Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage

2020 ◽  
pp. 193864002093204
Author(s):  
Ishaq O. Ibrahim ◽  
Brian T. Velasco ◽  
Michael Y. Ye ◽  
Christopher P. Miller ◽  
John Y. Kwon
Keyword(s):  
Odds Ratio ◽  
Demographic Data ◽  
Weight Bearing ◽  
Implant Removal ◽  
Inclusion Criteria ◽  
Tibiotalar Joint ◽  
Clear Space ◽  
Syndesmotic Screw ◽  
Screw Breakage ◽  
Bony Erosion

Background. The majority of retained syndesmotic screws will either loosen or break once the patient resumes weight-bearing. While evidence is limited, anecdotal experience suggests that intraosseous screw breakage may be problematic for some patients due to painful bony erosion. This study seeks to identify the incidence of intraosseous screw breakage, variables that may predict intraosseous screw breakage, and whether intraosseous screw breakage is associated with higher rates of implant removal secondary to pain. Methods. Five hundred thirty-one patients undergoing syndesmotic stabilization were screened, of which 43 patients (with 58 screws) experiencing postoperative screw breakage met inclusion criteria. Patient charts were retrospectively reviewed for demographic data, comorbidities, time to screw breakage, location of screw breakage, and implant removal. Several radiographic parameters were evaluated for their potential to influence the site of screw breakage. Results. Intraosseous screw breakage occurred in 32 patients (74.4%). Screw breakage occurred exclusively in the tibiofibular clear space in the remaining 11 instances (25.6%). Intraosseous screw breakage was significantly associated with eventual implant removal after breakage (P = .034). Screws placed further from the tibiotalar joint were at less risk for intraosseous breakage (odds ratio 0.818, P = .002). Screws placed at a threshold height of 20 mm or greater were more likely to break in the clear space (odds ratio 12.1, P = .002). Conclusion. Syndesmotic screw breakage may be more problematic than previously described. Intraosseous breakage was associated with higher rates of implant removal secondary to pain in this study. Placement of screws 20 mm or higher from the tibiotalar joint may decrease risk of intraosseous breakage. Levels of Evidence: Level III: Retrospective study

scholarly journals Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
Pablo Mococain ◽  
Pablo Wagner ◽  
Ruben Radkievich ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
X Rays ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Clear Space ◽  
Screw Breakage ◽  
The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

scholarly journals Recurrence of Syndesmotic Diastasis Following Syndesmotic Screw Removal: Does the Time Point of Screw Removal Matter?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0044
Author(s):  
Seth C. Shoap ◽  
Hans Polzer ◽  
Sebastian F. Baumbach ◽  
Viktoria Herterich ◽  
Christina Freibott ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Significant Loss ◽  
T Test ◽  
Screw Insertion ◽  
Clear Space ◽  
Syndesmotic Screw ◽  
Loss Of Reduction ◽  
Time Point

Category: Ankle Introduction/Purpose: Ankle fractures involving disruption to the syndesmotic complex are regularly treated with reduction and syndesmotic screw fixation. When syndesmotic screw fixation is used, it is a common to remove the screw after enough time has passed to allow for sufficient healing of the ligamentous tibiofibular syndesmosis complex. Delayed removal increases the risk of screw loosening or breakage, and more importantly prolongs the time to full weight bearing. Currently, there is little evidence supporting a definitive time point for screw removal. This multicenter study compared two different post-operative protocols following syndesmotic screw insertion. The goal was to determine an optimal time point for screw removal by assessing syndesmotic diastasis between these two institutions, each of which removed the screw at different time points. Methods: Patients from two institutions treated surgically for any type of ankle fracture between 01/2010 and 12/2016 that met the following inclusion criteria were selected: patients suffering any type of an acute, closed ankle fracture, syndesmotic disruption treated using a syndesmotic screw, removal of the syndesmotic screw in the same institution, at least one x-ray (mortise view) prior to screw removal and one following screw removal available for review. Exclusion criteria were open / pilon / tibial shaft fractures. The syndesmotic screw was removed approximately 12 weeks after insertion in the first institution, and 6 weeks after insertion in the second. Four radiographic measurements were performed and averaged by three researchers: medical clear space (oblique), tibio-fibular clear space, and tibio-fibular overlap. An independent samples t-test was conducted to analyze differences in radiographic parameters between the two cohorts. Measurements after syndesmotic screw insertion and at final follow-up after removal were compared. Results: The average time to removal of syndesmotic screw was 79.71 days in institution one (n=31) and 50.92 days in institution two (n=121) (p<0.001). For institution 1 the paired samples t-test revealed no significant differences when comparing measurements prior to syndesmotic screw removal with after screw removal for the tibio-fibular overlap (p=0.088) and tibio- fibular clear space (p=0.312) measurements. A significant difference was observed only regarding the medial clear space (p=0.008). For institution 2, significant differences were observed for all of these measurements (p<0.001). When comparing the measurements after syndesmotic screw removal between the two institutions, the independent samples t-test revealed significant differences in regard to the tibio-fibular overlap (p=0.001) and tibio-fibular clear space (p=0.004) measurements, but not in the medial clear space measurement (p=0.959). Conclusion: Removal of the syndesmotic screw after seven weeks led to a significant loss of reduction of the syndesmosis. In contrast, screw removal after 11 weeks did not lead to a significant loss of reduction. Our results suggest that it is not advisable to remove syndesmotic screws after 7 weeks. It is common to have the patient partial or non-weight bearing until screw removal to avoid screw breakage. To recommend non-weight bearing for 11 weeks will delay return to work and daily activity, and can lead to significant atrophy, however, it does allow for better maintenance of reduction.

