scholarly journals Vertebral fractures as a precursor to potential hip fractures in elderly women

2021 ◽  
Author(s):  
Xuan Wu ◽  
Xiang-xu Chen ◽  
Li-yong Bai ◽  
Hui Chen ◽  
Yun-feng Rui
Keyword(s):  
Hip Fracture ◽  
Vertebral Fracture ◽  
Hip Fractures ◽  
Vertebral Fractures ◽  
Elderly Women ◽  
Statistical Significance ◽  
Osteoporosis Treatment ◽  
Low Energy ◽  
Functional Training ◽  
Number Of Patients

Abstract Objective: The purpose of this study was to investigate the kind of low-energy fracture which is a precursor of hip fracture in the elderly, and to suggest the importance of osteoporosis treatment and gait training for fall prevention after this low-energy fracture to prevent the occurrence of secondary hip fracture. Methods: From January 2017 to December 2020, a total of 564 patients who underwent surgical treatment for hip fractures were admitted to the Zhongda Hospital affiliated to Southeast University. Baseline information including gender, age, diagnosis and type of low-energy fracture before hip fracture were collected. FRAX score, the number of patients received functional training and the number of patients received anti-osteoporosis treatment were analyzed. Results: There were180 male patients and 384 female patients in the total 564 patients. The number of male patients with low-energy fractures before hip fracture was 28, including hip fracture (8 cases), vertebral fracture (8 cases) and humeral fracture (7 cases), and radial fracture (5 cases). The number of female hip fracture patients with a low-energy fracture before fracture was 62, containing vertebral fracture (31 cases), hip fracture (15 cases), radial fracture (9 cases) and humeral fracture (7 cases). It was found that vertebral fractures were the most frequent low-energy fractures that preceded hip fractures in elderly women compared to other low-energy fractures. It was showed that the 10-year probability of hip fracture and other site fractures was significantly higher in the group with lumbar fractures and other site fractures than those in the group without fractures assessed by using the FRAX measurement system. There were no statistical significance among the three groups of patients who underwent functional training and anti-osteoporosis treatment. We could not find statistical significance among the three groups of patients who underwent functional training and anti-osteoporosis treatment. Conclusion: Vertebral fracture is a precursor of hip fracture in elderly women. In face of the vertebral fractures, surgeons, especially orthopedic surgeons, should pay extra attention to the treatment of osteoporosis and anti-fall functional training.

scholarly journals Experience of medical care which is provided to patients of older age groups with a hip fracture in Yaroslavl region

2020 ◽  
pp. 154-158
Author(s):  
M. V. Belov ◽  
K. Yu. Belova ◽  
A. A. Degtyarev ◽  
O. B. Ershova
Keyword(s):  
Hip Fracture ◽  
Medical Care ◽  
Hip Fractures ◽  
High Efficiency ◽  
Low Energy ◽  
Falls Prevention ◽  
Care Hospital ◽  
Osteoporosis Therapy ◽  
Secondary Fracture ◽  
Number Of Patients

Hip fractures are severe and life-threatening injuries with huge social, medical and economic consequences and a high mortality rate. The article is devoted to the organization of medical care in older patients group who received a hip fracture due to osteoporosis. Based on the experience of the Yaroslavl emergency medical care hospital n.a. N.V. Solovyov we analyze how the providing of medical care for these patients has changed over the past 10 years. A whole range of measures was introduced to ensure timely hospitalization, round-the-clock examination, availability of free metal structures, therapeutic support and early rehabilitation of patients. The result of these measures was the reduction in hospital mortality from 9.66% to 1.44%, the increase of operational activity from 71% to 92%, and the increase of the number of patients operated on within 48 hours from 0.3% to 82%. In addition, patients with low-energy fractures need implementing measures of falls prevention and prescription of the treatment for osteoporosis. These approaches help to reduce the frequency of further low-energy fractures and mortality of these patients. For this purpose, the secondary fracture prevention service (FLS) was created in this hospital. The service organized an active patients’ identification, fractures and falls risk assessment, prescription of osteoporosis therapy, recommendation of non-drug measures and physical training, and development of a plan for further monitoring of the patient. These approaches allowed to achieve high efficiency of the service: identification up to 97% in patients with fracture, prescription of drug therapy to 78% of patients. Thus, the introduction of a whole range of measures has significantly improved the quality indicators of medical care for patients with hip fractures.

