Search Results (101)

Human Immunodeficiency Virus (HIV) infection remains a major global health issue, with effective antiretroviral therapy (ART) extending life expectancy but also increasing age-related issues like osteopenia and osteoporosis. This cross-sectional study examines bone mineral density (BMD) and related risk factors in Romanian HIV-positive patients, emphasizing regional and therapy influences. The patients varying in HIV infection duration underwent DXA scanning to measure BMD in the lumbar spine, femoral neck, and total femur. A high prevalence of low BMD, especially in the lumbar spine, was identified along with significant associations between reduced BMD and factors such as smoking, alcohol use, vitamin D deficiency and serum phosphorus levels. ART like Protease Inhibitors and Nucleoside Reverse Transcriptase Inhibitors were linked to increased bone loss, emphasizing the multifactorial nature of osteoporosis in HIV-infected individuals and underscore the importance of regular BMD assessments, lifestyle adjustments, and careful management of antiretroviral therapy to minimize fracture risk and enhance overall health and quality of life. Full article

Neck of femur (NOF) fractures are a critical orthopaedic emergency with a high morbidity and mortality prevalence, particularly in people living with Human Immunodeficiency Virus (PLWHIV). A combination of HIV infection, combined antiretroviral therapy (cART), and compromised bone health further increases the risk of fragility fractures. Additionally, HIV-related immune dysfunction, cART-induced osteoporosis, and perioperative infection risks further pose challenges in ongoing surgical management. Despite the rising global prevalence of PLWHIV, no specific guidelines exist for the perioperative and post-operative care of PLWHIV undergoing NOF fracture surgery. This narrative review synthesises the current literature on the surgical management of NOF fractures in PLWHIV, focusing on pre-operative considerations, intraoperative strategies, post-operative complications, and long-term outcomes. It also explores infection control, fracture healing dynamics, and ART’s impact on surgical outcomes while identifying key research gaps. A systematic database search (PubMed, Embase, Cochrane Library) identified relevant studies published up to February 2025. Inclusion criteria encompassed studies on incidence, risk factors, ART impact, and NOF fracture outcomes in PLWHIV. Data were analysed to summarise findings and highlight knowledge gaps. Pre-operative care: Optimisation involves assessing immune status (namely, CD4 counts and HIV-1 viral loads), bone health, and cART to minimise surgical risk. Immunodeficiency increases surgical site and periprosthetic infection risks, necessitating potential enhanced antibiotic prophylaxis and close monitoring of potential start/switch/stopping of such therapies. Surgical management of neck of femur (NOF) fractures in PLWHIV should be individualised based on fracture type (intracapsular or extracapsular), age, immune status, bone quality, and functional status. Extracapsular fractures are generally managed with internal fixation using dynamic hip screws or intramedullary nails. For intracapsular fractures, internal fixation may be appropriate for younger patients with good bone quality, though there is an increased risk of non-union in this group. Hemiarthroplasty is typically favoured in older or frailer individuals, offering reduced surgical stress and lower operative time. Total hip arthroplasty (THA) is considered for active patients or those with pre-existing hip joint disease but carries a higher infection risk in immunocompromised individuals. Multidisciplinary evaluation is critical in guiding the most suitable surgical approach for PLWHIV. Importantly, post-operative care carries the risk of higher infection rates, requiring prolonged antibiotic use and wound surveillance. Antiretroviral therapy (ART) contributes to bone demineralisation and chronic inflammation, increasing delayed union healing and non-union risk. HIV-related frailty, neurocognitive impairment, and socioeconomic barriers hinder rehabilitation, affecting recovery. The management of NOF fractures in PLWHIV requires a multidisciplinary, patient-centred approach ideally comprising a team of Orthopaedic surgeon, HIV Physician, Orthogeriatric care, Physiotherapy, Occupational Health, Dietitian, Pharmacist, Psychologist, and related Social Care. Optimising cART, tailoring surgical strategies, and enforcing strict infection control can improve outcomes. Further high-quality studies and randomised controlled trials (RCTs) are essential to develop evidence-based guidelines. Full article

