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PubMed1989

Jaw fractures in the country of Stockholm (1978-1980). Injury dynamics--etiologic factors in relation to anatomic site of fracture.

This paper presents a retrospective review of jaw fractures sustained by 795 individuals in the county of Stockholm from 1978-80. The material comprised 904 mandibular and 249 maxillary fractures, a total of 1.153 fractures. The present part of the study concerns the relationship between etiologic factors and fracture location. Single fractures were noted in 43% of the mandibular fractures and in 4% of the maxillary fractures. The region most frequently fractured was the mandibular condyle (19% of all fractures). Violence was the etiologic in 42% of the total number of fractures and 47% of mandibular fractures. Compared to earlier reports, this seems to represent an increase over the last decades and probably reflects a general trend towards greater incidence of violence in society. Jaw fractures caused by traffic accidents accounted for 25% of all fractures and have decreased, probably as a result of the safety belt law of 1975 and better traffic security reforms. However, the severe Le Fort III fractures, combined with unconciousness and neurological injuries, are mainly the result of on traffic accidents. Falls accounted to 23% of the fractures, mostly localized to the mandible (81%).

Accidents↗
PubMed1981

[A biomechanical study on the senile intracapsular fracture of the femoral neck--speculation concerning the fracture lines and etiological factors (author's transl)].

In this study, intracapsular fracture of the femoral neck in the elderly was classified into three types, the typical type with the fracture line about 70 degrees from the horizontal line with the spike of the neck (60%), the crescent type with the arch-like fracture line without the spike of the neck (30%) and the mixed type with the fracture line about 70 degrees from the horizontal line without the spike of the neck (10%). After that, each etiological factor of these three types of the fracture was studied. From the investigation of the osteoporotic changes at the upper end of the femur in patients over 50 years old with the intracapsular fracture of the femoral neck, the statistical loading test on the head of the human cadaveric femur, the analyses of the upper half model of the human femur using the experimental stress analysis based on photoelasticity and the finite element method and the observations of the microscopic trabecular fractures, the following facts were found at the area of the upper capito-cervical junction near the epiphyseal scar; (1) that the cancellous bone is easily affected by the influence of osteoporotic changes, (2) that the acting stress is higher than the ultimate strength of the bone in activities of daily living, (3) and that many microscopic trabecular fractures can be observed. Therefore, this area will become "the area of reduced strength", that may sometimes remain unrecognized and heal spontaneously. Since any fracture starts from here, this area can be regarded as "the trigger" of the clinical intracapsular fracture of the femoral neck. Factors dividing the intracapsular fracture of the femoral neck into three types, except the unrecognizably remained and spontaneously healed one, may be as follows. 1) When the load approximately as heavy as body weight with the abruptly rotational force (especially external rotational force) is applied, the fracture classified into the typical type occurs (it has been examined experimentally). 2) Always when the repeated load is applied on the increase in number of the microscopic trabecular fractures, which happen because of severe osteoporotic changes and bone density loss, the fracture classified into the crescent type occurs. 3) When both the factors are present, the fracture classified into the mixed type occurs.

Biomechanical Phenomena↗
PubMed1996

Mortality following fractures in older women. The study of osteoporotic fractures.

BACKGROUND: Most investigators have hypothesized that the increase in mortality following osteoporotic fractures reflects poor underlying health status in addition to the acute effects of the fracture. METHODS: We observed 9704 ambulatory women aged 65 years or older enrolled in the Study of Osteoporotic Fractures. We obtained reports of fractures and deaths every 4 months and reviewed death certificates and hospital discharge summaries. Multivariable proportional hazards models were used to determine the association between fractures and age-adjusted mortality. RESULTS: During a mean follow-up of 5.9 years, 1737 women had nonspine fractures, with a postfracture mortality rate of 3 per 100 woman-years, compared with 1.8 per 100 woman-years in those who did not have fractures (P < .001). After adjusting for other factors associated with mortality, women (n = 361) with fractures of the hip or pelvis had a 2.4-fold (95% confidence interval, 1.7-3.3) increase in mortality. However, only 9 (14%) of the 64 deaths that occurred after hip or pelvic fractures were caused or hastened by the fracture. By contrast, 11 (17%) of these deaths seemed to have been a result of chronic conditions that has contributed to the hip or pelvic fracture, and 44 (69%) of the deaths were not clearly related to the fracture. CONCLUSIONS: Mortality is increased following several types of fractures in older women. Most of the increase following hip and pelvic fractures is due to underlying conditions and probably would not be affected by reductions in the incidence of these fractures.