scholarly journals Bone mineral density and trabecular bone score in elderly type 2 diabetes Southeast Asian patients with severe osteoporotic hip fractures

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241616
Author(s):  
Linsey U. Gani ◽  
Kundan R. Saripalli ◽  
Karen Fernandes ◽  
Suet F. Leong ◽  
Koh T. Tsai ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Type 2 Diabetes ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Elderly Women ◽  
Trabecular Bone Score ◽  
Southeast Asian ◽  
Mineral Density ◽  
Severe Osteoporosis

Introduction Studies show trabecular bone score (TBS) may provide information regarding bone quality independent of bone mineral density (BMD) in type 2 diabetes (DM2) patients. We analyzed our Southeast Asian severe osteoporotic hip fracture patients to study these differences. Methods We conducted a retrospective cross-sectional analysis of subjects admitted to Changi General Hospital, Singapore with severe osteoporotic hip fractures from 2014–2017 who had BMD performed. Electronic records were reviewed and subjects were classified as having diabetes according to the WHO 2019 criteria. DM2 patients were classified according to their HbA1c into well controlled (HbA1c < 7%) and poorly controlled (HbA1c ≥ 7%) DM2. Results Elderly patients with hip fractures present with average femur neck T scores at the osteoporotic range, however those with DM2 had higher BMD and TBS values compared to non DM2 patients. These differences were statistically significant in elderly women—poorly controlled elderly DM2 women with hip fracture had the highest total hip T-score (-2.57 ± 0.86) vs (-2.76 ± 0.96) in well controlled DM2 and (-3.09 ± 1.01) in non DM2 women with hip fracture, p < 0.001. In contrast, TBS scores were lower in poorly controlled DM2 women with hip fracture compared to well controlled DM2 women with hip fracture (1.22 ± 0.11) vs (1.24 ± 0.09), but these were still significantly higher compared to non DM2 women with hip fracture (1.19 ± 0.10), p < 0.001. In elderly men with hip fractures, univariate analysis showed no statistically significant differences in TBS or hip or LS BMD between those with poorly controlled DM2, well controlled DM2 and non DM2. The differences in TBS and BMD remained significant in all DM2 women with hip fractures even after adjustments for potential confounders. Differences in TBS and BMD in poorly controlled DM2 men with hip fractures only became significant after accounting for potential confounders. However, upon inclusion of LS BMD into the multivariate model these differences were attenuated and remained significant only between elderly women with well controlled DM2 and non DM2 women with hip fractures. Conclusions Elderly patients with DM2 and severe osteoporosis present with hip fractures at a higher BMD and TBS values compared to non DM2 patients. These differences were significant after adjustment for confounders in all DM2 women and poorly controlled DM2 men with hip fractures, TBS differences were attenuated with the inclusion LS BMD. Further studies are needed to ascertain differences in BMD and TBS in older Southeast Asian DM2 patients with variable glycemic control and severe osteoporosis.

scholarly journals Assessment and Early Management of Pain in Hip Fractures: The Impact of Paracetamol

2018 ◽  
Vol 9 ◽  
pp. 215145931880644 ◽  
Author(s):  
Ján Dixon ◽  
Fiona Ashton ◽  
Paul Baker ◽  
Karl Charlton ◽  
Charlotte Bates ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Pain Control ◽  
Patient Comfort ◽  
Central Feature ◽  
Significant Finding ◽  
Early Management ◽  
Intravenous Paracetamol ◽  
Number Of Patients ◽  
The Impact

