Polymorphisms in Genes Involved in Osteoblast Differentiation and Function Are Associated with Anthropometric Phenotypes in Spanish Women

Much of the genetic variance associated with osteoporosis is still unknown. Bone mineral density (BMD) is the main predictor of osteoporosis risk, although other anthropometric phenotypes have recently gained importance. The aim of this study was to analyze the association of SNPs in genes involved in osteoblast differentiation and function with BMD, body mass index (BMI), and waist (WC) and hip (HC) circumferences. Four genes that affect osteoblast differentiation and/or function were selected from among the differentially expressed genes in fragility hip fracture (FOXC1, CTNNB1, MEF2C, and EBF2), and an association study of four single-nucleotide polymorphisms (SNPs) was conducted in a cohort of 1001 women. Possible allelic imbalance was also studied for SNP rs87939 of the CTNNB1 gene. We found significant associations of SNP rs87939 of the CTNNB1 gene with LS-sBMD, and of SNP rs1366594 of the MEF2C gene with BMI, after adjustment for confounding variables. The SNP of the MEF2C gene also showed a significant trend to association with FN-sBMD (p = 0.009). A possible allelic imbalance was ruled out as no differences for each allele were detected in CTNNB1 expression in primary osteoblasts obtained from homozygous women. In conclusion, we demonstrated that two SNPs in the MEF2C and CTNNB1 genes, both implicated in osteoblast differentiation and/or function, are associated with BMI and LS-sBMD, respectively.

Preoperative fluid management of the older adult patient with hip fracture

<p>Background While recommendations about the preoperative fluid management of the older adult hip fracture patient have been produced the evidence relating to postoperative outcomes is scant. Aim The aim of this study is, therefore, to explore the relationships between preoperative fluid management (PFM) - defined as timing to start of fluids (oral or intravenous) after admission, preoperative oral fluid rate, and timing of last preoperative oral fluids – and postoperative outcomes - defined as change in renal function (creatinine and GFR), new reported postoperative confusion, timing of discontinuation of postoperative intravenous fluids (IV), and length of stay (LOS). Method This observational study looked at 100 consecutive older adult patients admitted to a tertiary New Zealand hospital with traumatic hip fracture between March and September, 2012. Data was gathered regarding cohort demographics and in hospital events, including surgical details, alongside PFM and postoperative outcomes. Descriptive statistics, linear regression, independent t-tests, tests of equality, and multiple logistic regression were utilised to ascertain relationships between variables. Results Characteristics of the perioperative journey of 100 consecutive patients, with mean age of 85.2 yr (SD 6.6) and predominantly female (70%), presenting to CCDHB with a fragility hip fracture were itemised. High rates of co-morbidities were observed in this group, with 92% of patients having cardiac, pulmonary, vascular or renal co-morbidities, but with a mortality rate (2%) much lower than the literature would suggest might be expected. There was no substantiated statistically significant relationships observed between preoperative fluid management in this cohort and postoperative outcomes, but this may reflect limited power in this study. Conclusion These results provide useful data for planning services with regards management of the older adult hip fracture patient at CCDHB. In addition, the study has highlighted a number of clinical guidelines that might be more effectively promoted.</p>

Preoperative fluid management of the older adult patient with hip fracture

<p>Background While recommendations about the preoperative fluid management of the older adult hip fracture patient have been produced the evidence relating to postoperative outcomes is scant. Aim The aim of this study is, therefore, to explore the relationships between preoperative fluid management (PFM) - defined as timing to start of fluids (oral or intravenous) after admission, preoperative oral fluid rate, and timing of last preoperative oral fluids – and postoperative outcomes - defined as change in renal function (creatinine and GFR), new reported postoperative confusion, timing of discontinuation of postoperative intravenous fluids (IV), and length of stay (LOS). Method This observational study looked at 100 consecutive older adult patients admitted to a tertiary New Zealand hospital with traumatic hip fracture between March and September, 2012. Data was gathered regarding cohort demographics and in hospital events, including surgical details, alongside PFM and postoperative outcomes. Descriptive statistics, linear regression, independent t-tests, tests of equality, and multiple logistic regression were utilised to ascertain relationships between variables. Results Characteristics of the perioperative journey of 100 consecutive patients, with mean age of 85.2 yr (SD 6.6) and predominantly female (70%), presenting to CCDHB with a fragility hip fracture were itemised. High rates of co-morbidities were observed in this group, with 92% of patients having cardiac, pulmonary, vascular or renal co-morbidities, but with a mortality rate (2%) much lower than the literature would suggest might be expected. There was no substantiated statistically significant relationships observed between preoperative fluid management in this cohort and postoperative outcomes, but this may reflect limited power in this study. Conclusion These results provide useful data for planning services with regards management of the older adult hip fracture patient at CCDHB. In addition, the study has highlighted a number of clinical guidelines that might be more effectively promoted.</p>

Early mobilisation following fragility hip fracture surgery: current trends and association with dicharge outcomes in a local tertiary hospital

Introduction: Postoperative day 1 (POD1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD1 mobilisation at our institution; and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination. Methods: In this preliminary observational study, data pertaining to demographics, pre-morbid function, health status, injury and surgical factors, POD1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD1 ambulation formed the “Early Ambulation (EA)” Group while the remaining patients formed the “Delayed Ambulation (DA)” group. Data were analysed for any significant difference between the groups. Results: 115 patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD1 was 80.0% (92 patients) which was comparable with data available from international hip fracture audit databases. 55 patients (47.8%) formed the EA group and 60 patients (52.5%) formed the DA group. EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20; 95% Confidence Interval 1.50-56.45; p = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to DA group (p > 0.05). Conclusion: This is the first local study to offer benchmark of the POD1 mobilisation status for this population. Patients who attained POD1 ambulation had better early functional recovery.

