Database : MEDLINE
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[PMID]: 29511368
[Au] Autor:Fisher A; Fisher L; Srikusalanukul W; Smith PN
[Ad] Address:Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT Health, Canberra, Australia.
[Ti] Title:Bone Turnover Status: Classification Model and Clinical Implications.
[So] Source:Int J Med Sci;15(4):323-338, 2018.
[Is] ISSN:1449-1907
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:To develop a practical model for classification bone turnover status and evaluate its clinical usefulness. Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures. Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 µg/L, bCTX≤0.250 µg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 µg/L), normal bone resorption (bCTX≤0.250 µg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX<100.0 (subtype 2B); 3- low bone formation, high bone resorption (bCTX>0.250 µg/L) and P1NP/bCTX<100.0; 4- high bone turnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX<100.0 (subtype 4B). Compared to subtypes 1 and 2A, subtype 2B was strongly associated with nonvertebral fractures (odds ratio [OR] 2.0), especially HF (OR 3.2), age>75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days. We proposed a classification model of bone turnover status and demonstrated that in orthogeriatric patients altered subtypes are closely related to presence of nonvertebral fractures, comorbidities and poorer in-hospital outcomes. However, further research is needed to establish optimal cut points of various biomarkers and improve the classification model.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Process
[do] DOI:10.7150/ijms.22747

  2 / 31127 MEDLINE  
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[PMID]: 29471156
[Au] Autor:Ma JX; Kuang MJ; Xing F; Zhao YL; Chen HT; Zhang LK; Fan ZR; Han C; Ma XL
[Ad] Address:Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China; Tianjin Hospital, Tianjin University, Tianjin, 300211, People's Republic of China. Electronic address: mjx969@163.com.
[Ti] Title:Sliding hip screw versus cannulated cancellous screws for fixation of femoral neck fracture in adults: A systematic review.
[So] Source:Int J Surg;52:89-97, 2018 Feb 20.
[Is] ISSN:1743-9159
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Femoral neck fracture is considered a difficult fracture to treat and often gives rise to unsatisfactory treatment results. Cannulated cancellous screws (CCS) or a sliding hip screw (SHS) are the mainstream internal fixations used for osteosynthesis of femoral neck fractures. There is a need to integrate existing data through a meta-analysis to investigate the safety and effectiveness of CCS and SHS in the treatment of femoral neck fractures. METHOD: According to the Cochrane Handbook for Systematic Reviews of Interventions, we screened for the relevant studies by searching Google Scholar, the Cochrane Controlled Trials Register, the Cochrane Library, Web of Science, EMBASE, and PubMed. The PICOS criteria was used to make sure the included studies fulfilled the inclusion criteria. RESULTS: Pooled data showed that there were no significant differences between the SHS and CCS groups for the Harris Hip Score. Significant differences were found between the SHS and CCS groups in terms of union time, postoperative complications, blood loss, operation time, incision length and length of hospital stay. CONCLUSIONS: Although the SHS and CCS groups showed similar functional recovery in treatment of femoral neck fracture in terms of the Harris Hip Score, the SHS group showed fewer postoperative complications and faster union time for patients with femoral neck fractures. Therefore, compared with CCS, the use of SHS may be a more effective treatment of femoral neck fractures.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  3 / 31127 MEDLINE  
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[PMID]: 29462672
[Au] Autor:Oshagbemi OA; Burden AM; Shudofsky KN; Driessen JHM; Vestergaard P; Krings A; Franssen FME; van den Bergh J; de Vries F
[Ad] Address:Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands; Care and Public Health Research Institute (CAPHR
[Ti] Title:Use of high-dose intermittent systemic glucocorticoids and the risk of fracture in patients with chronic obstructive pulmonary disease.
[So] Source:Bone;110:238-243, 2018 Feb 17.
