Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
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Fractures of the proximal end of the femur, together with vertebral fractures, are greatly exacerbated by osteoporosis and can be regarded as the most typical and most serious complications of this disease. The demand for prompt mobilisation with full loading of the affected limb, combined with a desire for the gentlest of treatments, becomes increasingly difficult to meet in ageing patients with advanced osteoporosis. The advantages of osteosynthesis in respect to these demands when operating on elderly patients with fractures do not apply due to the inability of the osteoporotic bone to hold the osteosynthetic components sufficiently until fracture healing occurs. ⋯ There seems to be a limit for a successful realisation of an osteosynthesis that lies at a femoral head bone mineral density of 250 mg/cm(3) calcium-hydroxyapatite (CaHAp). Nevertheless, high precision surgery in regard to fracture reduction and implant placement is a essential requirement for a successful osteosynthesis. Reproducible local measurements of bone mineral density and trabecular alterations, as well as quick screening methods, are very much desired by the authors.
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Comparative Study
Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland.
The aim of this study was to estimate the hospitalization incidence and the total number of hospital days related to all fractures and osteoporotic fractures in the year 2000 in Switzerland and to compare these with data from other frequent disorders in men and women. The official administrative and medical statistics database of the Swiss Federal Office of Statistics (SFOS) from the year 2000 was used. It covered 81.2% of all registered patient admissions and was considered to be representative of the entire population. ⋯ We conclude that, in 2000, osteoporosis continued to be a heavy burden on the Swiss healthcare system. Lack of awareness of the disease and its consequences prevents widespread use of drugs with anti-fracture efficacy. This limits their potential to reduce costs.
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Ankle fractures are the most common lower extremity fractures. In younger age groups these fractures occur more often in men than in women, but after menopause there is a female predominance. Foot fractures show a similar trend. ⋯ However, the need for internal fixation to secure fracture reduction must be weighed against the risk of operating on osteoporotic bone which lacks the strength to hold screws and plates. In the elderly, the preoperative evaluation of the peripheral blood supply is essential to avoid wound healing complications. We review here the surgical treatment of ankle and foot fractures with special reference to elderly patients.
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The mechanical behavior of trabecular bone depends on the internal bone structure. It is generally accepted now that the trabecular bone structure is a result of a load adaptive bone remodeling. The mathematical laws that relate bone remodeling to the local state of stress and strain, however, are still under investigation. ⋯ Right after the onset of menopause, bone was lost fast, where with the progression of age losses slowed down. The structures at the end-point of the simulations were then compared qualitatively and quantitatively to the structures of the post-menopausal group with all morphometric indices being within a narrow margin of error. These results suggest the feasibility of transforming "normal" to "osteopenic" bone on a microstructural level yielding in realistic bone models similar in appearance as well as in structural behavior if compared to a post-menopausal group of women.
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Demographic changes in the age structure of occidental populations are giving rise to osteoporosis and associated fractures, which are becoming a major public health burden. Various animal models have been established and used to investigate the pathogenesis of osteoporosis and to facilitate the preclinical testing of new treatment options such as antiresorptive drugs. Although osteoporosis can be induced in animals, spontaneous fractures without adequate trauma were only found in nonhuman primates. ⋯ The advantages and disadvantages of the models with regard to their application in the testing of new fracture-fixation devices or biological approaches to stimulate bone healing are discussed. Ovariectomy alone does not cause the bone loss seen in osteoporotic human patients. New models to simulate fracture of osteoporotic bone need to be explored and used to address the specific aims of an experiment.