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Yu C, Chen B, Su H, Yang Y. Long non-coding RNA MIAT serves as a biomarker of fragility fracture and promotes fracture healing. J Orthop Surg Res 2024; 19:343. [PMID: 38849896 PMCID: PMC11162066 DOI: 10.1186/s13018-024-04824-7] [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: 03/11/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Fragility fracture is common in the elderly. Osteoblast differentiation is essential for bone healing and regeneration. Expression pattern of long non-coding RNA MIAT during fracture healing was examined, and its role in osteoblast differentiation was investigated. METHODS 90 women with simple osteoporosis and 90 women with fragility fractures were included. Another 90 age-matched women were set as the control group. mRNA levels were tested using RT-qPCR. Cell viability was detected via CCK-8, and osteoblastic biomarkers, including ALP, OCN, Collagen I, and RUNX2 were tested via ELISA. The downstream miRNAs and genes targeted by MIAT were predicted by bioinformatics analysis, whose functions and pathways were annotated via GO and KEGG analysis. RESULTS Serum MIAT was upregulated in osteoporosis women with high accuracy of diagnostic efficacy. Serum MIAT was even elevated in the fragility fracture group, but decreased in a time manner after operation. MIAT knockdown promoted osteogenic proliferation and differentiation of MC3T3-E1, but the influences were reversed by miR-181a-5p inhibitor. A total of 137 overlapping target genes of miR-181a-5p were predicted based on the miRDB, TargetScan and microT datasets, which were mainly enriched for terms related to signaling pathways regulating pluripotency of stem cells, cellular senescence, and osteoclast differentiation. CONCLUSIONS LncRNA MIAT serves as a promising biomarker for osteoporosis, and promotes osteogenic differentiation via targeting miR-181a-5p.
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Affiliation(s)
- Chao Yu
- Department of Orthopedics, Liaocheng People's Hospital, No. 67, West Dongchang Road, Liaocheng, 252000, China
| | - Binbin Chen
- Department of Nephrology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Hui Su
- Department of Oncology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Yiqun Yang
- Department of Orthopedics, Liaocheng People's Hospital, No. 67, West Dongchang Road, Liaocheng, 252000, China.
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Galasso AC, Herzog LN, Sekar M, Hartsock LA, Reid KR. Intradepartmental orthopaedic fragility fracture liaison improves osteoporosis follow-up and treatment. Injury 2023; 54:110985. [PMID: 37599192 DOI: 10.1016/j.injury.2023.110985] [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: 12/13/2022] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Over 2 million people in the United States sustain fractures related to osteoporosis annually, but only 20% of these patients receive treatment for their osteoporosis. The purpose of this study was to evaluate the effects of a fragility fracture liaison within the orthopedic department on treatment and follow up for osteoporosis. DESIGN Retrospective cohort study SETTING: University Level I Trauma center PARTICIPANTS: 112 patients treated under the aegis of an interdepartmental fracture liaison and 208 patients treated following the introduction of an orthopedic fragility fracture liaison at a single institution. INTERVENTION Transition from referral to interdepartmental fracture liaison to intradepartmental orthopedic fragility fracture liaison for fragility fractures. MAIN OUTCOME MEASURES Outcomes evaluated included demographics, fracture type, DEXA scan results, follow up and treatment plan, and subsequent fracture. RESULTS The mean age at time of fracture was 75 years, and the mean BMI was 27. The most common fracture types were femoral neck fractures (29%), pertrochanteric fractures (30%) and femur fractures (8%). There was a statistically significant increase in adherence to follow up and treatment after the introduction of an orthopaedic fragility fracture liaison. CONCLUSIONS The introduction of an intradepartmental fragility fracture liaison significantly increases osteoporosis follow-up and introduces the ability to combine both osteoporosis treatment and postoperative orthopaedic care. The results of this study highlight the utility of incorporating a fragility fracture liaison within the orthopaedic department given the economic burden of fragility fractures and the morbidity associated with these fractures. LEVEL OF EVIDENCE III cohort study.
