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Purpose: To compare femoral bone mineral density (BMD) levels in hip-fracture women with versus without type 2 diabetes mellitus (T2DM). We hypothesized that BMD levels could be higher in the women with T2DM than in controls and we aimed to quantify the BMD discrepancy associated with the presence of T2DM. Methods: At a median of 20 days after the occurrence of an original hip fracture due to fragility we measured BMD by dual-energy x-ray absorptiometry at the non-fractured femur. Results: We studied 751 women with subacute hip fracture. Femoral BMD was significantly higher in the 111 women with T2DM than in the 640 without diabetes: mean T-score between-group difference was 0.50, (95% CI from 0.30 to 0.69, P< 0.001). The association between the presence of T2DM and femoral BMD persisted after adjustment for age, body mass index, hip-fracture type, neurologic diseases, parathyroid hormone, 25-hydroxyvitamin D and estimated glomerular filtration rate (P< 0.001). For a woman without versus with T2DM, the adjusted odds ratio to have a femoral BMD T-score below the threshold of − 2.5 was 2.13 (95% CI from 1.33 to 3.42, P= 0.002). Conclusions: Fragility fractures of the hip occurred in women with T2DM at a femoral BMD level higher than in control women. In the clinical assessment of fracture risk, we support the adjustment based on the 0.5 BMD T-score difference between women with and without T2DM, although further data from robust longitudinal studies is needed to validate the BMD-based adjustment of fracture risk estimation.

Riassunto: Il trattamento in due tempi rappresenta la migliore strategia per ridurre la quantità di complicazioni nelle fratture del pilone tibiale. Una nuova configurazione, denominata “tripolare”, del fissatore esterno utilizzato per la stabilizzazione in acuto è stata sviluppata e valutata in 15 casi consecutivi di fratture articolari e periarticolari della tibia distale. Si tratta di un montaggio essenziale, costituito solo da tre viti e tre barre, che è possibile eseguire anche in assenza di raggi X e in sedazione. In tutti i casi vi è stata assenza di problemi intra-operatori e una sufficiente stabilità per il nursing post-operatorio. Il tempo trascorso tra il trauma e questa procedura è stato di 3–144 ore; il tempo medio di posizionamento del fissatore di 8,4 minuti, l’osteosintesi definitiva è stata effettuata a un minimo di 4 e a un massimo di 15 giorni dopo il primo intervento, sempre senza problemi, sia in caso di ORIF che di fissazione esterna. Ulteriori studi con casistiche allargate sono necessari per confermare questi risultati preliminari incoraggianti.

Hyperhomocysteinemia is a well-established risk factor for cardiovascular diseases. The aims of this study were to longitudinally investigate, in a group of elite athletes, plasma homocysteine levels and to search for relationships with the muscular workload and the vitamin status. One hundred and three athletes (59 males and 44 females, respectively) were evaluated in different periods: namely the recovery period, the training period, and the competition period; 84 subjects (37 males and 47 females), served as controls. The evaluation sessions consisted in blood sampling and medical examination. The percentages of athletes with normal and elevated homocysteine levels, defined by levels below or above the limit of 15 umol/l, were 68.0% and 32.0%, respectively, in the recovery period, and these percentages remained unchanged during the following periods. In the control group, relevant percentages were 92.9% and 7.1%, respectively. The comparison between plasma homocysteine of male and female, evaluated in the recovery period, showed significantly higher levels in the former group (18.8±18.0 μmol/l vs10.7±5.9 μmol/l, p¼0.001 respectively), as well as a higher proportion of individuals with hyperhomocysteinemia (24/59 vs9/44, p¼0.05). The correlation analyses showed a weak but significant negative correlation between homocysteine and folate in the three periods considered, while no significant relationship was observed between homocysteine and creatine-kinase. We found excess prevalence of hyperhomocysteinemia in elite athletes of winter sports. A strategy to understand which mechanisms in these athletes subserve hyperhomocysteinemia is essential in order to reduce the potential risk for future cardio-vascular morbidity and mortality.