scholarly journals Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of “MRS BAD BONES” (Preprint)

2020 ◽  
Author(s):  
Alastair Stephens ◽  
Hannah Rudd ◽  
Emilia Stephens ◽  
Jayne Ward
Keyword(s):  
Vitamin D ◽  
Femoral Neck ◽  
Secondary Prevention ◽  
Fragility Fractures ◽  
Femoral Neck Fractures ◽  
Fisher Exact Test ◽  
Calcium Supplements ◽  
Dexa Scan ◽  
Retrospective Audit ◽  
The Impact

BACKGROUND Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. OBJECTIVE This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. METHODS A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, “MRS BAD BONES,” which addressed key factors in the assessment and management of osteoporosis: <i>m</i>edication review, <i>r</i>heumatology/renal advice, smoking cessation; <i>b</i>lood tests, <i>a</i>lcohol limits, <i>D</i>EXA (dual energy X-ray absorptiometry) scan; <i>b</i>one-sparing medications, <i>o</i>rthogeriatric review, <i>n</i>utrition, <i>e</i>xercise, supplements. The Fisher exact test was used for comparison analyses between each phase. RESULTS Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (<i>P</i>=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (<i>P</i>=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (<i>P</i>=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (<i>P</i>=.003), bone-sparing medications to 72.4% (n=21) (<i>P</i>&lt;.001), and DEXA scan requests to 60% (n=12) (<i>P</i>&lt;.001). CONCLUSIONS The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The “MRS BAD BONES” mnemonic significantly improved management and could be used in a wider setting. CLINICALTRIAL

scholarly journals Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of “MRS BAD BONES”

JMIR Aging ◽  
10.2196/25607 ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. e25607
Author(s):  
Alastair Stephens ◽  
Hannah Rudd ◽  
Emilia Stephens ◽  
Jayne Ward
Keyword(s):  
Vitamin D ◽  
Femoral Neck ◽  
Secondary Prevention ◽  
Fragility Fractures ◽  
Femoral Neck Fractures ◽  
Fisher Exact Test ◽  
Calcium Supplements ◽  
Dexa Scan ◽  
Retrospective Audit ◽  
The Impact

Background Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. Objective This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. Methods A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, “MRS BAD BONES,” which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase. Results Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (P=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (P=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (P=.003), bone-sparing medications to 72.4% (n=21) (P<.001), and DEXA scan requests to 60% (n=12) (P<.001). Conclusions The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The “MRS BAD BONES” mnemonic significantly improved management and could be used in a wider setting.

scholarly journals Secondary Prevention of Fragility Fractures: Are We Following the Guidelines?

2006 ◽  
Vol 88 (5) ◽  
pp. 470-474 ◽  
Author(s):  
N Prasad ◽  
D Sunderamoorthy ◽  
J Martin ◽  
JM Murray
Keyword(s):  
Vitamin D ◽  
Secondary Prevention ◽  
Nurse Practitioners ◽  
Blood Count ◽  
Fragility Fractures ◽  
Full Blood Count ◽  
Junior Doctors ◽  
Dexa Scan ◽  
Femur Fractures ◽  
Retrospective Audit

INTRODUCTION The aim of this study was to determine whether orthopaedic surgeons follow the British Orthopaedic Association (BOA) guidelines for secondary prevention of fragility fractures. PATIENTS AND METHODS A retrospective audit was conducted on patients with neck of femur fractures treated in our hospital between October and November 2003. A re-audit was conducted during the period August to October 2004. RESULTS There were 27 patients in the initial study period. Twenty-six patients (96%)had full blood count measured with LFT and bone-profile measured in 18 patients (66%). Only nine patients (30%)had treatment for osteoporosis (calcium and vitamin D). Only one patient was referred for DEXA scan. Steps were taken in the form of creating better awareness among the junior doctors and nurse practitioners of the BOA guidelines. In patients above 80 years of age, it was decided to use abbreviated mental score above 7 as a clinical criteria for DEXA referral. A hospital protocol based on BOA guidelines was made. A re-audit was conducted during the period August to October 2004. There were 37 patients. All had their full blood count and renal profile checked (100%). The bone-profile was measured in 28 (75.7%) and LFT in 34 (91.9%)patients. Twenty-four patients (65%) received treatment in the form of calcium + vitamin D (20) and bisphosphonate (4). DEXA-scan referral was not indicated in 14 patients as 4 were already on bisphosphonates and for 10 patients their abbreviated mental score was less than 7. Among the remaining 23 patients, 9 patients (40%) were referred for DEXA scan. This improvement is statistically significant (P = 0.03, chi square test). DISCUSSION AND CONCLUSIONS The re-audit shows that, although there is an improvement in the situation, we are still below the standards of secondary prevention of fragility fractures with 60% of femoral fragility fracture patients not being referred for DEXA scan. A pathway lead by a fracture liaison nurse dedicated to osteoporotic fracture patients should improve the situation.

