Association between low lean mass and low bone mineral density in 653 women with hip fracture: does the definition of low lean mass matter?

BACKGROUND AND AIMS: Loss of both muscle and bone mass results in fragility fractures with increased risk of disability, poor quality of life, and death. Our aim was to assess the association between low appendicular lean mass (aLM) defined according to different criteria and low bone mineral density (BMD) in hip-fracture women. METHODS: Six hundred fifty-three women admitted to our rehabilitation hospital underwent dual energy X-ray absorptiometry 19.1 ± 4.1 (mean ± SD) days after hip-fracture occurrence. Low aLM was identified according to either Baumgartner's definition (aLM/height2 less than two standard deviations below the mean of the young reference group) or FNIH criteria: aLM <15.02 kg, or aLM adjusted for body mass index (BMI) <0.512. Low BMD was diagnosed with a T-score <-2.5 at the unfractured femoral neck. RESULTS: Using Baumgartner's definition, the association between low aLM/height2 and low BMD was significant: χ 2(1, n = 653) = 8.52 (p = 0.004), but it was erased by adjustments for age and fat mass. Using the FNIH definition the association between low aLM and low BMD was significant: χ 2(1, n = 653) = 42.5 (p < 0.001), and it was confirmed after adjustment for age and fat mass (p < 0.001). With the FNIH definition based on aLM/BMI ratio the association between low aLM/BMI ratio and low BMD was nonsignificant: χ 2(1, n = 653) = 0.003 (p = 0.957). CONCLUSIONS: The association between low aLM and low BMD in women with hip fracture dramatically depends on the adopted definition of low aLM. FNIH threshold for aLM (<15.02 kg) emerges as a useful tool to capture women with damage of the muscle-bone unit.

Presarcopenia and sarcopenia in hip-fracture women: prevalence and association with ability to function in activities of daily living.

BACKGROUND AND AIMS: Sarcopenia staging systems have been proposed, but little is known on their application in hip-fracture patients. Our aim was to assess the prevalence of presarcopenia and sarcopenia and their association with ability to function in activities of daily living in hip-fracture women. METHODS: We investigated white women (N = 138 of 149) who were consecutively admitted to a rehabilitation hospital because of their first hip fracture. In each woman, we measured appendicular lean mass (aLM) by dual-energy X-ray absorptiometry, at a median of 18 days after hip fracture occurrence. On the same day, we assessed grip strength with a handheld dynamometer. Functional autonomy was assessed by the Barthel Index. We used the European Working Group on Sarcopenia in Older People (EWGSOP) definition to calculate the prevalence of presarcopenia and sarcopenia, taking into account both aLM/height(2) and handgrip strength. Gait speed was not considered, because of the recent hip fracture. RESULTS: Twenty-three (17 %) of the 138 women fulfilled the diagnostic criteria for presarcopenia whereas 80 (58 %) were sarcopenic. The women with presarcopenia were younger, healthier and with higher Barthel Index scores (median 65 vs. 55; interquartile range 60-75 and 50-60, respectively; p < 0.001) than those with sarcopenia. Significant differences in Barthel Index scores at the time of assessment (but not at the end of the rehabilitation course) persisted after multiple adjustments (p < 0.001). CONCLUSIONS: The prevalence of presarcopenia and sarcopenia was high in hip-fracture women. Presarcopenic women had higher ability to function in activities of daily living than sarcopenic women.

Parathyroid-hormone variance is only marginally explained by a panel of determinants: a cross-sectional study of 909 hip-fracture patients.

