scholarly journals The Effectiveness of Osteoporosis Screening and Treatment in the Midwest

2018 ◽  
Vol 9 ◽  
pp. 215145931876584 ◽  
Author(s):  
Dharmik Patel ◽  
John R. Worley ◽  
David A. Volgas ◽  
Brett D. Crist
Keyword(s):  
Fragility Fracture ◽  
Assessment Tool ◽  
The United States ◽  
Vitamin D Supplementation ◽  
Diagnosis Of Osteoporosis ◽  
Fracture Risk Assessment Tool ◽  
History Of ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Deliberate Effort

Introduction: With osteoporosis on the rise across the United States, the goal of this prospective study is to determine the effectiveness of our Midwest level-1 trauma center in diagnosing, treating, and educating osteoporosis patients after fracture with the use of questionnaires. Secondarily, we aimed to identify barriers that prevent our patients from complying with bone health recommendations. Methods: One hundred participants (≥55 years) were given 2 questionnaires (Fracture Risk Assessment Tool and a study-specific questionnaire) that were administered during the patient’s visit to the orthopedic trauma clinic. A group of patients diagnosed with osteoporosis was compared to a group of patients not diagnosed with osteoporosis. Statistical analyses were performed using SPSS 24 (IBM Corp, Chicago, Illinois). Results: Patients who had been diagnosed with osteoporosis were significantly older (72.7 vs 66.5, P = .009) and more were women (86.2% vs 66.2%, P = .043). Significantly, fewer patients without the diagnosis of osteoporosis had a history of fragility fracture (56.3%) compared to 92.9% of those diagnosed with osteoporosis ( P < .001). Of those with dual-energy X-ray absorptiometry (DXA) recommended by a healthcare provider, 20 (55.6%) of those without the diagnosis of osteoporosis and 13 (52%) of those with the diagnosis of osteoporosis had DXA screening before their fragility fracture ( P = .499). More patients diagnosed with osteoporosis (93.1%) were taking calcium and vitamin D supplementation compared to 66.2% of those without the diagnosis of osteoporosis ( P = .005). Only 37.9% of patients with the diagnosis of osteoporosis were receiving US Food and Drug Administration–approved medications for the management of their disease. Discussion: In patients without previous osteoporosis diagnosis, 59 (83.1%) of the 71 claimed that they did not receive any preventative education about osteoporosis, while 21 (72.4%) of the 29 patients with the diagnosis of osteoporosis claimed that they did not receive a preventative education ( P = .165). Both groups lacked optimum diagnosis, treatment, and education of osteoporosis. Conclusion: Our study highlights the need for a deliberate effort of a multidisciplinary team to focus efforts in all stages of osteoporosis management.

151 Optimising Bone Health on Sheffield Frailty Unit Through Quality Improvement

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C M Orton ◽  
N E Sinson ◽  
R Blythe ◽  
J Hogan ◽  
N A Vethanayagam ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Bone Health ◽  
Assessment Tool ◽  
Health Assessment ◽  
Fragility Fractures ◽  
Improvement Project ◽  
Number Of Patients ◽  
Fracture Risk Assessment Tool

Abstract Introduction NICE and the National Osteoporosis Guidance Group (NOGG) advise on evaluation of fracture risk and osteoporosis treatment1,2, with evidence suggesting that screening and treatment reduces the risk of fragility fractures 3,4,5. However, it is often overlooked in the management of older patients within secondary care. Audit data from Sheffield Frailty Unit (SFU) in 2018 showed that national guidance was not routinely followed. Fracture Risk Assessment Tool (FRAX®) scores were not calculated and bone health was poorly managed. Therefore, we undertook a quality improvement project aiming to optimise bone health in patients presenting to SFU. Method & Intervention In January 2019 we collaborated with Sheffield Metabolic Bone Centre (MBC) to develop a pathway aiming to improve bone health assessment and management in patients presenting to SFU with a fall or fragility fracture. This included a user-friendly flow chart with accompanying guidelines, alongside education for staff. Performance was re-evaluated in May 2019, following which a tick box prompt was added to post take ward round documentation. A re-audit was performed in March 2020. Results In March 2018 0% of patients presenting with a fall had a FRAX® score calculated and only 40% of those with a new fragility fracture were managed according to guidelines. In May 2019, this had improved to 18% and 100% respectively. In March 2020 86% of patients had a FRAX® score calculated appropriately and 100% of fragility fractures were managed according to guidelines. In both re-audits 100% of FRAX® scores were acted on appropriately. Conclusions There has been a significant increase in the number of patients who have their bone health appropriately assessed and managed after presenting to SFU. However, achieving optimum care is under constant review with the aim to deliver more treatment on SFU, thereby reducing the need for repeat visits to the MBC.

scholarly journals Instrumental diagnosis of osteosarcopenia in diagrams and tables