Aged↗
PubMed2000

Interventions for isolated diaphyseal fractures of the ulna in adults.

BACKGROUND: Isolated fractures of the shaft of the ulna, which are often sustained when the forearm is raised to shield against a blow, are generally treated on an out-patient basis. OBJECTIVES: To assess the effects of various forms of treatment for isolated fractures of the ulnar shaft in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE (1976 to August 1999), EMBASE (1981 to September 1999), the Cochrane Controlled Trials Register (up to Issue 4, 1999), and bibliographies of trial reports. Date of the most recent search: August 1999. SELECTION CRITERIA: Randomised or quasi-randomised trials of conservative and surgical treatment of isolated fractures of the ulnar shaft in adults. Excluded were fractures of the proximal ulna and Monteggia fracture dislocations. DATA COLLECTION AND ANALYSIS: Independent quality assessment and data extraction were performed by all reviewers. Requests for more information were sent to trialists. Given the limited and poor quality evidence available, quantitative analysis was kept to a minimum. MAIN RESULTS: Two small trials of conservative treatment, involving a total of 106 patients were included in this review. Both trials were of poor quality. One randomised trial compared short arm pre-fabricated functional braces with long arm plaster casts. There was no statistically significant difference in the time it took for fracture union. Patient satisfaction and return to work were better in the brace group. The other quasi-randomised trial compared Ace Wrap elastic bandage, short arm plaster cast and long arm plaster cast. The large loss to follow-up in this trial makes any data analysis tentative. However the need for replacement of the Ace wrap by other methods due to pain does indicate the potential for a serious problem with this intervention. REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine which method of treatment is the most appropriate for isolated fractures of the ulnar shaft in adults. There is a need to establish the incidence of this injury and the outcome and associated costs of the various forms of treatment. Well designed randomised trials of current forms of conservative treatment are recommended.

Adult↗
PubMed1993

Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation.

Hip fractures are common in elderly women, and early risk assessment of future hip fractures is relevant in relation to prevention. We studied the predictive value of radial and humeral fractures in women. The influence of weather conditions on the risk was also studied. Women aged 20-99 years with a fracture of the distal radius (n = 1162) or proximal humerus (n = 406) were followed for 0 to 9 years. The relative risk (RR) and 95% confidence limits (CL) of subsequent fracture among women suffering radial or humeral fractures compared with the background population were calculated. Women 60-79 years of age who had suffered a fracture of the distal radius or proximal humerus had relative risks of sustaining a hip fracture of 1.9 (1.3-2.6, 95% CL) and 2.5 (1.3-3.6, 95% CL) respectively. The relative risk of hip fracture was highest within the first years following a fracture of the radius or the humerus. Women suffering an upper extremity fracture (radius or humerus) in snowy or icy weather had a marginally increased risk (RR = 1.3, 0.4-2.3, 95% CL and RR = 1.8, 0.3-3.4, 95% CL) for a later hip fracture. A woman 50 years old with a radial or a humeral fracture had an estimated residual lifetime risk of sustaining a subsequent hip fracture of 17% and 16% respectively compared with 11% for the background population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-IV fracture.

BACKGROUND: There is an uncommon subset of supracondylar humeral fractures in children that are so unstable they can displace into both flexion and extension. The purposes of this study were to describe this subset of supracondylar fractures and to report a new technique of closed reduction and percutaneous pinning for their treatment. METHODS: In a retrospective review of 297 consecutive displaced supracondylar humeral fractures in children treated operatively at our institution, we identified nine that were completely unstable with documented displacement into both flexion and extension as seen on fluoroscopic examination with the patient under anesthesia. We used a new technique for closed reduction and fixation of these fractures, and then we assessed fracture-healing and complications from the injury and treatment. RESULTS: All nine fractures were treated satisfactorily with closed reduction and percutaneous pinning. The complication rate associated with these unstable fractures was no higher than that associated with the 288 more stable fractures. Seven of the nine fractures were stabilized with lateral entry pin placement, and two fractures were stabilized with crossed medial and lateral pins. None of the patients had a nonunion, cubitus varus, malunion, additional surgery, or loss of motion. CONCLUSIONS: In rare supracondylar fractures in children, multidirectional instability results in displacement into flexion and/or extension. This fracture can be classified as type IV according to the Gartland system, as it is less stable than a Gartland type-III extension supracondylar fracture. These fractures can be treated successfully with a new technique of closed reduction and percutaneous pinning, thus avoiding open reduction.

