We aimed to audit the results of one stop fragility
Type 2 diabetes mellitus (T2DM) impairs bone strength and is a significant risk factor for hip fracture, yet currently there is no reliable tool to assess this risk. Most risk stratification methods rely on bone mineral density, which is not impaired by diabetes, rendering current tests ineffective. CT-based finite element analysis (CTFEA) calculates the mechanical response of bone to load and uses the yield strain, which is reduced in T2DM patients, to measure bone strength. The purpose of this feasibility study was to examine whether CTFEA could be used to assess the hip fracture risk for T2DM patients. A retrospective cohort study was undertaken using autonomous CTFEA performed on existing abdominal or pelvic CT data comparing two groups of T2DM patients: a study group of 27 patients who had sustained a hip fracture within the year following the CT scan and a control group of 24 patients who did not have a hip fracture within one year. The main outcome of the CTFEA is a novel measure of hip bone strength termed the Hip Strength Score (HSS).Aims
Methods
The widely used
In conventional DXA (Dual-energy X-ray Absorptiometry) analysis, pixel bone mineral density (BMD) is often averaged at the femoral neck. Neck BMD constitutes the basis for osteoporosis diagnosis and
Objectives. In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians. Methods. A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with
Purpose: Stability of thoracic vertebrae affected by metastatic disease has been shown to be dependent on tumour size and bone density, but additional structural and geometric factors may also play a role in burst
Osteoporosis is common in total hip arthroplasty (THA) patients. It plays a substantial factor in the surgery’s outcome, and previous studies have revealed that pharmacological treatment for osteoporosis influences implant survival rate. The purpose of this study was to examine the prevalence of and treatment rates for osteoporosis prior to THA, and to explore differences in osteoporosis-related biomarkers between patients treated and untreated for osteoporosis. This single-centre retrospective study included 398 hip joints of patients who underwent THA. Using medical records, we examined preoperative bone mineral density measures of the hip and lumbar spine using dual energy X-ray absorptiometry (DXA) scans and the medications used to treat osteoporosis at the time of admission. We also assessed the following osteoporosis-related biomarkers: tartrate-resistant acid phosphatase 5b (TRACP-5b); total procollagen type 1 amino-terminal propeptide (total P1NP); intact parathyroid hormone; and homocysteine.Aims
Methods
Orthopaedic surgeons frequently assess fragility fractures (FF), however osteoporosis (OP) is often managed by primary care physicians (PCP). Up to 48% of FF patients have had a previous fracture (Kanis et al., 2004). Discontinuity between fracture care and OP management is a missed opportunity to reduce repeat fractures. This studied aimed to evaluate current OP management in FF patients presenting to cast clinic. A single centre, prospective observational study where seven traumatologists screened for FF in cast clinic. FF was defined as a hip, distal radius (DR), proximal humerus (PH), or ankle fracture due to a ground level fall. Patients completed a self-administered questionnaire for demographics, fracture type and treatment, medical and fracture history, and previous OP care. The primary outcome was number of FF patients who received OP investigation and/or treatment. Secondary outcomes included
The incidence of atypical femoral fractures (AFFs) continues to increase. However, there are currently few long-term studies on the complications of AFFs and factors affecting them. Therefore, we attempted to investigate the outcomes, complications, and risk factors for complication through mid-term follow-up of more than three years. From January 2003 to January 2016, 305 patients who underwent surgery for AFFs at six hospitals were enrolled. After exclusion, a total of 147 patients were included with a mean age of 71.6 years (48 to 89) and 146 of whom were female. We retrospectively evaluated medical records, and reviewed radiographs to investigate the fracture site, femur bowing angle, presence of delayed union or nonunion, contralateral AFFs, and peri-implant fracture. A statistical analysis was performed to identify the significance of associated factors.Aims
Methods
Spinal metastatic disease can result in burst fracture and neurologic compromise. This study aims to examine the effects of tumour location, shape and surface texture on burst fracture risk in the metastatic spine using a parametric poroelastic finite element model. Tumours were found to be most hazardous in the posterior region of the vertebral body, whereas the multiple tumour scenarios reduced risk. Tumour shape may affect the mechanism of burst fracture. Serrated and smooth outer tumour surfaces yielded similar trends. These results can be used to improve guidelines for burst
