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Bone fractures are a substantial health concern affecting approximately 2.7 million individuals annually across six European countries: France, Germany, Italy, Spain, Sweden, and the UK. If left untreated, this issue carries significant health risks, including fatality. It is crucial to accurately identify the types of fractures, especially subtle hairline fractures to mitigate long-term consequences. These fractures are characterized by small breaks where the bone fragments are aligned, and there is no visible displacement. Unfortunately, detecting hairline fractures is a significant challenge in the medical field. This is mainly attributed to the intricate nature of these fractures adding complexity, posing difficulties for both human and machine detection. Additionally, there is a lack of easily accessible datasets focused on hairline fractures. This paper introduces the iA-HLD model, a novel and enhanced approach for detecting hairline fractures. Through architectural modifications, this model exhibits superior capabilities in identifying hairline fractures across all types of human bones using deep learning and stands as the pioneering solution of its kind. A comprehensive comparative analysis is conducted, assessing the performance of the proposed model against established models, including ResNet-50, AlexNet, and convolutional neural network. Evaluation metrics, including accuracy, precision, recall, and F1-score, are used to compare the models. iA-HLD achieved an accuracy rate of 97.6%, highlighting its superior capabilities. In addition, it scored 98% in precision, recall, and F1-score, which surpasses all other models. These results show its improved capabilities as well as its potential for use in real-world applications across many fields. The research is a significant stride in advancing hairline fracture detection and addresses a critical gap in current medical diagnostic methods. [ABSTRACT FROM AUTHOR]

Trabecular bone, a porous and spongy kind of bone tissue composed of a lattice of connecting rods and/or plates, is crucial for the transfer of weight in crucial joints including the spine, hip, and knee. It is impacted by a variety of metabolic bone illnesses, such as osteoporosis, which result in bone loss, reduced bone strength, and an elevated risk of bone fracture. To promote osseointegration due to the permeable porous, we suggest, in this study, a new approach to design a femoral permeable porous implant to achieve suitable stiffness, lightweight, and biocompatibility for the bone. Accordingly, data are collected from a digital bio-model to design a femoral implant for mimics segmental bone defect (SBD) with a biocompatible material Ti6Al4V (Ti64). To do this, three lattice structures (LSs) are compared and derived from implicit surface modeling called a triply periodic minimal surface (TPMS) to obtain the LS suitable to create it within the solid inner volume of the tibia implant. Thus, performed the finite element analysis (FEA) method for the enhanced Designs and compare them in terms of stress, deformation, and lightweight. [ABSTRACT FROM AUTHOR]

The goal of this study was to develop an image analysis algorithm for quantifying the effects of remodelling on cortical bone during early fracture healing. An adaptive thresholding technique with boundary curvature and tortuosity control was developed to automatically identify the endocortical and pericortical boundaries in the presence of high-gradient bone mineral density (BMD) near the healing zone. The algorithm successfully detected boundaries in more than 47,000 microCT images from 12 pairs of healing ovine osteotomies and intact contralateral tibiae. Resampling techniques were used to achieve data dimensionality reduction on the segmented images, allowing characterisation of radial, circumferential, and axial distributions of cortical BMD. Local (transverse slice) and total (whole bone) remodelling scores were produced. These surrogate measures of cortical remodelling derived from BMD revealed that cortical changes were detectable throughout the region covered by callus and that the localised loss of cortical BMD was highest near the osteotomy. Total remodelling score was moderately and significantly correlated with callus volume and mineral composition (r > 0.64, p < 0.05), suggesting that the cortex may be a source of mineral needed to build callus. [ABSTRACT FROM AUTHOR]

Objective: Secondary osteoporosis is a condition when the underlying disease or its treatment causes the bone mass to decrease and the bone structure to deteriorate, increasing the risk of fracture. The importance of diagnosis and treatment during childhood and adolescence is due to the long-term negative effects. In this study, our objectives were to determine the diagnostic findings, treatment efficacy, and follow-up characteristics of children with secondary osteoporosis. Methods: Patients diagnosed with secondary osteoporosis between January 2000 and January 2021 were included. The research was a cross-sectional and descriptive study. Study participants had to be under 18 years of age when the primary underlying disease was diagnosed and had received treatment for secondary osteoporosis. Patient data were collected from patient files. Statistical analysis was performed using Statistical Package for the Social Sciences, version 20.0 (IBM Corp, Armonk, NY, USA). Results: Sixty-one patients (28 female; 45.9%) were evaluated. The most common underlying primary diseases were inflammatory diseases (57.7%), neuromuscular diseases (26.2%), immunodeficiency (13.1%), acute lymphoblastic leukemia (8.2%), metabolic diseases (8.2%), solid organ transplantation (8.2%), bone marrow transplantation (6.6%) and epilepsy (6.6%). The mean±standard deviation chronological age when secondary osteoporosis was diagnosed was 11.89±4.88 years. Patients were evaluated for osteoporosis at a mean of 6.39±5.13 years after the onset of the underlying primary chronic diseases. Most (78.7%) had a history of one or more chronic drug use, including systemic steroids (59%), chemotherapeutics (23%), immunomodulatory drugs (19.7%), antiepileptic drugs (8.2%), inhaled steroids (4.9%), intravenous immunoglobulin (1.6%), and antituberculosis drugs 1.6%.Bone pain was detected in 49.2%. All patients had vertebral fractures before treatment. Bisphosphonate treatment was given to 45 (73.8%). There was a significant increase in mean bone mineral density (BMD) and bone mineral content six months after treatment (both p<0.001). There was a significant increase in BMD Z-score values for chronological and height age (both p<0.001). Overall mean BMD values increased by 31.15% with treatment. Following bisphosphonate treatment, there was a significant reduction in both fracture number and bone pain (p<0.01). Similar benefits from bisphosphonate treatment were evident in those who did or did not receive steroid treatment. Conclusion: Secondary osteoporosis is a condition that is influenced by many factors, such as the primary disease causing osteoporosis and chronic medication use, especially steroids. If left untreated, osteoporosis may lead to clinically important morbidity (bone pain, fractures, immobilization) and reduced linear growth of bone. When used to treat childhood secondary osteoporosis, bisphosphonates significantly improve BMD and reduced fracture risk. [ABSTRACT FROM AUTHOR]

Transient osteoporosis of the hip is an uncommon bone marrow oedema syndrome of unknown pathophysiology affecting previously healthy pregnant women and young to middle-aged men. The disorder is characterised by hip pain, reduced mobility, and the risk of fracture, which is significantly higher in pregnant than in non-pregnant individuals. Diagnosis is by magnetic resonance imaging. Other than a single case-control study, published literature is limited to case series and case reports, with no evidence to guide management, risk of fracture, mode of delivery, safety of breastfeeding and risk of recurrence. An international pregnancy registry may be useful to try to answer some of these questions. [ABSTRACT FROM AUTHOR]

Osteoporotic vertebral compression fractures (OVCFs) are common fragility fractures. Patients who undergo surgical treatment for their initial OVCFs warrant particular attention because there is an elevated risk of subsequent vertebral fractures and other types of fragility fractures. However, the optimal osteoporosis treatment for this specific patient group is less investigated. This study compares the risk of subsequent osteoporotic fractures and mortality rate for patients who are initiated with denosumab and bisphosphonates and determines the effect of adherence to treatment. Retrospective nationwide cohort study. A total of 2,858 patients who had surgically-managed osteoporotic vertebral compression fractures. The risk of osteoporotic fractures, vertebral fractures, nonvertebral fractures and death. This is a retrospective nationwide cohort study that uses the National Health Insurance Research Database. Patients aged ≥50 years who were admitted for surgical interventions for OVCF between 2012 and 2016 and subsequently received denosumab or bisphosphonates for one year were included. Patients were stratified according to their antiosteoporosis medications and adherence to treatment. A multivariable, time-varying Cox proportional hazards model was used to determine the risk of osteoporotic fractures, vertebral fractures, nonvertebral fractures and death. A total of 2,858 patients were included in this study: 1,123 patients in the denosumab group and 1,735 patients in the bisphosphonates group. Compared to persistent denosumab users, the nonpersistent denosumab users, persistent bisphosphonate users and nonpersistent bisphosphonate users had a greater risk of osteoporotic fractures, with respective hazard ratios of 1.64 (95% confidence interval [CI], 1.16–2.32), 1.74 (95% CI, 1.25–2.42) and 1.53 (95% CI, 1.14–2.06). If osteoporotic fractures were divided into nonvertebral and vertebral fractures, none of the groups exhibited an increased risk of vertebral fractures compared to persistent denosumab users, with an HR of 1.00 (95% CI: 0.54–1.88) for nonpersistent denosumab users, 1.64 (95% CI: 0.96–2.81) for persistent bisphosphonate users and 1.52 (95% CI: 0.95–2.43) for nonpersistent bisphosphonate users. However, there was a significantly greater risk of nonvertebral fracture, with respective hazard ratios of 2.04 (95% CI, 1.33–3.11), 1.80 (95% CI, 1.18–2.76) and 1.56 (95% CI, 1.06–2.27) for nonpersistent denosumab users, persistent bisphosphonate users and nonpersistent users. Noteworthy, nonpersistent denosumab users exhibited a significantly greater risk of mortality than persistent denosumab users, with a hazard ratio of 3.12 (95% CI, 2.22–4.38). In terms of patients with OVCFs who require hospitalization and surgical intervention, those who receive ongoing denosumab treatment exhibit less risk of developing subsequent osteoporotic fractures than those who receive bisphosphonates or nonpersistent denosumab treatment. However, discontinuation of denosumab is associated with a significantly increased risk of subsequent fractures and mortality. Therefore, adherence to the treatment is crucial for patients who are initiated with denosumab. [ABSTRACT FROM AUTHOR]

