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1.
Orthop Clin North Am ; 52(4): 481-489, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538355
2.
BMC Musculoskelet Disord ; 22(1): 651, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332559

RESUMO

BACKGROUND: Osteoporotic fractures impose significant costs on society. The objective of this study was to estimate the direct costs of the hip, vertebral, and forearm fractures in the first year after fracture incidence in Iran. METHODS: We surveyed a sample of 300 patients aged over 50 years with osteoporotic fractures (hip, vertebral, and forearm) admitted to four hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2017 and were alive six months after the fracture. Inpatient cost data were obtained from the hospital patient records. Using a questionnaire, the data regarding outpatient costs were collected through a phone interview with patients at least six months after the fracture incidence. Direct medical and non-medical costs were estimated from a societal perspective. All costs were converted to the US dollar using the average exchange rate in 2017 (1USD = IRR 34,214) RESULTS: The mean ± standard deviation (SD) age of the patient was 69.83 ± 11.25 years, and 68% were female. One hundred and seventeen (39%) patients had hip fractures, 56 (18.67%) patients had vertebral fractures, and 127 (42.33%) ones had forearm fractures. The mean direct cost (medical and non-medical) during the year after hip, vertebral and forearm fractures were estimated at USD5,381, USD2,981, and USD1,209, respectively. CONCLUSION: The direct cost of osteoporotic fracture in Iran is high. Our findings might be useful for the economic evaluation of preventive and treatment interventions for osteoporotic fractures as well as estimating the economic burden of osteoporotic fractures in Iran.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Feminino , Antebraço , Custos de Cuidados de Saúde , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/terapia
3.
Int J Mol Sci ; 22(16)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34445423

RESUMO

Low-magnitude high-frequency vibration (LMHFV) has previously been reported to modulate the acute inflammatory response of ovariectomy-induced osteoporotic fracture healing. However, the underlying mechanisms are not clear. In the present study, we investigated the effect of LMHFV on the inflammatory response and the role of the p38 MAPK mechanical signaling pathway in macrophages during the healing process. A closed femoral fracture SD rat model was used. In vivo results showed that LMHFV enhanced activation of the p38 MAPK pathway at the fracture site. The acute inflammatory response, expression of inflammatory cytokines, and callus formation were suppressed in vivo by p38 MAPK inhibition. However, LMHFV did not show direct in vitro enhancement effects on the polarization of RAW264.7 macrophage from the M1 to M2 phenotype, but instead promoted macrophage enlargement and transformation to dendritic monocytes. The present study demonstrated that p38 MAPK modulated the enhancement effects of mechanical stimulation in vivo only. LMHFV may not have exerted its enhancement effects directly on macrophage, but the exact mechanism may have taken a different pathway that requires further investigation in the various subsets of immune cells.


Assuntos
Citocinas/sangue , Consolidação da Fratura , Fraturas por Osteoporose/terapia , Vibração/uso terapêutico , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Animais , Fenômenos Biomecânicos , Modelos Animais de Doenças , Feminino , Regulação da Expressão Gênica , Humanos , Sistema de Sinalização das MAP Quinases , Camundongos , Fraturas por Osteoporose/sangue , Fraturas por Osteoporose/imunologia , Células RAW 264.7 , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento , Microtomografia por Raio-X
4.
Biomed Res Int ; 2021: 4650057, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34327227