Background: Patients awaiting total hip arthroplasty (THA), particularly those with hip osteoarthritis (OA), face an elevated risk of osteoporosis due to age and gender-related factors. Osteoporosis, indicated by low bone mineral density (BMD), can affect implant osteointegration, long-term stability, and increase the likelihood of periprosthetic fractures. Despite these risks, osteoporosis is often underdiagnosed and undertreated in THA candidates. While several studies have addressed this issue in Northern populations, data on Southern European cohorts, particularly Italian patients, remain limited. This study aims to evaluate the prevalence of osteoporosis and vitamin D deficiency, as well as the rates of related treatments, in patients with hip osteoarthritis scheduled for THA. Methods: This single-center, retrospective study was conducted at Policlinico Universitario di TorVergata, Italy, involving 66 hip OA patients (35 men, 31 women; mean age 67.5 years). BMD was assessed at the femoral neck, total femur, and lumbar spine via DEXA, alongside vitamin D and PTH levels. Demographic data, ongoing anti-osteoporotic therapies, Harris Hip Score (HHS), and handgrip strength were recorded. Statistical analysis included t-tests and Pearson’s correlation. Osteoporosis was defined per WHO criteria, with significance set at p < 0.05. Results: In this study of 66 patients with hip osteoarthritis (35 men, 31 women; mean age 67.5 years), women exhibited significantly lower bone mineral density (BMD) at the total femur (−0.98 ± 1.42 vs. −0.08 ± 1.04; p < 0.05) and lumbar spine (−0.66 ± 1.74 vs. 0.67 ± 1.59; p < 0.05) compared to men. Handgrip strength was also significantly reduced in females (17.1 ± 8.2 kg) versus males (27.3 ± 10.3 kg; p < 0.05). Vitamin D levels were below 30 ng/mL in 89.4% of patients, and 63.6% had levels below 20 ng/mL; PTH levels were elevated (>65 pg/mL) in 54.5% of cases, indicating frequent secondary hyperparathyroidism. Only 9 patients were receiving vitamin D supplementation and none were on anti-osteoporotic treatment. Conclusions: These findings highlight the frequent coexistence of low BMD, vitamin D deficiency, and reduced muscle strength in THA candidates, suggesting a pattern of musculoskeletal vulnerability that warrants clinical attention. Full article

This paper presents the process of preparing and conducting a uniaxial compression test, developing the results, and determining the compressive strength of a femur made using 3D printing technology. The study considers the variable thickness of the outer layer—imitating cortical bone tissue—and the varying density of the inner layer—imitating trabecular bone tissue—which, with further analysis, may aim to replicate different states of osteoporosis. The compressive strength of the bones varied depending on the thickness of the outer layer and the filling degree. Failure patterns were observed, corresponding to different variants of the produced bones. The predominant failure pattern was the fracture of the femoral head or neck at the proximal end of the femur. The results were compared with previous studies on commercial femur bones, as well as those created using 3D printing technology by other authors. The highest compressive strength was found in the bone with an outer layer thickness of 3.0 mm and 30% infill, with a value of 4778 N. A very similar compressive strength was recorded for the bone with an outer thickness of 2.1 mm and 30% infill, reaching 4519 N. The lowest compressive strength, 2116 N, was observed in the bone with an outer thickness of 1.2 mm and 20% infill. Full article