Domino osteoporotic vertebral fractures (OVFs) involve multiple OVFs occurring simultaneously or sequentially, before healing of the initial OVFs. However, the risk factors and long-term clinical outcomes of domino OVFs are unclear. To identify the risk factors associated with domino OVFs and to assess their impact on patients' quality of life (QOL). Multicenter prospective observational cohort study. Patients (n = 190) treated conservatively for acute OVFs in 8 hospitals with 12-month follow-up. Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Multivariate analyses were performed to identify risk factors for domino OVFs. All patients underwent magnetic resonance imaging (MRI) at 3 months to detect subsequent domino OVFs. Domino OVF group included initial domino OVFs (multiple acute OVFs at baseline) and subsequent domino OVFs at 3 months. Paraspinal muscle assessment was performed using the lumbar indentation value and Goutallier classification. Patient characteristics, bone quality, paravertebral muscle degeneration, nutritional status, radiographic parameters, and QOL scores were compared between the nondomino and domino OVF groups. We evaluated 50 (26.3%) patients with domino OVFs (34 with initial domino OVFs; 20 with subsequent domino OVFs). Walking ability was poorer in the domino than in the nondomino OVF group, from baseline to the 12 months follow-up. Groups with 3 or more adjacent domino OVFs showed worse VAS and ODI scores. Multivariate logistic regression analysis revealed that severe fatty degeneration of the paraspinal muscle was an independent risk factor for domino OVFs. Severe paraspinal muscle fatty degeneration is an independent risk factor for domino OVFs. Our study showed that the quality, rather than the quantity, of paraspinal muscles had an impact on domino OVFs. Early assessment of fatty degeneration in the paraspinal muscles is essential for predicting the development of domino OVFs. [ABSTRACT FROM AUTHOR]

• We studied effectiveness of orthotics for osteoporotic vertebral fracture (OVF). • Orthotic treatment for OVF could contribute to the stabilization of fractured vertebra. • It could reduce the imminent vertebral fracture risk immediately after onset of OVF. Orthotic treatment is a common option for the conservative treatment of osteoporotic vertebral fractures (OVF). However, there is insufficient evidence of its clinical benefit. To investigate the effectiveness of orthotic treatment for OVF. Retrospective cohort study with data from two prospective studies. This study included 160 patients with fresh OVF enrolled in 2012 and 2020 prospective cohort studies. The visual analog scale (VAS) score for low back pain was used for clinical outcomes, and radiographic parameters included the percent height of the vertebra and angular change of the vertebral body. Moreover, the occurrence of secondary vertebral fractures was followed-up over time. The patients were divided into brace and no-brace groups and were matched according to propensity score for age, sex, anterior percent height at the initial examination, and presence of old OVFs. Hazard ratio for the cumulative incidence of secondary vertebral fractures with and without bracing were calculated and analyzed using the generalized Wilcoxon test. In addition, the brace group was divided into soft and rigid brace groups and compared with the no-brace group. Each group had 61 cases after propensity score matching. There were no significant differences in the VAS improvement for low back pain and the change in percent height of the anterior and posterior walls from initial examination to 6 months after injury (p=.87, p=.39 and p=.14, respectively, mixed-effect models). Meanwhile, the mean angular change of fractured vertebrae was 4.3° / 3.2° initially and 1.2° / 2.5° at 6 months (the brace group / no-brace group, respectively; p=.007, mixed-effect models). A significant difference was also observed between the rigid brace group and the no-brace group (p=.008, mixed effect models). The incidence of secondary vertebral fractures was 1.6% / 11.4% at 1 month, indicating a significant difference (the brace group / no-brace group, respectively; p=.028). The hazard ratio for the cumulative incidence of secondary fractures due to orthotic treatment was 0.47 (95% confidence interval 0.20–1.09, p=.054). Although orthotic treatment for fresh OVF did not relieve pain, it might contribute to the stabilization of the fractured vertebra, especially using a rigid brace. Moreover, it might influence a reduction of the imminent vertebral fracture risk immediately after the onset of OVF. Clinical study [ABSTRACT FROM AUTHOR]

H vessels are an essential link in angiogenic-osteogenic coupling and orchestrate the process of bone healing. H vessels are critically deficient in the setting of radiation-induced fractures, which have been reported to occur in up to 25% of patients undergoing radiotherapy. By increasing H-vessel proliferation, Deferoxamine (DFO) revitalizes the physiologic response to skeletal injury and accelerates irradiated fracture repair. H-vessel quantification is therefore an important outcome measure in histologic analysis of bone healing. However, an optimized protocol for staining H vessels in formalin-fixed paraffin-embedded (FFPE) tissue sections has not been reported. With this protocol, we describe a method of staining FFPE bone samples with minimal background fluorescence and high signal-to-noise ratio. We examined mandibular specimens in a rat model of bone healing from a range of fracture conditions, including healthy bone (Fx), irradiated bone (XFx), and irradiated bone with DFO treatment (XFx-DFO). Quantitative analysis revealed a significant increase of H vessels in the XFxDFO group compared to both the Fx and XFx groups. By optimizing immunofluorescent staining of H vessels in FFPE samples across a range of fracture conditions, we offer investigators an efficacious means of producing reliable imaging for quantitative analysis of H vessels in an irradiated fracture callus. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between glycosylated Hemoglobin (HbA1c) levels and bone mineral density (BMD) in individuals with varying glycemic statuses, including diabetes, prediabetes, and controls. Methods: This cross-sectional study conducted in Bengaluru, India, included 336 participants aged 20 to 60. Blood samples were taken to assess fasting blood glucose, HbA1c, and lipid profile. Participants were divided into tertiles based on HbA1c levels: low(HbA1c ≤ 5.5%), moderate(HbA1c > 5.5–6.0%), and high(HbA1c ≥ 6.1%).Dual energy-X-ray absorptiometry(DXA) measured hip, spine, and total BMD as indicators of bone health. Results: Intermediate and high HbA1c tertiles had a significantly higher hip and total BMD compared to low HbA1c tertiles (p < 0.001 and p = 0.006 for hip and total BMD). Spine BMD was comparable between the three groups. After adjusting for age, gender and BMI, a potential independent effect of glycemic control on hip BMD was observed (Low vs. intermediate and high glycemic status: β: 0.041, 95% C.I.: 0.003, 0.078, p = 0.034). Conclusion: Elevated HbA1c might be associated with higher hip and overall BMD as observed through DXA. Nonetheless, this doesn't necessarily imply better bone health; further evaluation is advised to prevent fractures. [ABSTRACT FROM AUTHOR]

Purpose: Osteoporotic fractures impose a vast burden on the health system, especially in countries with an old population or an ageing trend such as Iran. This study reviews the articles published by the Endocrinology and Metabolism Research Institute (EMRI) to map and summarize the evidence, identify key themes and highlight research gaps to plan future research. Method: We searched for studies affiliated with EMRI on osteoporotic fracture. Scopus, PubMed, Google Scholar, Scientific Information Database (SID) and Persian databases were used, without restricting time and language. All papers published up to December 2019 were retrieved and merged using Endnote software. Two independent researchers reviewed documents, and non-related papers were removed from the collection. The reference lists of the relevant articles were reviewed to avoid missing any publication. All papers addressing any aspects of fragility fractures were included. Meeting abstracts and letters to the editor were excluded. The visualization of the co-authorship network was illustrated with VOSveiwer program software. Results: The total number of 20 papers, published between 2004 and 2019 were included in our study. "Larijani, B" with 12, "Keshtkar, A", "Abolhassani, F", and "Soltani, A" with five papers were the most prolific authors. Six out of 20 (30 %) of the papers were published in the last three years. Among different perspectives of osteoporotic fractures, addressed by EMRI, four main categories of articles were defined including incidence (n = 7), related factors (n = 9), fracture risk assessment (n = 2), and the burden of osteoporotic fractures in Iran (n = 4). There was no updated information about the incidence of osteoporotic fracture and its burden in recent years. Conclusions: Considering the importance of osteoporotic fractures in Iran with an ageing trend, Osteoporosis Research Centers can play an essential role in providing evidence for policymakers. Worldwide, there is a large care gap to assess bone health and start treatments after fragility fractures. Accordingly, following international recommendations, practical interventions are required to fill this gap. EMRI began developing the "Registry of osteoporosis" and also pilot the "Fracture Liaison Services", as an operative model to address the existing care gap and implement applied research in this science area. [ABSTRACT FROM AUTHOR]

Purpose: Osteoporosis remains a major public health concern, considering its high prevalence along with its association with osteoporotic fractures. It imposes a heavy burden on the society worldwide as the population ages. This paper aims to provide a brief review on Iranian multicenter osteoporosis studies (IMOS) studies and provide some recommendations for improvement. Methods: IMOS studies were conducted to investigate the prevalence of osteoporosis and related risk factors. This paper provides a general view on the Iranian multicenter osteoporosis studies (IMOS), conducted during last decades. Results: The results showed a high prevalence of osteoporosis and vitamin D deficiency in the Iranian population. Although the study protocols were mainly similar, some differences were observed in terms of the study population and design. The protocol of IMOS-3 was modified to overcome the setbacks noted in the previous studies; however, it was implemented in two cities with noticeably different socioeconomic and geographical characteristics from five cities where the first phase was conducted, resulting in different lifestyles and habits. Although previous IMOS studies have raised major concerns regarding the high prevalence of osteoporosis and vitamin D deficiency, interpretation should be made with caution given the differences, especially in the surveyed cities. Such discrepancies cause problems in trend analysis, and nationally representative samplings are preferably needed to correctly compare the prevalence of osteoporosis and related risk factors. Conclusions: Considering the aging population and the importance of osteoporosis and its complication, developing a standard surveillance system to obtain valid and nationally representative estimates is recommended. [ABSTRACT FROM AUTHOR]

