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Bone-stress injury (BSI) is common in collegiate athletes. Injury rates and health care use in running athletes are not well documented. To describe the rate and classification of injury and associated health care use in collegiate cross-country runners with BSI. Descriptive epidemiology study. Sports medicine facilities participating in the Pac-12 Health Analytics Program. Pac-12 Conference collegiate cross-country athletes. Counts of injury and health care resources used for each injury. Injury rates were calculated based on athlete-seasons. A total of 168 BSIs were reported over 4 seasons from 80 team-seasons (34 men's and 46 women's team-seasons) and 1220 athlete-seasons, resulting in 1764 athletic training services and 117 physician encounters. Bone-stress injuries represented 20% of all injuries reported by cross-country athletes. The average BSI rate was 0.14 per athlete-season. Injury rates were higher in female (0.16) than male (0.10) athletes and higher in the 2019–2020 season (0.20) than the 2020–2021 (0.14), 2018–2019 (0.12), and 2021–2022 (0.10) seasons. Most BSIs occurred in the lower leg (23.8%) and the foot (23.8%). The majority of injuries were classified as overuse and time loss (72.6%) and accounted for most of the athletic training services (75.3%) and physician encounters (72.6%). We found a mean of 10.89 athletic training services per overuse and time-loss injury and 12.20 athletic training services per overuse and non–time-loss injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) than for athletic training services (10.50). Bone-stress injuries are common in collegiate cross-country runners and require considerable athletic training resources. Athletic trainers should be appropriately staffed for this population, and suspected BSIs should be confirmed with a medical diagnosis. Future investigators should track treatment codes associated with BSI to determine best-practice patterns. [ABSTRACT FROM AUTHOR]

Objective: Bone stress injuries (BSIs) in trabecular-rich bone are associated with greater biological risk factors compared with cortical-rich bone. We hypothesized that female runners with high Female Athlete Triad (Triad)-related risk would be at greater risk for trabecular-rich BSIs than runners with low Triad-related risk. Design: Prospective cohort study. Setting: Two NCAA institutions. Participants: Female runners were followed prospectively for up to 5 years. Intervention: The intervention consisted of team nutrition presentations focused on optimizing energy availability plus individualized nutrition sessions. Triad Cumulative Risk Assessment (CRA) categories were assigned yearly based on low-energy availability, menstrual status, age of menarche, low body mass index, low bone mineral density, and prior BSI. Main Outcome Measures: The outcome was the annual incidence of trabecular- and cortical-rich BSI. Generalized Estimating Equations (GEE, to account for the correlated nature of the observations) with a Poisson distribution and log link were used for statistical modeling. Results: Cortical-rich BSI rates were higher than trabecular-rich BSI rates (0.32 vs 0.13 events per person-year). Female runners with high Triad-related risk had a significantly higher incidence rate ratio of trabecular-rich BSI (RR: 4.40, P = 0.025) and cortical-rich BSI (RR: 2.87, P = 0.025) than women with low Triad-related risk. Each 1 -point increase in Triad CRA score was associated with a significant 26% increased risk of trabecular-rich BSI (P = 0.0007) and a nonsignificant 14% increased risk of cortical-rich BSI (P = 0.054). Conclusions: Increased Triad CRA scores were strongly associated with increased risk for trabecular-rich BSI. Incorporating Triad CRA scores in clinical care could guide BSI prevention. [ABSTRACT FROM AUTHOR]

Background: Menstrual irregularity (MI) is common in female athletes and is a component of the Female Athlete Triad (Triad). Many athletes with the Triad are started on hormonal contraceptives (HC) for MI, but this interferes with the ability to monitor menstrual cycle regularity and can mask other causes of MI. There are limited studies investigating the relationship between MI, HC use, and injury in female collegiate athletes. Objective: To examine the prevalence of and relationship between HC use, MI, and bone stress injuries in female collegiate athletes in the United States. Design: Cross‐sectional study. Setting: Online survey. Participants: 1020 U.S. female collegiate athletes (age ≥ 18 years). Methods or Interventions: Assessment of risk factors for menstrual irregularity and bone stress injuries was conducted via a one‐time survey. Main Outcome Measures: HC use, MI, history of stress fractures. Results: Current HC use prevalence was 65% (95% confidence interval [CI], 61.9%, 67.8%). Of all athletes, 47% reported past MI. Of the athletes who were not currently using HCs, 32% had current MI. Compared with athletes without past MI, more athletes with past MI reported current HC use (73% vs. 57%) and indicated menstrual cycle consistency as the primary reason for use (24% vs. 4%) (P <.001). Additionally, 25% of athletes reported a history of stress fractures, which was associated with lean/aesthetic sports participation (odds ratio [95% CI]: 1.9 [1.4, 2.5]; P <.001) and less oral contraceptive pill (OCP) use (0.7 [0.5, 1.0]; P =.043). Compared with OCPs, injectable HCs were associated with greater odds of a history of stress fractures (4.5[1.6, 12.3]; P =.004). Conclusions: HC use was prevalent among this cohort of female collegiate athletes, and almost half of the athletes reported past MI. A goal of menstrual cycle regularity was cited by 24% of athletes as a primary reason to use HCs, which shows that more athlete education is needed to avoid masking MI and the Triad with HCs. Further studies elucidating the relationship between HC use, MI, and sports‐related injury are warranted. [ABSTRACT FROM AUTHOR]

Objective: To explore and analyze the current status and causes of medical device-related pressure injuries(MDR PIs)in 7 Class Ⅲ Grade A hospitals in Hainan Province, and put forward corresponding intervention measures. Methods: Using the survey tools in Europe and the United States, a cross-sectional survey of inpatients in 7 Class Ⅲ Grade A hospitals was conducted by trained qualified investigators, and the data was statistically analyzed using SPSS 17.0 software. Results: Among the 7248 hospitalized patients,there were 30 cases of pressure injuries caused by medical devices, and the prevalence rate was 0.41 %, including 18 cases of medical device-related pressure injuries, the prevalence rate was 0.25 %, and 12 cases of mucosal membrane pressure injuries, which prevalence rate was 0.17 %. 83.33 % of the medical device-related pressure injuries were acquired by the hospital, and 82.22 % of the pressure injuries at the bone eminence were present on admission; Patients with intensive care and enteral nutrition are more likely to get pressure injuries from medical devices(P< 0.05). Nurses will be more conscious about using decompression dressings for patients with pressure injuries at the bone eminence(P< 0.05); Nasogastric tube(51.60 %) was the most common cause of medical device-related pressure injuries, followed by oxygen inhalation tube(19.35 %). Mucosal membrane pressure injury could not be staged according to the system,accounting for 38.71 %. Medical device-related pressure injuries mainly concentrated in stage 1 and stage 2, accounting for 51.61 %. The ear(22.58 %) was the most common site of medical device-related pressure injuries, while the nasal mucosa(35.47 %) was the most common site of mucosal membrane pressure injuries. Conclusions: Managers and clinical nurses of Class Ⅲ Grade A hospitals in Hainan Province have already recognized and actively prevented such pressure injuries, but they still need to further strengthen training and regulation, organize regular investigation and continuous monitoring, and build a Continuous care model; for departments, people and specific parts of the relatively high risk of medical device-related pressure injuries, early prevention, identification and protection should be provided. Medical devices should be used correctly, preventive medical device-related pressure injuries should be reduced proactively;At the same time, we actively pay attention to the main causes, sites, stages and progress of medical device-related pressure injuries, and adopt comprehensive intervention measures to establish an organizational structure for pressure injuries early warning management to form a cluster management. [ABSTRACT FROM AUTHOR]

