Search

Objectives: Hip fragility fractures were regarded as one of the most severe, but recent papers report on the underestimated burden of vertebral compression fractures. This study aims to compare morbidity and mortality of hip and vertebral fragility fractures in patients treated in the same setting., Methods: Patients aged ≥50 years with hip fracture, and those with vertebral fracture presenting to our hospital between January 2014 and January 2017 were included. Patients were evaluated 1 year after their index fracture. SF-36 scores, mortality, and institutionalization are then recorded. Patients were divided into 2 groups: hip fractures and vertebral fractures., Results: There were 106 and 90 patients respectively evaluated in hip and vertebral fracture groups at 1 year. Patients in both groups were comparable for age, sex, comorbidities and neuropsychiatric condition (P > 0.05). At 1 year follow-up, SF-36 showed better averages in all 8 scales in hip fracture group compared to vertebral fracture group. Mortality in the hip fracture group reached 32.1% compared to 10% for the vertebral fracture group (P < 0.01). Fifteen patients were institutionalized in the hip fracture group compared to 18 patients in the vertebral fracture group (P > 0.05)., Conclusions: When comparing patients treated in the same setting, hip fracture is associated with significantly increased mortality than vertebral fracture; however, the latter is associated with more morbidity., (© 2020 The Korean Society of Osteoporosis. Publishing services by Elsevier B.V.)

Coronary embolism is an uncommon mechanism of myocardial infarction in comparison with atherosclerotic plaque rupture. We present a unique case of an anterior ST elevation myocardial infarction as a result of coronary embolism, the source of which appears to be calcific debris from mitral annular calcification (MAC). Although embolic phenomena in the setting of MAC has been documented previously, particularly in the setting of acute ischemic stroke, to our knowledge this is the first reported case in the literature where MAC alone appears to have resulted in a coronary embolic event. < Learning objective: Myocardial infarction as the result of embolic coronary phenomena is uncommon. Thrombotic emboli in the setting of atrial fibrillation, paradoxical emboli in the setting of structural heart defects, and cardiac masses are among the most common causes of coronary embolism. We make the argument that debris from mitral annular calcification may also serve as an uncommon mechanism of embolic phenomena.>., (© 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

In this cross-sectional study we aimed to evaluate the relationship between physical fitness and bone variables across the body mass index (BMI) spectrum in women aged 20-35 years. The study included 13 underweight women (BMI < 18.5 kg/m 2 ), 24 normal weight women (BMI 18.5-24.9 kg/m 2 ), and 20 overweight/obese women (BMI ≥ 25 kg/m 2 ) aged between 20 and 35 years. Bone mineral density (BMD) and content (BMC) at the whole body, lumbar spine, and femoral neck, lumbar spine trabecular bone score, femoral neck geometry were assessed using dual-energy X-ray absorptiometry. Cardiorespiratory fitness and lower limb muscle power were estimated using the 20-m shuttle run test and the Sargent jump test, respectively. The associations between bone variables and physical fitness were different according to BMI categories. Correlations between physical fitness and bone parameters are particularly significant in normal BMI and less significant in low and high BMI. Multivariate ANCOVA regression models demonstrated that absolute VO 2max (L/min) is a strong determinant of all the bone parameters regardless of BMI. Implementing strategies for increasing VO 2max (L/min) by increasing lean mass and promoting resistance and/or high-intensity interval training could be effective to optimize bone health in underweight and overweight young adult women.

The aim of this study was to describe femoral neck (FN) geometry among eumenorrheic underweight women around the age of peak bone mass. Proximal femur geometry and body composition were assessed in 12 underweight women and in 24 healthy controls using dual-energy X-ray absorptiometry. The Hip Structural Analysis program was used to determine bone geometry at the FN. The cross-sectional area (CSA) and the cross-sectional moment of inertia (CSMI) were significantly lower in underweight women than in controls (p < 0.05). There was a trend toward lower sectional modulus (Z) and strength index in underweight women (p < 0.15). Body weight, body mass index, and lean mass (LM) were positively correlated with CSA, CSMI, Z, and neck-shaft angle (r = 0.428-0.611, p < 0.05). After controlling for body weight, body mass index, and LM, the differences in CSA, CSMI, Z, and neck-shaft angle were no more statistically significant between the 2 groups. The multivariate analysis retained LM as the main predictor of CSA, CSMI, and Z in the whole population. The present study suggests that thinness is associated with low resistance to axial forces (CSA) and bending load (Z and CSMI) in adult eumenorrheic women. LM seems to be a key determinant of FN geometry in underweight women., (Copyright © 2017 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

