Clinical Score for Predicting the Risk of Poor Ambulation at Discharge in Fragility Femoral Neck Fracture Patients: A Development Study.

Surgical treatment in patients with fragility femoral neck fractures often leads to a longer length of hospital stay (LOS) and higher costs. Intensive rehabilitation is one of the choices to reduce LOS, but patient selection criteria are controversial. We intended to develop a clinical score to predict the risk of poor ambulation at discharge. This study was based on a retrospective cohort of patients diagnosed with fragility femoral neck fractures surgically managed from January 2010 to December 2019 at Chiang Mai University (CMU) Hospital. Pre-, intra-, and post-operative factors that affect rehabilitation training were candidate predictors. All patients were categorized into able or unable groups based on their ability to bear self-weight at discharge. Logistic regression was used for score derivation. Five hundred and nine patients were included in this study. Male sex, end-stage kidney disease (ESRD), cerebrovascular disease, psychiatric disorders, pre-fracture ambulation with gait aids, concomitant fracture, post-operative intensive care unit (ICU) admission or ventilator use, and urinary catheter use at second day post-operation were identified as the prognostic factors. The score showed an AuROC of 0.84 with good calibration. The score can be used for risk stratification on the second day post-operation. External validation is encouraged before clinical implementation.

Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand.

An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients' outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes.

Bone mineral density response prediction following osteoporosis treatment using machine learning to aid personalized therapy.

Osteoporosis is a global health problem for ageing populations. The goals of osteoporosis treatment are to improve bone mineral density (BMD) and prevent fractures. One major obstacle that remains a great challenge to achieve the goals is how to select the best treatment regimen for individual patients. We developed a computational model from 8981 clinical variables, including demographic data, diagnoses, laboratory results, medications, and initial BMD results, taken from 10-year period of electronic medical records to predict BMD response after treatment. We trained 7 machine learning models with 13,562 osteoporosis treatment instances [comprising 5080 (37.46%) inadequate treatment responses and 8482 (62.54%) adequate responses] and selected the best model (Random Forests with area under the receiver operating curve of 0.70, accuracy of 0.69, precision of 0.70, and recall of 0.89) to individually predict treatment responses of 11 therapeutic regimens, then selected the best predicted regimen to compare with the actual regimen. The results showed that the average treatment response of the recommended regimens was 9.54% higher than the actual regimens. In summary, our novel approach using a machine learning-based decision support system is capable of predicting BMD response after osteoporosis treatment and personalising the most appropriate treatment regimen for an individual patient.

Predicting Survival in Thai Patients After Low Impact Hip Fracture Using Flexible Parametric Modelling: A Retrospective Cohort Study.

Predictive post-hip fracture mortality models have been presented for specific time points (in-hospital, 30-days or 1-year) and most provide marginal predictions based on the patient's risk group. However, the predictive model for individual survival probability following hip fracture is not available. This study aimed to develop a flexible parametric model for predicting individual survival probability for hip fracture patients. In this retrospective study, the medical charts of 765 Thai patients admitted to hospital with a hip fracture resulting from low-impact injury from January 2014 to December 2018 were reviewed. Predictors for all-cause mortality were identified using flexible parametric survival analysis and were used to develop the predictive model. The model was calibrated using a calibration graph and discrimination performance was evaluated using the C-statistic. Internal validity was assessed using bootstrapping. The overall mortality rate of the hip fracture patients was 14%. Predictors significantly associated with survival after hip fracture were age, active malignancy, dementia or Alzheimer's disease, chronic obstructive pulmonary disorder, diabetes mellitus, hemoglobin concentration, eGFR<30 mL/min/1.73m2 and operative treatments. The model-predicted survival was similar to that actually observed in the very low survival group in the first year after hip fracture. In bootstrapping, the apparent C-statistic and the test C-statistic of the reduced model were 0.79 (95% CI 0.77-0.81) and 0.79 (95% CI 0.78-0.80), respectively. The flexible survival model provides good predictive power for individual survival probability at any given time point within the first year after hip fracture and would be an easy to use tool in clinical practice.

