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Bone density and markers of bone turnover in predicting fracture risk and how changes in these measures predict fracture risk reduction.

Surrogate markers in clinical medicine provide a useful means to assess therapeutic response to pharmacologic therapy in a wide range of chronic disease states. In the area of osteoporosis, the surrogate markers of change in bone mineral density (BMD) and bone turnover markers (BTM) provide the clinician with a means of assessing the biologic response to osteoporosis-specific pharmacologic agents. Increases in BMD and/or reductions in BTM can independently be correlated to reductions in vertebral and nonvertebral fracture risk. In managing osteoporosis patients, the BTM change at an earlier point of time after initiation of therapy and a change in BTM can provide earlier feed-back to the patient and clinician regarding issues such as compliance and a bone biologic response. An increase in BMD at 12 or 24 months after initiation of therapy is also evidence of an improvement in bone strength though with antiresorptive agents no change in BMD may also be associated with risk reduction within clinical trial sets. In this regard, changes in BMD and BTM are complimentary in their application to patient management.

Biomarkers↗

Anterior tibial spine fracture - an easy fracture to miss.

Fractures of the intercondylar tibial spine are uncommon injuries that occur more frequently in the growing skeleton. They are easy to miss in the triage setting often being diagnosed as 'sprains' after sporting injuries. We report three cases that occurred in adolescents attending the same sporting event. We seek to highlight the importance of recognising these injuries so that the appropriate immediate treatment can be given.

Adolescent↗

Dorsal fractures of the triquetrum-avulsion or compression fractures?

In 76 wrists, which had a dorsal fracture of the os triquetrum, the mean size of the ulnar styloid process was radiologically measured and found to be significantly larger (p less than 0.0001) that those in a control group of 100 noninjured hands. This finding supports the view that such injuries are not avulsions, as they are assumed to be, but are the product of a chisel action of a powerful ulnar styloid process on the dorsum of the triquetrum during strong dorsiflexion and ulnar deviation. In accordance, persons with a long styloid process have an increased chance of this kind of injury.

Carpal Bones↗

[Are stress fractures "hormone fractures"? On the current discussion of the cause of this sports injury].

Discussion on the causes of stress reactions and/or stress fractures is at present under way. There are some pointers indicating that in women athletes this type of sports injury or damage is promoted by hormonal imbalance. Nevertheless, sports practice should always bear in mind that taking the "pill" cannot prevent stress damage. The primary cause is forced mechanical strain or load combined with improperly balanced training. The author makes specific reference to potentially dangerous types of training, and discusses these.

Athletic Injuries↗