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Concept: Hip protector

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Hip fractures are mainly caused by accidental falls and trips, which magnify forces in well-defined areas of the proximal femur. Unfortunately, the same areas are at risk of rapid bone loss with ageing, since they are relatively stress-shielded during walking and sitting. Focal osteoporosis in those areas may contribute to fracture, and targeted 3D measurements might enhance hip fracture prediction. In the FEMCO case-control clinical study, Cortical Bone Mapping (CBM) was applied to clinical computed tomography (CT) scans to define 3D cortical and trabecular bone defects in patients with acute hip fracture compared to controls. Direct measurements of trabecular bone volume were then made in biopsies of target regions removed at operation.

Concepts: Osteoporosis, Bone, Bone fracture, Hip fracture, Fall prevention, Femur, Cancellous bone, Hip protector

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Improved understanding is required of how the mechanics of the fall affect hip fracture risk. We used a hip impact simulator to determine how peak stresses at the femoral neck were affected by pelvis impact angle, hip abductor muscle force, and use of a wearable hip protector. We simulated falls from standing (2 m/s impact velocity) involving initial hip abductor muscle forces of 700 or 300 N. Trials were acquired for impact to the lateral aspect of the greater trochanter, and impact to the pelvis rotated 5°, 10° and 15° anteriorly (positive) or posteriorly (negative). Measures were acquired with and without a commercially available hip protector. During trials, we measured three-dimensional forces with a load cell at the femoral neck, and derived peak compressive and tensile stresses. Peak compressive stress increased 37% (5.91 versus 4.31 MPa; p < 0.0005) and peak tensile stress increased 209% (2.31 versus 0.75 MPa; p < 0.0005) when the pelvis impact angle changed from 15° anterior to -15° posterior. For lateral impacts, the peak tensile and compressive stresses averaged 73% and 8% lower, respectively, in the 700 N than 300 N muscle force condition, but the effect was reversed for anteriolateral or posteriolateral impacts. The attenuation in peak compressive stress from the hip protector was greatest for posteriolateral impacts (-15 to -5°; 36-41%), and least for anteriolateral (+15°; 10%). These results clarify the effects on hip fracture risk during a fall of pelvis impact angle and muscle forces, and should inform the design of improved hip protectors.

Concepts: Osteoporosis, Hip fracture, Affect, Force, Pelvis, Compressive stress, Tensile stress, Hip protector

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Cirrhosis is a risk factor for osteoporosis and fractures. However, little is known of the actual risk of hip fractures in patients with alcoholic cirrhosis. Using linked primary and secondary care data from the English and Danish nationwide registries, we quantified the hip fracture risk in two national cohorts of patients with alcoholic cirrhosis.

Concepts: Osteoporosis, Bone fracture, Hip fracture, Fall prevention, Cirrhosis, Alcoholism, England, Hip protector

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The SCreening for Osteoporosis in Older women for the Prevention of fracture [SCOOP] study was a community-based screening intervention, in women aged 70 to 85 years in the UK. In the screening arm, licensed osteoporosis treatments were recommended in women identified to be at high risk of hip fracture using the FRAX risk assessment tool (including BMD measurement). In the control arm, standard care was provided. Screening led to a 28% reduction in hip fractures over 5 years. In this planned post hoc analysis, we wished to examine for interactions between screening effectiveness on fracture outcome (any, osteoporotic and hip fractures) on the one hand and baseline FRAX 10-year probability of hip fracture on the other. All analyses were conducted on an intention-to-treat basis, based on the group to which women were randomised, irrespective of whether screening was completed. Of 12,483 eligible participants, 6,233 women were randomised to screening, with treatment recommended in 898 (14.4%). No evidence of an effect or interaction was observed for the outcomes of any fracture or osteoporotic fracture. In the screening arm, 54 fewer hip fractures were observed than in the control arm (164 versus 218, 2.6% vs 3.5%), and commensurate with treatment being targeted to those at highest hip fracture risk, the effect on hip fracture increased with baseline FRAX hip fracture probability (p = 0.021 for interaction); for example, at the 10thpercentile of baseline FRAX hip probability (2.6%), there was no evidence that hip fractures were reduced (HR 0.93, 0.71 to 1.23) but at the 90thpercentile (16.6%), there was a 33% reduction (HR 0.67, 0.53 to 0.84). Prior fracture and parental history of hip fracture positively influenced screening effectiveness on hip fracture risk. We conclude that women at high risk of hip fracture based on FRAX probability are responsive to appropriate osteoporosis management. This article is protected by copyright. All rights reserved.

