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Vinther D, Thomsen RW, Furnes O, Gjertsen JE, Pedersen AB. Impact of diabetes on the risk of subsequent fractures in 92,600 patients with an incident hip fracture: A Danish nationwide cohort study 2004-2018. Bone 2024; 184:117104. [PMID: 38636621 DOI: 10.1016/j.bone.2024.117104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE We investigated the incidence rates of a subsequent hip fracture (HF) and other subsequent fractures than HF after first incident HF, comparing patients with and without diabetes. METHODS Using Danish medical databases, we identified 92,600 incident HF patients in the period 2004-2018. Diabetes exposure was examined overall, by type of diabetes (T2D and T1D), and by presence of diabetes complications. We estimated cumulative incidence of subsequent HFs and fractures other than HF within two years of the incident HF. Using Cox regression, adjusted hazard ratios (aHRs) with 95 % confidence interval (CI) were calculated. RESULTS Among incident HF patients, 11,469 (12 %) had diabetes, of whom 10,253 (89 %) had T2D and 1216 (11 %) had T1D. The 2-year incidence rates for a new subsequent HF were 4.8 % (95 % CI: 4.6-4.9) for patients without diabetes (reference group), 4.1 % (95 % CI: 3.8-4.6) for T2D, and 4.3 % (95 % CI: 3.3-5.6) for T1D. Corresponding aHRs were 1.01 (95 % CI 0.90-1.14) for T2D and 1.17 (95 % CI 0.87-1.58) for T1D. There was effect modification by sex, as women with T1D had an aHR of 1.52 (95 % CI: 1.09-2.11) for subsequent HF, and by specific diabetes complications (for example, patients with T2D and prior hypoglycemia had an aHR of 1.75 (95 % CI: 1.24-2.42) for subsequent HF, while patients with T1D and neuropathy had an aHR of 1.73 (95 %: 1.09-2.75), when compared with patients without diabetes). For fractures other than HF, the 2-year incidence rates were 7.3 % (95 % CI: 7.2-7.5) for patients without diabetes, 6.6 % (95 % CI: 6.1-7.1) for T2D, and 8.5 % (95 % CI: 7.0-10.1) for T1D, with corresponding aHRs of 1.01 (95 % CI 0.92-1.11) for T2D and 1.43 (95 % CI: 1.16-1.78) for T1D. T2D was only a risk factor for other subsequent fractures among HF patients of high age (age 86-89 years: aHR 1.22 (95 % CI 0.99-1.55), age 90+ years: aHR 1.37 (95 % CI 1.08-1.74)), whereas T1D was robustly associated with increased risk of fractures other than HF in all subgroups. CONCLUSION Among HF patients, we found no strong overall association of T2D or T1D with increased risk of subsequent HF, but diabetes patients with prior hypoglycemic events or neuropathy were at increased risk. In contrast, patients with T1D had a clearly increased risk of subsequent fractures other than HF.
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Affiliation(s)
- Dennis Vinther
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
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Han S, Kim S, Yeh EJ, Suh HS. Understanding the long-term impact of incident osteoporotic fractures on healthcare utilization and costs in Korean postmenopausal women. Osteoporos Int 2024; 35:339-352. [PMID: 37878064 DOI: 10.1007/s00198-023-06934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
This study provides long-term evidence that healthcare resource utilization and costs of care in women who experienced incident osteoporotic fractures remained higher than those in women without fractures over a span of 5 years. These findings emphasize the importance of early diagnostics and treatment for osteoporosis. PURPOSE To evaluate healthcare resource utilization (HCRU) and costs of care over 5 years after the incident osteoporotic fractures (OF) in postmenopausal women. METHODS We used data from the National Health Insurance Service databases 2011-2018. Women aged ≥ 50 years with incident OF (OF group) were matched to women without OF (non-OF group). HCRU (inpatient, outpatient, and emergency room [ER] visits) and costs of care (inpatient, outpatient, and ER visits) during the 5-year follow-up period were derived after propensity score matching (PSM). Additionally, we identified women with subsequent fractures within the first 2 years after the incident OF. RESULTS After PSM, 47,238 OF and 134,813 non-OF women were identified. HCRU rates and costs of care were highest in the first year after OF and decreased substantially, but remained higher in the OF group during the entire follow-up period. The increase in cumulative HCRU rates over 5 years was highest in inpatient admissions with ER visits (138% higher in OF vs non-OF). The cumulative total costs over 5 years were 73% higher in the OF group than in the non-OF group, which was mostly driven by inpatient costs. Trends were similar for women with subsequent fractures, but they generally showed higher HCRU and costs than those in the total OF group. CONCLUSION OF imposes a substantial and sustained economic burden on women, resulting in an approximately twofold increase in the cumulative cost over 5 years compared to women without fracture, which highlights the need for early diagnostics and treatment of osteoporosis.
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Affiliation(s)
- S Han
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - S Kim
- College of Pharmacy, Woosuk University, Wanju-gun, Jeollabuk-do, South Korea
| | - E J Yeh
- Amgen Inc., Thousand Oaks, CA, USA
| | - H S Suh
- College of Pharmacy, Kyung Hee University, Seoul, South Korea.
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul, South Korea.
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, South Korea.
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Mai H, Mc Evoy L, Wilson C, Marov L, Kelly A, Haddad CE, Chroinin DN, Hassett G, Frost SA. Frailty and risk of subsequent fracture among older adults presenting to hospital with a minimal trauma fracture. Osteoporos Int 2023; 34:399-404. [PMID: 36472657 DOI: 10.1007/s00198-022-06630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
UNLABELLED We investigated frailty and refracture risk among older adults with a minimal trauma fracture. After adjusting for age, sex, and site of initial fracture, increasing frailty was associated with an increased risk subsequent fracture. These results indicate the need to routinely screen for frailty following an initial fracture among older adults. INTRODUCTION Minimal trauma fractures are common among older adults, and frailty increases risk of an initial minimal trauma fracture. This study was undertaken to estimate the risk of subsequent fracture based on frailty status at the time of an initial fracture. METHODS The study population was older adults presenting to hospital, aged 60 years or more, with a minimal trauma fracture. Frailty was estimated using a cumulative deficit approach. The risk of subsequent fracture based on increasing cumulative frailty deficit item group, adjusted for sex, age, and site of initial fracture, was estimated using Cox's proportional hazard model. RESULTS Between January 2014 and December 2020, 12,115 older adults presented to hospital (8371 women [69%]), with an initial minimal trauma fracture. The average age was 80 years (SD 9.5). Subsequent fractures identified during the follow-up period occurred in 1137 (9.4%) of study participants. The incidence of subsequent fracture ranged from 25.0 per 1000 older adults (95% confidence interval (CI) 22.4 to 27.8) among the lowest frailty deficit group (1 deficit item) to 31.8 per 1000 (95% CI 28.0 to 35.8) among the highest frailty deficit group (4 to 12 deficit items). After adjusting for age, sex, and site of initial fracture, an increasing number of frailty deficit items was associated with increased risk subsequent fracture (p-value for trend = 0.008). CONCLUSION Our results indicate that following an initial minimal trauma fracture, frailty independently increases the risk of a subsequent fracture. Therefore, it is important at the time of an initial fracture that older women and men are screened for the presence of frailty, and models of care are implemented to reduce the risk of subsequent fracture among this vulnerable group of older adults.
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Affiliation(s)
- Ha Mai
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, 1-3 Campbell Street Liverpool, Liverpool, 2170, Australia
| | | | - Carol Wilson
- Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - Lynda Marov
- Campbelltown Hospital, Campbelltown, Australia
| | - Ayano Kelly
- Liverpool Hospital, Liverpool, Australia
- SPHERE MSK Clinical Academic Group, Sydney, Australia
| | - Carlos El Haddad
- Liverpool Hospital, Liverpool, Australia
- SPHERE MSK Clinical Academic Group, Sydney, Australia
- South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Danielle Ni Chroinin
- Liverpool Hospital, Liverpool, Australia
- South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Geraldine Hassett
- Liverpool Hospital, Liverpool, Australia
- SPHERE MSK Clinical Academic Group, Sydney, Australia
- South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Steven A Frost
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, 1-3 Campbell Street Liverpool, Liverpool, 2170, Australia.
- Liverpool Hospital, Liverpool, Australia.
