Impact of osteoporosis liaison services on the expected lifetime osteoporosis-related medical expenses of patients with fragility fracture in a private hospital in Japan

We report the efficacy of a Japanese fracture liaison service (FLS), the osteoporosis liaison service (OLS), in suppressing osteoporosis-related expenses from the public insurance by preventing secondary fracture in spite of higher medication costs during expected life spans. OLS could reduce medical expenses for osteoporosis in all age groups.

PURPOSE

Osteoporosis liaison services (OLS), which are based on fracture liaison services (FLS), are used in Japan to prevent both primary and secondary fractures in older people. We aimed to clarify the effects of OLS on the medical expenses.

PATIENTS AND METHODS

We compared patients with fragile fractures hospitalized to Saitama Jikei Hospital before and after implementing OLS. These were labeled a non-OLS group and an OLS group, and they were further organized by age (< 75, 75-84, and ≥ 85 years). The expected osteoporosis-related medical expenses during life were calculated by the occurrence, fracture site, medication, and life expectancy and compared between the non-OLS and OLS groups by the age group.

RESULTS

The non-OLS group included 400 people (100 males and 300 females, mean age 81.7 ± 9.7 years), comprising 154 with vertebral fractures and 246 with hip fractures. The OLS group included 406 patients (101 males and 305 females, mean age 82.4 ± 9.3 years), of whom 161 had vertebral fractures and 245 had hip fractures. The suppressive secondary fracture effects of OLS were previously reported. The expected expense of osteoporosis treatment in the OLS group was found to be greater than that in the non-OLS group for all age groups. In contrast, expected expenses for treating secondary fractures were shown to increase more in the non-OLS group. However, total expenses were lower in the OLS group across all age groups.

CONCLUSION

The implementation of OLS can reduce overall healthcare costs despite the increased expenses required to provide medical therapy and periodic examinations.

Effectiveness of a Japanese multi-professional cooperative osteoporosis liaison service at a private hospital for decreasing secondary fractures in osteoporosis patients with fragility fractures

PURPOSE

A fracture liaison service (FLS) was established in England to support patients with fragility fractures, and it was introduced in Japan as the osteoporosis liaison service (OLS). The study aim was to determine if the Japanese OLS/FLS prevents secondary fractures in patients with fragility fractures and assess the value of the OLS/FLS. Our OLS/FLS evaluated the status of osteoporosis in patients and their life circumstances. Additionally, it introduced osteoporosis therapies during the patients' hospitalization period and then continued periodical examinations and prescription of drug after discharge.

PATIENTS AND METHODS

This study was conducted in consecutive patients: 400 were assigned to the non-OLS group and 406 to the OLS group. The mean age of the patients was 81.7 ± 9.7 years in the non-OLS group (154 patients with vertebral fractures and 246 with hip fractures; 100 males, 300 females) and 82.4 ± 9.3 years in the OLS group (245 patients with hip fractures and 161 with vertebral fractures; 101 males, 305 females).

RESULTS

During hospitalization, 74.9% of the OLS group patients started medications and 63.9% of patients continued after discharge, while 35.8% and 53.5% of non-OLS group. The incidence rate of secondary fractures was 89.8/1000 person-years in the non-OLS group, and 55.2/1000 person-years in the OLS group. The multivariate Cox hazards test showed that secondary fractures after vertebral or hip fractures increased with age, and the risk was 0.58-fold in patients in the OLS group.

CONCLUSION

OLS was effective in reducing secondary fractures in patients with osteoporosis with fragility fractures.

Light compensation points in shade-grown seedlings of deciduous broadleaf tree species with different successional traits raised under elevated CO2

We measured leaf photosynthetic traits in shade-grown seedlings of four tree species native to northern Japan, raised under an elevated CO2 condition, to investigate the effects of elevated CO2 on shade tolerance of deciduous broadleaf tree species with different successional traits. We considered Betula platyphylla var. japonica and Betula maximowicziana as pioneer species, Quercus mongolica var. crispula as a mid-successional species, and Acer mono as a climax species. The plants were grown under shade conditions (10% of full sunlight) in a CO2 -regulated phytotron. Light compensation points (LCPs) decreased in all tree species when grown under elevated CO2 (720 μmol·mol(-1) ), which were accompanied by higher apparent quantum yields but no photosynthetic down-regulation. LCPs in Q. mongolica and A. mono grown under elevated CO2 were lower than those in the two pioneer birch species. The LCP in Q. mongolica seedlings was not different from that of A. mono in each CO2 treatment. However, lower dark respiration rates were observed in A. mono than in Q. mongolica, suggesting higher shade tolerance in A. mono as a climax species in relation to carbon loss at night. Thus, elevated CO2 may have enhanced shade tolerance by lowering LCPs in all species, but the ranking of shade tolerance related to successional traits did not change among species under elevated CO2 , i.e. the highest shade tolerance was observed in the climax species (A. mono), followed by a gap-dependent species (Q. mongolica), while lower shade tolerance was observed in the pioneer species (B. platyphylla and B. maximowicziana).

