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Hosokawa T, Tajika T, Suto M, Honda A, Chikuda H. Impact of Possible Sarcopenia and Nutritional Status on Postoperative Quick Disabilities of the Arm, Shoulder, and Hand Score in Geriatric Women With Distal Radius Fracture. J Hand Surg Am 2024:S0363-5023(24)00313-7. [PMID: 39140919 DOI: 10.1016/j.jhsa.2024.07.007] [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: 02/01/2024] [Revised: 06/26/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Distal radius fracture (DRF), sarcopenia, and malnutrition have been reported to be interrelated. However, there are few reports on the effects of sarcopenia and malnutrition on DRF patients' postoperative outcomes. This study examined the healthy-side grip strength and preoperative blood tests to determine the presence of possible sarcopenia (PS) and malnutrition in geriatric women with DRF and their impact on postoperative functional outcomes. METHODS Fifty-five woman older than 60 years treated with volar-locking plate fixation for low-energy DRF from standing-level falls were retrospectively studied. Based on the criteria of The Asian Working Group for Sarcopenia 2019, patients with a healthy-side grip strength <18 kg were defined as PS. Nutritional assessment was performed using Onodera's Prognostic Nutritional Index (PNI) before surgery, with a value <50 defined as malnutrition. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) was used for functional assessment at 1 year after surgery. Patients were divided into two groups according to PS, and patient demographic data and postoperative outcomes were compared. Multiple regression analysis was performed to estimate the regression coefficient and 95% confidence intervals for 1-year QuickDASH after surgery with adjustment for age, PS, and malnutrition. RESULTS Possible sarcopenia was present in 10 patients (18.2%), and malnutrition in 24 patients (43.6%). Possible sarcopenia patients were older, had lower PNI, serum albumin, and both sides grip strength, and worse QuickDASH compared with non-PS patients. In multiple regression analysis, age, PS, and malnutrition were significant predictors of QuickDASH (standardized coefficient β, 0.35, 0.34, and 0.24; 95% confidence interval, 0.22-1.02, 3.52-16.49, and 0.50-10.78). CONCLUSIONS Possible sarcopenia with a healthy-side grip strength <18 kg and malnutrition with a PNI <50 were associated with worse 1-year QuickDASH after surgery in women DRF patients over 60 years. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic Ⅳ.
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Affiliation(s)
- Takafumi Hosokawa
- Department of Orthopaedic Surgery, Tone Chuo Hospital, Gunma, Japan; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
| | - Tsuyoshi Tajika
- Department of Rehabilitation, Gunma University Graduate School of Health Sciences, Gunma, Japan
| | - Morimichi Suto
- Department of Orthopaedic Surgery, Tone Chuo Hospital, Gunma, Japan
| | - Akira Honda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Wáng YXJ. For older women, the majority of hip fragility fractures and radiographic vertebral fragility fractures occur among the densitometrically osteoporotic population: a literature analysis. Quant Imaging Med Surg 2024; 14:4202-4214. [PMID: 38846307 PMCID: PMC11151245 DOI: 10.21037/qims-24-227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 06/09/2024]
Abstract
It has been frequently cited that 'the majority of fragility fractures (FF) occur at non-osteoporotic bone mineral density (BMD)'. For the reports with T-score measured around the time of a hip fracture, we conducted a systematic literature search in December 2022, and resulted in 10 studies with five for Caucasian women and five for East Asian women. Femoral neck (FN) T-score was reported in five Caucasian studies and three East Asian studies, three of five Caucasian studies had a mean T-score ≤-2.5, and one study had the majority of their patients measuring a mean T-score ≤-2.5. All three East Asian studies reported a mean FN T-score ≤-2.7. Total hip T-score was reported in two Caucasian studies and three East Asian studies, the two Caucasian studies both had a mean T-score ≤-2.5, and all three East Asian studies had a mean T-score ≤-2.6. A new literature search conducted in April 2024 results in additional three studies, with results being consistent with the data described above. A trend was noted that 'younger' patients suffer from hip fractures at a 'higher' T-score. For the highly cited articles where the notion the majority of FF occur at non-osteoporotic BMD was derived from, authors reported prospective epidemiological studies where BMD was not measured at the timepoint of hip fracture, instead, BMD was measured at the study baseline. These epidemiological studies suggest that >50% of hip fractures likely occur in women with an osteoporotic FN or hip T-score. However, a pattern was seen that older men suffer from hip fracture at a notably higher T-score than older women. For the cases of radiographic vertebral FF, despite varying criteria being used to classify these FFs, the majority of female patients had spine densitometric osteoporosis. Literature shows, compared with the cases of hip fracture, distal forearm fracture occurs at a 'younger' age and 'higher' BMD, suggesting distal forearm fracture is more likely associated with a 'higher' trauma energy level.