Objective： To observe the clinical results of proximal femoral nail anti-rotation （PFNA） combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly. Methods...Objective： To observe the clinical results of proximal femoral nail anti-rotation （PFNA） combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly. Methods： 60 elderly patients with osteoporotic intertrochanteric fractures were diagnosed using a dual energy X-ray bone density instrument. Patients were randomly divided into treatment or control groups （30 cases in each group）. Patients in both groups were treated by closed/open reduction and internal fixation using PFNA. In the treatment group, patients received one zoledronic phosphonic acid injection of 5 mg/100 ml via intravenous drip, in addition to 600 mg of Cakrate D （qd） and 0.25 μg of alpha ossification alcohol （qd）. The control group received 600 mg of Caltrate D （qd） and 0.25 μg of alpha ossification alcohol （qd）. The oral drugs were administered for 12 months. Bone pain relief was observed, and changes in the bone mineral density （BMD） of the lumbar and health-side hip were recorded. Clinical results were evaluated using the Visual Analogue Scale （VAS）, Harris joint function score, and Osteo- porosis Quality of Life Scale （OQOLS）. Results： Compared with the control group, bone pain symptoms wene significantly alleviated （p 〈 0.05） in the treatment group. In the treatment and control groups, both between-group and within-group differences in BMD were significantly increased in L1-4, femoral neck and trochanter （p 〈 0.05）. No significant differences were found between the two groups in regard to the involved hip or the total rate of improvement at the end of the follow-up period, although cases in the treatment group had higher OQOLS scores than those of the controls （p = 0.04）. Cases in the treatment group healed more quickly than those in the control group [（13 ± 3.2） weeks vs （15 ± 4.6） weeks, p = 0.02]. During the follow^up period, cases in the treatment group had no new fractures, whereas 2 new cases of hip fracture and 2 cases of distal radial fractures were observed among the controls. Conclusion： Zoledronic acid injection combined with PFNA is a favorable treatment option for the elderly patients with osteoporotic intertrochanteric fracture. It can effectivelly relieve bone pain, increase bone density, improve quality of life, reduce the occurrence of new fractures and promote fracture healing.展开更多
Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are un...Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a coi＇nbination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.展开更多
Background： Antihypertensive drugs have been linked to new-onset osteoporotic fracture （NOF）, and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effe...Background： Antihypertensive drugs have been linked to new-onset osteoporotic fracture （NOF）, and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effect of different antihypertensive drugs on the development of NOF in the elderly has not been well studied during long-term follow-up. Methods： In this study, we investigated the association between different classic antihypertensives and the development of NOF in the elderly. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance in Central Taiwan, China including case patients with NOF aged 65–80 years from January 2002 to December 2012 and non-NOF controls. Prescriptions for antihypertensives before the index date were retrieved from a prescription database. We estimated the hazard ratios （HR s） of NOF associated with antihypertensive use. Non-NOF controls served as the reference group. Results： A total of 128 patients with NOF were identified from among 1144 patients with hypertension during the study period. The risk of NOF after adjusting age, sex, comorbidities, and concurrent medications was higher among the users of angiotensin-converting enzyme （ACE） inhibitors （HR, 1.64; 95% confidence interval [CI], 1.01–2.66） than among nonusers. Patients who took calcium channel blockers （CCBs） （HR, 0.70; 95% CI, 0.49–0.99） were at a lower risk of developing NOF than nonusers. Loop diuretics, thiazide diuretics, angiotensin receptor blocker, beta-blocker, and alpha-blocker were not associated with the risk of NOF. Conclusions： Elderly with hypertension who take CCBs are at a lower risk of NOF and that the use of ACE inhibitors was associated with a significantly increased risk of developing NOF during the 11-year follow-up.展开更多
Background Colles’ fracture usually associated with osteoporosis is regarded as the predictor of subsequent osteoporotic fracture. However, it is not clear how the local changes of bone mass take place during the cou...Background Colles’ fracture usually associated with osteoporosis is regarded as the predictor of subsequent osteoporotic fracture. However, it is not clear how the local changes of bone mass take place during the course of treatment and whether the changes are related to clinical practice. The objective of the current study was to investigate the local changes of bone mass in patients with Colles’ fractur e and their possible clinical relevance in a follow-up study.Methods The radiograms of the second metacarpal in 64 patients with Colles’ fracture were assessed for bone density immediately after fracture, 6 weeks, 6 months and 1 year after fracture, respectively. Functional results were evaluated at one year.Results Bone mass six weeks after Colles’ fracture was signifi cantly decreased without returning to normal at one year though increased bone mass had been identified 6 months after fracture (P< 0.05), (P< 0.01). At one year significant (P< 0.05) or highly significant (P< 0.01) correlations were observed between bo ne mass indices of metacarpal and functional results, indicating that poor function is associated with lower bone density. Significant differences (P< 0.05) between fracture patterns also suggested that patients with more severe fractures have a more pronounced bone loss.Conclusions Bone loss during the course of treatment will have a direct effect upon the prognosis, so different treatment should be proposed for different patterns of fractures. Active exercise should be made to improve the recovery of bone mass.展开更多
