Radiofrequency Ablation for the Management of Pain of Spinal Origin in Orthopedics.

Radiofrequency (RF) is a minimally invasive procedure for interrupting or modifying nociceptive pathways to manage musculoskeletal neuropathic and nociplastic pain. RF has been used to manage cervical and lumbar facet joint syndromes. The benefits of RF are the following: it is safer than surgery; it doesn´t need general anesthesia, by that means diminishing the complications; it causes pain alleviation for a minimum of 3-4 months; it can be repeated if needed; it improves joint function; and it minimizes the necessity for oral pain treatment. RF must not be used in pregnant women; unstable joints, uncontrolled diabetes mellitus; and presence of an implanted defibrillator. Even though complications from RF are rare, possible adverse events are infection, hemorrhage, numbness or dysesthesia, greater pain in the procedure area, and differentiation impact. Even though there is a peril of injuring non-targeted neural tissue and other tissues, this can be lessened by carrying out the procedure with the help of fluoroscopy, ultrasonography or computed tomography. RF seems to be a helpful procedure for relieving chronic pain syndromes; despite this, definite proof of the procedure's effectiveness is still needed. RF is an encouraging procedure for treating chronic spinal pain, especially when other procedures are pointless or not feasible.

Upper limb and lower limb radiofrequency treatments in orthopaedics.

Radiofrequency (RF) is a minimally invasive technique for disrupting or altering nociceptive pathways to treat musculoskeletal neuropathic and nociplastic pain. RF has been employed to treat painful shoulder, lateral epicondylitis, knee and hip osteoarthritis, chronic knee pain, Perthes disease, greater trochanteric pain syndrome, plantar fasciitis, and painful stump neuromas; it has also been employed before and after painful total knee arthroplasty and after anterior cruciate ligament reconstruction. The benefits of RF include the following:it is safer than surgery; there is no need for general anaesthesia, thereby reducing adverse effects; it alleviates pain for a minimum of 3-4 months; it can be repeatable if necessary; and it improves joint function and minimizes the need for oral pain medication. RF is contraindicated for pregnant women; unstable joints (hip, knee, and shoulder); uncontrolled diabetes mellitus; presence of an implanted defibrillator; and chronic joint infection (hip, knee, and shoulder). Although adverse events from RF are unusual, potential complications can include infection, bleeding, numbness or dysesthesia, increased pain at the procedural site, deafferentation effect, and Charcot joint neuropathy. Although there is a risk of damaging non-targeted neural tissue and other structures, this can be mitigated by performing the technique under imaging guidance (fluoroscopy, ultrasonography, and computed tomography). RF appears to be a valuable technique for alleviating chronic pain syndromes; however, firm proof of the technique's efficacy is still required. RF is a promising technique for managing chronic musculoskeletal of the limbs pain, particularly when other techniques are futile or not possible.

Hybrid curvature-geometrical detection of landmarks for the automatic analysis of the reduction of supracondylar fractures of the femur.

BACKGROUND AND OBJECTIVE: The analysis of the features of certain tissues is required by many procedures of modern medicine, allowing the development of more efficient treatments. The recognition of landmarks allows the planning of orthopedic and trauma surgical procedures, such as the design of prostheses or the treatment of fractures. Formerly, their detection has been carried out by hand, making the workflow inaccurate and tedious. In this paper we propose an automatic algorithm for the detection of landmarks of human femurs and an analysis of the quality of the reduction of supracondylar fractures. METHODS: The detection of anatomical landmarks follows a knowledge-based approach, consisting of a hybrid strategy: curvature and spatial decomposition. Prior training is unrequired. The analysis of the reduction quality is performed by a side-to-side comparison between healthy and fractured sides. The pre-clinical validation of the technique consists of a two-stage study: Initially, we tested our algorithm with 14 healthy femurs, comparing the output with ground truth values. Then, a total of 140 virtual fractures was processed to assess the validity of our analysis of the quality of reduction. A two-sample t test and correlation coefficients between metrics and the degree of reduction have been employed to determine the reliability of the algorithm. RESULTS: The average detection error of landmarks was maintained below 1.7 mm and 2∘ (p< 0.01) for points and axes, respectively. Regarding the contralateral analysis, the resulting P-values reveal the possibility to determine whether a supracondylar fracture is properly reduced or not with a 95% of confidence. Furthermore, the correlation is high between the metrics and the quality of the reduction. CONCLUSIONS: This research concludes that our technique allows to classify supracondylar fracture reductions of the femur by only analyzing the detected anatomical landmarks. A initial training set is not required as input of our algorithm.

Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty.

Periprosthetic joint infection (PJI) is a major adverse event of primary total knee arthroplasty (TKA) from the patient's perspective, and it is also costly for health care systems. In 2010, the reported incidence of PJI in the first 2 years after TKA was 1.55%, with an incidence of 0.46% between the second and tenth year. In 2022, it has been published that 1.41% of individuals require revision TKA for PJI. The following risk factors have been related to an increased risk of PJI: male sex, younger age, type II diabetes, obesity class II, hypertension, hypoalbuminemia, preoperative nutritional status as indicated by prognostic nutritional index (PNI) and body mass index, rheumatoid arthritis, post-traumatic osteoarthritis, intra-articular injections prior to TKA, previous multi-ligament knee surgery, previous steroid therapy, current tobacco use, procedure type (bilateral), length of stay over 35 days, patellar resurfacing, prolonged operative time, use of blood transfusions, higher glucose variability in the postoperative phase, and discharge to convalescent care. Other reported independent risk factors for PJI (in diminishing order of importance) are congestive heart failure, chronic pulmonary illness, preoperative anemia, depression, renal illness, pulmonary circulation disorders, psychoses, metastatic tumor, peripheral vascular illness, and valvular illness. Preoperative intravenous tranexamic acid has been reported to diminish the risk of delayed PJI. Knowing the risk factors for PJI after TKA, especially those that are avoidable or controllable, is critical to minimizing (ideally preventing) this complication. These risk factors are outlined in this article.

Comparison of two different ways to apply a circular plaster cast for distal radius fractures: biomechanical study.

INTRODUCTION: Although conservative treatment with circular plaster cast is the most commonly used method in distal radius fractures, the best method to apply it remains unclear. MATERIAL AND METHODS: Two frequently used configurations of circular plaster cast (with and without a splint) were selected to compare. Group C was applied only with circular bandages (three units) and group S with a splint (one unit) and over it, a circular bandage (two units). Both configurations had the same weight. Five prototypes of each group were built and mechanically tested. Three-point flexural tensile strength and maximum deflection were measured and compared. RESULTS: The previously splinted prototypes (group S) obtained higher tensile strength with the same weight (p < 0.05). DISCUSSION: No other study regarding strength and configuration of circular casts for distal radius fractures immobilization has been previously published, leading to a high variability in construction among orthopedic surgeons. Data confirms that applying a splint before circular bandage offers more mechanical resistance to the cast in flexion, with the same weight. CONCLUSION: Applying a splint before circular bandage for plaster casts used for distal radius fractures make them more resistant to usual forces.

Automatic detection of landmarks for the analysis of a reduction of supracondylar fractures of the humerus.

An accurate identification of bone features is required by modern orthopedics to improve patient recovery. The analysis of landmarks enables the planning of a fracture reduction surgery, designing prostheses or fixation devices, and showing deformities accurately. The recognition of these features was previously performed manually. However, this long and tedious process provided insufficient accuracy. In this paper, we propose a geometrically-based algorithm that automatically detects the most significant landmarks of a humerus. By employing contralateral images of the upper limb, a side-to-side study of the landmarks is also conducted to analyze the goodness of supracondylar fracture reductions. We conclude that a reduction can be classified by only considering the detected landmarks. In addition, our technique does not require a prior training, thus becoming a reliable alternative to treat this kind of fractures.

New, Minimally Invasive, Anteromedial-Distal Approach for Plate Osteosynthesis of Distal-Third Humeral Shaft Fractures: An Anatomical Study.

