Knee osteoarthritis and adverse health outcomes: an umbrella review of meta-analyses of observational studies.

BACKGROUND: Knee osteoarthritis (OA) is a common condition, associated with a high rate of disability and poor quality of life. Despite the importance of such evidence in public health, no umbrella review (i.e., a review of other systematic reviews and meta-analyses) has systematically assessed evidence on association between knee OA and adverse health outcomes. AIMS: To map and grade all health outcomes associated with knee OA using an umbrella review approach. METHODS: The search was made across several databases up to 22 April 2022. We used an umbrella review of systematic reviews with meta-analyses of observational studies assessing the effect sizes, based on random effect summary, 95% prediction intervals, heterogeneity, small study effects, and excess significance bias. The evidence was then graded from convincing (class I) to weak (class IV). RESULTS: Among 3,847 studies initially considered, five meta-analyses were included for a total of five different outcomes. Three adverse outcomes were significantly associated with knee OA (i.e., cardiovascular mortality, falls, and subclinical atherosclerosis). The presence of knee OA was associated with a significantly higher risk of cardiovascular mortality (odds ratio, OR = 1.17; 95%CI, confidence intervals: 1.02-1.34), falls (RR = 1.34; 95%CI: 1.10-1.64), and conditions associated with subclinical atherosclerosis (OR = 1.43; 95%CI: 1.003-2.05). The certainty of each of this evidence was weak. CONCLUSIONS: Our umbrella review suggests that knee OA can be considered as putative risk factor for some medical conditions, including cardiovascular diseases and falls, however, it is important to note that the evidence is affected by potential biases.

Sarcopenia in gynaecological cancers.

Gynaecological cancers (GCs) comprise a group of cancers that originate in the female reproductive organs. Each GC is unique, with different signs and symptoms, risk factors and therapeutic strategies. Worldwide, the majority of GCs are still associated with high mortality rates, especially ovarian, due to difficulty in early detection. Despite numerous studies on the underlying pathophysiology, research in the field of GCs poses unique scientific and technological challenges. These challenges require a concerted multi- and inter-disciplinary effort by the clinical, scientific and research communities to accelerate the advancement of prognostic, diagnostic, and therapeutic approaches. Sarcopenia is a multifactorial disease which leads to the systemic loss of skeletal muscle mass and function. It can be caused by malignancies, as well as due to malnutrition, physical inactivity, ageing and neuromuscular, inflammatory, and/or endocrine diseases. Anorexia and systemic inflammation can shift the metabolic balance of patients with cancer cachexia towards catabolism of skeletal muscle, and hence sarcopenia. Therefore, sarcopenia is considered as an indicator of poor general health status, as well as the possible indicator of advanced cancer. There is a growing body of evidence showing the prognostic significance of sarcopenia in various cancers, including GCs. This review will outline the clinical importance of sarcopenia in patients with GCs.

Sarcopenic obesity and health outcomes: An umbrella review of systematic reviews with meta-analysis.

Many studies support the idea that sarcopenic obesity (SO) could be considered a potential risk factor for negative health outcomes. These results have been inconsistent, and no umbrella reviews exist regarding this topic. Several databases until November 2023 were searched for systematic reviews with meta-analysis of observational studies (cross-sectional, case-control and prospective). For each association, random-effects summary effect sizes with correspondent 95% confidence intervals (CIs) were evaluated using the GRADE tool. Among the 213 papers initially screened, nine systematic reviews with meta-analysis were included, for a total of 384 710 participants. In cross-sectional and case-control studies, 30 different outcomes were analysed, and 18 were statistically significant. In any population addressed in cross-sectional and case-control studies, compared with non-SO, SO increased the prevalence of cognitive impairment (k = 3; odds ratio [OR] = 3.46; 95% CI: 2.24-5.32; high certainty of evidence), coronary artery disease (k = 2; OR = 2.48; 95% CI: 1.85-3.31) and dyslipidaemia (k = 3; OR = 2.50; 95% CI: 1.51-4.15). When compared with sarcopenia or obesity, the results were conflicting. In prospective studies, the association between SO-compared with non-SO-and other negative outcomes was supported by low/very low certainty of evidence and limited to a few conditions. Besides, no comparison with sarcopenia or obesity was provided. Finally, only a few studies have considered muscle function/physical performance in the diagnostic workup. SO could be considered a risk factor only for a few conditions, with the literature mainly based on cross-sectional and case-control studies. Future studies with clear definitions of SO are needed for quantifying the importance of SO-particularly when compared with the presence of only sarcopenia or obesity-and the weight of muscle function/physical performance in its definition.

