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Summary: The purpose of this study is to scientifically and systematically investigate the clinical effectiveness of a fracture liaison service (FLS) for patients with femoral fractures. Methods: The international databases Ovid-MEDLINE, EMBASE, and The Cochrane Library and the Korean databases KISS, RISS, KoreaScience, Koreamed, and Kmbase were used. Risk of bias assessment was conducted at the study design level, and meta-analysis utilized both random-effects and fixed-effects models, along with subgroup analysis. Results: From the 32 selected articles, 14 articles related to subsequent fracture and 18 articles related to mortality were included in the meta-analysis. As a result of the meta-analysis, the risk of subsequent fracture in the group that participated in the fracture liaison service was 46% lower than that in the non-participated group, and this difference was statistically significant (RR = 0.54, 95% CI = 0.50–0.59). The risk of death in the group that participated in the FLS was 17% lower than that in the non-participating group, and this difference was not statistically significant as well (RR = 0.83, 95% CI = 0.67–1.03). As a result of subgroup analysis, there was a statistically significant difference in the reduction of subsequent fracture in the clinical outcomes, and there was a significant difference in mortality in the intervention follow-up period and clinical outcomes. Conclusion: The global implementation of FLS has played a crucial role in enhancing the clinical management and treatment of patients with femoral fractures, contributing to a decrease in subsequent fracture and mortality. This indicates the significant role of FLS in minimizing the disease burden associated with femoral fractures worldwide. [ABSTRACT FROM AUTHOR]

Introduction: Grip strength serves as a significant marker for diagnosing and assessing sarcopenia, particularly in elderly populations. The study aims to explore the relationship between individual thigh muscle volumes and grip strength, leveraging advanced AI-based UNETR segmentation techniques for accurate muscle volume assessment. Methods: The study included 49 participants from a cohort of 478 patients diagnosed with hip fractures at Gyeongsang National University Hospital. We recorded Grip strength and height and utilized UNETR-based segmentation techniques on CT scans, to calculate individual thigh muscle volumes. Point-biserial correlation was employed to explore the relationship between sarcopenia and thigh muscle volumes. The research also included a quantile analysis of grip strength. Results: Our findings revealed a strong statistical significance in specific thigh muscles like Rectus femoris, Vastus lateralis, and Vastus intermedius, particularly in males, in relation to sarcopenia. The male cohort displayed a trend where higher thigh muscle volumes correlated with better grip strengths. Meanwhile no such relationship was found within the female group. Conclusion: The findings indicate that stronger grip strength correlates with larger thigh muscles in males but not in females, with specific muscles like the Rectus femoris and Vastus lateralis linked to sarcopenia in men only. The study's small sample size calls for further research with more diverse and gender-balanced groups to verify these results. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are a common and debilitating condition, particularly among older adults. Loss of muscle mass and strength is a common consequence of hip fractures, which further contribute to functional decline and increased disability. Assessing changes in individual thigh muscles volume in follow-up patients can provide valuable insights into the quantitative recovery process and guide rehabilitation interventions. However, accurately measuring anatomical individual thigh muscle volume can be challenging due to various, labor intensive and time-consuming. Materials and Methods: This study aimed to evaluate differences in thigh muscle volume in followed-up hip fracture patients computed tomography (CT) scans using an AI based automatic muscle segmentation model. The study included a total of 18 patients at Gyeongsang National University, who had undergone surgical treatment for a hip fracture. We utilized the automatic segmentation algorithm which we have already developed using UNETR (U-net Transformer) architecture, performance dice score = 0.84, relative absolute volume difference 0.019 ± 0.017%. Results: The results revealed intertrochanteric fractures result in more significant muscle volume loss (females: −97.4 cm3, males: –178.2 cm3) compared to femoral neck fractures (females: −83 cm3, males: −147.2 cm3). Additionally, the study uncovered substantial disparities in the susceptibility to volume loss among specific thigh muscles, including the Vastus lateralis, Adductor longus and brevis, and Gluteus maximus, particularly in cases of intertrochanteric fractures. Conclusions: The use of an automatic muscle segmentation model based on deep learning algorithms enables efficient and accurate analysis of thigh muscle volume differences in followed up hip fracture patients. Our findings emphasize the significant muscle loss tied to sarcopenia, a critical condition among the elderly. Intertrochanteric fractures resulted in greater muscle volume deformities, especially in key muscle groups, across both genders. Notably, while most muscles exhibited volume reduction following hip fractures, the sartorius, vastus and gluteus groups demonstrated more significant disparities in individuals who sustained intertrochanteric fractures. This non-invasive approach provides valuable insights into the extent of muscle atrophy following hip fracture and can inform targeted rehabilitation interventions. [ABSTRACT FROM AUTHOR]