scholarly journals 91 Mrs Bad Bones: Impact of COVID-19 on Secondary Prevention of Fragility Fractures

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A Stephens ◽  
H Rudd ◽  
E Stephens ◽  
J Ward
Keyword(s):  
Vitamin D ◽  
Secondary Prevention ◽  
Fragility Fracture ◽  
Femur Fracture ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
Neck Of Femur ◽  
Calcium Supplements ◽  
Dexa Scan ◽  
Neck Of Femur Fracture

Abstract Introduction Management of osteoporosis is an important consideration for neck of femur fracture patients due to the morbidity and mortality it poses, and the significant financial burden to the NHS. Orthogeriatric teams input is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of healthcare teams and led to the redeployment of the orthogeriatricians to assist with the influx of medically unwell patients. This study explored the impact COVID-19 had on secondary fragility fracture prevention. Method A retrospective audit looking at the prescription of vitamin D/calcium supplements, bone-sparing medications, and DEXA scan requests in consecutive neck of femur fracture patients admitted to a trauma and orthopaedic unit pre- and post- UK lockdown in response to the pandemic. A re-audit was conducted following the implementation of our new mnemonic, “MRS BAD BONES”: Medication Review Rheumatology/Renal Advice Smoking Cessation Blood tests Alcohol limits DEXA scan Bone-sparing medications Orthogeriatric review Nutrition Exercise Supplements. Results Data for 50 patients was available in each phase. The orthogeriatric team reviewed 88% of patients pre-lockdown falling to 0% due to redeployment, before recovering to 38% in the post-intervention period. Upon lockdown there was a significant drop in the prescription of vitamin D/calcium supplements from 81.6% to 58.0% (p = 0.0156); of bone-sparing medications from 60.7% to 18.2% (p = 0.0037), and DEXA scan requests from 40.1% to 3.6% (p = 0.0027). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (p = 0.0034), bone-sparing medications to 72.4% (p = 0.0002) and DEXA scan requests to 60% (p &lt; 0.0001). Conclusion COVID-19 had a major impact on the secondary prevention of fragility fractures in this population. The “MRS BAD BONES” mnemonic significantly improved the management and could be considered for use in a wider setting.

Finite element analysis of the impact of screw insertion distal to the trochanter minor on the risk of iatrogenic subtrochanteric fracture

2018 ◽  
Vol 232 (8) ◽  
pp. 807-818 ◽  
Author(s):  
Ersin Sensoz ◽  
Fatih Mehmet Özkal ◽  
Volkan Acar ◽  
Ferit Cakir
Keyword(s):  
Finite Element ◽  
Femoral Neck ◽  
Screw Fixation ◽  
Subtrochanteric Fracture ◽  
Femoral Neck Fractures ◽  
Cannulated Screws ◽  
Screw Insertion ◽  
Subtrochanteric Fractures ◽  
Trochanter Minor ◽  
The Impact

