Advanced Age, High β-CTX Levels, and Impaired Renal Function are Independent Risk Factors for All-Cause One-Year Mortality in Hip Fracture Patients

Gulin, Tonko; Kruljac, Ivan; Kirigin, Lora Stanka; Merc, Marcela; Pavić, Marina; Trcin, Mirna Tominac; Bokulić, Adrijana; Megla, Željka Bukovec; Kaštelan, Darko

doi:10.1007/s00223-015-0070-x

Cited by 18 publications

(11 citation statements)

References 41 publications

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“…Subtypes 3, 4A and 4B accounted for 31 (96.9%) of 32 in-hospital deaths, while no fatal outcomes occurred among 211 subjects with subtypes 1 and 2A. This observation is in line with studies on older adults living in the community or RCFs showing a positive association between all-cause mortality and bCTX levels 120 - 123 as well as osteoporosis defined by BMD 124 - 128 .…”

Section: Discussionsupporting

confidence: 84%

Bone Turnover Status: Classification Model and Clinical Implications

Fisher¹,

Fisher²,

Srikusalanukul³

et al. 2018

Int. J. Med. Sci.

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Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness.Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures.Resalts: Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 μg/L, bCTX≤0.250 μg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 μg/L), normal bone resorption (bCTX≤0.250 μg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX<100.0 (subtype 2B); 3- low bone formation, high bone resorption (bCTX>0.250 μg/L) and P1NP/bCTX<100.0; 4- high bone turnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX<100.0 (subtype 4B). Compared to subtypes 1 and 2A, subtype 2B was strongly associated with nonvertebral fractures (odds ratio [OR] 2.0), especially HF (OR 3.2), age>75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days.Conclusions: We proposed a classification model of bone turnover status and demonstrated that in orthogeriatric patients altered subtypes are closely related to presence of nonvertebral fractures, comorbidities and poorer in-hospital outcomes. However, further research is needed to establish optimal cut points of various biomarkers and improve the classification model.

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Section: Discussionsupporting

confidence: 84%

Bone Turnover Status: Classification Model and Clinical Implications

Fisher¹,

Fisher²,

Srikusalanukul³

et al. 2018

Int. J. Med. Sci.

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“…Previous studies have shown that perioperative blood loss is associated with lower mobility during physiotherapy ( 26 ), an increased risk for major adverse cardiovascular events ( 27 ), acute kidney injury ( 28 ), a longer hospital stay, and a higher rate of rehospitalization ( 29 ). Impaired kidney function tests, which were more common in the IR group, have a strong association with functional status in the future ( 30 , 31 ), a greater risk of major adverse cardiovascular events ( 27 ), and even increased mortality ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

et al. 2020

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Background: As the population ages, the rate of hip fractures and the need for rehabilitation increases. Home-based rehabilitation (HBR) is an alternative to classic inpatient rehabilitation (IR), which is an expensive framework with non-negligible risks. Methods: A retrospective study of patients 65 years and above following surgery to repair a hip fracture who underwent HBR or IR between 2016 and 2019. The two rehabilitation frameworks were compared for rehabilitation outcome and factors predicting successful rehabilitation. The outcome was determined with the Montebello Rehabilitation Factor Score-Revised (MRFS-R). Results: Data were collected for 235 patients over 3 years. The mean age was 81.3 ± 8.0 and 172 (73.3%) were women. Of these, 138 underwent IR and 97 HBR. The HBR group had better family support and fewer lived alone. There were also differences in the type of fracture and surgery. The medical condition of the IR group was more complex, as reflected in a higher Charlson's comorbidity scores, higher rates for delirium and more infectious complications, a lower Norton score, lower serum hemoglobin, and albumin levels, and higher serum creatinine and urea levels. It also had a more significant functional decline after surgery and required a longer rehabilitation period. However, no difference was found in the rehabilitation outcomes between the two groups (MRFS-R ≥ 50). The independent predictors for rehabilitation in the IR group were serum albumin level, comorbidity, and cognitive state. There were no independent predictors in the HBR group. Conclusions: In this retrospective study, there was no significant difference in short-term rehabilitation outcomes between the HBR and IR groups event though the patients in the IR group were medically more complex. This result should be taken into account when planning rehabilitation services after hip fracture and tailoring rehabilitation frameworks to patients.

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“…These variables have been previously suggested to affect the prognosis. [20][21][22][23][24][25][26][27][28][29] Odds ratios and 95% confidence intervals were determined. A p value of <0.05 was considered significant for all statistical tests.…”

Section: Discussionmentioning

confidence: 99%