- SPHERE MSK Clinical Academic Group, Sydney, Australia.
- University of Wollongong, Wollongong, Australia.
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Whitney DG, Clines GA, Leis AM, Caird MS, Hurvitz EA. Five-year risk of fracture and subsequent fractures among adults with cerebral palsy. Bone Rep 2022; 17:101613. [PMID: 36052289 PMCID: PMC9424353 DOI: 10.1016/j.bonr.2022.101613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Epidemiologic evidence documenting the incidence of fracture and subsequent fractures among adults with cerebral palsy (CP) is lacking, which could inform fracture prevention efforts. The objective was to characterize the 5-year rate of initial and subsequent fragility fractures among adults with CP. Methods This retrospective cohort study used Medicare claims from 01/01/2008–12/31/2019 from adults ≥18 years old with CP (n = 44,239) and elderly ≥65 years old without CP (n = 2,176,463) as a comparison. The incidence rate (IR), IR ratio (IRR), and site distribution were estimated for the initial and subsequent fragility fractures over 5-years by sex and age. Results The IR of fragility fracture at any site over the 5-year follow-up was similar for 18–30-year-old men with CP (IR = 5.2; 95%CI = 4.4–5.9) and 30–34-year-old women with CP (IR = 6.3; 95%CI = 5.3–7.2) compared to the same sex youngest-old (65–74 years old) without CP (IRR = 1.09 and 0.94, respectively, both P > 0.05), and increased with older age for those with CP. The number of fragility fractures and IR of subsequent fragility fractures was similar for young men and middle-aged women with CP compared to elderly without CP, and increased with older age for those with CP. The proportion of fragility fracture at the tibia/fibula decreased while the vertebral column and multiple simultaneous sites (most involved hip/lower extremities) increased with older age. Conclusion Young and middle-aged adults with CP had similar-to-worse initial and subsequent fragility fracture profiles compared to the general elderly population- a well characterized group for bone fragility. Findings emphasize the need for fracture prevention efforts at younger ages for CP, possibly by ~5 decades younger. Fracture prevention efforts are focused on the elderly and postmenopausal women. Fragility fracture risk is elevated for those with CP across the adult lifespan. For men, the risk for 18–29 year olds (CP) was on par with 65–74 year olds (no CP). For women, risk for 30–34 year olds (CP) was on par with 65–74 year olds (no CP). CP had a higher risk of subsequent fragility fractures that was also premature.
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Affiliation(s)
- Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Corresponding author at: Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI, USA.
| | - Gregory A. Clines
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Endocrinology Section, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
| | - Aleda M. Leis
- Epidemiology Department, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S. Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Edward A. Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Fujiwara S, Buchanan-Hughes A, Ng A, Page J, Adachi K, Li H. Real-world evaluation of osteoporotic fractures using the Japan Medical Data Vision database. Osteoporos Int 2022; 33:2205-2216. [PMID: 35779100 DOI: 10.1007/s00198-022-06472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
UNLABELLED In Japanese patients who experienced an osteoporotic fracture, 10.8% and 18.6% had a subsequent fracture within 1 and 2 years of follow-up, respectively. Although the burden of hip and vertebral fractures has been reported widely, we found that patients with non-hip non-vertebral (NHNV) fractures had a 26% higher risk of subsequent fracture than patients with hip fractures; therefore, NHNV fractures should also be considered an important risk factor for subsequent fracture. INTRODUCTION To investigate imminent risk and odds of subsequent osteoporotic fractures and associated risk factors in patients who experienced an initial osteoporotic fracture. METHODS Patients aged ≥ 50 years with ≥ 1 osteoporotic fracture were analyzed from Japan's Medical Data Vision (MDV) database of claims from acute-care hospitals (January 2012-January 2017). Multivariable models were constructed to explore the impact of key comorbidities and medications on the subsequent fracture risk: Cox proportional hazards model for time to subsequent fracture and logistic regression models for odds of subsequent fracture within 1 and 2 years from index fracture. RESULTS In total, 32,926 patients were eligible with a median follow-up duration of 12.3 months. The percentage of patients experiencing subsequent fractures was 14.1% across the study duration, and 10.8% and 18.6% in patients with 1 and 2 years of follow-up, respectively. In the Cox proportional hazards model, patients with vertebral or NHNV index fractures had a higher subsequent fracture risk than patients with a hip index fracture (adjusted hazard ratio [aHR] 1.11 and 1.26, respectively); subsequent fracture risk was lower in males than females (aHR 0.89). Patients with baseline claims for tranquilizers and glucocorticoids had a higher subsequent fracture risk than those without (aHR 1.14 and 1.08, respectively). Additionally, baseline claims for anti-Parkinson's medications, alcoholism, and stage 4/5 chronic kidney disease were significantly associated with higher odds of subsequent fracture in the logistic regression models. CONCLUSION Several clinical and demographic factors were associated with a higher risk and odds of subsequent fracture. This may help to identify patients who should be prioritized for osteoporosis treatment.
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Affiliation(s)
| | | | - Alvin Ng
- Costello Medical, Singapore, Singapore
| | | | | | - Hong Li
- Amgen Asia Holding Limited, Hong Kong, China
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Lim EJ, Lee S, Kim JK, Kim H, Shin YH. The risk factors for subsequent fractures after distal radius fracture. J Bone Miner Metab 2022; 40:853-859. [PMID: 35941252 DOI: 10.1007/s00774-022-01355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the risk factors for subsequent fractures after distal radius fracture (DRF). MATERIALS AND METHODS We retrospectively reviewed 705 patients with DRF who performed dual-energy X-ray absorptiometry within six months before or after the DRF and followed more than 12 months. We identified patients with subsequent fractures and multivariate logistic regression analyses were conducted with demographic information, underlying disease status, and bone fragility parameters at the time of DRF to evaluate the risk factors for subsequent fractures. RESULTS Subsequent fractures occurred in 56 patients (7.9% of 705 patients) with 65 fractures at a mean time of 33.5 months after DRF. In multivariate logistic regression analysis, older age (OR 1.032; 95% CI, 1.001-1.064, p = 0.044), diabetes mellitus (DM) (OR 2.663; 95% CI, 1.429-4.963, p = 0.002) and previous fracture history (OR 1.917; 95% CI, 1.019-3.607, p = 0.043), and low total hip BMD (OR 1.410; 95% CI, 1.083-1.836, p = 0.011) were significant risk factors for the occurrence of subsequent fractures. CONCLUSION This study demonstrated that older age, DM, previous fracture history and low hip BMD are the risk factors for subsequent fractures after DRF. Active glycemic control would have a role in patients with DM and a more aggressive treat-to-target approach may be necessary for patients with low BMDs to prevent subsequent fractures after DRF.
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Affiliation(s)
- Eic Ju Lim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776 1sunhwan-ro, Seowon-gu, Cheongju, South Korea
| | - Sunhyung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Huijeong Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Chen JL, Tai TW, Chou CY, Ku CK, Chien LN, Huang TW, Tang CH. Incidence of different types of subsequent fractures and related mortality in Taiwan. Arch Osteoporos 2022; 17:55. [PMID: 35364728 DOI: 10.1007/s11657-022-01098-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/15/2022] [Indexed: 02/03/2023]
Abstract
Hip fracture is the most common type of fracture to occur within 2 years after an initial fracture. Mortality risk increases when a subsequent fracture occurs. The occurrence of subsequent fracture is significantly higher in patients with hip fractures than others. Prevention of subsequent fracture is of paramount important. PURPOSE Osteoporotic fracture significantly increases risk of subsequent fracture. In this retrospective cohort study, we used the Taiwan National Health Insurance Database (NHIRD) to analyze data on fractures in a group at high risk of osteoporosis. We aimed to distinguish differences in subsequent fracture types and their relationship with mortality. METHODS We enrolled patients aged ≥ 50 years old who were diagnosed with an initial fracture classified as hip, vertebral, upper end of the humerus, or wrist. Data from 2 years of follow-up were analyzed. Risks of subsequent fracture events and mortality were calculated by Kaplan-Meier estimation and assessed with Cox proportional hazards models. RESULTS We included 375,836 patients from the 2011-2015 NHIRD. Patients with initial hip fracture had the highest incidence of subsequent fracture at both 1- and 2-year follow-up (7.0% and 10.9%). Subsequent fractures occurred mainly at the hip. Conversely, other patients had a higher proportion of subsequent vertebral fracture. Patients with subsequent fracture classified as hip, vertebral, and upper end of the humerus had significantly higher cumulative mortality rates than that of patients who had no subsequent fracture, with adjusted hazard ratios of 1.64 (95% CI = 1.57-1.71, p < 0.01), 1.06 (95% CI = 1.00-1.12, p = 0.04), 1.31 (95% CI = 1.17-1.46, p < 0.01), respectively. CONCLUSION Patients who experienced an initial hip fracture are at greatest risk of subsequent fracture, most commonly the hip. Occurrence of subsequent fractures was associated with an increased mortality risk. Thus, there is a need for early intervention following initial hip fractures.
