Osteoporosis: a still increasing prevalence.

https://www.hand.theclinics.com/article/S0749-0712(12)00002-9/pdf

The Epidemiology of Distal Radius Fractures

Proximal humeral fractures account for 4% to 5% of all fractures, with only hip and distal radial fractures in the elderly being more common. Humeral fractures often require hospitalization and/or rehabilitation care1-6. While most proximal humeral fractures are minimally displaced and can be treated nonoperatively, the treatment of displaced fractures is controversial and includes nonoperative management, percutaneous fracture fixation, open reduction and internal fixation (ORIF), and arthroplasty7-13. The recent development of locking plate technology has expanded the indications of ORIF for certain fracture types, especially in those with osteoporotic bone14. Advances in techniques of percutaneous pinning have been used effectively for proximal humeral fractures with adequate bone stock. Shoulder and elbow fellowships have rapidly expanded recently, as well. To date, there have been no prospective randomized studies that have determined which treatment achieves the best outcome for proximal humeral fractures in the elderly15.

There is marked variation in the rates of orthopaedic surgical procedures among different geographic regions of the United States5,16-18. The degree of regional variability correlates inversely with the level of scientific evidence and consensus of the medical community regarding the most appropriate care for a given condition17,19. Interventions that have a strong evidence base and enjoy a consensus among the medical community, such as antibiotic administration for serious infection or surgical fixation of hip fractures, exhibit minimal regional variation in treatment20. On the other hand, procedures without high-quality literature supporting a consensus treatment, such as lumbar spine fusion, exhibit wide variation regionally17. Because there is poor consensus in the literature on the optimal treatment of proximal humeral fractures, we hypothesized that there would be significant regional variation in management. If a wide regional variation in the management of proximal humeral fractures exists, there is a compelling argument that additional research funding is needed to conduct high-quality studies to determine the optimal management of proximal humeral fractures in Medicare patients so that a consensus can be achieved.

The study of current practice patterns is important for the treatment of common orthopaedic conditions because these are important public health issues. As the population is aging, the management of fragility fractures is becoming a greater burden on the health-care system. Clinically, it is important to know what the odds of repeat surgery are after initial surgery so we can counsel patients accurately. If ORIF results in more repeat surgery, the increased cost and morbidity may be considered in determining the best treatment for a patient in the absence of high-quality data to support one technique over another. Furthermore, if the odds of repeat surgery are increasing over time, this should be studied.

The specific aims of this study were (1) to determine the incidence of proximal humeral fractures in the United States Medicare population both nationally and regionally, (2) to determine regional variability in treatment patterns of proximal humeral fractures, and (3) to compare the rates of revision surgery for ORIF and humeral head replacement. Our hypothesis was that the percentage of fractures treated surgically had increased in recent years and that this expansion in indications had led to an increased rate of revision surgery. We chose to look at rates in 1999 to 2000 and compare them with rates in 2004 to 2005 because locking plates were introduced between these time periods.

Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly.

Context Hip fractures are a public health concern because they are associated with significant morbidity, excess mortality, and the majority of the costs directly attributable to osteoporosis. Objective To examine trends in hip fracture rates in Canada. Design, Setting, and Patients Ecologic trend study using nationwide hospitalization data for 1985 to 2005 from a database at the Canadian Institute for Health Information. Data for all patients with a hospitalization for which the primary reason was a hip fracture (570 872 hospitalizations) were analyzed. Main Outcome Measures Age-specific and age-standardized hip fracture rates. Results There was a decrease in age-specific hip fracture rates (all P for trend Conclusions Age-standardized rates of hip fracture have steadily declined in Canada since 1985 and more rapidly during the later study period. The factors primarily responsible for the earlier reduction in hip fractures are unknown.

https://jamanetwork.com/journals/jama/articlepdf/184467/joc90086_883_889.pdf

Trends in hip fracture rates in Canada.

Purpose Adjuvant therapy for breast cancer can be associated with decreased bone mineral density (BMD) that may lead to skeletal morbidity. This study examined whether zoledronic acid can prevent bone loss associated with adjuvant endocrine therapy in premenopausal patients.

https://ascopubs.org/doi/pdf/10.1200/JCO.2005.02.7102

Zoledronic Acid Prevents Cancer Treatment–Induced Bone Loss in Premenopausal Women Receiving Adjuvant Endocrine Therapy for Hormone-Responsive Breast Cancer: A Report From the Austrian Breast and Colorectal Cancer Study Group

Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55–75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score <−2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.

Health-related quality of life after osteoporotic fractures.

Introduction Treatment of osteoporosis is becoming more effective, but methods to identify patients who are most suitable for investigation and treatment are still being debated. Should any type of...

Lisa Kartous

Papers

Health-related quality of life after osteoporotic fractures.

Women with low-energy fracture should be investigated for osteoporosis