Investigation of osteoporosis in elderly and senile patients with fractures of the proximal femur
DOI:
https://doi.org/10.32782/2415-8127.2024.69.4Keywords:
fractures, osteoporosis, biochemical, immunological markersAbstract
Introduction. The loss of bone mineral density (BMD) is one of the main causative factors of fractures and complications in surgical treatment. The purpose of the study: to investigate the patterns of metabolic changes in patients with osteoporotic fractures of the proximal femur from the standpoint of planning rehabilitation treatment in the postoperative period. Material and Methods. We studied 47 patients aged 72 to 89 years (mean age 76.4 ± 4.2 years). Internal osteosynthesis was used for 26 and primary hemiarthroplasty for 21 patients. The surgical intervention was done on day 2 or 3 from the time of injury. To assess the metabolism, the content of electrolytes, carbohydrates, proteins, lipids, activity of aminotransferases, phosphatases, creatine kinase and lysosomal enzymes in the blood serum was determined. To evaluate the immune system: total leukocytes, lymphocytes, T-lymphocytes and their subpopulations (T-helpers, T-suppressors), B-lymphocytes, phagocytic activity of neutrophils and phagocytic index, neutrophil metabolic activity (spontaneous NST test) and the level of circulating immune complexes. Results and their discussion. A decrease in bone mineral density was noted in all examined patients and depended on the age of the patients. For 21 (mean age 71.3 years), the average T-index value was 1.9 ± 1.03. For 29 (mean age 86.1 years), the average T-index value was 3.2 ± 0.84. Changes in metabolism in fractures indicate the development of an inflammatory response to trauma, lead to hypoproteinemia and progression of bone resorption. A combined type of immunodeficiency develops, which persists for a long time and correlates with the degree of bone resorption. Conclusions. Surgical interventions for osteoporotic fractures of the proximal femur should be performed as soon as possible after the injury to preserve the body's energy reserves. After surgery, a comprehensive drug therapy aimed at treating osteoporosis should be used and include immunocorrection. Rehabilitation treatment after surgery is longer and involves an individual approach for the functional load of the operated limb.
References
Bae G, Kim E, Kwon HY, An J, Park J, Yang H. Disability Weights for Osteoporosis and Osteoporotic Fractures in South Korea. J Bone Metab. 2019 May;26(2):83-88. doi: 10.11005/jbm.2019.26.2.83. Epub 2019 May 31. PMID: 31223604; PMCID: PMC6561851.
Özdemir E, Okkaoglu MC, Evren AT, Yaradilmis YU, Ates A, Altay M. The Cost and Consequences of Failed Osteosynthesis of Intertrochanteric Femur Fractures: A Matched Cohort Study. Indian J Orthop. 2021 Jan 3;55(3):629-635. doi: 10.1007/s43465-020-00322-0. PMID: 33995866; PMCID: PMC8081792.
Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med. 2010 Apr 8;3:1-17. PMID: 20463818; PMCID: PMC2866546.
Kovalenko VM, Bortkevych OP. Komorbidnist: vyznachennia, mozhlyvi napriamky diahnostyky ta likuvannia [Comorbidity: definition, possible directions of diagnosis and treatment] Ukrainskyi revmatolohichnyi zhurnal [Ukrainian rheumatologic journal]. 2019;3(77):33-44. [In Ukrainian]
Jiang L, Chou ACC, Nadkarni N, Ng CEQ, Chong YS, Howe TS, Koh JSB. Charlson Comorbidity Index Predicts 5-Year Survivorship of Surgically Treated Hip Fracture Patients. Geriatr Orthop Surg Rehabil. 2018 Nov 21;9:2151459318806442. doi: 10.1177/2151459318806442. PMID: 30479849; PMCID: PMC6249653.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.p.947 https://doi.org/10.1176/appi.books.9780890425596
Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med. 2000 Mar 7;132(5):337-44. doi: 10.7326/0003-4819-132-5-200003070-00002. PMID: 10691583.
Bansal A, Beniwal RK, Agarwal S. Primary bipolar replacement arthroplasty versus internal fixation in the management of unstable intertrochanteric fractures in the elderly. International Journal of Research in Orthopaedics 2019 Dec;6(1):111-116. DOI: 10.18203/issn.2455-4510.IntJResOrthop20195803
Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970 Apr;52(3):457-67. PMID: 5425640.
Lewiecki EM. Osteoporosis. 4th ed. Academic press. 2013. Chapter 63, Evaluation of the Patient at Risk for Osteoporosis; p. 1481–1504. https://doi.org/10.1016/b978-0-12-415853-5.00063-7
Barco CMR, Arija SM, Pérez MR. Biochemical Markers in Osteoporosis: Usefulness in Clinical Practice. Reumatología Clínica (English Edition). 2012;8(3):149-152. DOI:10.1016/J.REUMAE.2011.05.004
Kim BJ, Lee SH, Koh JM. Potential Biomarkers to Improve the Prediction of Osteoporotic Fractures. Endocrinol Metab (Seoul). 2020 Mar;35(1):55-63. doi: 10.3803/EnM.2020.35.1.55. PMID: 32207264; PMCID: PMC7090300.