Several factors affect the levels of parathyroid hormone (PTH) in hip-fracture patients. We hypothesized that a panel of easily assessable determinants could account for both a substantial proportion of PTH variance and the occurrence of secondary hyperparathyroidism. We evaluated 909 of 981 hip-fracture inpatients admitted consecutively to our Rehabilitation division. In each patient we assessed PTH, 25-hydroxyvitamin D, albumin-adjusted total calcium, phosphate, magnesium, and creatinine on a fasting blood sample 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Glomerular filtration rate (GFR) was estimated by the 4-variable Modification of Diet in Renal Disease Study equation. Functional level was assessed using the Barthel index. On multivariate analysis, six factors (phosphate, albumin-adjusted total calcium, estimated GFR (eGFR), 25-hydroxyvitamin D, age, and magnesium) were significantly associated with PTH levels. Overall, the panel of variables accounted for 23.7 % of PTH variance. Among the 909 patients, 304 (33.4 %) had PTH levels exceeding the normal range. Six factors (phosphate, albumin-adjusted total calcium, eGFR, 25-hydroxyvitamin D, age, and Barthel index scores) were significantly associated with the category of PTH level (either normal or elevated). The model correctly classified 70.4 % of cases. For the optimal cut-off point, sensitivity was 80 % and specificity was 61 %. Data shows that six factors were significantly associated with PTH levels in hip-fracture inpatients. However, the six factors accounted for only 23.7 % of PTH variance and the presence or absence of secondary hyperparathyroidism was correctly categorized in a modest proportion of cases. We conclude that more knowledge is needed on the factors affecting PTH levels after hip fracture.

Handgrip strength but not appendicular lean mass is an independent predictor of functional outcome in hip-fracture women: a short-term prospective study.

OBJECTIVE: To investigate the contribution of muscle mass and handgrip strength in predicting the functional outcome after hip fracture in women. DESIGN: Observational study. SETTING: Rehabilitation hospital. PARTICIPANTS: White women (N=123 of 149) who were consecutively admitted to a rehabilitation hospital because of their first fracture of the hip. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured appendicular lean mass (aLM) by dual-energy x-ray absorptiometry (DXA) 21.1 ± 8.7 (mean ± SD) days after hip fracture occurrence in the 123 women. On the same day, we assessed grip strength at the nondominant arm with a dynamometer. At the end of acute inpatient rehabilitation we measured the ability to function in activities of daily living by using the Barthel Index, and lower limb performance by using the Timed Up and Go (TUG) test. RESULTS: We found significant correlations between handgrip strength measured before rehabilitation and Barthel Index scores after rehabilitation (ρ=.50; P<.001), Barthel Index effectiveness (ρ=.45; P<.001), and the TUG test (ρ=-.41; P<.001). Conversely, we found no significant correlations between aLM/height(2) and Barthel Index scores after rehabilitation (ρ=.075; P=.41), Barthel Index effectiveness (ρ=.06; P=.53), or the TUG test (ρ=.005; P=.96). Significant associations between grip strength and all the outcome measures persisted after adjustment for 8 potential confounders, including Barthel Index scores before rehabilitation, age, number of medications, number of comorbidities, pressure ulcers, concomitant infections, time between fracture occurrence and assessment, and aLM/height(2). CONCLUSIONS: Grip strength, but not DXA-assessed aLM, significantly predicted short-term functional outcome in women after a hip fracture.

Parathyroid hormone is significantly associated with body fat compartment in men but not in women following a hip fracture.

BACKGROUND AND AIMS: Parathyroid hormone (PTH) exerts several actions beyond mineral metabolism and may affect body composition. The aim of our study was to assess the association between serum PTH and body fat compartment in hip fracture patients. METHODS: We studied 575 of 630 inpatients with hip fracture consecutively admitted to our Rehabilitation ward. Dual-energy X-ray absorptiometry (DXA) was used to measure body composition. DXA scan was performed 18.5 ± 8.6 (mean ± SD) days after hip fracture occurrence. A blood sample was collected within 4 days after DXA scan. In each subject, we evaluated PTH, 25-hydroxyvitamin D, calcium, phosphate, albumin, magnesium, and creatinine. Glomerular filtration rate was estimated by a conventional formula. RESULTS: In the 57 men, we found a significant correlation between PTH and both body mass index (BMI) (ρ = 0.37; p = 0.020) and trunk fat percentage (ρ = 0.62; p < 0.001). After multiple adjustments, we confirmed a significant association between PTH and BMI (r = 0.38; p = 0.004) or trunk fat percentage (r = 0.51; p < 0.001). In the 518 women, we found a slightly significant correlation between PTH and BMI (ρ = 0.09; p = 0.047), but after adjustments the correlation coefficient dropped to 0.02 (p = 0.69). We found no significant relationships between PTH and trunk fat percentage at bivariate correlation (ρ = 0.04; p = 0.35) or after adjustments (r = 0.04; p = 0.38). CONCLUSIONS: PTH serum levels were robustly associated with body fat compartment in men, but not in women following a fracture of the hip. A role of PTH in affecting body composition in hip fracture men is suggested. Its potential role in male prognostic disadvantage needs further investigation.