Mortality incidence and its determinants after fragility hip fractures: a prospective cohort study from an Egyptian level one trauma center

Background: Fragility hip fracture is a common condition with serious consequences. Most outcomes data come from Western and Asian populations. There are few data from African and Middle Eastern countries. Objective: The primary objective was to describe mortality rates after fragility hip fracture in a Level-1 trauma centre in Egypt. The secondary objective was to study the causes of re-admissions, complications, and mortality. Methods: A prospective cohort study of 301 patients, aged > 65 years, with fragility hip fractures. Data collected included sociodemographic, co-morbidities, timing of admission, and intraoperative,ostoperative, and post-discharge data as mortal- ity, complications, hospital stay, reoperation, and re-admission. Cox regression analysis was conducted to investigate factors associated with 1-year mortality. Results: In-hospital mortality was 8.3% (25 patients) which increased to 52.8% (159 patients) after one year; 58.5% of the deaths occurred in the first 3-months. One-year mortality was independently associated with increasing age, ASA 3-4, cardiac or hepatic co-morbidities, trochanteric fractures, total hospital stay, and postoperative ifection and metal failure. Conclusion: Our in-hospital mortality rate resembles developed countries reports, reflecting good initial geriatric health- care. However, our 3- and 12-months mortality rates are unexpectedly high. The implementation of orthogeriatric care after discharge is mandatory to decrease mortality rates. Keywords: Fragility hip fractures; trochanteric fractures; mortality rate.

Prognostic factors related to ambulation deterioration after 1-year of geriatric hip fracture in a Chinese population

The objective of this study was to investigate the prognostic factors predicting the ambulation recovery of fragility hip fracture patients. 2286 fragility hip fracture patients were collected from the Fragility Fracture Registry in Hong Kong. Predictive factors of ambulation deterioration including age, gender, pre-operation American Society of Anesthesiologists grade, pre-fracture mobility, delay to surgery, length of stay, fracture type, type of surgery, discharge destination and complications were identified. Patients with outdoor unassisted and outdoor with aids ambulatory function before fracture had 3- and 1.5-times increased risk of mobility deterioration, respectively (Odds Ratio (OR) = 2.556 and 1.480, 95% Confidence Interval (CI) 2.101–3.111 and 1.246–1.757, both p < 0.001). Patients living in old age homes had almost 1.4 times increased risk of deterioration when compared to those that lived in their homes (OR = 1.363, 95% CI 1.147–1.619, p < 0.001). The risk also increased for every 10 years of age (OR = 1.831, 95% CI 1.607–2.086, p < 0.001). Patients in the higher risk ASA group shows a decreased risk of ambulation deterioration compared to those in lower risk ASA group (OR = 0.831, 95% CI 0.698–0.988, p = 0.038). Patients who suffered from complications after surgery did not increased risk of mobility decline at 1-year post-surgery. Delayed surgery over 48 h, delayed discharge (> 14 days), early discharge (less than 6 days), and length of stay also did not increased risk of mobility decline. Male patients performed worse in terms of their mobility function after surgery compared to female patients (OR = 1.195, 95% CI 1.070–1.335, p = 0.002). This study identified that better premorbid good function, discharge to old age homes especially newly institutionalized patients, increased age, lower ASA score, and male patients, correlate with mobility deterioration at 1-year post-surgery. With the aging population and development of FLS, prompt identification of at-risk patients should be performed for prevention of deterioration.

Hip Fractures in Malta: Are we Missing an Opportunity?

Introduction Osteoporosis is a bone disease that is both preventable and treatable. It usually becomes evident when a fragility fracture occurs. Unfortunately, most studies show that only a small percentage of individuals at increased risk of fracture are assessed and treated, even following a fragility fracture. Objective The aim of this study was to determine whether patients suffering from a low-energy hip fractures in the Maltese Islands are given osteoporosis treatment. Method All patients older than 50 years presenting to the acute care hospitals in Malta and Gozo with a fragility hip fracture during December 1, 2015 and November 30, 2016 were included. Data on mortality, other fragility fractures, prescription of calcium, vitamin D, and antiresorptive therapy were collected. Results Calcium with vitamin D supplements were prescribed to 40% of patients; however, only 2.64% of patients were given pharmacological therapy. Following a hip fracture, the mortality rate was 18.5% at 1 year and 26.21% at 2 years. Apart from a high mortality rate, 28.19% of individuals sustained another fragility fracture before or after the hip fracture. Conclusion There should be increased osteoporosis awareness in Malta and a national bone mineral density screening program should be set up. An active role of the orthogeriatrics team in the management and treatment of osteoporosis following a fragility fracture might improve treatment rate and decrease refracture and mortality rates.