Background/Objectives: Osteoporosis is a skeletal disorder characterized by reduced bone mineral density (BMD) and increased fracture risk. Chronic inflammation is implicated in osteoporosis pathogenesis, with inflammatory mediators promoting bone resorption. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of systemic inflammation and have emerged as potential indicators of bone health. This study’s aim was to highlight the potential role of the NLR and PLR as markers of bone health in postmenopausal women affected by osteoporosis or osteopenia and to evaluate the possible influence of autoimmune disease in this context. Methods: This cross-sectional study included 124 postmenopausal women diagnosed with osteopenia or osteoporosis at the Orthopedic Unit of the Policlinico G. Rodolico in Catania, Italy. Demographic, clinical, laboratory, and diagnostic imaging data were collected. The NLR and PLR were calculated from complete blood counts, and BMD was measured using dual-energy X-ray absorptiometry (DEXA). Statistical analyses included correlations, group comparisons, and multiple and logistic regressions. Results: The NLR and PLR did not directly correlate with BMD or fracture incidence. However, the PLR weakly correlated with vitamin D levels. Notably, women without Hashimoto’s thyroiditis exhibited higher NLR values than those with the condition. Hypertensive women had a lower PLR than non-hypertensive women, while euthyroid women had a higher PLR than hyperthyroid or hypothyroid women. Multiple regression analysis revealed that age, BMI, CKD stage, vitamin D levels, NLR, PLR, diabetes, and autoimmune diseases significantly predicted BMD at the femur neck, with the PLR contributing significantly. Logistic regression confirmed these predictors for osteoporosis or osteopenia, with an increased PLR being associated with a higher likelihood of osteoporosis. Conclusions: While the NLR and PLR may not independently predict bone health, their inclusion in a multifactorial assessment considering age, BMI, vitamin D, and comorbidities could enhance osteoporosis management. Full article

Background: Dental fluorosis (DF) is an irreversible alteration of tooth enamel formation caused by excessive fluoride (F) consumption during tooth growth, leading to skeletal fluorosis development due to the high F content of tap water, which should be detected. Objective: To detect the signs of skeletal fluorosis by comparison of the bone mineral density (BMD) of the lumbar spine, femoral neck, and total femur, and the fluor (F) intake from water between adults without and with DF from northwestern Mexico. Methods: Participants were 36 adults without DF (G1) and 42 with DF (G2). Dean criteria, DEXA, and SPADNS methods were used to evaluate DF, BMD, and F content in water, respectively. Results. G1 participants consumed 0.789 ± 1.55 mg F/d from water with 0.385 ± 0.32 mg F/L, while G2 participants drank 2.42 ± 2.65 mg F/d from water with 1.46 ± 0.59 mg F/L. The binary variable DF and BMD values were not associated (p > 0.05); however, according to severity degree, questionable DF was associated with total femur BMD (p = 0.025). BMD in the evaluated regions was no different between both groups and could be related to actual moderate levels of F in the tap water and to the partial or total consumption of bottled water. Conclusions. There was no association between DF and the measured BMD to infer skeletal fluorosis. Bone region BMD was no different between both evaluated groups and could be related to adequate F intake, with moderate F levels in tap water, and the consumption of negligible F content bottled water. Full article

Proximal femoral fractures (PFFs) are the most frequent type of bone injury among the elderly. In Italy alone, 906,111 hospital admissions for hip fractures were recorded between 2007 and 2017. Globally, due to the aging population, the number of cases is expected to rise to 21.3 million by 2050. In older individuals, fractures of the femoral neck are commonly managed with prosthetic implants. While hemiarthroplasty has long been the standard treatment, total hip arthroplasty (THA) is increasingly favored for more active or functionally demanding patients. Among the surgical options, dual mobility THA (DM-THA) stands out for its potential to significantly reduce postoperative complications, particularly dislocations, when compared to both conventional THA and hemiarthroplasty. This study aimed to determine the most effective surgical strategy—dual mobility THA versus hemiarthroplasty—for managing femoral neck fractures in elderly patients. A thorough literature review was conducted using PubMed, Web of Science, and Scopus, focusing on the most recent and relevant publications. The findings highlight a consistent trend: patients treated with DM-THA generally experience better outcomes than those receiving hemiarthroplasty. Based on current evidence, DM-THA should be regarded as the preferred intervention for elderly individuals with femoral neck fractures, except in cases where severe comorbidities or anesthesia-related risks require a more conservative approach. Full article

