Asia-Pacific consensus on long-term and sequential therapy for osteoporosis.

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition. The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and antiresorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to antiresorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for individuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions: This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture.

OBJECTIVE: The study was undertaken to evaluate the efficacy and safety of a posterolateral reversed L-shaped knee joint incision for treating the posterolateral tibial plateau fracture. METHODS: Knee specimens from eight fresh, frozen adult corpses were dissected bilaterally using a posterolateral reversed L-shaped approach. During the dissection, the exposure range was observed, and important parameters of anatomical structure were measured, including the parameters of common peroneal nerve (CPN) to ameliorate the incision and the distances between bifurcation of main vessels and the tibial articular surface to clear risk awareness. RESULTS: The posterolateral aspect of the tibial plateau from the proximal tibiofibular joint to the tibial insertion of the posterior cruciate ligament was exposed completely. There was no additional damage to other vital structures and no evidence of fibular osteotomy or posterolateral corner complex injury. The mean length of the exposed CPN was 56.48 mm. The CPN sloped at a mean angle of 14.7° toward the axis of the fibula. It surrounded the neck of the fibula an average of 42.18 mm from the joint line. The mean distance between the opening of the interosseous membrane and the joint line was 48.78 mm. The divergence of the fibular artery from the posterior tibial artery was on average 76.46 mm from articular surface. CONCLUSIONS: This study confirmed that posterolateral reversed L-shaped approach could meet the requirements of anatomical reduction and buttress fixation for posterolateral tibial plateau fracture. Exposure of the CPN can be minimized or even avoided by modifying the skin incision. Care is needed to dissect distally and deep through the approach as vital vascular bifurcations are concentrated in this region. Placement of a posterior buttressing plate carries a high vascular risk when the plate is implanted beneath these vessels.

Analysis of Combined Indicators for Risk of Osteoporotic Hip Fracture in Elderly Women.

OBJECTIVE: To compare the accuracy of combined independent risk factors in assessing the risk of hip fractures in elderly women. METHODS: Ninety elderly females who sustained hip fractures (including femoral neck fractures and intertrochanteric fractures) and 110 female outpatients without a hip fracture were included in our cross-sectional study from 24 November 2017 to 20 May 2019. The age of subjects in the present study was ≥65 years, with the mean age of 78.73 ± 7.77 and 78.09 ± 5.03 years for women with and without elderly hip fractures, respectively. Bone mineral density (BMD), Beta-carboxy terminal telopeptide (ß-CTX), N-terminal/mid region (N-MID), and 25(OH)D levels were analyzed. A novel evaluation model was established to evaluate combined indicators in assessing hip fractures in elderly women. RESULTS: Compared with the control group, taller height (155.68 ± 6.40 vs 150.97 ± 6.23, P < 0.01), higher levels of ß-CTX (525.91 ± 307.38 vs 330.94 ± 289.71, P < 0.01), and lower levels of total hip BMD (0.662 ± 0.117 vs 0.699 ± 0.111, P = 0.022), femoral neck BMD (0.598 ± 0.106 vs 0.637 ± 0.100, P = 0.009), and 25(OH)D (15.67 ± 7.23 vs 29.53 ± 10.57, P < 0.01) were found in the facture group. After adjustment for confounding factors, logistic regression analysis revealed that 25(OH)D (adjusted OR 0.837 [95% CI 0.790-0.886]; P < 0.01), femoral neck BMD (adjusted OR 0.009 [95% CI 0.000-0.969]; P = 0.048) and height (adjusted OR 1.207 [95% CI 1.116-1.306]; P < 0.01) remained risk factors for hip fractures in elderly women. Then a model including independent risk factors was established. A DeLong test showed the area under the receiver operator characteristic (ROC) (Area under the curve [AUC]) of 25(OH)D was significantly greater than that for femoral neck BMD (P < 0.01) and height (P < 0.01). The AUC of model including 25(OH)D and height was significantly greater than that of other combinations (P < 0.01). CONCLUSION: 25(OH)D, femoral neck BMD and height were associated with the occurrence of hip fractures in elderly women even after adjustment for confounding factors, and a model including 25(OH)D and height could provide better associated power than other combinations in the assessment of elderly hip fractures.

A three-dimensional measurement based on CT for the posterior tilt with ideal inter-and intra-observer reliability in non-displaced femoral neck fractures.

