RESUMEN
Bone fractures are a significant public health issue among elderly subjects. This study examines the impact of diet and vitamin D status on the risk of long bone fractures due to falls in elderly subjects in Vojvodina, Serbia. Conducted at the University Clinical Center of Vojvodina in autumn/winter 2022-2023, the study included 210 subjects >65 years: 105 (F: 80/M: 15) with long bone fractures due to falls and 105 (F: 80/M: 15) controls. Groups were similar regarding age and BMI. Dietary intakes (by two 24-h recalls) and serum vitamin D levels were analyzed. The fracture group had a significantly lower median daily vitamin D intake (1.4 µg/day vs. 5.8 µg/day), intake of calcium, energy, proteins, fats, fibers, dairy products, eggs, fish, edible fats/oils, and a higher intake of sweets (p < 0.001 for all). Serum vitamin D levels were significantly lower in the fracture group (40.0 nmol/L vs. 76.0 nmol/L, p < 0.001). Logistic regression identified serum vitamin D as the most important protective factor against fractures, and ROC curve analysis indicated that serum vitamin D levels > 50.5 nmol/L decreased fracture risk. Nutritional improvements (increased intake of vitamin D and protein sources such as fish, eggs, and dairy), increased sun exposure, and routine vitamin D supplementation during winter are advised.
Asunto(s)
Accidentes por Caídas , Dieta , Fracturas Óseas , Estado Nutricional , Vitamina D , Humanos , Vitamina D/sangre , Vitamina D/administración & dosificación , Femenino , Masculino , Serbia/epidemiología , Anciano , Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/complicaciones , Anciano de 80 o más Años , Factores de RiesgoRESUMEN
Importance: The reasons for the increased fracture risk in type 2 diabetes (T2D) are not fully understood. Objective: To determine if poorer skeletal characteristics or worse physical function explain the increased fracture risk in T2D. Design, Setting, and Participants: This prospective observational study is based on the population-based Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures study cohort of older women, performed in the Gothenburg area between March 2013 and May 2016. Follow-up of incident fracture data was completed in March 2023. Data analysis was performed between June and December 2023. Exposures: Data were collected from questionnaires and through examination of anthropometrics, physical function, and bone measurements using bone densitometry (dual-energy x-ray absorptiometry), and high-resolution peripheral computed tomography. A subsample underwent bone microindentation to assess bone material strength index (BMSi). Main Outcomes and Measures: Baseline assessment of bone characteristics and physical function and radiograph verified incident fractures. Results: Of 3008 women aged 75 to 80 years, 294 women with T2D (mean [SD] age, 77.8 [1.7] years) were compared with 2714 women without diabetes (mean [SD] age, 77.8 [1.6] years). Women with T2D had higher bone mineral density (BMD) at all sites (total hip, 4.4% higher; femoral neck (FN), 4.9% higher; and lumbar spine, 5.2% higher) than women without. At the tibia, women with T2D had 7.4% greater cortical area and 1.3% greater density, as well as 8.7% higher trabecular bone volume fraction. There was no difference in BMSi (T2D mean [SD], 78.0 [8.3] vs controls, 78.1 [7.3]). Women with T2D had lower performance on all physical function tests. The study found 9.7% lower grip strength, 9.9% slower gait speed, and 13.9% slower timed up-and-go time than women without diabetes. During a median (IQR) follow-up of 7.3 (4.4-8.4) years, 1071 incident fractures, 853 major osteoporotic fractures (MOF), and 232 hip fractures occurred. In adjusted (for age, body mass index, clinical risk factors, and FN BMD) Cox regression models, T2D was associated with an increased risk of any fracture (HR, 1.26; 95% CI, 1.04-1.54) and MOF (HR, 1.25; 95% CI, 1.00-1.56). Conclusions and Relevance: In this cohort study of older women, T2D was associated with higher BMD, better bone microarchitecture, and no different BMSi but poorer physical function, suggesting that poor physical function is the main reason for the increased fracture risk in T2D women.