Background/Objectives: Bone mineral density (BMD) loss leads to osteoporosis, significantly increasing fracture risk in both the axial and peripheral skeleton. The extent to which it is possible to estimate the degree of osteoporosis in the hip by determining the density in Hounsfield Unit (HU) measurements derived from computed tomography (CT) scans and to calculate quantitative BMD and T values from the HU values should be examined. Methods: A total of 240 patients (mean age: 64.9 ± 13.1 years, BMI: 26.8 ± 6.8 kg/m²) underwent CT-based BMD assessments using CTXA-Hip. Subregions of the proximal femur, including the femoral head, femoral neck, and intertrochanteric region, were analyzed for cancellous density in HUs using circular and irregular region-of-interest (ROI) measurements. Correlations between HU values and DEXA-equivalent BMD (mg/cm²) and T values were computed. Predictive power for osteoporosis was evaluated using ROC curve analysis. Results: Cancellous bone density in the proximal femur showed a significant decline with increasing age and decreasing BMI (p < 0.05). The median BMD for the entire hip was 0.684 mg/cm², and the median HU value for the proximal femur was 123.15. Strong correlations were observed between HU values and BMD (R² = 0.904, p < 0.001) and T values (R² = 0.911, p < 0.001). A T value of −2.5 corresponded to an HU value of 95.79 in the entire femur. ROC analysis demonstrated high sensitivity (0.92) and specificity (0.93) for HU-based osteoporosis prediction. Conclusions: HU measurements provide a reliable method for estimating BMD and T values in the proximal femur, offering a valuable diagnostic tool for osteoporosis. The highest predictive accuracy was achieved when using an irregular ROI from the entire proximal femoral region. Full article

Background: Knowledge of the relative contributions to different growth areas in the proximal femur and acetabulum is limited due to the complex anatomy and lack of growth markers in children. There is increasing interest in using guided growth to improve hip joint stability and decrease dysplasia in children with neurological disability. Some children with cerebral palsy (CP) are treated with bisphosphonates for bone insufficiency, which leaves a dense growth arrest band in the bone at the time of treatment. The aim of this study was to develop a novel approach to understand the growth and maturation impact on hip development in children with CP using this growth arrest band. Methods: Pelvic radiographs of children with CP Gross Motor Function Classification System (GMFCS) level IV/V treated with bisphosphonate were analyzed. We measured neck–shaft angle (NSA), head–shaft angle (HSA), and migration percentage (MP) based on pamidronate bands (PamMP), NSA based on pamidronate bands (PamNSA), and HSA based on pamidronate bands (PamHSA). These measurements were compared using t-test. Results: Seven children (two GMFCS IV and five GMFCS V) were included. The mean age of the radiographic assessment was 11.4 ± 1.3 (range, 8.6–12.5) years, mean MP 22 ± 7% (range, 13–39%), PamMP 33 ± 7% (range, 18–46%), NSA 151 ± 7° (range, 140–161°), PamNSA 153 ± 4° (range, 142–163°), HSA 164 ± 12° (range, 142–175°), and PamHSA 169 ± 8° (range, 154–175°). MP decreased by 10.5% compared with PamMP (p < 0.001). NSA compared with PamNSA (p = 0.117) and HSA compared with PamHSA (p = 0.325) were not statistically different. Conclusions: This novel assessment method demonstrates that ossification of the lateral acetabulum and femoral head in children with CP GMFCS IV/V from age 8 to 12 years undergoes a mean decrease of 10% MP. A decrease of 10% MP after proximal femoral-guided growth has been reported as a positive outcome. However, based on the current measurements, this may be due to normal development. HSA and NSA remained unchanged. Full article

