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Cong T, Viola DCM, Witayakom W, Nieves JW, Lane JM. What's New in Osteoporosis: Emphasis on the Aging Athlete. J Bone Joint Surg Am 2024; 106:1538-1545. [PMID: 39052756 DOI: 10.2106/jbjs.24.00644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Ting Cong
- Metabolic Bone Disease Service, Department of Orthopedics, Hospital for Special Surgery, New York, NY
- Department of Orthopedics, Weill Cornell Medicine, New York, NY
| | - Dan C M Viola
- Metabolic Bone Disease Service, Department of Orthopedics, Hospital for Special Surgery, New York, NY
- Department of Orthopedics, Weill Cornell Medicine, New York, NY
| | - Witchaporn Witayakom
- Metabolic Bone Disease Service, Department of Orthopedics, Hospital for Special Surgery, New York, NY
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jeri W Nieves
- Metabolic Bone Disease Service, Department of Orthopedics, Hospital for Special Surgery, New York, NY
- Mailman School of Public Health, Columbia University, New York, NY
| | - Joseph M Lane
- Metabolic Bone Disease Service, Department of Orthopedics, Hospital for Special Surgery, New York, NY
- Department of Orthopedics, Weill Cornell Medicine, New York, NY
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Liu J, Wang B, Chen H, Yu X, Cao X, Zhang H. Osteoclast-derived exosomes influence osteoblast differentiation in osteoporosis progression via the lncRNA AW011738/ miR-24-2-5p/ TREM1 axis. Biomed Pharmacother 2024; 178:117231. [PMID: 39094542 DOI: 10.1016/j.biopha.2024.117231] [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: 05/08/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024] Open
Abstract
AIMS To investigate the molecular mechanism of osteoclast-derived exosomes in osteoporosis. MAIN METHODS RANKL induced osteoclast model was screened for significantly differentially expressed lncRNAs and mRNAs by whole RNA sequencing. Exosomes were characterized using electron microscopy, western blotting and nanosight. Overexpression or knockdown of AW011738 was performed to explore its function. The degree of osteoporosis in an osteoporosis model was assessed by mirco-CT. The osteoclast model, osteoblast differentiation ability and the molecular mechanism of lncRNA AW011738/miR-24-2-5p/TREM1 axis in osteoporosis were assessed by dual luciferase reporter gene assay, Western blotting (WB), immunofluorescence and ALP staining. Bioinformatics was used to predict interactions of key osteoporosis-related genes with miRNAs, transcription factors, and potential drugs after upregulation of AW011738. To predict the protein-protein interaction (PPI) network associated with key genes, GO and KEGG analyses were performed on the key genes. The ssGSVA was used to predict changes in the immune microenvironment. KEY FINDINGS Osteoclast-derived exosomes containing lncRNA AW011738 decreased the osteogenesis-related markers and accelerated bone loss in OVX mice. Osteoclast (si-AW011738)-derived exosomes showed a significant increase in biomarkers of osteoblast differentiation in vitro compared to the si-NC group. As analyzed by mirco-CT, tail vein injected si-AW011738 OVX mice were less osteoporotic than the control group. AW011738 inhibited osteoblast differentiation by regulating TREM1 expression through microRNA. Meanwhile, overexpression of miR-24-2-5p inhibited TREM1 expression to promote osteoblast differentiation. SIGNIFICANCE Osteoclast-derived exosomes containing lncRNA AW011738 inhibit osteogenesis in MC3T3-E1 cells through the lncRNA AW011738/miR-24-2-5p/TREM1 axis and exacerbate osteoporosis in OVX mice.
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Affiliation(s)
- Jingcheng Liu
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Binyu Wang
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Hongtao Chen
- Department Of Orthopedics, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China.
| | - Xiao Yu
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Xiaojian Cao
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Hongxiu Zhang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Nadaud J, Heidel E, Daley B, McKnight C. Outcomes After Implementation of a Fragility Fracture Pathway in Ground Level Falls. J Surg Res 2024; 301:704-708. [PMID: 39168043 DOI: 10.1016/j.jss.2024.07.083] [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: 03/05/2024] [Revised: 07/09/2024] [Accepted: 07/19/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Fragility fractures occur due to low energy mechanisms and result in significant morbidity and mortality. This study reviews the implementation of a fragility fracture program at a level I trauma center. In this pathway, trauma surgery provides clearance followed by admission and management with medical service and orthopedic consultation for injuries which meet fragility fracture criteria. METHODS This pathway, implemented in July 2021, includes patients with isolated fractures secondary to a low energy mechanism. We compared cohorts 2-ys before (PRE) and after (POS) pathway implementation. Demographics (age, sex, fracture location, injury severity score, American Society of Anesthesiologists score) and outcome data were collected and analyzed using between-subjects analyses. Measured outcomes included deep vein thrombosis/pulmonary embolism, hospital mortality, disposition to hospice, nonoperative rate, unplanned intensive care unit admission, time to surgery (TTS), and length of stay (LOS). RESULTS The study included n = 1137 patients (n = 564 PRE and n = 573 POS). POS patients had a higher injury severity score (P = 0.003) and different fracture location (P = 0.017), but no other demographics were different. Trauma admission decreased after implementation (P < 0.001; PRE: 21.5%, POS: 1.8%) with no differences in outcomes except increases in LOS (P < 0.001; PRE: 114 h, POS: 124 h) and TTS (P < 0.001; PRE: 15 h, POS: 18 h). CONCLUSIONS Morbidity and mortality did not correlate with pathway implementation; however, TTS and LOS increased. Although TTS increased, it remained under the American Academy of Orthopedic Surgery 48-h recommendation. The TTS and LOS increases were potentially from COVID-19 or cohort demographic differences. Decreased trauma as admitting service demonstrates pathway adherence. These findings highlight the need for investigation to better understand fragility fracture pathways.
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Affiliation(s)
- Jack Nadaud
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee.
| | - Eric Heidel
- University of Tennessee Medical Center Department of Surgery, Knoxville, Tennessee
| | - Brian Daley
- University of Tennessee Medical Center Department of Surgery, Knoxville, Tennessee
| | - Catherine McKnight
- University of Tennessee Medical Center Department of Surgery, Knoxville, Tennessee
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Pabla P, Jones E, Piasecki M, Phillips B. Skeletal muscle dysfunction with advancing age. Clin Sci (Lond) 2024; 138:863-882. [PMID: 38994723 PMCID: PMC11250095 DOI: 10.1042/cs20231197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024]
Abstract
As a result of advances in medical treatments and associated policy over the last century, life expectancy has risen substantially and continues to increase globally. However, the disconnect between lifespan and 'health span' (the length of time spent in a healthy, disease-free state) has also increased, with skeletal muscle being a substantial contributor to this. Biological ageing is accompanied by declines in both skeletal muscle mass and function, termed sarcopenia. The mechanisms underpinning sarcopenia are multifactorial and are known to include marked alterations in muscle protein turnover and adaptations to the neural input to muscle. However, to date, the relative contribution of each factor remains largely unexplored. Specifically, muscle protein synthetic responses to key anabolic stimuli are blunted with advancing age, whilst alterations to neural components, spanning from the motor cortex and motoneuron excitability to the neuromuscular junction, may explain the greater magnitude of function losses when compared with mass. The consequences of these losses can be devastating for individuals, their support networks, and healthcare services; with clear detrimental impacts on both clinical (e.g., mortality, frailty, and post-treatment complications) and societal (e.g., independence maintenance) outcomes. Whether declines in muscle quantity and quality are an inevitable component of ageing remains to be completely understood. Nevertheless, strategies to mitigate these declines are of vital importance to improve the health span of older adults. This review aims to provide an overview of the declines in skeletal muscle mass and function with advancing age, describes the wide-ranging implications of these declines, and finally suggests strategies to mitigate them, including the merits of emerging pharmaceutical agents.
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Affiliation(s)
- Pardeep Pabla
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, U.K
| | - Eleanor J. Jones
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, U.K
| | - Mathew Piasecki
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, U.K
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), U.K
- NIHR Nottingham Biomedical Research Centre (BRC), U.K
| | - Bethan E. Phillips
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, DE22 3DT, U.K
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), U.K
- NIHR Nottingham Biomedical Research Centre (BRC), U.K
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Ansari H, Fung K, Cheung AM, Jaglal S, Bogoch ER, Kurdyak PA. Outcomes following hip fracture surgery in adults with schizophrenia in Ontario, Canada: A 10-year population-based retrospective cohort study. Gen Hosp Psychiatry 2024; 89:60-68. [PMID: 38797059 DOI: 10.1016/j.genhosppsych.2024.05.010] [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: 01/03/2024] [Revised: 04/02/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To understand immediate and long-term outcomes following hip fracture surgery in adults with schizophrenia. METHODS Retrospective population-based cohort study leveraging health administrative databases from Ontario, Canada. Individuals aged 40-105 years with hip fracture surgery between April 1, 2009 and March 31, 2019 were included. Schizophrenia was ascertained using a validated algorithm. Outcomes were: 30-day mortality; 30-day readmission; 1-year survival; and subsequent hip fracture within 2 years. Analyses incorporated Generalized Estimating Equation models, Kaplan-Meier curves, and Fine-Gray competing risk models. RESULTS In this cohort study of 98,126 surgically managed hip fracture patients, the median [IQR] age was 83[75-89] years, 69.2% were women, and 3700(3.8%) had schizophrenia. In Fine-Gray models, schizophrenia was associated with subsequent hip fracture (sdRH, 1.29; 95% CI, 1.09-1.53), with male patients with schizophrenia sustaining a refracture 50 days earlier. In age- and sex-adjusted GEE models, schizophrenia was associated with 30-day mortality (OR, 1.31; 95% CI, 1.12-1.54) and readmissions (OR, 1.40; 95% CI, 1.25-1.56). Kaplan-Meier survival curves suggested that patients with schizophrenia were less likely to be alive at 1-year. CONCLUSIONS Study highlights the susceptibility of hip fracture patients with schizophrenia to worse outcomes, including refracture, with implications for understanding modifiable processes of care to optimize their recovery.
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Affiliation(s)
- Hina Ansari
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- ICES, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Earl R Bogoch
- Brookfield Chair in Fracture Prevention, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Paul A Kurdyak
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Nadaud J, Heidel E, Daley B, McKnight C. The Effect of a Hip Fragility Pathway on Outcomes of Ground Level Falls in the Elderly. Am Surg 2024; 90:1948-1950. [PMID: 38532264 DOI: 10.1177/00031348241241685] [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] [Indexed: 03/28/2024]
Abstract
Fragility hip fractures result from low energy mechanisms and are associated with morbidity and mortality, especially in the elderly. We examined outcomes 2 years before and after implementation of a fragility fracture program. The pathway involves emergency department clearance and admission by a medical service with orthopedic consultation. Demographics include age, gender, fracture location, injury severity score (ISS), and ASA. Outcomes include DVT/PE, mortality, disposition, non-operative rate, ICU admission, time to surgery (TTS), length of stay (LOS), and admission service. 777 patients were included (383 PRE/394 POS). POS patients were slightly younger. Trauma admission decreased and LOS and TTS increased. There were no other demographic or outcome differences. Although TTS increased, it remained under 48 hours. Length of stay increase was possibly a reflection of COVID-19. Decreased trauma admission demonstrates pathway adherence. Further studies need to be conducted to verify that quality care can be maintained after initiation of a hip fragility pathway.