Prognostic Factors for All-Cause Mortality in Thai Patients with Fragility Fracture of Hip: Comorbidities and Laboratory Evaluations.

Background and Objectives: Although the types of comorbidities and laboratory evaluations are major factors associated with mortality after hip fractures, there have been no studies of the association of these factors and mortality in Thai hip-fracture patients. This study aimed to identify prognostic factors associated with mortality after a hip fracture in the Thai population, including types of comorbidities, treatment-related factors, and laboratory evaluations. Materials and Methods: This five-year retrospective study was conducted in a tertiary care hospital in Thailand. A total of 775 Thai patients who had been admitted with a hip fracture resulting from a simple fall were identified using the International Classification of Disease 10 codes, and a review of their medical charts was conducted. Associations between general factors, comorbidities, laboratory evaluations, treatment factors including type of treatment, and time to death were analyzed using the Cox proportional hazard regression and the hazard ratio (HR). Results: The overall mortality rate of hip fracture patients was 13.94%. Independent prognostic factors found to be significantly associated with mortality were nonoperative treatment (HR = 3.29, p < 0.001), admission glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 (HR = 3.40, p < 0.001), admission hemoglobin concentration <10 g/dL. (HR = 2.31, p < 0.001), chronic obstructive pulmonary disorder (HR = 2.63, p < 0.001), dementia or Alzheimer's disease (HR = 4.06, p < 0.001), and active malignancy (HR = 6.80, p < 0.001). Conclusion: The types of comorbidities and laboratory evaluation findings associated with mortality in Thai patients with hip fractures include chronic obstructive pulmonary disorder, dementia or Alzheimer's disease, active malignancy, admission GFR < 30 mL/min/1.73 m2, and admission hemoglobin concentration <10 g/dL. The risks of mortality for Thai hip-fracture patients with these comorbidities or laboratory evaluation findings were 2.5, 4, 7, 3.5, and 2.5 times higher, respectively, than patients without those factors.

Posterior tibial slope modification in osteoarthritis knees with different ACL conditions: Cadaveric study of fixed-bearing UKA.

Unicompartmental knee arthroplasty (UKA) in anterior cruciate ligament deficiency (ACLD) has been debated for decades after the development of highly cross-linked polyethylene. This study aims to evaluate the effect of posterior tibial slope on restoring adequate knee stability and flexion after UKA in patients with ACLD. A total of 15 fresh cadaveric knees were divided into three groups: intact ACL, partial ACLD, and complete ACLD. Fixed-bearing UKAs including 3-D-printed tibial inserts with the slopes ranging from 3° to 12° were performed using computer-assisted navigation. Blinded evaluation of knee motion and anterior knee translation with knees flexed 20° and 90° was conducted using KT-arthrometry and stress radiography. A 1° slope increase translated the knees anteriorly by 0.85 mm and 0.76 mm in 20° and 90° of knee flexion for a complete ACLD ( R = 0.7 and 0.8, respectively, p < 0.001) compared to 0.5-0.6 mm for the normal and partial ACLD groups, respectively. Setting a slope of 5-8° of UKA for an intact ACL maintained both the stability and the motion of native knees. No significant changes of knee translation and flexion ability were observed after leveling the slopes at 5-7° and 5-6° for partial and complete ACLD, respectively ( p > 0.05 for all comparisons). In conclusion, UKA in complete ACLD knees is challenging since 1° of slope change nearly doubles the degree of knee translation compared to ACL-intact knees. The optimum posterior tibial slopes for fixed-bearing UKA patients with partial and complete ACLD are 5-7° and 5-6°, respectively.

Differentiation of patented crystalline glucosamine sulfate from other glucosamine preparations will optimize osteoarthritis treatment.

Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are recommended for the medium- to long-term management of knee osteoarthritis (OA) due to their abilities to control pain, improve function and delay joint structural changes. Among SYSADOAs, evidence is greatest for the patented crystalline glucosamine sulfate (pCGS) formulation (Mylan). Glucosamine is widely available as glucosamine sulfate (GS) and glucosamine hydrochloride (GH) preparations that vary substantially in molecular form, pharmaceutical formulation and dose regimen. Only pCGS is given as a highly bioavailable once-daily dose (1500 mg), which consistently delivers the plasma levels of around 10 µmol/L required to inhibit interleukin-1-induced expression of genes involved in the pathophysiology of joint inflammation and tissue destruction. Careful consideration of the evidence base reveals that only pCGS reliably provides a moderate effect size on pain that is higher than paracetamol and equivalent to non-steroidal anti-inflammatory drugs (NSAIDs), while non-crystalline GS and GH fail to reach statistical significance for pain reduction. Chronic administration of pCGS has disease-modifying effects, with a reduction in need for total joint replacement lasting for 5 years after treatment cessation. Pharmacoeconomic studies of pCGS demonstrate long-term reduction in additional pain analgesia and NSAIDs, with a 50% reduction in costs of other OA medication and healthcare consultations. Consequently, pCGS is the logical choice, with demonstrated medium-term control of pain and lasting impact on disease progression. Physician and patient education on the differentiation of pCGS from other glucosamine formulations will help to improve treatment selection, increase treatment adherence, and optimize clinical benefit in OA.

Contribution of Android and Gynoid Adiposity to Bone Mineral Density in Healthy Postmenopausal Thai Women.

Dual-energy X-ray absorptiometry (DXA) is one of the major tools for assessing the whole body and regional body composition and body adiposity. Various body composition parameters including android fat mass (AFM), gynoid fat mass (GFM), and android-to-gynoid fat ratio (AG fat ratio) obtained from whole body DXA can be used as a reliable surrogate marker for regional body composition analysis. This study aimed to explore the contribution of android and gynoid adiposity to bone mineral density (BMD) in healthy postmenopausal Thai women. This cross-sectional study enrolled 1448 healthy Thai women, ages 40-90 without medication history or known disease affecting the BMD. Lumbar spine (LS), total femur, and femoral neck BMDs, AFM, GFM, and AG fat ratio were measured by DXA. To evaluate the contribution of android and gynoid adiposity with various measures of BMDs, univariable and multivariable linear regression analyses were used to estimate the regression coefficients. AFM, GFM, and AG fat ratio had a significant positive association with BMD of all measured sites (p < 0.001) in the univariate analysis. The strongest association was found between AG fat ratio and LS BMD (ß = 0.156, p ≤ 0.001). In multivariate linear regression analysis, the results continued to show a positive association between AFM and GFM at all skeletal sites after adjusting for age, height, and total body lean mass. Relationship between AG fat ratio and BMD was found only in LS region. GFM had a strongest positive effect with BMD at the LS, total femur, and femoral neck regions. Higher android and gynoid adiposity was associated with higher BMD. GFM rather than AFM shows the strongest positive association with BMDs in postmenopausal Thai women.

Open-label study of treatment with alendronate sodium plus vitamin D in men and women with osteoporosis in Thailand.

