OBJECTIVE: To study the relevant factors affecting the occurrence of adjacent vertebral fractures in women with osteoporotic vertebral compression fractures after conservative treatments. METHODS: A total of 98 elderly female patients diagnosed with osteoporotic vertebral compression fractures and treated from January 2020 to January 2022 were retrospectively analyzed. The average age was (73.05±7.38) years old. Based on the follow-up results after two years of injury, the patients were divided into the adjacent vertebral fracture group (24 cases) and the non-adjacent vertebral fracture group (74 cases). The following factors were recorded for each patient:age, initial bone density, follow-up bone density, bone density changes, initial VAS score, degree of fracture compression, presence of old fractures, use of zoledronic acid, use of parathyroid hormone analogs, occurrence of complications, and further compression of the affected vertebrae. Univariate and multivariate Logistic regression analyses were performed to analyze the associated risk factors. RESULTS: Univariate analysis revealed that in elderly women undergoing conservative treatment for osteoporotic vertebral compression fractures, the degree of fracture compression, follow-up bone density, changes in bone density, use of zoledronic acid, and use of parathyroid hormone analogs were statistically significant(P<0.05). Multivariate Logistic regression analysis demonstrated that the degree of fracture compression 95%CI(0.040, 0.571), P=0.005, OR=0.151, changes in bone density 95%CI(1.264, 1 360.732), P=0.036, OR=41.477, and use of parathyroid hormone analogs 95%CI(1.638, 31.625), P=0.009, OR=7.196 were risk factors affecting the occurrence of adjacent vertebral fractures following vertebral compression fractures in elderly women with osteoporosis. CONCLUSION The degree of fracture compression, changes in bone density, and the use of parathyroid hormone analogs are factors influencing the occurrence of adjacent vertebral fractures following vertebral compression fractures in elderly women with osteoporosis. For patients with mild compression fractures (gradeⅠ), conservative treatment can be achieved by intensifying anti-osteoporosis therapy and using parathyroid hormone analogs.
Humans ; Female ; Aged ; Fractures, Compression/etiology* ; Spinal Fractures/therapy* ; Osteoporotic Fractures/therapy* ; Retrospective Studies ; Risk Factors ; Conservative Treatment ; Aged, 80 and over ; Bone Density

Postmenopausal osteoporosis is a kind of degenerative disease, also described as "invisible killer." Estrogen is generally considered as the key hormone for women to maintain bone mineral content during their lives. Iron accumulation refers to a state of human serum ferritin that is higher than the normal value but less than 1000 μg/L. It has been found that iron accumulation and osteoporosis could occur simultaneously with the decrease in estrogen level after menopause. In recent years, many studies indicated that iron accumulation plays a vital role in postmenopausal osteoporosis, and a significant correlation has been found between iron accumulation and fragility fractures. In this review, we summarize and analyze the relevant literature including randomized controlled trials, systematic reviews, and meta-analyses between January 1996 and July 2022. We investigate the mechanism of the effect of iron accumulation on bone metabolism and discuss the relationship of iron accumulation, osteoporosis, and postmenopausal fragility fractures, as well as the main clinical treatment strategies. We conclude that it is necessary to pay attention to the phenomenon of iron accumulation in postmenopausal women with osteoporosis and explore the in-depth mechanism of abnormal bone metabolism caused by iron accumulation, in order to facilitate the discovery of effective therapeutic targets for postmenopausal osteoporosis.
Humans ; Female ; Osteoporotic Fractures ; Osteoporosis, Postmenopausal/drug therapy* ; Postmenopause ; Osteoporosis ; Bone Density ; Estrogens ; Iron/therapeutic use*