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Affiliation(s)
- Jiun-Liang Chen
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi, Taiwan
| | - Ta-Wei Tai
- Department of Orphopedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Asia University Hospital, Wufeng, Taichung, Taiwan
| | - Chieh-Ko Ku
- Medical Affairs, Amgen Taiwan, Taipei, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Wen Huang
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi, Taiwan. .,Department of Orthopedic Surgery, Jen-Ai Hospital, Taichung, Taiwan.
| | - Chao-Hsuin Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
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Adams AL, Ryan DS, Li BH, Williams SA, Wang Y, Weiss RJ, Black DM. Outcomes post fragility fracture among members of an integrated healthcare organization. Osteoporos Int 2022; 33:783-790. [PMID: 34686906 PMCID: PMC8930877 DOI: 10.1007/s00198-021-06205-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study highlights an unmet need in osteoporosis management, suggesting that beyond bone mineral density and fracture history, gender, fracture type, and age should be considered for fracture risk assessment. Following fragility fracture, men, patients with a spine or hip fracture, and those aged ≥ 65 have a higher disease burden. INTRODUCTION The objective of this study was to characterize osteoporosis-related fracture incidence and identify predictors of subsequent fractures and mortality. METHODS This retrospective cohort study, conducted within Kaiser Permanente Southern California, included patients aged ≥ 50 years with qualifying fractures from 1/1/2007 to 12/31/2016, identified from diagnosis/procedure codes. Rates for fracture incidence, mortality, and resource utilization in the year post-fracture are reported. Associations between index fracture types and demographic/clinical characteristics, and mortality, subsequent fracture, and rehospitalization outcomes were estimated. RESULTS Of 63,755 eligible patients, 66.7% were ≥ 65 years and 69.1% female. Index fractures included nonhip/nonspine (64.4%), hip (25.3%), and spine (10.3%). Age-adjusted subsequent fracture rate/100 person-years was higher for those with an index spine (14.5) versus hip fracture (6.3). Hospitalization rate/100 person-years was highest for patients ≥ 65 (31.8) and for spine fractures (43.5). Men (vs women) had higher age-adjusted rates of hospitalization (19.4; 17.7), emergency room visits (73.8; 66.3), and use of rehabilitation services (31.7; 27.2). The 30-day age-adjusted mortality rate/100 person-years was 46.7, 32.4, and 15.5 for spine, hip, and nonspine/nonhip fractures. The 1-year age-adjusted mortality rate/100 person-years was 14.7 for spine and 15.6 for hip fractures. In multivariable analyses, spine and hip fractures (vs nonhip/nonspine fractures) were significant predictors of 1-year mortality, all-cause and osteoporosis-related hospitalization, and nursing home use (all P-values < 0.0001). CONCLUSION Morbidity is high in the year following a fragility fracture and men, patients with a spine or hip fracture, and those aged ≥ 65 have a greater disease burden.
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Affiliation(s)
- Annette L Adams
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Denison S Ryan
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Bonnie H Li
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Setareh A Williams
- Health Economics and Outcomes Research, Global Medical Affairs, Radius Health, Inc., 22 Boston Wharf Road, 7th Floor, Boston, MA, 02210, USA.
| | - Yamei Wang
- Biostatistics, Radius Health, Inc., Boston, MA, USA
| | - Richard J Weiss
- Health Economics and Outcomes Research, Global Medical Affairs, Radius Health, Inc., 22 Boston Wharf Road, 7th Floor, Boston, MA, 02210, USA
| | - Dennis M Black
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- University of California, San Francisco, San Francisco, CA, USA
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Morin SN, Yan L, Lix LM, Leslie WD. Long-term risk of subsequent major osteoporotic fracture and hip fracture in men and women: a population-based observational study with a 25-year follow-up. Osteoporos Int 2021; 32:2525-2532. [PMID: 34165587 DOI: 10.1007/s00198-021-06028-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED The risk of subsequent major osteoporotic and hip fracture following an initial fracture was increased in both sexes over 25 years, with modest time-dependent attenuation. This risk was highest in men, underscoring the importance of targeted treatment strategies particularly in this under-treated population. INTRODUCTION The risk of subsequent fractures is increased following an index fracture, and declines over time. We aimed to determine whether this risk was sustained over 25 years and evolved similarly in men and women. METHODS Using population-based databases, we performed a matched cohort study in 16,876 men and 39,230 women ≥ 50 years who sustained an index fracture during 1989-2006. Rates of subsequent major osteoporotic fractures (MOF) and hip fractures until 2016 were compared to rates for matched controls (n = 160,983). Age- and sex-stratified cumulative incidences to 25 years were estimated in the presence of competing mortality. Hazard ratios (HRs) with 95% confidence intervals (CI) for subsequent fractures were estimated for each on the first 15 years of follow-up with a final category ≥ 15 years, adjusted for comorbidities. RESULTS Risk for MOF and hip fractures remained elevated up to 25 years in both sexes. The cumulative incidence of fractures was higher in cases vs controls in both sexes and across all age categories except in those > 90 years. Crude rate ratios for subsequent MOF were 2.5 (95% CI 2.3-2.7) in men and 1.6 (95% CI 1.6-1.7) in women and were higher in the younger age groups. Adjusted HRs (aHRs) for subsequent MOF were higher in men than in women in the first year (men aHR 2.6, 95% CI 2.1-3.3; women aHR 1.6, 95% CI 1.4-1.7). CONCLUSIONS The risk of subsequent fractures following an initial fracture was increased over 25 years and the magnitude of risk was initially greater in men than in women.
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Affiliation(s)
- S N Morin
- McGill University Health Centre Research Institute, 5252 de Maisonneuve Ouest, 3E.11 , Montréal, Québec, H4A 3S5, Canada.
| | - L Yan
- University of Manitoba, Winnipeg, Canada
| | - L M Lix
- University of Manitoba, Winnipeg, Canada
| | - W D Leslie
- University of Manitoba, Winnipeg, Canada
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Li N, Hiligsmann M, Boonen A, van Oostwaard MM, de Bot RTAL, Wyers CE, Bours SPG, van den Bergh JP. The impact of fracture liaison services on subsequent fractures and mortality: a systematic literature review and meta-analysis. Osteoporos Int 2021; 32:1517-1530. [PMID: 33829285 PMCID: PMC8376729 DOI: 10.1007/s00198-021-05911-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/03/2021] [Indexed: 12/29/2022]
Abstract
UNLABELLED This systematic review and meta-analysis suggests that fracture liaison service (FLS) is associated with a significantly lower probability of subsequent fractures and mortality although the latter was only found in studies comparing outcomes before and after the introduction of an FLS. INTRODUCTION To systematically review and evaluate the impact of fracture liaison services (FLSs) on subsequent fractures and mortality using meta-analysis. METHODS A literature search was performed within PubMed and Embase to identify original articles published between January 1, 2010, and April 30, 2020, reporting the effect of FLSs on subsequent fractures and/or mortality. Only studies comparing FLS to no-FLS were included. A meta-analysis using random-effects models was conducted. The quality of studies was appraised after combining and modifying criteria of existing quality assessment tools. RESULTS The search retrieved 955 published studies, of which 16 studies fulfilled the inclusion criteria. Twelve studies compared outcomes before (pre-FLS) and after (post-FLS) FLS implementation, two studies compared outcomes between hospitals with and without FLS, and two other studies performed both comparisons. In total, 18 comparisons of FLS and no-FLS care were reported. Follow-up time varied from 6 months to 4 years. Sixteen comparisons reported on subsequent fractures and 12 on mortality. The quality assessment revealed methodological issues in several criteria. Excluding studies with very high selection bias, the meta-analysis of nine comparisons (in eight papers) revealed that the FLS care was associated with a significantly lower probability of subsequent fractures (odds ratio: 0.70, 95% CI: 0.52-0.93, P=0.01). In studies with a follow-up > 2 years, a significantly lower probability of subsequent fractures was captured for FLS care (odds ratio: 0.57, 95% CI: 0.34-0.94, P=0.03), while in studies ≤ 2 years, there was no difference in the odds of subsequent fractures. No significant difference in the odds of mortality was observed (odds ratio: 0.73, 95% CI: 0.49-1.09, P=0.12) in the meta-analysis of eight comparisons (in seven papers). However, a significantly lower probability of mortality was identified in the six pre-post FLS comparisons (odds ratio: 0.65, 95% CI: 0.44-0.95, P=0.03), but not in studies comparing hospitals with and without FLS. No difference was observed in mortality stratified by follow-up time. CONCLUSION This systematic review and meta-analysis suggests that FLS care is associated with a significantly lower probability of subsequent fractures and mortality although the latter was only found in studies comparing outcomes before and after the introduction of an FLS. The quality assessment revealed that some important methodological issues were unmet in the currently available studies. Recommendations to guide researchers to design high-quality studies for evaluation of FLS outcomes in the future were provided.
