Bibliographies: 'Osteoporosis – complications' – Grafiati (2024)

Abstract:

Patients with multiple myeloma suffer from bone pain, and spontaneous spinal and appendicular bone fractures due to osteoporosis. Osteoporosis occurs as a result of the following 2 factors: 1. Plasma cells secrete macrophage inflammatory protein-1 alpha, which induces osteoclastic activity; 2. Use of corticosteroids. The incidence of osteoporotic fractures and other complications of multiple myeloma are well described in the literature, but the management of cervical disc herniation and its associated complications has not been reported to date.Herein we present a case that we think exemplifies the management of cervical disc herniation and its complications. Consecutive multilevel cervical discectomy and placement of PEEK cages between the intervertebral cervical disc spaces may cause compression fracture of the vertebrae located between the PEEK cages in osteoporotic patients under continuous corticosteroid treatment¾whether or not they have MM; therefore, we recommend use of an anterior plate to prevent this complication.

Abstract:

<sec><title>Study Design</title><p>A retrospective comparative study.</p></sec><sec><title>Purpose</title><p>To compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis.</p></sec><sec><title>Overview of Literature</title><p>With increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis.</p></sec><sec><title>Methods</title><p>Ninety-one patients with OVC aged ≥50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared.</p></sec><sec><title>Results</title><p>Diabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%; <italic>p</italic>&lt;0.05). One patient in the secondary osteoporosis group developed methicillin-resistant <italic>Staphylococcus aureus</italic> infection that ultimately required instrument removal.</p></sec><sec><title>Conclusions</title><p>The overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis.</p></sec>

Abstract:

<p class="abstract">Vertebral fractures are one of the most common complications of osteoporosis. Prolonged and intractable pain leads to immobilization and significant morbidity. Vertebroplasty is designed primarily to relieve pain, and the procedure is considered when osteoporotic vertebral fracture does not respond to a reasonable period of conservative care. Vertebroplasty has a low complication rate with most common complication being adjacent vertebral body fracture and rare complication due to extra-vertebral cement leakage causing nerve root compression or pulmonary embolism. We report a case of 55 year old lady with osteoporotic D12 wedge compression fracture subjected to vertebroplasty resulting in intraspinal cement leakage noticed intra-operatively. Patient underwent immediate decompression, cement extraction and posterior instrumentation. Postoperative course was uneventful.</p>

Abstract:

The radiologist has a number of roles not only in diagnosing but also in treating osteoporosis. Radiologists diagnose fragility fractures with all imaging modalities, which includes magnetic resonance imaging (MRI) demonstrating radiologically occult insufficiency fractures, but also lateral chest radiographs showing asymptomatic vertebral fractures. In particular MRI fragility fractures may have a nonspecific appearance and the radiologists needs to be familiar with the typical locations and findings, to differentiate these fractures from neoplastic lesions. It should be noted that radiologists do not simply need to diagnose fractures related to osteoporosis but also to diagnose those fractures which are complications of osteoporosis related pharmacotherapy. In addition to using standard radiological techniques radiologists also use dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) to quantitatively assess bone mineral density for diagnosing osteoporosis or osteopenia as well as to monitor therapy. DXA measurements of the femoral neck are also used to calculate osteoporotic fracture risk based on the Fracture Risk Assessment Tool (FRAX) score, which is universally available. Some of the new technologies such as high-resolution peripheral computed tomography (HR-pQCT) and MR spectroscopy allow assessment of bone architecture and bone marrow composition to characterize fracture risk. Finally radiologists are also involved in the therapy of osteoporotic fractures by using vertebroplasty, kyphoplasty, and sacroplasty. This review article will focus on standard techniques and new concepts in diagnosing and managing osteoporosis.

Abstract:

Osteoporosis is the most common metabolic bone disease and the most common cause of fractures in older adults. Vertebral compression fracture (VCF) is the most common complication in patients with osteoporosis. At present, vertebroplasty (VP) and kyphoplasty (KP) are two minimally invasive techniques used to treat osteoporotic vertebral compression fractures. In clinical use, KP and VP have stable and reliable therapeutic effects. However, there are still some complications and issues surrounding KP and VP application, and for long-term clinical follow-up. Thus, it is important to continue to improve the technology of the filler materials used in KP and VP in order to evolve the biomechanical characteristics of the postoperative vertebra, and to reduce the incidence of complications. The filler materials used for both techniques require good biocompatibility, good biomechanical strength and stiffness, and good radiopacity for the fluoroscopy guided procedures. PMMA and new filler materials (calcium phosphate cement, calcium sulfate cement, composite materials) are now available for clinical use. In this review paper, we will focus on the issues and characteristics of these filler materials.