[Is] ISSN:1873-2763
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is characterised by persistent airflow obstruction and respiratory symptoms. While short course systemic GCs are prescribed in patients with acute COPD exacerbations, little is known of the risk of fractures with intermittent exposure to high-dose GC and the effect of proxies of disease severity. METHODS: A case-control study was conducted using the Danish National Hospital Discharge Registry (NHDR) between January 1996 to December 2011. Conditional logistics regression models were used to derive adjusted odds ratios (OR) risk of fractures in subjects with COPD stratified by intermittent high-dose, and proxies of disease severity. RESULT: A total of 635,536 cases and the same number of controls were identified (mean age 67.5±13.8, 65% female). COPD patients with intermittent use of high average daily dose oral glucocorticoids did not have an increased risk of any, osteoporotic, hip or clinically symptomatic vertebral fracture compared to non-COPD patients (adj. OR 0.65; 95% CI: 0.50-0.86, 0.70; 95% CI: 0.70-0.99, 1.17; 95% CI: 0.59-2.32, 1.98; 95% CI: 0.59-6.65 respectively). We identified an elevated risk of osteoporotic fracture among patients who visited the emergency unit (adj. OR 1.47; 95% CI 1.20-1.79) or were hospitalised in the past year for COPD (adj. OR 1.76; 95% CI 1.66-1.85). Current GC use among COPD patients was associated with an increased risk of osteoporotic, hip and clinically symptomatic vertebral fractures compared to patients without COPD. CONCLUSION: Intermittent high-dose GCs was not associated with an increased risk of any, osteoporotic, hip or clinically symptomatic vertebral fractures in patients with COPD. Current GC use was however associated with an increased risk of hip and clinically symptomatic vertebral fractures. Therefore, emphasis on prophylactic treatment of fractures may not be essential in patients with COPD receiving intermittent dose of GCs, whereas this should be considered for high-dose long-term users with advanced COPD disease stage, postmenopausal women and men over 40years.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  4 / 31127 MEDLINE  
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[PMID]: 29428552
[Au] Autor:De Luna G; Ranque B; Courbebaisse M; Ribeil JA; Khimoud D; Dupeux S; Silvera J; Offredo L; Pouchot J; Arlet JB
[Ad] Address:Internal Medicine Department, Sickle Cell Referral Center, Georges Pompidou European Hospital, AP-HP, Paris, France; Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité, Paris, France. Electronic address: gonzalo.deluna@aphp.fr.
[Ti] Title:High bone mineral density in sickle cell disease: Prevalence and characteristics.
[So] Source:Bone;110:199-203, 2018 Feb 08.
[Is] ISSN:1873-2763
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Osteosclerosis (OSC) is a rarely studied complication of sickle cell disease (SCD). The objective of our study was to determine the prevalence and characteristics of high bone mineral density (BMD) and its radiological features in adult SCD patients. METHODS: This prospective observational study was conducted from May 2007 to May 2016 in consecutive patients with steady-state SCD at two university hospitals. The BMD of the lumbar spine (L1-L4) and right femoral neck was determined by dual energy X-ray absorptiometry. Clinical, laboratory and radiographic data were recorded. High BMD was defined as a BMD Z-score of at least +2.5 standard deviations at the lumbar spine or hip. The characteristics of the patients with high BMD were compared to those of individuals with low or middle BMD, using multivariate ordinal logistic regression. RESULTS: 135 patients (86 women and 49 men) with a median age of 27 (IQR 23-33) years were included. High BMD was diagnosed in 20 (15%) patients with a median age of 33.5 (IQR 28-45) years. The SCD genotypes of these patients were SS in 11, SC in 5, S/beta+ in 3, and S/beta0 in 1. High BMD patients more frequently harbored the S/beta SCD genotype (21% vs 5% in non-high BMD patients; p=0.047) and were older (p=0.0007). Compared to patients with low or middle BMD, after adjustment for age and SCD genotype, high BMD patients had a higher prevalence of avascular necrosis history (p=0.009), higher BMI (p=0.007), and lower serum resorption marker CTX (p=0.04), bilirubin (p=0.02) and parathyroid hormone levels (p=0.02). There were no differences between groups regarding fracture history, H-shaped vertebrae or other biological variables. CONCLUSION: High-BMD values is a common manifestation in SCD patients, especially in those with the S/beta-thalassemia genotypes. The prevalence of high-BMD in SCD is associated with older age, suggesting that it will be more common in the future because the life span of patients with SCD is increasing thanks to significant progress in SCD treatment.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  5 / 31127 MEDLINE  
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[PMID]: 29427750
[Au] Autor:Yin H; Pan Z; Jiang H
[Ad] Address:Department of Orthopaedics, The Third Affiliated Hospital of AnHui Medical University, China. Electronic address: helloyh2008@126.com.
[Ti] Title:Is dynamic locking plate(Targon FN) a better choice for treating of intracapsular hip fracture? A meta-analysis.
