Utility of fragility fracture prediction tools in a group of postmenopausal women.

OBJECTIVES: Fractures are a common complication of osteoporosis. The main aim of our study was to assess the relation between fractures identified as low energy fractures (fragility), bone mineral density (BMD), trabecular bone score (TBS), and handgrip in a group of postmenopausal women. An additional aim was to determine the relation between fragility fractures and age, height loss, and falls (reported in the last 12 months and 5 years). MATERIAL AND METHODS: The study was conducted in a group of 120 (mean age 69 years; 59-81, SD 5.3) postmenopausal patients who were referred to the Medical Centre for an osteoporosis screening appointment by their general practitioner. All patients were interviewed (with a questionnaire containing questions on fracture risk factors and highest height), had their anthropometric measures taken (current height and weight) as well as TBS analysis following their DXA (dual-energy X-ray absorptiometry) scan and handgrip measure. RESULTS: Sixty patients from the study group had a history of fractures (with a total of 92 fractures), of whom 39 women (76 fractures) were identified as those with a low-energy fracture. Fragility fractures were more likely to be reported in older patients (Me 71 vs. 68 years, p < 0.05). Differences observed between TBS, handgrip and BMD in reference to fragility fractures were not statistically significant. Analysis showed significant correlations between BMD (neck and L1-L4) and TBS fracture risk categories. Falls reported in the last 5 years and height loss were factors which correlated with fragility fractures (p < 0.05). CONCLUSIONS: Risk of fragility fractures increases with age. Bone mineral density is insufficient as a fracture risk assessment tool. Information on falls and height loss may provide additional data on fracture risk assessment.

Relation between risk of falls, sarcopenia and parameters assessing quality of skeletal muscles in a group of postmenopausal women.

INTRODUCTION: Involutional changes that occur in skeletal muscle are a feature that characterizes the aging process. In women, age-related decreases in muscle mass and function of skeletal muscles occur more rapidly with the onset of menopause. Progressive muscle dysfunction has been directly linked with an increased probability of falls, fractures, disability and mortality. AIM OF THE STUDY: To assess the relationship between the risk of falls and parameters of skeletal muscle assessment in a group of postmenopausal women together with the identification of patients with sarcopenia. MATERIAL AND METHODS: This study was carried among 122 women over 60 years of age. Patients had their muscular system tested with the emphasis on the sarcopenia diagnosis using: Total Body Composition, handgrip and physical performance tests. Patients also underwent a questionnaire survey assessing occurrence of falls. RESULTS: The analysis showed an over 2-fold increase (OR 2.4; 95% CI, 1.02-5.56) in risk of falls in a year among subjects with decreased muscle mass. No such correlation was noted with parameters such as falls in the last 12 months and decrease of muscle strength as well as physical performance. Sarcopenia is more likely to be diagnosed with European Working Group on Sarcopenia in Older People (EWGSOP1) criteria than EWGSOP2 (updated in 2018) (18% vs. 4.1% respectively). The increased risk of falls has not been proven in women with sarcopenia. CONCLUSIONS: The decrease of muscle mass is significantly correlated with the risk of falls in the last year in postmenopausal women. Impact of sarcopenia on the risk of falls depends on diagnostic criteria.

Age and Sex Are Strongly Correlated to the Rate and Type of Mountain Injuries Requiring Search and Rescue Missions.