Background: There is a gap in evidence about medical outcomes in oldest-old patients (aged 85 and older) with vertebral fractures (VFs). The aim of this study was to evaluate the impact of patient and fracture characteristics on "short-term" hospital outcomes. Methods: All patients aged ≥ 85 presenting an acute or subsequent VF at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were length of stay (LOS) and in-hospital mortality. Further outcome parameters were the occurrence of general (non-operative) complications and Intensive Care Unit (ICU) admission. For statistical analysis, linear and binary logistic regression modeling were performed. Results: A total of 153 patients with an average age of 88.5 (range 85 to 99) met the inclusion criteria. Our patients were mostly female (68.6%) and moderately comorbid according to a Charlson Comorbidity Index (CCI) of 2.9. 58.8% had diagnosed osteoporosis. Fracture morphologies represented as "Osteoporotic Fracture" (OF) classification types were of central importance for undergoing operative treatment (OP) (p < 0.001), necessity for intensive care (p = 0.023), LOS (p = 0.014), and mortality (p = 0.018). 38.6% had OP. We recorded a complication rate of 59.5%, which highly influenced (p < 0.001) both primary outcome parameters. Overall, patients stayed 14.6 days with a mortality of 11.1%. Conclusion: VFs are a severe event in oldest-old patients with a crucial risk of poor medical outcomes during hospitalization. The fracture morphologies are of central importance. However, little is known about the hospital stay of oldest-old inpatients with VFs. Considering an aging population, further investigations would be recommended. [ABSTRACT FROM AUTHOR]

Background: Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury. Question/purpose: What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021? Methods: The United States National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition. Results: The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period. Conclusion: This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age. Level of Evidence: Level III, prognostic study. [ABSTRACT FROM AUTHOR]

Summary: Fragility fractures are a major problem in our aging society leading to early death and loss of independence for activities of daily living. Physical activity in a long-term follow-up of Portuguese women over 50 years with a fragility fracture was associated with better physical function and quality of life. Purpose: To evaluate the long-term impact of physical activity on physical function and health-related quality of life (HRQoL) in women ≥ 50 years old who suffered a fragility fracture. Methods: We evaluated the association of physical activity with physical function and HRQoL in women ≥ 50 years old who self-reported at least one low-impact fracture ≥ 40 years old from the EpiDoC cohort, a population-based cohort. Self-reported data regarding sociodemographics, clinical, and lifestyle behaviors were collected through a semi-structured questionnaire at baseline during a face-to-face clinical interview. During a long-term follow-up, a phone interview was conducted to evaluate physical activity (using a non-validated scale developed for the EpiDoC study), physical function (Health Assessment Questionnaire), and HRQoL (European Quality of Life – 5 Dimension). Women were divided into three groups according to the frequency of physical activity (non-frequent = 0 times/week, frequent = 1–2 times/week, or very frequent = ≥ 3 times/week). The association of physical activity frequency (non-frequent, frequent, and very frequent) with physical function and HRQoL over time was assessed through linear mixed models considering varying intercepts for each woman. Results: This study followed 323 post-fracture women, during a mean follow-up of 3.9 ± 3.5 years. Frequent (β = − 0.1419 [− 0.2783, − 0.0064]) and very frequent (β = − 0.1908 [− 0.2944, − 0.0881]) physical exercise were associated with improvements in physical function relative to non-frequent physical exercise adjusted for BMI, multimorbidity, hospitalizations, alcohol and smoking habits, and the number of fragility fractures at baseline. As for HRQoL, a positive association was found for exercise frequency, specifically frequent (β = 0.1305 [0.0646, 0.1958]) and very frequent (β = 0.1354 [0.0856, 0.1859]) suggesting improvements for HRQoL, in this follow-up period. Conclusions: These findings based on longitudinal data with long-term follow-up suggest that regular physical activity is associated with better function and HRQol among middle-aged and older post-fracture osteoporotic Portuguese women. [ABSTRACT FROM AUTHOR]

Summary: The association of renal function with fracture incidence during teriparatide or alendronate treatment in elderly Japanese women was examined. Fracture incidence differed by fracture type, renal function, and treatment protocol. The results provide important information on pharmacotherapy in clinical practice for osteoporosis. Purpose: Incidence rate of morphometric vertebral fracture was lower under treatment with once-weekly teriparatide (TPTD) followed by alendronate (ALN) than under treatment with ALN throughout the study among elderly Japanese women at high fracture risk in JOINT-05. This is an exploratory subgroup analysis according to chronic kidney disease (CKD) status at baseline. Methods: Participants received sequential therapy with TPTD for 72 weeks, followed by ALN for 48 weeks (TPTD-ALN group, N = 483) or ALN monotherapy for 120 weeks (ALN group, N = 496). Baseline CKD status was classified by the estimated glomerular filtration rate (eGFR) and categorized as: CKD 1/2 (eGFR ≥ 60 mL/min/1.73 m2), CKD 3a (eGFR 45–59 mL/min/1.73 m2), or CKD 3b/4 (eGFR < 45 mL/min/1.73 m2). Incidences of vertebral fractures including morphometric fractures, non-vertebral fractures, and all fractures were evaluated during follow-up. Results: Baseline characteristics were not different between treatment groups. Higher stages of CKD were associated with age and number of prevalent vertebral fracture. In CKD 1/2 patients (N = 556 with 90 incidents of morphometric vertebral fracture), the incidence of vertebral fractures was lower in the TPTD-ALN group than in the ALN group (p = 0.01). In CKD 3b/4 patients (N = 112 with 10 incidents of non-vertebral fracture), the incidence of non-vertebral fractures was lower in the ALN group than in the TPTD-ALN group, although the number of fractures was small. In the ALN group, the incidences of vertebral fractures, non-vertebral fractures, and all fractures remained constant across CKD stages. Conclusion: This exploratory analysis showed that fracture incidence on ALN was constant regardless of renal function. It also suggested that the incidence of vertebral fractures on TPTD-ALN was lower than ALN monotherapy in CKD 1/2 patients. These results provide important information for drug selection in the clinical practice of osteoporosis. [ABSTRACT FROM AUTHOR]

Summary: Sequential romosozumab-to-alendronate or sequential teriparatide-to-alendronate can be a cost-effective treatment option for postmenopausal women at very high risk of fracture. Purpose: To estimate the 10-year probability of a major osteoporotic fracture (MOF) at which sequential treatment with romosozumab or teriparatide followed by alendronate, compared with alendronate alone, becomes cost-effective in a UK setting. Methods: A microsimulation model with a Markov structure was used to simulate fractures, costs, and quality-adjusted life years (QALYs), in women receiving sequential treatment with either romosozumab or teriparatide followed by alendronate, compared with alendronate alone. Patients aged 50 to 90 years with a recent MOF, hip or spine fracture were followed from the start of a 5-year treatment until the age of 100 years or death. The analysis had a healthcare perspective. Efficacy of romosozumab, teriparatide and alendronate was derived from phase III randomised controlled trials. Resource use and unit costs were derived from the literature. Cost-effectiveness intervention threshold (CEIT), defined as the 10-year probability of a major osteoporotic fracture at which treatment becomes cost-effective, was compared with clinically appropriate intervention thresholds for bone-forming treatment in women with very high fracture risk as recommended by the UK National Osteoporosis Guideline Group (NOGG). Results: The base case analysis showed that sequential romosozumab-to-alendronate treatment was cost-effective from a 10-year MOF probability of 18–35% and above depending on age and site of sentinel fracture at a willingness to pay (WTP) of £30,000. For teriparatide-to-alendronate, treatment was cost-effective at a 10-year MOF probability of 27–57%. The results were sensitive to pricing of the drugs but relatively insensitive to treatment duration, romosozumab persistence assumptions, and site of sentinel fracture. The CEITs for romosozumab-to-alendronate treatment were lower than the clinical thresholds from the age of 70 years meaning that treatment could be considered both cost-effective and aligned with the NOGG treatment guidelines. By contrast, for teriparatide-to-alendronate the CEITs were higher than the clinical thresholds irrespective of age. However, cost-effective scenarios were found in the presence of strong clinical risk factors in addition to a recent sentinel fracture. Conclusion: The results of this study indicate that sequential romosozumab-to-alendronate or teriparatide-to-alendronate treatment can be a cost-effective treatment option for postmenopausal women at very high risk of fracture. [ABSTRACT FROM AUTHOR]

