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Bones and fractures
Published in Henry J. Woodford, Essential Geriatrics, 2022
Fragility fractures are those that occur following minimal trauma, which is conventionally acknowledged as falling from one's own height or less. ‘Severe' or ‘established' osteoporosis is defined as a BMD more than 2.5 SD below the normal reference plus a prior fragility fracture.20
Rheumatology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Non-osteoporotic causes of fragility fracture include: Metastatic bone disease: Suggested by bone pain and history of cancer and raised inflammatory markersMultiple myeloma: Suggested by bone pain, anaemia, hypercalcaemia and renal failure (see Section 8.2)Osteomalacia: Suggested by bone pain, muscle pain and proximal muscle weaknessPaget's disease of bone: Suggested by bone pain and deformity (enlargement of pelvis/spine/skull)
Animal Models of Osteopenia or Osteoporosis
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Donald B. Kimmel, Erica L. Moran, Earl R. Bogoch
The time from peak bone mass attainment until the development of fragility fractures is 30+ yrs. In women, accelerated estrogen-depletion bone loss lasts 5-8 yrs. An effective animal model known to experience peak bone mass and post-OVX bone loss should decrease both times by an order of magnitude. Convenience for animal models is denominated as cost of purchase, availability, housing, handling difficulties; and designing/implementing/validating new analysis procedures. Having validated small animal models is the best route to including the largest number of investigators in any research field. Using a highly accurate animal model occasionally can be so inconvenient that it may be more difficult than a human study.
Finite element analysis of bone mechanical properties using MRI-derived bound and pore water concentration maps
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Thammathida Ketsiri, Sasidhar Uppuganti, Kevin D. Harkins, Daniel F. Gochberg, Jeffry S. Nyman, Mark D. Does
Bone fragility is a widespread problem and current X-ray based diagnostics have not proven effective in predicting who is likely to suffer a fragility fracture (Cosman et al. 2014; Kanis et al. 2001). Magnetic resonance imaging (MRI) has shown promise to provide complimentary diagnostics of bone fracture risk (Manhard et al. 2017b). In cortical bone, MRI can measure concentrations water bound to collagen (bound water concentration, Cbw) and water inside pore spaces (pore water concentration, Cpw), and these two measures have been shown to correlate with various mechanical properties of cadaveric bone specimens (Horch et al. 2011) and whole bones (Manhard et al. 2016). This study aimed to determine whether MRI-derived Cbw and Cpw information can improve the prediction of mechanical bone properties, beyond what can be determined by structure alone. To this end, finite element (FE) analysis was used to incorporate MRI measurements of Cbw and Cpw along with the bone structure into the evaluation of whole cadaver bone mechanical properties.
Prevalence and influencing factors of spinal cord injury-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury: A cross-sectional, observational study
Published in The Journal of Spinal Cord Medicine, 2023
Kanyanat Mahitthiharn, Apichana Kovindha, Tawikar Kaewchur, Leslie R. Morse, Sintip Pattanakuhar
Regarding fragility fractures, age, female sex, duration of SCI of at least 10 years, active wheelchair use, and SCI-related osteoporosis diagnosis were significant independent factors of fragility fracture. Noteworthy, all participants with fragility fracture in our study were paraplegic, wheelchair users, and had at least 10 years duration of SCI. Although these factors are consistent with those from previous studies,7 we did not find other previously identified factors to be associated with fracture history in this study, including low BMI and use of anticonvulsants, heparin, opioid analgesics, as well as completeness of the injury. This might also be due to our relatively small sample size and small number of participants with fracture, resulting in an underpower of the study to detect the differences. Noteworthy, development of SCI-related osteoporosis and fragility fracture should be multifactorial since people who have duration of SCI longer than 10 years might not develop SCI-related osteoporosis if they have incomplete SCI and are able to ambulate.
Bone health 2022: an update
Published in Climacteric, 2022
T. J. de Villiers, S. R. Goldstein
Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds [1]. It is estimated that osteoporosis affects 200 million women worldwide. One-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and, actually two-thirds of women aged 90 carry this diagnosis [2]. Worldwide, one in three women after the age of 50 will experience osteoporotic fracture [3]. Bone as well as muscle is a hormonally sensitive organ. At menopause, the removal of estrogen has much greater effects in women than in men of similar age. The female-to-male ratio of osteoporotic fractures is approximately 1.6, such that 80% of forearm fractures, 75% of humerus fractures, 70% of hip fractures, and 58% of spine fractures occur in women [1]. A prior fracture is associated with an 86% increased risk of any subsequent fracture [4]. Fragility fractures are a leading cause of chronic disease morbidity. For instance, in Europe, fragility fractures are the fourth leading cause, after ischemic heart disease, dementia, and lung cancer; however, they surpass chronic obstructive pulmonary disease and ischemic stroke [5]. After sustaining a hip fracture, 10–20% of formerly community-dwelling patients require long-term nursing care [6]. Overall, hip fractures cause the most morbidity and reported mortality rates in up to 20–24% in the first year after a hip fracture [7]. Loss of function and independence among survivors is profound, with 40% unable to walk independently, and 60% requiring assistance a year later [8].