INTRODUCTION: Because of the growing popularity of mountain tourism, the number of injuries related to mountain activities has increased rapidly. The regional volunteer search and rescue team (Tatra mountain rescue team [MRT], Poland) anticipates future increases in injuries and accidents. METHODS: An analysis was performed on Tatra MRT incident reports for the years 2012 through 2013. These reports include information on the mechanism of injury, weather conditions, and demographic data of the injured tourists. The data were provided by the operation supervisor of each search and rescue mission. The study group consisted of 844 reports (median age 37 y, range 18-90 y). The analysis was designed to determine whether features such as age and sex of the injured tourist were correlated to the injury mechanisms (as identified by the rescuers) or their National Advisory Committee for Aeronautics-International Committee for Alpine Rescue (NACA ICAR) score. RESULTS: Our study of the Tatra MRT data revealed that age and sex are risk factors for the rate and severity of injuries in the mountain environment. Injured men were more likely to require resource-intensive search and rescue missions and usually had a worse NACA ICAR score (P=0.041). The age analysis showed that older people are more likely to sustain a serious injury (3-7 NACA ICAR score). However, the most common rescue scenario involved younger males (20-40 y) at a higher altitude (>1500 m, P<0.001). CONCLUSIONS: Sex and age are associated with the mechanisms and severity of injuries in the mountain environment. They should be considered in the development of appropriate prevention and response programs. Further studies are needed to confirm the results.

Vertebral fracture assessment, trabecular bone score and handgrip in a group of postmenopausal women with vertebral fractures - preliminary study.

OBJECTIVES: The aim of our study was to determine a possible correlation between vertebral fractures (indicated by VFA - vertebral fracture assessment), TBS (trabecular bone score) and muscle strength (measured by means of handgrip strength test results) in a group of postmenopausal women. MATERIAL AND METHODS: The study was conducted between 2014 and 2015 in a group of patients of Krakow Medical Centre (KMC). Women who participated in the study were referred to KMC by an attending physician for suspected vertebral fracture. Apart from VFA, patients were additionally tested for bone density (including TBS), muscle strength (by means of a handgrip strength test) and height loss. Altogether 35 patients with an average age of 69.7 years (49-95, SD = 10.49) were included in the study. RESULTS: In the group of 35 women, VFA analysis demonstrated vertebral fractures in 17 patients (40%). Vertebral height loss suggesting a fracture was revealed in 77 vertebrae. The mean result of the TBS was 1.195 (0.982-1.409, SD = 0.09), which suggests high risk of fracture. The majority of the subjects (65.7%) displayed major bone microarchitecture degradation (TBS < 1.23) and also the highest number of fractures (n = 62, 80.5% of all). There was no correlation between the spine bone mineral density (BMD) score and the TBS result, which confirms studies showing that subjects with the same bone density may have completely different TBS. Bone density (spine BMD) was similar (osteopenic) in groups with or without vertebral fracture (in VFA). We noted a significant correlation (r = 0.45, p < 0.05) between the number of fractured vertebrae and the handgrip score. CONCLUSIONS: VFA should be a part of a standard diagnostic procedure for patients with osteoporotic fractures. When it comes to identifying patients at risk of fracturing vertebrae, muscle strength (handgrip) may have potential use in clinical practice. The predictive value of the TBS in reference to vertebral fractures should be evaluated in bigger randomized studies.

Fracture Liaison Services - Polish Experience. Methods of Secondary Prevention of Osteoporotic Fractures.

BACKGROUND: Fragility fractures are a major challenge to health systems around the world. The risk of a subsequent fracture may increase even 11-fold after one's first fracture event. A coordinator-based system (Fracture Liaison Services) was established in Poland in order to fill the gap in the care of patients with osteoporotic fractures. In the past years, the FLS has become a crucial part of orthopaedic facilities worldwide, bringing benefits to patients and savings to health systems' budgets. MATERIAL AND METHODS: In 2015, the European Foundation of Osteoporosis and Musculoskeletal Diseases (EFOM) implemented the FLS in Poland under the name "System Zapobiegania Zlamaniom (SZZ)". It was established in 16 centres in different parts of Poland. During the preparation phase, 42 healthcare professionals from 17 sites participated in courses organized by EFOM. RESULTS: A total of 1,579 patients were included in the SZZ, with a total of 746 DXA scans performed in that group. Patients were educated about osteoporotic fractures, including the methods of prevention (causes of fractures, problem of falls, vitamin D and calcium supplementation). The number of patients receiving antiresorptive treatment increased by 74.1%. The percentage of patients taking vitamin D and calcium supplements increased by an average of 10.8%. Although all the participating patients had suffered a fragility fracture, only 42% fulfilled the WHO clinical criteria for osteoporosis. CONCLUSIONS: 1. The implementation of the Fracture Liaison Service concept in Poland is possible and beneficial for the patients and healthcare system. 2. The current WHO definition of osteoporosis might be insufficient. 3. The use of an integrated database in different facilities, in terms of fracture epidemiology, significantly improves the quality of data being collected.

