scholarly journals Prevalence of Vertebral Fractures in CTPA’s in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality

Geriatrics ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. 56
Author(s):  
Llewelyn Jones ◽  
Sukhdev Singh ◽  
Chris Edwards ◽  
Nimit Goyal ◽  
Inder Singh
Keyword(s):  
Vertebral Fracture ◽  
Clinical Outcomes ◽  
Computerized Tomography ◽  
Fragility Fracture ◽  
Vertebral Fractures ◽  
Elderly Population ◽  
Fragility Fractures ◽  
The Elderly ◽  
Overall Mortality

Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.

72 Prevalence of Reported and Unreported Vertebral Fractures in Ctpas in Older Adults Above 75 Years

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i22-i23
Author(s):  
L Jones ◽  
S Singh ◽  
C Edwards ◽  
N Goyal ◽  
I Singh
Keyword(s):  
Vertebral Fracture ◽  
Fragility Fracture ◽  
Vertebral Fractures ◽  
Fragility Fractures ◽  
Osteoporosis Treatment ◽  
Health Board ◽  
Pulmonary Angiogram ◽  
Mortality Difference ◽  
And Gender

Abstract Introduction Identifying vertebral fractures is prudent in the diagnosis of osteoporosis as they occur early in this hidden condition. Unfortunately, due to their unspecific presentation, only 25% are clinically recognised. Computerised Tomography Pulmonary Angiogram (CTPA) are frequently requested to confirm pulmonary thromboembolisms, but could also aid in detecting clinically silent vertebral fractures. Current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to measure the prevalence of vertebral fractures in CTPA and its relevance to clinical outcomes. Methods This is retrospective observational study based on the analysis of existing CTPA for acutely unwell patients admitted to medical assessment unit or A & E across three acute sites within Aneurin Bevan University Health board, Wales, UK between January and December 2015. All CTPA reports were reviewed for fragility factures and CTPA images were reassessed for any unreported vertebral fractures. Age and gender were recorded for all patients. Analysis was done for all patients in respect to subsequent fragility fractures and mortality. Difference of proportion test was used to compare two groups with and without vertebral fractures. Results 179 CTPA were reviewed, 161 patients were included for further analysis. 14.3% (n=23/161) were reported to have a vertebral fracture, however only 8.7% (n=14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 24.2% (n=39/161) vertebral fractures were noted. Therefore, overall prevalence of vertebral fractures was 38.5% (n=62/161). Only 9.1% (n=9/99) of patients without a vertebral fracture developed a subsequent fragility fracture. In comparison, 22.5% (n=14/62) of patients with a previous vertebral fracture sustained a new fragility fracture over next 4 years and this was significantly higher (p = 0.017). Overall mortality over 4 years follow-up was significantly higher for patients with vertebral fractures (64.5%, n=40/62) as compared to those without fractures (43.4%, n=43/99, p = 0.009). Only 48.4% (n=30/62) received osteoporosis treatment. Conclusions Vertebral fractures could be underreported by radiologists, likely due to human factors as they might be concentrating on the clinical scenario to exclude a pulmonary embolism. However, considering a significant higher mortality in patients with underlying vertebral fracture, it justifies that radiologists could be asked to examine sagittal view in the bone window for possible underlying vertebral fractures, to ensure osteoporosis is treated to guidance.

scholarly journals POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 294.2-294
Author(s):  
D. Ciardo ◽  
P. Pisani ◽  
F. A. Lombardi ◽  
R. Franchini ◽  
F. Conversano ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Bone Fragility ◽  
P Value ◽  
T Score ◽  
Caucasian Women

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)<0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)<0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.References:[1]Diez Perez A et al. Aging Clin Exp Res 2019; 31(10):1375-1389.[2]Pisani P et al. Measurement 2017; 101:243–249.Disclosure of Interests:None declared

scholarly journals Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008–2009 (KNHANES IV)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jihan Kim ◽  
Sami Lee ◽  
Sung Soo Kim ◽  
Jong-Pyo Lee ◽  
Jong Sung Kim ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Vertebral Fracture ◽  
Fragility Fracture ◽  
Odds Ratio ◽  
Fragility Fractures ◽  
Normal Weight ◽  
Obese Group ◽  
Nutrition Examination Survey ◽  
Korean Women ◽  
Health And Nutrition

