Prior fracture and refracture among patients admitted with hip fracture: Data from a regional hip fracture registry in Sri Lanka

2018 ◽  
Vol 21 (12) ◽  
pp. 2119-2121
Author(s):  
Saumyarika Sabapathippillai ◽  
Sarath Lekamwasam
2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Thilina Abeygunasekara ◽  
Sarath Lekamwasam ◽  
Janaka Lenora ◽  
Gayani Alwis

Abstract Introduction Hip fractures are associated with high mortality and morbidity. Many factors, before and after fracture, are linked with the survival of hip fracture patients. We analyzed the association between the one-year mortality and co-morbidity and physical dependence before fracture. Methods We used follow up data of Hip fracture registry maintained since September 2017. All patients with incident fragility hip fracture admitted to a tertiary care center in the Southern province of Sri Lanka were included and followed up. Information on co-morbidity (Age-adjusted Charlson co-morbidity index) was collected from previous records and interviews of patients and relatives. Barthel index-Sinhala version was used to collect information on physical dependence one week before fracture. Results Of 180 patients (149 women) followed up, 33 died within one year (mortality rate = 18%). Patients who survived were younger (mean age 75.6 vs 83.4ys, p < 0.001) and had lower co-morbidity (mean Age adjusted Charlson co-morbidity index 4.9 vs 6.3, p < 0.001) and higher Barthel index before fracture (97.4 vs 94.2, p = 0.001) when compared with those who died. Areas under curve (AUC) in the ROC analysis were 0.77 (SE 0.04, p < 0.001) for age, 0.79 (SE 0.04, p < 0.001) for co-morbidity and 0.67 (SE 0.05, p 0.003) for Barthel index. Conclusions Age, co-morbidity and prior fracture physical dependence are significantly associated with one-year survival of fragility hip fracture patients. This information can be used in early identification of patients who need special attention during the post-fracture follow up.


Injury Extra ◽  
2007 ◽  
Vol 38 (4) ◽  
pp. 131
Author(s):  
M. Arnander ◽  
J. Hopkins ◽  
A. Khaleel

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Raleigh A Fatoki ◽  
Bruce Ettinger ◽  
Malini Chandra ◽  
Kate M Horiuchi ◽  
Joan Chia-Mei Lo

Abstract BACKGROUND: Osteoporosis is traditionally associated with post-menopausal women, but up to up to one-third of osteoporosis-related fractures occur in elderly men. The International Society for Clinical Densitometry (ISCD), the World Health Organization, and the Fracture Risk Assessment Tool (FRAX) all recommend using a white female reference for BMD T-score for men. However, in clinical practice and previous clinical trials, a sex-specific white male reference T-score is used. This report examines the implications of using a female versus male reference for T-score calculation in men. METHODS: We reviewed BMD findings in 703 men (age 70-85y) who experienced a proximal femur, humerus, or distal radius/ulna fracture. For this cohort, femoral neck BMD was used to calculate a BMD T-score using either the young adult male and young adult female peak values (mean BMD 0.930 ± 0.136 and 0.849 ± 0.111 g/cm2, respectively). Osteoporosis was defined by BMD T-score ≤ -2.5, and osteopenia by BMD T-score < -1.0 and > -2.5. We also calculated FRAX-estimated fracture risk for hypothetical men ages 60-85y, with and without prior fracture. We used the National Osteoporosis Foundation (NOF) recommendations for treatment based on BMD (osteoporosis by BMD, or osteopenia by BMD with a 10-year risk of hip fracture ≥ 3% or 10-year risk of major osteoporotic fracture ≥ 20%). RESULTS: The mean BMD for this cohort was 0.670 g/cm2 and the median T scores were -2.0 (male reference) and -1.7 (female reference). Using the male T-score, 29% of men were classified as having osteoporosis, while using the female T-score, only 21% were so classified. 36% of men age 70-79y and 19% of men age 80-85y with osteoporosis (using the male T-score) would be reclassified from osteoporosis to osteopenia when a female T-score is used. Hypothetical cases of men age 60-85y (height 170 cm, weight 70 kg, BMD 0.590 g/cm2 equivalent to a male T -2.5 or female T -2.2) were used to calculate 10-year hip fracture risk using FRAX. For these hypothetical cases, the calculated 10-year risk of hip fracture exceeded the NOF treatment threshold of 3% (10-year hip fracture risk) for all cases, with or without prior fracture. CONCLUSION: For elderly men with fracture with male-T osteoporosis and female-T osteopenia, the T-score reference population used does not alter treatment recommendations because the calculated hip fracture risk is already above the treatment threshold of 3%. This is also true for men age ≥70 without a prior fracture. Hence the debate pertaining to the appropriate T-score reference population for men has limited relevance for men age ≥ 70 years who are being screened for osteoporosis.