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Affiliation(s)
- Jack Nadaud
- University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Eric Heidel
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Brian Daley
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Catherine McKnight
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
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Arvidsson L, Landgren M, Harding AK, Abramo A, Tägil M. Patients Aged 80 or More With Distal Radius Fractures Have a Lower One-Year Mortality Rate Than Age- and Gender-Matched Controls: A Register-Based Study. Geriatr Orthop Surg Rehabil 2024; 15:21514593241252583. [PMID: 38711473 PMCID: PMC11072058 DOI: 10.1177/21514593241252583] [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: 09/03/2023] [Revised: 03/03/2024] [Accepted: 04/14/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction With a rapidly ageing population, the number of distal radius fractures (DRFs) in the elderly will increase dramatically. The aim of this retrospective register study was to examine the 1- and 5-year mortality in DRF patients aged 80 years or more and correlate the overall survival to factors not related to the fracture itself. Material and Methods Patients aged ≥80 diagnosed with DRFs in Lund University Hospital in Sweden in the period 2010-2012 were extracted from the prospective Lund Distal Radius Fracture register. One- and 5-year standardised mortality rates (SMRs) were calculated using the Swedish standard population as a reference. Medical records were searched for non-fracture-related factors including comorbidity, medications, cognitive impairment and type of living. Cox proportional hazard regression models were used to identify prognostic factors for all-cause mortality. Results The study cohort included 240 patients, with a mean age of 86. The overall 1-year mortality was 5% (n = 11/240) and the 5-year mortality was 44% (n = 105/240). The 1-year SMR was .44 (CI .18-.69, P < .01) when indirectly adjusted for age and gender and compared to the Swedish standard population. The 5-year SMR was .96 (CI .78-1.14). The patients' ability to live independently in their own home had the highest impact on survival. Discussion The 1-year mortality rate among the super-elderly DRF patients was only 44% of that expected. Possibly, a DRF at this age could be a sign of a healthier and more active patient. Conclusions The DRF patients aged 80 or more had a substantially lower mortality rate 1 year after fracture compared to the age- and gender-matched standard population. Patients living independently in their own homes had the longest life expectancy. Treatment should not be limited solely because of old age, but individualised according to the patient's ability and activity level.
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Affiliation(s)
- Linnea Arvidsson
- Department of Clinical Sciences Lund, Orthopaedics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Marcus Landgren
- Department of Orthopaedic Surgery, Hand Surgery Unit, Copenhagen University Hospital, Herlev and Gentofte, Gentofte, Denmark
| | - Anna Kajsa Harding
- Department of Clinical Sciences Lund, Orthopaedics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Antonio Abramo
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Orthopaedics, Skåne University Hospital and Lund University, Lund, Sweden
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Vincent G, Adachi JD, Schemitsch E, Tarride JE, Ho N, Wani RJ, Brown JP. Postfracture survival in a population-based study of adults aged ≥66 yr: a call to action at hospital discharge. JBMR Plus 2024; 8:ziae002. [PMID: 38596507 PMCID: PMC11001756 DOI: 10.1093/jbmrpl/ziae002] [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: 08/27/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 04/11/2024] Open
Abstract
Postfracture survival rates provide prognostic information but are rarely reported along with other mortality outcomes in adults aged ≥50 yr. The timing of survival change following a fracture also needs to be further elucidated. This population-based, matched-cohort, retrospective database study examined 98 474 patients (73% women) aged ≥66 yr with an index fracture occurring at an osteoporotic site (hip, clinical vertebral, proximal non-hip non-vertebral [pNHNV], and distal non-hip non-vertebral [dNHNV]) from 2011 to 2015, who were matched (1:1) to nonfracture individuals based on sex, age, and comorbidities. All-cause 1- and 5-yr overall survival and relative survival ratios (RSRs) were assessed, and time trends in survival changes were characterized starting immediately after a fracture. In both sexes, overall survival was markedly decreased over 6 yr of follow-up after hip, vertebral, and pNHNV fractures, and as expected, worse survival rates were observed in older patients and males. The lowest 5-yr RSRs were observed after hip fractures in males (66-85 yr, 51.9%-63.9%; ≥86 yr, 34.5%), followed by vertebral fractures in males (66-85 yr, 53.2%-69.4%; ≥86 yr, 35.5%), and hip fractures in females (66-85 yr, 69.8%-79.0%; ≥86 yr, 52.8%). Although RSRs did not decrease as markedly after dNHNV fractures in younger patients, relatively low 5-yr RSRs were observed in females (75.9%) and males (69.5%) aged ≥86 yr. The greatest reduction in survival occurred within the initial month after hip, vertebral, and pNHNV fractures, indicating a high relative impact of short-term factors, with survival-reduction effects persisting over time. Therefore, the most critical period for implementing interventions aimed at improving post-fracture prognosis appears to be immediately after a fracture; however, considering the immediate need for introducing such interventions, primary fracture prevention is also crucial to prevent the occurrence of the initial fracture in high-risk patients.
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Affiliation(s)
- Geneviève Vincent
- Medical Affairs Division, Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Emil Schemitsch
- Division of Orthopaedic Surgery, Western University, London, ON N6A 3K7, Canada
| | - Jean-Eric Tarride
- McMaster Chair in Health Technology Management, Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON L8S 4L8, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON L8S 4L8, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Nathan Ho
- Medical Affairs Division, Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada
| | - Rajvi J Wani
- Research Division, Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada
| | - Jacques P Brown
- CHU de Québec Research Centre and Laval University, 2705 Boulevard Laurier, TR-83, Québec, QC L5N 0A4, Canada
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Altınsoy KE, Unat B. The role of bone turnover markers in diagnosis, monitoring, and pathological fractures of osteoporosis. ULUS TRAVMA ACIL CER 2024; 30:323-327. [PMID: 38738676 PMCID: PMC11154067 DOI: 10.14744/tjtes.2024.48409] [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: 02/16/2024] [Revised: 02/27/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND We investigated the utility of specific biomarkers-namely, c-terminal telopeptide (CTX), n-telopeptide (NTX), deoxypyridinoline (DPD), and tartrate-resistant acid phosphatase (TRAP)-compared to conventional diagnostic methods. We hy-pothesized that these novel biomarkers could hold substantial value in the diagnosis, treatment, and monitoring of osteoporosis. METHODS The study was conducted over a three-year period, from January 1, 2020, to January 1, 2023. We enrolled a total of 520 patients aged 50 years or older who had been diagnosed with osteoporosis. Patients undergoing steroid treatments, which are known to contribute to osteoporosis, were excluded from the study. Additionally, we carefully selected and matched a control group consisting of 500 patients based on demographic characteristics relevant to the diagnosis of osteoporosis. This meticulous selection process resulted in a comprehensive cohort comprising 1,020 patients. Throughout the study, patients were closely monitored for a duration of one year to track the occurrence of pathological fractures and assess their overall prognosis. RESULTS As a result of our rigorous investigation, we identified CTX, NTX, DPD, and TRAP as pivotal biomarkers that play a crucial role in evaluating bone health, monitoring treatment effectiveness, and detecting pathological fractures in the context of osteoporosis. CONCLUSION Our study underscores the significance of these biomarkers in advancing the diagnosis and management of osteo-porosis, offering valuable insights into the disease's progression and treatment outcomes.
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Affiliation(s)
- Kazım Ersin Altınsoy
- Department of Emergency Medicine, Faculty of Medicine, Gaziantep Islam Science and Technology University, Gaziantep-Türkiye
| | - Beytullah Unat
- Department of Orthopedics and Traumatology, Gaziantep City Hospital, Gaziantep-Türkiye
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Mohseni V, Fahimfar N, Ansarifar A, Masoumi S, Sanjari M, Khalagi K, Bagherifard A, Larijani B, Janani L, Mansourzadeh MJ, Ostovar A, Solaymani-Dodaran M. Mortality and re-fracture rates in low trauma hip fracture. BMC Geriatr 2024; 24:381. [PMID: 38684943 PMCID: PMC11059755 DOI: 10.1186/s12877-024-04950-1] [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: 10/10/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES This study aimed to estimate the incidence rate of re-fracture and all-cause mortality rate in patients with hip fractures caused by minor trauma in the first year following the event. MATERIALS AND METHODS This is a retrospective cohort study of patients over 50 years of age conducted in a referral hospital located in Tehran (Shafa-Yahyaian). Using the hospital information system (HIS), all patients hospitalized due to hip fractures caused by minor trauma during 2013-2019 were included in the study. We investigated the occurrence of death and re-fracture in all patients one year after the primary hip fracture. RESULTS A total of 945 patients with hip fractures during a 307,595 person-days of follow-up, were included. The mean age of the participants was 71 years (SD = 11.19), and 533 (59%) of them were women. One hundred forty-nine deaths were identified during the first year after hip fracture, resulting in a one-year mortality rate of 17.69% (95% CI: 15.06-20.77). The one-year mortality rate was 20.06% in men and 15.88% in women. Out of all the participants, 667 answered the phone call, of which 29 cases had experienced a re-fracture in the first year (incidence rate = 5.03%, 95% CI: 3.50-7.24). The incidence rates in women and men were 6.07% and 3.65%, respectively. CONCLUSION Patients with low-trauma hip fractures have shown a high rate of mortality in the first year. Considering the increase in the incidence of hip fractures with age, comprehensive strategies are needed to prevent fractures caused by minor trauma in the elderly population.
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Affiliation(s)
- Vahideh Mohseni
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Ansarifar
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Safdar Masoumi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Mansourzadeh
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Masoud Solaymani-Dodaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
- Minimally Invasive Surgery Research Center, Hazrat-e-Rasool Hospital, Iran University of Medical Science, Tehran, Iran.
