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Liang Y, Yang L, Zhang J, Hu J, He J, Chen P, Wang J. Association between Deltoid Muscle Density and Proximal Humeral Fracture in Elderly Patients. Orthop Rev (Pavia) 2024; 16:94103. [PMID: 38974660 PMCID: PMC11224064 DOI: 10.52965/001c.94103] [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: 07/28/2023] [Accepted: 02/05/2024] [Indexed: 07/09/2024] Open
Abstract
Background The potential role of deltoid muscle density in the occurrence of proximal humeral fractures remains uncertain. Therefore, the primary objective of this study was to examine the correlation between deltoid muscle density, as measured by CT attenuation value in Hounsfield units (HU), and the incidence of proximal humeral fractures in elderly patients. By investigating this association, we aim to shed light on the possible influence of deltoid muscle density on fracture risk in this specific population. Methods A total of 68 patients with computed tomography (CT) images were retrospectively reviewed. Among them, 34 patients presented with fractures following low-energy injuries, while the remaining 34 patients served as controls and underwent CT scans after low-energy injuries without any fractures. The muscle density of the deltoid muscles was assessed at the approximate tubercle of humerus. We compared these parameters between the two groups and conducted analyses considering factors such as age, sex, laterality, and deltoid muscle density of the shoulders. Results The demographic factors related to the shoulder did not exhibit any significant association with proximal humeral fracture. However, we observed a noteworthy difference in deltoid muscle density between patients with fractures (40.85 ± 1.35) and the control group (47.08 ± 1.61) (p = 0.0042), indicating a lower muscle density in the fracture group. Conclusion Based on the findings of this study, we can conclude that there exists a negative correlation between deltoid muscle density and the incidence of proximal humeral fractures. These results suggest that lower deltoid muscle density may be associated with an increased risk of proximal humeral fractures in the elderly population under investigation.
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Affiliation(s)
- Yuan Liang
- Department of OrthopedicsNorthern Jiangsu People’s Hospital Affiliated to Yangzhou University, Nantong West Road 98, Yangzhou, 225001, China
| | - Lixun Yang
- Department of OrthopedicsNorthern Jiangsu People’s Hospital Affiliated to Yangzhou University, Nantong West Road 98, Yangzhou, 225001, China
| | - Jiale Zhang
- Department of OrthopedicsNorthern Jiangsu People’s Hospital Affiliated to Yangzhou University, Nantong West Road 98, Yangzhou, 225001, China
| | - Jinlong Hu
- Department of OrthopedicsNorthern Jiangsu People’s Hospital Affiliated to Yangzhou University, Nantong West Road 98, Yangzhou, 225001, China
| | - Jinshan He
- Department of OrthopedicsNorthern Jiangsu People’s Hospital Affiliated to Yangzhou University, Nantong West Road 98, Yangzhou, 225001, China
| | - Pengtao Chen
- Department of OrthopedicsNorthern Jiangsu People’s Hospital Affiliated to Yangzhou University, Nantong West Road 98, Yangzhou, 225001, China
| | - Jingcheng Wang
- Department of OrthopedicsNorthern Jiangsu People’s Hospital Affiliated to Yangzhou University, Nantong West Road 98, Yangzhou, 225001, China
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Toro G, Braile A, Liguori S, Moretti A, Landi G, Cecere AB, Conza G, De Cicco A, Tarantino U, Iolascon G. The role of the fracture liaison service in the prevention of atypical femoral fractures. Ther Adv Musculoskelet Dis 2023; 15:1759720X231212747. [PMID: 38035253 PMCID: PMC10685792 DOI: 10.1177/1759720x231212747] [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: 03/16/2023] [Accepted: 09/29/2023] [Indexed: 12/02/2023] Open
Abstract
Osteoporosis and fragility fractures (FFs) are considered critical health problems by the World Health Organization (WHO) because of high morbidity, mortality, and healthcare costs. The occurrence of a FF raises the risk of a subsequent fracture (refracture). The hip is the most common site of fragility refracture, and its onset is associated with a further increase in patient's morbidity, mortality, and socioeconomic burden. Therefore, the prevention of refracture is essential. In this context, fracture liaison service (FLS) demonstrated to be able to reduce FF risk and also improve patients' adherence to anti-osteoporotic treatments, particularly for bisphosphonates (BPs). However, long-term and high adherence to BPs may lead to atypical femoral fractures (AFFs). These latter are tensile side stress fractures of the femur, with high rates of complications, including delayed and non-healing. An effective FLS should be able to prevent both FF and AFF. A comprehensive and interdisciplinary approach, through the involvement and education of a dedicated team of healthcare professionals (i.e. orthopedic, geriatrician, primary care physician, rehabilitation team, and bone nurse) for evaluating both FF and AFF risks might be useful to improve the standard of care.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, Naples 80138, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Unit of Orthopaedics and Traumatology, Ospedale del Mare, Naples, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Landi
- Unit of Orthopaedics and Traumatology, Santa Maria della Speranza Hospital, Battipaglia, Italy
| | | | - Gianluca Conza