Cost-effectiveness analysis of treatment of osteoporotic fractures in relation to FRAX algorithm in a sample of Polish population.

BACKGROUND: The increasing incidence of osteoporotic fractures is becoming a growing burden on the health service. Due to the high cost of treatment, these fractures require a broader look at the underlying problem. The aim of the study was to assess the 10-year probability of hip fracture or any other major osteoporotic fracture at which the treatment becomes cost-effective. MATERIAL AND METHODS: This was a retrospective study of a group of 1,024 patients. The cost-effectiveness of pharmacological low-energy fracture prevention was analyzed by means of the medication defined as the reimbursement limit basis in the reimbursement limit group 147.0. (medications used in bone diseases) in July 2013 (Alendrogen 70 mg). 3- and 5-year therapies were analysed. The outcome was compared with the results of FRAX® (of the Polish and British population) in every patient. RESULTS: The model for calculating cost-effectiveness showed that treatment after the age of 50 until the age of 60-65 years is cost-effective at a similar level of 10-year major fracture probability (regardless of treatment duration). After the age of 65, there is a clear decline in the profitability of the therapy. The results indicate that, for the population of women aged >50 years, the treatment is cost-effective when the 10-year major fracture probability equals 5.1% and 6% for a 3- and 5-year therapy, respectively. CONCLUSIONS: 1. The study showed pharmacological treatment to be cost-effective in a large group of patients forming the study population. 2. The analysis also revealed a strong correlation between study results and the specific tool employed to define fracture probability.

[The causes of falls and injuries after falls in women over the age of 50 living alone in Krakow]. / Przyczyny upadków i urazów po upadkach u kobiet powyzej 50 roku zycia zyjacych samodzielnie w Krakowie.

INTRODUCTION: Falls are one of the most devastating health problems of elderly people. The identification of causes of falls helps to establish proper prevention strategies. MATERIAL AND METHOD: The study was based on a group of community-dwelling, independent women aged over 50 years. The frequency of falls was calculated on the basis of a retrospective analysis of 1326 cases. 100 women were chosen for a telephone questionnaire to identify causes and consequences of falls. The average age was 63.9 (SD 8.6) and the average BMI was 27.6 (SD 5.4). RESULTS: Approximately 31% of 1326 women reported at least one fall a year. In the year preceding the questionnaire 62% of the participants reported one fall, 26%--two falls, 8%--three falls and 5%--four and more falls. In the surveyed group of 100 women 72% of falls occurred outdoors, which is 2.5 times more often than at home (28%). 68% of falls occurred between 12 pm and 6 pm. Summer is the season of the highest occurrence of falls (37%). In winter, the frequency of outdoor falls increases, whereas during summer the frequency of falls happening in and outdoors does not differ. The most frequent cause of falls, both in and outdoors, was slipping. Other important risk factors include: hypnotic drugs, walking impairments, balance deficit, vertigo, analgesics. Most of the falls had various intrinsic and extrinsic causes. KEY POINTS: We found that 30% of women aged over 50 years falls at least once a year. Both at home and outside falls resulted from slipping. For almost 80% of falls as a consequence of an injury. The majority of falls had intrinsic and extrinsic origins.

Fracture risk prediction in outpatients from Krakow Region using FRAX tool versus fracture risk in 11-year follow-up.