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Khan AZ, Zhang X, Macarayan E, Best MJ, Fedorka CJ, Haas DA, Armstrong AD, Jawa A, O’Donnell EA, Simon JE, Wagner ER, Malik M, Gottschalk MB, Updegrove GF, Warner JJ, Srikumaran U, Abboud JA. Five-Year Mortality Rates Following Elective Shoulder Arthroplasty and Shoulder Arthroplasty for Fracture in Patients Over Age 65. JB JS Open Access 2024; 9:e23.00133. [PMID: 38685966 PMCID: PMC11049713 DOI: 10.2106/jbjs.oa.23.00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background To effectively counsel patients prior to shoulder arthroplasty, surgeons should understand the overall life trajectory and life expectancy of patients in the context of the patient's shoulder pathology and medical comorbidities. Such an understanding can influence both operative and nonoperative decision-making and implant choices. This study evaluated 5-year mortality following shoulder arthroplasty in patients ≥65 years old and identified associated risk factors. Methods We utilized Centers for Medicare & Medicaid Services Fee-for-Service inpatient and outpatient claims data to investigate the 5-year mortality rate following shoulder arthroplasty procedures performed from 2014 to 2016. The impact of patient demographics, including fracture diagnosis, year fixed effects, and state fixed effects; patient comorbidities; and hospital-level characteristics on 5-year mortality rates were assessed with use of a Cox proportional hazards regression model. A p value of <0.05 was considered significant. Results A total of 108,667 shoulder arthroplasty cases (96,104 nonfracture and 12,563 fracture) were examined. The cohort was 62.7% female and 5.8% non-White and had a mean age at surgery of 74.3 years. The mean 5-year mortality rate was 16.6% across all shoulder arthroplasty cases, 14.9% for nonfracture cases, and 29.9% for fracture cases. The trend toward higher mortality in the fracture group compared with the nonfracture group was sustained throughout the 5-year postoperative period, with a fracture diagnosis being associated with a hazard ratio of 1.63 for mortality (p < 0.001). Medical comorbidities were associated with an increased risk of mortality, with liver disease bearing the highest hazard ratio (3.07; p < 0.001), followed by chronic kidney disease (2.59; p < 0.001), chronic obstructive pulmonary disease (1.92; p < 0.001), and congestive heart failure (1.90; p < 0.001). Conclusions The mean 5-year mortality following shoulder arthroplasty was 16.6%. Patients with a fracture diagnosis had a significantly higher 5-year mortality risk (29.9%) than those with a nonfracture diagnosis (14.9%). Medical comorbidities had the greatest impact on mortality risk, with chronic liver and kidney disease being the most noteworthy. This novel longer-term data can help with patient education and risk stratification prior to undergoing shoulder replacement. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam Z. Khan
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Panorama City, California
| | | | | | - Matthew J. Best
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - April D. Armstrong
- Bone and Joint Institute, Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Evan A. O’Donnell
- Boston Shoulder Institute, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason E. Simon
- Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric R. Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | | | | | - Gary F. Updegrove
- Bone and Joint Institute, Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jon J.P. Warner
- Boston Shoulder Institute, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph A. Abboud
- Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Stovall R, Kersey E, Li J, Baker R, Anastasiou C, Palmowski A, Schmajuk G, Gensler L, Yazdany J. Incidence Rate and Factors Associated With Fractures Among Medicare Beneficiaries With Ankylosing Spondylitis in the United States. Arthritis Care Res (Hoboken) 2024; 76:265-273. [PMID: 37605840 PMCID: PMC10843294 DOI: 10.1002/acr.25219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/30/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE We evaluated the incidence rate and factors associated with fractures among adults with ankylosing spondylitis (AS). METHODS We performed a retrospective cohort study with data from the Rheumatology Informatics System for Effectiveness registry linked to Medicare claims from 2016 to 2018. Patients were required to have two AS International Classification of Diseases codes 30 or more days apart and a subsequent Medicare claim. Then, 1 year of baseline characteristics were included, after which patients were observed for fractures. First, we calculated the incidence rate of fractures. Second, we constructed logistic regression models to identify factors associated with the fracture, including age, sex, race and ethnicity, body mass index, Medicare/Medicaid dual eligibility, area deprivation index, Charlson comorbidity index, smoking status, osteoporosis, historical fracture, and use of osteoporosis treatment, glucocorticoids, and opioids. RESULTS We identified 1,426 adults with prevalent AS. Mean ± SD age was 69.4 ± 9.8 years, 44.3% were female, and 77.3% were non-Hispanic White. Fractures occurred in 197 adults with AS. The overall incidence rate of fractures was 76.7 (95% confidence interval [CI] 66.4-88.6) per 1,000 person-years. Older age (odds ratio [OR] 2.8, 95% CI 1.39-5.65), historical fracture (OR 5.24, 95% CI 3.44-7.99), and use of more than 30 mg morphine equivalent (OR 1.86, 95% CI 1.08-3.19) conferred increased odds of fracture. CONCLUSIONS In this large sample of Medicare beneficiaries with AS, increasing age, historical fracture, and use of opioids had higher odds of fracture. Men and women were equally likely to have a fracture. Because opioid use was associated with fracture in AS, this high-risk population should be considered for interventions to mitigate risk.
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Affiliation(s)
- Rachael Stovall
- Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, CA
| | - Emma Kersey
- Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, CA
| | - Jing Li
- Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, CA
| | | | - Christine Anastasiou
- Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, CA
| | - Andriko Palmowski
- Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, CA
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, University of Copenhagen, Copenhagen, Denmark
| | - Gabriela Schmajuk
- Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, CA
- San Francisco VA Healthcare System
- UCSF Institute for Health Policy Research
| | - Lianne Gensler
- Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, CA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, CA
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Ramchand SK, Leder BZ. Sequential Therapy for the Long-Term Treatment of Postmenopausal Osteoporosis. J Clin Endocrinol Metab 2024; 109:303-311. [PMID: 37610985 DOI: 10.1210/clinem/dgad496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
Osteoporosis is a chronic condition characterized by decreased bone mass, loss of skeletal integrity, and increased susceptibility to fracture. Drugs used to treat osteoporosis can be classified as those that block bone resorption (antiresorptive), stimulate bone formation (anabolic), or do both. While all currently approved medications reduce the risk of fragility fractures in high-risk populations, they are generally unable to fully restore bone strength in most patients with established disease. Thus, the majority of patients require disease management over many years. Unfortunately, the continuous use of a single drug has limitations, both in terms of efficacy and safety, and so sequential therapy is commonly required. Given the expanding list of pharmacological agents currently available, careful consideration needs to be given as to which drugs to use and in what sequence. This review will evaluate the differential effects of antiresorptive, bone-forming, and dual-acting drugs when used in specific sequences and will explore the current evidence favoring the initial use of bone-forming/dual-acting drugs followed by antiresorptive medications. This review will also examine the notion that long-term treatment with an antiresorptive drug may diminish the efficacy of subsequent treatment with a bone-forming/dual-acting drug. Finally, this review will explore the current evidence pertaining to the specific issue of how to best prevent the clinical ramifications of denosumab cessation.
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Affiliation(s)
- Sabashini K Ramchand
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA
| | - Benjamin Z Leder
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA
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14
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Barik S, Kumar V. Male Osteoporosis and Frailty. Indian J Orthop 2023; 57:237-244. [PMID: 38107814 PMCID: PMC10721747 DOI: 10.1007/s43465-023-01027-w] [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: 08/29/2023] [Accepted: 10/12/2023] [Indexed: 12/19/2023]
Abstract
It is estimated that 50% women and 20% of men over the age of 50 years will have an osteoporosis-related fracture in their remaining life. Although, Osteoporosis is generally thought to be a disease affecting females, more than a third of hip fractures occur in males due to reduced bone strength. Along with Osteoporosis, the other pathological process which occurs simultaneously is Sarcopenia. It is defined as age-related atrophy of skeletal muscle mass that reduces muscle strength, function, and quality of life. This chapter discusses the various aspects of the disease process in the males including its classification, clinical features, diagnosis and treatment.
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Vishal Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
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15
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Tang G, Feng L, Pei Y, Gu Z, Chen T, Feng Z. Low BMI, blood calcium and vitamin D, kyphosis time, and outdoor activity time are independent risk factors for osteoporosis in postmenopausal women. Front Endocrinol (Lausanne) 2023; 14:1154927. [PMID: 37937050 PMCID: PMC10627178 DOI: 10.3389/fendo.2023.1154927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Aim To explore the risk factors of osteoporosis in postmenopausal women in China. Method This study collected all patient data from January 2014 to December 2015. Basic information and questionnaires were collected from 524 postmenopausal women in Sanya and Hainan Province. The questionnaire was administered to the enrolled participants by endocrinologists. Biochemical parameters were measured using fasting blood samples, and bone density was measured by dual energy X-ray absorptiometry at the department of radiology of Hainan hospital, PLA General Hospital. Participants with an R-value of ≤-2.5 were diagnosed with osteoporosis. After deleting missing values for each factor, 334 participants were divided into the osteoporosis (n=35) and non-osteoporosis (n=299) groups according to the R-values. Results The participants had a median age of 60.8 years (range: 44-94 years). Among the 334 postmenopausal women included in this study, 35 (10.5%) were diagnosed with osteoporosis. Univariate analysis showed statistically significant differences in age, BMI, type of work, alkaline phosphatase, years of smoking, blood calcium levels, kyphosis, fracture, and asthma between the two groups (P<0.05). In addition, multivariate logistic analysis showed that age (odds ratio [OR]: 1.185, 95% confidence interval [CI]: 1.085-1.293, P<0.001) and kyphosis times (OR:1.468, 95% CI: 1.076-2.001, P=0.015) were positively correlated with postmenopausal osteoporosis, whereas BMI (OR: 0.717, 95% CI: 0.617-0.832, P<0.001), blood calcium levels (OR: 0.920, 95% CI: 0.854-0.991, P=0.027), vitamin D levels (OR: 0.787, 95% CI: 0.674-0.918, P=0.002), and outdoor activity time (OR: 0.556, 95% CI: 0.338-0.915, P=0.021) were negatively correlated with postmenopausal osteoporosis. Conclusion Low BMI, blood calcium and vitamin D levels, kyphosis time, and outdoor activity time are independent risk factors for osteoporosis in postmenopausal women.