BACKGROUND: Fractures of the distal third of the humeral shaft remain a challenge today. Plate osteosynthesis is the most commonly used method of treatment. Current minimally invasive plate osteosynthesis (MIPO) techniques applied to the distal part of the humerus have shown a high risk of radial nerve injury, and they are unable to adequately fix distal-most fractures. Our hypothesis was that using a new MIPO approach, distal humeral shaft fractures can be safely fixed. The aim of this study was to develop this new anteromedial-distal MIPO approach. METHODS: We conducted a laboratory descriptive study using 16 arms from adult human specimens. A new anteromedial-distal MIPO approach, starting distally through a small window in the pronator teres muscle, was developed. A premolded plate was introduced in the anterior side of the medial epicondylar area, through the anterior face of the humerus, up to the proximal part of the humeral shaft. Several anatomical parameters were measured on dissection to define the distances of the plate and screws to the neurovascular structures that could be at risk. RESULTS: The radial nerve was not at risk because of its pathway through the posterior and lateral aspects of the arm. The mean distance from the most distal border of the medial epicondyle to the proximal border of the coronoid fossa was 3.36 cm (95% confidence interval [CI], 3.23 to 3.50 cm). At least 3 screws could be inserted in all specimens in this area and up to 5 when the fixation area was extended 2 cm proximally. The mean width of the medial epicondylar area was 2.19 cm (95% CI, 2.03 to 2.33 cm), space enough for the distal fixation of the plate. The ulnar nerve was at risk only from the tip of the most distal screw (mean distance of 2.50 mm; 95% CI, 1.60 to 3.40 mm) in specimens with a very narrow medial epicondylar area. CONCLUSIONS: This approach provides adequate fixation for distal humeral shaft fractures, but proper clinical studies must be undertaken. CLINICAL RELEVANCE: This new approach avoids the risk of radial nerve injury.

25-hydroxyvitamin D levels in the early healing of osteoporotic hip fracture and their relationship with clinical outcome / Niveles de 25-hidroxivitamina D en la fase precoz de la fractura osteoporótica de cadera y su relación con los resultados clínicos

INTRODUCTION: vitamin D is involved in recovery after an osteoporotic hip fracture (OHF). Previous studies have reported decreased serum vitamin D levels during fracture healing. OBJECTIVES: our aim was to evaluate: a) serum 25-hydroxyvitamin D3 (25OHD3) levels in patients with OHF at hospital admission and 8 days post-admission, and b) the relationship between 25OHD levels and clinical outcomes. METHODS: a prospective study including 66 patients aged over 65 years hospitalized for OHF. We gathered data on baseline demographic characteristics, medical history, Mini Mental State (MMS) assessment, Activities of Daily Living (ADL) results, nutritional assessment, and type of fracture and surgery. Laboratory results were collected on bone biomarkers, albumin, 25OHD3, and IL6. Clinical outcomes included length of stay, complications, and mortality. In the statistical analysis, a t-test was used for continuous variables and a chi-square test for qualitative variables. Linear regression models were used for the multivariate analysis, adjusted for covariates. RESULTS: our study population had low serum vitamin D levels at admission, with a mean [(standard error of the mean (SEM)] of 12.04 (1.03) ng/mL. Both 25OHD3 and interleukin 6 (IL-6) levels significantly declined (p < 0.001) during the early post-fracture phase. A greater decline in 25OHD3 levels was significantly associated with longer hospital stay (p = 0.042, multivariate analysis). Serum 25OHD3 levels were also associated with cognitive status as assessed using the MMS exam. CONCLUSIONS: 25OHD3 levels were reduced in OHF patients at admission, and significantly decreased during the first 8 days post-admission. 25OHD3 levels were associated with MMS-assessed cognitive status. A greater decline in serum 25OHD3 was associated with a longer hospital stay

