OBJECTIVETo appraise the value of clinical treatment of percutaneous reduction and fixation of osteoporotic fractures for the proximal humerus in a geriatric population.

METHODSPostoperation complication, mortality in hospital and within the first three months postoperation, operation time, blood transfusion requirement, the functional outcome of the shoulder had been analysed and observed in 37 cases for open and closed fixation.

RESULTSClosed reduction provided the benefit of obtaining and holding adequate reduction without the soft-tissue dissection of open reduction and internal fixation. The general complication and mortality in the first three months postoperation in the open reduction and internal fixation cases were more severe than the percutaneous cases.

CONCLUSIONSOpen operation increases the risk of the geriatric population with osteoporotic proximal humerus fracture; percutaneous reduction and fixation may be preferable.

Aged ; Aged, 80 and over ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Osteoporosis ; complications ; Postoperative Complications ; prevention & control ; Shoulder Fractures ; etiology ; surgery ; Treatment Outcome

OBJECTIVETo study the morbidity factors of bilateral intertrochanteric fractures by analyzing medical records, so as to provide evidences for preventing the multiple intertrochanteric fractures.

METHODSFrom Janurary 2000 to June 2009, 68 patients with bilateral intertrochanteric fractures were studied, including 31 males and 37 females, ranging in age from 42 to 95 years with an average age of 75 years. There were type A1 in 24 hips, type A2 in 96 hips, and type B3 in 16 hips. One hundred and twenty-eight hips had received surgical treatment, 8 hips were treated with conservative method. On the first injury, 67 patients discharged after treatment, 1 patients discharged after treatment in other department. On the second injury, 58 patients discharged after treatment, 2 patients died of complications, 8 patients dischagred after treatment in other department. The risk factors including age, cause of injury, fractures type, complications, osteoporosis and treatment were analyzed.

RESULTSThe average age of two fractures were (73.6 +/- 9.25) and (76.7 +/- 6.74) years; the major injury cause was fall; the A2-type fractures went up to 80.88% on the secondary injury;and the proportion of complications was high, mainly geriatric cognitive disorders, hemiplegic paralysis, and dysopia. Bone mineral density measurement of 16 cases showed marked osteoporosis.

CONCLUSIONOsteoporosis and fall injury contribute mostly to the multiple intertrochanteric fractures. Complication was the dominating risk factor. Treatment of osteoporosis, intensive care, postoperative rehabilitation and effective initial surgery are the key to prevent the secondary intertrochanteric fractures in old people.

Accidental Falls ; Adult ; Aged ; Aged, 80 and over ; Female ; Hip Fractures ; etiology ; prevention & control ; Humans ; Male ; Middle Aged ; Morbidity ; Osteoporosis ; complications ; Risk Factors

We investigated which of the three FRAX fracture risk assessment tool models is most applicable to Korean women. For 306 postmenopausal women (mean age, 77 yr) with a hip fracture, fracture probabilities were calculated using FRAX models from Japan, Turkey and China. Data on bone mineral density (BMD) at the femoral neck were available for 103 patients. Significant differences existed among the models, independent of the inclusion of BMD in the calculation of fracture probabilities. The probabilities of both major osteoporotic fractures and hip fractures were significantly higher in the Japanese model than in the Turkish or Chinese models. In all of the models, the probabilities of a major osteoporotic fracture, but not of a hip fracture, decreased significantly if calculated without BMD values. By applying the Japanese model, the ten-year probabilities for major osteoporotic and hip fractures increased significantly with age. Our results suggest that the Japanese FRAX model might be the most appropriate for Korean women.
Aged ; Aged, 80 and over ; Bone Density/physiology ; Female ; Fractures, Bone/*epidemiology/ethnology/prevention & control ; Hip Fractures/epidemiology/ethnology/prevention & control ; Humans ; Middle Aged ; *Models, Statistical ; Osteoporosis, Postmenopausal/complications ; Republic of Korea/epidemiology ; Risk Assessment

OBJECTIVETo evaluate the therapeutic effect of percutaneous vertebroplasty (PVP) guided by X-ray fluoroscopy in treating osteoporotic spinal compression fractures, hemangioma of vertebra and metastatic carcinoma of vertebra.

METHODSOne hundred and ninety patients with 275 diseased vertebra underwent PVP under the guidance of C-arm fluoroscopy (male 80, female 110, ranging in age from 53 to 91 years, with an average of 66 years). Bone marrow biopsy needle was inserted percutaneously via transpedicular way into the diseased vertebra. Polymethylmethacrylate (PMMA) was then injected into the diseased vertebra. Visual analogue scale (VAS), mobility and analgesic usage were evaluated pre-operation and 3 months after PVP.