Summary: This study employed bidirectional Mendelian randomization (MR) to investigate the causal relationship between osteoporosis (OP) and stroke. Utilizing large-scale genome-wide association data revealed a reciprocal relationship: stroke increases the risk of OP, and vice versa. These findings underscore the importance of addressing both conditions for comprehensive patient care. Introduction: The correlation between OP and stroke is unclear. This study used a two-sample bidirectional MR study to determine the causal relationship between OP and stroke. Methods: Summary data from genome-wide association studies (GWAS) were used to perform MR analyses. Summary data for OP (n = 300,147), OP with pathological fracture (n = 239,702), and postmenopausal OP with pathological fracture (n = 182,601) were extracted from large-scale GWAS and meta-analyses of European populations in the FinnGen consortium. Similarly, summary data for stroke (n = 446,696), ischemic stroke (IS, n = 440,328), small vessel stroke (SVS, n = 198,048), large artery atherosclerosis stroke (LAS, n = 150,765), and cardioembolic stroke (CES, n = 211,763) were extracted from the MEGASTROKE consortium. Methods such as inverse variance weighted, MR-Egger, and weighted median were applied to perform various outcome analyses for MR. Results: The results demonstrated significant positive causality of stroke, IS, and LAS on OP (stroke: odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.04–1.85, and P = 0.027; IS, OR: 2.02, 95% CI: 1.05–3.87, and P = 0.035; LAS: OR: 1.29, 95% CI: 1.08–1.55, and P = 0.005), positive causality of LAS on OP with pathological fracture (LAS: OR: 1.69, 95% CI: 1.18–2.42, and P = 0.004), and positive causality of stroke and LAS on postmenopausal OP with pathological fracture (stroke: OR: 2.02, 95% CI: 1.05–3.87, and P = 0.035; LAS, OR: 1.75, 95% CI: 1.06–2.90, and P = 0.030). There was also a significant positive causal relationship between OP and SVS (OP, OR: 1.08, 95% CI: 1.01–1.14, and P = 0.021). Conclusion: In conclusion, there is a causal relationship between stroke and OP, suggesting that they may be potential risk factors for each other. Therefore, patients with stroke should receive timely prevention for OP, OP with pathological fracture, and postmenopausal OP with pathological fracture. Similarly, patients with OP may need to be evaluated for potential cardiovascular risks. [ABSTRACT FROM AUTHOR]

Summary: Information in the electronic health record (EHR), such as diagnoses, vital signs, utilization, medications, and laboratory values, may predict fractures well without the need to verbally ascertain risk factors. In our study, as a proof of concept, we developed and internally validated a fracture risk calculator using only information in the EHR. Purpose: Fracture risk calculators, such as the Fracture Risk Assessment Tool, or FRAX, typically lie outside the clinician workflow. Conversely, the electronic health record (EHR) is at the center of the clinical workflow, and many variables in the EHR could predict fractures without having to verbally ascertain FRAX risk factors. We sought to evaluate the utility of EHR variables to predict fractures and, as a proof of concept, to create an EHR-based fracture risk model. Methods: Routine clinical data from 24,189 subjects presenting to primary care from 2010 to 2018 was utilized. Major osteoporotic fractures (MOFs) were captured by physician diagnosis codes. Data was split into training (n = 18,141) and test sets (n = 6048). We fit Cox regression models for candidate risk factors in the training set, and then created a global model using a backward stepwise approach. We then applied the model to the test set and compared the discrimination and calibration to FRAX. Results: We found variables related to vital signs, utilization, diagnoses, medications, and laboratory values to be associated with incident MOF. Our final model included 19 variables, including age, BMI, Parkinson's disease, chronic kidney disease, and albumin levels. When applied to the test set, we found the discrimination (AUC 0.73 vs. 0.70, p = 0.08) and calibration were comparable to FRAX. Conclusion: Routinely collected data in EHR systems can generate adequate fracture predictions without the need to verbally ascertain fracture risk factors. In the future, this could allow for automated fracture prediction at the point of care to improve osteoporosis screening and treatment rates. [ABSTRACT FROM AUTHOR]

Osteoporotic fracture has been understudied in men. In US male veterans aged 50 years and older between 2002 and 2019, hip fracture incidence increased between 2006 and 2019, fewer than 6% of men underwent DXA, and fewer than 0.5% of men were treated. Investigation of low screening and treatment rates is warranted. Purpose: In the United States, the annual incidence of osteoporotic hip fracture is estimated to be 250,000 to 300,000; the one-year mortality in some studies has been as high as 32%. Reports that hip fracture rates in US women 65 years and older may no longer be declining led to this investigation of hip fracture in men, a less studied population. We assessed the trends in the incidence of hip fracture in US male veterans 50 years and older of age as well as the rates of diagnosis and treatment in such men. Methods: We assessed the recent trends of hip fracture incidence in a nation-wide male veteran population 50 years and older of age. Using data from the US Veterans Affairs Informatics and Computing Infrastructure (VINCI) 2002–2019, we calculated the annual age-standardized hip fracture incidence. Secondary objectives included evaluating the annual proportion of hip fracture patients who underwent dual-energy X-ray absorptiometry (DXA) before or after the fracture and/or received osteoporosis medication after the hip fracture over the study period. Results: Hip fracture incidence increased in male veterans from 2006 to 2019. Fewer than 6% of men underwent a DXA scan and fewer than 0.5% received osteoporosis medications up to two years after a hip fracture. Conclusions: Despite available screening methods such as DXAs and medications for primary and secondary prevention of osteoporotic fractures, hip fracture incidence is not decreasing in older male veterans. Our study highlights a need for closer attention to fracture risk in men. [ABSTRACT FROM AUTHOR]

Summary: A retrospective analysis comparing a teriparatide biosimilar (RGB-10) with reference teriparatide for osteoporosis treatment in postmenopausal women at high fracture risk found them to be therapeutically equivalent. Both provided significant improvements in lumber spine BMD, TBS, and other parameters of bone health, assessed using multiple diagnostic methods. Purpose: To compare the therapeutic efficacy of a teriparatide biosimilar (RGB-10) with reference teriparatide for the treatment of osteoporosis in postmenopausal women at very high fracture risk. Methods: A retrospective analysis of 25 postmenopausal female patients treated for osteoporosis with RGB-10 for 24 months and a matched cohort of 25 patients treated with reference teriparatide. The following outcomes were assessed at baseline, 12 and 24 months: bone mineral density (BMD) at the lumbar spine, femoral neck and total hip using dual-energy x-ray absorptiometry (DXA) and integral, trabecular and cortical volumetric and surface BMD using 3D-SHAPER® imaging, trabecular bone score (TBS), quantitative ultrasound (QUS) measurements, and high-resolution peripheral quantitative computed tomography (HRpQCT) imaging of the radius and tibia. Results: No significant differences were observed between treatment groups in any of the measured parameters of BMD or bone health at baseline as well as in any timepoint when assessed using these various diagnostic methods. Both compounds provided equivalent significant improvements from baseline in measures of osteoporosis and fracture risk. Conclusion: The results of the analysis demonstrate the therapeutic equivalence of the teriparatide biosimilar (RGB-10) to reference teriparatide for the treatment of osteoporosis in postmenopausal women at very high risk of fracture. [ABSTRACT FROM AUTHOR]

Objective: To determine ED clinician's current management for five common minor self‐limiting fractures (MSLF) and evaluate practice against evidence‐informed direct discharge pathway (DD) protocols. Methods: A survey was provided to doctors, nurse practitioners and advanced scope physiotherapists working in seven metropolitan, public health EDs in Perth, Australia. The relative odds of ED location (e.g. which facility) and clinician level factors (e.g. country of initial training, years of ED experience, profession) on recommending care completely consistent with evidence informed direct discharge pathway protocols were estimated. Results: Two hundred sixty‐two clinicians completed the survey. There was variability in practice across all sites, with most reported care assessed at 60%–76% consistency with individual elements of DD care provision. Highest consistency was seen in lower limb immobilisation and DVT prophylaxis. Lowest consistency was seen in weight bearing advice, pain management and (boxer's) fracture reduction and immobilisation. There were very low levels of complete consistency, ranging from 9% (boxer's fracture) to 25% (radial head fracture). Two factors were associated with increased odds of completely consistent care: (i) clinician experience working in ED, with greater duration of practice associated with increased odds ratios (OR range, 1.6–3.3); and (ii) profession, where advanced scope physiotherapy was associated with increased odds ratios (OR range, 3.2–25.0). Conclusions: Survey results suggested system wide variation in ED fracture management practice and target areas for service improvement. Avenues for service improvement could include hospital wide agreed management plans for specific fractures and support for less experienced clinicians. [ABSTRACT FROM AUTHOR]

Pediatric bone injuries are traditionally diagnosed using radiography. However, ultrasonography is emerging as an alternative due to its speed and minimal invasiveness. This study assessed the diagnostic capabilities of ultrasound before radiography in a group of 186 children with suspected long bone fractures at Saint Etienne University Hospital (Saint-Priest-en-Jarez, France). Patients with open trauma and severe deformity were excluded. Ultrasonography demonstrated 88.2% sensitivity and 86.4% specificity, with better results for forearm injuries. Of the 186 cases, 162 were consistent with radiography and 24 varied. Factors influencing an accurate diagnosis included the presence of indirect signs, operator experience, and examination duration, while indirect signs often led to misinterpretation. Although ultrasound cannot completely replace radiography due to its limitations in identifying deeper fractures, this study revealed its substantial efficacy and ease, supporting its potential utility in pediatric trauma emergencies. [ABSTRACT FROM AUTHOR]

Objectives. To describe the national burden of injuries associated with e-bikes, bicycles, hoverboards, and powered scooters (micromobility devices) in the United States. Methods. We compared patterns and trends for 1 933 296 estimated injuries associated with micromobility devices from 2019 to 2022 using National Electronic Injury Surveillance System data. Results. The population-based rates of e-bike and powered scooter injuries increased by 293.0% and 88.0%, respectively. When reported, powered scooter injuries had the highest proportion for alcohol use (9.0%) compared with other modes, whereas e-bike injuries had the highest proportion for motor vehicle involvement (35.4%). Internal injuries were more likely among e-bike diagnoses than hoverboard and bicycle (P <.05), but fractures and concussions were more likely among hoverboard diagnoses compared with all other devices (P <.05). When helmet use was identified in clinical notes (20.3%), helmet usage was higher among e-bike injuries (43.8%) compared with powered scooter (34.8%) and hoverboard (30.3%) injuries but lower compared with bicycle injuries (48.7%). Conclusions. The incidence of severe e-bike and powered scooter injuries increased over the 4-year period. Public health stakeholders should focus on improved surveillance and prevention of injuries associated with electric micromobility devices. (Am J Public Health. 2024;114(12):1365–1374. https://doi.org/10.2105/AJPH.2024.307820) [ABSTRACT FROM AUTHOR]