Abstract:

Intermittent parathyroid hormone (PTH) administration has been shown to be a promising therapy for systemic bone loss. Accordingly, we hypothesized that PTH could have positive results in treating oral complications of osteoporosis. Hence, we evaluated both mandibular bone loss and its response to PTH in a rabbit model of osteoporosis induced by ovariectomy and glucocorticoid administration. There was a significant and marked decrease in bone mineral density (BMD), bone mineral content (BMC), and calcium content in ash from the osteoporotic peri-alveolar region, which influenced global jaw loss. Remarkably, PTH (1–34) administration to osteoporotic rabbits almost completely reversed BMD, BMC, and calcium content fall in the peri-alveolar region, subsequently reducing global mandibular bone loss. Thus, although the peri-alveolar region is particularly susceptible to osteoporosis, it also responds well to intermittent PTH. Therefore, these results suggest that PTH might represent a valid therapy for improving the osseointegration of dental implants in persons with osteoporosis.

Abstract:

Background: Osteoporosis is an important problem in those of advanced age. Osteoporosis can induce sacral insufficiency fractures (SIFs). As average life expectancy increases, the number of patients with osteoporotic SIFs also increases. Osteoporotic SIFs cause severe low back pain and immobilization. Treatment of SIFs varies from analgesia to surgery. Objectives: To describe our experience and assess the safety and effectiveness of minimally invasive percutaneous sacroplasty in patients with osteoporotic SIFs. Study Design: Retrospective evaluation. Setting: The spine and joint specialized hospital’s research center. Methods: We reviewed cases of percutaneous sacroplasty performed since 2009. We used data only from patients with osteoporotic SIFs who were followed for more than 12 months after sacroplasty. Tumor-related SIFs were excluded from our analysis. The following clinical parameters were investigated: initial diagnosis, symptoms, visual analog scale (VAS) of pain, functional mobility scale (FDC) score, past history of illness, amount of bone cement infused, and complications related to sacroplasty. Also, the following radiological parameters were analyzed: the pattern of SIFs, T-score cement leakage, and concomitant fractures in other sites. Results: Sixty-eight patients were enrolled in our study (4 men and 64 women). The mean age of the patients was 76.8 ± 6.2 years. All patients had severe osteoporosis (mean T score: -3.9 ± 0.5). Percutaneous sacroplasty was performed under fluoroscopic guidance. No major complications or procedure-related morbidity occurred. FDS and VAS scores significantly improved after sacroplasty, and the improvements lasted through the final follow-up period (P < 0.05). Limitations: This study is a retrospective analysis without a control group. Conclusion: Percutaneous sacroplasty is an effective minimally invasive treatment for osteoporotic SIFs refractory to conservative management. The study patients experienced significant relief of pain and increased mobility. Key words: Sacrum, sacroplasty, insufficiency fractures, osteoporosis, minimally invasive surgery

Abstract:

The literature is replete with reports of osteoporosis in rheumatoid arthritis, but the mechanism of bone loss remains obscure. This is probably due to the overlap with bone loss of aging and the menopause, whose exact mechanisms are also poorly understood. Against this background, a study was designed to evaluate generalised bone loss in young, premenopausal (if female), patients with rheumatoid arthritis. The protocol was designed to record demographic data, as well as information pertaining to the disease. Cortical bone mass was measured at the metacarpals and left femur, using an automated, computer-controlled technique. Trabecular bone was evaluated at the left femur (Singh index) as well as at the 3rd lumbar vertebra (Saville index). Bone kinetics were studied by the measurement of urinary excretion of calcium, phosphate and hydroxy-praline (resorption) and serum alkaline phosphatase (formation). Disease activity was measured clinically and with laboratory indices. Physical activity was indirectly measured by quantitating the disability, using the Keitel function test as well as a modified health assessment questionnaire (HAQ). The radiograph of the right wrist was scored by the Larsen index. The carpometacarpal ratio was also calculated from the radiograph. Numerous statistical techniques were applied in the analysis of the data. Healthy volunteers were used as controls. Patients with SLE were also studied, in order to compare the 2 inflammatory diseases. Patients with RA had generalised cortical bone loss (metacarpal and femur) (p < 0.001). Trabecular bone measurements were not significantly different from normals, using the crude radiographic techniques. Duration of disease was the most important clinical determinant of this bone loss. The relative contributions of disease activity and lack of physical activity to the loss of bone could not be adequately separated using conventional statistical techniques. Corticosteroid therapy did not promote metacarpal bone loss in these subjects, but may have contributed to thinning of the femoral cortex. Nonsteroidal anti-inflammatory drugs and disease modifying agents did not seem to influence the extent of the bone loss. Nutritional status and skinfold thickness did not correlate with bone mass. Dietary factors played no role in the genesis of bone loss, but may have had some effect on disease activity. Metacarpal measurements showed a sensitivity of 80% and specificity of 85% in discriminating between osteopaenic and normopaenic groups with RA. Osteopaenia could not be adequately predicted in the absence of metacarpal measurements. Metacarpal bone loss in RA was due to endosteal resorption, while in SLE it was due to periosteal resorption. The semi-automatic technique for measurement of metacarpal bone mass showed good reproducibility among 5 observers and at 2 different centres. The pathogenesis of bone loss in RA was multifactorial, the largest contribution probably coming from a humoral factor in the circulation, closely related to disease activity. Ionised calcium was elevated in 55% of RA patients, but only 5% of SLE patients. Serum PTH levels were normal in 99% of the RA subjects. Elevations in alkaline phosphatase. (25%) probably reflected disease activity rather than increased bone formation. Factor analysis of 27 variables showed that disease activity was central to the development of OP in RA. CS therapy tended to be used in the presence of active disease. Disability was not an important determinant of bone loss in RA, but may be a useful measure of activity of the disease. This study did not evaluate the relationships with sex hormonal status or vitamin D metabolism. Future research should aim at cohort analysis at 2 different periods, in order to improve our understanding of the pathogenesis of bone loss in RA.

Abstract:

Diabetes Mellitus is a chronic disease characterized by uncontrollable chronic high blood glucose (hyperglycemia) and complications, leading to serious damage to different tissues. In clinical studies, diabetic patients are found to have a higher risk of developing neurodegeneration and osteoporosis, and hyperglycemia-induced formation of advanced glycation endproducts (AGEs) may contribute towards the pathogenesis of diabetes-induced neurodegeneration and osteoporosis. Therefore the aim of this project is to investigate the role of hyperglycemia-induced methylglyoxal (MG) on neurodegeneration, neuroinflammation and osteoporosis.;Firstly, the role of MG on neurodegeneration of neuronal astrocytes, a kind of major glia in the brain, was studied. Astrocyte plays roles in the structural and functional support of the brain neurons and maintains normal brain physiology. In the present study, MG disturbed insulin signaling and led to apoptosis in rat primary astrocytes. Furthermore, the protective effects of ginsenosides were studied. From the results, impairment of insulin signaling was found in astrocyte culture under MG treatment. Moreover, cleavage of caspase and Poly ADP ribose polymerase (PARP) was observed together with insulin signaling disruption, showing the neurotoxic effects of MG towards astrocytes. The effects of ginsenosides in MG-treated astrocytes were also investigated. The ginsenosides Rd and R-Rh2 were shown to ameliorate the cell viability of MG-treated astrocytes and improve insulin signaling and inhibit apoptosis, indicating that Rd, R-Rh2, and related compounds may have therapeutic potential in treating diabetes-induced neurodegeneration.;Secondly, the role of MG on neuroinflammation was studied. The effects of MG in astrocytic cultures and hippocampi of experimental animals were compared. The astrocyte DITNC1 and C57BL/6 mice were treated with MG solution and hippocampi were harvested. MG induced astrogliosis in DITNC1 astrocytic cultures and C57BL/6 mice. Also, activation of the proinflammatory JNK signaling pathway was observed. Furthermore, increased gene expression of pro-inflammatory cytokines and astrocytic markers were observed. In addition, inhibition of JNK activities resulted in down-regulation of TNF- in MG-treated astrocytes. Our results suggest that MG may contribute to the progression of diabetes-related neurodegeneration through JNK pathway activation in astrocytes and the subsequent neuroinflammatory responses in the central nervous system.;Thirdly, the role of MG on osteoporosis and osteoclasts were studied. The osteoclasts are bone cells having catabolic action in the bone remodeling cycle. The effects of MG on osteoporosis in both animal and cell models were investigated. SD rats were treated with either MG or streptozotocin and the macrophage RAW264.7 was treated with MG. MG was shown to induce osteoclastogenesis by increased gene expression of osteoclast bone biomarkers CTSK, OSCAR and TRACP5. The results of MG-treated rats were similar to type 1 diabetic model. Furthermore, in MG-treated macrophages activation of the JNK was observed, and inhibition of JNK activities resulted in down-regulation of osteoclast biomarkers. Our results, suggested that MG may contribute to the progression of diabetes-related osteoporosis and the imbalanced bone remodeling through the JNK pathway in osteoclasts.;To conclude, MG causes different diabetic complications in multiple organs. It may be a potential therapeutic target to reduce and delay the development of neurodegeneration, neuroinflammation, and osteoporosis in diabetes.

