Silent compression fractures: a missed opportunity

Agnes Jonsson is a graduate of University College Dublin in 2013 and is currently working as a Registrar in Orthogeriatrics in St. Vincent’s Hospital in Dublin. Her areas of interest are dementia care and quality improvement. She wrote this blog with input from Dr. Yasser Aljabi, Orthopaedic Registrar. Together they are working to create a pathway of care for vertebral fractures in St. Vincent’s Hospital.

Osteoporotic fragility fractures have an estimated annual cost of 2 billion pounds in the UK. This includes the cost of acute hospital stay, rehabilitation and social care. Only a very small proportion of the cost is invested in pharmacological management and secondary prevention of osteoporosis. The National Osteoporosis Foundation recommends treatment with antiresorptive agents for patients with confirmed osteoporosis on DXA and for patients with neck of femur or vertebral fractures. Vertebral compression fractures have recently started to attract increasing amounts of attention, similar to that shown for hip fractures years ago prior to the implementation of hip fracture pathways of care.

You thought walking would keep your spine strong, but…

Dr. Dafne Zuleima Morgado Ramirez is based at the Interaction Centre (UCLIC) at University College London and is a member of the Global Disability Innovation Hub. She tweets at @zuleimamorgado. She has recently published work in Age and Ageing journal.

Walking has been promoted as a way of reducing the risk and progression of osteoporosis. Yet clinical studies have shown that walking does not increase bone mineral density at the spine unless it is performed along with other physical activities, and that even then, improvement is minimal. Physical activity produces vibration that is transmitted from the feet up to the head through the body. Although there is clear evidence that bone formation and resorption are responsive to mechanical stimulation, such as vibration, currently there is limited understanding of the vibration that is transmitted through the lumbar and thoracic spine during walking.

New research highlights unseen dangers of pelvic fracture

A new study published in Age & Ageing finds pelvic fracture mortality rates equivalent to those for hip fracture, despite lack of attention or funding. 

The study into osteoporotic pelvic fractures in older patients has shown worrying effects on mortality, length of hospital stay and independent living.
It finds that mortality rates for pelvic fractures are comparable to those for hip fractures, but that the issue receives far less attention or funding. It calls for new guidelines and better management of pelvic fractures in older people, helping them to maintain an independent life.

Yousif Shanshal and Sheena Waters, co-authors of the report, said:

“Pelvic fracture patients incur a high cost to an already stretched NHS, with increased lengths of stay and high mortality rates. They are usually frail elderly patients with multiple comorbidities, and often don’t regain normal function after their injury.

Following the work of the National Hip Fracture Database and the Best Practice Tariff, care for hip fracture patients has improved across the country. We now need to do the same thing for pelvic fracture patients.

It’s crucial that these patients are cared for by a geriatrician, in close liaison with their orthopaedic colleagues, and that a multi-disciplinary team is fully involved in each patient’s recovery and discharge.”

Good Vibrations: whole body vibration treatment

Falls are common in older people and are the direct cause of many osteoporotic fractures. There are limited treatments available to help frail older people who are at risk of falls. A study funded by the National Osteoporosis Society and the British Geriatrics Society on the potential benefits of whole body vibration for frail older people has now been published in Age and Ageing.

The collaborative work between the University of Loughborough and Nottingham University Hospitals NHS Trust showed that older people attending a falls prevention programme are able to tolerate whole body vibration.

Patients were recruited at The Nottingham University Hospitals Rehabilitation Unit and all of them took part in the NICE recommended falls prevention programme, which includes exercise. They were split at random into three groups. One group used a vibration platform that moved vertically up and down; one used a vibration platform with a “see-saw” action and one group stood upon a stationary platform whilst a buzzing noise was played so that they thought they were receiving vibration (sham vibration). The vibration training involved visiting the unit three times per week over 12 weeks, and standing on the plate during several short bouts of vibration, for a maximum of 6 minutes in total.

NHFD national report shows care for hip fracture patients is improving

The National Hip Fracture Database is a joint venture of the British Geriatrics Society and the British Orthopaedic Association, and is designed to facilitate improvements in the quality and cost effectiveness of hip fracture care.  Follow it on Twitter @NatHipFracData 

Hip fracture is a common, serious and costly injury affecting mainly older people. It usually results from the combination of osteoporosis and a fall from standing height or less.  Care is complex and involves surgical, medical and rehabilitation interventions.

The National Hip Fracture Database 2013 report covers casemix, care and outcomes of 61,508 cases submitted between 1 April 2012 and 31 March 2013 by 180 hospitals in England, Northern Ireland and Wales.

Vitamin D and bone health: A practical clinical guideline for patient management – National Osteoporosis Society Guideline

Dr Terence Ong is a Research Fellow at Nottingham University Hospitals NHS Trust.

Professor Opinder Sahota is Professor of Orthogeriatric Medicine and Consultant Physician at Nottingham University Hospitals NHS Trust

image by epSos.de

Vitamin D is not, in the truest sense, a vitamin because it is not exclusively obtained through diet alone. It is a secosteroid, mostly obtained intrinsically by the effect of ultraviolet radiation on previtamin D compounds and subsequent hydroxylation in the liver and kidneys.

Vitamin D plays an important role in calcium and phosphate homeostasis through its effect on gut and bone metabolism. Besides that, it also plays a key role in muscle function. In recent years, our understanding of vitamin D has expanded and we are starting to appreciate its much broader role in areas such as the immune system, cancer and cardiovascular disease.