Background: The increasing life expectancy of individuals with Down syndrome has led to a growing awareness of mid‐ and late‐life conditions. Methods: Based on the Disease Analyser database (IQVIA), this retrospective cohort study compared adults ≥18 years of age with Down syndrome (ICD‐10: Q90) in general practices in Germany with a propensity score‐matched cohort without Down syndrome. The outcome was the first diagnosis of a fracture within 5 years of the index date. The cumulative incidence of fractures over a 5‐year period was presented using Kaplan–Meier curves. Univariable Cox regression analyses by age group and sex were performed to assess the association between Down syndrome and fractures. Results: A total of 2547 individuals with Down syndrome and 12 735 individuals without Down syndrome were included in the study. A significantly higher cumulative fracture incidence within 5 years was observed in the age group 51–60 years (9.3% Down syndrome vs. 4.8% without Down syndrome, P = 0.003) as well as in the age group >60 years (20.3% Down syndrome vs. 8.6% without Down syndrome, P < 0.001) compared with the cohort without Down syndrome. Regression analysis showed a significant association between Down syndrome and fracture risk in women with Down syndrome aged 51–60 years (hazard ratio [HR] = 1.60; 95% confidence interval [CI]: 1.13–2.26), and in those aged 51–60 years (HR = 2.08; 95% CI: 1.27–3.41) and >60 years (HR = 2.98; 95% CI: 1.87–4.73)), but not in men. When comparing fractures in individuals with and without Down syndrome, shoulder and arm fractures were most common in the Down syndrome cohort. Conclusion: The results of our study indicate a positive association between individuals with Down syndrome and subsequent fractures in women and those aged >50 years. Prevention of falls appears to be particularly important in these populations. However, future studies should clarify the extent to which socio‐economic factors, such as housing, play a role in this context. [ABSTRACT FROM AUTHOR]

Background: 4-part proximal humerus fractures are complex injuries that are often associated with comminution of the greater tuberosity. The purpose of this study is to evaluate the functional outcomes of 4-part humerus fractures that are treated with reverse total shoulder arthroplasty (rTSA) and correlate these outcomes with the healing status of the greater tuberosity. Material and methods: A retrospective observational study was performed including 65 patients who underwent rTSA following a 4-part proximal humerus fracture. These patients were categorized into 3 groups according to the healing status of the greater tuberosity: patients with healed greater tuberosity in an anatomical position (group A, n = 43), patients with non-union of the greater tuberosity but in anatomical position (group B, n = 14), and patients with resorption or non-union of the greater tuberosity not in anatomical position (group C, n = 8). The Constant-Murley score and range of motion were recorded for each patient at 12 months postoperatively. The clinical and radiographical outcomes of the 3 groups were compared. Results: Patients with healed greater tuberosity (group A) had higher range of motion compared to patients with greater tuberosity migration or reabsorption (group C) regarding forward flexion (130° vs 80°, p < 0.001), abduction (110° vs 65°, p < 0.001) and external rotation (20° vs 10°, p = 0.004). However, no significant changes regarding forward flexion (130° vs 125°, p = 0.67), abduction (110° vs 100°, p = 0.60) and external rotation (20° vs 25°, p = 0.37) were noted between patients with healed greater tuberosity (group A) and those with non-united greater tuberosity that remained attached to the humeral prosthesis (group B). Similarly, Constant- Murley score was similar between patients of group A and group B (65.0 vs 61.5, p = 0.53), while it was higher in patients of group A compared to those of group C (65.0 vs 39.0, p = 0.053). Conclusions: The outcomes of this study indicate that reliable recovery regarding range of motion and functional status can be achieved in patients who undergo rTSA due to 4-part proximal humerus fractures, as long as the greater tuberosity remains in close proximity to the humeral prosthesis, even if it has signs of non-union with no continuity to the adjacent humerus. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to describe trends in inpatient and outpatient upper extremity fracture surgery between 2008 and 2021, along with identifying patient factors (age, sex, race, socioeconomic status) associated with outpatient surgery. Methods: Retrospectively, 12,593 adult patients who underwent upper extremity fracture repair from 2008 to 2021 at one of five urban hospitals in the Northeastern USA were identified. Using Distressed Communities Index (DCI), patients were divided into five quintiles based on their level of socioeconomic distress. Multivariable logistic regression was performed on patients from 2008 to 2019 to identify independent factors associated with outpatient management. Results: From 2008 to 2019, outpatient procedures saw an average increase of 31%. The largest increases in the outpatient management were seen in humerus (132%) and forearm fractures (127%). Carpal and hand surgeries had the lowest percent increase of 8.1%. Clavicle and wrist fractures were independently associated with outpatient management. Older age, male sex, higher Elixhauser comorbidity index, DCI scores in the 4th or 5th quintile, and fractures of the scapula, humerus, elbow, and forearm were associated with inpatient management. During the onset of the COVID-19 pandemic, there was a decrease in outpatient procedures. Conclusion: There is a shift toward outpatient surgical management of upper extremity fractures from 2008 to 2021. Application of our findings can serve as an institutional guide to allocate patients to appropriate surgical settings. Moreover, physicians and institutions should be aware of the potential socioeconomic disparities and implement plans to allow for equal access to care. [ABSTRACT FROM AUTHOR]

Purpose: The optimal duration of antibiotic therapy for fracture-related infection (FRI) has not been well defined. Our aim was to assess the recurrence rate of infection in patients who underwent six, 12, or 24 weeks of antibiotic therapy following surgical treatment for FRI one year after antibiotic discontinuation. Additionally, complications were monitored. Methods: Patients with FRI underwent surgical treatment, and antibiotic therapy was initiated. The patients were divided into groups at the 6th and 12th weeks of antibiotic therapy. The primary endpoint was the recurrence of deep or superficial infection at 90 days and one year after the end of antimicrobial therapy. Results: There was no difference in the recurrence of infection 90 days or one year after stopping antibiotic therapy among patients treated for six, 12, or 24 weeks (p = 0.98 and p = 0.19, respectively). The overall recurrence rate of infection 90 days after stopping antibiotic therapy was 4.9% (8/163), and one year after discontinuation of antibiotic therapy was 9.8% (16/163). There was a statistically significant difference in the incidence of adverse effects among the three groups (chi-square; p = 0.01). Adverse effects were more common in the group treated for 24 weeks than in the groups treated for 6 weeks (z score, p = 0.017) or 12 weeks (z score, p = 0.005). Conclusion: Antibiotic therapy longer than 6 weeks did not reduce the recurrence of FRI after one year of follow-up. Additionally, antibiotic treatment for 24 weeks increases adverse events such as skin reactions and acute renal failure. [ABSTRACT FROM AUTHOR]

Objective(s): Osteoporosis is a significant public health concern due to its association with fragility fractures. Despite experiencing such fractures, many patients remain at high risk of future fractures due to inadequate management and treatment of their underlying osteoporosis. This research presents a comprehensive intervention to enhance osteoporosis management in patients with fragility fractures. The intervention involves a thorough personalized assessment of fracture risk using clinical factors and bone density testing, followed by customized treatment based on the individual's fracture risk level. It also addresses non-compliance through patient education, counseling, reminders, and improved care coordination among acute, primary, and specialty providers. Materials and Methods: The aim is to create and characterize sodium alginate/hydroxyapatite (HA) scaffolds reinforced with zinc oxide nanoparticles (ZnO-NP) for bone tissue engineering. Freeze- drying was used to produce scaffolds with 0-15% ZnO-NP. Analyses confirmed the composite structure, uniform ZnO-NP distribution, and decreasing pore size with higher ZnO-NP content. Mechanical testing showed increased compressive strength with greater ZnO-NP. Results: The scaffolds exhibited over 70% porosity, neutral pH, and increased apatite deposition and bioactivity with higher ZnO-NP. They also demonstrated decreased swelling and strong antibacterial activity against Escherichia coli and Staphylococcus aureus, making them a promising candidate for bone regeneration. Conclusion: Additionally, the researchers used an artificial neural network (ANN) to better understand the relationships between various scaffold properties, and the ANN-based predictions showed that changes in pore size and porosity affect the other properties, with acceptable error compared to experimental results. [ABSTRACT FROM AUTHOR]

When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a "gold" radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist's knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In "milder" cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20–25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid's bow, and expansive endplate, among others. [ABSTRACT FROM AUTHOR]

Acoustic manipulation or perturbation of biological soft matter has emerged as a promising clinical treatment for a number of applications within regenerative medicine, ranging from bone fracture repair to neuromodulation. The potential of ultrasound (US) endures in imparting mechanical stimuli that are able to trigger a cascade of molecular signals within unscathed cells. Particularly, low-intensity pulsed ultrasound (LIPUS) has been associated with bio-effects such as activation of specific cellular pathways and alteration of cell morphology and gene expression, the extent of which can be modulated by fine tuning of LIPUS parameters including intensity, frequency and exposure time. Although the molecular mechanisms underlying LIPUS are not yet fully elucidated, a number of studies clearly define the modulation of specific ultrasonic parameters as a means to guide the differentiation of a specific set of stem cells towards adult and fully differentiated cell types. Herein, we outline the applications of LIPUS in regenerative medicine and the in vivo and in vitro studies that have confirmed the unbounded clinical potential of this platform. We highlight the latest developments aimed at investigating the physical and biological mechanisms of action of LIPUS, outlining the most recent efforts in using this technology to aid tissue engineering strategies for repairing tissue or modelling specific diseases. Ultimately, we detail tissue-specific applications harnessing LIPUS stimuli, offering insights over the engineering of new constructs and therapeutic modalities. Overall, we aim to lay the foundation for a deeper understanding of the mechanisms governing LIPUS-based therapy, to inform the development of safer and more effective tissue regeneration strategies in the field of regenerative medicine. [ABSTRACT FROM AUTHOR]