INTRODUCTION: A significant treatment gap has been observed in patients with osteoporosis. Our previous audit found a 31.5% rate of anti-osteoporosis medication initiation after fragility fractures at one year. We piloted the use of telecarers to monitor osteoporosis treatment and compliance. METHODS: From January 2017 to January 2018, all hip fracture patients at Changi General Hospital, Singapore, were automatically enrolled into the Health Management Unit valued care hip fracture programme. Telecarer calls were scheduled at discharge, 3, 6 and 12 months. We assessed the acceptability, completion and treatment rates of patients enrolled in this programme. RESULTS: A total of 537 patients with a hip fracture were enrolled in the telecarer programme over one year. Their average age was 79.8 ± 8.23 years, and 63.1% of them were female. A total of 341 patients completed 12 months of follow-up, of which 251 (73.6%) patients were on treatment at 12 months. The most common cause of lack of initiation of secondary osteoporosis treatment was patient or family rejection (34.4%), followed by physician failure to prescribe (24.4%) and renal impairment (24.4%). 16.7% of patients were deemed to have advanced dementia with a life-limiting illness and were, thus, deemed unsuitable for treatment. CONCLUSION Telecarers may be a useful adjunct in the monitoring of osteoporosis treatment after hip fractures in an elderly population. The main limitations are patient or family rejection and physician inertia. Further studies should focus on a combination of interventions for both patients and physicians to increase awareness of secondary fracture prevention.
Humans ; Female ; Aged ; Aged, 80 and over ; Male ; Osteoporotic Fractures/drug therapy* ; Bone Density Conservation Agents/therapeutic use* ; Osteoporosis/drug therapy* ; Hip Fractures/etiology* ; Secondary Prevention

Humans ; Fractures, Compression/surgery* ; Spinal Fractures/surgery* ; Multiple Myeloma/drug therapy* ; Vertebroplasty ; Osteoporotic Fractures/therapy* ; Treatment Outcome ; Bone Cements

OBJECTIVE: To evaluate the analgesic effect and application advantage of acupuncture combined with local anesthesia of lidocaine in percutaneous vertebroplasty (PVP) for the patients with osteoporotic vertebral compression fracture (OVCF). METHODS: A total of 60 patients with OVCF and receiving PVP at single vertebra under local anesthesia were selected and randomized into an acupuncture plus medication group and a simple medication group, 30 cases in each one. In the simple medication group, the local laying infiltration anesthesia with 1% lidocaine 30 mL was used. In the acupuncture plus medication group, firstly, filiform needles were used to stimulate Hegu (LI 4), Neiguan (PC 6), Jinmen (BL 63) and Yintang (GV 29) with reducing technique, and then the epidermal infiltration anesthesia was followed with 1% lidocaine 4 mL. The needles were retained till the end of operation. Successively, before operation (T RESULTS: In the acupuncture plus medication group, MAP and HR were lower than those in the simple medication group at T CONCLUSION Acupuncture combined with medication reduces the dose and adverse reactions of anesthetics, alleviates pain degree of patients, shortens the duration of operation and improves patients' subjective satisfaction in PVP for OVCF.
Analgesics ; Fractures, Compression/therapy* ; Humans ; Osteoporotic Fractures ; Spinal Fractures/therapy* ; Spine ; Treatment Outcome