Bone Nails↗
PubMed2006

Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability.

BACKGROUND: Volar plate fixation with use of either a locking plate or a neutralization plate has become increasingly popular among surgeons for the treatment of dorsally comminuted extra-articular distal radial fractures. The purpose of the present study was to compare the relative stability of five distal radial plates (four volar and one dorsal), all of which are commonly used for the treatment of dorsally comminuted extra-articular distal radial fractures, under loading conditions simulating the physiologic forces that are experienced during early active rehabilitation. METHODS: With use of a previously validated Sawbones fracture model, a dorsally comminuted extra-articular distal radial fracture was created. The fracture fixation stability of four volar plates (an AO T-plate, an AO 3.5-mm small-fragment plate, an AO 3.5-mm small-fragment locking plate, and the Hand Innovations DVR locking plate) were compared under axial compression loading and dorsal and volar bending simulating the in vivo stresses that are generated at the fracture site during early unopposed active motion of the wrist and digits. A single dorsal plate (an AO pi plate) was used for comparison, with and without simulated volar cortical comminution. The construct stiffness was measured to assess the resistance to fracture gap motion, and comparisons were made among the implants. RESULTS: The volar AO locking and DVR plates had greater resistance to fracture gap motion (greater stiffness) compared with the volar AO nonlocking and AO T-plates under axial and dorsal loading conditions (p < 0.01), with no significant difference between the AO volar locking and DVR plates. The volar AO locking plate had greater resistance to fracture gap motion than did the volar AO nonlocking plate under axial loading and dorsal bending forces (p < 0.01). The dorsal pi plate had the greatest resistance to fracture gap motion under axial loading and volar and dorsal bending forces (p < 0.01). However, the pi plate was significantly less stable to axial load and dorsal bending forces when the volar cortex was comminuted (p < 0.01). CONCLUSIONS: In this model of dorsally comminuted extra-articular distal radial fractures, dorsal pi-plate fixation demonstrated better resistance to fracture gap motion than did the four types of volar plate fixation. The AO volar locking and DVR plates conferred the greatest resistance to fracture gap motion among the four volar plates tested. Volar locking technology conferred a significant increase in resistance to fracture gap motion as compared with nonlocking plate technology.

Biomechanical Phenomena↗
PubMed2003

A new classification and treatment protocol for combined fractures of the femoral shaft with the proximal or distal femur with closed locked intramedullary nailing: clinical experience of 63 fractures.

The medical records and radiographs of 63 patients, who were admitted between 1989-1997, with a combined femur fracture, were reviewed. Associated injuries were present in 38 (60%) patients. The combined fractures were classified into four major types depending on their anatomical position: type I, femoral shaft fracture combined with hip neck fracture; type II, femoral shaft fracture combined with a trochanteric fracture; type III, femoral shaft fracture combined with a distal femur fracture; and type IV, femoral shaft fracture combined with a proximal or distal femur fracture. The fractures were treated with locked intramedullary nailing and additional free cancellous 6.5-mm screws as needed. Fifty-six fractures healed without further operations. Of the remaining 6 fractures, 2 were material failures, 1 malunion with 3-cm shortening and external rotation of the femoral diaphysis, 2 early infections of the surgical wound, and 1 pseudarthrosis of the femoral shaft. All fractures were healed between 16 and 32 weeks (average: 20 weeks).

Bone Nails↗
PubMedDate not supplied

Fractures of the lateral humeral condyle: role of the cartilage hinge in fracture stability.

