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INTRODUCTION: Although a well-established component of bone metabolism, the efficacy and safety of vitamin D supplementation for the prevention of fractures in elderly healthy individuals is still unclear. PURPOSE: To perform a meta-analysis comparing vitamin D supplementation with placebo and its contributions on fracture incidence. METHODS: This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under protocol CRD42023484979. We systematically searched PubMed, Embase, and Cochrane Central databases from inception to November 2023 for randomized controlled trials (RCTs) comparing vitamin D supplementation versus placebo in individuals with 60 years of age or more and without bone related medical conditions such as cancer and osteoporosis. RESULTS: Seven RCTs with 71,899 patients were included, of whom 36,822 (51.2%) were women. There was no significant difference in total fracture incidence (RR 1.03; 95% CI 0.93-1.14; p = 0.56; I2 = 58%) between groups or subgroups. However, women had an increased risk for hip fractures (164 vs. 121 events; RR 1.34; 95% CI 1.06-1.70; p = 0.01; I2 = 0%). There was no significant difference in non-vertebral fractures, osteoporotic fractures development, or falls (RR 1.02; 95% CI 0.94-1.12; p = 0.6; I2 = 47%; RR 0.97; 95% CI 0.87-1.08; p = 0.63; I2 = 0%; RR 1.01; 95% CI 0.97-1.04; p = 0.66; I2 = 55%, respectively). CONCLUSION: Vitamin D supplementation does not reduce the total fracture development rate in the elderly healthy population, and it may increase the incidence of hip fractures among elderly healthy women. This finding suggests refraining from prescribing high intermittent doses of vitamin D, without calcium, to individuals aged 60 or older with unknown vitamin D serum concentration or osteoporosis status and inadequate calcium intake.

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Diabetes mellitus (DM) is associated with increased fracture risk in White adults. However, the impact of DM on fractures in Black adults is unknown. This systematic review and meta-analysis investigated the association between DM and fractures in adults of African ancestry. MEDLINE, Scopus, CINAHL and Embase databases were searched from their inception up to November 2023 for all studies in the English language investigating the epidemiology of fractures (prevalence, incidence, or risk) in Black men and women (age ≥ 18 years) with type 1 or type 2 DM. Effect sizes for prevalence of previous fractures (%) and incident fracture risk (hazard ratio [HR]) were calculated using a random-effects model on Stata (version 18.0). There were 13 eligible studies, of which 12 were conducted in Black adults from the United States, while one was conducted in adults of West African ancestry from Trinidad and Tobago. We found no fracture data in Black adults with DM living in Africa. Five studies were included in a meta-analysis of incident fracture risk, reporting data from 2926 Black and 6531 White adults with DM. There was increased risk of fractures in Black adults with DM compared to non-DM (HR = 1.65; 95 % confidence interval [CI]: 1.14, 2.39). The risk of fractures was also higher in White adults with DM compared to non-DM (HR = 1.31; 95 % CI: 1.06, 1.61) among these studies. Five studies were included in a meta-analysis of fracture prevalence, of which three also reported fracture prevalence in White adults. There were 175 previous fractures among 993 Black adults with DM and 384 previous fractures among 1467 White adults with DM, with a pooled prevalence of 17.5 % (95 % CI: 15.4, 19.6) and 25.8 % (95 % CI: 4.8, 46.8), respectively. Our results indicate a high burden of fractures in Black adults with DM.

