Dear Editor, Systemic glucocorticoids remain a cornerstone of therapy in immunobullous diseases. Yet little is known about glucocorticoid induced osteoporosis (GIOP) in patients with immunobullous ...diseases. We performed a retrospective review of medical records at an immunodermatology clinic in a Singaporean tertiary centre. Inclusion criteria consisted of patients with a newly diagnosed immunobullous condition between January 2011 and October 2017, who were on long-term (>= 3 months) systemic glucocorticoids at a minimum daily dose of prednisolone 15mg. ...
Management of fragility fractures in India Mehta, Nishank; Garg, Bhavuk; Malhotra, Rajesh
Best practice & research. Clinical rheumatology,
April 2019, 2019-04-00, 20190401, Letnik:
33, Številka:
2
Journal Article
Recenzirano
Osteoporosis and fragility fractures have become a major healthcare challenge globally in the recent years. However, this problem has only recently been accorded its due importance in developing ...countries such as India. India is a model case study for the management of osteoporosis and fragility fractures in a resource-limited setting, as it harbors a large geriatric population and has the highest prevalence of osteopenia globally. It is imperative to identify the myriad factors contributing to poor bone health and understand the many hurdles encountered to tackle this healthcare problem in a developing country. Innovative methods for managing fragility fractures are commonly seen. Collaborative multidisciplinary care and structured, evidence-based management has finally found its place in India with the establishment of a regional fragility fracture network. This chapter outlines the current status of management of fragility fractures in India by focusing on the disease burden, hurdles, innovative treatment methods, and the challenges lying ahead.
With the elderly population living longer and 'baby boomer's now reaching the age of 65, there is great concern regarding a lack of diagnosis and treatment of osteoporosis. Osteoporosis is a ...well-known problem, yet there continue to be gaps regarding screening and treatment. An orthopaedic practice in the Southeastern United States specializing in bone health has an internal Fracture Liaison Service (FLS) that was not being fully utilized by the providers. A quality improvement project was implemented following the recommended FLS guidelines to identify individuals that should receive referral to the FLS. Chart audits were completed to analyze both pre- and post-implementation phases. An alert button was introduced into the electronic health record to prompt orthopaedic surgeons to refer to the FLS clinic when individuals met the requirements of age and a first-time fragility fracture. Descriptive data showed 5% FLS referrals in 2019. After implementation of the alert button the FLS referrals for 2020 were 19%, providing a 14% overall improvement rate. Evidence supports using standardized screening processes and that referring to an FLS is best practice for improving the treatment of osteoporosis and for decreasing morbidity, mortality, and health care cost.
Aims
The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The ...aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service.
Methods
Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019.
Results
There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002).
Conclusion
The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention.
RESUMEN Introducción: La osteoporosis es la enfermedad ósea más común de los adultos mayores y constituye un importante problema de salud pública en todo el mundo. Objetivo: Actualizar algunos ...conceptos sobre osteoporosis y su tratamiento. Métodos: Se realizó una revisión de publicaciones entre 2010-2020 en inglés, con los términos: “osteoporosis”, “tratamiento de la osteoporosis”, “fracturas por osteoporosis”. Resultados: La osteoporosis tiene gran impacto no solamente desde el ámbito clínico, sino también económico y social. Su tratamiento incluye medidas generales y el empleo de diversos grupos de fármacos. La posibilidad de fracturas por fragilidad en muñeca, columna y cadera es considerable lo que determina morbilidad y mortalidad elevadas.
ABSTRACT
The goal of this magnetic resonance (MR) imaging study was to quantify vertebral bone marrow fat content and composition in diabetic and nondiabetic postmenopausal women with fragility ...fractures and to compare them with nonfracture controls with and without type 2 diabetes mellitus. Sixty‐nine postmenopausal women (mean age 63 ± 5 years) were recruited. Thirty‐six patients (47.8%) had spinal and/or peripheral fragility fractures. Seventeen fracture patients were diabetic. Thirty‐three women (52.2%) were nonfracture controls. Sixteen women were diabetic nonfracture controls. To quantify vertebral bone marrow fat content and composition, patients underwent MR spectroscopy (MRS) of the lumbar spine at 3 Tesla. Bone mineral density (BMD) was determined by dual‐energy X‐ray absorptiometry (DXA) of the hip and lumbar spine (LS) and quantitative computed tomography (QCT) of the LS. To evaluate associations of vertebral marrow fat content and composition with spinal and/or peripheral fragility fractures and diabetes, we used linear regression models adjusted for age, race, and spine volumetric bone mineral density (vBMD) by QCT. At the LS, nondiabetic and diabetic fracture patients had lower vBMD than controls and diabetics without fractures (p = 0.018; p = 0.005). However, areal bone mineral density (aBMD) by DXA did not differ between fracture and nonfracture patients. After adjustment for age, race, and spinal vBMD, the prevalence of fragility fractures was associated with −1.7% lower unsaturation levels (confidence interval CI −2.8% to −0.5%, p = 0.005) and +2.9% higher saturation levels (CI 0.5% to 5.3%, p = 0.017). Diabetes was associated with −1.3% (CI –2.3% to −0.2%, p = 0.018) lower unsaturation and +3.3% (CI 1.1% to 5.4%, p = 0.004) higher saturation levels. Diabetics with fractures had the lowest marrow unsaturation and highest saturation. There were no associations of marrow fat content with diabetes or fracture. Our results suggest that altered bone marrow fat composition is linked with fragility fractures and diabetes. MRS of spinal bone marrow fat may therefore serve as a novel tool for BMD‐independent fracture risk assessment.
ABSTRACT Background Bone fragility fractures are associated with high morbidity and mortality. This study analysed the association between the current biochemical parameters of chronic kidney ...disease–mineral and bone disorders (CKD-MBD) and bone fragility fractures in the COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) project. Methods COSMOS is a 3-year, multicentre, open cohort, prospective, observational study carried out in 6797 haemodialysis patients (227 centres from 20 European countries). The association of bone fragility fractures (outcome) with serum calcium, phosphate and parathyroid hormone (PTH) (exposure), was assessed using standard Cox proportional hazards regression and Cox proportional hazards regression for recurrent events. Additional analyses were performed considering all-cause mortality as a competitive event for bone fragility fracture occurrence. Multivariable models were used in all strategies, with the fully adjusted model including a total of 24 variables. Results During a median follow-up of 24 months, 252 (4%) patients experienced at least one bone fragility fracture (incident bone fragility fracture rate 28.5 per 1000 patient-years). In the fractured and non-fractured patients, the percentage of men was 43.7% and 61.4%, mean age 68.1 and 63.8 years and a haemodialysis vintage of 55.9 and 38.3 months, respectively. Baseline serum phosphate >6.1 mg/dL (reference value 4.3–6.1 mg/dL) was significantly associated with a higher bone fragility fracture risk in both regression models {hazard ratio (HR) 1.53 95% confidence interval (CI) 1.10–2.13 and HR 1.44 (95% CI 1.02–2.05)}. The significant association persisted after competitive risk analysis subHR 1.42 (95% CI 1.02–1.98) but the finding was not confirmed when serum phosphate was considered as a continuous variable. Baseline serum calcium showed no association with bone fragility fracture risk in any regression model. Baseline serum PTH >800 pg/mL was significantly associated with a higher bone fragility fracture risk in both regression models, but the association disappeared after a competitive risk analysis. Conclusions Hyperphosphatemia was independently and consistently associated with an increased bone fracture risk, suggesting serum phosphate could be a novel risk factor for bone fractures in haemodialysis patients.
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