This study investigates the hypothesis that the integrity of the cartilage hinge at the distal humeral epiphysis determines the stability of fractures of the lateral humeral condyle. Sixteen patients with lateral humeral condyle fractures were studied with radiographs and magnetic resonance imaging (MRI). The clinical course of each patient was compared using these imaging studies to determine whether initial fracture displacement and the integrity of the cartilage hinge correlated with fracture stability. Radiographically, 4 fractures were considered unstable (with initial fracture displacement >3 mm) and 12 were stable (initial displacement < or =3 mm). On MRI, 6 fractures were complete (with disruption of the lateral cartilage hinge) and 10 were incomplete. All unstable fractures had complete fractures on MRI. Ten of the 12 patients with radiographically stable injuries had incomplete fractures on MRI. None of these displaced during treatment. Two patients had radiographically stable fractures and complete fractures on MRI. One of these fractures displaced, confirming the hypothesis that the stability of lateral humeral condyle fractures is related to the integrity of the cartilage hinge.

Cartilage, Articular↗
PubMed2000

Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures.

BACKGROUND: Antibiotic prophylaxis has been established policy for major surgical operations for many years. In fracture fixation, the effectiveness, and the duration of administration, have been a matter of debate. OBJECTIVES: To assess the effects of the prophylactic administration of antibiotics in patients undergoing surgical management of hip or other long bone fractures. SEARCH STRATEGY: We searched MEDLINE, EMBASE, Current Contents, Dissertation Abstracts, and Index to UK Theses, and bibliographies of identified articles. Trials were also obtained from the Cochrane Musculoskeletal Injuries Group trials register. Date of the most recent search: end of 1997. SELECTION CRITERIA PARTICIPANTS: Any patients with a hip or other closed long bone fracture undergoing surgery for internal fixation or replacement arthroplasty. INTERVENTIONS: Any regimen of systemic antibiotic prophylaxis administered at the time of surgery. OUTCOME MEASURES: Wound infection (deep and superficial), urinary tract infection, respiratory tract infection, adverse effects of prophylaxis, economic evaluations. DATA COLLECTION AND ANALYSIS: Both reviewers independently selected trials for inclusion, and assessed methodological quality and extracted data. Where possible, data were pooled and Peto odds ratios and absolute risk reductions, each with 95% confidence intervals, calculated. MAIN RESULTS: Twenty one randomised trials of only poor or moderate quality were included. The comparisons tested fell within six comparison groups, principally multiple dose or a single dose of antibiotic versus a placebo or no treatment. Antibiotic prophylaxis reduces wound, urinary and respiratory tract infections in patients undergoing surgery for closed fracture fixation. Economic modelling has indicated that this is a cost-effective intervention. There are limited data for the incidence of adverse effects, but as expected they appear to be more common in those receiving antibiotics. REVIEWER'S CONCLUSIONS: Antibiotic prophylaxis should be offered to those undergoing surgery for closed fracture fixation. On ethical grounds, further placebo controlled randomised trials of the effectiveness of antibiotic prophylaxis in closed fracture surgery are unlikely to be justified. Trials addressing the cost-effectiveness of different effective antibiotic regimens would need to be very large and may not be feasible.

Antibiotic Prophylaxis↗
PubMed2001

The effect of alendronate on fracture-related healthcare utilization and costs: the fracture intervention trial.

The Vertebral Fracture Arm (VFA) of the Fracture Intervention Trial (FIT) study demonstrated that alendronate reduced the incidence of spine, forearm and hip fractures in women with low bone mass and existing vertebral fractures by about 50%. The objective of the present study was to determine the effects of alendronate therapy versus placebo on fracture-related healthcare utilization and costs. Participants were randomly assigned to double-masked treatment with alendronate (5 mg/day for 2 years and then 10 mg/day for 1 year) or placebo for 3 years. For each patient experiencing a clinical fracture, we determined whether treatment in an emergency room, hospital, nursing home and/or rehabilitation hospital was a consequence of the fracture. The VFA of the FIT Study enrolled 2027 women aged 55-81 years with low bone mass and pre-existing vertebral fractures from population-based listings in 11 metropolitan areas of the United States. We measured (1) the proportion of patients who had any fracture-related healthcare event and (2) the estimated cost of fracture-related healthcare services. Alendronate significantly reduced the proportion of patients utilizing fracture-related healthcare (emergency room, hospital, rehabilitation hospital or nursing home) by 25% (p = 0.038). Alendronate significantly reduced the costs associated with hip-fracture-related care by 58%, or $181 per patient randomized (p = 0.036). The reduction in fracture-related total costs was 35% ($190 per patient randomized) in the alendronate group relative to the placebo group (p = 0.114). Alendronate thus not only reduces the incidence of clinical fractures and associated morbidity, but reduces the proportion of patients utilizing the associated healthcare resources.