RESULTSPVP was successful in 190 cases (275 vertebrae). VAS was tested by t test at 3 months after PVP (P < 0.05). Simultaneously, scale of patient's mobility and scale of analgesic usage was tested by rank sum test at 3 months after PVP (P < 0.05).

CONCLUSIONAs the mimimally invasive operation, PVP can alleviate pain in early time, avoid kinds of complications by shortening the patient's time in bed and have the characteristic of simply operative procedure and low expenses. It is an effective mini-invasive technique for osteoporotic spinal compression fractures, hemangioma of vertebra and metastatic carcinoma of vertebra.

Aged ; Aged, 80 and over ; Female ; Fluoroscopy ; Fractures, Compression ; surgery ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Polymethyl Methacrylate ; Postoperative Complications ; prevention & control ; Spinal Fractures ; surgery ; Spinal Neoplasms ; surgery ; Vertebroplasty ; adverse effects ; methods

OBJECTIVETo observe the effects of Danshen root compound (DSC) on blood lipid and bone biomechanics in mice with hyperlipemia-induced osteoporosis.

METHODSForty Kunming mice were randomized into 5 equal groups, and were given intragastric administration with distilled water (control), lipid emulsion (LE) at the daily dose of 5 ml/kg, LE plus simvastatin, LE plus DSC at 5.0 g/kg (DSC-L group), and LE plus DSC at 10.0 g/kg (DSC-H group), respectively. Serum TC, TG, and HDL-c levels and left femur hydroxyproline, calcium and phosphate contents were measured in the rats, with the right femur taken for bone biomechanical test.

RESULTSCompared with those in the control group, serum TC, LDL-c and AI of the mice increased and HDL-c, Hyp and bone calcium decreased significantly (P<0.01) with lowered bone biomechanical properties. Compared with those of the LE model group, AI decreased and HDL-c increased significantly in DSC-L and DSC-H groups (P<0.01), and the bone biomechanics in DSC-H group was improved.

CONCLUSIONLong-term intragastric administration of lipid emulsion causes lipid metabolic disorder and induces osteoporosis due to hyperlipemia in mice. DSC can significantly increase HDL-c and partially prevent the occurrence of osteoporosis in mice.

Animals ; Biomechanical Phenomena ; Bone and Bones ; drug effects ; metabolism ; physiopathology ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Hyperlipidemias ; complications ; drug therapy ; Lipids ; blood ; Male ; Mice ; Osteoporosis ; blood ; etiology ; prevention & control ; Phenanthrolines ; pharmacology ; therapeutic use ; Phytotherapy ; Salvia miltiorrhiza ; chemistry

Osteoporosis is a major, growing healthcare issue. This is especially of concern in an ageing population like that of Singapore. Osteoporotic patients are at risk of fractures, which can result in increased morbidity and mortality. The use of antiresorptive therapy with bisphosphonates or denosumab has been proven to reduce fracture risk. However, the use of these medications has rarely been associated with the development of osteonecrosis of the jaw, a potentially debilitating condition affecting one or both jaws. Appropriate understanding of the patient's antiresorptive therapy regime, as well as early institution of preventive dental measures, can play an important role in preventing medication-related osteonecrosis of the jaw (MRONJ). Regular monitoring and prompt referral to specialist care is warranted for patients with established MRONJ.
Aged ; Bone Density Conservation Agents ; adverse effects ; therapeutic use ; Denosumab ; adverse effects ; therapeutic use ; Diphosphonates ; adverse effects ; therapeutic use ; Humans ; Jaw Diseases ; chemically induced ; prevention & control ; Osteonecrosis ; chemically induced ; prevention & control ; Osteoporosis ; complications ; drug therapy ; Osteoporotic Fractures ; complications ; drug therapy ; Risk Factors ; Singapore ; Treatment Outcome

OBJECTIVETo study the treatment of spinal fractures in ankylosing spondylitis.

METHODSNineteen cases of spinal fractures complicating ankylosing spondylitis admitted in our hospital were studied retrospectively.