Introduction: As the number of patients sustaining hip fractures increases, interventions aimed at improving patient comfort and reducing complication burden acquire increased importance. Frailty, cognitive impairment, and difficulty in assessing pain control characterize this population. In order to inform future care, a review of pain assessment and the use of preoperative intravenous paracetamol (IVP) is presented. Materials and Methods: Systematic review of preoperative IVP administration in patients presenting with a hip fracture. Results: Intravenous paracetamol is effective in the early management of pain control in the hip fracture population. There is a considerable decrease in use of breakthrough pain medications when compared with other pain relief modalities. Additionally, IVP reduces the incidence of opioid-induced complications, reduces length of stay, and lowers mean pain scores. Another significant finding of this study is the poor administration of all analgesics to patients with hip fracture with up to 72% receiving no prehospital analgesia. Discussion: The potential benefits of IVP as routine in the early management of hip fracture-related pain are clear. Studies of direct comparison between analgesia regimes to inform optimum bundles of analgesic care are sparse. This study highlights the need for properly constructed pathway-driven comparator studies of contemporary analgesia regimes, with IVP as a central feature to optimize pain control and minimize analgesia-related morbidity in this vulnerable population.

scholarly journals The assessment of vertebral fractures in elderly women with recent hip fractures: the BREAK Study

2012 ◽  
Vol 24 (4) ◽  
pp. 1151-1159 ◽  
Author(s):  
S. Gonnelli ◽  
◽  
C. Caffarelli ◽  
S. Maggi ◽  
S. Rossi ◽  
...  
Keyword(s):  
Hip Fractures ◽  
Vertebral Fractures ◽  
Elderly Women

scholarly journals Observation on the risk of falling and self-efficacy in elderly patients with hip fracture

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Zongyou Mou ◽  
Ke Song ◽  
Jinquan Guo
Keyword(s):  
High School ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Self Efficacy ◽  
School Education ◽  
High School Education ◽  
Risk Of Falling ◽  
Post Surgery ◽  
Number Of Patients

Objectives:To study the risk of falling and self-efficacy in elderly patients with hip fracture. Methodology: Forty elderly patients with hip fractures that were caused by falling were admitted into our hospital from April 2018 to April 2019, and were enrolled into this study. All patients were assessed by using the Morse Fall Scale (MFS) and Falls Efficacy Scale(FES).The basic situation of the patients with hip fractures caused by falling and the scores of MFS and FES before and after falling were evaluated. Results: Results showed that the number of patients with femoral neck fractures accounted for 70% out of all patients, and the number of patients with intertrochanteric fractures accounted for the remaining30%of the patients. The number of patients with academic qualification below primary school is 16, the number of patients with middle high school education is 11 and the number of patients with high school education and above is 13. Slipping is the cause of hip fracture that accounted for the most in patients, followed by outing activities, whereas least patients with hip fractures was caused by falling in nursing home. There were 29 patients’ whoused crutches or walking aids and this number was more than that of those who required the devices. After the MFS and FES analyses, the results (scores of MFS and FES) showed that the risk before the fall was lower. In contrast, the risk of fracture and post-surgery after the fall was greatly increased. Conclusion: The elderly patients with hip fractures were found to have increased risk of falling and thus, these patients require good care.

scholarly journals SOSTOYaNIE MINERAL'NOY PLOTNOSTI KOSTNOY TKANI U ZhENShchIN, PERENESShIKh MALOTRAVMATIChNYE PERELOMY V VOZRASTE 50 LET I STARShE

2012 ◽  
Vol 15 (2) ◽  
pp. 9-12
Author(s):  
O V Dobrovol'skaya ◽  
N V Demin ◽  
N V Toroptsova
Keyword(s):  
Bone Mineral Density ◽  
Hip Fracture ◽  
Bone Mineral ◽  
Vertebral Fractures ◽  
High Frequency ◽  
Low Energy ◽  
Mineral Density ◽  
Wrist Fractures ◽  
History Of ◽  
The Mean

