Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures

This study investigated the long-term survival and incidence of secondary fractures after fragility hip fractures. The 5-year survival rate was 62%, and the mortality risk was seen in patients with GNRI < 92. The 5-year incidence of secondary fracture was 22%, which was significantly higher in patients with a BMI < 20.

BACKGROUND

Malnutrition negatively influences the postoperative survival of patients with fragility hip fractures (FHFs); however, little is known about their association over the long term.

OBJECTIVE

This study evaluated the ability of the geriatric nutritional risk index (GNRI) as a risk factor for long-term mortality after FHFs.

METHODS

This study included 623 Japanese patients with FHFs over the age of 60 years. We prospectively collected data on admission and during hospitalization and assessed the patients' conditions after discharge through a questionnaire. We examined the long-term mortality and the incidence of secondary FHFs and assessed the prognostic factors.

RESULTS

The mean observation period was 4.0 years (range 0-7 years). The average age at the time of admission was 82 years (range 60-101 years). The overall survival after FHFs (1 year, 91%; 5 years, 62%) and the incidence of secondary FHFs were high (1 year, 4%; 5 years, 22%). The multivariate Cox proportional hazard analysis revealed the risk factors for mortality as older age (hazard ratio [HR] 1.04), male sex (HR 1.96), lower GNRI score (HR 0.96), comorbidities (malignancy, HR 2.51; ischemic heart disease, HR 2.24; revised Hasegawa dementia scale ≤ 20, HR 1.64), no use of active vitamin D3 on admission (HR 0.46), and a lower Barthel index (BI) (on admission, HR 1.00; at discharge, HR 0.99). The GNRI scores were divided into four risk categories: major risk (GNRI, < 82), moderate risk (82-91), low risk (92-98), and no risk (> 98). Patients at major and moderate risks of GNRI had a significantly lower overall survival rate (p < 0.001). Lower body mass index (BMI) was also identified as a prognostic factor for secondary FHFs (HR 0.88 [p = 0.004]).

CONCLUSIONS

We showed that older age, male sex, a lower GNRI score, comorbidities, and a lower BI are risk factors for mortality following FHFs. GNRI is a novel and simple predictor of long-term survival after FHFs.

Challenges to prevent secondary fractures in patients with hip fractures in Joetsu Myoko, Japan through the increased use of osteoporosis treatment and collaboration with family doctors

The Niigata Prefectural Central Hospital (NPCH) is one of the main hospitals for the cities of Joetsu and Myoko, Niigata Prefecture, Japan, an area with a population of 240,141, of whom 26.7 % were aged ≥65 years in 2009. In the NPCH, patients with hip fractures are admitted to an orthopedic ward within 4 h, 89.2 % of patients are operated on within 48 h during working hours, and the prevalence of pressure ulcers is 1.5 %. To reduce the incidence of hip fractures, two major challenges emphasizing secondary fracture prevention were initiated in 2012. The first challenge used a team approach-hospital pharmacists asked patients about their drug use histories, orthopedic surgeons began drug therapy for osteoporosis after explaining to patients its importance for the prevention of secondary hip fractures, nurses assessed the risk of falling, and physiotherapists conducted rehabilitation with the aim of preventing falls. The second challenge focused on maintaining treatment for osteoporosis after discharge, when patients were under the oversight of family doctors. The percentages of patients with primary hip fractures who were taking anti-osteoporosis medications at the time of discharge in 2009, 2012, 2013 and 2014 were 21, 33, 41, and 43 %, respectively. The 12-month incidences of hip fractures on the unaffected side in 2009, 2012, 2013 and 2014 were 7.4, 2.2, 0, and 2.4 %, respectively, and the 24-month incidences of such fractures in 2009, 2012 and 2013 were 12, 7.6, and 5.2 %, respectively. Our challenges were effective at decreasing the incidence of secondary fractures.

Ten years change in post-fracture care for hip fracture patients

INTRODUCTION

This multicenter, retrospective study aimed to clarify the changes in postoperative care provided by orthopaedic surgeons after hip fractures and clarify the incidence of secondary fractures requiring surgery.

MATERIALS AND METHODS

Subjects were patients with hip fracture treated surgically in seven hospitals during the 10-year period from January 2008 to December 2017. Data on patient demographics, comorbidities, preoperative and postoperative osteoporosis treatments, and secondary fractures were collected from the medical records.

