Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version)

Zhao, Dewei; Zhang, Feng; Wang, Benjie; Liu, Baoyi; Li, Lü; Kim, Shin‐Yoon; Goodman, Stuart B.; Hernigou, Philippe; Cui, Quanjun; Lineaweaver, William C.; Xu, Jiake; Drescher, Wolf; Qin, Ling

doi:10.1016/j.jot.2019.12.004

Cited by 255 publications

(225 citation statements)

References 98 publications

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“…An effective fall prevention exercise program is as important as treating bone health amongst elderlies [ 35 ]. In fact, exercises have been shown to bring positive effects in patients with osteoporosis [ 35 ], osteonecrosis [ 36 ], etc. This meta-analysis provides evidence that effective exercise programs are effective in fall prevention and benefit in reducing fractures.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis

Wong

Chong

Law

et al. 2020

Journal of Orthopaedic Translation

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Summary Objective To analyze the effectiveness of exercise interventions on falls and fall-related fracture prevention among community-dwelling elderlies. Methods Literature search was conducted in Pubmed and Embase. Keywords used for literature search were “fracture” AND “fall” AND “exercise”. Randomized controlled trials involving community-dwelling elderlies older than 60 years old with physical exercises as intervention were included. A systematic review and meta-analysis was performed. The primary outcomes were falls and fractures. Results Twelve studies were included and 4784 participants were involved with a mean age of 75.4. The most common exercise interventions were strength and balance exercises. The results of meta-analysis of 11 studies showed that exercise intervention had beneficial effect on fall prevention (RR = 0.71, 95% CI, 0.62–0.82; I 2 = 24%, p < 0.0001). The effect was better when exercise intervention applied to women participants (RR = 0.64, 95% CI, 0.49–0.83; I 2 = 28%, p = 0.00009) compared to men and women participants (RR = 0.75, 95% CI, 0.64–0.89; I 2 = 24%, p = 0.001). The results of meta-analysis of seven studies showed that physical exercise had significant effect on fracture prevention (RR = 0.54, 95% CI, 0.35–0.83; I 2 = 25%, p = 0.005). However, the effect was significant when exercise intervention applied to women participants only (RR = 0.37, 95% CI, 0.20–0.67; I 2 = 0%, p = 0.001) but not significant when exercise intervention applied to both genders (RR = 0.80, 95% CI, 0.58–1.09; I 2 = 0%, p = 0.15). Conclusion Exercise interventions, especially the combination of strength and balance training, were effective in preventing falls. Resistance exercises and jumping exercises were effective for fracture prevention among community-dwelling older population. The effectiveness of exercise interventions on fracture prevention have more significant effect on women. Further studies are needed to test the effectiveness of exercise interventions in men. Translational potential The use of effective exercises or biophysical interventions including vibration therapy can be incorporated into Fracture Liaison Services to prevent future fall and fracture.

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Section: Discussionmentioning

confidence: 99%

The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis

Wong

Chong

Law

et al. 2020

Journal of Orthopaedic Translation

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“…The osteosclerosis band hinders the growth of new capillaries, which accelerates the progression of necrosis in the bone tissue and causes the femoral head collapse and secondary osteoarthritis in the late stage. [21] The current techniques used for the early diagnosis and treatment of ONFH to avoid the femoral head collapse are controversial. One of the common techniques used pre-collapse includes CD with bone graft.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal shockwave therapy combined with multiple drilling and intramedullary drug injection for treating early-stage Femur Head Necrosis

Chen

et al. 2020

Medicine

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Background: Early diagnosis and treatment of the osteonecrosis of the femoral head (ONFH), a refractory disease, is imperative to prevent femoral head collapse; however, the existing solutions remain controversial. This study assessed the safety and efficacy of extracorporeal shock wave therapy (ESWT) combined with multiple drilling and intramedullary drug injection, a novel cocktail therapy, as a randomized controlled trial (RCT) model to postulate an alternative therapy for patients with early-stage ONFH. Methods: Femoral head necrosis patients aged 20 to 60 years with stage ARCO I-II were recruited. One hundred twenty eligible participants were randomized into four groups in a 1:1:1:1 ratio: extracorporeal shock wave therapy combined with multiple drilling and intramedullary drug injection (group EMI), extracorporeal shock wave therapy (group E), multiple drilling combined with intramedullary drug injection (group MI), and multiple drilling (“positive” control group; group M). The primary outcomes included effective rate, subchondral collapse rate of the femoral head, lesion size, and grade of bone marrow edema. Secondary outcomes included the Harris Hip Score and the visual analog scale. All outcomes were measured at the screening visit (baseline) and at the planned time intervals during treatment and follow-up, and the efficacy was statistically analyzed according to the intention-to-treat sub-populations and per-protocol sub-populations. Objectives: To examine the clinical efficacy of ESWT combined with multiple drilling and intramedullary drug injection to provide a safe and more effective method for treating early-stage ONFH. Trial registration number: ChiCTR1900020888; Pre-results.

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“…The criteria for the cases included in this study are as follows: (1) ONFH patients diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) or X-ray (14); (2) Prior to the appearance of clinical manifestations of ONFH, patients had taken a dose equivalent to prednisolone with an average dose of 16.6 mg/day for one year. Or a maximum dose of 80 mg/day for more than a week (15)…”

Section: Subjectsmentioning

confidence: 99%

DNA Methylation in OPG/RANK/RANKL Pathway is Associated with Steroid-induced Osteonecrosis of the Femoral Head

Sun

Cao

Yang

et al. 2020

Preprint

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Background: The dysregulation of OPG/RANK/RANKL signaling pathway is a key step in the occurrence of steroid-induced osteonecrosis of the femoral head (ONFH). This study aims to understand the degree of methylation of OPG, RANK and RANKL genes in steroid-related ONFH.Methods: A case-control study was designed, including 50 patients and 50 controls. The Agena MassARRAY platform is used to detect the methylation status of OPG, RANK and RANKL genes in the blood of subjects. The relationship between the methylation level of the CpG site of each gene and the steroid-related ONFH was analyzed.Results: In the CpG islands of the OPG, RANK and RANKL genes of steroid-related ONFH patients, a number of CpG sites with high methylation rate and high methylation level were found. Some hypermethylated CpG sites increase the risk of steroid-related ONFH. In addition, by constructing the receiver operating characteristic (ROC) curve, we also discovered a few hypermethylated CpG sites, which have predictive diagnostic value for steroid-related ONFH.Conclusion: Methylation in the OPG / RANK / RANKL signaling pathway increases the risk of steroid-related ONFH. Some hypermethylated CpG sites can be used as early prediction and diagnostic targets for steroid-related ONFH.

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Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version)

Cited by 255 publications

References 98 publications

The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis

The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis

Extracorporeal shockwave therapy combined with multiple drilling and intramedullary drug injection for treating early-stage Femur Head Necrosis

DNA Methylation in OPG/RANK/RANKL Pathway is Associated with Steroid-induced Osteonecrosis of the Femoral Head

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