Purpose: Early initiation of anti-osteoporosis medications (AOMs) is recommended for patients on long-term glucocorticoid (GC) therapy. This study aimed to clarify the real-world effectiveness of AOMs against incident hip and vertebral fractures in patients undergoing GC therapy using the nationwide health insurance claims database of Japan (NDBJ).Methods: Patients aged ³50 years who were prescribed GC (≥5 mg/day prednisolone or equivalent) for ≥90 days and who were followed up regarding AOM prescription and hip and vertebral fracture incidences for the subsequent 1080 days between 2012 and 2018 were selected from NDBJ. Associations of AOMs prescribed within 90 days since GC therapy initiation with hip or vertebral fracture risk were evaluated by Cox proportional hazards regression using propensity score inverse probability weighting (IPW) for receiving any AOM or individual AOMs.Results: In total, 96475 women and 98385 men were included in the analysis; 38.0% of women and 27.6% of men received AOMs. Patients who received any AOM and those who received bisphosphonates or denosumab had a significantly lower risk of hip and vertebral fractures than those who received no AOM in both sexes after propensity score IPW. Teriparatide was associated with an increased risk of both fractures in women and an increased risk of vertebral fractures in men. Selection biases such as confounding by indication might have caused an underestimation of AOMs’ protective effects.Conclusions: Bisphosphonates and denosumab were associated with a lower fracture incidence in patients on long-term GC therapy in real-world settings.
It is important to keep the arm in a zero-position after surgery for rotator cuff tears of the shoulder. Ordinarily the casting plaster has been used to keep the arm in a zero-position, but there are some disadvantages in casting plaster: being heavy, easy to loose, stressful and uncomfortable in summer seasons. The outfit of the shoulder has some advantages to keep good function of upper extremity after surgery. These advantages are as follows; 1) light weight, 2) composition, 3) good fitness and well-ventilated, 4) relief of pain, and 5) being able to exercise the arm function during fitting outfit. Our new type outfit of the shoulder is composed of three parts, shell type arm brace, joints and corset type body brace. joint of outfit is composed of four different joints which are hinge, rotor, disc and axial. Junction of these four joints makes multi-axial motions of the shoulder possible. This outfit is very useful for the shoulder function after repair of rotator cuff tears.
Aim This retrospective cohort study assessed the association between the incidence of secondary vertebral fracture managed with a brace (SVF) and pharmacotherapy. Methods The association between the incidence of SVF and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Results The data of female patients ( n = 637 303) were analyzed. The 2‐year incidence of SVF was 73.5 per 10 000 patients ( n = 4687). Approximately 0.73% of patients without medications and 0.74% with medications had SVF. Patients taking bisphosphonates (0.87), denosumab (0.77), and selective estrogen receptor modulators (0.88) had significantly lower standardized incidence ratios (SIRs) than patients not taking medications after the occurrence of primary fracture; meanwhile, patients taking parathyroid hormone medications had considerably higher SIRs than those not taking medications. The non‐SVF group (59.1%) had a significantly higher mean MPR than the SVF group (55.5%). Patients taking denosumab in the non‐SVF group (68.2%) had the highest mean MPR. The proportion of patients taking denosumab with an MPR of ≥80% in the non‐SVF group was significantly higher than that in the SVF group. Conclusion Patients taking medications were at a lower risk of developing SVF than those not taking medications. Although this study did not compare the medications' SVF prevention effects, patients taking denosumab had a 0.77 SIR of SVF in Japan. The effect of pharmacotherapy on SVF prevention might be affected by the MPR of each medication. Geriatr Gerontol Int 2024; 24: 390–397 .
Clinical data regarding alendronate jelly are limited. We compared the efficacy and safety of once-weekly alendronate oral jelly with once-weekly alendronate tablet formulations in the context of primary osteoporosis.In this 6-month, open-label, prospective, observational study, Japanese patients aged ≥60 years with primary osteoporosis were included from 14 primary care centres in Japan. The effects of once-weekly alendronate oral jelly and tablet formulations on bone mineral density (BMD), bone turnover markers, and quality of life related to gastrointestinal symptoms were assessed at baseline and 6 months. Treatment was allocated by patient preference. This potentially confounding factor was adjusted for statistically.In total, 170 patients were enrolled (jelly, n = 97; tablet, n = 73). Mean percent changes in radius, lumbar spine, femoral neck, and hip BMD were similar in both treatment groups at 6 months. Both formulations decreased tartrate-resistant acid phosphatase 5b (TRACP-5b) and procollagen 1 N-terminal peptide (P1NP) between baseline and 6 months (by about 50% and 60%, respectively); no significant differences in mean changes were noted in these markers between groups. At 6 months, no significant differences were noted in visual analogue scale or EuroQOL five-dimension questionnaire scores between groups. The jelly group had significantly lower scores than the tablet group in the Izumo scale domains of heartburn (-0.81, P = 0.0040), epigastralgia (-0.94, P = 0.0003), and epigastric fullness (-0.49, P = 0.044). During treatment, more patients discontinued for upper gastrointestinal symptoms in the tablet group (n = 4) than the jelly group (n = 1).Once-weekly alendronate oral jelly 35 mg may be a suitable alternative therapeutic agent for primary osteoporosis in Japan.