Background/Objectives: Limited surgical invasiveness is desirable in elderly patients with femur fracture. Serum cytokines have been considered as a possible marker but with inconclusive evidence. The present study aimed to assess the systemic inflammatory response to surgical trauma through the serum levels of several cytokines (IL1β, IL6, IL8, and IL-10), inflammatory markers (c reactive protein—CRP), and muscular damage markers (creatinkinase—CK) at different time intervals in a consecutive series of patients affected by pertrochanteric fractures (PFs) and treated by two different surgical devices (intramedullary nailing (IM) vs. dynamic hip screw plate—DHS). Methods: A total of 60 consecutive patients (45 female and 15 male, mean age 85.6 years) with PFs (AO31A1.2-2.2) were randomly assigned to two groups according to the surgical procedure used (IM vs. DHS). Specimens of venous blood were collected 1 h preoperatively and at 24, 48, and 72 h postoperatively. Commercial ELISA kits were used. Results: In the adjusted linear mixed model, the serum levels of IL-1β, IL-8, IL-10, CRP, and CK revealed no statistically significant correlation with the type of surgical intervention performed. A significant (p < 0.001) correlation was found for IL-6 values in patients undergoing IM, showing higher serum values than patients receiving DHSs in all postoperative blood sample collections. Conclusions: The results of this study reveal that the use of DHSs may have less biological impact than IM in frail elderly due to a more limited secretion of IL-6 cytokines deriving from the preservation of the femoral medullary canal, representing a possible guide for the choice of the surgical device. Full article

Background/Objectives: The aim of this study was to evaluate changes in bone mineral density (BMD) around the stem in elderly patients with femoral neck fractures who underwent hemiarthroplasty using a collared and full hydroxyapatite coated cementless stem, as assessed using the Dorr classification and with anti-osteoporosis drug intervention. Methods: This study followed 85 older patients with femoral neck fractures classified by Dorr’s classification. We measured their BMD around the stem using dual-energy X-ray absorptiometry according to Gruen 7 zones classification and clinical scores. We compared the rate of BMD change based on Dorr’s classification and clinical scores. We also investigated the effect of osteoporosis treatment interventions on the rate of BMD change. The study followed up with the patients for one year after surgery. Results: After excluding patients with missing data, 40 patients were included in the analysis. The rate of change in BMD in zone 2 was significantly reduced in Dorr type C compared to Dorr type B. Clinical scores did not significantly differ between the three groups. Regarding the association between osteoporosis treatment and the rate of BMD change, the pre-injury intervention group had a significantly suppressed decline in the rate of BMD change in zones 1 and 7 compared to the post-injury intervention and no-intervention groups. Conclusions: Careful follow-up examination is crucial when performing hemiarthroplasty in patients with Dorr type C femoral neck fractures because the rate of BMD change may decline postoperatively. Pre-injury osteoporosis intervention therapy may suppress BMD loss around the stem. Full article

Background: Total hip replacement replaces the femoral head, which cannot heal, with an artificial femoral shaft to ensure the patient’s normal life. However, due to the stress-masking effect of the proximal femur loaded with the artificial femur stem, the implant bears a large part of the load, resulting in insufficient stress stimulation of the proximal femur and bone waste remodeling. In turn, it is easy to lose bone, resulting in loosening. As a new treatment method, electrical stimulation has been widely used for bone loss, nonunion, and other diseases, and it has achieved good therapeutic effects. Methods: Therefore, in this work, electrical stimulation was introduced for postoperative density assessment, and a new disuse remodeling model was established to simulate density loss after remodeling and the resistance effect of electrical stimulation. The effects of various parameters on density loss in the model are discussed. Results: The simulation results revealed significant stress masking and density loss in the neck of the femur after hip replacement, and electrical stimulation placed in the neck of the femur may resist this density loss to a certain extent. The rate of bone mineral density reduction decreased after the addition of electrical stimulation, indicating that electrical stimulation can have a certain resistance to the density reduction caused by stress shielding, and this result is helpful for the rehabilitation of hip arthroplasty. Full article

