Thiazolidinediones Tied to Increased Risk of Fracture

Materials used in additive techniques are initially in a plastic state to be inserted into different cavities or easily molded (a blunt, for example), after which they pass into a rigid phase. This process is carried out by various methods depending on the material nature. The process can be purely physical (solidifying the alloy melt, the termoplasticized macromolecular compounds), modification and rearrangement of the internal structure (sintering of ceramic masses, crystallization of glasses, amalgam intake), a process of evaporation of some components (lacquers, plasticizing polymers) or a chemical process. This latter process can be an acid-base reaction between two inorganic substances (PCZ, CIS cements), a chelating reaction (ZOE cements) between a phenolic range (organic compound, usually eugenol or orthoethoxybenzoic acid) and an inorganic powder (ZnO) or a reaction in which a macromolecular compound is formed. After the type of the reaction, the macromolecules are classified into polymers (the formation reaction is called polymerization, the compounds of which are obtained by monomers, the main chain is formed by the carbon atom only), polycondensates (the formation reaction is called polycondensation, the chain also formed from heteroatom-ON, depending on the type of material) or substances that are obtained by polyaddition ( a repeated addition, the mechanism being different from the polymerization. Our study was conducted in the Dental Clinic and comprises a total of 17 patients. The group was represented by patients aged 50-85 years. Clinical observations have been made on cases of fracture of acrylic bases, with the analysis and assessment of some clinical aspects with increased risk of fracture (jaw / mandible, median / paramedian fracture line, etc.), which increase the risk to and fracture when associated. Clinical observations have shown the presence of the risk of fracture in acrylic prostheses, with the need first of all for the proper design and realization of mobile prostheses, but also for the use of inserts.

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Obesity and Bone: A Complex Relationship

International Journal of Molecular Sciences ◽

10.3390/ijms222413662 ◽

2021 ◽

Vol 22 (24) ◽

pp. 13662

Author(s):

Giuseppe Rinonapoli ◽

Valerio Pace ◽

Carmelinda Ruggiero ◽

Paolo Ceccarini ◽

Michele Bisaccia ◽

...

Keyword(s):

High Fat Diet ◽

Obese Subject ◽

Osteoporotic Fractures ◽

Mechanical Effect ◽

Normal Weight ◽

Obese Children ◽

Risk Of Fracture ◽

Increased Risk ◽

Risk Of Falls ◽

The Relationship

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.

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Comorbid Conditions and GFR Predict Nonvertebral Fractures in Patients With Diabetes in an Ethnic-Specific Manner

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa141 ◽

2020 ◽

Vol 105 (6) ◽

pp. e2168-e2175

Author(s):

Rajesh K Jain ◽

Mark G Weiner ◽

Huaqing Zhao ◽

Tamara Vokes

Keyword(s):

Risk Factors ◽

Osteoporotic Fractures ◽

Comorbid Conditions ◽

Risk Of Fracture ◽

Increased Risk ◽

Major Osteoporotic Fractures ◽

Specific Manner ◽

Patients With Diabetes ◽

Race Ethnicity ◽

Insulin Use

Abstract Context Diabetes mellitus (DM) is associated with an increased risk of fracture, but it is not clear which diabetes and nondiabetes risk factors may be most important. Objective The aim of the study was to evaluate risk factors for incident major osteoporotic fractures (MOFs) of the hip, wrist, and humerus in African American (AA), Hispanic (HIS), and Caucasian (CA) subjects with DM. Methods This was a retrospective cohort study of 18 210 subjects with DM (7298 CA, 7009 AA and 3903 HIS) at least 40 years of age, being followed at a large healthcare system in Philadelphia, Pennsylvania. Results In a global model in CA with DM, MOF were associated with dementia (HR 4.16; 95% CI, 2.13-8.12), OSA (HR 3.35; 95% CI, 1.78-6.29), COPD (HR 2.43; 95% CI, 1.51-3.92), and diabetic neuropathy (HR 2.52; 95% CI, 1.41-4.50). In AA, MOF were associated with prior MOF (HR 13.67; 95% CI, 5.48-34.1), dementia (HR 3.10; 95% CI, 1.07-8.98), glomerular filtration rate (GFR) less than 45 (HR 2.05; 95% CI, 1.11-3.79), thiazide use (HR 0.54; 95% CI, 0.31-0.93), metformin use (HR 0.59; 95% CI, 0.36-0.97), and chronic steroid use (HR 5.03; 95% CI, 1.51-16.7). In HIS, liver disease (HR 3.06; 95% CI, 1.38-6.79) and insulin use (HR 2.93; 95% CI, 1.76-4.87) were associated with MOF. Conclusion In patients with diabetes, the risk of fracture is related to both diabetes-specific variables and comorbid conditions, but these relationships vary by race/ethnicity.

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Sodium-glucose cotransporter 2 inhibitors and fracture risk in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320961599 ◽

2020 ◽

Vol 11 ◽

pp. 204062232096159

Author(s):

Yake Lou ◽

Ying Yu ◽

Junchao Duan ◽

Sining Bi ◽

Khaing Nyein Chan Swe ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Subgroup Analysis ◽

Controlled Trials ◽

Risk Of Fracture ◽

Randomized Controlled ◽

Increased Risk

Background: Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fracture compared with those without T2DM. Some oral glucose-lowering agents may increase the incidence of fracture. Whether sodium-glucose co-transporter 2 inhibitors (SGLT2is) are associated with increased risk of fracture remains unclear. Methods: We retrieved articles from PubMed, Embase, Cochrane Library database, and other sources up to 24 October 2019. We included randomized controlled trials (RCTs) that reported fractures and analyzed the fracture incidence of SGLT2i, canagliflozin, dapagliflozin, and empagliflozin. Subgroup analysis was also performed based on baseline characteristics. Results: A total of 78 RCTs with 85,122 patients were included in our analysis. The overall SGLT2i fracture incidence was 2.56% versus 2.77% in the control group [odds ratio (OR), 1.03; 95% confidence interval (CI) (0.95, 1.12); p = 0.49]. Compared with the control treatment, treatment with canagliflozin led to a higher rate of fractures [OR, 1.17; 95% CI (1.00, 1.37); p = 0.05], but no significant difference was observed when compared with dapagliflozin [OR, 1.02; 95% CI (0.90, 1.15); p = 0.79] or empagliflozin [OR, 0.89; 95% CI (0.73, 1.10); p = 0.30]. Subgroup analysis showed that, in a follow-up of less than 52 weeks, SGLT2i decreased the incidence of fracture by 29% [OR, 0.71; 95% CI (0.55, 0.93); p = 0.01], but this benefit was lost when the follow-up extended to more than 52 weeks [OR, 1.08; 95% CI (0.98, 1.18); p = 0.12]. Conclusion: Canagliflozin seems to increase the risk of fracture, while other SGLT2is do not result in a higher incidence of fracture.

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