2021 ◽  
pp. 358-364
Author(s):  
A. V. Naumov ◽  
D. V. Demenok ◽  
Yu. S. Onuchina ◽  
N. O. Khovasova ◽  
V. I. Moroz ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Physical Performance ◽  
Assessment Tool ◽  
Mass Function ◽  
Dual Energy ◽  
Whole Body ◽  
Mineral Density ◽  
X Ray ◽  
Fracture Risk Assessment Tool ◽  
History Of

Osteoporosis and sarcopenia are age-associated diseases of the musculoskeletal system. Osteosarcopenia, the presence of osteopenia/osteoporosis and sarcopenia. The prevalence of osteosarcopenia in older adults with failing was 37% and associated with higher rate of death. Diagnosis of osteosarcopenia consists of describing medical history of fractures, providing x-ray of the spine (if it is needed) and bone densitometry, calculation of Fracture Risk Assessment Tool (FRAX), evaluating muscle strength, mass, function. The most common exam which is used to measure bone mineral density (BMD) is dual-energy x-ray absorptiometry (DXA or DEXA). Screening using the FRAX is recommended in all postmenopausal women and mеn over 50 in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis in patients with fragility fracture of large bones of the skeleton. Diagnosis of sarcopenia is consist of measures for three parameters: muscle strength, muscle quantity/quality and physical performance as an indicator of severity. Muscle strength can be measured with carpal dynamometry. Muscle mass can be evaluated dual-energy X-ray absorptiometry (program «Whole body»). Muscle function can be evaluated with short physical performance battery (SPPB) tests. In this article described algorithm of diagnosis of osteosarcopenia.

scholarly journals Higher Mortality Rate in Moderate-to-Severe Thoracoabdominal Injury Patients with Admission Hyperglycemia Than Nondiabetic Normoglycemic Patients

2019 ◽  
Vol 16 (19) ◽  
pp. 3562
Author(s):  
Wei-Ti Su ◽  
Shao-Chun Wu ◽  
Sheng-En Chou ◽  
Chun-Ying Huang ◽  
Shiun-Yuan Hsu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Injury Severity ◽  
Burn Injury ◽  
Past History ◽  
Trauma Patients ◽  
Thoracoabdominal Injuries ◽  
History Of ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center

Background: Hyperglycemia at admission is associated with an increase in worse outcomes in trauma patients. However, admission hyperglycemia is not only due to diabetic hyperglycemia (DH), but also stress-induced hyperglycemia (SIH). This study was designed to evaluate the mortality rates between adult moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia as DH or SIH and in patients with nondiabetic normoglycemia (NDN) at a level 1 trauma center. Methods: Patients with a glucose level ≥200 mg/dL upon arrival at the hospital emergency department were diagnosed with admission hyperglycemia. Diabetes mellitus (DM) was diagnosed when patients had an admission glycohemoglobin A1c ≥6.5% or had a past history of DM. Admission hyperglycemia related to DH and SIH was diagnosed in patients with and without DM. Patients who had a thoracoabdominal Abbreviated Injury Scale score <3, a polytrauma, a burn injury and were below 20 years of age were excluded. A total of 52 patients with SIH, 79 patients with DH, and 621 patients with NDN were included from the registered trauma database between 1 January 2009, and 31 December 2018. To reduce the confounding effects of sex, age, comorbidities, and injury severity of patients in assessing the mortality rate, different 1:1 propensity score-matched patient populations were established to assess the impact of admission hyperglycemia (SIH or DH) vs. NDN, as well as SIH vs. DH, on the outcomes. Results: DH was significantly more frequent in older patients (61.4 ± 13.7 vs. 49.8 ± 17.2 years, p < 0.001) and in patients with higher incidences of preexisting hypertension (2.5% vs. 0.3%, p < 0.001) and congestive heart failure (3.8% vs. 1.9%, p = 0.014) than NDN. On the contrary, SIH had a higher injury severity score (median [Q1–Q3], 20 [15–22] vs. 13 [10–18], p < 0.001) than DH. In matched patient populations, patients with either SIH or DH had a significantly higher mortality rate than NDN patients (10.6% vs. 0.0%, p = 0.022, and 5.3% vs. 0.0%, p = 0.043, respectively). However, the mortality rate was insignificantly different between SIH and DH (11.4% vs. 8.6%, odds ratio, 1.4; 95% confidence interval, 0.29–6.66; p = 0.690). Conclusion: This study revealed that admission hyperglycemia in the patients with thoracoabdominal injuries had a higher mortality rate than NDN patients with or without adjusting the differences in patient’s age, sex, comorbidities, and injury severity.

scholarly journals The influence of a statewide “Stay-at-Home” order on trauma volume and patterns at a level 1 trauma center in the united states

Injury ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 2437-2441 ◽  
Author(s):  
Stefan W. Leichtle ◽  
Edgar B. Rodas ◽  
Levi Procter ◽  
Jonathan Bennett ◽  
Robin Schrader ◽  
...  
Keyword(s):  
United States ◽  
Trauma Center ◽  
The United States ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
At Home

Is there a Sex Difference in the Course Following Traumatic Brain Injury?