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Unit of Orthopaedics and Traumatology, Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Lu KY, Tai TH, Liu YH, Chiang CJ, Loh EW, Wong CC, Wu JJ. Post-Operative Greater Tuberosity Resorption or Malreduction Is Associated with Poor Prognostic Outcomes in Patients with Proximal Humeral Fractures Treated Operatively-A Single-Center Retrospective Cohort Study. Diagnostics (Basel) 2023; 13:2789. [PMID: 37685327 PMCID: PMC10486750 DOI: 10.3390/diagnostics13172789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Proximal humerus fractures can be a debilitating condition if not properly treated. These fracture patterns are varied and differ in every patient. Functional outcomes may be determined by the integrity of the shoulder girdle involving the rotator cuff insertion. The post-operative resorption or malreduction of the greater tuberosity (GT) is an important factor contributing to the poor functional outcome of a patient. Thus, we intend to evaluate the cause-and-effect relationship between GT complications and clinical prognosis and outcomes. (2) Methods: A single-center retrospective comparative study was performed to evaluate the functional outcomes of patients undergoing operative fixation for this injury. A total of 387 consecutive cases treated operatively from 2019-2021 were included for analysis. (3) Results: 94 cases fulfilled our criteria for analysis. A matched-group comparison of 19 patients each was performed to compare demographics, post-operative fracture characteristics and clinical outcomes. (4) Conclusions: The resorption or malreduction of the GT contributes greatly to the prognostic outcome in patients treated with open reduction and internal fixation (ORIF) surgery. In our demographic study, obesity is another contributing factor affecting the parameters of post-operative reduction in proximal humerus fractures. Appropriate surgical planning and post-operative multidisciplinary care must be taken into consideration to attain a satisfactory prognostic outcome.
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Affiliation(s)
- Kuan-Yu Lu
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-Y.L.); (T.-H.T.); (Y.-H.L.); (C.-J.C.)
| | - Ting-Han Tai
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-Y.L.); (T.-H.T.); (Y.-H.L.); (C.-J.C.)
| | - Yu-Hsin Liu
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-Y.L.); (T.-H.T.); (Y.-H.L.); (C.-J.C.)
| | - Chang-Jung Chiang
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-Y.L.); (T.-H.T.); (Y.-H.L.); (C.-J.C.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - El-Wui Loh
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei 11031, Taiwan
- Department of Medical Imaging, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Chin-Chean Wong
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-Y.L.); (T.-H.T.); (Y.-H.L.); (C.-J.C.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- International PhD Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Research Center of Biomedical Devices, Taipei Medical University, Taipei 11031, Taiwan
| | - Jeffrey J. Wu
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (K.-Y.L.); (T.-H.T.); (Y.-H.L.); (C.-J.C.)
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Ratajczak K, Szczęsny G, Tomaszewski W. Stabilization of Comminuted Fractures of the Proximal Humerus with Intramedullary Nails and Angularly Stable Locking Plates—Functional Results before and during the SARS-COVID-19 Pandemics. Medicina (B Aires) 2023; 59:medicina59030575. [PMID: 36984576 PMCID: PMC10054681 DOI: 10.3390/medicina59030575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background and Objectives: Intramedullary nailing (IMN) and angularly stable plating (ASP) are the most popular techniques for the stabilization of comminuted fractures of the proximal humerus, without either one being obviously superior. The aim of the study was to validate the functional outcomes of both stabilization techniques in the COVID-19 pandemic by comparing them with data obtained just before the pandemic, because the limitations of the COVID-19 pandemic are affecting several aspects of social and medical life—being afraid of the transmission of the infection, patients reduce their exposure to healthcare to absolutely essential emergencies. Moreover, working conditions in the operating theater have also become more restrictive. Materials and Methods: Investigations were performed on 112 adult patients with Neer’s three- and four-fragment fractures stabilized with IMN (64) and ASP (48). Treatment effects were validated six months after surgery based on radiographs for evidence of bone union, humeral neck–shaft angle (NSA) and implant placement. Limb function was assessed with the QuickDash and Constant–Murley scores. Data obtained from patients treated in the COVID-19 pandemic were compared with those obtained before the pandemic. Results: The healing of all fractures was satisfactory, but complications developed in six cases. Three patients required secondary interventions due to inadequate repositioning: one after IMN and two after ASP. Additionally, one ASP was complicated by the secondary destabilization of a primarily properly stabilized major tubercle, and in two cases by conflict of the protruding implant with the acromion. ASP was noted to provide better functional results during the COVID-19 pandemic according to the Constant–Murley score (p = 0.0048; Student’s t-test). No significant differences were observed in the pre-COVID-19 pandemic. Conclusions: Our results suggest that ASP is more beneficial for the stabilization of comminuted fractures of the proximal humerus during the COVID-19 pandemic.