Introduction: The ‘gold standard’ currently used to assess bone quality is bone mineral density (BMD) measured by Dual Energy X-ray Absorptiometry (DEXA). However BMD accounts for no more than 60 – 70% of bone strength. X-rays are affected primarily by the mineral phase of bone; the organic phase remains essentially invisible. Yet it is known that the material strength and toughness of bone is critically dependent on its organic phase. A Raman spectroscopic technique was used that permitted visualisation of both phases of bone deep to unbroken skin by successfully removing spectral information from the overlying tissues. Hypothesis: Spectral features of both the mineral and organic phases of bone from different murine genotypes can be measured objectively through the unbroken skin using time-resolved Raman spectroscopy. Methods: We used an 800 nm probe laser (1 kHz, 1 ps pulses, focussed to 1 mm diameter) with a synchronised 4 ps optical Kerr gate that had a variable picosecond delay that effectively shuttered out photons from the overlying tissues. We measured bone spectra at a point 2mm above the carpus from two mouse genotypes: wildtype and oim/oim (matched for age, sex and weight) at a typical depth 1.1mm. We then repeated the measurements once the overlying tissues had been carefully removed to expose the bones directly. Oim/oim mice produce only homotrimeric collagen I, (á1(I)3), associated with this change in collagen is a poor mineralisation of the bone tissue, making it an ideal model for a this study. Results: We recorded the main spectral features in both phases of bone and showed that the ratios of spectral bands from the two phases were similar within each genotype, whether measured through the skin or directly from exposed bone. However, there was a significant difference in the same ratios between genotypes associated with a reduced mineralisation in the oim/oim mice; a significant difference that was apparent both directly from bone and through skin. The band associated with CH2 wag of collagen (organic phase) showed a frequency shift between the genotypes. Discussion: Measurements of the spectra and their analysis were similar whether made directly on bone or transcutaneously. We were able to detect changes in mineralisation between genotypes and, unlike measurements of BMD, we showed also changes in collagen. Since the material strength of bone is critically dependent on collagen, this indicates an appreciable advantage of this technique over DEXA. Conclusions: This novel technique allowed objective transcutaneous spectral measurements of bone tissue and was able to distinguish between normal and unhealthy bone tissue. With a laser focussed to 1 mm diameter that was readily moveable, these measurements were specific to that site (2 mm proximal to the carpus). After further optimisation, this technology is likely to improve
For over a decade, bisphosphonate administration
has evolved and become the cornerstone of the prevention and treatment
of fragility fractures. Millions of post-menopausal women have relied
on, and continue to depend on, the long-acting, bone density-maintaining
pharmaceutical drug to prevent low-energy fractures. In return,
we have seen the number of fragility fractures decrease, along with
associated costs and emotional benefits. However, with any drug,
there are often concerns with side effects and complications, and
this unique drug class is seeing one such complication in atypical
subtrochanteric femoral fracture, counterproductive to that which
it was designed to prevent. This has created concern over long-term
bisphosphonate administration and its potential link to these atypical
fractures. There is controversial evidence surrounding such a definitive
link, and no protocol for managing these fractures. This review offers the latest information regarding this rare
but increasingly controversial adverse effect and its potential
connection to one of the most successful forms of treatment that
is available for the management of fragility fractures.
There have been recent reports linking alendronate and a specific pattern of subtrochanteric insufficiency fracture. We performed a retrospective review of all subtrochanteric fractures admitted to our institution between 2001 and 2007. There were 20 patients who met the inclusion criteria, 12 of whom were on long-term alendronate. Alendronate-associated fractures tend to be bilateral (Fisher’s exact test, p = 0.018), have unique radiological features (p <
0.0005), be associated radiologically with a pre-existing ellipsoid thickening of the lateral femoral cortex and are likely to be preceded by prodromal pain. Biomechanical investigations did not suggest overt metabolic bone disease. Only one patient on alendronate had osteoporosis prior to the start of therapy. We used these findings to develop a management protocol to optimise fracture healing. We also advocate careful surveillance in individuals at-risk, and present our experience with screening and prophylactic fixation in selected patients.