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Affiliation(s)
- N Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - M M van Oostwaard
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R T A L de Bot
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Orthopaedics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S P G Bours
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine, University Hasselt, Hasselt, Belgium
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11
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Park SM, Go SJ, Han H, Park JW, Lee YK, Kim HJ, Yeom JS, Koo KH. Risk factors for subsequent vertebral fractures following a previous hip fracture. J Bone Miner Metab 2021; 39:193-200. [PMID: 32683499 DOI: 10.1007/s00774-020-01133-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/12/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of our study was to evaluate the incidence and to identify risk factors of subsequent vertebral fractures after hip fractures, and to determine whether the subsequent vertebral fracture increases the mortality rate of elderly hip fracture patients. MATERIALS AND METHODS From January 2009 to July 2016, 1,554 patients were diagnosed as having a hip fracture and were treated surgically at our institution. Among them, 1121 patients age > 50 years at the time of injury and were followed up for 1 year or longer after the hip fracture surgery. In these patients, radiographs of the hip and spine were taken at each follow-up. We reviewed medical records and radiographs of these patients. Among the 1121 patients, 107 patients (9.5%) had subsequent vertebral fractures after the hip fracture during entire follow-up periods. RESULTS In multivariable analysis, previous history of vertebral fracture [odds ratio (OR), 2.62; p < 0.001], medication possession rate (MPR) of osteoporosis treatment < 80% (OR, 1.92; p = 0.014), and a lower lumbar bone mineral density (BMD) (OR, 2.58; p = 0.001) appeared as risk factors for subsequent vertebral fractures. CONCLUSION However, the subsequent vertebral fractures did not affect the mortality after the hip fractures. Age ≥ 70 years [hazard ration (HR) 2.70; p = .039], body mass index < 18.5 kg/m2 (HR, 2.57; p =0 .048), and Charlson comorbidity index ≥ 2 (HR, 2.04; p =0.036) were risk factors of the death. Timely management is warranted to prevent subsequent vertebral fractures in hip fracture patients with risk factors.
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Affiliation(s)
- Sang-Min Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Sung Jun Go
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Heesoo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Jung Wee Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea.
| | - Ho-Joong Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Jin S Yeom
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
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12
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de Vries BCS, Hegeman JH, Nijmeijer W, Geerdink J, Seifert C, Groothuis-Oudshoorn CGM. Comparing three machine learning approaches to design a risk assessment tool for future fractures: predicting a subsequent major osteoporotic fracture in fracture patients with osteopenia and osteoporosis. Osteoporos Int 2021; 32:437-449. [PMID: 33415373 DOI: 10.1007/s00198-020-05735-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
UNLABELLED Four machine learning models were developed and compared to predict the risk of a future major osteoporotic fracture (MOF), defined as hip, wrist, spine and humerus fractures, in patients with a prior fracture. We developed a user-friendly tool for risk calculation of subsequent MOF in osteopenia patients, using the best performing model. INTRODUCTION Major osteoporotic fractures (MOFs), defined as hip, wrist, spine and humerus fractures, can have serious consequences regarding morbidity and mortality. Machine learning provides new opportunities for fracture prediction and may aid in targeting preventive interventions to patients at risk of MOF. The primary objective is to develop and compare several models, capable of predicting the risk of MOF as a function of time in patients seen at the fracture and osteoporosis outpatient clinic (FO-clinic) after sustaining a fracture. METHODS Patients aged > 50 years visiting an FO-clinic were included in this retrospective study. We compared discriminative ability (concordance index) for predicting the risk on MOF with a Cox regression, random survival forests (RSF) and an artificial neural network (ANN)-DeepSurv model. Missing data was imputed using multiple imputations by chained equations (MICE) or RSF's imputation function. Analyses were performed for the total cohort and a subset of osteopenia patients without vertebral fracture. RESULTS A total of 7578 patients were included, 805 (11%) patients sustained a subsequent MOF. The highest concordance-index in the total dataset was 0.697 (0.664-0.730) for Cox regression; no significant difference was determined between the models. In the osteopenia subset, Cox regression outperformed RSF (p = 0.043 and p = 0.023) and ANN-DeepSurv (p = 0.043) with a c-index of 0.625 (0.562-0.689). Cox regression was used to develop a MOF risk calculator on this subset. CONCLUSION We show that predicting the risk of MOF in patients who already sustained a fracture can be done with adequate discriminative performance. We developed a user-friendly tool for risk calculation of subsequent MOF in patients with osteopenia.
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Affiliation(s)
- B C S de Vries
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.
| | - J H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - W Nijmeijer
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands
| | - J Geerdink
- Department of Information & Organization, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - C Seifert
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - C G M Groothuis-Oudshoorn
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
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Adachi JD, Brown JP, Schemitsch E, Tarride JE, Brown V, Bell AD, Reiner M, Packalen M, Motsepe-Ditshego P, Burke N, Slatkovska L. Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada. BMC Musculoskelet Disord 2021; 22:224. [PMID: 33637078 PMCID: PMC7908684 DOI: 10.1186/s12891-021-04051-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The secondary fracture prevention gap in the osteoporosis field has been previously described as a 'crisis'. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1-2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures. METHODS This retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged > 65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized. RESULTS Among 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555 days (interquartile range: 236-955). For each index fracture site examined, median time from index to second fracture was < 2 years. The proportion of patients with BMD assessment was 10.3% ≤1 year prior to and 16.4% ≤1 year post index fracture. The proportion of patients receiving osteoporosis therapy was 29.8% ≤1 year prior, 34.6% ≤1 year post, and 25.9% > 3 years post index fracture. CONCLUSIONS This cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated.
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Affiliation(s)
| | - Jacques P Brown
- CHU de Québec Research Centre and Laval University, Québec, QC, Canada
| | - Emil Schemitsch
- Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health, The Research Institute of St. Joe's Hamilton, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Vivien Brown
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Alan D Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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14
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Lee SB, Park Y, Kim DW, Kwon JW, Ha JW, Yang JH, Lee BH, Suk KS, Moon SH, Kim HS, Lee HM. Association between mortality risk and the number, location, and sequence of subsequent fractures in the elderly. Osteoporos Int 2021; 32:233-241. [PMID: 32820370 DOI: 10.1007/s00198-020-05602-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022]
Abstract
UNLABELLED The mortality risk showed a positive correlation as the number of subsequent fractures increased. Hip fracture showed the greatest association with mortality risk, followed by vertebral fracture. For the combination of hip and vertebral fracture, a hip fracture after a vertebral fracture showed the highest mortality risk. INTRODUCTION It is unclear whether subsequent fractures or a certain location and sequence of subsequent fractures are associated with mortality risk in the elderly. We aimed to investigate the relationship between subsequent fractures and mortality risk. METHODS Using the Korean National Health Insurance Research Database, we analyzed the cohort data of 24,756 patients aged > 60 years who sustained fractures between 2002 and 2013. Cox regression was used to assess the mortality risk associated with the number, locations, and sequences of subsequent fractures. RESULTS Mortality hazard ratios (HRs) for women and men were shown to be associated with the number of subsequent fractures (one, 1.63 (95% confidence interval [CI], 1.48-1.80) and 1.42 (95% CI, 1.28-1.58); two, 1.75 (95% CI, 1.47-2.08) and 2.03 (95% CI, 1.69-2.43); three or more, 2.46(95% CI, 1.92-3.15) and 1.92 (95% CI, 1.34-2.74), respectively). For women, the mortality risk was high when hip (HR, 2.49; 95% CI, 1.80-3.44) or vertebral (HR, 1.40; 95% CI, 1.03-1.90) fracture occurred as a second fracture. Compared with a single hip fracture, there was a high mortality risk in the group with hip fracture after the first vertebral fracture (HR, 2.90; 95% CI, 1.86-4.54), followed by vertebral fracture after the first hip fracture (HR, 1.90; 95% CI, 1.12-3.22). CONCLUSION The mortality risk showed a positive correlation as the number of subsequent fractures increased. Hip fracture showed the greatest association with mortality risk, followed by vertebral fracture. For the combination of hip and vertebral fracture, a hip fracture after a vertebral fracture showed the highest mortality risk.