Aged↗
PubMed1995

Minimal trauma fractures in older nursing home residents: the interaction of functional status, trauma, and site of fracture.

OBJECTIVE: This study was conducted to determine the incidence of long bone fractures in institutionalized older persons and to describe preceding traumatic events and the functional status of individuals sustaining fractures. DESIGN: A 1-year, prospective, cumulative incidence survey. SETTING: Eleven skilled nursing care facilities in the state of Wisconsin. PATIENTS: All residents of the 11 facilities. MEASUREMENTS: All incident reports of long bone fractures, description of events preceding the fractures, and functional status of the fracture cases. In addition, demographic and medical information was collected on fracture cases and the general nursing home population. MAIN RESULTS: Overall long bone fracture incidence was 3.52 per 100 subjects per year. Minimal trauma fracture incidence was 0.84 per 100 subjects per year. Fracture location was significantly related to type of trauma. Functional status was significantly related to fracture location and to the type of trauma preceding the fracture. Minimal trauma fractures occurred in individuals who were less mobile and more likely to be bed-bound, and the location was more likely to be the lower extremity below the hip. CONCLUSION: This is the first prospective survey of long bone and spontaneous fracture incidence rates in multiple nursing home facilities. Minimal trauma fractures are common in the nursing home, and most have no clear precipitating factors other than severely impaired mobility.

Accidental Falls↗
PubMed2004

Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong?

UNLABELLED: A worldwide epidemic of hip fractures has been predicted. Time trends in BMD testing, bone-sparing medications and hip and wrist fractures in the province of Ontario, Canada, were examined. From 1996 to 2001, BMD testing and use of bone-sparing medications increased each year, whereas despite the aging of the population, wrist and hip fracture rates decreased. INTRODUCTION: If patients with osteoporosis are being diagnosed and effective treatments used with increasing frequency in the population, rates of hip and wrist fractures will remain stable or possibly decrease. We report here time trends in BMD testing, prescriptions for bone-sparing medications, hip and wrist fracture rates, and population projections of fracture rates to 2005 in the province of Ontario, Canada. MATERIALS AND METHODS: Ontario residents have universal access to Medicare. To examine time trends in BMD testing, all physician claims for DXA from 1992 to 2001 were selected from the Ontario Health Insurance Plan (OHIP) database. Trends in prescribing were examined from 1996 to 2003 using data from the Ontario Drug Benefit plan, which provides coverage to persons > or = 65 years of age. Actual numbers of hip and wrist fractures were determined for 1992-2000 and population projections for 2001-2005 using time-series analysis. Wrist fractures were identified in the OHIP database and hip fractures through hospital discharge abstracts. RESULTS: From 1992 to 2001, the number of BMD tests increased 10-fold. There has been a steady increase in the number of persons filling prescriptions for antiresorptives (12,298 in 1996 to 225,580 in 2003) and the majority were for etidronate. For women, the rate of decline for wrist fractures is greater than that for hip fractures. The rate of hip fracture was fairly constant around 41 per 10,000 women > or = 50 years between 1992 and 1996. In 1997, the hip fracture rate began to decrease, and the population projections suggest that this downward trend will continue to a rate of 33.1 per 10,000 in 2005. CONCLUSIONS: Our findings suggest that fracture rates may be on the decline, despite the aging of the population, because of increased patterns of diagnosis and treatment for osteoporosis.

Aged↗
PubMed1986

[Fractures and dislocation fractures of the wrist joint].

