Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.598
Filtrar
1.
Sud Med Ekspert ; 64(2): 10-13, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33739061

RESUMO

THE AIM OF THE STUDY: Is to determine the features of the injuries formation in children-pedestrians in a collision with moving cars on the basis of studying the nature and localization of injuries on the body of the victims. It was analyzed the materials of the forensic medical examination of 140 children death cases (91 boys and 49 girls) caused by a collision of moving cars with pedestrian-children aged 6 to 17 years. It was found that the majority of children-pedestrians with a car injury develop concomitant craniocerebral trauma (CCT) (78%), concomitant trauma of the chest (CT) (46.4%) and abdomen (50.2%), spinal cord injury (SCI) (25.7%) and fractures of the limb bones (55%). TBI is quite often accompanied by fractures of the bones of the vault and base of the skull. For CT of the chest and organs of the chest cavity, unilateral fractures of the ribs and bruises of the lungs are typical. In the structure of the abdomen organs CT, damage to the parenchymal organs prevails. In SCI, damage to the structures of the cervical and thoracic spinal column is more common, while separation of the spinal cord is quite common. This type of injury is characterized by the formation of femurs fractures, bones of the lower leg and upper limbs.


Assuntos
Traumatismos Craniocerebrais , Fraturas Ósseas , Pedestres , Acidentes de Trânsito , Adolescente , Automóveis , Criança , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino
2.
Ann R Coll Surg Engl ; 103(3): 160-166, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645278

RESUMO

INTRODUCTION: The COVID-19 pandemic resulted in reconfiguration of the NHS. Elective services were stopped and trauma services focused on decreasing patient-clinician interactions and managing injuries nonoperatively wherever possible. The everyday life of the general public changed dramatically with the introduction of a national lockdown to prevent the spread of COVID-19. This paper looks at the experience of a South West London trauma unit. MATERIALS AND METHODS: All patients reviewed in fracture clinic and by the orthopaedic on-call team between 23 March to 23 April 2020 were included. Data on the mechanism of injury and whether this was a usual activity, the injury sustained and its management were collected. RESULTS: A total of 167 trauma injuries were seen, compared with 735 new patients with injuries in the previous month. The number of trauma operations completed decreased by 38%; 55% of injuries occurred inside the home and 44% outside the home during daily exercise. Some 31% of injuries were secondary to a new activity taken up during lockdown. Three open fractures and two polytrauma cases were seen that would have normally been managed at the local major trauma centre. CONCLUSION: Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.


Assuntos
Acidentes Domésticos/estatística & dados numéricos , Exercício Físico , Fraturas Ósseas/epidemiologia , Centros de Traumatologia , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ciclismo/lesões , Criança , Pré-Escolar , Controle de Doenças Transmissíveis , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Jardinagem , Humanos , Lactente , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/etiologia , Fraturas do Rádio/cirurgia , Adulto Jovem
3.
Eur J Endocrinol ; 184(4): 597-606, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33606665

RESUMO

Objective: Several small studies reported increased prevalence and incidence of asymptomatic vertebral fractures in patients with non-functioning adrenal adenomas and adenomas with mild autonomous cortisol secretion. However, the risk of symptomatic fractures at vertebrae, and at other sites remains unknown. Our objective was to determine the prevalence and incidence of symptomatic site-specific fractures in patients with adrenal adenomas. Design: Population-based cohort study, Olmsted County, Minnesota, USA, 1995-2017. Methods: Participants were the patients with adrenal adenoma and age/sex-matched referent subjects. Patients with overt hormone excess were excluded. Main outcomes measures were prevalence and incidence of bone fractures. Results: Of 1004 patients with adrenal adenomas, 582 (58%) were women, and median age at diagnosis was 63 years (20-96). At the time of diagnosis, patients had a higher prevalence of previous fractures than referent subjects (any fracture: 47.9% vs 41.3%, P = 0.003, vertebral fracture: 6.4% vs 3.6%, P = 0.004, combined osteoporotic sites: 16.6% vs 13.3%, P = 0.04). Median duration of follow-up was 6.8 years (range: 0-21.9 years). After adjusting for age, sex, BMI, tobacco use, prior history of fracture, and common causes of secondary osteoporosis, patients with adenoma had hazard ratio of 1.27 (95% CI: 1.07-1.52) for developing a new fracture during follow up when compared to referent subjects. Conclusions: Patients with adrenal adenomas have higher prevalence of fractures at the time of diagnosis and increased risk to develop new fractures when compared to referent subjects.