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Dworkin M, Harrison WJ, Chidothi P, Mbowuwa F, Martin C, Agarwal-Harding K, Chokotho L. Epidemiology and Treatment of Distal Radius Fractures at Four Public Hospitals in Malawi. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00003. [PMID: 38530958 DOI: 10.5435/jaaosglobal-d-23-00282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Little is known about the burden or management of distal radius fractures (DRFs) in low- and middle-income countries. The purpose of this study was to describe the care of DRFs in Malawi. METHODS We retrospectively reviewed a registry of all patients with fractures who presented to the orthopaedic departments at four public hospitals in Malawi. RESULTS Totally, 1,440 patients (14.5%) were with a DRF. Average age was 40, and 888 (62.0%) were male. Surgery was done for 122 patients (9.5%). Patients presenting to Queen Elizabeth Hospital, patients presenting after a fall, and patients initially evaluated by an orthopaedic registrar or orthopaedic clinical officer had lower odds of receiving surgical treatment. Meanwhile, open injuries had the greatest odds of receiving surgery. CONCLUSION The most common musculoskeletal injury among patients in the Malawi Fracture Registry was fractures of the distal radius. These most affected young adult male patients may benefit from surgery; however, the majority were managed nonsurgically. Lack of access to surgical fixation and conservative follow-up may have long-term functional consequences in a predominantly agrarian society. Outcomes-based research is needed to help guide management decisions and standardize patient care and referral protocols.
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Affiliation(s)
- Myles Dworkin
- From the Department of Orthopaedic Surgery, The Warren Alpert School of Medicine at Brown University, Ontario, RI (Dr. Dworkin), Harvard Global Orthopaedics Collaborative, Boston, MA (Dr. Dworkin). AO Alliance, Davos, Switzerland (Mr. Harrison, Mr. Chidothi, Mr. Mbowuwa, and Dr. Martin); Countess of Chester Hospital NHS Foundation Trust, London (Mr. Harrison and Mr. Chidothi); Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding); Department Harvard Medical School, Program in Global Surgery and Social Change, Global Health and Social Medicine, Boston, MA (Dr. Agarwal-Harding), Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi (Ms. Chokotho)
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Ma SB, Lee SK, An YS, Kim WS, Choy WS. The clinical necessity of a distal forearm DEXA scan for predicting distal radius fracture in elderly females: a retrospective case-control study. BMC Musculoskelet Disord 2023; 24:177. [PMID: 36894929 PMCID: PMC9996865 DOI: 10.1186/s12891-023-06265-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Recent studies have demonstrated that the distal forearm dual-energy X-ray absorptiometry (DEXA) scan might be a better method for screening bone mineral density (BMD) and the risk of a distal forearm fracture, compared with a central DEXA scan. Therefore, the purpose of this study was to determine the effectiveness of a distal forearm DEXA scan for predicting the occurrence of a distal radius fracture (DRF) in elderly females who were not initially diagnosed with osteoporosis after a central DEXA scan. METHODS Among the female patients who visited our institutes and who were over 50 years old and underwent DEXA scans at 3 sites (lumbar spine, proximal femur, and distal forearm), 228 patients with DRF (group 1) and 228 propensity score-matched patients without fractures (group 2) were included in this study. The patients' general characteristics, BMD, and T-scores were compared. The odds ratios (OR) of each measurement and correlation ratio among BMD values of the different sites were evaluated. RESULTS The distal forearm T-score of the elderly females with DRF (group 1) was significantly lower than that of the control group (group 2) (p < 0.001 for the one-third radius and ultradistal radius measurements). BMD measured during the distal forearm DEXA scan was a better predictor of DRF risk than BMD measured during the central DEXA (OR = 2.33; p = 0.031 for the one-third radius, and OR = 3.98; p < 0.001 for the ultradistal radius). The distal one-third radius BMD was correlated with hip BMD, rather than lumbar BMD (p < 0.05 in each group). CONCLUSION Performing a distal forearm DEXA scan in addition to a central DEXA scan appears to be clinically significant for detecting the low BMD in the distal radius, which is associated with osteoporotic DRF in elderly females. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Sang Beom Ma
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, South Korea
| | - Sang Ki Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, South Korea.