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PURPOSE OF REVIEW: Bone fractures can have a devastating effect on health, especially in the elderly, undermining their independence for daily activities, and increasing the risk of comorbidities and mortality. Nutrition is a key factor in maintaining an optimal bone health across the lifespan. The number of people that choose to avoid meat or even all animal products is increasing globally, for a diversity of reasons. Properly planned vegetarian and vegan diets are widely recognized as a healthy dietary pattern, but the long-term impact of these diets on bone health and more specifically risk of bone fractures is less clear. Classic studies have observed a slightly lower bone mineral density in vegetarians but have many limitations, including inadequate adjusting for relevant confounding factors, and cross-sectional design. The aim of this review is to summarize and put into context the current evidence on the effect of vegetarian and vegan diets on bone health, with a focus on fracture risk. RECENT FINDINGS: In recent years, results from many large prospective studies have emerged, which allowed us to assess the risk of incident bone fractures in vegetarians. In these studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. In many recent prospective cohort studies, vegetarian and especially vegan diets were associated with an increased risk of bone fractures. At least part of this risk could be due to a lower body mass index and a lower intake of nutrients such as calcium, vitamin D, and protein. Some evidence suggests that combined vitamin D and calcium supplementation and other factors such as consumption of protein-rich foods may attenuate this risk. The eventual deleterious effect of vegetarian diets on bone health should be contextualized and balanced with its benefits, such as lower risk of cardiovascular disease and cancer.

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Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.

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OBJECTIVE: Evaluate injury trends in Brazilian Jiu Jitsu (BJJ) participation by presenting to U.S. emergency departments over a 10-year period and formulate an injury profile. METHODS: The U.S. Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS) database was queried for martial arts related injuries from 1 January 2012 to 31 December 2021. Codes and narratives were examined to compile data for patients sustaining BJJ-related injuries. RESULTS: From 1 January 2012 to 31 December 2021 there were 7,722 (NE = 282,315) ED-diagnosed martial arts related injuries with 911 (NE = 36,023) BJJ-related injuries identified. Regression analysis demonstrated an increasing trend in the annual incidence of Brazilian Jiu Jitsu injuries presenting to the ED (R2 = 0.934; SE = 2.069: p < .0001). Average age was 25.68 years of age (range 4-83). The most common injury diagnoses were sprains/strains and other/not listed at 27.68% and 26.39%. The most commonly injured body parts were the upper trunk, and the shoulder comprising 13.66% and 12.14% of injured body parts, respectively. The most commonly fractured region was toes, at 14.15% of all fractures. The most common dislocations occurred at the shoulder and knee, at 32.49% and 28.45% of dislocations, respectively. The most common mechanisms of injury specifically identified were indeterminate contact between players, fall onto ground, or fall onto another player comprising 18.62% and 17.17%, of injuries, respectively. CONCLUSION: There was an increasing trend of BJJ-related injuries presenting to U.S. Emergency Departments. The most common diagnoses and body parts injured were sprains/strains and upper trunk and shoulder, respectively. The most commonly fractured and dislocated regions were toes and shoulder, respectively. The most common mechanisms of injury were indeterminate contact or falling. This study provides novel information concerning trends in injury and injury profiles for Brazilian Jiu Jitsu related injuries.

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Evidence on the management of rebound-associated vertebral fractures after denosumab discontinuation is scarce. This study describes seven patients retreated with denosumab, teriparatide or zoledronate for 24 months. Their bone mineral density remained stable or improved and no new fractures occurred suggesting that all three options might be adequate for their treatment. PURPOSE: To describe the densitometric and biochemical changes achieved with osteoactive treatment after 24 months of follow-up in patients who suffered rebound-associated vertebral fractures (RAVFs) after Dmab discontinuation, and to report the occurrence of new vertebral and non-vertebral fractures. METHODS: Patients with RAVFs who received retreatment (RT) for 24 months were included. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry at the lumbar spine (LS), femoral neck (FN) and total hip (TH), along with C-terminal cross-linked telopeptide of type I collagen, osteocalcin, and bone alkaline phosphatase. Data were collected at the start of the RT and after 24 months. RESULTS: Seven female patients were included. RT consisted in Dmab (n = 3), teriparatide (TPT) (n = 3) and zoledronate (Zol) (n = 1). At 24 months, the mean BMD change was 2.2% at LS, 6.8% at FN and 3.8% at TH in the Dmab group, 7.5% at LS, 1.4% at FN and 3.7% at TH in the TPT group and, 5.0% at LS, 0.6% at FN and 3.9% at TH in the patient with Zol. After 24 months of follow-up, no patient suffered new fractures. CONCLUSION: In this series of patients with RAVFs, we did not observe any new fractures and the BMD remained stable after 24 months of RT. Future studies are needed to evaluate the most suitable treatment approach after RAVFs but these preliminary data suggest that all denosumab, zoledronate and teriparatide might be adequate options.