Abstract:

Background: Osteoporosis has become a major problem worldwide as the population ages. An osteoporotic fracture is associated with a high rate of morbidity and mortality. Data on the prevalence, risk factors and outcome of osteoporotic fractures in South Africa remains sparse. Method: A retrospective audit was undertaken in all patients attending the Endocrine Clinic at Groote Schuur Hospital between March 2019 and March 2020 for the treatment of osteoporosis. Patients folders were reviewed to obtain the following information: demographic data, risk factors, laboratory investigations, treatment, baseline and follow up DEXA scans. Results: 264 patients were evaluated, average age 65.7 ± 12.3 years, 92.8% (n=245) were female. Common risk factors included smoking (50.8%, n=134), vitamin D deficiency (29.2%, n=77), steroid use (21.6%, n=57) and primary hyperparathyroidism (15.2%, n=40). A fragility fracture was diagnosed in 68.6% (n=181) - vertebral only (54.7%, n=99), hip only (14.9%, n=27), vertebral and hip (10.5%, n=19), wrist (7.2%, n=13) and other (12.7%, n=23). Bisphosphonates were used by 75% (n=198) of patients at the time of enrolment. Of these, 80.8% (n=160) received intravenous zoledonic acid alone, 6.1% (n=12) received oral alendronate alone and 13.1% (n=26) initially received alendronate followed by intravenous zoledronic acid. Over 5.2 years there was an improvement in bone mineral density (BMD) of 4.4% at the lumbar spine, while there was slight worsening of BMD at the femoral neck (- 0.17%). A fracture whilst on treatment occurred in 10.6% (n=21) of patients. Conclusion: The majority of patients with osteoporosis at Groote Schuur Hospital had a fragility fracture at diagnosis with a vertebral fracture being most common. Bisphosphonate treatment showed a measurable improvement in BMD at the lumbar spine, however, there was no improvement at the femoral neck. Despite this, few patients had a symptomatic vertebral or hip fracture whilst on treatment.

Abstract:

Background. Diabetes seems to be associated with an increased risk of fractures in the general population. We aimed to determine whether pre-transplant diabetes increases the risk of fractures among patients receiving solid organ transplantation.
Methods. We conducted a nested case-control study in a cohort of subjects 18 years and older who received a first solid organ transplantation in Quebec between January 1st 1986 and July 31st 2005, and who were covered by the RAMQ drug plan at least 1 year before the transplantation and 3 months after the date of discharge from the transplantation hospitalization. Cases were subjects from the cohort who had sustained a fracture between the date of discharge from the hospitalization for transplantation and the end of the study period or the patient's death. The fracture date was the case index date. All incidental fractures were included except fractures of the skull, phalanges of the hand and foot, multiple fractures and pathological fractures, and were identified by medical service claims. Controls were matched to cases on the type of organ transplanted and on the date of the transplantation (+/- 3 months). Crude and adjusted odds ratios (OR) were obtained with univariate and multivariate conditional logistic regression models.
Results. The study included 238 cases and 873 controls. Pre-transplant diabetes was present in 30% of the cases and 22% of the controls (crude OR: 2.16, 95% CI: 1.7--2.8). After adjusting for potential confounders, pre-transplantation diabetes remained a significant risk factor for fractures (adjusted OR: 1.94, 95% CI: 1.5--2.6).
Conclusion. Pre-transplant diabetes appeared to significantly increase post-transplant fractures among adults receiving solid organ transplantation.

