scholarly journals Managing Osteoporosis in Patients with Fragility Fractures: Did the British Orthopaedic Association Guidelines Have Any Impact?

2007 ◽  
Vol 89 (5) ◽  
pp. 504-509 ◽  
Author(s):  
MF Nixon ◽  
T Ibrahim ◽  
Y Johari ◽  
S Eltayef ◽  
D Hariharan ◽  
...  

INTRODUCTION The incidence of fragility fractures could double in the next 50 years. Effective treatments for osteoporosis exist and the British Orthopaedic Association (BOA) has guidelines governing how to manage underlying osteoporosis in patients with fragility fractures. This study assessed how well two trauma units treat underlying osteoporosis and whether the BOA guidelines made any impact. PATIENTS AND METHODS Case notes of patients with a fracture of their proximal femur admitted during January and February in 2003, 2004 and 2005 were reviewed. The results were analysed for differences between site and year. RESULTS A total of 602 case notes were reviewed. There was a significant difference in the number of patients discharged on osteoporosis medication between the two sites (27% at LRI, 8% at KGH; P < 0.001), but not between 2003 and 2005 (22% and 16%; P = 0.16). Of the patients started on treatment, 83% were started on calcium and/or vitamin D3 supplements. CONCLUSIONS The number of patients who had their underlying osteoporosis addressed was low and the type of treatment sub-optimal. This suggests the BOA guidelines have not made an impact and further work is required to improve the management of these patients.

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 175 ◽  
Author(s):  
Annelyn Torres-Reveron ◽  
Michael Serra-Torres

Background: Despite the high incidence of osteoporosis, many patients at risk of fragility fractures may not initiate treatment due to concerns about side effects, cost or under-diagnosis, such as the case of vertebral fractures. We aimed to identify whether the patient population with non-vertebral fragility fractures where already receiving prophylactic treatment for osteoporosis at presentation within a regional hospital in the southernmost region of the United States.  This region is characterized by a high number of patients from Hispanic/Latino heritage (80%) and reduced access to healthcare services. Methods: We conducted a three-year, retrospective cohort study of patients presenting with low impact fractures of the humerus or the shoulder griddle, lower end of radius or ulna and forearm, hip fractures (femoral neck, intertrochanteric/ subtrochanteric), and ankle fractures.  Male and female subjects of 50 years or older were included.  Demographic data and information on medications reported at fracture presentation were extracted from electronic medical records. Results: We found that 42% of the patients were taking at least one medication to prevent osteoporosis. The predominant combination was vitamin D plus calcium and bisphosphonates. If patients taking only vitamin D plus calcium are excluded, 16.7% of the sample took osteoporosis medications at the fragility fracture presentation.  The likelihood of taking osteoporosis medication was increased by age and type of health insurance (Medicare/private insurance), and concomitant diagnosis of impaired gait and mobility.  The percentage of the patients taking prophylactic medications for osteoporosis at the time of a fragility fracture was comparable to reported national standards and associated with increased age and health insurance coverage. Conclusion: In a predominantly Hispanic/Latino patient population living in a medically underserved region, there is substantial recognition and prevention strategies for osteoporosis.


2020 ◽  
Author(s):  
Michael J. Serra-Torres ◽  
Annelyn Torres-Reveron

AbstractDespite the high incidence of osteoporosis, many patients at risk of fragility fractures may not initiate treatment due to concerns about side effects, or cost. We aimed to identify whether the patient population presenting with fragility fractures is receiving prophylactic treatment for osteoporosis within a single academic hospital in the southernmost region of the United States. This region is characterized by a high number of patients from Hispanic/Latino heritage (80%) and reduced access to healthcare services. We conducted a three-year, retrospective cohort study of patients presenting with low impact fractures of the humerus or the shoulder griddle, lower end of radius or ulna and forearm, hip fractures (femoral neck, intertrochanteric/subtrochanteric), the lower end of tibia, medial malleolus, lateral malleolus or lower leg. Male and female subjects of 50 years or older were included. Demographic data and information on medications reported at fracture presentation were extracted from electronic medical records. We found that 42% of the patients were taking at least one medication to prevent osteoporosis. The predominant combination was vitamin D plus calcium and bisphosphonates. If patients taking only vitamin D plus calcium are excluded, 16.7% of the sample took osteoporosis medications at the fragility fracture presentation. The likelihood of taking osteoporosis medication was increased by age and type of health insurance (Medicare/private insurance), and concomitant diagnosis of impaired gait and mobility. The percentage of the patients taking prophylactic medications for osteoporosis at the time of a fragility fracture was comparable to reported national standards and associated with increased age and health insurance coverage. In a predominantly Hispanic/Latino patient population living in a medically underserved region, there is substantial recognition and prevention strategies for osteoporosis.


