The risk of fracture secondary to low-impact trauma is greater in obese children, suggesting obese children are at risk of skeletal fragility. However, despite this finding, there is a lack of agreement about the impact of excessive adiposity on skeletal development. The combination of poor diet, sedentary lifestyle, greater force generated on impact through falls, and greater propensity to falls may in part explain the increased risk of fracture in obese children. To date, evidence suggests that in early childhood years, obesity confers a structural advantage to the developing skeleton. However, in time, this relationship attenuates and then reverses, such that there is a critical period during skeletal development when obesity has a detrimental effect on skeletal structure and strength. Fat mass may be important to the developing cortical and trabecular bone compartments, provided that gains in fat mass are not excessive. However, when fat accumulation reaches excessive levels, unfavorable metabolic changes may impede skeletal development. Evidence from studies examining bone microstructure suggests skeletal adaption to excessive load fails, and bone strength is relatively diminished in relation to body size in obese children. Mechanisms that may explain these changes include changes in the hormonal environment, particularly in relation to alterations in adipokines and fat distribution. Given the concomitant rise in the prevalence of childhood obesity and fractures, as well as adult osteoporosis, further work is required to understand the relationship between obesity and skeletal development.
Accidental Falls ; Adipokines ; Adiposity ; Adult ; Body Size ; Bone Density ; Child* ; Critical Period (Psychology) ; Diet ; Humans ; Obesity ; Osteoporosis ; Pediatric Obesity ; Prevalence ; Sedentary Lifestyle ; Skeleton

STUDY DESIGN: Retrospective analysis using magnetic resonance imaging (MRI). PURPOSE: To identify MRI features that could discriminate benign from malignant vertebral fractures. OVERVIEW OF LITERATURE: Discrimination between benign and malignant vertebral fractures remains challenging, particularly in patients with osteoporosis and cancer. Presently, the most sensitive means of detecting and assessing fracture etiology is MRI. However, published reports have focused on only one or a few discriminators. METHODS: Totally, 106 patients were assessed by MRI within six weeks of sustaining 114 thoracic and/or lumbar vertebral fractures (benign, n=65; malignant, n=49). The fractures were pathologically confirmed if malignant or clinically diagnosed if benign and were followed up for a minimum of six months. Seventeen features were analyzed in all fractures' magnetic resonance images. Single parameters were analyzed using the chi-square test; a logit model was established using multivariate logistic regression analysis. RESULTS: The chi-square test revealed 11 malignant and 4 benign parameters. Multivariate logistic regression analysis selected (i) posterior wall diffuse protrusion (odds ratio [OR], 48; 95% confidence interval [CI], 4.2–548; p=0.002), (ii) pedicle involvement (OR, 21; 95% CI, 2.0–229; p=0.01), (iii) posterior involvement (OR, 21; 95% CI, 1.5–21; p=0.02), and (iv) band pattern (OR, 0.047; 95% CI, 0.0005–4.7; p=0.19). The logit model was expressed as P=1/[1+exp (x)], x=−3.88×(i)−3.05×(ii)−3.02×(iii)+3.05×(iv)+5.00, where P is the probability of malignancy. The total predictive value was 97.3%. The only exception was multiple myeloma with features of a benign fracture. CONCLUSIONS: Although each MRI feature had a different meaning with a variable differentiation power, combining them led to an accurate diagnosis. This study identified the most relevant MRI features that would be helpful in discriminating benign from malignant vertebral fractures.
Diagnosis ; Discrimination (Psychology)* ; Humans ; Logistic Models ; Magnetic Resonance Imaging* ; Multiple Myeloma ; Neoplasm Metastasis ; Osteoporosis ; Retrospective Studies ; Spinal Fractures ; Spine

Given the rapid growth of the population of cancer survivors, increased attention has been paid to their health problems. Although gastric cancer is one of the most common cancers, empirical evidence of survivorship care is limited. The objectives of this study were to describe the health care status of gastric cancer survivors and to report the experience of using the shared-care model during a one-year experience at the cancer survivorship clinic in Seoul National University Hospital. This is a descriptive, single-center study of 250 long-term gastric cancer survivors who were referred to the survivorship clinic. The status of their health behaviors, comorbid conditions, secondary cancer screenings, and survivorship care status were investigated through questionnaires and examining the medical records. Among the survivors, 7.2% were current smokers, 8.8% were at-risk drinkers, and 32.4% were physically inactive. Among the patients who did not know their bone density status, the majority were in the osteopenic (37.1%) or osteoporotic range (24.1%). Screening among the eligible population within the recommended time intervals were 76.3% for colorectal cancer, but only 13.6% for lung cancer. All of the survivors were provided with counseling and medical management at the survivorship clinic, as appropriate. In conclusion, Long-term gastric cancer survivors have various unmet needs. Shared-care through survivorship clinics can be an effective solution for providing comprehensive care to cancer survivors.
Adult ; Aged ; Aged, 80 and over ; Bone Diseases, Metabolic/diagnosis ; Counseling ; Delivery of Health Care ; Health Behavior ; Health Status ; Humans ; Influenza, Human/prevention & control ; Middle Aged ; Osteoporosis/diagnosis ; Pneumonia/prevention & control ; Republic of Korea ; Stomach Neoplasms/*prevention & control ; Surveys and Questionnaires ; Survivors/*psychology ; Vaccination

