Contribution of Clinical Risk Factors to the Assessment of Hip Fracture Risk and Treatment Decision Making

2011 ◽  
Author(s):  
Martin Root ◽  
John Anderson
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Treatment Decision ◽  
Clinical Risk Factors ◽  
Hip Fracture Risk ◽  
Treatment Decision Making ◽  
Clinical Risk

scholarly journals WHO absolute fracture risk models (FRAX): Do clinical risk factors improve fracture prediction in older women without osteoporosis?

2011 ◽  
Vol 26 (8) ◽  
pp. 1774-1782 ◽  
Author(s):  
Teresa A Hillier ◽  
Jane A Cauley ◽  
Joanne H Rizzo ◽  
Kathryn L Pedula ◽  
Kristine E Ensrud ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Older Women ◽  
Fracture Prediction ◽  
Clinical Risk Factors ◽  
Risk Models ◽  
Clinical Risk

Group Decision-Making during Trauma Patient Resuscitation and Anesthesia

1993 ◽  
Vol 37 (4) ◽  
pp. 372-376 ◽  
Author(s):  
Colin F. Mackenzie ◽  
Richard L. Horst ◽  
David L. Mahaffey ◽  
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Trauma Patient ◽  
Treatment Decision ◽  
Post Treatment ◽  
Trauma Treatment ◽  
Treatment Decision Making ◽  
Knowledge Based ◽  
Team Interactions ◽  
Video And Audio

We examined decision-making in the real-world environment of trauma patient resuscitation and anesthesia in a Level One Trauma Center. The present paper focuses on the risk factors in the trauma treatment environment that can lead to errors or misjudgments, and strategies that may be helpful in reducing these risks. Video and audio recordings were made of a number of trauma cases involving tracheal intubation, including both emergency intubations performed during resuscitation and “elective” intubations prior to surgery. Post-treatment questionnaires completed by anesthesia personnel suggested that their perceived misjudgments were primarily procedural errors caused by lack of preparation for low probability events, inadequate monitoring of available indices, or carelessness. However, video analyses of a subset of the cases by a non-participant anesthesiologist, in conjunction with examination of patient management records, not only confirmed the occurrence of such errors but also identified instances of knowledge-based errors, which caused subsequent cascades of adverse events. Video analysis also documented the shortcuts that are characteristic of emergency intubations. The post-treatment questionnaires also suggested an association between team interactions and anesthesiologist performance. To follow up on this, we transcribed and categorized verbal communications for several minutes before, during, and after intubation in a subset of cases. This analysis indicated that during emergency intubations not only was more information communicated than during elective intubations, but that there were increases specifically in the incidence of directives, comments conveying plans or strategies, and comments both seeking and offering needed information. The discussion presents a number of strategies that emerged from the present analyses for reducing the risk factors involved in trauma treatment decision-making.

scholarly journals Pelvic Organ Prolapse and Relationship with Skeletal Integrity

2009 ◽  
Vol 5 (3) ◽  
pp. 325-333 ◽  
Author(s):  
Lubna Pal
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Pelvic Organ ◽  
Clinical Risk Factors ◽  
Mineral Density ◽  
Female Population ◽  
Clinical Risk ◽  
Age Related

Health burden related to osteoporotic fractures in an aging female population far exceeds that imposed by other chronic disorders such as cardiovascular disease and breast cancer. Bone mineral density assessment and clinical risk factors provide independent insights into fracture risk in individuals. A finite list of clinical risk factors are identified as prognostic of fracture risk, namely among aging women, including low body mass, compromised reproductive physiology (e.g., prolonged periods of amenorrhea and early menopause), parental and personal histories of fracture, and alcohol and tobacco use. Pelvic organ prolapse is a common gynecologic entity and a contributor to age-related morbidities. The purpose of this review is to communicate data identifying pelvic organ prolapse as another clinical risk factor for fracture risk in postmenopausal women and to increase the caregiver's vigilance in anticipating and instituting preventive care strategies to a population (i.e., postmenopausal women with clinically appreciable pelvic organ prolapse) that may be at an enhanced lifetime risk for skeletal fractures.

scholarly journals Fracture risk assessment in frail older people using clinical risk factors

2008 ◽  
Vol 37 (5) ◽  
pp. 536-541 ◽  
Author(s):  
J. S. Chen ◽  
J. M. Simpson ◽  
L. M. March ◽  
I. D. Cameron ◽  
R. G. Cumming ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Older People ◽  
Fracture Risk ◽  
Fracture Risk Assessment ◽  
Clinical Risk Factors ◽  
Frail Older People ◽  
Clinical Risk

scholarly journals One leg standing time predicts fracture risk in older women independent of clinical risk factors and BMD