BACKGROUND: It is generally believed that Thai people do not suffer from hypovitaminosis D because there is abundant sunlight throughout the year, and that taking vitamin D supplements could result in abnormally high levels of vitamin D. This is a Thai FDA-driven study to investigate this risk over a period of 26 weeks of taking alendronate sodium/vitamin D3 combination tablets. METHODS: Osteoporosis patients in Thailand were recruited to a multicenter, open-label, 6-month trial of oral alendronate sodium 70 mg/vitamin D3 5600 IU. Patients received study medication once a week for 26 weeks. Serum 25-hydroxyvitamin D (25(OH)D) and Beta-CrossLaps (ß-CTx) levels were measured at baseline and 26 weeks. The primary endpoint was the proportion of patients with 25(OH)D ≥ 50 ng/mL at week 26; it was hypothesized that 26 weeks' treatment would not result in 25(OH)D serum levels ≥ 50 ng/mL in > 7% of osteoporosis patients. RESULTS: One hundred ninety-eight patients were recruited. At baseline, 67.2% of the patients had 25(OH)D < 30 ng/mL; this declined to 34.4% by week 26. The mean 25(OH)D level improved from 27.8 ng/mL at baseline to 33.6 ng/mL at week 26. Five patients (2.69% of the full analysis set) had 25(OH)D levels ≥ 50 ng/mL at 26 weeks. The highest 25(OH)D level, 64.3 ng/mL, was observed in a patient whose baseline level was 102.2 ng/mL. The majority (62.9%) of the patients had optimal 25(OH)D levels (30-50 ng/mL). ß-CTx levels were reduced by 57.7% after 26 weeks' treatment. No clinically significant cases of hypercalcemia which could be associated with hypervitaminosis D were identified during physical examination, in vital signs, or in laboratory results. Overall, 73 patients (36.9%) reported at least one adverse event (AE), with 13 (6.6%) reporting drug-related AEs. Four patients discontinued due to AEs, two of which were drug-related. Serious AEs were reported for four patients, of which one was considered drug-related. CONCLUSIONS: Oral alendronate sodium 70 mg plus vitamin D3 5600 IU once weekly had an acceptable safety profile in this study, and increased serum 25(OH)D and reduced ß-CTx levels in osteoporosis patients. This treatment improved 25(OH)D levels, without causing abnormally high levels, after 26 weeks' treatment. TRIAL REGISTRATION: Clinical Trials.gov NCT01437111 , Registered September 19, 2011.

3D CAD/reverse engineering technique for assessment of Thai morphology: Proximal femur and acetabulum.

PURPOSE: To assess morphological parameters of proximal femur and acetabulum in Thai population with three-dimensional measurement technique, and to analysis of collateral side symmetric, gender difference, and correlation between morphometric parameters. METHODS: Investigation was performed in 240 femurs. All three-dimensional femur models were acquitted from 64-slice spiral CT scanner. Morphometric parameters under consideration included acetabular diameter, femoral head diameter, shaft isthmus location, intramedullary canal diameter, diaphyseal diameter, femoral head height, femoral neck isthmus, femoral neck length, neck shaft angle, bow angle, and anteversion angle. All parameters were measured based on functions and least-square regression function in CAD software. Obtained measured data were then used for analysis of collateral side symmetric, gender difference, correlation between morphometric parameters, and compared with other populations. RESULTS: Female had a smaller dimension compared with male in most of the parameters. No significant difference was observed between left and right femurs. High correlation pairs of morphometric parameters included femoral head diameter-acetabular diameter, femoral head diameter-neck isthmus diameter, femoral head diameter-diaphyseal diameter at shaft isthmus level, acetabular diameter-neck isthmus diameter, neck isthmus diameter-diaphyseal diameter at shaft isthmus level, and acetabular diameter-diaphyseal diameter at shaft isthmus level. Some morphometric parameters of Thai are smaller than other Caucasian, and some Asian nation, i.e. femoral head diameter, femoral neck length, and femoral head height. CONCLUSIONS: This study provides essential morphometric data for various orthopedic implant designs relating to proximal femur region.

Second hip fractures at Chiang Mai University Hospital.

BACKGROUND: Hip fractures are a major public health problem. Patients who have suffered a hip fracture have an increased risk of a subsequent hip fracture. This study examines the incidence ofsecondhip fractures and attempts to identify underlying risk factors. OBJECTIVE: To examine the incidence ofsecond hip fractures in osteoporotic patients at Chiang Mai University Hospital and to identify risk factors related to second hip fractures. MATERIAL AND METHOD: A retrospective review was conducted of all low-energy mechanism hip fracture patients admitted during 2008 and 2009. Analysis of second hip fractures was conducted using survival analysis and logistic regression analysis. RESULTS: A total of 191 patients were observed for 391.68 person-years (mean 2.05 person-years per patient). Among that group, nine second hip fractures were identified, an overall incidence rate of 0.023 second fractures per person-year. Second hip fractures tended to occur within the first year following an initial hip fracture. There were no significant differences related to either gender or comorbid medical conditions. Logistic regression analysis revealed that increased risk of a second hip fracture was associated with age (highest between 80 to 89 years) and patients who were not treated for osteoporosis following their initial fracture. CONCLUSION: The incidence of second hip fractures at Chiang Mai University Hospital was 0.023 per person-year Careful follow-up of older patients, especially those over 80, and treatment ofosteoporosis with bisphosphonate plus vitamin D and calcium supplements was correlated with a reduction in the incidence of second hip fractures.