Assuntos
Adenoma/epidemiologia , Neoplasias das Glândulas Suprarrenais/epidemiologia , Fraturas Ósseas/epidemiologia , Adenoma/complicações , Adenoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Fraturas Ósseas/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Adulto Jovem
4.
J Hand Surg Asian Pac Vol ; 26(1): 36-40, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33559580

RESUMO

Background: Angle grinders are a handheld power tool used for grinding and polishing stone, metal, and concrete. Some people, however, use them with a circular saw blade attachment for cutting wood and consequently, suffer injuries. We aimed to investigate the underlying cause and mechanisms of injuries caused by cutting wood with an angle grinder. Methods: We conducted a retrospective study using medical records from our trauma center and identified 15 patients treated for angle grinder injury between 2017 and 2018. Moreover, we contacted the National Consumer Affairs Center of Japan for further information about angle grinder injuries. Results: Nine of the 15 patients used angle grinders improperly, of which only three patients were aware of the risk of injury. The details of the nine patients were as follows: the types of injuries: complete finger amputation (n = 2), partial finger amputation (n = 1), tendon injury with phalangeal fracture (n = 5), and tendon injury alone, (n = 1); the causes of accidents: kickback (n = 7) and glove entanglement (n = 2); and the accident situations: on-the-job (n = 5) and do-it-yourself (n = 4). Conclusions: The primary cause of angle grinder injury caused by cutting wood was a lack of user knowledge that an angle grinder cannot be used as a cutting tool. Appropriate feedback from hand surgeons are necessary to urge manufacturers to take safety measures.


Assuntos
Amputação Traumática/etiologia , Traumatismos dos Dedos/etiologia , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/etiologia , Traumatismos dos Tendões/etiologia , Acidentes/estatística & dados numéricos , Adulto , Idoso , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Madeira , Adulto Jovem
5.
PLoS One ; 16(2): e0246956, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33592046

RESUMO

BACKGROUND: The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. METHODS: All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). FINDINGS: Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. CONCLUSIONS: While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.


Assuntos
/epidemiologia , Fraturas Ósseas/epidemiologia , Quarentena/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , /prevenção & controle , Fraturas Ósseas/classificação , Fraturas Ósseas/etiologia , Alemanha , Hospitais Universitários/estatística & dados numéricos , Humanos
6.
Injury ; 52(3): 395-401, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33627252

RESUMO

PURPOSE: The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time. METHODS: A study period of twelve weeks following the introduction of the nationwide "lockdown period", March 23rd - June 14th, 2020 was identified and compared to the same time period in 2019 as a "baseline period". A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the 'eTrauma' management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis. RESULTS: The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury across all age groups in both time periods. The proportion sports related injuries compared to the overall number of injuries fell significantly during the lockdown period (p<0.001), however, the proportion of pushbike related accidents increased significantly (p<0.001). The total number of operations performed during the lockdown period fell by 38.8% (n=1046) during lockdown (n=1732). The proportion of patients undergoing operative intervention for Neck of Femur (NOF) and ankle fractures remained similar during both study periods. A more non-operative approach was seen in the management of wrist fractures, with 41.4% of injuries undergoing an operation during the lockdown period compared to 58.6% at baseline (p<0.001). CONCLUSION: In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/tendências , Ciclismo/lesões , Procedimentos Ortopédicos/tendências , Encaminhamento e Consulta/tendências , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Traumatismos do Braço/epidemiologia , Traumatismos do Braço/etiologia , Traumatismos do Braço/terapia , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/terapia , Criança , Pré-Escolar , Grupos Diagnósticos Relacionados , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Fraturas Expostas/epidemiologia , Fraturas Expostas/etiologia , Fraturas Expostas/terapia , Humanos , Lactente , Recém-Nascido , Traumatismos da Perna/epidemiologia , Traumatismos da Perna/etiologia , Traumatismos da Perna/terapia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Centros de Traumatologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/etiologia , Traumatismos do Punho/terapia , Adulto Jovem
7.
Medicine (Baltimore) ; 100(7): e24839, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607854