Traumatic composite bone‐muscle injuries, such as open fractures, often require multiple surgical interventions and still typically result in long‐term disability. Clinically, a critical indicator of composite injury severity is vascular integrity; vascular damage alone is sufficient to assign an open fracture to the most severe category. Challenging bone injuries are often treated with bone morphogenetic protein 2 (BMP‐2), an osteoinductive growth factor, delivered on collagen sponge. Previous studies in a composite defect model found that a minimally bridging dose in the segmental defect model was unable to overcome concomitant muscle damage, but the effect of BMP dose on composite injuries has not yet been studied. Here, we test the hypotheses that BMP‐2‐mediated functional regeneration of composite extremity injuries is dose dependent and can be further enhanced via co‐delivery of adipose‐derived microvascular fragments (MVF), which have been previously shown to increase tissue vascular volume. Although MVF did not improve healing outcomes, we observed a significant BMP‐2 dose‐dependent increase in regenerated bone volume and biomechanical properties. This is the first known report of an increased BMP‐2 dose improving bone healing with concomitant muscle damage. While high dose BMP‐2 delivery can induce heterotopic ossification (HO) and increased inflammation, the maximum 10 μg dose used in this study did not result in HO and was associated with a lower circulating inflammatory cytokine profile than the low dose (2.5 μg) group. These data support the potential benefits of an increased, though still moderate, BMP‐2 dose for treatment of bone defects with concomitant muscle damage. Published 2019. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal injuries, including lower extremity bone stress injuries (BSI) significantly impact initial entry training (IET) in the U.S. Army due to limited duty days, trainee attrition, early medical discharge, and related financial costs. Factors complicating trainee BSI surveillance include inconsistent BSI coding practices, attrition documentation as both administrative separations and medical discharges and the inability to code for BSI grade or severity when using International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) codes.Methods: A multidisciplinary expert panel developed policy guidance to enhance clinical and administrative management of BSI, following extensive analysis of current, peer-reviewed literature. Policy guidance incorporates leading practices concerning clinical BSI management, including imaging procedures, recommended notifications, early intervention, and ICD-10 diagnostic coding procedures. Policy guidance also standardizes BSI grading criteria for magnetic resonance imaging and skeletal scintigraphy (bone scan).Findings: Multidisciplinary expert opinion indicates inconsistent BSI diagnosis and management across IET due to variability in trainee BSI grading, documentation, and coding practices. Injury surveillance conducted by the United States Army Medical Command (USAMEDCOM) will benefit from routine, standardized musculoskeletal injury data base searches by BSI severity/grade and anatomical location upon implementation of BSI policy guidance.Discussion: Effective injury surveillance is critical for determining trainee BSI incidence and attrition, developing anticipated return to duty (RTD) timelines, and assessing long-term outcomes. BSI RTD timelines should account for gender, BSI grade/severity, anatomical location, and type of intervention. Well-defined RTD timelines would benefit administrative decision-making purposes, including whether to grant convalescent leave or enroll in the Warrior Training and Rehabilitation Program during BSI recovery. Enhanced management procedures may improve initial enlistment completion rates for trainees sustaining at least one BSI who eventually complete IET. [ABSTRACT FROM AUTHOR]

Background: During the conflicts in Iraq and Afghanistan, more than 52,000 U.S. military members were wounded in action. The battlefield mortality rate was lower than in past conflicts, however, those surviving often had complex soft tissue and bone injuries requiring multiple surgeries. This report describes the rates, types, and risks of infections complicating the care of combat casualties.Patients and Methods: Infection and microbiology data obtained from the Trauma Infectious Disease Outcomes Study (TIDOS), a prospective observational study of infections complicating deployment-related injuries, were used to determine the proportion of infection, types, and associated organisms. Injury and surgical information were collected from the Department of Defense Trauma Registry. Multivariable Cox proportional hazards and logistic regression models were used to evaluate potential factors associated with infection.Results: From 2009-2012, 1,807 combat casualties were evacuated to U.S. TIDOS-participating hospitals. Among the 1,807 patients, the proportion of overall infections from time of injury through initial U.S. hospitalization was 34% with half being skin, soft tissue, or bone infections. Infected wounds most commonly grew Enterococcus faecium, Pseudomonas aeruginosa, Acinetobacter spp. or Escherichia coli. In the multivariable model, amputation, blood transfusions, intensive care unit admission, injury severity scores, mechanical ventilation, and mechanism of injury were associated with risk of infection.Conclusions: One-third of combat casualties from Iraq and Afghanistan develop infections during their initial hospitalization. Amputations, blood transfusions, and overall injury severity are associated with risk of infection, whereas more easily modifiable factors such as early operative intervention or antibiotic administration are not. [ABSTRACT FROM AUTHOR]

Background: This article aimed to examine and compare the frequency of occurrence of a broad range of non‐suicidal self‐injury (NSSI) behaviours in an international sample of women. Methods: Female participants with NSSI (n = 464) were recruited via a range of websites and completed a questionnaire examining 17 different types of NSSI types and their frequency, severity, and duration. Results: Prevalent acts were cutting, scratching, and word carving; cutting and scratching occurred frequently, whilst word carving most often occurred as a single episode. Analyses revealed significant differences between Australian and U.S. participants, with U.S. participants having significantly higher rates of cutting, wound interference, carving, scratching, and sharp object sticking. Participants also reported on other self‐harm methods not assessed by the questionnaire. Conclusions: Word carving may be qualitatively different from other forms of NSSI. More severe NSSI methods (e.g., bone breaking) are less prevalent than less dangerous methods (e.g., scratching). Participants considered a range of indirectly harmful or suicidal behaviours as self‐injury contrary to researcher or clinician understanding. Finally, there may be cultural differences in relation to NSSI between countries where such behaviours are common, although further research is required to determine this. [ABSTRACT FROM AUTHOR]