Sarcopenia increases mortality risk in liver transplantation: a systematic review and meta-analysis.

INTRODUCTION: Liver transplantation is an efficacious treatment option for those with liver cirrhosis. However, the prognostic role of sarcopenia in these patients is unknown. Given this background, we conducted a systematic review and meta-analysis of the impact of sarcopenia on mortality in patients listed, evaluated and undergoing liver transplantation. EVIDENCE ACQUISITION: Several databases were searched from the inception to December 2022 for observational studies regarding sarcopenia in liver transplant and mortality. We calculated the risk of mortality in sarcopenia vs. no sarcopenia using the most adjusted estimate available and summarizing the data as risk ratios (RRs) with their 95% confidence intervals (CIs). A random-effect model was considered for all analyses. EVIDENCE SYNTHESIS: Among 1135 studies initially considered, 33 articles were included for a total of 12,137 patients (mean age: 55.3 years; 39.4% females). Over a median of 2.6 years and after adjusting for a median of 3 covariates, sarcopenia increased the risk of mortality approximately 2-fold (RR: 2.01; 95% CI: 1.70-2.36). After accounting for publication bias, the re-calculated RR was 1.75 (95% CI: 1.49-2.06). The quality of the studies was generally low, as determined by the Newcastle Ottawa Scale. CONCLUSIONS: Sarcopenia was significantly linked with an increased risk of mortality in patients listed, evaluated, and undergoing a liver transplantation, indicating the need of interventional studies in this special population with the main aim to reverse this potential reversible condition and decrease mortality risk.

Periodontal Health and Its Relationship with Psychological Stress: A Cross-Sectional Study.

Background: Studies suggest that chronic psychological stress can lead to oral health deterioration, alter the immune response, and possibly contribute to increased inflammation, which can impact the physiological healing of periodontal tissues. This cross-sectional study seeks to assess and improve clinical understanding regarding the relationship between perceived stress, mindfulness, and periodontal health. Methods: A total of 203 people were analyzed from December 2022 to June 2023. The Periodontal Screening and Recording (PSR) score and Gingival Bleeding Index (GBI), and Plaque Control Record (PCR) of every patient were registered. Subsequently, participants completed the Sheldon Cohen Perceived Stress Scale (PSS) and the Mindfulness Awareness Attention Scale (MAAS) questionnaires. The collected data underwent statistical analysis, encompassing the evaluation of correlations and dependencies. Applying Welch's t-test to assess the relationship between MAAS and the variable indicating the presence or absence of periodontitis, a noteworthy p-value of 0.004265 was obtained. Results: This underscores a significant distinction in MAAS scores between patients affected by periodontitis and those unaffected by the condition. Additionally, Pearson correlations were computed for GBI and perceived stress, PCR and perceived stress, PCR and MAAS. The resulting p-values of 2.2-16, 3.925-8, and 2.468-8, respectively, indicate a statistically significant correlation in each instance. Conclusions: These findings contribute valuable insights into the interconnectedness of these variables, emphasizing the significance of their associations in the study context. Despite the limitations, the findings of this study suggest a significant relationship between psychological stress, mindfulness, and periodontal tissue health. Clinical trials are necessary to incorporate the assessment of a patient's psychological status as a new valuable tool in the management of periodontal health.