RESULTSAll of 19 cases were up to the diagnosis standards of ankylosing spondylitis. Eleven patients had cervical fracture and 8 had thoracolumbar fracture. Of the patients with cervical fracture, fractures occurred at C(5 - 7) in 9 patients. Of the patients with thoracolumbar injury, stress fractures were seen in 7 patients and all of seven fractures occurred at T(10)-L(2). Sixteen of the 19 patients sustained fractures through three columns of the spine. Nine patients had spinal cord injures; eight of the 9 cases had cervical fracture. All of the 19 patients were treated operatively. Four different surgical procedures were used in patients with cervical fracture; decompression, fusion and stabilization with instrumentation by anterior approach were performed in 9 patients. Of the patients with thoracolumbar fractures, four different operations were performed; fusion by both anterior and posterior approach plus a long posterior instrument were used in 5 cases. Eighteen patients had an average follow-up period of 46.6 months. Nine patients with preoperative neurological deficits improved in 8 and was stabilized in 1. Radiographic evidence of fusion was observed in all of the 18 patients. Two patients suffered neurological deterioration during surgery. One patient died from cerebrovascular infarction. Two patients had pneumonia after the operative procedure.

CONCLUSIONSSpinal fractures in ankylosing spondylitis are associated with a high rate of neurological injury. Shearing fracture usually occurs at the lower cervical spine (C(5 - 7)) and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine. Surgical intervention may be indicated in this injury. Fracture union and neurological improvement can be achieved in most patients treated by operation. We suggest that, fusion and stabilization with instrumentation by anterior approach is indicated in most cervical shearing fracture, and a combined fusion by both sides plus a long posterior instrument is probably beneficial in patients with thoracolumbar stress fracture. Complications is not rare after surgery and appropriate preventive measures are necessary for these patients.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; complications ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications ; Postoperative Care ; Postoperative Complications ; prevention & control ; Radiography ; Retrospective Studies ; Spinal Fractures ; etiology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome

Vitamin D deficiency is common and may contribute to osteopenia, osteoporosis and falls risk in the elderly. Screening for vitamin D deficiency is important in high-risk patients, especially for patients who suffered minimal trauma fractures. Vitamin D deficiency should be treated according to the severity of the deficiency. In high-risk adults, follow-up serum 25-hydroxyvitamin D concentration should be measured 3-4 months after initiating maintenance therapy to confirm that the target level has been achieved. All patients should maintain a calcium intake of at least 1,000 mg for women aged ≤ 50 years and men ≤ 70 years, and 1,300 mg for women > 50 years and men > 70 years.
Aged ; Bone Density ; Bone Diseases, Metabolic ; prevention & control ; Calcium, Dietary ; therapeutic use ; Cholecalciferol ; administration & dosage ; Female ; Hip Fractures ; complications ; epidemiology ; Humans ; Male ; Middle Aged ; Osteoporosis ; prevention & control ; Practice Guidelines as Topic ; Prevalence ; Primary Health Care ; methods ; Risk Factors ; Vitamin D ; analogs & derivatives ; blood ; Vitamin D Deficiency ; diagnosis ; epidemiology

PURPOSE: Our aim was to determine the effects of infliximab on bone mineral metabolism in rheumatoid arthritis (RA) patients and analyze the relationship between inflammatory markers of acute phase thought to play a major role in bone remodeling. MATERIALS AND METHODS: 36 patients with established RA were investigated. All patients underwent physical examination and blood and urinary analysis at baseline, 2 weeks, 14 weeks, 6 months and 12 months after the initiation of treatment. The serum levels of: tumor necrosis factor alpha (TNF-alpha), tumor necrosis factor alpha receptor 1 (TNFR1), TNFR2, interleukin 6 (IL-6), IL-17, IL-23 and markers of bone remodeling such as osteocalcin (BGP), deoxypyridynoline (Dpd), and N-telopeptide of type I collagen (NTx) were measured by ELISA. RESULTS: The results showed significant decrease of all the above cytokines levels in RA patients in comparison with those after 2 weeks of treatment. After 6 months, the markers of bone formation and resorption decreased compared to baseline values. We found positive correlation between the levels of NTx and the levels of IL-6, IL-17 and TNFR1, and between the levels of Dpd and IL-6 and Dpd and TNFR2, whereas negative correlation between BGP and IL-23. After 12 months the positive association was found at the BGP level and IL-6 as well as Dpd and the level of IL-6. We also observed a positive relation between Dpd and TNF-alpha and negative between BGP and TNFR1. CONCLUSION: We suggest that infliximab treatment may limit the risk of osteoporosis in RA patients.
Adult ; Aged ; Antibodies, Monoclonal/*therapeutic use ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/blood/complications/*drug therapy ; Biological Markers/metabolism ; Bone Remodeling/*drug effects ; Bone Resorption ; Cytokines/*metabolism ; Female ; *Gene Expression Regulation ; Humans ; Interleukin-17/metabolism ; Interleukin-6/metabolism ; Middle Aged ; Osteoporosis/complications/prevention & control ; Receptors, Tumor Necrosis Factor, Type I/metabolism