RESUMO

BACKGROUND: To systematically evaluate the efficacy of teriparatide and bisphosphonates in preventing fractures in postmenopausal women with osteoporosis. MATERIALS AND METHODS: We performed a systematic search of PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) that compared teriparatide and bisphosphonates for osteoporosis treatment. Searches were performed without language restrictions and included studies from beginning of time to March 2019. Two authors independently screened and extracted the selected article. The quality of the included studies was evaluated using the Cochrane system evaluation method. Data were extracted and analysed using RevMan 5.2 software. RESULTS: Nine RCTs were included for a total of 2990 postmenopausal women with osteoporosis. Of these, 1515 patients were treated with teriparatide and 1475 were treated with bisphosphonates. After pooling the data of 9 studies, there were significant differences between teriparatide and bisphosphonates [relative risk (RR): 0.61, 95% confidence interval (CI) (0.51, 0.74)] in the prevention of fractures according to different follow-up durations (P < .05), whatever alendronate [RR: 0.51, 95% CI (0.27, 0.95)] and other bisphosphonates [RR: 0.63, 95% CI (0.51, 0.77)]. In addition, we found significant differences between teriparatide and bisphosphonates in the prevention of vertebral fractures [RR: 0.47, 95% CI (0.35, 0.64)] and non-vertebral fractures [RR: 0.76, 95% CI (0.58,0.99)]. There were no significant differences in adverse effects between teriparatide and bisphosphonates [RR: 0.89, 95% CI (0.76, 1.03)]. CONCLUSIONS: Based on the results of our meta-analysis, teriparatide was better than bisphosphonates in preventing fractures in postmenopausal women with osteoporosis both in the short-term and long-term follow-up periods. Teriparatide was superior to bisphosphonates in preventing vertebral and non-vertebral fractures. These drugs did not differ in terms of their adverse effects. More high-quality studies are needed to compare other factors such as costs and adverse reactions.


Assuntos
Difosfonatos/uso terapêutico , Fraturas Ósseas/prevenção & controle , Osteoporose Pós-Menopausa/tratamento farmacológico , Teriparatida/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Alendronato/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Estudos de Casos e Controles , Difosfonatos/efeitos adversos , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Incidência , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/prevenção & controle , Teriparatida/efeitos adversos , Resultado do Tratamento
8.
Instr Course Lect ; 70: 355-366, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438921

RESUMO

Osteoporosis is common, affecting more than 40 million people, and is associated with increased fracture risk, loss of independence, chronic pain, and disability. Osteoporosis is underdiagnosed and undertreated even after fracture where secondary fracture prevention has been shown to be cost effective in reducing further fracture risk and mortality. Osteoporosis is also undiagnosed in patients undergoing orthopaedic and spine surgery in up to one-third of cases and negatively affects outcomes, need for revision surgery, and risk of complications. The diagnosis of osteoporosis was previously based on bone mineral density; however, recent clinical definitions include T-scores less than -2.5, the presence of hip and spine fractures, and high fracture risk. Surgeons should adopt bone health optimization for elective surgery. This program screens patients to determine whether a bone mineral density test is indicated and provides counseling for nutritional supplements, elimination of toxins, fall risk assessment, and education regarding bone health. Following assessment, patients meeting the criteria for osteoporosis are referred to a bone health specialist or a fracture liaison program. Both antiresorptive and anabolic antiosteoporotic medications appear effective at improving outcomes and reducing complications of orthopaedic and spine surgery, although a delay in surgery may be required.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Procedimentos Ortopédicos , Ortopedia , Osteoporose , Densidade Óssea , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Fraturas Ósseas/cirurgia , Humanos , Procedimentos Ortopédicos/efeitos adversos
9.
Maturitas ; 144: 68-73, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33358211