Surgical treatment of patients with thoracolumbar vertebral fracture without neurological deficit is still controversial.Management of vertebral fracture with percutaneous fixation was first reported in 2004.Advantages of percutaneous fixation are: less tissue dissection; decreased post-operative pain; decreased bleeding and operative time (depending on the steep learning curve); better screw positioning with fluoroscopy compared with an open freehand technique; and a decreased infection rate.The limitations of percutaneous fixation of vertebral fractures include increased radiation exposure to the patient and the surgeon, together with the steep learning curve for this technique.Adding a screw at the level of the fractured vertebra has the advantages of incorporating fewer motion segments with less operative time and bleeding. This also increases the axial, sagittal and torsional stiffness of the construct.Percutaneous fixation alone without grafting is sufficient for treating type A and B1 (AO classification) thoracolumbar fractures with satisfactory results concerning kyphosis reduction when compared with open instrumentation and fusion and with open fixation.Type C and B2 fractures (ligamentous injuries) should undergo fusion since the ligamentous healing is mechanically weak, increasing the risk of instability.This review offers a detailed description of percutaneous screw insertion and discusses the advantages and disadvantages. Cite this article: EFORT Open Rev 2018;3:604-613. DOI: 10.1302/2058-5241.3.170026., Competing Interests: ICMJE Conflict of interest statement: G. Riouallon declares payment for speaking and/or teaching and travel costs from Medtronic, activity outside the submitted work.

The relationship between vitamin D and trabecular bone score (TBS) in young adults remains unclear. The aim of this study was to explore the relationship between 25-hydroxyvitamin D [25(OH)D] serum levels and TBS in a healthy adult population. A total of 54 men and 61 women whose ages range from 18 to 35 participated in the present study. Participants with 25(OH)D insufficiency (between 21 and 29 ng/mL) were 55.7%, and those with 25(OH)D deficiency (≤20 ng/mL) were 11.4%. TBS positively correlated with 25(OH)D in men (r = 0.393; p <0.05) and women (r = 0.324; p < 0.05). In both genders, TBS was significantly higher in 25(OH)D-sufficient participants (≥30 ng/mL). The present study provides evidence that vitamin D positively affects bone health and suggests that maintaining adequate vitamin D status may be essential for optimal TBS values., (Copyright © 2018 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

Optimizing bone mass in adulthood is of great importance to prevent the occurrence of osteoporosis in later age. Vitamin D is an essential component of bone health. Low-serum vitamin D is associated with low bone mineral density (BMD), which is an important predictor of fracture risk. However, most cells, apart from renal tubular cells, are exposed to free rather than to total 25-hydroxyvitamin D. Whether free vitamin D would be a better marker than total vitamin D is still under debate. The aim of the present study was to explore the relationships between serum total vitamin D, vitamin D-binding protein (BP), free vitamin D, and bone parameters in a group of young Lebanese women. This study included 88 young female adults aged between 18 and 35 yr. Body composition and BMD were assessed by dual-energy X-ray absorptiometry, and the lumbar spine trabecular bone score was derived. Bone mineral content (BMC) and BMD were measured at the whole body (WB), the lumbar spine (L1-L4), the total hip (TH), and the femoral neck (FN). To evaluate hip bone geometry, dual-energy X-ray absorptiometry scans were analyzed at the FN, the intertrochanteric region, and the femoral shaft by the Hip Structure Analysis program. The cross-sectional area, the index of axial compression strength, and the section modulus (Z), as well as index of bending strength, were measured from bone mass profiles. Composite indices of FN strength (compressive strength index [CSI], bending strength index, and impact strength index [ISI]) were calculated as previously described. Direct measurement of free 25-hydroxyvitamin D concentrations was performed by immunoassay, which detects free vitamin D by ELISA on a microtiter plate. Serum vitamin D BP was measured using a Quantikine ELISA kit, which employed the quantitative sandwich enzyme immunoassay technique. Serum free vitamin D was positively correlated with WB BMC (r = 0.26, p < 0.05), WB BMD (r = 0.29, p < 0.05), L1-L4 BMD (r = 0.28, p < 0.05), TH BMD (r = 0.34, p < 0.01), FN BMD (r = 0.29, p < 0.05), CSI (r = 0.24, p < 0.05), and ISI (r = 0.28, p < 0.05). No positive correlations were detected between the total vitamin D level, the vitamin D BPs, and BMD. The positive associations between free vitamin D and several bone variables (WB BMC, WB BMD, L1-L4 BMD, TH BMD, FN BMD, CSI, bending strength index, and ISI) remained significant after adjustment for weight. In conclusion, the current study suggests that the free vitamin D serum level is a stronger positive determinant of bone parameters and hip bone strength indices in young female adults than total serum vitamin D., (Copyright © 2018 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

