[Management of hip fractures: practice, results, and problems in the last decade]


APRIL 15, 2009

Ca&Bone - 2009;12(01)

[Among fractures attributable to osteoporosis, hip fractures are associated with the most severe consequences and the greatest costs. Surgical therapy for this condition is continuing to improve. Increasingly recent implants and techniques are being developed and introduced to successfully control postoperative adverse events. The authors briefly outline actual practice in Hungary and present some results of the follow-up of their patients in the last decade. These show that, in order to improve outcomes of hip fracture patients, all domains of management need to be addressed.]



Further articles in this publication




[Antiresorption - same goal, different ways]



[Denosumab - pharmacokinetic and clinical evidences]


[Denosumab is a fully human monoclonal antibody to RANKL modifying bone resorption in a rapid, sustained and reversible way. In postmenopausal women with low bone mineral density, denosumab 60 mg every 6 months increased mineral density, and reduced bone turnover. In postmenopausal women, it reduced the risk of vertebral, hip, and non-vertebral fractures. Increase in body mass index and reduction in bone turnover was more pronounced with denosumab than with alendronate. In patients who were switched from alendronate to denosumab, positive effects on bone were more pronounced than in those continuing alendronate. Denosumab was safe and well tolerated, and it holds the promise of becoming an efficacious therapy for postmenopausal osteoporosis.]


[The role of physiotherapy/therapeutic exercise in the treatment of osteoporotic hip fractures]

MAKOVICSNÉ Landor Erika, KOLTAI Endréné

[The authors briefly present the role of the physiotherapist in the treatment of osteoporosis. Primary, secondary, and tertiary prevention of locomotion system problems is analyzed. The authors’ specific focus is the complex physiotherapeutic treatment of osteoporotic hip fractures. They propose a prevention program involving locomotion exercises for the prevention of falls. Analyzing the physiotherapists’ activities, the authors describe the most important aspects of patient education and patient information.]


[Significance of quantitative ultrasound bone densitometry and its introduction into pediatric bone medicine]


[INTRODUCTION - Quantitative Ultrasound (QUS) examination of the bones provides information about not only bone mineral mass but also its quality. Adaptation of the method to the continuous growing of body size allowed its pediatric use. However, for introduction into routine use, a normal reference range in healthy children has to be established. The primary aim of this study was to establish the Hungarian reference range for QUS of the bone - in both genders and across a wide range of ages. As a secondary aim, QUS and the bone density were compared to internationally accepted data to comparatively determine correlations of specific QUS measurements to photon absorption based values. SUBJECTS AND METHODS - Measurement was performed on the calcaneus by Achilles Insight (Lunar, WI) device. Bone Mineral Density (BMD) of the lumbar spine was measured using the Double X-ray Absorptiometry (DXA) device DPX-L (Lunar, WI). Latter was also used to measure total body calcium content. Measurements were performed in 154 healthy boys and girls aged 5 to 18 years. We analyzed data as a function of age, and correlated results of he two types of measurement. RESULTS - Gender-specific reference ranges for normally developing children of the above ages were built up for Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS). BUA showed the best correlation to BMD. SOS and Stiffness Index (SI) derived from BUA and SOS, correlated weaker to BMD, consonantly with the fact that SOS reflects bone elasticity (quality) rather than bone mineral mass. CONCLUSION - These newly constructed normal ranges can provide a basis of performing pediatric bone examinations using QUS, which is less expensive and more mobile.]

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Related contents


[Bone metabolism and body mass index in postmenopausal women]

TÁRCZY Csaba, TOLDY Erzsébet, SZERB János, VARGA László

[INTRODUCTION - In addition to several other causes constitutional factors play an important role in the development of osteoporosis.Various aspects of bone metabolism were examined to explain the differences in bone density between women with low and high body mass index (BMI). PATIENTS AND METHOD - One hundred and ninetytwo postmenopausal women were included in the study. Bone density was measured by forearm densitometry.To assess bone formation, serum osteocalcin levels were measured, while the rate of bone absorption was estimated from C-terminal telopeptide levels of collagen type I measured in urine and blood. RESULTS - The prevalence of osteoporosis was higher in women with low BMI than in those with normal or higher BMI. Bone metabolism - both formation and absorption - was increased in both groups, however, in women with low BMI this increase was more pronounced and bone metabolism tended to be shifted to absorption compared to patients with normal or higher BMI. CONCLUSION - Postmenopausal lean women have accelerated bone metabolism compared to obese women. This fact and the shift to absorption may be the main reasons for the higher frequency of osteoporosis found by densitometry in women with low BMI than in those with higher BMI.]


