Journal of Bone and Mineral Metabolism最新文献

Introduction: Type 2 diabetes is associated with an increased risk of fragility fractures, even in individuals with normal or high bone mineral density. However, the impact of type 2 diabetes on postoperative outcomes after hip fracture surgery in elderly Japanese patients remains unclear. This study evaluated the association between type 2 diabetes and postoperative complications, including in-hospital mortality, using a nationwide database in Japan.

Materials and methods: A retrospective cohort study was conducted using the Diagnosis Procedure Combination (DPC) database from April 2016 to March 2022. Patients aged ≥ 65 years who underwent hip fracture surgery were included. Propensity score matching (1:1) was performed to adjust for confounders. Logistic regression analyses were used to assess associations between type 2 diabetes and outcomes.

Results: Of the 474,293 eligible patients included in this study, 18.5% were identified as having comorbid type 2 diabetes. Following 1:1 propensity score matching, the final analytic cohorts each comprised 83,283 patients. Although statistically significant, the presence of type 2 diabetes was associated with only modest increases in the risks of postoperative myocardial infarction (risk difference [RD]: 0.0007), cognitive dysfunction (RD: 0.0029), and in-hospital mortality (RD: 0.0045), with all comparisons yielding p-values of less than 0.0001. Additionally, the length of hospital stay was longer among patients with type 2 diabetes.

Conclusions: Although the absolute risk differences were small, type 2 diabetes remains an independent risk factor for adverse postoperative outcomes following hip fracture surgery in elderly Japanese patients. Tailored perioperative strategies may help optimize outcomes in this vulnerable population.

Introduction: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic, and mortality increases in elderly patients with comorbidities. This study aims to examine the in-hospital complications and mortality for elderly patients with proximal femur fractures during the COVID-19 pandemic or countermeasure periods.

Materials and methods: The proximal femur fractures undergoing surgery during the COVID-19 pandemic or countermeasure period were compared with the pre-pandemic in a Japanese national inpatient data. The assessed outcomes were the development of pneumonia, deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality during hospitalization in two periods, and those for COVID-19-positive patients.

Results: A total of 284,922 proximal femur fractures aged over 65 years were included. In the COVID-19 pandemic period compared to the pre-pandemic, the odds of pneumonia, DVT, PE, and mortality decreased to 0.942 (95% confidence interval [CI]: 0.901 - 0.986, P = 0.0102) and 0.839 (95% CI: 0.745 - 0.946, P = 0.004), increased to 1.153 (95% CI: 1.112 - 1.195, P < 0.001), and 1.048 (95% CI: 0.982 - 1.118, P = 0.1554), respectively. For COVID-19 positivity at admission, the odds of PE increased significantly to 12.95 (95% CI: 8.795 - 19.06, P < 0.001). For COVID-19 positivity during hospitalization, the odds of pneumonia and mortality were increased to 2.896 (95% CI: 1.820 - 4.608, P < 0.001) and 6.303 (95% CI: 3.440 - 11.55, P < 0.001), respectively.

Conclusion: These findings alert healthcare professionals and patients to the elevated complications, especially PE rate for proximal femoral fracture with COVID-19 positive.

Introduction: The purpose of this study is to evaluate the increase in bone mineral density (BMD) and achievement of treatment goals based on the ASBMR/BHOF position statement over 3 years of sequential therapy with 2 years of twice-weekly teriparatide (2/W TPTD) followed by 1 year of bisphosphonate (BP) therapy.

Materials and methods: This was a multicenter, retrospective study. Thirty-eight postmenopausal patients with primary osteoporosis at very high risk of fracture according to the Diagnostic Criteria for Primary Osteoporosis in Japan were enrolled. Changes in BMD at the lumbar spine (LS) and total hip (TH) were evaluated. Patients were divided into the naïve group (no history of osteoporosis treatment) and the pre-BP group (prior BP treatment). The treatment goals were assessed using the BMD T-score as follows; Baseline T-score ≤ - 2.5: Greater than - 2.5 at 3 years and baseline T-score > - 2.5: Increase at least 0.5 for LS and 0.2 for TH.

