Osteoporosis International最新文献

Atraumatic bilateral femoral neck fractures are rare, especially in younger patients and those without significant comorbidities. However, pregnant individuals appear to be at increased risk due to normal physiological changes in calcium balance, leading to transient osteoporosis of the hip. In these individuals, calcium and bone mineral density are generally decreased, reflecting the calcium demands of the developing fetus. Therefore, peripartum non-osteoporotic bilateral femoral neck fractures sustained remain a rare presentation. A 31-year-old patient presented with worsening hip pain; imaging studies revealed bilateral femoral neck fractures. A complicated birth requiring specialized maneuvers 11 months prior resulted in moderate hip pain, and a single step down from the bottom rung of a ladder approximately 7 months after the delivery initiated acute exacerbation of the hip pain. Orthopedic evaluation determined that the patient would benefit most from the surgical fixation of both femoral necks with an arthroplasty on the right and a dynamic hip screw on the left. Rheumatologic evaluation of the patient revealed no relevant risk factors for osteoporosis other than suboxone use, tobacco use, and low levels of vitamin D. A DXA scan was unremarkable, and interestingly, the only notable laboratory findings were markedly increased parathyroid hormone levels with a slight increase in calcium. Pregnant patients with high serum levels of parathyroid hormone might be at risk for atraumatic hip fractures regardless of serum calcium levels, particularly when maneuvers that put stress on the femoral neck are employed. This case demonstrates the importance of increased clinical suspicion of hip fractures and evaluation for hyperparathyroidism in a patient presenting with atypical hip pain immediately following labor.

The implementation of an in-hospital fracture liaison service facilitated prompt initiation of anti-osteoporosis treatment following a hip fracture (HF), increasing follow-up and treatment rates. This led to a 48% reduction in the risk of subsequent HF and a 29% decrease in mortality rates.

Purpose: To demonstrate the impact of an institutional fracture liaison service (FLS) which allowed in-hospital anti-osteoporosis treatment following hip fracture (HF) on subsequent HF and mortality rate.

Methods: We retrospectively evaluated patients aged 65 years and older, admitted with an osteoporotic HF, who were transferred following surgery for rehabilitation in the geriatrics department in two time periods: before and after the implementation of an institutional FLS ("geriatric-pre-FLS" and "geriatric-FLS" cohorts, respectively). Data were captured from electronic records and the two cohorts were compared following an assessment of baseline characteristics, follow-up, and anti-osteoporosis treatment initiation. A multivariable Cox regression model evaluated differences between the cohorts regarding subsequent HF and mortality rates.

Results: Three hundred and eighteen and 448 patients comprised the geriatric-pre-FLS (07/2008-06/2014) and the geriatric-FLS (03/2016-03/2020) cohorts, respectively. Baseline characteristics were comparable between the cohorts (median age 81 vs. 82, p = 0.08 and female sex 73% vs. 70%, p = 0.48, respectively). Rates of endocrine consultation (3.5% vs. 99%%, p < 0.001), DXA-BMD testing (7.5% vs. 34%, p < 0.001), and parenteral anti-osteoporosis treatment (4% vs. 76.6%, p < 0.001) were all higher in the geriatric-FLS cohort. The implementation of the FLS led to a 48% reduction in subsequent HF risk (HR 0.52; 95% CI 0.37-0.74, p < 0.001) and a 29% decrease in mortality rate (HR 0.71; 95% CI 0.54-0.92, p = 0.011).

Conclusions: The implementation of an in-hospital FLS facilitated prompt initiation of anti-osteoporosis treatment following a HF, increased follow-up and treatment rates, and resulted in a 48% reduction in subsequent HF risk and a 29% reduction in mortality rates.