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

scholarly journals Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy

2021 ◽  
Vol 5 (1) ◽  
pp. 2514183X2110173
Author(s):  
Johannes Kaesmacher ◽  
Giovanni Peschi ◽  
Nuran Abdullayev ◽  
Basel Maamari ◽  
Tomas Dobrocky ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Clinical Effect ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Cardioembolic Stroke ◽  
Inclusion Criteria ◽  
Early Reperfusion ◽  
Factors Associated ◽  
Randomized Controlled ◽  
Interaction Terms

Objective: To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods: A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms. Results: A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095). Conclusion: Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT.

Venous leg symptoms, ecchymosis, and coldness in patients with peripheral varicose vein: A multicenter assessment and validation study (VEIN-VIOLET study)

Vascular ◽  
2020 ◽  
pp. 170853812098020
Author(s):  
Ertan Yetkin ◽  
Makbule Kutlu Karadag ◽  
Mehmet Ileri ◽  
Ramazan Atak ◽  
Nevzat Erdil ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Regression Analysis ◽  
Varicose Vein ◽  
Odds Ratio ◽  
Venous Insufficiency ◽  
Study Quality ◽  
Inclusion Criteria ◽  
Economic Study ◽  
Independent Association

Objectives We aimed to evaluate peripheral varicose vein symptoms including ecchymosis and coldness by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire. Methods A total of 1120 patients were enrolled to the analysis after the exclusion of 199 patients who did not match the inclusion criteria. Patients were asked to answer the VEINES-Sym questionnaire and questions about ecchymosis and coldness. Scores of ecchymosis and coldness were calculated similar to VEINES-Sym questionnaire. Classifications of peripheral varicose vein were made according to the clinical part of clinical, etiological, anatomical, and pathophysiological classification system and patients with grade 2 or higher were considered as positive for peripheral varicose vein. Results Frequency of symptoms present in the VEINES-Sym instrument, ecchymosis and coldness were significantly higher in patients with peripheral varicose vein. Mean score of each symptom was significantly lower in peripheral varicose vein patients including scores of ecchymosis and coldness. Logistic regression analysis revealed that presence of hemorrhoids and all symptoms in VEINES-Sym questionnaire except restless leg were significantly and independently associated with peripheral varicose vein. Besides, ecchymosis (odds ratio: 2.04, 95% confidence interval: 1.34–3.08, p = 0.008) but not coldness was significantly and independently associated with peripheral varicose vein. There was also significant correlation of VEINES-Sym score with ecchymosis ( r = 0.43, p < 0.001) and coldness ( r = 0.47, p < 0.001). Conclusions Venous leg symptoms present in VEINES-Sym questionnaire except restless legs, presence of hemorrhoids and ecchymosis are significantly and independently associated with peripheral varicose vein. Not only ecchymosis but also coldness has shown an independent association with total VEINES-Sym score.

scholarly journals Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses

2020 ◽  
Vol 12 ◽  
pp. 1759720X2098121
Author(s):  
Gustavo Constantino de Campos ◽  
Raman Mundi ◽  
Craig Whittington ◽  
Marie-Josée Toutounji ◽  
Wilson Ngai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Ischemic Attack ◽  
Meta Analyses ◽  
The Relationship ◽  
Related Mortality