This study was aimed to evaluate the bone mineral density (BMD) in women at the age of 50 years and older with the his tory of fracture(s) after a low-energy trauma. For this purpose the osteodensitometry of three areas was performed in 173 women with different low-traumatic fractures. Osteoporosis and osteopenia were found in 77% and 21% of patients respectively. Osteoporosis at least in one of three areas was revealed in 80% of women with hip fracture, in 77% of women with wrist fractures, in 73% of patients with humeral fractures, in 86% women after vertebral fractures and in 62% of patients with ankle fractures. Moreover, in these subgroups the osteoporosis in two areas of three was found in 38%, 23%, 30%, 33% and 24% of cases respectively. Osteoporosis in all three areas was detected more frequently in women with wrist fractures (in 39% of cases). The high frequency of osteoporosis in women with the history of low-traumatic fractures argues the need of an adequate antiosteoporotic treatment without mandatory verification of the reduced BMD by the mean of the osteodensitometry.

scholarly journals obesity paradox and mortality after pathological hip fractures: a Swedish registry study

2022 ◽  
pp. 185-189
Author(s):  
Jessica Ehne ◽  
Panagiotis Tsagozis ◽  
Anja Lind ◽  
Rikard Wedin ◽  
Margareta Hedström
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Patient Survival ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Obesity Paradox ◽  
Clinical Parameter ◽  
Overweight And Obesity ◽  
Study Cohort ◽  
Nutritional Studies

Background and purpose — Obesity as measured by BMI has been associated with increased survival in various diseases, a phenomenon known as the “obesity paradox.” It is unknown whether obesity is associated with survival after pathological fractures. We investigated the association between BMI and survival after surgery for pathological hip fracture, to improve survival prognostication, and lay grounds for further interventional nutritional studies. Patients and methods — We analyzed prospectively collected data from Swedish nationwide registry “RIKSHÖFT.” The study cohort included 1,000 patients operated for a pathological hip fracture between 2014 and 2019. BMI registered on admission was available in 449 patients. Overall patient survival was measured according to the Kaplan–Meier method. Multivariable regression was used to evaluate association with other potential factors that influence patient survival. Results — Overweight and obesity were associated with an increased postoperative survival in male patients with surgically treated pathological hip fractures. Multivariable analysis considering potential confounders confirmed this finding. The association was not that strong in women and did not reach statistical significance. Interpretation — BMI, a commonly available clinical parameter, is a good predictor of overall survival for patients operated on for pathological hip fracture. Incorporation of BMI in existent survival prognostication algorithms should be considered. Treatment of malnutrition in this frail group of patients is worth studying.

scholarly journals Effect of Abaloparatide vs Alendronate on Fracture Risk Reduction in Postmenopausal Women With Osteoporosis

2019 ◽  
Vol 105 (3) ◽  
pp. 938-943 ◽  
Author(s):  
Benjamin Z Leder ◽  
Bruce Mitlak ◽  
Ming-yi Hu ◽  
Gary Hattersley ◽  
Richard S Bockman
Keyword(s):  
Vertebral Fracture ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Risk Reduction ◽  
Vertebral Fractures ◽  
Statistical Significance ◽  
Fracture Rate ◽  
Alendronate Treatment ◽  
Clinical Fractures ◽  
Fracture Risk Reduction