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Affiliation(s)
- Karol Ratajczak
- Department of Orthopedic Surgery and Traumatology, Medical University, 02-005 Warsaw, Poland
| | - Grzegorz Szczęsny
- Department of Orthopedic Surgery and Traumatology, Medical University, 02-005 Warsaw, Poland
- Correspondence: ; Tel.: +48-501-167-475
| | - Wiesław Tomaszewski
- ARS MEDICA Foundation for Medical Education and Promotion of Health, Art and Culture, 04-036 Warsaw, Poland
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Toro G, Braile A, De Cicco A, Pezzella R, Ascione F, Cecere AB, Schiavone Panni A. Fragility Fractures of the Acetabulum: Current Concepts for Improving Patients' Outcomes. Indian J Orthop 2022; 56:1139-1149. [PMID: 35813545 PMCID: PMC9232661 DOI: 10.1007/s43465-022-00653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
The incidence of fragility fractures of the acetabulum (FFA) is constantly increasing. Generally, these fractures are related to a fall on the greater trochanter involving the anterior column. The management of FFA is extremely difficult considering both patients' comorbidities and poor bone quality. Both non-operative and several operative treatment protocols are available, and the choice among them is still ambiguous. The proposed surgical techniques for FFA [namely open reduction and internal fixation (ORIF), percutaneous fixation and total hip arthroplasty (THA)] are associated with a high complication rate. The treatment with the higher early mortality is the ORIF + THA, while the one with the lowest is the non-operative. However, at longer follow-up, this difference dreadfully change is becoming the opposite. Frequently ORIF, percutaneous fixation, and non-operative treatment need a subsequent re-operation through a THA. This latter could be extremely difficult, because of poor bone quality, acetabular mal union/non-union, bone gaps and hardware retention. However, the outcomes of each of the proposed treatment are mostly poor and controverted; therefore, a comprehensive patient evaluation and an accurate fracture description are required to appropriately manage acetabular fracture in the elderly.
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Affiliation(s)
- Giuseppe Toro
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy ,grid.6530.00000 0001 2300 0941Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Adriano Braile
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Annalisa De Cicco
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Raffaele Pezzella
- Unit of Orthopedics and Traumatology, AORN San Giuseppe Moscati, 83100 Avellino, Italy
| | - Francesco Ascione
- grid.461850.eDepartment of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Naples, Italy
| | - Antonio Benedetto Cecere
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alfredo Schiavone Panni
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Pluskiewicz W, Wilk R, Adamczyk P, Hajzyk M, Swoboda M, Sladek A, Koczy B. The incidence of arm, forearm, and hip osteoporotic fractures during early stage of COVID-19 pandemic. Osteoporos Int 2021; 32:1595-1599. [PMID: 33515269 PMCID: PMC7846903 DOI: 10.1007/s00198-020-05811-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/23/2020] [Indexed: 12/01/2022]
Abstract
UNLABELLED The study analyzes whether the COVID-19 pandemic affects the incidence of arm, forearm, and hip fractures. Additionally, the change in the overall cost of those fractures treatment was estimated. During the COVID-19 pandemic, the incidence of arm, forearm, and hip fractures and the cost of fracture management are decreased. INTRODUCTION Purposes of the study were to analyze if COVID-19 pandemic influences the incidence of arm, forearm, and hip osteoporotic fractures and to estimate the changes in costs of their management. METHODS Data on arm, forearm, and hip fracture incidence were collected for inhabitants aged over 50 years in the district of Tarnowskie Góry and the city of Piekary Śląskie, South Poland, in the early stage of COVID-19 pandemic (77 days, from March 16th to May 31st 2020). These results were compared with the number of fractures noted in years 2015-2019 in the same period of the year. The ratio of analyzed fractures per 100,000 inhabitants was calculated. RESULTS The recorded numbers of fractures of arm, forearm, and hip were 13, 43, and 29, respectively. The respective mean number for fractures reported in corresponding period in 2015-2019 years was 23.6, 52, and 33. The year fracture incidence calculated per 100,000 inhabitants decreased by 45.8%, 18.4%, and 13.4%, respectively. The estimated numbers of avoided fractures extrapolated for the whole country for arm, forearm, and hip were 1722, 1548, and 947, respectively. The total number of avoided fractures was 4217. The expected nationwide cost reduction for the arm, forearm, and hip fracture management was estimated at € 568,260, € 332,820, and € 1,628,840, respectively. The total cost reduction was € 2,529,920 over the period of observation. CONCLUSION During COVID-19 pandemic, a decrease of arm, forearm, and hip fracture incidence was observed which may result in decrease of total costs for Polish healthcare system.
