fragility fractures
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2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Khalid Aligail ◽  
Joel A. Dave ◽  
Ian Louis Ross

Abstract Background Tumor-induced osteomalacia is a rare, acquired paraneoplastic syndrome, including hypophosphatemia, high serum alkaline phosphatase, reduced active vitamin D, suboptimal bone mineral density, bone pain, fragility fractures, and muscle weakness. Case presentation We report a case of 74–year–old male of mixed ancestry with hypophosphatemia resistant to treatment despite optimal compliance, associated with profound reduction of bone mineral density and multiple nontraumatic fractures, including bilateral rib fractures, lower-thoracic (T11, T12) vertebrae, and two fractures involving the surgical and anatomical neck of the right humerus. We discuss an approach to identifying the underlying cause of hypophosphatemia associated with fragility fractures, and options for management of this rare condition. Conclusion Although rare, tumor-induced osteomalacia can be diagnosed if a logical stepwise approach is implemented. Surgery could be curative if the tumor is properly located and is resectable.


Author(s):  
Zefeng Zhao ◽  
Meng Nian ◽  
Hong Lv ◽  
Jiangxin Yue ◽  
Haifa Qiao ◽  
...  

Osteoporosis is a common metabolic bone disease, and treatment is required for the pre-vention of low bone mass, deterioration of microstructural bone tissue, and fragility fractures. Osteoporosis therapy includes calcium, vitamin D, and drugs with antiresorptive or anabolic action on the bone. Therapy for osteoporosis does not include taking non-steroidal anti-inflammatory drugs (NSAID), but pain associated with osteoporotic fractures can be treated by taking non-steroidal anti-inflammatory drugs (NSAID). Recently, polysaccharides extracted from medicinal herbs and edible substances (PsMHES) have attracted attention on account of their safety and promising anti-osteoporosis effects, whereas a systematic review about their potential in anti-osteoporosis is vacant to date. Herein, we reviewed the recent progress of PsMHES with anti-osteoporosis activities, looking to introduce the advances in the various pharmacological mechanisms and targets involved in the anti-osteoporosis effects, extraction methods, main mechanism involved in Wnt/β-catenin pathways and pathways and RANKL (Receptor Activator for NFκB ligand or TNFSF25) pathways, and Structure-Activity elationships (SAR) analysis of PsMHES. Typical herbs like Achyranthes bidentate and Morinda officinalis used for the treatment of osteoporosis are introduced; their traditional uses in traditional Chinese medicine (TCM) are discussed in this paper as well. This review will help to the recognition of the value of PsMHES in anti-osteoporosis and provide guidance for the research and development of new anti-osteoporosis agents in clinic.


2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Lucía Méndez-Sánchez ◽  
Mónica Caló ◽  
Muhammad Kassim Javaid ◽  
Grushenka Aguilar ◽  
Andrea Olascoaga-Gómez de León ◽  
...  

2021 ◽  
Vol 21 (2) ◽  
pp. 83-88
Author(s):  
Saif Abdulkareem Raoof Al-Shaibani ◽  

Background:Rheumatoid arthritis is a chronic systemic inflammatory disorder that is associated with progressive disability and systemic complications. One of these complications is osteoporosis. Patients with severe osteoporosis have one or more fragility fractures in addition to T-score -2.5 or lower. Osteoporosis is more prevalent in rheumatoid arthritis patients who have higher disease activity. Objective: To show the effect of irregular treatment in patients with rheumatoid arthritis on the severity of osteoporosis. Patients and Methods: A cross-sectional study enrolled a total of 40 female patients who had rheumatoid arthritis. The data collected from patients include disease duration, disease activity and patients’ compliance to their drugs. They were sent to dual-energy x- ray absorptiometry scan and results were recorded. Results: The mean age was 45.95 ± 10.0 years; 45% of them had rheumatoid arthritis for less than five years; 55% had a low level of disease activity; and 65% of them had received treatment irregularly. Osteoporosis was diagnosed in 60% of them and 41.7% of them had severe osteoporosis. The highest prevalence of osteoporosis among patients with rheumatoid arthritis was seen significantly among older patients, patients with longer duration of rheumatoid arthritis, those with higher activity of rheumatoid arthritis, and those with irregular treatment. More than half of those who received treatment irregularly had severe osteoporosis with a significant association between treatment regularity of rheumatoid arthritis and severity of osteoporosis. Conclusion: Severe osteoporosis occurs in rheumatoid arthritis patients with a history of irregular treatment which occurs either due to patient incompliance or delay in diagnosis. Osteoporosis is more prevalent in rheumatoid arthritis patients with longer disease duration, older age, higher disease activity and those who received treatment irregularly. Keywords: Rheumatoid arthritis, Osteoporosis, Irregular Treatment


Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6380
Author(s):  
Roberta Zanotti ◽  
Massimiliano Bonifacio ◽  
Cecilia Isolan ◽  
Ilaria Tanasi ◽  
Lara Crosera ◽  
...  

Systemic mastocytosis (SM) and other adult clonal mast cell disorders (CMD) are often underestimated, and their epidemiology data are scarce. We aimed at evaluating the impact of the activity of the Interdisciplinary Group for Study of Mastocytosis (GISM) of Verona on the prevalence and incidence of CMD. We examined the data of 502 adult patients diagnosed with CMD and residing in the Veneto Region, consecutively referred to GISM between 2006 and 2020. SM was diagnosed in 431 cases, while 71 patients had cutaneous mastocytosis or other CMD. Indolent SM represented the most frequent SM variant (91.0%), mainly with the characteristics of bone marrow mastocytosis (54.8%). The prevalence of SM in the adult population of the Veneto region and of the Verona province was 10.2 and 17.2/100,000 inhabitants, respectively. The mean incidence of new SM cases in Verona was 1.09/100,000 inhabitants/year. Hymenoptera venom allergy was the main reason (50%) leading to the CMD diagnosis. Osteoporosis, often complicated by fragility fractures, was present in 35% of cases, even in young patients, especially males. Our data show a higher prevalence and incidence of SM than previously reported, confirming that reference centers with multidisciplinary approach are essential for the recognition and early diagnosis of CMD.


Author(s):  
E. Verkinderen ◽  
G. Moorkens ◽  
E. De Smet ◽  
I. Huyghe ◽  
V. Mertens

Pitfalls in the diagnosis of fragility fractures in geriatric patients Osteoporosis is a frequent and often undiagnosed condition in the geriatric population. The presence of this pathology has, however, important implications, the main one being the increased occurrence of fragility fractures. It is essential to be vigilant for these fractures when older patients present with hip or back pain in the emergency room. If the classic radiography is negative but the clinical picture is suspect for a fracture, further investigations with imaging are necessary.


Author(s):  
Bowen Wang ◽  
Zehai Wang ◽  
Atharva A Poundarik ◽  
Mohammed J Zaki ◽  
Richard S Bockman ◽  
...  

Abstract Context Fracture risk is underestimated in people with type 2 diabetes (T2D). Objective To investigate the longitudinal relationship of glycated hemoglobin (HbA1c) and common medications on fracture risk in people with T2D. Design Retrospective cohort study was conducted using de-identified claims and EHR data obtained from the OptumLabs ® Data Warehouse during 01/01/2007 to 09/30/2015. For each individual, the study was conducted within a two-year HbA1c observation period and a two-year fracture follow-up period. Setting Population-based study. Participants 157,439 individuals with T2D [age ≥ 55 years with mean HbA1c value ≥ 6%] were selected from 4,018,250 US Medicare Advantage/Commercial enrollee with T2D diagnosis. Main Outcome Measures. All fractures and fragility fractures were measured. Results With covariates adjusted, poor glycemic control in T2D individuals was associated with an 29% increase of all fracture risk, compared to T2D individuals with adequate glycemic control (HR: 1.29, 95% CI 1.22-1.36). Treatment with metformin (HR: 0.88, 95% CI 0.85-0.92) and DPP4 inhibitors (HR: 0.93, 95% CI 0.88-0.98) were associated with a reduced all fracture risk, while insulin (HR: 1.26, 95% CI 1.21-1.32), thiazolidinediones (HR: 1.23, 95% CI 1.18-1.29), meglitinides (HR: 1.12, 95% CI 1.00-1.26) were associated with an increased all fracture risk (All p-value < 0.05). Bisphosphonates were associated similarly with increased fracture risk in T2D group and in non-diabetic group. Conclusions Longitudinal two-year HbA1c is independently associated with an elevated all fracture risk in T2D individuals during a two-year follow-up period. Metformin and DPP4 inhibitors can be used for management of T2D fracture risk.


