Fluoride ingestion reduces intestinal calcium absorption; its molecular basis has not been studied. We studied the mRNA expression of calcium-sensing receptor (CaR), vitamin D receptor (VDR) and calbindin D 9 k (D 9 k) by northern blot analysis in the duodenal mucosa of rats. Weanling pups fed with chow diet containing adequate calcium (0.5% w/w) and drinking water (NaF < 1 ppm) served as controls (Group I) and were studied at 9 and 15 weeks. The pups, born to rats fed with a calcium-deficient diet (0.03%) and excess fluoride water (NaF 50 ppm), were continued on the same diet and water (Group II) until 9 weeks of age. Subsequently, Group II rats were divided into 4 subgroups; 3 subgroups with fluoride free water [II-A adequate calcium, II-B excess calcium (Ca 2%) and II-D calcium deficient], whereas II-C received fluorinated water and adequate calcium diet until 15 weeks. At 9 weeks, as compared to group-I, group-II had decreased VDR (P < 0.001) and D 9 k mRNA (P < 0.001), whereas CaR mRNA levels increased (P < 0.05). At 15 weeks, as compared to group-I, VDR mRNA further reduced in group II-D (P < 0.001) and II-C (P < 0.001), whereas it increased in group II-A. Removal of fluoride ingestion and calcium replenishment increased D 9 k mRNA expression, maximally in adequate calcium group (P < 0.001), while it was further reduced in group II-C (P < 0.001). CaR expression decreased significantly in all the groups. We conclude that excess fluoride reduces the mRNA levels of VDR and D 9 k in the duodenal mucosa of rats, thereby possibly reducing calcium absorption. Calcium supplementation with simultaneous fluoride removal improves their expression.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Fractures of the proximal femur are relatively common injuries in adults and common source of morbidity and mortality among the elderly. Fractures of the proximal femur include trochantric and subtrochantric fractures. The present study was designed to evaluate and analyze the role of proximal femoral nail (PFN) in the treatment of proximal femoral fractures.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">It was a prospective study on 125 cases of proximal femoral fractures. The fractures were classified according to AO classification. Salvati and Wilson Score were used for functional assessment</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In this study at 6 months follow up, union was achieved in 123 cases, open reduction was performed in 11% of cases (14 cases). Technical and mechanical complications were noted in 21% cases (27 cases). Reoperation rate was 4% (Five cases). According to Salvati and Wilson scoring system excellent results were seen in 36% of cases (45 cases), good results in 46% cases (58 cases), fair result in 13% cases (16 cases) and poor results in 5% cases (6 cases)</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">It is concluded from our study that proximal femoral nailing is an attractive and suitable implant for Proximal Femoral Fractures and its use in unstable intertrochantric fractures is very encouraging</span><span lang="EN-IN">.</span></p>

The reversibility of osteopenia secondary to isolated Ca deficiency (CaDef) is still not clear. We studied the effect of severe CaDef on Ca homeostasis and bone accrual in a 'hypercalcaemic' animal, the rabbit, during the post-weaning period and its reversibility on Ca supplementation. Male Belgian 5-week-old rabbit pups were fed CaDef diet (0·026 % Ca) for 10 weeks. As compared with those fed with a normal chow diet (0·45 % Ca), CaDef pups developed significant hypocalcaemia (P,0·05), hypocalciuria (urinary Ca 76 (SEM 12) v. 17 (SEM 1) mg/l; P,0·005), hypophosphataemia (serum inorganic P 100 (SEM 6) v. 65 (SEM 4) mg/l; P,0·005), secondary hyperparathyroidism (SHPT) (serum intact parathyroid hormone human equivalent 18·2 (SEM 1·4) v. 125·0 (SEM 4·5) pg/ml; P,0·001) and elevated serum calcitriol levels (34·0 (SEM 3·9) v. 91·0 (SEM 1·0) pg/ml; P,0·005). Elevated urinary C-terminal telopeptide of class I collagen (P,0·005) and total serum alkaline phosphatase (P,0·005) suggested increased bone turnover. There was a significantly lower gain in bone mineral density (BMD) and bone mineral content (BMC) in the whole body and lumbar spine in vivo, and various sub-regions of the femur and tibia in vitro. Supplementation of adequate Ca (0·45 % Ca) after 15 weeks on the normal diet resulted in rapid catch-up growth, and resolution of SHPT. Rapid gain in various BMD and BMC parameters continued at 30 weeks of age, and both were comparable with those in rabbits on a normal diet. We conclude that Ca deficiency-induced SHPT and poor bone accrual in growing rabbit pups are rapidly reversible with Ca supplementation. The present study indicates that early intervention may be a more appropriate window period for human nutritional corrective measures.

Introduction: Intertrochanteric and femoral neck fractures account for nearly 90% of proximal femur fractures. It is customary to use 65 years of age to define the elderly. One year mortality in these elderly patients ranges from 12%-36%. The main objective of this prospective study is to study the effect of age, sex, co morbidities, delay in surgery and complications on outcome in elderly with proximal femur fractures and to identify optimal measures that can be taken to improve outcome in these patients. It was presumed that early surgery within 48 hours after stabilization of co morbid conditions improves outcome in these elderly patients with proximal femur fractures. Materials and Methods: In this prospective study elderly patients with proximal femur fractures were selected, after careful selection with inclusion and exclusion criteria. They underwent surgery after preoperative assessment and followed for up to one year at a tertiary referral centre. Results: Increasing age and male sex are not significant factors affecting outcome. Increasing number of co morbidities (2, 3 or more) is associated with significant increase in mean length of hospital stay (p values .006, and .001), increased incidence in number of complications (p value .008) and mortality (p value .028). Presence of complications is significantly associated with increase in mean length of hospital stay (p values .000, .001), decline in recovery of pre injury mobility status (p value 0.018), increased incidence in number of deaths (p value .01). Delay in surgery more than 48 hours is associated with significant increase in mean length of hospital stay (p value .001) and increased incidence in number of complications (p value .028). Conclusion:Early surgery within 48 hours after stabilization of co morbid conditions is associated with improvement of outcome in elderly patients with proximal femur fractures is proved correct in terms of decreasing mean length of hospital stay and decreasing incidence of number of complications.

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