RESUMO

Background: Postoperative pain, dysfunction, and significant bone loss may occur after vertebral fractures, which will lead to the occurrence of refractures and shorten the survival time, so postoperative rehabilitation is very important. Pulsed electromagnetic field therapy is noninvasive, pain-relieving, and beneficial to reduce bone loss and is an important treatment for patients to recover after surgery. Therefore, this study analyzed the effect of postmenopausal women's vertebral fracture rehabilitation after pulsed electromagnetic field treatment. Method: This study uses a randomized controlled study, respectively, in the pulsed electromagnetic field treatment group (40 cases) and the control group (42 cases), respectively. We studied the results of health-related quality of life scores (HRQOL), back pain, body function, hip bone density, bone microstructure of tibia, and radius after 1 month and 3 months after surgery. Results: Compared with the control group, the pulsed electromagnetic field treatment group (PEMF) can improve significantly the psychological score, 6-minute walk test, and Chair Sit-and-Reach one month after the operation. And at 3 months after surgery, the pulsed electromagnetic field treatment group can improve significantly in health-related quality of life scores (HRQOL), back pain, and body function. Regarding the effect of changes in bone mass, compared with the control group, pulsed electromagnetic field treatment had no significant effect on changes in hip bone density. As a result of changes in bone microstructure, pulsed electromagnetic field treatment can significantly improve the bone microstructure of the radius and tibia three months after vertebral fractures. Conclusion: Pulsed electromagnetic field therapy has positive significance for improving pain, body functional changes, and bone loss after vertebral fracture surgery.


Assuntos
Campos Eletromagnéticos , Fraturas por Osteoporose/terapia , Pós-Menopausa/fisiologia , Fraturas da Coluna Vertebral/terapia , Densidade Óssea , Osso e Ossos/patologia , Osso e Ossos/fisiopatologia , Humanos , Pessoa de Meia-Idade , Tamanho do Órgão , Fraturas por Osteoporose/fisiopatologia , Qualidade de Vida , Fraturas da Coluna Vertebral/fisiopatologia
5.
Arch Osteoporos ; 16(1): 103, 2021 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-34176022

RESUMO

PURPOSE: Orthogeriatrics is a team approach that aims to provide adequate and timely intervention for individuals suffering from fragility fractures, particularly hip fractures. These patients are mostly the frailest older adults. The aim of orthogeriatrics is to re-gain functionality as early as possible and to decrease disability and mortality. Some developed countries have established orthogeriatric services, while many others, including Turkey, have so far not. Here, to identify areas for improvement, we outline the status of the orthogeriatrics in older adults in Turkey. METHODS: We present clear calls for action, emphasizing possible and noteworthy areas for improvement. RESULTS: Our proposals include the need for an easily applied, short version of comprehensive geriatric assessment; appropriate laboratory testing on admission; paracetamol with a special emphasis in its dosings and clues for state-of-the-art analgesic management; the essential need to introduce oral nutritional supplementation, irrespective of nutritional status; the need for vitamin D commencement, in almost all patients; and starting osteoporosis treatment in fracture hospitalization, whenever appropriate. Last but not least, the ever-increasing prerequisite to establish "fracture liaison services" is stipulated. CONCLUSION: We suggest that our recommendations offer great potential in Turkey, for the improvement of frail fracture patients' care. We call the other countries that do not have established orthogeriatric lines to model our approach to improve the management of fracture patients globally.


Assuntos
Serviços de Saúde para Idosos , Fraturas do Quadril , Fraturas por Osteoporose , Idoso , Idoso Fragilizado , Fraturas do Quadril/terapia , Hospitalização , Humanos , Fraturas por Osteoporose/terapia , Turquia
6.
Medicine (Baltimore) ; 100(20): e25705, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011028

RESUMO

RATIONALE: One repetition maximum (1-RM) testing is a standard strength assessment procedure in clinical exercise intervention trials. Because no adverse events (AEs) are published, expert panels usually consider it safe for patient populations. However, we here report a vertebral fracture during 1-RM testing. PATIENT CONCERNS: A 69-year-old breast cancer survivor (body-mass-index 31.6 kg/m2), 3 months after primary therapy, underwent 1-RM testing within an exercise intervention trial. At the leg press, she experienced pain accompanied by a soft crackling. DIAGNOSIS: Imaging revealed a partially unstable cover plate compression fracture of the fourth lumbar vertebra (L4) with a vertical fracture line to the base plate, an extended bone marrow edema and a relative stenosis of the spinal canal. INTERVENTIONS: It was treated with an orthosis and vitamin D supplementation. Another imaging to exclude bone metastases revealed previously unknown osteoporosis. OUTCOMES: The patient was symptom-free 6.5 weeks after the event but did not return to exercise. CONCLUSION: This case challenges safety of 1-RM testing in elderly clinical populations. LESSONS: Pre-exercise osteoporosis risk assessment might help reducing fracture risk. However, changing the standard procedure from 1-RM to multiple repetition maximum (x-RM) testing in studies with elderly or clinical populations would be the safest solution.