Most carpal fractures are based on the same injury mechanism. In most cases the injury is caused by a fall on the dorsiflexed hand, which is raised as a protective measure, and less frequently by a fall on the clenched fist. The latter leads to passive palmar flexion, pronation and radial inclination of the hand; in the former, the hand is passively superextended by the impact, supinated, and brought into ulnar inclination. The instability caused by injury to various articular structures has four developmental stages. The bones or syndesmoses that are involved depend on the stage and quantitative relationship between the three above-mentioned moments of force. If the lateral ligament of the wrist is slack, scaphoid fractures occur; in the last stage of superextension, fractures of the capitate bone occur. With increasing ulnar inclination, perilunar dislocations or fracture-dislocations and triquetrum fractures occur in the third stage and dislocations of the semilunar bone in the fourth stage. In addition, compression and avulsion of the 1st, 4th or 5th metacarpal bones cause fractures of the trapezium and the hamate bone. To avoid unpleasant late sequels, scaphoid fractures with diastasis due to soft tissue interposition or non-reducible dislocated scaphoid fractures must be treated surgically. Vertical oblique fractures and scaphoid fractures with small proximal fragments are relatively good indications for operation. Perilunar instability and dislocations, particularly De Quervain's fracture-dislocations, must be treated operatively because reduction of the scaphoid bone requires a different approach than correcting alignment in the carpus and because soft tissue interpositions are always present, even though they may not be evident in the X-ray pictures. Fracture-dislocations in the distal carpal row also require operation, preferably percutaneous internal fixation using K-wire and fluoroscopy. Immobilization is accomplished by a below-elbow cast with a dorsal plaster splint up to the interdigital webs and from the palmar to the proximal crease. The thumb is only embedded in trapezium fractures; fractures requiring fist or above-elbow casts are indications for operation.

Adolescent↗
PubMed2006

Posterior malleolar fracture is often associated with spiral tibial diaphyseal fracture: a retrospective study.

BACKGROUND: It is known that posterior malleolar fracture is often associated with tibial diaphyseal fractures. However, in literature there are very few studies on tibial shaft fractures with respect to posterior malleolus fragment. We hypothesized that the incidence of posterior malleolar fracture is higher than in previous studies. METHODS: A total of 74 closed tibial shaft fractures were treated with intramedullary nailing in Turku University Central Hospital between January 1994 and December 1998. There were 55 men and 19 women, with a mean age of 39 years (range, 16 to 58 years). Two cases were excluded and 72 tibial shaft fractures were analyzed retrospectively. RESULTS: Posterior malleolar fracture was observed in 18 cases (25.0%). Only 10 were observed preoperatively in plain films, seven were detected postoperatively and one was not detected at all during the treatment. Retrospectively, all 18 posterior malleolar fractures were detectable in preoperative plain films. CONCLUSION: A fracture of the posterior malleolus was involved in every fourth tibial diaphyseal fracture. The fractures of the posterior malleolus were always detected in preoperative plain films and should be suspected, especially in cases of low-energy spiral distal tibial diaphyseal fractures. We recommend additional plain films to be taken at the ankle region to better visualize these fractures.

Adolescent↗
PubMed2004

Association of severe vertebral fractures with reduced quality of life: reduction in the incidence of severe vertebral fractures by teriparatide.

OBJECTIVE: The association between vertebral fracture severity and health-related quality of life (HRQOL) was investigated in a subset of patients in the Fracture Prevention Trial. We sought to determine whether vertebral fracture severity was associated with HRQOL scores, and if so, to determine the effects of teriparatide (recombinant human parathyroid hormone 1-34) on vertebral fracture grades that most strongly impact HRQOL in postmenopausal women with osteoporosis. METHODS: Vertebral fracture severity was assessed by the visual semiquantitative (SQ) method. A subset of 444 patients with a baseline radiograph completed the Osteoporosis Assessment Questionnaire. Baseline HRQOL scores were modeled as a function of maximum baseline vertebral fracture grade, while controlling for age, bone mineral density, body mass index, and back pain. RESULTS: The effect of baseline vertebral fracture grade on baseline HRQOL was statistically significant, while interactions between vertebral fracture grade and the other variables were not statistically significant. SQ grade 3 (SQ3) vertebral fractures were associated with a significantly lower overall HRQOL score and with significantly lower physical function, symptoms, and emotional status dimension scores. After a median of 19 months of therapy, new or worsening SQ3 vertebral fractures occurred in 21 of 448 patients (4.7%) in the placebo group compared with 3 of 444 patients (0.7%) in the 20 mug/day teriparatide group. The risk of developing a new or worsened SQ3 vertebral fracture was reduced by 86% (P < 0.001) in patients treated with 20 mug/day teriparatide. CONCLUSION: Compared with prevalent fractures of lesser severity, SQ3 vertebral fractures were associated with reduced HRQOL. Teriparatide treatment significantly reduced the risk of new or worsening SQ3 vertebral fractures. These findings suggest, but do not directly demonstrate, a benefit of teriparatide on HRQOL.

