Background: Menopause accelerates bone loss after 10 years of cessation of the menstrual cycle causing osteoporosis. Hip fractures among postmenopausal women escalate morbidity and mortality in these women. Objective: The study was done to evaluate the effect of duration of menopause on BTMs so that it could detect post-menopausal osteoporosis at the earliest and predict the fracture risk Materials and Methods: The study was conducted in a tertiary hospital in Mangalore on 100 postmenopausal women. The duration of menopause was divided into quartiles. Evaluation and correlation of serum osteocalcin, urinary hydroxyproline, BMI, calcium, phosphorous and alkaline phosphatase was done on the duration of menopause. The subjects comprised 50 osteoporotic and 50 non-osteoporotic post-menopausal women. Continuous variables were represented as median and interquartile ranges. Comparison between two groups was done using the Mann Whitney U test. Comparison between more than two groups was done using the Kruskal Wallis test. The correlation was done using spearman’s correlation test. Statistical significance was considered at p<0.05. Results: Serum osteocalcin levels significantly declined and urinary hydroxyproline levels elevated between quartiles of duration of menopause in the entire study group and in osteoporotic women. (p<0.001). There was no significant difference in osteocalcin and hydroxyproline levels between the quartiles in the fracture group. 82% of the osteoporotic had >15 YSM. Conclusion: Osteocalcin levels plateaued after 8years of menopause and started decreasing after 15 YSM. Osteoporotic fractures were higher in more than 15 YSM and the osteocalcin level was 2.47 ng/ml in this quartile. There is no significant difference in osteocalcin levels in those with fractures, indicating no significance of screening for serum osteocalcin levels once the fractures have occurred. Hence concluding that the duration of menopause is the key indicator for osteoporosis and serum osteocalcin is a potent biomarker for detection of the risk of fracture. Monitoring of serum osteocalcin levels(<2.55ng/ml) after 8 years of menopause is very essential for early prophylactic treatment in order to prevent osteoporotic fractures and the burden associated with it. KEYWORDS: Duration of menopause, osteocalcin, quartiles, urinary hydroxyproline, osteoporotic fractures
Background: One of the most frequently fractured bones in the body is the clavicle. Traditionally, midshaft clavicle fractures have been treated conservatively. There is a higher prevalence of patients with displaced midshaft clavicle fractures going in for non-union or mal-union after conservative treatment than in those treated with Open Reduction & Internal Fixation (ORIF). The primary treatment for displaced midshaft clavicular fractures is surgery. Improved functionality, a reduction in the time taken for a union, and early return to activity were observed in patients treated operatively as compared to those treated with a conservative approach. Materials and methods: The
Background: Clavicle Fracture is one of the most common bony injuries. Midshaft fractures have traditionally been treated conservatively. The prevalence of non-union or mal-union in displaced midshaft clavicle fractures after conservative treatment is higher as compared to those treated with ORIF. Surgery is believed to be the primary treatment for displaced midshaft clavicular fractures. Operative fixation of the clavicle fractures results in improved function, shorter time for union, and early return to activity as compared to those treated conservatively. Materials and Methods: A hospital-based retrospective and prospective study was conducted at the Department of Orthopaedics, A.J. Institute of Medical Sciences and Research Centre, Mangalore, for two years. A total of 100 cases of midshaft clavicle fractures, meeting the inclusion and exclusion criteria were treated by operative and non-operative methods after ethical clearance. After 3 weeks, physiotherapy was started. Patient follow-ups were done at 6, 12 and 24 weeks and evaluated radiologically by a senior orthopaedic surgeon and radiologist. Results: Males outnumbered females by 66% (i.e 83% against 17%). 54 patients (54%) had an RTA while the remaining 46 patients(46%) a history of fall. The youngest patient was 19yrs, and the oldest was 72yrs old. The mean age was 36.93 years. Amongst complications plate breakage in 1 patient, non-union in 13 patients and restriction of range of motion in 18 patients were seen. In our study, 63% of patients had leftsided fracture while the remaining 37% of patients had a right-sided fracture. Radiological union at 12 and 24 weeks was faster in the operative group (p > 0.05) than conservative group. Conclusion: Midshaft clavicular fractures treated operatively have better union rates radiologically and clinically when compared to those treated conservatively.
Introduction and Aim: Osteoporosis is common among women following 10 years of cessation of menstruation, due to bone loss accelerated by menopause. The study was done to evaluate the effect of duration of menopause on bone turnover markers (BTMs). Materials and Methods: The study involved 100 postmenopausal women; 50 osteoporotic and 50 non-osteoporotic. Comparison and correlation of serum calcium, phosphorus, alkaline phosphatase (ALP), serum osteocalcin (sOC) and urinary hydroxyproline (uHP) were done based on duration of menopause. Comparison of biochemical parameters was done using Independent t-test and ANOVA test for two groups and more than two groups respectively. Correlation was done using Pearson’s correlation test. Statistical significance was considered at p<0.05. Results: The sOC significantly declined and uHP levels increased between quartiles of duration of menopause among study participants. (p<0.001). However, in those without fractures, sOC and uHP were higher in those with <7 years since menopause (YSM) and then plateaued after 8 YSM. The percentage of osteoporotic women having >15 YSM was 82%. Duration of menopause correlated better with sOC (r=-0.633) than uHP (r=0.575) (p<0.001). Conclusion: Osteoporotic fractures were higher in more than 15 YSM. There was no difference in both sOC and uHP in those with fractures, proving non-significance of screening these markers once the fractures have occurred. As sOC correlates better with duration of menopause, monitoring of sOC in early years of menopause is required to prevent osteoporotic fractures and associated burden through prophylactic treatment.
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