Assuntos
Neoplasias da Mama/complicações , Teste de Esforço/efeitos adversos , Fraturas por Osteoporose/etiologia , Treinamento de Força/efeitos adversos , Fraturas da Coluna Vertebral/etiologia , Idoso , Sobreviventes de Câncer , Ensaios Clínicos como Assunto , Teste de Esforço/métodos , Feminino , Humanos , Vértebras Lombares/lesões , Aparelhos Ortopédicos , Fraturas por Osteoporose/terapia , Treinamento de Força/métodos , Fraturas da Coluna Vertebral/terapia , Vitamina D/administração & dosagem
7.
J Am Acad Orthop Surg ; 29(17): 741-747, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33826546

RESUMO

INTRODUCTION: Despite guidelines recommending postfracture bone health workup, multiple studies have shown that evaluation and treatment of osteoporosis has not been consistently implemented after fragility fractures. The primary aim of this study was to evaluate rates of osteoporosis evaluation and treatment in adult patients after low-energy thoracolumbar vertebral compression fractures (VCFs). METHODS: We retrospectively reviewed all patients ≥60 years old presenting to a single academic trauma center with acute thoracolumbar VCFs after a ground-level fall from 2016 to 2020 . Rates of osteoporosis screening with dual-energy x-ray absorptiometry and initiation of pharmaceutical treatment were recorded at four time points: before the date of injury, during index hospitalization, at first primary care provider follow-up, and at final primary care provider follow-up. Rates of subsequent falls and secondary fragility fractures were recorded. One-year mortality and overall mortality were also calculated. RESULTS: Fifty-two patients with a mean age of 83 years presenting with thoracic and/or lumbar fractures after a ground-level fall were included. At a mean final follow-up of 502 days, only 10 patients (19.2%) received pharmacologic therapy for osteoporosis and only 6 (11.5%) underwent postinjury dual-energy x-ray absorptiometry evaluation. Twenty-five patients (48%) had at least one subsequent fall at a mean of 164 days from the initial date of injury. Eleven patients with subsequent falls sustained an additional fragility fracture because of the fall, including six operative injuries. One-year mortality among the 52 patients was 26.9%, and the overall mortality rate was 44.2% at the final follow-up. DISCUSSION: Osteoporosis remains a major public health issue that markedly affects quality of life and healthcare costs. Our study demonstrates the additional need for improved osteoporosis workup and intervention among patients who have sustained VCFs. We hope that our study helps raise awareness for improved osteoporosis evaluation and treatment among spine surgeons and all medical professionals treating patients with fragility fractures. LEVEL OF EVIDENCE: Retrospective Case Series, Level IV Evidence.


Assuntos
Fraturas por Compressão , Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Adulto , Idoso de 80 Anos ou mais , Fraturas por Compressão/etiologia , Fraturas por Compressão/terapia , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/epidemiologia , Fraturas por Osteoporose/terapia , Qualidade de Vida , Estudos Retrospectivos , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia
8.
Arch Osteoporos ; 16(1): 59, 2021 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-33813681

