Angiotensin Receptor Blocker is Associated with A Lower Fracture Risk: An Updated Systematic Review and Meta-Analysis

Background The angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are prevalently used in the treatment of hypertension. Hypertension often presents with osteoporosis. However, over the past decade, it has been unclear whether long-term use of ACEI/ARB reduces fracture risk. This meta-analysis aims to investigate the potential clinical effects of ACEI/ARB on osteoporosis fracture (OF). Methods This meta-analysis was identified through PubMed, EMBASE, Cochrane Library, and Web of Science. Related studies about ACEI/ARB with the risk of fracture were published from inception to September, 2021. Results Nine qualified prospective designed studies, involving 3,649,785 subjects, were included in this analysis. Overall, the RR of ACEI compared with the non-users were 0.98 (95% CI: 0.88, 1.10; P < 0.001) for composite fractures and 0.96 (95% CI: 0.87, 1.05; P = 0.048) for hip fractures; the RR of ARB compared to the non-users were 0.82 (95% CI: 0.73, 0.91; P < 0.001) for composite fractures and 0.85 (95% CI: 0.74, 0.97; P = 0.028) for hip fractures. Furthermore, in the subgroup analysis, male may benefit from ARB (RR = 0.65, 95% CI 0.49, 0.89, P = 0.028), and the European may also benefit from ARB (RR = 0.86, 95% CI 0.80, 0.93, P = 0.015). Conclusions ACEI usage will not decrease the risk of osteoporosis fracture. On the contrary, ARB usage can decrease the risk of total fracture and hip fracture, especially for the male and European. Compared with ACEI, for patients at higher risk of fracture in cardiovascular diseases such as hypertension, the protective effect of ARB should be considered.

MicroRNA-21: An Emerging Player in Bone Diseases

MicroRNAs (MiRNAs) are small endogenous non-coding RNAs that bind to the 3′-untranslated region of target genes and promote their degradation or inhibit translation, thereby regulating gene expression. MiRNAs are ubiquitous in biology and are involved in many biological processes, playing an important role in a variety of physiological and pathological processes. MiRNA-21 (miR-21) is one of them. In recent years, miR-21 has received a lot of attention from researchers as an emerging player in orthopedic diseases. MiR-21 is closely associated with the occurrence, development, treatment, and prevention of orthopedic diseases through a variety of mechanisms. This review summarizes its effects on osteoblasts, osteoclasts and their relationship with osteoporosis, fracture, osteoarthritis (OA), osteonecrosis, providing a new way of thinking for the diagnosis, treatment and prevention of these bone diseases.

Intra Focal K-Wiring for Distal End Radius (Kapandji Technique): Surgical Technique

Many years distal end radius fractures (DRF) are the most encountered type of fracture. In standard form, extra-articular distal end radius fractures were fixed after manual reduction and then pinned extra-articular by drilling distal cortex and passing fracture site to fix proximal fragment (Figure 1). But after 2 to 3 weeks depending upon osteoporosis fracture collapse(cancellous bone heal by collapse) and flexibility of the K wire distal fragment moves back until the K wire abut the inferior edge of the proximal fragment and does not avoid secondary displacement (Figure 2) [1].

Hormonal Replacement Therapy in Surgically Induced Menopause: A Prospective Cross Section Study from a Tertiary Care Institution from A Sub-himalayan State

Background: Early surgical menopause increases risk of cardiovascular disease, osteoporosis, fracture, cognitive impairment and sexual dysfunction than women with late menopause. Estrogen therapy (ET) remains the most effective therapy for vasomotor symptoms related to surgically induced menopause. Meterials and Methods: It was a prospective cross-section study. Result: Amongst 255 symptomatic women, 163 (63.92%) women had severe vasomotor symptoms and 54 (33.12% of 163 women) of them had very incapacitating symptoms with marked reduction in their quality of life. 59 (23.13%) women had moderate symptoms with mild disturbances in their sleep while 33 (12.94%) women had only mild symptoms. Conclusion: It is agreed that women who undergo bilateral oophorectomy before the onset of natural menopause should be considered for estrogen therapy for the management of vasomotor symptoms until the average age of natural menopause.