Surgery in the first half of the nineteenth century was primarily dominated by pain and fear of lethal infections. Therefore, the absolute majority of fractures and dislocations were treated non-operatively. Development of operative treatment of fractures was influenced by three major inventions: anaesthesia (1846), antisepsis (1865) and X-rays (1895). The first to use external fixation is traditionally considered to be Malgaigne (1843). However, his devices cannot be really considered as external fixation. The external fixation device invented by Lambotte in 1902 is generally thought to be the first "real fixator". In America it was Clayton Parkhill, in 1897, with his "bone clamp" who started the process. Both Parkhill and Lambotte observed that metal pins inserted into bone were tolerated extremely well by the body. Mainly on the basis of their research findings, many external fixation devices have been and are being developed. [ABSTRACT FROM AUTHOR]

This article succinctly summarizes the available evidence on the risk of bone fractures with sodium-glucose co-transporter-2 inhibitors. The US Food and Drug Administration has strengthened the warning for canagliflozin related to the increased risk of bone fractures, and added new information about decreased bone mineral density. The agency has also said that it will evaluate the risk of bone fractures with other drugs in the sodium-glucose co-transporter-2 inhibitor class. Increases in parathyroid hormone levels and decreases in 1,25-dihydroxyvitamin D levels have been postulated as possible mechanisms. In contrast, some studies with dapagliflozin have shown no effects on bone health. Because a consensus has not been reached, we believe that an expert opinion on how to interpret the available evidence would be of great benefit for clinicians. [ABSTRACT FROM AUTHOR]

Background Context: Atlantoaxial fusion is used to correct atlantoaxial instability that is often secondary to traumatic fractures, Down syndrome, or rheumatoid arthritis. The effect of age and comorbidities on outcomes following atlantoaxial fusion is unknown.Purpose: This study aimed to better understand trends and predictors of outcomes and charges following atlantoaxial fusion and to identify confounding variables that should be included in future prospective studies.Study Design: A retrospective analysis of data from the Nationwide Inpatient Sample (NIS), a nationally representative, all-payer database of inpatient diagnoses and procedures in the United States.Patient Sample: We included all patients who underwent atlantoaxial fusion (International Classification of Disease, Ninth Revision, Clinical Modification code 81.01) between 1998 and 2011 who were 18 years or older at the time of admission.Outcome Measures: Outcome measures included in-hospital charges, hospital length of stay (LOS), in-hospital mortality, and discharge disposition.Methods: Predictors of outcome following atlantoaxial fusion were assessed using a series of univariable analyses. Those predictors with a p-value of less than .2 were included in the final multivariable models. Independent predictors of outcome were those that were significant at an alpha level of 0.05 following inclusion in the final multivariable models. Logistic regression was used to determine predictors of in-hospital mortality and discharge disposition whereas linear regression was used to determine predictors of hospital charges and LOS. Discharge weights were used to produce generalizable results.Results: From 1998 to 2011, there were 8,914 hospitalizations recorded wherein atlantoaxial fusion was performed during the inpatient hospital stay. Of these hospitalizations, 8,189 (91.9%) met inclusion criteria. Of the study sample, 62% was white, and the majority of patients were either insured by Medicare (47.2%) or had private health insurance (35.6%). The most common comorbidity as defined by the NIS and the Elixhauser comorbidity index was hypertension (43.2%). The in-hospital mortality rate for the study population was 2.7%, and the median LOS was 6.0 days. The median total charge (inflation adjusted) per hospitalization was $73,561. Of the patients, 48.9% were discharged to home. Significant predictors of in-hospital mortality included increased age, emergent or urgent admissions, weekend admissions, congestive heart failure, coagulopathy, depression, electrolyte disorder, metastatic cancer, neurologic disorder, paralysis, and non-bleeding peptic ulcer. Many of these variables were also found to be predictors of LOS, hospital charges, and discharge disposition.Conclusion: This study found that older patients and those with greater comorbidity burden had greater odds of postoperative mortality and were being discharged to another care facility, had longer hospital LOS, and incurred greater hospital charges following atlantoaxial fusion. [ABSTRACT FROM AUTHOR]

Background: Scaphoid fractures are common but may be missed on initial radiographs. Advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) have improved diagnostic accuracy, but at an increased initial cost. The purpose of this study was to evaluate the cost-effectiveness of immediate advanced imaging for suspected occult scaphoid fractures.Methods: A decision analysis model was created to evaluate three diagnostic strategies for patients with concerning history and examination but negative radiographs: (1) empiric cast immobilization with orthopaedic follow-up and repeat radiography at two weeks post-injury, (2) immediate CT scanning, or (3) immediate MRI. Prevalence of occult scaphoid fracture, sensitivity and specificity of CT and MRI, and risks and outcomes of a missed fracture were derived from published clinical trials. Costs of imaging, lost worker productivity, and surgical costs of nonunion surgery were estimated on the basis of the literature.Results: Advanced imaging was dominant over empiric cast immobilization; advanced imaging had lower costs and its health outcomes were projected to be better than those of empiric cast immobilization. MRI was slightly more cost-effective than CT on the basis of the mean published diagnostic performance, but was highly sensitive to test performance characteristics. Advanced imaging would have to increase in cost to more than $2000 or decrease in sensitivity to <25% for CT or <32% for MRI for empiric cast immobilization to be cost-effective.Conclusions: Given its relatively low cost and high diagnostic accuracy, advanced imaging for suspected scaphoid fractures in the setting of negative radiographs represents a cost-effective strategy for reducing both costs and morbidity. The decision to use CT compared with MRI is a function of individual institutional costs and local test performance characteristics. [ABSTRACT FROM AUTHOR]

The article presents research which examined the incidence of second cervical vertebral fractures among elderly patients in the U.S. from 2005 to 2008. Researchers characterized the incidence depending on several factors such as age and geographical region. According to them, the incidence has exceeded the rate forecasted in relation to changing age distribution and growth.