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Affiliation(s)
- S-B Lee
- Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Republic of Korea
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, 10444, Republic of Korea.
| | - D-W Kim
- Research Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - J-W Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, 10444, Republic of Korea
| | - J-W Ha
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, 10444, Republic of Korea
| | - J-H Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - B H Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - K-S Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S-H Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H-S Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H-M Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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15
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Jung HS, Jang S, Chung HY, Park SY, Kim HY, Ha YC, Lee YK, Nho JH. Incidence of subsequent osteoporotic fractures after distal radius fractures and mortality of the subsequent distal radius fractures: a retrospective analysis of claims data of the Korea National Health Insurance Service. Osteoporos Int 2021; 32:293-299. [PMID: 32876712 DOI: 10.1007/s00198-020-05609-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED A better understanding of the features of subsequent fractures after distal radius fracture (DRF) is important for the prevention of further osteoporotic fractures. This study found that the cumulative incidence of subsequent osteoporotic fractures in South Korea increased over time and that the mortality rates of subsequent DRFs were lower than those of first-time DRFs. INTRODUCTION We examined the incidence of osteoporotic fractures following distal radius fractures (DRFs) and the mortality rate after subsequent DRFs using claims data from the Korea National Health Insurance (KNHI) Service. METHODS We identified records for 41,417 patients with first-time DRFs in 2012. The occurrence of osteoporotic fractures of the spine, hip, wrist, and humerus at least 6 months after the index DRF was tracked through 2016. All fractures were identified by specific diagnosis and procedure codes. One-year mortality rates and standardized mortality ratios (SMRs) for initial and subsequent DRFs were calculated for all patients. RESULTS The 4-year cumulative incidence of all subsequent osteoporotic fractures was 14.74% (6105/41,417; 9.47% in men, 15.9% in women). The number of associated subsequent fractures was 2850 for the spine (46.68%), 2271 for the wrist (37.2%), 708 for the hip (11.6%), and 276 for the humerus (4.52%). The cumulative mortality rate 1 year after the first-time and subsequent DRF was 1.47% and 0.71%, respectively, and the overall SMR was 1.48 (95% CI: 1.37-1.61) and 0.71 (95% CI: 0.42-1.21), respectively. CONCLUSION The cumulative incidence of osteoporotic fractures following DRFs increased over the study period and was higher among women. The cumulative mortality rates and SMRs of subsequent DRFs were lower than those of first-time DRFs at the 1-year follow-up. Given the increasing incidence rate of DRFs, the incidence of subsequent osteoporotic fractures may also increase.
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Affiliation(s)
- H-S Jung
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - S Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - H-Y Chung
- Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - S Y Park
- Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - H-Y Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Y-C Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Y-K Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J-H Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
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16
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Inose H, Kato T, Ichimura S, Nakamura H, Hoshino M, Togawa D, Hirano T, Tokuhashi Y, Ohba T, Haro H, Tsuji T, Sato K, Sasao Y, Takahata M, Otani K, Momoshima S, Takahashi K, Yuasa M, Hirai T, Yoshii T, Okawa A. Risk factors for subsequent vertebral fracture after acute osteoporotic vertebral fractures. Eur Spine J 2021; 30:2698-2707. [PMID: 33515331 DOI: 10.1007/s00586-021-06741-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/18/2020] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the incidence and characteristics of subsequent vertebral fracture after osteoporotic vertebral fractures (OVFs) and identify risk factors for subsequent vertebral fractures. METHODS This post-hoc analysis from a prospective randomized multicenter trial included 225 patients with a 48-week follow-up period. Differences between the subsequent and non-subsequent fracture groups were analyzed. RESULTS Of the 225 patients, 15 (6.7%) had a subsequent fracture during the 48-week follow-up. The annual incidence of subsequent vertebral fracture after fresh OVFs in women aged 65-85 years was 68.8 per 1000 person-years. Most patients (73.3%) experienced subsequent vertebral fractures within 6 months. At 48 weeks, European Quality of Life-5 Dimensions, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire pain-related disorder, walking ability, social life function, and lumbar function scores were significantly lower, while the visual analog scale (VAS) for low back pain was higher in patients with subsequent fracture. Cox proportional hazards analysis showed that a VAS score ≥ 70 at 0 weeks was an independent predictor of subsequent vertebral fracture. After adjustment for history of previous fracture, there was a ~ 67% reduction in the risk of subsequent vertebral fracture at the rigid-brace treatment. CONCLUSION Women with a fresh OVF were at higher risk for subsequent vertebral fracture within the next year. Severe low back pain and use of soft braces were associated with higher risk of subsequent vertebral fractures. Therefore, when treating patients after OVFs with these risk factors, more attention may be needed for the occurrence of subsequent vertebral fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Tsuyoshi Kato
- Department of Orthopaedics, Ome Municipal General Hospital, Tokyo, 198-0042, Japan.,Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Shoichi Ichimura
- Department of Orthopaedics, Kyorin University, Tokyo, 181-8611, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan
| | - Masatoshi Hoshino
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan
| | - Daisuke Togawa
- Department of Orthopaedic Surgery, Hamamatsu University of Medicine, Shizuoka, 431-3192, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University, Tokyo, 173-8610, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, 409-3898, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, 409-3898, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, 108-8642, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume University, Fukuoka, 830-0011, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, Graduate School, School of Medicine, St. Marianna University, Kanagawa, 216-8511, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, 060-8638, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Suketaka Momoshima
- Department of Diagnostic Radiology, Center for Preventive Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Masato Yuasa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
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17
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Shim YB, Park JA, Nam JH, Hong SH, Kim JW, Jeong J, Shin JY. Incidence and risk factors of subsequent osteoporotic fracture: a nationwide cohort study in South Korea. Arch Osteoporos 2020; 15:180. [PMID: 33188505 DOI: 10.1007/s11657-020-00852-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study analyzed the incidence and risk factors of subsequent osteoporotic fractures in South Korea. The results showed that the incidence rate of subsequent fractures within 24 months was 10.23 per 100 person-years. Additionally, the index hip fracture site was a significant risk factor for a subsequent fracture. PURPOSE To identify and analyze the incidence and risk factors of subsequent osteoporotic fractures in South Korea. METHODS This retrospective cohort study analyzed data from the National Health Insurance Review and Assessment claims database from 2012 to 2017. Men and women with osteoporosis, aged ≥50 years, with index fractures between July 1, 2014, and July 1, 2015, were included. The incidence rate of subsequent fractures was calculated by determining the number of second event within 2 years from the index fracture. To identify the risk factors for subsequent fractures, we applied the Cox proportional hazard model to estimate the hazard ratios (HRs). RESULTS Of the 73,717 patients with osteoporotic fractures, 13,203 (17.91%) had a subsequent fracture. The incidence rate of subsequent fractures within 24 months was 10.23/100 person-years. The index fracture site was a significant risk factor for a subsequent fracture, with the hip showing the highest risk (HR, 7.51; 95% confidence interval [CI], 6.77-8.34), followed by the vertebra (HR, 1.99; 95% CI, 1.91-2.06). The risk of subsequent fractures increased with a higher Charlson Comorbidity Index (CCI) score (CCI score ≥ 5: HR, 1.79; 95% CI, 1.67-1.92). CONCLUSION The incidence rate of subsequent osteoporotic fractures in South Korea is similar or higher than that reported in the USA and Europe. A hip fracture within the prior 2 years, relative to other fracture sites, significantly increased the risk of subsequent fractures in osteoporosis patients. Patients who have these risk factors need closer disease management to prevent subsequent fractures.