"Locomotive syndrome" is used to designate the condition of individuals with musculoskeletal disease who are highly likely to require nursing care. This article reviews screening, prevalence, causal and related factors, and the relationship between locomotive syndrome and falls and fractures in older adults with this syndrome. A few self-administered questionnaire tools are available to assess individuals for locomotive syndrome. Additionally, screening methods, including a physical functioning assessment, are appropriate for detailed discrimination of locomotive syndrome. The prevalence of locomotive syndrome is significantly higher in women than in men, and tends to increase markedly from 70 years of age. More severe locomotive syndrome is related to knee pain, osteoporosis, sarcopenia, and lumbar disease. The incidence of falling in locomotive syndrome is higher than the incidence for the older population in general. Locomotive training including squats and a unipedal standing exercise has been recommending to prevent locomotive syndrome. This training improves muscle strength and balance function for older people who have a risk for locomotive syndrome.
Accidental Falls* ; Adult ; Aged* ; Asian Continental Ancestry Group* ; Discrimination (Psychology) ; Female ; Humans ; Incidence ; Knee ; Male ; Mass Screening ; Muscle Strength ; Musculoskeletal Diseases ; Nursing Care ; Osteoporosis ; Prevalence ; Sarcopenia

OBJECTIVETo investigate the impact of self-efficacy theory health education in patients of diabetic osteoporosis.

METHODSWe used SPSS 19.0 software to generate random numbers and 260 diabetic osteoporosis patients were randomly divided into an observation group and a control group. There was 130 patients in observation group, 130 in control group. The self-efficacy theory health education was carried out in observation group, and routine health education in control group. SF-36 questionnaire was used to assess the quality of life. Osteoporosis self-efficacy scale (OSES) was used to assess self-efficacy. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. Blood glucose was detected by glucose oxidase method. Glycosylated hemoglobin was detected by high efficiency liquid chromatography to estimate the index change before intervention and after one year's follow up.

RESULTSThe number of patients that had completed follow-up was 104 in control group and 107 in observation group. The self-efficacy scores, movement efficiency scores and calcium intake efficiency scores were all higher in intervention group ((82.25 ± 13.54) , (79.26 ± 15.37) , (84.39 ± 17.09) points) than which in the control group ((71.14 ± 14.19), (63.89 ± 19.87), (75.24 ± 10.70) points) after one year's follow up, there were significant differences in two groups (t values were 6.04, 7.95, 5.77, all P values<0.05). The scores of quality of life in the dimension of general health, vitality, social function, role emotional and mental health were all higher in intervention group ((75.29 ± 14.90) , (68.61 ± 17.38) , (75.74 ± 18.50) , (71.22 ± 17.93) , (73.69 ± 14.40 ) points) than in the control group ( (44.25 ± 11.01) , (47.39 ± 18.90) , (63.54 ± 15.95), (49.04 ± 19.36), (55.15 ± 19.74) points), there were significant differences in two groups (t values were 8.45, 8.83, 6.92, 8.79, 8.05, all P values<0.05) . Fasting blood-glucose 2 hour postprandial blood glucose and glycosylated hemoglobin were all lower in intervention group ((7.29 ± 1.81) mmol/L, (8.21 ± 2.37) mmol/L, (6.59 ± 0.92) %) than in the control group ((8.53 ± 1.66) mmol/L, (9.41 ± 3.30) mmol/L, (7.66 ± 1.50) %) , there were significant differences in two groups (t values were 5.33, 4.67, 5.49, all P values<0.05). There were 1 (0.93%) fracture case in observation group and 7 (6.73%) cases in control group during one year's follow up, there are significant difference in two groups (χ(2) = 4.86, P = 0.028).

CONCLUSIONSThe self-efficacy theory health education may improve the quality of life and decreased fracture risk of diabetic osteoporosis patients.

