Glucocorticoids Increase Fracture Risk and Fracture Prevalence Independently from Bone Mineral Density and Clinical Risk Factors: Results from the Gliwice Osteoporosis (GO) Study

The aim of the study was to establish the influence of glucocorticoids (GC) on fracture risk, probability, and prevalence. A set of 1548 postmenopausal women were divided into study group – treated with GC (n=114, age 66.48±7.6 years) and controls (n=1434, age 66.46±6.83 years). Data on clinical risk factors for osteoporosis and fractures were collected. Hip bone densitometry was performed using a device Prodigy (GE, USA). Fracture probability was established by FRAX, and fracture risk by Garvan algorithm and POL-RISK. Fracture risk and fracture probability were significantly greater for GC-treated women in comparison to controls. In the study group, there were 24, 3, 24, and 6 fractures noted at spine, hip, forearm, and arm, respectively. The respective numbers of fractures reported in controls at those skeletal sites were: 186, 23, 240, and 25. The use of GCs increased significantly prevalence of all major, spine and arm fractures. Also the number of all fractures was affected by GC use. Following factors significantly increased fracture probability: age (OR 1.04 per each year; 95% CI: 1.03–1.06), GC use (OR 1.54; 95% CI: 1.03–2.31), falls (OR 2.09; 95% CI: 1.60–2.73), and FN T-score (OR 0.62 per each unit; 95% CI: 0.54–0.71). In conclusion, in patients treated with GCs the fracture risk, probability, and prevalence were increased. This effect was evident regardless of whether GC therapy is included in the algorithm as a risk factor (FRAX, POL-RISK) or not taken into consideration (Garvan nomogram).

Keel bone fractures in Danish laying hens: Prevalence and risk factors

Keel bone fractures (KBF) in commercial poultry production systems are a major welfare problem with possible economic consequences for the poultry industry. Recent investigations suggest that the overall situation may be worsening. Depending on the housing system, fracture prevalences exceeding 80% have been reported from different countries. No specific causes have yet been identified and this has consequently hampered risk factor identification. The objective of the current study was to investigate the prevalence of KBF in Danish layer hens and to identify risk factors in relation to KBF in all major productions systems, including parent stock production. For risk factor identification, production data from the included flocks was used. In total, 4794 birds from 40 flocks were investigated at end-of-lay. All birds were euthanized on farm and underwent inspection and palpation followed by necropsy. All observations were recorded and subsequently analysed using the SAS statistical software package. In flocks from non-caged systems, fracture prevalence in the range 53%-100%, was observed whereas the prevalence in flocks from enriched cages ranged between 50–98%. Furthermore, often multiple fractures (≥4) were observed in individual birds (range 5–81% of the birds with fractures) depending on the flock. The localization of the fractures at the distal end of the keel bone is highly consistent in all flocks (>96%). Macroscopically the fractures varied morphologically from an appearance with an almost total absence of callus, most frequently observed in caged birds, to large callus formations in and around the fracture lines, which was a typical finding in non-caged birds. Despite being housed under cage-free conditions, parent birds had significantly fewer fractures (all flocks were 60 weeks old) per bird, than other birds from cage-free systems. The body weight at end-of-lay had an effect on the risk of having fractures, heavy hens have significantly fewer fractures at end-of-lay. The older the hens were at onset of lay, the lower was the flock prevalence at end-of-lay. Additionally, the daily egg size at onset of lay was of importance for the risk of developing fractures, the production of heavier eggs initially, resulted in higher fracture prevalence at depopulation. The odds ratio of body weight, (+100 g) was 0.97, age at onset of lay (+1 week) was 0.87 and daily egg weight at onset (+1 gram) was 1.03. In conclusion, the study demonstrated a very high prevalence of KBF in hens from all production systems and identified hen size, age at onset of lay and daily egg weight at onset of lay to be major risk factors for development of KBF in the modern laying hen. Further research regarding this is warranted to strengthen the longevity and enhance the welfare of laying hens.

Dynamic spine hyperflexion is related to vertebral compression fractures in postmenopausal women

Background: Previous studies on osteoporotic vertebral fractures are usually based on the neutral posture of the spine; however, the fractures are usually associated with the curvature of the spine. Therefore, we aimed to ascertain the relationship between vertebral compression fractures and thoracolumbar hyperflexion Cobb angles (TLHCobb) and determine the clinical cut-off of the TLHCobb angle.Methods: In this retrospective case-control study, TLHCobbs were collected from 154 postmenopausal women with thoracolumbar fractures (study group) and 310 postmenopausal women with lumbar instability or spondylolisthesis (control group). Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests and unpaired t-tests were used to assess the group characteristics and proportions. Logistic regression was used to examine the association between vertebral compression fractures and TLHCobb.Results: Fracture prevalence was higher in the higher TLHCobb study group than that in the control group [OR = 2.81 (2.15–3.67)] after adjusting for age, BMI, and QCT findings. TLHCobbs at and > 20.05° were associated with an increased fracture prevalence and ORs of 2.79 (1.82–4.27) and 4.83 (3.24–7.20), respectively. TLHCobb and QCT values differed between the study and control groups (p < 0.001 for both). There were no significant differences in body mass index (BMI), disk height, or coronal TLCobb between the two groups.Conclusion: There was an association between the prevalence of vertebral compression fractures and TLHCobbs in postmenopausal women, and a TLHCobb > 20.05° can be an indicator of vertebral fracture.

Euthanasia Through Cervical Dislocation or CO2 Might Affect Keel Bone Fracture Prevalence in 30-Week-Old Laying Hens

Laying hens are susceptible to keel bone fractures due to continuous endogenous calcium resorption for eggshell formation. Although it is assumed that external trauma to the keel bone, e.g., due to collisions, is the main cause for fractures, accumulated forces or asymmetric load on a weakened bone might contribute to the high keel bone fracture prevalence found in commercial laying hens. The objective of this study was to investigate whether forces applied to the keel due to involuntary convulsions and uncontrolled wing flapping during euthanasia have the potential to cause keel bone fractures. Two hundred and seventy Dekalb White laying hens were euthanized at 30 weeks of age using cervical dislocation (n = 60) or CO2 (n = 210). All hens were radiographed immediately before and after euthanasia. Radiographs were compared side by side to detect new fractures. Four out of the 270 hens (1.5%) obtained a fracture during euthanasia. Specifically, 0.95% of hens euthanized with CO2 (2 out of 210) and 3.3% of hens euthanized through cervical dislocation (2 out of 60) obtained a euthanasia-induced fracture. All four hens with a euthanasia-induced fracture had signs of damage to the keel before euthanasia, indicating that pre-existing fractures could affect fracture susceptibility. Based on our results, we cannot rule out that convulsions during euthanasia can cause keel bone fractures in laying hens. In studies investigating keel bone integrity in birds euthanized with CO2 or cervical dislocation, fracture prevalence might be overestimated. Future research is needed to assess whether euthanasia might be more likely to cause keel bone fractures in older birds and to quantify the frequency and strength of convulsions as a potential cause of fractures.