Aged↗
PubMed2004

Impact of incident vertebral fractures on health related quality of life (HRQOL) in postmenopausal women with prevalent vertebral fractures.

Vertebral fractures are a common complication of osteoporosis and may cause a decrease of health-related quality of life (HRQOL). This study was designed to determine the impact of incident vertebral fractures on HRQOL. The Multiple Outcomes of Raloxifene Evaluation (MORE), a multicenter, randomized, double blind trial, in which women were taking raloxifene or placebo. This study was done in European centers only in a subset of 361 women from seven European countries, all with prevalent vertebral fractures. A specific questionnaire for osteoporosis developed by the International Osteoporosis Foundation was used for assessment at baseline, 1, 2 and 3 years. This questionnaire, Qualeffo, contains 41 questions in the domains pain, physical function, social function, general health perception and mental function. Domain and total scores are expressed on a 100-point scale with 0 corresponding to the best HRQOL. Standardized lateral spinal radiographs were made at baseline, 2 and 3 years and evaluated in a central facility. Sixty-seven patients sustained a fracture in a vertebra that was not fractured at baseline (incident vertebral fractures). Twenty of these were accompanied by signs and symptoms necessitating immediate doctor's attention (clinical vertebral fractures) and 47 vertebral fractures were only diagnosed on radiographs (subclinical vertebral fractures). Incident vertebral fractures (clinical and subclinical) were associated with an increase of back pain (mean score change 6.4; 95% CI 2.1-10.7), deterioration of physical function (mean score change 2.4; 95% CI 0.1-4.8), and worse general health perception (mean score change 3.8; 95% CI 0.1-7.5). Score changes for patients with subclinical vertebral fractures were intermediate between those for patients with clinical vertebral fractures and patients without incident vertebral fracture. Clinical and subclinical incident vertebral fractures both have an adverse impact on HRQOL.

Aged↗
PubMed2004

Discriminative capacity of calcaneal quantitative ultrasound and of osteoporosis and fracture risk factors in postmenopausal women with osteoporotic fractures.

Bone fragility fractures constitute the principal complication of osteoporosis. The identification of individuals at high risk of sustaining osteoporotic fractures is important for implementing preventive measures. The purpose of this study is to analyze the discriminative capacity of a series of osteoporosis and fracture risk factors, and of calcaneal quantitative ultrasound (QUS), in a population of postmenopausal women with a history of osteoporotic fracture. A cross-sectional analysis was made of a cohort of 5195 women aged 65 or older (mean +/- SD: 72.3 +/- 5.4 years) seen in 58 primary care centers in Spain. A total of 1042 women (20.1%) presented with a history of osteoporotic fracture. Most fractures (93%) were non-vertebral. Age-adjusted odds ratios corresponding to each decrease in one standard deviation of the different QUS parameters ranged from 1.47 to 1.55 (P < 0.001) for fractures. The age-adjusted multivariate analysis yielded the following risk factors independently associated with a history of osteoporotic fracture: number of fertile years, a family history of fracture, falls in the previous year, a history of chronic obstructive airway disease, the use of antiarrhythmic drugs, and a low value for any of the QUS parameters. The area under the receiver operating characteristic curve of the best model was 0.656. In summary, a series of easily assessable osteoporotic fracture risk factors has been identified. QUS was shown to discriminate between women with and without a history of fracture, and constitutes a useful tool for assessing fracture risk. Various of the vertebral and hip fracture risk factors frequently cited in North American and British populations showed no discriminative capacity in our series--thus suggesting that such factors may not be fully applicable to our population and/or to the predominant type of fractures included in the present study.

Aged↗