Non-Pharmacological Pain Treatment of Patients with Myofascial Pain Syndrome of the Masticatory Muscles-Case Series.

Myofascial pain is the most common cause of chronic pain in the masticatory region and can be assessed through clinical analysis and muscle palpation. Generally, it appears with headache and orofacial pain associated with sensitive points (trigger points) due to the excessive contraction of the masticatory muscle fibers. The study aims to evaluate how a correct treatment of myofascial pain can improve the life quality of affected patients. In this case series, 300 patients with myofascial pain were divided into two groups: 150 with intra- and extra-articular disorders and 150 with only extra-articular disorder. Each group included 75 males and 75 females. All the patients were treated with gnathological therapy through passive aligners and biofeedback exercises for four months. They underwent pain assessment (through a visual analogue scale and muscular palpation test) before, during, and after the treatment, as well as nuclear magnetic resonance of the temporomandibular joint before and after the gnathological treatment. The treatment considerably reduced the pain in all patients, without drugs, in four months according to the visual analogue scales and the palpation test. The temporomandibular magnetic resonance in each patient was similar before and after the gnathological treatment. The improvement in pain did not depend on a change in the relationship between the articular condyle and the disc.

Interpreting the prevalence of musculoskeletal pain impacting Italian and Peruvian dentists likewise: A cross-sectional study.

Background: Musculoskeletal pain is a frequent condition among dental practitioners due to working in prolonged static isometric/eccentric contraction. The study aimed to describe musculoskeletal pain prevalence and the interplay between environmental conditions, lifestyle, and drugs consumed among Italian and Peruvian dentists. Methods: A 18 multiple choice questionnaire was administered to Peruvian and Italian dental care practitioners. A total of 187 questionnaires were submitted. One hundred sixty-seven questionnaires were selected for the analysis, including 86 questionnaires from Italy, and 81 from Perú. The study examined musculoskeletal pain presence in dental practitioners. The prevalence of musculoskeletal pain presence was analyzed considering different parameters: gender, age, type of dental practitioners, specialization in dentistry, hours of work per day, years of work, physical activity, localization of musculoskeletal pain and the influence of musculoskeletal pain on the performance on work. Results: The selected questionnaires for analysis were 167 (67 from Italy and 81 from Perú). Male and female participants were numerically equal. Most of the dental practitioners were dentists. The percentage of dentists who present musculoskeletal pain is 87.2% in Italy and 91.4% in Perú (p < 0.05). Conclusion: Musculoskeletal pain represents a very diffused condition in dental practitioners. The results about the prevalence of musculoskeletal pain show how the two populations (Italian and Peruvian) are very similar despite the geographical distance. Nevertheless, the high percentages of musculoskeletal pain in dental practitioners translate into the need to use solutions to reduce its onsets, such as improving ergonomics and physical activity.

Prevalence of Ponticulus Posticus and Migraine in 220 Orthodontic Patients: A Cross-Sectional Study.

BACKGROUND: Ponticulus posticus (PP) is a medical term that describes an anomaly of the atlas (C1), which has a complete or partial bone bridge over the vertebral artery (VA) groove. The purpose of the study is to estimate the prevalence of PP in patients with a diagnosis of migraine. METHODS: Cone beam CT (CBCT) scans (n = 220) were reviewed for the detection of PP in the University "G. D'Annunzio" of Chieti in the Department of Medical, Oral and Biotechnological Sciences. The sample included 220 Italian patients between 18 and 87 years. Pearson chi-square analysis (p < 0.05 and 95% CI) was used to establish an association between migraine and PP. RESULTS: The present study found a prevalence of PP of 20.9% and a prevalence of migraine of 12.272%. The association between migraine and PP was confirmed by the chi-square statistic, since the p-value was 0.008065 (significant at p < 0.05). PP was more frequent in the migraine without aura group, without a statistical difference relative to the migraine with aura group. CONCLUSIONS: The study concluded that PP is positively associated with migraine.