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Densidad Ósea , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Anciano , Estudios Prospectivos , Anciano de 80 o más Años , Factores de Riesgo , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Suecia/epidemiología , Absorciometría de Fotón , IncidenciaRESUMEN
The gut microbiota (GM) can regulate bone mass, but its association with incident fractures is unknown. We used Cox regression models to determine whether the GM composition is associated with incident fractures in the large FINRISK 2002 cohort (n = 7043, 1092 incident fracture cases, median follow-up time 18 years) with information on GM composition and functionality from shotgun metagenome sequencing. Higher alpha diversity was associated with decreased fracture risk (hazard ratio [HR] 0.92 per standard deviation increase in Shannon index, 95% confidence interval 0.87-0.96). For beta diversity, the first principal component was associated with fracture risk (Aitchison distance, HR 0.90, 0.85-0.96). In predefined phyla analyses, we observed that the relative abundance of Proteobacteria was associated with increased fracture risk (HR 1.14, 1.07-1.20), while the relative abundance of Tenericutes was associated with decreased fracture risk (HR 0.90, 0.85-0.96). Explorative sub-analyses within the Proteobacteria phylum showed that higher relative abundance of Gammaproteobacteria was associated with increased fracture risk. Functionality analyses showed that pathways related to amino acid metabolism and lipopolysaccharide biosynthesis associated with fracture risk. The relative abundance of Proteobacteria correlated with pathways for amino acid metabolism, while the relative abundance of Tenericutes correlated with pathways for butyrate synthesis. In conclusion, the overall GM composition was associated with incident fractures. The relative abundance of Proteobacteria, especially Gammaproteobacteria, was associated with increased fracture risk, while the relative abundance of Tenericutes was associated with decreased fracture risk. Functionality analyses demonstrated that pathways known to regulate bone health may underlie these associations.
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Fracturas Óseas , Microbioma Gastrointestinal , Humanos , Masculino , Femenino , Fracturas Óseas/microbiología , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Persona de Mediana Edad , Finlandia/epidemiología , Anciano , Bacterias/clasificación , Bacterias/genética , Bacterias/aislamiento & purificación , Metagenoma , Estudios de Cohortes , Incidencia , Metagenómica/métodos , Proteobacteria/genética , Proteobacteria/aislamiento & purificación , Factores de Riesgo , AdultoRESUMEN
BACKGROUND: The associations of physical pre-frailty and frailty with bone fractures and the modified effect of sedentary lifestyle remain uncertain. This study was performed to explore the association of physical pre-frailty and frailty with risk of incident bone fractures, and test the modification effects of sedentary lifestyle and other risk factors. METHODS: This cohort study included 413 630 participants without bone fractures at baseline in the UK Biobank study between 2006 and 2010 and followed up to 2021. The mean age of the participants was 56.5 years. A total of 224 351 (54.2%) enrolled participants were female and 376 053 (90.9%) included participants were White. Three Cox regression models were constructed to analyze the association of pre-frailty and frailty with total fractures, hip fractures, vertebrae fractures, and other fractures. RESULTS: As compared with the physical nonfrailty group, the multivariate-adjusted hazard ratios were 1.17 (95% confidence interval [CI]: 1.14-1.21) and 1.63 (95% CI: 1.53-1.74) for the physical pre-frailty group and frailty group, respectively (p-trendâ <â .001). In addition, we found that sedentary behavior time significantly accentuated the associations of physical pre-frailty and frailty with total fractures (p-interaction <.001), hip fractures (p-interactionâ =â .013), and other fractures (p-interaction <.001). CONCLUSIONS: Our results indicate that physical pre-frailty and frailty are related to higher risks of bone fractures; such association was more pronounced among those with longer sedentary behavior time.
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Fracturas Óseas , Fragilidad , Conducta Sedentaria , Humanos , Femenino , Masculino , Persona de Mediana Edad , Fragilidad/epidemiología , Factores de Riesgo , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Incidencia , Reino Unido/epidemiología , Anciano , Estudios de Cohortes , Modelos de Riesgos ProporcionalesRESUMEN
ABSTRACT: Musculoskeletal changes occur with gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS) used in the care of transgender adolescents and adults. Survey results have shown that orthopaedic surgeons desire to care for transgender individuals but express concern over a knowledge deficit. This article reviews the physiology and pathophysiology that may occur with GAHT and GAS. Transgender women have lower bone mineral density (BMD) prior to GAHT than cisgender men. Limited fracture data would suggest that transgender women >50 years of age have fracture rates similar to those of cisgender women. Transgender men have normal BMD prior to GAHT and are not at an increased risk for fracture compared with cisgender women. The use of puberty-blocking medications in the care of transgender youth does result in a decline in BMD, which returns to baseline with GAHT, but the effect of delaying puberty on maximal BMD and the lifetime fracture risk are unknown. At present, dual x-ray absorptiometry (DXA) is used to measure BMD and assess fracture risk. Attention should be paid to using the appropriate reference group in the interpretation of DXA for transgender individuals. Promote musculoskeletal health by ensuring appropriate calcium, vitamin D, weight-bearing activity, and a healthy lifestyle. Adherence to GAHT needs to be encouraged to avoid bone loss. Data with regard to therapy for osteoporosis in transgender patients have been lacking, but, at present, use of available therapies is expected to be effective. Information with regard to differences in other musculoskeletal health issues such as joint injuries has been lacking in transgender individuals.