RESUMO

OBJECTIVES: Gestational diabetes mellitus (GDM) is a common pregnancy complication. This study aims to investigate the association between a history of GDM and bone mineral density (BMD), fractures, and falls in later life. STUDY DESIGN: We used data from the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) where BMD at calcaneum was measured at second health check (1997-2000) using broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in 7,515 women. Fractures and falls were documented from hospital admissions data via linkage with ENCORE (East Norfolk Commission Record) and history of GDM from health questionnaires at baseline. We examined the relationship between GDM and BUA/VOS using linear regression. Cox regression was used to estimate hazard ratios (HRs) for incident fractures and falls, controlling for age, BMI, smoking status, physical activity, area deprivation, self-reported stroke, use of diuretics, calcium and vitamin D supplements, social class and education, statin and total blood cholesterol, prevalent diabetes, hormone therapy and menopausal status. RESULTS: History of GDM (n = 183) was not statistically significantly associated with BUA/VOS in fully adjusted linear regression models with unstandardised beta coefficients (standard error): -0.37 (1.40) and -5.41 (3.48). GDM was significantly (p < 0.05) associated with risk of hip and all fractures, fully adjusted HRs(95 %CI) 2.46(1.54-3.92) and 1.60(1.09-2.35), respectively. Median follow-up from first live birth to date of admission was 53 and 52 years, respectively. CONCLUSION: There was an association between history of GDM and risk of any fracture as well as hip fracture specifically. Further research is required to confirm this.


Assuntos
Densidade Óssea , Diabetes Gestacional/epidemiologia , Fraturas Ósseas/epidemiologia , Acidentes por Quedas , Adulto , Idoso , Calcâneo/diagnóstico por imagem , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Ultrassonografia
10.
Medicine (Baltimore) ; 99(50): e23206, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327237

RESUMO

INTRODUCTION: Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans. METHODS AND DESIGN: The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL. DISCUSSION: The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers. TRIAL REGISTRATION: The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number - PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).


Assuntos
Exercício Físico/fisiologia , Fraturas do Fêmur/reabilitação , Fraturas Ósseas/etiologia , Fraturas Ósseas/reabilitação , Infecções por HIV/complicações , Adulto , Densidade Óssea/fisiologia , Terapia por Exercício/métodos , Feminino , Fraturas do Fêmur/cirurgia , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Marcha/fisiologia , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Qualidade de Vida , África do Sul/epidemiologia
11.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318265

RESUMO

We present a 9-year-old male child having history of fractures on trivial trauma with a family history of the same. He was treated for osteogenesis imperfecta (OI; zolendronate, calcium and vitamin D) and showed clinical improvement. On evaluating his bone health using dual energy X-ray absorptiometry and peripheral quantitative CT, we found that the child had bone density within the reference range but a smaller bone mass for his height, low muscle mass and thin bones with a lower strength strain index in comparison with healthy children. Our case suggests that treatment with bisphosphonates results in increase in bone density; however, bones remain thin and the lean body mass in these children may also be low. Controlled physical activity to improve muscle health and newer approaches to improve bone geometry would result in better bone health in children with OI.


Assuntos
Absorciometria de Fóton , Densidade Óssea , Osteogênese Imperfeita/diagnóstico por imagem , Osteogênese Imperfeita/fisiopatologia , Tomografia Computadorizada por Raios X , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/uso terapêutico , Criança , Difosfonatos/uso terapêutico , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Masculino , Osteogênese Imperfeita/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Vitamina D/uso terapêutico , Ácido Zoledrônico/uso terapêutico
12.
Maturitas ; 141: 63-70, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33036705

RESUMO

During the last decade, a cascade of evidence has questioned the anti-fracture efficacy of vitamin D supplementation. In general, vitamin D status, reflected by serum 25-hydroxy-vitamin D [25(OH)D] concentrations, seems to predict fracture risk and bone mineral density (BMD). Despite the well-documented detrimental effect of vitamin D deficiency on bones, vitamin D monotherapy does not seem to reduce the risk of fractures. On the other hand, high vitamin D doses, either at monthly (60,000-100,000 IU) or daily intervals (>4000 IU), appear to be harmful with regard to falls, fracture risk and BMD, especially for people without vitamin D deficiency and at low fracture risk. Therefore, a U-shaped effect of vitamin D on the musculoskeletal system may be supported by the current evidence. Vitamin D supplementation could be of value, at daily doses of at least 800 IU, co-supplemented with calcium (1000-1200  mg/day), in elderly populations, especially those with severe vitamin D deficiency [25(OH)D <25-30  nmol/L (<10-12  ng/mL)], although its anti-fracture and anti-fall efficacy is modest. Good compliance and at least 3-5 years of therapy are required.