This study investigates the morphological impact of using three-dimensional (3D) printed custom implants in surgical hip reconstruction compared to the conventional bone graft and standard size implant methods. An amount of 16 patients at the Rizzoli Orthopaedic Institute who underwent hip reconstruction surgery for tumors involving the P2 pelvis region were selected using stratified sampling. Half of them were randomly selected to receive 3D-printed implants, and the other half were selected to receive standard implants with bone grafts. Six months post-surgery, computed tomography (CT) scans were used to identify the hip joint center of rotation and to measure greater the trochanter offset and acetabular inclination angle. These CT scans were also used to construct a 3D model of the pelvis for 3D measurements. The results show no significant differences in accuracy, using Student’s t-test and Mann–Whitney U-test (p-value > 0.05), between the two methods for reconstructing the hip joint center of rotation or greater trochanter offset. However, 3D-printed implants showed statistically significant greater precision, using Student’s t-test (p-value < 0.05), in reconstructing the acetabular inclination angle compared to the conventional bone graft and standard-sized off-the-shelf implants. This superior precision reduces the risk of impingement of the femur implant neck with the acetabulum implant cup, which directly relates to improved implant survivorship. These findings support the continued exploration of 3D printing technology for personalized orthopedic solutions. Full article

Background/Objectives: A neck of femur (NOF) fracture is one of the most common fractures, and its treatment in the geriatric population using cemented bipolar hemiarthroplasty (HA) is a standard procedure worldwide. Various surgical approaches have been described for this operation, aiming to reduce complications and improve early mobilization. The present study compares two minimally invasive approaches, the anterolateral minimally invasive approach (ALMIS) and the direct superior approach (DSA), with respect to their intraoperative and early postoperative complications in cemented bipolar HA. Methods: The medical records of all patients undergoing cemented bipolar HA for a NOF fracture between January 2017 and December 2023 were analyzed. The aim of the study was to compare the two surgical approaches. The evaluation focused on intraoperative parameters and early complications. Results: A total of 226 patients were included in the analysis, with 62 undergoing DSA and 164 ALMIS, with an average age of 83.5 years. The two approaches did not differ significantly in terms of stem implantation quality, length of hospital or intensive care unit stay, postoperative mobilization, or the need for transfusions. However, the ALMIS was associated with a significantly shorter operative time (DSA: 89.7 min vs. ALMIS: 77.2 min; p < 0.01). On the other hand, the DSA had a significantly lower complication rate (DSA: 0/61 vs. ALMIS: 11/163; p = 0.04). Conclusions: In a comparison of the two minimally invasive approaches, DSA and ALMIS, for treating a NOF fracture with cemented bipolar HA, the DSA demonstrated a lower complication rate, though it had a slightly longer operating time. Full article

Background: The rarity and variability of MEN1-related primary hyperparathyroidism (mPHPT) has led to contradictory data regarding the bone phenotype in this patient population. Methods: A single-center retrospective study was conducted among young age- and sex-matched patients with mPHPT and sporadic hyperparathyroidism (sPHPT). The main parameters of calcium–phosphorus metabolism, bone remodeling markers, and bone mineral density (BMD) measurements were obtained during the active phase of hyperparathyroidism before parathyroidectomy (PTE) and 1 year after. Trabecular Bone Score (TBS) and 3D-DXA analysis of the proximal femur were used to evaluate the differences in bone architecture disruption between groups. Results: Patients with mPHPT had significant lower preoperative BMD compared to sPHPT at lumbar spine—LS (p = 0.002); femur neck—FN (p = 0.001); and total hip—TH (p = 0.002). 3D-DXA analysis showed the prevalence of cortical rather than trabecular bone damage in mPHPT compared to sPHPT: cortical thickness (p < 0.001); cortical surface BMD (p = 0.001); cortical volumetric BMD (p = 0.007); and trabecular volumetric BMD (p = 0.029). One year after, PTE DXA and 3D-DXA parameters were similar between groups, while 3D-visualisation showed more extensive regeneration in cortical sBMD and cortical thickness in mPHPT. Conclusions: mPHPT is associated with lower preoperative BMD values with predominant architecture disruption in the cortical bone. The absence of differences in DXA and 3D-DXA parameters 1 year after PTE between mPHPT/sPHPT combined with significantly lower BMD in mPHPT at the initial stage may indicate faster bone recovery after surgery in mPHPT than in sPHPT. Full article