Abstract: Introduction: In the U.S. alone, an estimated 30,000 knee–thigh–hip (KTH) injuries occur annually in frontal motor vehicle collisions. These fractures typically occur through occupant contact with the vehicle''s knee bolster. Research has suggested that knee airbags (KABs) can mitigate the forces sustained during this contact, resulting in decreased injury risk; however, previous research has been limited by small sample sizes or by occurring in a controlled setting. The objective of the current study is to determine the effectiveness of KABs on KTH fracture risk using nationally representative, real-world data. Methods: Using combined data from the Crash Injury Research and Engineering Network and the National Automotive Sampling Survey, a matched cohort study was conducted among front-seat occupants of vehicles involved in a frontal collision occurring from 2000 to 2009. Occupants exposed to a KAB deployment were matched to occupants with no KAB deployment based on age ±5 years, sex, seatbelt use, vehicle seating position (i.e., driver or front passenger), car vehicle body type, collision impact, and sampling weight. A Cox proportional hazards model was used to calculate risk ratios (RRs) and associated 95% confidence intervals (95% CI) to estimate the association between KAB deployment and lower extremity fracture risk. Results: There was no association between KAB deployment and risk of lower extremity fracture (RR 0.83, 95% CI 0.52–1.31). A notable pattern in fracture risk, though not statistically significant, was observed, with a decreased risk of hip (RR 0.72, 95% CI 0.26–1.97) and thigh fracture (RR 0.81, 95% CI 0.32–2.05), and an increased risk of tibia/fibula (RR 1.23, 95% CI 0.52–2.90) and foot fracture (RR 1.96, 95% CI 0.72–5.32). Conclusions: The results of the current study suggest that KABs are not associated with the risk of lower extremity fractures. However, given the small sample size of the current study, it is difficult to definitively say whether the observed injury pattern is representative of the true pattern. [Copyright &y& Elsevier]

Fractures are an important public health problem affecting patients of all ages. Although most fractures heal quickly, some heal poorly and some do not heal at all. To achieve an optimal healing outcome, the standard of care for most fractures consists of reduction followed by immobilization, with a myriad of options regarding the approach to fracture-healing. Currently, biopharmaceutical companies are sponsoring research with regard to products that aim to enhance or accelerate fracture-healing; however, as there are no approved and marketed systemic therapies for fracture-healing, the development and commercialization process for such products will require close collaboration between industry, academia, and regulators to determine how to bring these products to market in the most efficient manner. The following manuscript provides a brief overview of the regulatory process in the United States for systemic therapies in fracture-healing and discusses key issues that may arise in connection with the regulatory approval of these novel investigational treatments. [ABSTRACT FROM AUTHOR]

Coracoid process fractures are rare and can be overlooked on routine radiographs due to the anatomical orientation of the CP and superimposition of adjacent bone structures. Early fracture detection reduces morbidity and allows for proper treatment. Sonography of the shoulder is usually performed for evaluation of peri-articular soft tissues. To the best of our knowledge, sonographic diagnosis of CP fracture has not been reported in the literature. We present a retrospective review of seven cases of sonographically detected coracoid fractures which were undiagnosed at previous standard radiographs. The US diagnosis was confirmed in three subjects, two with CT and in one patient with axillary view radiograph. [ABSTRACT FROM AUTHOR]

Background: There is minimal published information regarding the epidemiology of simple elbow dislocations. The purpose of this study was to report the estimated incidence of elbow dislocations in the United States, with use of the National Electronic Injury Surveillance System (NEISS) database. Methods: The NEISS database includes 102 hospitals representing a random sampling of all patients presenting to U.S. emergency departments. The database was queried for elbow dislocation events. NEISS data for 2002 through 2006 were used for raw data and weighted injury counts, Incidence rates with 95% confidence intervals (95% Cl) were calculated by age group and sex, with use of U.S. census data. Results: One thousand and sixty-six elbow dislocations were identified, representing a weighted estimate of 36,751 acute dislocations nationwide. A calculated incidence of 5.21 dislocations per 100,000 person-years (95% CI, 4.74 to 5.68) was noted. The highest incidence of elbow dislocations (43.5%) occurred in those who were ten to nineteen years old (6.87 per 100,000 person-years; 95% Cl, 5.97 to 7.76). The incidence rate ratio for the comparison of dislocations in males with those in females was 1.02 (5.26 per 100,000 for males and 5.16 per 100,000 for females). In patients ten years or older, 474 injuries (44.5% of total dislocations) were sustained in sports. Males dislocated elbows in football, wrestling, and basketball. Females sustained elbow dislocations most frequently in gymnastics and skating activities. Conclusions: The estimated incidence of elbow dislocations in the U.S. population is 5.21 per 100,000 person-years, with use of a national database. Adolescent males are at highest risk for dislocation. Nearly half of acute elbow dislocations occurred in sports, with males at highest risk with football, and females at risk with gymnastics and skating activities. [ABSTRACT FROM AUTHOR]

The article presents a case study of 15-year-old obese girl who was admitted to the hospital due to injury in her right knee after she fell over her friend's leg during play in school in the U.S. Medical examination reveals that she had posterior dislocation of her right knee and with no pulse on her extremity. To address the problem, bridging external fixator was done to stabilize the tibiofemoral joint.

Chronic kidney disease (CKD) has been recognized as a significant public health problem, with 20 million Americans, or 11% of the adult population, currently living with CKD. Life expectancy in patients with CKD is limited by the development of disturbances of mineral metabolism, which occurs in virtually all patients during the progression of their disease, and is associated with bone loss and fractures, cardiovascular disease, immune suppression, and increased mortality. As kidney disease develops, there is decreased functional renal mass and a reduction in renal 1α-hydroxylase activity and thus in renal production of calcitriol at very early CKD stages. Recently, a potentially important role of vitamin D receptor activation (VDRa) in the survival of patients undergoing dialysis has been suggested. Beyond the effect on parathyroid hormone suppression, the pleiotropic effect of vitamin D has been associated with improvement of cardiovascular risk factors, including increased renin activity, hypertension, inflammation, insulin resistance, diabetes, and albuminuria. However, the current K/DOQI and KDIGO recommendations limit the administration of VDRa agents for treatment of hyperparathyroidism only. The role of vitamin D administration in the different CKD stages will be discussed in this review. [ABSTRACT FROM AUTHOR]

The Study of Women's Health Across the Nation (SWAN) is an NIH-funded, multidisciplinary, longitudinal observational study of middle-aged U.S. women of multiple ethnicities in or near Boston, Newark, Pittsburgh, Detroit, Chicago, Oakland, and Los Angeles. SWAN measures multiple variables annually, including spine and hip areal bone mineral density (aBMD), serum and urine indices of bone remodeling, and pituitary, ovarian, and adrenal hormones. This chapter outlines the findings of the SWAN study so far. [ABSTRACT FROM AUTHOR]