Prevalence of Sarcopenia in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

An association between knee osteoarthritis (OA) and sarcopenia has been proposed, but the evidence is controversial, with the recent literature showing disparate results. Therefore, we aimed to perform a systematic review and meta-analysis to evaluate the prevalence of sarcopenia in knee OA patients compared to people not affected by this condition. We searched several databases until 22 February 2022. The data regarding prevalence were summarized using odds ratios (ORs) with their 95% confidence intervals (CIs). Among the 504 papers initially screened, 4 were included for a total of 7495 participants with a mean age of 68.4 years, who were mainly females (72.4%). The prevalence of sarcopenia in people with knee OA was 45.2%, whilst, in the controls, it was 31.2%. Pooling the data of the studies included that the prevalence of sarcopenia in knee OA was more than two times higher than in the control group (OR = 2.07; 95%CI: 1.43-3.00; I2 = 85%). This outcome did not suffer any publication bias. However, after removing an outlier study, the recalculated OR was 1.88. In conclusion, the presence of sarcopenia in knee OA patients was high, affecting one person in every two persons and was higher than in the control groups included.

Prevalence of shoulder discomfort in paraplegic subjects.

INTRODUCTION: The annual incidence of acute spinal cord injury, as reported in the National Spinal Cord Injury Statistical Center, was estimated to be approximately 40 cases per million, or approximately 11.000 new cases in the United States each year (1). In subjects with spinal cord injury, overstress of the upper extremities occurs not only during daily life activities, but also utilizing wheelchair. The aim of this study is to determine the prevalence of shoulder discomfort in subjects affected by paraplegia living in our country area and evaluate the associated risk factors negatively affecting the shoulder function. MATERIAL AND METHOD: A computerized database search for paraplegic patients was performed at the Department of Orthopedic Surgery, Trauma Surgery and Rehabilitation Medicine. Among the 54 selected paraplegic patients, 47 accepted to participate at the study. Once the patients were contacted, the medical records were reviewed to obtain information regarding shoulder, elbow and spine region pain and discomfort. RESULTS: The 60% of all the patients who answered to the questionnaire complain shoulder pain, 90% bilaterally, and the 30% referred elbow pain, 20% bilaterally. 77% complains back pain, involving particularly lumbar region. Only 2% of this population undergoes a shoulder surgery treatment for cuff tear and shoulder disability. DISCUSSION AND CONCLUSION: The present study is the first in our country that gives an overview of prevalence of upper limb discomfort in paraplegic patients. We have shown the interplay between shoulder elbow and spine with pain, age of patients and type of wheel chair utilized. The previous factors can be corrected and upper limb discomfort relieved.

EU health co-design policies to counteract the COVID-19 pandemic effect promoting physical activity.

BACKGROUND: The research is placed in the context of interdisciplinary medical-legal studies on the importance of promoting physical activity as a public health tool. OBJECTIVE: The aim was to highlight the tools that can be used by EU members for planning interventions aimed at overcoming the consequences of the COVID-19 pandemic and for responding to a future crisis. METHODS: First, the medical resources relating to the indirect and direct effects of the COVID-19 pandemic are analysed. Then, the results are compared with the measures of the EU bodies to verify the correspondence of the scientific arrests, with the political-regulatory interventions. RESULTS: It was found that the prolonged closure of sports centres and the contagion from COVID-19 produce affects the body in a way that can only be recovered by motor activity. However, in the EU, there does not exist a regulatory harmonization about health issues that can directly impose the Members to implement their legislation to promote motor activity. CONCLUSIONS: The signing of the Rome Declaration at the Global Health Summit on 21 May 2021 constitutes an important and concrete commitment for the exchange in the medical-scientific field, and for an effective co-design of intervention strategies for the relaunch of physical activity within projects such as EU4Health and the two-year HealthyLifestyle4All campaign.

The Evaluation of Physical Activity Habits in North Italian People before and during COVID-19 Quarantine: A Pilot Study.

