Efficacy and Safety of Generic Alendronate for Osteoporosis Treatment.

Background: While osteoporosis increases the risk of fragility fractures, bisphosphonate has been proven to increase bone strength and reduce the risk of vertebral and non-vertebral fractures. In addition to its efficacy, substituting the brand with generic medication is a strategy to optimize healthcare expenditures. This study aimed to evaluate the efficacy of generic alendronate treatment and assess potential adverse events in patients with osteoporosis. Materials and Methods: A retrospective review was conducted on 120 patients who met the indications for osteoporosis treatment, received weekly generic alendronate (70 mg) for >1 year, and underwent evaluation through standard axial dual-energy X-ray absorptiometry (DXA). The outcomes of this study were the percent change in bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip after one year of treatment. The major adverse events occurring during medication that led to the discontinuation of drug administration were documented. Results: Most patients were female (96.7%) with an average age of 69.0 ± 9.3 years. The percent change in BMD increased at all sites after one year of generic alendronate treatment (lumbar spine: 5.6 ± 13.7, p-value <0.001; femoral neck: 2.3 ± 8.3, p-value = 0.023; total hip: 2.1 ± 6.2, p-value = 0.003), with over 85% of patients experiencing increased or stable BMD. Three patients discontinued the medication due to adverse effects: two had dyspepsia, and one had persistent myalgia. Conclusion: Generic alendronate may be considered an effective antiresorptive agent for osteoporosis treatment with a low incidence of adverse effects.

The Current Concept and Evidence-Based Practice in the Base of the First Metacarpal Bone Fracture.

Repetitive instances of sudden injuries to the first metacarpal bone can affect thumb movement. These injuries typically occur after vertical impact to the thumb. The treatment for these injuries should focus on restoring the structure and biomechanics of the trapeziometacarpal joint, with surgery being recommended for optimal results. Bennett's fracture involves the bifurcation of the bone into two distinct fragments, characterized by a smaller fragment and a larger counterpart. Rolando fracture is associated with a fracture of the base of the first metacarpal bone, typically divided into three parts. An extra-articular fracture involves the metacarpal bone of the thumb. Conservative treatment outcomes have been found to be unsatisfactory when the fracture is displaced. Therefore, surgery methods such as minimally invasive surgery, open reduction, and arthroscopic surgery have been proven to be effective. Surgical techniques for bone procedures include pin fixation, direct screw fixation, indirect screw fixation, and mini-plate fixation. Additionally, the prognosis of this condition depends on the ability to restore joint mobility during rehabilitation.

The Mini-Incision Technique Versus Conventional Open Approach for Carpal Tunnel Release: A Retrospective, Comparative Cohort Study.

Background and objective Open carpal tunnel release (OCTR) is the gold standard technique for treating carpal tunnel syndrome (CTS). While mini-incision carpal tunnel release (MCTR) has been introduced as an alternative approach, there have been some concerns over its effectiveness and risks. In light of this, the aim of the study was to compare the long-standing clinical outcomes after MCTR with those following OCTR. Methods We employed a retrospective cohort design for this study. Patients were classified into two surgery groups, followed up for two years, and compared in terms of the following variables: duration of symptoms; pinch strength; grip strength; 2-point discrimination; visual analog scale (VAS) score; Levine symptom score; Levine function score; quick disabilities of the arm, shoulder, and hand (QuickDASH) score; wound pain; and pillar pain. Results The study included data regarding 120 patients, 71.66% of whom were females. The MCTR and OCTR groups were similar in terms of age, sex, duration of symptoms, and certain other aspects at baseline. The operation duration (15.15 ±2.20 vs. 25.01 ±2.15 minutes, p<0.01) and incision length (11.425 ±1.56 vs. 20.35 ±2.43 mm, p<0.01) were significantly shorter in the MCTR group compared to the OCTR group. Wound pain and pillar pain were not documented in the MCTR group at three and six months. The OCTR group had pillar pain in 25% of the patients till two years postoperatively. Conclusion Based on our findings, we propose that MCTR is superior to OCTR. The mini-incision technique has the advantages of small incision and scar, low pain, and faster recovery. Moreover, the technique was also found to be safe with no major complications or recurrence of symptoms. Further randomized control trials may help to re-evaluate the technique and validate our findings.

Perioperative Outcomes of Patients Who Were Not Candidates for Additional Nonsteroidal Anti-inflammatory Drugs in a Multimodal Pain Control Regimen for Total Knee Arthroplasty.

BACKGROUD: Postoperative pain following total knee arthroplasty (TKA) may hamper patients from a rapid recovery and increase perioperative blood loss and stress on the cardiovascular system. Therefore, our objective was to assess perioperative outcomes after TKA in patients who were not candidates for the additional nonsteroidal anti-inflammatory drugs (NSAIDs) in a multimodal pain control regimen. METHODS: Propensity score matching for age, sex, body mass index, American Society of Anesthesiologists class, and preoperative hemoglobin level was conducted on patients undergoing unilateral TKA, and thereby 52 patients remained in each group. The control group comprised patients who received parenteral parecoxib every 12 hours during the first 48 hours after TKA. The No-NSAIDs group did not receive NSAIDs because of known contraindications. Identical postoperative pain control including intravenous patient-controlled analgesia was applied for all patients. Visual analog scale (VAS) score for pain, knee flexion, blood loss, serum cardiac troponin-T (cTnT), and length of stay (LOS) were determined. RESULTS: The No-NSAIDs group had significantly higher VAS scores in 6-96 hours and consumed more morphine at 24 hours and 48 hours after the surgery than the control group. The No-NSAIDs group had significantly less knee flexion at 48 hours (p = 0.045) and tended to have more emesis and longer LOS than the control group. The blood loss of the No-NSAIDs and control group was 552.52 mL and 397.65 mL (p = 0.02), respectively, and blood transfusion rate was 23.1% and 17.3% (p = 0.63), respectively. The cTnT of the No-NSAIDs group rose over the first 48 hours and was significantly higher than that of the control group at 48 hours. CONCLUSIONS: Patients who were not candidates for NSAIDs had significantly higher pain scores and consumed more morphine after TKA. They also tended to have greater blood loss and the rising of cardiac biomarkers during the first 48 hours after TKA. Hence, these patients may benefit from supplementary analgesia and appropriate perioperative monitoring.