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Affiliation(s)
- Guo Tang
- Department of Pain, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Long Feng
- Department of Pain, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
- Department of Anesthesiology, People's Liberation Army (PLA) General Hospital of Hainan Hospital, Sanya, Hainan, China
| | - Yu Pei
- Department of Endocrinology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhaoyan Gu
- Department of Endocrinology, The Second Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Tingting Chen
- Department of Anesthesia and Cardiopulmonary Bypass, Cardiovascular Medical Department, The Sixth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zeguo Feng
- Department of Pain, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
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16
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Arnst J, Jing Z, Cohen C, Ha SW, Viggeswarapu M, Beck GR. Bioactive silica nanoparticles target autophagy, NF-κB, and MAPK pathways to inhibit osteoclastogenesis. Biomaterials 2023; 301:122238. [PMID: 37441901 PMCID: PMC10530178 DOI: 10.1016/j.biomaterials.2023.122238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
Spherical 50 nm silica-based nanoparticles (SiNPs) promote healthy bone homeostasis and maintenance by supporting bone forming osteoblast lineage cells while simultaneously inhibiting the differentiation of bone resorbing osteoclasts. Previous work demonstrated that an intraperitoneal injection of SiNPs in healthy mice - both young and old - increased bone density and quality, suggesting the possibility that SiNPs represent a dual action therapeutic. However, the underlying mechanisms governing the osteoclast response to SiNPs have yet to be fully explored and defined. Therefore, the goals of this study were to investigate the cellular and molecular mechanisms by which SiNPs inhibit osteoclastogenesis. SiNPs strongly inhibited RANKL-induced osteoclast differentiation within the first hours and concomitantly inhibited early transcriptional regulators such as Nfatc1. SiNPs simultaneously stimulated expression of autophagy related genes p62 and LC3β dependent on ERK1/2 signaling pathway. Intriguingly, SiNPs were found to stimulate autophagosome formation while inhibiting the autophagic flux necessary for RANKL-stimulated osteoclast differentiation, resulting in the inhibition of both the canonical and non-canonical NF-κB signaling pathways and stabilizing TRAF3. These results suggest a model in which SiNPs inhibit osteoclastogenesis by inhibiting the autophagic machinery and RANKL-dependent functionality. This mechanism of action defines a novel therapeutic strategy for inhibiting osteoclastogenesis.
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Affiliation(s)
- Jamie Arnst
- Emory University, Department of Medicine, Division of Endocrinology, Atlanta, GA, 30322, USA
| | - Zhaocheng Jing
- Emory University, Department of Medicine, Division of Endocrinology, Atlanta, GA, 30322, USA; The Second Hospital of Shandong University, Department of Orthopedics, Jinan, Shandong, 250033, China
| | - Cameron Cohen
- Emory University, Department of Medicine, Division of Endocrinology, Atlanta, GA, 30322, USA
| | - Shin-Woo Ha
- Emory University, Department of Medicine, Division of Endocrinology, Atlanta, GA, 30322, USA
| | - Manjula Viggeswarapu
- The Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, 30033, USA
| | - George R Beck
- The Atlanta Department of Veterans Affairs Medical Center, Decatur, GA, 30033, USA; Emory University, Department of Medicine, Division of Endocrinology, Atlanta, GA, 30322, USA; The Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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Schlacht TZ, Haque I, Skelton DA. What are the Effects of Exercise on Trabecular Microarchitecture in Older Adults? A Systematic Review and Meta-analysis of HR-pQCT Studies. Calcif Tissue Int 2023; 113:359-382. [PMID: 37725127 PMCID: PMC10516781 DOI: 10.1007/s00223-023-01127-7] [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: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Abstract
The objective of this review was to determine the effects of exercise on high-resolution peripheral quantitative computed tomography (HR-pQCT) derived trabecular microarchitecture parameters in older adults. Five electronic databases were systematically searched by two independent reviewers. Inclusion criteria were adults age ≥ 50, any type of exercise as part of the intervention, and trabecular microarchitecture assessed via HR-pQCT. Data was extracted from included studies, and where suitable, included in a meta-analysis. Quality of included studies was appraised. Seven studies (397 participants) were included. All participants were postmenopausal women. Interventions included jumping, whole-body vibration, and power/plyometric training. All studies were rated as either weak or moderate quality. Meta-analysis (5 studies) showed no significant changes in any parameters when considering all exercise or sub-analysing based on type. Exercise was not found to have significant effects on trabecular microarchitecture in postmenopausal women over the age of 50. These findings should be interpreted with caution due to the small number of studies investigating few modes of exercise, their weak to moderate quality, and risk of bias. High-quality studies are needed to determine the effects of additional types of exercise in a more diverse population of older adults, including men.
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Affiliation(s)
- Thomas Z Schlacht
- Research Centre for Health (ReaCH), Physiotherapy and Paramedicine, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Inaya Haque
- Research Centre for Health (ReaCH), Physiotherapy and Paramedicine, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), Physiotherapy and Paramedicine, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
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18
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Zheng C, Ding L, Xiang Z, Feng M, Zhao F, Zhou Z, She C. Circ_0001825 promotes osteogenic differentiation in human-derived mesenchymal stem cells via miR-1270/SMAD5 axis. J Orthop Surg Res 2023; 18:663. [PMID: 37674252 PMCID: PMC10481475 DOI: 10.1186/s13018-023-04133-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The implication of deregulated circular RNAs in osteoporosis (OP) has gradually been proposed. Herein, we aimed to study the function and mechanism of circ_0001825 in OP using osteogenic-induced human-derived mesenchymal stem cells (hMSCs). METHODS The content of genes and proteins was tested by quantitative real-time polymerase chain reaction and Western blotting. The osteogenic differentiation in hMSCs were evaluated by ALP activity and Alizarin Red staining, as well as the detection of osteogenesis-related markers. Cell viability and apoptosis were measured by CCK-8 assay and flow cytometry. The binding between miR-1270 and circ_0001825 or SMAD5 (SMAD Family Member 5) was confirmed by using dual-luciferase reporter assay and pull-down assay. RESULTS Circ_0001825 was lowly expressed in OP patients and osteogenic induced hMSCs. Knockdown of circ_0001825 suppressed hMSC viability and osteogenic differentiation, while circ_0001825 overexpression showed the exact opposite effects. Mechanistically, circ_0001825/miR-1270/SMAD5 formed a feedback loop. MiR-1270 was increased and SMAD5 was decreased in OP patients and osteogenic induced hMSCs. MiR-1270 up-regulation suppressed hMSC viability and osteogenic differentiation, which was reversed by SMAD5 overexpression. Moreover, miR-1270 deficiency abolished the effects of circ_0001825 knockdown on hMSCs. CONCLUSION Circ_0001825 promoted hMSC viability and osteogenic differentiation via miR-1270/SMAD5 axis, suggesting the potential involvement of circ_0001825 in osteoporosis.
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Affiliation(s)
- Changjun Zheng
- Department of Joint Surgery, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, Jiangsu Province, China
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, 318000, Zhejiang, China
| | - Lingzhi Ding
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, 318000, Zhejiang, China
| | - Ziming Xiang
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, 318000, Zhejiang, China
| | - Mingxuan Feng
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, 318000, Zhejiang, China
| | - Fujiang Zhao
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, 318000, Zhejiang, China
| | - Zhaoxin Zhou
- Department of Joint Surgery, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, Jiangsu Province, China
| | - Chang She
- Department of Joint Surgery, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, 215004, Jiangsu Province, China.
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Moles RJ, Perry L, Naylor JM, Center J, Ebeling P, Duque G, Major G, White C, Yates C, Jennings M, Kotowicz M, Tran T, Bliuc D, Si L, Gibson K, Basger BJ, Bolton P, Barnett S, Hassett G, Kelly A, Bazarnik B, Ezz W, Luckie K, Carter SR. Safer medicines To reduce falls and refractures for OsteoPorosis (#STOP): a study protocol for a randomised controlled trial of medical specialist-initiated pharmacist-led medication management reviews in primary care. BMJ Open 2023; 13:e072050. [PMID: 37620274 PMCID: PMC10450068 DOI: 10.1136/bmjopen-2023-072050] [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: 01/29/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Minimal trauma fractures (MTFs) often occur in older patients with osteoporosis and may be precipitated by falls risk-increasing drugs. One category of falls risk-increasing drugs of concern are those with sedative/anticholinergic properties. Collaborative medication management services such as Australia's Home Medicine Review (HMR) can reduce patients' intake of sedative/anticholinergics and improve continuity of care. This paper describes a protocol for an randomised controlled trial to determine the efficacy of an HMR service for patients who have sustained MTF. METHOD AND ANALYSIS Eligible participants are as follows: ≥65 years of age, using ≥5 medicines including at least one falls risk-increasing drug, who have sustained an MTF and under treatment in one of eight Osteoporosis Refracture Prevention clinics in Australia. Consenting participants will be randomised to control (standard care) or intervention groups. For the intervention group, medical specialists will refer to a pharmacist for HMR focused on reducing falls risk predominately through making recommendations to reduce falls risk medicines, and adherence to antiosteoporosis medicines. Twelve months from treatment allocation, comparisons between groups will be made. The main outcome measure is participants' cumulative exposure to sedative and anticholinergics, using the Drug Burden Index. Secondary outcomes include medication adherence, emergency department visits, hospitalisations, falls and mortality. Economic evaluation will compare the intervention strategy with standard care. ETHICS AND DISSEMINATION Approval was obtained via the New South Wales Research Ethics and Governance Information System (approval number: 2021/ETH12003) with site-specific approvals granted through Human Research Ethics Committees for each research site. Study outcomes will be published in peer-reviewed journals. It will provide robust insight into effectiveness of a pharmacist-based intervention on medicine-related falls risk for patients with osteoporosis. We anticipate that this study will take 2 years to fully accrue including follow-up. TRIAL REGISTRATION NUMBER ACTRN12622000261718.
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Affiliation(s)
- Rebekah Jane Moles
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lin Perry
- School of Nursing and Midwifery, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Southwestern Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Center
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Christopher White
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Christopher Yates
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Matthew Jennings
- Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Mark Kotowicz
- Epi-Centre for Healthy Ageing, Deakin University - Geelong Campus at Waurn Ponds, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
| | - Thach Tran
- Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Dana Bliuc
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Lei Si
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kathryn Gibson
- Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Benjamin Joseph Basger
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrick Bolton
- Public Health and Community Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Stephen Barnett
- GP Academic Unit, University of Wollongong, Wollongong, New South Wales, Australia
| | - Geraldine Hassett
- Ingham Institute, Liverpool, New South Wales, Australia
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ayano Kelly
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Barbara Bazarnik
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Wafaa Ezz
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kate Luckie
- Musculoskeletal Clinical Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Ross Carter
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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20
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Riester MR, Beaudoin FL, Joshi R, Hayes KN, Cupp MA, Berry SD, Zullo AR. Evaluation of post-acute care and one-year outcomes among Medicare beneficiaries with hip fractures: a retrospective cohort study. BMC Med 2023; 21:232. [PMID: 37400841 DOI: 10.1186/s12916-023-02958-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Post-acute care (PAC) services after hospitalization for hip fracture are typically provided in skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), or at home via home health care (HHC). Little is known about the clinical course following PAC for hip fracture. We examined the nationwide burden of adverse outcomes by PAC setting in the year following discharge from PAC for hip fracture. METHODS This retrospective cohort included Medicare Fee-for-Service beneficiaries > 65 years who received PAC services in U.S. SNFs, IRFs, or HHC following hip fracture hospitalization between 2012 and 2018. Individuals who had a fall-related injury (FRI) during PAC or received PAC services in multiple settings were excluded. Primary outcomes included FRIs, all-cause hospital readmissions, and death in the year following discharge from PAC. Cumulative incidences and incidence rates for adverse outcomes were reported by PAC setting. Exploratory analyses examined risk ratios and hazard ratios between settings before and after inverse-probability-of-treatment-weighting, which accounted for 43 covariates. RESULTS Among 624,631 participants (SNF, 67.78%; IRF, 16.08%; HHC, 16.15%), the mean (standard deviation) age was 82.70 (8.26) years, 74.96% were female, and 91.30% were non-Hispanic White. Crude incidence rates (95%CLs) per 1000 person-years were highest among individuals receiving SNF care for FRIs (SNF, 123 [121, 123]; IRF, 105 [102, 107]; HHC, 89 [87, 91]), hospital readmission (SNF, 623 [619, 626]; IRF, 538 [532, 544]; HHC, 418 [414, 423]), and death (SNF, 167 [165, 169]; IRF, 47 [46, 49]; HHC, 55 [53, 56]). Overall, rates of adverse outcomes generally remained higher among SNF care recipients after covariate adjustment. However, inferences about the group with greater adverse outcomes differed for FRIs and hospital readmissions based on risk ratio or hazard ratio estimates. CONCLUSIONS In this retrospective cohort study of individuals hospitalized for hip fracture, rates of adverse outcomes in the year following PAC were common, especially among SNF care recipients. Understanding risks and rates of adverse events can inform future efforts to improve outcomes for older adults receiving PAC for hip fracture. Future work should consider calculating risk and rate measures to assess the influence of differential time under observation across PAC groups.