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Densidad Ósea , Personas Transgénero , Humanos , Masculino , Femenino , Procedimientos de Reasignación de Sexo/efectos adversos , Cirugía de Reasignación de Sexo , Fracturas Óseas/etiología , Factores SexualesRESUMEN
BACKGROUND: Around 10% of fractures lead to complications. With increasing fracture incidences in recent years, this poses a serious burden on the healthcare system, with increasing costs for treatment. In the present study, we aimed to identify potential 'new' blood markers to predict the development of post-surgical complications in trauma patients following a fracture. METHODS: A total of 292 trauma patients with a complete three-month follow-up were included in this cohort study. Blood samples were obtained from 244 of these patients. Two complication groups were distinguished based on the Clavien-Dindo (CD) classification: CD grade I and CD grade III groups were compared to the controls (CD 0). The Mann-Whitney U test was used to compare the complication groups to the control group. RESULTS: Analysis of the patients' data revealed that risk factors are dependent on sex. Both, males and females who developed a CD III complication showed elevated blood levels of B7-1 (p = 0.015 and p = 0.018, respectively) and PlGF-1 (p = 0.009 and p = 0.031, respectively), with B7-1 demonstrating greater sensitivity (B7-1: 0.706 (male) and 0.692 (female), PlGF-1: 0.647 (male) and 0.615 (female)). Further analysis of the questionnaires and medical data revealed the importance of additional risk factors. For males (CD 0: 133; CD I: 12; CD III: 18 patients) alcohol consumption was significantly increased for CD I and CD III compared to control with p = 0.009 and p = 0.007, respectively. For females (CD 0: 107; CD I: 10; CD III: 12 patients) a significantly increased average BMI [kg/m2] from 25.5 to 29.7 with CD III was observed, as well as an elevation from one to three comorbidities (p = 0.003). CONCLUSIONS: These two potential new blood markers hold promise for predicting complication development in trauma patients. Nevertheless, further studies are necessary to evaluate the diagnostic utility of B7-1 and PlGF-1 in predicting complications in trauma patients and consider sex differences before their possible use as routine clinical screening tools.
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Biomarcadores , Fracturas Óseas , Factor de Crecimiento Placentario , Humanos , Masculino , Femenino , Biomarcadores/sangre , Persona de Mediana Edad , Adulto , Fracturas Óseas/sangre , Fracturas Óseas/epidemiología , Fracturas Óseas/diagnóstico , Fracturas Óseas/etiología , Factor de Crecimiento Placentario/sangre , Factores de Riesgo , Estudios de Cohortes , Anciano , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Estudios de SeguimientoRESUMEN
BACKGROUND: Complications of prolonged continuous kidney replacement therapy (CKRT) have not been well described. Our objective was to describe mineral metabolism and bone findings in children who required prolonged CKRT. METHODS: In this single center prospective observational study, we enrolled 37 patients who required CKRT for ≥ 28 days with regional citrate anticoagulation. Exposure was duration on CKRT and outcomes were 25-hydroxy vitamin D and osteopenia and/or fractures. RESULTS: The prevalence of vitamin D deficiency and insufficiency was 17.2% and 69.0%, respectively. 29.7% of patients had radiographic findings of osteopenia and/or fractures. There was no association between vitamin D deficiency or insufficiency with age or ethnicity. Time on CKRT and intact PTH levels were not predictive of vitamin D levels. Children with chronic liver disease were more likely to have osteopenia and/or fractures compared children with other primary diagnoses, odds ratio (3.99 (95%CI, 1.58-2.91), p = 0.003) after adjusting for age and time on CKRT. CONCLUSION: Vitamin D deficiency and/or insufficiency, and osteopenia and/or fractures are prevalent among children who require CKRT for a prolonged period. The risk for MBD may be higher with chronic liver disease. Higher doses of vitamin D may be required to maintain normal levels while on CKRT.