Correlation of proximal femoral bone geometry from plain radiographs and dual energy X-ray absorptiometry in elderly patients.

BACKGROUND: Fracture prevention in osteoporotic patients is the primary treatment goal in assessing bone mineral density, identification of fracture risk, and determination of who should be treated. The literature shows that parameters of proximal femoral bone geometry such as hip axis length, femoral neck shaft angle (FNA), femoral neck width (FNW) and femoral neck cortical thickness (FNCT) can predict the risk of hip fracture. Those parameters are presented automatically with dual energy X-ray absorptiometry (DXA) scans, which are available in well-equipped hospitals. OBJECTIVE: To determine the correlation between proximal femoral bone geometry and the parameters from DXA scans and those from plain radiographs. MATERIAL AND METHOD: Forty-eight patients with no previous hip fractures or history of secondary osteoporosis underwent both a DXA scan of the hip area and a plain hip radiograph done in the same position, 25 degrees internal rotation. Bone geometries from both groups were measured to determine the correlation using Pearson correlation coefficient. RESULTS: Correlation between the parameters HAL, FNA, FNW andFNCT from the DXA scans and from the measurement of the plain radiograph was significant (p < 0.01) and the level of correlation was moderate to high. The FNCT had least mean difference (0.04). In addition, the parameter FNCT less than 0.29 mm in both DXA scans and plain radiographs, showed a significant correlation with osteoporosis (T-score <-2.5). CONCLUSION: The bone geometry parameters from either DXA scans orplain radiographs may be used to predict osteoporotic hip fracture with a moderate to high correlation. Plain radiographs are very helpful when DXA scan results are not available. The FNCT parameter has a strong correlation with osteoporosis.

Factors related to mortality after osteoporotic hip fracture treatment at Chiang Mai University Hospital, Thailand, during 2006 and 2007.

OBJECTIVE: To investigate the one-year mortality rate after osteoporotic hip fracture and to identify factors associated with that mortality rate. MATERIAL AND METHOD: A retrospective review of 275 osteoporotic patients who sustained a low-trauma hip fracture and were admitted in Chiang Mai University Hospital during January 1, 2006 to December 31, 2007 was accomplished. Eligibility criteria were defined as age over 50 years, fracture caused by a simple fall and not apathologicalfracture caused by cancer or infection. Results of this one-year mortality rate study were compared to studies of hip fracture patient mortality in 1997 and the period 1998-2003. RESULTS: The average one-year mortality rate in 2006-2007 was 21.1%. Factors correlated with higher mortality were non-operative treatment, delayed surgical treatment, and absence of medical treatment for osteoporosis. The 2006-2007 mortality rate was slightly higher than for the 1997 and 1998-2003 periods. CONCLUSION: The one-year mortality rate after osteoporotic hip fracture of 21.1% was approximately 9.3 times the mortality rate for the same age group in the general population, indicating that treatment of osteoporosis as a means of helping prevent hip fracture is very important for the individual, the family, and society as a whole.

Femoral mechanical-anatomical angle of osteoarthritic knees.

