Search Results (56)

The association of atrial fibrillation (AF) and neck of femur fractures (NOF) are common in old people, creating a complex clinical scenario with significant implications for morbidity, mortality, and healthcare systems. This narrative review explores the bidirectional relationship between AF and NOF, focusing on shared risk factors, pathophysiological links, and challenges in clinical management, and also reviews the benefit of an orthogeriatric model. Advanced age, frailty, osteoporosis, polypharmacy, and cardiovascular comorbidities predispose patients to both conditions, while AF itself increases fall risk through haemodynamic instability, syncope, and adverse effects of rate- or rhythm-controlling medications. Importantly, the physiological stress of hip fracture and subsequent surgery can precipitate new-onset or worsening AF via inflammatory, neurohormonal, and metabolic mechanisms. The main challenge for ortho-geriatricians lies in anticoagulation management and preoperative and postoperative management. While anticoagulation reduces thromboembolic risk in AF, it increases perioperative bleeding risk in patients with NOF, often leading to delays in surgery that are independently associated with poorer outcomes. This review examines the current evidence regarding perioperative anticoagulation strategies, timing of surgery, and postoperative resumption of therapy. In addition, the review examines important outcome parameters such as mortality, stroke, bleeding, length of hospital stay, and functional recovery. This highlights the importance of not only improving multidisciplinary care involving orthopaedics, cardiology, geriatrics, and anaesthesia to optimise outcomes, but also enhancing risk stratification. Standardised perioperative pathways and integrated geriatric–cardiac assessment may help mitigate complications. Therefore, understanding how AF and NOF interact is key to delivering holistic, patient-centred care for an increasingly elderly population in orthogeriatric wards. Full article

The coexistence of obesity, osteoporosis, and sarcopenia has been associated with adverse outcomes such as risk of falls, fractures, immobility, disability and frailty, yet data from Latin American populations are scarce. This study aimed to determine the prevalence and associations of obesity, osteoporosis, and sarcopenia—individually and combined—with frailty in Mexican elderly women. We conducted a cross-sectional study in which patients with body mass index < 18.5 kg/m², uncorrected sensory deficits, immobility, musculoskeletal diseases, or patients with implanted devices were excluded. Frailty was assessed using the FRAIL scale, obesity by body fat percentage, osteoporosis according to American Association of Clinical Endocrinology (AACE) guidelines and sarcopenia following the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) recommendations. A total of 115 participants aged ≥60 years were assessed between January and June 2025. Frailty was present in 21.7% of the patients; 67.0% had obesity, 72.2% osteoporosis, 20.0% sarcopenia and 13.0% osteosarcopenic obesity. Sarcopenic phenotypes were associated with frailty: odds ratios (95% CI) were 3.05 (1.12–8.26) for sarcopenia, 4.23 (1.42–12.55) for sarcopenic obesity and 3.98 (1.28–12.40) for osteosarcopenic obesity. Sarcopenic phenotypes showed associations with frailty in Mexican elderly women. Full article

Background/Objectives: The increase in life expectancy and the share of the elderly population has the effect of increasing the number of osteoporotic hip fractures. At the same time, the number of total hip arthroplasty (THA) interventions is continuously increasing. The objective of this study is to investigate the incidence rates of hip fractures during the period 2008–2019, in Romania, among people who are at least 40 years old, as well as to determine the extent to which the increase in the prevalence of people who have undergone THA has affected the incidence of hip fractures, given that the operated hip no longer presents a risk of fracture. Methods: We extracted the information, between 2008 and 2019, from nationwide retrospective studies about the incidence and time trend of hip fractures in Romania. Information on primary THA interventions during the period 2001–2019 was obtained from the Romanian Arthroplasty Register (RAR). We obtained the population size, by gender and age groups, from the reports of the National Institute of Statistics. For the period 2008–2019, we calculated the standardized annual hip fracture incidence rates by sex and by age. Given that each person has two hips at risk of fracture, we calculated hip fracture rates in a scenario without THA interventions. For this, we subtracted 0.5 people from the at-risk population for each prevalent hip prosthesis. Thus, we revealed the effects of decreasing fracture rates due to having hip prostheses. Results: From 2008 to 2019, age-standardized incidence rates of hip fractures increased by 10.8% in women, and by 2.8% in men. By excluding hips being replaced with prostheses in the at-risk population, we obtained higher hip fracture incidence rates. These recorded values were considerably higher for the elderly population. The variation in hip fracture rates during the observed period was 10.16% (9.76% in women and 11.68% in men) lower due to the increased prevalence of hip prostheses. Conclusions: Although the incidence of hip fractures has continued to rise, the growing number of people who have undergone THA and are living with hip prostheses has helped to blunt this increase. Full article