Abstract Background The present study examined the relationship between body mass index (BMI) and the risk for fragility fractures in postmenopausal Korean women. Methods Among subjects who participated in the 4th Korea National Health and Nutrition Examination Survey (2008–2009), 2114 women ≥ 40 years of age were included. BMI was based on standards set by the Korean Society for the Study of Obesity, as follows: < 18.5 kg/m2, underweight; 18.5 ≤ to < 25 kg/m2, normal weight; and ≥ 25 kg/m2, obese. Subjects were also divided into three groups according to the location of fragility fracture: spine, hip, or wrist. Results The mean (± SD) rate of fragility fracture was significantly different among the three groups: 5.9 ± 2.9% (underweight), 1.1 ± 0.3% (normal weight), and 3.0 ± 0.7% (obese) (p = 0.001). After correcting for age, family history, and treatment history of osteoporosis and rheumatoid arthritis, smoking and drinking status, and level of exercise, multivariable regression analysis revealed that the odds ratio for fragility fracture in the underweight group was 5.48 [95% confidence interval (CI) 1.80–16.73] and 3.33 (95% CI 1.61–6.87) in the obese group. After subdividing fragility fractures into vertebral and non-vertebral, the odds ratio for vertebral fracture in the underweight group was 5.49 (95% CI 1.31–23.09) times higher than that in the normal weight group; in the obese group, the non-vertebral fracture odds ratio was 3.87 (95% CI 1.45–10.33) times higher. Analysis of non-vertebral fractures in the obese group revealed an odds ratio for fracture 22.05 (95% CI 1.33–365.31) times higher for hip fracture and 3.85 (95% CI 1.35–10.93) times higher for wrist fracture. Conclusions Obesity and underweight increased the risk for fragility fractures in postmenopausal Korean women.

scholarly journals Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

2019 ◽  
Vol 11 (3) ◽  
Author(s):  
Philipp Born ◽  
Isabella Manzoni ◽  
Thomas Ilchmann ◽  
Martin Clauss
Keyword(s):  
Aseptic Loosening ◽  
Elderly Population ◽  
Weight Bearing ◽  
The Elderly ◽  
Full Weight Bearing ◽  
Septic Loosening ◽  
Term Survival ◽  
Press Fit ◽  
Revision Tha

Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.

P1339ARTERIOVENOUS FISTULA AND BASILIC VEIN TRANSPOSITION IN ELDERLY PATIENTS ON HEMODIALYSIS: AN OBSERVATIONAL STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vinant Bhargava ◽  
Priti Meena ◽  
Ambrish Satwik ◽  
Apurv Srivastava ◽  
A K Bhalla ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Vascular Access ◽  
Elderly Population ◽  
The Elderly ◽  
Primary Patency ◽  
New Delhi ◽  
Secondary Patency ◽  
Basilic Vein ◽  
The Mean

Abstract Background and Aims With the increase in the line expectancy of chronic kidney disease in the older population (&gt;60 years), the numbers requiring haemodialysis is progressively rising. The elderly population may be different from the younger in terms of non-suitable vessels for access creation, non-maturation, and vascular calcifications, and this may alter the outcomes of use of arteriovenous fistula (AVF). This study was conducted to analyse the outcomes of AVF in elderly patients (&gt;60 years). Method Retrospective study was conducted in the Department of Nephrology at Sir Ganga Ram Hospital, New Delhi. Patients of more than 60 years of age in whom AVF was created from 1st January 2012 to 31st December 2016 were included in the study. Follow-up data of 3.5 years was analysed. The primary endpoint was to assess primary and secondary patency rates. Results A total of 300 patients were included in the study. The mean age was 63.8 years. Radiocephalic AVF (RCAVF) was the most common site of [69.8% (n = 210)], followed by brachiocephalic (BCAVF) in 25.2% (n = 75) and basilic vein transposition (BVT) in 5% (n = 15). At 12 months, overall survival of the AVF was 66.8%. At 42 months, the primary patency rate of RCAVF, BCAVF, and BVT was 50.6%, 52.6%, and 50.4% respectively. The commonest cause of access failure was thrombosis (20.4%) followed by non-maturation (9%). Vascular access abandonment was found least in BCAVF. Conclusion AVF remains the preferred vascular access for haemodialysis in the elderly population. Brachiocephalic AVF has higher primary and secondary patency rates. Thrombosis and failure of maturation are major concerns in the elderly AVF.

scholarly journals The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review

2020 ◽  
pp. 219256822094803
Author(s):  
Barry Ting Sheen Kweh ◽  
Hui Qing Lee ◽  
Terence Tan ◽  
Joost Rutges ◽  
Travis Marion ◽  
...  
Keyword(s):  
Systematic Review ◽  
Elderly Patients ◽  
Vertebral Fractures ◽  
Postural Stability ◽  
Elderly Population ◽  
The Elderly ◽  
Functional Improvement ◽  
Osteoporotic Vertebral Fractures ◽  
Spinal Orthoses

Study Design: Systematic review. Objective: Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures. Methods: A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed. Results: Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing. Conclusion: The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.

scholarly journals Nonsurgical Corrective Union of Osteoporotic Vertebral Fracture with Once-Weekly Teriparatide