Assuntos
Densidade Óssea/efeitos dos fármacos , Fraturas Ósseas/prevenção & controle , Vitamina D/administração & dosagem , Acidentes por Quedas , Idoso , Osso e Ossos/efeitos dos fármacos , Cálcio na Dieta/administração & dosagem , Suplementos Nutricionais , Fraturas Ósseas/etiologia , Humanos , Vitamina D/efeitos adversos , Vitamina D/análogos & derivados , Deficiência de Vitamina D/complicações , Vitaminas/uso terapêutico
14.
Arch Osteoporos ; 15(1): 163, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067646

RESUMO

Use of the FRAX (Fracture Risk Assessment Tool) tool to assess fracture risk is the most common practice worldwide. Our findings suggest that in treatment-naïve women with osteopenia treatment would be cost-effective for approximately one-third of the study population and nearly half of the subjects over 75 years, according to the Greek-specific FRAX-based thresholds. INTRODUCTION: When evaluating a patient with low bone mineral density (BMD), fracture risk estimation is of paramount importance. Fracture risk assessment using the FRAX tool is the most common and most studied practice worldwide. PATIENTS-METHODS: The primary aim of the "ACROSS" study was to record the 10-year probability of major osteoporotic fractures and hip fractures, using the Greek version of the FRAX tool, in a rather representative population of 230 postmenopausal treatment-naïve women with osteopenia. Secondary aims of the study were to identify (1) the risk for fractures according to age and the years from menopause, (2) the proportion of patients qualifying for treatment according to the Greek cost-effective FRAX thresholds, and (3) the perception of both the patient and the treating physician regarding the estimated fracture risk. RESULTS: The mean 10-year risk was 10.7% ± 6.6 for major osteoporotic fractures and 3.4% ± 4.2 for hip fractures. For women up to 75 years of age, the 10-year risk for major osteoporotic and hip fractures was 8.8% and 2.1%, respectively, while for women over 75 years, the risk was 15.2% and 6.6%, respectively. Patients generally believed that they had low fracture risk independently of age, while the physicians considered that the risk increases with advancing age. CONCLUSIONS: According to the Greek-specific FRAX-based thresholds, the administration of osteoporosis treatment would be cost-effective for approximately one-third of the study population and nearly half of the subjects over 75 years. Patients are not fully aware of their fracture risk.


Assuntos
Doenças Ósseas Metabólicas/complicações , Fraturas Ósseas/etiologia , Fraturas por Osteoporose/etiologia , Pós-Menopausa , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Doenças Ósseas Metabólicas/epidemiologia , Feminino , Fraturas Ósseas/epidemiologia , Grécia/epidemiologia , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Fraturas por Osteoporose/epidemiologia , Fatores de Risco
15.
ANZ J Surg ; 90(11): 2237-2241, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32940413

RESUMO

BACKGROUND: The coronavirus disease outbreak in December 2019 rapidly spread around the world with profound effects on healthcare systems. In March 2020, all elective surgery and elective outpatient clinics were cancelled in our institution, a regional hospital in Northern New South Wales, Australia. With regard to orthopaedic fracture clinics, a telehealth system was implemented on an emergency basis for patient and staff safety to prevent disease transmission. The aim of our study was to investigate whether rapid implementation of telehealth for orthopaedic fracture clinics resulted in an increase in complications. METHODS: A retrospective cohort study of all patients with orthopaedic fracture clinic appointments at a regional New South Wales hospital between 17 March and 8 May 2020 was undertaken. There were 191 patients, including 390 appointments of which 23.1% were conducted via telehealth, namely by phone call. Complications requiring phone calls to the orthopaedic team, presentations to the emergency department, admission to hospital or return to theatre, were recorded. RESULTS: There was no increase in complications following emergent implementation of telehealth for orthopaedic fracture clinic follow-up in our institution. Patients in the telehealth group were significantly older than those in the clinic group. CONCLUSION: The study demonstrates that application of telehealth fracture clinics in a regional Australian setting can be achieved without increasing complication rates and can be used to formulate a rapid telehealth implementation plan if a similar scenario occurs in the future.


