. Results Over 24 months of recruitment, 209,301 recruitment letters were mailed, resulting in 6818 telephone interviews. The two most productive recruitment methods were letters (72% of randomized participants) and the research registries at the University of Pittsburgh (11%). An average of 211 letters were required to be mailed for each participant enrolled. Of those interviewed, 2854 were ineligible, 2,825 declined to enroll and 1139 were enrolled and randomized. Most participants were female (84.4%), under age 75 (64.2%), and 50% took an osteoporosis medication. Not having a prior fragility fracture was the most common reason for not being eligible (87.5%). The most common reason provided for declining enrollment was not feeling healthy enough to participate (12.6%). Conclusions The WISE study achieved its overall recruitment goal. Bulk mailing was the most productive method for recruiting community-dwelling older adults at risk of serious fall-related injury into this long-term physical activity intervention trial, and electronic registries are important sources and should be considered.
Collapse
Affiliation(s)
- Christopher N Sciamanna
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Box HO34, 500 University Drive, Hershey, PA, 17033, USA.
| | | | | | | | | | | | | | | | | | | | | | - Erik Lehman
- Penn State College of Medicine, Hershey, USA
| | | | | | | | | | | | - Kayla Rutt
- Penn State College of Medicine, Hershey, USA
| | | | | | | | - Anne Tsay
- Penn State College of Medicine, Hershey, USA
| |
Collapse
|
8
|
Teng Z, Zhu Y, Yu X, Liu J, Long Q, Zeng Y, Lu S. An analysis and systematic review of sarcopenia increasing osteopenia risk. PLoS One 2021; 16:e0250437. [PMID: 33909650 PMCID: PMC8081219 DOI: 10.1371/journal.pone.0250437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
Sarcopenia is a progressive generalized skeletal muscle disorder, which may increase the risk of osteopenia. The aim of this study was to systematically review studies on the association between sarcopenia and osteopenia by pooled analysis. The PubMed and Embase databases were searched from inception to October 2020 for studies focusing on the association between sarcopenia and osteopenia. Two reviewers independently extracted data and assessed study quality. A pooled analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) using random-effects models. Subgroup analysis was conducted to explore the source of heterogeneity and the stability of outcome. A total of 25 independent studies involving 47,744 participants fulfilled the inclusion criteria. Sarcopenia significantly increased the risk of osteopenia (OR, 2.08; 95% CI, 1.66–2.60); Sensitivity analyses indicated the outcome was stable. Subgroup analyses showed that sarcopenia significantly increased osteopenia risk in each subgroup. No evidence of publication bias among the studies existed. In this study, our findings showed that sarcopenia significantly increased the risk of osteopenia. Thus, we suggest that sarcopenia can be a predictor of osteopenia risk.
Collapse
Affiliation(s)
- Zhaowei Teng
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
- Yunnan Key Laboratory of Digital Orthopedics, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yun Zhu
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Xiaochao Yu
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Jie Liu
- Yunnan Key Laboratory of Digital Orthopedics, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Qing Long
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Yong Zeng
- The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
- * E-mail: (YZ); (SL)
| | - Sheng Lu
- Yunnan Key Laboratory of Digital Orthopedics, The First People’s Hospital of Yunnan Province, Kunming, China
- * E-mail: (YZ); (SL)
| |
Collapse
|
9
|
Ahmadi SA, Takahashi S, Hoshino M, Takayama K, Sasaoka R, Tsujio T, Yasuda H, Kanematsu F, Kono H, Toyoda H, Nakamura H. Association between MRI findings and back pain after osteoporotic vertebral fractures: a multicenter prospective cohort study. Spine J 2019; 19:1186-1193. [PMID: 30772505 DOI: 10.1016/j.spinee.2019.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osteoprotic vertebral fractures (OVFs) are common in elderly people. The association between back pain due to OVF with magnetic resonance imaging (MRI) signal change is unclear. In this study we hypothesized that MRI findings would be a predictive factor for back pain measured by visual analogue scale (VAS) at 6 months follow-up. PURPOSE The aim was to study the MRI findings that predict back pain after OVF and the association between radiological findings and scores of back pain. STUDY DESIGN Multicenter prospective cohort study. PATIENT SAMPLE A total of 153 OVF patients. OUTCOME MEASURE The outcome measures were VAS back pain and MRI signal change. METHODS This study was performed from 2012 to 2015. Consecutive patients with less than 2-week-old OVFs at 11 institutions were enrolled prospectively. MRI was performed at enrollment and at 1, 3, and 6 months follow-up. T1- and T2-weighted images (T1WI and T2W1) were obtained at each time point and their association with VAS scores of back pain at 6 months were investigated. Anterior compression ratio, posterior compression ratio, and angular motion of vertebral bodies were also measured on X-rays at each follow-up. This research had no financial support. There are no conflicts of interest. RESULT The 6 months follow-up was completed by 153 patients. At enrollment, the average VAS score of back pain was 75 mm, and it had improved at the 6-month follow-up to an average score of 20 mm. There was a significant correlation between T1 diffuse low signal change and VAS scores at the 6-month follow-up (p<.01). T2 high signal changes (odds ratio; 4.01, p<.01) and old vertebral fractures (odds ratio; 2.47, p=.04) were independent risk factors for back pain. The correlation between angular motion of vertebrae on X-rays and the VAS score of back pain was significant at all time points. CONCLUSION This study demonstrates the radiological factors associated with persistent back pain after an OVF and the association between the VAS score of back pain and radiological findings. In addition, T2 high signal changes in acute phase and old vertebral fractures were independent risk factors for residual back pain.