This study aims to assess for the first time in the Middle East, the clinical benefits of an FLS model established in a hospital in Beirut, Lebanon. It shows a significant 54% relative risk reduction in re-fracture incidence, confirming the patient-oriented benefit of diffusing this system in the Middle East region., Purpose/introduction: Few hospitals in Lebanon applied Fracture Liaison Service (FLS) program. A type A FLS is established at Bellevue hospital in Beirut in July 2013. This study aims to assess its clinical benefits and efficacy., Methods: Patients aged 50 years and above presenting to our hospital with minimal trauma fracture from July 2012 till June 2014 are enrolled. These are divided into two groups, before (group A) and after (group B) FLS implementation. Both groups are compared for re-fracture incidence, bone health assessment; osteoporosis treatment maintenance, and death in a 2-year follow-up., Results: Nighty-eight patient composing group B are compared to 100 patients in the group A. Around 65% of patients in the FLS group underwent Dexa osteodensitometry following their fracture compared to 28% in the comparator group (p < 0.001). About 54% of patients in group B maintained osteoporosis treatment compared to 26% in group A (p < 0.001). Sixteen percent of patients died in the FLS study group compared to 16% of patients in the comparator group (p = 0.950). A second fracture, happened in 8.2% of patients in the FLS study group compared to 18% of the patients in the comparator group p = 0.004. Number needed to treat reached 10.2 patients., Conclusions: The statistical analysis results go with the overwhelming evidence concerning FLS importance in promoting bone health assessment and osteoporosis treatment in fracture patients. It also confirms the clinical value and the patient-oriented benefit of an implementation of such a system.

Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people.Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population.Percutaneous fixation by 'vertebroplasty' is a tempting alternative for open surgical management of these fractures.Despite discouraging initial results of early trials for vertebroplasty, cement augmentation proved its superiority for the treatment of symptomatic osteoporotic vertebral fracture when compared with optimal medical treatment.Early intervention is also gaining ground recently.Kyphoplasty has the advantage over vertebroplasty of reducing kyphosis and cement leak.Stentoplasty, a new variant of cement augmentation, is also showing promising outcomes.In this review, we describe the additional techniques of cement augmentation, stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed. Cite this article: EFORT Open Rev 2017;2:293-299. DOI: 10.1302/2058-5241.2.160057., Competing Interests: ICMJE Conflict of interest statement: None declared.

Burkholderia cepacia spondylodiscitis is a rare entity that has been reported in only four cases. We hereby report the case of a 43-year-old, previously healthy, woman who was found to have a B. cepacia spondylodiscitis after a cholecystectomy. She was treated with a three-month regimen of ceftazidime and ciprofloxacin with complete clinical, biological, and radiological remission.

