Osteoporotic fracture admissions compared to other major medical admissions in Irish public hospitals

Multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis. Hospital care represents the costliest portion of health services. We found public hospital bed days for fragility fractures in Ireland increased by 43% between 2008 and 2017 which exceeded those for other common diseases.

INTRODUCTION

Recent multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis, manifesting clinically as fragility fractures (FF). International reports show that FF incidence, rate of hospital admission and cost are similar or greater than those for breast cancer, myocardial infarction and stroke. Studies addressing the illness burden of osteoporosis in Ireland are few, and none compares fragility fractures to other common chronic diseases.

METHODS

A retrospective analysis of national administrative data for all public hospital admissions was performed on adults aged 50 years and older from January 2008 to December 2017.

RESULTS

In 2017, public hospital bed days for FF totalled 249,887 outnumbering Chronic Obstructive Pulmonary Disease (COPD): 131,897; 6 solid cancers (CA): 118,098; myocardial infarction (MI): 83,477; and diabetes mellitus (DM): 31,044. Bed days for FF increased by 43% between 2008 and 2017, in contrast to a 32%, 28% and 31% reduction for CA, MI and DM, respectively, and a 12% increase for COPD. Public hospital bed days for FF in 2016 were greater than MI, stroke, atrial fibrillation and chest pain combined but less than a combination of COPD, pneumonia and lower respiratory tract infection.

CONCLUSION

Osteoporotic fractures represent a large and rapidly increasing illness burden amongst older Irish adults, with substantial care requirements and the resulting onus on our healthcare system. Urgent action is needed to address this public health issue and the services for those at risk of fracture.

Model surgery prediction for mandibular midline distraction osteogenesis

Mandibular midline distraction osteogenesis is available as a treatment option for the correction of mandibular transverse arch deficiency. A model surgery technique is presented here through a case report that will allow the surgeon to predict the amount of transverse expansion that can be gained by this procedure. Utilizing measurements from a three-dimensional stereolithography model, the mandibular cast is mounted on a semi-adjustable articulator. The maxillary model is mounted onto the articulator using an interocclusal record. Acrylic straps are fabricated that relate the condylar elements of the articulator to the right and left mandibular dental segments. The mandibular model is sectioned at the midline, the hemi-mandibular segments are rotated laterally until the desired midline expansion is achieved and the mandibular model is luted into its new position. The post-expansion relationship of the maxillary and mandibular arches can be visualized on the articulator and provide useful information to the surgeon and orthodontist.