RESUMO

This study shows a diagnostic and therapeutic gap for osteoporosis in patients with fragility fractures of the hip, distal radius, and vertebrae. Patients with fragility fractures treated in Mexico fail to receive an osteoporosis diagnosis, referral, and follow-up treatment. The therapeutic gap is higher than reported in other countries. INTRODUCTION: Osteoporosis is a highly prevalent and disabling disease. While there is typically a gap between osteoporosis diagnosis and treatment after a fragility fracture, this gap has not been measured in Mexico. The study aimed to describe and quantify the gap between osteoporosis diagnosis and treatment after an incident fragility fracture. MATERIALS AND METHODS: A descriptive and 3-year retrospective chart review study was conducted on patients over the age of 50 with a diagnosis of an incident acute low-energy fracture of either the hip, distal radius, or vertebrae. RESULTS: We included 838 patients with a mean age of 76.3 ± 12.2 years. The sample was mostly women (665 participants, 79.4%); 589 (70.3%) had a hip fracture, 173 (20.6%) had a distal radius fracture, and 76 (9.1%) had a vertebral fracture. Only 28 (3.3%) had a previous diagnosis and were taking a pharmacological treatment for osteoporosis; 11 (1.3%) received their diagnosis while hospitalized. Immediately after the fracture, and 1 and 3 years later, 144 (17.1%), 71 (8.4%), and 96 (11.4%) respectively received a pharmacological treatment, 195 (23.2%), 65 (7.7%), and 45 (5.3%) supplementation, and 16 (1.9%), 16 (1.9%), and 21 (2.5%) a non-pharmacologic treatment. No significant differences in treatment prescriptions were found after a second or third fracture. CONCLUSION: The study quantifies the too high frequency of failure to diagnose and treat osteoporosis in patients with fragility fractures. Measures should be established to reduce the yawning gap between osteoporosis diagnosis and treatment after a fragility fracture.


Assuntos
Conservadores da Densidade Óssea , Osteoporose , Fraturas por Osteoporose , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/terapia , Estudos Retrospectivos
9.
Biomed Res Int ; 2021: 6650358, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33928158

RESUMO

Objective: We conducted this meta-analysis to provide better evidence of the efficacy and safety of zoledronic acid (ZA) combined with percutaneous vertebroplasty/kyphoplasty (PVP/PKP) on osteoporotic vertebral compression fracture (OVCF) and proposed a protocol for its application in clinical practice. Methods: All randomized controlled trials (RCTs) of ZA combined with PVP or PKP compared to individual PVP/PKP for the management of patients with OVCFs were included in this study. Electronic database searches were conducted from database inception to November 2020, including the Cochrane Library, PubMed, Web of Science, and Embase. The pooled data were analyzed using RevMan 5.3 software. Results: Seven RCTs with 929 subjects were finally included. All included studies reported visual analog scores (VAS), and no statistically significant differences were identified at follow-ups of 3 d and 1 w (P > 0.05). In contrast, significant differences were observed at the 1 mo, 3 mo, 6 mo, and 12 mo follow-ups (P < 0.05). Two trials reported the Cobb angle and vertebral body height (VBH), including 182 subjects without significant differences at the 12 mo follow-up (P > 0.05). In addition, significant differences in the bone mineral density (BMD), ß-isomerized C-terminal telopeptide of type I collagen (ß-CTX), N-terminal propeptide of type I collagen (PINP), and N-terminal molecular fragment (N-MID) levels were observed between the two groups (P < 0.05). All trials reported side effects. Significant differences in recurrent fractures, fever, flu-like symptoms, and arthralgia or myalgia were identified (P < 0.05); however, no significant difference in postoperative leakage was detected (P > 0.05). Conclusion: Compared to PVP/PKP alone, an additional ZA injection had advantages of long-term analgesic effects with improved bone metabolism indexes. Moreover, combination therapy significantly prevented complications and drug reactions were well tolerated. Overall, this systematic review revealed that ZA combined with PVP/PKP was an effective, safe, and comprehensive therapy for patients with OVCFs.


Assuntos
Fraturas por Compressão/terapia , Cifoplastia , Fraturas por Osteoporose/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/terapia , Vertebroplastia , Ácido Zoledrônico/efeitos adversos , Ácido Zoledrônico/uso terapêutico , Fraturas por Compressão/tratamento farmacológico , Fraturas por Compressão/cirurgia , Humanos , Fraturas por Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/tratamento farmacológico , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
10.
J Bodyw Mov Ther ; 25: 170-173, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33714491