Abstract Context The ACTIVE study demonstrated the antifracture efficacy of abaloparatide in postmenopausal women with osteoporosis. ACTIVExtend demonstrated sustained fracture risk reduction with alendronate in abaloparatide-treated participants from ACTIVE. A direct comparison of the efficacy of abaloparatide and antiresorptive therapies has not been performed. Objective The objective of this analysis is to compare the antifracture efficacy of abaloparatide in ACTIVE with that of alendronate in ACTIVExtend. Design In this post hoc analysis, the rate of new vertebral fractures for women in ACTIVExtend (N = 1139) was calculated based on baseline and endpoint radiographs for placebo or abaloparatide in ACTIVE and alendronate in ACTIVExtend. Vertebral fracture rates between abaloparatide and alendronate were compared in a Poisson regression model. Fracture rates for nonvertebral and clinical fractures were compared based on a Poisson model during 18 months of abaloparatide or placebo treatment in ACTIVE and 18 months of alendronate treatment in ACTIVExtend. Results The vertebral fracture rate was lower during abaloparatide treatment in ACTIVE (0.47 fractures/100 patient-years) than alendronate treatment in ACTIVExtend (1.66 fractures/100 patient-years) (relative risk reduction 71%; P = .027). Although the comparisons did not meet statistical significance, after switching from placebo (ACTIVE) to alendronate (ACTIVExtend), the rate of new vertebral fractures decreased from 2.49 to 1.66 fractures per 100 patient-years, and after switching from abaloparatide to alendronate from 0.47 to 0.19 fractures per 100 patient-years. The rates of nonvertebral fractures and clinical fractures were not significantly different. Conclusion Initial treatment with abaloparatide may result in greater vertebral fracture reduction compared with alendronate in postmenopausal women with osteoporosis.

scholarly journals Osteoporosis treatment rates after hip fracture 2011–2019 in Hawaii: Undertreatment of men after hip fractures

2021 ◽  
Vol 7 (3) ◽  
pp. 103-109
Author(s):  
Luke Taylor ◽  
Chieko Kimata ◽  
Andrea M. Siu ◽  
Samantha N. Andrews ◽  
Prashant Purohit ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Osteoporosis Treatment

Improving outcomes after hip fracture at a safety net hospital with a standardised hip fracture protocol

2020 ◽  
pp. 112070002091933
Author(s):  
Anthony V Christiano ◽  
Hannah C Elsevier ◽  
Salman Sarker ◽  
George Agriantonis ◽  
David Joseph ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Safety Net ◽  
Management Service ◽  
Protocol Implementation ◽  
Time To Surgery ◽  
Number Of Patients ◽  
Safety Net Hospital ◽  
Urban Safety

Introduction: standardised protocols for the care of geriatric hip fractures demonstrate improved patient outcomes with decreased cost. The purpose of this study is to evaluate outcomes of a standardised hip fracture protocol at an urban safety-net hospital. Methods: All trauma patients presenting to our urban safety-net hospital are included in a trauma database and inpatient outcomes recorded. A hip fracture protocol was introduced at our institution in 2015, which depended on admission to a monitored setting due to the absence of a geriatric co-management service. The database was queried to identify patients surgically treated for a geriatric hip fracture in the 3 years prior to protocol implementation (2012–2014) and patients treated in the 3 years following protocol implementation (2016–2018). Demographics, time to surgery, inpatient complications, and length of stay were compared between groups. Results: A total of 633 patients treated operatively for isolated hip fractures were identified, 262 patients in the 2012–2014 pre-protocol cohort, and 371 patients in the 2016–2018 protocol cohort. Following implementation of a hip fracture protocol the number of patients admitted to a surgical service increased from 198 (76%) to 348 (94%, p < 0.005) with the number of patients being admitted to a monitored setting increasing from 40 (15%) to 83 (22%, p = 0.026). The time to surgery was reduced to 2.75 days ( p = 0.054). The complication rate fell from 23% to 4% ( p < 0.0005). Length of stay was significantly reduced from 13.2 days to 12 days ( p = 0.045). Conclusions: A hip fracture protocol including admission to a monitored setting can be effectively implemented at an urban safety-net hospital where geriatric co-management is not available. This resulted in a decrease in complications and length of stay. Additional interventions are required to decrease average time to surgery below 36 hours.

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