Appendicular lean mass does not mediate the significant association between vitamin D status and functional outcome in hip-fracture women.

OBJECTIVE: To investigate whether muscle mass mediates the significant association between vitamin D status and functional recovery after hip fracture in women. DESIGN: Observational study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: We investigated white women (N=280) of 305 who were consecutively admitted to a rehabilitation hospital because of their first fracture of the hip. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To assess muscle mass, we measured appendicular lean mass (aLM) by dual-energy x-ray absorptiometry (DXA), 21.2±6.2 (mean ± SD) days after hip fracture occurrence in the 280 women. On the same day, we assessed serum levels of 25-hydroxyvitamin D and parathyroid hormone (PTH). Ability to function in activities of daily living was evaluated by the Barthel Index both before and after acute inpatient rehabilitation. RESULTS: After adjustment for 8 confounders, including age, cognitive impairment, pressure ulcers, neurologic impairment, infections, fracture type, Barthel Index score at admission to rehabilitation, and aLM/height(2) (aLM/ht(2)), 25-hydroxyvitamin D levels were significantly associated both with Barthel Index scores after rehabilitation (P=.003) and their changes during rehabilitation (P=.008). Similar results were obtained when the 25-hydroxyvitamin D/PTH ratio was substituted for 25-hydroxyvitamin D levels. Conversely, aLM/ht(2) was not significantly correlated with Barthel Index scores and their changes during rehabilitation. Furthermore, we found no significant associations between either 25-hydroxyvitamin D levels or the 25-hydroxyvitamin D/PTH ratio and aLM/ht(2). CONCLUSIONS: The significant association between 25-hydroxyvitamin D levels (and 25-hydroxyvitamin D/PTH ratio) and the ability to function in women with hip fractures was not mediated by aLM assessed by DXA.

Severity of unilateral spatial neglect is an independent predictor of functional outcome after acute inpatient rehabilitation in individuals with right hemispheric stroke.

OBJECTIVE: To investigate the relationship between severity of unilateral spatial neglect (USN) and functional recovery in activities of daily living after a right-hemisphere stroke. DESIGN: Observational study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: We investigated 107 of 131 inpatients with right-hemisphere stroke who were consecutively admitted to our rehabilitation hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To assess USN severity, conventional and nonconventional Behavioral Inattention Tests (BITs) were performed at admission to inpatient rehabilitation at a median of 19 days after stroke occurrence. FIM was performed both on admission to and discharge from inpatient rehabilitation to assess functional autonomy. FIM efficiency (improvement of FIM score per day of stay length) and FIM effectiveness (proportion of potential improvement achieved) were calculated. RESULTS: Fifty-four (50.5%) of the 107 patients were affected by USN. In these 54 patients, both conventional and nonconventional BIT scores were significantly correlated with FIM scores assessed at discharge from rehabilitation: ρ values were .385 (P=.004) and .396 (P=.003), respectively. After adjustment for 7 potential confounders, including FIM scores before rehabilitation, we found a significant positive association between either conventional or nonconventional BIT scores and FIM scores after rehabilitation (r=.276, P=.047 and r=.296, P=.033, respectively), FIM efficiency (r=.315, P=.022 and r=.307, P=.025, respectively), and FIM effectiveness (r=.371, P=.006 and r=.306, P=.026, respectively). CONCLUSIONS: Data support the independent prognostic role of USN severity assessed at admission to inpatient rehabilitation after a right-hemisphere stroke. Models aimed at predicting the functional outcome in stroke survivors may benefit from inclusion of USN severity.