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Affiliation(s)
- Yoon-Bo Shim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
| | - Jae-A Park
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
| | - Jin Hyun Nam
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
| | - Sung-Hyun Hong
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea. .,Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
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Sun HB, Jing XS, Tang H, Hai Y, Li JJ, Shan JL, Wang DC. Clinical and radiological subsequent fractures after vertebral augmentation for treating osteoporotic vertebral compression fractures: a meta-analysis. Eur Spine J 2020; 29:2576-90. [PMID: 32776263 DOI: 10.1007/s00586-020-06560-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/02/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE This study aimed to identify all relevant randomized controlled trials (RCT) and prospective non-RCTs to further investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent fractures on unoperated levels. METHODS We systematically searched PubMed, EMBASE, Cochrane library, Google Scholar, web of science, and ClinicalTrial.gov from the establishment of the database to January 2020. All eligible studies comparing subsequent fractures after PVA with those after conservative treatment (CT) were incorporated. The pooled risk ratio (RR) with its 95% confidence intervals (95% CIs) was used. Heterogeneity, sensitivity, and publication bias analyses were performed. RESULTS In all, 32 studies were included in the study: 82/512 patients (16.02%) and 58/433 patients (13.39%) had clinical subsequent fractures in the PVA group and CT group, respectively. No significant differences were observed between the two groups [RR = 1.22, 95% CI 0.70-2.12, P = 0.49]. Further, 175/837 patients (20.91%) in the PVA group and 160/828 patients (19.32%) in the CT group had radiological subsequent fractures. No significant difference was observed between groups [RR = 0.91, 95% CI 0.71-2.12, P = 1.16]. Further, no statistical difference was observed on subgroup analysis between RCTs and non-RCTs or PVP and PKP. CONCLUSION Our systematic review revealed that subsequent fractures on unoperated levels were not associated with PVA, regardless of whether they were clinical or radiological subsequent fractures.
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Shin YH, Hong WK, Kim J, Gong HS. Osteoporosis care after distal radius fracture reduces subsequent hip or spine fractures: a 4-year longitudinal study. Osteoporos Int 2020; 31:1471-1476. [PMID: 32300839 DOI: 10.1007/s00198-020-05410-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/03/2020] [Indexed: 01/31/2023]
Abstract
UNLABELLED We evaluated whether active osteoporosis care in patients experiencing their first distal radius fracture (DRF) reduces subsequent hip or spine fractures by comparing two cohorts. The incidence of subsequent fractures was significantly lower in the active care cohort than the other cohort in 4-year follow-up. PURPOSE Studies show that osteoporosis care in patients with osteoporotic fracture reduces subsequent fractures, but the impact of such active care in patients with distal radius fracture (DRF) has not been well studied. We evaluated how much osteoporosis care in patients experiencing their first DRF can reduce subsequent hip or spine fractures at 4-year follow-up. METHODS Active osteoporosis care by orthopedic surgeons for patients with DRF started from September 2009 at our institution, thus we had a unique opportunity to compare the two cohorts: pre-involvement (PreI) group (DRF before September 2009) and post-involvement (PostI) group (DRF from September 2009). We compared the two cohorts for subsequent hip or spine fracture incidence in the 4 years following DRF. RESULTS Overall, 1057 patients with a DRF (85% women; mean age, 70 years) were studied, of whom 205 patients were in PreI group and 852 in PostI group. Subsequent fractures occurred in 27 patients (2.6%), with a mean interval of 29 months after DRF. The incidence was significantly lower in the PostI group than in the PreI group (1.9% vs. 5.4%, p = 0.004), especially in hip fractures (0.4% vs. 2.9%, p = 0.002). The relative risk reduction was 65% for all subsequent fractures and 86% for hip fractures. CONCLUSION This study demonstrates that active osteoporosis care in patients with DRF significantly reduces subsequent fracture incidence even for the 4-year follow-up period. These findings add an evidence for the current proactive osteoporosis care programs such as fracture liaison services. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Y H Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - W K Hong
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173, 82 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, South Korea
| | - J Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - H S Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173, 82 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, South Korea.
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Alarkawi D, Bliuc D, Tran T, Ahmed LA, Emaus N, Bjørnerem A, Jørgensen L, Christoffersen T, Eisman JA, Center JR. Impact of osteoporotic fracture type and subsequent fracture on mortality: the Tromsø Study. Osteoporos Int 2020; 31:119-130. [PMID: 31654084 DOI: 10.1007/s00198-019-05174-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022]
Abstract
UNLABELLED Less is known about the impact of non-hip non-vertebral fractures (NHNV) on early death. This study demonstrated increased risk of dying following hip and NHNV fractures which was further increased by a subsequent fracture. This highlights the importance of early intervention to prevent both initial and subsequent fractures and improve survival. INTRODUCTION Osteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures. METHODS The Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables. RESULTS Of 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73-2.42 in women and 2.49, 95% CI 2.00-3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21-1.84 and 1.81, 95% CI 1.37-2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52-2.35 and 1.77, 95% CI 1.16-2.71), respectively. CONCLUSION Hip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention.
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Affiliation(s)
- D Alarkawi
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia.
| | - D Bliuc
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - T Tran
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - L A Ahmed
- Institute of Public Health, United Arab Emirates University, Al Ain, UAE
| | - N Emaus
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - A Bjørnerem
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - L Jørgensen
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - T Christoffersen
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
- Finnmark Hospital Trust, Hammerfest, Norway
| | - J A Eisman
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Clinical School, St Vincent's Hospital, Sydney, Australia
- School of Medicine Sydney, University of Notre Dame, Sydney, Australia
| | - J R Center
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Clinical School, St Vincent's Hospital, Sydney, Australia
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Sanli I, van Helden SH, Ten Broeke RHM, Geusens P, Van den Bergh JPW, Brink PRG, Poeze M. The role of the Fracture Liaison Service (FLS) in subsequent fracture prevention in the extreme elderly. Aging Clin Exp Res 2019; 31:1105-11. [PMID: 30311093 DOI: 10.1007/s40520-018-1054-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Several guidelines recommend a bone and fall-related osteoporosis risk assessment in all patients with fracture and age > 50 years. In practice, however, there is no consensus whether screening > 85 years is useful. AIM To evaluate the subsequent fracture risk in all patient > 85 years, comparing the two populations of Fracture Liaison Service (FLS) attenders and non-attenders. METHODS All patients > 85 years that presented at the FLS with a non-vertebral fracture were included in the study during a 5-year period (September 2004 and December 2009). Excluded were pathologic fractures, death < 30 days, or patients on osteoporosis treatment. in patients that attended the FLS, assessment of bone mineral density and fall-risk factors were screened. In both the attenders and non-attenders groups, mortality and subsequent fracture rates were scored during a follow-up of 2 years. RESULTS 282 patients fulfilled inclusion criteria for screening, of which 160 (57%) patients did not attend the FLS. 122 patients were screened for osteoporosis and fall-related risk of whom 72 were diagnosed with osteoporosis. Subsequent fracture risk in both groups was 19%. Medical treatment was started in 51 patients, of which 15 patients developed a subsequent fracture. Cox-regression analysis indicated a significantly lower mortality rate, but not a diminished subsequent fracture rate in the FLS screened population compared to the non-attenders. CONCLUSION The advantage of a FLS in reducing subsequent fracture risk in patients > 85 years seems to be limited. In practice a large proportion of these patients are not screened.