Introduction: Management of orthopaedic fractures involves acute intervention and follow up through to recovery. Patient-centered care needs to encompass all aspects of this treatment. Limited research is available on outpatient satisfaction and patient-reported outcomes from fracture clinic (FRCL). The purpose of this evaluation is to report on pain levels perceived by patients from minor orthopaedic procedures that were necessary for the continued management of fracture care. Methods: Patients were recruited in the FRCL if they were planned to undergo minor orthopaedic procedures. They were asked to report the pain they experienced at baseline, during the procedure, 20 min post-procedure, and 24 h following the procedure on a verbal numeric rating scale of 0–10. Healthcare professionals (HCP) were then asked to rank their perception of the severity of pain from each procedure type. Finally, qualitative interviews were conducted on a convenience sample of patients. Results: 51 patients were included in this evaluation. Halo pin, external fixation device, Kirschner wire, and screw removal exhibited a mean increase in pain from baseline greater than 3 units during the procedure. The external fixation device removal group showed the greatest pain reported with a statistically significant increase from baseline to the end of the procedure (mean = 7.1; p = 0.002). There was good concordance of pain perception by the HCP to patient experience. Qualitative interviewing revealed two major themes. Discussion: This study provided valuable qualitative and quantitative insight into the pain perceptions by FRCL patients. This data may help improve the patient experience inside the FRCL. [ABSTRACT FROM AUTHOR]

Bone impairment associated with Cushing's disease (CD) is a complex disorder, mainly involving deterioration of bone quality and resulting in an increased fracture rate, often despite normal bone mineral density. Bone complications are common in patients with CD at the time of diagnosis but may persist even after successful treatment. There is currently no agreement on the optimal diagnostic methods, thresholds for anti-osteoporotic therapy and its timing in CD. In this review, we summarize the current data on the pathophysiology, diagnostic approach and management of bone complications in CD. [ABSTRACT FROM AUTHOR]

Background: Severe mental illness (SMI) has been associated with reduced bone density and increased risk of fractures, although some studies have shown inconsistent results. Aim: To examine the association between SMI and recorded diagnosis of osteoporosis and fragility fracture in people aged ≥50 years. Design and setting: Population-based cohort study set in UK primary care. Method: Anonymised primary care data (IQVIA Medical Research Database) were used. Patients with a diagnosis of SMI aged 50–99 years (2000–2018) were matched to individuals without SMI. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and age, accounting for social deprivation, year, smoking, alcohol, and body mass index. Results: In total, 444 480 people were included (SMI n = 50 006; unexposed n = 394 474). In men, diagnosis of SMI increased the likelihood of an osteoporosis diagnosis, with differences mainly observed among the youngest (aged 50–54 years: HR 2.12, 95% CI = 1.61 to 2.79) and the oldest (aged 85–99 years: HR 2.15, 95% CI = 1.05 to 4.37), and SMI increased the risk of fragility fractures across all ages. In women, SMI increased the risk of an osteoporosis diagnosis only in those aged 50–54 years (HR 1.16, 95% CI = 1.01 to 1.34), but increased the risk of fragility fractures across all ages. There were more than twice as many men with SMI with fragility fracture records than with an osteoporosis diagnosis: fragility fracture:osteoporosis = 2.10, compared with fragility fracture:osteoporosis = 1.89 in men without SMI. The fragility fracture:osteoporosis ratio was 1.56 in women with SMI versus 1.11 in women without SMI. Conclusion: SMI is associated with an increased likelihood of fragility fractures and osteoporosis underdiagnosis. Interventions should be considered to mitigate the increased risk of fractures in people with SMI. [ABSTRACT FROM AUTHOR]

Background: Oral health management has become increasingly important for acute inpatients. Older patients often require extended periods of medical care, and oral health management is necessary in the convalescent period following the acute period. During the convalescent period, oral health management remains unclear as convalescent hospitals have limited dental resources, and effective dental care must be provided if the objective of hospitalization is to improve life functions. This study aimed to clarify the relationship between daily functioning and oral health status at the time of admission to a convalescent hospital to aid in improving daily functioning in the convalescent period. Methods: We included patients admitted to the rehabilitation department of a specific convalescent hospital from January to December 2021. A total of 375 patients were included in the study, with complete data records. At admission, we gathered information from the medical records, including the patient's age, sex, primary disease, Charlson Comorbidity Index, Mini Nutritional Assessment Short-Form (MNA-SF), Functional Oral Intake Scale (FOIS), Functional Independence Measure (FIM), number of teeth, and Oral Health Assessment Tool (OHAT). Statistical analysis was conducted using SPSS Ver. 27, with a significance level of 5%. Results: The mean age of the 375 participants (189 men and 186 women) was 75.0 ± 12.1 years (range, 42–97 years), and over 80% were > 65 years. About 30% of major diseases could be attributed to strokes and fractures, followed by spinal cord and spine diseases. In non-stroke patients, multiple regression analysis using FIM motor, FIM cognitive, and FIM and OHAT total scores as objective variables showed that higher total scores of MNA-SF, FOIS, and lower modified Rankin Scale and OHAT were significantly associated with better FIMs. Lower OHAT scores were significantly associated with lower FOIS and MNA-SF scores, male sex, having fewer teeth, and poor dietary patterns. Conclusions: The convalescent period is an opportune time to provide intensive dental care due to the generally stable condition and extended hospital stay. Our results suggest that oral health management, such as dysphagia rehabilitation and denture treatment, is important for maintaining and improving independence, a key objective of convalescent rehabilitation, and malnutrition improvement. [ABSTRACT FROM AUTHOR]

Purpose Osteoporosis (OP) is characterized by a gradual onset and an increased susceptibility to osteoporotic fractures. Previous retrospective studies have suggested that hemoglobin (HGB) levels could be a potential diagnostic marker for OP. However, the relationship between OP and anemia remains uncertain. This prospective study aimed to investigate the association between HGB levels and OP. Methods Leveraging data from the UK Biobank, a cohort of 452 778 individuals was analyzed. Employing a modified Cox proportional hazards model that accounted for sociodemographic factors, lifestyle, and health-related factors, we examined the links between incident OP and sex. Moreover, we investigated the impact of OP with or without a pathological fracture. Results Following a median follow-up period of 5.85 years, 4294 participants were diagnosed with OP. After adjusting for a comprehensive range of pertinent confounders, individuals with anemia exhibited a 2.15-fold higher risk of OP in males and a 1.41-fold higher risk in females. Moreover, each unit increase in HGB concentration corresponded to a 0.83-fold decrease in OP risk for men and a 0.94-fold decrease for women. Perspectives Our findings reveal a significant correlation between HGB levels or anemia and OP, with males demonstrating a greater susceptibility compared to females. The risk of OP decreased with higher HGB concentrations in both sexes, although this effect was more pronounced in males. It is recommended to conduct longitudinal studies to investigate the causality of the observed connections and experimental studies to understand the underlying mechanisms. Key messages What is already known on this topic Cross-sectional studies have shown that anemia are associated with osteoporosis, and gender differences present in both diseases, but their role in this association is rarely studied at present. What this study adds There is a significant correlation between hemoglobin levels and osteoporosis, with male gender demonstrating a greater susceptibility compared to females. The risk of osteoporosis decreased with higher hemoglobin levels in both genders, although this effect was more pronounced in males. How this study might affect research, practice or policy Regular screening of bone health and elevating hemoglobin levels are recommended for anemic patients to proactively prevent osteoporosis, especially in male gender. Large-scale, multicenter, longitudinal studies are encouraged to investigate the association, and experimental studies are necessary to comprehend the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Context Contemporary patients with primary hyperparathyroidism are diagnosed with milder disease than previously. Clinical and biochemical factors predictors with an impact on fracture incidence and bone mineral density after surgery have not been firmly established. Objective To investigate predictors of fracture incidence and bone mineral density preoperatively and after surgery for primary hyperparathyroidism (pHPT). Design Prospectively collected surgical cohort with matched population controls. Data were cross-linked with the Swedish National Patient Register, the Prescribed Drug Register, and the Cause of Death Register. Setting Tertiary referral center. Patients or other participants Seven hundred nine patients with successful parathyroidectomy for pHPT and 2112 controls matched on sex, age, and municipality were included in the study. Main outcome measures Fracture incidence, absolute change, and ≥2.77% increase in bone mineral density of femoral neck, L2–L4, and distal third of radius at 1-year follow-up. Results Patients with pHPT had an increased fracture incidence before surgery but not after pHPT surgery. Fracture incidence after surgery was inversely related to preoperative 24-hour urine calcium (incidence rate ratio for the highest tertile 220– mg/d 0.29, 95% confidence interval 0.11-0.73). Serum and 24-hour urine calcium, parathyroid hormone, osteocalcin, and adenoma weight were all associated with bone mineral density recovery after surgery. Conclusion Twenty-four-hour urine calcium is the most important biochemical variable to predict a decreased fracture incidence and improved bone mineral density after surgery for pHPT. [ABSTRACT FROM AUTHOR]