[The concept of adherence and its significance in osteoporosis]


[Today, in relation to the economical aspects of medical therapies, the patterns of patients’ drug taking have come into focus. One of the important indicators is adherence, which consists of four different concepts concerning faithfulness to therapy: acceptance, concordance, persistance and compliance. In chronic diesases, medical therapy without a certain degree of adherence is no more useful than no therapy at all. A number of international clinical studies show that in osteoporosis, the therapy can only lead to a decrease in the number of fracture in case of sufficient adherence.]


[Sacral insufficiency fractures]

FERENC Mária, PUHL Mária, VARGA Péter Pál

[BACKGROUND - The spontaneous osteoporotic fracture of the sacrum, known as a sacral insufficiency fracture (SIF) was first described as an unrecognized syndrome of the elderly by Laurie, in 1982. Numerous case histories and a few series of cases have been discussed in medical journals; however, none have been reported in Hungary. GOAL - To delineate the leading diagnostic steps in the recognition of SIF and review the therapeutic guidelines. CASE HISTORIES, METHODS - Between January 2009 and the first six months of 2010 11 cases of SIF were diagnosed at the National Center for Spinal Disorders. We examined the clinical aspects of the illness, the radiological modalities, the fracture markings, the pace of recovery and duration. RESULTS - The 11 patients were found to have various SIF predestining etiological factors and the following classic fractures - H-type, unilateral, horizontal, unilateralhorizontal and vertical as well as a bilateral pattern. In cases often not showing obvious clinical symptoms and in cases resulting in conventional radiological examinations of low sensitivity and specificity, we used mapping techniques in setting up the exact diagnosis. CONCLUSION - If we consider SIF from patient history and known risk factors, diagnostic procedure (primer original) may be shortened and a number of unnecessary tests (biopsy) may be avoided.]


[Overcome of bisphosphonate resistance with alphacalcidol: results of a one year, open follow-up study]

GAÁL János, BENDER Tamás, VARGA József, HORVÁTH Irén, KISS Judit, SOMOGYI Péter, SURÁNYI Péter

[INTRODUCTION - A considerable part of osteoporotic patients do not respond satisfactorily to adequate treatment with a bisphosphonate plus supplementation with calcium and conventional vitamin D3. This study intended to determine whether the replacement of vitamin D3 with alphacalcidol results in any BMD increase, i.e. is it possible to overcome resistance to bisphosphonates. PATIENTS AND METHOD - In 76 patients unresponsive to the combination of alendronate and conventional vitamin D3, the latter had been replaced with alphacalcidol (0.5 μg/day), and then the patients were followed up for a year. Clinical and laboratory parameters were recorded at baseline and after one year of treatment; and their changes were analysed by statistical methods. RESULTS - After treatment for one year, Wilcoxon test revealed a small but statistically significant (p<0.001) increase in the BMD values of the forearm (+2.2%) and lumbar vertebrae (+1.4%). At the end of the treatment period, the following, significant changes were observed compared to baseline (median values): serum calcium level increased by 0,06 mmol/l; serum phosphorus level decreased by 0.05 mmol/l, serum alkaline phosphatase activity decreased by 13 U/l, and urinary calcium/creatinine ratio in first-voided morning urine increased by 0.1. Additionally, serum PTH level decreased by 10.7 pg/ml (median). Serum levels of osteocalcin decreased by 0.4 ng/ml, along with the urinary D-Pyr /kreatinine ratio by 0.2 nmol/mmol (median). No significant increase of adverse events occurred. DISCUSSION - As suggested by our results, combination therapy with alendronate and alfacalcidol increases bone density and improves the biochemical markers of bone turnover - without any substantial increase in the incidence of adverse effects.]


[Atypical femur fracture during long-term bisphosphonate therapy: adverse effect or coincidence?]