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Abstract Objective To describe suspected/confirmed cases of child maltreatment related to fractures in a pediatric hospital in southern Brazil. Method Study of the Information System of Notifiable Diseases notifications and the victims' medical records between January/2016 and December/2020. Variables related to the victim, the perpetrator, the type of abuse, the presence of fractures, and their anatomical location and death were evaluated. Logistic regression was performed to identify fracture-related variables, adjusted for sex and age. The results were expressed in odds ratios and their respective 95% confidence intervals. It was considered significant p < 0.05. Results There were 276 cases, 73 infants (26.4%), male predominance (151, 54.7%), with authorship of the mistreatment by relatives (245, 96,0%), 85 (31,5%), they presented fractures, with five deaths (1.9%). Factors related to the presence of fracture: age of the victim (less than two years old; n = 82; or 2.48; 95% CI: 1.45 - 4.25), having more than two aggressors involved (n = 144; or 2.09; 95% CI: 1.16-3.75), the medium being traffic/automobile accident, (n = 52; or 2.65; 95% CI: 1.04-6.75), consult an orthopedist (n = 91; or 6.77 / 95% CI: 3.66-12.51), and the need for surgical intervention (n = 15; OR 36.72; 95% CI: 8.22-164.03). Conclusions The importance of suspicion, early identification of aggression, and the correct completion of notifications for activating the system of guaranteeing rights and removal of the aggressor was emphasized.

Resumo Objetivo Descrever os casos suspeitos/confirmados de maus-tratos infantis relacionados a fraturas, atendidos em um hospital pediátrico no Sul do Brasil. Método Estudo das notificações do Sistema de Informação de Agravos de Notificação e dos prontuários das vítimas, entre janeiro/2016 e dezembro/2020. Avaliadas variáveis relacionadas à vítima, ao autor, à tipologia de maus-tratos, à presença de fraturas e sua localização anatômica e óbito. Regressão logística foi realizada para identificar as variáveis relacionadas à fratura, ajustada para sexo e idade, expressa em razão de chance e seus respectivos intervalos de confiança de 95%. Foi considerado significativo p < 0.05. Resultados Houve 276 casos, 73 lactentes (26,4%), predomínio do sexo masculino (151, 54,7%), com autoria dos maus-tratos por parentes (245, 96,0%), 85 (31,5%), apresentaram fraturas, sendo cinco óbitos (1,9%). Fatores relacionados à presença de fratura: idade da vítima (menor de dois anos; n = 82; RC 2,48; IC 95%: 1,45 - 4,25), ter mais de dois agressores envolvidos (n = 144; RC 2,09; IC 95%: 1,16 - 3,75), o meio ser trânsito/acidente automobilístico, (n = 52; RC 2,65; IC 95%: 1,04-6,75), consultar com ortopedista (n = 91; RC 6,77 / IC 95%: 3,66-12,51), e necessidade de intervenção cirúrgica (n = 15; RC 36,72; IC 95%: 8,22-164,03). Conclusões Ressaltada a importância da suspeição e identificação precoce da agressão, o preenchimento correto das notificações, para o acionamento do sistema de garantia de direitos e afastamento do agressor.

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INTRODUCTION: as the population pyramid gets inverted, more active and longer lives are lived, geriatric patients with high energy trauma (HET) become more frequent; requiring more resources, getting worse results with more perioperative complications, coupled with a fragile state of health and osteopenia, make these fractures difficult to manage. With the hypothesis that the incidence of pelvic and acetabular fractures in the elderly due to HET is higher than that reported in the world literature, the research question was generated: What is the incidence of pelvic and acetabular fractures in the elderly due to HET, in a 5-year period? MATERIAL AND METHODS: with the authorization of the Ethics Committee, an observational study of a retrospective cohort was carried out, using medical records, identifying the incidence of these fractures, surgically treated in our institution Clínica Las Vegas, Medellin, Colombia, a level III hospital, from July 1, 2016 to June 30, 2021. RESULTS: a cumulative incidence of 1.95 new cases per 100,000 person-years was calculated, a prevalence of 13.8%; resulting in a higher incidence and prevalence, confirming our hypothesis. CONCLUSION: treatment should be aimed at improving quality of life with stable fixation, identification and treatment of associated injuries, minimizing the risk of mechanical complications and prioritizing the reinforcement of preventive measures, also in the improvement of male role behavior, whom, as it seems, will keep carrying out risky activities despite their age.