RESULTS

In total, 4764 new hip fractures in 982 men and 3782 women (mean age: 81.3 ± 10.0 years) were identified. Approximately 10% of patients had a history of osteoporosis drug treatment and 35% of patients received postoperative drug treatment. The proportion of patients receiving postoperative drug therapy increased by approximately 10% between 2009 and 2010, 10% between 2010 and 2011, and 10% between 2011 and 2013. Although the rate of secondary fractures during the entire period and within 3 years decreased from 2011, the rate of secondary fracture within 1 year remained at around 2% every year.

CONCLUSIONS

The approval of new osteoporosis drugs and the establishment of osteoporosis liaison services have had a positive effect on the use of postoperative drug therapy in the orthopedic field. Our finding that the rate of secondary fracture within 1 year of the initial fracture remained around 2% every year, despite improvements in postoperative drug therapy, suggests that both rehabilitation for preventing falls and early postoperative drug therapy are essential to prevent secondary fractures.

Are we treating osteoporotic fractures of the hip adequately? A Middle Eastern cohort study

Fragility hip fractures treated in a center in the Middle East were retrospectively studied for adequacy of osteoporosis management. Of the 318 patients treated, over 70% did not have a structured investigation and about 30% did not receive any therapeutic supplements. Our series showed a preventable 8.8% secondary fracture rate.

PURPOSE

To study the adequacy of evaluation and treatment of osteoporosis after fragility fractures of the hip. The study also attempts to estimate the prevalence of secondary fractures after the original injury.

METHODS

This is a retrospective evaluation of the electronic database to search all the admissions for fractures of the hip in patients over 50 years at a tertiary care Trauma and Orthopaedic center in the Sultanate of Oman. The study period was defined as October 2010 to December 2015. Their case records, BMD reports, and laboratory data were analyzed. Pharmacological interventions and the documented compliance with such therapy were also recorded.

RESULTS

Over the study period, 318 fragility fractures of the hip were treated. Of these, 233 (73.3%) did not receive a DEXA scan and 94% did not have their vitamin D₃ (vit D) tested. About 29.9% percent cases did not receive any nutritional supplement or therapeutic intervention though diagnosed as fragility fracture. Twenty-eight patients (8.8%) reported for secondary fractures of the hip. Of these, 86% was initiated on supplement after their index fracture though 78.6% had not had a BMD study.

CONCLUSIONS

Less than 27% patients receive BMD test following fragility fracture of the hip and only 6% a vit D3 assay. Secondary fractures of the hip tend to occur in approximately 9% of the cases in Oman; this seems to occur equally in patients who have had as well as not had any calcium and vit D supplements after the index injury.

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

PURPOSE

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

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

PURPOSE

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSION

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

Periprosthetic fracture rate after short and long hip nails: Analysis of a regional health database

INTRODUCTION

Intertrochanteric hip fractures are a major socio-economic burden, and a significant source of morbidity and mortality. Treatment is generally surgical, with either a dynamic hip screw or a cephalomedullary hip nail. Recently, there has been a trend toward the use of hip nails. The use of short nails over long nails, which span the length of the femur, remains a source of controversy. Historically, short nails were associated with a higher periprosthetic fracture rate compared with long nails, however newer nail designs, appear to have resolved this issue. Small retrospective studies show a refracture rate similar in both long and short nails. Given the small sample size of current studies, it remains unclear if the refracture rate is indeed the same between treatment arms, or if studies are not sufficiently large to identify a difference between the two. A large database review would provide the practical next step to further explore this question.

METHODS

Intertrochanteric hip fracture cases from our Regional Hip Fracture Registry were reviewed. All patients with an intertrochanteric fracture treated with a cephalomedullary nail from June 2009 to December 2017 were included. Patient demographics were compared using the t-test. Fracture rate was compared using the chi square test.

RESULTS

655 short nails and 315 long nails were reviewed. Patients in the short nail (SN) group were older than in the long nail group (LN) (SN: 81, LN 76 p < 0.001). The periprosthetic fracture rate was 2.1% overall with 1.3% in LN group and 2.4% in SN group (p = 0.34). There was no difference identified in the rate of blood transfusions (SN 38% LN 40% p = 0.5), however the procedure time was shorter in the SN group (SN: 81 min LN: 112 min p < 0.001).