Chen Z, Xie L, Xu J, Lin X, Ye J, Shao R, Yao X. Changes in alkaline phosphatase, calcium, C-reactive protein, D-dimer, phosphorus and hemoglobin in elderly osteoporotic hip fracture patients. Ann Palliat Med. 2021 Feb;10(2):1079-1088. doi: 10.21037/apm-20-218. Epub 2020 Oct 9. PMID: 33040555.
Li L, Bennett-Brown K, Morgan C, Dattani R. Hip fractures. Br J Hosp Med (Lond). 2020;81(8):1–10. https://doi. org/10.12968/hmed.2020.0215
Wade SW, Strader C, Fitzpatrick LA, Anthony MS, O’Malley CD. Estimating prevalence of osteoporosis: examples from industrialized countries. Arch Osteoporos. 2014;9(1):182. https://doi.org/10.1007/s11657- 014- 0182-3.
Bentler SE, Liu L, Obrizan M, et al. The af termath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009 Nov 15;170(10):1290-1299. https://doi.org/10.1093/aje/kwp266
Borgström F, Karlsson L, Ortsäter G, et al; In ternational Osteoporosis Foundation. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos. 2020 Apr 19;15(1):59. https://doi.org/10.1007/ s11657-020-0706-y.
Coughlan T, Dockery F. Osteoporosis and fracture risk in older people. Clin Med (Lond). 2014 Apr;14(2):187-91. doi: 10.7861/clinmedicine.14-2-187. PMID: 24715132; PMCID: PMC4953292.
Jayaram G, Sudhakar MV, Kumar RA, Jijulal CU. Study of outcomes of cemented hemiarthroplasty for comminuted intertrochanteric fractures in the elderly. J Orthop. 2023 May 26;41:67-72. doi: 10.1016/j.jor.2023.05.011. PMID: 37362961; PMCID: PMC10285444.
Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008 Apr;19(4):385-97. doi: 10.1007/s00198-007-0543-5. Epub 2008 Feb 22. PMID: 18292978; PMCID: PMC2267485.
Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol. 2006 Feb;194(2 Suppl):S3-11. doi: 10.1016/j.ajog.2005.08.047. PMID: 16448873.
Malgo F, Appelman-Dijkstra NM, Termaat MF, van der Heide HJ, Schipper IB, Rabelink TJ, Hamdy NA. High prevalence of secondary factors for bone fragility in patients with a recent fracture independently of BMD. Arch Osteoporos. 2016;11(1):12. doi: 10.1007/s11657-016-0258-3. Epub 2016 Feb 23. PMID: 26906974; PMCID: PMC4764633.
Cunningham TD, Martin BC, DeShields SC, Romero CC. The impact of osteoporotic fractures compared with other health conditions in older adults living in Virginia, United States. Osteoporos Int. 2016 Oct;27(10):2979-88. doi: 10.1007/s00198-016-3620-9. Epub 2016 May 10. PMID: 27165285.
Saito D, Mikami T, Oda Y, Hasebe D, Nishiyama H, Saito I, Kobayashi T. Relationships among maxillofacial morphologies, bone properties, and bone metabolic markers in patients with jaw deformities. Int J Oral Maxillofac Surg. 2016 Aug;45(8):985-91. doi: 10.1016/j.ijom.2016.02.003. Epub 2016 Mar 11. PMID: 26972158.
Ding C, Parameswaran V, Udayan R, Burgess J, Jones G. Circulating levels of inflammatory markers predict change in bone mineral density and resorption in older adults: a longitudinal study. J Clin Endocrinol Metab. 2008 May;93(5):1952-8. doi: 10.1210/jc.2007-2325. Epub 2008 Feb 19. PMID: 18285417.
Zhang W, Gao R, Rong X, Zhu S, Cui Y, Liu H, Li M. Immunoporosis: Role of immune system in the pathophysiology of different types of osteoporosis. Front Endocrinol (Lausanne). 2022 Sep 6;13:965258. doi: 10.3389/fendo.2022.965258. PMID: 36147571; PMCID: PMC9487180.
Aghamirsalim M, Mehrpour SR, Kamrani RS, Sorbi R. Effectiveness of educational intervention on undermanagement of osteoporosis in fragility fractures. Arch Orthop Trauma Surg. 2012 Oct;132(10):1461-5. doi: 10.1007/s00402-012-1569-5. Epub 2012 Jun 27. PMID: 22736021.
Soucanye de Landevoisin E, Bertani A, Candoni P, Charpail C, Demortiere E. Proximal femoral nail antirotation (PFNATM) fixation of extra-capsular proximal femoral fractures in the elderly: retrospective study in 102 patients. Orthop Traumatol Surg Res. 2012 May;98(3):288-95. doi: 10.1016/j.otsr.2011.11.006. Epub 2012 Apr 5. PMID: 22483629.
Pountos I, Giannoudis PV. The management of intertrochanteric hip fractures. Orthopaedics and Trauma. 2016;30:103-108. https://doi.org/10.1016/j.mporth.2016.03.004
Chen M, Wang J, Cheema AN, Yang S, Liu X. A bone-conserving revision stem for unstable intertrochanteric fractures of the geriatric osteoporotic population. Arthroplasty. 2022 Nov 5;4(1):48. doi: 10.1186/s42836-022-00151-6. PMID: 36333743; PMCID: PMC9636650.