Asunto(s)
Enfermedades Óseas Metabólicas , Terapia de Reemplazo Renal Continuo , Deficiencia de Vitamina D , Vitamina D , Humanos , Femenino , Masculino , Enfermedades Óseas Metabólicas/epidemiología , Enfermedades Óseas Metabólicas/etiología , Estudios Prospectivos , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/tratamiento farmacológico , Niño , Vitamina D/sangre , Vitamina D/análogos & derivados , Vitamina D/uso terapéutico , Preescolar , Adolescente , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , PrevalenciaRESUMEN
BACKGROUND: Intimate partner violence (IPV) is a prevalent issue in the United States, despite universal screening measures for women of reproductive age. Orthopaedic surgeons have a unique opportunity to intervene in cases of IPV as musculoskeletal injuries, including fractures, are the second most common type of injury seen in IPV patients. This systematic literature review aims to identify patterns in musculoskeletal injuries caused by IPV to increase identification of patients afflicted by IPV. METHODS: A comprehensive search of PubMed, PsycINFO, and Web of Science yielded 316 articles. Included were cohort studies and literature reviews of patients with an IPV-associated orthopaedic injury. Excluded were case studies, perspective articles, material predating 2003, and studies with pediatric or elderly populations. Sixteen articles met criteria. RESULTS: Data supported historical findings that musculoskeletal injury is the second most common injury in patients with IPV, with upper extremity fractures prevailing. Minimally displaced phalanges fractures were most common (9.9%-64%), and isolated ulnar fractures had significant relative risk of IPV association (8.5-12.8). Patients with multiple fractures of varying chronicity were more likely to be victims of IPV (sensitivity 25.2%, specificity 99.2%, positive predictive value 96.2%), and these chronic fractures matched patterns of acute injury caused by IPV. New findings in male victims included a higher proportion of lower extremity and pelvic fractures seen in male cohorts. CONCLUSION: This study synthesizes evidence of IPV-related orthopaedic injuries, offering objective criteria for identifying victims. Despite limitations in fracture descriptions, the findings aid various physicians in recognizing IPV victims. Considering ongoing IPV prevalence and screening challenges, further research on injury patterns is recommended. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.
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Fracturas Óseas , Violencia de Pareja , Humanos , Violencia de Pareja/estadística & datos numéricos , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Femenino , MasculinoRESUMEN
Orthopaedic and sports medicine clinicians can improve outcomes for transgender patients by understanding the physiological effects of gender-affirming hormone therapy (GAHT). This narrative review investigated the role of GAHT on bone mineral density, fracture risk, thromboembolic risk, cardiovascular health and ligament/tendon injury in this population. A search from the PubMed database using relevant terms was performed. Studies were included if they were levels 1-3 evidence. Due to the paucity of studies on ligament and tendon injury risk in transgender patients, levels 1-3 evidence on the effects of sex hormones in cisgender patients as well as basic science studies were included for these two topics. This review found that transgender patients on GAHT have an elevated fracture risk, but GAHT has beneficial effects on bone mineral density in transgender women. Transgender women on GAHT also have an increased risk of venous thromboembolism, stroke and myocardial infarction compared with cisgender women. Despite these elevated risks, studies have found it is safe to continue GAHT perioperatively for both transgender women and men undergoing low-risk operations. Orthopaedic and sports medicine clinicians should understand these unique health considerations for equitable patient care.
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Densidad Ósea , Medicina Deportiva , Personas Transgénero , Humanos , Masculino , Femenino , Fracturas Óseas/prevención & control , Fracturas Óseas/etiología , Ortopedia , Traumatismos de los Tendones/terapia , Tromboembolia/prevención & control , Tromboembolia/etiologíaRESUMEN
BACKGROUND: People with multiple sclerosis (PwMS) exhibit reduced bone mineral density (BMD) across several anatomical regions. Studies have indicated that PwMS are at a heightened risk of fractures due to decreased BMD and increased prevalence of osteopenia and osteoporosis. This study aimed to investigate the prevalence and risk of osteopenia, osteoporosis, and fracture among PwMS. METHODS: Relevant studies were identified through comprehensive searches of databases (PubMed/MEDLINE, Scopus, Embase, and Web of Science) from January 1, 2000, to January 21, 2024. R software version 4.4.0 and random-effects models were employed to estimate the pooled prevalence, odds ratio (OR), and risk ratio (RR) of osteopenia, osteoporosis, and fracture among PwMS, along with their respective 95 % confidence intervals (CIs). RESULTS: From a total of 2039 articles, 51 studies with 1,503,785 PwMS met our inclusion criteria. The pooled prevalence of osteopenia, osteoporosis, and overall fracture among PwMS was 41.41 % (95 % CI: 36.14% to 46.69 %, I2=97 %), 14.21 % (95 % CI: 10.75 % to 17.68 %, I2=99 %), and 12.84 % (95 % CI: 8.49 % to 17.19 %, I2 = 100 %), respectively. The likelihood of osteopenia (OR=2.02, 95 % CI: 1.46 to 2.8, p-value<0.01, I2=17 %) and osteoporosis (OR=1.71, 95 % CI: 1.27 to 2.31, p-value<0.01, I2=74 %), as well as the probability of overall fracture (RR=1.86, 95 % CI: 1.61 to 2.14, p-value<0.01, I2=74 %) were significantly higher in PwMS than healthy controls (HCs). CONCLUSION: PwMS were at a substantially increased risk of developing osteopenia (2-fold), osteoporosis (1.7-fold), and overall fractures (1.9-fold). Well-designed studies are needed to explore these associations further.