RESUMO

Osteoporotic fractures (OF) may occur without major trauma or injury. This case reports present a spine OF in Parkinson's disease (PD) and Pisa syndrome (PS). A 75-years-old woman diagnosed with PD for 19 years and PS has been developed. She recently has acute and severe low back pain. No recent injury or fall. After clinical examination and radiograph imaging, moderate wedge compression OF at L2 was revealed without a spinal cord or nerve compression. A program of conservative treatment was applied include antiosteoporotic supplementary, 6-days of bed rest, spine orthosis, and 10-weeks of exercises. The study adapted to use the following outcomes: visual analogues scale for low back pain, wall goniometer for lateral trunk flexion, and Oswesrty disability index for disability. After the intervention, the outcomes were improved as these values: visual analogues scales 7 points, lateral trunk flexion 20°, and Oswesrty disability index 60%. The case report suggests that the posture deformity as PS in PD may increase the risk of spine OF. The conservative treatment could be beneficial and safe for the OF in PD and PS. Further studies are required to confirm the role of PD postural deformities in OF and the effectiveness of therapeutic interventions.


Assuntos
Fraturas por Osteoporose , Doença de Parkinson , Idoso , Dor nas Costas , Tratamento Conservador , Feminino , Humanos , Fraturas por Osteoporose/terapia , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Coluna Vertebral
11.
Curr Opin Rheumatol ; 33(3): 270-276, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33651725

RESUMO

PURPOSE OF REVIEW: Rheumatoid arthritis (RA) is associated with increased risk for osteoporotic fracture. We highlight RA-specific risk factors for bone mineral density (BMD) loss and fractures and considerations regarding the diagnosis and treatment of osteoporosis in patients with RA. RECENT FINDINGS: Anticitrullinated protein antibody (ACPA) positivity, although associated with low BMD in early RA, is not associated with accelerated BMD loss over time when compared to ACPA negative individuals. Studies have found reduced BMD in individuals on low doses of glucocorticoids (GCs). Poor functional status and frailty are additional important risk factors for low BMD and fractures. Heightened fracture risk in RA may be mitigated by tight disease control, and biologic therapies are associated with more stable BMD compared to nonbiologic therapies. Evidence-based guidelines specific for treating osteoporosis in patients with RA do not exist. Thus, treatment decisions are based on general osteoporosis guidelines, taking into account additional RA-specific risk factors. SUMMARY: Recent studies have advanced knowledge of RA-specific risk factors for BMD loss and fractures. Future studies applying these findings to modify established fracture risk algorithms as well as evaluating osteoporosis treatments in RA cohorts are needed to reduce the risk of disabling fractures in these patients.


Assuntos
Artrite Reumatoide , Osteoporose , Fraturas por Osteoporose , Artrite Reumatoide/complicações , Artrite Reumatoide/terapia , Densidade Óssea , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Osteoporose/diagnóstico , Osteoporose/etiologia , Osteoporose/terapia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/terapia , Fatores de Risco
14.
Ultrasonics ; 113: 106360, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33561635

RESUMO

Low-intensity pulsed ultrasound (LIPUS) with an intensity (spatial average temporal average, ISATA) of 30 mW/cm2 has been widely proved to be effective on impaired bone healing, but showing little effectiveness in the treatment of osteoporosis. We hypothesized that the intensity of LIPUS may be a key factor in explaining this difference, thus two intensity levels, the widely used 30 mW/cm2 and a higher 150 mW/cm2, were used to simultaneously treat osteoporosis and osteoporotic bone defect in ovariectomized (OVX) rats with a 1-mm drill hole on their left femurs.Results showed that 150 mW/cm2 LIPUS augmented the healing rate of the drill hole than 30 mW/cm2 after 3-week LIPUS treatment, although did not further enhance the healing rate after 6-week LIPUS treatment. For ameliorating osteoporosis, 150 mW/cm2 LIPUS achieved more advantages over 30 mW/cm2 in improving bone density, microstructure and biomechanics 6 weeks after LIPUS intervention. In conclusion, LIPUS with an intensity of 30 mW/cm2 was sufficient to facilitate bone defect healing, but a higher intensity can be considered as a rapid trigger for osteoporotic bone repair. In addition, improving the intensity of LIPUS may be a potentially effective consideration for alleviation of osteoporosis, and the LIPUS regimen in the treatment of osteoporosis remains to be optimized.