Introduction: Intertrochanteric femoral fractures (IFFs) are the most common traumatic injuries in elderly people and significantly impact the patient’s health status. The current evidence indicates that short intramedullary nails may be a better choice than dynamic hip screws in IFF management, being less invasive and biomechanically superior, providing a buttress to limit fracture collapse. On the other hand, an unstable fracture may collapse even after adequate reduction and fixation. This paper aims to describe the surgical complexity of the nail-to-total hip arthroplasty (THA) conversion, focusing on the restoration of normal hip geometry. Material and Methods: Patients referred to our level I trauma center with failed cephalomedullary nailing following IFFs and managed with the nail-to-THA conversion were retrospectively recruited. The anteroposterior postoperative pelvis radiographs were analyzed to establish whether the normal biomechanics of the involved hip were restored. The following radiographic parameters were recorded and compared to the contralateral unaffected side: hip offset, cervical–diaphyseal angle, and limb length discrepancy. Clinical assessment was performed using the following scores: the Harris hip score (HHS) and the visual analog scale for pain (VAS). The independent samples t-test and the Pearson correlation test were performed. The tests were two-tailed; a p < 0.05 was considered significant. Results: A total of 31 patients met the inclusion and exclusion criteria (10 males and 21 females; mean age: 76.2 years; range: 66–90 years) and were included in this study. The modes of trochanteric nail failure included the following: cut-out in 22 cases (70.97%), non-union in 4 cases (12.9%), peri-implant fracture in 1 case (3.23%), cut-through in 2 cases (6.45%), and femoral head avascular necrosis (HAN) in 2 cases (6.45%). Long stems were used in 21 patients out of 31 (67.74%), while dual-mobility cups were implanted in 24 patients out of 31 (77.41%). A significant mean neck shaft angle (NSA) increase (p < 0.001) and a significant mean femoral offset reduction (FO, p 0.001) compared to the contralateral hip were recorded; a mean limb length discrepancy (LLD) of 8.35 mm was observed. A significant correlation between HHS and ∆NSA (p = 0.01) and ∆FO (p = 0.003) was recorded. Conclusions: Conversion from a cephalomedullary nail to THA is a complex procedure that should be considered a revision surgery, rather than a primary surgery. Surgeons must be aware that normal hip geometry may not be obtained during this surgical procedure; thus, a patient undergoing the nail-to-THA conversion for intertrochanteric fixation failure may have an increased risk of implant-related complications. Full article