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Enfermedades Óseas Metabólicas , Esclerosis Múltiple , Osteoporosis , Humanos , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/complicaciones , Osteoporosis/epidemiología , Osteoporosis/etiología , Enfermedades Óseas Metabólicas/epidemiología , Enfermedades Óseas Metabólicas/etiología , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Densidad Ósea/fisiologíaRESUMEN
OBJECTIVES: To examine the risk of fractures in a cohort of patients with newly diagnosed rheumatoid arthritis (RA), compared to the background population, and predictors of fractures detectable early in RA. METHODS: An inception cohort of patients with RA (N = 233; 164 women/69 men, recruited 1995-2005) was evaluated according to a structured program, including repeated clinical assessments and measures of bone mineral density (BMD), from diagnosis to 10 years later. Matched population controls were identified using the national census register. Fractures through 2019 were identified based on ICD codes. Cox regression models were used to assess the risk of fractures in RA patients compared with controls, and for assessment of potential predictors for fractures in the RA population. RESULTS: RA patients had an increased risk of fractures (fully adjusted hazard ratio (HR) 1.52, 95â¯% CI 1.13; 2.06). In the RA cohort, high age, low body mass index, and low BMD were significant baseline predictors of future fractures in multivariate analyses, but baseline RA disease characteristics were not. Worse disability (i.e. higher Health Assessment Questionnaire (HAQ) scores) over time was significantly associated with increased risk of fractures (age-sex-adjusted HR 1.33 per SD, 95â¯% CI 1.09; 1.63) and there was an inverse association between BMD Z-scores over time and fractures. CONCLUSION: Patients with RA had higher risk of fractures than controls. Fracture risk was related to BMD at baseline and over time in patients with RA. In addition, worse disability (measured by HAQ) over time was associated with higher risk of fractures.
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Artritis Reumatoide , Densidad Ósea , Fracturas Óseas , Humanos , Artritis Reumatoide/complicaciones , Masculino , Femenino , Persona de Mediana Edad , Estudios de Seguimiento , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Anciano , Factores de Riesgo , AdultoRESUMEN
Metastatic pheochromocytomas and paragangliomas (PPGLs) are frequently associated with skeletal complications. Primary objective: to describe the frequency of adverse skeletal related events (SREs) in PPGL patients with bone metastases (BMs). Secondary objectives: to 1) identify predictive and prognostic factors for SREs and 2) obtain information on the effectiveness of bone resorption inhibitors in reducing SRE risk and improving outcomes in term of survival and SREs time onset. In this retrospective multicenter, multinational study, 294 PPGL patients were enrolled. SREs occurred in 90 patients (31 %). Fifty-five patients (19 %) had bone fractures, 47 (16 %) had spinal cord compression, and 11 (4 %) had hypercalcemia. Twenty-two patients (7 %) had more than one SRE. Sixty-four patients (22 %) underwent surgery, and 136 (46 %) underwent radiotherapy. SREs occurred a median of 4.4 months after diagnosis of BM (range, 0-246.6 months). Independent factors associated with reduced risk of SREs in multivariable analysis were I-131-MIBG radionuclide therapy (hazard ratio [HR], 0.536 [95 % CI, 0.309-0.932]; P = .027) and absence of liver metastases (HR, 0.638 [95 % CI, 0.410-0.992]; P = .046). The median overall survival duration was 5.3 year. In multivariable analysis, age younger than 48 years at PPGL diagnosis (HR, 0.558 [95 % CI, 0.3877-0.806]; P = .002), absence of liver metastases (HR, 0.618 [95 % CI, 0.396-0.965]; P = .034), treatment with bisphosphonates or denosumab (HR, 0.598 [95 % CI, 0.405-0.884]; P = .010), and MIBG radionuclide therapy (HR, 0.444 [95 % CI, 0.274-0.718]; P = .001) were associated with a reduced risk of death. SREs occur frequently and early in bone-metastatic PPGL patients but do not negatively impact survival. MIBG radionuclide therapy and treatment with bone resorption inhibitors are associated with favorable outcome.