INTRODUCCIÓN: a medida que se invierte la pirámide poblacional, se viven vidas más largas y activas, se vuelven más frecuentes los pacientes geriátricos con trauma de alta energía; requiriendo más recursos, obteniéndose peores resultados, con más complicaciones perioperatorias, hacen a estas fracturas difíciles de manejar. Establecida la hipótesis de que la incidencia de las fracturas de pelvis y acetábulo, en el adulto mayor por trauma de alta energía, es superior a la reportada en la literatura mundial, se generó la pregunta de investigación: ¿Cuál es la incidencia de fracturas de pelvis y acetábulo por trauma de alta energía en el adulto mayor en un período de cinco años? MATERIAL Y MÉTODOS: una vez obtenida la autorización del Comité de Ética, se realizó un estudio observacional de una cohorte retrospectiva, utilizando registros médicos, identificando la incidencia de estas fracturas, tratadas quirúrgicamente en nuestro hospital de III nivel, Clínica Las Vegas, Medellín, Colombia, del 1 de Julio de 2016 a 30 de Junio de 2021. RESULTADOS: se calculó una incidencia acumulada de 1.95 nuevos casos por cada 100,000 personas-año, una prevalencia de 13.8%; resultando en una mayor incidencia y prevalencia, confirmándose nuestra hipótesis. CONCLUSIÓN: el tratamiento debe orientarse a mejorar la calidad de vida con una fijación estable, identificación y tratamiento de lesiones asociadas, minimizando el riesgo de complicaciones mecánicas y priorizar el reforzamiento de medidas preventivas y a la mejora del comportamiento del rol masculino, que aparentemente, seguirán realizando actividades de riesgo a pesar de su edad.

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INTRODUCTION: Fractures in children and adolescents are a public health issue. However, reliable epidemiological descriptions of the South American population must be improved. This study aims to present epidemiological data on fractures from a children's orthopedic hospital in one of the five largest cities in Latin America. PATIENTS AND METHODS: Descriptive epidemiological data from 2015 to 2019 were used to characterize children's fractures. Demographic variables, the number of fractured bones, high-energy trauma findings, fracture characteristics, fingertip injuries, and associated complications discriminated by the type of treatment are presented. Long bone fractures were classified according to the AO classification. All children less than 18 years of age were included. RESULTS: In a population of 3,616 children, 4,596 fractures were identified. More boys than girls sustain a fractured bone, with ratios as high as 6:1 around 15 years old. Distal forearm fractures were the most common (31.9%), followed by distal humerus (20.2%). Most of the complications were related to these two sites of fractures. The OR of complications between surgical and conservative management was 2.86. CONCLUSION: Epidemiological data of fractures from the authors' institution display the usual trending reported in most populations. Gender-related and age-related differences were relevant. Most fractures and complications are related to upper limb low-energy trauma. The most frequent are loss of ROM and loss of reduction. LEVEL OF EVIDENCE: Level III - retrospective cohort study.

