The role of the orthopaedic surgeon in the prevention of refracture in patients treated surgically for fragility hip and vertebral fracture

Beraldi, Rosella; Masi, Laura; Parri, Simone; R, Partescano; Brandi, Maria Luisa

doi:10.11138/ccmbm/2014.11.1.031

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…Multiple studies in different countries with variable results reported the importance of treating osteoporosis and its association with reducing hip refracture rate and mortality [12,13,14]. However, local data on this topic are lacking.…”

Section: Introductionmentioning

confidence: 99%

Association Between Osteoporosis and Refracture Rate Among Patients With Hip Fractures at King Abdulaziz Medical City, Saudi Arabia

Alyami¹,

Alosaimi²,

Alshehri³

et al. 2022

Cureus

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BackgroundHip fracture is a major medical and surgical topic and is a significant cause of morbidity and mortality. Older women, especially those with osteoporosis, are at an increased risk for hip fractures. Multiple studies have shown the effect of osteoporosis on the refracture rate among the elderly population. Therefore, selecting a targeted population for screening and treating osteoporosis has an essential role in decreasing the hip fracture rate. This study aimed to determine the association between osteoporosis treatment and refracture rate among patients with hip fractures at King Abdulaziz Medical City, Jeddah, Saudi Arabia. MethodsCollected data included patient demographics (men: ≥55 years old; women: ≥50 years old), the used osteoporosis investigation method, osteoporosis treatment history, presence of comorbidities, and refracture as a primary outcome. The refracture rate among patients with hip fracture was calculated and used to determine the association between hip refracture and osteoporosis. ResultsOur study included a total of 292 patients who presented to our hospital due to hip fractures. The patients were divided into two groups, the osteoporotic and non-osteoporotic groups. These groups were then compared. There was no statistical significance between osteoporosis and hip refracture (p = 0.721), and there was no association between the treatment of osteoporosis and hip refracture (p = 0.493). Statistical difference was found between patients who had undergone dual-energy X-ray absorptiometry scan and were not treated for osteoporosis (p = 0.00). Lastly, the mortality of the refracture group was 10%, while it was 11% in the no-refracture group (p = 1.00). ConclusionMorbidity and mortality rates are higher among patients with hip fractures. Our study showed that there was no association between hip refracture rate and osteoporosis whether the patient is treated for osteoporosis or not. We recommend a systematic review that can include more studies in this field to acquire more definitive results regarding this topic.

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Section: Introductionmentioning

confidence: 99%

Association Between Osteoporosis and Refracture Rate Among Patients With Hip Fractures at King Abdulaziz Medical City, Saudi Arabia

Alyami¹,

Alosaimi²,

Alshehri³

et al. 2022

Cureus

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show abstract

“…[34] A recent study reported that an osteoporotic fracture represented the most important predictive factor for further osteoporotic fractures, so, every country in the world has been attempting to treat osteoporosis for the prevention of osteoporotic fractures and refractures. [56]…”

Section: Introductionmentioning

confidence: 99%

Incidence of Osteoporotic Refractures Following Proximal Humerus Fractures in Adults Aged 50 Years and Older in Korea