Iatrogenic subtrochanteric fractures are rarely encountered after cannulated screw fixation of femoral neck fractures; however, when they do occur, there can be several complications. Many orthopedic surgeons have concerns about the potential for iatrogenic subtrochanteric fractures after screw fixation distal to the trochanter minor; therefore, some surgeons are typically reluctant to perform this procedure. This study focused on the risk of an iatrogenic subtrochanteric fracture after treating femoral neck fractures with cannulated screws. The main purpose of the study was to understand iatrogenic subtrochanteric fractures and evaluate the effects on these fractures of an inverted triangular–shaped configuration for placement of the cannulated screws. A femur bone with an femoral neck fracture at a 40° incline to the horizontal plane was generated along with a representation of a three-dimensional finite element model, and three inverted triangular–shaped configurations for placement of the cannulated screws were investigated using finite element analyses. Statistical results indicated that the occurrence risk of ISF increases when the screw is located distal to the trochanter minor. Moreover, the risk of occurrence of intertrochanteric fracture increases when the screw is located medial to the trochanter minor because of local concentrated stress on the surface of the screw canals. To avoid the vulnerability of the subtrochanteric region, it was found that proximal placement of the screws using the inverted triangular–shaped configuration could yield better results. In addition, the results of this study provide suggestions on improved screw configurations.

Risk of bone loss in men with multiple sclerosis

2004 ◽  
Vol 10 (2) ◽  
pp. 170-175 ◽  
Author(s):  
Bianca Weinstock-Guttman ◽  
Eileen Gallagher ◽  
Monika Baier ◽  
Lydia Green ◽  
Joan Feichter ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Lumbar Spine ◽  
Bone Loss ◽  
Femoral Neck ◽  
Bone Mass ◽  
Multivariate Linear Regression Analysis ◽  
Mineral Density ◽  
Factors Associated ◽  
Dexa Scan

Context: O steoporosis and the increased fracture risk associated with osteoporosis become apparent in men appro ximately 10 years later than women. However, in recent studies, appro ximately 20% of healthy men in the age range 55-64 years were found to be osteopenic. Emerging data suggest a significantly increased prevalence of osteoporosis in men and women with multiple sclerosis (MS) compared to age-matched controls, but no specific clinical testing recommendations are available for men. Objective: To determine the proportion of male MS patients with osteoporosis and to identify the factors associated with the reduction in bone mass. Design: C onsecutive male MS patients seen at our MS clinic were screened with dual-X-ray absorptiometry (DEXA) scan for determining the bone mineral density (BMD). A ll patients had neurological Expanded Disability Status Scale (EDSS) evaluation. The results were compared to healthy age-matched male reference population using the Z score and to a cohort of women MS patients and women controls. C alcium, total testosterone, sex-hormone binding globulin (SHBG), 25-hydro xy-vitamin-D, and parathyroid hormone (PTH) were evaluated in male patients with decreased BMD. Relevant data on body mass index (BMI), medicatio n, alcohol consumption, smoking, and sexual dysfunction were recorded. Setting: Academic MS C entre. Patients and other participants: Forty consecutive male MS patients, age mean 51.2±8.7 years, and mean EDSS of 5.8±1.9 were evaluated with DEXA scan. O f these, 17.5% patients were relapsing - remitting (RR) MS, 57.5% were secondary progressive (SP) MS and 25% were primary progressive (PP) MS. Main outcome measure: Proportion of male MS patients with reduced BMD at the lumbar spine and femoral neck. Results: Thirty-two (80%) of our patients had a reduced bone mass of either lumbar spine or the femoral neck; of these 17 patients (42.5%) had osteopenia and 15 patients (37.5%) had osteoporosis. Twenty-o ne per cent (eight out of 38 patients) had vertebral, rib or extremities fractures. Multivariate linear regression analysis indicated that the EDSS (P B-0.0001) and BMI (P =0.0004) were the important factors associated with low BMD at the femoral neck and the EDSS was the important factor (P =0.0017) associated with low BMD at the lumbar spine. The same factors emerged as significantly associated with the corresponding Z scores, which are corrected for age and sex. No clear association between intravenous steroid therapy and BMD was evident in the multivariate analysis. Low levels of 25-hydroxy-vitamin-D were seen in 37.5% of patients. Conclusions: The proportion of male MS patients with reduced bone mass is high and disproportionate to their age and ambulation, consistent with an association between the MS disease process and patho logical bone loss. Increased awareness and bone density screening of male and female MS patients over 40 years of age is warranted.