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Affiliation(s)
- Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 200 Dyer Street, Box 2013, Providence, RI, 02912, USA.
| | - Francesca L Beaudoin
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 200 Dyer Street, Box 2013, Providence, RI, 02912, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Richa Joshi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 200 Dyer Street, Box 2013, Providence, RI, 02912, USA
| | - Kaleen N Hayes
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 200 Dyer Street, Box 2013, Providence, RI, 02912, USA
- Graduate Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Toronto Leslie Dan, Toronto, ON, Canada
| | - Meghan A Cupp
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 200 Dyer Street, Box 2013, Providence, RI, 02912, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 200 Dyer Street, Box 2013, Providence, RI, 02912, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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21
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Thorne TJ, Steffenson L, O'Neill DC, Marchand LS, Martin BI, Haller JM. No Increased Risk of Nonunion with Bisphosphonate Use in a Medicare Claims Cohort Following Operatively Treated Long-Bone Fractures. J Bone Joint Surg Am 2023; 105:549-555. [PMID: 36753557 DOI: 10.2106/jbjs.22.01127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The diagnosis of a fragility fracture represents an important intervention event for the initiation of medical osteoporosis treatments. However, it is unclear if osteoporosis medications increase the risk of nonunion if administered in the setting of acute fracture. The purpose of the present study was to investigate whether bisphosphonates or selective estrogen receptor modulators/hormone replacement therapy (SERM/HRT) are associated with nonunion following fracture in a Medicare population. METHODS A retrospective analysis of Medicare claims from 2016 to 2019 was performed to identify patients ≥65 years of age who had a surgically treated long-bone fracture as identified with Current Procedural Terminology (CPT) codes and International Classification of Diseases, 10th Revision (ICD-10) codes. Successive claims were linked for each beneficiary through 1 year following the fracture to determine fracture union status. Multivariable logistic regression models were specified to identify the association between medications and fracture union status while controlling for age, sex, race, Charlson Comorbidity Index (CCI), and fracture type. RESULTS Of the 111,343 included fractures, 10,452 (9.4%) were associated with a diagnosis of nonunion within 1 year. The nonunion group was younger (79.8 ± 8.3 versus 80.6 ± 8.4 years; p < 0.001), more likely to be White (92.4% versus 90.9%; p < 0.001), and more likely to have a CCI of ≥2 (50.9% versus 49.4%; p < 0.001). Bisphosphonate use was more common in the nonunion group (12.2% versus 11.4%; p = 0.017). When controlling for race, age, sex, and CCI, neither bisphosphonates (OR, 1.06 [95% CI, 0.99 to 1.12]; p = 0.101) nor SERM/HRT (OR, 1.13 [0.93 to 1.36]; p = 0.218) were associated with nonunion. Bisphosphonate use within 90 days post-fracture was not significantly associated with nonunion (OR, 0.94 [95% CI, 0.86 to 1.03]; p = 0.175), and the timing of medication administration did not influence fracture union status. CONCLUSIONS The rate of nonunion after operatively treated long-bone fractures was 9.4%. In this cohort, use of a bisphosphonate or SERM/HRT was not associated with fracture union status at 1 year. Orthopaedic surgeons should not withhold or delay initiating medical therapies for osteoporosis in the setting of acute fracture out of concern for nonunion. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tyler J Thorne
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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22
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Omer M, Ngo C, Ali H, Orlovskaya N, Cheong VS, Ballesteros A, Garner MT, Wynn A, Martyniak K, Wei F, Collins BE, Yarmolenko SN, Asiatico J, Kinzel M, Ghosh R, Meckmongkol T, Calder A, Dahir N, Gilbertson TA, Sankar J, Coathup M. The Effect of Omega-9 on Bone Viscoelasticity and Strength in an Ovariectomized Diet-Fed Murine Model. Nutrients 2023; 15:1209. [PMID: 36904208 PMCID: PMC10005705 DOI: 10.3390/nu15051209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Few studies have investigated the effect of a monosaturated diet high in ω-9 on osteoporosis. We hypothesized that omega-9 (ω-9) protects ovariectomized (OVX) mice from a decline in bone microarchitecture, tissue loss, and mechanical strength, thereby serving as a modifiable dietary intervention against osteoporotic deterioration. Female C57BL/6J mice were assigned to sham-ovariectomy, ovariectomy, or ovariectomy + estradiol treatment prior to switching their feed to a diet high in ω-9 for 12 weeks. Tibiae were evaluated using DMA, 3-point-bending, histomorphometry, and microCT. A significant decrease in lean mass (p = 0.05), tibial area (p = 0.009), and cross-sectional moment of inertia (p = 0.028) was measured in OVX mice compared to the control. A trend was seen where OVX bone displayed increased elastic modulus, ductility, storage modulus, and loss modulus, suggesting the ω-9 diet paradoxically increased both stiffness and viscosity. This implies beneficial alterations on the macro-structural, and micro-tissue level in OVX bone, potentially decreasing the fracture risk. Supporting this, no significant differences in ultimate, fracture, and yield stresses were measured. A diet high in ω-9 did not prevent microarchitectural deterioration, nevertheless, healthy tibial strength and resistance to fracture was maintained via mechanisms independent of bone structure/shape. Further investigation of ω-9 as a therapeutic in osteoporosis is warranted.
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Affiliation(s)
- Mahmoud Omer
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Christopher Ngo
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
| | - Hessein Ali
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Nina Orlovskaya
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Vee San Cheong
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield S1 3JD, UK
| | | | | | - Austin Wynn
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Kari Martyniak
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
| | - Fei Wei
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
| | - Boyce E. Collins
- Engineering Research Center for Revolutionizing Biomaterials, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Sergey N. Yarmolenko
- Engineering Research Center for Revolutionizing Biomaterials, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Jackson Asiatico
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Michael Kinzel
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Ranajay Ghosh
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Teerin Meckmongkol
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
- Department of General Surgery, Nemours Children’s Hospital, Orlando, FL 32827, USA
| | - Ashley Calder
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Naima Dahir
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | | | - Jagannathan Sankar
- Engineering Research Center for Revolutionizing Biomaterials, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Melanie Coathup
- Biionix Cluster, University of Central Florida, Orlando, FL 32827, USA
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23
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Chang K, Albright JA, Testa EJ, Balboni AB, Daniels AH, Cohen E. Sarcopenia Is Associated with an Increased Risk of Postoperative Complications Following Total Hip Arthroplasty for Osteoarthritis. BIOLOGY 2023; 12:biology12020295. [PMID: 36829571 PMCID: PMC9953618 DOI: 10.3390/biology12020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/10/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
Sarcopenia is a state of catabolic muscle wasting prevalent in geriatric patients. Likewise, osteoarthritis is an age-related musculoskeletal disease affecting patients with similar demographics. Late-stage hip osteoarthritis is often treated with total hip arthroplasty (THA). As sarcopenia influences the surgical outcomes, this study aimed to assess the impact of sarcopenia on the outcomes of THA. A 1:3 matched case-control study of sarcopenic to control patients was performed using a large national database. In total, 3992 patients were analyzed. Sarcopenic patients undergoing THA were more likely to experience dislocation (odds ratio (OR) = 2.19, 95% confidence interval (CI) 1.21-3.91) within 1 year of THA. Furthermore, sarcopenic patients had higher urinary tract infection rates (OR = 1.79, CI 1.32-2.42) and a greater risk of 90-day hospital readmission (hazard ratio (HR) = 1.39, CI 1.10-1.77). Sarcopenic patients experienced more falls (OR = 1.62, CI 1.10-2.39) and fragility fractures (OR = 1.77, CI 1.34-2.31). Similarly, sarcopenic patients had higher day of surgery costs (USD 13,534 vs. USD 10,504) and 90-day costs (USD 17,139 vs. USD 13,394) compared with the controls. Ultimately, sarcopenic patients undergoing THA experience higher rates of postoperative complications and incur greater medical costs. Given the potential risks, orthopedic surgeons may consider treating or reducing the severity of sarcopenia before surgery.
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Affiliation(s)
- Kenny Chang
- Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
- Correspondence:
| | - J. Alex Albright
- Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Edward J. Testa
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Alanna B. Balboni
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Eric Cohen
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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24
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Debopadhaya S, Marmor MT. Frailty and comorbidity predict 30 day postoperative outcomes, independent of anatomical site of fracture. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04764-7. [PMID: 36648540 DOI: 10.1007/s00402-023-04764-7] [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: 09/16/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Fragility fractures are a major threat to geriatric patients. However, it is unclear whether this patient population's inherent frailty and comorbidity or the physiologic insult caused by the fracture and its surgery contribute more to undesirable patient outcomes. Hence, this study examines if frailty and comorbidity can predict 30 day postoperative outcomes while the effects of multiple fracture sites are accounted for. METHODS A retrospective review of patients ≥ 65 years of age in the National Surgical Quality Improvement Program who underwent surgical treatment between 2013 and 2017 was performed. A total of 52,497 patients were included in the final analysis, including fracture cases of the extremities, limbs, and hip. Demographics, several metrics of preoperative health, temporal variables, and fracture location were tested in bivariate analysis of 30 day postoperative mortality, length of stay in hospital, discharge outcome, and complications. Significant variables were considered for multivariate logistic regression models for each outcome. RESULTS Frailty, comorbidity, and time to surgery were found to be the significant predictors in multivariate analysis of each 30 day postoperative outcome, independent of the effects of fracture site (p < 0.05). Examination of 30 day mortality found that American Society of Anesthesiologists Class ≥ 3 (2.30 Odds Ratio), modified Frailty Index > 0 (1.37 OR), Charleston Comorbidity Index ≥ 6 (1.63 OR), and time to surgery (1.45 OR) were especially important (all p < 0.05). Additionally, the worst outcomes were associated with fractures of the pelvis/hip and femur/knee, including 30 day mortality (5.90 and 5.12 OR, respectively; both p < 0.05). CONCLUSION The effects of the preoperative health were found to be independent of patient demographics and fracture site. Additionally, specific high-risk fracture sites are significant predictors of outcome, supporting the need to prioritize these patients. Clinical care pathways for geriatric patients may benefit from emphasis on these high-risk fractures and preoperative patient health.