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PURPOSE: This cross-sectional study aimed to assess bone mineral density (BMD), bone microarchitecture and fracture prevalence in women with chronic postsurgical hypoparathyroidism (hypoPT). METHODS: Twenty-seven women with postsurgical hypoPT and 44 age-matched healthy women were included. Dual-energy X-ray absorptiometry was used to evaluate areal BMD and vertebral fracture assessment. High-resolution peripheral quantitative computed tomography assessed microarchitecture and volumetric BMD at the distal radius and tibia. Biochemical parameters, including fibroblast growth factor 23, C-terminal cross-linking telopeptide of type I collagen (ICTP), and procollagen type I N-terminal propeptide (P1NP), were also measured. Previous low-impact fractures were assessed and the 10-year fracture risk was estimated using the FRAX tool for the Brazilian population. RESULTS: No participant had prevalent clinical fractures, and both groups showed low risk for major and hip based on FRAX tool, but two hypoPT patients had moderate to severe morphometric vertebral fractures. Women with hypoPT had increased aBMD in the lumbar spine, femoral neck and total hip (p < 0.05) and higher cortical vBMD in the radius (p = 0.020) and tibia (p < 0.001). Trabecular bone was not affected. Both P1NP and ICTP suggested low bone turnover rates, but no significant correlation was observed between bone density or microstructure and any of the biochemical parameters. CONCLUSIONS: The prevalence of fragility fractures was low in HypoPT women and compatible with low fracture risk estimated by the FRAX tool. Patients had a higher aBMD and cortical vBMD than those of healthy control women, but the association with decreased bone turnover remains unclear.

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BACKGROUND: The prevalence of aluminum (Al) intoxication has declined over the past 3 decades. However, different groups still report on the diagnosis of Al in bone. Prolonged and low-intensity exposures to Al may not be captured by serum Al measurements, preventing its proper diagnosis. We hypothesize that bone Al accumulation may be related to bone and cardiovascular events in the current Era. AIMS: To detect the diagnosis of bone Al accumulation; to explore bone and cardiovascular consequences of Al accumulation. METHODS: This is a sub-analysis of The Brazilian Registry of Bone Biopsy, a prospective, multicentre cohort, with a mean follow-up of 3.4 years, including patients with CKD undergoing bone biopsy; bone fracture and major cardiovascular events (MACE) were adjudicated; Al accumulation was identified by solochrome-azurine staining; history of previous Al accumulation was registered based on information provided by the nephrologist who performed the bone biopsy; bone histomorphometry parameters, clinical data, and general biochemistry were registered. RESULTS: 275 individuals were considered; 96 (35%) patients have diagnosed with bone Al accumulation and were younger [50 (41-56) vs. 55 (43-61) years; p = 0.026], had lower body mass index [23.5 (21.6-25.5) vs. 24.3 (22.1-27.8) kg/m2; p = 0.017], higher dialysis vintage [108 (48-183) vs. 71 (28-132) months; p = 0.002], presented pruritus [23 (24%) vs. 20 (11%); p = 0.005], tendon rupture [7 (7%) vs. 3 (2%); p = 0.03) and bone pain [2 (0-3) vs. 0 (0-3) units; p = 0.02]. Logistic regression reveals that prior bone Al accumulation [OR: 4.517 (CI: 1.176-17.353); p = 0.03] and dialysis vintage [OR: 1.003 (CI: 1.000-1.007); p = 0.046] as independent determinants of bone Al accumulation; minor perturbations in dynamic bone parameters and no differences in bone fractures rate were noted; MACE was more prevalent in patients with bone Al accumulation [21 (34%) vs. 23 (18%) events; p = 0.016]. Cox regression shows the actual/prior diagnosis of bone Al accumulation and diabetes mellitus as independent predictors for MACE: [HR = 3.129 (CI: 1.439-6.804; p = 0.004) and HR = 2.785 (CI: 1.120-6.928; p = 0.028]. CONCLUSIONS: An elevated proportion of patients have bone Al accumulation, associated with a greater prevalence of bone pain, tendon rupture, and pruritus; bone Al accumulation was associated with minor perturbations in renal osteodystrophy; actual/prior diagnosis of bone Al accumulation and diabetes mellitus were independent predictors for MACE.

