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Osteoporosis International : a Journal... Jul 2011
Topics: Female; Fractures, Spontaneous; Hip Fractures; Humans; Male; Osteoporotic Fractures
PubMed: 21607806
DOI: 10.1007/s00198-011-1643-9 -
Frontiers in Endocrinology 2023Osteoporosis and fractures increase morbidity and mortality rates after solid organ transplantation (SOT), but few studies have analyzed the risk of osteoporosis and...
BACKGROUND
Osteoporosis and fractures increase morbidity and mortality rates after solid organ transplantation (SOT), but few studies have analyzed the risk of osteoporosis and related fractures after SOT. In this retrospective cohort study, we investigated the risk of osteoporosis and fractures in different SOT recipients.
METHODS
This study was a retrospective cohort study using a nationally representative database in Taiwan. We collected the data of SOT recipients and used the propensity score matching method to obtain a comparison cohort. To reduce bias, we excluded patients who had been diagnosed with osteoporosis or fracture before inclusion. All participants were followed up until the date of diagnosis as having a pathological fracture, death, or the end of 2018, whichever occurred first. The Cox proportional hazards model was used to investigate the risk of osteoporosis and pathological fracture in SOT recipients.
RESULTS
After adjustment for the aforementioned variables, SOT recipients were observed to have a higher risk of osteoporosis (hazard ratio (HR) = 1.46, 95% confidence interval (CI): 1.29-1.65) and fracture (HR: 1.19, 95% CI: 1.01-1.39) than the general individuals. Among the different SOT recipients, the highest risk of fractures was noted in heart or lung transplant recipients, with a HR of 4.62 (95% CI: 2.05-10.44). Among the age groups, patients aged >61 years had the highest HRs for osteoporosis (HR: 11.51; 95% CI, 9.10-14.56) and fracture (HR: 11.75, 95% CI: 8.97-15.40).
CONCLUSION
SOT recipients had a higher risk of osteoporosis and related fractures than the general population, with the highest risks observed in patients receiving heart or lung transplants, older patients, and patients with CCI scores of >3.
Topics: Humans; Retrospective Studies; Fractures, Spontaneous; Cohort Studies; Osteoporosis; Organ Transplantation; Fractures, Bone
PubMed: 37288297
DOI: 10.3389/fendo.2023.1167574 -
Joint Bone Spine Mar 2009Male osteoporosis is challenging to diagnose and to treat. Underestimation of the risk of male osteoporosis, the combined presence of several interwoven causative... (Review)
Review
Male osteoporosis is challenging to diagnose and to treat. Underestimation of the risk of male osteoporosis, the combined presence of several interwoven causative factors in many patients, and uncertainty regarding the absorptiometry cutoffs associated with fractures are major obstacles to the diagnosis of male osteoporosis and to the identification of men at risk for fractures. The lifetime risk of osteoporotic fracture is estimated at 15% among men older than 50 years. One-third of proximal femoral fractures occur in men, and the associated mortality rate is 2- to 3-fold that in women. In men, nearly half the cases of osteoporosis are related to disease, medications, or risk factors. Although the criteria for diagnosing male osteoporosis are not agreed on, the definitions developed by the World Health Organization can be used provided the reference population is composed of young males. An absorptiometry T-score < or = -2.5 is useful for diagnosing osteoporosis but fails to adequately predict the fracture risk. The identification of men at high risk for fractures requires a combined evaluation of bone mineral density data, clinical risk factors, and risk factors for falls.
Topics: Absorptiometry, Photon; Bone Density; Femoral Fractures; Fractures, Spontaneous; Humans; Male; Middle Aged; Osteoporosis; Risk; Risk Factors; Risk Reduction Behavior; Survival Rate
PubMed: 19176288
DOI: 10.1016/j.jbspin.2008.07.014 -
European Review For Medical and... Nov 2022The humerus is the second long bone most affected by pathological fractures. According to Capanna and Campanacci criteria, surgical choice is based on bone metastasis...
OBJECTIVE
The humerus is the second long bone most affected by pathological fractures. According to Capanna and Campanacci criteria, surgical choice is based on bone metastasis location, on the patient's status and on the residual functional capacity. Metadiaphysis is an area of conflict in the choice between megaprosthesis implant and intramedullary nail osteosynthesis. This study compares these two surgical procedures in terms of reacquired functionality and local control of metastasis.
PATIENTS AND METHODS
Thirty-eight patients (17 males and 21 females; mean age: 66 years old) treated in our institution between January 2010 and December 2020 for pathological humeral metadiaphyseal fractures caused by metastasis, were included in this study. We choose the Musculoskeletal Tumor Society rating system (MSTS) and the Quick Disability of Arm-Shoulder-Hand (QuickDASH) scores for the evaluation of the upper limb function after surgery.
