Immobilization in external rotation after an initial shoulder dislocation reduces the risk of recurrence compared with that associated with the conventional method of immobilization in internal rotation. This treatment method appears to be particularly beneficial for patients who are thirty years of age or younger.

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Low-dose bFGF with HA was effective for osteochondral repair in rabbits. The significant osteochondral reparative role of bFGF with HA comparing with GM incorporating bFGF might be explained by the potential carrier role of HA and possible synergistic action between these two agents. The combination of HA with bFGF significantly suppressed the side effects resulting from single use of bFGF.

Risedronate decreases osteoporotic fracture incidence; however, its effects remain unclear in elderly osteoporotic patients. Vitamin K mediates carboxylation of osteocalcin (OC), and high undercarboxylated osteocalcin (ucOC) levels indicate vitamin K deficiency and increased osteoporotic fracture risk. We aimed to evaluate the effects of risedronate alone or combined with vitamin K2 on serum ucOC, OC, and incidence of vertebral fractures in elderly osteoporotic patients. A total of 101 women with postmenopausal osteoporosis aged >60 years were randomly stratified into two groups-R group (n = 51), treated with risedronate alone; and R + K group (n = 50), treated with risedronate and vitamin K2. Serum ucOC, OC and incidence of vertebral fractures were evaluated before treatment and at 6 and 12 months post-treatment. Decreased ucOC rates at 6 and 12 months were not significant between groups. However, at 6 and 12 months, decreased OC rates in the R group (p < 0.01 and 0.05, respectively) were significantly higher than in the R + K group, and ucOC/OC change rates in the R group (p < 0.05 and 0.001, respectively) were significantly lower than in the R + K group. Vertebral fracture incidence was not significantly different between the groups at 6 and 12 months. ucOC levels in patients with incident vertebral fractures were significantly higher than in patients without incident vertebral fractures in the R group at 6 months (p < 0.05). Although no significant difference was observed for ucOC decrease rate and incidence of vertebral fractures between treatments, ucOC levels in patients with incident vertebral fractures were significantly greater than in patients without when using risedronate alone.

BackgroundLow-intensity pulsed ultrasound is a pain-free therapy performed daily at home by the patient and has been shown to promote fracture healing. Teriparatide is a parathyroid hormone preparation that activates osteoblastic bone formation and is also reported to be effective in promoting bony union.Case presentationWe report the case of a 56-year-old Japanese male with a femoral shaft fracture who underwent intramedullary osteosynthesis nailing initially. He had no radiologic or clinical sign of healing 3 months later and low-intensity pulsed ultrasound was initiated at that time. He was reassessed in another 3 months, with evidence of mild bone consolidation but the fracture gap persisted. Subsequent treatment with human parathyroid hormone was initiated in combination with low-intensity pulsed ultrasound. Full fracture healing was present 6 months after beginning the combination low-intensity pulsed ultrasound and teriparatide. It is hypothesized that the potential additive effects of low-intensity pulsed ultrasound and teriparatide therapy ultimately triggered sufficient bone formation to support osseous union.ConclusionThe case reported herein is a femoral shaft atrophic nonunion in which traditional interventions failed. Successful fracture healing was finally achieved with low-intensity pulsed ultrasound and teriparatide therapy. This is the first reported case of diaphyseal nonunion with deterioration of bone quality in long bones resolved with teriparatide and low-intensity pulsed ultrasound.

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Vitamin D affects not only bone but also muscle to prevent falls and osteoporotic fractures. However, these effects on muscle and the mechanisms of fall prevention are still unclear. The purpose of this study was to investigate the effects of alfacalcidol [1α(OH)D 3 ] on muscle strength, muscle fatigue, and bone mineral density (BMD) in ovariectomized rats. Seven-month-old female Wistar rats were orally administered 1α(OH)D 3 or its vehicle everyday for 4 weeks after ovariectomy (OVX) or sham operation. Calf muscle strength and fatigue were evaluated by electrical stimulation of the sciatic nerve under general anesthesia. 1α(OH)D 3 administration significantly increased the maximum muscle strength in the sham-operated (P < 0.01) and the OVX (P < 0.01) groups compared to their respective control groups. However, 1α(OH)D 3 administration did not significantly affect muscle fatigue in these groups. The BMD of the femur in the 1α(OH)D 3 -treated OVX group was significantly higher than that in the vehicle-treated OVX group (P = 0.04). These results suggested that 1α(OH)D 3 increases muscle strength but does not affect muscle fatigue in this rat model. The effectiveness of activated vitamin D in preventing bone fractures may be partly owing to its effect on muscle strength in addition to its known effect on bone metabolism.The active, hormonal form of vitamin D 1,25-dihydroxyvitamin D 3 [1,25(OH) 2 D 3 or calcitriol] and its prodrug 1α-hydroxyvitamin D 3 [1α(OH)D 3 or alfacalcidol] have been widely used to treat a variety of metabolic bone diseases, such as rickets/osteomalacia, renal osteodystrophy, and osteoporosis (8, 41). Activated vitamin D can prevent fractures by improving bone quality, bone metabolism, and bone mineral density (BMD) (7,22,40,45,50). However, its preventive effects on fractures were more significant than its effects on bone quality or BMD. Several recent meta-analyses have demonstrated that native or activated vitamin D has preventive effects on falls (2, 16). This preventive effect on falls contributes to a partial reduction of fractures by vitamin D in elderly osteoporotic individuals (3, 37). However, the mechanisms by which activated vitamin D prevents falls remain unknown. Several factors have been reported as physical risk factors for falls, including decreased muscle strength or function of lower extremity, impaired physical function such as single-leg standing, and postural imbalance with aging (26,28,34,36). Vitamin D may act directly on muscle tissue to exert its preventive effect on falls. It has been known that osteomalacia and rickets cause muscular atrophy and decrease muscle strength and that the muscular symptoms associated with these diseases quickly improve with vitamin D treatment (39, 43). These findings indicate a potential association between vitamin D and muscle tissue. Therefore, the effects of vitamin D on muscle tissue with regard to fall prevention have been of focus in aged and osteoporotic patients. Muscle function is defined by several factors, including mu...