ObjectiveTo evaluate the incidence of osteoporotic hip fracture in the Macarena Health Area (Seville).Setting and participantsThis was a prospective observational study that collected all osteoporotic hip fractures that occurred between March 2013 and February 2014 at the Clinical Unit of Traumatology and Orthopaedics. All cases collected during the first 6 months of the study were followed for 1 year after the occurrence of the event.Outcome measuresWe evaluated the incidence of osteoporotic hip fractures in the Macarena Health Area (Seville) from 1 March 2013 to 28 February 2014, and we compared the incidence with that in 2 previous studies carried out with the same methodology in 1994 and 2006. Furthermore, we calculated the morbidity and degree of disability 1 year after the fracture occurred and determined mortality and the associated factors.ResultsThe overall incidence was 228 per 100 000 individuals/year (95% CI 204.5 to 251.6), and the incidence was higher in women than in men. In women, the incidence rate decreased in all age groups over time, while in men, the incidence rate increased. The mortality rate 1 year after the episode was 27.2%. The factors associated with overall mortality were a body mass index below 25 kg/m2, renal failure and low plasma proteins.ConclusionsOur results show a high incidence of osteoporotic hip fracture that is increasing in men, and in men it is associated with a higher mortality than in women. There is room to improve the modifiable factors associated with mortality and the available rehabilitation interventions to reduce the disability associated with these fractures.

A great variety of powder metallurgy techniques can produce biomimetic porous titanium structures with similar mechanical properties to host bone tissue. In this work, loose sintering and space holder techniques, two frequently used metallurgical techniques, are compared to evaluate the influences of porosity (content, size, morphology and wall roughness), mechanical properties (stiffness and yield strength) and in-vitro cellular responses (adhesion and proliferation of myoblasts and osteoblasts). These comparisons are made to achieve the best balance between biomechanical and bifunctional behavior of a partial porous implant for cortical bone replacement. Cell adhesion (filopodia presence) and spreading were promoted on both porous surfaces and fully dense substrates (non-porous control surfaces). Porous scaffold samples designed using 50 vol.% NaCl space holder technique had an improved bioactive response over those obtained with the loose sintering technique due to higher roughness and scaffold pore diameter. However, the presence of large and heterogeneous pores compromises the mechanical reliability of the implant. Considering both scenarios, the substrates obtained with 40 vol.% NH4HCO3 and pore size ranges between 100 and 200 μm provide a balanced optimization of size and strength to promote in-vitro osseointegration.

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Fragility fractures constitute a major public health problem worldwide, causing important high morbidity and mortality rates. The aim was to present the epidemiology of fragility fractures and to assess the imminent risk of a subsequent fracture and mortality. This is a retrospective population-based cohort study (n = 1369) with a fragility fracture. We estimated the incidence rate of index fragility fractures and obtained information on the subsequent fractures and death during a follow-up of up to three years. We assessed the effect of age, sex, and skeletal site of index fracture as independent risk factors of further fractures and mortality. Incidence rate of index fragility fractures was 86.9/10,000 person-years, with highest rates for hip fractures in women aged ≥80 years. The risk of fracture was higher in subjects with a recent fracture (Relative Risk(RR), 1.80; p < 0.01). Higher age was an independent risk factor for further fracture events. Significant excess mortality was found in subjects aged ≥80 years and with a previous hip fracture (hazard ratio, 3.43 and 2.48, respectively). It is the first study in Spain to evaluate the incidence of major osteoporotic fractures, not only of the hip, and the rate of imminent fracture. Our results provide further evidence highlighting the need for early treatment.

Objectives: To describe the Fracture Liaison Service (FLS), to know the characteristics of the patients attended with emphasis on sex differences, and to know the compliance of International Osteoporosis Foundation (IOF) quality standards. Methods: Observational, prospective research. All the consecutive patients that attended in usual clinical practice from May 2018 to October 2019, were over 50 years, and with a fragility fracture (FF), were included. Results: Our FLS is a type A multidisciplinary unit. We included 410 patients, 80% women. FF recorded in 328 women were: Hip (132, 40%), Clinical Vertebral (81, 25%) and No hip No vertebral (115, 35%). Those in 82 men were: Hip (53, 66%), Clinical Vertebral (20, 24%) and No hip No vertebral (9, 10%), p = 0.0001. Men had more secondary osteoporosis (OP). The most remarkable result was the low percentage of patients with OP receiving treatment and the differences between sex. Forty-nine (16%) women versus nine (7%) men had received it at some point in their lives, p = 0.04. The probability of a man not receiving prior treatment was 2.5 (95%CI 1.01–6.51); p = 0.04, and after the FF was 0.64 (0.38–1.09). Treatment adherence in the first year after the FLS was 96% in both sexes. The completion of IOF quality standards was bad for patient identification and reference time. It was poor for initial OP screening standard and good for the remaining ten indicators. Conclusions: the FLS narrowed the gap in diagnosis, treatment, and follow-up of fragility fracture patients, especially men. The FLS meets the IOF quality standards.

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide and it is associated with an increased risk of osteoporosis and fragility fractures. Our aim is to analyze the effect of T2DM on bone quality. This is a case-control study. The studied population consisted of 140 patients: 54 subjects with hip fracture (OP) without T2DM, 36 patients with hip fracture and T2DM (OP-T2DM), 28 patients with osteoarthritis (OA) without T2DM, and 22 patients with OA and T2DM (OA-T2DM). Bone markers, bone mineral density, FRAX score, microstructural, and bone material strength from femoral heads were assessed. The group with hip fracture presented lower BMD values than OA (p < 0.05). The OP, OP-T2DM, and OA-T2DM groups showed a decrease in bone volume fraction (BV/TV), in trabecular number (Tb.N), and in trabecular thickness (Tb.Th), while an increase was presented in the structural model index (SMI) and trabecular bone pattern factor (Tb.Pf), The groups OP, OP-T2DM, and OA-T2DM also presented lower values than those in group OA regarding the biomechanical parameters in the form of Young’s modulus or elastic modulus, toughness, ultimate stress, ultimate load, extrinsic stiffness, and work to failure (p < 0.05). Our results show the negative effect of type 2 diabetes mellitus on trabecular bone structure and mechanical properties.

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In this work, the mechanical and bio-functional behavior of a TiNbTa alloy is evaluated as a potential prosthetic biomaterial used for cortical bone replacement. The results are compared with the reference Ti c.p. used as biomaterials for bone-replacement implants. The estimated mechanical behavior for TiNbTa foams was also compared with the experimental Ti c.p. foams fabricated by the authors in previous studies. A TiNbTa alloy with a 20–30% porosity could be a candidate for the replacement of cortical bone, while levels of 80% would allow the manufacture of implants for the replacement of trabecular bone tissue. Regarding biocompatibility, in vitro TiNbTa, cellular responses (osteoblast adhesion and proliferation) were compared with cell growth in Ti c.p. samples. Cell adhesion (presence of filopodia) and propagation were promoted. The TiNbTa samples had a bioactive response similar to that of Ti c.p. However, TiNbTa samples show a better balance of bio-functional behavior (promoting osseointegration) and biomechanical behavior (solving the stress-shielding phenomenon and guaranteeing mechanical resistance).