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Affiliation(s)
| | - Meir T Marmor
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco (UCSF), 2550 23Rd Street, Building 9, 2Nd Floor, San Francisco, CA, 94110, USA.
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25
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Lee DY, Yoo DK, Han SY, Lee K, Lee Y, Teopiz KM, Mansur RB, Rosenblat JD, McIntyre RS. Association between depressive symptoms and bone density in elderly patients with non-dialysis dependent chronic kidney disease. J Affect Disord 2022; 319:549-554. [PMID: 36113692 DOI: 10.1016/j.jad.2022.09.014] [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: 06/08/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression is a disease that is commonly accompanied by elderly chronic kidney disease (CKD) patients, but when the two diseases are accompanied, etiology or combination are not well known. We aimed to evaluate the etiology of CKD and comorbid depression by investigating bone disorders that are observed in persons affected by both CKD and depression. METHODS We conducted a cross-sectional study with a total of 646 patients with CKD. We compared the sociodemographic factors, kidney function, markers for CKD-Mineral and Bone Disorder (CKD-MBD) and bone mineral density according to the depressive symptoms. We conducted a univariate and multivariate logistic regression analysis to calculate odd ratios (95 % confidence interval) between depressive symptoms and low bone mineral density. RESULTS Individuals with CKD and depressive symptoms were associated with lower level of education attained, living alone, exercising less, low 24-hour urine phosphorus, and low bone density. Depressive symptoms were significantly associated with low bone density in lowest parts (1.55 [1.06-2.29]) and in total hip (1.72 [1.17-2.53]) even after adjusting for diabetes mellitus, hypertension, kidney function, proteinuria, age, sex, smoking, and body mass index. LIMITATIONS A cross-sectional design was used in this study and the bone biopsy for diagnosis of CKD-MBD was not done because of invasiveness and practical difficulties. CONCLUSION Low bone density was associated with depressive symptoms in elderly patients with non-dialysis chronic kidney disease.
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Affiliation(s)
- Dong-Young Lee
- Department of Internal Medicine, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Dong Kyun Yoo
- Department of Internal Medicine, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Sang Youb Han
- Department of Internal Medicine, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Gyeonggi, Republic of Korea
| | - Kangbaek Lee
- Yonsei Miso Dental Clinic, Seongnam, Gyeonggi, Republic of Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Kayla M Teopiz
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada.
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26
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Dubale NM, Kapron CM, West SL. Commentary: Zebrafish as a Model for Osteoporosis-An Approach to Accelerating Progress in Drug and Exercise-Based Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15866. [PMID: 36497941 PMCID: PMC9739463 DOI: 10.3390/ijerph192315866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Osteoporosis (OP) is a degenerative disease characterized by reduced bone strength and increased fracture risk. As the global population continues to age, the prevalence and economic burden of osteoporosis can be expected to rise substantially, but there remain various gaps in the field of OP care. For instance, there is a lack of anti-fracture drugs with proven long-term efficacy. Likewise, though exercise remains widely recommended in OP prevention and management, data regarding the safety and efficacy for patients after vertebral fracture remain limited. This lack of evidence may be due to the cost and inherent difficulties associated with exercise-based OP research. Thus, the current research landscape highlights the need for novel research strategies that accelerate OP drug discovery and allow for the low-cost study of exercise interventions. Here, we outline an example of one strategy, the use of zebrafish, which has emerged as a potential model for the discovery of anti-osteoporosis therapeutics and study of exercise interventions. The strengths, limitations, and potential applications of zebrafish in OP research will be outlined.
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Affiliation(s)
- Natnaiel M. Dubale
- Department of Biology, Trent University, Peterborough, ON K9L 0G2, Canada
| | - Carolyn M. Kapron
- Department of Biology, Trent University, Peterborough, ON K9L 0G2, Canada
| | - Sarah L. West
- Department of Biology, Trent University, Peterborough, ON K9L 0G2, Canada
- Department of Kinesiology, Trent University, Peterborough, ON K9L 0G2, Canada
- Trent/Fleming School of Nursing, Trent University, Peterborough, ON K9L 0G2, Canada
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27
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Role of Essential Amino Acids in Age-Induced Bone Loss. Int J Mol Sci 2022; 23:ijms231911281. [PMID: 36232583 PMCID: PMC9569615 DOI: 10.3390/ijms231911281] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Age-induced osteoporosis is a global problem. Essential amino acids (EAAs) work as an energy source and a molecular pathway modulator in bone, but their functions have not been systematically reviewed in aging bone. This study aimed to discuss the contribution of EAAs on aging bone from in vitro, in vivo, and human investigations. In aged people with osteoporosis, serum EAAs were detected changing up and down, without a well-established conclusion. The supply of EAAs in aged people either rescued or did not affect bone mineral density (BMD) and bone volume. In most signaling studies, EAAs were proven to increase bone mass. Lysine, threonine, methionine, tryptophan, and isoleucine can increase osteoblast proliferation, activation, and differentiation, and decrease osteoclast activity. Oxidized L-tryptophan promotes bone marrow stem cells (BMSCs) differentiating into osteoblasts. However, the oxidation product of tryptophan called kynurenine increases osteoclast activity, and enhances the differentiation of adipocytes from BMSCs. Taken together, in terms of bone minerals and volume, more views consider EAAs to have a positive effect on aging bone, but the function of EAAs in bone metabolism has not been fully demonstrated and more studies are needed in this area in the future.
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Rhee SY, Yon DK, Kwon MJ, Kim JH, Kim JH, Bang WJ, Lee JW, Kwon BC, Choi HG, Min C. Association between metabolic syndrome and osteoporosis among adults aged 50 years and older: using the National Health Information Database in South Korea. Arch Osteoporos 2022; 17:124. [PMID: 36114354 DOI: 10.1007/s11657-022-01161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/01/2022] [Indexed: 02/03/2023]
Abstract
This study aimed to examine the association between a history of metabolic syndrome (MetS) and osteoporosis with specific characteristics. The results showed that MetS was inversely associated with osteoporosis. In contrast, MetS was positively associated with osteoporosis in both obese men and postmenopausal obese women. PURPOSE Although several previous studies have investigated the association between MetS and osteoporosis, their findings remain controversial. This study aimed to examine the association between a MetS history and osteoporosis using a subset of data from a large, long-term, national database. METHODS This nested case-control study used the National Health Information Database (NHID) of the Korea National Health Insurance Service (NHIS) from 2009 to 2017. Osteoporosis (n = 459,771) and control (n = 459,771) participants were matched in a 1:1 ratio by age, gender, income, and region of residence. MetS was defined based on the modified National Cholesterol Education Program-Adult Treatment Panel III criteria. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for osteoporosis in patients with MetS and its components were analyzed using logistic regression. Subgroup analyses were performed according to the combination of gender, menopausal status, and obesity status. RESULTS The adjusted OR (95% CI) for osteoporosis in patients with MetS was 0.95 (0.94-0.96). This finding was consistent with the subgroup analyses in normal weight men, premenopausal (pre-MP) women with all obesity statuses, and postmenopausal (post-MP) underweight and normal weight women. In contrast, the opposite was observed for obese men (OR = 1.05, 95% CI = 1.01-1.09) and post-MP obese women (OR = 1.05, 95% CI = 1.01-1.08). CONCLUSION This study results suggested that MetS was associated with a low occurrence of osteoporosis. In contrast, MetS was associated with a high occurrence of osteoporosis in both obese men and post-MP obese women.
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Affiliation(s)
- Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.,Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Anyang, Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jung Woo Lee
- Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Bong-Cheol Kwon
- Department of Orthopaedic Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea. .,Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
| | - Chanyang Min
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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29
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ALJohani HT, Alshugair I, Alfadhel SF, Alghamdi EA, Alkaff H, Alrashedan BS, ALYousif H. One-Year Mortality Rates Following Fragility Femoral Fractures in Patients Presenting to King Saud Medical City in Riyadh, Saudi Arabia: A Retrospective Study. Cureus 2022; 14:e28844. [PMID: 36105905 PMCID: PMC9447471 DOI: 10.7759/cureus.28844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: The objective is to investigate one-year mortality rates following femur osteoporotic fractures, and to investigate factors that are associated with higher mortality rates. Design: A retrospective study was conducted from 2010 to 2021 (11 years) of all patients who presented to King Saud Medical City, Saudi Arabia, and had a fragility fracture of the proximal or distal femur. Patients: One hundred eight patients who sustained a proximal or distal femoral fracture, as a result of low-energy trauma, were included. Results: The majority of our cohort (77.8%) had proximal femoral fractures, whereas only 22.2% had a distal femoral fracture. 55.6% were less than 75 years old, and 44.4% were 75 years or older. All patients had fallen from standing height. Hypertension and diabetes were the most common comorbidities among our cohort at 49.1% and 47.2%, respectively, but neither showed a statistically significant increase in the risk of mortality. When assessing the overall mortality, 21.3% of our patients had passed away. Although this finding was not statistically significant, mortality rates were found to be higher in patients with proximal femoral fractures compared to distal femoral fractures (25% vs. 8.3%, respectively, p=0.095). Patients with a normal bone mass density (BMD) had higher mortality rates as opposed to those with abnormal BMD (p=0.001). Conclusions: Mortality rates are higher in proximal femoral fractures compared to distal femoral fractures. In addition, within our study cohort, patients with normal BMD had higher mortality rates. We recommend prospective studies that compare mortality rates between proximal and distal femoral fractures in patients with osteoporosis, as these studies would provide more accurate data. We also recommend having BMD measured in those patients to avoid further fractures in this patient population.