BACKGROUND: To perform total knee arthroplasty, some surgeons prefer to use a fixed valgus angle, for example 5° or 6°, for the distal femoral cut with every patient. This angle may be appropriate for some patients, but may not be for all. OBJECTIVE: To determine the proper angle of the distal femoral cut during total knee arthroplasty (TKA) in Thai patients with osteoarthritis of the knee. MATERIAL AND METHOD: A cross-sectional study was conducted of 80 osteoarthritic knees of 50 Thai patients with a mean age of 69 years (range 52-82, SD 7.64) who had received total knee arthroplasty at Chiang Mai University Hospital between January 2011 and March 2013. The femoral mechanical-anatomical (FMA) angle, femorotibial (FT) angle, mechanical femorotibial (MFT) angle, femoral bowing angle, femoral length, hip offset, gender, and age of the patients were analysed using multivariate regression analysis. RESULTS: Average FMA angle was 6.46° (range 4°-10°, SD 1.26°). The FMA angle was 6.85° and 5.28° in patients with varus and valgus deformity, respectively. Fifteen percent of all patients showed a FMA angle either less than 5° or greater than 7°. CONCLUSION: The average FMA angle of patients with gonarthrosis was 6.46°. If it is not possible to measure the FMA angle in Thai patients, 7° valgus cut angle is recommended for patients with varus deformity. Variation in this angle was high. Pre-operative measurement of FMA angle is beneficial for precise TKA.

Effect of fat mass and lean mass on bone mineral density in postmenopausal and perimenopausal Thai women.

BACKGROUND: The purpose of this study was to investigate the association between fat mass, lean mass, and bone mineral density (BMD) in postmenopausal and perimenopausal Thai women. METHODS: A cross-sectional study was conducted in 1579 healthy Thai women aged 40-90 years. Total body, lumbar spine, total femur, and femoral neck BMD and body composition were measured by dual x-ray absorptiometry. To evaluate the associations between fat mass and lean mass and various measures of BMD, multivariable linear regression models were used to estimate the regression coefficients for fat mass and lean mass, first in separate equations and then with both fat mass and lean mass in the same equation. RESULTS: Among the study population, 1448 subjects (91.7%) were postmenopausal and 131 (8.3%) were perimenopausal. In postmenopausal women, after controlling for age, height, and duration of menopause, both fat mass and lean mass were positively correlated with BMD when they were analyzed independently of each other. When included in the same equation, both fat mass and lean mass continued to show a positive effect, but lean mass had a significantly greater impact on BMD than fat mass at all regions except for total body. Lean mass but not fat mass had a positive effect on BMD at all skeletal sites except the lumbar spine, after controlling for age and height in perimenopausal women. CONCLUSION: Lean mass had a significant beneficial effect on BMD in both postmenopausal and perimenopausal women and can be considered as one of the determinants of bone mass. The effect of the fat mass was related to menopausal status, but only demonstrated a positive impact in perimenopausal women.

Increasing incidence of hip fracture in Chiang Mai, Thailand.

Hip fracture is a major health problem in Thailand. This study attempted to examine the incidence, related factors, and trends of hip fracture in Chiang Mai, Thailand. All hip fracture data among patients aged 50 yr or older were collected from hospitals in Chiang Mai, Thailand from August 1, 2006 to July 3, 2007. Data from the 1997 Chiang Mai hip fracture study were used for comparison. In the study period, 690 hip fractures were reported: 203 males and 487 females (male to female ratio was 1 to 2.4), with a mean age of 76.7 yr. The estimated cumulative incidence was 181.0 per 100,000, and the adjusted incidence was 253.3 (males: 135.9; females: 367.9). A simple fall was the most common mechanism (79%) of fracture, and 80% of the hip fractures occurred in patients aged 70 yr or older. The highest incidence of hip fracture was observed in patients older than 85 yr (1239). At 6 mo postfracture, most patients (61%) used a walking aid. Compared with the 1997 data, hip fracture incidence had increased by an average of 2% per yr, and the incidence of hip fracture had increased significantly from August 1, 2006 to July 31, 2007, especially in patients older than 75 yr. In patients older than 84 yr, the incidence increased by a factor of 2. Urgent strategies for the prevention and treatment of osteoporosis, and hence hip fracture, are needed.

Hyaluronan production and chondrogenic properties of primary human chondrocyte on gelatin based hematostatic spongostan scaffold.