INTRODUCCIÓN: la vitamina D se ha relacionado con la recuperación tras la fractura osteoporótica de cadera (FOC). Estudios previos muestran un descenso de los niveles de vitamina D en la fase precoz tras la fractura. OBJETIVOS: evaluar: a) los niveles séricos de 25-hidroxivitamina D3 (25OHD3) al ingreso y a los 8 días del ingreso en hospitalizados por FOC; b) la relación de los niveles de 25OHD3 con los resultados clínicos, así como con el nivel cognitivo y funcional. MÉTODOS: estudio prospectivo de 66 pacientes (> 65 años) ingresados por FOC. Se estudiaron las características demográficas, los antecedentes personales, la valoración nutricional, el test Mini Mental State (MMS), el cuestionario Activities of Daily Living (ADL), el tipo de fractura y de cirugía, y parámetros bioquímicos del metabolismo óseo, la 25OHD3, la albúmina y la interleuquina 6. Como resultados clínicos se analizaron: estancia hospitalaria, complicaciones y mortalidad durante el ingreso. El análisis estadístico consistió en: a) prueba de la t para las variables continuas y χ2 para las cualitativas; b) análisis multivariable utilizando modelos de regresión lineal ajustados según el análisis de la covarianza. RESULTADOS: la población estudiada muestra niveles bajos de 25OHD3 al ingreso: media [± error estándar de la media (EEM)] = 12,04 (1,03) ng/mL. Durante el ingreso, 25OHD3 e interleuquina 6 decrecen significativamente (p < 0,001). El descenso de 25OHD3 se asocia con la estancia hospitalaria (p = 0,042 en análisis multivariable). Los valores disminuidos de 25OHD3 se asocian a un bajo nivel cognitivo (p = 0,042). CONCLUSIONES: los pacientes ingresados por fractura osteoporótica de cadera tienen niveles bajos de 25OHD3 que decrecen significativamente tras 8 días de ingreso. El descenso de 25OHD3 se asocia significativamente a la estancia hospitalaria. Los niveles disminuidos de 25OHD3 se asocian a un peor estado cognitivo evaluado mediante el MMS

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Effect of cefazolin and cefuroxime on fracture healing in rats.

OBJECTIVE: To determine the effect of cefazolin and cefuroxime (the two most commonly used beta lactam antibiotics) at therapeutic doses in fracture healing in an animal model. MATERIAL AND METHODS: 75 adult male wistar rats (3months old) were selected. They were divided into three groups of 25 animals each (placebo, cefazolin and cefuroxime). A closed fracture was made in the middle third of the right femur of each rat and fixed with a Kirschner wire. Each group was treated with either saline (placebo), cefazolin or cefuroxime at therapeutic doses during fracture healing. Four weeks after fracture rats were killed and femora analysed through mechanical and histological testing. RESULTS: The group treated with cefuroxime showed a lower mechanical resistance of the healing callus and a lower histological grade than placebo. The group treated with cefazoline showed a similar mechanical resistance and histological grade of callus to placebo. CONCLUSION: Cefuroxime appear to disturb fracture healing more than cefazolin or placebo in Wistar rats. If those results are similar to human, the use of cefuroxime during fracture healing should be avoided in the clinical setting, if possible.

Lesiones de la porción larga del bíceps / Long biceps tendon injuries

Se ha realizado una revisión de las lesiones que ocurren en el tendón de la porción larga del bíceps, desde su inserción proximal, hasta las lesiones más distales del mismo, incluyendo aquellas que se dan a lo largo de la polea bicipital. Partiendo del análisis de la anatomía de dicha región, profundizaremos en las lesiones, su diagnóstico y tratamiento más actuales; para concluir, en la importancia que posee el conocimiento de las variantes anatómicas, el estudio de imagen y el manejo terapéutico, fundamentalmente artroscópico, para obtener un adecuado manejo de estas lesiones

A review of the long bíceps tendon has been mad, from it insertion until the more distal lesions, including the pulley biceps injuries. Describing the anatomy, injuries, diagnoses and treatment, concluding in the importance of knowing anatomical variations, imaging studies and the arthroscopic treatment, for a proper management of these injuries