[So] Source:Int J Surg;52:30-34, 2018 Feb 07.
[Is] ISSN:1743-9159
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:PURPOSE: The aim of this study was to assess the outcomes of dynamic locking plate (Targon FN) and other alternative implant (cannulated cancellous screws or sliding hip screw) for treating of intracapsular hip fracture. METHODS: Relevant clinical trials on the dynamic locking plate and alternative implant treatment for intracapsular hip fracture were retrieved through searching the databases, PubMed, Embase and the Cochrane Central Register of Controlled Trials up to August 2017. Studies that investigated the comparing effectiveness or complications between both groups and provided sufficient data of interest were included in this meta-analysis. RESULTS: Four studies involving 385 intracapsular hip fractures were included. The differences in nonunion [odds ratio (OR) 0.16,95% confidence interval (CI) 0.05-0.49], revision (OR 0.56, 95%CI 0.32-0.96) and replacement rate (OR 0.26, 95%CI 0.10-0.69) were statistically significant between dynamic locking plate and alternative implant group. There was no statistically significant difference in osteonecrosis (OR1.73, 95%CI0.59-5.02), cut-out (OR0.89,95%CI0.23-3.46)and non orthopaedics complication rate (OR0.73, 95% CI 0.38-1.41). CONCLUSIONS: The available evidence indicate that dynamic locking plate offers a superior outcome in comparison with alternative implants and reduces the nonunion, revision and replacement rates for treating intracapsular hip fractures, but does not affect the osteonecrosis, cutout and non-orthopadeics complication rate. Decisions should be made in accordance with specific conditions for clinical application.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  6 / 31127 MEDLINE  
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[PMID]: 29204597
[Au] Autor:Ravi B; Pincus D; Wasserstein D; Govindarajan A; Huang A; Austin PC; Jenkinson R; Henry PDG; Paterson JM; Kreder HJ
[Ad] Address:Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
[Ti] Title:Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery: A Population-Based, Matched Cohort Study.
[So] Source:JAMA Intern Med;178(1):75-83, 2018 Jan 01.
[Is] ISSN:2168-6114
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time. Objective: To determine if overlapping surgery is associated with greater risk for complications following surgical treatment for hip fracture and arthritis. Design, Setting, and Participants: This was a retrospective population-based cohort study in Ontario, Canada (population, 13.6 million), for the years 2009 to 2014. There was 1 year of follow-up. This study encompassed 2 large cohorts. The "hip fracture" cohort captured all persons older than 60 years who underwent surgery for a hip fracture during the study period. The "total hip arthroplasty" (THA) cohort captured all primary elective THA recipients for arthritis during the study period. We matched overlapping and nonoverlapping hip fractures by patient age, patient sex, surgical procedure (for the hip fracture cohort), primary surgeon, and hospital. Exposures: Procedures were identified as overlapping if they overlapped with another surgical procedure performed by the same primary attending surgeon by more than 30 minutes. Main Outcomes and Measures: Complication (infection, revision, dislocation) within 1 year. Results: There were 38 008 hip fractures, and of those, 960 (2.5%) were overlapping (mean age of patients, 66 years [interquartile range, 57-74 years]; 503 [52.4%] were female). There were 52 869 THAs and of those, 1560 (3.0%) overlapping (mean age, 84 years [interquartile range, 77-89 years]; 1293 [82.9%] were female). After matching, overlapping hip fracture procedures had a greater risk for a complication (hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = .001), as did overlapping THA procedures (HR, 1.79; 95% CI, 1.02-3.14; P = .04). Among overlapping hip fracture operations, increasing duration of operative overlap was associated with increasing risk for complications (adjusted odds ratio, 1.07 per 10-minute increase in overlap; P = .009). Conclusions and Relevance: Overlapping surgery was relatively rare but was associated with an increased risk for surgical complications. Furthermore, increasing duration of operative overlap was associated with an increasing risk for complications. These findings support the notion that overlapping provision of surgery should be part of the informed consent process.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review
[do] DOI:10.1001/jamainternmed.2017.6835

  7 / 31127 MEDLINE  
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[PMID]: 29523987
[Au] Autor:Tarantino U; Piscitelli P; Feola M; Neglia C; Rao C; Gimigliano F; Iolascon G
[Ad] Address:Division of Orthopaedics and Traumatology, University of Tor Vergata, Rome, Italy.