Aim: As the population is aging, falls by older people, in particular falls from four-wheeled walkers (“rollators”), are a growing problem. These falls must be examined by targeted research and interventions that incorporate gender differences. Therefore, this study examined the injury patterns of elderly patients admitted to a tertiary trauma centre in Switzerland after falls from rollators and focussed on gender differences. Methods: This was a retrospective single-centre study for the period from May 2012 to December 2019 which included elderly patients (≥65 years) who had suffered a fall from a rollator. Injury history, patient data, demographic information, and patient outcomes were compared between males and females, with the data sourced from the Ecare patient database, which contains all information related to patient visits and treatment procedures. Results: A total of 152 eligible patients were included in the analysis, with 56.6% hospitalised at our facility and 14.5% transferred to another hospital. The cohort comprised 50 (32.9%) males and 102 (67.1%) females. Males were more prevalent in the 75–84 age group, while females predominated in the 85 and older group, and this difference was statistically significant (p = 0.043). Osteoporosis was significantly more common in females (37.3% vs. 10%, p ≤ 0.001). Consequently, treatment with vitamin D and/or calcium was also significantly more prevalent among women (29.4% vs. 8%, p = 0.003). Most falls occurred at home (22.4%) or in nursing care facilities and rehabilitation centres (22.4%), without gender-based differences (p = 0.570). Men were six times more likely than women to sustain injuries when under the influence of alcohol (p = 0.002). Fractures to the lower extremities were the most common injuries, accounting for 34.2% of all injuries, with no statistically significant differences between groups (p = 0.063). Head injuries occurred in 34.9% of patients, with a trend towards more injuries in males (44% vs. 30.4%, p = 0.098). The cumulative rates of fractures to the pelvis, upper extremities, and lower extremities were significantly higher in females (59.8%) than in males (38%), p = 0.011. In-hospital mortality was significantly higher in men than in women (12.9% vs. 2.9%, p = 0.026). Operative procedures were significantly more common in women (33% vs. 16.3%; p < 0.001). Conclusion: Women were more frequently affected by falls related to rollators than men. Most falls occurred at home, in nursing care facilities, or rehabilitation centres, with no significant gender-based differences. There was a trend toward more head injuries in males, while the cumulative fracture rate of the pelvis, upper extremities, and lower extremities was significantly higher in females. In-hospital mortality was more than four times higher in men. These findings may guide the development of gender-specific interventions to reduce rollator-related injuries in the vulnerable elderly population. Full article

Osteoporosis is a chronic disease that is characterized by a loss of bone density, which mainly affects the microstructure of the bones due to a decrease in bone mass, thereby making them more fragile and susceptible to fractures. Osteoporosis is currently considered one of the pandemics of the 21st century, affecting around 200 million people. Its most serious consequence is an increased risk of bone fractures, thus making osteoporosis a major cause of disability and even premature death in the elderly. In this review, we discuss its causes, the biochemical mechanisms of bone regeneration, risk factors, pharmacological treatments, prevention and the effects of diet, focusing in this case on compounds present in a diet that could have palliative and preventive effects and could be used as concomitant treatments to drugs, which are and should always be the first option. It should be noted as a concluding remark that non-pharmacological treatments such as diet and exercise have, or should have, a relevant role in supporting pharmacology, which is the recommended prescription today, but we cannot ignore that they can have a great relevance in the treatment of this disease. Full article

Background/Objectives: The aim was to investigate diagnostic, treatment and preventive options to establish an overview of the existing evidence on hemorrhage in pelvic fractures in older adults. Methods: A systematic review was conducted. Due to the rarity of this complication, only case reports and series with individuals older than 55 years with a pelvic ring fracture that is caused by a low-energy trauma or no apparent trauma, along with hemorrhage, were eligible. A search was performed on four databases. The CARE checklist was used to investigate the reporting integrity of the included studies. Analysis was performed narratively, and this study was registered on the Open Science Framework. Results: 21 patients from 19 studies were included (17 females and 4 males) with an average age of 82.1 years. The 21 patients suffered a total of 29 fractures. Pubic ramus fractures were present in 48.3% of all fractures. In 42.9%, an active hemorrhage was reported. Arterial vessels were injured in direct anatomical relationship to the fracture. Abdominal pain and hemorrhagic instability were the main red flag symptoms reported. Active arterial hemorrhage was diagnosed by CT with angiogram and treated by embolization with or without additional surgery. Conclusions: Clinically relevant hemorrhage in pelvic fractures due to low-energy trauma is rare. However, these fractures, combined with clinically relevant hemorrhage, account for an increased mortality and morbidity in elderly people. This systematic review was able to create a clinical decision tree for hemorrhage in ramus pubic fractures. Full article