Results: The naïve group showed a significant increase in LS-BMD and TH-BMD of 14.6% and 4.8%, respectively, and the pre-BP group only showed a significant increase in LS-BMD of 8.4% over 3 years. In the naïve group, 60.7% (17/28) achieved the treatment goal for LS-BMD, and 39.3% (11/28) achieved for TH-BMD. In the pre-BP group, 50.0% (4/8) achieved the treatment goal for LS-BMD, but no patient achieved the goal for TH-BMD.

Conclusion: After 3 years of sequential therapy from 2/W TPTD to BP, 50% or more of the patients achieved the treatment goal in the LS-BMD but not in the TH-BMD.

Introduction: Fracture Liaison Service (FLS) programs are beneficial for reducing the frequency of subsequent fractures and mortality in post-hip fracture patients. The aim of this study was to investigate recent changes in the rate of pharmaceutical treatment for osteoporosis in post-hip fracture surgery patients in the absence of FLS programs compared to the previous 10 and 20 years, and whether introduction of a new reimbursement scheme in hip fracture care, launched in 2022 by the Japanese government, improved the pharmaceutical treatment rate after surgical intervention.

Materials and methods: Study 1 included 1490 post-hip fracture patients in seven hospitals without an FLS program. Study 2 included 396 osteoporosis patients who were covered by the new reimbursement scheme at five of the seven hospitals. Treatment-related variables and the number of patients who received the different pharmaceutical treatments at 0, 3, 6 and 12 months after discharge from the hospital were examined.

Results: Two hundred and thirty-two of 1474 patients received anti-osteoporotic medication at hospital discharge, which was not a significant improvement in the rate of pharmaceutical treatment in comparison with that in our previous studies over 20 years. On the other hand, introduction of the new reimbursement scheme at hospitals significantly improved the rate of pharmaceutical treatment, with 263 of the 391 patients receiving anti-osteoporotic medication at discharge, as well as a significant improvement.

Conclusion: We demonstrated a significant improvement in the pharmaceutical treatment rate for osteoporosis in post-hip fracture surgery patients after introduction of the new reimbursement scheme launched by the Japanese government.

Background: There are no established guidelines for antibiotic administration to prevent the development of medication related-osteonecrosis of the jaw (MRONJ) after tooth extraction in patients receiving antiresorptive agents (ARAs). Since 2022, the duration of antibiotic administration during extractions in such patients has been intentionally shortened to prevent antimicrobial resistance at our hospitals.

Methods: This retrospective study involved 160 patients on low-dose bisphosphonates (BPs) requiring tooth extractions between 2019 and 2024 at four Japanese institutions. In 2019-2021, patients received amoxicillin (AMPC) 500 mg 1 h before and 750 mg per day for 2 days post-extraction. In 2022-2024, a single 500 mg dose of AMPC was administered 1 h pre-extraction. Patients were managed with tension-free wound suturing and regular follow-up. The rates of MRONJ development were compared between the two periods.

Results: MRONJ developed in 3 out of 170 teeth (1.76%) in 2019-2021, and in 2 out of 147 teeth (1.36%) in 2022-2024, with no significant difference (P = 1.000). All MRONJ cases were low-stage (Stage 1) and healed completely within 12-16 weeks. Four out of five MRONJ cases (80%) exhibited radiopaque changes around the root. When all teeth in both groups were surveyed, MRONJ development was significantly higher in teeth with such changes compared to those without (4/58 vs. 1/259; P = 0.004).

Conclusion: A single preoperative dose of AMPC may be sufficient for tooth extractions in patients on low-dose BPs. However, teeth with radiopaque changes around the root require careful monitoring postextraction.