BACKGROUND: Autologous chondrocyte transplantation is a promising technique for treatment of cartilage defects. Three dimensional chondrocyte cultures on a scaffold are widely used to retain the chondrogenic phenotype. Using a biodegradable gelatin scaffold is one option for the cell delivery system, but molecular and histological studies of the method have not yet been done. METHODS: We evaluated the chondrogenic property of the primary human chondrocyte on a gelatin scaffold as compared to a collagen scaffold over a period of 21 days. We examined the production of glycosaminoglycan by quantitative and histological analysis. Gene expression of cartilage-associated molecules was assessed by quantitative RT-PCR. RESULTS: The gelatin scaffold showed the ability to promote chondrocyte expansion, chondrogenic phenotype retention at molecular and mRNA levels. CONCLUSIONS: This scaffold is thus suitable for use as an in vitro model for chondrocyte 3D culture.

Discrepancy of left and right hip bone mineral density (BMD) in Thai women: diagnostic agreement and misclassification.

OBJECTIVE: To determine the diagnostic agreement and the degree of misclassification when using data from the left and right hips. METHODS: The cross-sectional study of 1,943 perimenopausal and postmenopausal Thai women, who had bone mineral density (BMD) measurements at the left (non-dominant) and right hips for the screening of low bone mass (LBM) or osteoporosis (OP) in the Department of Radiology, Faculty of Medicine, Chiang Mai University from September 2008 to August 2010 was performed. The kappa statistic was used to assess diagnostic agreement. The prevalence of LBM and OP and the percentage of misclassification were reported. RESULTS: There was a significant correlation between the left and right BMD values for the femoral neck (FN) (r (2) = 0.83; p < 0.001) and the total hip (TH) (r (2) = 0.89; p < 0.001). The diagnostic agreement of the FN and TH regions was significant in all study groups ranging from 0.69 to 0.76 (p < 0.001). For the final diagnosis, which is based on the least T-score of the FN or TH regions, the diagnostic agreement was 0.73 for all women, 0.77 for perimenopausal women, 0.73 for postmenopausal women, 0.70 for postmenopausal women age less than 65 years and 0.71 for postmenopausal women age greater than or equal to 65 years. The percentage of misclassification for all women was 16.9 %, with 3.3 % being downgraded from normal to LBM and 3.4 % from LBM to OP. CONCLUSION: Despite the fact that good diagnostic agreement was demonstrated in this study, a significant number of diagnostic discordance between left and right hips (16.9 %) was also observed. BMD measurements of both hips are recommended for diagnosing LBM and OP in clinical practice.

Long-term mortality after osteoporotic hip fracture in Chiang Mai, Thailand.

The purpose of the study was to investigate 10-yr mortality and associated factors after osteoporotic hip fracture. A prospective cohort study of mortality and associated factors was carried out in patients who sustained hip fracture and were admitted to Chiang Mai University Hospital from 1998 through 2003. Eligibility criteria were defined as age over 50yr, hip fracture caused by simple fall, and Singh index of 3 or less.Mortality rates at 3, 6, 12, 24, 36, 60, 96, and 120mo were 10%, 14%, 18%, 27%, 32%, 45%, 55%, and 68%, respectively. One-year mortality rates were 31% in males and 16% in females. The median survival time was 6yr. Ten-year mortality was 68%. Factors correlated with higher mortality were male gender, age greater than 70yr, and nonoperative treatment. Mortality after osteoporotic hip fracture in Thais was extremely high, especially in the first year. It was about 8 times higher than that in the age-adjusted general population.

Vitamin D status of Thai premenopausal women.

Vitamin D insufficiency of Thai elderly women in urban area were higher than in rural area because of the difference in life style. Until now there are no any evidences about vitamin D status in Thai premenopausal women. This study was the multicenters study from 5 provinces of Thailand which cover all region of Thailand except southern area. The mean (SE) of calcidiol level of Thai premenopausal women was 29.09 (0.42) ng/ml, and with the cut point of < or = 35 ng/ml; the prevalence of vitamin D insufficiency was 77.81%. Chiang Mai had lowest calcidiol level (25.09 ng/ml) and had highest PTH, and bone resorption markers. The prevalence of vitamin D insufficiency was highest in Khon Kaen (88.78%) and Chiang Mai (84.62%) province respectively. Life style modification to expose more sunlight should be advised for increasing the serum vitamin D and lowering the risk of osteoporosis.