[Ti] Title:Decreasing trend of hip fractures incidence in Italy between 2007 and 2014: epidemiological changes due to population aging.
[So] Source:Arch Osteoporos;13(1):23, 2018 Mar 09.
[Is] ISSN:1862-3514
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:We analyzed hospitalization for hip fractures in elderly Italian people from 2007 to 2014. The number of fractures increased by 5.50% (women + 3.36; men + 12.9%) only due to people aged ≥ 85 years old. Incidence rates per 10,000 inhabitants decreased in all the age groups (65-74, 75-84, and also ≥ 85). PURPOSE: To assess the burden of hip fractures in elderly Italian population moving from our previous researches documented a reduced incidence of hip fractures in Italian women aged 65-74 years old. METHODS: We analyzed national hospitalization records from 2007 to 2014 to compute age- and sex-specific rates at national and regional level. RESULTS: Seven hundred forty-one thousand six hundred thirty-three a total of 741,633 hospitalizations were observed in people ≥ 65 (women 568,203; men 173,430), with an overall increase of 5.50% over the 8-year period (females + 3.36; males + 12.9%). About 43.75% of total hip fractures were suffered by patients aged ≥ 85 years old. Women aged ≥ 85 accounted for 34.49% (n = 255,763) of total fractures. The incidence rate per 10,000 inhabitants in people aged 65-74 decreased from 28.65 to 25.31 in women (- 13.02%) and from 13.41 to 11.65 in men (- 13.12%). Incidence per 10,000 in people 75-84 decreased from 121.6 to 105.2 in women (- 13.49%) and from 55.8 to 47.5 in men (- 14.87%). Also, in people aged ≥ 85, the incidence per 10,000 declined from 300.99 to 268.72 in women (- 10.72%) and from 174.59 to 171.17 in men (- 1.96%). Standardized rates (SR) per 10,000 in the overall population aged 65 years old and over decreased between 2007 and 2014 from 22.9 to 20.1 and from 7.0 to 6.3 in women and men, respectively. Decreasing trends were documented in all Italian regions between 65 and 79 years old, with further reduction up to 84 years old in 16 regions out of 20. Region Lazio showed a decreasing trend also in people aged > 85 years old. CONCLUSION: While the number of hospitalizations for hip fractures in Italy is still increasing due to the fractures occurring in people ≥ 85 years old, incidence rates are decreasing in all the age groups, including the oldest one, possibly because the number of subjects aged ≥ 85 is growing faster than the number of fractures.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1007/s11657-018-0423-y

  8 / 31127 MEDLINE  
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[PMID]: 29435849
[Au] Autor:Deeks ED
[Ad] Address:Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand. demail@springer.com.
[Ti] Title:Denosumab: A Review in Postmenopausal Osteoporosis.
[So] Source:Drugs Aging;35(2):163-173, 2018 Feb.
[Is] ISSN:1179-1969
[Cp] Country of publication:New Zealand
[La] Language:eng
[Ab] Abstract:Denosumab (Prolia ; Pralia ) is a human monoclonal antibody targeting the key bone resorption mediator RANKL. The drug is administered via subcutaneous injection once every 6 months and is approved for various indications, including the treatment of postmenopausal (PM) women with osteoporosis at increased/high risk of fracture or failure/intolerance of other osteoporosis therapies (indications featured in this review). Denosumab showed benefit in several phase 3 or 4 studies in PM women with osteoporosis or low bone mineral density (BMD), including the pivotal 3-year double-blind FREEDOM trial and its 7-year open-label extension. Denosumab reduced the risk of vertebral, nonvertebral and hip fractures and increased BMD across skeletal sites versus placebo in FREEDOM, with these benefits maintained over up to 10 years' therapy in the extension. The drug was also more effective in improving BMD than bisphosphonates, including in women switched from a bisphosphonate regimen, in 1-year trials; however, whether these differences translate into differences in anti-fracture efficacy is unclear. Denosumab was generally well tolerated over up to 10 years' treatment, although an increased risk of multiple vertebral fractures was observed after discontinuation of the drug. Thus, denosumab is a key treatment option for PM women with osteoporosis who have an increased/high risk of fracture or failure/intolerance of other osteoporosis therapies, although the potential for multiple vertebral fractures to occur after discontinuation of the drug requires consideration of subsequent management options.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1007/s40266-018-0525-7

  9 / 31127 MEDLINE  
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[PMID]: 29220072
[Au] Autor:Harvey NC; Odén A; Orwoll E; Lapidus J; Kwok T; Karlsson MK; Rosengren BE; Ljunggren Ö; Cooper C; McCloskey E; Kanis JA; Ohlsson C; Mellström D; Johansson H
[Ad] Address:MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
[Ti] Title:Falls Predict Fractures Independently of FRAX Probability: A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study.