DISCUSSION

This study did not find a statistical difference in periprosthetic fracture rate when comparing short and long cephalomedullary nails for the treatment of intertrochanteric fractures. Procedure time was shorter in the SN group. However, no difference in rate of blood transfusion was noted between patient groups. This study supports use of both nail type for hip fracture fixation, on the basis of periprosthetic fracture rate.

Secondary fracture and mortality risk with very high fracture risk osteoporosis and proximal femoral fracture

INTRODUCTION

We aimed to investigate secondary fracture and mortality rates, and risk factors in patients with proximal femoral fractures.

MATERIALS AND METHODS

We conducted a multicenter prospective cohort study on female patients with proximal femoral fractures who underwent surgical treatment between April 2020 and March 2021. Postoperative follow-ups were performed at 6-, 12-, 18-, and 24-month intervals to determine the secondary fracture and mortality rates, and the risk factors and its influence were examined.

RESULTS

Of the 279 registered patients, 144 patients (51.6%) were diagnosed with very high fracture risk osteoporosis. The postoperative osteoporosis rate exceeded 96%; however, osteoanabolic agents were used sparingly. The risk factor of both secondary fracture and mortality was very high fracture risk osteoporosis, and secondary fractures within 12 months were markedly occurred. Secondary fracture rates increased as the number of matched very high fracture risk osteoporosis criteria increased. Notably, secondary fractures and mortality were recorded in 21.4% and 23.5% of the patients who met all criteria, respectively.

CONCLUSION

Over half of the female patients with proximal femoral fractures had very high fracture risk osteoporosis. Although, very high fracture risk osteoporosis demonstrated a notably increased risk of secondary fractures, particularly at 12 months post-surgery, the use of osteoanabolic agents was substantially low. Collectively, our findings highlight the need to consider the risk of very high fracture risk osteoporosis, expand the use of medications to include osteoanabolic agents, and reconsider the current healthcare approach for proximal femoral fractures.

Impact of social determinants on osteoporosis treatment and secondary fracture risk after primary fragility fractures

This study examined the impact of social determinants of health (SDOH) on osteoporosis management and secondary fractures after primary fragility fractures. Despite similar osteoporosis treatment rates between patients with and without adverse SDOH, patients with adverse SDOH experienced significantly higher secondary fracture rates, highlighting the need for targeted interventions to improve post-fracture care in socioeconomically disadvantaged populations.

PURPOSE

Osteoporosis is a global health concern affecting over 500 million people. Fragility fractures are often the first indication of osteoporosis and are associated with significant morbidity and mortality. While low socioeconomic status is associated with increased risk of fragility fractures, the impact of social determinants of health (SDOH) on osteoporosis treatment and secondary fracture rates following primary fragility fractures remains unclear.

METHODS

Patients aged 50 and older who sustained primary fragility fractures and had no prior osteoporosis treatment were identified using a large national database. Patients were stratified by the presence of adverse SDOH. Kaplan-Meier and multivariate Cox proportional hazards regression analyses were performed to evaluate the cumulative incidence of osteoporosis treatment within 1 year (including bisphosphonates, biologics, parathyroid hormone analogs, estrogens, and selective estrogen receptor modulators) and rates of secondary fractures within two years.

RESULTS

A total of 276,845 patients were included in this study. Overall, 4.4% of patients with adverse SDOH and 5.3% of patients without were prescribed osteoporosis treatment within a year of fracture; however, this difference was not significant after controlling for confounders (hazard ratio (HR) 0.98; P = 0.82). Patients with adverse SDOH had significantly higher rates of secondary fractures within 2 years (7.4% versus 6.0%; HR 1.29; P < 0.001).

CONCLUSION

Adverse SDOH were associated with increased rates of secondary fractures among patients with primary fragility fractures, despite similar osteoporosis management rates between groups. Overall, osteoporosis treatment rates remain low. Targeted strategies to optimize secondary prevention and tailored interventions are needed, particularly for socioeconomically disadvantaged populations.