Background: The prevention and treatment of bone loss and osteoporotic fractures is a public health challenge. Combined with normobaric hypoxia, whole-body vibration has a high clinic potential in bone health and body composition. The effect of this therapy may be mediated by its action on bone marrow mesenchymal stem cells (MSCs). Objectives: Evaluate the effects of cyclic low-vibration stimuli and/or hypoxia on bone marrow-derived human MSC differentiation. Methods: MSCs were exposed four days per week, two hours/day, to hypoxia (3% O₂) and/or vibration before they were induced to differentiate or during differentiation into osteoblasts or adipocytes. Gene and protein expression of osteoblastic, adipogenic, and cytoskeletal markers were studied, as well as extracellular matrix mineralization and lipid accumulation. Results: early osteoblastic markers increased in undifferentiated MSCs, pretreated in hypoxia and vibration. This pretreatment also increased mRNA levels of osteoblastic genes and beta-catenin protein in the early stages of differentiation into osteoblasts without increasing mineralization. When MSCs were exposed to vibration under hypoxia or normoxia during osteoblastic differentiation, mineralization increased with respect to cultures without vibrational stimuli. In MSCs differentiated into adipocytes, both in those pretreated as well as exposed to different conditions during differentiation, lipid formation decreased. Changes in adipogenic gene expression and increased beta-catenin protein were observed in cultures treated during differentiation. Conclusions: Exposure to cyclic hypoxia in combination with low-intensity vibratory stimuli had positive effects on osteoblastic differentiation and negative ones on adipogenesis of bone marrow-derived MSCs. These results suggest that in elderly or frail people with difficulty performing physical activity, exposure to normobaric cyclic hypoxia and low-density vibratory stimuli could improve bone metabolism and health. Full article

Background and Objectives: The incidence of hip fractures in people of advanced ages is increasing due to our aging society. Patient positioning for the intertrochanteric fractures of the femur can be performed in various ways. The aim of this study is to clinically and radiologically compare the use of the supine hemilithotomy position, the lateral decubitus position, and the traction table when performing proximal femoral nail (PFN) surgery for femoral intertrochanteric fractures in the geriatric age group. Materials and Methods: A total of 170 elderly patients with femoral intertrochanteric fractures were included in this cross-sectional study. The patients were divided into three groups (the supine hemilithotomy group, the lateral decubitus group, and the fracture table group). For the postoperative period, complications, length of stay in the intensive care unit, and length of stay in hospital were examined, while in postoperative radiographs, tip–apex distances (TADs), collodiaphyseal angles (CDAs), and Cleveland–Bosworth quadrants were examined to evaluate the placement of the lag screw in the femoral head. The quality of fracture reduction was evaluated according to the modified Baumgaertner criteria. Results: The mean age of the patients was 77.8 ± 8.8; 57.6% of patients were female. According to the modified Baumgaertner criteria, it was determined that patients with ‘poor’ reduction quality had an approximately ten times higher risk of cut-out than those with ‘good’ reduction quality (OR = 10.111, p = 0.002, 95% confidence interval; 2.313–44.207). The operative time for patients in the fracture table group was longer than that of the other groups Additionally, the CDA in the supine hemilithotomy position group was longer. Conclusions: Although PFN surgery using the traction table is longer in terms of surgical time compared to surgery performed in the lateral decubitus position and the supine hemilitotomy position, it is advantageous in terms of better TAD and CDA values and lower complication rates. Full article