Endocrinology ◽  
2019 ◽  
Vol 160 (9) ◽  
pp. 2143-2150 ◽  
Author(s):  
Pamela Rufus-Membere ◽  
Kara L Holloway-Kew ◽  
Adolfo Diez-Perez ◽  
Mark A Kotowicz ◽  
Julie A Pasco

Abstract Impact microindentation (IMI) measures bone material strength index (BMSi) in vivo. However, clinical risk factors that affect BMSi are largely unknown. This study investigated associations between BMSi and clinical risk factors for fracture in men. BMSi was measured using the OsteoProbe in 357 men (ages 33 to 96 years) from the Geelong Osteoporosis Study. Risk factors included age, weight, height, body mass index (BMI), femoral neck bone mineral density (BMD), parental hip fracture, prior fracture, type 2 diabetes mellitus (T2DM), secondary osteoporosis, smoking, alcohol consumption, sedentary lifestyle, medications, diseases, and low serum vitamin D levels. BMSi was negatively associated with age (r = −0.131, P = 0.014), weight (r = −0.109, P = 0.040), and BMI (r = −0.083, P = 0.001); no correlations were detected with BMD (r = 0.000, P = 0.998) or height (r = 0.087, P = 0.10). Mean BMSi values for men with and without prior fracture were 80.2 ± 6.9 vs 82.8 ± 6.1 (P = 0.024); parental hip fracture, 80.1 ± 6.1 vs 82.8 ± 6.9 (P = 0.029); and T2DM, 80.3 ± 8.5 vs 82.9 ± 6.6 (P = 0.059). BMSi did not differ in the presence vs absence of other risk factors. In multivariable models, mean (± SD) BMSi remained associated with prior fracture and parental hip fracture after adjusting for age and BMI: prior fracture (80.5 ± 1.1 vs 82.8 ± 0.4, P = 0.044); parental fracture (79.9 ± 1.2 vs 82.9 ± 0.4, P = 0.015). No other confounders were identified. We conclude that in men, BMSi discriminates prior fracture and parental hip fracture, which are both known to increase the risk for incident fracture. These findings suggest that IMI may be useful for identifying men who have an increased risk for fracture.


Anaesthesia ◽  
2014 ◽  
Vol 69 (6) ◽  
pp. 644-644
Author(s):  
T. J. S. Chesser ◽  
A. J. Timperley
Keyword(s):  

2016 ◽  
Vol 45 (6) ◽  
pp. 883-886 ◽  
Author(s):  
Antony Johansen ◽  
Christopher Boulton ◽  
Jenny Neuburger

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252592
Author(s):  
Duy K. Hoang ◽  
Minh C. Doan ◽  
Linh D. Mai ◽  
Thao P. Ho-Le ◽  
Lan T. Ho-Pham

Purpose To estimate the proportion of men and women aged 50 years and older who would be classified as "high risk" for fracture and eligible for anti-fracture treatment. Methods The study involved 1421 women and 652 men aged 50 years and older, who were recruited from the general population in Ho Chi Minh City, Vietnam. Fracture history was ascertained from each individual. Bone mineral density (BMD) was measured at the lumbar spine and femoral neck by DXA (Hologic Horizon). The diagnosis of osteoporosis was based on the T-scores ≤ -2.50 derived from either femoral neck or lumbar spine BMD. The 10-year risks of major fractureand hip fracture were estimated from FRAX version for Thai population. The criteria for recommended treatment were based on the US National Osteoporosis Foundation (NOF). Results The average age of women and men was ~60 yr (SD 7.8). Approximately 11% (n = 152) of women and 14% (n = 92) of men had a prior fracture. The prevalence of osteoporosis was 27% (n = 381; 95% CI, 25 to 29%) in women and 13% (n = 87; 95% CI, 11 to 16%) in men. Only 1% (n = 11) of women and 0.1% (n = 1) of men had 10-year risk of major fracture ≥ 20%. However, 23% (n = 327) of women and 9.5% (n = 62) of men had 10-year risk of hip fracture ≥ 3%. Using the NOF recommended criteria, 49% (n = 702; 95% CI, 47 to 52%) of women and 35% (n = 228; 95% CI, 31 to 39%) of men would be eligible for therapy. Conclusion Almost half of women and just over one-third of men aged 50 years and older in Vietnam meet the NOF criteria for osteoporosis treatment. This finding can help develop guidelines for osteoporosis treatment in Vietnam.


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