RESULTS
Eighteen (47%) pathological fractures were treated by resection and megaprosthesis implantation, twenty (53%) were treated by medullary nail osteosynthesis. A reduction in pain and greater mechanical stability in the immediate post-operative period was found in all patients. Twenty-two patients died (58%) and sixteen survived (42%). Long-term functional recovery of patients undergoing osteosynthesis is greater than megaprothesis group.
CONCLUSIONS
Both medullary nail osteosynthesis and resection and megaprosthesis implantation guarantee excellent recovery at 72 months after surgery, improvement in quality of life and pain relief. Patients treated with osteosynthesis showed a great short-term functional recovery since the joint portion of the limb is not involved, whereas patients treated with megaprosthesis showed better local oncologic control. It is therefore possible to define the type of treatment not only on the localization of the fracture (diaphysis or epiphysis) but above all on the conditions and characteristics of the patient.
Topics: Adult; Female; Male; Humans; Aged; Shoulder; Fractures, Spontaneous; Quality of Life; Humerus; Epiphyses; Fractures, Bone; Bone Neoplasms; Upper Extremity; Pain
PubMed: 36448865
DOI: 10.26355/eurrev_202211_30288 -
Injury Mar 2024Proximal femur simple bone cysts (SBCs) are rare in children, but with a risk of pathological fractures and the associated poor outcomes. This study aimed to evaluate...
INTRODUCTION
Proximal femur simple bone cysts (SBCs) are rare in children, but with a risk of pathological fractures and the associated poor outcomes. This study aimed to evaluate the functional and radiographic outcomes of children with proximal femur SBCs.
PATIENTS AND METHODS
38 children with proximal femur SBCs treated surgically at our department, West China hospital, were enrolled in the study. Patients were divided into two groups according to whether pathological fractures presented before treatment. The non-fracture group received treatment of open curettage, cavity electrocauterization, bone grafting, and fixation (proximal femoral plate, intramedullary nail or Kirschner wire). The pathological fracture group received the same procedures of curettage, electrocauterization, grafting, and fixation. Autogenous iliac bone grafting was done in all cases, and the artificial bone was used as a supplementary based on the size of the cavity. Postoperatively, all patients underwent hip spica or similar orthosis immobilization for six weeks and received the same rehabilitation program after the removal of hip spica. Patients were evaluated by two independent observers, including the functional results based on the Ratliff's criteria, avascular necrosis, healing rate based on the Neer scoring system, coxa vara, and premature physeal arrest. We described the good outcome in Ratliff's criteria as "Satisfactory results", and fair and poor outcomes as "Unsatisfactory results." Grade 1 and grade 2 Neer results were termed as failures in treatment, and grades 3 and 4 were considered successes and healing.
RESULTS
38 patients with 38 hips (18 on the left side and 20 on the right side) were evaluated, including 9 females and 29 males, with a mean age of 9.0±2.6 years old (range, 5 to 14 years). There was no significant difference between these two groups in the baseline data of gender, age, side, grafting, staging, and fixation methods. The rate of unsatisfactory functional results in the pathological fractures group was 56.3% (9/16), significantly higher than that in patients without fracture (22.7%, 5/22. p= 0.047). There was also a significant difference in avascular necrosis of the femoral head between the pathological fractures group (7/16) and the group without fracture (2/22, p=0.021). Thirty cases presented with healing, including 13 in the fractures group and 17 in the non-fracture group (p=1.000), and eight cases were graded as failures (2 cases of grade 1 and 6 cases of grade 2). There were also no significant differences between these two groups in premature physeal arrest (2 in fracture group and 1 in non-fracture group, P=0.562), and Coxa vara (3 in the fracture group and 0 in non-fracture group, P=0.066).
CONCLUSIONS
Pathological fracture significantly increases the risk of unsatisfactory functional results and avascular necrosis of the femoral head in patients with femoral neck SBCs. Prophylactic treatment and fixation of SBCs in weight bearing proximal femur region is better to manage without complications than managing with pathological fractures.
Topics: Male; Child; Female; Humans; Fractures, Spontaneous; Femur Head Necrosis; Coxa Vara; Fractures, Bone; Femur; Bone Wires; Bone Cysts; Treatment Outcome; Fracture Fixation, Internal; Retrospective Studies; Femoral Neck Fractures
PubMed: 37798196
DOI: 10.1016/j.injury.2023.111068 -
Pathological fracture of the mandible caused by radicular cyst: A case report and literature review.Medicine Dec 2018Pathological fracture of the mandible caused by radicular cyst is rare. This report describes a unique case of a mandibular pathological fracture caused by radicular... (Review)
Review
RATIONALE
Pathological fracture of the mandible caused by radicular cyst is rare. This report describes a unique case of a mandibular pathological fracture caused by radicular cyst, arising from an endodontically treated molar.