Aims: The objective of this review was to examine the relationship between osteoarthritis (OA) and mobility-related comorbidities, specifically diabetes mellitus (DM) and cardiovascular disease (CVD). It also investigated the relationship between OA and mortality. Methods: An overview of meta-analyses was conducted by performing two targeted searches from inception to June 2020. The association between OA and (i) DM or CVD ( via PubMed and Embase); and (ii) mortality ( via PubMed) was investigated. Meta-analyses were selected if they included studies that examined adults with OA at any site and reported associations between OA and DM, CVD, or mortality. Evidence was synthesized qualitatively. Results: Six meta-analyses met inclusion criteria. One meta-analysis of 20 studies demonstrated a statistically significant association between OA and DM, with pooled odds ratio of 1.41 (95% confidence interval: 1.21, 1.65; n = 1,040,175 patients). One meta-analysis of 15 studies demonstrated significantly increased risk of CVD among OA patients, with a pooled risk ratio of 1.24 (1.12, 1.37, n = 358,944 patients). Stratified by type of CVD, OA was shown to be associated with increased heart failure (HF) and ischemic heart disease (IHD) and reduced transient ischemic attack (TIA). There was no association reported for stroke or myocardial infarction (MI). Three meta-analyses did not find a significant association between OA (any site) and all-cause mortality. However, OA was found to be significantly associated with cardiovascular-related death across two meta-analyses. Conclusion: The identified meta-analyses reported significantly increased risk of both DM and CVD (particularly, HF and IHD) among OA patients. It was not possible to confirm consistent directional or causal relationships. OA was found to be associated with increased mortality, but mostly in relation to CVD-related mortality, suggesting that further study is warranted in this area.

Cement-in-cement femoral component revision

2021 ◽  
Vol 103-B (7) ◽  
pp. 1215-1221
Author(s):  
John W. Kennedy ◽  
Nigel Y. B. Ng ◽  
David Young ◽  
Nicholas Kane ◽  
Andrew G. Marsh ◽  
...  
Keyword(s):  
Femoral Component ◽  
Short Form ◽  
Demographic Data ◽  
Senior Author ◽  
Inclusion Criteria ◽  
Reliable Technique ◽  
Patient Demographic Data ◽  
Oxford Hip Score ◽  
Component Revision

Aims Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. Results A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. Conclusion Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215–1221.

scholarly journals A Study Examining the Efficacy of Ferric Carboxymaltose in a Large Pediatric Cohort

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 17-18
Author(s):  
Chandni Dargan ◽  
David Simon ◽  
Nathan Fleishman ◽  
Alka Goyal ◽  
Mukta Sharma
Keyword(s):  
Pediatric Population ◽  
Demographic Data ◽  
Deficiency Anemia ◽  
Ferric Carboxymaltose ◽  
Iron Dextran ◽  
Pediatric Hospital ◽  
Inclusion Criteria ◽  
Short Bowel ◽  
Time Period ◽  
Iv Iron