Técnicas actuales de reparación nerviosa / Current techniques in peripheral nerve repair

Las lesiones del sistema nervioso periférico son uno de los retos terapéuticos de nuestra especialidad, no sólo por la dificultad técnica e instrumental necesaria para resolverlas, sino por la importancia de sus secuelas y los pobres resultados obtenidos con una deficiente técnica quirúrgica. Para obtener un óptimo resultado, es preceptivo, no sólo realizar un correcto diagnóstico, sino además, conocer y dominar las distintas opciones terapéuticas. El objetivo de la presente revisión es abordar las distintas indicaciones y técnicas quirúrgicas usadas actualmente para el tratamiento de las lesiones nerviosas

The injuries of the peripheral nervous system are one of the therapeutic challenges in our speciality given their technical and instrumental difficulty, the importance of the disability and the few results obtained with a deficient surgical technique. For an optimum result, a correct diagnosis is needed as well as to know and to dominate the different therapeutics options. The objetive of the current review is to deal with the different indications and surgery techniques currently used for the treatment of the nervous injuries

Kinesiotaping. Evidencia actual / Kinesiotaping. Current evidence

En este artículo se revisa la función y el uso de los vendajes tipo Kinesiotaping en la medicina deportiva actual y la Ortopedia. Se estudian las diferentes lesiones dentro de la medicina del deporte en la cual se pueden usar y la evidencia clínica existente. Esta revisión concluye que la utilidad del kinesiotaping es confusa. La literatura no aporta evidencia clínica probada sobre el uso de este vendaje e incluso podría intuirse un fin mercantilista en su uso

This paper reviews the function and use of Kinesiotaping in today’s Sports Medicine and Orthopedics. The different sports medicine injuries in which could be used and the current clinical evidence are reviewed. This review concludes the utility of Kinesiotaping is not clear. Literature shows lack of proved clinical evidence about the use of this bandage and even a mercantilist purpose could be suspected

El uso del manguito de isquemia en COT / The use of tourniquet in orthopaedic surgery

El uso del manguito de isquemia es muy habitual en cirugía ortopédica y traumatología. Las recomendaciones básicas actuales son utilizar un manguito lo más ancho posible, bien almohadillado, y lo más distal posible. La extremidad debe exanguinarse con venda de esmarch o mediante elevación, al menos 5 minutos tras la administración del antibiótico profiláctico de la cirugía (si procede). Nunca se debería mantener durante más de dos horas, y en todo caso, siempre el menor tiempo posible. La presión también debe ser la mínima, recomendándose actualmente usar la presión de oclusión del miembro (LOP) más un margen de seguridad. Si se va a cementar, se recomienda usar isquemia, al menos durante el momento de la cementación. Las complicaciones son raras y casi siempre debidas al mal empleo del torniquete. La más frecuente es el dolor postoperatorio. Cada vez se está usando más el manguito en combinación con técnicas de anestesia troncular (muñeca y tobillo). Las contraindicaciones absolutas para el uso del manguito son la neuropatía periférica, la trombosis venosa profunda, la enfermedad de Raynaud, y la enfermedad vascular periférica

Application of tourniquet during surgery is very common in Orthopaedics. General guidelines are to use a cuff as wide as possible, to pad the tourniquet properly, and to place it distally. The limb should be exanguinated, by elevating and/or using an Esmarch bandage, at least five minutes after the administration of prophylactic antibiotic. The tourniquet should never be hold more than two hours, and in any case, it should be released as soon as possible. Use of lowest effective inflation pressure is the standard, moreover, use of the Limb Occlusion Pressure (LOP) with a safety margin has been currently advocated. It is also recommended to use the tourniquet at least during cementation. In addition, combination of tourniquet with regional anesthesia techniques (wrist and ankle) is becoming more popular. Complications are rare and usually due to a wrong use of the tourniquet. The most common is postoperative pain. Absolute contraindications for the tourniquet are peripheral neuropathy, deep vein thrombosis, Raynaud’s disease and peripheral vascular disease

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Effect of levobupivacaine on articular chondrocytes: an in-vitro investigation.