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Neoplasias de las Glándulas Suprarrenales , Neoplasias Óseas , Paraganglioma , Feocromocitoma , Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Óseas/secundario , Neoplasias Óseas/complicaciones , Feocromocitoma/complicaciones , Feocromocitoma/patología , Feocromocitoma/mortalidad , Estudios Retrospectivos , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/mortalidad , Neoplasias de las Glándulas Suprarrenales/terapia , Adulto , Anciano , Paraganglioma/complicaciones , Paraganglioma/patología , Paraganglioma/mortalidad , Adulto Joven , Compresión de la Médula Espinal/etiología , Fracturas Óseas/etiología , Adolescente , Anciano de 80 o más Años , Hipercalcemia/etiología , Factores de Riesgo , Conservadores de la Densidad Ósea/uso terapéutico , PronósticoRESUMEN
Obesity and type 2 diabetes (T2D) are risk factors for fragility fractures. It is unknown whether this elevated risk is due to a diet favoring obesity or the diabetes that often occurs with obesity. Therefore, we hypothesized that the fracture resistance of bone is lower in mice fed with a high fat diet (45% kcal; HFD) than in mice that fed on a similar, control diet (10% kcal; LFD), regardless of whether the mice developed overt T2D. Sixteen-week-old, male NON/ShiLtJ mice (resistant to T2D) and age-matched, male NONcNZO10/LtJ (prone to T2D) received a control LFD or HFD for 21 weeks. HFD increased the bodyweight to a greater extent in the ShiLtJ mice compared to the NZO10 mice, while blood glucose levels were significantly higher in NZO10 than in ShiLtJ mice. As such, the glycated hemoglobin A1c (HbA1c) levels exceeded 10% in NZO10 mice, but it remained below 6% in ShiLtJ mice. Diet did not affect HbA1c. HFD lowered trabecular number and bone volume fraction of the distal femur metaphysis (micro-computed tomography or µCT) in both strains. For the femur mid-diaphysis, HFD significantly reduced the yield moment (mechanical testing by three-point bending) in both strains but did not affect cross-sectional bone area, cortical thickness, nor cortical tissue mineral density (µCT). Furthermore, the effect of diet on yield moment was independent of the structural resistance of the femur mid-diaphysis suggesting a negative effect of HFD on characteristics of the bone matrix. However, neither Raman spectroscopy nor assays of advanced glycation end-products identified how HFD affected the matrix. HFD also lowered the resistance of cortical bone to crack growth in only the diabetic NZO10 mice (fracture toughness testing of other femur), while HFD reduced the ultimate force of the L6 vertebra in both strains (compression testing). In conclusion, the HFD-related decrease in bone strength can occur in mice resistant and prone to diabetes indicating that a diet high in fat deleteriously affects bone without necessarily causing hyperglycemia.
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Densidad Ósea , Diabetes Mellitus Tipo 2 , Dieta Alta en Grasa , Obesidad , Animales , Diabetes Mellitus Tipo 2/metabolismo , Dieta Alta en Grasa/efectos adversos , Obesidad/metabolismo , Masculino , Ratones , Densidad Ósea/fisiología , Fracturas Óseas/etiología , Huesos/metabolismo , Huesos/patologíaRESUMEN
PURPOSE OF THE STUDY: To investigate the effects of anatomical variations on the mechanism of scaphoid fracture by comparing the radiologic parameters of the wrist of patients with and without scaphoid fracture after a fall on an outstretched hand. MATERIAL AND METHODS: Cross-sectional comparative retrospective analysis of radiographs of patients with (Group 1, n=169) and without scaphoid fracture (Group 2, n=188). Morphometric data were measured including radial inclination (RI), radial height (RH), ulnar variance (UV), carpal height (CH) ratio, revised carpal height (RCH) ratio and palmar tilt of the distal radius (PT). Receiver operating characteristics (ROC) curve analysis was used to assess the diagnostic performance for each variable with statistically significant difference. RESULTS: The mean RI and PT degrees and RH length were statistically significantly higher, and the mean UV was lower in Group 1 compared to Group 2. No difference was determined between the groups with respect to the CH ratio and RCH ratio. With ROC curve analysis, the cut-off value with the highest odds ratio was determined as RH (Cut-off value=10.77 mm, OR=21.886). CONCLUSIONS: Although higher RI, RH, PT values and more negative ulnar variance were observed in the scaphoid fracture group compared to the non-fracture group, ROC curve analysis showed that only increased RH can be considered as a possible risk factor for scaphoid fractures after fall on an outstretched hand. KEY WORDS: radiographs, risk factor, scaphoid fracture, wrist morphology.
