The crippling consequences of fractures and their impact on quality of life

Cooper, Cyrus

doi:10.1016/s0002-9343(97)90022-x

Cited by 585 publications

(389 citation statements)

References 18 publications

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“…48 The morbidity and mortality of hip fractures is higher in men than in women, with 20.7% of men (compared with 7.5% of women) age Ͼ 75 years dying after a hip fracture. 49 The mortality rate in men 5 years after hip or spinal fracture is Ϸ 20% in excess of the expected rate. 49,50 Fracture rates in men with prostate carcinoma who are receiving ADT Hypogonadism with serum testosterone levels in the castrate range has been identified as a common cause of osteoporotic fractures, with a near-doubling of spinal fracture risk and a 5-fold increase in hip fracture risk.…”

Section: Fracture Rates In Men and Women Who Present With Osteoporosismentioning

confidence: 99%

“…49 The mortality rate in men 5 years after hip or spinal fracture is Ϸ 20% in excess of the expected rate. 49,50 Fracture rates in men with prostate carcinoma who are receiving ADT Hypogonadism with serum testosterone levels in the castrate range has been identified as a common cause of osteoporotic fractures, with a near-doubling of spinal fracture risk and a 5-fold increase in hip fracture risk. 51,52 However, to our knowledge, there are no well designed prospective studies assessing spinal and nonspinal fracture rates in men with prostate carcinoma treated on a long-term basis with ADT.…”

Section: Fracture Rates In Men and Women Who Present With Osteoporosismentioning

confidence: 99%

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Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Diamond

Higano

Smith

et al. 2004

Cancer

242

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BACKGROUNDAndrogen‐deprivation therapy (ADT) is prescribed with increasing frequency for men with prostate carcinoma. There is growing concern about the effects of such therapy on the skeleton. In the current review, the authors addressed the current research, diagnostic methods, and treatment recommendations for bone loss and osteoporosis in men with prostate carcinoma who received ADT.METHODSData were obtained from electronic literature searches (for the years 1986 through 2002) and from abstracts and meeting proceedings. All randomized and nonrandomized clinical trials, retrospective studies, and cross‐sectional studies of osteoporosis in men with prostate carcinoma who received ADT with or without other therapies were reviewed.RESULTSThe findings confirmed that ADT resulted in significant bone loss in men with prostate carcinoma. Bone mineral density (BMD) of the hip, as measured by dual‐energy X‐ray absorptiometry (DXA), is considered the preferred site of assessment in older men. Spinal BMD is equally important, although careful interpretation of spinal DXA values is required, because of coexisting facet joint disease and extravertebral calcification. Osteoporosis is diagnosed when BMD is > 2.5 standard deviations below a reference mean. Men with prostate carcinoma who were treated with ADT had average BMD measurements below those of eugonadal men. Rates of bone loss ranged from 2% to 8% in the lumbar spine and from 1.8% to 6.5% in the femoral neck during the initial 12 months of continuous ADT. Retrospective data indicated an increased risk of fracture in men with prostate carcinoma who were treated with ADT.CONCLUSIONSFor men with prostate carcinoma who are at high risk for osteoporosis and fractures, clinical management should be dictated by the results of radiographic and DXA skeletal assessment. Cancer 2004;100:892–9. © 2004 American Cancer Society.

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Section: Fracture Rates In Men and Women Who Present With Osteoporosismentioning

confidence: 99%

Section: Fracture Rates In Men and Women Who Present With Osteoporosismentioning

confidence: 99%

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Diamond

Higano

Smith

et al. 2004

Cancer

242

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“…Cooper et al [6] have estimated that as a result of an increasing proportion of elderly people in the world, the number of hip fractures will approximate four million in 2025. A hip fracture changes the patient's life; 20% to 25% of patients die after 1 year [10], 40% are still unable to walk independently, 60% have difficulty with at least one essential activity of daily living, and 80% are restricted in other activities such as grocery shopping or driving [5]. Hip fractures are classified as either intracapsular femoral neck fractures or extracapsular fractures, which are either trochanteric or subtrochanteric fractures.…”

Section: Introductionmentioning

confidence: 99%

Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

Støen

Lofthus

Nordsletten

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Hemiarthroplasty has been shown superior to internal fixation for displaced femoral neck fractures (FNF) in the first 2 years. However, there are unanswered questions about the performance of hemiarthroplasty over the longer term compared with internal fixation. Questions/purposes We sought to compare hemiarthroplasty with internal fixation in terms of (1) outcomes scores for pain, hip function, and quality of life at a minimum of 5 years after surgery in a randomized trial. A secondary purpose was to compare (2) patient survival and (3) frequency of reoperation in the two groups. Methods A total of 222 consecutive patients older than 60 years, including those cognitively impaired, with FNF were randomized to either internal fixation with two parallel screws or bipolar hemiarthroplasty. At a minimum followup of 4.9 years (mean, 5.9 years; range, 4.9-7.2 years), 68 of the 70 surviving patients were examined by a study nurse and study physiotherapist blinded to initial treatment. Questionnaires on hip function (Harris hip score), quality of life (Eq5D), and activity of daily living function (Barthel ADL) were administered. The Barthel ADL index score was split into good function (score 95 or 100) and reduced function (score below 95).

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“…Vertebral fractures are the most common type of osteoporotic fractures, 70 but the majority occur asymptomatically and only one-third is clinically recognized. 71 The lack of an effect of LMWH on BMD was apparent in the clinical trials as opposed to observational cohort studies. However, the observational studies examined bone outcomes as their primary endpoints.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

et al. 2016

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BACKGROUND: Adults who require long-term anticoagulation with low-molecular-weight heparin (LMWH) such as cancer patients or the elderly may be at increased risk of fractures. OBJECTIVE: To determine the effects of LMWH therapy of at least 3 months' duration on fractures and bone mineral density (BMD) in non-pregnant adult populations. METHODS: We systematically reviewed electronic databases (e.g., MEDLINE, EMBASE), conferences and bibliographies until June 2015 and included comparative studies in non-pregnant adult populations that examined the effects of LMWH (≥3 months) on fractures and BMD. We synthesized evidence qualitatively and used random-effects meta-analysis to quantify the effect of LMWH on fractures. RESULTS: Sixteen articles reporting 14 studies were included: 10 clinical trials (n = 4865 participants) and four observational cohort studies (3 prospective, n = 221; 1 retrospective, n = 30). BMD and fractures were secondary outcomes in the majority of trials, while they were primary outcomes in the majority of observational studies. In participants with venous thromboembolism and underlying cardiovascular disease or cancer (5 RCTs, n = 2280), LMWH for 3-6 months did not increase the relative risk of all fractures at 6-12 months compared to unfractionated heparin, oral vitamin K antagonists or placebo [pooled risk ratio (RR) = 0.58, 95 % CI: 0.23-1.43; I 2 = 12.5 %]. No statistically significant increase in the risk of fractures at 6-12 months was found for cancer patients (RR = 1.08, 95 % CI: 0.31-3.75; I 2 = 4.4 %). Based on the data from two prospective cohort studies (n = 166), LMWH for 3-24 months decreased mean BMD by 2.8-4.8 % (depending on the BMD site) compared to mean BMD decreases of 1.2-2.5 % with oral vitamin K antagonists. CONCLUSIONS: LMWH for 3-6 months may not increase the risk of fractures, but longer exposure for up to 24 months may adversely affect BMD. Clinicians should consider monitoring BMD in adults on long-term LMWH who are at increased risk of bone loss or fracture.

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The crippling consequences of fractures and their impact on quality of life

Cited by 585 publications

References 18 publications

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

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