Assuntos
Osteoporose/terapia , Fraturas por Osteoporose/terapia , Ondas Ultrassônicas , Animais , Densidade Óssea , Modelos Animais de Doenças , Feminino , Fêmur , Consolidação da Fratura , Ovariectomia , Ratos , Ratos Sprague-Dawley
15.
J Bone Miner Res ; 36(3): 459-468, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33484586

RESUMO

This study aimed to assess the cost-utility of a Fracture Liaison Service (FLS) with a systematic follow-up according to patients' follow-up compliance trajectories. The Lucky Bone™ FLS is a prospective cohort study conducted on women and men (≥40 years) with fragility fractures. Dedicated personnel of the program identified fractures, investigated, treated, and followed patients systematically over 2 years. Groups of follow-up compliance trajectories were identified, and Markov decision models were used to assess the cost-utility of each follow-up trajectory group compared to usual care. A lifetime horizon from the perspective of the healthcare payer was modeled. Costs were converted to 2018 Canadian dollars and incremental cost-utility ratios (ICURs) were measured. Costs and benefits were discounted at 1.5%. A total of 532 participants were followed in the FLS (86% women, mean age of 63 years). Three trajectories were predicted and interpreted; the high followers (HFs, 48.4%), intermediate followers (IFs, 28.1%), and low followers (LFs, 23.5%). The costs of the interventions per patient varied between $300 and $446 for 2 years, according to the follow-up trajectory. The FLS had higher investigation, treatment, and persistence rates compared to usual care. Compared to usual care, the ICURs for the HF, IF, and LF trajectory groups were $4250, $21,900, and $72,800 per quality-adjusted life year (QALY) gained, respectively ($9000 per QALY gained for the overall FLS). Sensitivity analyses showed that the HF and IF trajectory groups, as well as the entire FLS, were cost-effective in >67% of simulations with respect to usual care. In summary, these results suggest that a high-intensity FLS with a systematic 2-year follow-up can be cost-effective, especially when patients attend follow-up visits. They also highlight the importance of understanding the behaviors and factors that surround follow-up compliance over time as secondary prevention means that they are at high risk of re-fracture. © 2020 American Society for Bone and Mineral Research (ASBMR).


Assuntos
Osteoporose , Fraturas por Osteoporose , Canadá , Análise Custo-Benefício , Atenção à Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/terapia , Estudos Prospectivos , Estados Unidos
16.
Injury ; 52 Suppl 2: S97-S100, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32654846

RESUMO

The prevalence of osteoporotic fracture is high due to global aging problem. Delayed and impaired healing in osteoporotic fractures increase the socioeconomic burden significantly. Through intensive animal and clinical research in recent years, the pathogenesis of osteoporotic fracture healing is unveiled, including decreased inflammatory response, reduced mesenchymal stem cells and deteriorated angiogenesis, etc. The enhancement of osteoporotic fracture healing is important in shortening hospitalization, thus reducing related complications. Mechanical stimulation is currently the most well-accepted approach for rehabilitation of osteoporotic fracture patients. Some new interventions providing mechanical signals were explored extensively in recent years, including vibration treatment, and osteoporotic fracture healing was found to respond very well to these signals. Vibration treatment could accelerate osteoporotic fracture healing with improved callus formation, mineralization and remodeling. However, the mechanism of how osteoporotic fracture bones sense mechanical signals and relay to bone formation remains unanswered. Osteocytes are the most abundant cells in bone tissues. Cumulative evidence confirm that osteocyte is a type of mechanosensory cell and shows altered morphology and reduced cell density during aging. Meanwhile, osteocytes serve as endocrine cells to regulate bone and mineral homeostasis. However, the contribution of osteocytes in osteoporotic fracture healing is largely unknown. A recent in vivo study was conducted to examine the morphological and functional changes of osteocytes after vibration treatment in an osteoporotic metaphyseal fracture rat model. The findings demonstrated that vibration treatment induced significant outgrowth of canaliculi and altered expression of various proteins (E11, DMP1, FGF23 and sclerostin), particularly osteocyte-specific dentin matrix protein 1 (DMP1) which was greatly increased. DMP1 may play a major role in relaying mechanical signals to bone formation, which may require further experiments to consolidate. Most importantly, vibration treatment significantly increased the mineralization and accelerated the osteoporotic fracture healing in metaphyseal fracture model. In summary, osteocyte is the major cell type to sense mechanical signals and facilitate downstream healing in osteoporotic fracture bone. Vibration treatment has good potential to be translated for clinical application to benefit osteoporotic fracture patients, while randomized controlled trials are required to validate its efficacy.