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

PURPOSE: To evaluate the diagnostic performance of diffusion-weighted steady-state free precession (DW-SSFP) in comparison to diffusion-weighted echo-planar imaging (DW-EPI) for differentiating the neoplastic and benign osteoporotic vertebral compression fractures. MATERIALS AND METHODS: The subjects were 40 patients with recent vertebral compression fractures but no history of vertebroplasty, spine operation, or chemotherapy. They had received 3-Tesla (T) spine magnetic resonance imaging (MRI), including both DW-SSFP and DW-EPI sequences. The 40 patients included 20 with neoplastic vertebral fracture and 20 with benign osteoporotic vertebral fracture. In each fracture lesion, we obtained the signal intensity normalized by the signal intensity of normal bone marrow (SI norm) on DW-SSFP and the apparent diffusion coefficient (ADC) on DW-EPI. The correlation between the SI norm and the ADC in each lesion was analyzed using linear regression. The optimal cut-off values for the diagnosis of neoplastic fracture were determined in each sequence using Youden's J statistics and receiver operating characteristic curve analyses. RESULTS: In the neoplastic fracture, the median SI norm on DW-SSFP was higher and the median ADC on DW-EPI was lower than the benign osteoporotic fracture (5.24 vs. 1.30, P = 0.032, and 0.86 vs. 1.48, P = 0.041, respectively). Inverse linear correlations were evident between SI norm and ADC in both neoplastic and benign osteoporotic fractures (r = −0.45 and −0.61, respectively). The optimal cut-off values for diagnosis of neoplastic fracture were SI norm of 3.0 in DW-SSFP with the sensitivity and specificity of 90.4% (95% confidence interval [CI]: 81.0–99.0) and 95.3% (95% CI: 90.0–100.0), respectively, and ADC of 1.3 in DW-EPI with the sensitivity and specificity of 90.5% (95% CI: 80.0–100.0) and 70.4% (95% CI: 60.0–80.0), respectively. CONCLUSION: In 3-T MRI, DW-SSFP has comparable sensitivity and specificity to DW-EPI in differentiating the neoplastic vertebral fracture from the benign osteoporotic vertebral fracture.
Bone Marrow ; Diagnosis ; Diagnosis, Differential* ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Drug Therapy ; Echo-Planar Imaging* ; Fractures, Compression* ; Fractures, Spontaneous ; Humans ; Linear Models ; Magnetic Resonance Imaging ; Osteoporotic Fractures ; ROC Curve ; Sensitivity and Specificity ; Spine ; Vertebroplasty

OBJECTIVETo evaluate the efficacy of conservative treatment with teriparatide for promoting bone fracture healing in patients with osteoporotic vertebral fracture.

METHODSTwelve postmenopausal patients (aged 73±4.8 years) with osteoporotic spinal fracture confirmed by MRI or CT scanning received conservative treatment with teriparatidesc injection supplemented with calcium and analgesics for 6 months. At the beginning and at the end of the therapy, VAS score, Oswestry Disability Index (ODI), bone mass densitometry, and X-ray of the thoracic and lumbar spine, and serum P1NP and beta-CTX levels were measured. Six of the patients received a second MRI scan after the therapy to evaluate the bone healing.

RESULTSAll the 12 patients completed the treatment, during which no new fractures or adverse events occurred. At the end of the first month of treatment, analgesic was withdrawn for all the patients. The average VAS score decreased from 8±2 to 1±2 at 1 month during the therapy, and ODI was reduced from (76±12)% to (20±5)% at 1 month and further to (5±4)% at 6 month. After the 6-month therapy, the height of the fractured vertebrae (presented as the anterior to posterior wall height ratio) was insignificantly decreased from (75±20)% to (61±20)%, the BMD was increased by (20±5)%, P1NP increased significantly from 20.9±11.4 ng/mL to 80.0±41.2 ng/mL, and beta-CTX increased from 0.30±0.17 ng/mL to 0.51±0.3 ng/mL. The 6 patients re-examined with MRI demonstrated complete bone healing after the therapy.

CONCLUSIONTeriparatide is effective for conservative treatment of osteoporotic spinal fracture and can promote bone fracture healing, improve the quality of life, and prevents vertebral collapse, and can be therefore an alternative treatment to PVP or BV.

Aged ; Analgesics ; therapeutic use ; Bone Density ; Calcium ; therapeutic use ; Fractures, Compression ; drug therapy ; Humans ; Lumbar Vertebrae ; pathology ; Magnetic Resonance Imaging ; Osteoporotic Fractures ; drug therapy ; Pain Measurement ; Quality of Life ; Spinal Fractures ; drug therapy ; Teriparatide ; therapeutic use ; Treatment Outcome

BACKGROUNDAntihypertensive drugs have been linked to new-onset osteoporotic fracture (NOF), and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effect of different antihypertensive drugs on the development of NOF in the elderly has not been well studied during long-term follow-up.