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Affiliation(s)
- W Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - R Wilk
- Municipal Hospital, Department of Orthopedic and Trauma Surgery, Sosnowiec, Poland
| | - P Adamczyk
- Department of Paediatrcs, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Hajzyk
- Department of Pediatric Orthopedics & Traumatology, Combined City Hospitals, Chorzów, Poland
| | - M Swoboda
- Department of General and Vascular Surgery, City Hospital, Ruda Śląska, Poland
| | - A Sladek
- Department of General and Vascular Surgery, City Hospital, Ruda Śląska, Poland
| | - B Koczy
- Department of Trauma and Orthopedics, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland
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Yoon SH, Kim BR, Lee SY, Beom J, Choi JH, Lim JY. Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study. BMC Geriatr 2021; 21:283. [PMID: 33910513 PMCID: PMC8082882 DOI: 10.1186/s12877-021-02227-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background The incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources. Methods This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6 ± 6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval’s grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM)-locomotion, Modified Rivermead Mobility Index, Berg Balance Scale (BBS), 4-Meter Walking speed Test (4MWT), the Korean version of the Mini-Mental State Examination(K-MMSE), Geriatric Depression Scale (GDS), EuroQol Five-Dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index (K-MBI), the Korean version of the Instrumental Activities of Daily Living (K-IADL), and Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery. Results Multivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval’s grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively. Conclusions This study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.
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Affiliation(s)
- Soo Hoon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jun Hwan Choi
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
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Marocco C, Zimatore G, Mocini E, Fornari R, Iolascon G, Gallotta MC, Bimonte VM, Baldari C, Lenzi A, Migliaccio S. Efficacy of Denosumab Therapy Following Treatment with Bisphosphonates in Women with Osteoporosis: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041728. [PMID: 33579002 PMCID: PMC7916792 DOI: 10.3390/ijerph18041728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/02/2023]
Abstract
Denosumab is a human monoclonal antibody that neutralizes RANKL, a cytokine able to interact with the RANK receptor on preosteoclasts and osteoclasts, decreasing their recruitment and differentiation, leading to a decreased bone resorption. The aim of this observational real-life study was to analyze adherence to denosumab therapy and assess its efficacy in increasing bone mineral density (BMD) and modulating biochemical skeletal markers following previous treatments with bisphosphonates in a group of post-menopausal women with osteoporosis. Women were recruited in the specialized center from March 2012 to September 2019. Biochemical markers were recorded at baseline and every six months prior to subsequent drug injection. Dual X-ray absorptiometry was requested at baseline and after 18/24 months. Comparing BMD at baseline and after denosumab therapy in naive patients and in those previously treated with bisphosphonates, a positive therapeutic effect was observed in both groups. The results of our real-life study demonstrate, as expected, that BMD values significantly increased upon denosumab treatment. Interestingly, denosumab showed an increased efficacy in patients previously treated with bisphosphonates. Moreover, biochemical markers data indicate that osteoporotic patients, without other concomitant unstable health conditions, could be evaluated once a year, decreasing the number of specialistic center access.
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Affiliation(s)
- Chiara Marocco
- Department of Movement, Human and Health Sciences, Health Sciences Section, University Foro Italico of Rome, 00135 Rome, Italy; (C.M.); (V.M.B.)
| | - Giovanna Zimatore
- Department of Movement, Human and Health Sciences, Health Sciences Section, University Foro Italico of Rome, 00135 Rome, Italy; (C.M.); (V.M.B.)
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy;
- IMM-CNR, Institute for Microelectronics and Microsystems, 40129 Bologna, Italy
- Correspondence: (G.Z.); (S.M.)
| | - Edoardo Mocini
- Department of Experimental Medicine, Medical Pathophysiology, Endocrinology and Nutrition Section, University Sapienza of Rome, 00185 Rome, Italy; (E.M.); (R.F.); (A.L.)
| | - Rachele Fornari
- Department of Experimental Medicine, Medical Pathophysiology, Endocrinology and Nutrition Section, University Sapienza of Rome, 00185 Rome, Italy; (E.M.); (R.F.); (A.L.)
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Maria Chiara Gallotta
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy;
| | - Viviana Maria Bimonte
- Department of Movement, Human and Health Sciences, Health Sciences Section, University Foro Italico of Rome, 00135 Rome, Italy; (C.M.); (V.M.B.)
| | - Carlo Baldari
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy;
| | - Andrea Lenzi
- Department of Experimental Medicine, Medical Pathophysiology, Endocrinology and Nutrition Section, University Sapienza of Rome, 00185 Rome, Italy; (E.M.); (R.F.); (A.L.)
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, Health Sciences Section, University Foro Italico of Rome, 00135 Rome, Italy; (C.M.); (V.M.B.)
- Correspondence: (G.Z.); (S.M.)
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