2004 ◽  
Vol 5 (4) ◽  
pp. 299-310 ◽  
Author(s):  
Catherine J. Kirkness ◽  
Robert L. Burr ◽  
Pamela H. Mitchell ◽  
David W. Newell
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Animal Studies ◽  
Injury Severity ◽  
The United States ◽  
Initial Injury ◽  
Rate Of Recovery ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Physiologic Data

Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Sex has not been thoroughly examined as a factor that may influence outcome following TBI. Clinical studies involving humans that have focused on sex and TBI outcome have yielded inconclusive results, yet sex-related physiologic differences have been demonstrated in animal studies. The purpose of this study is to examine the interaction of sex and age in relation to outcome at 3 and 6 months postinjury in a population of individuals with TBI. The sample includes 157 subjects (124 males, 33 females), 16 to 89 years of age, admitted to a level 1 trauma center following TBI. Physiologic data and information about injury severity and clinical course were gathered during hospitalization. Outcome was assessed at 3 and 6 months postinjury using the Extended Glasgow Outcome Scale (GOSE) and Functional Status Examination (FSE). In this sample, there was a significant relationship between sex and age with respect to functional outcome at 6 months following TBI, controlling for initial injury severity. Females age 30 years or older had significantly poorer outcome as measured by the GOSE (P = 0.031) and the FSE (P = 0.037) than either males or younger females. There was also a very different rate of recovery, with women age 30 years and older, on average, showing no improvement between 3 and 6 months postinjury. Further study is needed to elucidate the reasons why sex may affect outcome following TBI.

09 Characteristics of Community Fallers and the Diagnosis of Osteoporosis in the Falls Clinic of a Public Tertiary Hospital

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv3-iv3
Author(s):  
Reena Nadarajah ◽  
Gordon Hwa Mang Pang ◽  
Elizabeth Gar Mit Chong ◽  
Rizah Mazzuin Razali ◽  
Fatt Soon Lee ◽  
...  
Keyword(s):  
Fragility Fracture ◽  
Tertiary Hospital ◽  
P Value ◽  
Mineral Density ◽  
Presumptive Diagnosis ◽  
Diagnosis Of Osteoporosis ◽  
Treatment Benefits ◽  
Injurious Falls ◽  
Bmd Testing ◽  
History Of

Abstract Introduction Osteoporosis is a chronic asymptomatic condition. The US National Bone Health Alliance recommends that osteoporosis may be diagnosed by bone mineral density (BMD) testing, the occurrence of low-trauma fractures or through the use of fracture risk algorithms. However, osteoporosis has low screening rates despite having clear treatment benefits. Methodology This study aimed to describe the characteristics of patients in the falls clinic with and without osteoporosis and the ways by which diagnosis of osteoporosis was made. A retrospective, descriptive study was carried out on all patients who attended the falls clinic from January 2015 till March 2019, with data collected from its falls database. Results A total of 117 patients were included in this study. All patients had a history of fall, either single or recurrent. 43 patients had osteoporosis, of which 72.1% were female (p value &lt;0.05). In this study, age and ethnicity were not found to be risk factors for osteoporosis. Polypharmacy, having three or more comorbidities along with alcohol and smoking habits were also not significantly associated with osteoporosis. This study also showed no differences in terms of history of recurrent falls and level of mobility between the two groups of patients. Of the 43 patients with osteoporosis, six patients (14.0%) were diagnosed by BMD testing prior to their attendance at the falls clinic. 24 patients (55.8%) had a presumptive diagnosis of osteoporosis made based on prior fragility fracture, of which majority were vertebral fractures (45.8%); and the remaining 13 patients (32.0%) were diagnosed to have osteoporosis by BMD testing after their visit to the falls clinic. Conclusion Most patients who attended the falls clinic have had a prior fragility fracture, which could have been prevented by treatment. Screening for osteoporosis should therefore be carried out more robustly in the community to prevent injurious falls.

Recent Cases of Regressive and Racially Disparate Taxation in the United States

2019 ◽  
pp. 469-486
Author(s):  
Andre L. Smith
Keyword(s):  
United States ◽  
Low Income ◽  
Black People ◽  
The United States ◽  
Budget Deficits ◽  
Communities Of Color ◽  
Collateral Consequence ◽  
Financial Interests ◽  
History Of ◽  
Deliberate Effort

This chapter assesses whether there is a national trend in the United States toward disproportionate imposition of regressive taxes on low-income communities of color, reflective of a deliberate effort to shift the tax burden from the wealthy and white to the poor and black. This phenomenon is not new. There is a history of communities that are facing financial exigencies correcting their budget deficits by levying formal and informal taxes on black people. The collateral consequence of formal and informal taxes levied disproportionately on black people includes more potentially violent confrontations with police and responses like the Black Lives Matter Movement. The chapter then considers whether well-intentioned white folks have lent their support to racist taxation, perhaps unwittingly, because the stated purposes of increased taxes satisfy their social desires while it squares with their financial interests to ignore the disparate racial ramifications.

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