Clinical calcium
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WHO fracture risk assessment tool (FRAX) been included in two representative guidelines, one issued from European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the other from National Osteoporosis Foundation in U. S. (NOF). Both guidelines commonly set the new track for the use of FRAX with BMD in addition to the conventional algorithm based on BMD and clinical risk factors. ⋯ ESCEO guideline proposed age-dependent values of, such as approximately 15%, 20%, and 30% of 10-year fracture probability for major osteoporotic fractures at the respective ages of 60, 70, and 80 years for postmenopausal women. On the other hand, NOF guideline indicated the fixed value 20% for osteoporotic fracture or 3% for hip fracture at the ages of 50 or more. These two different approaches may provide clues when including FRAX in the guideline for clinicians in Japan.
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WHO's FRAX aims to identify bone-fracture high-risk individuals requiring medical intervention by calculating each individual's 10-year probability (%) of bone fracture based on clinical risk factors or clinical risk factors plus bone mineral density (BMD). The risk factors are age, sex, femoral neck mineral density, or body mass index (BMI) if BMD data are unavailable, history of bone fracture, parental history of femoral neck fracture, smoking, consumption of alcohol, use of steroids, rheumatoid arthritis, and secondary osteoporosis. Model with clinical risk factors alone can predict osteoporotic fracture risk as well as the model with BMD and clinical risk factors. FRAX with clinical risk factors alone would be useful to screen those at high risk of fracture in population-based health check-ups.
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We performed 3 types of surgical procedures for thoracic myelopathy due to OPLL : posterior decompression, OPLL-extirpation, and posterior decompression with instrumented fusion (PDF). A considerable degree of neurological recovery was obtained in all patients who underwent PDF, despite the anterior impingement of the spinal cord by OPLL remaining. In addition, the rate of post-operative complications was extremely low with PDF, when compared with posterior decompression and OPLL-extirpation groups. We recommend that one stage posterior decompression with instrumented fusion be selected for cases in whom the spinal cord is severely damaged pre-operatively.
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We retrospectively studied patients with cervical myelopathy due to OPLL to compare surgical outcome of anterior approach with that of laminoplasty. In patients with occupying ratio > or = 60%, the anterior approach yielded a better neurological outcome than laminoplasty. Although the anterior approach is technically demanding and has a higher incidence of surgery-related complications, it is preferable to laminoplasty for patients with occupying ratio of OPLL > or = 60%and/or hill-shaped ossification.