2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987751
Author(s):  
Takahiro Niikura ◽  
Keisuke Oe ◽  
Yoshitada Sakai ◽  
Takashi Iwakura ◽  
Tomoaki Fukui ◽  
...  

Background: Data of vitamin D sufficiency in Asian patients with osteoporotic fragility hip fractures are limited. This study aimed to obtain data from the Japanese population. Methods: Patients aged 60 years or older with hip fractures were prospectively enrolled. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured. Levels were compared between patients receiving and not receiving treatment for osteoporosis, those with and without previous contralateral hip fractures, and those with femoral neck versus trochanteric fractures. Sex-based differences were also assessed. The serum levels in patients younger than 60 years with extremity fractures were assessed, and differences between elderly and younger patients were evaluated. The individual correlation between 25(OH)D levels and the ultraviolet (UV) index and age was analyzed in elderly patients with hip fractures. Results: The data of 360 patients (aged 84.7 ± 8.2 years), comprising 80 men and 280 women, were analyzed. The mean 25(OH)D level was 16.5 ± 7.2 ng/mL. The prevalence of vitamin D insufficiency (25(OH)D <30 ng/mL) and deficiency (25(OH)D <20 ng/mL) was 93.9% and 71.7%, respectively. A significant difference was noted in the prevalence of vitamin D deficiency between patients with and without previous contralateral hip fractures. Age and 25(OH)D levels were found to be correlated, with no correlation between the UV index and the 25(OH)D levels. The 25(OH)D level in the younger population ( n = 123) was 20.7 ± 8.6 ng/mL, which was significantly higher than that of the elderly. Conclusion: Perennial vitamin D insufficiency is prevalent in elderly Japanese patients with hip fractures.


2019 ◽  
Vol 47 (5) ◽  
pp. 1843-1847 ◽  
Author(s):  
Mir Sadat-Ali ◽  
Sulliman M AlShammari ◽  
Fares Z Uddin ◽  
Fawaz M Alani ◽  
Omar S Dahduli

Objective The objective of this study was to identify deficiencies in initiating anti-osteoporotic treatment following a fragility femoral fracture. Methods All patients ≥55 years of age treated for a fragility femoral fracture between June 2012 and May 2017 were enrolled. Medications at discharge and at 90 days and 1 year of follow up were analyzed. Patients were classified into 4 groups: Group I did not receive any treatment for osteoporosis; Group II received only calcium and vitamin D3; Group III received an anabolic agent, calcium, and vitamin D3; and Group IV received bisphosphonates, calcium, and vitamin D3. Results A total of 167 patients with an average age of 65.81±12.55 years were included. There were 88 (52.7%) males and 79 (47.3%) females. At discharge, 107 patients (64.1%) were not prescribed optimal treatment for osteoporosis, and this reduced to 55 (32.9%) at the 90-day follow up. At 1 year, the number of patients receiving suboptimal treatment was further reduced to 25.74%. Conclusions Although the number of patients with fragility fractures receiving insufficient treatment was lower in the present study than in previous reports, increased efforts and coordinated treatment plans initiated by a fracture liaison service should be of high priority.


2012 ◽  
Vol 42 (2) ◽  
Author(s):  
Anton Budhi Darmawan ◽  
Dwi Utami Anjarwati