文摘Objective： To observe the clinical results of proximal femoral nail anti-rotation （PFNA） combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly. Methods： 60 elderly patients with osteoporotic intertrochanteric fractures were diagnosed using a dual energy X-ray bone density instrument. Patients were randomly divided into treatment or control groups （30 cases in each group）. Patients in both groups were treated by closed/open reduction and internal fixation using PFNA. In the treatment group, patients received one zoledronic phosphonic acid injection of 5 mg/100 ml via intravenous drip, in addition to 600 mg of Cakrate D （qd） and 0.25 μg of alpha ossification alcohol （qd）. The control group received 600 mg of Caltrate D （qd） and 0.25 μg of alpha ossification alcohol （qd）. The oral drugs were administered for 12 months. Bone pain relief was observed, and changes in the bone mineral density （BMD） of the lumbar and health-side hip were recorded. Clinical results were evaluated using the Visual Analogue Scale （VAS）, Harris joint function score, and Osteo- porosis Quality of Life Scale （OQOLS）. Results： Compared with the control group, bone pain symptoms wene significantly alleviated （p 〈 0.05） in the treatment group. In the treatment and control groups, both between-group and within-group differences in BMD were significantly increased in L1-4, femoral neck and trochanter （p 〈 0.05）. No significant differences were found between the two groups in regard to the involved hip or the total rate of improvement at the end of the follow-up period, although cases in the treatment group had higher OQOLS scores than those of the controls （p = 0.04）. Cases in the treatment group healed more quickly than those in the control group [（13 ± 3.2） weeks vs （15 ± 4.6） weeks, p = 0.02]. During the follow^up period, cases in the treatment group had no new fractures, whereas 2 new cases of hip fracture and 2 cases of distal radial fractures were observed among the controls. Conclusion： Zoledronic acid injection combined with PFNA is a favorable treatment option for the elderly patients with osteoporotic intertrochanteric fracture. It can effectivelly relieve bone pain, increase bone density, improve quality of life, reduce the occurrence of new fractures and promote fracture healing.
文摘Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a coi＇nbination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.
文摘Background： Antihypertensive drugs have been linked to new-onset osteoporotic fracture （NOF）, and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effect of different antihypertensive drugs on the development of NOF in the elderly has not been well studied during long-term follow-up. Methods： In this study, we investigated the association between different classic antihypertensives and the development of NOF in the elderly. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance in Central Taiwan, China including case patients with NOF aged 65–80 years from January 2002 to December 2012 and non-NOF controls. Prescriptions for antihypertensives before the index date were retrieved from a prescription database. We estimated the hazard ratios （HR s） of NOF associated with antihypertensive use. Non-NOF controls served as the reference group. Results： A total of 128 patients with NOF were identified from among 1144 patients with hypertension during the study period. The risk of NOF after adjusting age, sex, comorbidities, and concurrent medications was higher among the users of angiotensin-converting enzyme （ACE） inhibitors （HR, 1.64; 95% confidence interval [CI], 1.01–2.66） than among nonusers. Patients who took calcium channel blockers （CCBs） （HR, 0.70; 95% CI, 0.49–0.99） were at a lower risk of developing NOF than nonusers. Loop diuretics, thiazide diuretics, angiotensin receptor blocker, beta-blocker, and alpha-blocker were not associated with the risk of NOF. Conclusions： Elderly with hypertension who take CCBs are at a lower risk of NOF and that the use of ACE inhibitors was associated with a significantly increased risk of developing NOF during the 11-year follow-up.
文摘Background Colles’ fracture usually associated with osteoporosis is regarded as the predictor of subsequent osteoporotic fracture. However, it is not clear how the local changes of bone mass take place during the course of treatment and whether the changes are related to clinical practice. The objective of the current study was to investigate the local changes of bone mass in patients with Colles’ fractur e and their possible clinical relevance in a follow-up study.Methods The radiograms of the second metacarpal in 64 patients with Colles’ fracture were assessed for bone density immediately after fracture, 6 weeks, 6 months and 1 year after fracture, respectively. Functional results were evaluated at one year.Results Bone mass six weeks after Colles’ fracture was signifi cantly decreased without returning to normal at one year though increased bone mass had been identified 6 months after fracture (P< 0.05), (P< 0.01). At one year significant (P< 0.05) or highly significant (P< 0.01) correlations were observed between bo ne mass indices of metacarpal and functional results, indicating that poor function is associated with lower bone density. Significant differences (P< 0.05) between fracture patterns also suggested that patients with more severe fractures have a more pronounced bone loss.Conclusions Bone loss during the course of treatment will have a direct effect upon the prognosis, so different treatment should be proposed for different patterns of fractures. Active exercise should be made to improve the recovery of bone mass.