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Naohisa Miyakoshi ◽  
Akira Horikawa ◽  
Yoichi Shimada
Keyword(s):  
Vertebral Fracture ◽  
Fracture Healing ◽  
Clinical Experience ◽  
Vertebral Body ◽  
Vertebral Fractures ◽  
Surgical Intervention ◽  
Osteoporotic Vertebral Fracture ◽  
Kyphosis Angle ◽  
Osteoporotic Vertebral Fractures

Osteoporotic vertebral fractures usually heal with kyphotic deformities with subsidence of the vertebral body when treated conservatively. Corrective vertebral union using only antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously. An 81-year-old female with osteoporosis presented with symptomatic fresh L1 vertebral fracture with intravertebral cleft. Segmental vertebral kyphosis angle (VKA) at L1 was 20° at diagnosis. Once-weekly teriparatide administration, hospitalized rest, and application of a thoracolumbosacral orthosis alleviated symptoms within 2 months. Corrective union of the affected vertebra was obtained with these treatments. VKA at 2 months after injury was 8° (correction, 12°) and was maintained as of the latest follow-up at 7 months. Teriparatide has potent bone-forming effects and has thus been expected to enhance fracture healing. Based on the clinical experience of this case, teriparatide may have the potential to allow correction of unstable vertebral fractures without surgical intervention.

scholarly journals Selenium and Mortality in the Elderly: Results from the EVA Study

2005 ◽  
Vol 51 (11) ◽  
pp. 2117-2123 ◽  
Author(s):  
N Tasnime Akbaraly ◽  
Josiane Arnaud ◽  
Isabelle Hininger-Favier ◽  
Veronique Gourlet ◽  
Anne-Marie Roussel ◽  
...  
Keyword(s):  
Elderly Population ◽  
Proportional Hazards ◽  
Dietary Habits ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Health Maintenance ◽  
Plasma Selenium ◽  
Optimal Health ◽  
Low Selenium

Abstract Background: Inadequate plasma selenium can adversely affect the maintenance of optimal health; therefore, reported decreases in plasma selenium in an aging population are cause for concern. To further examine this hypothesis, we explored the relationships between plasma selenium and mortality in an elderly population: the EVA (Etude du Vieillissement Artériel) study. Methods: The EVA study was a 9-year longitudinal study with 6 periods of follow-up. During the 2-year period from 1991 to 1993 (EVA0), 1389 men and women born between 1922 and 1932 were recruited. The effects of plasma selenium at baseline on mortality were determined by Cox proportional hazards regression analysis, adjusting for the following variables: sociodemographic characteristics, dietary habits, health, and cognitive factors. Results: During the 9-year follow-up, 101 study participants died. Baseline plasma selenium was higher in individuals who were alive at the end of follow-up [mean (SD), 1.10 (0.20) μmol/L] than in those who died during the follow-up [1.01 (0.20) μmol/L; P &lt;10−4]. Mortality rates were significantly higher in individuals with low selenium [increments = 0.2 μmol/L; relative risk (RR) = 1.56 (95% confidence interval, 1.28–1.89)]. After we controlled for various potential confounding factors, this association remained significant [RR = 1.54 (1.25–1.88)]. When the underlying causes of death were considered, we found an association with cancer-related mortality [adjusted RR = 1.79 (1.32–2.44)]. Conclusions: Even if it is premature to present selenium as a longevity indicator in an elderly population, our results are in accordance those of large, interventional, randomized trials with selenium, which suggest that this essential trace element plays a role in health maintenance in aging individuals.

scholarly journals Fatores intrínsecos do risco de queda de idosos no domicilio: estudo descritivo

2018 ◽  
Vol 16 (4) ◽  
pp. 480
Author(s):  
Izabel Cristina Luiz ◽  
Ana Karine Ramos Brum
Keyword(s):  
Home Environment ◽  
Elderly Population ◽  
Mini Mental State Examination ◽  
Monitoring Program ◽  
The Elderly ◽  
Average Score ◽  
Intrinsic Factors ◽  
Risk Of Fall ◽  
State Examination

Goal: to associate the intrinsic factors for risk of fall with the occurrence of falls in the home environment in elderly people with chronic diseases. Method: a descriptive study with a quantitative approach, conducted between June and July 2015 with 36 octogenarian elderly, participants of a multidisciplinary chronic disease monitoring program in the state of Rio de Janeiro. We applied the Downton Scale for data collection. Results: all the elderly underwent the Mini Mental State Examination and presented a 27 point average score; 86.1% presented high intrinsic risk for falls, although sensorial handicap (P = 0.09), previous falls (p = 0.35), drug use (p = 1) and ambulation (p = 1) did not present any significant association with the occurrence of the fall during the six months of follow-up. Conclusion: There was a high intrinsic risk of falling in the elderly population studied. Among the most prevalent factors were the previous falls and use of medications, especially hypotensive drugs.

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