Association between pharmacotherapy and secondary hip fracture in a real-world setting: a nationwide database study

INTRODUCTION

This study aimed to assess the association between pharmacotherapy and secondary hip fracture incidence.

MATERIALS AND METHODS

The correlation between secondary hip fracture incidence and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

RESULTS

Data collected from female patients (n = 1,435,347) were analyzed. The 2-year secondary hip fracture incidence was 3.48% (n = 49,921). Secondary hip fracture was significantly more common in patients without medications (3.80%) than in those with medications (3.00%). Patients receiving selective estrogen receptor modulators (SERMs) had the lowest average age. The crude incidence of secondary hip fracture was the lowest in patients receiving SERMs (n = 2088 [2.52%]), followed by those taking bisphosphonates (n = 11,355 [2.88%]), denosumab (n = 1118 [2.90%]), no medications (n = 32,747 [3.80%]), and parathyroid hormone (PTH: n = 2163 [4.55%]), whereas the age-adjusted incidence was the lowest in patients administered denosumab (2.27%), followed by those taking bisphosphonates (2.47%), SERMs (2.55%), PTH (3.67%), and no medications (3.80%). The mean MPR was the highest in patients taking denosumab (64.9%), followed by those receiving bisphosphonates (58.7%), SERMs (58.2%), and PTH (40.6%) in the no hip fracture group.

CONCLUSION

Secondary hip fractures were less likely to occur with medication versus no medication. Differences in the crude incidence of secondary hip fracture based on medications usage might be attributed to background characteristics.

Application of an in-hospital, surgeon-led anti-osteoporotic medication algorithm in patients with hip fractures improves persistence to medication and can prevent the second fragility fracture

INTRODUCTION

Secondary fracture prevention is an essential part of hip fracture treatment. Despite this, many patients are discharged without the appropriate anti-osteoporotic medication. The aim of this study is to report the outcomes of the application of an in-hospital, surgeon-led anti-osteoporotic medication algorithm to patients with hip fractures.

MATERIALS AND METHODS

This prospective cohort study followed patients with hip fractures who were treated at a tertiary referral hospital between 2020 and 2022. At discharge, anti-osteoporotic medication according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation algorithm was prescribed to all patients. Multivariate Cox regression analysis was used to investigate the risks of non-persistence to medication and of secondary fracture.

RESULTS

Two hundred thirteen consecutive patients were prospectively followed. Mean follow-up was 17.2 ± 7.1 months. Persistence to medication at 2 years was 58% (95%CI 51-65%). A secondary osteoporotic fracture occurred in 1/126 (0.8%) persistent patients and 9/87 (11.4%) non-persistent patients. Multivariable Cox regression analysis confirmed that persistence to medication was significantly associated with a lower risk of secondary fracture (cause-specific hazard ratio [csHR] 0.05; 95%CI 0.01-0.45; p = 0.007).

CONCLUSION

The application of the surgeon-led AO Foundation algorithm enables the in-hospital initiation of anti-osteoporotic treatment, leading to better persistence to medication and decreased incidence of secondary osteoporotic fractures.

Reducing femoral peri-implant fracture risk through optimized plate length and screw configuration - a biomechanical study

BACKGROUND

Locked plating of femur fractures is associated with secondary peri-implant fractures which may be a result of stress concentrations at the proximal plate end region. The aim of this study was to investigate whether the strength of healed femoral bone-locking-compression-plate constructs can be increased by modifying the screw configurations and plate length to minimize the risks of peri-implant femur fractures.

METHODS

The detached shaft of a variable angle condylar locking compression plate (VA-LCP Condylar Plate; Johnson & Johnson MedTech) was fixed to the proximal two-third of twenty-four intact artificial femurs in four different configurations (n = 6) distinguished by either using a short plate with cortical or locking screws whereby the most proximal screw was inserted in the femoral shaft 50 mm below the lesser trochanter, or using a long plate with either cortical or locking screws whereby the most proximal screw was positioned in the femoral neck. Simulating a situation after fracture healing, constructs were cyclically tested under progressively increased loading until catastrophic failure.