METHODSIn this study, we investigated the association between different classic antihypertensives and the development of NOF in the elderly. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance in Central Taiwan, China including case patients with NOF aged 65-80 years from January 2002 to December 2012 and non-NOF controls. Prescriptions for antihypertensives before the index date were retrieved from a prescription database. We estimated the hazard ratios (HR s) of NOF associated with antihypertensive use. Non-NOF controls served as the reference group.

RESULTSA total of 128 patients with NOF were identified from among 1144 patients with hypertension during the study period. The risk of NOF after adjusting age, sex, comorbidities, and concurrent medications was higher among the users of angiotensin-converting enzyme (ACE) inhibitors (HR, 1.64; 95% confidence interval [CI], 1.01-2.66) than among nonusers. Patients who took calcium channel blockers (CCBs) (HR, 0.70; 95% CI, 0.49-0.99) were at a lower risk of developing NOF than nonusers. Loop diuretics, thiazide diuretics, angiotensin receptor blocker, beta-blocker, and alpha-blocker were not associated with the risk of NOF.

CONCLUSIONSElderly with hypertension who take CCBs are at a lower risk of NOF and that the use of ACE inhibitors was associated with a significantly increased risk of developing NOF during the 11-year follow-up.

Aged ; Aged, 80 and over ; Angiotensin-Converting Enzyme Inhibitors ; adverse effects ; therapeutic use ; Antihypertensive Agents ; adverse effects ; therapeutic use ; Calcium Channel Blockers ; adverse effects ; therapeutic use ; Cohort Studies ; Female ; Humans ; Hypertension ; drug therapy ; Longitudinal Studies ; Male ; Osteoporotic Fractures ; chemically induced ; epidemiology ; Retrospective Studies ; Risk Factors ; Taiwan ; epidemiology

BACKGROUNDRoughly focused extracorporeal shock waves therapy (ESWT) is characterized by a wide focal area, a large therapy zone, easy positioning, and less pain during treatment. The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin (OPG) and bone morphogenetic protein-2 (BMP-2) in osteoporotic fractures in rats.

METHODSSeventy-two female Sprague-Dawley (SD) rats, 3 months old, were divided into sham-operated group (n = 6) and an ovariectomized (OVX) group (n = 66). Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation. The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm2, 60 doses/min, and 2000 pact quantities. The contralateral right tibia was left untreated and served as a control. Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry, real-time polymerase chain reaction (PCR), and Western blotting analysis.

RESULTSBone mineral density (BMD) at the proximal tibia, femur, and L5 spine was significantly reduced after ovariectomy. BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group. Meanwhile, bilateral oophorectomy resulted in a lower trabecular bone volume fraction (BV/TV) in the proximal tibia of the sham-OVX animals. Three months after bilateral oophorectomy, BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs (P < 0.001). These data showed that the SD rats became a suitable model of osteoporosis, 3 months after they were OVX. Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group. Compared with the contralateral controls, decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT, followed by a later increase at 7 days, was indicated by real-time PCR and Western blotting analysis. The OPG messenger RNA (mRNA) expression levels peaked at 6 weeks after the shock wave treatment, paired with a much earlier (at 4 weeks) increase of BMP-2, and declined close to normal at 8 weeks.

CONCLUSIONSRoughly focused ESWT may promote the expression of OPG and BMP-2 in the osteoporotic fracture area in rats. BMP-2 and OPG may act synergistically and may lead to a significant enhancement of bone formation and remodeling.

Animals ; Bone Density ; radiation effects ; Bone Morphogenetic Protein 2 ; metabolism ; Female ; Femur ; metabolism ; radiation effects ; Fracture Healing ; radiation effects ; High-Energy Shock Waves ; Osteoporotic Fractures ; metabolism ; therapy ; Osteoprotegerin ; metabolism ; Ovariectomy ; Rats ; Rats, Sprague-Dawley ; Tibia ; metabolism ; radiation effects