Background: Previous studies on medical costs in patients with hip fractures have focused on medical costs incurred for a short period after the injury. However, patients often had comorbidities before their hip fractures that would have affected medical costs even had they not sustained a fracture. Consequently, these studies may have overestimated the costs associated with hip fractures and did not characterize the duration of increased medical costs adequately. Without knowing this crucial information, it is difficult to craft thoughtful health policy to support these patients' needs.Questions/purposes: (1) To compare the direct medical costs for 5 years before fracture and up to 5 years after injury in a group of patients who underwent hip fracture surgery with a matched group of patients who did not experience a hip fracture, (2) to analyze the duration over which the increased direct medical costs associated with a hip fracture continues, and (3) to analyze whether there is a difference in direct medical costs according to age group using a nationwide claims database in South Korea.Methods: The National Health Insurance Service Sample cohort in South Korea consisted of 1 million patients who were selected using a systematic, stratified, random sampling method from 48,222,537 individuals on December 31, 2006. Under a compulsory social insurance system established by the National Health Insurance Act, all patients were followed until 2015. Patients with hip fractures and matched controls were selected from the National Health Insurance Service sample of South Korea. Patients with hip fractures were defined as those who were hospitalized with a diagnosis of femoral neck fracture or intertrochanteric fracture and who underwent surgical treatment. We excluded patients with hip fractures before January 1, 2007 to ensure a minimum 5-year period that was free of hip fractures. Patients with hip fractures were matched with patients of the same age and gender at the date of admission to an acute care hospital for surgery (time zero). If patients with hip fractures died during the follow-up period, we performed matching among patients whose difference from the time of death was within 1 month. This method of risk-set matching was repeated sequentially for the next patient until the last patient with a hip fracture was matched. We then sequentially performed 1:5 random sampling for each risk set. A total of 3583 patients in the hip fracture cohort (patients with hip fractures) and 17,915 patients in the matched cohort (those without hip fractures) were included in this study. The mean age was 76 ± 9 years, and 70% were women in both groups. Based on the Charlson comorbidity index score, medication, and medical history, the patients with hip fractures had more comorbidities. Person-level direct medical costs per quarter were calculated for 5 years before time zero and up to 5 years after time zero. Direct medical costs were defined as the sum of that insurer's payments (that is, the National Health Insurance Service's payments), and that patient's copayments, excluding uncovered payments. We compared direct medical costs between patients with hip fractures and the patients in the matched cohort using a comparative interrupted time series analysis. The difference-in-difference estimate is the ratio of the differences in direct medical costs before and after time zero in the hip fracture cohort to the difference in direct medical costs before and after time zero in the matched cohort; the difference in difference estimates were calculated each year after injury. To identify changes in direct medical cost trends in patients with hip fractures and all subgroups, joinpoint regression was estimated using statistical software.Results: The direct medical costs for the patients with hip fractures were higher than those for patients in the matched cohort at every year during the observation period. The difference in direct medical costs between the groups before time zero has increased every year. The direct medical costs in patients with hip fractures was the highest in the first quarter after time zero. Considering the differential changes in direct medical costs before and after time zero, hip fractures incurred additional direct medical costs of USD 2514 (95% CI 2423 to 2606; p < 0.01) per patient and USD 264 (95% CI 166 to 361; p < 0.01) per patient in the first and second years, respectively. The increase in direct medical costs attributable to hip fracture was observed for 1.5 to 2 years (difference-in-difference estimate at 1 year 3.0 [95% CI 2.8 to 3.2]; p < 0.01) (difference-in-difference estimate at 2 years 1.2 [95% CI 1.1 to 1.3]; p < 0.01; joinpoint 1.5 year). In the subgroups of patients younger than 65, patients between 65 and 85, and patients older than 85 years of age, the increase in direct medical costs attributable to hip fracture continued up to 1 year (difference-in-difference estimate ratio at 1 year 2.7 [95% CI 2.1 to 3.4]; p < 0.01; joinpoint 1 year), 1.5 to 2 years (difference-in-difference estimate ratio at 1 year 2.8 [95% CI 2.6 to 3.1]; p < 0.01; difference-in-difference estimate ratio at 2 years 1.2 [95% CI 1.1 to 1.3]; p < 0.01; joinpoint 1.5 years), and 39 months to 5 years (difference-in-difference estimate ratio at 1 year 5.2 [95% CI 4.4 to 6.2]; p < 0.01; difference-in-difference estimate ratio at 5 years 2.1 [95% CI 1.4 to 3.1]; p < 0.01; joinpoint 39 months) from time zero, respectively.Conclusion: The direct medical costs in patients with hip fractures were higher than those in the matched cohort every year during the 5 years before and after hip fracture. The increase in direct medical costs because of hip fractures was maintained for 1.5 to 2 years and was greater in older patients. Based on this, we suggest that health policies should focus on patients' financial and social needs, with particular emphasis on the first 2 years after hip fracture with stratification based on patients' ages.Level Of Evidence: Level II, economic analysis. [ABSTRACT FROM AUTHOR]