Background: Falls are a common cause of morbidity and functional impairment in the elderly and represent a significant health problem. General practitioners (GPs) are the first point of contact for health issues and may provide preventive services. The randomized clinical trial PREMIO was conducted by GPs to evaluate the effects of a multicomponent intervention for the prevention of falls in older adults aged ≥ 65 years at high risk of falling. Methods: 117 GPs enrolled 1757 patients (1116 F, 641 M) and randomized them into 2 groups (intervention and control). The intervention group received medical and behavioral counseling, home risk-factor assessment, a physical-activity program and nutritional counseling. The control group received only the nutritional counseling. Both groups were followed for one year. The primary outcome was the rate of falls at home over 12 months. Results: 1225 patients completed the study. Subjects receiving the intervention had, on average, fewer falls at home (percentage change −31.2%, p < 0.02) and fewer total falls (−26.0%, p < 0.02), although the reduction in the number of fallers was small (−3.9%, p = 0.05). Among the secondary endpoints, rates of general hospital or emergency-department admission and GP visits showed slight improvements (not statistically significant), while the risk of fractures was unexpectedly increased in the intervention group compared to the controls (odds ratio 2.39, p = 0.023). Conclusions: Future studies and public-health interventions to prevent domestic falls among community-dwelling older people at high risk of falling could benefit from a multicomponent approach including medication review, physical exercise and home risk assessment and should include assessment of risk factors for fractures. Full article

Fragility fractures, caused by low-energy trauma, are a significant global health concern, with 158 million people aged 50 and over at risk. Hip fractures, a common issue in elderly patients, are often linked to underlying conditions such as osteoporosis. This study proposed a cost-effective solution using a non-wheeled smart walker with load sensors to measure gait parameters, addressing the high cost of traditional gait analysis equipment, the prototype used PASCO load cells PS2200 for force measurement, eliminating the need for Arduino UNO or microcontroller-based hardware. A lightweight amplifier PS2198 amplified the signal, which was transmitted via USB to a personal computer. PASCO capstone software was used for data recording and visualization. The smart walker was tested on forty volunteers divided into two equal groups: those with osteoporosis and those without, by performing a 10 m walk test three times. ANOVA comparing spatiotemporal parameters (TSPs) of the two participant groups (α = 0.05) showed that significant differences lay in terms of time taken to complete the walk test (p < 0.01), left step length (p = 0.03), walking speed (p = 0.02), and stride length (p < 0.02). The results indicate that this smart walker is a reliable tool for assessing gait patterns in individuals with osteoporosis. The proposed system can be an alternative for time consuming and costly methods such as motion capture, and for socially stigmatizing devices such as exoskeletons. It can also be used further to identify risk factors of osteoporosis. Full article

Osteoporosis is a health condition that involves weak bone mass and a deteriorated microstructure, which consequently lead to an increased risk of bone fractures with age. In elderly people, a fracture attributable to osteoporosis elevates mortality. The objective of this review was to examine the effects of macronutrients on bone mineral density (BMD), bone turnover markers (BTMs), and bone fracture in elderly people based on human studies. A systematic search was conducted in the PubMed^®/MEDLINE^® database. We included human studies published up to April 2023 that investigated the association between macronutrient intake and bone health outcomes. A total of 11 meta-analyses and 127 individual human studies were included after screening the records. Carbohydrate consumption seemed to have neutral effects on bone fracture in limited studies, but human studies on carbohydrates’ effects on BMD or/and BTMs are needed. The human studies analyzed herein did not clearly show whether the intake of animal, vegetable, soy, or milk basic proteins has beneficial effects on bone health due to inconsistent results. Moreover, several individual human studies indicated an association between eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and osteocalcin. Further studies are required to draw a clear association between macronutrients and bone health in elderly people. Full article