Collapse
Affiliation(s)
- Sayed Abdullah Ahmadi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazushi Takayama
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Ryuichi Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Ikoma, Nara, Japan
| | - Hiroyuki Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Fumiaki Kanematsu
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hiroshi Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Higashi Osaka, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
10
|
Shu HT, Bodendorfer BM, Folgueras CA, Argintar EH. Follow-up Compliance and Outcomes of Knee Ligamentous Reconstruction or Repair Patients Enrolled in an Electronic Versus a Traditional Follow-up Protocol. Orthopedics 2018; 41:e718-e723. [PMID: 30168836 DOI: 10.3928/01477447-20180828-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
Patient-reported outcome measures are increasingly used in research and clinical practice, but their collection can be burdensome. The primary purpose of this study was to determine whether patients who underwent ligamentous reconstruction or repair of the knee enrolled in an automated electronic follow-up system had greater follow-up compliance than patients enrolled in a traditional follow-up protocol. This study also evaluated whether enrollment in an automated electronic follow-up system was associated with improved surgical outcomes. The authors retrospectively reviewed follow-up data from 183 patients who underwent ligamentous knee reconstruction or repair from 2012 to 2017 by a single surgeon. Follow-up compliance was documented as any contact with a patient greater than 6 weeks from surgery, and patient-reported outcome measures between 3 months and 1 year postoperatively were compared between groups. Patients enrolled in automated electronic follow-up had a trend toward greater follow-up compliance (80.00% vs 74.22%, P=.4028), with greater benefit for patients who underwent multiligamentous knee reconstruction (85.71% vs 65.52%, P=.3048). Patient-reported outcome measures were not significantly different between the traditional follow-up group and the automated follow-up group, despite a significantly greater time from operation to follow-up in the traditional follow-up group (9.3±2.30 vs 7.0±2.88 months, P=.038). Patients enrolled in the traditional follow-up protocol had a significantly increased complication rate (8% vs 0%, P=.034). The use of an automated electronic follow-up system has the potential to significantly increase follow-up compliance, especially in subgroups of patients having classically poor follow-up, with minimal limitations and lower burden on clinicians and staff. [Orthopedics. 2018; 41(5):e718-e723.].
Collapse
|
11
|
O'Brien LK, Armstrong AD, Hassenbein SE, Fox EJ. Evaluation of Patients' Response Toward Osteoporosis Letter Intervention Versus Phone Call Plus Letter Intervention. Geriatr Orthop Surg Rehabil 2015; 6:246-50. [PMID: 26623157 PMCID: PMC4647194 DOI: 10.1177/2151458515604359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The aim of this study was to compare the effectiveness of 2 interventions in prompting patients to obtain osteoporosis follow-up after a fracture. Our hypothesis was that a phone call plus letter would yield greater response toward osteoporosis evaluation versus a letter alone to patients after sustaining a fragility fracture. MATERIALS AND METHODS Prospective study randomized 141 patients age 50 years and older with a fragility fracture into 3 groups for comparison. Group 1 (letter only) patients received a letter 3 months after their diagnosis of fracture indicating their risk for osteoporosis and urging them to follow-up for evaluation. Group 2 (phone call plus letter) patients were contacted via phone 3 months after their diagnosis of fracture. A letter followed the phone call. Group 3 (control) patients were neither contacted via phone nor sent a letter. All groups were contacted via phone 6 months after their initial visit to determine if they followed up for evaluation. RESULTS In group 1, 23 (52.27%) of 44 had follow-up, and 21 (47.73%) of 44 did not follow-up. In group 2, 30 (62.5%) of 48 had follow-up, and 18 (37.50%) of 48 did not follow-up. In group 3, 6 (12.24%) of 49 had some sort of follow-up, and 43 (87.76%) of 49 did not have any follow-up. A statistical significance was achieved between group 3 (control) and both groups 1 and 2 with regard to follow-up (P < .0001). The results did not show a statistically significant difference between Groups 1 and 2, however, there was a trend toward improved response with a phone call plus letter (P = .321). CONCLUSION A more personalized approach with a phone call plus follow-up letter to patients increased osteoporosis follow-up care by an additional 10%, however, this was not a statistically significant difference from just sending out a letter alone.
Collapse
Affiliation(s)
- Lisa K O'Brien
- Department of Orthopedics, Medical Education, Pinnacle Health System, Harrisburg, PA, USA
| | - April D Armstrong
- Penn State Milton S. Hershey Medical Center Bone and Joint Institute, Hershey, PA, USA
| | - Susan E Hassenbein
- Penn State Milton S. Hershey Medical Center Bone and Joint Institute, Hershey, PA, USA
| | - Edward J Fox
- Penn State Milton S. Hershey Medical Center Bone and Joint Institute, Hershey, PA, USA
| |
Collapse
|
12
|
Abstract
This article provides an overview of the current burden of osteoporosis and its complications in today's health care system. The impact of osteoporosis on patients' quality of life and direct financial consequences to the entire health care system are emphasized to highlight the need for increased knowledge and awareness of its complications if left untreated or treated incorrectly. Special attention is given to hip fracture and vertebral compression fracture, stressing the importance of diagnosing osteoporosis before fragility fractures occur. Models for improved care of fragility fractures during follow-up in the outpatient setting and the use of pharmacologic agents are discussed.
Collapse
Affiliation(s)
- Matthew A Varacallo
- Penn State Hershey Department of Orthopaedics and Rehabilitation, College of Medicine, 30 Hope Drive, Building A, Hershey, PA 17033, USA.
| | - Ed J Fox
- Penn State Hershey Department of Orthopaedics and Rehabilitation, College of Medicine, 30 Hope Drive, Building A, Hershey, PA 17033, USA
| |
Collapse
|