COVID-19 caused a global pandemic state. Many governments enforced quarantines which had several negative effects on peoples' health. The present study aimed to investigate the social restriction effects on the physical activity (PA) habits of north Italian people and understand whether PA was a healthy support during lockdown. Moreover, it analysed some possible strategies which could promote an active lifestyle when the pandemic ends. A new questionnaire was proposed (Cronbach's alpha = 0.816), and 309 surveys were collected in people from two Italian regions (53.72% from Emilia-Romagna and 46.28% from Veneto; 62.46% were female and 37.54% were male; and the age range was 46.67 ± 15.45 years). The number of younger people (≤25 years) who practiced PA increased during lockdown (p < 0.01); in addition, they were more active than people who were 26-35 years old (p < 0.001). The training frequency before COVID-19 was higher in females than males (p = 0.01), and the frequency of weekly PA increased during lockdown in groups aged 26-35 years (p < 0.001). Despite the fact that PA was a psychological support during lockdown (p < 0.001), performing forced home-based PA demotivated people (p < 0.001). Finally, people thought to practice outdoor PA (OPA) at the end of lockdown because they wanted to retain contact with nature, which can improve psychological well-being. Future strategies to promote OPA may increase participation in PA, especially in older people.

ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People.

BACKGROUND AND OBJECTIVE: Prescribing cascades occur when a drug is prescribed to manage side effects of another drug, typically when a side effect is misinterpreted as a new condition. A consensus list of clinically important prescribing cascades that adversely affect older persons' health (i.e., where risks of the prescribing cascade usually exceed benefits) was developed to help identify, prevent, and manage prescribing cascades. METHODS: Three rounds of a modified Delphi process were conducted with a multidisciplinary panel of 38 clinicians from six countries with expertise in geriatric pharmacotherapy. The clinical importance of 139 prescribing cascades was assessed in Round 1. Cascades highly rated by ≥ 70% of panelists were included in subsequent rounds. Factors influencing ratings in Rounds 1 and 3 were categorized. After three Delphi rounds, highly rated prescribing cascades were reviewed by the study team to determine the final list of clinically important cascades consistent with potentially inappropriate prescribing. RESULTS: After three rounds, 13 prescribing cascades were highly rated by panelists. Following a study team review, the final tool includes nine clinically important prescribing cascades consistent with potentially inappropriate prescribing. Panelists reported that their ratings were influenced by many factors (e.g., how commonly they encountered the medications involved and the cascade itself, the severity of side effects, availability of alternatives). The relative importance of these factors in determining clinical importance varied by panelist. CONCLUSIONS: A nine-item consensus-based list of clinically important prescribing cascades, representing potentially inappropriate prescribing, was developed. Panelists' decisions about what constituted a clinically important prescribing cascade were multi-factorial. This tool not only raises awareness about these cascades but will also help clinicians recognize these and other important prescribing cascades. This list contributes to the prevention and management of polypharmacy and medication-related harm in older people.

Identifying key prescribing cascades in older people (iKASCADE): a transnational initiative on drug safety through a sex and gender lens-rationale and design.

PURPOSE: To describe the objectives, methods and expected impact of an international consortium (iKASCADE) whose purpose is to improve drug safety for older adults by addressing prescribing cascades through a sex and gender lens. METHODS: To create a comprehensive, internationally relevant inventory of prescribing cascades affecting older adults, the consortium has created a modified Delphi procedure where international experts in prescribing and managing pharmacotherapy for older adults will rank a list of prescribing cascades as to their clinical importance. We will use administrative and clinical data on older adults to evaluate the frequency of prescribing cascades by sex internationally, in the hospital, long-term care and community settings. Finally, we will use semi-structured interviews and realistic, country-specific vignettes, each incorporating a prescribing cascade with identified sex differences, to explore how socially constructed gender roles contribute to the experience, presentation and management of prescribing cascades. RESULTS: The consortium will synthesize the quantitative and qualitative results to produce a position paper and products-aimed at knowledge users within and outside of academia-designed to elevate the importance of integrating a gender dimension in the identification and prevention of prescribing cascades. CONCLUSION: Findings will improve our understanding of how adverse drug events are different between older women and men and inform the development and dissemination of tailored knowledge translation products to reduce the frequency and impact of prescribing cascades.