It is very important to keep track of decreases in the bone mineral density (BMD) of elderly people since it can be correlated with the risk of incidence of major osteoporotic fractures leading to fatal injuries. Even though dual-energy X-ray absorptiometry (DXA) is the one of the most precise measuring techniques used to quantify BMD, most patients have restricted access to this machine due to high cost of DXA equipment, which is also rarely distributed to local clinics. Meanwhile, the conventional X-rays, which are commonly used for visualizing conditions and injuries due to their low cost, combine the absorption of both soft and bone tissues, consequently limiting its ability to measure BMD. Therefore, we have proposed a specialized automated smart system to quantitatively predict BMD based on a conventional X-ray image only by reducing the soft tissue effect supported by the implementation of a convolutional autoencoder, which is trained using proposed synthesized data to generate grayscale values of bone tissue alone. From the enhanced image, multiple features are calculated from the hip X-ray to predict the BMD values. The performance of the proposed method has been validated through comparison with the DXA value, which shows high consistency with correlation coefficient of 0.81 and mean absolute error of 0.069 g/cm². Full article

Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder among older adults. The aim of this review is to shed light on PHPT, particularly in this age group, in terms of prevalence, clinical manifestations, medical and surgical management, and post-operative complications. Methods: Eligible studies were those considering PHPT exclusively in the older population (main databases: PubMed, Medline, Google Scholar and the University Online database). Articles published in the last 10 years (2013–2023) were considered. Eligibility criteria followed the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. The methodological quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tool. A total of 29 studies (mainly observational) matched the inclusion criteria. Results: The prevalence of PHPT is approximately 1 per 100 in the elderly, and it is more common in females. The clinical presentation varies by age and can include osteoporosis, fractures, and neuropsychiatric symptoms. Conservative management can be an option whenever surgery is not indicated or feasible. However, parathyroidectomy (PTX) remains a safe and effective modality in aging populations with improvement to symptoms, bone mineral density, fracture risk, frailty, quality of life, and metabolic derangements. Complication rates are similar in elderly people compared to younger ones, except for mildly longer length of hospital stay and reoperation for those with higher frailty. Conclusion: PHPT is a common yet overlooked and underdiagnosed condition among the older population. The safety and efficacy of PTX in the older population on different levels is now well demonstrated in the literature. Full article

Nowadays, more studies deal with “OrthoGeriatrics”, for the co-management of elderly patients suffering fractures, from the admission to the discharge and beyond. For the first time at Cagliari University Hospital, we introduced an orthogeriatric service, in which trained geriatricians stay in orthopedic unit alongside trained orthopedics. The primary aim of the study was to analyze the rate of death and rehospitalization in elderly femur-fractured people of 65 or more years of age, identifying possible predictive factors. The secondary aim of the study was to analyze the recovery of daily living autonomies during the months following surgery. To reach the aim, we designed a prospective study, which is currently ongoing. We evaluated femur-fractured patients aged 65 years or more with a comprehensive geriatric assessment before surgery. The most common fractures were lateral hip ones, treated with osteosynthesis. Cognitive–affective, functional, and nutritional status, mood, and comorbidities were less impaired than in the outpatient service of the same hospital devoted to frail elderly. Pain control was excellent. A significantly low delirium incidence was found. More than a third of the sample were recognized as frail (according to the Survey of Health, Ageing and Retirement in Europe—Frailty Instrument (SHARE-FI)), and over a third of the sample were identified as a moderate-high risk of hospitalization and death (according to Multidimensional Prognostic Index (MPI)). Overall mortality rate was 13.87%, and rehospitalization rate was 11.84%. Frail people were more likely to die than non-frail (HR: 5.64), and pre-frail ones (HR: 3.97); similarly, high-risk patients were more likely to die than low-risk (HR: 8.04), and moderate-risk ones (HR: 5.46). Conversely, neither SHARE-FI nor MPI predicted rehospitalization. Creatinine (OR: 2.66, p = 0.003) and folate (OR: 0.75, p = 0.03) levels were independently associated with death and rehospitalization, respectively. Finally, the patients did recover the lost autonomies later, 6 months after surgery. Our study demonstrated that SHARE-FI and MPI are reliable tools to predict mortality in an orthogeriatric setting, and that creatinine and folate levels should also be measured given their independent association with negative outcomes. Full article