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Fraturas Ósseas/terapia , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/etiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , New South Wales , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Estudos Retrospectivos , Adulto Jovem
16.
Eur J Endocrinol ; 183(5): R119-R132, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32869608

RESUMO

Despite well recognized improvements in obesity-related comorbidities, increasing evidence implicates bariatric surgery in the onset of adverse skeletal health outcomes. The purpose of this review is to provide a focused update in three critical areas: (i) emergent data on sleeve gastrectomy and bone loss, (ii) evidence linking bariatric surgery to incident fracture, and (iii) intervention strategies designed to mitigate surgical bone loss. Better understanding of these issues will inform our treatment of skeletal health for patients planning bariatric surgery.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Fraturas Ósseas/etiologia , Gastrectomia/efeitos adversos , Obesidade Mórbida/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
17.
Arch Osteoporos ; 15(1): 134, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32820451

RESUMO

This study demonstrates a low anti-osteoporosis drug treatment rate (22.1% in women, 9.5% in men) after osteoporotic fracture in the real-world setting of Fujian, China. The primary medication was calcitonin. The suboptimal treatment was particularly critical among men, low-level hospitals, wrist/vertebral fracture, and the younger elderly patients. INTRODUCTION: The objective of this study was to investigate the prescription patterns and related influencing factors of anti-osteoporosis drug prescribing after osteoporotic fracture in Fujian, China, between 2010 and 2016. METHODS: This is a retrospective cohort study based on an existing electronic health record database (National Healthcare Big Data in Fuzhou, China, 37 hospitals included). Patients over 50 years old with newly diagnosed osteoporotic fractures between 2010 and 2016 were included. Postfracture osteoporosis therapies were summarized by overall and fracture site. Multivariate logistic regression was performed to identify influencing factors of anti-osteoporosis medication (AOM) prescription. RESULTS: Overall, 22.1% of women and 9.5% of men over 50 years old received AOM treatment after osteoporotic fracture within 1 year during 2010-2016, with particular low use of bisphosphonates, 5.3% in women and 1.5% in men. The highest rate of AOM treatment was found in patients with hip fracture (24.5%), followed by vertebral fracture (14.2%) and wrist fracture (2.3%). Of the AOM-treated patients, 90.5% received calcitonin therapy. The treatment rate of AOM showed a slight decline during 2010-2016, but steady rise trends were observed in Ca/vitamin D (VD) prescription. Hospital level, age, sex, previous osteoporosis, previous AOM prescription, and previous oral glucocorticoid prescription were strong predicting factors of AOM prescription. CONCLUSION: In a real-world setting, AOM treatment was suboptimal and the treatment rate even decreased over time among osteoporosis fracture patients in Fujian, China. The suboptimal treatment was particularly critical among men, low-level hospitals, wrist/vertebral fracture, and the younger elderly patients.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Calcitonina/uso terapêutico , Difosfonatos/uso terapêutico , Fraturas Ósseas/etiologia , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/efeitos dos fármacos , China/epidemiologia , Estudos de Coortes , Prescrições de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos , Registros Eletrônicos de Saúde , Feminino , Fraturas Ósseas/tratamento farmacológico , Fraturas do Quadril/tratamento farmacológico , Fraturas do Quadril/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Estudos Retrospectivos
18.
J Am Acad Orthop Surg ; 28(16): e716-e728, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32769720

RESUMO

Improvements in cancer treatment have led to prolonged survival and increased rates of cure. An estimated 14 million cancer survivors live in the United States. The cornerstones of cancer treatment, including radiation, chemotherapy, and surgery, give rise to a host of chronic health conditions, some of which affect the musculoskeletal system. As survivorship continues to improve, orthopaedic surgeons across all subspecialties will be tasked with managing these complications of treatment. This article reviews orthopaedic health concerns secondary to cancer treatment that are likely to present to orthopaedic surgeons for evaluation, such as osteoporosis, osteonecrosis, secondary malignancies, radiation-associated fractures, exercise tolerance, and perioperative evaluation.