RESULTS

Long plates fixed with a cortical screws demonstrated the highest failure load (1091 N ± 142 N) which was significantly higher compared to long plates fixed with locking screws (888 N ± 80 N), short plates fixed with cortical screws (471 N ± 42 N), and short plates fixed with locking screws (450 N ± 19 N). In addition, whereas the locking screw construct with a long plate was associated with a significantly higher failure load compared to both short plate constructs, there were no significant differences between the latter two. The failure modes were predominantly characterized by neck screw pull-out in both long plate constructs and peri-implant bone fractures at the most proximal screw in both constructs with short plates. None of the specimens exhibited a femoral neck fracture.

CONCLUSION

The findings of this study performed on synthetic bones indicate that from a biomechanical perspective long plates that extend into the femoral neck sustained higher failure loads compared to short plates. In addition, long plates fixed with a cortical neck screw further enhanced the construct strength and reduced the risk of peri-implant fractures compared to the use of a locking neck screw. Therefore, this study supports the use of long locking plates combined with use of cortical neck screws, particularly in high-risk patients, such as those with severe osteoporosis.

Incidence of Secondary Fractures After Implementation of Different Models of FLS Secondary Prevention Programs: Scoping Review

BACKGROUND

As the number of programs aimed at preventing fragility fractures and mitigating the phenomenon of cascade fractures is increasing worldwide, so it is necessary to evaluate the effectiveness of such programs to seek their feasible implementation at regional and global levels.

AIMS

This paper aims to provide an overview focusing on the incidence of secondary fractures after the implementation of any type of fracture liaison service (FLS). To this end, a scoping review was conducted focusing on the identification of clinical evidence reported in systematic reviews of the medical literature in this area.

METHODS

A total of 230 titles were obtained through structured searches in four electronic libraries (updated to September 2023), from which a total of 11 systematic reviews were selected.

RESULTS

Tables of methodological characteristics were developed. Different programs such as orthogeriatric units, educational strategies, exercise strategies, screening strategies using DXA or FRAX, and specialist intervention by orthopedic specialists or osteoporosis nurses were found in 20 different countries. The reported incidence of secondary fractures varies between populations and strategies compared depending on the data collected and the type of methodological design used. The incidence of secondary fractures in these 11 systematic reviews ranged from 0 to 37%.

CONCLUSION

The incidence by intervention is described in the Supplementary Tables of the primary studies.

Evaluation of using grip strength and hand muscle cross-sectional area to predict secondary fractures post distal radius fracture

Grip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in distal radius fracture patients. This simple tool enhances clinical practice by identifying high-risk patients for targeted interventions, potentially preventing or reversing functional decline and recurrent fractures.

PURPOSE

To evaluate grip strength and hand muscle cross-sectional area as predictors of secondary fracture risk in patients with a history of distal radius fracture (DRF), serving as surrogates of the diagnosis of sarcopenia.

METHODS

A retrospective cohort study of 745 DRF patients was analyzed with their grip strength data using Cox proportional hazards regression, receiver operating characteristic analysis, and Kaplan-Meier analysis to predict secondary fracture risk over an average of 12 years. Hand muscle cross-sectional area was similarly analyzed.

RESULTS

Patients with a history of DRF were predicted to have a 4.1% higher likelihood of experiencing a secondary fracture per kilogram reduction in their grip strength (p < 0.008), independent of age and sex. Patients were categorized as high-risk (≤ 16 kg), moderate-risk (17-24 kg), or low-risk (≥ 25 kg) (p < 0.001). High-risk patients showed a 2.2-fold (95% CI = 1.55-3.17) higher recurrent fracture risk compared to low-risk patients. Cumulative secondary fracture probabilities of the high-risk group patients at 5, 10, and 15 years were estimated to be 16%, 30%, and 54%, respectively.

CONCLUSIONS

Grip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in patients with DRF. This simple tool could improve clinical practice by identifying high-risk patients for targeted interventions to prevent recurrent fractures or even reverse functional decline.

[First fracture in patients with osteoporosis : How does the "fracture career" of our patients with osteoporosis begin?]

BACKGROUND

Given that a primary osteoporotic fracture can result in subsequent fractures and that the precise etiology of the typical fracture cascade remains uncertain, it is pertinent to determine the initiating factor and the specific fracture involved in this cascade.