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Oliveira T, Kendler DL, Schneider P, Juby AG, Wani RJ, Packalen M, Avcil S, Li S, Waters-Banker C, Graves E, McMullen S, Brown J. Trends in osteoporotic fracture and related in-hospital complications during the COVID-19 pandemic in Alberta, Canada. Arch Osteoporos 2022; 17:109. [PMID: 35920903 PMCID: PMC9349109 DOI: 10.1007/s11657-022-01114-9] [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: 02/10/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic. PURPOSE/INTRODUCTION This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior. METHODS A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017-2019) and COVID-19 restrictions periods (2020) were calculated. RESULTS Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9-64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods. CONCLUSIONS These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.
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Affiliation(s)
- T Oliveira
- Amgen Canada Inc, Mississauga, ON, Canada
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - P Schneider
- Division of Orthopaedic Trauma, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - A G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - R J Wani
- Amgen Canada Inc, Mississauga, ON, Canada
| | - M Packalen
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Avcil
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Li
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - C Waters-Banker
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - E Graves
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - S McMullen
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada.
| | - J Brown
- Department of Medicine, Laval University and CHU de Québec Research Centre, Quebec City, QC, Canada
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Mandell JC, Khurana B. Musculoskeletal Trauma and Infection. Magn Reson Imaging Clin N Am 2022; 30:441-454. [PMID: 35995472 DOI: 10.1016/j.mric.2022.04.007] [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: 10/15/2022]
Abstract
MR is often the most definitive imaging for assessment of musculoskeletal trauma and infection. Although it is not possible to address all the intricacies of these complex topics in a single article, this review will attempt to provide a useful toolbox of skills by discussing several common clinical scenarios faced by emergency radiologists in interpretation of adult trauma and infection. These scenarios include MR assessment of hip and pelvic fracture, traumatic soft tissue injuries, septic arthritis, soft tissue infection, and osteomyelitis.
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Affiliation(s)
- Jacob C Mandell
- Musculoskeletal Imaging and Intervention, Division of Musculoskeletal Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Brigham and Women's Hospital, Trauma Imaging Research and Innovation Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Bell A, Kendler DL, Khan AA, Shapiro C M M, Morisset A, Leung JP, Reiner M, Colgan SM, Slatkovska L, Packalen M. A retrospective observational study of osteoporosis management after a fragility fracture in primary care. Arch Osteoporos 2022; 17:75. [PMID: 35513573 PMCID: PMC9072526 DOI: 10.1007/s11657-022-01110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/18/2022] [Indexed: 02/03/2023]
Abstract
In many countries, osteoporosis is predominantly managed by primary care physicians; however, management after a fragility fracture has not been widely investigated. We describe osteoporosis care gaps in a real-world patient cohort. Our findings help inform initiatives to identify and overcome obstacles to effective management of patients after fragility fracture. PURPOSE A fragility fracture is a major risk factor for subsequent fracture in adults aged ≥ 50 years. This retrospective observational study aimed to characterize post-fracture management in Canadian primary care. METHODS A total of 778 patients with an index fragility fracture (low-trauma, excluding small bones) occurring between 2014 and 2016 were identified from medical records at 76 primary care centers in Canada, with follow-up until January 2018. RESULTS Of 778 patients (80.5% female, median age [IQR] 73 [64-80]), 215 were on osteoporosis treatment and 269 had osteoporosis diagnosis recorded prior to their index fracture. The median follow-up was 363 (IQR 91-808) days. Of patients not on osteoporosis treatment at their index fracture, 60.2% (n = 339/563) remained untreated after their index fracture and 62.2% (n = 23/37) continued untreated after their subsequent fracture. After their index fracture, fracture risk assessment (FRAX or CAROC) was not performed in 83.2% (n = 647/778) of patients, and 59.9% (n = 466/778) of patients did not receive bone mineral density testing. Of patients without osteoporosis diagnosis recorded prior to their index date, 61.3% (n = 300/489) remained undiagnosed after their index fracture. At least one subsequent fracture occurred in 11.5% (n = 86/778) of patients. CONCLUSION In the primary care setting, fragility fracture infrequently resulted in osteoporosis treatment or fracture risk assessment, even after multiple fragility fractures. These results suggest a fragility fracture is not recognized as a major risk factor for subsequent fracture and its occurrence does not prompt primary care physicians to intervene. These data urge initiatives to identify and overcome obstacles to primary care physicians' effective management of patients after fragility fractures.
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Affiliation(s)
- Alan Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - David L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Aliya A Khan
- Department of Medicine, Divisions of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Marla Shapiro C M
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne Morisset
- Department of Medicine, Division of Internal Medicine, Sherbrooke University, Sherbrooke, QC, Canada
| | - Jean-Pierre Leung
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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Goeree R, Burke N, Jobin M, Brown JP, Lawrence D, Stollenwerk B, Willems D, Johnson B. Cost-effectiveness of romosozumab for the treatment of postmenopausal women at very high risk of fracture in Canada. Arch Osteoporos 2022; 17:71. [PMID: 35471711 PMCID: PMC9042964 DOI: 10.1007/s11657-022-01106-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/31/2022] [Indexed: 02/03/2023]
Abstract
This study evaluated the cost-effectiveness of 1 year of romosozumab followed by alendronate versus oral bisphosphonates alone in women with postmenopausal osteoporosis at very high risk for fracture in Canada. Results showed that romosozumab sequenced to alendronate is a cost-effective treatment option, dominating both alendronate and risedronate alone. PURPOSE To demonstrate the value of romosozumab sequenced to alendronate compared to alendronate or risedronate alone, for the treatment of osteoporosis in postmenopausal women with a history of osteoporotic fracture and who are at very high risk for future fracture in Canada. METHODS A Markov model followed a hypothetical cohort of postmenopausal osteoporotic women at very high risk for future fractures, to estimate the cost-effectiveness of romosozumab and alendronate compared to oral bisphosphonates alone. A total treatment period of 5 years was assumed. Quality-adjusted life years and costs were estimated for each comparator across health states defined by different types of fragility fractures. RESULTS Romosozumab/alendronate was associated with a lifetime gain of 0.103 and 0.127 QALYs and a cost reduction of $343 and $3805, relative to alendronate and risedronate, respectively. These results were driven by a reduction of the number of fractures (2561 per 1000 patients, versus 2700 for alendronate and 2724 for risedronate over lifetime). Romosozumab/alendronate had the highest probability of being cost-effective, relative to alendronate and risedronate, at any willingness to pay threshold value. CONCLUSION Romosozumab/alendronate was associated with reduced costs and greater benefit relative to other comparators. Probabilistic, deterministic, and scenario analyses indicate that romosozumab/alendronate represents the best value for money; the uncertainty analyses are robust, and therefore romosozumab should be considered for reimbursement by public drug plans in Canada .
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Affiliation(s)
- Ron Goeree
- Goeree Consulting Inc, Mount Hope, Canada
- McMaster University, Hamilton, Canada
| | - Natasha Burke
- Amgen Canada Inc, 6775 Financial Drive, Suite 100, Mississauga, ON, L5N 0A4, Canada.
| | - Manon Jobin
- Amgen Canada Inc, 6775 Financial Drive, Suite 100, Mississauga, ON, L5N 0A4, Canada
| | - Jacques P Brown
- Department of Medicine, Division of Rheumatology, CHU de Québec Research Centre, Laval University, Quebec City, Canada
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Kaya S, Schurman CA, Dole NS, Evans DS, Alliston T. Prioritization of Genes Relevant to Bone Fragility Through the Unbiased Integration of Aging Mouse Bone Transcriptomics and Human GWAS Analyses. J Bone Miner Res 2022; 37:804-817. [PMID: 35094432 PMCID: PMC9018503 DOI: 10.1002/jbmr.4516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022]
Abstract
Identifying new genetic determinants of bone mineral density (BMD) and fracture promises to yield improved diagnostics and therapies for bone fragility. However, prioritizing candidate genes from genome-wide screens can be challenging. To overcome this challenge, we prioritized mouse genes that are differentially expressed in aging mouse bone based on whether their human homolog is associated with human BMD and/or fracture. Unbiased RNA-seq analysis of young and old male C57BL/6 mouse cortical bone identified 1499, 1685, and 5525 differentially expressed genes (DEGs) in 1, 2, and 2.5-year-old bone, relative to 2-month-old bone, respectively. Gene-based scores for heel ultrasound bone mineral density (eBMD) and fracture were estimated using published genome-wide association studies (GWAS) results of these traits in the UK Biobank. Enrichment analysis showed that mouse bone DEG sets for all three age groups, relative to young bone, are significantly enriched for eBMD, but only the oldest two DEG sets are enriched for fracture. Using gene-based scores, this approach prioritizes among thousands of DEGs by a factor of 5- to 100-fold, yielding 10 and 21 genes significantly associated with fracture in the two oldest groups of mouse DEGs. Though these genes were not the most differentially expressed, they included Sost, Lrp5, and others with well-established functions in bone. Several others have, as yet, unknown roles in the skeleton. Therefore, this study accelerates identification of new genetic determinants of bone fragility by prioritizing a clinically relevant and experimentally tractable number of candidate genes for functional analysis. Finally, we provide a website (www.mouse2human.org) to enable other researchers to easily apply our strategy. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Serra Kaya
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Charles A. Schurman
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA
| | - Neha S. Dole
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Tamara Alliston
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA
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Physical Activity Is Associated with a Lower Risk of Osteoporotic Fractures in Osteoporosis: A Longitudinal Study. J Pers Med 2022; 12:jpm12030491. [PMID: 35330490 PMCID: PMC8949817 DOI: 10.3390/jpm12030491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/28/2022] Open
Abstract
The purpose of our study was to examine the occurrence of osteoporotic fractures (fxs) according to the level of physical activity (PA) among osteoporosis using the Korean National Health Insurance Service (NHIS) customized database. From NHIS data from 2009 to 2017, osteoporosis was selected as requested. PA was classified into ‘high PA’ (n = 58,620), ‘moderate PA’ (n = 58,620), and ‘low PA’ (n = 58,620) and were matched in a 1:1:1 ratio by gender, age, income within the household unit, and region of residence. A stratified Cox proportional hazard model was used to calculate hazard ratios (HRs) for each type of fx comparing PA groups. The ‘low PA’ group was the reference group. For vertebral fx, the adjusted HR (95% confidence intervals (CIs)) was 0.27 (0.26–0.28) for the ‘high PA’ group and 0.43 (0.42–0.44) for the ‘moderate PA’ group. For hip fx, the adjusted HR (95% CIs) was 0.37 (0.34–0.40) for the ‘high PA’ group and 0.51 (0.47–0.55) for the ‘moderate PA’ group. For distal radius fx, the adjusted HR (95% CIs) was 0.32 (0.30–0.33) for the ‘high PA’ group and 0.46 (0.45–0.48) for the ‘moderate PA’ group. The results of this study suggest that a higher intensity of PA is associated with a lower risk of osteoporotic fxs, including vertebral fx, hip fx, and distal radius fx.