Abstract:

Chapter 71 discusses osteoporosis, which is a systemic skeletal disease characterized by generalized loss of bone mass. Osteoporosis is the most common metabolic bone disorder. Symptoms in osteoporosis arise from complications, particularly fractures. Early diagnosis is important because osteoporotic fractures can markedly decrease quality of life and reduce life expectancy. Radiography alone is inadequate for detecting early bone loss. MRI has a higher sensitivity for detecting nondisplaced fractures in osteopenic bone than does radiography. Dual-energy x-ray absorptiometry (DXA) is the gold standard for diagnosis and fracture risk prediction. Detection of fragility and insufficiency fractures is highly important in patient care, often initiating lifestyle modification and pharmacologic therapy.

Abstract:

Endplate subsidence and vertebral body (VB) fracture are potential complications following lumbar total disc replacement (TDR) [1]. Early clinical evidence suggests that these events can be ameliorated in patients with osteopenia and osteoporosis by vertebral augmentation performed at the time of TDR [2]. However, the biomechanical basis to support vertebral augmentation of TDR has not been established. The objective of this study was to quantify the effects of vertebral augmentation with Cortoss on VB mechanics under compression by a TDR implant. We hypothesize that augmentation with Cortoss will improve the mechanical behavior in compression.

Abstract:

Metastatic disease in the thoracolumbar spine represents a large and growing problem. These metastases can lead to pain, pathologic fracture, and neurologic compromise. Over the last two decades, the utilization of polymethylmethacrylate (PMMA) for percutaneous vertebral stabilization has increased. Most of the biomechanical and outcomes data addresses the use of vertebroplasty and kyphoplasty procedures for osteoporotic fractures [1,2]. Use of these procedures for metastatic disease enjoys a long clinical history, but the outcomes and complications are notably higher than in osteoporosis [3,4]. Newer formulations of PMMA used in advanced systems such as the Perimeter System (DePuy, Raynham, MA) may allow carefully controlled, anatomically directed PMMA application with far greater control. However, The relative benefits of these newer, proprietary systems have not been demonstrated. Proposed benefits of direct void reconstruction, as opposed to anterior vertebral body fill include: tumor lysis, decreased risk of later tumor growth with canal compromise, the ability to use less total PMMA, decreased impact on adjacent segment mechanics, and therefore, a decreased adjacent segment fracture risk. This study was conducted to examine and compare the biomechanical effectiveness of the cement augmentation (vertebroplasty) and directed PMMA injection using the Perimeter system.

Abstract:

Bisphosphonate use has expanded beyond traditional applications, such as the prevention of osteoporosis, into non-traditional pediatric low bone mass diseases including osteogenesis imperfecta (OI) [1]. Despite enthusiasm, some questions remain on the overall effectiveness and implications of long-term treatment. In the Brtl/+ mouse model for OI, bisphosphonate treatment improves bone size, but bending strength fails to increase to proportionate levels and bones remain brittle [2]. Complications associated with long-term bisphosphonate treatment have been noted in other systems [3,4] leading to a need for critical information describing local drug-cell interactions responsible for these observations. The purpose of this study was to validate a fluorescent bisphosphonate analog, far-red fluorescent pamidronate (FRFP) [5] as a biomarker of bisphosphonate deposition and retention in vivo to monitor local drug concentration in a site-specific manner.

Abstract:

Kyphoplasty/vertebroplasty procedures traditionally use PMMA to treat the fractured vertebrae due to its mechanical properties. However, with time the bone erodes around the cement due to osteoporosis and inhibited bone remodeling due to the cyotoxicity of PMMA (1). The exothermic reaction of PMMA is also responsible for thermal necrosis and can cause complications in cases of extravasation (1; 2; 3). Lastly, PMMA is not bioactive and will not be reabsorbed (1; 2; 3). Thus, alternative cements with similar mechanical strengths are being explored. Calcium phosphate cements (CaP) have been explored due to their bioactive and non-thermal properties (3; 4). Despite these advantages, there are reservations of traditional CaP cements due to deficiencies in mechanical properties (1; 4). We evaluated new polymerized calcium phosphate (pCaP) cement which is not brittle like traditional CaP cements. Mechanical properties of vertebral bodies augmented with either PMMA or pCaP after fracture were determined.