The relationship between initial trunk control or postural balance and inpatient rehabilitation outcome after stroke: a prospective comparative study.

OBJECTIVE: To compare the predictive validity of trunk control in sitting position assessed by Trunk Impairment Scale and balance in lying, sitting and standing posture assessed by Postural Assessment Scale for Stroke patients on functional outcome in stroke survivors. DESIGN: Prospective observational study. SETTING: A single rehabilitation hospital in Italy. SUBJECTS: Sixty of 68 consecutive subjects admitted to a rehabilitation hospital after stroke. MAIN MEASURES: We performed Trunk Impairment Scale and Postural Assessment Scale for Stroke patients at admission to inpatient rehabilitation. Outcome measures at discharge were Functional Independence Measure score and destination (classified as either home or institution). RESULTS: After adjustment for 14 potential confounders, including Functional Independence Measure score at admission to rehabilitation, both Trunk Impairment Scale and Postural Assessment Scale for Stroke patients scores were significantly associated with the Functional Independence Measure score at discharge (P = 0.010 and P =0.04, respectively), change in the Functional Independence Measure score during rehabilitation (P = 0.003 and P<0.001, respectively), Functional Independence Measure effectiveness (P = 0.024 and P =0.017, respectively) and destination at discharge (P = 0.040 and P =0.032, respectively). The panel of prognostic variables predicted 64-65% of the variance in the final Functional Independence Measure score, 30-35% of the variance in the change of the Functional Independence Measure score during rehabilitation, and 45-46% of the variance in the Functional Independence Measure effectiveness depending on the inclusion of either Trunk Impairment Scale or Postural Assessment Scale for Stroke patients score among the predictors.

Type of hip fracture in patients with Parkinson disease is associated with femoral bone mineral density.

OBJECTIVE: To investigate the association between bone mineral density (BMD) and hip fracture type (cervical or trochanteric) in a sample of fallers with Parkinson disease (PD). DESIGN: Observational study. SETTING: Rehabilitation hospital in Italy. PATIENTS: We investigated 1040 of 1120 white fallers consecutively admitted to a rehabilitation hospital for hip fracture. Thirty-eight (3.65%) of the 1040 patients suffered from PD secondarily. Thirty-eight controls matched for sex, age, and hip fracture type were found among the 1002 non-PD fallers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMD was assessed by dual-energy x-ray absorptiometry at a mean+/-SD of 21.9+/-7.5 days after fracture occurrence in the 38 PD patients and 21.6+/-5.9 days after fracture occurrence in the 38 controls. RESULTS: BMD assessed at total femur, trochanter, and intertrochanteric region was significantly lower in the 15 PD patients with trochanteric fractures than in the 23 with cervical fractures; the mean T score differences were 0.57 (95% confidence interval [CI], 0.07-1.08; P=.028), 0.66 (95% CI, 0.04-1.28; P=.037), and 0.63 (95% CI, 0.11-1.15; P=.019), respectively. A significant association between femoral BMD and hip fracture type was found at logistic regression after adjustment for several confounders. Results in the 38 controls were similar to those obtained in the 38 PD fallers. CONCLUSIONS: In a sample of PD fallers as in a control group of non-PD fallers, BMD levels assessed at 3 femoral sites were significantly lower in the patients who sustained trochanteric fractures than in those with cervical fractures of the hip.