METHOD

All patients with a fracture of a long bone were consecutively screened over the 12-month study period. All participants were asked about existing risk factors (including previous fractures) in accordance with the applicable guidelines of the Umbrella Organization Osteology (DVO). The existing risk factors were employed to calculate the fracture risk and this formed the basis of the diagnosis and indications for treatment.

RESULTS

A total of 613 patients were included in the study. Of the total number of patients 378 were deemed to require pharmacological treatment for osteoporosis. In this cohort 182 fractures were reported. Among the previous fractures distal radius fractures were the most common, occurring in 54 patients followed by fractures of the proximal femur (n = 40) and proximal humerus (n = 27). As anticipated, a breakdown of the data by gender revealed a different picture. In line with the incidences it can be seen that men have fewer distal radius fractures and more fractures close to the hip joint.

DISCUSSION

The results indicate that women with a distal radius fracture have the potential to facilitate an early diagnosis and subsequent treatment for osteoporosis. In contrast, in men fractures in the region of the hip joint were the most common initial presentation, precluding the possibility of deriving an early indication of the presence of osteoporosis from previous fractures.

Thoracolumbar kyphosis prognoses poor results after proximal femoral fracture: a 3-year multicenter prospective cohort study

INTRODUCTION

Proximal femoral fractures are critically associated with increased risk of mortality and secondary fractures. Identifying prognosis predictors related to sagittal imbalance that are known to have negative impact on fracture risk and mortality is crucial. This study aimed to explore the relationship between various sagittal imbalance parameters and the prognosis of proximal femoral fractures to identify the most important prognostic indicators.

MATERIALS AND METHODS

This multi-center prospective cohort study included patients with proximal femoral fractures treated surgically from April 2020 to March 2021. Spinal standing radiographs were obtained to measure various sagittal spine parameters. Postoperative follow-ups were conducted at 6, 12, 18, 24, and 36 months to assess mortality and secondary fracture rates and examine the predictors and their effects.

RESULTS

Among the 137 patients who underwent spinal standing radiographs, 22 died and 23 developed secondary fractures. Multivariate analyses identified the number of previous vertebral fractures and thoracolumbar kyphosis (TLK) as significant risk factors for mortality and secondary fractures. Survival analysis revealed that patients with TLK < 20° had significantly higher survival rates than those with TLK ≥ 20° (P = 0.002 and P < 0.001 for mortality and secondary fractures, respectively). In addition, serum albumin was associated with mortality, and the intake of sleeping pills and antidepressants was associated with secondary fractures.

CONCLUSION

TLK after surgery and the number of previous vertebral fractures affected both mortality and secondary fractures. When each risk factor, such as low serum albumin levels, intake of sleeping pills and antidepressants, was also considered, it was found that comprehensive postoperative care is essential.

Regional disparities in the risk of secondary fractures in patients with hip fractures

PURPOSE

We aimed to examine the regional disparities in secondary fracture incidence among patients with hip fractures in South Korea.

METHODS

This observational, retrospective, cohort study was conducted using data of 6,213 South Korean nationals from the National Health Insurance Service-National Sample Cohort (2004-2019). Secondary fractures included hip, wrist, humerus, spine, ankle, and pelvis fractures that occurred 6 months after hip fracture. The position value for relative composite index was used to identify medically vulnerable regions. Cox proportional hazards models were used for statistical analysis.

RESULTS

Among the 6,213 (1,949 male, 4,264 female) patients with hip fracture, 981 lived in medically vulnerable areas and 5,232 in non-vulnerable areas. Patients residing in vulnerable areas had a higher risk of secondary fractures than did those residing in non-vulnerable areas (hazard ratio [HR]: 1.24, 95 % confidence interval [CI]: 1.05-1.47); the factors that increased their risk included female sex (HR: 1.30, 95 % CI: 1.08-1.57), age ≥71 years (HR: 1.23, 95 % CI: 1.01-1.44), and not receiving osteoporosis medication (HR: 1.47, 95 % CI: 1.14-1.89). Ten years after hip fracture surgery, the risk of secondary fracture more than tripled in the vulnerable areas than that in the non-vulnerable areas.

CONCLUSION

Patients living in vulnerable regions had a higher risk of secondary fractures than that of those in non-vulnerable regions. Prevention and medication policies should thus be implemented to reduce regional healthcare disparities.