Comparison of proximal femoral nailing (PFN) and proximal femoral locking plate (PFLP) for intertrochanteric femur fracture in elderly.

Objective: To compare the functional outcome of PFN and PFLP for the treatment of unstable four part intertrochanteric femur fracture. Study Design: Randomized Controlled Trial study. Setting: Orthopedics Department, Dow International Medical College, Karachi. Period: February 2019 to January 2020. Material & Methods: 281 patients were included and assigned to each group PFNA and PFLP alternatively. Both groups were compared for functional evaluation by Harris hip score. Result: Duration of surgery, perioperative hemoglobin loss, and duration of fracture healing were significantly lower in PFNA group as compared to PFLP, P<0.05. But Harris Hip score was significantly higher in PFNA group as compare to PFLP P>0.05. Conclusion: PFN has better functional outcome. This makes it a better method of fixation as compared to PFLP in elderly intertrochanteric femur fracture.

Microstructural and mechanical studies of multi-walled CNTs/Mg composite fabricated through FSP

Flourishing trend of aerospace and automobile applications endlessly demand for significantly higher encouraging performance lightweight materials. Potentially Magnesium got limelight for having lightweight physical property and thus has great potential to energize mechanical property by making its composites. Therefore, magnesium composite was fabricated by incorporating multi-walled carbon nanotubes (MWCNTs) as reinforcement into magnesium matrix at volume percentages 10, 20 and 30, respectively through friction stir processing (FSP). Furthermore, the effect of MWCNTs was investigated and validated through various characterizations. The X-ray diffraction (XRD) investigation ensured the existence of parent phases of materials. The mechanical properties of MWCNT/Mg composites such as tensile strength and micro hardness were investigated and found optimum results at 20 vol% MWCNTs. The optimum upsurge in tensile strength attained was twice relative to pure magnesium. Moreover, the wear test was conducted to analyse the wear behaviour. Since the grain growth was obstructed by MWCNTs reinforcement and encouraged to enrich grain refinement, thus the wear resistance was improved. However, the mechanical properties deteriorated beyond 20% due to clustering of reinforcement revealed from fracture study.

Associations between Osteocalcin, Calciotropic Hormones, and Energy Metabolism in a Cohort of Chinese Postmenopausal Women: Peking Vertebral Fracture Study

Objective. The endocrine function of bone in energy metabolism may be mediated by the osteocalcin (OC). We examined the association between OC and energy metabolism among Chinese postmenopausal women. Design and Setting. A cross-sectional cohort study enrolling 1635 participants was conducted using data from the Peking Vertebral Fracture study. Partial correlation analysis was performed to explore the correlation of OC, parathyroid hormone (PTH), or 25-hydroxyvitamin D (25(OH)D) with glycemic and lipid metabolic parameters. A logistic regression model was used to investigate the association of OC, PTH, or 25(OH)D with the prevalence of diabetes and dyslipidemia. Results. Serum levels of OC, PTH, and 25(OH)D were all positively correlated with serum cholesterol levels, whereas only OC was negatively associated with serum glucose level. In the logistic regression model, both OC and PTH were negatively associated with the prevalence of diabetes (odds ratio [OR], 95% confidence interval [95% CI]: 0.967, 0.948–0.986 for OC and 0.986, 0.978–0.994 for PTH). No significant association was found between 25(OH)D and diabetes. Both OC and 25(OH)D, rather than PTH, were associated with abnormalities of high cholesterol levels, such as hypercholesterolemia and high LDL-C levels. Further classifying the population based on the median value of OC and PTH, low OC and low PTH subgroup had the highest OR, 95% CI for diabetes (1.873, 1.287–2.737) and the lowest OR, 95% CI for hypercholesterolemia (0.472, 0.324–0.688) and for high LDL-C (0.538, 0.376–0.771). Conclusion. Among Chinese postmenopausal women, a lower serum level of OC was associated with a higher prevalence of diabetes and lower serum cholesterol levels, and a low PTH concentration could magnify these associations.

ANABOLIC THERAPY AND OPTIMAL TREATMENT SEQUENCES FOR PATIENTS WITH OSTEOPOROSIS AT HIGH RISK FOR FRACTURE

Objective: Provide an update regarding anabolic medications for osteoporosis, which are often considered to be the last resort for patients with osteoporosis, after multiple fractures have already occurred and other medications have already been administered. Methods: Literature review and discussion. Results: Recent pivotal trial data for anabolic agents and randomized trials comparing anabolic and antiresorptive medications suggest that three anabolic agents (teriparatide, abaloparatide, and romosozumab) reduce nonvertebral and vertebral fractures faster and to a greater extent than potent antiresorptive treatments. Furthermore, bone density accrual is maximized when patients are given anabolic agents first, followed by potent antiresorptive therapy. Since total hip bone density during or after osteoporosis treatment has emerged as an excellent surrogate for future fracture risk, attaining a greater hip bone mineral density is a treatment goal for high-risk osteoporosis patients. Conclusion: This review defines the highest-risk patients and summarizes the rationale for the evolving role of anabolic therapy in the management of postmenopausal women at high risk for fracture. Abbreviations: ACTIVE = Abaloparatide Comparator Trial in Vertebral Endpoints; ARCH = Active Controlled Fracture Study in Postmenopausal Women with Osteoporosis at High Risk; BMD = bone mineral density; FRAME = Fracture Study in Postmenopausal Women with Osteoporosis; FRAX = Fracture Risk Assessment Tool; PTH = parathyroid hormone; TBS = trabecular bone score