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Brozek W, Reichardt B, Zwerina J, Dimai HP, Klaushofer K, Zwettler E. Higher dose but not low dose proton pump inhibitors are associated with increased risk of subsequent hip fractures after first hip fracture: A nationwide observational cohort study. Bone Rep 2019; 10:100204. [PMID: 30993153 PMCID: PMC6451165 DOI: 10.1016/j.bonr.2019.100204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 02/26/2019] [Accepted: 03/30/2019] [Indexed: 12/12/2022] Open
Abstract
Aim To examine the association of proton pump inhibitor (PPI) use with subsequent hip fracture incidence in hip fracture patients, accounting for gender, age, PPI doses, PPI initiation before or after first fracture, and year from first fracture in which the first subsequent fracture occurred. Methods Data from 31,668 Austrian patients ≥50 years with the first hip fracture between July 2008 and December 2010 were analyzed retrospectively. After exclusion of patients on anti-osteoporotic medication, incidence of subsequent hip fractures was compared between users and non-users of PPIs using regression models. Results In general, use of PPIs among hip fracture patients was associated with increased risk for subsequent hip fracture (OR 1.58, 95%-CI 1.25–2.00), in particular in men, in the age group of 70–84 years, and when PPIs were initiated before the first fracture. Low PPI doses of ≤90 cumulative DDDs and ≤0.25 DDDs/day, however, were not linked to elevated subsequent fracture risk, especially among female patients. Subsequent hip fracture incidence was elevated within the first year after first fracture in female and male PPI users (OR 1.75, 95%-CI 1.28–2.38) and dropped in women but not in men in the second year. Conclusions Low-dose PPI use is not associated with increased risk of subsequent hip fractures, especially in women. Patients thus get most benefit of short-term PPI use after a hip fracture that has previously been linked to lowered mortality if low doses are not exceeded. Varying risk profiles for the time of subsequent hip fracture could have implications for risk group-specific follow-up care. PPI users were at particularly high risk of subsequent hip fracture within the first year after first fracture Use of proton pump inhibitors (PPIs) was generally associated with increased risk of subsequent hip fractures Low PPI doses ≤90 DDDs and ≤0.25 DDDs/day were not associated with increased subsequent hip fractures, particularly in women Short-term PPI use at low doses has positive effects on survival after hip fracture as demonstrated recently
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Affiliation(s)
- Wolfgang Brozek
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria
| | - Berthold Reichardt
- Sickness Fund Burgenland, Burgenländische Gebietskrankenkasse, Siegfried Marcus Str. 5, 7000 Eisenstadt, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria
| | - Hans Peter Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria
| | - Elisabeth Zwettler
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of the WGKK and AUVA Trauma Center, 1 Medical Department at Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria
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Kim J, Jang SB, Kim SW, Oh JK, Kim TH. Clinical effect of early bisphosphonate treatment for pyogenic vertebral osteomyelitis with osteoporosis: An analysis by the Cox proportional hazard model. Spine J 2019; 19:418-429. [PMID: 30172897 DOI: 10.1016/j.spinee.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients with pyogenic vertebral osteomyelitis (PVO) are expected to have an increased risk of bone loss. Therefore, early bisphosphonate therapy would be clinically effective for PVO patients with osteoporosis. PURPOSE This study aimed to investigate the effect of bisphosphonate on clinical outcomes of PVO patients with osteoporosis. STUDY DESIGN/SETTING A retrospective comparative study. PATIENT SAMPLE PVO patients with osteoporosis. OUTCOME MEASURES Four events of interest for Cox proportional hazard model included surgical treatment, recurrence of infection, subsequent fracture of adjacent vertebral bodies, and death. METHODS PVO patients were divided into three groups: group A (initiation of bisphosphonate within 6 weeks after PVO diagnosis), group B (initiation of bisphosphonate between 6 weeks and 3 months after PVO diagnosis), and group C (no treatment for osteoporosis). Cox proportional hazard model was used for the four events of interest. RESULTS A total of 360 PVO patients with osteoporosis were investigated for the four events of interest. Group A had significantly lower hazard ratios for undergoing later (>6 weeks after diagnosis) surgery than group C (p = .014) despite similar occurrences of overall surgery. A significant difference was also observed in the occurrence of subsequent fractures at adjacent vertebral bodies (p = .001 for model 1 and p = .002 for model 2). Groups A and B had significantly lower hazard ratios for subsequent fracture than group C. No significant differences were observed in the hazard ratios of recurrence and death among the three groups. CONCLUSIONS Early bisphosphonate treatment in PVO patients with osteoporosis was associated with a significantly lower occurrence of subsequent vertebral fracture at adjacent vertebral bodies and lower occurrence of subsequent surgery.
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Affiliation(s)
- Jihye Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Seung Bo Jang
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang, Gyeonggi-Do 431-070, South Korea
| | - Seok Woo Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang, Gyeonggi-Do 431-070, South Korea
| | - Jae-Keun Oh
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang, Gyeonggi-Do 431-070, South Korea
| | - Tae-Hwan Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang, Gyeonggi-Do 431-070, South Korea.
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Kendler DL, Chines A, Brandi ML, Papapoulos S, Lewiecki EM, Reginster JY, Muñoz Torres M, Wang A, Bone HG. The risk of subsequent osteoporotic fractures is decreased in subjects experiencing fracture while on denosumab: results from the FREEDOM and FREEDOM Extension studies. Osteoporos Int 2019; 30:71-78. [PMID: 30244369 PMCID: PMC6331737 DOI: 10.1007/s00198-018-4687-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
Abstract
UNLABELLED This post-hoc analysis queried whether women experiencing fracture on denosumab indicates inadequate treatment response or whether the risk of subsequent fracture remains low with continuing denosumab. Results showed that denosumab decreases the risk of subsequent fracture and fracture sustained while on denosumab is not necessarily indicative of inadequate treatment response. INTRODUCTION This analysis assessed whether a fracture sustained during denosumab therapy indicates inadequate treatment response and if the risk of a subsequent fracture decreases with continuing denosumab treatment. METHODS In FREEDOM, a clinical trial to evaluate the efficacy and safety of denosumab, postmenopausal women with osteoporosis were randomized to placebo or denosumab for 3 years. In the 7-year FREEDOM Extension, all participants were allocated to receive denosumab. Here we compare subsequent osteoporotic fracture rates between denosumab-treated subjects during FREEDOM or the Extension and placebo-treated subjects in FREEDOM. RESULTS During FREEDOM, 438 placebo- and 272 denosumab-treated subjects had an osteoporotic fracture. Exposure-adjusted subject incidence per 100 subject-years was lower for denosumab (6.7) vs placebo (10.1). Combining all subjects on denosumab from FREEDOM and the Extension for up to 10 years (combined denosumab), 794 (13.7%) had an osteoporotic fracture while on denosumab. Of these, one or more subsequent fractures occurred in 144 (18.1%) subjects, with an exposure-adjusted incidence of 5.8 per 100 subject-years, similar to FREEDOM denosumab (6.7 per 100 subject-years) and lower than FREEDOM placebo (10.1 per 100 subject-years). Adjusting for prior fracture, the risk of having a subsequent on-study osteoporotic fracture was lower in the combined denosumab group vs placebo (hazard ratio [95% CI]: 0.59 [0.43-0.81]; P = 0.0012). CONCLUSIONS These data demonstrate that denosumab decreases the risk of subsequent fracture and a fracture sustained while on denosumab is not necessarily indicative of inadequate treatment response.
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Affiliation(s)
- D L Kendler
- University of British Columbia, Vancouver, BC, Canada.