Southern states have the highest age-adjusted hip fracture rates among older adults in the United States. Regional hip fracture rates in the United States in 1986–1993 correlate with death rates from rickets in the 1940s. Historical patterns of bone nutrition early in life might explain contemporary geographic patterns in bone fragility. State of residence early in life is a better predictor of the risk of hip fracture after age 65 than state of current residence. Therefore, the geography of rickets mortality in the United States before 1950 was compared with the geography of hip fracture rates among older adults in the United States during 1986–1993. Vital statistics data for the US white population for 1942–1948 allowed calculation of the ratio of deaths from rickets to live births for each geographic division of the USA. These ratios were correlated with previously published, standardized hip fracture rates among whites 65–89 years old during 1986–1993 by census division. During 1942–1948, the rickets mortality ratio among whites was 3.11 in the South, 1.91 in the Northeast, 1.75 in the Midwest, and 1.04 in the West. The correlation of mortality with risk of hip fracture was 0.71 ( p = 0.03) for both sexes combined and 0.86 ( p = 0.01) for women. Inadequate nutrition during skeletal formation early in life might explain the higher incidence of hip fracture among older adults in the South. [ABSTRACT FROM AUTHOR]

Pathologic fractures are often excluded in epidemiologic studies of osteoporosis. Using Medicare administrative data, we identified persons with vertebral and hip fractures. Among these, 48% (vertebral) and 3% (hip) of the fractures were coded as pathologic. Only 25% and 66% of persons with these pathologic fractures had evidence for malignancy. Analyses of osteoporosis-related fractures that use administrative data often exclude pathologic fractures (ICD-9 733.1x) due to concern that these are caused by cancer. We examined “pathologic” fractures of the vertebrae and hip to evaluate their contribution to fracture incidence and assessed the evidence for a malignancy. We studied US Medicare beneficiaries age ≥65 with new fractures identified using ICD-9 diagnosis codes 733.13 (pathologic vert), 805.0, 805.2, 805.4, 805.8 (nonpathologic vert); and 733.14 (pathologic hip), 820.0, 820.2, 820.8 (nonpathologic hip). We further examined the proportion of cases with a diagnosis of a malignancy proximate to the fracture. We identified 44,120 individuals with a vertebral fracture and 60,354 with a hip fracture. Approximately 48% of vertebral fractures and 3% of hip fractures were coded as pathologic. For only approximately 25% of persons with a “pathologic” vertebral fracture ICD-9 code, but 66% of persons with a “pathologic” hip fracture, there was evidence of a possible cancer diagnosis. Among US Medicare beneficiaries, one fourth of pathologic vertebral fracture and two thirds of pathologic hip fracture cases had evidence for a malignancy. Particularly for vertebral fractures, excluding persons with pathologic fractures in epidemiologic analyses that utilize administrative claims data substantially underestimates the burden of fractures due to osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Bone and soft-tissue loss are common extremity injuries sustained in current military conflicts. Selected host national patients had their definitive orthopedic care performed at our combat support hospital. Soft-tissue reconstruction can be a challenging task in this environment. There are several situations in which free or rotational flap coverage is not possible, including the presence of a single vessel limb, local muscle damage, and/or nonavailability of an experienced flap surgeon. The technique of shortening and angulation for extremity soft-tissue reconstruction is described using tools available in a theater of operations. Methods: We treated 6 limbs in 5 patients with the technique of shortening and/or angulation to obtain soft-tissue coverage for extremity war wounds at our combat support hospital. Bony stabilization was accomplished using the standard Hoffman II external fixator (Stryker Orthopedics, Mahwah, NJ). The extremities treated included: 2 humerus fractures, 3 tibia fractures, and 1 ankle fracture. Two of the patients required vascular reconstruction. Patients were followed for as long as possible given individual circumstances. Results: One patient in the series died of multiple organ system failure because of intra-abdominal injuries. Average follow-up on the remaining patients was 7.03 weeks (1 to 14 weeks). In the patient with 1-week follow-up, the skin graft had 100% take. All other wounds were healed at the latest follow-up without signs of infection. Conclusion: Shortening and/or angulation of extremities with bone and soft-tissue loss is an effective means of obtaining soft-tissue coverage in a theater of operations. [ABSTRACT FROM AUTHOR]

Abstract: According to the US Department of Health and Human Services, in 2005, an estimated 1460 children died of maltreatment. The purpose of this study is to further examine the pattern of bony injuries in child maltreatment fatalities, with an emphasis on the prevalence of antemortem fractures and the presence of associated perimortem fractures. The sample was 162 male and female children. The majority of the data were collected from the case files of the NC Child Fatality Prevention Team at the Office of the Chief Medical Examiner in Chapel Hill, North Carolina (n =152) spanning from 2000 to 2005. An additional 10 cases from 2001 to 2006 were included from the Charleston County Coroner''s Office, Charleston, SC. Six age categories were used in this study: 0–3 months, 4–6 months, 7–9 months, 10–16 months, 17 months to 2 years, and 2–6 years. Lesions were documented and categorized into four general body loci: craniofacial, thoraco/abdominal, appendicular, and multiple. The peak age categories of death were 0–3 months (25%) and 2–6 years (19%), with 50% of deaths occurring in infants 9 months old or younger. The body locus most frequently affected was craniofacial. [Copyright &y& Elsevier]

The article focuses on the challenges facing clinicians in the U.S. in managing patients who have experienced hip fractures. Despite the extent of the problem of hip fracture and their associated costs, morbidity and mortality, there is evidence to support the use of bisphosphonates in preventing such disease. However, there are also potential concern that exist about using bisphosphonates in hip fracture patients, which include the time to start for postoperative of the drug and the time of fracture healing. In addition, a forum that discusses the scope and seriousness of hip fracture is also noted.

The article presents a cross-sectional study regarding the association between resting energy expenditure (REE) and bone mineral density (BMD) among white individuals in the U.S. It reveals that fracture risks are more prone on women compared to men which are attributed to postmenopausal hormone loss in women. REE is also credited for weight gain among individuals regardless of its sex differences. It also offers the possibility of body size as one of the grounds on bone breakage. The study also provides different levels of spine bone mineral density in terms of weight and REE.