Asunto(s)
Accidentes por Caídas , Fracturas Óseas , Radiografía , Hueso Escafoides , Humanos , Hueso Escafoides/lesiones , Hueso Escafoides/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/etiología , Radiografía/métodos , Masculino , Femenino , Adulto , Estudios Transversales , Estudios Retrospectivos , Persona de Mediana Edad , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/etiología , Adulto Joven , Articulación de la Muñeca/diagnóstico por imagen , AdolescenteRESUMEN
PURPOSE: Oxaliplatin-containing adjuvant chemotherapy yields a significant survival benefit in stage III colon cancer and is the standard of care. Simultaneously, it causes dose-dependent peripheral neuropathy that may increase the risk of fall-related injury (FRI) such as fracture and laceration. Because these events carry significant morbidity and the global burden of colon cancer is on the rise, we examined the association between treatment with a full versus shortened course of adjuvant chemotherapy and post-treatment FRI and fracture. METHODS: In this overlap propensity score weighted, retrospective cohort study, we included patients aged ≥ 18 years with resected stage III colon cancer diagnosed 2007-2019 and treated with oxaliplatin-containing adjuvant chemotherapy (oxaliplatin plus a fluoropyrimidine; capecitabine [CAPOX] or 5-fluorouracil and leucovorin [FOLFOX]). Propensity score methods facilitate the separation of design from analysis and comparison of baseline characteristics across the weighted groups. Treatment groups were defined as 50% (4 cycles CAPOX/6 cycles FOLFOX) and > 85% (7-8 cycles CAPOX/11-12 cycles FOLFOX) of a maximal course of adjuvant chemotherapy to approximate the treatment durations received in the IDEA collaboration. The main outcomes were time to any FRI and time to fracture. We determined the subdistribution hazard ratios (sHR) estimating the association between FRI/fracture and treatment group, accounting for the competing risk of death. RESULTS: We included 3,461 patients; 473 (13.7%) received 50% and 2,988 (86.3%) received > 85% of a maximal course of adjuvant therapy. For post-treatment FRI, median follow-up was 4.6 years and total follow-up was 17,968 person-years. There were 508 FRI, 301 fractures, and 692 deaths. Treatment with > 85% of a maximal course of therapy conferred a sHR of 0.84 (95% CI 0.62-1.13) for post-treatment FRI and a sHR of 0.72 (95% CI 0.49-1.06) for post-treatment fracture. CONCLUSION: For patients with stage III colon cancer undergoing treatment with oxaliplatin-containing adjuvant chemotherapy, any potential neuropathy associated with longer durations of treatment was not found to result in greater rates of FRI and fracture. Within the limits of this retrospective study, our findings suggest concern about FRI, while mechanistically plausible, ought not to determine treatment duration.
Asunto(s)
Accidentes por Caídas , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias del Colon , Fluorouracilo , Leucovorina , Estadificación de Neoplasias , Oxaliplatino , Humanos , Estudios Retrospectivos , Femenino , Masculino , Quimioterapia Adyuvante/métodos , Quimioterapia Adyuvante/efectos adversos , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/patología , Neoplasias del Colon/mortalidad , Persona de Mediana Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Oxaliplatino/administración & dosificación , Oxaliplatino/efectos adversos , Oxaliplatino/uso terapéutico , Anciano , Accidentes por Caídas/estadística & datos numéricos , Leucovorina/uso terapéutico , Leucovorina/efectos adversos , Leucovorina/administración & dosificación , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Fluorouracilo/uso terapéutico , Fracturas Óseas/etiología , Fracturas Óseas/epidemiología , Capecitabina/administración & dosificación , Puntaje de Propensión , Adulto , Compuestos OrganoplatinosRESUMEN
BACKGROUND AND PURPOSE: Electric scooters (e-scooters) have become increasingly popular as a mode of transportation in recent years. The impact of e-scooter accidents on the healthcare system and resulting orthopaedic injuries remains largely unknown. This study describes the distribution of fractures caused by e-scooter accidents. METHODS: All patients who had one or more fractures from e-scooter accidents registered in the Swedish Fracture Register (SFR) between 7 April 2019 and 30 December 2022 were included. Fractures were classified using the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification system. We analysed the distribution of fractures, the proportion that required surgical management and seasonal variation of injuries. RESULTS: During the study period, 1,874 fractures in 1,716 patients were registered in the SFR. The mean age of patients was 29 (SD 14) years and 70% of fractures occurred in males. High-energy accidents accounted for 299 fractures (16%). The most common fractures were of the hand (n = 363, 19%), wrist (n = 352, 19%) and proximal forearm (n = 356, 19%). Wrist fractures were the most common injury in children (n = 183), accounting for 44% of paediatric fractures. Surgical treatment was performed on 556 (30%) fractures, with wrist fractures being the most commonly treated in both adults (n = 78, 17%) and children (n = 36, 36%). INTERPRETATION: Fractures caused by e-scooter accidents predominantly occur in the upper extremity. E-scooter accidents comprise a new source of injury requiring attention and surgical resources from an already strained healthcare system.