Shoulder Function After Cardioverter-Defibrillator Implantation: 5-Year Follow-up.

BACKGROUND: Implantable cardioverter-defibrillator (ICD) represents the main tool for prevention of sudden cardiac death. Different kinds of postimplant complications have been described; however, little is known about shoulder functional impairment and its impact on quality of life. METHODS: Patients with standard indications for elective prepectoral subcutaneous ICD insertion were enrolled during a 1-year period. The impact of ICD implantation on shoulder motility, pain, general disability, and quality of life was evaluated prospectively at baseline, and after 2 weeks, 3 months, 1 year, and 5 years using the Constant score, the Numeric Pain Rating Scale, the Disabilities of the Arm, Shoulder, and Hand scale, and the Short Form-36 Health Survey questionnaire. RESULTS: A total of 50 patients underwent insertion of single, dual chamber, or biventricular ICDs. Two weeks after implantation, functional impairment and mild pain were observed in ipsilateral shoulder movements, with a reduction in the Short Form-36 Health Survey score. Shoulder functional impairment improved at the third-month evaluations, with almost normalization at 1-year and 5-year assessments, as well as pain and quality of life. CONCLUSIONS: Prepectoral subcutaneous ICD implantation may be associated with ipsilateral shoulder functional impairment that regresses partially after 3 months and completely at 1-year and 5-year assessments. The less invasive implantation technique and the relatively small size of modern ICDs, independently from types and volumes, may be relevant to the degree of postimplantation shoulder functional impairment and recovery time. Shoulder function should be assessed at routine checks, especially soon after ICD implantation because of potential functional impairment and subsequent impact on quality of life.

Panton-Valentine leukocidin gene detected in Staphylococcus aureus strain isolated from a knee arthroprosthesis infection.

This report focuses on the molecular characterization of a Staphylococcus aureus strain isolated from a knee arthroprosthesis infection and recognized retrospectively as a carrier of the Panton-Valentine leukocidin gene. The stored microbiological isolate, which belonged to the strain collection of the Research Unit on Implant Infections of the Rizzoli Orthopaedic Institute, was retrieved for molecular analysis. Genotyping was carried out, revealing an interesting profile. In addition to the positivity for the Panton-Valentine toxin gene, the results indicated that the isolate belonged to the agr III group and was endowed with bbp and cna genes, both encoding for staphylococcal adhesins that bind bone proteins. The strain had the mecA gene for methicillin resistance, even though it was unable to resist any of the beta-lactam or other antibiotics. Its gene configuration matched that of other community-acquired methicillin-resistant and methicillin-susceptible Staphylococcus aureus(CA-MRSA and CA-MSSA) strains which have recently been reported worldwide. As far as we know,this is the first report on a PVL-positive S. aureus strain associated with an orthopedic implant (knee arthroprosthesis) infection.

Osteolytic lesion of greater tuberosity in calcific tendinitis of the shoulder.

HYPOTHESIS: This study investigated tuberosity osteolysis, an uncommon and frequently misdiagnosed form of calcific tendinitis of the shoulder, and evaluated its effects on clinical and surgical outcomes. MATERIALS AND METHODS: A total of 126 patients with calcific tendinitis studied with radiographs, ultrasound, and magnetic resonance images (MRIs) were divided into groups positive and negative for tuberosity osteolysis and treated by arthroscopy. Follow-up evaluation was at 2 years, using the Constant score. RESULTS: Tuberosity osteolysis was associated with significantly lower Constant scores, both before and after surgical treatment. Clinical and imaging findings exhibited a significant correlation. A 100% correlation was found between arthroscopy and MRI findings of tuberosity osteolysis compared with 90% with radiographs. CONCLUSION: Imaging and functional data indicate that calcific tendinitis of the rotator cuff with tuberosity osteolysis is a distinctive form of calcific tendinitis that should be considered in clinical and surgical practice. LEVEL OF EVIDENCE: Level 2; Prospective non-randomized comparison prognosis study.