Abstract:

Musculoskeletal adaptations to aging and disuse environment have significant physiological effects on skeletal health, i.e., osteopenia and bone loss. Osteoporosis often occurs together with muscle loss. Such musculoskeletal complications cause severe physiologic changes and have been proposed the synergistic effects of muscle function and bone adaptation. The role of mechanobiology in the skeletal tissue may be closely related to load-induced transductive signals, e.g., bone fluid flow, which is proposed to be a critical mediator of bone and muscle adaptation. The skeletal muscle may serve as a muscle pump that may mediate bone mechanotransduction via modulation of intramedullary pressure. Muscular stimulation (MS) is proposed to be used to simultaneously treat both muscle and bone loss. Indeed, our recent data have demonstrated that high frequency, short duration stimulation can inhibit bone loss and muscle atrophy. Although 10 min dynamic loading can effectively attenuate bone loss, it cannot totally recover disuse osteopenia. The optimal parameters required for such treatment are unclear. Studies have separately investigated the optimal signal parameters for bone or muscle. Insertion of recovery periods during high frequency stimulations to extend the loading cycles have shown potential to reduce muscle atrophy by minimizing fatigue and mimicking physiologic contractions, and demonstrated enhancement of bone remodeling. The overall hypothesis for this study is that dynamic MS can enhance anabolic activity in bone, and inhibit bone loss in a functional disuse condition. Combined high frequency and sufficient loading cycle may be able to completely mitigate bone loss induced by disuse osteopenia.

Abstract:

In clinical settings, doctors classify pulmonary disorders into two main categories, obstructive lung disease and restrictive lung disease. The former is characterized by the airway obstruction which is associated with several disorders like chronic bronchitis, asthma, bronchiectasis, and emphysema [1]. The latter is caused by different conditions where one of the triggers is tied to the spine deformity. In general, a pulmonary function test (PFT) [2] is used to evaluate and diagnose lung function, and physicians depend on the test results to identify the disease patterns of the patients (obstructive or restrictive lung disease). In the PFT, some parameters including total lung capacity (TLC), vital capacity (VC), and residual volume (RV) can infer the lung volume and lung capacity. Other parameters, such as forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), are often employed to assess the pulmonary mechanics. Scoliosis is an abnormal lateral curvature of the spine which involves not only the curvature from side to side but also an axial rotation of the vertebrae. Restrictive lung disease often happens in scoliosis patients, especially with severe spine deformity. Spine deformity if left untreated may lead to progression of the spinal curve, respiratory complications, and the reduction of life expectancy due to the decrease in thoracic volume for lung expansion. However, the relationship between thoracic volume and pulmonary function is not broadly discussed, and anatomic abnormalities in spine deformity (ex: scoliosis, kyphosis, and osteoporosis) can affect thoracic volume. Adequate thoracic volume is needed to promote pulmonary function. Previous literature has shown that the deformity of the thoracic rib cage will have detrimental effects on the respiratory function in adolescent idiopathic scoliosis patients [3–4]. In this paper, we aim to correlate thoracic volume and the parameters in PFTs in adult scoliosis patients 25–35 years after receiving treatments during their adolescence, either with physical bracing or spinal fusion surgery.

Abstract:

A proximal femur fracture due to osteoporosis is one of serious health care problems in aging societies. Osteosynthesis with pin or screw type of implants, such as Hansson pin (HP), Dual SC Screw (DSCS), is widely used for femoral neck fracture treatment in Japan. Unfortunately, some complications such as secondary fractures, especially peri-prosthetic fractures, may occur during postoperative rehabilitation period. In order to reveal the potential cause of the postoperative fracture from the viewpoint of the biomechanics, authors had already performed the dynamic stress analysis of the treated proximal femur based on finite element (FE) analysis. The final goal of our project is to establish the reliable postoperative bone fracture risk assessment method in response to the daily activity including mainly walking. The aim of this study is to propose a novel elastic multi body analysis method based on FE analysis for proximal femur biomechanics. Patient-specific 3D left hip joint FE model was constructed from an elderly female volunteer’s CT images. The model consists of the pelvis, proximal femur, cartilage and DSCS, as multi bodies. The dynamic loading and boundary conditions were applied to the model for simulating a gait motion. Direction and magnitude of the loads varies in response to the gait motion. The time dependent loading forces; hip contact, gluteus medius, gluteus maximus, tensor fasciae latae and adductor, acting around the hip joint was obtained by inverse dynamic analysis of a human gait using in-house lower-limb musculoskeletal model. These loading and boundary conditions for simulating the gait motion are the major technical advantages of the proposed multi body analysis comparing with the conventional static FE analysis. Time varying stress distribution during the gait was evaluated by using dynamic explicit method via ABAQUS. In order to visually demonstrate dynamic stress distribution, we examined the time varying von Mises stresses at the representative points located on the cortical surface of the proximal femur; femoral head, fracture surface and around the lateral insertion holes. The results indicate significant increase of the stresses around the proximal lateral insertion holes for DSCS treatment. Maximum stress values are good agreement with the previous static FE analysis, on the other hand, these biomechanical discussions based on the stress time histories are only obtained from the proposed method. It is indicated that the proposed method is feasible to support the better pre- and postoperative clinical decisions, which is the main contribution of this study.

Abstract:

Purpose: Breast cancer patients are at increased risk of developing comorbidities such as lymphedema, sarcopenia, osteoporosis and cardiovascular disease after breast cancer treatment. These complications contribute to a decrease in quality of life, cardiorespiratory fitness and muscle strength. Regular and long-term physical activity is an effective non-pharmacological strategy that can improve physical, psychological and social outcomes. The aim of our research was to evaluate the effect of various modes of an exercise intervention on physical performance, body composition, depression and autonomic nervous system in breast cancer survivors. Methods: 16 women after surgery with hormonal treatment enter the research. Thirteen of them completed the controlled, quasi-experimental study (54 ± 9 yrs, 164cm ± 6cm, 72 ± 12kg) and were divided into 3 groups according to their place of living: trained under supervision (n=5) (SUPERV), trained at home without supervision by videos (n=7) (HOME) and with no prescribed physical activity (n=4) (CON). Exercise intervention lasted 3 months and comprised of 60 min training units 3 × week (aerobic with resistant exercise in a 2 : 1 mode combined with regular weekly yoga and breathing exercises). The exercise intensity was set individually at 65–75% of HRR based on spiroergometry and was continuously controlled by heart rate monitors. The same principles applied to the HOME group, which, in addition to heart rate monitors, recorded frequency, length, HRmax, HRavg, and Borg scale of intensity perception. VO2max, BMI, fat mass, depression level (Beck’s depression inventory) and the power of the autonomic nervous system (total power and sympatho-vagal balance) were analyzed. For data evaluation we used descriptive statistics and Cohens d effect size. Results: 3 women dropped out of research because of medical reason. In all groups VO2max values increased. The largest increase in VO2max values was in SUPERV group by 36%, in HOME group by 20% and in CON group by 2%. Body weight decreased for groups SUPERV (˗1.2 kg) and CON (-0.1kg), for HOME group there was an increase (+0.2 kg). Body mass index decreased for SUPERV group (-0.4), for HOME and CON it increased (both +0.1). Total power decreased in SUPERV (-0.6) and HOME group (-0.2), in CON has not changed. The same results were achieved by the sympatho-vagal balance, only the CON group increased. Values from Beck’s depression inventory decreased for all groups, most for CON group. Conclusion: A 3-months of supervised and controlled exercise had a significant effect on physical fitness and body composition in comparison with non-supervised home-based physical intervention. Our results indicate that it is strongly advisable to apply a supervised exercise program to induce positive physiological changes in breast cancer survivors as part of aftercare.

Abstract:

Complex three part proximal humerus fractures in osteoporotic patients are a particularly challenging injury to manage as the associated bone loss reduces the efficacy of standard fixation techniques. Locking plates are commonly used for three part fracture fixation. However, a clinical study conducted by Owsley et al [1] reports complications with 57% of patients over 60 years of age. In cases of severe bone loss an intramedullary (IM) bone graft implant can be used in conjunction with locking plates to improve fixation and to provide structural stability. The limited and variable availability of bone grafts mean high cost and variable material properties.