| | - A Chines
- Amgen Inc., Thousand Oaks, CA, USA
| | | | - S Papapoulos
- Leiden University Medical Center, Leiden, The Netherlands
| | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | | | | | - A Wang
- Amgen Inc., Thousand Oaks, CA, USA
| | - H G Bone
- Michigan Bone and Mineral Clinic, Detroit, MI, USA
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van de Ven LI, Klop C, Overbeek JA, de Vries F, Burden AM, Janssen PK. Association between use of antidepressants or benzodiazepines and the risk of subsequent fracture among those aged 65+ in the Netherlands. Osteoporos Int 2018; 29:2477-2485. [PMID: 30112636 PMCID: PMC6208956 DOI: 10.1007/s00198-018-4632-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED This is the first study to examine the association between antidepressant and benzodiazepine use following a MOF and risk of subsequent fracture in those 65+. Using national data, drug use following MOF showed that the 1-year fully adjusted risk of subsequent MOF in those on antidepressants was more than doubled. INTRODUCTION We evaluated the association between the use of antidepressants or benzodiazepines and the risk of a subsequent major osteoporotic fracture. METHODS A cohort study was performed using the Dutch PHARMO Database Network. Between 2002 and 2011, a total of 4854 patients sustained a first major osteoporotic fracture after the age of 65 years, of which 1766 sustained a hip fracture. Incidence rates and adjusted hazard ratios were calculated using Cox proportional hazards models. RESULTS Within 1 year following a major osteoporotic fracture, 15% (95% CI 13.7-15.7) and 31% (95% CI 30.1-32.8) of patients were dispensed an antidepressant or benzodiazepine, respectively. Current use of antidepressants in the first year following a major osteoporotic fracture was associated with subsequent fracture (adjusted HR 2.17 (95% CI 1.37-3.43)). Recent and past use of antidepressants were also associated with an increased risk of subsequent fracture. When the complete follow-up period was included, only the current use of antidepressants was associated with subsequent fracture following a major osteoporotic fracture (adjusted HR 1.48; 95% CI 1.06-2.06). Current benzodiazepine use was not associated with an increased risk of fracture within 1 year following a major osteoporotic fracture (adjusted HR 1.18; 95% CI 0.76-1.81) or during the complete follow-up period (adjusted HR 1.18; 95% CI 0.90-1.55). CONCLUSION This study provides evidence that antidepressants should be used with caution following a major osteoporotic fracture. It provides needed insights that can be used to inform clinicians when assessing subsequent fracture risk in patients.
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Affiliation(s)
- L I van de Ven
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C Klop
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - F de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - A M Burden
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zürich, Zürich, Switzerland
| | - P K Janssen
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Departments of Hospital Pharmacy and Intensive Care, VieCuri Medical Center, Venlo, The Netherlands
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Kim HS, Ju CI. Spinal Instability Predictive Scoring System for Subsequent Fracture After Bone Cement Augmentation in Patients with Osteoporotic Vertebral Compression Fracture. World Neurosurg 2017; 106:736-745. [PMID: 28735136 DOI: 10.1016/j.wneu.2017.07.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Bone cement augmentation procedures (vertebroplasty and kyphoplasty) are the primary treatments for osteoporotic vertebral compression fracture (VCF). However, these procedures are associated with various problems resulting in subsequent fracture. The purpose of this study was to evaluate the spinal instability factors related to subsequent fracture after vertebral augmentation procedures. METHODS We retrospectively reviewed patients who underwent augmentation procedures for osteoporotic VCF. Between May 2011 and November 2014, 285 patients (vertebroplasty, n = 231; kyphoplasty, n = 54) were enrolled. Subsequent fractures were classified into 4 types based on the fracture patterns: 1) no subsequent fracture, 2) neofracture, 3) hammer fracture (new vertebral fractures involving another vertebra without a definitive history of trauma), and 4) kyphotic compression fracture. We analyzed subsequent fracture patterns and their occurrence rates according to factors that may induce subsequent fracture and developed a predictive scoring system with respect to the hammer fracture occurrence rate. We classified all cases into 4 groups (A,B,C,D) according to Spinal Instability Predictive Scoring System score. Groups A, B, C, and D were defined by total scores of 0∼5, 6∼10, 11∼15, and 16∼20, respectively. RESULTS The subsequent fracture types for vertebroplasty were as follows: no subsequent fracture (n = 112; 48.28%); hammer fracture (n = 65; 28.02%); neofracture (n = 35; 15.09%); and kyphotic compression fracture (n = 19; 8.19%). According to the total scores, the occurrence rate of subsequent hammer fracture (no subsequent fracture, hammer fracture, neofracture, and kyphotic compression fracture) were as follows: group A (84.21%, 0%, 10.52%, and 5.26%), group B (64.58%, 10.45%, 12.5%, and 12.5%), group C (39.39%, 33.3%, 15.15%, and 12.12%), and group D (11.67%, 63.3%, 21.67%, and 3.33%). CONCLUSIONS Predictive scores can be calculated and used to predict the possibility of subsequent fracture according to scores. Group D showed the highest predictive scores and will need more preventative treatment.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea
| | - Chang Il Ju
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea.
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Katsumi K, Hirano T, Watanabe K, Ohashi M, Yamazaki A, Ito T, Sawakami K, Sano A, Kikuchi R, Endo N. Surgical treatment for osteoporotic thoracolumbar vertebral collapse using vertebroplasty with posterior spinal fusion: a prospective multicenter study. Int Orthop 2016; 40:2309-2315. [PMID: 27194159 DOI: 10.1007/s00264-016-3222-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aimed to investigate the clinical outcomes and limitations after vertebroplasty with posterior spinal fusion (VP+PSF) without neural decompression for osteoporotic vertebral collapse. METHODS We conducted a prospective multicenter study including 45 patients (12 men and 33 women, mean age: 77.0 years) evaluated between 2008 and 2012. Operation time, blood loss, visual analog scale (VAS) of back pain, neurological status, kyphosis angle in the fused area, and vertebral union of the collapsed vertebra were evaluated. RESULTS The mean operation time was 162 min and blood loss was 381 mL. The postoperative VAS score significantly improved, and the neurological status improved in 35 patients (83 %), and none of the remaining patients demonstrated a deteriorating neurological status at two years post-operatively. The mean kyphosis angle pre-operatively, immediately post-operatively, and two years post-operatively was 23.8°, 10.7°, and 24.3°, respectively, and there was no significant difference between the angles pre-operatively and two years post-operatively. The extensive correction of kyphosis >16° was a risk factor for a higher correction loss and subsequent fracture. Union of the collapsed vertebra was observed in 43 patients (95 %) at two years post-operatively. CONCLUSIONS The present study suggests that spinal stabilization rather than neural decompression is essential to treat OVC. Short-segment VP+PSF can achieve a high union rate of collapsed vertebra and provide a significant improvement in back pain or neurological status with less invasive surgery, but has a limit of kyphosis correction more than 16°.
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Affiliation(s)
- Keiichi Katsumi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Toru Hirano
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Akiyoshi Yamazaki
- Spine Center, Department of Orthopaedic Surgery, Niigata Central Hospital, Niigata City, Niigata, Japan
| | - Takui Ito
- Department of Orthopedic Surgery, Niigata City General Hospital, Niigata City, Niigata, Japan
| | - Kimihiko Sawakami
- Department of Orthopedic Surgery, Niigata City General Hospital, Niigata City, Niigata, Japan
| | - Atsuki Sano
- Department of Orthopedic Surgery, Niigata Prefectural Shibata Hospital, Shibata City, Niigata, Japan
| | - Ren Kikuchi
- Department of Orthopedic Surgery, Niigata Rosai Hospital, Joetsu City, Niigata, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachidori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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Kim DJ, Kim TW, Park KH, Chi MP, Kim JO. The proper volume and distribution of cement augmentation on percutaneous vertebroplasty. J Korean Neurosurg Soc 2010; 48:125-8. [PMID: 20856660 DOI: 10.3340/jkns.2010.48.2.125] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 06/18/2010] [Accepted: 08/09/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the optimal volume of injected cement and its distribution when used to treat vertebral compression fractures, and to identify factors related to subsequent vertebral fractures. METHODS A retrospective analysis of newly developing vertebral fractures after percutaneous vertebroplasty was done. The inclusion criteria were that the fracture was a single first onset fracture with exclusion of pathologic fractures. Forty-three patients were included in the study with a minimum follow up period of six months. Patients were dichotomized for the analysis by volume of cement, initial vertebral height loss, bone marrow density, and endplate-to-endplate cement augmentation. RESULTS None of the four study variables was found to be significantly associated with the occurrence of a subsequent vertebral compression fracture. In particular, and injected cement volume of more or less that 3.5 cc was not associated with occurrence (p = 0.2523). No relation was observed between initial vertebral height loss and bone marrow density (p = 0.1652, 0.2064). Furthermore, endplate-to-endplate cement augmentation was also not found to be significantly associated with a subsequent fracture (p = 0.2860) by Fisher's exact test. CONCLUSION Neither volume of cement, initial vertebral height loss, bone marrow density, or endplate-to-endplate cement augmentation was found to be significantly related to the occurrence of a subsequent vertebral compression fracture. Our findings suggest that as much cement as possible without causing leakage should be used.
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Affiliation(s)
- Dong Joon Kim
- Department of Neurosurgery, Seoul Veterans Hospital, Seoul, Korea
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