Fixation of HA-coated unicortical locking screws in a sheep gap model: a comparative biomechanical study.

OBJECTIVES: To evaluate whether fixing a locking compression plate (LCP) with hydroxyapatite (HA)-coated screws provides improved biomechanical fixation and healing compared with standard screws under loaded conditions. METHODS: Ten sheep were randomly divided into 2 groups. A resection osteotomy of 8 mm was performed in the sheep's right tibiae. Five tibiae were fixed with a 9-hole LCP and 8 standard unicortical locking screws (Group Non-HA), and 5 tibiae were fixed with a 9-hole LCP and 8 HA-coated unicortical locking screws (Group HA). All screws were implanted at the same insertion torque of 4000 Nmm. Three months after surgery, all the sheep were euthanized. Bone segments after screw removal were randomly chosen from each group for histologic analysis (Group Non-HA=5, Group HA=5). RESULTS: Mean screw extraction torque was 438+/-288 Nmm in Group Non-HA (n=40) and 2317+/-657 Nmm in Group HA (n=40) (P<0.0005). The tibial torque resistance of the resected tibiae was 24+/-8 Nm in Group Non-HA (n=5) and 31+/-3 in Group HA (n=5) (P=0.045). In Group Non-HA, histology showed bone resorption and fibrous tissue encapsulation in all the samples, but this was not found in any of the Group HA samples. CONCLUSIONS: This study shows that an LCP with HA-coated screws provides improved biomechanical fixation than an LCP with similar standard screws as shown by a 5-fold greater screw extraction torque (P<0.0005). Furthermore, the higher tibial torque resistance is potentially beneficial for improved gap healing, as shown by higher tibial torque resistance.

Alendronate improves screw fixation in osteoporotic bone.

BACKGROUND: Animal studies have demonstrated the efficacy of the use of bisphosphonates to enhance screw fixation in bone. In this prospective, randomized study of pertrochanteric fractures treated with external fixation, we tested whether systemic administration of bisphosphonates would improve the fixation of hydroxyapatite-coated screws implanted in osteoporotic bone. METHODS: Sixteen consecutive patients with a pertrochanteric fracture were selected. Inclusion criteria were female gender, an age of at least sixty-five years, and a bone mineral density T-score of less than -2.5 standard deviations. Exclusion criteria included bisphosphonate treatment during the two-year period prior to the fracture. Fractures were fixed with a pertrochanteric fixator and four hydroxyapatite-coated pins. Two pins were implanted in the femoral head (pin positions 1 and 2), and two were placed in the femoral diaphysis (pin positions 3 and 4). The patients were randomized either to therapy with alendronate for a three-month postoperative period (Group A) or to no therapy (Group B). The Group-A patients received an oral dose of 70 mg of alendronate per week. The fixators were removed after three months. RESULTS: All of the fractures healed, and no loss of reduction, nonunion, or delayed union was observed. The combined mean extraction torque (and standard deviation) of the pins implanted at positions 1 and 2 (cancellous bone) was 2558 +/- 1103 N/mm in Group A and 1171 +/- 480 N/mm in Group B (p < 0.0005). The combined mean extraction torque of the pins implanted at positions 3 and 4 (cortical bone) was 4327 +/- 1720 N/mm in Group A and 4075 +/- 1022 N/mm in Group B. CONCLUSIONS: These data show that weekly systemic administration of alendronate improves pin fixation in cancellous bone in elderly female patients with osteoporosis. We observed a twofold increase in extraction torque with the pins implanted in cancellous bone. These results support the use of alendronate in the treatment of osteoporotic pertrochanteric fractures to improve screw fixation in the femoral head.