Background: Iron deficiency anemia (IDA) is common in the pediatric population with high risk factors such as nutritional deficiency, inflammatory bowel disease (IBD) and other bowel inflammatory disorders, menorrhagia, blood loss, poor absorption and anemia of chronic disease. Intravenous (IV) iron supplementation has become a more desirable mode of treatment in patients with moderate to severe anemia and in patients who are either unresponsive to or have undesirable side-effects secondary to oral iron. Iron sucrose and Iron dextran have been traditionally used in pediatrics as they both are FDA approved for use in this population. Ferric carboxymaltose (FCM) has only been FDA approved for use in adults however is currently used in pediatrics as well. One of the major advantages of Ferric carboxymaltose is the ease of dosing and efficacy. Though FCM was approved for adults in 2013 and there have been no safety concerns, it is not yet FDA approved for pediatric patients despite a few pediatric studies demonstrating its safety and efficacy (Laass, et al., 2014; Powers et al., 2017; Tan et al., 2017, Carman et al., 2019). The purpose of this study is to examine the utilization of different IV iron formulations in a large pediatric hospital as well as evaluate the safety and efficacy of ferric carboxymaltose in comparison to other IV iron formulations. At this time, we present data regarding the use of different forms of IV iron. Methods: This is a retrospective chart review study of all patients who met inclusion criteria in a large pediatric hospital who received Iron dextran, Iron sucrose, and/or FCM between the dates of 8/1/2018 through 9/30/2019. Anonymized data from eligible patients was entered into a secure electronic database. Once our population of interest was isolated, based on the proposed criteria, we reviewed charts individually and collected data including demographics and details about each IV iron administration. Demographic data encompassed race and gender. We also recorded the patients' underlying diagnosis (or diagnoses) contributing to iron deficiency anemia. In addition to compiling demographic data, we also wanted to analyze the trend of IV iron usage in our institution. This was done by tallying the number of each type of IV iron infusion monthly for the allotted time period. Results: A total of 120 patients met inclusion criteria and were included in this study with details regarding diagnosis in Figure 1. Fifty-six (46.7%) patients were male and 64 (53.3%) were female. We also analyzed the underlying diagnoses leading to IDA of patients who received IV iron infusions. Most patients had an underlying IBD diagnosis (Crohn's Disease 49.2%, Ulcerative colitis 15.8%, and Indeterminate colitis 5.8% of all included patients). Additional diagnoses included 18 patients (15%) with nutritional IDA and 8 patients (6.7%) with heavy menses. Examples of "other" diagnoses are blood loss secondary to immune thrombocytopenia, short bowel secondary to complex gastroschisis, gastrointestinal bleed secondary to Helicobacter pylori, short bowel secondary to bowel resection due to graft versus host disease after hematopoietic stem cell transplant, TMPRSS6 mutation, protein losing enteropathy, short bowel secondary to midgut volvulus and intestinal atresia, among other diagnoses. We also analyzed the overall usage of IV iron in our institution during this same time period. The number of IV iron infusions has steadily increased since August 2018. The average number of IV iron infusions was 18 per month in 2018 and 22.67 per month in 2019. As shown in figure 3, the utilization of iron dextran has decreased over time. The graph also displays that the usage of FCM at our institution continues to increase as time progresses. Conclusion: Analysis of demographic data reveals that an underlying gastrointestinal diagnosis is the most common reason for receiving IV iron likely due to decreased absorption of enteral iron. Our data has also shown that the overall usage of IV iron is increasing in the pediatric population as well as specifically FCM. This study is the first retrospective pediatric review comparing the utilization of different IV iron formulations including FCM. Preliminary data demonstrates an increase in hemoglobin after treatment with FCM, however further analysis of the data is ongoing. Figure 1 Disclosures No relevant conflicts of interest to declare.

scholarly journals Epidemiological study on the relationship among menopausal condition, bone fragility, and knee osteoarthritis

2020 ◽  
Author(s):  
Eiji Sasaki ◽  
Daisuke Chiba ◽  
Seiya Ota ◽  
Yuka Kimura ◽  
Shizuka Sasaki ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Knee Osteoarthritis ◽  
Epidemiological Study ◽  
Odds Ratio ◽  
Weight Bearing ◽  
Predictive Marker ◽  
P Value ◽  
Mineral Density ◽  
High Turnover ◽  
The Relationship

Abstract Background: Knee osteoarthritis (KOA) occurs more often in middle-aged females. While this age-group experiences comorbid osteoporosis with menopause, its influence on KOA has not been clarified. This epidemiological study aimed to investigate the relationship between menopausal conditions, bone mineral density (BMD), and KOA. Methods: A total of 518 female volunteers who participated in the Iwaki cohort study were enrolled and divided into groups (pre- and post-menopause). Antimullerian hormone (AMH) was measured as a predictive marker for menopause in the pre-menopausal subjects. Weight-bearing anterior-posterior knee radiographs were classified by Kellgren-Lawrence grade, and grade ≥ 2 was defined as definitive KOA (DKOA). Early KOA (EKOA) was defined by Luyten’s criteria, and BMD was measured at a distal radius. The relationship between menopausal condition, BMD, and KOA was analyzed by ROC and regression analysis. Results: Fifty-two participants (10.0%) were diagnosed with EKOA and 204 (39.4%) with DKOA. A total of 393 (75.9%) females began menopause, and the prevalence of DKOA was up to 48.1% and >12.0% in pre-menopause females (p < 0.001, Odds ratio: 6.79). From the ROC analysis in pre-menopausal females, cut-off value of AMH for detecting EKOA was 0.08 ng/ml (AUC: 0.712, p5%CI: 0.527 to 0.897, p-value: 0.025, Odds ratio: 8.28). Regression analysis showed that lower AMH was related to EKOA (p=0.035, Odds ratio: 5.55) and DKOA (p=0.032, Odds 1.59), and lower BMD and high turnover bone metabolism were correlated with DKOA. Conclusions: KOA increased after menopause and was correlated with lower BMD. Furthermore, reduction in AMH was a valuable biomarker for the detection of EKOA.

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