A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a single home visit by an occupational therapist in the reduction of fall risk after hip fracture in elderly women. DESIGN: Quasi-randomized controlled trial. PARTICIPANTS: Ninety-five women aged 60 years or older, living in the community, who sustained a fall-related hip fracture. METHODS: The women were allocated alternately to intervention or control groups. All the women underwent a multidisciplinary programme targeted at fall prevention during in-patient rehabilitation. Additionally, the intervention group received a home visit by an occupational therapist a median of 20 days after discharge. Falls were recorded at a 6-month follow-up. RESULTS: Thirteen of the 50 women in the control group sustained 20 falls during 9231 days, whereas 6 of the 45 women in the intervention group sustained 9 falls during 8970 days. After adjustment for observation periods, Barthel Index scores, and body height, a significantly lower proportion of fallers was found in the intervention group: the odds ratio was 0.275 (95% confidence interval 0.081-0.937, p=0.039). CONCLUSION: A single home visit by an occupational therapist after discharge from a rehabilitation hospital significantly reduced the risk of falling in a sample of elderly women following hip fracture.

Fat mass and skeletal muscle mass in hip-fracture women: a cross-sectional study.

OBJECTIVES: To investigate the association between appendicular lean mass (aLM) and age, fat mass (FM), serum levels of Vitamin D, parathyroid hormone, three parameters of the protein nutritional status (total lymphocyte count, serum albumin, and insulin-like growth factor I), levels of independence in activities of daily living (assessed by using Barthel index scores), type both of hip fracture and surgical operation, number of medications in use, and number of concomitant diseases in hip-fracture women. METHODS: We investigated 299 of 327 hip-fracture women admitted consecutively to a rehabilitation hospital. Soft tissue body composition was assessed by dual-energy X-ray absorptiometry, 22.1+/-7.5 (mean+/-S.D.) days after fracture occurrence. Appendicular LM was calculated as the sum of LM in arms and legs. Because metal implants (prostheses and nails) affect the regional assessment of body composition, aLM was corrected by substituting LM in unfractured leg for LM in fractured leg: corrected aLM=(LM in unfractured leg x 2)+LM in arms. We divided corrected aLM by height squared (aLM/ht(2)), to adjust it for body size. RESULTS: Four variables were significantly correlated with corrected aLM: age, height, FM, and Barthel index score. FM was the only variable significantly correlated with aLM/ht(2) (r=0.492; p<0.001). This significant correlation was not affected after adjustment for age and Barthel index score. CONCLUSIONS: FM measured after hip fracture was significantly associated with aLM/ht(2) in women.

Parathyroid hormone response to severe vitamin D deficiency is associated with femoral neck bone mineral density: an observational study of 405 women with hip-fracture.

OBJECTIVE: Hip-fracture patients with vitamin D deficiency can have either secondary hyperparathyroidism or normal levels of parathyroid hormone (PTH). We hypothesized that bone mineral density (BMD) could be lower in patients with high PTH levels than in those with normal levels of PTH, irrespectively of the severity of vitamin D depletion. DESIGN: In this cross-sectional study, we examined 405 women who had serum 25-hydroxyvitamin D below 12ng/ml 20.0 ± 5.9 (mean ± SD) days after a hip-fracture. PTH was assessed by a chemiluminescent immunometric assay and BMD by dual-energy x-ray absorptiometry at the unfractured femoral neck. RESULTS: BMD was significantly lower in the 148 women with secondary hyperparathyroidism than in the 257 with normal PTH levels: the mean T-score (SD) was -2.88 (0.93) and -2.65 (0.83), respectively, in the two groups (mean difference 0.23; 95% CI 0.05 - 0.41; P = 0.010). The association between PTH status and BMD persisted after adjustment for age, body mass index, phosphate, albumin-adjusted total calcium, 25-hydroxyvitamin D, estimated glomerular filtration rate, and magnesium (P=0.01). The presence of secondary hyperparathyroidism was significantly associated with a femoral neck T-score lower than -2.5. The adjusted odds ratio was 1.81 (95% CI 1.11 - 2.95; P=0.017). CONCLUSIONS: Our results show that PTH levels in the presence of severe vitamin D deficiency were significantly associated with femoral BMD in women with hip-fracture. Prevention and treatment of vitamin D deficiency may be particularly relevant in women who develop secondary hyperparathyroidism.