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As quedas em idosos representam um importante problema de saúde pública devido à associação com a morbimortalidade. Objetivos: Descrever o perfil epidemiológico de idosos com fratura de fêmur proximal, bem como associar o tempo de espera para a cirurgia e os desfechos clínicos com as variáveis físico-funcionais. Métodos: Estudo transversal analítico, de idosos com fratura de fêmur proximal de origem traumática. Os aspectos físico-funcionais foram avaliados pelo Índice de Barthel, Escala de Lawton, Medical Research Council e Dinamometria de Força de Preensão Palmar em dois momentos distintos, admissão e alta hospitalar. Foi realizado análise estatística descritiva e inferencial adotando-se p<0,05. Resultados: A amostra foi composta por 64 indivíduos, sendo 48 (75%) do sexo feminino, com média de idade de 77,8 anos (±8,73). Os pacientes com maior dependência funcional no Índice de Barthel na admissão (U= 282,000; p<0,05) e na alta hospitalar (U= 248,000; p<0,05) aguardaram mais tempo para o procedimento cirúrgico. O principal desfecho foi a alta, de 55 pacientes (85,9%), no entanto aqueles que evoluíram a óbito apresentaram piores pontuações na Escala de Lawton (t(62)= -2,060; p<0,05) e no Índice de Barthel (U= 145,500; p<0,05) no momento da admissão. Conclusão: O perfil de idosos com fratura de fêmur proximal são mulheres, na transição para a oitava década de vida, vítimas de queda da própria altura. Idosos com maior dependência funcional aguardaram mais tempo para a cirurgia e apresentaram piores desfechos

Falls in the elderly represent an important public health problem due to the association with morbidity and mortality. Objectives: To describe the epidemiological profile of elderly people with proximal femur fractures, as well as to associate the waiting time for surgery and clinical outcomes with physical-functional variables. Methods: Analytical cross-sectional study of elderly patients with fractures of the proximal femur of traumatic origin. Sociodemographic, trauma and clinical information were obtained via electronic medical records. The physical-functional aspects were assessed using the Barthel Index, Lawton Scale, Medical Research Council and Hand Grip Strength at two different times, admission and hospital discharge. Descriptive and inferential statistical analysis was performed, adopting p<0.05. Results: The sample consisted of 64 individuals, 48 (75.0%) of which were female, with a mean age of 77.8 years (±8.73). The median waiting time for surgery was 12 (8-15) days. Patients with greater functional dependence on the Barthel Index at admission (U= 282.000; p<0.05) and at hospital discharge (U= 248.000; p<0.05) waited longer for the surgical procedure. The main outcome was discharge 55 (85.9%), however, patients who evolved to death had worse scores on the Lawton Scale (t(62)= -2.060; p<0.05) and on the Barthel Index (U = 145.500; p<0.05) at admission. Conclusion: The profile of elderly people with proximal femur fractures are women, in the transition to the eighth decade of life, victims of a fall from their own height. Elderly people with greater functional dependence waited longer for surgery and had worse outcomes

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Traumatic injuries are a significant cause of death for birds worldwide, as they are at an increased risk of collisions and other injuries due to man-made environments. This study examined the frequency and morphological characteristics of fatal traumatic injuries in endemic and migratory Passeriformes and Psittaciformes from the Cerrado Biome, a biodiverse but threatened area in Brazil. Results showed that fatal traumatic injuries were found in 21.8% of birds (285/1305), mainly in spring and summer, during the birds' reproductive period. The yellow-chevroned parakeet (Brotogeris chiriri) and Passeriformes from the Thraupidae family were the most affected. Nearly 70% of the fatal injuries observed were to the thoracic, pelvic limbs, and skull, and types of fractures and affected bones were thoroughly evaluated. Blunt traumas were one of the most frequent causes of injuries. Injuries affecting the appendicular skeleton and head represented significant causes of traumatic death for Passeriformes and Psittaciformes. The frequency of these fatal injuries has been increasing in recent years, which may be related to the remarkable environmental changes in the Cerrado Biome and jeopardize the survival of many bird species.