Context Type 2 diabetes mellitus is associated with more rapid bone loss in women, but less evidence is available for men or those with prediabetes. Objective To determine whether bone loss rate is affected by diabetes status in older men, we analyzed data from the Osteoporotic Fractures in Men (MrOS) study. Methods The multisite MrOS study enrolled 5994 men aged ≥ 65 years. Diabetes status was defined by self-report, diabetes medication use, or elevated fasting serum glucose at baseline. Hip bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA) at baseline and a follow-up visit after 4.6 ± 0.4 years. This analysis included 4095 men, excluding those without follow-up DXA or with unknown diabetes status. Changes in hip BMD in participants with normoglycemia (NG), prediabetes, or type 2 diabetes, excluding thiazolidinedione (TZD) users, were evaluated using generalized linear models (GLM). Diabetes medication use and BMD loss among those with type 2 diabetes were also evaluated with GLM. Results In adjusted models, hip BMD loss was greater in men with type 2 diabetes (− 2.23%; 95% CI: −2.54 to −1.91; P <.001) but not in men with prediabetes (−1.45%; 95% CI −1.63 to −1.26; P =.33) compared with NG (−1.57%; 95% CI −1.73 to −1.41). Among men with type 2 diabetes, TZD, insulin, and sulfonylurea use were associated with greater hip BMD loss. Conclusion Men with type 2 diabetes, but not prediabetes, experienced accelerated bone loss compared to participants with normoglycemia. More rapid bone loss predicts increased risk of fractures and mortality in broader populations. [ABSTRACT FROM AUTHOR]

This research introduces an innovative method for fracture classification using convolutional neural networks (CNN) for high-accuracy image classification. The study addresses the need to improve the subjectivity and limited accuracy of traditional methods. By harnessing the capability of CNNs to autonomously extract hierarchical features from medical images, this research surpasses the limitations of manual interpretation and existing automated systems. The goal is to create a robust CNN-based methodology for precise and reliable fracture classification, potentially revolutionizing current diagnostic practices. The dataset for this research is sourced from Kaggle's public medical image repository, ensuring a diverse range of fracture images. This study highlights CNNs' potential to significantly enhance diagnostic precision, leading to more effective treatments and improved patient care in orthopedics. The novelty lies in the unique application of CNN architecture for fracture classification, an area not extensively explored before. Testing results show a significant improvement in classification accuracy, with the proposed model achieving an accuracy rate of 0.9922 compared to ResNet50's 0.9844. The research suggests that adopting CNN-based systems in medical practice can enhance diagnostic accuracy, optimize treatment plans, and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Chronic kidney disease–mineral and bone metabolism disorder (CKD-MBD) is a common chronic kidney disease (CKD)-associated complication that increases the risk of metabolic bone diseases, fractures, osteoblastic trans-differentiation of vascular smooth muscle cells, and cardiovascular events. SD rats were randomised into five groups with six rats per group: sham, CKD, CKD + advanced glycosylation end products (AGEs), CKD + Quercetin, and CKD + AGEs + Quercetin. The protective effects of AGEs and quercetin on SD rats were assessed by renal function, renal pathology, bone metabolism, osteoblastic trans-differentiation of vascular smooth muscle cells, and the receptor for AGE (RAGE) expression. Compared with the control group, rats in the CKD and CKD + AGEs groups had significantly lower body weight, higher serum AGEs levels, impaired renal function, increased levels of oxidative stress in the kidney and bone marrow tissues, lower femoral bone mineral density (BMD), callus mineralised volume fraction (mineralised bone volume/total volume), abnormal serum bone metabolism levels, and increased renal tissue, bone tissue, and abdominal aorta RAGE expression levels, and the RAGE downstream NF-κB signalling pathway was upregulated. Quercetin significantly improved renal dysfunction, attenuated serum AGE levels, reduced oxidative stress levels in the kidney and bone marrow tissues, and downregulated RAGE expression in the kidney, bone, and abdominal aorta and the RAGE downstream NF-κB signalling pathway in rats with CKD. AGEs are involved in the pathogenesis of CKD-MBD by promoting osteoblastic trans-differentiation of vascular smooth muscle cells and abnormal bone metabolism. Quercetin plays a role in the prevention and treatment of CKD-MBD by reducing the production of AGEs. [ABSTRACT FROM AUTHOR]

Background: One in three women and one in five men over the age of 50 will experience an osteoporotic fracture. Vertebral fractures can be very painful, affect patients' daily function, and in severe cases require hospitalization. Traditionally, fracture pain is treated conservatively with analgesics, and bracing. Vertebral augmentation, also known as vertebroplasty, has been used during the last three decades as a minimally invasive treatment option for vertebral compression fractures, but the evidence base for its efficacy is weak. We describe a double-blind randomized sham-controlled clinical trial to assess the impact of vertebroplasty on self-reported clinical outcomes in patients with painful osteoporotic vertebral compression fractures and vertebral oedema. Methods: Two hundred and forty patients with painful osteoporotic vertebral fractures and MRI verified oedema will be randomized in a prospective, double-blind, single-center, clinical trial to either vertebroplasty or a sham procedure, with the possibility of crossover 12 weeks after randomization and operation. The primary outcome will be difference in self-reported pain 12 weeks after treatment between the vertebroplasty and sham group. Secondary outcomes will be patient-reported disability, health-related quality of life, societal costs of treatment and complications. Analysis will be based on intention-to-treat. Repeated measures ANCOVA with baseline ODI, Numerical Pain Rating Scale, EQ-5D-5 L, and number of levels involved as co-variates will be performed. Discussion: With an aging population, the prevalence of osteoporosis and related complications such as vertebral compression fractures is expected to increase. Therefore, there is a growing need for evidence-based fracture treatments. This study fills a gap in the evidence base for treatment of painful osteoporotic vertebral fractures and will likely influence future treatment guidelines. Trial registration: The study has been evaluated and approved by the Regional Committees on Health Research for Southern Denmark October 9 2023 (Projekt-ID S-20230058) and the Danish Data Protection Agency 23/40,938. The protocol has been registered at ClinicalTrials.gov with trial registration number NCT06141187 November 21, 2023. [ABSTRACT FROM AUTHOR]

Objective: We conducted this meta-analysis to explore the risk factors and incidence of deep surgical site infections (DSSIs) after orthopaedic trauma surgery. Methods: A systematic search was conducted across various databases, including MEDLINE, Embase, Cochrane Library, and Web of Science, for studies examining risk factors associated with DSSIs after bone trauma procedures. The search concluded on September 1, 2024. Data analysis was performed using Stata 15.0. Results: Among 2,722 publications screened, 16 studies that met the eligibility criteria were included in the analysis, involving a total of 22,318 patients, of whom 894 experienced DSSIs. The meta-analysis revealed a combined incidence of deep infections after orthopedic trauma surgery at [ES = 6.7%, 95% CI (5.1%–8.2%)]. Risk factors identified included male gender [OR = 1.99, 95% CI (1.39, 2.86), p < 0.0001], current smoking status [OR = 2.60, 95% CI (1.85, 3.65), p < 0.0001], open injuries [OR = 3.17, 95% CI (1.72, 5.85), p < 0.0001], a BMI greater than 26.0 kg/m2 [OR = 1.95, 95% CI (1.24, 3.07), p = 0.004], wound class ≥ 2 [OR = 2.40, 95% CI (1.56, 3.70), p < 0.0001], and a surgery duration of 60 min or more [OR = 2.41, 95% CI (1.63, 3.55), p < 0.0001]. These factors significantly contribute to the risk of developing DSSIs post-surgery. However, age did not exhibit a significant difference. Conclusion: This study identifies key risk factors for DSSI following orthopedic trauma surgery, addressing a gap in the existing literature and offering some insights for clinical decision-making. To mitigate the risk of DSSI, clinical practice should encourage patients to lose weight and quit smoking prior to surgery, optimize surgical procedures, and improve wound management strategies. Future research should aim to standardize follow-up durations and further refine the classification of risk factors, in order to validate and expand on the conclusions of this study. [ABSTRACT FROM AUTHOR]

Background: Chronic low-grade inflammation is related to bone metabolism in patients with type 2 diabetes mellitus (T2DM). However, credible data indicating the relationship between inflammation and fragility fracture risk in postmenopausal anemic females with T2DM are sparse. The current study sought to investigate the relationships between the systemic immune-inflammatory index (SII) and fragility fracture events, as well as the future 10-year fragility fracture probability evaluated using the fracture risk assessment tool (FRAX) in postmenopausal females with T2DM. Methods: According to the tertiles of SII, 423 postmenopausal females with T2DM were divided into three groups: low-level (≤ 381.32, n = 141), moderate-level (381.32–629.46, n = 141), and high-level (≥ 629.46, n = 141). All participants were followed up for 7 years with a median of 46.8 months (1651 person-years). The association between SII and fragility fracture risk was assessed. Results: Of 423 subjects, 75 experienced a fragility fracture event. Spearman partial correlation analysis revealed that SII was negatively related to bone mineral density (BMD) and was positively associated with the future 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF). Restricted cubic spline (RCS) analysis revealed a positive correlation between SII and fragility fracture risk in an approximately inverted J-shaped dose–response pattern (P for overall < 0.0001). Multivariate Cox regression analysis demonstrated that patients with a high SII presented a greater risk of fragility fractures (P = 0.011). Stratified analysis revealed that fragility fractures in the high-level SII were predominantly associated with anemia with an increase of 4.15 times (P = 0.01). Kaplan‒Meier analysis indicated a greater cumulative incidence of fragility fractures in patients with a high SII (log-rank, all P = 0.0012). Receiver operating characteristic (ROC) analysis indicated an optimal SII cut-off value of 537.34, with an area under the curve (AUC) of 0.646, a sensitivity of 60%, and a specificity of 64.1% (P < 0.001). Conclusion: The SII revealed a significant positive association with a real-world fragility fracture event and a future 10-year fragility fracture probability in postmenopausal females with T2DM, particularly evident in individuals with anemia. Therefore, monitoring the SII and hemoglobin in postmenopausal older women with T2DM is helpful in routine clinical practice to identify individuals at high risk for fragility fractures and to promptly execute appropriate fracture intervention procedures. [ABSTRACT FROM AUTHOR]