Assuntos
Antineoplásicos/efeitos adversos , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/terapia , Neoplasias/terapia , Radioterapia/efeitos adversos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Sobreviventes de Câncer/estatística & dados numéricos , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Fraturas Ósseas/terapia , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/prevenção & controle , Neoplasias/complicações , Osteonecrose/diagnóstico , Osteonecrose/etiologia , Osteonecrose/prevenção & controle , Osteonecrose/terapia , Osteoporose/diagnóstico , Osteoporose/etiologia , Osteoporose/prevenção & controle , Osteoporose/terapia
19.
Arch Osteoporos ; 15(1): 137, 2020 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-32860546

RESUMO

As a result of the current demographics, increased projections of osteoporosis (OP) and prevalence of the disease in Turkey, a panel of multidisciplinary experts developed a thorough review to assist clinicians in identifying OP and associated fracture risk patients, diagnosing the disease with the appropriate available diagnostic methods, classifying the disease, and initiating appropriate treatment. The panel expects to increase the awareness of this prevalent disease, decrease consequences of OP with corresponding cost savings and, ultimately, decrease the overall burden of OP and related fractures in Turkey. BACKGROUND: OP is not officially accepted as a chronic disease in Turkey despite the high prevalence and predicted increase in the following years. However, there are areas where the country is performing well, such as having a country-specific fracture risk assessment model, DXA access, and the uptake of FRAX. Additional efforts are required to decrease the existing treatment gap estimating 75-90% of patients do not receive pharmacological intervention for secondary prevention, and the diagnosis rate is around 25%. METHODS: A selected panel of Turkish experts in fields related to osteoporosis was provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion until a consensus was achieved. Represented in the panel were a number of societies including The Turkish Osteoporosis Society, The Society of Endocrinology and Metabolism of Turkey (SEMT), and The Turkish Society of Physical Medicine and Rehabilitation. RESULTS: Standardized general guidelines to identify OP and related fractures and at-risk population in Turkey, which will enable clinicians to accurately and effectively diagnose the disease, treat the appropriate patients with available pharmacological and non-pharmacological treatments and decrease the burden of the disease. CONCLUSIONS: This manuscript provides a review of the current state of OP and related fractures in Turkey. Moreover, this manuscript reviews current international guidelines and national studies and proposes a number of helpful country-specific classifications that can be used by healthcare providers caring for the at-risk population. Additionally, the panel proposes practical recommendations that should be implemented nationally in order to decrease the burden of OP and related fractures and effectively preventing the burden in future generations.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Cálcio/uso terapêutico , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/tratamento farmacológico , Vitamina D/uso terapêutico , Consenso , Suplementos Nutricionais , Fraturas Ósseas/etiologia , Humanos , Masculino , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Guias de Prática Clínica como Assunto , Prevalência , Medição de Risco , Sociedades Médicas , Resultado do Tratamento , Turquia/epidemiologia
20.
Maturitas ; 138: 14-25, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32631584

RESUMO

This narrative review discusses several aspects of the management of osteoporosis in patients under 50 years of age. Peak bone mass is genetically determined but can also be affected by lifestyle factors. Puberty constitutes a vulnerable period. Idiopathic osteoporosis is a rare, heterogeneous condition in young adults due in part to decreased osteoblast function and deficient bone acquisition. There are no evidence-based treatment recommendations. Drugs use can be proposed to elderly patients at very high risk. Diagnosis and management of osteoporosis in the young can be challenging, in particular in the absence of a manifest secondary cause. Young adults with low bone mineral density (BMD) do not necessarily have osteoporosis and it is important to avoid unnecessary treatment. A determination of BMD is recommended for premenopausal women who have had a fragility fracture or who have secondary causes of osteoporosis: secondary causes of excessive bone loss need to be excluded and treatment should be targeted. Adequate calcium, vitamin D, and a healthy lifestyle should be recommended. In the absence of fractures, conservative management is generally sufficient, but in rare cases, such as chemotherapy-induced osteoporosis, antiresorptive medication can be used. Osteoporosis in young men is most often of secondary origin and hypogonadism is a major cause; testosterone replacement therapy will improve BMD in these patients. Diabetes is characterized by major alterations in bone quality, implying that medical therapy should be started sooner than for other causes of osteoporosis. Primary hyperparathyroidism, hyperthyroidism, Cushing's syndrome and growth hormone deficiency or excess affect cortical bone more often than trabecular bone.


Assuntos
Osteoporose/tratamento farmacológico , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Fraturas Ósseas/etiologia , Humanos , Osteoporose/complicações , Osteoporose/diagnóstico , Pré-Menopausa
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...