As lesões traumáticas são uma causa significativa de morte nas aves em todo o mundo, pois apresentam um risco maior de colisões e outras lesões devido aos ambientes degradados e criados pelo homem. Este estudo examinou a frequência e as características morfológicas das lesões traumáticas fatais em Passeriformes e Psittaciformes endêmicos e migratórios do Bioma Cerrado, uma área com rica biodiversidade, mas ameaçada no Brasil. Os resultados demostraram que as lesões traumáticas fatais foram observadas em 21,8% das aves (285/1305), principalmente na primavera e verão, durante a época reprodutiva das aves. O periquito-do-encontro-amarelo (Brotogeris chiriri) e Passeriformes da família Thraupidae foram as aves mais frequentemente acometidas. Por volta de 70% das lesões fatais observadas foram nos membros torácicos e pélvicos, e crânio, e os tipos de fraturas e ossos afetados foram minuciosamente avaliados. Os traumas contudentes foram as principais causas das lesões. As injúrias que afetaram o esqueleto apendicular e a cabeça representaram as mais importantes causas de morte traumática para Passeriformes e Psittaciformes. A frequência dessas lesões fatais vem aumentando nos últimos anos, o que pode estar relacionado às mudanças ambientais marcantes no Bioma Cerrado e colocar em risco a sobrevivência de muitas espécies de aves.

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Heart failure (HF) is a prevalent clinical syndrome that causes significant physical limitations. Osteoporosis is also an important cause of loss of functionality, and it mainly affects women. There are several reports linking HF and osteoporosis, and both share risk factors. Most of the data available so far point to bone fragility as a consequence of HF, and several mechanisms have been identified to explain this relationship. Among the proposed pathophysiological mechanisms are the hyperactivation of the renin-angiotensin-aldosterone system and the increase in parathyroid hormone, functional limitation, production of inflammatory mediators and the use of drugs for HF. The role of osteoprotegerin has gained attention owing to its cardiovascular and skeletal effects, its observed deficiency during the postmenopausal period along with its compensatory increases in HF and severe osteoporosis. The objective of this review was to perform a literature search for the main evidence on skeletal impairment in HF, with emphasis on women. As for epidemiological studies, we selected data from 3 meta-analyses and 20 individual observational studies, which together showed the interrelationship between the two clinical conditions in terms of both decreased bone density and increased fracture risk. In conclusion, HF and osteoporosis are interrelated conditions mediated by complex pathophysiological mechanisms which may be more relevant for postmenopausal women, considered to be a vulnerable population for both cardiovascular diseases and bone fragility.

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Proton pump inhibitors (PPIs) can directly interfere with osteoclastic function, induce hypergastrinemia, and inhibit calcium absorption, leading to reduced bone mineral density (BMD), a measure of bone metabolism that may be associated with the risk of fractures. The current study involves a systematic review and meta-analysis aimed at assessing the relationship between prolonged use of PPI drugs and fractures in menopausal women. A systematic search and meta-analysis were performed on PubMed, Scopus, and Science Direct databases according to PRISMA guidelines. Two independent reviewers analyzed the articles. The five articles found in the databases, which met the eligibility criteria, covered participants who were menopausal women aged between 56 and 78.5 years, using or not using a PPI for a minimum of 12 months. All studies showed an increase in the rate of fractures related to using PPIs, as an outcome. Prolonged use of PPIs in menopausal women can affect bone metabolism and cause fractures. However, other factors, such as the use of other classes of drugs, obesity, low weight, poor diet, replacement hormones, and comorbidities, should also be considered for assessing the risk of fractures.

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The objective was to know the behavior of fractures in Mexican children and adolescents. According to our study, fractures in Mexican male children and adolescents seem to be decreasing; however, we still need more national studies to know the possible causes of these fractures. PURPOSE: To describe the trends of fractures in Mexican children and adolescents across a 12-year period (2007 to 2019), and to analyze if these trends have changed over time between sexes and age groups. METHODS: We identified all fracture cases registered in children and adolescents (0 to 19 years) at the emergency rooms and surgical departments of the Mexican Institute of Social Security between January 2007 and December 2019. We used ICD-10 to classify the fractures. The population was divided into two age groups: children (0 to 9 years) and adolescents (10 to 19 years). Additional information regarding sex and age was gathered up as well. We calculated annual incidence; incidence rates are presented per 10,000 population at risk. Changes in fracture trends were calculated using the average annual percentage change (AAPC). RESULTS: Over 12 years, 1,400,443 fractures were registered. The most frequent site of fracture was forearm in 37.1% followed by shoulder (18.1%). The overall rates of fractures have remained similar over 12 years (86.5, IQR 81.0-94.2); however, a significant decrease in fractures was observed the last 3 years (2017-2019). According to the AAPC, only in men, in both age groups, a significant decrease in fractures was observed. CONCLUSION: This is the first study in Mexico to follow the behavior of fractures in the pediatric population over 12 years. Fractures seem to be decreasing in children and adolescents. An epidemiological follow-up of childhood fractures is necessary to understand the causes of fractures to generate better prevention and treatment strategies.