Background: In 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis-St. Paul., Methods and Results: Eleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and <76 and presumed cardiac etiology. Patients with other rhythms, known do not resuscitate/do not intubate, noncardiac etiology, significant bleeding, and terminal disease were excluded. The primary outcome was survival to hospital discharge with favorable neurological outcome. Patients (315 out of 331) who were resuscitated from VT/VF and transferred alive to the Emergency Department had complete medical records. Of those, 231 (73.3%) were taken to the CCL per the Minnesota Resuscitation Consortium protocol while 84 (26.6%) were not taken to the CCL (protocol deviations). Overall, 197 (63%) patients survived to hospital discharge with good neurological outcome (cerebral performance category of 1 or 2). Of the patients who followed the Minnesota Resuscitation Consortium protocol, 121 (52%) underwent percutaneous coronary intervention, and 15 (7%) underwent coronary artery bypass graft. In this group, 151 (65%) survived with good neurological outcome, whereas in the group that did not follow the Minnesota Resuscitation Consortium protocol, 46 (55%) survived with good neurological outcome (adjusted odds ratio: 1.99; [1.07-3.72], P=0.03)., Conclusions: Early access to the CCL after cardiac arrest due to a shockable rhythm in a selected group of patients is feasible in a large metropolitan area in the United States and is associated with a 65% survival rate to hospital discharge with a good neurological outcome., (© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)

Synovial chondromatosis is a rare panarticular synovial disease affecting large joints and especially the knee. When the disease is localized in the knee, it affects the anterior compartment. We report the case of a posterior localized disease with a review of the literature focusing on arthroscopic treatment.

Vitamin D is well known for its effects on bone metabolism, calcium and phosphorus homeostasis. Recently, a worldwide focus has been made on the extraskeletal effects of this liposoluble vitamin. The New York Times even called it the "wonder drug". Vitamin D is a liposoluble vitamin and acts via an intracellular receptor. This article reviews the extra-skeletal effects of vitamin D focusing on cardiovascular effects, regulation of glucose, antitumoral properties, and effect on the immune system and the skeletal muscle and attempts to offer possible molecular explanations to these effects.

The aim of this study was to explore the relationship between maximal oxygen consumption (VO2 max) and bone mineral density (BMD) in a group of young Lebanese adults. Twenty women and 37 men whose ages range from 18 to 32 yr participated in this study. Informed written consent was obtained from the participants. Body weight and height were measured, and body mass index was calculated. VO2 max was determined by direct measurement while exercising on a bicycle ergometer (Siemens-Elema RE 820; Rodby Elektronik AB, Enhorna, Sweden). Whole body bone mineral content (WB BMC), whole body bone mineral density (WB BMD), lumbar spine BMD (L1-L4 BMD), total hip BMD (TH BMD), and femoral neck BMD (FN BMD) were measured by dual-energy X-ray absorptiometry. In women, VO2 max (expressed as L/mn) was positively correlated to WB BMC (r = 0.82; p < 0.001), WB BMD (r = 0.80; p < 0.001), L1-L4 BMD (r = 0.73; p < 0.001), TH BMD (r = 0.80; p < 0.001), and FN BMD (r = 0.85; p < 0.001). In men, VO2 max (expressed as L/mn) was positively correlated to WB BMC (r = 0.57; p < 0.001), WB BMD (r = 0.53; p < 0.001), L1-L4 BMD (r = 0.50; p < 0.001), TH BMD (r = 0.38; p < 0.01), and FN BMD (r = 0.30; p < 0.05). In both sexes, the positive associations between VO2 max and bone variables (BMC and BMD) remained significant after adjustment for age (p < 0.001). This study suggests that VO2 max (L/mn) is a positive determinant of BMC and BMD in young adults. Aerobic power seems to be a determinant of BMC and BMD in young adults., (Copyright © 2014 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to investigate the influence of the weight-status (obese, overweight and normal-weight) on bone mineral density of the forearm in Lebanese women. 3,989 Lebanese women (1,138 obese, 1,570 overweight and 1,281 normal weight) aged from 19 to 92 years old participated in this study. Weight and height were measured, and body mass index (BMI) was calculated. BMD of the ultra-distal (UD) radius, the 1/3 radius and the total radius was measured by DXA (GE Healthcare Lunar Prodigy). In the whole population, body weight was positively correlated to UD Radius BMD (r = 0.41; P < 0.001), 1/3 radius BMD (r = 0.35; P < 0.001) and total radius BMD (r = 0.48; P < 0.001) while age was negatively correlated to UD BMD (r = -0.42; P < 0.001), 1/3 Radius BMD (r = -0.52; P < 0.001) and total radius BMD (r = -0.42; P < 0.001). Using multiple linear regression analysis models, age and weight explained 36 %, 41 % and 42 of the UD radius BMD, 1/3 radius BMD and total radius BMD variances respectively. UD radius BMD, 1/3 radius BMD and total radius BMD values were significantly different among the three groups (P < 0.001). UD Radius BMD, 1/3 radius BMD and total radius BMD values were higher in obese and overweight women compared to normal-weight women (P < 0.001) and in obese women compared to overweight women (P < 0.001). These differences among the three groups remained significant after adjusting for age and height (P < 0.001). This study suggests that obesity is associated with higher UD radius, 1/3 radius and total radius BMD values in Lebanese women. Thus, obesity seems to be protective against forearm osteopenia in Lebanese women.