2021 ◽  
Author(s):  
◽  
Nikola Florance

<p>Osteoporosis remains a major health issue worldwide. The impact of the condition and the fractures that can occur, can have significant debilitating impact and also incur substantial financial costs to healthcare systems. The burden of osteoporosis and the rate of osteoporotic fractures in New Zealand is comparable to other countries such as Australia, the United States and Europe. There is global literature evidence dating back as far as 1960, indicating that a fracture sustained after a simple trip or fall can be an indicator of osteoporosis. There is a need to ensure that fracture patients with a potential osteoporosis diagnosis, receive follow up care for assessment to treat any underlying bone health issue to prevent future fragility fractures, particularly, hip fractures. Due to limited formal literature sources describing the associated New Zealand context, the aim of this research work was to explore current practice for osteoporosis assessment following a fragility wrist fracture in the general practitioner (GP) primary health care setting in Wellington, New Zealand.  A quantitative cross-sectional descriptive survey of Wellington GPs was undertaken for this purpose. The reporting of study results were guided by the recommendations detailed within the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement on reporting observational studies (Vandenbroucke et al., 2014). 35 out of 297 GPs from 60 practices in the Wellington region responded to the survey. When describing the local context in Wellington, New Zealand, study results showed that almost three quarters of Wellington GP survey respondents follow up patients who have sustained a potential fragility wrist fracture. The discharge summary was also shown to be a vital part of the communication process between the tertiary and primary health care sectors, acting as a prompt to the GP for further investigation. The single biggest barrier inhibiting processes to enable timely osteoporosis treatment as perceived by GP survey respondents, was lack of public funding, in particular to support availability of diagnostic Dual Energy X-ray Absorptiometry (DEXA) scanning.  Other barriers were identified by the GP survey respondents, such as anti-osteoporosis medication side effects, patient compliance to treatment plans and a lack of time within the scheduled consultation to screen patients for osteoporosis. The main educational resources that a large percentage of GP survey respondents independently accessed on a regular basis, were those that were readily available. These included GP guidelines published by “Osteoporosis New Zealand” and possibly other, and online resources such as “Health Pathways” (a best-practice, condition-specific guideline and information resource for primary health care practitioners - https://3d.healthpathways.org.nz). The results also highlighted that most GP survey respondents preferred to take the lead role in the care for patients needing to undergo osteoporosis investigation and treatment. In addition, the GP survey respondents demonstrated a high level of knowledge regarding osteoporosis risk factors.  In summary, this study has identified features of practice with regards to osteoporosis assessment following a fragility wrist fracture in the Wellington region. In addition, this study has also enabled identification of specific areas that could be better supported and resourced to assist GP’s in the prevention of secondary fragility fractures. These include highly visible public health campaigns to raise public awareness of osteoporosis and education to GP’s regarding the available screening tools. A significant finding was also that the GP respondents in this study indicated they considered that an important part of their role was responsibility for osteoporosis prevention and treatment. The study results also highlight that despite funding issues, GP survey respondents view osteoporosis prevention and treatment as best placed in the care of the primary health care sector.  This is the first New Zealand study that has identified and described the local context around current practice for fragility wrist fracture care within the Wellington GP community, establishing important reference points which can be used to support further development and research.</p>


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