PATIENT CONCERN
A 49-year-old female was referred to our department with persistent pain in left mandibular angle, accompanying with restricted mouth opening and malocclusion.
DIAGNOSE
An orthopantomograph (OPG) showed a unilocular lesion with a relatively well-defined border, and the lesion was associated with a fracture in the inferior border of the mandible.
INTERVENTION
This patient was treated through curettage of the cyst combined with open reduction and internal fixation of the fracture.
OUTCOMES
At the 1-year follow-up visit, the patient did not have any complaints, and the radiographs indicated the consolidation of the fracture without recurrence of cyst.
LESSONS
This case report highlights the routine follow-up of endodontically treated teeth in order to check for apical healing and detect the cystic change at early stages.
Topics: Female; Fractures, Spontaneous; Humans; Mandibular Fractures; Middle Aged; Molar; Radicular Cyst; Tooth Diseases
PubMed: 30558010
DOI: 10.1097/MD.0000000000013529 -
BMC Musculoskeletal Disorders May 2022Following curettage of giant cell tumor of bone (GCTB), it is common to fill the cavity with polymethylmethacrylate (PMMA) bone cement, bone allograft, or artificial...
BACKGROUND
Following curettage of giant cell tumor of bone (GCTB), it is common to fill the cavity with polymethylmethacrylate (PMMA) bone cement, bone allograft, or artificial bone to maintain bone strength; however, there is a 2-14% risk of postoperative fractures. We conducted this retrospective study to clarify the risk factors for fractures after curettage for GCTB of the extremities.
METHODS
This study included 284 patients with GCTBs of the extremities who underwent curettage at our institutions between 1980 and 2018 after excluding patients whose cavities were not filled with anything or who had additional plate fixation. The tumor cavity was filled with PMMA bone cement alone (n = 124), PMMA bone cement and bone allograft (n = 81), bone allograft alone (n = 63), or hydroxyapatite graft alone (n = 16).
RESULTS
Fractures after curettage occurred in 10 (3.5%) patients, and the median time from the curettage to fracture was 3.5 months (interquartile range [IQR], 1.8-8.3 months). The median postoperative follow-up period was 86.5 months (IQR, 50.3-118.8 months). On univariate analysis, patients who had GCTB of the proximal or distal femur (1-year fracture-free survival, 92.5%; 95% confidence interval [CI]: 85.8-96.2) presented a higher risk for postoperative fracture than those who had GCTB at another site (100%; p = 0.0005). Patients with a pathological fracture at presentation (1-year fracture-free survival, 88.2%; 95% CI: 63.2-97.0) presented a higher risk for postoperative fracture than those without a pathological fracture at presentation (97.8%; 95% CI: 95.1-99.0; p = 0.048). Patients who received bone grafting (1-year fracture-free survival, 99.4%; 95% CI: 95.7-99.9) had a lower risk of postoperative fracture than those who did not receive bone grafting (94.4%; 95% CI: 88.7-97.3; p = 0.003).
CONCLUSIONS
For GCTBs of the femur, especially those with pathological fracture at presentation, bone grafting after curettage is recommended to reduce the risk of postoperative fracture. Additional plate fixation should be considered when curettage and cement filling without bone grafting are performed in patients with GCTB of the femur. This should be specially performed for those patients with a pathological fracture at presentation.
Topics: Bone Cements; Bone Neoplasms; Curettage; Extremities; Fractures, Spontaneous; Giant Cell Tumor of Bone; Humans; Neoplasm Recurrence, Local; Polymethyl Methacrylate; Retrospective Studies; Risk Factors
PubMed: 35590280
DOI: 10.1186/s12891-022-05447-x -
Clinical Orthopaedics and Related... Jul 2011Osteoporosis remains underrecognized and undertreated in both men and women, but men who sustain fragility fractures experience greater morbidity and mortality. While... (Review)
Review
BACKGROUND
Osteoporosis remains underrecognized and undertreated in both men and women, but men who sustain fragility fractures experience greater morbidity and mortality. While men exhibit advanced comorbidity at the time of hip fracture presentation, there are distinct sex- and gender-specific factors related to the pathophysiology and treatment of osteoporosis that further influence morbidity and mortality.