With the increasing life expectancy, osteoporosis is becoming a major worldwide health problem. Osteoporotic fragility fractures affect the quality of life and are associated with premature mortality. The magnitude of the disease may become larger in developing countries, particularly in the Middle East where the prevalence of low bone mass is higher than in Western countries. Besides two small studies, there is no serious fragility fracture registry in Lebanon. The British Orthopedic Association published guidelines on the care of fragility fractures in 2007. Inspired by this effort, and taking into consideration the Lebanese socio-medico-economical particularities, we will detail the multidisciplinary management of a fragility fracture, as listed in the international standards, from its presentation to the Emergency Department, through its peri-operative care, and we will pay particular attention to the different aspects of secondary prevention. We hope that this paper will contribute to the upgrading of care of fragility fractures in Lebanon in order to meet the international standards of care, thus setting the example to other countries and healthcare systems in the Middle East region.

The occurrence of intracoronary thrombus during percutaneous coronary intervention (PCI) is a well-known complication. It has been estimated that it complicates approximately 6% of all coronary procedures. Patients at highest risk for this complication include those with acute ischemic syndromes or with angiographically apparent thrombus. Since the development of PCI, intravenous unfractionated heparin (UFH) has remained the primary antithrombotic therapy for the prevention of periprocedural ischemic complications. The availability of a rapid "point of care'' test for dose individualization (the activated clotting time [ACT]) has facilitated this process. Other forms of antithrombotic therapies such as direct thrombin inhibitors or low-molecular-weight heparin have been proposed as more effective anticoagulants during PCI. Bivalirudin is a direct thrombin inhibitor proven to decrease post-PCI ischemic complication rate compared with UFH and have a lower vascular complication rate compared with glycoprotein IIb/IIIa receptor antagonists. We herein report a case of acute macrothrombus formation during PCI despite adequate ACT achieved with bivalirudin.

Objectives: We sought to determine whether eptifibatide decreases the incidence of in-laboratory angiographic complications and to determine the relationship of angiographically evident complications to elevations of creatine kinase-MB (CK-MB) enzyme levels during percutaneous coronary intervention., Background: In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, eptifibatide during coronary intervention was associated with decreased ischemic complications at 48 h and 30 days., Methods: Patients (n = 2,064) were randomized to placebo versus eptifibatide (two 180 microg/kg boluses 10 min apart and as a continuous infusion of 2 microg/kg per min) during percutaneous coronary stenting. Angiographic complications including major dissection, distal embolization, residual thrombus, abrupt closure, residual stenosis >50% and side-branch occlusion were prospectively recorded by the operator. Creatine kinase-MB levels were measured after the procedure and every 6 h thereafter. The incidence of angiographic complications and CK-MB elevation was determined for eptifibatide versus placebo groups., Results: Eptifibatide-treated patients demonstrated nonsignificant trends toward fewer angiographic complications (10 vs. 12% for placebo patients, p = 0.13) and, for patients with angiographic complications, fewer subsequent CK-MB elevations (43 vs. 50% for placebo patients, p = 0.31). In patients without any angiographic complications, the incidence of CK-MB elevation >3 times the normal was 7% with placebo and 4% with eptifibatide (p = 0.003)., Conclusions: Eptifibatide during nonurgent coronary stent intervention only minimally (and insignificantly) reduces the incidence of angiographic complications and subsequent CK-MB elevations in patients developing an angiographic complication. The greater effect is to reduce myocardial infarction in patients undergoing otherwise uneventful coronary stent implantation as well as in the overall study population.