The distal radius, the most frequent fracture localization in humans: a histomorphometric analysis of the microarchitecture of 60 human distal radii and its changes in aging.

BACKGROUND: The distal radius is the most frequent fracture localization in humans. Although younger patients receive a distal radius fracture after an adequate trauma, elderly patients suffer fractures through low-energy mechanisms. Low-energy fractures are hallmarks of osteoporosis. Osteoporotic changes of the distal radius are well described by DXA and peripheral quantitative computed tomography measurements. However, to date, the effects of aging on the microarchitecture of the distal radius have not been investigated. METHODS: To investigate whether the microarchitecture of the human distal radius shows osteoporotic changes in bone mass and structure during aging, we dissected out 60 complete human distal radii from 30 age- and gender-matched patients at autopsy. Each of the three different age groups (group I: 20-40 years, group II: 41-60 years, group III: 61-80 years) was represented by 10 autopsy cases and 20 specimens (double-sided extraction), respectively. The specimens were analyzed by peripheral quantitative computed tomography, contact-radiography, and histomorphometry. RESULTS: We observed a significant age-related decrease in bone mass, bone mineral density and an increase in typical osteoporotic changes of the bone microarchitecture in female distal radius specimens. Comparable observations of age-related changes have not been made in male specimens. CONCLUSIONS: The distal radius is a location of osteoporosis-specific bone changes. Our data provide evidence for the occurrence of typical osteoporotic changes, especially postmenopausal osteoporotic changes, in the distal radius during aging.

Effects of increased bone formation on fracture healing in mice.

BACKGROUND: Fracture healing is a complex and sequential process. One important step in fracture healing is callus remodeling. As we could previously show, an increase of osteoclast bone resorption as a result of estrogen deficiency impairs the fracture healing process. Therefore, the aim of our study was to analyze whether an increased bone formation, as the counterpart of bone resorption in callus remodeling, would accelerate the fracture healing process. METHODS: Standardized femoral fractures were produced in 10-week-old control, leptin-deficient (ob/ob), and leptin receptor-deficient (db/db) mice using a guillotine-like fracture device. Accordingly, the fractures were intramedullary stabilized. The ob/ob and db/db mice are known to have a twofold increase in bone formation in comparison with normal wildtype mice. At different stages of fracture healing, contact X-ray, histologic, and biomechanical analyses were performed. RESULTS: We observed that a twofold increase in bone formation leads to an accelerated periosteal callus formation followed by callus remodeling. As compared with the control group, chondrocytes area was increased, and the subsequent mineralization appeared earlier. In the late stage of fracture healing, the ob/ob and db/db mice showed a thinner but increased mineralized cortex. Biomechanical testing confirmed the beneficial effects of an increased bone formation on restoration of biomechanical competence. CONCLUSION: These results indicate that bone formation is of major importance in all stages of fracture healing. A twofold increase in bone formation is able to significantly accelerate the fracture healing process of long bones at least in mice. Therefore, an increase in bone formation would be a possible pharmaceutical target to enhance fracture healing.

Acceptance of telemonitoring to enhance medication compliance in patients with chronic heart failure.

Noncompliance with medication often leads to a deterioration of health status in patients with chronic heart failure (CHF). The aim of this pilot study was to test a telemonitoring intervention that can increase compliance and prevent readmissions in order to improve patients' quality of life. The study's purpose was to identify processes and outcomes of telemonitoring as well as factors associated with its acceptance. Sixty-two (n = 62) CHF patients participated in a controlled, longitudinal study. Medication intake was monitored with a medication box transferring data to an electronic health record. Physicians, nurses, or pharmacists monitored signals and, in case of absence of signal transfers, initiated interventions. Patients were assessed regarding their medication intake, clinical status, and health status, as well as acceptance of medication monitoring. There was a significant improvement in mental and physical health status from study intake to 1-month follow-up. Self-reported noncompliance and mental health were significantly lower in study patients. Mental health of controls did not improve in the course of the study. The acceptance of the tool was high, however, 47% of patients did not consider it necessary to continue monitoring after study termination. Medication telemonitoring might prove an effective method to improve medication intake and health in home care in a subset of patients with self-reported noncompliance.