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Infancy and adolescence are crucial periods for bone health, since they are characterized by intense physical growth and bone development. The unsatisfactory acquisition of bone mass in this phase has consequences in adult life and increases the risk of developing bone diseases at more advanced ages. Nutrient deficiencies, especially calcium and vitamin D, associated with a sedentary lifestyle; lack of sun exposure; and epigenetic aspects represent some of the main risk factors for poor bone quality. In addition, recent studies relate childhood obesity to impaired bone health; however, studies on the adiposity effects on bone health are scarce and inconclusive. Another gap concerns the implications of obesity on child sexual maturity, which can jeopardize their genetic potential bone mass and increase fracture risk. Therefore, we reviewed the analyzed factors related to bone health and their association with obesity and metabolic syndrome in adolescents. We concluded that obesity (specifically, accumulated visceral fat) harms bones in the infant-juvenile phase, thereby increasing osteopenia/osteoporosis in adults and the elderly. Thus, it becomes evident that forming and maintaining healthy eating habits is necessary during infancy and adolescence to reduce the risk of fractures caused by bone-metabolic diseases in adulthood and to promote healthy ageing.

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Catastrophic musculoskeletal injuries (CMI) pose a major welfare concern to horses and their riders, yet limited data are available describing their occurrence in South America. Using a retrospective cohort and case-control design, the objective of the study was to determine the incidence of CMI for Thoroughbreds in training and racing, and associated horse-level risk factors in Uruguay. Seventy-seven Thoroughbreds sustained a CMI, 37 of which were age- and sex-matched to 111 control horses in the same race. Training and racing data from 2011 to 2017 were collected. Incidence of race day CMI per 1,000 race starts and training CMI incidence per 100 horse months were calculated using Poisson regression. Univariable logistic regression was used to assess relationships between race history and occurrence of CMI by fracture location, and multivariable for all fracture locations. Overall race day incidence of CMI was 0.42 per 1,000 race starts (95% CI 0.29, 0.60). The incidence of CMI in training was 0.059 per 100 horse months. Twenty-nine percent (22/77) of horses that sustained a CMI had not raced prior. Most fractures were of the forelimbs (80.3%). There were 32 (41.6%) distal and 39 (50.6%) proximal limb fractures. The risk of CMI was greater for horses with fewer places (P = .001), and greater time between the previous race and the race in which CMI occurred (P = .020). The rate of race day CMI was low, despite Uruguay being a racing jurisdiction with policies and risk factors associated with greater CMI rates compared to other jurisdictions. Lightly raced horses with long periods since their previous race start should be monitored closely.

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BACKGROUND: A secondary cause can be found in up to one third of women with osteoporosis, potentially modifying their therapeutic approach. AIM: To determine the prevalence of secondary causes and risk factors for decreased bone mineral density (BMD) and osteoporosis. Material and Methods: We included postmenopausal women with a diagnosis of osteoporosis or low BMD who consulted for the first time in an endocrinology clinic between October 2018 and March 2020. A complete medical history, physical examination and a standardized laboratory assessment to identify secondary causes were performed. RESULTS: During the study period, 114 women were evaluated, 30 of them with low BMD and 84 with osteoporosis. After obtaining a medical history and a structured laboratory screening, at least one secondary cause was found in 50% of patients with osteoporosis and in 67% of those with low BMD. Most patients with no identified secondary cause had at least one risk factor for fragility fractures. Conclusions: A structured evaluation that includes medical history and standardized laboratory study in postmenopausal women with osteoporosis or low BMD, is a valuable tool to identify secondary causes of osteoporosis.

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