Fragility Fractures: Risk Factors and Management in the Elderly

Migliorini, Filippo; Giorgino, R; Hildebrand, Frank; Spiezia, Filippo; Peretti, Giuseppe M.; Alessandri‐Bonetti, Mario; Eschweiler, Jörg; Maffulli, Nicola

doi:10.3390/medicina57101119

Cited by 67 publications

(26 citation statements)

References 94 publications

(107 reference statements)

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“…Osteoporotic fractures, also known as fragility fractures, refer to fractures that occur after minor trauma or in daily activities and are commonly found in the vertebrae, hip, distal forearm, proximal humerus, and distal tibia in elderly ( 4 , 5 ). Aging of the world populations increased the incidence of osteoporotic fractures in recent years.…”

Section: Introductionmentioning

confidence: 99%

Expert consensus on the bone repair strategy for osteoporotic fractures in China

Zhang

Yan²,

Chen³

et al. 2022

Front. Endocrinol.

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Osteoporotic fractures, also known as fragility fractures, are prevalent in the elderly and bring tremendous social burdens. Poor bone quality, weak repair capacity, instability, and high failure rate of internal fixation are main characteristics of osteoporotic fractures. Osteoporotic bone defects are common and need to be repaired by appropriate materials. Proximal humerus, distal radius, tibia plateau, calcaneus, and spine are common osteoporotic fractures with bone defect. Here, the consensus from the Osteoporosis Group of Chinese Orthopaedic Association concentrates on the epidemiology, characters, and management strategies of common osteoporotic fractures with bone defect to standardize clinical practice in bone repair of osteoporotic fractures.

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Section: Introductionmentioning

confidence: 99%

Expert consensus on the bone repair strategy for osteoporotic fractures in China

Zhang

Yan²,

Chen³

et al. 2022

Front. Endocrinol.

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“…Patients older than 80 or patients with common elderly multimorbidity aged over 70 are defined as “geriatric” [ 12 ], and 25 to 50% of patients over 85 are considered frail [ 13 ]. Frailty is a specific condition described as an increased vulnerability to stressors [ 13 ], and frailty fractures are defined as bone damage in the absence of important trauma or following a fall from standing height or less; in this context, hip fractures are the most common type of frailty fracture [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Proximal Femoral Fractures in the Elderly: A Few Things to Know, and Some to Forget

Maffulli

Aicale

2022

Medicina

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Hip fractures are a leading cause of hospitalisation in elderly patients, representing an increasing socioeconomic problem arising from demographic changes, considering the increased number of elderly people in our countries. Adequate peri-operative treatment is essential to decrease mortality rates and avoid complications. Modern management should involve a coordinated multidisciplinary approach, early surgery, pain treatment, balanced fluid therapy, and prevention of delirium, to improve patients’ functional and clinical outcomes. The operative treatment for intertrochanteric and subtrochanteric fractures is intramedullary nail or sliding/dynamic hip screw (DHS) on the basis of the morphology of the fracture. In the case of neck fractures, total hip replacement (THR) or hemiarthroplasty are recommended. However, several topics remain debated, such as the optimum thromboprophylaxis to reduce venous thromboembolism or the use of bone cement. Postoperatively, patients can benefit from early mobilisation and geriatric multidisciplinary care. However, during the COVID-19 pandemic, a prolonged time to operation with a subsequent increased complication rate have burdened frail and elderly patients with hip fractures. Future studies are needed with the aim to investigate better strategies to improve nutrition, postoperative mobility, to clarify the role of home-based rehabilitation, and to identify the ideal analgesic treatment and adequate tools in case of patients with cognitive impairment.

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“…Furthermore, the new welfare organizations had to consider as ordinary those patients affected by COVID-19, which in itself guarantees a notable picture of comorbidity and care difficulties. It is well known that fractures of the femur represent a large part of the necessary care for elderly patients [14,15] and have been a fundamental item in the organization of the new protocols [16]. In the evaluation of these fragile patients, different research groups tried to better understand how COVID-19 infection impacted the management, morbidity and mortality of such patients [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Elderly Patients Treated for Proximal Femoral Fractures during the Second Wave of Pandemic in Italy and Iran: A Comparison between Two Countries

Giorgino

Soroush

et al. 2022

Medicina

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Background and objevtive: The worldwide spread of SARS-CoV-2 has affected the various regions of the world differently. Italy and Iran have experienced a different adaptation to coexistence with the pandemic. Above all, fractures of the femur represent a large part of the necessary care for elderly patients. The aim of this study was to compare the treatment in Italy and Iran of COVID-19-positive patients suffering from proximal femur fractures in terms of characteristics, comorbidities, outcomes and complications. Materials and Methods: Medical records of COVID-19-positive patients with proximal femoral fractures treated at IRCCS Istituto Ortopedico Galeazzi in Milan (Italy) and at Salamat Farda and Parsa hospitals in the province of Tehran (Iran), in the time frame from 1 October 2020 to 16 January 2021, were analyzed and compared. Results: Records from 37 Italian patients and 33 Iranian patients were analyzed. The Italian group (mean age: 83.89 ± 1.60 years) was statistically older than the Iranian group (mean age: 75.18 ± 1.62 years) (p value = 0.0003). The mean number of transfusions for each patient in Italy was higher than the Iranian mean number (p value = 0.0062). The length of hospital stay in Italy was longer than in Iran (p value < 0.0001). Furthermore, laboratory values were different in the post-operative value of WBC and admission and post-operative values of CRP. Conclusions: The present study shows that differences were found between COVID-19-positive patients with proximal femoral fractures in these two countries. Further studies are required to validate these results and to better explain the reasons behind these differences.

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Fragility Fractures: Risk Factors and Management in the Elderly

Cited by 67 publications

References 94 publications

Expert consensus on the bone repair strategy for osteoporotic fractures in China

Expert consensus on the bone repair strategy for osteoporotic fractures in China

Proximal Femoral Fractures in the Elderly: A Few Things to Know, and Some to Forget

COVID-19 Elderly Patients Treated for Proximal Femoral Fractures during the Second Wave of Pandemic in Italy and Iran: A Comparison between Two Countries

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