| | - Young Sun An
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, South Korea
| | - Woo-Suk Kim
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, South Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, South Korea
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Chandran M, Brind'Amour K, Fujiwara S, Ha YC, Tang H, Hwang JS, Tinker J, Eisman JA. Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: a systematic review. Osteoporos Int 2023; 34:1037-1053. [PMID: 36735053 DOI: 10.1007/s00198-022-06657-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023]
Abstract
UNLABELLED Robust data on osteoporosis in the Asia Pacific region could improve healthcare decision-making. Osteoporosis affects 10-30% of women aged 40 + , and up to 10% of men in 7 developed economies in Asia Pacific. Fractures affect 500-1000 adults aged 50 + per 100,000 person-years. Policymakers and clinicians must address this problem. PURPOSE Osteoporosis and associated fractures result in considerable morbidity, loss of productivity, early mortality, and increased healthcare expenses. Many countries in the Asia Pacific (AP) region, especially middle- and higher-income economies, are faced with aging and increasingly sedentary populations. It is critical to consolidate and analyze the available information on the prevalence and incidence of the disease in these countries. METHODS We systematically reviewed articles and gray literature for Australia, China, Hong Kong, Japan, Singapore, South Korea, and Taiwan. We searched PubMed, ScienceDirect, JSTOR, Cochrane, Google Scholar, and other databases for data published 2009-2018. We included articles with prevalence or incidence estimates for adults with osteoporosis or related fractures. RESULTS All locations had data available, but of widely varying quantity and quality. Most estimates for osteoporosis prevalence ranged from 10 to 30% for women ages 40 and older, and up to 10% for men. Osteoporotic fracture incidence typically ranged between 500 and 1000 per 100,000 person-years among adults aged 50 and older. Both outcomes typically increased with age and were more common among women. CONCLUSION Osteoporosis and associated fractures affect significant portions of the adult population in developed economies in the AP region. Governments and healthcare systems must consider how best to prevent and diagnose osteoporosis, and manage affected individuals, to reduce healthcare costs and mortality associated with fractures.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
| | | | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, Republic of China
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | - John A Eisman
- UNSW Sydney and School of Medicine Sydney, Garvan Institute of Medical Research, St Vincent's Hospital, University of Notre Dame Australia, Sydney, NSW, Australia
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Siew KFS, Satku M. The Prevalence of Osteoporosis in Patients Older than 50 Years with Distal Radius Fractures in an Institutional Registry of 2,572 Patients in Singapore. J Hand Surg Asian Pac Vol 2022; 27:130-134. [PMID: 35037579 DOI: 10.1142/s2424835522500023] [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: 11/18/2022]
Abstract
Background: The distal radius is one of the common sites for fragility fractures. A fracture of the distal radius in the elderly is often associated with low bone mineral density (BMD). It is an early predictor of osteoporosis and increased risk of subsequent fragility fractures of the hip and the spine with greater morbidity. Osteoporosis is becoming an increasing cause for concern in the elderly population. The aim of this study is to determine the prevalence of osteoporosis in patients aged 50 years and above with distal radius fractures in our local population. Methods: This is a retrospective study of all patients aged 50 years and above who were treated for a distal radius fracture at our institution over a 4-year period. Data regarding gender, mechanism of injury (low or high energy), and outcome of BMD scans were collected. The data were analyzed to look at the prevalence of osteoporosis and osteopenia and the relation amongst BMD, gender, and the mechanism of injury. Results: About 2,572 patients aged 50 years and above were treated at our institution over a 4-year period from 2013 to 2016. The average age of the patients was 67.7 years old and 1,938 (75.3%) were women. A total of 1,034 patients had BMD scans and of these 56.0% had osteoporosis and 37.4% had osteopenia. There was no correlation between the prevalence of osteoporosis and gender or the mechanism of injury. Conclusions: The prevalence of osteoporosis in patients aged 50 and above with distal radius fractures is a significant cause for concern in Singapore. Routine assessment for osteoporosis is recommended for all patients above 50 years old with distal radius fractures. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Ka Fai Stephen Siew