Light compensation points in shade-grown seedlings of deciduous broadleaf tree species with different successional traits raised under elevated CO2

We measured leaf photosynthetic traits in shade-grown seedlings of four tree species native to northern Japan, raised under an elevated CO2 condition, to investigate the effects of elevated CO2 on shade tolerance of deciduous broadleaf tree species with different successional traits. We considered Betula platyphylla var. japonica and Betula maximowicziana as pioneer species, Quercus mongolica var. crispula as a mid-successional species, and Acer mono as a climax species. The plants were grown under shade conditions (10% of full sunlight) in a CO2 -regulated phytotron. Light compensation points (LCPs) decreased in all tree species when grown under elevated CO2 (720 μmol·mol(-1) ), which were accompanied by higher apparent quantum yields but no photosynthetic down-regulation. LCPs in Q. mongolica and A. mono grown under elevated CO2 were lower than those in the two pioneer birch species. The LCP in Q. mongolica seedlings was not different from that of A. mono in each CO2 treatment. However, lower dark respiration rates were observed in A. mono than in Q. mongolica, suggesting higher shade tolerance in A. mono as a climax species in relation to carbon loss at night. Thus, elevated CO2 may have enhanced shade tolerance by lowering LCPs in all species, but the ranking of shade tolerance related to successional traits did not change among species under elevated CO2 , i.e. the highest shade tolerance was observed in the climax species (A. mono), followed by a gap-dependent species (Q. mongolica), while lower shade tolerance was observed in the pioneer species (B. platyphylla and B. maximowicziana).

Three-dimensional characterization of BaHfO3 precipitates in GdBa2Cu3O7-y flim using STEM tomography

IntroductionSince the discovery of REBa2Cu3O7-y (RE: Rare Earth element, REBCO) superconductors, they have been expected as the best candidates for the power cable application due to its high critical temperature (Tc) and critical current density (Jc). Among those REBCO superconductors, GdBa2Cu3O7-y (GdBCO) have been receiving great interest because they have higher Tc and Jc than YBa2Cu3O7-y [1].GdBCO with various types of precipitates as artificial pinning centers (APCs) have been proposed to minimize the anisotropy of Jc characteristics under the magnetic field. Among those precipitates, BaHfO3 (BHO) was found most effective precipitates as APCs in GdBCO film prepared by pulsed laser deposition (PLD) method [2]. It is therefore necessary to investigate not only the morphologies but also the dispersion of BHO precipitates within the GdBCO, to understand the role of BHO for the superconducting characteristics. In this study, morphologies and dispersions of BHO precipitates were characterized three-dimensional by scanning transmission electron tomography ExperimentalBHO dispersed GdBCO films were fabricated on Hastelloy C-276TM substrates with buffer layers of CeO2/LaMnO3/MgO/ Gd2ZrO7 by PLD method.To observe microstructure of GdBCO film with BHO precipitates, cross-section TEM specimens were prepared by FIB method using Quanta 3D-200 (FEI, USA) with acceleration voltage from 2 to 30 kV. Three-dimensional information such as morphology and dispersion, of BHO precipitates were characterized by electron tomography using STEM-HAADF. Result and discussionFigure 1 shows three-dimensional reconstructed volume of BHO precipitates in GdBCO, which revealed that fine BHO precipitates have rod- and plate-like morphologies with homogeneous dispersion in GdBCO. In addition, growth directions of these precipitates were found with wide angular distributions from growth direction of GdBCO. Anisotropy of Jc in the magnetic fields was probably enhanced by various growth directions and homogeneous dispersion of nanosized BHO within GdBCO.jmicro;63/suppl_1/i26/DFU080F1F1DFU080F1Fig. 1.Three-dimensional reconstructed volume of BHO.

Protective effects of insulin-like growth factor-I on the decrease in myogenic differentiation by ionizing radiation

PURPOSE

The aim of the work is to evaluate the effects of insulin-like growth factor-1 (IGF-1) on the decrease in myotube formation induced by ionizing radiation.

MATERIALS AND METHODS

We induced C2C12 cells to a myogenic linage following X-ray irradiation at 2 and 4 Gy. Myogenic differentiation was estimated using immnocytochemical staining with anti-myosin antibody, and the anti-myosin antibody positive areas, the total number of nuclei, the number of nuclei included in multinucleated myotubes per field, and the myotube formation ratio were analyzed.

RESULTS

In the myogenic differentiation in the presence of IGF-1, the decrease in anti-myosin antibody positive areas, the nuclei included in myotubes, and the myotube formation ratio induced by X-ray irradiation at 2 Gy was restored to control levels.

CONCLUSIONS

The addition of IGF-1 protected against the decrease myotube formation induced by X-ray irradiation at 2 Gy. Since X-ray irradiation at 2 Gy is usually used for multi-fractionated irradiation in radiotherapy, our findings suggest that IGF-1 could be useful to protect against impairment of muscle repair induced by therapeutic dose radiation.

Gamma loop dysfunction of the quadriceps femoris of elderly patients hospitalized after fall injury

BACKGROUND AND PURPOSE

Gamma loop dysfunction may increase the risk of falls. Therefore, we evaluated gamma loop function in subjects hospitalized after fall injury and examined whether aging affects the gamma loop.

METHODS

Maximal voluntary contraction (strength) of knee extension and integrated electromyography (I-EMG) of the quadriceps femoris were examined to evaluate the activities of alpha motoneurons before and after 20-min vibration applied to the quadriceps femoris. Mean percentage changes were calculated as: (previbration value-postvibration value)/previbration valuex100). As strength and I-EMG of both uninjured (UG) and injured limbs (IG) of patients with a history of falls resulting in hospitalization were examined in each group, the mean percentage changes of the 4 groups were compared with those of controls [young control group (YCG) and elderly control group (ECG)].

RESULTS

Mean percentage changes in strength of UG and IG were significantly different from YCG but not the ECG. Mean percentage changes in I-EMG for VL (vastus lateralis) and VM (vastus medialis)in IG were significantly different from YCG. However, I-EMG of RF of IG were not significantly different from YCG. Although mean percentage changes in I-EMG of UG were not significantly different from ECG, those for VL and VM of IG were different from ECG.

CONCLUSIONS

As the gamma loop dysfunction exited in the uninjured limbs of subjects with a history of falls resulting in hospitalization, a dysfunctional gamma loop could be a risk factor for falling. Further studies are needed to identify the effects of aging on gamma loop function.