Assuntos
Fraturas por Osteoporose , Animais , Consolidação da Fratura , Humanos , Osteócitos , Fraturas por Osteoporose/terapia , Ratos , Ratos Sprague-Dawley , Vibração/uso terapêutico
17.
World Neurosurg ; 145: 462-470.e1, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32891841

RESUMO

BACKGROUND: Vertebroplasty (VP), kyphoplasty (KP), SpineJack system (SJ), radiofrequency kyphoplasty (RFK), Kiva system (Kiva), Sky kyphoplasty system (SK), and conservative treatment are widely used in the treatment of osteoporotic vertebral compression fractures (OVCFs). However, it is still unknown which is the best intervention. The aim of the current study was to evaluate the effectiveness and safety of VP, KP, SJ, RFK, Kiva, SK, and CT in the treatment of OVCFs. METHODS: Randomized controlled trials and cohort studies comparing VP, KP, SJ, RFK, Kiva, SK, or CT for the treatment of OVCFs were identified on the basis of databases including PubMed, the Cochrane Library, Web of Science, and Springer Link. A network meta-analysis was performed using STATA 15.1. RESULTS: A total of 56 studies with 6974 patients and 7 interventions were included in this study. The results of the surface under the cumulative probability demonstrated that SK was the best intervention in decreasing VAS scores and recovering middle vertebral height, RFK was the best intervention in improving ODI scores and decreasing incidence of new fractures, SJ was the best intervention to restore kyphosis angle, and Kiva was the best intervention to reduce incidence of bone cement leakage. Cluster analysis showed that SK was the preferable intervention on the basis of the outcomes of VAS, ODI, middle vertebral height, and kyphotic angle, and RFK was the preferable treatment in decreasing the incidence of adverse events. In our network meta-analysis, node-splitting analysis and loop inconsistency analysis showed no significant inconsistencies. CONCLUSIONS: SK may be the most effective treatment in relieving pain, improving the quality of life, and recovering vertebral body height and kyphotic angle, while RFK may be the safest intervention for OVCFs. However, considering the limitations of this study, more high-quality trials are needed in the future to confirm the current conclusion.


Assuntos
Fraturas por Compressão/terapia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Tratamento Conservador/métodos , Humanos , Metanálise em Rede , Procedimentos Ortopédicos/métodos
18.
Ann Rheum Dis ; 80(1): 57-64, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32332077

RESUMO

OBJECTIVE: To establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older. METHODS: Points to consider were developed in accordance with EULAR standard operating procedures for EULAR-endorsed recommendations, led by an international multidisciplinary task force, including patient research partners and different health professionals from 10 European countries. Level of evidence and strength of recommendation were determined for each point to consider, and the mean level of agreement among the task force members was calculated. RESULTS: Two overarching principles and seven points to consider were formulated based on scientific evidence and the expert opinion of the task force. The two overarching principles focus on shared decisions between patients and non-physician health professionals and involvement of different non-physician health professionals in prevention and management of fragility fractures. Four points to consider relate to prevention: identification of patients at risk of fracture, fall risk evaluation, multicomponent interventions to prevent primary fracture and discouragement of smoking and overuse of alcohol. The remaining three focus on management of fragility fractures: exercise and nutritional interventions, the organisation and coordination of multidisciplinary services for post-fracture models of care and adherence to anti-osteoporosis medicines. The mean level of agreement among the task force for the overarching principles and the points to consider ranged between 8.4 and 9.6. CONCLUSION: These first EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older serve to guide healthcare practice and education.