Background: Chronic suppurative otitis media (CSOM) is one infectious disease of the middle ear, most commonly caused by Pseudomonas aeruginosa. A high number of patients come to the ENT outpatient clinic with active benign type of CSOM. The bacteria Pseudomonas aeruginosa is capable of producing biofilm which protects itself from penetration of antibiotics, and therefore creates resistance towards antibiotics and difficult to eradicate. Objective: The aim of this study was to compare the sensitivity levels of chloramphenicol, polymyxin-neomycin, cyprofloxacin and ofloxacine against Pseudomonas aeruginosa in patients with active benign type CSOM in ENT clinic. Method: The method used was across sectional study on 25 patients, from August 2010 until December 2010. Samples were taken withear swab and then put on sensitivity test to chloramphenicol, polymyxin-neomycin, cyprofloxacin andofloxacine using the diffusion disc method. The analysis used in this study was Cochran test. Results: Results showed a significant difference in sensitivity among chloramphenicol (38,70%), polymyxinneomycin(83,87%),cyprofloxacin(90,32%)andofloxacin(58,06%)withp=0,000(p<0,05).PostHocanalysisusing the Mc Nemar indicated that there were significant differences in sensitivity betweenpolymyxin-neomycin to chloramphenicol with p=0,000 (p<0,05), ciprofloxacin to chloramphenicol andciprofloxacin to ofloxacine with p= 0,002, but there were no significant differences between cyprofloxacinto polymyxin-neomycin with p=0,687, polymyxin-neomycin to ofloxacin p=0.057 and ofloxacin tochloramphenicol p=0,109.   There were significant differences in antibiotic ear dropssensitivity to Pseudomonas aeruginosa in patients with active benign type of CSOM. Cyprofloxacin andpolymyxin-neomycin were more sensitive than ofloxacin and chloramphenicol. Keywords: Pseudomonas aeruginosa, active benign type of chronic suppurative otitis media, antibioticear drops.  Abstrak :  Latar belakang: Otitis media supuratif kronik (OMSK) merupakan penyakit infeksi kronik telinga tengah yang sering dijumpai di klinik THT. Penyebab tersering OMSK adalah bakteri Pseudomonasaeruginosa. Pseudomonas aeruginosa mempunyai kemampuan untuk membentuk biofilm yangmelindunginya dari penetrasi antibiotik sehingga menimbulkan resistensi terhadap antibiotik dan sulituntuk eradikasinya. Tujuan: Untuk mengetahui perbandingan tingkat sensitivitas kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin terhadap isolat Pseudomonas aeruginosa padapasien OMSK benigna aktif di klinik THT RSMS. Metode: Metode yang digunakan adalah crosssectional terhadap 29 pasien OMSK di klinik THT RSMS periode bulan Agustus 2010 - Desember2010. Pengambilan sampel dilakukan dengan swab telinga. Uji sensitivitas terhadap kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin dilakukan dengan metode cakram secara difusi.Analisis yang digunakan dalam penelitian ini adalah Cochran dan analisis post hoc. Hasil: Didapatkansensitivitas kloramfenikol sebesar 38,70%, polimiksin-neomisin sebesar 83,87%, ciprofloksasin sebesar90,32% dan ofloksasin sebesar 58,06% dengan p=0,01 (P<0,05), yang menunjukkan adanya perbedaansensitivitas yang bermakna antara kloramfenikol, polimiksin-neomisin, ciprofloksasin dan ofloksasinterhadap Pseudomonas aeruginosa. Analisis post hoc menggunakan Mc Nemar menunjukkan bahwaterdapat perbedaan sensitivitas yang bermakna antara tetes telinga polimiksin-neomisin terhadapkloramfenikol, dan ciprofloksasin terhadap kloramfenikol p=0,000 (p<0,05), serta terdapat perbedaanyang bermakna antara tetes telinga ciprofloksasin terhadap ofloksasin, p=0,002, tetapi tidak terdapatperbedaan yang bermakna antara ciprofloksasin terhadap polimiksin-neomisin, p=0,687, polimiksinneomisinterhadap ofloksasin p=0,057, dan kloramfenikol terhadap ofloksasin p=0,109. Kesimpulan:Terdapat perbedaan sensitivitas yang bermakna tetes telinga antibiotik terhadap Pseudomonas aeruginosa pada pasien OMSK benigna aktif. Ciprofloksasin dan polimiksin-neomisin tetes telinga mempunyai sensitivitas yang lebih baik dibanding ofloksasin dan kloramfenikol. Kata kunci: Pseudomonas aeruginosa, otitis media supuratif kronik, tetes telinga antibiotik 


2011 ◽  
Vol 152 (29) ◽  
pp. 1161-1166 ◽  
Author(s):  
Zsuzsanna Valkusz

Over the last decades a considerable amount of data has accumulated to indicate that metabolic and endocrine alterations of diabetes affect bone quantity and quality. These skeletal changes may increase the risk of bone fracture. There is strong evidence that in type 1 diabetes the decreased bone mass, lack of insulin and insulin-like growth factor-1, dysregulation of adipokines, and increased levels of proinflammatory cytokines are in the background of fragility fractures. In type 2 diabetes hyperinsulinemia, insulin resistance and increased body weight may result in an increase of bone mass; however, accumulation of advanced glycation end products within the bone collagen driven by glucotoxicity may increase the cortical porosity. There is a higher incidence of falls resulting from diabetes-related co-morbidities such as diabetic retinopathy, peripheral neuropathy, hypoglycemic episodes and sometimes from the medications. Vitamin D deficiency has special impact on glucose metabolism and the prevalence of diabetes. Vitamin D supplementation in childhood can decrease incidence of type 1 diabetes by 80%. The effect of thiazolidinediones, glucagon-like peptide-1 agonists and metformin, agents for treatment of diabetes open a new connection between bone, carbohydrate and fat metabolism. Orv. Hetil., 2011, 152, 1161–1166.