Many studies indicate racial differences in areal bone mineral density (aBMD). African-Americans tend to have the greatest aBMD, followed by Caucasian, Hispanic and Native Americans. Asian Americans, on average, have the lowest aBMD. Differences in aBMD are attenuated when adjustments are made for bone size, weight and lifestyle factors. While many studies have focused on racial differences in bone density, it is important to consider fracture risk since it is the clinically meaningful outcome and is determined by many factors other than bone density. African- and Asian-Americans have a relatively low risk of fracture compared to other groups, despite drastically different bone density, as measured by dual X-ray absorptiometry (DXA). Factors that cannot be completely evaluated by DXA, such as bone size, volumetric density, bone microarchitecture and turnover may be important in explaining disparate fracture rates. Newer technologies such as central quantitative computed tomography (CT) and high-resolution peripheral CT promise to contribute important knowledge in this regard. Despite recent advances, more fracture risk data is needed for non-Caucasian groups to assist in the development of relevant screening and treatment guidelines. [ABSTRACT FROM AUTHOR]

The article discusses the use of thiazolidinediones to treat men and women who have osteoporosis in their lifetime in the U.S. According to the authors, osteoporotic fractures are associated with significant morbidity and death. The research shows that an estimated 30 percent to 50 percent and 15 percent to 30 percent of women and men respectively will experience a fracture related to osteoporosis. The thiazolidinediones are a relatively new and effective class of oral antidiabetic that have gained wide use in clinical conditions characterized by insulin resistance. However, studies show that thiazolidinediones can reduce osteoblastic bone formation and accelerate bone loss.

This article re-evaluates the literature on vitamin D and fracture reduction, highlighting the relevance of new understandings for fracture prevention. A new set of science-based research guidelines for clinical trials on vitamin D and fracture is proposed. The existing clinical trials on vitamin D and fracture are analyzed, focusing on studies that most closely meet the proposed guidelines. An estimation of the true fracture-reduction potential of therapeutic-level vitamin D supplementation is offered. The analysis outlined in this article leads to a series of striking conclusions. First, most of the available clinical trials and meta-analyses of vitamin D and fracture underestimate the true fracture reduction potential of vitamin D. Second, achievement of vitamin D serum sufficiency levels (now set in the United States, Europe, and many other places at a minimum of 32 ng/ mL) could provide for a 50-to 60-percent fracture reduction. And third, providing for vitamin D sufficiency is the simplest, most life-supporting, and most cost effective means of significantly reducing the incidence of osteoporotic fractures worldwide. Given the urgent need, the Osteoporosis Education Project (OEP) has initiated a call for universal vitamin D repletion as the primary basis for osteoporotic fracture prevention worldwide. [ABSTRACT FROM AUTHOR]

Abstract: Paget disease of bone causes excessive osteoblastic and osteoclastic activity resulting in bone that is structurally inferior to normal bone. Paget disease of bone is the second most common bone disorder in the United States, yet it often goes unrecognized. It is often asymptomatic; therefore, treatment is often delayed until the disease is in the late stages. In the late stages of the disease, the most common presentation is bone pain. Paget disease of bone may also cause fractures, bone deformity, neurologic symptoms, and cardiovascular complications. It is diagnosed by radiographs and laboratory panels, and is treated with bisphosphonates. [Copyright &y& Elsevier]

Abstract: The International Society for Clinical Densitometry (ISCD) convenes a Position Development Conference (PDC) every 2yr to make recommendations for standards in the field of bone densitometry. The recommendations are based on clinically relevant issues in bone densitometry such as quality control, acquisition, analysis, interpretation and reporting. Topics for consideration are developed by the ISCD Board of Directors and its Scientific Advisory Committee. Clinically relevant questions related to each topic area are assigned to task forces for a comprehensive review of the medical literature and subsequent presentation of the reports to an international panel of experts. For this PDC, the Expert Panel included representatives of the American Society for Bone and Mineral Research, International Bone and Mineral Society and the National Osteoporosis Foundation. The recommendations of the PDC Expert Panel are then reviewed by the ISCD Board of Directors. Recommendations that are approved become Official Positions of the ISCD. The most recent PDC was held July 20–22, 2007, in Lansdowne, Virginia, USA. Topics considered included vertebral fracture assessment, technical and clinical issues relevant to dual-energy X-ray absorptiometry (DXA), and bone densitometry technologies other than central DXA. This report describes the methodology and the results of the Lansdowne, Virginia, USA 2007 PDC, and a summary of all ISCD Official Positions, including the ones recently adopted by this PDC and the 2007 Pediatric PDC held in Montreal, Quebec, Canada. [Copyright &y& Elsevier]

The article offers information on several research papers which are to be presented on the scheduled sessions and symposiums from 9:00am to 10:30am on March 23, 2007 in the U.S. including one is aimed at optimizing recovery post hip fracture through the Baltimore Hip Studies (BHS) in Maryland, one which manages the missing data in behavior change research related to BHS, and one which tests the effectiveness of the exercise plus program post hip fracture.

This article presents the development of an algorithm to predict the 5-year risk of hip fracture in postmenopausal women. There are 329,000 hip fractures annually in the U.S. that are associated with high morbidity, mortality and medical costs. Identification of those at the greatest risk could be a step towards prevention. Most hip fractures happen in women who are not osteoporotic as determined by bone density testing which is why the authors sought another predictive tool. They based their algorithm on 11 clinical factors and tested it. The conclusion was that the algorithm may be useful in predicting hip fractures in postmenopausal women but further studies are needed to assess the clinical implications.

The National Osteoporosis Foundation and American College of Obstetrics- Gynecology have expanded osteoporosis therapy recommendations by changing the treatment threshold. We determined the impact of this recommendation using nationally representative U.S. data. The new threshold changes the number of women for whom treatment is recommended from 6.4 million to 10.8 million among women age sixty-five and older (at a net cost of at least $28 billion) and from 1.6 million to 4.0 million among women ages 50-64 (at a net cost of at least $18 billion). Whether or not offering treatment to these additional women will reduce the number of hip fractures is unknown. [ABSTRACT FROM AUTHOR]

The article describes a novel radiographic and clinical finding of an ulnar impaction fracture, which they equate to the Hill-Sachs lesion noted in the humeral head following dislocation of the shoulder in the U.S. The case presented represents a novel mechanism for irreducibility of a so-called complex dislocation of the distal radioulnar joint. They recommend acquiring a computed tomography scan of all complex dislocations of the distal radioulnar joint to search for this impaction injury.