Posterior tilt is associated with prognosis of non-displaced femoral neck fractures (FNFs). Knowledge of their association is critical and informs surgeons whether to choose internal fixation or arthroplasty in treatment of non-displaced FNFs. This study aimed to design a novel three-dimensional (3D) posterior tilt measurement and evaluate the intra- and inter-observer variability compared to two-dimensional (2D) measurement proposed by Palm. We hypothesized that 3D measurement would be more accurate and realistic with higher reliability. To test the hypothesis, three observers measured the posterior tilt on the radiographs of 50 non-displaced FNFs, twice with both methods. Intra- and inter-observer reliability for each measurement method used were determined. The measured angle was divided into two categories, at the cut-off of 20° for clinical practice simulation. Intra- and inter-observer reliability were identified for clinical effectiveness. The results indicated that inter- and intra-observer reliability for 3D measurement and its classification was almost perfect with an intraclass coefficient of 0.995 (0.994) and a kappa value of 0.927(0.947), respectively. Conversely, a substantial inter- and intra-observer reliability for the 2D measurement was obtained with an interclass coefficient of 0.764 as well as an intraclass coefficient of 0.773. The clinical validity for 2D measurement showed slight inter-reliability and moderate intra-reliability with a kappa value of 0.192 and 0.587, respectively. Hence, the novel 3D measurement appears to be more reliable with a strong inter- and intra-observer reliability measurement. Further clinical studies are needed to carry out to validate this hypothesis.

An evaluation of mathematical models for the outbreak of COVID-19.

Mathematical modelling performs a vital part in estimating and controlling the recent outbreak of coronavirus disease 2019 (COVID-19). In this epidemic, most countries impose severe intervention measures to contain the spread of COVID-19. The policymakers are forced to make difficult decisions to leverage between health and economic development. How and when to make clinical and public health decisions in an epidemic situation is a challenging question. The most appropriate solution is based on scientific evidence, which is mainly dependent on data and models. So one of the most critical problems during this crisis is whether we can develop reliable epidemiological models to forecast the evolution of the virus and estimate the effectiveness of various intervention measures and their impacts on the economy. There are numerous types of mathematical model for epidemiological diseases. In this paper, we present some critical reviews on mathematical models for the outbreak of COVID-19. Some elementary models are presented as an initial formulation for an epidemic. We give some basic concepts, notations, and foundation for epidemiological modelling. More related works are also introduced and evaluated by considering epidemiological features such as disease tendency, latent effects, susceptibility, basic reproduction numbers, asymptomatic infections, herd immunity, and impact of the interventions.

[Meta-analysis of alendronate preventing hip fracture risk of postmenopausal women].

OBJECTIVE: To study the efficacy of alendronate to prevent hip fracture risk of postmenopausal women. METHODS: Randomized controlled trials in postmenopausal women receiving alendronate or placebo for preventing hip fractures rate were searched from Medline, EMBASE, Cochrane Trial Registry and China Biological Medicine database between January 1980 to December 2007. Key words included hip fractures, alendronate, postmenopausal and placebo-controlled. Language was limited in English and Chinese. The software Revman 4.2 was used to perform meta-analysis. RESULTS: Six trials, which included 8610 postmenopausal women, met all our inclusion criteria Meta-analysis showed that alendronate can decrease hip fracture rate (OR = 0.51, 95% CI: 0.34, 0.77). CONCLUSION: Alendronate can reduce significantly hip fracture rate in postmenopausal women.

miR-383 negatively regulates osteoblastic differentiation of bone marrow mesenchymal stem cells in rats by targeting Satb2.

Emerging evidence indicates that microRNAs (miRNAs, miRs) play diverse roles in the regulation of biological processes, including osteoblastic differentiation. In this study, we found that miR-383 is a critical regulator of osteoblastic differentiation. We showed that miR-383 was downregulated during osteoblastic differentiation of rat bone marrow mesenchymal stem cells (BMSCs). Overexpression of miR-383 suppressed osteoblastic differentiation of BMSCs by downregulating alkaline phosphatase (ALP), matrix mineralization, and mRNA and protein levels of RUNX2 and OCN, whereas a knockdown of miR-383 promoted osteoblastic differentiation in vitro. The results of in vivo analysis indicated that inhibition of miR-383 expression enhanced the efficacy of new bone formation in a rat calvarial defect model. Mechanistic experiments revealed that special AT-rich-sequence-binding protein 2 (Satb2) was a direct and functional target of miR-383. Knockdown of Satb2 had inhibitory effects resembling those of miR-383 on the osteoblast differentiation of rat BMSCs. In addition, the positive effect of miR-383 suppression on osteoblastic differentiation was apparently abrogated by Satb2 silencing. Collectively, these results indicate that miR-383 plays an inhibitory role in osteogenic differentiation of rat BMSCs and may act by targeting Satb2.

Ligustrazine Inhibits Cartilage Endplate Hypertrophy via Suppression of TGF-ß1.

CEP hypertrophy is one of the characteristics of intervertebral disc degeneration (IDD). LIG exerts a protective effect on IDD in animal model. The effect of LIG on CEP hypertrophy is further investigated in the present study. Cells were isolated from hypertrophic samples obtained from patients during vertebral fusion surgery. Cellular proliferation and the expression of type I collagen (Col I) and TGF-ß1 were tested. In the bipedal rats, the edges of the CEP and the sizes of noncartilaginous outgrowth, as well as the expression of osteogenic markers, Col1a, ALP, Runx2, and TGF-ß1, were detected. Within two passages, the condensed hypertrophic CEP cells exhibited osteogenic capacity by bony-like nodules and ALP positive staining, along with increased expression of Col I and TGF-ß1. LIG inhibited proliferation of CEP cells and downregulated the expression of Col I and TGF-ß1 in vitro. Furthermore, LIG attenuated CEP hypertrophy on the lumbar spine of bipedal rats by reducing Col1a, ALP, Runx2, and TGF-ß1 mRNA expression and TGF-ß1 distribution in vivo. We concluded LIG exerted a preventive effect on CEP hypertrophy via suppression of TGF-ß1 levels. This information could be used to develop alternative therapeutic methods to treat spinal CEP hypertrophy.

