Osteoporotic fractures of the proximal humerus, pelvis, and ankle: epidemiology and diagnosis.

Although fractures involving the wrist, spine, and proximal femur are known to be strongly associated with osteoporosis, the underlying bone insufficiency often receives insufficient diagnostic and therapeutic attention. Osteoporosis also increases the risk of fractures at other sites. Low-energy fractures in patients older than 50 years should lead to investigations for osteoporosis, the only exceptions being fractures of the skull, cervical spine, fingers, and toes. The incidence rates of fractures of the proximal humerus, pelvis, and ankle are climbing relentlessly. Whereas fractures of the proximal humerus and pelvis are undoubtedly related to osteoporosis, the link is less well established for fractures of the ankle. Mortality and morbidity rates associated with pelvic fractures are similar to those seen with fractures of the proximal femur, in keeping with the fact that both fractures occur in elderly individuals.

Sigma ESR: an erythrocyte sedimentation rate adjusted for the hematocrit and hemoglobin concentration.

The aim of the study was to simplify the first Sigma erythrocyte sedimentation rate (ESR) method (manual hematocrit adjustment to 0.35, sum of 4 sedimentation levels) and to confirm its clinical relevance. The erythrocyte sedimentation rate of undiluted blood samples from 576 patients was measured simultaneously with and without manual hematocrit adjustment to 0.35 to identify an approximate expression of the area under the curve and a formula for calculating the Sigma ESR. The Sigma ESR formula was based on the sum of 2 unadjusted sedimentation levels, at 30 and 60 minutes, together with the hematocrit value and the hemoglobin concentration. Sigma ESR values in 274 healthy subjects showed a gaussian distribution, no difference between men and women, and no significant increase with age. In recent-onset arthritis or disk-related lumbosciatic syndrome, Sigma ESR seemed to be a more reliable marker of inflammation than the Westergren ESR and C-reactive protein. We also obtained data clarifying the controversial relationship of ESR with lipid levels and arterial hypertension.

Elevated parathyroid hormone 44-68 in idiopathic calcium pyrophosphate dihydrate crystal deposition disease. Role of menopause and iron metabolism?

OBJECTIVE: To examine whether idiopathic calcium pyrophosphate dihydrate (CPPD) crystal deposition disease (CDD) is related to altered parathyroid hormone (PTH) metabolism. METHODS: Forty-two patients with idiopathic CPPD CDD were compared with 67 controls, 33 of whom were matched for age and sex. RESULTS: Serum PTH 44-68 concentrations were elevated in 29% of patients and were significantly higher in the patients than in their sex- and age-matched controls (Z = -4.664, p < 0.0001). PTH 1-84 levels were normal. Serum calcium, phosphorus, and ferritin levels were normal, but were significantly higher in the patients. Serum PTH 44-68 levels correlated negatively with serum transferrin in female controls aged >or= 45 years, and with transferrin saturation in the female patients. Correlation between serum ferritin and age was linear and positive in the former subjects and quadratic in the latter. CONCLUSION: Elevated serum concentration of PTH mid-fragments containing the 44-68 region could explain the joint disorders associated with idiopathic CPPD CDD, as shown in genetic hemochromatosis. In female patients the elevation of PTH mid-fragments could be linked to changes in iron metabolism provoked by the menopause.

Bed rest or normal activity for patients with acute low back pain: a randomized controlled trial.

BACKGROUND: The management of common low back pain has two principal objectives: to relieve acute pain and to attempt prevention of transition to chronicity. Several studies have shown the ineffectiveness of prolonged periods of bed rest. OBJECTIVE: To compare 4 days of bed rest with continued normal daily activity in acute low back pain, taking into account the type of work (physical or sedentary labor). METHODS: This open, comparative multicenter study enrolled 281 ambulatory patients, ages 18 to 65 years, with low back pain (onset < 72 hours). The subjects did not have pain radiating below the buttocks and did not have work-related injuries. They were randomized into two treatment groups: one instructed to continue normal activity (insofar as the pain allowed), and the other prescribed 4 days of bed rest. After inclusion, patients were seen at three visits: on day 6 or 7, after 1 month, and after 3 months. RESULTS: On day 6 or 7, pain intensity was similar for both groups, as was the overall judgment of the treatment by patients and physicians. At 1 and 3 months, the groups again had equivalent intensity of back pain, functional disability, and vertebral stiffness. A higher proportion of patients in the bed rest group than in the normal activity group had an initial sick leave (86% vs 52%; P < 0.0001). This difference was greater for the patients whose work was sedentary. CONCLUSIONS: For patients with acute low back pain, normal activity is at least equivalent to bed rest. The findings of this study indicate that prescriptions for bed rest, and thus for sick leaves, should be limited when the physical demands of the job are similar to those for daily life activities.