Time trend 2000-2013 of vitamin D status in older people who sustain hip fractures: steps forward or steps back? A retrospective study of 1599 patients.

BACKGROUND: Substantial proportions of hip-fracture patients have very low serum levels of 25-hydroxyvitamin D, which can negatively affect rehabilitation. However, it is not known whether changes in vitamin D deficiency have occurred over the last years in the patients who sustain hip fractures. AIM: To assess time trend 2000-2013 of calcifediol serum levels in the hip-fracture patients admitted to our rehabilitation division. DESIGN: Retrospective observational study. SETTING: A rehabilitation hospital division. POPULATION: A number of 1599 inpatients with a hip fracture admitted between January 1, 2000 and December 31, 2013 to our rehabilitation division. METHODS: A blood sample was collected in the morning following an overnight fasting 14.4±4.4 (mean±SD) days after surgery. We assessed 25-hydroxyvitamin D levels by an immunoenzymatic assay. RESULTS: Calcifediol levels increased till 2006-2007 and decreased afterward. In 2006-2007, the median 25-hydroxyvitamin D level (13.1 ng/mL, interquartile range 7.9-25ng/mL) was significantly higher (P<0.001) than the one found in both the periods 2000-2001 (5.4 ng/mL, interquartile range 3.5-9 ng/mL), and 2012-2013 (7ng/mL, interquartile range 5-14 ng/mL). In the last two-year period of observation (2012-2013), 25-hydroxyvitamin D levels were slightly higher (P<0.001) than in the first one (2000-2001). The association between periods of observation and 25-hydroxyvitamin D levels persisted after adjustment for age, BMI, and sex (P<0.001). CONCLUSIONS: A significant increase in calcifediol concentrations was seen till 2006-2007, but a significant decrease was observed afterward. Finally, calcifediol levels were only slightly higher in the last two years of observation than in the first two years and severe vitamin D deficiency was common during the whole 14-year study period. CLINICAL REHABILITATION IMPACT: Heightened awareness is needed to prevent and treat vitamin D deficiency in hip-fracture patients.

Prevalence and burden of vertebral fractures in older men and women with hip fracture: A cross-sectional study.

AIM: To investigate the prevalence and burden (combination of number and severity) of vertebral fractures in men and women with hip fracture. METHODS: We investigated 458 of 490 hip-fracture patients admitted consecutively to a rehabilitation hospital. Lateral radiographs of the spine were taken 19.2 ± 5.5 days (mean ± SD) after hip-fracture occurrence. To obtain a summary measure of vertebral fracture burden, we calculated the spinal deformity index (SDI) by summing the fracture grades assessed using Genant's method of all vertebrae (T4 to L4). RESULTS: The median SDI score was 2 in both the 411 women and the 47 men (interquartile range 0-4 in both groups), and no significant between-sex differences were found (P = 0.52). A total of 69% of the women (95% CI 65-74%), and 60% of the men (95% CI 45-74%) had at least one mild vertebral fracture (SDI score ≥1), 41% of the women (95% CI 36-46%) and 38% of the men (95% CI 24-53%) had a SDI score ≥3, whereas 16% of the women (95% CI 12% 19%) and 17% of the men (95%CI 6-28%) had at least one severe vertebral fracture. Sex was not significantly associated with a SDI score ≥1, or ≥3 or with the presence of at least one severe vertebral fracture after adjustment for age, hip-fracture type, cognitive impairment, pressure ulcers, neurological impairment, comorbidities, number of medications in use and Barthel index scores. CONCLUSIONS: The prevalence of vertebral fractures was high after hip fracture in both men and women. We found no significant between-sex differences in the prevalence and burden of vertebral fractures.

Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

OBJECTIVE: The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. DESIGN: Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. RESULTS: In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. CONCLUSIONS: Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

Handgrip strength is an independent predictor of functional outcome in hip-fracture women: a prospective study with 6-month follow-up.

The objective of this study was to investigate the contribution of handgrip strength in predicting the functional outcome after hip fracture in women.We prospectively investigated white women (N = 193 of 207) who were consecutively admitted to a rehabilitation hospital after a hip fracture. We measured handgrip strength with a Jamar dynamometer (Lafayette Instrument Co, Lafayette, IN), on admission to rehabilitation. Ability to function in activities of daily living was assessed by the Barthel index both on discharge from rehabilitation and at a 6-month follow-up.We found significant correlations between handgrip strength measured before rehabilitation and Barthel index scores assessed both on discharge from rehabilitation (ρ = 0.52, P < 0.001) and after 6 months (ρ = 0.49, P < 0.001). Significant associations between handgrip strength and Barthel index scores persisted after adjustment for age, comorbidities, pressure ulcers, medications in use, concomitant infections, body mass index, hip-fracture type, and Barthel index scores assessed both preinjury and on admission to rehabilitation (P = 0.001). Further adjustments for both Barthel index scores and Timed Up-and-Go test assessed at rehabilitation ending did not erase the significant association between handgrip strength and the Barthel index scores at the 6-month evaluation (P = 0.007). To define successful rehabilitation, we categorized the Barthel index scores as either high (85 or higher) or low (<85). The adjusted odds ratio for 1 SD increase in grip strength was 1.73 (95% confidence interval [CI] 1.05-2.84, P = 0.032) for having a high Barthel index score at the end of inpatient rehabilitation and 2.24 (95% CI 1.06-5.18) for having a high Barthel index score at the 6-month follow-up.Handgrip strength assessed before rehabilitation independently predicted the functional outcome both after inpatient rehabilitation and at a 6-month follow-up in hip-fracture women.

Men recover ability to function less than women do: an observational study of 1094 subjects after hip fracture.

OBJECTIVE: The aim of this study was to investigate the association between sex and functional outcome after acute inpatient rehabilitation in hip-fracture patients. DESIGN: We investigated 1094 of 1186 people admitted consecutively to our rehabilitation hospital because of a hip fracture. Functional outcome was assessed using Barthel Index scores. Barthel Index efficiency (improvement per day of stay length) and Barthel Index effectiveness (proportion of potential improvement achieved) were calculated. RESULTS: The median Barthel Index score at discharge from inpatient rehabilitation was 85 in the 970 women and 75 in the 124 men (interquartile range, 65-95 in women and 60-95 in men, P = 0.001). Both Barthel Index efficiency and effectiveness were significantly lower in men (P = 0.030 and P = 0.007, respectively). After adjustment for six confounders, we confirmed that men had lower Barthel Index scores (P = 0.030), Barthel Index efficiency (P = 0.024), and Barthel Index effectiveness (P = 0.040). The risk of achieving a low Barthel Index score (i.e., <85) at the end of acute inpatient rehabilitation was higher for men than for women (adjusted odds ratio, 2.055; 95% CI, 1.212-3.483; P = 0.007). CONCLUSIONS: In our large sample of hip-fracture patients, men had a significantly worse functional outcome than did women after acute inpatient rehabilitation.

Sarcopenia is more prevalent in men than in women after hip fracture: a cross-sectional study of 591 inpatients.