Jung

Nho

et al. 2019

J Bone Metab

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Background The purpose of this study was to investigate the incidence and characteristics of osteoporotic refractures after proximal humerus fracture in Korean adults aged above 50 years. Methods Patients aged 50 years or older with initial proximal humerus fractures reported in 2012 were enrolled and followed up until 2016 using the Korean National Health Insurance data. Based on the last claim date, the refractures were classified as osteoporotic fractures including spine, hip, distal radius, and humerus 6 months after the index fracture involving the proximal humerus. Each osteoprotic fracture was identified using specific International Classification of Diseases, 10th Revision codes and site-specific physician claims for procedures. Results A total of 5,587 first-time fractures involving proximal humerus were reported in 2012. Among them, a total of 1,018 osteoporotic refractures occured between 2012 and 2016. The total cumulative incidence of osteoporotic refractures was 4.85% (271/5,587) at 1 year, 9.61% (537/5,587) at 2 years, 14.21% (794/5,587) at 3 years, and 18.22% (1,018/5,587) at 4 years. In terms of site by year, the incidence of associated refractures was as follows: spine, 48.62% (495/1,018); hip, 25.83% (263/1,018); wrist 18.57% (189/1,018); and humerus 6.97% (71/1,018) during all the follow-up periods. Conclusions Our study showed that the cumulative incidence of osteoporotic refractures following proximal humerus fractures in the elderly population has been increasing over the years. Given that osteoporotic refractures are associated with an increased mortality risk, a public health strategy to prevent the refracture after proximal humerus fracture in the elderly is imperative.

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“…As the initially cartilaginous soft callus calcifies into a fracture‐stabilizing bony callus, osteoclasts return, and alongside osteoblasts, remodel the callus until physiological bone architecture is restored. Should fracture healing proceed inefficiently, however, the discontinuity caused by the fracture may persist or, following apparent healing, there may be persistent structural weakness that can contribute to re‐fracture . This is of concern in aged individuals, where the efficiency of the bone healing process is diminished.…”

mentioning

confidence: 99%

“…Should fracture healing proceed inefficiently, however, the discontinuity caused by the fracture may persist or, following apparent healing, there may be persistent structural weakness that can contribute to re-fracture. 4,5 This is of concern in aged individuals, where the efficiency of the bone healing process is diminished. Current strategies to improve skeletal healing include local surgical delivery of osteo-inductive materials or proteins and systemic delivery of anti-resorptive or anabolic therapy.…”

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confidence: 99%

Suppression of Notch Signaling in Osteoclasts Improves Bone Regeneration and Healing

Goel

Moharrer

Hebb

et al. 2019

Journal Orthopaedic Research

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Owing to the central role of osteoclasts in bone physiology and remodeling, manipulation of their maturation process provides a potential therapeutic strategy for treating bone diseases. To investigate this, we genetically inhibited the Notch signaling pathway in the myeloid lineage, which includes osteoclast precursors, using a dominant negative form of MAML (dnMAML) that inhibits the transcriptional complex required for downstream Notch signaling. Osteoclasts derived from dnMAML mice showed no significant differences in early osteoclastic gene expression compared to the wild type. Further, these demonstrated significantly lowered resorption activity using bone surfaces while retaining their osteoblast stimulating ability using ex vivo techniques. Using in vivo approaches, we detected significantly higher bone formation rates and osteoblast gene expression in dnMAML cohorts. Further, these mice exhibited increased bone/tissue mineral density compared to wild type and larger bony calluses in later stages of fracture healing. These observations suggest that therapeutic suppression of osteoclast Notch signaling could reduce, but not eliminate, osteoclastic resorption without suppression of restorative bone remodeling and, therefore, presents a balanced paradigm for increasing bone formation, regeneration, and healing. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2089–2103, 2019

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The role of the orthopaedic surgeon in the prevention of refracture in patients treated surgically for fragility hip and vertebral fracture

Abstract: SummaryThe role of the orthopaedic surgeon in the treatment of patients with fragility fractures is twofold: the conservative or surgical treatment of the fracture, and the prevention of further fractures, establishing diagnostic and therapeutic procedures for osteoporosis. We

Cited by 4 publications

References 12 publications

Association Between Osteoporosis and Refracture Rate Among Patients With Hip Fractures at King Abdulaziz Medical City, Saudi Arabia

Association Between Osteoporosis and Refracture Rate Among Patients With Hip Fractures at King Abdulaziz Medical City, Saudi Arabia

Incidence of Osteoporotic Refractures Following Proximal Humerus Fractures in Adults Aged 50 Years and Older in Korea

Suppression of Notch Signaling in Osteoclasts Improves Bone Regeneration and Healing

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