Survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association.

A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific. PURPOSE: Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies. The current incidence of hip and other fragility fractures across the Asia Pacific region is enormous and set to escalate rapidly in the coming decades. This publication describes findings of a survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association (APOA) conducted in 2022. METHODS: The survey was developed as a collaboration between the Asia Pacific Osteoporosis and Fragility Fracture Society and the Asia Pacific Fragility Fracture Alliance, and included questions relating to aspects of care upon presentation, during surgery and mobilisation, secondary fracture prevention, and access to specific services. RESULTS: In total, 521 APOA members completed the survey and marked variation in delivery of care was evident. Notable findings included: Fifty-nine percent of respondents indicated that analgesia was routinely initiated in transit (by paramedics) or within 30 minutes of arrival in the Emergency Department. One-quarter of respondents stated that more than 80% of their patients underwent surgery within 48 hours of admission. One-third of respondents considered non-hip, non-vertebral fractures to merit assessment of future fracture risk. One-third of respondents reported the presence of an Orthogeriatric Service in their hospital, and less than a quarter reported the presence of a Fracture Liaison Service. CONCLUSION: A Call to Action for all National Orthopaedic Associations affiliated with APOA is proposed to improve the care of fragility fracture patients across the region.

Poor knowledge about osteoporosis in learned Indian women.

OBJECTIVES: The present study was done to assess knowledge about osteoporosis in learned Indian women, identify their source of knowledge and to study the correlation of level of knowledge with other variables. METHODS: A total of 73 female staff members (average age 44.7 years) of a teaching institute completed the Osteoporosis Questionnaire (OPQ). The mean +/- SD of total score for the sample was 4.1 +/- 4.1 (range -8 to 15; maximum possible score 20). RESULTS: The correct definition of osteoporosis was given by 74%, but there was general lack of awareness in all the areas assessed. There was statistically significant difference in the total score depending on the faculty of education, with staff members from the science faculty having the maximum mean score (p < 0.05). We found no influence of age, menopausal status, previous history of fracture and family history of osteoporosis on the level of knowledge. Media (74%) was the commonest source of knowledge followed by friends (49%) and doctors (25%). CONCLUSIONS: This study highlights the general lack of knowledge about osteoporosis in learned Indian women and also the need for increased involvement of medical professionals in patient education.

Normative reference database for bone mineral density in Indian men and women using digital X-ray radiogrammetry.

Osteoporosis is a major healthcare problem around the world and its importance lies in the fractures that result. A variety of devices are available in India and other Asian countries for bone mineral density (BMD) assessment, but their clinical utility is limited because of non-availability of local normative database. The purpose of this study was to establish the normative reference database for BMD in Indian women and men using digital x-ray radiogrammetry (DXR). Radiographs of the non-dominant hand were obtained on 262 women and 178 men between 20 and 79 years of age following strict inclusion and exclusion criteria. The radiographs were analysed by DXR using pronosco x-posure system V.2 to estimate the BMD (DXR-BMD). The peak value for DXR-BMD in women was 0.588 g/cm2 at age 35 years and 0.602 g/cm2 in men at age 42 years. There were statistically significant differences in BMD in women and men across all age ranges. An age dependent decline in BMD was seen in both women and men over the age of 50 years. The use of DXR should broaden the availability of fracture risk assessments in places where DXA is not available.

Tuberculosis of the hip.

Tuberculosis of the hip constitutes approximately 15% of all cases of osteoarticular tuberculosis. The common age of presentation is in the second and third decades. In Stages II and III of the disease, the radiologic features are very obvious and diagnostic, and almost always predict the final clinical outcome. A progressive pattern of destruction of the hip occurs in patients who are not treated. Treatment must be instituted early with an aim of salvaging the hip. Treatment comprised of drug therapy, traction, and supervised mobilization produces good results in patients with early stages of the disease. Patients who do not have a favorable clinical response to conservative treatment should have surgery before the hip is destroyed. In the eastern hemisphere, patients prefer a painless but mobile joint, for satisfying the customary needs of squatting, sitting cross-legged, and kneeling. Therefore, excision arthroplasty produces satisfactory results as compared with hip arthrodesis. Total hip arthroplasty should be considered only after a safe period of absolute disease quiescence.

Unusual manifestations of osteoarticular tuberculosis.

Unusual manifestations of osteoarticular tuberculosis, especially tubercular osteomyelitis, are described. Diagnostic problems may arise and lead to delay in treatment if these conditions are not considered in the differential diagnosis. The importance of bacteriologic and histopathologic confirmation of the disease is stressed.