The objective of this study is to compare three dimensional (3D) postoperative motion between metal and ceramic bipolar hip hemiarthroplasty for femoral neck fracture.Materials and MethodsThis study was conducted with forty cases (20 cases of metal bipolar hemiarthroplasty (4 males, 16 females), 20 cases of ceramic bipolar hemiarthroplasty (2 males, 18 females)) from November 2012 to November 2014. Average age was 80.8±7.5 years for the metal bipolar group and 79.3±10.5 years for the ceramic bipolar group. We obtained motion pictures from standing position to maximum abduction in flexion by fluoroscopy then analyzed by 2D–3D image matching method. The motion range of the “Shell angle”, “Stem neck angle” and the “Stem neck and shell angle” has been compared between the metal bipolar group and the ceramic bipolar group (Fig. 1).ResultsMetal bipolar showed greater variability of the Stem neck angle and Shell angle than ceramic bipolar. Six of the twenty cases reached unilateral oscillation angle of 37 degree...
11 cases of scaphoid fractures were surgically treated. Operative procedures employed were K-wire fixation, Russe Procedure, and Herbert screw fixation with bone graft.We employed K-wire fixation for 2 cases of acute unstable type. One case of acute unstable type and 4 cases of established non-union (stable type) were treated with Russe procedure, one of which failed to unite. It was re-operated using the Hervert-screw with bone graft. Four cases of established non-union (unstable type) and one re-operated case were managed by the Hervert-screw with bone graft.
Thirty-six beagles, 18 months of age, underwent ovariohysterectomy (OHX) or a sham operation. Sham-operated animals were given a diet with standard calcium (1.4%) (group 1, n = 6) or a restricted calcium diet (0.14%) (group 2, n = 6). The OHX animals were given the restricted calcium diet and YH529 orally with respective daily doses of 0, 0.02, 0.1, and 0.5 mg/kg of body weight (groups 3-6, n = 6 each) for 12 months. At the end of this period, the lumbar bone mineral densities (BMDs) in groups 2 and 3 and the load values for group 3 were significantly smaller than those for group 1. The midfemur BMD did not differ among the groups. The urinary deoxypyridinoline (U-Dpy) and bone formation rates (BFR/BS, BFR/BV) in groups 2 and 3 and the osteonal BFR/BS and trabecular osteoclast number (Oc.N/BS) in group 3 were significantly larger than the respective values for group 1. However, these parameters did not significantly differ between groups 2 and 3. The serum osteocalcin (OC) level, wall thickness (W.Th), and mineral apposition rate values for group 3 were significantly larger than those for group 2. In group 2, the trabecular activation frequency (Ac.F) increased by 3.11 times, and the percent values of the number of labeled osteons (L-Ot.N/T-Ot.N, %) in the tibia by 3.28 times over those for group 1. In group 3, the Ac.F increased by 3.20 times and the number of labeled osteons by 3.77 times over those for group 1. In groups 4-6, the U-Dpy and Oc.N/BS values were smaller, but their OC levels did not significantly differ from the level for group 3. The lumbar BMD, the load, and W.Th were dose-dependently significantly larger than those for group 3. The Ac.F values were significantly smaller, and the respective value in groups 4-6 was 67.9, 25.5, and 10.2% of that in group 3. The BMDs of the midfemur in groups 4-6 were significantly larger than those in group 3, but the ultimate load values did not significantly differ. The L-Ot.N/T-Ot.N values were also significantly smaller, and the respective value in groups 4-6 was 82.0, 48.5, and 55.2% of that in group 3. The tibial endocortical and periosteal BFR/BSs did not differ significantly. These data demonstrate that the effects of OHX on bone mass and turnover were small in the beagles fed a restricted calcium diet. YH529 maintained the mass and strength of the lumbar bone by reducing the bone resorption. The cortical bone appeared to be less sensitive to the agent than the trabecular bone in this animal model.