scholarly journals Impact of intercurrent illness on calcium homeostasis in children with hypoparathyroidism: a case series

2017 ◽  
Vol 6 (8) ◽  
pp. 589-594 ◽  
Author(s):  
A Chinoy ◽  
M Skae ◽  
A Babiker ◽  
D Kendall ◽  
M Z Mughal ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Calcium Homeostasis ◽  
Calcium Supplementation ◽  
Case Series ◽  
Close Monitoring ◽  
Oral Calcium ◽  
Calcium Supplements ◽  
Intercurrent Illness ◽  
The Impact

Background Hypoparathyroidism is characterised by hypocalcaemia, and standard management is with an active vitamin D analogue and adequate oral calcium intake (dietary and/or supplements). Little is described in the literature about the impact of intercurrent illnesses on calcium homeostasis in children with hypoparathyroidism. Methods We describe three children with hypoparathyroidism in whom intercurrent illnesses led to hypocalcaemia and escalation of treatment with alfacalcidol (1-hydroxycholecalciferol) and calcium supplements. Results Three infants managed with standard treatment for hypoparathyroidism (two with homozygous mutations in GCMB2 gene and one with Sanjad-Sakati syndrome) developed symptomatic hypocalcaemia (two infants developed seizures) following respiratory or gastrointestinal illnesses. Substantial increases in alfacalcidol doses (up to three times their pre-illness doses) and calcium supplementation were required to achieve acceptable serum calcium concentrations. However, following resolution of illness, these children developed an increase in serum calcium and hypercalciuria, necessitating rapid reduction to pre-illness dosages of alfacalcidol and oral calcium supplementation. Conclusion Intercurrent illness may precipitate symptomatic hypocalcaemia in children with hypoparathyroidism, necessitating increase in dosages of alfacalcidol and calcium supplements. Close monitoring is required on resolution of the intercurrent illness, with timely reduction of dosages of active analogues of vitamin D and calcium supplements to prevent hypercalcaemia, hypercalciuria and nephrocalcinosis.

scholarly journals Challenges and opportunities for osteoporosis care during the COVID-19 pandemic

2021 ◽  
Author(s):  
Sara J Cromer ◽  
Elaine W Yu
Keyword(s):  
Vitamin D ◽  
Bone Health ◽  
Fragility Fractures ◽  
Osteoporosis Treatment ◽  
Vitamin D Supplementation ◽  
Adverse Outcomes ◽  
Beneficial Effects ◽  
Viral Spread ◽  
Challenges And Opportunities ◽  
The Impact

Abstract Purpose The Coronavirus Disease 2019 (COVID-19) has both directly and indirectly affected osteoporosis diagnosis and treatment throughout the world. Methods This mini-review summarizes the available evidence regarding the effects of COVID-19, its treatment, and the consequences of the pandemic itself on bone health. Additionally, we review evidence and expert recommendations regarding putative effects of osteoporosis medications on COVID-19 outcomes and vaccine efficacy and summarize recommendations for continuation of osteoporosis treatment during the pandemic. Results The use of standard screening procedures to assess for osteoporosis and fracture risk declined dramatically early in the pandemic, while rates of fragility fractures were largely unchanged. COVID-19, its treatments, and public health measures to prevent viral spread are each likely to negatively affect bone health. Osteoporosis treatments are not known to increase risk of adverse events from COVID-19, and pre-clinical data suggests possible beneficial effects of some therapies. Vitamin D deficiency is clearly associated with adverse outcomes from COVID-19, but it remains unclear whether vitamin D supplementation may improve outcomes. Osteoporosis treatment should be continued whenever possible, and recommendations for substituting therapies, if required, are available. Conclusion The COVID-19 pandemic has decreased screening and disrupted treatment for osteoporosis. Osteoporosis medications are safe and effective during the pandemic and should be continued whenever possible. Further studies are needed to fully understand the impact of the COVID-19 pandemic on long-term bone health.

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