Assuntos
Acidentes por Quedas/prevenção & controle , Conservadores da Densidade Óssea/uso terapêutico , Suplementos Nutricionais , Exercício Físico , Pessoal de Saúde , Osteoporose/terapia , Fraturas por Osteoporose/prevenção & controle , Equipamentos de Autoajuda , Comitês Consultivos , Idoso , Idoso de 80 Anos ou mais , Europa (Continente) , Humanos , Adesão à Medicação , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Nutricionistas , Terapeutas Ocupacionais , Osteoporose/complicações , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/terapia , Farmacêuticos , Fisioterapeutas , Prevenção Primária , Reumatologia , Medição de Risco , Abandono do Hábito de Fumar
19.
J Nucl Med ; 62(4): 446-454, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33310738

RESUMO

Bone mineral density (BMD) measurement by dual-energy x-ray absorptiometry (DXA) is an internationally accepted standard-of-care screening tool used to assess fragility-fracture risk. Society guidelines have recommended which populations may benefit from DXA screening and the use of the fracture risk assessment tool (FRAX) to guide decisions regarding pharmacologic treatment for osteoporosis. According to the U.S. National Osteoporosis Foundation guidelines, postmenopausal women and men at least 50 y old with osteopenic BMD warrant pharmacologic treatment if they have a FRAX-calculated 10-y probability of at least 3% for hip fracture or at least 20% for major osteoporotic fracture. Patients with osteoporosis defined by a clinical event, namely a fragility fracture, or with an osteoporotic BMD should also be treated. Patients who are treated for osteoporosis should be monitored regularly to track expected gains in BMD by serial DXA scans. With some drug therapies, BMD targets can be reached whereby further improvements in BMD are not associated with further reductions in fracture risk. Although reaching this target might suggest a stopping point for therapy, the reversibility of most treatments for osteoporosis, except for the bisphosphonates, has dampened enthusiasm for this approach. In the case of denosumab, it is now apparent that stopping therapy at any point can lead to an increase in multiple-fracture risk. For patients who do not respond to antiosteoporosis pharmacologic therapy with an improvement in BMD, or who have an incident fragility fracture on therapy, secondary causes of osteoporosis or non-compliance with medical therapy should be considered.


Assuntos
Densidade Óssea , Humanos , Osteoporose/fisiopatologia , Osteoporose/terapia , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/terapia , Medição de Risco
20.
Rev. Méd. Clín. Condes ; 31(5/6): 430-440, sept.-dic. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1224135

RESUMO

La fractura osteoporótica es una entidad clínica que afecta seriamente la calidad y expectativa de vida del paciente, agregándose un impacto socioeconómico elevado, superando incluso a los gastos de patologías como el infarto agudo de miocardio, accidente cerebrovascular y cáncer de mama, y cuya incidencia y prevalencia va en aumento a medida que la población mundial envejece. La gran mayoría de los casos cursan inadvertidos y sub diagnosticados, dejando a tres de cuatro pacientes, sin tratamiento y expuestos a nuevos eventos. El foco mundial en los países desarrollados como estrategia de enfrentamiento de esta patología endémica ha sido el de la prevención, vale decir medicina primaria. Sin embargo, una vez diagnosticada la fractura osteoporótica, no existe consenso en el tipo de tratamiento óptimo, así como sus plazos en estos pacientes. La mayoría de las guías internacionales y los trabajos publicados, presentan diferencias en el manejo de esta lesión.


The osteoporotic fracture is a clinical entity that seriously affects the quality and life expectancy of the patient, adding a high socioeconomic impact, even exceeding the expenses of pathologies such as acute myocardial stroke, vascular cerebral stroke and breast cancer, and whose incidence and prevalence is increasing as the world population ages. The vast majority of cases are non-diagnosed, leaving three of four patients with non treatment at all. The target in developed countries as a strategy to confront this endemic pathology has been prevention, or, primary medicine. However, once the osteoporotic fracture is diagnosed, there is no consensus on the type of optimal treatment, as well as its deadlines in these patients. The majority of international guidelines and published articles show differences in the management and treatment of this fracture.


Assuntos
Humanos , Idoso , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/terapia , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/classificação , Fraturas por Osteoporose/classificação
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