Feasibility of Using Fat Degeneration of Lumbar Extensor Muscle as an Alternative Diagnostic Criterion for Sarcopenia in Patients with Osteoporotic Vertebral Fractures.

STUDY DESIGN: Feasibility study. PURPOSE: To investigate the feasibility of using fat degeneration of lumbar extensor muscle (LEM) as an alternative diagnostic criterion for sarcopenia in patients with osteoporotic vertebral fractures. OVERVIEW OF LITERATURE: Although sarcopenia has been gaining increased attention among researchers and healthcare practitioners, there is uncertainty about the association between sarcopenia and fat degeneration of LEM. METHODS: In this study, 33 patients with osteoporotic vertebral fractures (group 1) and 29 patients without such fractures (group 2) were enrolled. Sarcopenia was diagnosed in accordance with the Asian Working Group for Sarcopenia (AWGS) criteria, including assessment of extremity muscle mass using dual-energy X-ray absorptiometry, grip strength, and gait speed. The bone mineral density and fat degeneration of LEM were investigated using magnetic resonance imaging. RESULTS: The mean rates of fat degeneration of LEM and the skeletal muscle index were 38.3% and 5.5 kg/m2 in group 1 and 28.9% and 6.3 kg/m2 in group 2, respectively. The fat degeneration of LEM was negatively correlated with gait speed (r=-0.44, p=0.01) and handgrip strength (r=-0.37, p=0.01). The fat degeneration of LEM also demonstrated a significant relationship with osteoporotic vertebral fractures (p=0.01). Receiver operating characteristic curve analysis between fat degeneration of LEM and osteoporotic vertebral fractures showed that the cut-off value of fat degeneration was 31.9% (sensitivity=0.67, specificity=0.66). There was a positive correlation between sarcopenia defined by the AWGS and that defined by the 31.90% cut-off value of fat degeneration of LEM instead of extremity muscle mass (r=0.46, p=0.01). CONCLUSIONS: These results suggest the feasibility of using fat degeneration of LEM as an alternative diagnostic criterion for sarcopenia in patients with osteoporotic vertebral fractures. A cut-off value of fat degeneration of LEM of 31.9% was shown to be useful for diagnosing osteoporotic vertebral fractures.

Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures.

PURPOSE: To evaluate the success rate of fixation approaches for greater trochanter (GT) fracture types in those with unstable intertrochnateric fractures. MATERIALS AND METHODS: Forty-four patients who underwent arthroplasty for unstable intertrochanteric fractures between January 2015 and November 2017 and followed-up more than six months were included in this study. The fractures of GT were classified into one of four types (i.e., A, B, C, and D) and fixed using either figure-8 wiring or cerclage wiring according to fracture type. Fractures were type A (n=7), type B (n=20), type C (n=6), and type D (n=11). Type A and B, which are fractures located above the inferior border of GT were fixed using figure-8 wiring and/or adding cerclage wiring. On the other hand, all type C and D fractures, which were located below the inferior border, were fixed using cerclage wiring. Fixation failure was defined as breakage of wire and progressive migration of GT fragment greater than 5 mm on follow-up radiographs. RESULTS: The most common GT fracture types were B and D, both of which are longitudinal fractures. The success rates of fixation were 85.7% (6 out of 7 cases) for the treatment of type A, 90.0% (18 out of 20 cases) for the treatment of type B, and 100% for the treatment of types C (6 out of 6 cases) and D (11 out of 11 cases). CONCLUSION: We note high success rates following fixation methods were selected based on the GT fracture type.

Feasibility of Serum Pentosidine Level as a Potential Risk Factor for Osteoporotic Vertebral Compression Fracture.

STUDY DESIGN: Feasibility study. PURPOSE: To evaluate the feasibility of using serum pentosidine level as a potential marker for osteoporotic vertebral compression fracture (OVCF). OVERVIEW OF LITERATURE: A review of previous studies suggests a negative correlation between serum pentosidine concentration and bone strength. However, it is unclear whether serum pentosidine level might be a potential marker of OVCF in Koreans. METHODS: Forty patients who underwent bone mineral density examination were included in this study, and their serum pentosidine levels were prospectively analyzed. Serum pentosidine level was evaluated using enzyme-linked immunosorbent assay. Among all the patients, 11 with OVCF were assigned to the vertebral fracture group and 29 who did not have vertebral fracture were included in the non-fracture group. In addition, we used the Fracture Risk Assessment (FRAX) tool Korean version for assessing the 10-year probability of fracture. RESULTS: There was a statistically significant difference in the mean serum pentosidine level (p=0.04) of the vertebral fracture group (110.8 ng/mL) and the non-fracture group (64.3 ng/mL). Logistic regression analyses showed that serum pentosidine was significantly associated with OVCF. The vertebral fracture group had significantly higher 10-year probability of major osteoporotic fracture as per FRAX than the non-fracture group. There was a positive correlation between pentosidine level and FRAX results (r=0.35, p=0.02). CONCLUSIONS: These results suggest that increased serum pentosidine level could be a potential marker for OVCF.