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Charles A, Mugisha A, Iconaru L, Baleanu F, Benoit F, Surquin M, Bergmann P, Body JJ. Impact of non-hip fractures in elderly women: a narrative review. Climacteric 2021; 25:240-245. [PMID: 34806931 DOI: 10.1080/13697137.2021.1998433] [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: 10/19/2022]
Abstract
The association of hip fractures with adverse outcomes is well established, but for non-hip fractures this association still needs to be further investigated. The objective of this narrative review is to describe the state of the art with regards to the health impact of clinically relevant non-hip fracture locations in postmenopausal women. PubMed and Scopus databases were searched from January 2010 until December 2020. Studies were included when the crude rates and/or relative risk of 1-year subsequent fractures and/or mortality were reported as well as the precise fracture site. Twenty-three studies met the inclusion criteria. Regarding mortality rates, there was a high variability between studies, with higher rates for vertebral, proximal humerus and pelvic fractures. There was a small or no impact of wrist, ankle or tibia fractures. The mortality rate increased with age after vertebral, proximal humerus and wrist fractures. Moreover, proximal humerus and vertebral fractures were associated with a higher mortality risk. This narrative review indicates that, besides fractures of the hip, fractures of the vertebrae, proximal humerus or pelvis deserve more attention when trying to prevent adverse outcomes of osteoporosis. More studies on the topic of non-hip fractures are urgently needed.
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Affiliation(s)
- A Charles
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Mugisha
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Translational Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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You F, Ma C, Sun F, Liu L, Zhong X. The risk factors of heart failure in elderly patients with hip fracture: what should we care. BMC Musculoskelet Disord 2021; 22:832. [PMID: 34583660 PMCID: PMC8479890 DOI: 10.1186/s12891-021-04686-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure is a common adverse postoperative complication in elderly patients. It is necessary to explore the risk factors of heart after the operation of elderly patients with hip fracture during hospitalization. METHODS Patients with hip fractures admitted to our hospital from January 1, 2019 to December 31 2020 were included, all the patients received internal fixation surgery. The characteristics of patients with and without postoperative heart failure were compared. Multivariate logistic regression analyses were applied to analyze the risk factors of heart failure in elderly patients with hip fracture. RESULTS A total of 283 patients with hip fractures were included, the incidence of heart failure was 12.37 %. There were significant differences in the age, hypertension, anemia hypoalbuminemia and duration of surgery between heart failure and no heart failure group(all p < 0.05). There were no significant differences in the gender, BMI, diabetes mellitus, hyperlipidemia, history of heart failure, cognitive dysfunction, type of fracture, preoperative oxygen saturation, white blood cell count, platelet count, red blood cell count, creatinine, alanine aminotransferase, aspartate aminotransferase and estimated blood loss during surgery between heart failure and no heart failure group(all p > 0.05). Logistic regression analyses indicated that age ≥ 70y(OR2.446, 95% CI1.044 ~ 4.149), hypertension(OR2.152, 95% CI1.125 ~ 4.023), anemia(OR3.094, 95% CI1.294 ~ 5.907), hypoalbuminemia(OR2.377, 95% CI1.205 ~ 4.537), duration of surgery ≥ 120 min(OR1.683, 95% CI1.094 ~ 2.782) were the risk factors of heart failure in elderly patients with hip fracture(all p < 0.05). CONCLUSIONS The incidence of postoperative heart failure in elderly patients with hip fracture is relatively high, which is the result of a combination of high-risk factors. Peri-period risk assessment and prevention of related risks are the keys to a good prognosis for patients.
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Affiliation(s)
- Fei You
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China.
| | - Chaoyang Ma
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China
| | - Fangfang Sun
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China.
| | - Lian Liu
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China
| | - Xiuwen Zhong
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China
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Tarride JÉ, Adachi JD, Brown JP, Schemitsch E, Slatkovska L, Burke N. Incremental costs of fragility fractures: a population-based matched -cohort study from Ontario, Canada. Osteoporos Int 2021; 32:1753-1761. [PMID: 33599789 PMCID: PMC8387251 DOI: 10.1007/s00198-021-05877-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/04/2021] [Indexed: 01/20/2023]
Abstract
UNLABELLED Using a matched cohort design, the 1-year excess cost of incident fragility fractures at any site was $26,341 per patient, with 43% of total excess costs attributed to hospitalization. The high economic burden of fractures in Ontario underscores the urgency of closing the secondary fracture prevention gap. INTRODUCTION This retrospective real-world observational study was conducted to document the incremental costs associated with fragility fractures in Ontario, Canada. METHODS Patients aged >65 years with an index fragility fracture occurring between January 2011 and March 2015 were identified from administrative databases and matched 1:1 to a cohort of similar patients without a fracture. Healthcare resource utilization data were extracted from healthcare records and associated costs were calculated on a per-patient level and for the province of Ontario. Costs were presented as 2017 Canadian dollars. RESULTS The eligible cohort included 115,776 patients with a fragility fracture. Of these, 101,773 patients were successfully matched 1:1 to a non-fracture cohort. Overall, hip fractures (n = 31,613) were the most common, whereas femur fractures (n = 3002) were the least common type. Hospitalization and continuing care/home care/long-term care accounted for more than 60% of 1-year direct costs, whereas 5% was attributed to medication costs. First-year costs per patient in the fracture cohort were approximately threefold higher versus the non-fracture cohort (mean $37,362 versus $11,020, respectively). The incremental first-year direct healthcare costs of fragility fractures for the province of Ontario were calculated at $724 million per year. CONCLUSIONS Fragility fractures were associated with a threefold increase in overall mean healthcare costs per patient compared to patients without fractures. With an aging population, there is an urgent need for improved prevention strategies for patients at high-risk of fracture to decrease the economic burden of fragility fractures on the Canadian healthcare system.
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Affiliation(s)
- J-É Tarride
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health, The Research Institute of St. Joe's Hamilton, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - J P Brown
- Department of Medicine, Division of Rheumatology, CHU de Québec Research Centre, Laval University, Québec City, Québec, Canada
| | - E Schemitsch
- Department of Surgery, Western University, London, Ontario, Canada
| | | | - N Burke
- Amgen Canada Inc, Mississauga, Ontario, Canada.
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Debiais F. Male osteoporosis: Recommendations to improve its treatment. Joint Bone Spine 2021; 88:105250. [PMID: 34274519 DOI: 10.1016/j.jbspin.2021.105250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Françoise Debiais
- Service de Rhumatologie, CHU de Poitiers, Université Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
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Talevski J, Sanders KM, Vogrin S, Duque G, Beauchamp A, Seeman E, Iuliano S, Svedbom A, Borgström F, Kanis JA, Stuart AL, Brennan-Olsen SL. Recovery of quality of life is associated with lower mortality 5-year post-fracture: the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Arch Osteoporos 2021; 16:112. [PMID: 34264432 DOI: 10.1007/s11657-021-00981-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Little is known about factors that lead to excess mortality post-fracture. This study demonstrated that 5-year mortality is lower in older adults who recovered to their pre-fracture health-related quality of life (HRQoL) at 12-months compared to those who did not recover. Our results highlight the importance of post-fracture interventions known to improve HRQoL. INTRODUCTION Fragility fractures lead to increased mortality and decreased health-related quality of life (HRQoL) in older adults, although whether an association exists between these outcomes remains uncertain. The aim of this study was to determine whether recovery of HRQoL 12-month post-fracture is associated with lower 5-year mortality. METHODS This data linkage study included 524 adults (mean age: 70.2 years; 79.2% women) with fragility fracture (150 hip, 261 distal forearm, 61 vertebral, 52 humerus) from the Australian arm of the International Costs and Utilities Related to Osteoporotic fractures Study (AusICUROS). HRQoL was measured using the EQ-5D-3L and all-cause mortality post-fracture was ascertained from the Australian National Death Index (NDI). Cox proportional hazards models were used to assess the association between HRQoL recovery (vs. non-recovery) and all-cause mortality within 5 years. RESULTS Overall, 279 participants (53.2%) recovered to their pre-fracture HRQoL at 12-month follow-up. There were 70 deaths (13.4%) during the 5-year post-fracture. Mortality rate was the highest in hip fracture participants (24.7%), followed by vertebral (16.4%), humeral (13.5%), and distal forearm fracture participants (6.1%). After adjustment for age, pre-fracture HRQoL, and fracture site, mortality risk was lower in participants who recovered to their pre-fracture HRQoL at 12-months compared to those who did not recover (HR = 0.56, 95% CI: 0.33-0.96, p = 0.034). CONCLUSION This study provides evidence that HRQoL recovery post-fracture is associated with improved 5-year survival in older adults. The extent to whether current interventions known to improve HRQoL post-fracture could prevent some of these deaths is unknown.
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Affiliation(s)
- Jason Talevski
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.
| | - Kerrie M Sanders
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Gustavo Duque
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Alison Beauchamp
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Rural Health, Monash University, Melbourne, VIC, Australia
| | - Ego Seeman
- Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, VIC, Australia.,Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Sandra Iuliano
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, VIC, Australia
| | | | - Fredrik Borgström
- Quantify Research, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.,Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Amanda L Stuart
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia.,Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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41
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Abstract
Osteoporosis is an incurable chronic condition, like heart disease, diabetes, or hypertension. A large gap currently exists in the primary prevention of fractures, and studies show that an estimated 80% to 90% of adults do not receive appropriate osteoporosis management even in the secondary prevention setting. Case finding strategies have been developed and effective pharmacological interventions are available. This publication addresses how best to use the pharmacological options available for postmenopausal osteoporosis to provide lifelong fracture protection in patients at high and very high risk of fracture. The benefit of osteoporosis therapies far outweighs the rare risks.
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Affiliation(s)
- Jacques P Brown
- Division of Rheumatology, Department of Medicine, Laval University, Quebec City, QC, Canada
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42
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Rinonapoli G, Ruggiero C, Meccariello L, Bisaccia M, Ceccarini P, Caraffa A. Osteoporosis in Men: A Review of an Underestimated Bone Condition. Int J Mol Sci 2021; 22:2105. [PMID: 33672656 PMCID: PMC7924179 DOI: 10.3390/ijms22042105] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is called the 'silent disease' because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of the literature on male osteoporosis, dwelling on epidemiology, causes of osteoporosis in men, diagnosis, and treatment. The analysis of the literature shows that male osteoporosis is underscreened, underdiagnosed, and undertreated, both in primary and secondary prevention of fragility fractures.
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Affiliation(s)
- Giuseppe Rinonapoli
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Carmelinda Ruggiero
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy;
| | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, AORN San Pio “Gaetano Rummo Hospital”, via R.Delcogliano, 82100 Benevento (BN), Italy;
| | - Michele Bisaccia
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Paolo Ceccarini
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Auro Caraffa
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
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