2021 ◽  
Author(s):  
B.A.M. Larsson ◽  
L. Johansson ◽  
D. Mellström ◽  
H. Johansson ◽  
K.F. Axelsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Older Women ◽  
Clinical Risk Factors ◽  
Standing Time ◽  
Clinical Risk

scholarly journals Redefining osteoporosis treatment: who to treat and how long to treat

2006 ◽  
Vol 50 (4) ◽  
pp. 694-704 ◽  
Author(s):  
E. Michael Lewiecki ◽  
Stuart L. Silverman
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Weight Bearing ◽  
Pharmacological Therapy ◽  
Clinical Risk Factors ◽  
Common Disease ◽  
Mineral Density ◽  
Clinical Risk ◽  
Increased Risk ◽  
Bmd Testing

Osteoporosis is a common disease that is associated with increased risk of fractures and serious clinical consequences. Bone mineral density (BMD) testing is used to diagnose osteoporosis, estimate the risk of fracture, and monitor changes in BMD over time. Combining clinical risk factors for fracture with BMD is a better predictor of fracture risk than BMD or clinical risk factors alone. Methodologies are being developed to use BMD and validated risk factors to estimate the 10-year probability of fracture, and then combine fracture probability with country-specific economic assumptions to determine cost-effective intervention thresholds. The decision to treat is based on factors that also include availability of therapy, patient preferences, and co-morbidities. All patients benefit from nonpharmacological lifestyle treatments such a weight-bearing exercise, adequate intake of calcium and vitamin D, fall prevention, avoidance of cigarette smoking and bone-toxic drugs, and moderation of alcohol intake. Patients at high risk for fracture should be considered for pharmacological therapy, which can reduce fracture risk by about 50%.

scholarly journals Associations Between Bone Impact Microindentation and Clinical Risk Factors for Fracture

Endocrinology ◽  
2019 ◽  
Vol 160 (9) ◽  
pp. 2143-2150 ◽  
Author(s):  
Pamela Rufus-Membere ◽  
Kara L Holloway-Kew ◽  
Adolfo Diez-Perez ◽  
Mark A Kotowicz ◽  
Julie A Pasco
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Clinical Risk Factors ◽  
Material Strength ◽  
Mineral Density ◽  
Clinical Risk ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
Prior Fracture ◽  
Impact Microindentation

Abstract Impact microindentation (IMI) measures bone material strength index (BMSi) in vivo. However, clinical risk factors that affect BMSi are largely unknown. This study investigated associations between BMSi and clinical risk factors for fracture in men. BMSi was measured using the OsteoProbe in 357 men (ages 33 to 96 years) from the Geelong Osteoporosis Study. Risk factors included age, weight, height, body mass index (BMI), femoral neck bone mineral density (BMD), parental hip fracture, prior fracture, type 2 diabetes mellitus (T2DM), secondary osteoporosis, smoking, alcohol consumption, sedentary lifestyle, medications, diseases, and low serum vitamin D levels. BMSi was negatively associated with age (r = −0.131, P = 0.014), weight (r = −0.109, P = 0.040), and BMI (r = −0.083, P = 0.001); no correlations were detected with BMD (r = 0.000, P = 0.998) or height (r = 0.087, P = 0.10). Mean BMSi values for men with and without prior fracture were 80.2 ± 6.9 vs 82.8 ± 6.1 (P = 0.024); parental hip fracture, 80.1 ± 6.1 vs 82.8 ± 6.9 (P = 0.029); and T2DM, 80.3 ± 8.5 vs 82.9 ± 6.6 (P = 0.059). BMSi did not differ in the presence vs absence of other risk factors. In multivariable models, mean (± SD) BMSi remained associated with prior fracture and parental hip fracture after adjusting for age and BMI: prior fracture (80.5 ± 1.1 vs 82.8 ± 0.4, P = 0.044); parental fracture (79.9 ± 1.2 vs 82.9 ± 0.4, P = 0.015). No other confounders were identified. We conclude that in men, BMSi discriminates prior fracture and parental hip fracture, which are both known to increase the risk for incident fracture. These findings suggest that IMI may be useful for identifying men who have an increased risk for fracture.

scholarly journals Patient Relocation in the 6 Months After Hip Fracture: Risk Factors for Fragmented Care

2004 ◽  
Vol 52 (11) ◽  
pp. 1826-1831 ◽  
Author(s):  
Kenneth S. Boockvar ◽  
Ann Litke ◽  
Joan D. Penrod ◽  
Ethan A. Halm ◽  
R. Sean Morrison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Hip Fracture Risk
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