Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
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Chronic treatment with glucocorticoids (GCs) leads to significant bone loss and increased risk of fractures. In chronically GC-treated patients, hip fracture risk is nearly 50%. The purpose of this investigation was to determine if there are differences in the quantities of trabecular and cortical bone and bone strength of the hip between GC-treated osteoporotic patients and controls. ⋯ Chronic GC treatment in postmenopausal women resulted in significantly decreased BMD of the hip, measured by QCT, with loss of both trabecular and cortical bone. In addition, GC treatment decreased bone strength as determined by FEM. The reduced cortical and trabecular bone mass in the hip may contribute to the disproportionately high hip fracture rates observed in GC-treated subjects.
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Renal osteodystrophy is a major complication in hemodialysis patients. Measurement of serum peptide derived from the degradation of bone collagen could potentially provide an indirect estimate of bone resorption. The present study estimated the significance of the C-terminal telopeptide of type I collagen (beta-CTx) as a serum bone resorption marker in male hemodialysis patients. ⋯ Inclusion in the highest quartile of PTH (above 288 pg/ml) predicted rapid bone loss with a sensitivity of only 26%. This means that the upper limit for serum PTH level recommended by K/DOQI may be too high, since 74% of cases with rapid bone loss showed serum PTH levels of below 288 pg/ml. In conclusion, serum measurement of beta-CTx may provide a new commercially viable and relevant serum assay to reflect cortical bone resorption in hemodialysis patients.
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Fractures are more prevalent among people with severe and profound developmental disabilities than in the general population. In order to characterize the tendency of these people to fracture, and to identify features that may guide the development of preventive strategies, we analyzed fracture epidemiology in people with severe and profound developmental disabilities who lived in a stable environment. Data from a 23-year longitudinal cohort registry of 1434 people with severe and profound developmental disabilities were analyzed to determine the effects of age, gender, mobility, bone fractured, month of fracture, and fracture history upon fracture rates. ⋯ Gender was not a factor in fracture risk. Two primary fracture mechanisms are apparent: one, largely associated with lack of weight-bearing in people with the least mobility, is exemplified by femoral fractures during non-traumatic events as simple as diapering or transfers; the other, probably due to movement- or fall-related trauma, is exemplified by hand/foot fractures in people who ambulate. The fracture experience of people with severe and profound developmental disabilities is unique and, because it differs qualitatively from postmenopausal osteoporosis, may require population-specific methods for assessing risk, for improving bone integrity, and for reduction of falls and accidents.
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Fractures of the proximal end of the femur, together with vertebral fractures, are greatly exacerbated by osteoporosis and can be regarded as the most typical and most serious complications of this disease. The demand for prompt mobilisation with full loading of the affected limb, combined with a desire for the gentlest of treatments, becomes increasingly difficult to meet in ageing patients with advanced osteoporosis. The advantages of osteosynthesis in respect to these demands when operating on elderly patients with fractures do not apply due to the inability of the osteoporotic bone to hold the osteosynthetic components sufficiently until fracture healing occurs. ⋯ There seems to be a limit for a successful realisation of an osteosynthesis that lies at a femoral head bone mineral density of 250 mg/cm(3) calcium-hydroxyapatite (CaHAp). Nevertheless, high precision surgery in regard to fracture reduction and implant placement is a essential requirement for a successful osteosynthesis. Reproducible local measurements of bone mineral density and trabecular alterations, as well as quick screening methods, are very much desired by the authors.
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Ankle fractures are the most common lower extremity fractures. In younger age groups these fractures occur more often in men than in women, but after menopause there is a female predominance. Foot fractures show a similar trend. ⋯ However, the need for internal fixation to secure fracture reduction must be weighed against the risk of operating on osteoporotic bone which lacks the strength to hold screws and plates. In the elderly, the preoperative evaluation of the peripheral blood supply is essential to avoid wound healing complications. We review here the surgical treatment of ankle and foot fractures with special reference to elderly patients.