BACKGROUND: Intra-articular injection of local anaesthetics is a technique commonly used to enhance postoperative analgesia following arthroscopic surgery. However, the potential for cartilage damage due to toxicity of intra-articular local anaesthetics is a concern. Most studies indicate that the toxic effect is drug and time dependent. OBJECTIVES: The objective of this study is to compare the in-vitro chondrotoxic effect of levobupivacaine on human cartilage with saline and bupivacaine. DESIGN: An experimental study. SETTING: University hospital. PARTICIPANTS: Adult patients undergoing knee surgery. INTERVENTIONS: Human articular cartilage was harvested and removed from five patients during knee replacement surgery. Chondrocytes were cultured and divided into three groups exposed to bupivacaine 0.5%, levobupivacaine 0.5% or physiological saline for 15, 30 or 60 min. MAIN OUTCOME MEASURES: Viability of human cartilage cells after contact with the different study drugs at different durations of exposure using two techniques: live/dead cell viability flow cytometry analysis and trypan blue exclusion assay. RESULTS: At 1 h of exposure, chondrocyte mortality in cartilage explants was significantly greater after treatment with levobupivacaine or bupivacaine than with saline (25.9% ±â€Š14.1, 20.7% ±â€Š10.4 and 9.6% ±â€Š5.4, respectively). No differences between groups were found when exposure to the experimental drug was limited to 15 or 30 min. CONCLUSION: In-vitro 0.5% levobupivacaine is more chondrotoxic than saline in human articular cartilage after 1 h of exposure. Bupivacaine seems to be less chondrotoxic than levobupivacaine. With shorter exposures, no clear chondrotoxic effect was shown.

Renovación de la revista: adaptándonos al siglo XXI / Renovation of the journal: Adapting to the XXI century

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Protein intake and fracture risk in elderly people: a case-control study.

BACKGROUND & AIMS: We investigated whether protein intake (PI) is related to osteoporotic fractures (OP) in the elderly by analyzing vegetable protein intake (VPI), animal protein intake (API), and animal/vegetable protein intake ratio (AVR) and by calcium intake (CaI). METHODS: A 1:1 matched by age and sex case-control study with 167 cases was carried out at the Hospital of Jaen (Spain). Cases were patients aged ≥65 years with a low-energy fracture. Controls were people without previous fractures. Diet was assessed by a food frequency questionnaire. Multivariable analyses were fitted using analysis of covariance (for comparison of adjusted means) and conditional logistic regression (estimating adjusted odds ratios [ORs]). RESULTS: The control-group showed a higher API (p = 0.046) even when CaI was <800 mg/day (p = 0.041). ORs for AVR were 0.68 (0.38-1.19) and 0.38 (0.15-0.98), respectively with a p for trend = 0.046. A PI<15% of the total energy intake showed an OR of 2.86 (1.10-7.43). CONCLUSIONS: Patients with fracture history have lower API suggesting that high API reduce the occurrence of OP in elderly even if CaI is <800 mg/day. A PI<15% of total calories were associated with an increased risk of OP in elderly.

Vitamina C y riesgo de fractura osteoporótica en mujeres ancianas no fumadoras. Un estudio de casos y controles / Vitamin C and risk of osteoporotic fracture in non-smoking elderly women. A case-control study