Asunto(s)
Fracturas Óseas , Sistema de Registros , Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto Joven , Accidentes de Tránsito/estadística & datos numéricos , Estudios de Cohortes , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Suecia/epidemiologíaRESUMEN
The objective of this review is to examine the connection between osteoporosis and diabetes, compare the underlying causes of osteoporosis in various forms of diabetes, and suggest optimal methods for diagnosing and assessing fracture risk in diabetic patients. This narrative review discusses the key factors contributing to the heightened risk of fractures in individuals with diabetes, as well as the shared elements impacting the treatment of both diabetes mellitus and osteoporosis. Understanding the close link between diabetes and a heightened risk of fractures is crucial in effectively managing both conditions. There are several review articles of meta-analysis regarding diaporosis. Nevertheless, no review articles showed collected and well-organized medications of antidiabetics and made for inconvenient reading for those who were interested in details of drug mechanisms. In this article, we presented collected and comprehensive charts of every antidiabetic medication which was linked to fracture risk and indicated plausible descriptions according to research articles.
Asunto(s)
Hipoglucemiantes , Osteoporosis , Humanos , Osteoporosis/tratamiento farmacológico , Osteoporosis/etiología , Hipoglucemiantes/uso terapéutico , Fracturas Óseas/etiología , Diabetes Mellitus , Densidad Ósea , Complicaciones de la Diabetes , Factores de RiesgoRESUMEN
Treatment for breast cancer, including endocrine therapies, can contribute to bone loss and increase the risk of osteoporosis and fractures. Management of bone health in patients with cancer is often coordinated between oncologists, endocrinologists, and primary care physicians. In this article, we discuss the approach to screening for fracture risk among patients initiating treatments for breast cancer and recommendations for lifestyle modifications to optimize bone health. We will review 3 indications for pharmacologic bone-targeted therapies: prevention of cancer treatment-induced bone loss, adjuvant therapy to reduce recurrence, and management of bone metastases.
Asunto(s)
Neoplasias Óseas , Neoplasias de la Mama , Osteoporosis , Humanos , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Femenino , Osteoporosis/etiología , Osteoporosis/prevención & control , Osteoporosis/terapia , Neoplasias Óseas/secundario , Conservadores de la Densidad Ósea/uso terapéutico , Fracturas Óseas/prevención & control , Fracturas Óseas/etiología , Fracturas Óseas/epidemiología , Densidad Ósea/efectos de los fármacosRESUMEN
Fracture risk in type 2 diabetes (T2D) patients is paradoxically increased despite no decrease in areal bone mineral density (BMD). This phenomenon, known as the "diabetic bone paradox", has been attributed to various factors including alterations in bone microarchitecture and composition, hyperinsulinemia and hyperglycemia, advanced glycation end products (AGEs), and comorbidities associated with T2D. Zhao et al. recently investigated the relationship between T2D and fracture risk using both genetic and phenotypic datasets. Their findings suggest that genetically predicted T2D is associated with higher BMD and lower fracture risk, indicating that the bone paradox is not observed when confounding factors are controlled using Mendelian randomization (MR) analysis. However, in prospective phenotypic analysis, T2D remained associated with higher BMD and higher fracture risk, even after adjusting for confounding factors. Stratified analysis revealed that the bone paradox may disappear when T2D-related risk factors are eliminated. The study also highlighted the role of obesity in the relationship between T2D and fracture risk, with BMI mediating a significant portion of the protective effect. Overall, managing T2D-related risk factors may be crucial in preventing fracture risk in T2D patients.