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Affiliation(s)
| | | | - Molly Sekar
- University of Arizona, College of Medicine Phoenix, United States
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Cattaneo S, Adriani M, Tonolini S, Oransky M, Galante C, Grava G, Milano G, Casiraghi A. FRAGILITY FRACTURES OF THE SACRUM: A SILENT EPIDEMIC. Orthop Rev (Pavia) 2022; 14:38572. [DOI: 10.52965/001c.38572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Fragility fractures of the sacrum (FFS) are caused by low-energy trauma in the elderly population. Due to the nuanced symptomatology, many FFS remains unrecognized and the prevalence is underestimated. The clinical presentation varies, typically presenting with weightbearing low back pain without even remembering of a previous trauma. Radiographs are usually insufficient for the diagnosis and second level imaging modalities are required. In particular, magnetic resonance demonstrated the highest diagnostic accuracy. Treatment should aim to guarantee early mobilization and weightbearing, efficient pain relief and early discharge from the hospital to a proper facility for rehabilitation. Conservative treatment is reserved to non-displaced fractures with an adequate pain relief within one week allowing early mobilization. Otherwise, surgical treatment must be preferred. Nowadays, minimally invasive techniques, such as ileo-sacral screws or trans-sacral bar osteosynthesis, are safe and effective procedures and have overcome open procedures. In more complex patterns, with complete dissociation between the pelvic ring and the ilio-lumbar spine, spino-pelvic fixation is the procedure of choice.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppe Milano
- Department of Bone and Joint Surgery, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Schmidt C, Riedel C, Stürznickel J, Mushumba H, Delsmann MM, Ries C, Kleiss S, Bannas P, Beil FT, Amling M, Püschel K, Rolvien T, Hubert J. Investigation of distal femur microarchitecture and factors influencing its deterioration: An ex vivo high-resolution peripheral quantitative computed tomography study. J Orthop Res 2022; 40:2057-2064. [PMID: 34985148 DOI: 10.1002/jor.25246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/05/2021] [Accepted: 12/13/2021] [Indexed: 02/04/2023]
Abstract
While fractures of the distal femur are often considered as fragility fractures, detailed knowledge of the bone microarchitecture at this skeletal site is largely unavailable. Initial evaluation of a patient cohort with distal femur fractures showed a markedly increased occurrence in elderly women. The purpose of this study was to determine the extent to which demographic characteristics of distal femur fractures are reflected by general age- and sex-specific variations in local microarchitectural parameters. Fifty cadaveric femora were collected from 25 subjects (12 females, 13 males, age 25-97 years). A volume of interest within 3 cm proximal to the condyles was analyzed using high-resolution peripheral quantitative computed tomography (HR-pQCT), which revealed impaired trabecular and cortical bone microarchitecture in women compared to men as well as in osteoporotic compared to normal or osteopenic subjects, as classified by dual-energy X-ray absorptiometry (DXA) T-score. Linear regression analyzes showed negative associations between age and HR-pQCT parameters in women (e.g., cortical thickness -14 µm/year, 95% CI: -21 to -7 µm/year), but not in men (e.g., cortical thickness 1 µm/year, 95% CI: -12 to 14 µm/year). HR-pQCT parameters showed strong positive associations with areal bone mineral density (aBMD) determined by DXA at the hip in both sexes. Taken together, our findings suggest that female sex, advanced age, and low aBMD represent major risk factors for impaired microarchitecture at the distal femur. Both the diagnostic value of DXA for predicting distal femur fractures and the efficacy of bone-specific agents on fracture risk reduction should be investigated in the future.
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Affiliation(s)
- Constantin Schmidt
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Stürznickel
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herbert Mushumba
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian M Delsmann
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ries
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Kleiss
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Hubert
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Secondary fracture prevention: global approaches. OTA Int 2022. [PMCID: PMC9359005 DOI: 10.1097/oi9.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Osteoporotic fractures, a major cause of disability and associated medical care expenditures, are expected to continue to increase worldwide. Adults who sustain primary osteoporotic fractures are more likely to sustain additional subsequent fractures, but few receive interventions to prevent those secondary fractures. Fracture liaison service models have been developed to systematically streamline preventative care for patients who have sustained a primary fragility fracture, proving cost-effective and efficacious. These programs have been developed in many countries, with varying degrees of success. There continues to be a need to better understand the various approaches to fracture liaison service programs in different regions enabling best practices to be adopted, successful approaches to be shared, and common obstacles to be addressed. The reports in this supplement address the status of fracture liaison service programs in different countries, focusing on national standards and guidelines, successes and barriers, and future directions. This work represents a collaborative effort of member societies of the International Orthopaedic Trauma Association (IOTA), an international association of orthopaedic societies dedicated to the promotion of musculoskeletal trauma care through advancements in patient care, research, and education. The expectation is that the information in these reports will aid efforts to address the growing need for fragility fracture programs.
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Levitt EB, Patch DA, Ponce BA, Razi AE, Kates SL, Patt JC. Barriers and Resources to Optimize Bone Health in Orthopaedic Education: Own the Bone (OTB): Bone Health Education in Residency. JB JS Open Access 2021; 6:JBJSOA-D-21-00026. [PMID: 34646973 PMCID: PMC8500628 DOI: 10.2106/jbjs.oa.21.00026] [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: 12/03/2022] Open
Abstract
Osteoporosis is a critical public health issue with substantial morbidity and healthcare costs. Resident education on osteoporosis is not standardized. Little is known about the barriers to osteoporosis treatment and the usefulness of educational programming from the perspective of orthopaedic residency program directors (PDs).