Internal fixation of diaphyseal fractures of the forearm by interlocking intramedullary nail: short-term results in eighteen patients.

OBJECTIVE: This study was designed to evaluate the efficacy of the treatment of diaphyseal fractures of the forearm using the ForeSight forearm interlocking intramedullary nail. DESIGN: Retrospective study. SETTING: University-affiliated teaching hospital. PATIENTS: Eighteen patients with 32 displaced diaphyseal forearm fractures were identified. INTERVENTION: All fractures were treated with the ForeSight forearm interlocking intramedullary nail. Eighteen fractures were stabilized with static interlocking technique. MAIN OUTCOME MEASURES: The assessment of patients was based on the time to union, the functional recovery, and the incidence of complications. Physical capability was evaluated by using the rating system of Grace and Eversmann. Patient-rated outcome was assessed by completion of the Disability of Arm Shoulder Hand questionnaire (DASH). RESULTS: All fractures healed with the index procedure. The average time to union for fractures utilizing a closed technique was 10 weeks; for fractures using an open reduction technique, 15 weeks. The mean pronation was 62 (range, 0-96) degrees, and the mean supination was 80 (range, 0-105) degrees. Compared with the normal arm, the mean loss of rotation of the forearm was 32 (range, 5-162) degrees. Using the rating system of Grace and Eversmann, 13 patients had an excellent or good result, 3 had an acceptable result, and 2 had an unacceptable result. Using the patient-rated functional questionnaire, the mean DASH of 19 (range, 4-72) points at the time of the most recent follow-up indicated a mild-to-moderate impairment. There were 7 postoperative complications. The incidence of complications was 22% (7/32). One cross-union between forearm bones occurred in a patient with a closed head injury and high-energy trauma. Two nondriving end screws of the ulna nail backed out causing wrist pain and had to be removed. There were 4 superficial infections occurring all in the fractures that necessitated an open reduction technique. The overall rate of infection was 12.5% (4/32). Three patients who presented with an open fracture needed a skin graft to cover the open wound. CONCLUSIONS: Forearm interlocking intramedullary nailing is an acceptable method to stabilize displaced diaphyseal forearm fractures in adult.

Morphological measurements of the posterior surface of the normal proximal tibia in a healthy Chinese population.

BACKGROUND: To measure and calculate the morphological parameters and determine the anatomical characteristics of the posterior surface of the proximal tibia in a healthy Chinese population. METHODS: A total of 150 volunteers with normal knees were enrolled. The parameters in the multi-slice spiral computed tomography (MSCT) three-dimensional (3-D) reconstruction images were measured and calculated by two independent qualified observers. The differences and correlation were investigated. The intraclass correlation coefficient (ICC) was used to assess inter-observer reliability. RESULTS: The posterior margin of the tibial plateau is presented as two superior arc-shapes. The central angles of these arcs were 118°±14° (medial) and 106°±20° (lateral). The radii of these arcs both showed a skewed distribution. The median radii of the arcs were 22 mm in the medial and 20mm in the lateral. There were two significant angles present in the sagittal plane of the posterior cortex of the proximal tibia. The first angles were 39°±7° (medial) and 47°±7° (lateral). The second angles were 39°±4° (medial) and 41°±5° (lateral). Significant differences were observed in the central angles and the first angles but not in the second angles between the medial and lateral. There were no significant differences between different gender groups, and between left and right limbs. All of these parameters exhibited excellent to moderate ICC. CONCLUSION: Due to the varying anatomic morphology between the postero-medial and postero-lateral surface of the proximal tibia, the internal fixation implants of these two parts should be designed differently.

[Treatment of osteonecrosis of femoral head with free vascularized fibula grafting].

OBJECTIVE: To evaluate the effect of the treatment of necrosis of femoral head with the free vascularized fibula grafting. METHODS: From October 2000 to February 2002, 31 hips in 26 patients with ischemic necrosis of the femoral head were treated with free vascularized fibula graft. Among these patients, 21 patients (25 hips) were followed up for 6-18 months (12 months on average). According to Steinberg stage: II period, 5 hips; III period, 8 hips; IV period, 12 hips. RESULTS: Among 25 hips, their Harris Hip Score at all satges were improved during the follow-up. The symptom of pain diminished or disappeared after operation. The patient's ability to work and live was not limited or only slightly limited during the follow-up. Radiographic evaluation showed that most femoral heads improved (18 hips) or unchanged (6 hips) and only one worsened. CONCLUSION: The free vascularized fibular grafting is a valuable method for femoral head necrosis. With this method, we can prevent or delay the process of the disease.