Fundamento: La vitamina C es fundamental para el tejido óseo y es necesaria para mantener la estructura del colágeno. Esta vitamina se ha relacionado tanto con la masa ósea como con el riesgo de fractura, con diferentes resultados. Objetivo: Determinar si la vitamina C (dietética y sérica) se relaciona con las fracturas osteoporóticas en ancianas no fumadoras. Pacientes y método: Estudio de casos y controles de base secundaria (135 casos, 135 controles). Los casos son mujeres no fumadoras de 65 años o más con antecedentes de fractura osteoporótica. Los controles (mujeres no fumadoras sin antecedentes de fractura) se seleccionaron emparejados con los casos 1:1 según edad. Se realizó valoración dietética mediante cuestionario de frecuencia de consumo. La vitamina C sérica se determinó por cromatografía líquida de alta resolución. Se realizaron análisis multivariables ajustando por variables de confusión usando análisis de covariancia (comparación de medias ajustadas) y regresión logística condicional (estimación de odds ratio [OR] ajustada). Resultados: Hay diferencia significativa entre casos y controles en los valores de vitamina C sérica, más altos en los controles (p = 0,0088). La asociación entre vitamina C sérica y riesgo de fractura muestra una tendencia lineal (p = 0,036), con disminución significativa del riesgo en el tercero (OR = 0,21; intervalo de confianza [IC] del 95%, 0,07-0,65) y el cuarto cuartil (OR = 0,30; IC del 95%, 0,09-0,99). No se ha encontrado resultados significativos para la vitamina C dietética. Conclusiones: La vitamina C sérica está disminuida en las ancianas con fractura osteoporótica, lo que indica que aumenta el riesgo de fractura cuando las concentraciones de vitamina C son bajas (AU)

Background: Vitamin C is essential for bone tissue as it is required for collagen synthesis. Levels of vitamin C have been related both to bone mass and the risk of fracture, with differing results. Objective: To determine whether there is an association between vitamin C intake and vitamin C blood concentrations and the risk of osteoporotic fracture in elderly non-smoking women. Patients and method: A hospital-based case-control study (135 cases, 135 controls) was carried out. Cases were defined as non-smoking women aged 65 or more years old with a history of low-energy fracture. Controls were non-smoking women with no history of fracture, matched by age with the cases. Diet was assessed by a semiquantitative questionnaire on the frequency of food intake. Serum vitamin C levels were measured using high-performance liquid chromatography. Multivariate analyses were adjusted for confounding factors using analysis of covariance (comparison of adjusted means) and conditional logistic regression (for estimating adjusted odds ratios). Results: Vitamin C blood levels were significantly higher in controls than in cases (p = 0.0088). Analysis of the association between vitamin C and fracture risk showed a linear trend (p = 0.036) with a significantly reduced risk for the two upper quartiles (third quartile, OR = 0.21; 95% CI, 0.07-0.65); fourth quartile, OR = 0.30; 95% CI, 0.09-0.99). Vitamin C intake showed no association with the risk of fracture. Conclusions: Serum vitamin C concentrations were lower in cases with osteoporotic fractures than in controls, suggesting that low vitamin C levels increase the risk of fracture (AU)

Vitamin C, vitamin B12, folate and the risk of osteoporotic fractures. A case-control study.

Water-soluble vitamins influence the development of an adequate structure of bone tissue, but there is scant information relating them with osteoporotic fractures. We analyze whether serum vitamin C, vitamin B12, and erythrocyte folate, or dietary intake of vitamin C and folate, are related with osteoporotic fractures in the elderly. A hospital-based case-control study was carried out at the Hospital of Jaén (167 cases, 167 controls), Spain. Cases were defined as patients aged 65 or more years with a low-energy fracture. Controls were people without fracture, matched for age and sex with cases. Diet was assessed by a semi-quantitative food frequency questionnaire. Serum vitamin C was measured using high-performance liquid chromatography (HPLC). Folic acid and vitamin B12 were measured using procedures of competitive or immunometric immunoassay. Multivariable analyses were also fitted to adjust for confounding using analysis of covariance (for the comparison of adjusted means) and conditional logistic regression (for estimating adjusted odds ratios). A statistically significant difference between cases and controls for vitamin C blood levels was found, being higher for controls (p = 0.01). Analysis of the association between serum vitamin C and fracture risk showed a linear trend (p = 0.03) with a significantly reduced risk for the upper quartile (OR = 0.31; 95% CI 0.11-0.87). The intake of vitamin C, folic acid, and B12 was not related to fracture risk, nor was there any association with erythrocyte folate or serum vitamin B12. In conclusion, serum vitamin C levels were lower in cases with osteoporotic fractures than in controls.