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Affiliation(s)
- Eli B Levitt
- University of Alabama at Birmingham, Birmingham, Alabama
| | - David A Patch
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | - Joshua C Patt
- Atrium Health - Musculoskeletal Institute, Levine Cancer Institute, Carolinas Medical Center Charlotte, North Carolina
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Osteoporosis Is Undertreated After Low-energy Vertebral Compression Fractures. J Am Acad Orthop Surg 2021; 29:741-747. [PMID: 33826546 DOI: 10.5435/jaaos-d-20-01132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/08/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Despite guidelines recommending postfracture bone health workup, multiple studies have shown that evaluation and treatment of osteoporosis has not been consistently implemented after fragility fractures. The primary aim of this study was to evaluate rates of osteoporosis evaluation and treatment in adult patients after low-energy thoracolumbar vertebral compression fractures (VCFs). METHODS We retrospectively reviewed all patients ≥60 years old presenting to a single academic trauma center with acute thoracolumbar VCFs after a ground-level fall from 2016 to 2020 . Rates of osteoporosis screening with dual-energy x-ray absorptiometry and initiation of pharmaceutical treatment were recorded at four time points: before the date of injury, during index hospitalization, at first primary care provider follow-up, and at final primary care provider follow-up. Rates of subsequent falls and secondary fragility fractures were recorded. One-year mortality and overall mortality were also calculated. RESULTS Fifty-two patients with a mean age of 83 years presenting with thoracic and/or lumbar fractures after a ground-level fall were included. At a mean final follow-up of 502 days, only 10 patients (19.2%) received pharmacologic therapy for osteoporosis and only 6 (11.5%) underwent postinjury dual-energy x-ray absorptiometry evaluation. Twenty-five patients (48%) had at least one subsequent fall at a mean of 164 days from the initial date of injury. Eleven patients with subsequent falls sustained an additional fragility fracture because of the fall, including six operative injuries. One-year mortality among the 52 patients was 26.9%, and the overall mortality rate was 44.2% at the final follow-up. DISCUSSION Osteoporosis remains a major public health issue that markedly affects quality of life and healthcare costs. Our study demonstrates the additional need for improved osteoporosis workup and intervention among patients who have sustained VCFs. We hope that our study helps raise awareness for improved osteoporosis evaluation and treatment among spine surgeons and all medical professionals treating patients with fragility fractures. LEVEL OF EVIDENCE Retrospective Case Series, Level IV Evidence.
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Abstract
➤ Our ability to accurately identify high fracture risk in individuals has improved as the volume of clinical data has expanded and fracture risk assessment tools have been developed. ➤ Given its accessibility, affordability, and low radiation exposure, dual x-ray absorptiometry (DXA) remains the standard for osteoporosis screening and monitoring response to treatment. ➤ The trabecular bone score (TBS) is a DXA software add-on that uses lumbar spine DXA imaging to produce an output that correlates with bone microarchitecture. It has been identified as an independent fracture risk factor and may prove useful in further stratifying fracture risk among those with a bone mineral density (BMD) in the osteopenic range (-1.0 to -2.4 standard deviations), in those with low-energy fractures but normal or only mildly low BMD, or in those with conditions known to impair bone microarchitecture. ➤ Fracture risk assessment tools, including the Fracture Risk Assessment Tool (FRAX), Garvan fracture risk calculator, and QFracture, evaluate the impact of multiple clinical factors on fracture risk, even in the absence of BMD data. Each produces an absolute fracture risk output over a defined interval of time. When used appropriately, these enhance our ability to identify high-risk patients and allow us to differentiate fracture risk among patients who present with similar BMDs. ➤ For challenging clinical cases, a combined approach is likely to improve accuracy in the identification of high-risk patients who would benefit from the available osteoporosis therapies.
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Affiliation(s)
| | - Lisa K Schroder
- University of Minnesota, Minneapolis, Minnesota.,Park Nicollet Methodist Hospital, St. Louis Park, Minnesota
| | - Julie A Switzer
- University of Minnesota, Minneapolis, Minnesota.,Park Nicollet Methodist Hospital, St. Louis Park, Minnesota
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Figved W, Myrstad M, Saltvedt I, Finjarn M, Flaten Odland LM, Frihagen F. Team Approach: Multidisciplinary Treatment of Hip Fractures in Elderly Patients. JBJS Rev 2019; 7:e6. [DOI: 10.2106/jbjs.rvw.18.00136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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