Background: Machine learning (ML) has been widely applied to predict the outcomes of numerous diseases. The current study aimed to develop a prognostic prediction model using machine learning algorithms and identify risk factors associated with residual back pain in patients with osteoporotic vertebrae compression fracture (OVCF) following percutaneous vertebroplasty (PVP). Methods: A total of 863 OVCF patients who underwent PVP surgery were enrolled and analyzed. One month following surgery, a Visual Analog Scale (VAS) score of ≥ 4 was deemed to signify residual low back pain following the operation and patients were grouped into a residual pain group and pain-free group. The optimal feature set for both machine learning and statistical models was adjusted based on a 2000-resample bootstrap-based internal validation via an exhaustive search. The area under the curve (AUC), classification accuracy, sensitivity, and specificity of each model were then calculated to evaluate the predictive performance of each model. Results: In our current study, two main findings were observed: (1) Compared with statistical models, ML models exhibited superior predictive performance, with SVM demonstrating the highest prediction accuracy; (2) several variables were identified as the most predictive factors by both the machine learning and statistical models, including bone cement volume, number of fractured vertebrae, facet joint violation, paraspinal muscle degeneration, and intravertebral vacuum cleft. Conclusion: Overall, the study demonstrated that machine learning classifiers such as SVM can effectively predict residual back pain for patients with OVCF following PVP while identifying associated predictors in a multivariate manner. [ABSTRACT FROM AUTHOR]

Osteoporosis (OP) is a prevalent bone disease characterized by reduced bone density and quality, increasing fragility and fracture risk. Osteoclast (OC) activity and circadian rhythm play a role in the pathogenesis of OP. Melatonin is a circadian regulator that affects bone metabolism, but its molecular mechanism has not been studied in detail. This study aimed to identify the relationship between melatonin‐related genes and OP through bioinformatics methods and to verify it experimentally.We analysed microarray data from the GSE35959 dataset, identifying differentially expressed genes in OP patients. Circadian rhythm‐related genes and melatonin‐related genes intersect with these differentially expressed genes, highlighting that CSNK1D is a central gene. Functional enrichment, correlation and protein–protein interaction analyses were conducted. Experimental validation involved in vitro differentiation assays using RAW264.7 cells and in vivo studies with an ovariectomy‐induced rat model of OP to evaluate the role of CSNK1D in osteoclastogenesis to verify its effect on OP. Differential expression analysis revealed 272 significant genes, with CSNK1D identified as central to the circadian rhythm and to melatonin and OP interplay. Functional analyses showed involvement of CSNK1D in OC differentiation and inflammatory pathways. in vitro experiments confirmed CSNK1D upregulation during OC differentiation, and small interfering RNA‐mediated knockdown reduced OC marker expression and TRAP+ cell formation. in vivo, CSNK1D expression is associated with bone loss in OP rats. Melatonin‐related CSNK1D promotes OC differentiation and promotes the development of OP. These findings suggest CSNK1D as a potential therapeutic target for OP, offering insights into new treatment strategies integrating circadian rhythm regulation. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the risk factors for short-term residual low back pain (SRBP) following percutaneous kyphoplasty (PKP) in patients with initial thoracolumbar osteoporotic vertebral compression fractures (OVCFs). Methods: The clinical data of 389 patients with primary thoracolumbar OVCFs treated with PKP in our hospital from January 2018 to December 2022 were retrospectively analysed. A numerical rating scale (NRS) was used to evaluate whether SRBP was present 2 days after the operation. Patients with NRS scores > 4 were assigned to the SRBP group, and those with NRS scores ≤ 4 were assigned to the non-SRBP group. The general clinical data and surgical imaging-related data of the two groups were statistically analysed. Risk factors were analysed using binary logistic regression analysis. Results: Binary logistic regression analysis showed four independent predictors of SRBP after PKP, including bone mineral density (BMD) (OR = 0.087, P = 0.044), preoperative injured vertebral kyphosis (OR = 1.26, P = 0.01), preoperative thoracolumbar fascia injury (TLFI) (OR = 8.929, P < 0.001), and cement distribution type (OR = 5.921, P < 0.001) and bone cement filling ratio (OR = 0.651, P < 0.001). Conclusions: A decreased BMD, a larger preoperative kyphosis angle of the injured vertebra, preoperative TLFI, bone cement distributed in blocks and a low cement filling ratio of the injured vertebra are closely related to the occurrence of SRBP in OVCF patients after PKP. Clinicians should pay more attention to the prevention and treatment of risk indicators to further improve the therapeutic effect of PKP. Trial registration: The trial was registered in the China Trial Registry (ChiCTR 2200067164). [ABSTRACT FROM AUTHOR]

Background: The incidence of adjacent vertebral body re-fracture after percutaneous kyphoplasty (PKP) is associated with a number of variables, of which decreased bone mineral density is one of the major risk factors. Forearm bone mineral density (BMD) measurements are gaining attention because of their convenience and validity, but there is a lack of systematic research on the specific relationship between forearm BMD and the risk of adjacent vertebral re-fracture after PKP. Purpose: To investigate the correlation between forearm BMD and the risk of adjacent vertebral re-fracture after PKP in osteoporotic vertebral compression fractures (OVCF) patients. Methods: Retrospective evaluation of 198 OVCF patients receiving PKP was conducted in this study. The patients were divided into two groups: the no-fracture group and the re-fracture group, according to whether or not they had undergone vertebral re-fracture. Obtain basic information about the patient's age, sex, body mass index, bone cement leakage, smoking history, diabetes history, and surgical segmentation. Using computed tomography, the mean Hounsfield unit (HU) values for the BMD of the L1 lumbar spine were determined. For the dual-energy X-ray BMD test, the distal one-third lengths of the patient's nondominant forearm's radius and ulna were chosen. Receiver operating characteristic curves were utilized to evaluate the predictive value of forearm BMD versus lumbar CT values for vertebral re-fracture, and univariate and multivariate logistic regression analyses were employed to identify characteristics related with vertebral re-fracture following PKP. Results: Re-fracture rate after PKP was 17.2% at a minimum 12-month follow-up. Significant differences were seen between the refracture and non-fracture groups in terms of hypertension, Cobb angle correction, vertebral height recovery rate, intradiscal cement leakage, forearm bone density, and vertebral HU values. In multifactorial logistic regression analysis, forearm bone density (OR 0.821; 95% CI 0.728–0.937, p = 0.008) and HU values (OR 0.815; 95% CI 0.733–0.906, p = 0.005) were independent risk factors for vertebral re-fracture. The area under the curve (AUC) for forearm BMD values and HU values predicting adjacent vertebral re-fracture were 0.956 and 0.967, respectively. Conclusions: Forearm BMD is an independent risk factor for re-fracture of adjacent vertebrae after PKP. In addition, forearm BMD, as a valid indicator of postoperative re-fracture after PKP in patients with OVCF, and the HU value of lumbar spine CT were both powerful tools for predicting re-fracture. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community‐dwelling Medicare beneficiaries after accounting for claims‐based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims‐derived cost indicators.Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community‐dwelling fee‐for‐service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector‐specific healthcare costs ascertained for 36 months after frailty assessment.Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims‐based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors.As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector‐specific expenditures after accounting for claims‐derived indicators. The parsimonious SOF phenotype can be readily assessed in space‐constrained and time‐limited practice settings to improve identification of older adults at high risk of costly care. [ABSTRACT FROM AUTHOR]

Summary A 10‐year‐old Quarter Horse mare presented with acute and severe lameness, persisting despite initial farriery intervention. Upon physical examination, palpation of the proximal thirds of the third and fourth metacarpal bones elicited marked pain. Radiographic evaluation revealed a well‐defined radiolucency within the proximal third of the left third metacarpal bone, localised to the enthesis of the proximal suspensory ligament. Ultrasonographic findings demonstrated moderate thickening and increased vascularity of the suspensory ligament at this level. Surgical intervention was considered; however, its feasibility was constrained by the atypical nature and location of the lesion. Subsequent magnetic resonance imaging (MRI) provided a detailed characterisation of the lesion, confirming its expansile nature and the suspected associated avulsion fracture presence. Histopathological examination corroborated the diagnosis of an aneurysmal bone cyst (ABC) with an accompanying bone fracture and bone remodelling. Cases like the one described here define the importance of utilising advanced imaging techniques in combination with conventional modalities, especially when diagnosing and assessing the extent of unusual or complex lesions, to inform prognosis and guide treatment decisions. Due to the lesion's intramedullary location, expansile nature and involvement of critical anatomical structures, surgical interventions were limited which led to a recommendation for humane euthanasia. [ABSTRACT FROM AUTHOR]

Infected fracture healing is a complicated process that includes intricate interactions at the cellular and molecular levels. In addition to angiogenesis and osteogenesis, the significance of neurogenesis in fracture healing has also been recognized in recent years. Here, a nanocomposite hydrogel containing pH‐responsive zinc‐gallium‐humic acids (HAs) nanoparticles is developed. Through the timed release of Zn2+, Ga3+, and HAs, the hydrogel exhibits potent antibacterial effects and promotes angiogenesis, osteogenesis, and neurogenesis. The enhanced neurogenesis further promotes angiogenesis and osteogenesis, forming a mutually supportive angiogenesis–osteogenesis–neurogenesis cycle at the fracture site. The hydrogel achieves rapid infected fracture healing and improves tissue regeneration in mice. This study proposes a comprehensive treatment approach that combines antibacterial effects with the regulation of tissue regeneration to improve infected fracture healing. [ABSTRACT FROM AUTHOR]