[So] Source:J Bone Miner Res;33(3):510-516, 2018 Mar.
[Is] ISSN:1523-4681
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Although prior falls are a well-established predictor of future fracture, there is currently limited evidence regarding the specific value of falls history in fracture risk assessment relative to that of other clinical risk factors and bone mineral density (BMD) measurement. We therefore investigated, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether past falls predicted future fracture independently of FRAX and whether these associations varied with age and follow-up time. Elderly men were recruited from MrOS Sweden, Hong Kong, and USA. Baseline data included falls history (over the preceding 12 months), clinical risk factors, BMD at femoral neck, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the associations between falls, FRAX probability, and incident fracture, adjusting for age, time since baseline, and cohort in base models; further models were used to investigate interactions with age and follow-up time. Random-effects meta-analysis was used to synthesize the individual country associations. Information on falls and FRAX probability was available for 4365 men in USA (mean age 73.5 years; mean follow-up 10.8 years), 1823 men in Sweden (mean age 75.4 years; mean follow-up 8.7 years), and 1669 men in Hong Kong (mean age 72.4 years; mean follow-up 9.8 years). Rates of past falls were similar at 20%, 16%, and 15%, respectively. Across all cohorts, past falls predicted incident fracture at any site (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 1.49, 1.90), major osteoporotic fracture (MOF) (HR = 1.56; 95% CI 1.33, 1.83), and hip fracture (HR = 1.61; 95% CI 1.27, 2.05). Relationships between past falls and incident fracture remained robust after adjustment for FRAX probability: adjusted HR (95% CI) any fracture: 1.63 (1.45, 1.83); MOF: 1.51 (1.32, 1.73); and hip: 1.54 (1.21, 1.95). In conclusion, past falls predicted incident fracture independently of FRAX probability, confirming the potential value of falls history in fracture risk assessment. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1002/jbmr.3331

  10 / 31127 MEDLINE  
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[PMID]: 29521686
[Au] Autor:Teo T; Schaeffer E; Cooper A; Mulpuri K
[Ad] Address:Department of Orthopaedic Surgery, British Columbia Children's Hospital.
[Ti] Title:Do immediate postoperative radiographs change patient management after fracture fixation? A systematic review.
[So] Source:J Orthop Trauma;, 2018 Feb 20.
[Is] ISSN:1531-2291
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: To evaluate whether immediate (0-3 day) postoperative radiography leads to alterations in management for patients post-fracture fixation. DATA SOURCES: Systematic review of English-language articles in the MEDLINE (1946-2016), EMBASE (1974-2016), CDSR (2005-2016), CENTRAL (1948-2016) and Google Scholar databases using PRISMA guidelines. STUDY SELECTION: Randomized or non-randomized controlled trials and prospective or retrospective cohort studies that addressed surgical management of upper extremity, lower extremity or hip fractures were eligible for review. All included studies needed to have performed radiography within 0-3 days of surgery and reported any directly resulting management changes. DATA EXTRACTION: Data were independently extracted by two reviewers using a standardized data collection form with predefined data fields for demographics, interventions, study methods, complications and management outcomes. DATA SYNTHESIS: A random-effects model was applied and pooled effects for absolute benefit increase (ABI) and number needed to treat (NNT) were calculated. CONCLUSIONS: Combining the 11/12 articles that reported by patient numbers, the absolute benefit increase (ABI) of immediate postoperative radiography for management change was 0.13% (95% CI: 0.00078-0.60%; NNT = 753). The ABI for identification of complications was 0.22% (95% CI: 0.0015-1.24%; NNT = 453). Current literature suggests that immediate postoperative radiography does not lead to management change in the majority of patients post-fracture fixation. More comprehensive reporting, along with further prospective comparative research, is encouraged. LEVEL OF EVIDENCE: Diagnostic Level III.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1097/BOT.0000000000001152


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