Concepts: Osteoporosis, Bone fracture, Hip fracture, Fall prevention, Risk, Risk assessment, Copyright, Hip protector

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Osteoporotic hip fractures can be life changing and can increase mortality. Treatment of osteoporosis following hip fracture is often delayed. We began offering osteoporosis medication during hospitalization for hip fracture, dramatically increasing the number of patients meeting standard of care.

Concepts: Osteoporosis, Bone, Bone fracture, Hip fracture, Fall prevention, Fracture, Bone fractures, Hip protector

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We conducted a meta-analysis based on eligible studies to assess the efficacy and safety of zoledronic acid treatment for postmenopausal women with osteoporosis. PubMed, Web of Science, and Embase were searched for eligible studies that assessed the efficacy of zoledronic acid in the prevention of fractures among postmenopausal women with osteoporosis. The primary outcomes were new vertebral fracture, nonvertebral fracture, and hip fracture. Secondary outcomes were bone mineral density (BMD) and safety outcomes. A fixed-effect or random-effect model was used to pool the estimates according to the heterogeneity among the included studies. Eight randomized controlled trials, involving 13,335 patients, were included in this meta-analysis. Pooled results showed that treatment with zoledronic acid significantly reduced the incidences of nonvertebral fractures, vertebral fractures, and hip fractures, as compared with placebo. Zoledronic acid was also associated with significant improvement in BMD at lumbar spine, total hip, femoral neck, and trochanter. However, the incidence of any adverse events was higher in the zoledronic acid group than that in the control group, and serious adverse events were comparable between the 2 groups. This meta-analysis indicated that zoledronic acid could significantly reduce the fracture risk and increase BMD in postmenopausal women with osteoporosis. Furthermore, it would not result in serious adverse events. Zoledronic acid could be used as an effective and well-tolerated treatment for postmenopausal women with osteoporosis.

Concepts: Osteoporosis, Bone, Bone fracture, Hip fracture, Fall prevention, Bone density, Randomized controlled trial, Hip protector

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Although both clinical and biomechanical studies suggest that cephalomedullary implants have a mechanical advantage over extramedullary implants, a high rate of complications or implant failure remains in elderly patients with osteoporosis. In an attempt to address some of these challenges, new implants with improved designs named proximal femoral nail antirotation II (PFNA II) and Zimmer natural nail (ZNN) were developed for elderly patients. Although the PFNA II reportedly has good clinical outcomes, it is unclear which implant achieves better safety and efficacy for treating intertrochanteric hip fractures. The primary objective of this prospective, randomized trial involved 353 patients was to evaluate Harris Hip Score (HHS). The secondary objective was to compare results associated with clinical outcome such as operation time, fluoroscopy time, lateral hip pain, walking ability, and reoperation rate as well as the incidence of cut-out by using implant position and fracture reduction quality.

Concepts: Osteoporosis, Epidemiology, Bone fracture, Hip fracture, Fall prevention, Randomized controlled trial, Hip fracture treatment, Hip protector

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It is estimated that Iran accounted for about 1% of hip fracture burden of the world in 2007, but these data are based on incomplete evidence. As the country’s population is ageing, it is expected that a dramatic rise in hip fracture incidence will result. There is no single national study that accurately estimates the incidence of all hip fractures in the country or identifies the direct costs for affected patients. To help fill this gap, the current study has been designed to determine the incidence of hip fracture associated with osteoporosis in the Iranian population and to assess the direct costs involved.

Concepts: Osteoporosis, Bone, Bone fracture, Hip fracture, Fall prevention, Population, Iran, Hip protector

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Hip protectors represent an attractive strategy for reducing hip fractures among high-risk fallers in long-term care facilities. However, clinical studies yield conflicting results regarding their clinical value. This is mainly due to poor acceptance and adherence among users in wearing these devices. As a result, there is an urgent need to identify potential barriers and facilitators to initial acceptance and continued adherence with hip protector use.

Concepts: Health care, Osteoporosis, Clinical trial, Avicenna, Geriatrics, Hip protector