Our aim was to compare the prevalence of sarcopenia in men and women with hip fracture. We studied 591 of 630 hip fracture inpatients consecutively admitted to our Rehabilitation ward. All the patients underwent a Dual-Energy X-Ray Absorptiometry (DXA) scan 18.4 ± 8.7 (mean ± SD) days after hip fracture occurrence. Sarcopenia was defined when appendicular lean mass divided by height squared was less than two standard deviations below the mean of the young reference group obtained from population based studies. Using normative data from the New Mexico Elder Health Study, 340 of the 531 women (64.0%), and 57 of the 60 men (95.0%) had sarcopenia. Using normative data from the survey performed in Rochester, Minnesota, 116 of the 531 women (21.8%), and 52 of the 60 men (86.7%) had sarcopenia. After adjustment for age, time between fracture occurrence and DXA scan, number of medications in use, and number of concomitant diseases, men had a significantly higher prevalence of sarcopenia than women (p < 0.001). The adjusted odds ratio was either 10.54 (95% CI from 3.25 to 34.16) or 23.64 (from 10.8 to 51.6) depending on the reference population adopted. Our data shows a high proportion of sarcopenic subjects after hip-fracture. Sarcopenia was significantly more prevalent in men than in women. Relevancy of prevention and treatment of muscle loss is emphasized, particularly in men.

Low levels of 25-hydroxyvitamin D are associated with the occurrence of concomitant upper limb fractures in older women who sustain a fall-related fracture of the hip.

OBJECTIVE: To investigate the association between serum levels of 25-hydroxyvitamin D and the occurrence of simultaneous fractures of the upper limb in older women who sustain a fall-related fracture of the hip. STUDY DESIGN: Cross-sectional study. MAIN OUTCOME MEASURES: We investigated 472 of 480 white women consecutively admitted to a rehabilitation hospital because of a fall-related hip fracture. Twenty-seven (5.7%) of the 472 women sustained a concomitant upper-limb fracture of either distal radius (20 women) or proximal humerus (seven women). We assessed serum levels of 25-hydroxyvitamin D 14.2 ± 4.1 (mean ± SD) days after surgical repair of the hip fracture in the 472 women by an immunoenzymatic assay. RESULTS: Twenty-five-hydroxyvitamin D levels were significantly lower in the 27 women with concomitant fractures of both hip and upper limb than in the remaining 445 hip-fracture women: mean ± SD values were 6.5 ± 5.0 ng/ml and 11.7 ± 10.4 ng/ml respectively in the two groups (mean difference between groups 5.2 ng/ml: 95% CI 1.2-9.2; p=0.011). Low levels of 25-hydroxyvitamin D were significantly associated with concomitant fractures of the upper limb (p=0.017), after adjustment for eight potential confounders including age, height, weight, hip-fracture type, cognitive impairment, neurologic impairment, previous hip fracture, and previous upper-limb fracture. CONCLUSIONS: Low levels of 25-hydroxyvitamin D were significantly associated with concomitant upper-limb fractures in our sample of older women with a fall-related fracture of the hip. Preventing vitamin D deficiency may lower the incidence of simultaneous fractures due to a singe fall in elderly women.

Prevalence of sarcopenia and its association with osteoporosis in 313 older women following a hip fracture.

Changes in body composition, including a decrease in muscle and bone mass, accompany aging. Our aim was to assess the prevalence of sarcopenia and its association with osteoporosis in hip-fracture women. We performed a Dual-Energy X-Ray Absorptiometry (DXA) scan in 313 of 340 women, 20.9 ± 6.5 (mean ± S.D.) days after hip-fracture occurrence. To adjust appendicular lean mass for body size we divided it by height squared in each woman. A total of 180 of the 313 women (58%) were sarcopenic, whereas 230 (74%) were osteoporotic. After adjustment for age and interval between fracture and DXA scan we found a significant association between sarcopenia and osteoporosis (p=0.026). For a sarcopenic woman the adjusted odds ratio (OR) for osteoporosis was 1.80 (95%CI=1.07-3.02). Our data shows the high prevalence of sarcopenia and its significant association with osteoporosis in a large sample of hip-fracture women. Data supports a research approach on preventive and treatment strategies for osteoporosis and sarcopenia targeting both bone and muscle tissue. Furthermore, data should be considered when the economic burden of sarcopenia is estimated, given the high proportion of sarcopenic women with bone fragility.