Aged ; Blood Glucose ; Bone Density ; Diabetes Complications ; psychology ; Humans ; Osteoporosis ; psychology ; Quality of Life ; Self Efficacy ; Surveys and Questionnaires

Distal radius fractures are one of the most common types of fractures in the elderly. It is well documented that increased risk of a distal radius fracture in older patients is associated with decreased bone mineral density. Also, low bone mineral density increased severity of fracture and instability of fracture after reduction. Fracture displacement in the elderly does not necessarily result in functional impairment. Therefore, conservative treatment has been a mainstay treatment even in unstable fracture in the elderly. However, there is an increasing trend toward operative treatment recently, because functional demand increased in the elderly due to active life style and volar locking plate fixation enables the elderly early return to daily activity even in osteoporotic distal radius fracture.
Aged ; Bone Density ; Displacement (Psychology) ; Humans ; Life Style ; Osteoporosis ; Radius ; Radius Fractures

Osteoporosis is charactered by body bone mass reduce and bone microstructure degration. With the improvement of biology-psychology-social medical model, it have found a certain relation between osteoporosis and psychology. Psychology have an influence on BMD, contents of bone transition index, bone cytokine consistency and fragility fracture rate. Meantime, life of quality of the patients have been affected by osteoporosis, leading to their psychology situation have an according changes.
Bone Density ; Fractures, Bone ; epidemiology ; Humans ; Mental Disorders ; complications ; metabolism ; Osteoporosis ; etiology ; psychology ; Quality of Life

As a result of aging population, the incidence of pelvic insufficiency fracture has been increasing. Pain-related immobility caused by pelvic insufficiency fractures may result in a serious dependency and high mortality with preexisting comorbidities. We present two cases of pelvic insufficiency fracture in elderly patients which had good clinical outcome by parathyroid hormone 1-34(teriparatide) treatment as well as a literature review.
Aged ; Aging ; Comorbidity ; Dependency (Psychology) ; Fractures, Stress ; Humans ; Incidence ; Osteoporosis ; Parathyroid Hormone ; Pelvis

BACKGROUND/AIMS: Increased osteoclast activity is a pivotal finding in osteoporosis. This increase is mediated via the mevalonate-to-cholesterol pathway, which is involved in producing the intermediates required for osteoclast activity. D-003, a mixture of high molecular weight sugarcane wax acids, has been shown to inhibit cholesterol synthesis prior to mevalonate production, resulting in a reduction of bone loss and resorption in ovariectomized rats. Moreover, previous studies have demonstrated that short-term D-003 treatment reduces urinary excretion of deoxypyridinoline/creatinine in postmenopausal women. METHODS: We performed a double-blinded, placebo-controlled study to investigate the effects of D-003 (10 mg/day) treatment for 3 years on bone mineral density (BMD) in 83 postmenopausal women with low BMD. RESULTS: Over 3 years, D-003 treatment increased lumbar spine BMD (5.1%, p < 0.01) and improved osteoporosis-related quality of life scores as compared with placebo-treated controls. D-003 was also well tolerated; the frequency of adverse events in the bone, joints, or muscle with D-003 treatment (p < 0.05) was lower than in the placebo group. CONCLUSIONS: D-003 treatment (10 mg/day) for 3 years increased lumbar spine BMD and produced clinical improvements in postmenopausal women with low BMD. Further studies, however, will be required to confirm these results.
Absorptiometry, Photon ; Adult ; Aged ; Analysis of Variance ; Bone Density/*drug effects ; Bone Density Conservation Agents/*administration & dosage/adverse effects ; Cuba ; Double-Blind Method ; Fatty Acids/*administration & dosage/adverse effects ; Female ; Femur Neck/*drug effects/radiography ; Humans ; Lipids/blood ; Lumbar Vertebrae/*drug effects/radiography ; Middle Aged ; Osteoporosis, Postmenopausal/blood/*drug therapy/psychology/radiography ; Quality of Life ; Questionnaires ; Time Factors ; Treatment Outcome

INTRODUCTIONWe evaluated if there was significant stress in caregivers of elderly patients with osteoporotic hip fractures and determine any contributory factors.

MATERIALS AND METHODSA prospective cohort study was performed from June 2005 to June 2006 in a single tertiary hospital. Patients admitted during this period and their primary caregivers were interviewed on admission and at 6 months. Information on patient's demographics, comorbidities, functional and mental status, placement post-discharge and financial strain were noted. Caregiver stress was measured using the caregiver strain index (CSI). Relationships between key variables were analysed to derive possible correlations.

RESULTSThe study comprised caregivers of 76 patients with a mean age of 77 years (range, 50 to 95; SD, 11). Within 1 week of admission, 45 of the 76 caregivers (59.2%) were significantly stressed based on the CSI while at 6 months, 30 of the caregivers (50%) were significantly stressed. The mean CSI within 1 week of admission and at 6 months post-admission was 7.18 and 6.25 respectively (P = 0.042). The most significant contributory factor to stress was financial strain (P = 0.01) attributable to medical bills, rehabilitation costs and transport expenses.

CONCLUSIONThere is a significant amount of stress that is experienced by caregivers of elderly patients with hip fractures which commences from admission of the patient and it remains high at 6-months post-fracture. Financial strain has been found to be the only significant cause on both univariate and multivariate analysis. Adequate resources should be available to caregivers of patients with osteoporotic hip fractures.

Aged ; Aged, 80 and over ; Caregivers ; economics ; psychology ; Cost of Illness ; Female ; Hip Fractures ; etiology ; rehabilitation ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Prospective Studies ; Stress, Psychological