- Department of Hand & Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore.,
| | - Mala Satku
- Department of Hand & Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore.,
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Shah GM, Gong HS, Chae YJ, Kim YS, Kim J, Baek GH. Evaluation and Management of Osteoporosis and Sarcopenia in Patients with Distal Radius Fractures. Clin Orthop Surg 2020; 12:9-21. [PMID: 32117533 PMCID: PMC7031429 DOI: 10.4055/cios.2020.12.1.9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Abstract
Distal radius fractures (DRFs) are one of the most common fractures seen in elderly people. Patients with DRFs have a high incidence of osteoporosis and an increased risk of subsequent fractures, subtle early physical performance changes, and a high prevalence of sarcopenia. Since DRFs typically occur earlier than vertebral or hip fractures, they reflect early changes of the bone and muscle frailty and provide physicians with an opportunity to prevent progression of frailty and secondary fractures. In this review, we will discuss the concept of DRFs as a medical condition that is at the start of the fragility fracture cascade, recent advances in the diagnosis of bone fragility including emerging importance of cortical porosity, fracture healing with osteoporosis medications, and recent progress in research on sarcopenia in patients with DRFs.
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Affiliation(s)
- Gajendra Mani Shah
- Department of Orthopedics and Trauma Surgery, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ju Chae
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeun Soo Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Niempoog S, Sukkarnkosol S, Boontanapibul K. Prevalence of Osteoporosis in Patients with Distal Radius Fracture from Low-Energy Trauma. Malays Orthop J 2019; 13:15-20. [PMID: 31890105 PMCID: PMC6915318 DOI: 10.5704/moj.1911.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction: Osteoporosis is a devastating problem leading to significant morbidity and mortality. Patients with osteoporosis usually present with fractures from low-energy trauma and falls, commonly of the distal radius, which may precede more severe fractures like fracture of the neck of femur, but data from Thailand are limited. The objective of our study was to determine the prevalence of osteoporosis in patients with distal radius fracture from low-energy trauma. Materials and Methods: This was a descriptive retrospective study, performed at Thammasat University Hospital in Thailand, from January 2011 to June 2017. Patients aged more than 50 years with distal radial fractures from low-energy trauma with available bone mineral density (BMD) result were included. Patients with known secondary causes of osteoporosis were excluded. Patients were grouped by age, sex, and BMD status (normal, osteopenic and osteoporotic). Results: One hundred out of 351 patients with distal radial fractures had bone mineral density data but only 79 (73 females) met the inclusion criteria. Most patients were aged 60-69 years old (n=31, 42.5%). 47 (59.5%) patients were osteoporotic, 23 (29.1%) osteopenic, and 9 (11.4%) were normal. Seven (6 osteoporotic) patients suffered a more severe fracture subsequently. No deaths were recorded. Conclusion: Our study found a high rate of osteoporosis mostly in females, consistent with published literature. Assessing BMD is crucial in middle age and elderly patients with fractures to better manage osteoporosis and prevent more severe fractures in the future.
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Affiliation(s)
- S Niempoog
- Department of Orthopaedics, Thammasat University, Pathum Thani, Thailand
- Department of Orthopedics, Chulabhorn International College of Medicine, Pathum Thani, Thailand
| | - S Sukkarnkosol
- Department of Orthopaedics, Thammasat University, Pathum Thani, Thailand
- Department of Orthopedics, Chulabhorn International College of Medicine, Pathum Thani, Thailand
| | - K Boontanapibul
- Department of Orthopedics, Chulabhorn International College of Medicine, Pathum Thani, Thailand
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French KD, Emanuele D. Osteoporosis: Increasing Screening and Treatment for Postmenopausal Women. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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