This study employs regression analysis to explore population and sex differences in the pattern of age-associated bone loss, as reflected by histomorphometric variables that are measures of intracortical and endocortical bone remodeling. A comparison of an African American sample from the Washington Park Cemetery in St. Louis, Missouri, and a European American rib sample composed of cadavers, autopsies, and forensic cases from Missouri reveals the existence of complex age-associated patterns for differences in measures of intracortical remodeling and cortical area. Females from the two samples express similar bone dimensions and dynamics. The African American females appear to lose more bone than their male counterparts, but this difference is absent in the European American sample. When age-associated patterns are considered, it is in the younger cohorts that African Americans exhibit greater relative cortical area than European Americans, but this is reversed in the older ages, when the latter group manifests greater bone mass. The European American males consistently differ in the slopes and intercepts for the variables compared to the other groups, and differences are highly significant with African American females, with the former group maintaining bone mass while the latter exhibit a more rapid bone loss. Achieving larger relative cortical area due to smaller endosteal area, coupled with better bone quality due to lower intracortical porosity early in life, may be a mechanism by which African Americans, especially females, maintain ad- equate bone mass in older ages, which buffers them from bone loss and related fragility fractures despite higher rates of intracortical remodeling and endosteal expansion later in life. These results suggest that both genetic and environmental factors are responsible for the differences in bone remodeling and bone mass observed between these samples. [ABSTRACT FROM AUTHOR]

Introduction: A reliable procedure for identifying persons at risk for osteoporosis and subsequent fracture is needed so that preventive measures may be initiated. Material and Methods: Participants included 7,532 women, ages 20 and older, surveyed in the National Health and Nutrition Examination Survey III (NHANES, 1988-1994). Influences of race, body composition, exercise, alcohol intake, smoking status, as well as the effect of nutritional intake of calcium, phosphorus, magnesium, iron, zinc, sodium, and potassium on bone mineral density (BMD) were assessed. Results: Advancing age, low body weight, low exercise expenditure, and smoking were significant predictors for low BMD. Nutritional variables examined were not significant in the predictive models. Conclusions: The absence of calcium from the predictive models indicates the need for re-evaluation of the current recommended intake levels of this nutrient. A greater emphasis on factors such as exercise and achieving adequate weight is recommended. Discussion: Providing women with the knowledge of their risk for low BMD may influence lifestyle behaviors, which may ultimately result in the prevention of bone injury. [ABSTRACT FROM AUTHOR]

Osteoporotic vertebral compression fractures (VCS) affect 700,000 patients per year in the United States. They had includes an annual cost of 10 billions, alone 260,000 are painful and refractory to medical therapy. The operative stabilization is rarely employed because of its significant rate of morbidity and high likelihood of instrumentation failure. Vertebroplasty and calcitonin are procedures for the treatment of intense pain caused by vertebral compression fractures. Objective. To evaluate the safety and efficiency of vertebroplasty versus calcitonin, in the treatment of painful osteoporotic vertebral compression fractures. Design. Controlled clinical trial. Material and methods. Between september 2002 and January 2004, in our institution 60 patients were randomly assigned to receive either 100 UI of calcitonin or percutaneous vertebroplasty. All had severe back pain for more than three months which did not respond to conservative treatment. Pain evaluation was performed daily using a visual analogue (VAS). Safety was determined for complications of the treatments. The pain relief, morbidity and mortality were measurements 1, 30, 60 and 90 days. Success was defined percentage reduction of pain intensity ≥ 80%. It was considered statistically significant p < 0.05. Intention-to-treat analysis and statistical model GEE was performed. Results. A total of 60 patients (54 female and 6 male), the mean age was 75.5 years (range, 55-92 yr). The duration of follow-up was 3 months. Complete assessments were performed in all patients. Both groups they had pain intensity, of EVA 8 (P5= 8 y P95 = 9). In the vertebroplasty (n = 30) group , compared with calcitonin (n = 30). Significant postprocedural improvement in the vertebroplasty group was demonstrated versus calcitonin group at 90 days (p < 0.05 pain and mobility). The adverse effects were similar for the both groups 6.6%. Conclusion. The vertebroplasty provided significant relief in a high percentaje of patients with painful osteoporotic compression fractures. Is a safe and feasible than calcitonin. [ABSTRACT FROM AUTHOR]

Most studies that have examined the role of skeletal factors in the relationship between an individual's family history of fracture or osteoporosis and their fracture risk have focused on bone density. In this study, we expanded the scope of skeletal factors to include geometric properties (subperiosteal width, section modulus, cortical thickness, and buckling ratio) in addition to areal bone mineral density (BMD). We compared these skeletal factors at the femur neck and shaft by self-reported maternal history of osteoporosis (OP HX) from 5334 non-Hispanic whites, ages > or =20 years in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94). A total of 213 men and 315 women reported a positive OP HX (e.g., their biological mother had sustained a hip fracture after age 50 years or had a physician's diagnosis of osteoporosis). Differences in bone density and geometry by OP HX were examined after adjusting for potential confounding variables. Several bone parameters differed significantly by OP HX in both sexes at the femur neck, but none differed at the femur shaft. At the neck, those with a positive OP HX had values that differed by approximately 3% to 4% (lower for BMD, bone mineral content (BMC), cross-sectional area, and cortical thickness; higher for buckling ratios) from those with a negative OP HX (P < 0.05). The magnitude of these relationships was similar in both sexes, but differences were greater in younger versus older adults. In conclusion, both men and women with a positive maternal history of osteoporosis may be at greater risk of femur neck fracture owing to thinner cortices and lower BMC, which in turn results in potentially greater cortical instability (buckling ratio) at this skeletal site. [ABSTRACT FROM AUTHOR]

Osteoporosis is a crippling condition that often results in premature mortality ana significant morbidity that is manifested in the form of fractures, bone deformity, and pain. Osteoporosis is a serious public health problem that affects 25 million people in the United States, 80% of whom are women. National health objectives indicate an urgent need to reduce deaths due to falls, reduce the incidence of hip fractures, and increase the number of women educated about Osteoporosis. Strategies for preventing osteoporosts include maximizing peak bone mass and minimizing bone losses through health education and health promotion programs. This study describes the process evaluation of an Osteoporosis Prevention Program for middle-aged women utilizing the Health Belief Model and provides recommendations for future programs. [ABSTRACT FROM AUTHOR]

Presents a case report of multiple myeloma with a pathologic fracture during pregnancy in the U.S. Production of lytic bone lesions throughout the skeleton as the result of a monoclonal proliferation of plasma cells that invade the medullary space and activate osteoclasts; Consideration of bone pain as the most common symptom of myeloma; Clinical manifestations of the disease.