Author(s):  
Sanjeeva Kumar Goud T ◽  
Rahul Kunkulol

The present study was aimed to study the effect of Sublingual Vitamin D3 on Serum Vitamin D level in Vitamin D deficiency patients. This was a cross-sectional and interventional study. All the Vitamin D deficiency patients of age 18-60years and either gender, willing to participate in the study were included. Patients who had greater than 20 ng/ml were excluded from the study. The total number of participants in our study was 200, out of these 111 males and 89 females, the mean age in our study was 51.07 ± 7.39Yrs. All volunteers were given sublingual vitamin D3 (60,000IU) in six doses every fifteen days of follow up for 3 months. The subject’s serum 25(OH)D levels were estimated before and after the treatment of sublingual vitamin D3. There was a statistically significant difference in serum vitamin D3 level before 16.61±6.71 ng/ml and after 35.80±7.80 ng/ml after treatment with Sublingual Vitamin D3. Six doses of 60,000IU of Vitamin D3 sublingual route having improved the role of serum 25(OH)D levels in the treatment of Vitamin D3 deficiency patients.Keywords: Vitamin D3; Sublingual route


2019 ◽  
Vol 16 (11) ◽  
pp. 1063-1071 ◽  
Author(s):  
Gonzague Foucault ◽  
Guillaume T Duval ◽  
Romain Simon ◽  
Olivier Beauchet ◽  
Mickael Dinomais ◽  
...  

Background: Vitamin D insufficiency is associated with brain changes, and cognitive and mobility declines in older adults. Method: Two hundred and fifteen Caucasian older community-dwellers (mean±SD, 72.1±5.5years; 40% female) received a blood test and brain MRI. The thickness of perigenual anterior cingulate cortex, midcingulate cortex and posterior cingulate cortex was measured using FreeSurfer from T1-weighted MR images. Age, gender, education, BMI, mean arterial pressure, comorbidities, use of vitamin D supplements or anti-vascular drugs, MMSE, GDS, IADL, serum calcium and vitamin B9 concentrations, creatinine clearance were used as covariables. Results: Participants with vitamin D insufficiency (n=80) had thinner total cingulate thickness than the others (24.6±1.9mm versus 25.3±1.4mm, P=0.001); a significant difference found for all 3 regions. Vitamin D insufficiency was cross-sectionally associated with a decreased total cingulate thickness (β=- 0.49, P=0.028). Serum 25OHD concentration correlated positively with the thickness of perigenual anterior (P=0.011), midcingulate (P=0.013) and posterior cingulate cortex (P=0.021). Conclusion: Vitamin D insufficiency was associated with thinner cingulate cortex in the studied sample of older adults. These findings provide insight into the pathophysiology of cognitive and mobility declines in older adults with vitamin D insufficiency.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures


Author(s):  
Darius M. Thiesen ◽  
Dimitris Ntalos ◽  
Alexander Korthaus ◽  
Andreas Petersik ◽  
Karl-Heinz Frosch ◽  
...  

Abstract Introduction For successful intramedullary implant placement at the femur, such as nailing in unstable proximal femur fractures, the use of an implant that at least reaches or exceeds the femoral isthmus and yields sufficient thickness is recommended. A number of complications after intramedullary femoral nailing have been reported, particularly in Asians. To understand the anatomical features of the proximal femur and their ethnic differences, we aimed to accurately calculate the femoral isthmus dimensions and proximal distance of Asians and Caucasians. Methods In total, 1189 Asian and Caucasian segmented 3D CT data sets of femurs were analyzed. The individual femoral isthmus diameter was precisely computed to investigate whether gender, femur length, age, ethnicity or body mass index have an influence on isthmus diameters. Results The mean isthmus diameter of all femurs was 10.71 ± 2.2 mm. A significantly larger diameter was found in Asians when compared to Caucasians (p < 0.001). Age was a strong predictor of the isthmus diameter variability in females (p < 0.001, adjusted r2 = 0.299). With every year of life, the isthmus showed a widening of 0.08 mm in women. A Matched Pair Analysis of 150 female femurs showed a significant difference between isthmus diameter in Asian and Caucasian femurs (p = 0.05). In 50% of the cases the isthmus was found in a range of 2.4 cm between 16.9 and 19.3 cm distal to the tip of the greater trochanter. The female Asian femur differs from Caucasians as it is wider at the isthmus. Conclusions In absolute values, the proximal isthmus distance did not show much variation but is more proximal in Asians. The detailed data presented may be helpful in the development of future implant designs. The length and thickness of future standard implants may be considered based on the findings.


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