QUESTIONS/PURPOSES
With a selective review of the literature, we evaluated sex- and gender-based differences contributing to increased morbidity and mortality in men with osteoporosis. WHERE ARE WE NOW?: Sex-specific differences in bone biology and morphology may affect the pathophysiology of osteoporosis, choice of pharmacotherapy, and surgical implant selection. Additionally, estrogen metabolism may play a key role in both fracture prevention and healing. Gender-based differences in recommendations for screening and prevention between men and women may influence the severity at which osteoporosis is recognized. Primary, secondary, and tertiary prevention efforts in men lag behind those of women. This may be due to a lack of consensus regarding screening guidelines for osteoporosis in men but may be attributed to lack of awareness in the physician and patient about osteoporosis and its potentially debilitating consequences. WHERE DO WE NEED TO GO?: These disparities are a call to action for healthcare providers to raise awareness for early prevention and treatment of this potentially debilitating disease, particularly in men. HOW DO WE GET THERE?: Continued prospective research on the differences between men and women diagnosed with osteoporosis is needed, as well as sex-specific stratification of data in all studies on osteoporosis.
Topics: Bone Density; Bone and Bones; Comorbidity; Fracture Healing; Fractures, Spontaneous; Hip Fractures; Humans; Male; Mass Screening; Men; Osteoporosis; Risk Factors; Sex Characteristics; Sex Factors; Survival Rate; Treatment Outcome; Women
PubMed: 21400003
DOI: 10.1007/s11999-011-1849-3 -
Pediatric Blood & Cancer Apr 2017Pathologic fractures occur in 5-10% of pediatric osteosarcoma (OS) cases and have historically been considered a contraindication to limb salvage. Our purpose was to...
PURPOSE
Pathologic fractures occur in 5-10% of pediatric osteosarcoma (OS) cases and have historically been considered a contraindication to limb salvage. Our purpose was to describe the radiographic features of pathologic fracture and examine its impact on local recurrence rates, functional outcomes, and overall survival.
METHODS
We retrospectively analyzed patients at our institution from 1990 to 2015 with pathologic fracture at diagnosis or during neoadjuvant chemotherapy. We selected a control group of 50 OS patients of similar age and gender without pathologic fracture from 1990 to 2015. Functional outcomes were scored using Musculoskeletal Tumor Society criteria. Chi-square test was used for comparative analysis of groups.
RESULTS
Thirty-six patients with 37 pathologic fractures form the study cohort. Of patients who received surgery, 18 of 34 patients with fracture underwent amputation compared to 8 of 48 patients in the nonfracture group (P = 0.007). Indications for amputation in fracture patients were tumor size (n = 7), neurovascular involvement (n = 6), and tumor progression during neoadjuvant chemotherapy (n = 5). Only one patient (2.9%) in the fracture group who underwent limb salvage suffered local recurrence. Of patients who received neoadjuvant chemotherapy, 25 of 34 fracture patients showed poor histological response compared to 24 of 47 nonfracture patients (P = 0.044). There was no statistically significant difference in overall survival (P = 0.96). Functional outcomes were significantly lower in fracture patients (median = 17.5) than nonfracture patients (median = 24) (P = 0.023).
CONCLUSIONS
Radiographic features of pathologic fractures were highly variable in this population. Limb salvage surgery can be performed without increased risk of local recurrence. Patients with pathologic fracture suffer worse functional outcomes but no decrease in overall survival.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Child; Child, Preschool; Female; Follow-Up Studies; Fractures, Bone; Fractures, Spontaneous; Humans; Limb Salvage; Male; Neoplasm Staging; Osteosarcoma; Prognosis; Retrospective Studies; Salvage Therapy; Survival Rate; Young Adult
PubMed: 27897381
DOI: 10.1002/pbc.26290 -
Yakugaku Zasshi : Journal of the... 2019Fragility fractures associated with osteoporosis can have a major impact on a person's "activities of daily living" (ADL) and life span. Therefore, osteoporosis and its... (Review)
Review
Fragility fractures associated with osteoporosis can have a major impact on a person's "activities of daily living" (ADL) and life span. Therefore, osteoporosis and its complications must be addressed by early screening and prompt intervention. A Fracture Risk Assessment Tool (FRAX) has been developed by the WHO. FRAX allows the calculation/estimation of absolute fracture risk over a 10-year period. The FRAX can be completed using a free application form, accessible online. The relationship between FRAX and the young adult mean (YAM) was investigated in order to calculate the cut-off value of FRAX for each age group. FRAX can be used by both physicians and other healthcare professionals to pre-screen patients for more detailed subsequent work-ups. Using FRAX in clinical practice has proven to be simple, inexpensive and useful.
Topics: Aged; Early Diagnosis; Female; Fractures, Spontaneous; Humans; Male; Middle Aged; Osteoporosis; Risk Assessment; Sensitivity and Specificity
PubMed: 30606925
DOI: 10.1248/yakushi.18-00154-4