More than 260,000 total joint replacements are performed every year in the United States. The University of New Mexico Hospital is a publicly held hospital that provides healthcare to many patients who are uninsured and indigent. More than 200 joint replacement surgeries are performed every year at University Hospital, Albuquerque, NM, resulting in an average length of stay of 5.7 days and other patient outcomes. The average cost ranges from $18,000 to $22,000 per procedure, with a reimbursement rate of 61%. Nursing care of these patients can be a challenge and an orthopaedic nurse case manager can effect positive patient outcomes. [ABSTRACT FROM AUTHOR]

: Background contextVertebral compression fractures (VCFs) are a common clinical problem and may follow trauma or be pathological. Osteoporosis increases susceptibility to fracture by reducing bone mass and weakening bone architecture. Approximately 2.5 million osteoporotic fractures occur worldwide annually, usually involving the vertebrae, wrist and hip. In the United States 700,000 VCFs occur annually, causing significant morbidity, mortality and economic burden. An initial VCF often leads to subsequent VCFs. The strain distribution along the anterior cortex, the major load-bearing pathway in flexion, may be predictive of impending VCF. Regions of high strain distribution are likely to experience secondary fracture.: PurposeTo investigate the distribution of anterior cortical strain at, above and below an experimentally created index VCF to determine the vertebral body at risk of secondary fracture.: Study designIn vitro experimental study using cadaveric thoracic spinal segments.: MethodsSeventeen thoracic spines underwent dual-energy X-ray absorptiometry (DEXA) to assess bone mineral density and were divided into T1–T3 (Subsegment 1), T4–T6 (Subsegment 2), T7–T9 (Subsegment 3) and T10–T12 (Subsegment 4). Rectangular rosette strain gauges were applied to the anterior cortices of the vertebrae of each subsegment (vertebrae in each specimen were denoted V1-superior, V2-intermediate and V3-inferior). V1 and V3 were partially embedded into polyester resin blocks, which were used to mount the specimens in a materials testing machine. Nondestructive predefect testing was performed in compression at 125 N and 250 N, followed by flexion at 1.25 Nm and 2.5 Nm. To ensure fracture reproducibility, V2 of each specimen had a trabecular defect created to a volume of 21.3±4.4% of the V2 centrum. Postdefect nondestructive compression and flexion were then performed in a manner similar to the predefect tests, followed by destructive testing in flexion. Anterior cortical shear strain on V1, V2 and V3, applied moments and applied flexion angle were all measured and analyzed.: ResultsA VCF occurred in 55 of the 59 subsegments. Fifty-one VCF (93%) were seen in V2 and 4 VCF (7%) were seen in V1. After the creation of the trabecular defect, the shear strain on V2 increased, but a comparison of the postdefect with the predefect nondestructive tests showed no significant differences. The pre- and postdefect shear strain distribution in compression and flexion was V1strain > V3strain > V2strain. Shear strain at failure was highest on V2, and in all subsegments there were significant differences between V2 and V3 (p<.05). In all subsegments there were no significant differences between V2 and V1 (p > .05) at failure with the exception of Subsegment 1 where V2 and V1 were significantly different (p<.05). The predominant strain pattern at failure was V2strain > V1strain > V3strain (V2strain≫V3strain). Using shear strain as the codeterminant of peak moment with bending stiffness and applied angle at failure, the strain on V1 was the greatest predictor (p = .0084; R2 = 0.78). These findings suggest that the events leading to a secondary fracture probably start before the index VCF occurs and continue with loading beyond the index VCF.: ConclusionAnterior cortical strain is concentrated at the apex of a thoracic kyphotic curve. The vertebral body immediately above the index VCF has the next highest amount of strain and therefore the highest risk of secondary fracture. [Copyright &y& Elsevier]

Osteoporosis affects nearly 28 million elderly Americans. Its major clinical manifestation is fragility fractures of the spine, hip, and distal radius. Low bone mass is the most important risk factor for a fragility fracture. In 1994, the World Health Organization defined osteoporosis on the basis of a bone mineral density that is 2.5 standard deviations below that in peak young normal persons. Three common imaging modalities used to assess bone strength are dual-energy x-ray absorptiometry, quantitative computed tomography, and calcaneal ultrasonography. The first two modalities measure bone mineral density in both the lumbar spine and peripheral sites. It is thought that calcaneal ultrasonography measures bone architecture and density. Unlike the other studies, ultrasonography currently cannot be used for monitoring skeletal changes over time or evaluating response to therapy.. [ABSTRACT FROM AUTHOR]

The article reports on treatment of Postmenopausal Osteoporosis. It states that in the United States, osteoporotic fractures account for more than 400,000 hospital admissions and an estimated 13.8 billion U.S. dollar in health care costs each year. Thus, the use of alendronate for the treatment of postmenopausal osteoporosis has been evaluated in several clinical trials. There are three groups of data that bear on the issue of the efficacy of alendronate treatment in increasing bone mineral density and decreasing fracture risk.

The epidemiology of fractures among 553 residents of an intermediate care facility for persons with mental retardation was examined. In a 10-month period, 61 fractures occurred among 55 residents; application of fracture rates in the United States revealed an expected number of 15 fractures among the 553 residents, p < .001. Although 52% of fractures involved small bones of the hands and feet, elderly residents were more likely to fracture major bones and to suffer their fractures from a fall than were younger residents. The relationship between potential risk factors and fracture risk were examined and implications for preventive and rehabilitative measures discussed. [ABSTRACT FROM AUTHOR]

In this article, the author discusses the prevalence of vertebroplasty in the U.S. in 2009. He reports that there are approximately 1.4 million individuals with vertebral compression fractures worldwide, wherein approximately 750,000 are from the U.S. He also talks about the impact of compassionate care and tincture of time on treating vertebroplasty.

Abstract: This study compared the data on mandibular fractures that occurred in a city in the United States and one in Turkey between 1991 and 2000. The 210 Turkish patients had 252 mandibular fractures, whereas the 665 US patients had 1042 mandibular fractures. Males accounted for 84% (560 patients) and females for 16% (105 patients) of the cases in the US. The male:female ratio was 5.5:1. In Turkey, males accounted for 76% (160 patients) and females for 24% (50 patients) of cases. The male:female ratio was 3.2:1. Assault (53.7%) was the most common cause of fracture in the US, whereas in Turkey the most common cause was a motor vehicle accident (36.2%). The most common site of mandibular fracture in the US was the angle (27.57%); in Turkey the most common site was the body (28.97%). Many of these variations may be related to socioeconomic, cultural and environmental differences between the two countries. [Copyright &y& Elsevier]

Data were obtained from the Health Care Financing Administration and the Department of Veterans Affairs (formerly called Veterans Administration) on all hospital discharges among the elderly population from 1984 through 1987 and combined with census estimates to calculate incidence rates of hip fracture for the elderly population of the United States. Rates for White women were the highest, reaching 35.4 per 1,000 per year among 95 year-olds, Comparably, White men, Black women, and Black men experienced similar age-related increases in risk, although of less magnitude and relatively less rate of change, respectively. [ABSTRACT FROM AUTHOR]

Abstract: Geographic variations in hip fracture rates across the nine US Census Divisions were examined using data for elderly Whites from the 1979-85 National Hospital Discharge Survey. Rates varied considerably and were highest in the West North Central Division where rates for females were 50 percent higher than the US rate. Reasons for the geographic variations in hip fracture rates are unknown but do not appear to be closely related to latitude or fall-related deaths. [ABSTRACT FROM AUTHOR]