INTRODUCTION: FRAX is a an algorithm accepted by WHO for evaluating fragility fracture risk of women aged 40 years or more. The aim of this study was to use the FRAX tool to verify the risk of fractures in a population of women from the Cracow region in an 11-year follow-up. MATERIALS AND METHODS: The study was a retrospective cohort survey evaluating the incidence of fragility fractures over 11 years of follow-up. 5,092 women aged 50 years and more were randomly chosen from a group of 100,000 female patients of the Cracow Medical Centre who came to the Centre for densitometric examination between 1997 and 2001. Finally, 1024 patients were randomized into the study. After an average of 11 years a follow-up telephone survey was conducted among a randomly selected group of patients using a questionnaire corresponding to the one applied in the first survey. 10-year fracture risk was calculated for each patient using FRAX based on the BMI (Body Mass Index) and for 886 women using FRAX based on BMD (Bone Mineral Density) at the femoral neck. The Polish version of FRAX was validated by comparing the predicted risk with the actual incidence of fractures during the 11-year follow-up. RESULTS: The 10-year probability of a major osteoporotic fracture calculated using FRAX based on BMI for the entire group was 5.3% (median, 1st/3rd quartile: 3.5-8.5%) and the probability of a proximal femur (hip) fracture was 1.3% (median, 1st-3rd quartile: 0.7% -2.4%). In 886 women whose BMD T-score at the femoral neck was available, the mean probability of a major osteoporotic fracture was 4.9% (3.3-7.9%) and of a hip fracture 0.9% (0.3-2.3%). The actual absolute fracture risk calculated on the basis of the number of patients who had experienced a fracture during the follow-up was surprisingly much higher than the predicted figure. The risk of a major fracture in the study group was 17.7% and of a proximal femur fracture, 3%. CONCLUSION: In our opinion, FRAX is a very good screening tool, but not a precise diagnostic tool.

Epidemiology, clinical significance, costs and fall prevention in elderly people.

Falls are the fifth most frequent cause of death among elderly people. They are one of the main causes of disability and reduction in the quality of life in this age group. Falls are the direct cause of the majority of limb and femoral neck fractures. Fall prevention is a difficult, expensive and underestimated problem in Poland. 30-40% of women aged 65 years or older experience a fall at least once a year. Falls lead directly to fractures in 5% of those living on their own and 20% of hospital inpatients. Underlying a fall are dysfunctions of multiple organs and the influence of external factors. About 400 different fall risk factors have been described. It has been demonstrated that the risk of falls can be decreased by as much as 40% provided that the patient is treated by a multidisciplinary team of specialists. Standard procedures of care have already been developed in Europe and in the world. This paper presents current knowledge on the epidemiology, significance and costs of treatment of complications of falls in elderly people.

Causes of falls in women in Krakow population.

INTRODUCTION: Falls rank among the most serious medical problems in elderly persons, having psychological as well as social consequences. With several hundred fall risk factors known at present, it is necessary to select those that occur most frequently in a particular population. Only then will it be possible to implement effective fall prevention programmes with the aim of increasing awareness of the causes and consequences of falls in elderly persons. The aim of the study was to identify the profile of circumstances of falls in the population of women from Krakow above 50 years of age. MATERIAL AND METHODS: This paper presents the results of a pilot study carried out as a telephone survey. RESULTS: The study population of 50 women experienced 77 falls. The results served to estimate that over half of the women fell once in a year, with most falls occurring in summer as well as during the day. Among the environmental causes of falls outdoors, over 70% were attributable to slippery ground and uneven surface. 56% of the women were taking antihypertensive and cardiovascular drugs and 54% received at least two medications at the same time. Environmental causes were more important than health-related causes of falls. CONCLUSIONS: 1. A fall is most frequently the result of several causes. 2. While the study data need to be verified against a bigger study population, they are an important source and basis for further studies.